When assisting a client two or from a chair, you should always?

According to the CDC, falls are the leading cause of injury-related death among adults aged 65 and older. To minimize risk and ensure safety for both you and the client, you should always prepare the environment, communicate clearly, and use proper body mechanics when assisting a client two or from a chair.

Quick Summary

Ensure safety and comfort during transfers by always assessing the client's capabilities and surroundings, communicating each step clearly, and utilizing proper body mechanics with assistive devices like a gait belt when needed. Plan the transfer to minimize risks and respect the client's dignity.

Key Points

• Pre-Assess the Situation: Always assess the client's condition, the environment for hazards, and ensure all equipment like wheelchair brakes are locked before starting any transfer.

• Communicate Clearly: Provide simple, step-by-step instructions to the client, using consistent verbal cues like 'Ready, steady, stand,' to ensure coordinated movement.

• Use Proper Body Mechanics: Stand with your feet shoulder-width apart, bend your knees, and keep your back straight to lift with your legs, not your back, protecting yourself from injury.

• Engage Assistive Devices: Use a gait belt for a secure grip during transfers, and a mechanical lift for clients who are non-weight-bearing, to ensure maximum safety.

• Never Pull on Arms: Always avoid pulling or jerking on a client's arms or shoulders, as this can cause serious injury; a gait belt or proper technique is the correct way to provide support.

• Maintain Control During Descent: Guide the client slowly and remain in front of them until they are safely and completely seated in the target chair to prevent falls at the final stage.

Prioritizing Safety Through Preparation and Communication

Transferring a client from a chair is a common task in senior care and home health, but it's also one of the most common sources of injury for both the client and the caregiver. The key to a successful, safe, and dignified transfer lies in a three-pronged approach: thorough preparation, clear communication, and impeccable execution using correct techniques. These principles not only prevent falls but also empower the client by including them in the process, fostering a sense of control and collaboration.

The Importance of a Pre-Transfer Assessment

Before you begin, a quick assessment is paramount. This isn’t just about the client's physical state but also about the environmental conditions and available resources. A well-executed transfer begins long before the first movement.

• Assess the Client's Condition: Is the client dizzy, fatigued, or in pain? Are they able to follow instructions? Do they have a stronger side? These questions will inform your entire approach. A client who is weak on their right side should be approached from their left. Checking in on their status right before the transfer can prevent issues.
• Clear the Area: Any objects in the transfer path—loose rugs, furniture, pet toys—can become a tripping hazard. Ensure the path is clear and well-lit. There should be ample space to maneuver around the chair.
• Lock All Devices: Brakes on wheelchairs and beds must be locked securely. The chair you are transferring to should be stable and placed on a non-slip surface.
• Use Proper Footwear: Both the client and the caregiver should be wearing non-slip shoes with good grip. Bare feet or socks can lead to a slip, especially on hard floors.

The Step-by-Step Transfer Process

Once the area is prepared and the client is ready, follow a systematic process to minimize risk and maximize comfort.

1. The Setup: Positioning the Client and Yourself

Positioning is the foundation of a safe transfer. It ensures stability and leverage for both parties.

• Client Position: Help the client scoot to the edge of the chair, with their feet flat on the floor, shoulder-width apart. Their feet should be slightly behind their knees to facilitate a forward motion. This is crucial for leveraging their body weight effectively.
• Caregiver Position: Stand directly in front of the client. Your feet should be wide apart, creating a strong base of support. Your knees should be bent, not your back, to engage your leg muscles. If using a gait belt, ensure it is snugly fastened around the client's waist.

2. The Execution: Standing and Pivoting

Executing the transfer involves clear cues and coordinated movement.

• Verbal Cues: Tell the client exactly what to expect. Use simple, clear instructions like, “On the count of three, we will stand up together.” A countdown prepares them mentally and physically. Using a consistent phrase, such as “Ready, steady, stand,” can help synchronize movements, especially if two caregivers are assisting.
• Standing: As you count, encourage the client to push off from the armrests of the chair while you assist with a firm grip on the gait belt. Crucially, never pull a client by their arms or shoulders, as this can cause injury.
• Pivoting: Once standing, pivot toward the target chair or surface. The client should be instructed to take small, controlled steps. It is often safest to turn towards the client's stronger side. You should be in front, guiding the movement.

3. The Follow-Through: Sitting Down Safely

The descent into the new chair is just as important as the ascent. Many falls occur during this final stage.

