Back Care Lab PDF

BACK CARE
&
PATIENT TRANSFERRING TECHNIQUES
LETHBRIDGE COMMUNITY COLLEGE

HEALTH & ALLIED WELLNESS
Developed by Em M. Pijl Zieber RN, BSN

2002; Revised 2004
INTRODUCTION
Welcome to the Back Care and Patient Transferring Techniques workshop. I am
confident that your time spent in this workshop will be extremely valuable to you.
You have chosen a line of work that is physically demanding. There are also many
psychological and emotional demands when working closely with people. As care
providers who work with individuals who have limited physical capabilities you are
at risk for getting hurt. When you assist individuals who require help walking or
transferring (for example, from a bed to a wheelchair) you need to be very careful
and use techniques that protect your back. As you will learn in this workshop, the
back is vulnerable, but there are methods you can use to minimize the risk of
personal injury while transferring and assisting individuals. These techniques are
some of the most valuable skills you will learn because they will prepare you for a
long, injury-free career and a disability-free life away from work.
This workshop will cover topics such as: basic back function, exercises to protect and
strengthen your back, body mechanics for lifting and transferring, assessing patient
abilities, patient transfer criteria and transfer levels, no-lift policy, and a variety of
techniques used to move patients from one place or position to another.
This workshop consists of a short theory section, followed by extensive demonstration
and practice using the techniques. The accompanying manual contains both theory and
procedural elements to help you practice in between workshop days to learn the
techniques.
The purpose of this workshop is to prepare students for transferring patients safely in
the workplace, developing knowledge and competence through practice. Emphasis is
placed on the learning and practicing of techniques as described and demonstrated by
the instructor, and on thinking critically to explore why these techniques work, what their
shortfalls and requirements are, and what safe modifications can be made to them to
accommodate a variety of patients.
This workshop is intended to provide you with the knowledge and practice you need, so
questions are always welcome at any time during the presentation, demonstrations or
practice components.
Back Care and Patient Transferring Techniques

Developed by Em M. Pijl Zieber RN, BSN (2002; Revised 2004)
Page 2
BACK CARE 101
THE BASICS
Introduction:
Back injuries and back pain is one of the main causes of physical limitation and
disability.
In health care we face many different shapes and sizes of individuals who have
different abilities to move or transfer themselves.
As caregivers we need to care for our backs and ourselves. We are at risk for
back injuries.
Injuries and pain can be minimized through the correct use of body mechanics,
transfers that utilize patient ability, and the use of mechanical lifting devices.
Back basics:
The spinal column is made up of 24 mobile

vertebrae that are stacked one on top of
the other. Between them are discs, which
act like cushions.
The majority of back problems occur in the
lowest 5 vertebrae. This area is called the
lumbar spine.
Each vertebra is linked to the one above it

and below it by joints, called facet joints.
The spinal cord is enclosed within the
spinal canal. Nerves branch off from the
spinal cord on their way to various parts of
the body.
Hundreds of muscles, ligaments and
tendonsboth in the back and in the
abdomensupport the spinal column and
enable us to move.
Online Source: http://www.backrelief.com/diagnosis/anatomy.html

Page 3
The spine is strengthened and made moveable by

muscles. This structure changes your back from a
rigid rod into a moveable spine.
Many injuries to the back are soft tissue injuries in
which muscle tissue is damaged. Injured muscle
tissue can present as muscle spasms, searing pain,
sciatica (pinched sciatic nerve) or immobility.
The spine carries the weight of the top half of the
body and transfers it to the pelvis. In addition it
carries any load being moved or handled.
Online source (diagram):

http://www.shb.ie/content525439453_1.cfm#Functions
Causes of back injuries:

Many factors affect back injuries among healthcare personnel: an aging workforce,
sicker patients, staffing shortages, obesity in both patients and employees, gender, and
stress. On an individual level, back pain and other work-related musculoskeletal injuries
may be caused by:
A single traumatic event, such as a slip, fall or an incident involving a patient
transfer.
Other factors, such as genetics; age (older populations experience an increase in
arthritis and disc degeneration); being out of shape or overweight; having poor
posture; bending, standing, sitting, or lifting improperly; tension, emotional
problems or personal stress; pregnancy; smoking; poor physical condition; and
sports or hobbies.
Cumulative trauma to the spine and related structures. For example, overexerting
the spine (from lifting improperly or lifting patients that are too heavy for the
workers back to support) may cause small injuries that do not cause pain. If not
allowed to heal, the damage may build up and result in a bulging or ruptured
disk, creating a cumulative injury marked by pain.

Page 4
WARM UP EXERCISES
BEFORE YOU START WORK
Stand with knees slightly bent and feet apart, place palms on
lower back, fingers pointing downward. Gently push your palms
forward and gently bend your back backwards. Hold for 5-10
seconds. Repeat 3-5 times.
Then bend the knees and lower the body forward as far as
comfortable. Relax the neck, shoulders and arms. Hold 5
seconds.
Keep knees bent and slowly uncurl to an upright position.
Slowly roll your shoulders backward five times in a circular

motion. Slowly roll your shoulders forward five times in a circular
motion.
Interlace fingers. Turn palm upwards above your head as you

straighten your arms. Stretch and hold for 5-10 seconds.
Repeat 3-5 times.
Fingers interlaced behind your back. Slowly turn your elbow

outward while straightening your arms. Hold for 5-10 seconds.
Repeat 3-5 times.
Interlace fingers. With palms facing out, straighten arms out to

the front of you. Hold for 5-10 seconds. Repeat 3-5 times.

Page 5
Hold left elbow with right hand. Gently pull elbow behind head
until you feel a stretch. Hold for 5-10 seconds. Repeat 3-5
times. Repeat with other arm.
Gently pull your left elbow across your chest towards your right
shoulder until you feel a stretch. Hold for 5-10 seconds. Repeat
3-5 times. Repeat with other arm.
Sit or stand upright. Interlace fingers and lift arms

overhead. Keeping the elbows straight, press arms as far back
as you can. Slowly bend to the left side until you feel a stretch.
Hold for 5-10 seconds. Slowly bend to the right side until
you feel a stretch. Hold for 5-10 seconds. Repeat 3-5 times.
Sit with left leg across right leg. Rest elbow or forearm of right
arm on the outside of the left upper thigh. Gently apply pressure
with right elbow or forearm towards the right. As you apply
pressure, look over your left shoulder. Hold for 5-10 seconds.
Repeat 3-5 times. Repeat with the other side.

Page 6
Stand upright with right hand supported on a wall or the back of

a stationary chair. Grab your left ankle with your left hand. Keep
left knee pointed towards the ground. Slowly pull the left leg
towards the buttock until you feel a stretch in the front of the
thigh. Hold for 5-10 seconds. Repeat 3-5 times. Repeat with the
other leg.
Stand arms length from a wall or other support, feet facing

forward. Place right foot forward and keep the left leg straight
and the heel on the ground. Lean your body towards the wall
until you feel a stretch in the left calf. Hold for 5-10 seconds.
Repeat 3-5 times. Repeat with the other side.
Adapted from University of Toronto, Office of Environmental Health & Safety.

Found online at http://www.utoronto.ca/safety/ergoweb/exercise.html
Adapted for similarity to the Workers Compensation Board of Alberta 10-minute warm up produced by
the Rehabilitation Centre.

