Transfers

Front 1

Physical abilities to be considered in assessment or planning patient transfers (6)

Back 1

1. Muscle strength
2. Joint and soft-tissue flexibility
3. Sitting and Standing balance
4. Endurance
5. Tolerance to sitting and standing positions
6. Motor control

Front 2

Factors affecting your decision on the appropriate transfer (4)

Back 2

1. Evaluation
2. Written Information available
3. Information from patient
4. Goals of treatment

Front 3

When are assistive devices for transfers indicated?

Back 3

1. When the patient cannot perform a safe transfer without them
2. When the caregiver cannot safely assist without them

Front 4

When are assistive devices for transfers contraindicated?

Back 4

When their use would perpetuate dependence

Front 5

What are 7 things you need to do before the actual patient transfer?

Back 5

1. Introduce yourself
2. Explain the activity
3. Demonstrate the activity if needed
4. Instruct patient on how to assist or perform the activity
5. Make sure patient is properly dressed: clothing is not excessively loose, or shoes loose and slippery
6. Apply safety belt
7. Obtain consent

Front 6

Why should a patient strive to become independent in bed mobility?

Back 6

Necessary to become independent with transfers

Front 7

General Transfer Principles (10)

Back 7

1. Predetermine mental and physical capabilities, including weight bearing status
2. Suitable clothes and shoes
3. Mentally preplan activities and sequence; teach and practice components
4. Instruct the patient slowly and concisely; allow time for pt. to process and apply
5. Select, position, secure equipment; apply safety belt
6. Be alert for unusual events
7. Do not guard using clothing or holding arm; use safety belt and trunk
8. Position yourself to guard, guide, direct and protect
9. Direct pt using simple, directive terms; assist as necessary
10. After transfer, position for comfort, stability, and safety; document changes in pt performance

Front 8

Best place to stand to prevent falls

Back 8

In front of and slightly to one side of the patient

Front 9

Way of documenting number of persons needed for transfer

Back 9

Plus 1, Plus 2, etc

Front 10

What do most transfer descriptions indicate?

Back 10

Whether the patient requires assist or not

Front 11

Types of transfers (8)

Back 11

1. Standing, dependent pivot
2. Standing, assisted pivot (min mod or max)
3. Standing, standby pivot
4. Standing, Independent pivot
5. Sitting, Assisted Transfer
6. Sitting, Independent Transfer
7. Sitting, Dependent Lift
8. Recumbent, Dependent lift

Front 12

Wheelchair preparation

Back 12

1. Position wheelchair at 45-degree angle to transfer surface.
2. Remove armrest closest to transfer surface EXCEPT in standing pivot transfers
3. Remove footrest closest to transfer surface
4. Swing away other footrest.
5. LOCK BRAKES

Front 13

Sit to Stand, Body Alignment

Back 13

1. Position balls of feet under knees
2. Extend lower back
3. Sift upper body forward "nose over toes"
4. Choose appropriate transfer technique
5. Allow knees to move forward over feet when coming to stand

Front 14

Sit-to-stand, assisted

Back 14

1. Scoot to edge
2. Prepare for stance (follow sit-to-stand, body alignment guidelines)
3. Caregiver support affected arm at elbow
4. Cue for low back extension with flat hand
5. Provide knee support with your knees on both sides.
6. Shift you body back slowly, allowing for forward movement
7. Give upward cues at back and arm to complete stance

Front 15

Sit-to-stand, cued

Back 15

1. Scoot to edge
2. Prepare for stance (follow sit-to-stand, body alignment guidelines)
3. Caregiver cue forward
4. Cue upward
5. Cue erect posture

Front 16

Standing pivot transfer, assisted (without gait belt)

Back 16

1. Prepare wheelchair
2. Assume sitting position (see rolling, sidelying-to-sit, and scooting to edge sequences)
3. Prepare for sit-to-stand (see sit-to-stand sequence)
4. Guard affected knee, but do not prevent all forward movement
5. Place you other hand on the lower back.
6. Cue forward movement of the shoulders while maintaining back extension as you shift your weight backward
6. Assist individual to upright stance
7. Pivot
8. Instruct impaired individual to reach back to surface
9. Shift your weight forward, lowering the impaired person to sit.

