TRANSFER
OVERALL OBJECTIVE ☞Analyze and organize the activity.
⁍ To transfer patient from a bed to a chair, wheelchair,
commode, or stretcher with maximum comfort and safety
for the patient and nurse.
SPECIFIC OBJECTIVES
▸Assess a patient to determine ability to move, bear
weight and maintain balance.
▸Analyze data to identify whether the patient can
participate in the transfer process.
▸Determine appropriate patient outcomes related to
transfer and recognize the potential for adverse
outcomes.
▸Plan an effective transfer technique for the
individual patient.
▸Cary put a variety of different transfer techniques
safely for the patient and the nurse.
▸Use appropriately selected lift devices to assist in
the transfer of patients.
▸Evaluate the effectiveness of the transfer
technique used.
▸Document the transfer technique used and the
patient’s response
▸Moving patients out of bed is beneficial for them.
▵Movement maintains and restores muscle
tone
▵Stimulates the respiratory and circulatory
systems
▵Improves elimination
▸Patients need only dangle their legs over the side
of the bed or sit in a chair at the bedside for a few
minutes to improve their physical and psychological
well-being.
▸Ergonomics ⇢science of fitting a job to a
person’s anatomic and physiologic characteristics to
enhance efficiency and well-being.
▸Many clients cannot move at all or need
assistance in moving: transferring between bed and
chair or wheelchair, between wheelchair and toilet,
between bed and stretcher; transfer for the purposes
of care, transport for therapies and tests, and
change of patient’s positions.
TRANSFER
↳Moving from one place to another
・Before transferring any client, the nurse must:
☞Determine the client’s physical and mental
capabilities to participate in the transfer
technique
FUNDAMENTALS OF NURSING REVIEWER 2019 / NV
・During transfer, keep patient safe while protecting
oneself from injury.
・Developing competence and the practice of good
body mechanics increase the chance of going
through the procedure safely.
SAFETY CONSIDERATIONS (to minimize, if not
avoid accidents):
✓Follow the plan.
✓Give patients clear instructions and
encouragement throughout he transfer.
✓Make sure the patient leans with his or her strong
side if possible.
✓Have unsteady patient grasp your arm or the arm
of the chair for support. (Do not allow patient to hold
you around the neck).
✓Place your hands either on the transfer belt or
behind the person’s upper back (to help support the
patient).
✘ Do not place your hands under a patient’s
armpits to help support him or her.
✓Know if patient is contraindicated on the use of
transfer belt (patients with heart disorders ; S/P
abdominal surgery) .
✓Observe good body mechanics and back safety.
BODY MECHANICS
↳The way you align, balance and coordinate
movements
A – ALIGNMENT (good posture) – lessens
strain in your joints & muscle and keeps
your back in a neutral position.
B – BALANCE – involves wide base of
support and low center of gravity.
C – COORDINATED MOVEMENTS – use
weight of body to help with movement
*straightening your knees, allowing the
momentum of the movement to assist in
task)
・Assistance depends on the weight-bearing
abilities of the patient.
・A transfer belt is never used to lift a person who
cannot bear weight (use mechanical lift device).
Report immediately:
▻Complains of dizziness, shortness of breath, chest
pain, a rapid or irregular heart beat
▻Complains of pain when trying to bear weight
▻Changes in patient’s usual grip, strength or ability
 TRANSFER
▻When a usually cooperative patient refuses to
participate
▻Equipment is not working properly or is broken
▻Gait belt/transfer belt/walking belt
▴Suitable for clients who can bear weight
and require only minimal assistance
▴Should not be used to lift a client off the
floor or for bariatric clients
▴Use for transfer falls into either a moderate
or high-risk category for low-back disorders
▴Can have handles that allow the nurse to
control movement of the client during
transfer or during ambulation.
▻Sliding board – made of low-friction materials or
with movable sliding sections
▴Can be used to transfer a client between a
bed and chair
General Guidelines for Transfer Technique
✓Plan what to do and how to do it.
✓Obtain essential equipment before starting and
check that all equipment are functioning correctly.
✓Remove the obstacles from the area used for the
transfer.
✓Explain the transfer to the client including what the
client should do.
✓Explain the transfer to the nursing personnel who
are helping: specify who will give directions (one
person needs to be in charge).
✓Always hold/support the client farther than the
equipment and ensure the client’s safety and dignity.
✓During the transfer, explain step by step what the
client should do, for example, “Move your right foot
forward.”
✓Make a written plan of the transfer, including the
client’s tolerance (e.g., pulse and respiratory rates)
WHEELCHAIR SAFETY
▹Always lock the brakes on both wheels of the
wheelchair when the client transfers in or out of it.
▹Raise the footplates before transferring the client
into the wheelchair.
▹Lower the footplates after the transfer, and place
the client’s feet on them.
▹Ensure the client is positioned well back in the seat
of the wheelchair.
▹Use seatbelts that fasten behind the wheelchair to
protect the confused clients from falls. Note:
FUNDAMENTALS OF NURSING REVIEWER 2019 / NV
Seatbelts are a form of restraint and must be used in
accordance with policies and procedures that apply
to the use of restraints.
