When transferring a resident from the bed to the wheelchair who has a week's side, what side should the wheelchair be placed on?

According to the CDC, falls are the leading cause of injury-related death among adults 65 and older, and unsafe patient transfers are a significant contributor. Knowing the correct technique, such as when transferring a resident from the bed to the wheelchair who has a week's side, what side should the wheelchair be placed on?, is vital for preventing accidents and ensuring patient dignity. This guide details the proper procedure for a safe and confident transfer.

Quick Summary

For a safe transfer, place the wheelchair on the resident's stronger side, which allows them to bear weight and pivot with their more stable limb, minimizing the risk of falls and injury. This strategic positioning facilitates a safer and more confident transition from bed to wheelchair for both the resident and the caregiver.

Key Points

• Position the Wheelchair on the Strong Side: Always place the wheelchair parallel to and on the resident's stronger, unaffected side [1].

• Enhance Stability: Using the strong side allows the resident to bear weight and pivot more easily, creating a stable and secure foundation during the transfer [1].

• Reduce Fall Risk: This method minimizes the risk of imbalance and falls, protecting both the resident and the caregiver from injury [1].

• Communicate Every Step: Explain the process clearly and calmly to the resident before and during the transfer to build trust and ensure cooperation [1, 4].

• Use a Gait Belt: A gait belt provides a secure handhold for the caregiver, offering better control and support during the pivot [1].

• Practice Proper Body Mechanics: Caregivers should bend their knees and keep their back straight during the transfer to protect themselves from strain and injury [1, 4].

Ensuring Safety First: The Golden Rule for Transfers

When assisting a resident with a weak or affected side, proper technique is paramount for safety. The golden rule for all transfers is to utilize the resident's strength to your advantage while protecting their weakness. This means positioning the wheelchair on the resident's stronger side [1]. By doing so, the resident can use their more stable arm and leg to assist with the pivot, reducing the strain on both the resident and the caregiver [1, 3]. This is a fundamental principle taught in caregiver training, and it dramatically lowers the risk of falls during the transfer process [1].

Step-by-Step Guide for a Safe Bed-to-Wheelchair Transfer

Following a clear, step-by-step process is the best way to ensure a smooth and safe transfer. Preparation and communication are key components that should never be overlooked [1, 4].

1. Prepare the environment: Remove any obstacles from the transfer path [1]. Ensure the floor is clean and dry. Position the bed to a height that is comfortable for the caregiver and allows the resident's feet to be flat on the floor when sitting on the edge [1, 4].
2. Position the wheelchair: Place the wheelchair parallel to the bed, close to the resident's stronger side [1]. The front edge of the wheelchair should be at a slight angle toward the head of the bed to facilitate the pivot. Lock the wheelchair brakes and move the footrests out of the way to prevent tripping hazards [1, 4].
3. Assist the resident to a seated position: Help the resident to a seated position on the side of the bed. Allow them a moment to adjust and ensure they are not dizzy before proceeding [1, 4].
4. Secure the resident's feet: Place non-slip socks or shoes on the resident's feet. Their feet should be firmly on the ground, shoulder-width apart, to provide a stable base [1].
5. Use a gait belt: If trained, apply a gait belt securely around the resident's waist, over their clothes. This provides a firm and safe handhold for the caregiver [1].
6. Initiate the pivot: Stand directly in front of the resident, with your knees slightly bent [1, 4]. Ask the resident to place their hands on your shoulders (not around your neck) [1]. On a count of three, help them push off the bed with their stronger arm and stand up [1].
7. Pivot and seat: Guide the resident in a pivot motion toward the wheelchair [1, 4]. They will use their strong side to lead the movement [1]. Back up until you feel the wheelchair against the back of their legs [1, 4]. Prompt them to reach for the wheelchair's armrests and lower themselves slowly [1].
8. Ensure comfort: Once seated, reposition the resident for comfort, put the footrests back in place, and communicate to them that the transfer is complete [1].

Why Strong-Side Placement is Critical

Placing the wheelchair on the resident's stronger side is not an arbitrary choice; it is based on principles of biomechanics and patient safety [1]. This approach is crucial for several reasons:

• Enhanced Stability: The stronger leg can bear more weight during the pivot, providing the resident with a more stable and secure foundation [1].
• Improved Balance: The resident can better control their center of gravity by leaning and pushing off with their stronger side, reducing the risk of tipping or falling [1].
• Reduced Caregiver Strain: When the resident assists with the transfer using their strength, the caregiver's physical strain is significantly lessened [1].
• Increased Resident Confidence: Allowing the resident to use their capabilities empowers them, fostering a sense of independence and cooperation. This can also help in their physical rehabilitation [1].

