1. PATIENT
TRANSFER

2. PATIENT TRANSFER
A transfer is the safe movement of
the patient from one place to another,
like from bed to wheelchair and by
the used of assistive devices. In
doing so, the nurse must teach
patient and ask for his or her
participation for successful results.
There are many methods of transfer.

3. The nurse should choose an
appropriate technique for the
patient by taking into
considerations his or her
disabilities and abilities. In most
cases, it is very helpful if the
nurse demonstrates the technique
first before the transfer. During
the transfer, the nurse coaches
and assists the patient.

4. LEVEL OF TRANSFER
Independent transfers
◦The patient consistently performs all aspects
of the transfer, including setup, in a safe
manner and without assistance.
Assisted transfers
◦The patient actively participates, but also
requires assistance by a clinician(s).
Dependent transfers
◦The patient does not participate actively, or
only very minimally and the clinician(s)
perform all aspects of the transfer

5. LEVELS OF ASSISTANCE
Stand-by assist (aka supervision)
Close guarding
Contact guarding
Minimal assist
Moderate assist
Maximal assist

6. Risk Factors Related to Patient

7. Communication
The caregiver must assess the patient’s
ability or inability to communicate.
The risk of injury increases if the
patient:
• Does not speak/understand the same
language as the
caregiver
• Does not understand speech
• Does not understand non-verbal
communication
• Can not follow simple commands

8. •Communicates with sign language
or assistive communication devices
• Has a hearing impairment
• Has a speech problem
• Has a low level of consciousness

9. Cognition
Often hospitalized patients have an
altered level of cognition affecting their
ability to participate in lifts/transfers.
Short term memory loss, poor
judgment, and difficulty making
decisions can all be manifestations of
altered cognition.
Questions testing the short term
memory can often give some indication
of the level of cognition.

10. Medical Status
Signs and symptoms of various
medical conditions can impact on a
patient’s ability to transfer i.e. the
tremors and movement initiation
problems associated with Parkinson’s
disease.
Medications can also
affect the patient’s ability to transfer.
Fatigue, pain and stiffness will affect
the quality of the transfer.

11. The medical status can change
dramatically
during a shift and caregivers need
to observe these changes and
modify
the lift/transfer as necessary.

12. Physical Status
A physical assessment should include:
• Weight bearing status
• Weight
• Height
• Range of motion (ROM)
• Strength
• Balance
• Coordination
• Sensation
• Clothing
• Footwear

13. Emotional and Behavioral Status
Patients behavioral and emotional state
may change throughout the day
i.e. Sundowners. The caregiver should
be aware of behavior changes
including:
• Anxiety
• Aggression
• Agitation
• Combativeness
• Confusion
• Depression
• Hostility

14. •Impulsiveness
• Low tolerance for change
• Low self esteem (if they think poorly
of their abilities they may not
complete the transfer to the level of
their ability)
• Rejection
• Resistive
• Self Destructive
• Unpredictable

15. Risk Factors Related to the
Environment
• Layout
• Space
• Lighting
• Color
• Temperature
• Obstacles
• Floor

16. Risk Factors related to the
Equipment
• Medical devices (catheter bags, IV's,
prosthesis)
• Inadequate training in the use of
equipment
• Improper use of equipment or use of
faulty equipment
•Risk increases when
furniture/equipment not adjustable

17. TRANSFER ASSIST DEVICES
Primarily used to:
•Provide a safer means of moving and
transferring a person from one place to
another.
•Facilitate independence and maintain
the dignity of the person being moved
or transferred.
•Eliminate or minimize risk factors that
can lead to caregiver or patient injury.

18. •Where possible, patients should be
encouraged to move themselves. Those
with good balance and upper body
strength may be able to maintain or
regain independence through the use of
certain transfer assist devices.
•Transfer assist devices may reduce the
amount of force exerted by caregivers
and improve their posture when moving
partially or totally dependent patients.

19. •Transfer assist devices do not reduce
the weight of a patient and should not
be used to lift, carry, or support the
whole or a large part of a patient’s body
weight.
•A safer means of moving the patient,
such as a mechanical lift, may be
required. Safety for both patient and
caregiver must always be considered.

20. BEST PRACTICES WHEN USING
TRANSFER ASSIST DEVICES
•Only use transfer assist devices if properly
trained in their safe use. When safe,
encourage patients to move themselves.
•Tell the patient what you intend to do before
you do it. Ensure that the brakes of the bed,
stretcher, or wheelchair are on before
beginning any movement.
•Inspect each device before use. Tag and
remove damaged equipment from service.
•Set the bed at the height of caregivers’ upper
thighs.

