Chapter 17

Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 17Chapter 17

Safe Resident Handling, Safe Resident Handling, Moving, and TransfersMoving, and Transfers


When providing care, you will:When providing care, you will: Turn and reposition persons oftenTurn and reposition persons often Move persons in bedMove persons in bed Transfer persons to and from beds, chairs, Transfer persons to and from beds, chairs,

wheelchairs, stretchers, and toiletswheelchairs, stretchers, and toilets You must use your body correctly.You must use your body correctly.

Slide 2


Preventing Work-Related InjuriesPreventing Work-Related Injuries

OSHA recommends that:OSHA recommends that: Manual lifting be minimized in all casesManual lifting be minimized in all cases Manual lifting be eliminated when possibleManual lifting be eliminated when possible

For safe resident handling, moving, and For safe resident handling, moving, and transfers, the nurse and health team transfers, the nurse and health team determine:determine: The resident’s dependence levelThe resident’s dependence level The amount of assistance neededThe amount of assistance needed What procedure to useWhat procedure to use The equipment neededThe equipment needed

Slide 3


Persons with dementia may:Persons with dementia may: Not understand what you are doingNot understand what you are doing Resist your handling, moving, and transfer effortsResist your handling, moving, and transfer efforts Shout at you, grab you, or try to hit youShout at you, grab you, or try to hit you

Measures to provide safe care for persons with Measures to provide safe care for persons with dementia include:dementia include: Always get a co-worker to help you.Always get a co-worker to help you. Do not force the person.Do not force the person. Proceed slowly and use a calm, pleasant voice.Proceed slowly and use a calm, pleasant voice. Divert the person’s attention.Divert the person’s attention. Tell the nurse at once if you have problems handling, Tell the nurse at once if you have problems handling,

moving, or transferring the person.moving, or transferring the person.

Slide 4


Moving Persons in BedMoving Persons in Bed

Some persons can move and turn in bed.Some persons can move and turn in bed. Those who are weak, unconscious, paralyzed, or in Those who are weak, unconscious, paralyzed, or in

casts need help.casts need help. If the person has a dependence level of If the person has a dependence level of Code 3: Code 3:

Extensive Assistance Extensive Assistance oror Code 4: Total Dependence, Code 4: Total Dependence, use a mechanical lift or friction-reducing device. At use a mechanical lift or friction-reducing device. At least two staff members are needed. least two staff members are needed.

If the person weighs less than 200 poundsIf the person weighs less than 200 pounds, , two to two to three staff members and a friction-reducing device three staff members and a friction-reducing device are needed. are needed.

If the person weighs more than 200 lbs, at least three If the person weighs more than 200 lbs, at least three staff members and a friction-reducing device are staff members and a friction-reducing device are needed. needed.

Slide 5


Protecting the skinProtecting the skin Friction and shearing injure the skin.Friction and shearing injure the skin. Friction and shearing cause infection and pressure Friction and shearing cause infection and pressure

ulcers.ulcers. Reduce friction and shearing when moving Reduce friction and shearing when moving

the person in bed by:the person in bed by: Rolling the personRolling the person Using a lift sheet (turning sheet)Using a lift sheet (turning sheet) Using a turning pad, a large incontinence product, Using a turning pad, a large incontinence product,

slide board, or slide sheetslide board, or slide sheet

Slide 6


Raising the person’s head and shouldersRaising the person’s head and shoulders You can raise the person’s head and shoulders easily and You can raise the person’s head and shoulders easily and

safely by locking arms with the person.safely by locking arms with the person. It is best to have help with older persons and with those who It is best to have help with older persons and with those who

are heavy or hard to move.are heavy or hard to move. Moving the person up in bedMoving the person up in bed

The person is moved up in bed for good alignment and The person is moved up in bed for good alignment and comfort.comfort.

You can sometimes move lightweight adults up in bed alone You can sometimes move lightweight adults up in bed alone if they can assist and use a trapeze.if they can assist and use a trapeze.

Two or more staff members are needed to move heavy, Two or more staff members are needed to move heavy, weak, and very old persons.weak, and very old persons.

Always protect the person and yourself from injury.Always protect the person and yourself from injury.