Comparison of Transfer Methods

Feature	Strong-Side Transfer	Weak-Side Transfer
Wheelchair Position	On the resident's stronger side [1]	On the resident's weaker side [1]
Resident Support	Stronger limbs are actively used for support [1]	Relies heavily on caregiver for full support [1]
Fall Risk	Greatly minimized due to resident participation [1]	Significantly increased due to instability [1]
Caregiver Strain	Lower, as resident assists with the load [1]	Higher, requiring more lifting and balancing [1]
Pivoting Ability	Smoother, using strong side to lead [1]	Awkward and difficult, with high risk of imbalance [1]
Best For	Residents with partial strength or one-sided weakness [1]	Not recommended; only for non-ambulatory transfers [1]

The Importance of Communication and Pacing

Effective communication is as crucial as proper positioning [1, 4]. The caregiver should explain each step of the transfer to the resident in a clear and calm voice [1, 4]. This builds trust and ensures the resident knows what to expect, preventing sudden, unexpected movements [1]. Before starting, establish a signal, like a "one, two, three" count, to coordinate the motion [1]. Move slowly and deliberately, pausing if the resident feels unsteady [1]. The pace should be determined by the resident's comfort level and capabilities [1]. For more advanced information on safe patient handling, a resource like the American Nurses Association provides valuable guidelines: ANA Safe Patient Handling and Mobility.

The Role of Technology and Assistive Devices

For residents with significant weakness, or when a manual transfer is unsafe, assistive devices are essential [1]. These include stand-assist aids, mechanical lifts, and transfer boards [1]. Caregivers must be properly trained in the use of any device to ensure it is used correctly and safely [1]. In some cases, a two-person transfer may be required, in which case both caregivers must communicate and work together seamlessly [1].

Conclusion: A Safer, More Dignified Experience

The question of when transferring a resident from the bed to the wheelchair who has a week's side, what side should the wheelchair be placed on? has a clear and critical answer: the stronger side [1]. This principle reduces fall risk, decreases caregiver strain, and promotes resident confidence [1]. By combining proper positioning with clear communication and, when necessary, the use of assistive devices, caregivers can ensure a safer and more dignified experience for those in their care [1, 4]. Every transfer is an opportunity to reinforce trust and uphold the resident's wellbeing, so adhering to best practices is not just a recommendation but a necessity [1].

Frequently Asked Questions

What is the primary reason to place the wheelchair on the resident's strong side?

The primary reason is to allow the resident to use their stronger, more stable limbs to assist with bearing weight and pivoting, which significantly reduces the risk of falling during the transfer [1].

What are the first steps to take before transferring a resident?

Before the transfer, you should ensure the area is clear of obstacles, place the wheelchair on the resident's strong side with the brakes locked, and communicate the process to the resident clearly [1, 4].

What if the resident has weakness on both sides?

If a resident has significant weakness on both sides and cannot assist in a pivot transfer, a mechanical lift or other assistive device should be used. This ensures maximum safety for both the resident and the caregiver [1].

Can I transfer a resident without a gait belt?

While it may be possible in some cases, using a gait belt is highly recommended and often a safety protocol. It provides a secure grip point, preventing the caregiver from grasping the resident's clothes or arms, which could cause injury [1].

How do I communicate with a resident during the transfer?

Use clear, concise, and simple language. Explain each step before you perform it. Count to three before initiating the pivot, and offer constant reassurance and instructions to the resident to maintain a smooth process [1, 4].

What should I do if the resident begins to fall during the transfer?

If a resident begins to fall, do not try to lift them. Instead, protect their head and neck and guide them safely to the floor. Use the gait belt to control their descent. Do not attempt to complete the transfer alone; seek immediate assistance [1].

What are the common mistakes to avoid during bed-to-wheelchair transfers?

Common mistakes include forgetting to lock the wheelchair brakes, transferring on the resident's weak side, not communicating with the resident, and using improper body mechanics, which can lead to injury for both parties [1, 4].