21. •Lower the side rail on the bed to
reduce awkward reaching.
•Minimize gaps and height differences
between surfaces whenperforming a
lateral transfer (for example, from bed
to stretcher), and bridge gaps with
transfer boards, where necessary.
•Avoid differences in height between
two surfaces when performing a
transfer. A gentle decline, however,
may be preferable for some seated or
supine transfers using a transfer board.

22. •When moving a patient up in bed, tilt
the bed to a “head down” position to
allow gravity to assist, unless
contraindicated.
•Use moving and handling equipment
in accordance with your organization’s
policies and procedures.
•Ensure friction-reducing devices are
large enough to be placed under the
main points of contact. For supine
patients, this includes the pelvis,
shoulders and, if possible, the feet.

23. •Do not leave friction-reducing devices
under the patient unless the manufacturer
specifically recommends it. Leaving an
unsecured friction-reducing device under
an unsupervised patient may put the
patient at risk of falling out of bed. as low-
friction draw sheets, are designed to be
left under the patient. These sheets are
secured by tucking the sides of the sheets
under the mattress, so that the sheets
don’t have to be continually placed and
removed
•Have the patient assist as much as
possible during the transfer or reposition.
•Avoid lifting the patient.

24. Set of two draw sheets
Draw and slider sheets
Draw sheets
•Draw or slide sheets are made of low-
frictionfabrics or gel-filled plastics that enable
an individual to slide over a surface instead of
being dragged or lifted. These sheets come in
a variety of widths and lengths and may be
used in pairs, singly, or folded.
•drawsheet has the slippery surface only on
one side and can be kept under the patient.
•A slide sheet, on the other hand, is slippery
on both sides and should be removed once the
patient is repositioned.

25. Slider sheets
•Slider or roller sheets are tubular
sliding sheets made of specialized
fabrics with low-friction inner surfaces
that glide over themselves.
•Slider sheets may be flat or padded
and can be placed under draw sheets or
incontinence pads.
•Slider sheets come in several sizes
and lengths.
Set of two slider sheets

26. •Short slider sheets are primarily used
for pivoting and repositioning tasks
such as sitting a patient up on the side
of the bed or repositioning a patient up
in bed.
•Long lateral slider sheets are intended
for transferring supine patients from
one surface to another, such as from
bed to stretcher.

27. •“ONE-WAY SLIDES,” slide in one
direction only. This facilitates
moving a patient up in bed or back
in a wheelchair, while preventing
the patient from sliding down the
bed or forward in a wheelchair.
One-way slides reduce the need to
manually reposition a patient in a
bed or chair.

28. •Note:
Slider sheets may be used independently
or with partial help. When used
independently, a patient with good sitting
balance and sufficient arm or leg strength
may be able to slide from one surface to
another or up and down in bed. When
providing partial help, it is important to
apply forces horizontally only, resulting in a
slide, not a lift. The chosen technique
should, as much as possible, eliminate the
need for the caregiver to twist, reach, or
stoop.
Padded one-way slide

29. Two roller sheets
USES
•Facilitate independent bed mobility
•Move patients up in bed
•Move patients from the side of the bed to the
centre or vice versa
•Turn patients onto their side in bed
•Transfer patients from one surface to another,
such as from a bed to a stretcher (when used in
conjunction with other devices, such as transfer
boards)
•Move patients who have fallen into confined or
awkward spaces to a place where a mechanical
lift can be used
•Pivot patients in bed and aid exercise

30. Lateral transfer aid
ADVANTAGES
•Draw and slider sheets have the following
advantages:
•Simple and versatile
•Sliding patients may avoid the need to
manually lift them
•Draw sheets may be tucked partway
under seated patients or completely under
lying patients who have been rolled onto
their sides
•Handles may provide caregivers with a
firm grip

31. DISADVANTAGES
•Sliding patients who have pressure sores or
other sources of sensitivity may cause them pain.
•Heavy patients may still require excessive force
to move. And mechanical lift may be more
appropriate.
•If the same sheet is used for more than one
person infection-control precautions must be
taken.
•Not be suitable for some transfers because they
do not bridge gaps. Where gaps need to be
bridged, caregivers can use slide sheets in
conjunction with transfer boards.
Two flat sheets

32. DISADVANTAGES
•A slide may actually turn into a lift if
caregivers do not use proper techniques.
•The move or transfer still requires two
caregivers.
•The use of these sheets may involve
additional effort and handling tasks to
position and remove them.