Slide 7


Moving the person up in bed with an assist Moving the person up in bed with an assist devicedevice Assist devices are used to move some persons up in Assist devices are used to move some persons up in

bed.bed. With these devices, the person is moved more easily With these devices, the person is moved more easily

and more evenly.and more evenly. With these devices, shearing and friction are reduced, With these devices, shearing and friction are reduced,

helping to prevent pain and skin damage.helping to prevent pain and skin damage. These devices also help prevent injury to bones, joints, These devices also help prevent injury to bones, joints,

and the spinal cord. and the spinal cord. The device is placed under the person from the head The device is placed under the person from the head

to above the knees or lower.to above the knees or lower. At least two staff members are needed.At least two staff members are needed.

Slide 8


When moving the person up in bed, OSHA When moving the person up in bed, OSHA recommends the following:recommends the following: If the person weighs less than 200 pounds, two or If the person weighs less than 200 pounds, two or

three staff members and a friction-reducing device three staff members and a friction-reducing device are needed.are needed.

If the person weighs more than 200 pounds, at If the person weighs more than 200 pounds, at least three staff members and a friction-reducing least three staff members and a friction-reducing device are needed.device are needed.

Slide 9


Moving the person to the side of the bedMoving the person to the side of the bed One method involves moving the person in One method involves moving the person in

segments.segments. Use a mechanical lift or the assist device method Use a mechanical lift or the assist device method

for:for:• Tall or heavy personsTall or heavy persons

• Totally dependent personsTotally dependent persons

• Persons requiring extensive assistancePersons requiring extensive assistance

• Older personsOlder persons

• Persons with arthritisPersons with arthritis

• Persons recovering from spinal cord injuries or spinal cord Persons recovering from spinal cord injuries or spinal cord surgerysurgery

Slide 10


Turning PersonsTurning Persons

Turning persons onto their sides helps prevent Turning persons onto their sides helps prevent complications from bedrest. Certain procedures and complications from bedrest. Certain procedures and care measures also require the side-lying position. care measures also require the side-lying position. The direction of turning depends on the person’s The direction of turning depends on the person’s condition and the situation. condition and the situation.

The person is turned toward you or away from you.The person is turned toward you or away from you. After the person is turned, position him or her in good After the person is turned, position him or her in good

alignment.alignment. Persons may:Persons may:

Be able to turn and reposition themselves in bedBe able to turn and reposition themselves in bed Need helpNeed help Totally depend on the nursing staff for careTotally depend on the nursing staff for care

Slide 11


Logrolling is turning the person as a unit, in Logrolling is turning the person as a unit, in alignment, with one motion.alignment, with one motion. The procedure is used to turn:The procedure is used to turn:

• Older persons with arthritic spines or kneesOlder persons with arthritic spines or knees

• Persons recovering from hip fracturesPersons recovering from hip fractures

• Persons with spinal cord injuriesPersons with spinal cord injuries

• Persons recovering from spinal surgeryPersons recovering from spinal surgery

The spine is kept straight all times.The spine is kept straight all times.

Slide 12


Sitting on the Side Sitting on the Side of the Bed (Dangling)of the Bed (Dangling)

Residents dangle for many reasons.Residents dangle for many reasons. Many older persons become dizzy or faint Many older persons become dizzy or faint

when getting out of bed too fast. when getting out of bed too fast. They may need to sit on the side the bed for 1 to 5 They may need to sit on the side the bed for 1 to 5

minutes before walking or transferring. minutes before walking or transferring. While dangling the legs, the person:While dangling the legs, the person:

Deep breathes and coughsDeep breathes and coughs Moves the legs back and forth in circlesMoves the legs back and forth in circles

Two staff members may be needed to help Two staff members may be needed to help the person sit on the side of the bed. the person sit on the side of the bed.

Slide 13


Transferring PersonsTransferring Persons

Residents are moved to and from beds, chairs, Residents are moved to and from beds, chairs, wheelchairs, shower chairs, commodes, toilets, and wheelchairs, shower chairs, commodes, toilets, and stretchers.stretchers.

The amount of help needed and the method used The amount of help needed and the method used vary with the person’s dependency level.vary with the person’s dependency level.

Arrange the room so there is enough space for a safe Arrange the room so there is enough space for a safe transfer. Correct placement of the chair, wheelchair, transfer. Correct placement of the chair, wheelchair, or other device also is needed for a safe transfer.or other device also is needed for a safe transfer.

