When transferring a resident from her bed to the wheelchair, you must follow crucial safety steps

According to the Centers for Disease Control and Prevention (CDC), falls are a leading cause of injury among older adults. To prevent this, you must take careful precautions when transferring a resident from her bed to the wheelchair, including preparing the environment and communicating clearly to ensure safety for both the resident and caregiver. This authoritative guide outlines the necessary steps for a secure and smooth transition.

Quick Summary

Before beginning, you must prepare the resident and surrounding area, including locking the wheelchair brakes and clearing obstacles. Using proper body mechanics, a gait belt, and clear communication is essential for a safe and controlled pivot to the wheelchair. This process prevents injury for both the resident and caregiver.

Key Points

• Lock the Brakes: Always lock the wheelchair brakes and remove footrests to prevent the chair from shifting during the transfer.

• Use a Gait Belt: Secure a gait belt around the resident's waist to provide a safe, firm grip point and avoid pulling on their limbs.

• Use Proper Body Mechanics: Bend at your knees, not your back, and use your leg muscles to lift and pivot, keeping the resident close to your body.

• Communicate Clearly: Verbally explain each step to the resident, use a count to coordinate movements, and check for signs of dizziness.

• Pivot Safely: Guide the resident to stand and pivot their whole body with small steps instead of twisting, lowering them slowly into the seat.

• Prepare the Environment: Clear all obstacles and ensure the resident is wearing non-skid footwear before starting the transfer.

Preparing for the Transfer: Safety First

Before you begin the physical transfer, a thorough preparation is the most critical step for ensuring a safe and successful maneuver. Failure to properly prepare the environment and resident can lead to falls and serious injuries.

Assess the Resident's Condition

First, assess the resident's current physical and mental state. Check for signs of pain, dizziness, or confusion that may affect their ability to assist or follow instructions. If the resident has a weaker side, always position the wheelchair on their stronger side to maximize their participation.

Ready the Environment

Clear the pathway between the bed and the wheelchair of any clutter, rugs, or other tripping hazards. Ensure the resident is wearing non-skid footwear or socks to provide stable footing during the pivot. Lower the bed to a safe height, so the resident's feet can rest flat on the floor when seated on the edge of the bed. This provides a stable base and reduces the distance they need to move.

Setting up the Equipment: The Wheelchair

Proper positioning and securing of the wheelchair are non-negotiable safety measures. Skipping these steps is a primary cause of transfer accidents.

Position and Secure the Wheelchair

Move the wheelchair to the side of the bed, positioning it at a slight angle (around 45 degrees) towards the bed. This minimizes the distance of the pivot. Engage the wheel locks firmly to prevent any movement. Next, move the footrests out of the way or swing them to the side to ensure they do not obstruct the resident's feet or legs during the transfer.

Moving the Resident to the Edge of the Bed

Once the environment and equipment are ready, focus on preparing the resident for the move.

Assisted Sit-Up Technique

1. Roll and Sit Up: Roll the resident onto their side, facing the direction of the wheelchair. Place one arm under their shoulders and the other behind their knees. On the count of three, help them to sit up, using the momentum from swinging their legs over the side of the bed.
2. Steady and Adjust: Allow the resident a moment to sit and regain their balance. Check for any signs of dizziness. Help them scoot forward to the edge of the bed so their feet are flat on the floor, and their knees are bent at a 90-degree angle. This puts their body in the best position for a stand-pivot.

Executing the Stand-Pivot Transfer

This technique is used for residents who can bear some weight. If the resident is unable to bear weight, a mechanical lift should be used.

The Caregiver's Position and Body Mechanics

To protect yourself from injury, use proper body mechanics. Stand with your feet shoulder-width apart, with one foot slightly ahead of the other for a wide, stable base. Bend your knees, keeping your back straight, and engage your core muscles.