33. TIPS
Follow these tips when using draw and
slider sheets:
•Use a “palms up” grip when pulling on
the slide/roller sheet. A “palms up” grip is
a stronger grip than a “palms down” grip.
A “palms up” grip keeps elbows close to
the body and helps to maintain a neutral
shoulder posture.
•Keep knuckles in contact with the
bedsheet to ensure a sliding motion, not a
lifting motion.

34. •Avoid shrugging the shoulders while
moving the patient, as this indicates a
lifting motion.
•If repositioning the patient up in bed, tilt
the entire bed with the head down, which
allows gravity to assist with the movement.
•Ensure that the sheet is taut before
moving the patient to prevent jerking the
patient.
•Draw sheets can be left under the patient

35. •Reduces the forces required to move
patients
•Reduces awkward postures if used
correctly
•More comfortable for patients than
transfer boards

36. Transfer belts
TRANSFER BELTS
•Transfer belts do not reduce the patient’s
weight in any way, and must not be used for
lifting patients.
•Transfer belts come in a variety of sizes and
shapes. They fasten with a buckle, a clasp, or
Velcro, and they usually have handles.
•Note: Although Velcro fastening is quicker and
easier than using buckles or clasps, the hooks
may get caught on the patient’s clothing and may
deteriorate rapidly if not carefully laundered.

38. USES
Transfer belts can be used:
•During assisted walking
•To guide patients along transfer boards during
seated transfers
ADVANTAGES
Transfer belts have the following advantages:
•They provide a secure grip.
•Caregivers do not need to grip the patient’s clothing
or limbs.
•Caregivers can guide a falling patient to the floor.
•NOTE Do not use transfer belts to catch or support a
falling patient’s weight.
•Caregivers can work in a more upright posture.

39. DISADVANTAGES
Transfer belts have the following disadvantages:
•Belts that are too wide may affect a patient’s
ability to lean forward. Narrow, unpadded belts
may dig into the patient’s waist.
•Using a belt to lift all or most of a patient’s body
weight is not an acceptable practice.
•Belts without handles encourage the caregiver
to grip the belt with a clenched fist. This generally
causes the knuckles to press into the patient’s
side, resulting in discomfort.

40. •Caregivers should not place their arms
through handles, as pictured. Caregivers
would rarely have time to free their arms if
the patient reacted or fell suddenly.
•Caregivers are placed at significant risk
when patients are allowed to hold around
the caregiver’s neck. Caregivers can avoid
this situation by placing their arms outside
Never place your those of the patient when providing
arm through
transfer belt assistance.
handles

41. TIPS
Follow these tips when using transfer belts:
•As long as it is safe to do so, place the
transfer belt on the patientvwith the bed in
a raised position to avoid awkward
bending.
•Ensure that the belt is fairly snug (you
should only be able to place two fingers in
between the belt and the patient) to
reduce the chances of the belt sliding up
the patient during the transfer.

42. •When performing the transfer, caregivers
should shift their body weight from one leg
to the other and perform a gentle pulling
motion, using the legs to do the work.
Avoid lifting during the transfer movement.
•Get the patient to assist as much as
possible.

43. SLIDE/TRANSFER BOARDS
•Slide/transfer boards or smooth movers are
made of wood or plastic and can be used in
conjunction with roller sheets or slide sheets.
Some boards have rollers, while others have
fabric or vinyl coverings designed to further
reduce friction.
•Slide/transfer boards are used to reduce friction
and bridge gaps when sliding patients between
two horizontal surfaces such as from a bed to a
stretcher.
Rolling slide/transfer board

44. •These boards are suitable only for those
patients who can power themselves by sliding or
rolling along the board with guidance from a
knowledgeable caregiver. Some procedures
require the caregiver to push or pull the board to
accomplish the transfer.
•Others involve pushing the patient or pulling a
draw sheet across the transfer board. Large
patients and patients with sensitive skin may find
slide/transfer boards uncomfortable. If possible
the use of a mechanical lift is recommended over
a slide/transfer board.

