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Chapter%20Eight

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Title: Chapter%20Eight


1
  • 1. Define important words in this chapter (cont)
  • ergonomics
  • the science of designing equipment and setting up
    areas to make them safer and to suit the workers
    abilities.
  • Fowlers
  • position with the person lying on his or her back
    with the head of bed elevated about 45 to 60
    degrees.
  • gait belt
  • a belt made of canvas or other heavy material
    used to help residents walk also called a
    transfer belt.
  • lateral
  • position with person on his or her side.

2
  • 1. Define important words in this chapter (cont)
  • logrolling
  • moving a person as a unit, without disturbing the
    alignment of the body.
  • mechanical lift
  • special equipment used to lift and move or lift
    and weigh a person.
  • MSDs
  • acronym that stands for work-related
    musculoskeletal disorders.
  • positioning
  • helping people into positions that will be
    comfortable and healthy for them.

3
  • 1. Define important words in this chapter (cont)
  • prone
  • position with person lying on his or her
    stomach..
  • shearing
  • rubbing or friction resulting from the skin
    moving one way and the bone underneath it
    remaining fixed or moving in the opposite
    direction.
  • Sims
  • position with person lying on his or her left
    side with one leg drawn up.
  • supine
  • position with person lying flat on his or her
    back.

4
  • 1. Define important words in this chapter (cont)
  • transfer
  • moving a resident from one place to another.
  • transfer belt
  • a belt made of canvas or other heavy material
    used to assist residents who are weak, unsteady,
    or uncoordinated also called a gait belt.

5
  • 2. Explain body alignment and review the
    principles of body mechanics
  • Body alignment is also known as posture.
  • Use these guidelines for proper body alignment
  • Assess the load.
  • Think ahead, plan, and communicate the load.
  • Check you base of support and be sure you have
    firm footing.
  • Face what you are lifting.
  • Keep your back straight.

6
  • 2. Explain body alignment and review the
    principles of body mechanics
  • Use these guidelines for proper body alignment
    (cont)
  • Begin in a squatting position, and lift with your
    legs.
  • Tighten your stomach muscles when beginning the
    lift.
  • Keep the object close to your body.
  • Do not twist.
  • Push or pull when possible, rather than lifting.

7
  • 3. Explain why position changes are important for
    bedbound residents and describe basic body
    positions
  • Positioning means helping residents into
    positions that promote comfort and good health.
  • Five basic body positions are
  • Supine
  • Lateral/Side
  • Prone
  • Fowlers
  • Sims

8
  • Transparency 11-1 Five Basic Positions

Supine
Fowlers
Lateral
Sims
Prone
9
Locking arms with a resident and raising head and
shoulders
  1. Identify yourself by name. Identify the resident.
    Greet the resident by name.
  2. Wash your hands.
  3. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  4. Provide for the residents privacy with a
    curtain, screen, or door.

10
Locking arms with a resident and raising head and
shoulders
  1. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  2. Place pillow at the head of bed against the
    headboard.
  3. Lower the side rail (if bed has one and if it is
    not already lowered) on side nearest you.
  4. Stand at the side of the bed and face the head of
    bed.

11
Locking arms with a resident and raising head and
shoulders
  1. Spread feet shoulder-width apart and slightly
    bend the knees to protect your back.
  2. Avoid trauma or pain to the resident throughout
    the procedure.
  3. Gently slide one hand under the residents
    closest shoulder.
  4. Gently slide the other hand under the residents
    upper back.

12
Locking arms with a resident and raising head and
shoulders
  1. At the count of three, slowly raise the
    residents head and shoulders. Give necessary
    care (Fig. 11-10).
  2. Replace pillow under the residents head.
  3. Make resident comfortable.
  4. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.

Fig. 11-10.
13
Locking arms with a resident and raising head and
shoulders
  1. Leave call light within residents reach.
  2. Wash your hands.
  3. Be courteous and respectful at all times.
  4. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

14
Assisting a resident to move up in bed
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  • Provide for the residents privacy with a
    curtain, screen, or door.

15
Assisting a resident to move up in bed
  1. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  2. Lower the head of bed. Move the pillow to the
    head of bed.
  3. Lower the side rail (if bed has one and if it is
    not already lowered) on side nearest you.

16
Assisting a resident to move up in bed
  1. Stand by bed with feet shoulder-width apart. Face
    the resident. Point foot closest to the head of
    the bed towards the head of the bed.
  2. Avoid trauma or pain to the resident throughout
    the procedure.
  3. Place one arm under the residents shoulder
    blades. Place the other arm under the residents
    thighs.