Page 7
BACK CARE 101
LIFTING MECHANICS AND SAFETY
Lifting mechanics:
Keep your back in balance and maintain good posture. Maintain the three natural
curves of your spine.
Always lift with your quads. These are long and strong. If you bend at your waist
and extend your upper body to lift an object, you upset your backs alignment and
your center of balance. You also force your spine to support the weight of your
body and the weight of the object you're lifting. Your lower back lifts 7-10 times
the weight of an object. For example, if you bend over to pick up a 10 lb. box,
your back is lifting 70-100 lbs., plus the weight of your upper body. This situation
is called "overload". You can avoid overloading your back by using good lifting
techniques.
Maintain a wide base of support by keeping your feet apart.
Avoid twisting your back. Twisting can overload your spine and lead to serious
injury. Make sure your feet, knees, shoulders and hips are pointed in the same
direction when lifting or transferring.
Do not lift heavy objects above shoulder level. Avoid reaching.
Tuck your pelvis. By tightening your stomach you can tuck your pelvis which will help
your back stay in balance while you lift.
Bend at your knees instead of at your waist. This helps you keep your centre of
balance and lets the strong muscles in your legs do the lifting. Lift with your legs.
Hold the patient or object close to you and in line with your centre of gravity. If
necessary, hop onto a patients bed if you need to be closer to him for a move.
Never work over a bedrail. Always lower it prior to providing any patient care.
Always raise the bed to a good working level. Make sure you lower it once you are
done so your patient can safely get out of bed, or so if she falls, she will not fall as
far.
Whenever possible, utilize gravity instead of fighting against it. For example, if
transferring a patient from a bed to a chair, make sure the bed is slightly higher than
the chair.
Pushing is easier than pulling, as the body weight can be used to help move the
object or person. When pushing, get close to the object/person, push with your legs,
arms should be lock in a bent position, the back should be straight, and push
horizontally.
When pulling, keep the back and arms straight, and use your legs and body weight
to pull.

Page 8
Other principles:
Plan ahead and make all preparations prior to moving the patient. This means
getting the wheelchair ready, the bed ready, and putting the brakes on the bed,
wheelchair, lift or commode. Take the time to organize staff, equipment, and the
area. Have a contingency plan in case problems are encountered during the
transfer.
Utilize the patients abilities. Patients may change day to day or even hour to hour.
Can he stand and for how long? Can he weight bear? Is he stable? Is he confused
or unreliable? How does he transfer? What else do I need to know?
Use the mechanical lifts. Mechanical lifts are safer for you and safer for the patient.
Two staff are often required, depending on agency policy.
Ask for help. Spending five minutes helping a colleague can save them years of
disability and pain. Ask for help before you begin the move or transfer. While you
wait for someone to come and help you with a transfer, finish preparing yourself, the
environment and the patient for the transfer, so when help comes, you are
completely ready.
Know how to do the transfer that is being used. Is it safe? Can you do it safely?
What is the shortfall of this method? What do I need to do to carry this out safely?
Advocate for your own safety. Make sure equipment is in good working order.
Access help and request equipment if you need it.
Patient safety:
When working with the elderly, be cognizant that they are often frail. Osteoporosis,
which affects both males and females, renders bones fragile. It is unwise to grasp an
elderly persons long bones across the shaft to transfer, support or move him/her.
Many elderly patients suffer from arthritis, which renders joints painful, swollen and
in varying degrees of immobility. Caution and care is required to ensure that patients
are not injured or in discomfort during transfers.
Patients who are at risk for falling must receive diligent care to prevent falls. Hip
fractures due to falls are common and also a cause of significant premature mortality
(33.6% in five years).
Always return the bed to the height that is safe for the patient, which is usually the
lowest position.
Always ensure bedrails are up when the patient is in bed, if required.
Never leave a patient unattended on the edge of a bed, unless she can fully support
herself and is able to walk. Never leave a patient with poor truncal support tottering
on a bed.
Gather all needed supplies ahead of time, prior to beginning care, so the patient is
not left unattended.
Better to be safeusing a lift and having the help of a colleaguethan sorry.
If you are helping a patient to walk or stand and he starts to fall, do not attempt to
stop him from falling. Instead, guide and support his fall and protect his head.

Page 9
About footwear:
Proper footwear is an essential part of a happy back. Not only can improper or
substandard footwear lead to sores, deformities, corns, calluses and ulcers, it can also
lead to back pain and back injury. Lets face it: Your feet are the unsung heroes of your
body; you walk all over them and they hardly ever complain!
Working in health care is demanding. Many health care workers walk several miles
each shift, even though most of that time they are in one ward. When we work with
people, we tend to be on our feet a lot. Our feet carry the weight of our bodies and bear
the strain of distance and speed. When we transfer and move patients, our feet take
that on, too. So, as you can see, good footwear is paramount. In addition, the Workers
Compensation Board requires that footwear worn in the workplace must be closed toe
and closed heel.
Here are some tips for happy feet:
Wear cotton socks. Cotton lets your feet breath and helps prevent sweating.
If you have varicose veins, or if your feet feel tired after standing for a prolonged
time, try wearing support socks. This will put a spring back in your step!
Provide your feet with excellent quality footwear. Dont be afraid to spend over $100
on a pair of shoes. Your feet will thank you.
Shop for shoes in the early afternoon, since your feet tend to swell during the day
and by this time they will reach their maximum size.
What to look for when buying new shoes:
Size: Your feet may be two different sizes. Always buy shoes to fit the bigger foot.
Forget vanity about the size of your feet and go with what feels and fits right.
Insoles: Consider removable insoles to accommodate orthotics. Bring your orthotics
with you when buying shoes so you can be sure they will fit properly.
Fasteners: Shoes should have a minimum of six laces (for best fit and control) or
Velcro straps (that pass through a loop and fastens back on itself).
Fit:
Shoes should be (one thumb width) longer than your longest toe. When
measuring, make sure your heel is placed into the back of the shoe.
The sole of the shoe should accommodate the widest portion of your foot.
Your foot should not be hanging over the edges of the sole.
The shape of the toe box should mirror the shape of your toes. If the big and
little toes press against the side of the shoe, the toe box is too narrow. Avoid
pointed toes.
The shoe should be deep enough through the toe box to accommodate the
height of your toes. If toes press against the roof of the shoe, it is too shallow

Page 10
Construction:
Consider shoes with leather uppers and rubber soles. Leather allows the skin
to breathe. Athletic shoes with synthetic fabric uppers are light, washable and
breathable. Athletic shoes should have a padded tongue to cushion against
lace pressure and padded heel counter to cushion the ankle and help prevent
achilles tendonitis.
Make sure the shoe has a plastic heel counter that encompasses the heel
and is well bonded to the show. This will stabilize the heel bone.
Shoes should be relatively flat, with a height difference of less than
between the heel and forefoot area. With a greater incline than this the bodys
weight is distributed further forward, which can lead to both foot and back
problems. Your foot was not designed to carry all of your weight on the ball.
The heel should be neutral or flare out. The heel of the shoe should not be
narrower than the heel counter.
The shoe should have a straight last (it should not dip in at the arch). More
support is gained when more of the shoe is in contact with the ground. This
can also help prevent the foot from going over on its side.
A good walking shoe will have a comfortable soft upper, good shock
absorption, smooth tread and a rocker sole design that encourages the
natural roll of the foot during the walking motion.
Trying it on
If the shoe fits uncomfortably when you first try it on, do not buy it. It will most likely
continue to be uncomfortable.
Try on several different makes and brand names before you make your decision.
Walk around the store as much as you can. Do you feel pressure areas? Friction?
Or, do they feel like heaven?

Page 11
PATIENT ABILITIES
KNOWING THE PATIENT
Rationale: Knowing the patient and what he is capable of doing is the first step
towards a safe transfer.
Questions to consider:
1. Can the patient weight bear sufficiently?
2. How reliable is he? Is there a possibility he may become confused or dizzy or
tired once standing?
3. Is she at high risk of falling?
4. Is she able to follow verbal directions for transferring?
How to find out about the patients transferring status:

1. Check for a logo at the bedside. Transferring status can be upgraded to a
higher level (e.g. standing pivot transfer to Sara Lift) but not to a lower level
(e.g. Sara Lift to standing pivot transfer) at the discretion of assisting staff.
Follow transfer status guidelines.
2. Check the patient chart or kardex. This will give you good background
information on your patient, but not current to-the-day status information.
3. Ask a staff person who knows the patient well. This will give you techniques and
background information specific to a patient, based on daily experience with that
patient. Information may be related to how the patient usually transfers, unless
certain circumstances dictate that another method is used, and how to tell which
situation best describes the patient at a given time.
4. Ask staff who are currently working with the patient. Patient status can change
on a daily basiseven an hourly basis. Sometimes a patients physical status
remains unchanged but psychologically he is unable to perform certain physical
tasks, perhaps due to a mood change.
5. Ask the patient. If your patient is highly reliable she is a good source of
transferring information (for example, young spinal cord injured individuals are
usually able to direct transfers). Even if your patient is unreliable, she can still
tell you how she is feeling about a transfer, which can guide you to raise the
transfer level to ensure safety. For example, if the patient says she is feeling
dizzy, you will delay a standing pivot transfer until her circulation has adjusted
and she feels better and more ready to transfer.