45. Banana board
SMALLER SLIDE/TRANSFER BOARDS
•Smaller slide/transfer boards are designed for
seated lateral transfers. They are often tapered
at each end and can be used to bridge a gap such
as when transferring between a bed and a
Smaller slide/transfer wheelchair or commode. Patients with good to
boards
with movable sliding use their arms and legs to move themselves.
sections
Boards are often made of a low-friction material
or with moveable sliding sections. Be careful
when using slide/transfer boards with sliding
sections because these sliding sections may
cause pinching.

46. USES
•Slide/transfer boards can be used to
bridge gaps between two surfaces to
facilitate patient transfer, such as between:
•Bed and wheelchair
•Wheelchair and toilet
•Chair and wheelchair
•Wheelchair and car
•Rolling slide boards can be used when
transferring supine patients between bed
and stretcher.

47. Roller sheet on
transfer board ADVANTAGES
Slide/transfer boards have the following
advantages:
•Caregivers do not need to lift manually.
•Some patients may be able to transfer
themselves, avoiding the need for caregivers to
perform certain transfers.
•When used appropriately, slide/transfer boards
allow for less horizontal forces during caregiver-
assisted transfers.
•Boards are available in a range of widths,
lengths, and curves.
•Curved transfer boards make it possible to
transfer around fixed armrests.

48. DISADVANTAGES
Slide/transfer boards have the following
disadvantages:
•Inappropriate use (for example, with
patients who cannot offer sufficient
assistance) may put caregivers at a high risk
of MSI.
•Some slide/transfer boards do not
sufficiently reduce friction.
•Two equal-height surfaces are needed for
easy transfer. For seated transfers, patients
must have some degree of sitting balance.

49. •Many boards have no handles for
positioning or carrying the board.
•Caregivers must be careful not to twist
during the transfer.
•Caregivers may still apply horizontal forces
in awkward postures.
•Fingers may be trapped under board
edges.

50. TIPS
Follow these tips when using slide/transfer
boards:
•When transferring a patient between two
surfaces, ensure the receiving surface is a
little bit lower (no more than 2.5 centimetres
or one inch) to allow gravity to assist. Avoid a
difference of more than 2.5 centimetres as
this may be too jarring for the patient.
•Use of a flat sheet directly under the patient
will increase the ease of the transfer because
it will provide the caregivers with something
to grasp onto when pulling the patient onto
the bed/stretcher

51. •If the patient is lying on a fitted
sheet, do not use the sheet for the
transfer. It’s difficult to keep the sheet
taut during the transfer, and it creates
more friction with the slide/transfer
board, thereby increasing the force
required by the caregiver.
•When applicable, place the receiving
surface to the patient’s stronger side.

52. TURNING DISCS
•Turning or pivot discs come in
various sizes and may be flexible or
solid. They consist of two circular
discs that rotate against each other.
The inner surfaces are made of low-
friction material, while the outer
surfaces are typically high-friction
material. Turning discs are often used
with transfer boards or transfer belts.
Turning discs

53. FLEXIBLE TURNING DISCS
•Flexible turning discs conform to the
contours of a surface and are most
useful for pivoting seated patients (for
example, when transferring patients
into vehicles). The inner surfaces are
typically low-friction plastic or other
synthetic material. The top is often
made of quilted or padded fabric for
comfort.

54. SOLID TURNING DISCS
•Solid turning discs are more durable and
are used for pivoting patients who are
weight bearing and can stand. Solid turning
discs are usually made of wood or moulded
plastic and may contain bearings. Patients
who are weight bearing and can balance
when standing may be guided to a standing
position and swivelled around without
having to adjust their feet.

55. Patients must have the strength to stand, or
this procedure will require the caregiver to exert
excessive force in an awkward posture. Use
transfer belts with handles to pivot patients
standing on flexible or solid turning discs. Use
turning discs only for patients who can stand up
independently. Patients who are unable to
independently rise to a standing position require
a sit-stand or total body lift.

56. USES
Turning discs assist with rotation of
patients during a transfer between:
•Wheelchair and bed
•Wheelchair and chair
•Wheelchair and car

57. ADVANTAGES
Turning discs have the following
advantages:
•The patient’s feet do not need to be
turned or adjusted after the transfer.
•Some discs have a small handle that
makes positioning and storing easier.
•Turning discs reduce the forces required
to rotate or pivot patients.

58. DISADVANTAGES
Turning discs have the following disadvantages:
•The larger the disc, the greater the risk that the
disc will be in the way of the caregiver’s feet.
•Some solid discs have ball bearings in their
swivel mechanism.
•Choose and use these discs with care. They can
be difficult to control, especially with light
patients.