17
Assisting a resident to move up in bed
  1. Ask resident to bend knees, brace feet on the
    mattress, and push feet on the count of three.
  2. Keep your back straight. At the count of three,
    shift body weight to move resident while resident
    pushes with her feet (Fig. 11-12).
  3. Replace pillow under the residents head.
  4. Make resident comfortable.

Fig. 11-12. Keep your back straight and your
knees bent.
18
Assisting a resident to move up in bed
  1. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.
  2. Leave call light within residents reach.
  3. Wash your hands.
  4. Be courteous and respectful at all times.

19
Assisting a resident to move up in bed
  1. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

20
Assisting a resident to move up in bed with
assistance (using draw sheet)
  • Equipment draw sheet
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

21
Assisting a resident to move up in bed with
assistance (using draw sheet)
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  3. Lower the head of bed. Move the pillow to the
    head of bed.
  4. Lower the side rail (if bed has one and if it is
    not already lowered) on side nearest you.

22
Assisting a resident to move up in bed with
assistance (using draw sheet)
  1. Stand on the opposite side of the bed from your
    helper. Each of you should be turned slightly
    toward the head of the bed. For each of you, the
    foot that is closest to the head of the bed
    should be pointed in that direction. Stand with
    feet about 12 inches apart. Bend your knees. Keep
    your back straight.
  2. Avoid trauma or pain to the resident throughout
    the procedure.

23
Assisting a resident to move up in bed with
assistance (using draw sheet)
  1. Roll the draw sheet up to the residents side.
    Have your helper do the same on his side of the
    bed. Grasp the sheet with your palms up at the
    residents shoulders and hips. Have your helper
    do the same.
  2. Shift your weight to your back foot (the foot
    closer to the foot of the bed). Have your helper
    do the same (Fig. 11-13). On the count of three,
    both shift your weight to your forward feet.

Fig. 11-13. Both workers shift their weight to
their back feet and prepare to move.
24
Assisting a resident to move up in bed with
assistance (using draw sheet)
  • (cont) Slide the resident toward the head of the
    bed (Fig. 11-14).
  • Replace pillow under the residents head.
  • Make resident comfortable. Unroll the draw sheet.
    Leave it in place for the next repositioning.
  • Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.

Fig. 11-14. Both workers shift their weight to
their back feet and prepare to move.
25
Assisting a resident to move up in bed with
assistance (using draw sheet)
  1. Leave call light within residents reach.
  2. Wash your hands.
  3. Be courteous and respectful at all times.
  4. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

26
Moving a resident to the side of the bed
  1. Identify yourself by name. Identify the resident.
    Greet the resident by name.
  2. Wash your hands.
  3. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  4. Provide for the residents privacy with a
    curtain, screen, or door.

27
Moving a resident to the side of the bed
  1. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  2. Lower the head of bed. Move the pillow to the
    head of bed.
  3. Stand on one side of the bed. Lower the side rail
    (if bed has one and if it is not already lowered)
    on side nearest you.

28
Moving a resident to the side of the bed
  1. Stand with feet about 12 inches apart. Bend your
    knees. Keep your back straight.
  2. Avoid trauma or pain to the resident throughout
    the procedure.
  3. Gently slide your hands under the residents head
    and shoulders and move toward you (Fig. 11-15).

Fig. 11-15. Gently move the head and shoulders
toward you.
29
Moving a resident to the side of the bed
  1. Gently slide your hands under the residents
    midsection and move toward you.
  2. Gently slide your hands under the residents hips
    and legs and move toward you (Fig. 11-16).
  3. Make resident comfortable. Reposition pillow
    under head.

Fig. 11-16. Gently move the hips and legs toward
you.
30
Moving a resident to the side of the bed
  1. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.
  2. Leave call light within residents reach.
  3. Wash your hands.
  4. Be courteous and respectful at all times.

31
Moving a resident to the side of the bed
  1. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

32
Moving a resident to the side of the bed with
assistance (using draw sheet)
  • Equipment draw sheet
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

33
Moving a resident to the side of the bed with
assistance (using draw sheet)
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  3. Lower the head of bed. Move the pillow to the
    head of bed.
  4. Stand on the opposite side of the bed from your
    helper. Each of you should be facing each other.

34
Moving a resident to the side of the bed with
assistance (using draw sheet)
  • (cont) Lower both side rails (if bed has them).
    Stand up straight facing the side of the bed with
    feet about 12 inches apart. Point feet toward the
    side of the bed. Bend your knees.
  • Avoid trauma or pain to the resident throughout
    the procedure.

