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Transfers and Assistive Devices

Transfers are one of the most important parts of being a Personal Support Worker. What is even more important than knowing how to do them, is knowing how to do them properly.

One thing that all PSW's need to remember is Body Mechanics, which is the use of muscles, body movements, and posture in a way that aids in lifting. This method will not only securely transfer your resident but it will ensure you do not hurt your back.

Assistive devices are important in regards to transferring, the different assistive devices are:
 Transfer belt—a wide, webbed belt, up to five feet long, that is placed around a resident’s waist. It is used to stabilize and direct the resident, never to lift.
 Hydraulic lift—a mechanical device used for heavy residents or those who cannot bear weight on their legs. Never used to wheel patients to another location. Caregivers must be specially trained to use lifts safely.
 Slide board—a smooth plank of hard material that is placed between two surfaces of equal height such as a bed and a chair.
The resident slides across the "bridge" with assistance from the caregiver.
 Transfer board—a full-length board that is used to transfer residents in a flat, lying down position.
Usually used for residents who must keep their spines straight because of spinal injury or suspected spinal injury.
 Drawsheet—a sheet placed beneath the resident’s hips and shoulders used to turn or transfer a resident who must remain lying down. Never use a drawsheet for a resident who has, or is at risk for, a back injury.

Now for an overview of the different sorts of transfers and how to accomplish them in a safe manner.

Before beginning a transfer, you should have a basic understanding of the resident’s medical condition. Heart or respiratory problems can interfere with endurance, arthritis may cause significant pain on transfer, and history of a stroke may have left the resident paralyzed on one side. Has there been recent surgery? Is the resident confused or weak? If you’re unsure about how the resident’s medical status might affect a transfer, check with the nurse.

Transfers are guiding and/or assisting the patient from one surface to another. The patient is able to bear some weight in the legs and/or arms, and/or a part of the weight is borne by an assistive device such as a transfer board, walker or cane.

Lifts are any procedure where the patient’s entire body weight is borne by someone or something other than the patient (i.e.: a mechanical lifting device) for purposes of repositioning or moving to another surface. Repositioning is shifting, adjusting or changing the patient’s position in bed, wheelchair, chair, or other supportive surface.

ASSESSMENT
Completing an assessment before a transfer or lift is important because it:
Helps to determine risk for injury.
Promotes continuity of care.
Helps you to be prepared for possible risks.
Helps to minimize the risk of injury for the health care worker and the client.

ASSESSMENT OF THE WORK AREA
The work area should allow easy access to patients.
A room should not be cluttered with furniture or equipment.
A cluttered room increases the potential for trips and falls.
A small room, such as a bathroom, may not allow natural body movements.
Transfer patients onto a shower chair outside the bathroom to reduce transfers in crowded spaces.
In small rooms, there may not be enough room for a portable lifting device. There are fixed lifting aids ontracks which do not require a lot of space.
There should be enough clearance around beds and toilets to allow access on either side (at least 90 cm).
A highly polished or wet floor does not provide good traction or a safe base for lifting (i.e. shower). Slips are more likely to occur on a highly polished or wet floor.
Cover floors that get wet with a non-slip material.

EQUIPMENT
Removable arm and foot rests on wheelchairs and shower chairs make transfers easier.
Beds that can be raised or lowered also make transfers easier.
Adaptive clothes are needed for patients who are toileted using the hoist.
The shower and toilets should be designed so pushing and pulling shower chairs into position is as easy as possible (i.e. reduce height changes in the floor).

STAFFING
Ensure there are enough nurses and nursing assistants available to perform patient handling tasks safely especially during high activity periods.

CLIENT COGNITION
Assess the client’s senses, state of mind, memory, communication medical status and physical condition before engaging in client handling procedure.

ONE-PERSON TRANSFER BELT/ PIVOT TRANSFER
This should be used when a client can stand unsupported or weight bear with assistance of one person who will provide less than 40 pounds (18 kg) of assistance. (5) This transfer can also be performed if the physician orders feather, toe-touch or partial weight bearing. For safe handling a transfer belt must be used.

TWO-PERSON STANDING PIVOT TRANSFER
This transfer should be used when a client can bearweight through the legs but is heavy and unreliable. This technique requires two health care workers, with the tall person behind the patient. A transfer belt must be used.

WALKER TRANSFER
Walker transfer should be used when a client can bear weight through at least one leg, and whose upper extremity strength and mobility are adequate. This can also be used if the physician orders feather, toe-touch,or partial weight bearing.

SIT-STAND MECHANICAL LIFT (SARA LIFT)
This lifting technique should be used when a client can sit with minimal support at the edge of the bed and is able to bear some weight
The client may be cognitively predictable and reliable.
The client is able to tolerate harness under his/her arms. This should not be used with clients who have a hemiplegic arm
Avoid awkward or sustained postures or repetitive movements by varying your work activities throughout your day.
Avoid forceful movements with a high load to avoid back injury.
Maintain a neutral relaxed posture.
Maintain client handling equipment.
Ensure adequate staff to client ratios when considering engaging in client handling procedures.
Ensure that staff has access to appropriate patient handling devices and ensure that all devices are in good working order.
Ensure that your work area provides easy access to clients. (i.e. transfer patients onto a shower chair outside the bathroom to reduce transfers in crowded spaces).
Plan ahead to ensure that you have considered all of the factors before engaging in a client-handling procedure.
Adjust the working height of equipment to avoid bending stretching or twisting.
Consider the use of a mechanical aid for client transfers.
Exercise such as strength and conditioning helps maintain functional ability and helps prevent muscle sprains, low back pain, osteoarthritis, osteoporosis, shoulder instability and knee stability and pain.
Stretching should be incorporated into an exercise program to help improve flexibility.
Do not lift anything immediately after sitting for an extended period of time. Walk around and loosen up.

*Remember a client/residents dignity and safety ALWAYS comes first!*

TOTAL MECHANICAL LIFT
A total mechanical lift should be used when a client can only minimally transfer or is not able to assist with weight bearing. This should also be used if the client is cognitively unreliable or uncooperative, has poor head control or sitting balance or is extremely large or heavy and requires assistance.

PREVENTION of Injury for residents and PSW
 Examine your work environment.
 Avoid awkward or sustained postures or repetitive movements by varying your work activities throughout your day.
 Avoid forceful movements with a high load to avoid back injury.
 Maintain a neutral relaxed posture.
 Maintain client handling equipment.
 Ensure adequate staff to client ratios when considering engaging in client handling procedures.
 Ensure that staff has access to appropriate patient handling devices and ensure that all devices are in good working order.
 Ensure that your work area provides easy access to clients. (i.e. transfer patients onto a shower chair outside
 the bathroom to reduce transfers in crowded spaces).
 Plan ahead to ensure that you have considered all of the factors before engaging in a client-handling procedure.
 Adjust the working height of equipment to avoid bending stretching or twisting.
 Consider the use of a mechanical aid for client transfers.
 Exercise such as strength and conditioning helps maintain functional ability and helps prevent muscle sprains,
 low back pain, osteoarthritis, osteoporosis, shoulder instability and knee stability and pain.
 Stretching should be incorporated into an exercise program to help improve flexibility.
 Do not lift anything immediately after sitting for an extended period of time. Walk around and loosen up.

*Remember a client/residents dignity and safety ALWAYS comes first!*