Safe Patient Handling
Transferring from a Bed to a Wheelchair Using a Transfer Belt
Select a Skill:
- » Assisting with Moving a Patient in Bed
- » Assisting with Positioning a Patient in Bed
- » Transferring from a Bed to a Wheelchair Using a Transfer Belt
- » Transferring from a Bed to a Stretcher
- » Performing Passive Range-of-Motion Exercises
- » Applying Elastic Stockings
- » Assisting with Ambulation Using a Gait Belt
- » Using a Sequential Compression Device
- » Using a Hydraulic Lift
Take the Review Test:
Safety
- Determine if the patient can fully assist or partially assist. Do not start the procedure until all required caregivers are at the bedside.
- If the patient demonstrates weakness or paralysis of one side of the body, place the wheelchair on the patient’s stronger side.
- Properly apply the transfer belt.
- Position the wheelchair facing toward the foot of the bed, midway between the head and the foot of the bed.
- Position the wheelchair at a 45-degree angle to the bed, lock the brakes, and remove the footrests or swing them out of the way. Lock the bed brakes.
- Adjust the height of the bed to the level of the wheelchair seat.
- Keep back, neck, pelvis, and feet aligned, and avoid twisting. Twisting your spine can lead to serious injury.
- Tighten stomach muscles and tuck your pelvis; this provides balance and protects the back.
- Bend at the knees; this helps to maintain your center of gravity and lets the strong muscles of the legs do the lifting.
- Keep the weight to be lifted as close to the body as possible; this action places the weight in the same plane as the lifter and keeps it close to the center of gravity for balance.
- Maintain the trunk erect and the knees bent, so that multiple muscle groups work together in a synchronized manner.
- The best height for lifting vertically is approximately 2 feet off the ground and close to the lifter’s center of gravity.
- The person with the heaviest load coordinates efforts of the personnel involved in lifting or transferring.
- Know how physiological influences on body alignment and mobility affect patients throughout the life span.
- Know the pathological conditions that affect a patient’s body alignment and mobility. Postural abnormalities affect body mechanics.
- Know the history of underlying chronic conditions (e.g., diabetes, chronic obstructive pulmonary disease) or malnutrition.
- Control factors that indirectly affect body mechanics by altering the safety of the environment. Cluttered hallways and bedside areas increase the risk of falling.
- Know the patient’s fluid balance status. Dehydration predisposes patients to orthostatic hypotension.
- Know the patient’s range of motion (ROM). Contractures or spasticity limit joint and muscle mobility.
- Determine the patient’s level of sensory perception.
Equipment
(Roll cursor over items to see labels)
Transfer belt
Nonskid slippers or shoes
Wheelchair
PrintableDelegation
The skill of transferring a patient from a bed to a wheelchair using a transfer belt can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- How to assist and supervise when moving patients who are transferring for the first time after prolonged bed rest, extensive surgery, critical illness, or spinal cord trauma
- Report any changes, such as the patient's mobility restrictions, changes in blood pressure, or sensory alterations, or any factors that may affect a safe transfer
Preparation
- Determine if the patient can fully or partially assist. Do not begin the procedure until all required caregivers are at the bedside.
- Assess the physiological capacity of a patient to transfer and the need for special adaptive techniques. Assess for the following:
- Muscle strength (legs and upper arms)
- Joint mobility and contracture formation
- Paralysis or paresis (spastic or flaccid)
- Bone continuity (trauma, amputation
- Assess for the presence of weakness, dizziness, or postural hypotension.
- Assess the patient’s level of endurance:
- Assess level of fatigue during activity.
- Assess vital signs.
- Assess the patient’s proprioceptive function, or awareness of posture, and changes in equilibrium:
- Ability to maintain balance while sitting in bed or on the side of the bed
- Tendency to sway to one side or to position himself or herself to one side
- Assess the patient’s sensory status, including adequacy of central and peripheral vision, adequacy of hearing, and loss of peripheral sensation.
- Assess the patient for pain, such as joint discomfort or muscle spasms, and measure the level of pain, using a scale from 0 to 10. Offer a prescribed analgesic 30 to 60 minutes before transfer.
- Assess the patient’s cognitive status:
- Ability to follow verbal instructions
- Short-term memory
- Recognition of physical deficits and limitations to movement
- Assess the patient’s level of motivation, such as eagerness versus unwillingness to be mobile.
- Assess for conditions such as neuromuscular deficits, motor weakness, calcium loss from long bones, cognitive and visual dysfunction, and altered balance.
