PATIENT

TRANSFE
R
 PATIENT TRANSFER

A transfer is the safe movement of

the patient from one place to
another, like from bed to
wheelchair and by the used of
assistive devices. In doing so,
the nurse must teach patient
and ask for his or her
participation for successful results.
There are many methods of transfer.
The nurse should choose an
appropriate technique for the
patient by taking into
considerations his or
her disabilities and abilities. In
most cases, it is very helpful
if the nurse demonstrates the
technique first before the
transfer. During the transfer,
the nurse coaches and assists
the patient.
 LEVEL OF TRANSFER

Independent transfers
◦The patient consistently performs all aspects
of the transfer, including setup, in a safe
manner and without assistance.

Assisted transfers
◦The patient actively participates, but also
requires assistance by a clinician(s).

Dependent transfers
◦The patient does not participate actively, or
only very minimally and the clinician(s)
perform all aspects of the transfer
 LEVELS OF ASSISTANCE

Stand-by assist (aka supervision)

Close guarding

Contact guarding

Minimal assist

Moderate assist

Maximal assist
Risk Factors Related to Patient
 Communication
The caregiver must assess the
patient’s ability or inability to
communicate.
The risk of injury increases if the
patient:

• Does not speak/understand the same

language as the
caregiver
• Does not understand speech
• Does not understand non-verbal
communication
• Can not follow simple commands
•Communicates with sign language
or assistive communication devices

• Has a hearing impairment

• Has a speech problem

• Has a low level of consciousness

 Cognition

Often hospitalized patients have an

altered level of cognition affecting their
ability to participate in lifts/transfers.

Short term memory loss, poor

judgment, and difficulty making
decisions can all be manifestations of
altered cognition.

Questions testing the short term

memory can often give some indication
of the level of cognition.
 Medical Status

Signs and symptoms of various

medical conditions can impact on a
patient’s ability to transfer i.e.
the tremors and movement initiation
problems associated with
Parkinson’s disease.

Medications can also tran

affect the patient’s ability sfer
to Fatigue, pain and stiffness .
will the quality of the
transfer. affect
The medical status can change
dramatically
during a shift and caregivers need
to observe these changes and
modify
the lift/transfer as necessary.
 Physical Status

A physical assessment should

include:

• Weight bearing status

• Weight
• Height
• Range of motion (ROM)
• Strength
• Balance
• Coordination
• Sensation
• Clothing
• Footwear
 Emotional and Behavioral Status

Patients behavioral and emotional

state may change throughout the day
i.e. Sundowners. The caregiver should
be aware of behavior changes
including:

• Anxiety
• Aggression
• Agitation
• Combativeness
• Confusion
• Depression
• Hostility
•Impulsiveness
• Low tolerance for change
• Low self esteem (if they think poorly
of their abilities they may not
complete the transfer to the level
of their ability)
• Rejection
• Resistive
• Self Destructive
• Unpredictable
Risk Factors Related to the
Environment

• Layout
• Space
• Lighting
• Color
• Temperature
• Obstacles
• Floor
 Risk Factors related to the
Equipment

• Medical devices (catheter bags, IV's,

prosthesis)

• Inadequate training in the use of

equipment

• Improper use of equipment or use of

faulty equipment

•Risk increases when

furniture/equipment not adjustable
 TRANSFER ASSIST DEVICES

Primarily used to:

•Provide a safer means of moving and

transferring a person from one place to
another.

•Facilitate independence and

maintain the dignity of the person
being moved or transferred.

•Eliminate or minimize risk factors that

can lead to caregiver or patient injury.
•Where possible, patients should be
encouraged to move themselves.
Those with good balance and upper
body strength may be able to
maintain or regain independence
through the use of certain transfer
assist devices.

•Transfer assist devices may reduce

the amount of force exerted by
caregivers and improve their posture
when moving partially or totally
dependent patients.
•Transfer assist devices do not
reduce the weight of a patient and
should not be used to lift, carry, or
support the whole or a large part of a
patient’s body weight.

•A safer means of moving the patient,

such as a mechanical lift, may be
required. Safety for both patient and
caregiver must always be considered.
 BEST PRACTICES WHEN USING
TRANSFER ASSIST DEVICES

•Only use transfer assist devices if properly

trained in their safe use. When safe,
encourage patients to move themselves.

•Tell the patient what you intend to do

before you do it. Ensure that the brakes of
the bed, stretcher, or wheelchair are
on before beginning any movement.