Front 17

Toilet Transfer

Back 17

1. Prepare wheelchair
2. Unfasten clothing, if necessary
3. Choose most appropriate transfer sequence
4. If using a squat transfer, lower clothing prior to transfer
5. If using a standing pivot transfer, lower clothing in stance after pivoting toward toilet.
6. Gain additional support with a toilet safety frame for standing pivot transfers

Front 18

Tub transfer

Back 18

1. Provide a nonslip surface in tub/shower
2. Prepare wheelchair
3. Prepare equipment in tub/shower
4. Choose most appropriate transfer method
5. Lift feet into tub one at a time; use clasped hands around knee to self-assist lifting of affected leg (CAUTION:GUARD FOR LOSS OF BALANCE WHEN LIFTING LEGS
6. CAUTION: DRY COMPLETELY BEFORE RETURNING TO WHEELCHAIR
7. CAUTION: DRY FLOOR BEFORE RETURNING TO WHEELCHAIR

Front 19

Car Transfer

Back 19

1. Open car door fully
2. Move front seat back as far as possible
3. Roll down window if needed as a stable surface to hold to for balance
4. Choose most appropriate transfer method
5. Modify technique for transfer in this tight space.

Front 20

Car Transfer tips

Back 20

1. Stand slightly to side
2. Remove both footrests
3. Use wheelchair seat for a supporting surface
4 Assist from over, rather than around, the impaired person.
5. Protect head when getting in and out of car
6. Remember to pick up all wheelchair accessories (arm and foodrests, etc)

Front 21

Why must a person become independent in bed mobility?

Back 21

They need to be independent in bed mobility before they can become independent in transfers

Front 22

mat and bed skills level are not:

Back 22

necessarily the same thing

Front 23

5 things you can do if If having difficulty with bed mobility

Back 23

1. Reduce friction
2. Centralize weight
3. Reduce the effects of gravity
4. Have gravity assist

Front 24

5 Transfers focus areas

Back 24

1. Planning/preparation
2..Precautions
3. Identify transfer principles
4. Types of transfer/techniques
5. Bed/mat mobility - principles and techniques

Front 25

Safe transfers require what before movement

Back 25

planning

Front 26

2 most important things in transfers preparation

Back 26

1. Review medical records
2. Plan for assistance level and precautions

Front 27

10 questions to ask yourself when planning transfers

Back 27

1. What medical precautions?
2. Performed safely by one or assist required?
3. Enough time?
4. Does pt. understand? Are they afraid?
5. Equip in good working order?
6. Height of surfaces? Can be adjusted?
7. Equip placed in correct position?
8. Any obstructions?
9. Pt. dressed properly? Bed mobility or leg management?

Front 28

What must you do before beginning transfers?

Back 28

Introduce yourself to patient, explain and have them repeat

Front 29

10 Transfer precautions for THP (Total Hip Replacement)

Back 29

1. No adduction
2. No rotation
3. No flexion beyond 90 degrees
4. No extension beyond neutral flexion/extension
5. Do not cross affected extremity over opposite
6. Do not pull on affected extremity
7. Do not allow the patient to lie of replaced hip
8. Maintain in abduction when moving to and during sidelying
9. Patient sit in semireclining position
10. Pt maintain affected extremity in abduction when moving side to side

Front 30

3. Transfer precautions for Low back trauma or discomfort

Back 30

1. Avoid excessive lumbar rotation, trunk side bending, trunk flexion
2. When turning, logroll
3. May be more comfortable with the hips and knees partially flexed when they are in a supine or side-lying position

Front 31

Transfer precautions for SCI (Spinal Cord Injury)

Back 31

1. Avoid rotation
2.Logroll when turning
3. Protective positioning or restraints will be required when pt is side-lying or sitting without support
4. If an older injury, be aware that osteoporosis may lead to fracture even under mild or moderate stress
5. Patient may experience syncope when going from supine to sitting

Front 32

2 Transfer precautions for burn patients

Back 32

1. Primary precaution is to avoid shear across the surface of the burnwound, graft site, or area from which graft was taken
2. Instruction pt. to elevate the body or extremitiies when moving an area with a burn

