What is a CNA's responsibility during an in-house transfer of the resident?

According to the Agency for Healthcare Research and Quality (AHRQ), roughly 38,000 in-house patient transfers occur annually within U.S. hospitals alone, underscoring the frequency and importance of these moves. Understanding what is a CNA's responsibility during an in-house transfer of the resident is fundamental for providing safe, dignified, and compassionate care during these transitions.

Quick Summary

A CNA's responsibility during an in-house resident transfer involves careful planning, safe use of proper body mechanics and assistive devices, clear communication with the resident and care team, and meticulous documentation. Prioritizing the resident's dignity and safety is crucial, ensuring a smooth transition that minimizes anxiety and prevents injury.

Key Points

• Pre-Transfer Assessment: Review the resident’s care plan and gather all necessary equipment, such as a gait belt or wheelchair, before starting the transfer.

• Safe Body Mechanics: Use proper lifting techniques, keeping your back straight and lifting with your legs, and enlist help from other staff for heavy transfers to prevent injury to yourself and the resident.

• Clear Communication: Explain each step of the transfer process to the resident clearly and calmly to reduce their anxiety and encourage their cooperation.

• Maintain Dignity and Comfort: Ensure the resident is covered and comfortable throughout the move, respecting their privacy and personal space.

• Thorough Documentation: Accurately chart the transfer details, including any observations made about the resident's condition or tolerance during the move.

• Effective Hand-off: Verbally report the resident's arrival and any important information to the receiving nursing staff to ensure a smooth transition of care.

Preparing for the Transfer

Proper preparation is the cornerstone of a safe and successful in-house transfer. Rushing this process can lead to miscommunication, increased resident anxiety, and a higher risk of injury for both the resident and the caregiver. The preparation phase requires attention to several key details.

Before the Move

• Review the Resident's Care Plan: The CNA must review the resident’s care plan to understand specific transfer instructions, weight-bearing status, and any physical or cognitive limitations. This includes checking for any recent changes in condition that might affect the transfer method.
• Gather Equipment: All necessary equipment, such as a wheelchair, gait belt, stretcher, or lifting device, must be gathered and checked for proper function before entering the resident's room.
• Communicate with the Resident: Clearly and calmly explain the plan to the resident, including where they are going and how the transfer will occur. This helps build trust and reduces fear. Encouraging the resident to participate as much as possible promotes their independence.
• Ensure the New Space is Ready: Confirm that the receiving room is prepared. This might involve ensuring a bed is made, necessary items are accessible, and the area is clutter-free.

The Transfer Process

Once preparation is complete, the CNA can initiate the transfer, keeping the resident's safety and comfort as the highest priorities. This stage relies heavily on communication and the use of proper techniques.

The Move Itself

1. Introduce and Identify: Introduce yourself and confirm the resident's identity using at least two identifiers, such as their name and date of birth.
2. Ensure Privacy: Maintain the resident's dignity by ensuring privacy throughout the process, closing doors or using curtains as needed.
3. Engage and Instruct: Communicate with the resident step-by-step. For instance, instruct them to push off the bed and onto the wheelchair, using their arms if able.
4. Use Proper Body Mechanics: To prevent injury to yourself and the resident, always lift with your legs, not your back, and maintain a wide, stable base. Keep the resident close to your body and avoid twisting your spine.
5. Secure the Resident: Use the gait belt for transfers from bed to chair or for ambulation, ensuring it is snug but not constricting. The gait belt is a stabilizing tool, not a lifting device.
6. Pivot, Don't Twist: When moving from one surface to another, pivot your feet rather than twisting your back. This protects your spine and makes the movement safer and more controlled.

After the Transfer: Post-Move Responsibilities

The CNA's role doesn't end when the resident arrives at the new location. A complete transfer includes ensuring the resident is settled and that all necessary information has been conveyed to the new care team.

• Settle the Resident: Help the resident get comfortable in their new space. Ensure the bed is in its lowest position, the call bell is within reach, and any personal items are organized.
• Hand-off Communication: Report the resident's arrival and any relevant details to the charge nurse or receiving staff in the new unit. This 'hand-off' is crucial for continuity of care.
• Document the Transfer: Accurately document the time of the transfer, the method used, the resident's tolerance of the move, and any changes in their condition.
• Check on Belongings: Confirm all personal belongings have been transferred and accounted for.

Comparison of Assisted vs. Full-Dependent Transfers

Feature	Assisted Transfer	Full-Dependent Transfer
Resident's Role	The resident can bear some weight and assist with the transfer.	The resident cannot bear weight or assist with the transfer.
Equipment	May require a gait belt, cane, or wheelchair.	Requires specialized equipment like a mechanical lift or Hoyer lift.
Caregiver Effort	The CNA provides stability and guidance, using their legs to assist with the move.	The CNA must manage the entire lift and transfer, often with assistance from a second caregiver.
Technique	The CNA guides the resident through standing and pivoting with proper foot placement.	The CNA or team uses the lift to raise and position the resident safely.
Key Focus	Encouraging independence and building confidence.	Maximizing safety and minimizing physical strain for both the resident and staff.

Conclusion

Ultimately, the CNA’s responsibility during an in-house transfer is a combination of technical skill, proper procedure, and compassionate communication. By meticulously preparing for the move, executing the transfer with safety and dignity, and communicating effectively with both the resident and the healthcare team, CNAs ensure that a potentially stressful event is managed smoothly. Following these protocols not only protects the resident from harm but also ensures a seamless transition of care. Ongoing training and adherence to facility policies, as outlined by organizations like the American Nurse Journal, are essential for maintaining these high standards of care. For further insights on patient safety, consult resources from authoritative organizations American Nurse Journal.

Frequently Asked Questions

What is the very first step a CNA should take before an in-house resident transfer?

The first step is to confirm the resident's identity using two identifiers and review their care plan to understand their specific needs and limitations for the transfer.

Why is using a gait belt so important for CNAs during transfers?

A gait belt provides a secure, firm grip for the CNA to assist and stabilize the resident, giving them more control and reducing the risk of falls or injury for both parties.

What should a CNA do if a resident appears dizzy during the transfer?

If a resident shows signs of dizziness or lightheadedness, the CNA should immediately help them back to a seated position and have them rest. The CNA must report this incident to the charge nurse.

What kind of communication is necessary during an in-house transfer?

Effective communication involves not only speaking with the resident but also reporting their arrival and any relevant details to the receiving staff to ensure continuity of care.

How can a CNA ensure a resident's belongings are safely transferred?

The CNA is responsible for managing the resident's personal belongings, including ensuring they are securely packed, moved with the resident, and accounted for in the new location.

What is the correct way for a CNA to use proper body mechanics during a transfer?

CNAs should bend their knees, keep their back straight, and lift with their legs. They should also maintain a wide base of support and keep the resident close to their body.

Is it the CNA's responsibility to notify the family of an in-house transfer?

No, notifying the family is typically the responsibility of administrative staff, social workers, or nursing staff. The CNA focuses on the direct care of the resident during the move.