•Inspect each device before use. Tag

and remove damaged equipment from service.

•Set the bed at the height of caregivers’ upper

thighs.
•Lower the side rail on the bed to
reduce awkward reaching.

•Minimize gaps and height differences

between surfaces whenperforming a
lateral transfer (for example, from
bed to stretcher), and bridge gaps
with transfer boards, where necessary.

•Avoid differences in height

between two surfaces when
performing a transfer. A gentle
decline, however, may be preferable
for some seated or supine transfers
using a transfer board.
•When moving a patient up in bed, tilt
the bed to a “head down” position to
allow gravity to assist, unless
contraindicated.

•Use moving and handling equipment

in accordance with your
organization’s policies and procedures.

•Ensure friction-reducing devices are

large enough to be placed under the
main points of contact. For
supine patients, this includes the
pelvis, shoulders and, if possible, the
feet.
•Do not leave friction-reducing devices
under the patient unless the manufacturer
specifically recommends it. Leaving an
unsecured friction-reducing device under
an unsupervised patient may put the
patient at risk of falling out of bed. as low-
friction draw sheets, are designed to be
left under the patient. These sheets are
secured by tucking the sides of the sheets
under the mattress, so that the sheets
don’t have to be continually placed and
removed

•Have the patient assist as much as

possible during the transfer or reposition.

•Avoid lifting the patient.

Set of two draw sheets Draw and slider sheets

Draw sheets

•Draw or slide sheets are made of low-

frictionfabrics or gel-filled plastics that enable
an individual to slide over a surface instead of
being dragged or lifted. These sheets come in
a variety of widths and lengths and may be
used in pairs, singly, or folded.

•drawsheet has the slippery surface only on

one side and can be kept under the patient.

•A slide sheet, on the other hand, is slippery

on both sides and should be removed once the
patient is repositioned.
 Slider sheets

•Slider or roller sheets are tubular

sliding sheets made of specialized
fabrics with low-friction inner surfaces
that glide over themselves.

•Slider sheets may be flat or padded

and can be placed under draw sheets
or incontinence pads.

•Slider sheets come in several

sizes and lengths.

Set of two slider sheets

•Short slider sheets are primarily used
for pivoting and repositioning tasks
such as sitting a patient up on the side
of the bed or repositioning a patient up
in bed.

•Long lateral slider sheets are intended

for transferring supine patients
from one surface to another, such as
from bed to stretcher.
•“ONE-WAY SLIDES,” slide in
one direction only. This
facilitates moving a patient up in
bed or back in a wheelchair,
while preventing the patient from
sliding down the bed or forward
in a wheelchair. One-way slides
reduce the need to manually
reposition a patient in a bed or
chair.
 •Note:
Slider sheets may be used independently
or with partial help. When used
independently, a patient with good
sitting balance and sufficient arm or leg
strength may be able to slide from one
surface to another or up and down in
bed. When providing partial help, it is
important to apply forces horizontally
only, resulting in a slide, not a lift. The
chosen technique should, as much as
possible, eliminate the need for the
caregiver to twist, reach, or stoop.
Padded one-way slide
Two roller sheets USES

•Facilitate independent bed mobility

•Move patients up in bed
•Move patients from the side of the bed to the
centre or vice versa
•Turn patients onto their side in bed
•Transfer patients from one surface to another,
such as from a bed to a stretcher (when used in
conjunction with other devices, such as transfer
boards)
•Move patients who have fallen into confined
or awkward spaces to a place where a
mechanical lift can be used
•Pivot patients in bed and aid exercise
Lateral transfer aid ADVANTAGES

•Draw and slider sheets have the

following advantages:
•Simple and versatile
•Sliding patients may avoid the need
to manually lift them
•Draw sheets may be tucked
partway under seated patients or
completely under lying patients who have
been rolled onto their sides
•Handles may provide caregivers with
a firm grip
 DISADVANTAGES
•Sliding patients who have pressure sores
or other sources of sensitivity may cause them
pain. •Heavy patients may still require excessive
force to move. And mechanical lift may be
more appropriate.
•If the same sheet is used for more than
one person infection-control precautions
must be taken.
•Not be suitable for some transfers because
they do not bridge gaps. Where gaps need
to be bridged, caregivers can use slide
sheets in conjunction with transfer boards.
Two flat sheets
 DISADVANTAGES

•A slide may actually turn into a lift if

caregivers do not use proper
techniques.