▹Back the wheelchair into and out of an elevator ,
rear large wheel first.
▹Place your body between the wheelchair and the
bottom of an incline.
SAFE USE OF STRETCHERS
▹Lock the wheels of the bed and stretcher before
the client transfers in or out of them.
▹Fasten safety straps across the clients on a
stretcher, and raise the side rails.
▹Never leave a client unattended on a stretcher
unless the wheels are locked and the side rails are
raised on both sides and/or the safety straps are
secured across the client.
▹Always push a stretcher from the end where the
client’s head is positioned. This position protects the
client’s head in the event of a collision.
▹If the stretcher has two swivel wheels and two
stationary wheels:
▴A. always position the client’s head at the
end with the stationary wheels
▴B. Push the stretcher from the end with the
stationary wheels. The stretcher is
maneuvered more easily when pushed from
this end.
▹Maneuver the stretcher when entering the elevator
so that the client’s head goes in first.
TRANSFERRING BETWEEN BED AND CHAIR
PURPOSE:
⁍ A client may need to be transferred between a bed
and a wheelchair or chair, the bed and the commode
or a wheelchair and the toilet.
ASSESSMENT
✓The client’s body size
✓Ability to follow instructions
✓Ability to bear weight
✓Ability to position/reposition feet on the floor
✓Ability to push down with arms and lean forward
✓Ability to achieve independent sitting balance
✓Activity tolerance
✓Muscle strength
✓Joint mobility
 TRANSFER
✓Presence of paralysis
✓Level of comfort
✓Presence of orthostatic hypotension
✓The technique with which the client is familiar
✓The space In which the transfer will need to be
maneuvered
✓The number of assistants needed to accomplish
the transfer safely
PLANNING
✓Review the client’s record.
✓Gather needed equipment:
-robe or appropriate clothing
-non-skid shoes or slippers
-Gait/ transfer belt
-chair/ commode/ wheelchair as appropriate to
client need
IMPLEMENTATION
✓Introduce self, verify the client’s identity. Explain
the transfer process to the client
✓Hand hygiene and appropriate infection prevention
procedures.
✓Provide for client privacy
✓Position the equipment appropriately:
-lower the bed to its lowest possible
position---client’s feet will rest flat on floor; Lock
the wheels of the bed
-Place the wheelchair parallel to the bed and as
close to the bed as possible. Put the wheelchair
on the side of the bed that allows the client to move
toward his/her stronger side. Lock the wheels and raise
the footplate.
▸Prepare the client:
・Assist the client in sitting position on the side of the
bed.
・Assess for orthostatic hypotension before moving
the client from the bed.
・Put on bathrobe and nonskid slippers/shoes
・Place gait/ transfer belt snugly around the client’s
waist.
▸Give explicit instructions to the client:
・Have the patient move forward and sit on the edge
of the bed with feet placed flat on floor. This brings
the client’s center of gravity closer to the nurse.
・Lean forward slightly from hips.
☞This brings the client’s center of gravity more directly
over the base of support and positions the head and
trunk in the direction of the movement.
・Place the foot of the stronger leg beneath the
edge of the bed and put the other foot forward.
☞In this way, the client can use the stronger leg
muscles to stand and power the movement. A broader
base of support makes the client more stable during the
transfer.
・Place the client’s hand on the bed surface so that
the client can push on standing
☞This provides additional force for the movement and
reduces the potential for strain on the nurse’s back
▸Position yourself correctly:
・Stand directly in front of the client and to the side
requiring the most support.
・Hold the gait/transfer belt with the nearest hand; the
other hand supports the back of the client’s shoulder.
・Lean your trunk forward from hips. Flex your hips,
knees and ankles.
・Assume broad stance, placing one foot forward
and one back. Brace the client’s feet with your feet
to prevent the client from sliding forward or laterally.
(Mirroring)
▸Assist the client to stand, and then move together
toward the wheelchair/ sitting area
・Verbal instructions: On the count of three - “stand”
・Support the client in upright position for few
moments
・Together, pivot on your foot farthest from the
chair, or take a few steps toward the wheelchair,
chair/ commode
▸Assist the client to sit.
▸Have the client back up to the wheelchair and
place the legs against the seat. To minimize the risk
of the client falling when sitting down.
▸Have client hold the arms of the wheelchair.
▸Tighten your grasp on the transfer belt, have the
client sit down while you bend your knees/hips and
lower the client onto the wheelchair seat.
▸Ensure client’s safety.
▸Ask the client to push back into the wheelchair
seat.
FUNDAMENTALS OF NURSING REVIEWER 2019 / NV
 TRANSFER
▸Remove the gait/ transfer belt.
▸Lower the footplates, and place the client’s feet on
them, if applicable.

LINK:
https://www.youtube.com/watch?v=JZPh9uK30eQ&t
=29s

FUNDAMENTALS OF NURSING REVIEWER 2019 / NV