Transfer belts (gait belts) are used to:Transfer belts (gait belts) are used to: Support residents during transfersSupport residents during transfers Reposition persons in chairs and wheelchairsReposition persons in chairs and wheelchairs

Bed to chair or wheelchair transfersBed to chair or wheelchair transfers Help the person out of bed on his or her strong side.Help the person out of bed on his or her strong side.

Slide 14


Chair or wheelchair to bed transfersChair or wheelchair to bed transfers If the person is weak on one side, transfer the person If the person is weak on one side, transfer the person

so that the strong side moves first.so that the strong side moves first. Mechanical lifts Mechanical lifts

Mechanical lifts are used Mechanical lifts are used • To transfer persons whoTo transfer persons who

Cannot help themselves.Cannot help themselves. Are too heavy for the staff to transfer.Are too heavy for the staff to transfer.

• For transfers to and from beds, chairs, stretchers, tubs, For transfers to and from beds, chairs, stretchers, tubs, shower chairs, toilets, commodes, whirlpools, or vehicles. shower chairs, toilets, commodes, whirlpools, or vehicles.

The type of sling used depends on the person’s size, The type of sling used depends on the person’s size, condition, and other needs.condition, and other needs.

• Slings are padded, unpadded, or made of mesh. Slings are padded, unpadded, or made of mesh.

Slide 15


Before using a mechanical lift:Before using a mechanical lift:• You must be trained in its use.You must be trained in its use.

• It must work.It must work.

• The sling, straps, hooks, and chains must be in The sling, straps, hooks, and chains must be in good repair.good repair.

• The person’s weight must not exceed the lift’s The person’s weight must not exceed the lift’s capacity.capacity.

• At least two staff members are needed. At least two staff members are needed.

• Always follow the manufacturer’s instructions.Always follow the manufacturer’s instructions.

Slide 16


Using the bathroom for elimination Using the bathroom for elimination promotes dignity, self-esteem, and independence. Ipromotes dignity, self-esteem, and independence. I is more private than using a bedpan, urinal, or bedside is more private than using a bedpan, urinal, or bedside

commode. commode. Transferring the person to and from the toiletTransferring the person to and from the toilet

Sometimes mechanical lifts are used.Sometimes mechanical lifts are used. A slide board may be used if:A slide board may be used if:

• The wheelchair armrests are removable.The wheelchair armrests are removable.• The person has upper body strength.The person has upper body strength.• The person has good sitting balance.The person has good sitting balance.• There is enough room to position the wheelchair next to the There is enough room to position the wheelchair next to the

toilet.toilet.

Slide 17


Stretchers (gurneys) are used for persons Stretchers (gurneys) are used for persons who:who: Cannot sit up.Cannot sit up. Must stay in a lying position.Must stay in a lying position. Are seriously ill.Are seriously ill.

To transfer the person to the stretcher:To transfer the person to the stretcher: A drawsheet, turning pad, large incontinence A drawsheet, turning pad, large incontinence

product, slide sheet, or slide board is used.product, slide sheet, or slide board is used. At least two or three staff members are needed.At least two or three staff members are needed.

Slide 18


When the person is on the stretcher:When the person is on the stretcher: Safety straps are used.Safety straps are used. The stretcher side rails are kept up during the The stretcher side rails are kept up during the

transport.transport. The stretcher is moved feet first.The stretcher is moved feet first. Never leave a person on a stretcher alone.Never leave a person on a stretcher alone.

Slide 19


Repositioning in a Chair Repositioning in a Chair or Wheelchairor Wheelchair

For good alignment and safety, the person’s For good alignment and safety, the person’s back and buttocks must be against the back back and buttocks must be against the back of the chair.of the chair.

Follow the nurse’s directions and the care Follow the nurse’s directions and the care plan for the best way to reposition the person.plan for the best way to reposition the person.

If the person cannot help, a mechanical lift is If the person cannot help, a mechanical lift is needed to re-position the person. needed to re-position the person.

Slide 20


Quality of LifeQuality of Life

You must protect the right to privacy at all You must protect the right to privacy at all times.times.

The person’s rights also are protected by The person’s rights also are protected by allowing personal choice whenever possible.allowing personal choice whenever possible.

The person has the right to be free from The person has the right to be free from restraint.restraint.

Promote independence.Promote independence.

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Chapter 17

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