• Proper Positioning: Ensure the client's legs are touching the back of the target chair before they sit down. This provides a tactile cue that they are in the correct position.
• Verbal Cues: Instruct the client to reach back for the armrests of the new chair and to bend at the hips and knees slowly. You will provide gentle, controlled assistance with the gait belt as they lower themselves.
• Remain Supportive: Remain in front of the client until they are fully and safely seated. Make sure they are comfortable before disengaging and moving to the next task.

Transfer Method Comparison Table

Feature	One-Person Stand-Pivot Transfer	Two-Person Stand-Pivot Transfer	Mechanical Lift Transfer
Level of Assistance	Minimal to moderate; client has some weight-bearing ability.	Moderate to maximal; client requires significant support.	Maximal; client is non-weight-bearing.
Equipment	Often a gait belt.	Two gait belts or one gait belt with two-person handling.	Powered or manual lift with a sling.
Risk of Injury	Lower for both parties if proper technique is used.	Reduced risk due to shared load; requires excellent coordination.	Lowest for both client and caregiver due to automated lifting.
Dignity & Independence	Promotes independence as much as possible.	Still encourages client participation but with more support.	Can be less personal; focus is on safe, efficient transfer.
Communication Needs	Clear and direct verbal cues.	Clear, coordinated, and consistent verbal cues between caregivers and client.	Explaining the process and ensuring client comfort during setup.

The Role of Technology and Assistive Devices

While good technique is vital, assistive devices can significantly enhance safety and reduce caregiver strain. A gait belt is the most common tool, but others exist for more challenging situations.

• Gait Belts: A gait belt should be used for most assisted transfers. It provides a secure handle for the caregiver to support the client's core, preventing a dangerous grip on the client's arms.
• Mechanical Lifts: For non-weight-bearing clients or those with significant mobility issues, mechanical lifts (e.g., Hoyer lifts) are the safest option. They eliminate the need for manual lifting, protecting both the client and caregiver from injury.
• Transfer Boards: For transfers between surfaces of similar height (e.g., bed to wheelchair), a transfer board can help bridge the gap, allowing the client to slide over smoothly with minimal lifting.

A Final Word on Empathy and Dignity

Remember that assisting a client with a simple movement like a chair transfer can impact their sense of independence. Approach each interaction with patience, empathy, and respect. Encourage them to participate as much as they are able, and always explain your actions beforehand. A transfer is more than a physical task; it's an opportunity to build trust and provide compassionate care. For more detailed information on safe patient handling, a comprehensive resource is the Occupational Safety and Health Administration (OSHA) guidelines.

In conclusion, when faced with the question of what to do when assisting a client to or from a chair, the answer is always to prioritize safety through preparation, communication, and proper technique. By consistently applying these principles, caregivers can protect themselves and their clients, ensuring every transfer is as safe and comfortable as possible.

Frequently Asked Questions

What is the most common cause of injury during a client transfer?

The most common cause of injury during a transfer is improper lifting technique by the caregiver, such as twisting the back or lifting with the arms instead of the legs, and improper positioning of the client or equipment.

How can I make the transfer more comfortable for the client?

You can increase comfort by ensuring the transfer is done slowly and with clear communication, using a gait belt for support, and allowing the client to do as much as they safely can. Ensuring their footwear is non-slip is also key.

Should I use a gait belt when assisting a client to or from a chair?

Yes, unless contraindicated by a medical condition, a gait belt should almost always be used for assisted transfers. It provides a secure, ergonomic handle for the caregiver, protecting both parties from injury.

What if the client becomes dizzy during the transfer?

If a client becomes dizzy, immediately guide them back to a seated position safely. Do not continue the transfer. Wait for a moment, check on their status, and reassess if it is safe to proceed.

When should I use a mechanical lift instead of a manual transfer?

A mechanical lift should be used for clients who are non-weight-bearing, significantly heavier than the caregiver, or if the client's condition makes a manual transfer unsafe. Always follow the care plan's guidance on transfer methods.

How do I involve the client in the transfer process?

Involve the client by explaining each step beforehand, asking for their input, and encouraging them to use their own strength to assist. This promotes dignity and helps them feel more secure and in control.

What's the best way to coordinate with another caregiver during a two-person transfer?

Effective coordination involves appointing one person to be the lead, using consistent verbal cues (e.g., 'Ready, steady, stand'), and making eye contact before the lift to ensure synchronized movement.