35
Moving a resident to the side of the bed with
assistance (using draw sheet)
  1. Roll the draw sheet up to the residents side.
    Have your helper do the same on his side of the
    bed. Grasp the sheet with your palms up at the
    residents shoulders and hips. Have your helper
    do the same (Fig. 11-17).
  2. On the count of three, slide the resident toward
    the side of the bed. Your weight should be equal
    on each foot because you are moving the person to
    the side of the bed, not the head of the bed.

Fig. 11-17. Both workers grasp the draw sheet at
the residents shoulders and hips and prepare to
move.
36
Moving a resident to the side of the bed with
assistance (using draw sheet)
  1. Make resident comfortable. Unroll the draw sheet.
    Leave it in place for the next repositioning.
    Reposition pillow under head.
  2. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.
  3. Leave call light within residents reach.

37
Moving a resident to the side of the bed with
assistance (using draw sheet)
  1. Wash your hands.
  2. Be courteous and respectful at all times.
  3. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

38
Turning a resident away from you
  1. Identify yourself by name. Identify the resident.
    Greet the resident by name.
  2. Wash your hands.
  3. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  4. Provide for the residents privacy with a
    curtain, screen, or door.

39
Turning a resident away from you
  1. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  2. Lower the head of bed.
  3. Stand on side of bed opposite to where person
    will be turned. The far side rail should be
    raised (if bed has one).
  4. Lower side rail nearest you if it is up.

40
Turning a resident away from you
  1. Avoid trauma or pain to the resident throughout
    the procedure.
  2. Move resident to side of bed nearest you using
    previous procedure.
  3. Cross residents arm over his or her chest. Move
    arm out of the way on side toward which resident
    is being turned. Cross leg nearest you over the
    far leg (Fig. 11-18).

Fig. 11-18. Cross leg nearest you over the far
leg.
41
Turning a resident away from you
  1. Stand with feet about 12 inches apart. Bend your
    knees.
  2. Place one hand on the residents shoulder. Place
    the other hand on the residents nearest hip.
  3. While supporting the body, gently push resident
    toward other side of bed. Shift your weight from
    your back leg to your front leg (Fig. 11-19).
    Make sure residents face is not covered by the
    pillow.

Fig. 11-19. Gently push resident toward other
side of bed while shifting your weight from your
back leg to your front leg.
42
Turning a resident away from you
  • Position resident properly in good alignment
  • head supported by pillow
  • shoulder adjusted so resident is not lying on arm
  • top arm supported by pillow
  • back supported by supportive device
  • hips properly aligned
  • top knee flexed
  • supportive device between legs with top knee
    flexed knee and ankle supported.

43
Turning a resident away from you
  1. Cover resident with top linens and straighten.
    Make resident comfortable.
  2. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.
  3. Leave call light within residents reach.
  4. Wash your hands.
  5. Be courteous and respectful at all times.

44
Turning a resident away from you
  1. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

45
Turning a resident toward you
  1. Identify yourself by name. Identify the resident.
    Greet the resident by name.
  2. Wash your hands.
  3. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  4. Provide for the residents privacy with a
    curtain, screen, or door.

46
Turning a resident toward you
  1. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  2. Lower the head of bed.
  3. Stand on side of bed opposite to where person
    will be turned. The far side rail should be
    raised (if bed has one).
  4. Lower side rail nearest you if it is up.

47
Turning a resident toward you
  1. Avoid trauma or pain to the resident throughout
    the procedure.
  2. Move resident to side of bed nearest you using
    previous procedure. Put side rail up and go to
    the opposite side of the bed. Lower the side
    rail.
  3. Cross residents arm over his or her chest. Move
    arm out of the way on side toward which resident
    is being turned.

48
Turning a resident toward you
  • (cont) Cross leg furthest from you over the
    near leg.
  • Stand with feet about 12 inches apart. Bend your
    knees.
  • Place one hand on the residents far shoulder.
    Place the other hand on the residents far hip.
  • While supporting the body, gently roll the
    resident toward you (Fig. 11-20). Make sure
    residents face is not covered by the pillow.

