Saturday, July 28, 2012

TRANSFERRING BETWEEN BED & CHAIR

Purpose:
1. To strengthen the patient gradually
2. To provide a change in position

Equipments:
- Robe or appropriate clothing
- Slippers or shoes
- Chair or wheelchair

Assessment:
- The clients body size
- Ability to follow instructions
- Activity tolerance
- Muscle strength
- Joint mobility
- Presence of paralysis
- Level of comfort
- The technique with wich the client is familiar
- The skill & strength of the caregiver

Preparation:
- Plan what to do & how to do it.
- Obtain essential equipment before starting & check if it is functional
- Remove obstacles from the area used for the transfer

Performance:
1. Introduce self & verify the clients identity using the agency protocol. Explain the transfer process to the patient.

- This facilitates cooperation of the patient

2.Perform hand hygiene.
- Hand hygiene deters the spread of microorganisms.

3. Provide for client privacy.

4. Position the equipment appropriately.
- Lower the bed to its lower position so that the clients feet will rest flat on the floor. Lock the wheels of the bed.

- Place the wheelchair parallel to the bed as close to the bed as possible.

Put the wheelchair on the side of the bed that allows the client to move toward his or her stronger side.

- Lock the wheels of the wheelchair & raise the footplate.

5. Prepare & assess the client
- Assist the client to a sitting position on the side of the bed.

- Assess the client for orthostatic hypotention before moving the client from the bed.

- Assist the client in putting on a bathrobe & slippers

- Place a transfer belt snugly around the client’s waist. Check to be certain that the belt is securely fastened.

6. Give explicit instructions to the client;
Ask the client to:

- Move forward & sit on the edge of the bed. This brings the clients center of gravitycloser to the nurse’s

- Lean forward sligtly from the hips. This brings the clients center of gravity more directly over the base of support & positions the head & trunk in the direction of the movement.

- Place the foot of the stronger leg beneath the edge of the bed & put the other foot forward. In this way, the client can use the stronger leg muscles to stand & power the movement. A broader base of support makes the client more stable during the transfer.

- Place the client’s hands on the bed surface or on your shoulders so that the client can push while standing. This provides additional force for the movement & reduces the the potential for strain on the nurse’s back. The client should not grasp your neck for support. Doing so can injure the nurse.

7. Position yourself correctly.
- Stand directly infront of the client. Encircle the clients waist w/ your arms & grasp the transfer belt at the clients back if there is any. The belt provides a secure handle for holding on the client & controlling the movement.

8. Assist the client to stand & then move together toward the wheelchair.

- On the count of three, ask the client to push with the back foot, rock to the forward foor & extend the joints of the lower extremities. Push or pull up with the hands, while pushing w/ the forward foot, rock to the back foot, extend the joints of the lower extremities & pull the client into a standing position.

- Support the client in an upright standing position for a few moments. This allows the nurse & the client to extend the joints & provides the nurse w/ an oportunity to ensure that the client is stable before moving away from the bed.

- Together, pivot or take few steps toward the wheelchair.

9. Assist the client to sit.
Ask the client to:
a. Back up to the wheelchair & place the legs against the seat.
- Having the client place the legs against the wheelchair seat minimizes the risk of the client falling when sitting down.


b. Place the fot of the stronger leg sligtly behind the other.
- This supports body weight during the movement


c. Keep the other foot forward.
- This provides a broad base of support.

d. Place both hands on the wheelchair arms or on your shoulders.
- This increases stability & lessens the strain on the nurse.
• Stand directly infront of the client. Place one foot forward & one back.
• Tighten your grasp on the trasnsfer belt & tighten your leg, gluteal, abdominal & arm musles.
• On the count of three, have the client shift the body weight & lower the body onto the edge of the wheelchair seat by flexing the joints of the legs arms.

10. Ensure client safety.
- Ask the client to push back into the wheelchair seat.
- Lower the footplates & place the clients feet on them.
- Apply a seat belt as required.

11. Documentation
- Clients ability to bear weight & pivot
- Number of staff needed for transfer
- Length of time up in chair
- Clients response to transfer & being up in chair or wheelchair.

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