•The move or transfer still requires two

caregivers.

•The use of these sheets may involve

additional effort and handling tasks to
position and remove them.
 TIPS
Follow these tips when using draw and
slider sheets:
•Use a “palms up” grip when pulling on
the slide/roller sheet. A “palms up” grip is
a stronger grip than a “palms down” grip.
A “palms up” grip keeps elbows close
to the body and helps to maintain a
neutral shoulder posture.

•Keep knuckles in contact with the

bedsheet to ensure a sliding motion, not a
lifting motion.
•Avoid shrugging the shoulders while
moving the patient, as this indicates a
lifting motion.

•If repositioning the patient up in bed, tilt

the entire bed with the head down, which
allows gravity to assist with the movement.

•Ensure that the sheet is taut

moving the patient before to prevent
patient. jerking the
•Draw sheets can be left under the patient
•Reduces the forces required to
move patients

•Reduces awkward postures if used

correctly

•More comfortable for patients

transfe than boards
r
Transfer belts
TRANSFER BELTS

•Transfer belts not reduce the patient’s

do weight in any and must not be used for
way, lifting patients.

•Transfer belts come in a variety of sizes

and shapes. They fasten with a buckle, a
clasp, or Velcro, and they usually have handles.

•Note: Although Velcro fastening is quicker

and easier than using buckles or clasps, the
hooks may get caught on the patient’s clothing
and may deteriorate rapidly if not carefully
laundered.
 USES
Transfer belts can be used:
•During assisted walking
•To guide patients along transfer boards during
seated transfers

ADVANTAGES
Transfer belts have the following advantages:
•They provide a secure grip.
•Caregivers do not need to grip the patient’s clothing
or limbs.
•Caregivers can guide a falling patient to the floor.
•NOTE Do not use transfer belts to catch or support
a falling patient’s weight.
•Caregivers can work in a more upright posture.
 DISADVANTAGES

Transfer belts have the following disadvantages:

•Belts that are too wide may affect a

patient’s ability to lean forward. Narrow,
unpadded belts may dig into the patient’s waist.

•Using a belt to lift all or most of a patient’s

body weight is not an acceptable practice.

•Belts without handles encourage the

caregiver to grip the belt with a clenched fist.
This generally causes the knuckles to press
into the patient’s side, resulting in discomfort.
 •Caregivers should not place their arms
through handles, as pictured.
Caregivers would rarely have time to free
their arms if the patient reacted or fell
suddenly.
transfer belt handles

Never place your

arm through
•Caregiv around the caregiver’s neck. Caregivers
ers are can avoid this situation by placing their
placed arms outside those of the patient
at when providing assistance.
significa
nt risk
when
patients
are
allowed
to hold
TIPS
Follow these tips when using transfer belts:

•As long as it is safe to do so, place

the transfer belt on the patientvwith the
bed in a raised position toavoid
awkward bending.

•Ensure that the belt is fairly snug (you

should only be able to place two fingers in
between the belt and the patient) to
reduce the chances of the belt sliding up
the patient during the transfer.
•When performing the transfer,
caregivers should shift their body weight
from one leg to the other and perform a
gentle pulling motion, using the legs to
do the work. Avoid lifting during the
transfer movement.

•Get the patient to assist as much as

possible.
 SLIDE/TRANSFER BOARDS

•Slide/transfer boards or smooth movers

are made of wood or plastic and can be
used in conjunction with roller sheets or
slide sheets. Some boards have rollers, while
others have fabric or vinyl coverings
designed to further reduce friction.

•Slide/transfer boards are used to reduce

friction and bridge gaps when sliding patients
between two horizontal surfaces such as from a
bed to a stretcher.

Rolling slide/transfer board

•These boards are suitable only for
those patients who can power themselves by
sliding or rolling along the board with
guidance from a knowledgeable caregiver.
Some procedures require
the caregiver to push or pull the board to
accomplish the transfer.