Fig. 11-20. Gently roll the resident toward you.
49
Turning a resident toward you
  • Position resident properly in good alignment
  • head supported by pillow
  • shoulder adjusted so resident is not lying on arm
  • top arm supported by pillow
  • back supported by supportive device
  • hips properly aligned
  • top knee flexed
  • supportive device between legs with top knee
    flexed knee and ankle supported

50
Turning a resident toward you
  1. Cover resident with top linens and straighten.
    Make resident comfortable.
  2. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.
  3. Leave call light within residents reach.
  4. Wash your hands.

51
Turning a resident toward you
  1. Be courteous and respectful at all times.
  2. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

52
Logrolling a resident with assistance
  • Equipment draw sheet
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

53
Logrolling a resident with assistance
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics. Adjust the bed to a
    safe level, usually waist high. Lock the bed
    wheels.
  3. Lower the head of bed.
  4. Both co-workers stand on the same side of the
    bed. Lower the side rail (if bed has one and if
    it is not already lowered) on side nearest you.

54
Logrolling a resident with assistance
  • (cont) One person stands at the residents head
    and shoulders. The other stands near the
    residents midsection.
  • Avoid trauma or pain to the resident throughout
    the procedure.
  • Place a pillow under the residents head to
    support the neck during the move.

55
Logrolling a resident with assistance
  1. Place the residents arms across his or her
    chest. Place a pillow between the knees.
  2. Stand with feet about 12 inches apart. Bend your
    knees.
  3. Grasp the draw sheet on the far side (Fig.
    11-21).

Fig. 11-21. Both workers should grasp the draw
sheet on the far side.
56
Logrolling a resident with assistance
  1. On the count of three, gently roll the resident
    toward you. Turn the resident as a unit (Fig.
    11-22).
  2. Reposition resident comfortably in good
    alignment. Place pillow under head. Cover
    resident with top linens and straighten.
  3. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.

Fig. 11-22. On the count of three, both workers
should roll the resident towards them, turning
the person as a unit.
57
Logrolling a resident with assistance
  1. Leave call light within residents reach.
  2. Wash your hands.
  3. Be courteous and respectful at all times.
  4. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

58
Assisting a resident to sit up on side of bed
dangling
  1. Identify yourself by name. Identify the resident.
    Greet the resident by name.
  2. Wash your hands.
  3. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  4. Provide for the residents privacy with a
    curtain, screen, or door.

59
Assisting a resident to sit up on side of bed
dangling
  1. Practice good body mechanics. Adjust the bed to
    the lowest safe working level. Lock the bed
    wheels.
  2. Avoid trauma or pain to the resident throughout
    the procedure.
  3. Raise the head of bed to sitting position. Fold
    linen to the foot of the bed. Lower the side rail
    (if bed has one and if it is not already lowered)
    on side nearest you.

60
Assisting a resident to sit up on side of bed
dangling
  1. Stand at the side of the bed with feet about 12
    inches apart. Bend your knees. Keep your back
    straight. Help resident slowly move toward the
    side of the bed on which you are standing.
  2. Place one arm under residents shoulder blades.
    Place the other arm under residents thighs (Fig.
    11-23).



Fig. 11-23. One arm should be under the
residents shoulder blades, and the other arm
should be under the thighs.
61
Assisting a resident to sit up on side of bed
dangling
  1. On the count of three, gently and slowly turn
    resident into sitting position with legs dangling
    over the side of bed (Fig. 11-24).
  2. Ask resident to sit up straight and push both
    fists into the edge of mattress. Assist resident
    to put on robe.

Fig. 11-24. The resident should remain sitting
with legs dangling over the side of bed for as
long as ordered.
62
Assisting a resident to sit up on side of bed
dangling
  1. Have resident dangle as long as ordered. Place a
    pillow or other supporting device behind
    residents back during dangle. Stay with the
    resident at all times. Check for dizziness. If
    resident feels dizzy or faint, help her lie down
    again and make sure she is secure. Tell the nurse
    at once.
  2. Take vital signs as ordered (Chapter 13).

63
Assisting a resident to sit up on side of bed
dangling
  1. Gently assist resident back into bed. Place one
    arm around residents shoulders. Place the other
    arm under residents knees. Slowly swing
    residents legs onto bed.
  2. Make resident comfortable. Cover resident with
    top linens and straighten. Replace pillow under
    the residents head.

64
Assisting a resident to sit up on side of bed
dangling
  1. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.
  2. Leave call light within residents reach.
  3. Wash your hands.
  4. Be courteous and respectful at all times.
  5. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

65
  • 4. Describe how to safely transfer residents
  • Ergonomics is the science of designing equipment
    and setting up areas to make them safer and to
    suit the workers abilities.
  • A transfer belt is a safety device used to
    transfer residents who are weak, unsteady, or
    uncoordinated.
  • A transfer belt is called a gait belt when it is
    used to help residents walk.

