Lying in bed for a long period of time is generally depressing and boring for most patients. To lighten up their feelings, patients often ask for a change in position and surroundings. The only way to do this is to safely transfer the patient from bed to chair or wheelchair. Being transferred on a chair enables the patient to execute some slight movements that is beneficial in improving circulation. As for being transferred on a wheelchair, it serves as a way to transport a weak patient on hospital areas (such as x-ray or ultrasound rooms) to complete some laboratory examinations. It is also beneficial in transporting the patient for a change of scenery that will help brighten his mood and increase his chance for socialisation. This type of transfer should be done with extreme caution. Proper handling of the patient and proper body mechanics of the handler must be applied in order to execute the task in the safest way possible. If the patient has enough body strength to move, it is best to make him help you with the manoeuvre.
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Assess the patients’ overall strength and check for cognitive impairment. Examining the strength of the patient will help you set up a good plan for the manoeuvre -- whether he is strong enough to participate in the procedure or not. Checking the cognition of the patient will help you realise if he has the capability of understanding or following instructions.
Inform the patient about the procedure. If the patient wants to be transferred on a chair, explain the details of how the manoeuvre is done. And if there is a need for him to be transferred on a wheelchair, explain the purpose and destination of the transfer. Informing the patient about the actual manoeuvre will facilitate cooperation and will make him feel that he is being respected rather than being controlled.
Position the chair or wheelchair next to the bed facing the foot of the bed. Bring the chair as close as possible to reduce the distance of the transfer. If a wheelchair is used, make sure to lock its brake and fold the foot rests, as soon as you position it near the bed.
Adjust the height of the bed in its lowest position; this way it will be easy for the patient to step down on the floor, thus, decreasing the risk of injury from falling. Lock the brake of the bed and then assist the patient in doing side lying position, facing the direction of the transfer.
Lower the side rail of the bed and gradually raise the head of the bed up to a tolerable level. Constantly check the state of the patient when doing this procedure – make sure that the patient is not feeling dizzy or nauseous.
Place one arm under the shoulder of the patient and the other arm supporting the patients’ thigh on the opposite side (you are facing the patient when doing this manoeuvre). Count to three and then carefully swing the legs of the patient over the side of the bed and assist him in lifting his trunk and shoulders until he is in sitting position. If patient is strong enough to do some movements, allow the patient to participate on the manoeuvre. Ask patient to use the leg on the outer side of the bed to scoop the leg on the other side. Than carefully swing both his legs on the side of the bed and then assist him in lifting his trunk and shoulders until he is in sitting position.
Place your arms around the torso of the patient for support. Put one arm of the patient over your shoulder; while his other arm is extended on the bed, to help support the position. Instruct the patient to scoot over the edge of the bed until feet is flat on the floor.
Widen the distance of your feet, with right foot forward, and the left foot back for an easy shift of your weight as you lift the patient. Maintain the position above, with your arms still supporting the torso of the patient. One arm of the patient should still be on your shoulder and his other arm should still be extended on the bed (palm flat on bed).
Position your right foot alongside the patients’ left foot (the side to where the little toe is at) and position your leg on the level on his knee. The positioning of your foot and leg provides stability by preventing slipping of the patients’ foot and knee buckling when he is lifted to standing position.
Slightly bend your knees and lean your body. Then instruct the patient to get ready for a push from one arm that’s extended on the bed, as you lift him up to standing position. Count to three as you assist the patient to standing position and he is pushing off from at the same time.
Raise patient to standing position and keep your back straight as you do this manoeuvre. Pivot the patient so that his back is positioned in front of the chair or wheelchair; instruct him to grasp on the armrest for additional support, and then slowly assist the patient as he lowers himself on the seat of the chair. Remember to bend your knees, while keeping your back straight during the assist.
Help the patient in positioning himself properly when seated. Make sure that his buttocks are entirely rested on the seat and his back firmly resting on the back support. When in a wheelchair, place his arms on the armrests and his feet on the footrests.
Document the safe transfer of the patient. It is important to always record procedures that are performed on the patient, especially when it is executed in a hospital setting.
Tips and warnings
- Remember to not change the position of the patient from lying to an immediate standing. A quick change in position may cause sudden drop of blood pressure otherwise known as orthostatic or postural hypotension. It is manifested by dizziness, light headedness, blurred vision, tingling sensation, or fainting. Do the elevation process gradually: elevate the head of bed to a tolerable level, followed by sitting position, and then standing.