•Others involve pushing the patient or pulling

a draw sheet across the transfer board.
Large patients and patients with sensitive skin
may find slide/transfer boards uncomfortable.
If possible the use of a mechanical lift is
recommended over a slide/transfer board.
Banana board SMALLER SLIDE/TRANSFER BOARDS

•Smaller slide/transfer boards are designed

for seated lateral transfers. They are often
tapered at each end and can be used to bridge a
gap such as when transferring between a
Smaller slide/transfer
bed and a wheelchair or commode. Patients
boards
with movable sliding with good to use their arms and legs to
sections
move themselves. Boards are often made of a
low-friction material or with moveable sliding
sections. Be careful when using slide/transfer
boards with sliding sections because these
sliding sections may cause pinching.
 USES

•Slide/transfer boards can be used

to bridge gaps between two surfaces
to facilitate patient transfer, such as
between: •Bed and wheelchair
•Wheelchair and toilet
•Chair and wheelchair
•Wheelchair and car
•Rolling slide boards can be used when
transferring supine patients between
bed and stretcher.
Roller sheet
on transfer
board
ADVANTAGES

Slide/transfer boards have the

following advantages:
•Caregivers do not need to lift manually.
•Some patients may be able to
transfer themselves, avoiding the
need for caregivers to perform certain
transfers.
•When used appropriately, slide/transfer
boards allow for less horizontal forces
during caregiver-assisted transfers.
•Boards are available in a range of
widths, lengths, and curves.
•Curved transfer boards make it
possible to transfer around fixed armrests.
 DISADVANTAGES

Slide/transfer boards have the

following disadvantages:
•Inappropriate use (for example,
with patients who cannot offer
sufficient assistance) may put
caregivers at a high risk of MSI.
•Some slide/transfer boards do not
sufficiently reduce friction.
•Two equal-height surfaces are needed
for easy transfer. For seated transfers,
patients must have some degree of sitting
balance.
•Many boards have no handles for
positioning or carrying the board.

•Caregivers must be careful not to

twist during the transfer.

•Caregivers may still apply horizontal

forces in awkward postures.

•Fingers may be trapped under

board edges.
 TIPS
Follow these tips when using slide/transfer
boards:

•When transferring a patient between two

surfaces, ensure the receiving surface is a
little bit lower (no more than 2.5 centimetres
or one inch) to allow gravity to assist. Avoid
a difference of more than 2.5 centimetres
as this may be too jarring for the patient.

•Use of a flat sheet directly under the patient

will increase the ease of the transfer because
it will provide the caregivers with something
to grasp onto when pulling the patient onto
the bed/stretcher
•If the patient is lying on a
fitted sheet, do not use the sheet
for the transfer. It’s difficult to keep
the sheet taut during the transfer,
and it creates more friction with the
slide/transfer board, thereby
increasing the force required by the
caregiver.

•When surface
applicable,
place the
receiving
to the
patient’s
stronger
side.
 TURNING DISCS

•Turning or pivot discs come

in various sizes and may be flexible
or solid. They consist of two
circular discs that rotate against
each other. The inner surfaces are
made of low-friction material,
while the outer surfaces are
typically high-friction material.
Turning discs are often used with
 transfer boards or transfer belts.
Turning discs
 FLEXIBLE TURNING DISCS

•Flexible turning discs conform to

the contours of a surface and are
most useful for pivoting seated
patients (for example, when
transferring patients into vehicles).
The inner surfaces are typically low-
friction plastic or other synthetic
material. The top is often made of
quilted or padded fabric for comfort.
 SOLID TURNING DISCS

•Solid turning discs are more durable and

are used for pivoting patients who
are weight bearing and can stand. Solid
turning discs are usually made of wood or
moulded plastic and may contain
bearings. Patients who are weight
bearing and can balance when standing
may be guided to a standing position and
swivelled around without having to
adjust their feet.
Patients must have the strength to stand,
or this procedure will require the caregiver to
exert excessive force in an awkward
posture. Use transfer belts with handles to
pivot patients standing on flexible or solid
turning discs. Use turning discs only for
patients who can stand up independently.
Patients who are unable to independently
rise to a standing position require a sit-stand or
total body lift.
 USES

Turning discs assist with rotation

patients of during a transfer between:

•Wheelchair and bed

•Wheelchair and chair

•Wheelchair and car

 ADVANTAGES

Turning discs have the following

advantages:

•The patient’s feet do not need to be

turned or adjusted after the transfer.

•Some discs have a small handle that

makes positioning and storing easier.

•Turning discs reduce the forces

to rotate required or pivot patients.
 DISADVANTAGES

Turning discs have the following disadvantages:

•The larger the disc, the greater the risk that

the disc will be in the way of the caregiver’s feet.

•Some solid discs have ball bearings in their

swivel mechanism.