Page 12
TRANSFER LEVELS
PROMOTING SAFETY
Transfer levels: Transfer levels indicate the way a patient is transferred.

Transfer criteria considers the following factors:
Level of cooperation
Level of assistance
Need for verbal guidance or cueing
Level of predictability
Ability to bear weight (partial or full) through the extremities,
one or two legs
Level of reliability
Ability to follow instructions
Ability to hold with one or two hands
Level of difficulty to put patient in sitting position in bed
Ability of patient to maintain a sitting position in bed
Level of rigidity
Weight of patient and extremities
Following transfer levels: You must follow patient transfer status guidelines, for
your own safety and for the safety of your patient.
You can increase the level of transfer but you cannot
decrease it. (i.e. You can increase a stand-by supervision
transfer to a one-person assist, but you cannot decrease
a one-person assist to a stand-by supervision transfer.
Changes in patient transfer status:
Patients change, over a long period of time and also within the day.
Make sure you are aware of the current transfer of the patient you are working with.
Ask a Registered Nurse and the Aides who work with the patient how the patient has
been doing and how he is doing with transfers.
Notify the Registered Nurse if you notice any changes in the patients ability to
transfer.

Page 13
TRANSFER LEVELS
LEVELS, LOGOS AND CRITERIA
Source: This is a transfer level poster from Extendicare, Lethbridge, which maintains a
zero-lift policy.

Page 14
ZERO-LIFT POLICY
NO MANUAL LIFTING!
What does zero-lift mean?
A
PERSON TRANSFER.
Follow the
Assess and reassess patient

Document your concerns.
Transfer assessments are done by a Registered Nurse, Rehabilitation Therapist, or

Physiotherapist.
Transfer levels cannot be decreased by anyone except the above-mentioned staff.
Transfer assessments are ongoing with each transfer.
Transfer status is noted in the care plan, at the bedside and on assistive devices.
Use equipment as intended and in accordance with the

manufacturers operating
is used for ALL patients assessed as a ONE

posted at the bedside.
. Discuss concerns with the RN.
All transfers done with a
will be done by a minimum of

who are actively participating in the use of the lift and
the completion of the transfer.
Activity staff will perform transfers as required for a scheduled

program.
A patient who has fallen or who is found on the

until he is assessed by the
.
When a chair lift is in use, all safety belts must be in place.

will not be moved
Page 15
TECHNIQUES
GETTING STARTED
Be prepared:
1. Are YOU prepared?
Proper footwear (closed toe, supportive, rubber soled, comfortable)

10-minute warm up at start of shift
Transfer belt (one or two, kept around your waist)
Appropriate attire, hygiene and grooming
Always have a contingency plan for if the patient tires or is otherwise unable
to complete a transfer as expected
2. Is the ENVIRONMENT prepared?

Ensure the area is free of obstacles and hazards
Position the wheelchair and apply the brakes
Ensure bed brakes are applied
3. Is the PATIENT prepared?
Apply any required splints, hearing aides and glasses.
Ideally, the patient should be alert during a transfer.
Always tell the patient what you are going to do and where she is going (Note:
This manual provides information and techniques concerning transferring but
does not include aspects such as communication.)
Proper non-slip footwear should be on prior to the patients feet touching the
floor
Proper position prior to transfer
Apply transfer belt
Three progressive stages in providing assistance:
1. Verbal cueing (Hi, Mrs. Smith. The hairdressers ready for you now.
Would you like to come with me?)
2. Manual cueing (Put your hands here, on your walker, and push yourself
up.)
3. Physical assist (On the count of three, you are going to stand and I will
help you using the transfer belt.)
4. Is your PARTNER prepared?
Communicate with others involved in a transfer. Decide before initiating a
transfer whether you will move on the count of three or count to three and
then lift. Always count out loud.
Plan out the sequence for a transfer before starting.
Two caregivers are required when using a mechanical lift, when the patient is
combative or resistive, or for a patient who weighs over 150 lbs (CHR).

Page 16
TECHNIQUES
USING A MECHANICAL LIFT: MAXI LIFT
Arjo Maxi
PATIENT SELECTION CRITERIA
UNRELIABLE
UNCOOPERATIVE
UNPREDICTABLE
UNABLE TO FOLLOW INSTRUCTIONS
UNABLE TO WEIGHT BEAR
USES
ALL NON-WEIGHT BEARING LIFTS:
MISUSES
LONG DISTANCE TRANSPORT OF PATIENTS
INCORRECT SLING SIZE SELECTION
LEAVING PATIENT UNATTENDED
PATIENT POSITIONED IN UPRIGHT SITTING
FROM BED
FROM CHAIR
FROM FLOOR
LIFTS TO TOILET (SPECIAL SLING)
POSITION FOR PROLONGED PERIODS
LIFTS TO REPOSITION IN CHAIRS/WHEELCHAIRS
APPLICATIONS WITH SPECIAL SLINGS
TOILETING
BATHING
USE WITH AMPUTEES
PATIENT SAFETY
TO ENSURE PATIENT SAFETY BEFORE AND DURING THE LIFT, ALWAYS
1. VISUALLY AND PHYSICALLY CHECK THAT ALL CLIPS ARE IN PROPER POSITION
2. MONITOR THE TENSION OF THE CLIPS AS THE PATIENTS WEIGHT IS TRANSFERRED TO THE LIFT.
3. MONITOR CLOSELY IF PATIENT ACTIVITY RESULTS IN A RELEASE OF TENSION ON THE CLIPS.
4. ENSURE PATIENT IS NOT IN THE WAY OF LOWERING EQUIPMENT.
5. ENSURE PATIENT WEIGHT DOES NOT EXCEED 440 LBS.
6. REMAIN WITH THE PATIENT AT ALL TIMES WHILE IN THE LIFT. NEVER LEAVE A PATIENT HANGING
UNSUPERVISED.
7. HAVE A SECOND CAREGIVER PRESENT WHEN USING ANY MECHANICAL LIFT (CHR POLICY).
8. ENSURE YOU KNOW HOW TO ATTACH THE CORRECT SLING, AS THERE ARE MANY DIFFERENT KINDS.
9. DO NOT LEAVE A SLING UNDERNEATH A PATIENT WHO HAS COMPROMISED SKIN INTEGRITY.
Before you start
Have you been trained to use this type of lift?

Is the lift in good working condition?
Do the brakes work?
Are the straps frayed?
Is the battery charged?
Do all the buttons work?
Does it make strange noises?
Is the sling in good condition?
Do not use a mechanical lift that has broken parts; it puts both you and the
patient at risk.