59. •Do not use turning discs to transfer unpredictable
patients or dependent, non-weight-bearing
patients.
•The greater the profile (thickness) of a solid disc,
the greater the tripping hazard it presents to the
patient and caregiver.
•A patient’s support base is narrowed while
standing on a turning disc.
•Some patients may become disoriented when
they are turned on the disc.
•Heavy patients may still require excessive force to
move them.

60. TIPS
Follow these tips when using turning discs:
•For standing pivots, only one of the patient’s feet
should be placed on the solid disc. The patient must
be able to use the other leg to guide the pivot
motion.
•For standing pivots, the patient’s foot should be
placed in the centre of the disc.
•Remove obstacles.
•Place caregivers’ feet shoulder-width apart for a
good base of support.

61. Assessment
Prior to lifting any object or materials an assessment of
the most appropriate method of lifting should be
completed. Plan the lift in your mind - organize the lift so
that it will be best for you and your co-workers.
• If you are uncertain about your ability to lift an object
safely, get help! Never “go it alone.” Try the heft test. Get
an idea if you can manage the lift.
• Always consider proper positioning of the spine and
upper extremity to prevent injury.
• If you have an idea how the lift or environment could
be improved, talk to your manager. Taking a few seconds
to consciously prepare for the lift may prevent you or a
co-worker from days, months or years of pain.

62. Assessment before starting a lift or
transfer is essential.
A good assessment
• Ensures that the transfer/lift is
appropriate for the caregiver and
patient
• Aids in preventing back and
shoulder strain/injury to the caregiver
• Reduces the risk to the patient
and/or caregiver

63. An appropriate transfer/lift
• Is safe for the caregiver and patient
• Enables the patient to be as
independent as possible
• Is comfortable for the patient
• Provides the least wear and tear on
the back and shoulders of the
caregiver

64. Why is consistency important?
• Unexpected incidences or lack of patient
cooperation are often contributing factors in
injuries to caregivers. When the lifting technique
is consistent the patient is more likely to
cooperate and be less anxious.
Who should do the assessment?
• The nurse is responsible for assessing the
patients transfer/lift needs.
• Physiotherapists and/or Occupational
Therapists are available for consultation
concerning complex cases. A referral may be
required if intervention to improve transfers is
indicated.

65. When should the initial assessment be done?
• The admitting nurse should do the assessment
of the most appropriate lift/transfer at the time
of admission.
• The accepted lift/transfer should be noted on
the admission history and the Kardex.
What should be included in the initial
assessment?
• Caregiver status
• Assess the patients abilities (strength, ROM,
balance, etc)
• The environment
• Equipment available

66. When are lifts/transfers reassessed?
• A brief reassessment must be done every
time, before a caregiver intends to
lift/transfer a patient
• Reassessment is important because a
patient’s ability to assist and cooperate
may vary from day to day, or even at
different times during the same day
because of medication, fatigue, stress or
pain

67. •Reassessment may help to prevent those
unexpected incidents
• More formal reassessments are
necessary when a patient’s condition
improves or deteriorates. This ensure the
procedure listed on the kardex is most
appropriate
• Reassessment also helps to maintain a
high level of awareness
about patient handling

68. What needs to be reassessed?
• Change in medical status
• Patients ability to communicate
• Level of cognition
• Level of aggression
• Physical Abilities (ROM, strength)
• Environment
• Availability of Equipment
Caregiver Ability

69. FACTORS TO CONSIDER WHEN ASSESSING PATIENT HANDLING TASKS

70. PREPARATION
Preparing for the lift/transfer
1. Prepare the equipment
• Adjust position of the equipment (bed,
stretcher, wheelchair, etc)
• Adjustments to the chair include locking
brakes, checking cushion position (if
available), removing arm rests if necessary
for transfer/lift, positioning chair at
appropriate angle.

