When assisting a patient resident with transferring, the nursing assistant prioritizes safety and clear communication

Back injuries are one of the most common workplace injuries for nursing assistants, with statistics showing a significantly high rate due to improper lifting and transferring techniques. Therefore, when assisting a patient resident with transferring, the nursing assistant must prioritize safety by preparing the environment, communicating clearly with the resident, and using proper body mechanics to protect both themselves and the patient.

Quick Summary

The nursing assistant ensures a safe and smooth transfer by assessing the resident's mobility, preparing the area, communicating each step, and using appropriate equipment. Correct body mechanics, such as bending knees and pivoting feet, are essential to prevent injury. The process is customized based on the resident's strength, condition, and any specified care plan instructions.

Key Points

• Pre-transfer safety checklist: Always check the resident's care plan, gather all necessary equipment, and remove environmental hazards before starting any transfer.

• Use proper body mechanics: To prevent injury, nursing assistants should bend their knees, keep their back straight, maintain a wide stance, and lift with their leg muscles, not their back.

• Prioritize clear communication: Explain the transfer process to the resident clearly and calmly to reduce anxiety and ensure cooperation. Always encourage their participation if they are able.

• Utilize assistive devices: Depending on the resident's needs, use appropriate equipment such as a gait belt for support or a mechanical lift for non-weight-bearing transfers.

• Protect the resident's weak side: For residents with one side weaker than the other, position the equipment and perform the transfer toward their stronger side to maximize their assistance and stability.

• Lock all equipment wheels: This is a critical safety step to prevent accidental movement. Ensure brakes are locked on the bed, wheelchair, or any other wheeled device involved in the transfer.

• Wear non-skid footwear: Both the nursing assistant and the resident should wear non-skid footwear to provide traction and prevent slips or falls during the transfer.

Essential steps before any transfer

Before initiating any patient transfer, the nursing assistant must follow a series of crucial preparation steps to ensure the safety and comfort of the resident. This includes a careful assessment, clear communication, and readying the environment. The specific needs of each resident, including any physical limitations or weaknesses, must be accounted for.

• Review the care plan: Always check the resident's care plan for the correct transfer method. This specifies the level of assistance required, which might be a one-person assist, two-person assist, or a mechanical lift.
• Gather equipment: Collect all necessary equipment before starting. This may include a gait belt, wheelchair, or mechanical lift. Having everything on hand prevents leaving the resident unattended during the process.
• Prepare the environment: Remove any obstacles from the transfer path, such as rugs, furniture, or medical tubing. Position the destination surface—whether it's a chair, wheelchair, or commode—as close as possible to the resident. Always ensure the brakes are locked on the bed and any wheeled equipment.
• Ensure proper attire: Make sure the resident is wearing appropriate, non-skid footwear to prevent slipping. Check that the resident's clothing is not loose or in a position to cause a trip hazard.
• Explain the procedure: Inform the resident clearly and calmly about what is going to happen, describing each step of the transfer. This reduces anxiety and encourages cooperation. Never use complex medical jargon. If the resident is able, encourage them to help as much as they can.

Proper body mechanics for a nursing assistant

Proper body mechanics are the foundation of a safe transfer. Using the correct posture and movements protects the nursing assistant from musculoskeletal injury, particularly back strain, which is a significant risk in this profession.

1. Bend at the knees: Instead of bending at the waist, keep your back straight and bend your knees to get to the resident's level. The large muscles in your legs are much stronger and can bear weight more safely than your back.
2. Maintain a wide base of support: Stand with your feet shoulder-width apart, with one foot slightly in front of the other. This lowers your center of gravity and increases your stability.
3. Keep the resident close: Always work as close to the resident as possible. Holding a heavy object or person away from your body increases the strain on your back.
4. Pivot, don't twist: Never twist your torso while transferring a resident. To turn, move your feet and pivot your entire body in the direction of the transfer. Keep your hips and shoulders aligned.
5. Lift with your legs: During the lift, push up with your legs rather than using your back muscles.