Page 17
Number of staff required: 2

Procedure:
1. Get patient ready for lift. Acquire necessary equipment including the sling.
Ensure you are using the correct sling for the patient: Size, toileting versus
regular sling. Ensure the patients mass can be accommodated by the lift and
sling.
2. Position the patient and wheelchair/chair and the destination
bed/chair/wheelchair to ensure efficiency and accommodate the mechanical lift.
3. Put sling around the back of the patient, securing any required buckles. If the
patient is in bed this will require turning him to one side, fanfolding the sling,
then turning the patient the other way and pulling the fanfolded sling through to
the other side. Turn the patient onto his back and bring the leg straps under
each leg.
4. Bring the lift in close, spreading the feet if necessary to accommodate a chair
and to enhance stability.
5. Lower the bar that will support the patient in the sling. Be sure to not hit the patient
with it.
6. Attach the sling to the lift (four loops). Ensure all loops are connected securely prior
to lifting. Different loops can be selected to assist positioning the patient once he is
lowered to where he is going.
7. Ensure the patients arms are in the sling (like in a cocoon) and that the patient is not
trying to hold on to the sling or the lift. This can result in injury to the patient.
8. Begin lifting. Always watch to ensure the patient is not falling out, and that all loops
are secure. Sometimes patients inadvertently remove a loop or two prior to lift off.
9. Raise the patient only as high as necessary.
10. Steer the lift and bring the patient to the destination bed/wheelchair/chair.
Remember, jerky movements make the sling swing, and this can be frightening for
the patient, not to mention unstable in general.
11. Upon arriving where the patient is to be transferred to, ensure the area is ready for
the patient. Begin lowering the patient. Ensure the patient does not get pinched or hit
by the lift. Have a partner pull on the back loop to pull the patient to the back of the
chair. You control the lift and push on the patients knees to help ensure his buttock
is at the back of the chair. When lowering the lift, watch the patients head and feet.
12. Remove the loops from the lift. Remove the lift. Remove the sling from under the
patient. Position the patient.
Variations:
1. Tilting the wheelchair so that the footrests rest on the base of the Maxi Lift is useful
for ensuring that when the patient is being lowered into the wheelchair she is certain
to be seated properly at the back of the wheelchair.
2. When using a Maxi Lift to seat a patient into a Broda chair, recline the Broda chair
and then access it with the Lift from the side.
Page 18
TECHNIQUES
USING A MECHANICAL LIFT: SARA LIFT
Arjo Sara
PATIENT SELECTION CRITERIA
RELIABLE
COOPERATIVE
ABLE TO FOLLOW INSTRUCTIONS
ABLE TO HOLD WITH AT LEAST ONE HAND
ABLE TO WEIGHT BEAR ON AT LEAST ONE LEG
ABLE TO ACTIVELY CONTRACT THEIR QUADRICEPS
MISUSES
USES
WEIGHT BEARING TRANSFERS
USING WITH PATIENTS WHO DO NOT MEET
TOILETING AND COMMODING
SELECTION CRITERIA
DRESSING
REPOSITIONING IN CHAIRS/WHEELCHAIRS
ADJUSTING SEAT CUSHIONS
APPLICATIONS WITH SPECIAL SLINGS
TOILETING
BATHING
USE WITH AMPUTEES
PATIENT SAFETY
TO ENSURE PATIENT SAFETY BEFORE AND DURING THE LIFT, ALWAYS
1. VISUALLY AND PHYSICALLY CHECK THAT ALL CLIPS ARE IN PROPER POSITION
2. MONITOR THE TENSION OF THE CLIPS AS THE PATIENTS WEIGHT IS TRANSFERRED TO THE LIFT.
3. MONITOR CLOSELY IF PATIENT ACTIVITY RESULTS IN A RELEASE OF TENSION ON THE CLIPS.
4. ENSURE PATIENT IS NOT IN THE WAY OF LOWERING EQUIPMENT.
5. ENSURE PATIENT WEIGHT DOES NOT EXCEED 440 LBS.
6. REMAIN WITH THE PATIENT AT ALL TIMES WHILE IN THE LIFT, UNLESS THE PATIENT IS SITTING ON
THE TOILET. ALLOW FOR PRIVACY, BUT YOU MUST CHECK BACK AT LEAST EVERY FIVE MINUTES.
7. HAVE A SECOND CAREGIVER PRESENT WHEN USING ANY MECHANICAL LIFT (CHR POLICY).
Before you start
Have you been trained to use this type of lift?

Is the lift in good working condition?
Do the brakes work?
Are the straps frayed?
Is the battery charged?
Do all the buttons work?
Does it make strange noises?
Is the sling in good condition?
Do not use a mechanical lift that has broken parts; it puts both you and the
patient at risk.

Page 19

Procedure:
1. Get patient ready for lift. Acquire necessary equipment including the sling. Ensure
the patients mass can be accommodated by the lift and sling. Position the patient
and wheelchair/chair and the destination bed/chair/wheelchair to ensure efficiency
and accommodate the mechanical lift.
2. Assist the patient to a sitting position on the side of the bed. Put the sling around the
back of the patient and secure the buckle or Velcro in the front securely at chest
level.
3. Bring the lift in close, spreading the feet if necessary. Apply the brakes.
4. Lower the bar that will support the patient in the sling. Be sure to not hit the patient
with it. The patient may find it helpful to hold onto the lift while sitting.
5. Secure the sling to the lift, choosing the correct loop for patient height.
6. Ensure the patients feet are sitting squarely on the foot platform, and ensure the
patients knees are in line with the knee holders.
7. Have the patient hold onto the appropriate place on the raising bar of the lift. Ensure
patients arms are outside of the sling. Do a final count to ensure secure positioning
in the lift: 2 feet, 2 knees, 2 loops, 2 hands and a buckle.
8. Begin lifting. Always watch to ensure the loops remain secure.
9. Raise the patient only as high as necessary and in one smooth motion. Many elderly
patients find standing completely upright painful.
10. Steer the lift and bring the patient to the destination bed/wheelchair/chair.
11. Begin lowering the patient. Have a partner guide the patient to the back of the chair.
You control the lift.
12. Remove the loops from the lift. Remove the patients feet from the lift and remove
the lift. Remove the sling from around the patient. Position the patient. Ensure the
patients clothes are straight and not wrinkled behind his back.

Page 20
1.
TECHNIQUES
USING A TRANSFER BELT
Preparation: Purchase your own transfer belt and wear it around your waist so that
you always have it when you need it!. Transfer belts with a plastic clip
in front, multiple handles on all sides and padding are recommended.
Having two transfer belts is also helpful if you want the patient to have
something to hold onto during transfers.
Procedure for general use in transfers:

1. Select a transfer belt of the size appropriate to your patient.
2. Apply the transfer belt around the patients waist, close to or around the hips (the
centre of gravity).
3. Hold the transfer belt with your fingers pointing up to support the patient during the
transfer.
4. Always use a transfer belt when walking a patient who is unsteady. A transfer belt is
also called a gait belt when used to assist or guide patient ambulation.
Procedure for use in assisting ambulation:

1. Select a transfer belt of the size appropriate to your patient.
2. Ensure the patient is wearing shoes with non-slip soles. Slippers or bare feet present
a falling hazard.
3. Apply the transfer belt around the patients waist, close to or around the hips. The
belt should be loose enough for you to hold it without your knuckles digging into the
patients side.
4. To support the patient, hold the transfer belt with an underhand grasp (your fingers
pointing up) around the back. Walk to the side and slightly behind the patient. Extra
support can be provided using two hands:
5. Encourage the patient to walk normally with his head up and back straight.
Discourage shuffling. Walk only as far as required and as tolerated.

Page 21
TECHNIQUES
MOVING THE PATIENT UP IN BED
Bed characteristics: Soaker pad or draw sheet under patient.

Patient characteristics: Unable to scoot self up in bed.
Procedure:
1. Raise the bed to a safe working level.
2. Lower the head of bed (HOB) to flat. Remove pillow from under the patients
head and place it between the HOB and bed frame. The patient should be lying
flat on his back.
3. Ask the patient (and assist him if necessary) to bend his knees. Have him cross
his arms over his chest. Ask the patient to tuck his chin down.
4. One helper stands on each side of the bed. Roll the soaker pad close to the patient
on either side, with your wrists straight and palms down. One of your hands should
be at the patients shoulder, and the other at his hip; the same for your assisting
partner.
5. Place your knee that is closest to the HOB on the bed (in the direction of travel).
6. Lower your hips as if you were sitting down.
7. Count out loud to ensure a team lift. (Ensure comprehension: On 3: 1, 2, 3).
8. With your arms and back straight and chin tucked in, use body leverage to tighten
the soaker pad. Then move your entire body towards the HOB, sliding the patient up
as you go. You can move the patient up incrementally or if he is light, all in one
move.
9. If the patient is continually sliding down (not uncommon in high fowlers position) you
may wish to put a second soaker pad partially under the primary soaker pad, under
the patients hips. This way you will have a soaker pad that is closer to the correct
position when you return to reposition the patient next time.
10. Replace the pillow and ensure patient comfort. Return the bed to a lower level for
patient safety and readjust bed for patient comfort. Replace side rails if required.
For heavy patients:

1. Involve more staff.
2. Place a garbage bag under the soaker pad to provide a sliding surface. Place it
under the patient by turning him side to side. Remove it afterwards and store it
safely.