•Choose and use these discs with care. They can

be difficult to control, especially with
patients. light
•Do not use turning discs to transfer
unpredictable patients or dependent, non-weight-
bearing patients.

•The greater the profile (thickness) of a solid disc,

the greater the tripping hazard it presents to the
patient and caregiver.

•A patient’s support base is narrowed while

standing on a turning disc.

•Some patients may become disoriented when

they are turned on the disc.

•Heavy patients may still require excessive force

to move them.
 TIPS

Follow these tips when using turning discs:

•For standing pivots, only one of the patient’s feet

should be placed on the solid disc. The patient
must be able to use the other leg to guide the pivot
motion.

•For standing pivots, the patient’s foot should be

placed in the centre of the disc.

•Remove obstacles.

•Place caregivers’ feet shoulder-width apart for a

good base of support.
 Assessment
Prior to lifting any object or materials an assessment of
the most appropriate method of lifting should be
completed. Plan the lift in your mind - organize the lift
so that it will be best for you and your co-workers.

• If you are uncertain about your ability to lift an object

safely, get help! Never “go it alone.” Try the heft test.
Get an idea if you can manage the lift.

• Always consider proper positioning of the spine

and upper extremity to prevent injury.

• If you have an idea how the lift or environment

could be improved, talk to your manager. Taking a few
seconds to consciously prepare for the lift may prevent
you or a co-worker from days, months or years of pain.
Assessment before starting a lift or
transfer is essential.

A good assessment
• Ensures that the transfer/lift
is appropriate for the caregiver
and patient
• Aids in preventing back and
shoulder strain/injury to the caregiver
• Reduces the risk to the
patient and/or caregiver
An appropriate transfer/lift

• Is safe for the caregiver and patient

• Enables the patient to be

as independent as possible

• Is comfortable for the patient

• Provides the least wear and tear

on the back and shoulders of the
caregiver
Why is consistency important?
• Unexpected incidences or lack of
patient cooperation are often contributing
factors in injuries to caregivers. When the
lifting technique is consistent the patient is
more likely to cooperate and be less anxious.

Who should do the assessment?

• The nurse is responsible for assessing
the patients transfer/lift needs.

• Physiotherapists and/or Occupational

Therapists are available for
consultation concerning complex cases. A
referral may be required if intervention to
improve transfers is indicated.
When should the initial assessment be done?
• The admitting nurse should do the
assessment of the most appropriate lift/transfer
at the time of admission.
• The accepted lift/transfer should be noted
on the admission history and the Kardex.

What should be included in the initial

assessment?
• Caregiver status
• Assess the patients abilities (strength ROM,
balance, etc) ,
• The environment
• Equipment available
When are lifts/transfers reassessed?

• A brief reassessment must be done

every time, before a
caregiver intends to
lift/transfer a patient

• Reassessment is important because a

patient’s ability to assist and
cooperate may vary from day to day,
or even at different times during the
same day because of medication,
fatigue, stress or pain
•Reassessment may help to prevent
those unexpected incidents

• More formal reassessments are

necessary when a patient’s
condition improves or deteriorates. This
ensure the procedure listed on the
kardex is most appropriate

• Reassessment also helps to maintain a

high level of awareness
about patient handling
What needs to be reassessed?

• Change in medical status

• Patients ability to communicate
• Level of cognition
• Level of aggression
• Physical Abilities (ROM, strength)
• Environment
• Availability of Equipment
Caregiver Ability
FACTORS TO CONSIDER WHEN ASSESSING PATIENT HANDLING
TASKS
 PREPARATION

Preparing for the lift/transfer

1. Prepare the equipment

• Adjust position of the equipment (bed,
stretcher, wheelchair, etc)

• Adjustments to the chair include locking

brakes, checking cushion position (if
available), removing arm rests if necessary
for transfer/lift, positioning chair at
appropriate angle.
•Adjustments to the bed include locking
brakes, putting down side rails,
adjusting bed height (hip height if
standing, mid thigh height if knee on
bed, level with chair if using sliding
board or hemi transfer)

• Ensure all devices are in good

working order including belts, lifts,
slings
2. Prepare the patient

• Explain what you are about to

do with the patient

• A well-prepared patient can

make your workload easier!

• Ensure the patient places

their hands on the appropriate place
to assist with the lift i.e. the side rail.
DO NOT ALLOW THE PATIENT
TO GRAB AROUND
THE CAREGIVERS NECK.
This could lead to neck injury or
strain.