66
Applying a transfer belt
  • Equipment transfer belt
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

67
Applying a transfer belt
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics. Adjust bed to low,
    flat position. Lock bed wheels.
  3. Supporting the back and hips, assist resident to
    a sitting position with feet flat on the floor.
  4. Put on and properly fasten non-skid footwear on
    resident.

68
Applying a transfer belt
  1. Place the belt over the residents clothing below
    the rib cage and above the waist. Do not put it
    over bare skin.
  2. Tighten the buckle until it is snug. Leave enough
    room to insert three fingers into the belt. The
    fingers should fit comfortably under the belt.
    The belt must not interfere with circulation or
    breathing.

69
Applying a transfer belt
  1. Check to make sure that breasts are not caught
    under the belt.
  2. Position the buckle slightly off-center in the
    front or back for comfort.

70
Transferring a resident from bed to a chair or
wheelchair
  • Equipment wheelchair, transfer belt, non-skid
    footwear
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

71
Transferring a resident from bed to a chair or
wheelchair
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics.
  3. Remove wheelchair footrests close to the bed.
  4. Place wheelchair near the head of the bed with
    arm of the wheelchair almost touching the bed.

72
Transferring a resident from bed to a chair or
wheelchair
  • (cont) Wheelchair should be placed on
    residents stronger, or unaffected, side. Lower
    the side rail (if bed has one and if it is not
    already lowered) on side nearest you.
  • Lock wheelchair wheels.
  • Raise the head of the bed. Adjust bed level. The
    height of the bed should be equal to or slightly
    higher than the chair. Lock bed wheels.

73
Transferring a resident from bed to a chair or
wheelchair
  1. Avoid trauma or pain to the resident throughout
    the procedure.
  2. Assist resident to sitting position with feet
    flat on the floor. Let resident sit for a few
    minutes.
  3. Put non-skid footwear on resident and securely
    fasten.

74
Transferring a resident from bed to a chair or
wheelchair
  • With transfer (gait) belt
  • Stand in front of resident.
  • Stand with feet about 12 inches apart. Bend your
    knees. Keep your back straight.
  • Place belt below the rib cage and above the
    waist. Do not put it over bare skin. Grasp belt
    securely on both sides.

75
Transferring a resident from bed to a chair or
wheelchair
  • Without transfer belt
  • Stand in front of resident.
  • Stand with feet about 12 inches apart. Bend your
    knees. Keep your back straight.
  • Place your arms around the residents torso under
    the arms, but not in the armpits (axilla).

76
Transferring a resident from bed to a chair or
wheelchair
  • (cont) Repeated pressure in the axilla may
    cause nerve damage. Do not allow resident to
    grasp your shoulders or around your neck. This
    may cause you to lose your balance.
  • Provide instructions to allow resident to help
    with transfer. Instructions may include When
    you start to stand, push with your hands against
    the bed.

77
Transferring a resident from bed to a chair or
wheelchair
  • (cont) Once standing, if youre able, you can
    take small steps in the direction of the chair.
    Once standing, reach for the chair with your
    stronger hand.
  • With your legs, brace residents lower legs to
    prevent slipping (Fig. 11-29).
  • Count to three to alert resident.
  • On three, slowly help resident to stand.

Fig. 11-29. Bracing the residents lower legs
with your legs helps prevent slipping.
78
Transferring a resident from bed to a chair or
wheelchair
  1. Help resident to pivot to front of wheelchair
    with back of residents legs against wheelchair
    (Fig. 11-30).
  2. Ask resident to put hands on wheelchair armrests
    if able.
  3. Gently lower resident into wheelchair.
  4. Reposition resident with hips touching back of
    wheelchair. See previous guidelines on how to do
    this. Remove transfer belt, if used.

Fig. 11-30. Pivoting is safer than twisting.
79
Transferring a resident from bed to a chair or
wheelchair
  1. Attach footrests. Place residents feet on
    footrests.
  2. Make resident comfortable.
  3. Remove privacy measures.
  4. Leave call light within residents reach.
  5. Wash your hands.
  6. Be courteous and respectful at all times.

80
Transferring a resident from bed to a chair or
wheelchair
  • Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.
  • To Transfer Back To Bed From Wheelchair, Follow
    These Steps
  • Perform steps 1 through 8 above.
  • Adjust bed level to a low position. The height of
    the bed should be equal to or slightly lower than
    the chair. Lock bed wheels.