Page 22
TECHNIQUES
MOVING A PATIENT TO THE SIDE OF THE BED
Uses: Preparing to turn a patient in bed on to her side.

Patient abilities: Ask the patient to move as much as she can.
Procedure for 1:
1. Raise the bed to a good working level.
2. Lower head of bed (HOB) to flat. Remove the pillow from under the patients head.
She should be lying flat on her back.
3. Stand on the side of the bed to which you will move the patient.
4. Lower the bedrail near you.
5. Cross the patients arms over her chest.
6. Place one knee up on the bed. Flex your other leg behind you.
7. Place your arm under the patients neck and shoulders. Grasp the far shoulder.
Place your other arm under the midback.
8. Move the upper part of the patients body toward you by rocking backward and
shifting your weight from your knee (pressing into the mattress) to your other leg.
9. Repeat steps 7 & 8 for moving the patients waist and thighs, and then thighs and
calves. Moves will likely be incremental, so you will have to return to each segment
and gradually move each to the desired location.
10. Ensure patient comfort, return the bed to a lower level and replace bedrails for
patient safety.
Procedure for 2:
2. Lower the HOB to flat. Remove the pillow from under the patients head. The patient
should be lying flat on her back.
3. You and your partner each stand on one side of the bed and lower the bedrails.
4. Cross the patients arms over her chest.
5. Roll the lift sheet up close to the patient, grasping near the patients shoulders and
hips.
6. Each partner places one knee on the bed.
7. Communicate with your lifting partner and count out loud to ensure lifting as a team.
8. Rock backward, moving the person toward you. Your partner rocks backward slightly
and then forward toward you.
9. Unroll the lift sheet and tuck it in.
10. Ensure patient comfort, return the bed to a lower level and replace bedrails for
patient safety.

Page 23
TECHNIQUES
TURNING A PATIENT IN BED
Number of staff required: 1 or 2

Purpose: To relieve pressure and provide for comfort.
Procedure:
2. Lower head of bed (HOB) to flat. Move the patient to the side of the bed as
previously described. You will be turning the patient towards the centre of the bed.
3. Cross the patients arms over his chest. Cross the far leg over the leg near you, or
bend the far knee, leaving the near let straight.
4. Place one knee on the bed. Your other leg should be flexed behind you.
5. Place one hand on the patients far shoulder and the other on the far hip (or, place
your arm along the femur with your hand on the patients hip).
6. Roll the patient toward you gently while rocking backward.
7. Support the patient using a pillow behind the back, under the upper leg, and under
the head and neck. A pillow may also be used under the upper hand and arm.
8. Ensure patient comfort, return the bed to a lower level for patient safety and replace
side rails.

Page 24
TECHNIQUES
LOGROLLING A PATIENT
Bed characteristics: Soaker pad or draw sheet under patient.

Patient characteristics: Rotation of spine contraindicated (e.g. spinal cord injury)
Number of staff required: 3-5 (depending on patient diagnosis and size)
Requires special training in some institutions.
Procedure:
1. Raise the bed to a safe working level. Ensure bed brakes are applied.
2. Using the draw sheet, move the patient to the side of the bed as follows:
a. One person (the Lead) maintains neck alignment (if required) by
being stationed at the head. (You may have to move the bed away
from the wall.) The Lead places her elbows against the mattress and
places one forearm on either side of the patients head, with her
hands grasping the patients shoulders.
b. Place the patients arms across his chest.
c. Place a pillow between the patients knees.
d. Two people stand on either side of the patient and roll the draw sheet
up close to the patients body. Clarify with the others which direction
you will be moving the patient. Get into position, using a broad base
of support with one foot in front of the other.
e. The Lead directs the move, saying, Ready? On 3: 1-2-3. Gently and
in one smooth motion (or a series of small moves) move the patient
as a unit to one side of the bed.
3. Using the draw sheet, turn the patient while keeping his body in straight
alignment as follows:
a. The Lead directs the move, saying, Ready? On 3: 1-2-3. With the
Lead at the patients head and the other helpers at the shoulder, hips
and legs, gently turn the patient as a unit in one smooth motion.
b. The helper that is to the patients back organizes pillows and other
supportive devices to maintain the side lying position and proper body
alignment.
c. The Lead stabilizes and supports the patients head and ensures the
patients neck remains in proper alignment using pillows.
4. Ensure the patient is comfortable. Reapply bed rails.

Page 25
TECHNIQUES
MOVING A PATIENT FROM LYING TO SITTING

Patient characteristics: Must have good truncal support.
Equipment: An overhead trapeze bar assists many patients going from lying to sitting.
Important safety considerations:
Make sure the patient is sitting far enough back on the bed to ensure stability.
The patients knees should be at the edge of the bed, not the thighs or
buttocks.
Have the patient hold onto the edge of the mattress. Do not leave him alone
but remain in front of him. Support him as necessary by placing your hands
on his shoulders. This position is called dangling.
Because going from a lying to a sitting position can cause a drop in blood
pressure, monitor your patient. Ask her how she feels and if she feels dizzy or
lightheaded. Watch her pulse and respirations, and note any difficulty
breathing, pale skin, or cyanosis. Help her lie down if necessary.
Procedure: Utilizing high fowlers

1.
2.
3.
4.
5.
6.
7.
8.
9.
Place the patient in high fowlers.

Lower the bed rail hear you.
Stand near the patients waist, on the side of the bed the patient will be sitting.
Standing at the patients lower legs, place one of your feet in front of the other. Slide
your hands and forearms under the patients lower legs. Rocking backwards from
your front foot to your back foot, pull the patients lower legs towards you until they
are hanging slightly off the bed.
Place one knee on the bed, closest to the HOB. Place the hand that is closest to the
patients head under his far shoulder blade, grasping the shoulder.
Grasp the patients hip with your other hand and roll him toward you, keeping your
hips low. Cradle the patients shoulders with your arm, bringing him close to your
chest.
Place your hand closest to the patients legs over and behind his knees.
Pushing through your bent knee, rock the patient to a sitting position. The dropping
knees will aid the leverage.
Straighten your body as the patient load decreases.

Page 26
Procedure: For flat bed

1. Lower the bed rail on the side of the bed the patient will be sitting.
2. Standing at the patients lower legs, place one of your feet in front of the other. Slide
your hands and forearms under the patients lower legs. Rocking backwards from
your front foot to your back foot, pull the patients lower legs towards you until they
are hanging slightly off the bed.
3. Bend the patients far leg, as when preparing to turn a patient onto her side.
4. Position the patients near arm to allow for her body to turn. Position the patients far
arm bent across her chest.
5. Place your knee closest to the HOB on the bed. Place your arm closest to the
patients legs across the shaft of the femur, with your hand on her hip. Place your
other arm (closest to the HOB) on the patients far shoulder.
6. Turn the patient onto her side.
7. Have the patient place the hand of her upper arm, palm down on the bed to push
herself up.
8. Place your hand that is closest to the patients head, under the patients far shoulder.
Place your hand that is closest to the patients legs over and behind her knees.
9. Communicate with your patient that on the count of 3, she is going to push up with
her hand as you assist her.
10. On the count of 3, pushing through your bent knee, rock the patient to a sitting
position. The dropping knees will aid the leverage.
11. Straighten your body as the patient load decreases.