• Position the IV tubing/poles,

catheter bags and other
appliances so that they do not
interfere with the transfer
• Maintain the patient’s dignity
3. Prepare the Caregiver

• Complete a brief reassessment to ensure appropriate

lift • Position the caregiver so the patient feels safe,
the patient can hear and see the caregiver, and
with appropriate body mechanics (the feet apart and
knees bent slightly)
• Discuss the plan with lifting partners
• Explain the plan to the patient including their role in
the transfer/lift
• Use simple instructions/one step commands
• Tighten abdominal muscles (core) before you
lift. Maintain normal spinal alignment by keeping a
slight inward curve just above the pelvis. Use the
powerful leg muscles to help with the handling
procedure
• Use both hands and hold the patient as close
to your body as possible. Never grasp the
patient under the arms. This can lead to
injury or subluxation
• Count with lifting partners so everyone
moves at same time “1,2,3,lift”
• Be prepared for the unexpected.
• If the load starts to slip or the patient starts
to fall, go with it. Try not to rotate. Protect
the patient’s head
• If the patient falls assess their condition
before returning them to bed
• Postpone the lift/transfer if the patient
is resistive, uncooperative or aggressive (if
non emergent)
4. The Environment

• Clear a working area

• Eliminate any obstacles

• Ensure adequate lighting

• Dry floor

• Minimize distracting noises

 THE PRINCIPLES OF SAFER PATIENT HANDLING
Before the task:

• Wear the right clothes: Make sure your

clothing and footwear are appropriate –
clothes should allow free movement and shoes
should be non-slip, supportive and stable

• Never lift: Never plan to lift manually –

always use a hoist to lift a patient

• Know your limits: Know your own

capabilities and don’t exceed them – for
instance, if you need training in the technique
to be used, tell your manager
• Do one thing at a time: Don’t try to do
two things at once – for instance, don’t try to
adjust the patient’s clothing during the transfer

• Prepare for the task: Make sure everything

is ready before you start – for instance, check
other carers are available if needed,
equipment is ready and the handling
environment is prepared

• Choose a lead carer: The lead carer checks

the patient profi le and co-ordinates the move.
You should also try to match the height of
carers if possible to avoid awkward postures
Apply safe principles: Always use
safe biomechanical principles – and use
rhythm and timing to aid the task.

caution – High risk. The patient shouldn’t

hold on to you or your clothing, because it
is diffi cult for you to disengage and
the patient could pull you off balance.
It is unsafe for carers and patients.
 Safe biomechanical principles

Here’s the safe way to hold your body:

• Stand in a stable position: Your feet should
be shoulder distance apart, with one leg slightly
forward to help you balance – you may need to
move your feet to maintain a stable posture

• Avoid twisting: Make sure your shoulders and

pelvis stay in line with
each other

• Bend your knees: Bend your knees slightly,

but maintain your natural
spinal curve – avoid stooping by bending slightly at
the hips (bottom
out)
• Elbows in: Keep elbows tucked in
your and avoid reaching further away
– the the body the from the greater
load is, potential for the
harm

• Tighten abdominal muscles: Tighten

your abdominal muscles to support your
spine

• Head up: Keep your head raised,

with your chin tucked in during the
movement
• Move smoothly: smoothly
throughout Move the avoid
holds. technique and fixed
 Carrying out the task:

• Check patient profi le: Decide if the task is

still necessary and that the handling plan is
still appropriate. Check it still matches the
clinical pathway and physician’s orders

• Seek advice: Talk to your manager or the

patient handling adviser if you need advice
on the techniques and equipment you should be
using

• Check equipment: Ensure equipment is

available in good order with all components in
place and ready to use (eg. batteries charged).
Always follow the manufacturer’s instructions
Prepare handling Position furniture
environment: correctly, check ways are clear,
route and access check the and
destination is available

• Explain the task: Explain the task to the patient and

other carers who will be helping

• Prepare the patient: Ensure the patient’s clothes

and footwear are appropriate for the task, and they
have any aids they need. Adjust their clothes,
aids and position – for instance, encourage the
patient to lean forward

• Give precise instructions: The lead carer directs

the move and gives clear instructions, eg. “Ready,
steady, stand”. This helps carer/s and patient work
together.
 After the task:
• Correct your posture: Stand up straight
to correct your spinal alignment. Hold your
chest open, shoulders back and abdominal
muscles in so your lower body aligns properly
with your upper body

• Re-evaluate the task: Could the task have

been done better? How? Mark the patient
profile with your comments

• Report any issues: If you identify issues

that affect patient handling, report them to
your manager and add them to the workplace
control plan for action.
 MOVING PATIENTS FROM BED TO
WHEELCHAIR

Remember: When patients are weak,

brace your knees against theirs to keep
their legs from buckling. Also, transfer
toward patient’s stronger side if
possible.
1 .Sit the Patient Up
•Position and lock the
wheelchair close to the bed.
Remove armrest nearest
bed and swing away both
leg rests.