81
Transferring a resident from bed to a chair or
wheelchair
  1. Avoid trauma or pain to the resident throughout
    the procedure.
  2. Perform steps 13 through 17 above.
  3. The resident should be allowed to stand until he
    feels stable enough to move toward the bed. If
    the transfer belt is used, do not let go of it
    during this time.

82
Transferring a resident from bed to a chair or
wheelchair
  1. Help resident to pivot to bed with back of
    residents legs against bed. When he feels the
    bed, he should slowly sit down on the side of the
    bed.
  2. Make resident comfortable. Remove transfer belt,
    if used.
  3. Return bed to low position if raised. Ensure
    residents safety. Return side rails to ordered
    position. Remove privacy measures.

83
Transferring a resident from bed to a chair or
wheelchair
  1. Leave call light within residents reach.
  2. Wash your hands.
  3. Be courteous and respectful at all times.
  4. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

84
Transferring a resident from bed to stretcher
with assistance
  • Equipment stretcher, bath blanket
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

85
Transferring a resident from bed to stretcher
with assistance
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics. Lower the head of
    bed so that it is flat. Lock bed wheels.
  3. Fold linens to foot of the bed. Cover resident
    with bath blanket. Do not expose resident during
    the procedure.
  4. Lower the side rail on side to which you will
    move resident (if in use for resident).

86
Transferring a resident from bed to stretcher
with assistance
  1. Avoid trauma or pain to the resident throughout
    the procedure.
  2. Move the resident to the side of the bed. Have
    your co-workers help you do this. Refer back to
    the procedure Moving a resident to the side of
    the bed earlier in this chapter.
  3. Place stretcher solidly against the bed. Lock
    stretcher wheels. Bed height should be equal to
    or slightly above the height of the stretcher.
    Move stretcher safety belts out of the way.

87
Transferring a resident from bed to stretcher
with assistance
  1. Two workers should be on the side of the bed
    opposite the stretcher. Two more workers should
    be on the outside of the stretcher.
  2. Each worker should roll up the sides of the draw
    sheet and prepare to move the resident (Fig.
    11-31). Protect the residents arms and legs
    during the transfer. If facility policy permits,
    two workers may actually get up on the bed on
    their knees to protect their backs.

Fig. 11-31. With two workers on each side, roll
up the sides of the draw sheet and prepare to
move the resident.
88
Transferring a resident from bed to stretcher
with assistance
  1. On the count of three, the workers should lift
    and move the resident to the stretcher. All
    should move at once (Fig. 11-32). Make sure the
    resident is centered on the stretcher.
  2. Raise the head of the stretcher or place a pillow
    under the residents head if allowed. Make sure
    bath blanket still covers the resident.

Fig. 11-32. On the count of three, all workers
should lift and move at once.
89
Transferring a resident from bed to stretcher
with assistance
  1. Place safety straps across the resident. Raise
    side rails on stretcher.
  2. Unlock stretchers wheels. Take resident to
    appropriate site. Stay with the resident until
    another team member takes over.
  3. Wash your hands.
  4. Be courteous and respectful at all times.

90
Transferring a resident from bed to stretcher
with assistance
  • Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.
  • To Transfer Back To Bed From Stretcher The bed
    height should be equal to or slightly below the
    stretcher when transferring the resident back to
    bed.

91
Transferring a resident using a mechanical lift
with assistance
  • Equipment wheelchair or chair, mechanical or
    hydraulic lift, washcloth
  • Before performing this procedure, check the
    weight limit of the lift to make sure the
    resident is within the weight limit. Make sure
    you know how to use this lift.
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.

92
Transferring a resident using a mechanical lift
with assistance
  1. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  2. Provide for the residents privacy with a
    curtain, screen, or door.
  3. Practice good body mechanics. Lower bed to proper
    position for the move. Lock bed wheels.

93
Transferring a resident using a mechanical lift
with assistance
  1. Remove wheelchair footrests close to the bed.
  2. Position wheelchair next to bed. Lower the side
    rail (if bed has one and if it is not already
    lowered) on side nearest you. Lock wheelchair
    brakes.
  3. Avoid trauma or pain to the resident throughout
    the procedure.

94
Transferring a resident using a mechanical lift
with assistance
  1. Help the resident turn to one side of the bed.
    Pad the sling where the neck will rest with a
    washcloth for residents comfort. A sheet may be
    used over the sling to protect it from soiling.
    Position the sling under the resident, with the
    edge next to the residents back. Fanfold if
    possible. Fanfolding means folding several times
    into pleats. Make the bottom of the sling even
    with the residents knees (some slings only come
    to the top of the buttocks).

