What would the nurse aide do to prevent a resident from falling when moving from bed to wheelchair?

According to the CDC, millions of older adults fall each year, with many falls occurring during transfers. Understanding the correct procedure for moving a resident is essential to ensure safety and prevent injury. This guide will detail the crucial steps a nurse aide should take to prevent a resident from falling when moving from bed to wheelchair.

Quick Summary

To prevent a resident from falling during a bed-to-wheelchair transfer, a nurse aide must first ensure the environment is safe, communicate clearly with the resident, and use proper body mechanics and assistive devices like a gait belt. The process involves methodical preparation, careful execution of the transfer, and post-transfer safety checks.

Key Points

• Prepare the Area: Always lock bed and wheelchair brakes, clear obstacles, and position the chair correctly before starting the transfer.

• Communicate Clearly: Explain the transfer process to the resident, check for dizziness before standing, and instruct them to use their hands and legs to help if possible.

• Use a Gait Belt: Apply a gait belt securely around the resident's waist to provide a firm, safe grip during the transfer.

• Employ Proper Technique: Use your leg muscles to lift and pivot, avoiding strain on your back. Stand with a wide, stable base.

• Complete Post-Transfer Checks: After the resident is seated, ensure they are comfortable, their feet are on the footrests, the brakes are engaged, and the call bell is within reach.

Ensuring a Safe Environment and Preparation

Before any transfer, a nurse aide must take several proactive steps to create a safe environment. This minimizes risks and helps both the resident and the caregiver feel more secure.

• Lock the Brakes: The first and most critical step is to lock the brakes on both the bed and the wheelchair. This prevents the equipment from shifting unexpectedly during the transfer, which is a major cause of falls.
• Position the Wheelchair: Place the wheelchair as close to the bed as possible, on the resident's stronger side if applicable. The wheelchair should be positioned at a slight angle to allow for a pivot transfer rather than a direct turn, which can be awkward and unsafe.
• Clear the Area: Ensure the pathway is clear of any clutter, rugs, or obstacles that could be tripped over. The floor should be dry to prevent slipping.
• Adjust Bed Height: Raise the bed to a safe, comfortable working height for the nurse aide. This helps maintain proper body mechanics, preventing back strain for the caregiver and making the resident's transfer easier.

Communicating with the Resident

Clear communication is key to a successful and safe transfer. It helps the resident feel involved and reduces anxiety.

• Explain the Process: Tell the resident exactly what you plan to do, step by step. This allows them to mentally prepare and cooperate with the move.
• Encourage Participation: Encourage the resident to help as much as they are able, such as pushing off the bed with their hands or using their stronger leg. This promotes independence and muscle engagement.
• Check for Dizziness: Before standing, have the resident sit on the edge of the bed for a few moments. Ask them if they feel dizzy. This check is crucial for residents who may experience orthostatic hypotension (a drop in blood pressure upon standing), which can cause lightheadedness and fainting.

Proper Transfer Technique

Once the environment is safe and communication is established, the nurse aide can proceed with the transfer using the correct technique.

Using a Gait Belt Safely

A gait belt is a vital tool for assisting in a transfer, providing a secure handle to support the resident..

1. Apply the belt snugly around the resident's waist, over their clothing, ensuring it doesn't pinch or feel too tight.
2. Check that the belt buckle is centered in the front for easy access.
3. Grasp the belt from the sides or back, using a firm, underhand grip.

The Pivot Transfer Steps

1. Position the Resident: Help the resident move to the edge of the bed, with their feet flat on the floor.
2. Caregiver's Stance: Stand directly in front of the resident, with your feet shoulder-width apart. Place your inner foot slightly in front of your outer foot to create a stable base.
3. Count to Three: On the count of three, guide the resident to a standing position, using your legs to lift rather than your back. The resident can push off with their hands and stronger leg to assist.
4. Pivot: Once standing and steady, pivot together towards the wheelchair. The resident should be looking towards the wheelchair, not at their feet.
5. Lower onto the Wheelchair: As the resident backs up to the wheelchair, instruct them to place their hands on the armrests. On the count of three, gently lower them into the chair, bending at your knees and keeping your back straight.