•Help the patient turn over.

•Put an arm under the

patient’s neck with
your hand supporting •Swing legs over
the shoulder the edge of the
blade; put your other bed, helping the
hand under the knees. patient to sit up.
2.Stand the Patient Up
•Have the patient scoot to the edge of
the bed.

•Put your arms around the patient’s

chest and clasp your hands behind his
or her back. Or, you may also use a
transfer belt to provide a firm handhold.
•Supporting the leg farthest from the
wheelchair between your legs, lean back,
shift your weight, and lift.
3. Pivot Toward Chair

•Have the patient

pivot toward the
chair, as you continue
to clasp your hands
around the patient.

•A helper can support

the wheelchair or
patient from behind.
4. Sit the Patient Down

•As the patient bends toward you, bend

your knees and lower the patient into
the back of the wheelchair.

•A helper may position the patient’s

buttocks and support the chair.
 PULLING A PATIENT UP IN BED
1. Grasp the Draw-
Sheet
•Put the head of the
bed down and
adjust the top of the
bed to waist- or hip-
level of the shorter
person.

•Grasp the draw-

sheet, pointing one
foot in the direction
you’re moving the
patient.
•Lean in the direction
of the move, using
your legs and body
weight.

•On the count of

three, lift and pull the
patient up. Repeat
this step as
many times as
needed to position
the patient.
•Also,patients can bend their knees, push
down with their feet, and pull up with a
trapeze (a device overhead) to help
Remember:
Putting a pillow under your patients’
feet helps them push down, making it
easier for you to pull them up.
Never clasp the underarm to move
the patient. This may cause injury to
the shoulder (i.e., dislocation).
 TURNING PATIENTS OVER IN BED

1.Cross Arms
•Put the bed rail and head of the bed down;
adjust the top of the bed to waist- or hip-level.

•Cross the patient’s arms on his or her chest;

bend the leg farther away from you.
 2.Turn the Patient

•Put one hand behind

the patient’s far
shoulder.
•Put your other hand
behind the patient’s
hip.

•Turn the patient, supporting the

patient’s leg with your knee.
Remember: Putting one knee on the bed gets you closer
to the patient, so you pull more with you
 MOVING PATIENTS FROM BED TO
STRETCHER (GURNEY)

Remember: If you move patient’s legs

first, you can decrease the stress on
your back by as much as a third.

•Patient safety is often the main concern when

moving patients from bed. But remember not to
lift at the expense of your own back. And, never
move a patient by yourself. Two people usually
can do this move safely. The leader, who pulls,
should be the stronger of the two. The helper
holds the draw-sheet, neither pushing nor
lifting.
1

The leader should have one

foot forward with knees
bent.

1.Prepare to Move
•Put the head of the torso.
bed down and adjust
the bed height.

•Put a garbage bag or

plastic slide board
between the sheet and
draw-sheet,
beneath one edge
of the patient’s
•Move the patient’s legs closer to
the edge of the bed.
•Instruct patient to cross arms
across chest and explain move to
patient.
2. Pull to Edge of Bed
Grasp the draw-sheet on both sides of the bed.
•On the count of three, lean back and shift your
weight, sliding the patient to the edge of the
bed. The helper holds the sheet, keeping it from
slipping.
3.Position Stretcher
•Have the helper “cradle” the patient in the
draw-sheet while you retrieve a stretcher.
•Adjust the bed to be slightly higher than the
stretcher. Then, position the stretcher, locking
it in place.
•Move the patient’s legs onto the stretcher.
4. Slide onto
Stretcher
•Have the helper
kneel on the bed,
holding on to the
draw-sheet.

•On the count of

three, grasp the
draw-sheet and
slide the patient
onto the stretcher.
You may need to
repeat this step.
 TRANSFERRING USING A TRANSFER BOARD

A caregiver may use a gait belt to

help you move across the transfer
rd.
boa Using a Transfer Board
1. Place the wheelchair
as close to the bed as
possible, and position it
at about a 30-degree
angle with the bed.