95
Transferring a resident using a mechanical lift
with assistance
  • (cont) Help the resident roll to his opposite
    side. Spread out the fanfolded edge of the sling,
    then roll back to the middle of the bed.
  • Roll the mechanical lift to bedside. Make sure
    the base is opened to its widest point. Push the
    base of the lift under the bed. Lock lift wheels.
  • Place the overhead bar directly over the
    resident. Be careful so the swing does not hit
    anyone.

96
Transferring a resident using a mechanical lift
with assistance
  1. With the resident lying on her back, attach one
    set of straps to each side of the sling. Attach
    one set of straps to the overhead bar (Fig.
    11-34). If available, have a co-worker support
    the resident at the head, shoulders, and knees
    while being lifted. The residents arms should be
    folded across her chest. If the device has S
    hooks, they should face away from resident. Make
    sure all straps are connected properly.

Fig. 11-34. Attach straps to overhead bar.
97
Transferring a resident using a mechanical lift
with assistance
  1. Following manufacturers instructions, raise the
    resident two inches above the bed. Pause a moment
    for the resident to gain balance.
  2. If available, a lifting partner can help support
    and guide the residents body (Fig. 11-35). You
    can then move the lift so that the resident is
    positioned over the chair or wheelchair.

Fig. 11-35. Make sure that one person supports
and guides the residents body to help prevent
injury.
98
Transferring a resident using a mechanical lift
with assistance
  • Slowly lower the resident into the chair or
    wheelchair. Push down gently on the residents
    knees to help the resident into a sitting
    position.
  • Undo the straps from the overhead bar. Leave the
    sling in place for transfer back to bed (some
    slings can be easily removed when resident is
    seated).

99
Transferring a resident using a mechanical lift
with assistance
  1. Be sure the resident is seated comfortably and
    correctly in the chair or wheelchair. Put
    non-skid footwear on resident and fasten. Replace
    footrests. Cover the resident with a lap cover or
    robe if he requests it.
  2. Remove privacy measures.
  3. Leave call light within residents reach.
  4. Wash your hands.

100
Transferring a resident using a mechanical lift
with assistance
  1. Be courteous and respectful at all times.
  2. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

101
Transferring a resident onto and off a toilet
  • Equipment disposable gloves, toilet tissue,
    wheelchair, transfer belt, non-skid shoes
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

102
Transferring a resident onto and off a toilet
  1. Provide for the residents privacy with a
    curtain, screen, or door.
  2. Practice good body mechanics.
  3. Position wheelchair at a right angle to the
    toilet to face the hand bar/wall rail. Place
    wheelchair on the residents stronger side, if
    possible.

103
Transferring a resident onto and off a toilet
  1. Remove wheelchair footrests. Lock wheels. Put on
    and properly fasten non-skid footwear on
    resident.
  2. Avoid trauma or pain to the resident throughout
    the procedure.
  3. Apply a transfer belt around the residents
    waist. Grasp the belt. Put one of your hands
    toward the residents back and one toward the
    residents front.

104
Transferring a resident onto and off a toilet
  1. Ask resident to push against the armrests of the
    wheelchair and stand, reaching for and grasping
    the hand bar with his stronger arm (Fig. 11-36).

Fig. 11-36. Ask the resident to push up using the
armrests of the wheelchair, stand and grasp the
hand bar.
105
Transferring a resident onto and off a toilet
  1. Ask resident to pivot her feet and back up so
    that she can feel the front of the toilet with
    the back of her legs (Fig. 11-37).
  2. Help resident to pull down underwear and pants.
    You may need to keep one hand on the transfer
    belt while helping to remove clothing.

Fig. 11-37. Have the resident pivot and feel the
toilet with the back of her legs.
106
Transferring a resident onto and off a toilet
  1. Help resident to slowly sit down onto the toilet.
    Remove transfer belt. Allow privacy unless
    resident cannot be left alone. Ask resident to
    pull on the emergency cord if she needs help.
    Close bathroom door. Stay near the door until
    resident is finished.
  2. When the resident is finished, apply gloves.
    Assist with perineal care as necessary (see
    Chapters 12 and 16). Reapply transfer belt if
    removed. Ask her to stand and reach for the hand
    bar.