Comparison of Fall Prevention Techniques

Technique	Description	Resident Benefit	Nurse Aide Benefit	Considerations
Gait Belt Transfer	Using a belt to assist a resident to stand and pivot.	Offers firm support and security during the move.	Provides a secure grip, reducing risk of back injury.	Not suitable for all residents (e.g., abdominal wounds).
Stand-Assist Lift	A mechanical device that assists a resident who can bear some weight to stand.	Reduces physical strain and provides greater stability.	Minimizes physical exertion and reduces risk of injury.	Requires resident to have some leg strength and upper body control.
Full-Body Lift (Hoyer Lift)	A mechanical lift used for residents unable to bear any weight.	Provides complete support and eliminates physical lifting.	Completely removes the need for manual lifting.	Always requires two trained assistants for safety.

Post-Transfer Safety Measures

Once the resident is successfully seated in the wheelchair, the nurse aide must not assume the process is complete. Final safety checks are vital to prevent a fall from the chair itself.

• Ensure Proper Seating: Check that the resident is sitting back comfortably and securely in the chair.
• Reposition Footrests: Move the resident's feet onto the footrests and ensure they are positioned correctly. Swing the footrests away from the chair before the transfer to avoid tripping hazards, and return them afterward.
• Final Brake Check: Double-check that the wheelchair brakes are still engaged, especially if the chair is not moving immediately.
• Call Bell: Make sure the resident's call bell is within reach, allowing them to summon help if needed.

Conclusion: Commitment to Safety

Preventing a fall during a bed-to-wheelchair transfer is a multi-step process that relies on careful planning, clear communication, and proper technique. From preparing the environment by locking brakes and clearing obstacles to using assistive devices like a gait belt and following a careful procedure, a nurse aide plays a pivotal role in ensuring resident safety. Ongoing vigilance and adherence to these best practices are essential to protecting the well-being of residents in their care. For more information on patient safety protocols, consult authoritative healthcare resources like the Agency for Healthcare Research and Quality (AHRQ).

Frequently Asked Questions

What is the most important step before moving a resident from bed to wheelchair?

The single most important step is to lock the brakes on both the bed and the wheelchair. This prevents unexpected movement that could lead to a fall and is a fundamental safety procedure.

When should a gait belt not be used for a transfer?

A gait belt should not be used if the resident has had recent abdominal surgery, has a feeding tube, ostomy, or certain heart conditions. In such cases, a different transfer method, such as a mechanical lift, should be used based on the care plan.

How can a nurse aide check for dizziness before a transfer?

After the resident is sitting up on the edge of the bed, the nurse aide should have them wait for a few moments. Ask the resident directly, 'Do you feel dizzy or lightheaded?' This simple question helps assess for orthostatic hypotension before they stand.

How should a nurse aide position their body to prevent back injury during a transfer?

A nurse aide should stand with their feet shoulder-width apart to create a stable base, bend at their knees and hips, and keep their back straight. The lifting should come from the legs, not the back, to prevent strain and injury.

Why is it important to talk to the resident during the transfer?

Talking to the resident serves multiple purposes. It keeps them engaged and cooperative, reduces anxiety by explaining the steps, and ensures they are alert and feeling well throughout the process.

What is the difference between a stand-assist lift and a full-body mechanical lift?

A stand-assist lift is for residents who have some weight-bearing capability and can help with the standing motion. A full-body lift, like a Hoyer lift, is for residents who cannot bear any weight and requires two people to operate safely.

What is the correct way to position a resident's feet during a transfer?

The resident's feet should be placed flat on the floor, directly beneath their knees. Their feet should be wearing non-skid footwear to provide traction and prevent slipping.