71. •Adjustments to the bed include locking
brakes, putting down side rails, adjusting
bed height (hip height if standing, mid
thigh height if knee on bed, level with
chair if using sliding board or hemi
transfer)
• Ensure all devices are in good working
order including belts, lifts,
slings

72. 2. Prepare the patient
• Explain what you are about to do
with the patient
• A well-prepared patient can make
your workload easier!
• Ensure the patient places their
hands on the appropriate place to
assist with the lift i.e. the side rail. DO
NOT ALLOW THE PATIENT

73. TO GRAB AROUND THE
CAREGIVERS NECK. This could lead
to neck injury or strain.
• Position the IV tubing/poles,
catheter bags and other
appliances so that they do not
interfere with the transfer
• Maintain the patient’s dignity

74. 3. Prepare the Caregiver
• Complete a brief reassessment to ensure appropriate lift
• Position the caregiver so the patient feels safe, the
patient can hear and see the caregiver, and with
appropriate body mechanics (the feet apart and knees
bent slightly)
• Discuss the plan with lifting partners
• Explain the plan to the patient including their role in the
transfer/lift
• Use simple instructions/one step commands
• Tighten abdominal muscles (core) before you lift.
Maintain normal spinal alignment by keeping a slight
inward curve just above the pelvis. Use the powerful leg
muscles to help with the handling
procedure

75. • Use both hands and hold the patient as close to
your body as possible. Never grasp the patient
under the arms. This can lead to injury or
subluxation
• Count with lifting partners so everyone moves
at same time “1,2,3,lift”
• Be prepared for the unexpected.
• If the load starts to slip or the patient starts to
fall, go with it. Try not to rotate. Protect the
patient’s head
• If the patient falls assess their condition before
returning them to bed
• Postpone the lift/transfer if the patient is
resistive, uncooperative or aggressive (if non
emergent)

76. 4. The Environment
• Clear a working area
• Eliminate any obstacles
• Ensure adequate lighting
• Dry floor
• Minimize distracting noises

77. THE PRINCIPLES OF SAFER PATIENT HANDLING
Before the task:
• Wear the right clothes: Make sure your clothing
and footwear are appropriate – clothes should
allow free movement and shoes should be non-
slip, supportive and stable
• Never lift: Never plan to lift manually – always
use a hoist to lift a patient
• Know your limits: Know your own capabilities
and don’t exceed them – for
instance, if you need training in the technique to
be used, tell your manager

78. • Do one thing at a time: Don’t try to do two
things at once – for instance, don’t try to adjust
the patient’s clothing during the transfer
• Prepare for the task: Make sure everything is
ready before you start – for instance, check other
carers are available if needed, equipment is
ready and the handling environment is prepared
• Choose a lead carer: The lead carer checks the
patient profi le and co-ordinates the move. You
should also try to match the height of carers if
possible to avoid awkward postures

79. Apply safe principles: Always use safe
biomechanical principles – and use rhythm
and timing to aid the task.
caution – High risk. The patient shouldn’t
hold on to you or your clothing, because it
is diffi cult for you to disengage and the
patient could pull you off balance. It is
unsafe for carers and patients.

80. Safe biomechanical principles
Here’s the safe way to hold your body:
• Stand in a stable position: Your feet should be
shoulder distance apart, with one leg slightly forward
to help you balance – you may need to move your
feet to maintain a stable posture
• Avoid twisting: Make sure your shoulders and
pelvis stay in line with
each other
• Bend your knees: Bend your knees slightly, but
maintain your natural
spinal curve – avoid stooping by bending slightly at
the hips (bottom
out)

81. • Elbows in: Keep your elbows tucked in
and avoid reaching – the further away from
the body the load is, the greater the
potential for harm
• Tighten abdominal muscles: Tighten your
abdominal muscles to support your spine
• Head up: Keep your head raised, with
your chin tucked in during the movement
• Move smoothly: Move smoothly
throughout the technique and avoid fixed
holds.

82. Carrying out the task:
• Check patient profi le: Decide if the task is still
necessary and that the handling plan is still
appropriate. Check it still matches the clinical
pathway and physician’s orders
• Seek advice: Talk to your manager or the patient
handling adviser if you need advice on the
techniques and equipment you should be using
• Check equipment: Ensure equipment is available
in good order with all components in place and
ready to use (eg. batteries charged). Always follow
the manufacturer’s instructions

83. Prepare handling environment: Position furniture
correctly, check route and access ways are clear, and
check the destination is available
• Explain the task: Explain the task to the patient and
other carers who will be helping
• Prepare the patient: Ensure the patient’s clothes and
footwear are appropriate for the task, and they have
any aids they need. Adjust their clothes, aids and
position – for instance, encourage the patient to lean
forward
• Give precise instructions: The lead carer directs the
move and gives clear instructions, eg. “Ready, steady,
stand”. This helps carer/s and patient work together.