Page 27
TECHNIQUES
ASSISTING A PATIENT TO STANDING, SITTING

Patient requirements: Must be able to weight bear. Must be able to balance.
Equipment: Transfer belt on patient.
Variables: Patient may require use of wheelchair armrests to push himself up.
Patient may benefit from having wheelchair armrests removed.
Patient may require physical space to complete a transfer.
Patient may feel crowded by the assisting caregiver.
Patients with one-sided weakness (i.e. due to a stroke) should lead with the
unaffected side. For example, during a bed to wheelchair transfer the side
with active movement should be closest to the wheelchair.
Wheelchair cushions: When transferring a patient to a wheelchair, ensure that the
wheelchair cushion is ready, as follows:
Properly placed in the wheelchair, with the buttock indentation towards the rear
and the raised area towards the front. Sometimes cushions are improperly
replaced by staff who change the cushion cover. This can result in serious injury
to the patient.
ROHO or air-filled cushions are properly inflated.
Gel cushions are kneaded to soften them.
Patients with skin problems should be using special cushions in the wheelchair,
and to glean the most benefit from this equipment they need to be sitting directly
on it without a sling, soaker pad or any other materials between them and the
pressure relieving cushion.
Procedure: Minimal assist

1. The patient should be wearing rubber-soled shoes.
2. Adjust the height of the bed so the patients knees are at an angle greater than 90
degrees. This will bring the patients legs into a position closer to standing,
increasing the ease of moving into standing.
3. Position the transfer belt around the patients waist.
4. Have the patient use the bedside pole (Saskapole) as she stands, or ask her to lean
forward, placing the palms of her hands against the edge of the mattress, enabling
her to push off.
5. As needed, place your foot against the end of her toes to prevent her from slipping
and to give her something to brace against.
6. Hold the transfer belt in case she needs support.
7. For a weak or unsteady patient, have one caregiver on each side.

Page 28
Procedure: One-person assist / Standing pivot transfer

2. Provide the patient with clear directions.
3. Prepare the transfer destination. For example, place a wheelchair at a right angle to
where the patient is transferring from.
4. Position the transfer belt around the patients waist or hips.
5. Standing directly in front of the patient, brace your knees against her knees
(cushioning with a towel may make this more comfortable) and hold her feet in place
with your feet.
6. Holding on to the transfer belt, put yourself in the position of sitting down in midair
(bending your knees and lowering your hips). Make sure the patients arms are
inside yours and not holding on to your shoulders or behind your neck. If you are
wearing a second transfer belt around your waist, have the patient hold onto it, with
his arms inside yours.
7. Communicate clearly with the patient, stating that on the count of 3 she is going to
stand.
8. As the patient stands, stand with her. Do not pull the patient up. Instead, your body
position will provide leverage. Pulling the patient up can strain your back.
9. If transferring to a nearby chair, pivot (slow dance) the patient 90 to the waiting
chair, allowing her feet room to manoeuvre. Provide verbal cueing, such as
Turnturnand sit.
10. Pivot until the patients knees touch the wheelchair. Instruct the patient to reach back
for the wheelchair armrest and slowly sit down on the count of three. Then, holding
the transfer belt and again anchoring her feet and knees between yours, sit down as
she sits down. This enables a controlled and gentle descent into the chair.
11. Ensure the patients buttocks are all the way to the back of the wheelchair to
promote good posture and prevent sliding down in the chair.

Page 29
Procedure: Patient stands using a walker

1. Place the walker so the patient can reach it easily. If the walker has a braking
mechanism, employ it.
2. Apply a transfer belt if required.
3. Let the patient position the walker.
4. If transferring from a wheelchair, ensure brakes have been applied.
5. Ask the patient to scoot to the edge of the bed or chair and ask him to lean forward
slightly so that his head is over his feet. Ensure he has a wide base of support.
6. As needed verbally or manually guide the patient to hold on to the walker.
7. Help the patient to rise to standing as needed.
Procedure: Patient sits using a walker

1. If transferring to a wheelchair or commode, apply the wheel locks. If transferring to
bed, raise the head of the bed to a sitting position.
2. Ask the patient to stand with his back to the chair and back up with the walker until
his knees touch the seat.
3. Ask the patient to take one hand off the walker and to use that hand to reach and
grasp the armrest or grab bar, or to reach for the bed. If armrests or grab bars are
not available and the patient is unsteady or weak, use a transfer belt to assist the
patient.
4. Help the patient sit down slowly. The patients buttocks should be at the back of the
seat.
Procedure: Two-person transfer

2. Provide the patient with clear directions.
3. Prepare the transfer destination. For example, place a wheelchair at a right angle to
where the patient is transferring from.
4. Apply the transfer belt at the patients waist or hips.
5. You and your partner stand on either side of the patient, facing the patient squarely.
Both of you will be doing the identical (but mirror image) actions.
6. Block the side of the patients foot nearest you using the outside of your nearest foot.
Your partners foot pressed against the other side will secure the patients feet.
Ensure the patients knees are secured likewise.
7. Using the hand closest to the patient, grasp the transfer belt at the patients side.
Keep your arms and wrists straight. Place the hand of your outer arm on the back of
the patients shoulder. The patient can hold on to your arm if necessary.
8. Tuck your chin in. Bend your knees and lower your hips.
9. Count out loud to ensure a team lift.
10. Keeping your body, arms and wrists straight, lean back for leverage.
11. When the patient reaches the standing position, bend your arm and straighten your
body to release the leverage.

Page 30
TECHNIQUES
REPOSITIONING ELDERLY PATIENT IN A CHAIR
Proper position in a chair:
The patients back and buttock should be against the back of the chair.
The patients back should be straight. He should not be leaning to the side.
The patients feet should be flat on the floor or on wheelchair footrests.
The backs of the knees and calves should be slightly away from the edge of the
seat.
Paralyzed arms should be supported on pillows. Follow the nursing care plan.
Some patients have specialized supportive and positional devices. Make sure you
know their correct use.
Some patients are unable to hold their upper body erect and require the use of
postural supports such as pelvic holders or torso supports.

Patient situation: The patient has slid down in his wheelchair, resulting in poor
posture, compromised alignment and susceptibility of skin and soft
tissues to injury. Some patients are not able to reposition
themselves.
Patient ability: Often a patient is able, with cueing, to scoot his buttocks into the back
of the chair. This method of restoring posture and alignment promotes
independence and range of motion.
Procedure for a frail, elderly patient who is unable to follow verbal cues:
1. Unbuckle patient lap belt. Apply wheelchair brakes.
2. Place the patients feet firmly on floor and arms on the armrests to assist (if able) or
arms on his lap (if not able to assist) or on a transfer belt around your waist.
3. Apply a transfer belt around the patients waist.
4. Placing your feet about one foot apart, place the patients knees between your
knees.
5. Have the patient lean forward over his knees, while you assume a sitting position
and place your hands on either side of the transfer belt.
6. On the count of 3, roll your feet onto your toes and push with your knees against
the patients knees. The counter balance results in the patients buttock being raised
off the cushion so it can be slid into position against the back of the chair. Always be
gentle. Do not lift the patient.
7. Release the patient back into a sitting position and reapply the lap belt.
8. Ensure the patient is comfortable prior to leaving him.

Page 31
TECHNIQUES
PARAPLEGIC TRANSFER FROM CHAIR TO BED

Patient requirements: Must be familiar with transferring
Equipment: Transfer board, removable armrest on wheelchair, footrests
Procedure:
1. Lower the bed to below the level of the wheelchair cushion.
2. Place the wheelchair beside the bed at a slight angle. Apply wheelchair brakes.
Remove the armrest closest to bed.
3. Apply transfer belt around patients waist or hips.
4. Wedge a transfer board under the patients buttock closest to bed by having
him lean in the opposite direction (away from bed). The transfer board should
be partially under the patient and partially on the bed.
5. Ensure the patients feet are on the wheelchair footrests.
6. Stand directly in front of the patient with your feet about a foot apart and as close to
the footrests as possible.
7. Have the patient lean forward and to the side of you, so that his head is beside your
hip. Have the patient put his hand that is closest to the bed on the far end of the
transfer board.
8. With your knees and hips flexed, reach over to the patients beltline or transfer belt
and grasp.
9. Communicate with the patient for a count. On the count of 3, rock your body
backwards while turning the patients buttocks towards the bed, along the transfer
board. You should not be bearing any weight, only acting as a pivot. The majority of
the patients weight is above his feet, permitting his body to pivot against yours.
10. The pivot transfer can be completed in more than one move if necessary.
11. Once complete, remove the transfer board and stow near the bed or on the
wheelchair. Remove the transfer belt. Attend to patient comfort and safety.
Variation: Using a towel as a sling

1. Have the patient sit forward and place a towel under the patients buttocks, leaving
the long ends for you to hold onto.
2. Follow steps 1 through 7 with the exception of the transfer belt. A transfer board is
optional.
3. With your knees and hips flexed, grasp the towel.
4. Communicate with the patient for a count. On the count of 3, rock your body
backwards while turning the patients buttocks towards the bed using the towel as a
sling. You should not be bearing any weight, only acting as a pivot. The majority of
the patients weight is above his feet, permitting his body to pivot against yours.
5. The pivot transfer can be completed in more than one move if necessary.
6. Once complete, remove the towel and stow near the bed or on the wheelchair.
Attend to patient comfort and safety.