- Assess for previous modes of transfer (if applicable).
Follow-up
- Monitor the patient’s vital signs. Ask if the patient feels dizzy or fatigued.
- Note the patient’s behavioral response to the transfer.
- Ask if the patient experienced pain during the transfer.
Documentation
- Record the procedure, including pertinent observations regarding weakness, ability to follow directions, balance, weight-bearing ability, ability to pivot, and amount of assistance (muscle strength) required to complete the transfer.
- Report to the next shift or other caregivers the patient’s transfer ability and the amount of assistance needed. Report the patient’s progress or remission to the rehabilitation staff (physical therapist, occupational therapist).
Review Questions
1. When preparing to safely transfer a patient from a bed to a wheelchair using a transfer belt, the nurse would do what first?
Coordinate extra help.- Assess the patient’s vital signs.
Assess the patient’s physiological capacity to transfer.- Determine whether to transfer the patient to a wheelchair or chair.
INCORRECT. The nurse must determine whether extra help is needed before arranging for such assistance.
INCORRECT. Assessing vital signs is not the first action the nurse would take.
CORRECT. Assessing the patient’s physiological capacity to transfer determines the patient’s ability to tolerate and assist with the transfer and whether special adaptive techniques are necessary.
INCORRECT. Determining whether to transfer the patient to a wheelchair or chair is not the first action the nurse would take.
2. Which instruction would the nurse give a patient who is able to assist with transfer from a bed to a wheelchair using a transfer belt?
- “When I count to three, please rock yourself into a standing position.”
- “Please hold on to my waist while I help you stand.”
- “Please tell me how I can best help you get up off the bed and stand up.”
- “Please push down onto the mattress with both hands and stand when I count to three.”
INCORRECT. The patient and nurse rock together for three counts.
INCORRECT. The patient would not be instructed to hold on to the nurse’s waist. Doing so is not a safe action.
INCORRECT. Asking the patient to advise the nurse does not instruct the patient on moving from the bed to a wheelchair.
CORRECT. Telling the patient to push against the mattress is the best instruction the nurse can give because it teaches the patient how to help achieve a standing position during the transfer.
3. A patient lying supine in bed is being transferred to a wheelchair using a transfer belt. Which action would the nurse perform just before moving the patient to the side of the bed?
- Help the patient put on skid-resistant footwear.
- Raise the head of the bed 30 degrees.
- Place the transfer belt over the patient’s clothing.
- Position the chair so that the patient will move toward his or her stronger side.
INCORRECT. Footwear would not be applied at this point in the process.
CORRECT. The nurse would raise the head of the bed 30 degrees right before moving the patient to the side of the bed.
INCORRECT. The transfer belt would not be applied at this point in the process.
INCORRECT. The wheelchair would already be in position at this point in the process.
4. The nurse is preparing to transfer a patient with left-sided weakness from the bed to a wheelchair using a transfer belt. Which position would the nurse instruct the patient to assume?
- Place both feet together on the floor.
- Place your weaker foot forward and your stronger leg toward the back.
- Extend both of your legs and feet.
- Place your stronger leg forward and your weaker leg toward the back.
INCORRECT. Placing both feet together on the floor will not help the patient stand safely.
INCORRECT. Placing the weaker foot forward places the stronger leg in the dependent position. The weaker leg, called upon to bear the bulk of the patient’s weight, may not be able to do so.
INCORRECT. Extending both of the legs and feet will not help the patient stand safely.
CORRECT. The nurse will instruct the patient to place the stronger leg forward, with the weaker foot toward the back, allowing the stronger leg to support most of the patient’s body weight.
5. A patient has been transferred to a wheelchair with a transfer belt. What is one action the nurse would take to position the patient safely in the chair?
- Remove the wheelchair leg rests.
- Ask the patient to rate his or her pain level.
- Lower the foot rests, and place the patient’s feet on them.
- Remove the transfer belt.
INCORRECT. Removing the leg rests will not help position the patient safely in the wheelchair.
INCORRECT. Asking about the patient’s pain is not relevant to safe positioning, since a patient may be comfortable even when positioned unsafely.
CORRECT. The nurse lowers the foot rests and places the patient’s feet on them once the patient has been positioned in the wheelchair. Doing so supports the patient’s feet and keeps them from dragging and creating a falling hazard when the chair is moved.
INCORRECT. Removing the transfer belt will not help position the patient safely in the wheelchair.
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