84. After the task:
• Correct your posture: Stand up straight to
correct your spinal alignment. Hold your chest
open, shoulders back and abdominal muscles in
so your lower body aligns properly with your
upper body
• Re-evaluate the task: Could the task have been
done better? How? Mark the patient profile with
your comments
• Report any issues: If you identify issues that
affect patient handling, report them to your
manager and add them to the workplace control
plan for action.

85. MOVING PATIENTS FROM BED TO
WHEELCHAIR
Remember: When patients are weak,
brace your knees against theirs to keep
their legs from buckling. Also, transfer
toward patient’s stronger side if possible.

86. 1
.Sit the Patient Up
•Position and lock the
wheelchair close to the bed.
Remove armrest nearest
bed and swing away both
leg rests.
•Help the patient turn over.
•Put an arm under the
patient’s neck with your
hand supporting the •Swing legs over
shoulder blade; put your the edge of the
other hand under the bed, helping the
knees. patient to sit up.

87. 2.Stand the Patient Up
•Have the patient scoot to the edge of the
bed.
•Put your arms around the patient’s chest
and clasp your hands behind his or her
back. Or, you may also use a transfer belt to
provide a firm handhold.
•Supporting the leg farthest from the
wheelchair between your legs, lean back,
shift your weight, and lift.

88. 3. Pivot Toward Chair
•Have the patient
pivot toward the
chair, as you continue
to clasp your hands
around the patient.
•A helper can support
the wheelchair or
patient from behind.

89. 4. Sit the Patient Down
•As the patient bends toward you, bend
your knees and lower the patient into the
back of the wheelchair.
•A helper may position the patient’s
buttocks and support the chair.

90. PULLING A PATIENT UP IN BED
1. Grasp the Draw-
Sheet
•Put the head of the
bed down and
adjust the top of the
bed to waist- or hip-
level of the shorter
person.
•Grasp the draw-
sheet, pointing one
foot in the direction
you’re moving the
patient.

91. •Lean in the direction
of the move, using
your legs and body
weight.
•On the count of
three, lift and pull the
patient up. Repeat
this step as many
times as needed to
position the patient.
•Also, patients can bend their knees, push down
with their feet, and pull up with a trapeze (a
device overhead) to help

92. Remember:
Putting a pillow under your patients’
feet helps them push down, making it
easier for you to pull them up.
Never clasp the underarm to move the
patient. This may cause injury to the
shoulder (i.e., dislocation).

93. TURNING PATIENTS OVER IN BED
1.Cross Arms
•Put the bed rail and head of the bed down;
adjust the top of the bed to waist- or hip-level.
•Cross the patient’s arms on his or her chest;
bend the leg farther away from you.

94. 2.Turn the Patient
•Put one hand behind
the patient’s far
shoulder.
•Put your other hand
behind the patient’s
hip.
•Turn the patient, supporting the patient’s
leg with your knee.
Remember: Putting one knee on the bed gets you closer
to the patient, so you pull more with you

95. MOVING PATIENTS FROM BED TO
STRETCHER (GURNEY)
Remember: If you move patient’s legs
first, you can decrease the stress on
your back by as much as a third.
•Patient safety is often the main concern when
moving patients from bed. But remember not to
lift at the expense of your own back. And, never
move a patient by yourself. Two people usually
can do this move safely. The leader, who pulls,
should be the stronger of the two. The helper
holds the draw-sheet, neither pushing nor lifting.

96. 1
The leader should have one
foot forward with knees
bent.
1.Prepare to Move
•Put the head of the
bed down and adjust
the bed height.
•Move the patient’s
legs closer to the edge
•Put a garbage bag or
of the bed.
plastic slide board
•Instruct patient to
between the sheet and
cross arms across chest
draw-sheet, beneath
and explain move to
one edge of the
patient.
patient’s torso.

97. 2. Pull to Edge of Bed
Grasp the draw-sheet on both sides of the bed.
•On the count of three, lean back and shift your
weight, sliding the patient to the edge of the bed.
The helper holds the sheet, keeping it from
slipping.
3.Position Stretcher
•Have the helper “cradle” the patient in the
draw-sheet while you retrieve a stretcher.
•Adjust the bed to be slightly higher than the
stretcher. Then, position the stretcher, locking it
in place.
•Move the patient’s legs onto the stretcher.

98. 4. Slide onto
Stretcher
•Have the helper
kneel on the bed,
holding on to the
draw-sheet.
•On the count of
three, grasp the
draw-sheet and
slide the patient
onto the stretcher.
You may need to
repeat this step.