Page 32
TECHNIQUES
REPOSITIONING PARAPLEGIC IN A CHAIR
Proper position in a chair:
The patients back and buttock should be against the back of the chair.
The patients back should be straight. He should not be leaning to the side.
The patients feet should be flat on the floor or on wheelchair footrests.
The backs of the knees and calves should be slightly away from the edge of the
seat.
Paralyzed arms should be supported on pillows. Follow the nursing care plan.
Some patients have specialized supportive and positional devices. Make sure you
know their correct use.

Patient situation: The Patient has slid down in his wheelchair, resulting in poor
posture, compromised alignment and susceptibility of skin and soft
tissues to injury.
This procedure applies to paraplegics and low quadriplegics who
are unable to reposition without assistance.
Procedure:
1. Unbuckle the patient lap belt. Apply wheelchair brakes.
2. Ensure the patients feet firmly on footrests.
3. Placing your feet about one foot apart, place the patients knees between your
knees.
4. Have the patient lean forward and place his head to the side of your upper leg.
5. Place your hands on either side of his mid-back.
6. On the count of 3, roll your feet onto your toes and push with your knees against
the patients knees. The counter balance results in the patients buttock being raised
off the cushion so it can be slid into position against the back of the chair. Always be
gentle. Do not lift the patient.
7. Release the patient back into a sitting position and reapply the lap belt.
8. Ensure patient is comfortable prior to leaving him. Ensure the male patients testicles
are sitting in front of him and not underneath him, as this can lead to a spike in blood
pressure that can be fatal.

Page 33
TECHNIQUES
GUIDING A PATIENT FALL
Prevention of falls:
When getting a patient out of bed to go for a walk, make sure you let her dangle on
the edge of her bed so she can adjust to the position change.
Monitor the patient for signs of dizziness, light-headedness, confusion or weakness.
Ask the patient, How are you doing? and How are you feeling? frequently.
Apply a transfer belt prior to walking.
Have another staff assist you as you help the patient walk.
If the patient is tired, unreliable or weak, have another staff person follow behind
in a wheelchair as you help the patient walk.
When helping a patient walk, always be mentally and physically prepared for a fall,
and have a contingency plan.
When a patient starts to fall:

Do not try to stop him from falling. This will likely result in you getting hurt. Instead, ease
him to the floor, working with gravity and controlling the direction of the fall and
protecting the patients head. The goal is to cushion the fall and prevent serious injury.
1. Stand with your feet apart and keep your back straight.
2. Bring the person close to your body using the transfer belt. (If a transfer belt is not in
use, put your arms around the patients waist or hold the patient under the arms.
3. Move your leg so the patients buttocks rest on it and your other leg is flexed and
braced behind you.
4. Let the patient slide down your leg to the floor. Bend at the hips and knees as you
lower him. Go down with the patient as gently as possible.
5. Get help and document the fall.
After a patient has fallen, or if you find a patient on the floor, call for help. Call the RN to
assess the patient prior to moving or transferring him.
Report all falls to the RN or your supervisor. Complete an incident report if required by
the agency.

Page 34
If you are working in a private home you may not have an RN present to assess the
patient after a fall. Follow procedures as required by your employer. Assess the patient
and determine course of action:
1. Call 911 if the patient has
Lost consciousness
Uncontrollable bleeding
Stopped breathing
Injury for which medical attention is required immediately
If you feel overwhelmed by the patients situation, call 911 or call your supervisor.
2. Check for signs of a fracture which may include:
The patient reports pain, tenderness or hearing a bone snap or pop
Visible swelling or bruising
The patient has difficulty moving a limb.
Classic signs of a hip fracture include:
Leg shortening
External rotation of hip
Hip crepitations (assess for this by placing your palm on each greater
trochanter and rotating)
Never move or attempt to mobilize a patient with a suspected hip fracture.
3. Check for signs of head injury such as confusion, head pain, altered level of
consciousness or changes in speech.
4. Complete a head-to-toe assessment. Check for other injuries such as cuts. Check
for bleeding. Check the patients arms and shoulders for injury by having him reach
up.
5. Consider the cause of the fall: Did the patient lose consciousness or have a seizure?
Did he trip? Did she suddenly become weak? What signs preceded the fall?
6. If you observe signs of a fracture, or if you suspect a head, neck or spinal injury do
not move the patient. Call your supervisor for help and keep the patient warm and
calm. Stay with the patient until help arrives. Call 911 if necessary.
7. If the patient is unhurt and able to assist, help him up to a nearby chair. (Techniques
are in following section.)
8. Always chart if a patient has fallen. Always chart your complete assessment and
what steps you took, such as phoning for help. If the patient is unhurt and able to get
up, chart in detail: Pt. able to weight bear. Able to take 3 steps and sit in chair. This
indicates that serious injury was not sustained, an important determinant in liability if
the patient falls again and is hurt.

Page 35
1.
TECHNIQUES
ASSISTING A PATIENT UP OFF THE FLOOR
Patient assessment: When a patient falls he needs to be assessed by a

Registered Nurse prior to his getting up off the floor.
Remember: The floor is a safe place for a patient to remain until help arrives.
Procedure for weight-bearing and ambulatory patients who are unhurt:

1.
2.
3.
4.
5.
6.
Place a chair beside the patient. Have the patient use the armrests for support.
If the patient is lying on his back, help him to roll over onto his stomach.
Support the patients hips and assist him into a kneeling position, facing the chair.
Have the patient rest his forearms on the chair. Apply a transfer belt.
Tell the patient to lift one knee and place the foot on the floor. Assist as required.
One the count of 3, help the patient push up, stand, and pivot into the chair, while
holding onto the armrests.
7. Once in the chair, let the patient rest before assisting him up again.
Procedure for non weight-bearing, non-ambulatory or injured patients:

1. Prepare the patient for transfer using the Maxi Lift (a Maxi Lift can reach all the way
to the floor) by placing the correct sling under the patient. You will need two staff to
assist you.
2. Have the patients wheelchair or bed ready nearby to receive the patient.
3. Spread the legs of the Maxi Lift to accommodate the patient. Lower the lift to enable
securing the sling loops. Double check loops prior to lifting and at start of lifting.
4. Begin raising the patient from the floor. Raise the patient only as far as necessary to
be placed into a waiting wheelchair or bed.
5. Follow Maxi Lift procedures.
6. Ensure the patient is secure following the transfer (i.e. bedrails, lap belt, etc.).

Page 36
Procedure for weight-bearing patients who are unhurt but unable to rise, and
a mechanical lift is not available:
This technique can be hazardous to the worker and is not advised except in an
emergency in which all other methods have been ruled out. You will need the help of at
least one other person. If you are in a situation in which a patient falls and you have no
means of assistance, consider calling emergency services for help.
1. With the patient on his back, squat down and assist the patient to bend his knees.
Apply a transfer belt around his waist.
2. With your partner on the other side of the patient, grasp hands behind the patients
shoulders and on a count of 3 assist him to a sitting position.
3. In a wide stance, flexed at the knees, anchor the patients near foot with your foot.
Your partner will do the same on her side. Your other foot will be near the patients
torso.
4. Grasp the transfer belt. Instruct the patient to reach forward and assist by pushing
up on the count of 3. A third helper may be useful to support the patient from
behind.
5. On the count of 3, assist the patient to a standing position by pushing through your
quads. Maintain a straight back at all times.
6. Enable the patient to sit to recover.