Using a Gait Belt

A gait belt is an essential tool for providing a secure grip without pulling on the resident's limbs. Secure the gait belt snugly around the resident's natural waist, over their clothing. Ensure it is not too tight and allows for a firm, underhand grip on the belt's sides.

The Pivot Maneuver

1. Rock to Stand: With the resident's hands placed on the bed beside them, stand close to them and wrap your hands around the gait belt. Instruct the resident to lean forward ("nose over toes"). Use a rocking motion to build momentum. On the count of three, assist them in pushing up to a standing position, lifting with your legs.
2. Pivot: Once standing, have the resident take small, shuffling steps backward until they feel the wheelchair against the back of their legs. Avoid twisting your body; instead, pivot your entire body by moving your feet.
3. Lower to Sit: Guide the resident to reach back for the armrests of the wheelchair. Instruct them to slowly bend their knees while you gently lower them into the seat, maintaining your strong grip on the gait belt. Ensure they are fully seated before releasing your grip.

Comparison of Safe vs. Unsafe Transfer Techniques

Feature	Safe Transfer	Unsafe Transfer
Equipment Setup	Brakes locked, footrests moved.	Brakes unlocked, footrests in the way.
Body Mechanics	Bend at the knees, keep back straight, lift with legs.	Twist at the waist, bend at the back, lift with back and arms.
Grip	Secure hold on a gait belt.	Pulling on arms or clothing, grabbing under armpits.
Communication	Clear, simple instructions; count for coordination.	Little to no communication, sudden movements.
Resident Participation	Encouraged to assist as much as possible.	Resident is passive, caregiver does all the work.
Final Position	Resident seated fully back in chair, feet on footrests.	Resident perched on the edge of the seat, feet dangling.

Post-Transfer and Conclusion

After the transfer is complete, secure the resident's feet on the footrests and re-position the resident for comfort. Remove the gait belt. Remind the resident to call for assistance before attempting to stand again.

In conclusion, mastering the safe transfer from bed to wheelchair is a fundamental skill in caregiving. It protects the resident from harm, builds their trust, and safeguards the caregiver from debilitating back injuries. The process, which always includes locking the wheelchair brakes and using proper body mechanics, is a series of methodical steps that, when followed correctly, ensure the dignity and safety of all involved. For more in-depth guidance on patient transfer techniques, resources such as MedlinePlus provide comprehensive information.

By prioritizing preparation, clear communication, and correct technique, you can minimize risk and provide compassionate, professional care.

Frequently Asked Questions

What is the very first thing you must do when preparing to transfer a resident to a wheelchair?

The very first and most critical step is to lock the brakes on the wheelchair. This prevents the wheelchair from moving unexpectedly and causing a fall during the transfer.

Why is a gait belt important for a transfer from bed to wheelchair?

A gait belt provides a secure and safe point of contact for the caregiver to hold the resident during the transfer. It prevents the caregiver from pulling on the resident’s arms or clothing and helps distribute the force evenly.

What should the caregiver do with their legs during the pivot transfer?

The caregiver should stand with their feet shoulder-width apart, bend at the knees, and use their legs to lift and pivot. They should move their feet to turn their whole body, avoiding twisting their back.

How should the resident's feet be positioned before starting the transfer?

The resident’s feet should be flat on the floor, positioned directly under their knees and slightly apart. This creates a stable base and helps with the upward momentum.

What is the 'nose over toes' technique?

The 'nose over toes' technique is a cue for the resident to lean forward with their head and shoulders over their feet. This shifts their center of gravity and makes it easier to stand up with assistance.

What if the resident becomes dizzy or unsteady during the transfer?

If the resident becomes dizzy, lower them slowly and safely back to the bed or a nearby stable surface. Do not attempt to force the transfer. Ensure they are secure and get help if needed.

How do you position the wheelchair relative to the bed for a transfer?

Position the wheelchair as close to the bed as possible, at a slight angle (approximately 45 degrees). The wheelchair should be on the resident's stronger side to maximize their participation.