107
Transferring a resident onto and off a toilet
  1. Use toilet tissue or damp cloth to clean the
    resident. Make sure he or she is clean and dry
    before pulling up clothing. Remove and dispose of
    gloves.
  2. Pull up residents clothing. Help resident to the
    sink to wash hands. Wash your hands.
  3. Help resident back into wheelchair. Be sure the
    resident is seated comfortably and correctly in
    the chair or wheelchair. Replace footrests.

108
Transferring a resident onto and off a toilet
  1. Help resident to leave the bathroom.
  2. Leave call light within residents reach.
  3. Wash your hands.
  4. Be courteous and respectful at all times.
  5. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.

109
Transferring a resident into a car
  • Equipment car, wheelchair
  • Identify yourself by name. Identify the resident.
    Greet the resident by name.
  • Wash your hands.
  • Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.

110
Transferring a resident into a car
  1. Practice good body mechanics.
  2. Place wheelchair close to the car at a 45-degree
    angle. Open the door on the residents stronger
    side.
  3. Lock wheelchair.
  4. Ask the resident to push against the arm rests of
    the wheelchair and stand.

111
Transferring a resident into a car
  1. Ask the resident to stand, grasp the car or
    dashboard, and pivot his foot so the side of the
    car seat touches the back of the legs.
  2. The resident should then sit in the seat and lift
    one leg, and then the other, into the vehicle
    (Fig. 11-38).
  3. Carefully position the resident comfortably in
    the car. Help secure seat belt.

Fig. 11-38. After resident sits in the car seat,
he should put his legs in one at a time.
112
Transferring a resident into a car
  1. See that door can be safely shut. Shut the door.
  2. Return the wheelchair to the appropriate place
    for cleaning.
  3. Wash your hands.
  4. Document procedure using facility guidelines.

113
  • 5. Discuss ambulation
  • Regular ambulation and exercise help improve
    these things
  • quality and health of the skin
  • circulation
  • strength
  • sleep and relaxation
  • appetite
  • elimination
  • oxygen level

114
Assisting a resident to ambulate
  1. Identify yourself by name. Identify the resident.
    Greet the resident by name.
  2. Wash your hands.
  3. Explain procedure to resident. Speak clearly,
    slowly, and directly. Maintain face-to-face
    contact whenever possible. Encourage resident to
    assist if possible.
  4. Provide for the residents privacy with a
    curtain, screen, or door.

115
Assisting a resident to ambulate
  1. Avoid trauma or pain to the resident throughout
    the procedure.
  2. Help resident move to a dangling position as
    described in earlier procedure.
  3. Practice good body mechanics. Adjust bed to a low
    position so that the residents feet are flat on
    the floor. Lock bed wheels.
  4. Put on and properly fasten non-skid footwear for
    resident.

116
Assisting a resident to ambulate
  • Stand in front of and face the resident.
  • Brace the residents lower extremities. Bend your
    knees. If resident has a weak knee, brace it
    against your knee.
  • With transfer (gait) belt
  • Place belt around residents waist. Grasp the
    belt while assisting resident to stand.

117
Assisting a resident to ambulate
  • Without transfer belt
  • Place arms around the residents torso under the
    arms, but not in the armpits (axillae), while
    assisting resident to stand.
  • With transfer belt
  • Walk slightly behind and to one side of resident
    for the full distance, while holding onto the
    transfer belt (Fig. 11-39). If the resident has a
    weaker side, stand on the weaker side.

Fig. 11-39. Walk slightly behind, standing on the
weaker side, when assisting a resident to
ambulate. Hold onto the transfer belt, if used,
for the full distance.
118
Assisting a resident to ambulate
  • (cont) Ask resident to look forward, not down
    at floor, during ambulation. If resident becomes
    dizzy or faint, help him to a nearby seat and
    call nurse for help.

119
Assisting a resident to ambulate
  • Without transfer belt
  • Walk slightly behind and to one side of resident
    for the full distance. Support residents back
    with your arm. Ask resident to look forward, not
    down at floor, during ambulation. If resident
    becomes dizzy or faint, help him to a nearby seat
    and call nurse for help.

120
Assisting a resident to ambulate
  1. After ambulation, make resident comfortable.
    Remove transfer belt, if used.
  2. Return bed to low position if raised. Ensure
    residents safety. Remove privacy measures.
  3. Leave call light within residents reach.
  4. Wash your hands.
  5. Be courteous and respectful at all times.

121
Assisting a resident to ambulate
  1. Report any changes in the resident to the nurse.
    Document procedure using facility guidelines.
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