Comparison of transfer types

Transfer Type	Resident Participation	Equipment Used	CNA Requirement	Key Safety Points
Stand Pivot	Partial weight-bearing; follows commands.	Gait belt, non-skid footwear.	One person (with a strong resident) or two people (for greater assistance).	Position on resident's strong side; lock all equipment brakes; use a wide stance.
Lateral (Sliding Board)	Upper body strength; unable to bear weight on legs.	Sliding board, transfer belt.	Often requires two people for safety.	Ensure board is properly placed; do not pinch fingers; use friction-reducing sheets.
Mechanical Lift (Sit-to-Stand)	Partial weight-bearing; follows commands; good upper body strength.	Sit-to-stand lift, sling, nonskid footwear.	One or two people, depending on facility policy and resident stability.	Check sling placement; keep resident's feet on base; lock wheels before starting.
Mechanical Lift (Full-Body)	Non-weight-bearing; no or limited mobility.	Full-body lift, sling.	Always requires two people for safety.	Ensure sling fits properly; follow manufacturer's instructions; keep arms within sling.

Executing a stand pivot transfer from bed to wheelchair

For a resident who can bear some weight, the stand pivot transfer is a common and effective method.

1. Position the resident: Raise the head of the bed, then assist the resident to a seated position with feet flat on the floor. Allow them a moment to dangle their feet and adjust to prevent dizziness.
2. Position the wheelchair: Place the wheelchair next to the bed at a 45-degree angle on the resident's stronger side. Lock the wheelchair brakes and move the footrests out of the way.
3. Apply the gait belt: Fasten the gait belt snugly around the resident's waist, over their clothing. Check that it is tight enough to grip firmly but not so tight as to cause discomfort.
4. Stand and brace: Stand in front of the resident, placing your feet shoulder-width apart. Position your knees against the resident's knees to provide stability.
5. Count and stand: On the count of three, have the resident push off the bed with their hands while you grasp the gait belt and shift your weight from your back to your front leg, assisting them to a standing position.
6. Pivot to the wheelchair: With the resident standing, pivot together in small steps toward the wheelchair. Wait for the resident to feel the wheelchair against the back of their legs.
7. Lower and secure: Instruct the resident to reach back for the armrests as you bend your knees and shift your weight back, gently lowering them into the wheelchair. Once seated, remove the gait belt, reposition the footrests, and ensure they are comfortable.

Conclusion

By consistently following established protocols, employing proper body mechanics, and ensuring clear, respectful communication with residents, nursing assistants can perform transfers that are both safe and dignifying. The specific method of transfer is determined by the resident's physical capabilities and the care plan, but the principles of preparation, safety, and communication remain constant. This diligence protects not only the patient from falls and injury but also safeguards the nursing assistant's own health and well-being.

For more comprehensive information on proper patient handling techniques, a resource such as Physiopedia provides detailed guides and principles.

Frequently Asked Questions

What should the nursing assistant do first before transferring a resident?

First, the nursing assistant should check the resident's care plan, perform hand hygiene, gather all necessary equipment like a gait belt, and introduce themselves to the resident. Explaining the procedure calmly is also a crucial initial step to ensure the resident's cooperation and reduce anxiety.

How should a nursing assistant position themselves during a transfer to avoid injury?

A nursing assistant should use proper body mechanics by bending at the knees instead of the waist, keeping their back straight, and maintaining a wide base of support with feet shoulder-width apart. They should also keep the resident's weight as close to their body as possible during the transfer.

When transferring a resident with a weaker side, on which side should the nursing assistant position the wheelchair?

The nursing assistant should position the wheelchair or other transfer destination on the resident's stronger, or unaffected, side. This allows the resident to use their stronger side to assist with the pivot and movement, improving stability and safety.

Why is a gait belt used during a resident transfer?

A gait belt is used to provide the nursing assistant with a secure and firm grip on the resident's waist, which aids in supporting their balance and controlling their movement during a transfer. It is a safety tool, not a lifting device.

What is the correct way to transfer a resident from a bed to a wheelchair using a gait belt?

After preparing the environment and the resident, the CNA helps the resident to a seated position with feet flat on the floor. They apply the gait belt, stand with knees bent and feet apart, and brace their knees against the resident's knees. On a count, they assist the resident to stand by pushing with their legs, pivot toward the chair, and gently lower them.

What should be done if a resident starts to fall during a transfer?

If a resident begins to fall, the nursing assistant should not try to stop the fall completely, as this can cause injury to both parties. Instead, they should widen their stance, bring the resident close, and use their leg muscles to gently lower the resident to the floor in a controlled manner, protecting the head.

What are the final steps after completing a transfer?

After the resident is safely transferred and seated comfortably, the nursing assistant should ensure the call light is within reach, remove the gait belt, and perform hand hygiene. The resident should be checked for proper body alignment and comfort.