Page 37
2.
TECHNIQUES
EMERGENCY EVACUATION
Use: Patients must be evacuated immediately and wheelchairs and beds cannot be
used. To be used in dire emergencies only.
Procedures:
1. Assisted walk: Faces the patient and put arms around him under his arms (like a
hug) then walk backward supporting the patient to safety.
2. Cradle: Place a blanket on the floor parallel to the bed. With the patient in supine
position, put your arms under the patients armpits. Your partner, facing the
patients feet, stations herself between the patients legs and grabs the patient
around the legs under the knees. Lift and lower the patient gently onto the blanket
on the floor. Using the blanket, one person pulls the patient headfirst to safety.
3. Two-person carry: With the patient in the supine position (face upward), put your
arms around the patient from behind and under the patients armpits. Your partner,
facing the patients feet, stations herself between the patients legs and grabs the
patient around the legs under the knees. Carry the patient to safety.

Page 38
BACK EXERCISE
BEING GOOD TO YOUR BACK
Back exercises are one of the most important things you can do to strengthen your back
and help protect it from accidental injury. The more fit you are, the less likely you are to
have back or neck pain. The following exercises, when done on a daily basis, can help
keep your back in condition. (Remember, though, if you are experiencing back pain of
any sort, check with a healthcare professional before doing these or any exercises.)
Pelvis Tilt
Lie as shown with knees bent and flat on the floor.
Slowly tighten your stomach and buttocks as you press
your lower back onto the floor. Hold for 10 seconds and
then release. Repeat the sequence 5-10 times.
Hamstring Stretch
Lie on your back with one leg straight in front of you and
the other bent. Hold onto the ankle of your bent leg and
slowly try to straighten your leg. (Keep your lower back
on the floor.) Hold for 10 seconds. Relax. Repeat 5-10
times, and then switch sides.
Bent-Knee Sit-Ups
Lie as shown with knees bent and feet and lower back
on the floor. Place your arms as shown and slowly raise
your shoulders, using your stomach muscles. (Do not
stretch with your neck or arms.) Hold for 10 seconds.
Relax. Repeat 5-10 times.
Leg Lift
Lie on the floor with one leg straight in front of you and
the other bent as shown. Slowly raise your straightened
leg as far as you can. Hold for 10 seconds. Slowly lower
your leg to the floor. Relax. Repeat 5-10 times, then
switch sides.

Page 39
BACK CARE RIOT ACT
THE WAY IT IS, FOLKS!
Prevention:
Take your time and think each transfer through. No one ever died from being
transferred a little slower, but quick transfers that were not thought out have hurt
and disabled many.
Assess every situation. If you feel uncomfortable with doing or assisting in a
particular lift or transfer, voice your concerns and find remedies to make the situation
better.
Do not try to be a back hero. There is no such thing.
If you hurt your back at work:
It may result in a permanent, painful and chronic condition.

Workers Compensation may not cover you, depending on the situation and if they
can determine that you had a pre-existing condition, thus making you appear to
have made a poor career choice and that this is really all your fault.
You will be susceptible to more injuries, resulting in further disability and chronic
problems and pain.
Your colleagues probably wont send flowers or frozen dinners to cheer or help you,
no matter what your level of disability.
Your colleagues will suffer themselves as they will work short-staffed.
Your boss will step over your body to get to the next person to get the job done. It is
cruel and impersonal, but thats the way it is.
You MUST fill out an incident report and injury form within 24 hours. Tell someone,
like your supervisor or the RN, that you have been hurt. Do not complete your shift if
you have been hurt. See your physician the same day as your injury.
Final words:
Guard your back like it is gold. Your life and wellbeing hinge upon it. No one cares
about your back like you do. Guard it, protect it, and be very, very good to it. Its the only
one you will ever have.

Page 40
REFERENCES
Canadian Back Institute
Chinook Health Region, Continuing Care Program. Mobility Safety: Lifts, transfers,
repositioning and back injury prevention manual for continuing care in the
Chinook Health Region.
Mosbys Textbook for Nursing Assistants, 2000, Sheila A. Sorrentino
St. Michaels Health Centre Occupational Therapy Department, Lethbridge, AB
University of Toronto, Office of Environmental Health & Safety (Found online:
http://www.utoronto.ca/safety/ergoweb/exercise.html)
Vancouver Hospital and Health Sciences Centre: GF Strong Rehabilitation (Spinal Cord
Injury Program)
Wisdom Back Care Program
Workers Compensation Board of Alberta 10-minute warm up produced by the
Rehabilitation Centre.
Workers Compensation Board (Alberta) Safety Publications
Online sources:
http://apha.confex.com/apha/130am/techprogram/paper_46121.htm
http://www.backrelief.com/diagnosis/anatomy.html
http://www.drmcbain.com/shoes.html
http://www.emc.maricopa.edu/academics/physed/wellness/Proper_Footwear.html
http://www.premierinc.com/all/safety/resources/back_injury/
http://www.shb.ie/content-525439453_1.cfm#Functions

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BACK CARE

PATIENT TRANSFERRING TECHNIQUES

LETHBRIDGE COMMUNITY COLLEGE

Developed by Em M. Pijl Zieber RN, BSN

Back Care and Patient Transferring Techniques

BACK CARE 101

The spinal column is made up of 24 mobile

Each vertebra is linked to the one above it

Back Care and Patient Transferring Techniques

The spine is strengthened and made moveable by

Online source (diagram):

Causes of back injuries:

Back Care and Patient Transferring Techniques

BEFORE YOU START WORK

Slowly roll your shoulders backward five times in a circular

Interlace fingers. Turn palm upwards above your head as you

Fingers interlaced behind your back. Slowly turn your elbow

Interlace fingers. With palms facing out, straighten arms out to

Back Care and Patient Transferring Techniques

Sit or stand upright. Interlace fingers and lift arms

Back Care and Patient Transferring Techniques

Stand upright with right hand supported on a wall or the back of

Stand arms length from a wall or other support, feet facing

Adapted from University of Toronto, Office of Environmental Health & Safety.

Back Care and Patient Transferring Techniques

BACK CARE 101

LIFTING MECHANICS AND SAFETY

Back Care and Patient Transferring Techniques

Back Care and Patient Transferring Techniques

Back Care and Patient Transferring Techniques

Back Care and Patient Transferring Techniques

KNOWING THE PATIENT

How to find out about the patients transferring status:

Back Care and Patient Transferring Techniques

Transfer levels: Transfer levels indicate the way a patient is transferred.

Changes in patient transfer status:

Back Care and Patient Transferring Techniques

LEVELS, LOGOS AND CRITERIA

Back Care and Patient Transferring Techniques

What does zero-lift mean?

Assess and reassess patient

Transfer assessments are done by a Registered Nurse, Rehabilitation Therapist, or

Transfer levels cannot be decreased by anyone except the above-mentioned staff.

Transfer assessments are ongoing with each transfer.

Use equipment as intended and in accordance with the

is used for ALL patients assessed as a ONE

All transfers done with a

will be done by a minimum of

Activity staff will perform transfers as required for a scheduled

A patient who has fallen or who is found on the

When a chair lift is in use, all safety belts must be in place.

Back Care and Patient Transferring Techniques

will not be moved

Proper footwear (closed toe, supportive, rubber soled, comfortable)

2. Is the ENVIRONMENT prepared?

Back Care and Patient Transferring Techniques

USING A MECHANICAL LIFT: MAXI LIFT

Before you start

Have you been trained to use this type of lift?

Back Care and Patient Transferring Techniques

Number of staff required: 2

USING A MECHANICAL LIFT: SARA LIFT