2. Lock the brakes on the wheelchair, move the

footrests out of the way, and remove the armrest
on the side closest to the patient.
3. Help the patient to sit on the edge of the
bed with his feet flat on the floor.

4. Help the patient to lean over slightly away

from the wheelchair, and carefully slide one
end of the transfer board under the thigh that
is closest to the wheelchair. Point the end of
the board down into the bed as you do this,
to avoid pinching the patient's skin.

5. Place the other end of the transfer board

flat on the seat of the wheelchair with the end
of the board pointed at the back seat corner
farthest from the bed.
6. Assist the patient with several short
"scooting" motions onto the board. If the
board is on the patient's left, have him lean
his upper body slightly to the right before
each scooting motion. The patient can place
his hands on the bed and rest some of his
weight on his hands to make it easier to move
onto the board.

7. Make sure the patient doesn't fall as he

moves across the board in several small
movements, until he is seated on the
wheelchair.

8. Remove the board, replace the armrest,

and position the footrests.
 TRANSFER: WHEELCHAIR TO CHAIR

up.

2.Help the person scoot to

the edge of the chair.
Be sure the patient’s feet
are under his or her body.
Lift as the person pushes
1. Patients who cannot walk are
taught to use
wheelchairs. For safety, have the
therapist show you the correct
way to help someone out
of a wheelchair. Start by
locking the wheels of the
chair. Then stand as close to
the patient as you can. Make
sure your footing is stable. The
patient should always wear a
special belt for you to grip.
3.Keep the
person’s
weaker knee
between your
legs.
Pivot the person
around in front
of the toilet
or chair. Lower
him or her
gently.
 TRANSFER—WHEELCHAIR TO TOILET
1. Stand the patient up
•Lock the wheelchair.
•Be sure the person’s feet are under
his or her body.
•Grasp the back of a belt
or pants and lift.

2. Move on the toilet

•Keep the person’s weaker knee
between your legs.
•Pivot the person around in front of
the toilet. Always transfer toward the
person’s stronger side.
•Gently sit the patient down onto the
toilet.
•Help the patient adjust their clothing.
•Never pull on the person’s weaker
arm or lift the person by the armpits.
Take Care of Your Back
Lifting a patient can be hard on your back.
To reduce the risk of a back injury,
remember to do the following:
Organize the steps in your head before
you move.
Keep the patient close to you.
Keep your knees bent and your back
straight.
Get help when you need it.
 WHEN A PATIENT FALLS
Once the momentum has started, it’s almost
impossible to stop a patient from falling. By trying to do
so, you can injure your back. Instead, guide the
patient to the ground; then get help to move the
patient back to a bed or stretcher.
Guiding the Fall
Help falling patients to the
floor with as little impact as
possible. If you’re near a
wall, gently push the
patient against it to
slow the fall. If you can,
move close enough to “hug”
the patient. Focus on
protecting the patient’s
head as you move down
to the floor. Then call for
help.
 Moving a Fallen Patient

1. Roll onto Blanket

•Roll the patient onto his
or her side.
•Put a blanket under the
patient and roll the
patient onto it.
•Position two or more
people on each side of
the patient.
 2. Lift from Floor
•Kneel on one
knee and grasp
the blanket.
•On a count of
three, lift the
patient and stand
up.
•Move the patient
onto a bed or
stretcher.

Remember: Be proactive; assess and identify a patient

as a fall risk and start intervention to prevent a fall.
 PATIENT SAFETY
This is demonstrated by keeping the following things in mind:

S – Sliding boards are used to bridge the gap between the bed
and the chair if the patient’s muscles are not strong enough to
overcome the resistance of body weight. Transfer or
movement devices may be used in cases where mechanical
devices are not available, additional personnel is needed for
large patients.
A – Ascertain that chairs and beds are locked before the
patient transfers. Potential hazards associated with
transferring patients should be identified by the nurse and
establishment of safe practices is essential.
F – Frequent assessment of patient needs by a registered
nurse before transfer to determine patient’s ability to
participate during the transfer and use necessary skill
appropriate for this patient.
E – Ensure that one staff member remains with the patient
during the transfer.
THANK YOU FOR
LISTENING!

MOHAMMAD
SHAH J. AHID