99. TRANSFERRING USING A TRANSFER BOARD
A caregiver may use a gait belt to
help you move across the transfer
board.
Using a Transfer Board
1. Place the wheelchair
as close to the bed as
possible, and position it
at about a 30-degree
angle with the bed.
2. Lock the brakes on the wheelchair, move the
footrests out of the way, and remove the armrest
on the side closest to the patient.

100. 3. Help the patient to sit on the edge of the
bed with his feet flat on the floor.
4. Help the patient to lean over slightly away
from the wheelchair, and carefully slide one
end of the transfer board under the thigh that
is closest to the wheelchair. Point the end of
the board down into the bed as you do this, to
avoid pinching the patient's skin.
5. Place the other end of the transfer board
flat on the seat of the wheelchair with the end
of the board pointed at the back seat corner
farthest from the bed.

101. 6. Assist the patient with several short
"scooting" motions onto the board. If the
board is on the patient's left, have him lean
his upper body slightly to the right before
each scooting motion. The patient can place
his hands on the bed and rest some of his
weight on his hands to make it easier to move
onto the board.
7. Make sure the patient doesn't fall as he
moves across the board in several small
movements, until he is seated on the
wheelchair.
8. Remove the board, replace the armrest,
and position the footrests.

102. TRANSFER: WHEELCHAIR TO CHAIR
1. Patients who cannot walk
are taught to use
wheelchairs. For safety, have
the therapist show you the
correct way to help
someone out of a
wheelchair. Start by locking
the wheels of the chair.
Then stand as close to the
patient as you can. Make
2.Help the person scoot to
sure your footing is stable.
the edge of the chair. Be
The patient should always
sure the patient’s feet are
wear a special belt for you
under his or her body. Lift
to grip.
as the person pushes up.

103. 3.Keep the
person’s weaker
knee between
your legs. Pivot
the person around
in front of the
toilet or chair.
Lower him or her
gently.

104. TRANSFER—WHEELCHAIR TO TOILET
1. Stand the patient up
•Lock the wheelchair.
•Be sure the person’s feet are under
his or her body.
•Grasp the back of a belt
or pants and lift.
2. Move on the toilet
•Keep the person’s weaker knee
between your legs.
•Pivot the person around in front of
the toilet. Always transfer toward the
person’s stronger side.
•Gently sit the patient down onto the
toilet.
•Help the patient adjust their clothing.
•Never pull on the person’s weaker
arm or lift the person by the armpits.

105. Take Care of Your Back
Lifting a patient can be hard on your back. To
reduce the risk of a back injury, remember to
do the following:
Organize the steps in your head before you
move.
Keep the patient close to you.
Keep your knees bent and your back
straight.
Get help when you need it.

106. WHEN A PATIENT FALLS
Once the momentum has started, it’s almost impossible
to stop a patient from falling. By trying to do so, you can
injure your back. Instead, guide the patient to the
ground; then get help to move the patient back to a bed
or stretcher.
Guiding the Fall
Help falling patients to the
floor with as little impact as
possible. If you’re near a wall,
gently push the patient
against it to slow the fall. If
you can, move close enough
to “hug” the patient. Focus on
protecting the patient’s head
as you move down to the
floor. Then call for help.

107. Moving a Fallen Patient
1. Roll onto Blanket
•Roll the patient onto his
or her side.
•Put a blanket under the
patient and roll the
patient onto it.
•Position two or more
people on each side of
the patient.

108. 2. Lift from Floor
•Kneel on one
knee and grasp
the blanket.
•On a count of
three, lift the
patient and stand
up.
•Move the patient
onto a bed or
stretcher.
Remember: Be proactive; assess and identify a patient
as a fall risk and start intervention to prevent a fall.

109. PATIENT SAFETY
This is demonstrated by keeping the following things in mind:
S – Sliding boards are used to bridge the gap between the bed
and the chair if the patient’s muscles are not strong enough to
overcome the resistance of body weight. Transfer or movement
devices may be used in cases where mechanical devices are not
available, additional personnel is needed for large patients.
A – Ascertain that chairs and beds are locked before the
patient transfers. Potential hazards associated with transferring
patients should be identified by the nurse and establishment of
safe practices is essential.
F – Frequent assessment of patient needs by a registered
nurse before transfer to determine patient’s ability to
participate during the transfer and use necessary skill
appropriate for this patient.
E – Ensure that one staff member remains with the patient
during the transfer.

110. THANK YOU FOR
LISTENING!
MOHAMMAD
SHAH J. AHID