Front 33

Transfer precautions for hemiplegia patients

Back 33

1. Avoid pulling on involved or weakened extremities, especially the shoulder
2. Many will experience discomfort when they lieon or roll over the involved shoulder

Front 34

Procedures associated with a standing transfer (9)

Back 34

1. Examine and evaluate pt's mental and physical capacities to perform or assist with the transfer
2. Position, secure, stabilize wheelchair; swing away foot plates; apply safety belt
3. Instruct, indicate activities expected, demonstrate. Instruct the patient to move forward in chair (or provide assistance) position feet flat on the floor
4. Pt. initiates transfer with trunk momentun or inclining trunk forward (nose over toes); CG positioned in front and slightly to one side to protect and guard
5. Pt. stands; assistance provided as needed using knees and safety belt
6. Pt. stands briefly to establish balance then turns or pivots
7. Pt contacts the object using upper and lower extremity before lowering onto object; assistance provided as needed.
8. Position adjusted for proper support, stablity, and safety; evaluate reactiona dn physiological response
9. Remove safety belt, document performance and assistance needed.

Front 35

Transfers Focus Areas (5)

Back 35

1. Planning/Preparation
2. Precautions
3. Identify transfer principles
4. Types of transfers/techniques
5.Bed/mat mobility-principles and techniques

Front 36

When a pt. has SCI that occured several months or years earlier, what should you be aware of? (4)

Back 36

1. Osteoporosis, especially in the long bones of the LE and vertebral bodies, may be present.
2. Even mild to mod stress or strain to these bones may lead to a fx.
3. Some patients could experience a fx when turning over or transferring from w/c to floor or floor to other objects.
4. Be aware that the pt may experience syncope when transferred from supine to sitting

Front 37

General Transfer principles (10)

Back 37

1. Predetermine the patient's mental and physical capabilities to perform the transfer, including weight-bearing status
2. Pt. clothing and shoes suitable for transfer
3. Mental preplan activities and sequence; teach and practice components of the transfer before attempting the transfer
4. Instruct pt. slowly and concisely; allow time for pt. to process and apply the info.
5. Select, position, and secure needed equip.; apply a safety belt
6. Be alert for unusual events that may occur.
7.Do not guard the pt. using clothing or grasping the arm; use safety belt and trunk.
8. Position yourself to guard, guide, direct, and protect the pt. throughout the transfer.
9. Request the pt. to intiate and perform the transfer in simple directive terms; assist as necessary
10. At the conclusion of transfer, position pt. for comfort, stability, and safety; document changes in pt's performance.

Front 38

Bed to w/c transfer-board transfer procedure (5)

Back 38

1. Position w/c at an angle next ot the bed, facing the foot of the bed with the caster wheels forward and opposite the pt's hips. Lock the chair, remove the armrest nearest the bed, and swing away the front rigging.
2. Assist the pt to a long-sitting position, apply safety belt, and assist the pt. to move to the edge of mattress. The LE positioned over the edge of mattress or remain parallel.
3. Position one end of the transfer board under the pt's upper thighs and buttocks; the other end rests on the chair seat. Position yourself slightly in front and to the near side of the pt. to guard and protect throughout the transfer.
4. Assist the pt. to move across the board onto the chair seat. Guard and protect the trunk if the LE need to be lowered from the bed; remove the board.
5. Place the feel on the footrests, position the body for safety and comfort, and remove the safety belt.

Front 39

w/c to bed transfer procedure (5)

Back 39

1. Position chair at an angle next to the bed, facing the foot of the bed and midway between the head and foot of the bed. Lock the chair and remove the armrest nearest the bed. Swing away the front rigging with the caster wheels forward.
2. Assist the pt. to move forward in the chair. Place one end of the board under the thighs and buttocks; the other end should rest on the bed surface. Positon yourself slightly in front of and to one side of the pt to guard and protect.
3. Assist the pt. to move across teh board onto the bed; the legs may dangle over the edge before they are lifted onto the bed. Guard and protect as the LE are placed onto the surface.
4. Remove the board; assist the pt to move toward the center of the bed and lie down.
5. Position the body for safety and comfort; remove the safety belt.