Community Health Nursing I: Individual and Family as Client

Related Learning Experience, Skills Laboratory

Transfer Ambulation

Definition and Rationale:

Transfer is the moving of a patient from one location to another.

Ambulation is to walk about or to move from one place to another.

Objectives: After 4.5 hours of various classroom and laboratory activities, the Level II
students will be able to:

1. define the following terms:

1.1. alignment. 1.11. mobility.

1.2. ambulation. 1.12. movement.
1.3. ambulatory. 1.13. non-ambulatory.
1.4. braces. 1.14. orthostatic hypotension.
1.5. canes. 1.15. stretcher.
1.6. carry. 1.16. transfer.
1.7. crutches 1.17. transfer belt.
1.8. gait. 1.18. walker.
1.9. hydraulic lift. 1.19. weight.
1.10. lift sheet. 1.20. wheelchair.

2. discuss the following:

2.1. importance of transfer and ambulation.

2.2. indications of transfer and ambulation.
2.3. contraindications of transfer and ambulation.
2.4. basic guidelines in transferring and ambulating clients.
2.5. factors affecting transfer and ambulation.
2.6. principles involved in transfer and ambulation.

3. identify the following:

3.1. mechanical devices used in:

3.1.1. transferring patients using:

3.1.1.1. stretcher. 3.1.1.3 transfer belt.
3.1.1.2. wheelchair. 3.1.1.4 hydraulic lift.

3.1.2. ambulating patients using:

3.1.2.1. canes.
3.1.2.2. walkers.
3.1.2.3. crutches.

3.2. measurement of crutches.

3.3. proper use of crutches.

3.4. different gaits using:

 3.4.1. two-point gait. 3.4.4 swing to-gait.
3.4.2. three-point gait. 3.4.5 swing through gait.
3.4.3. four-point gait.

3.5. types of carry

4. demonstrate beginning skills in:

4.1. transferring patients from bed to chair to wheelchair

4.2. transferring a patient from bed to stretcher and vice versa
4.3. proper transport of patient on:

4.3.1. stretcher
4.3.2. wheelchair

4.3.2.1. flat or level surfaces

4.3.2.2. ramps or inclines surfaces
4.3.2.3. through doors and elevators

4.3.3. using canes

4.3.4. using crutches
4.3.5. using walkers

5. explore safety points or issues when a patient is on:

5.1. stretcher
5.2. wheelchair

Criteria for Mastery:

1. 70% score on the quiz

2. Submission of Procedure Guide with rationales
3. Individual Return Demonstration

Enrichment Activities:
A. Read from the following references:

National League of Philippine Government Nurses, Incorporated. (2007). Public Health

Nursing in the Philippines. Manila: National League of Philippine Government
Nurses, Incorporated.

National League of Philippine Government Nurses, Incorporated. (2000). Community

Health Nursing Services in the Philippines. Manila: National League of Philippine
Government Nurses, Incorporated

Famorca, Z. U., Nies, M. A., & McEwen, M. (2013). Nursing Care of the Community.
Singapore: Elsevier Inc.
Materials needed for Transfer and Ambulation

Assistive Devices for Ambulation Assistive Devices for Transfer

• Canes - Wheelchairs
• Walkers - Mechanical Lift
• Crutches - Lift sheets
- Stretchers

Procedure Guide for Transferring Clients from Bed to Wheelchair

PROCEDURE RATIONALE
1. Explain the procedure to the client.

2. Wash the hands and observe other

appropriate infection control.

3. Provide client privacy.

4. Position the equipment appropriately.

Lower the bed. Place the wheelchair on
the side of the bed and parallel to it. Lock
the wheels of the wheelchair and raise the
footplate.

5. Prepare and assist the client to a sitting

position. Assess for orthostatic
hypotension before moving the client
from the bed.

6. Assist the client in putting gown/ bathrobe

and nonskid shoes or slippers.

7. Place the transfer belt around the client’s

waist.

8. Give instruction to the client and ask to:

move forward and sit on the edge of the
bed, place the foot of the stronger leg
beneath the edge of the bed and put the
other foot forward, place the client’s
hands on the bed surface or on your
shoulders so that the client can push while
standing.

9. Position yourself correctly. Stand directly

in front of the client. Lean your trunk. Flex
hips, knees, and ankles. Place one foot
forward and one back. Encircle the client’s
waist with your arms and grasp the
transfer belt at the client’s back.
 PROCEDURE RATIONALE
10. Assist the client to stand and then move
together toward the wheelchair. On the
count of three, ask the client to push with
the back foot, rock to the forward foot and
extend the joints of the lower extremities.

11. Push or pull with the hands, while

pushing the forward foot, rock the back foot,
extend the joints of the lower extremities
and pull the client into a standing position.

12. Assist the client to stand and ask the

patient: back up the wheelchair and place
the legs against the chair, place the foot of
the stronger leg slightly behind the other,
place both hands on the wheelchair arms or
on your shoulders. On the count of three,
have the client shift the body weight by
rocking to the back foot, lower the body to
the edge of the wheelchair seat by flexing
the joints of the legs and arms.

13. Ensure the client’s safety. Ask the

client to push back into the wheelchair seat.
Lower the footplates and place the client’s
feet on them. Apply the seat belts as
required.

Variations:
o For clients who have difficulty in
walking, place the wheelchair at
45 degrees angle to the bed.

o For clients who need minimal

assistance, place the hands
against the sides of the client’s
chest during the transfer

o For clients who need minimal

assistance, place the hands
against the sides of the client’s
chest during the transfer

o For clients who require more

assistance, reach through the
clients’ axilla and place the hands
on the client’s scapula during the
transfer

o When the client is able to stand,

position yourself on both sides of
 the client. Flex your hips, knees
and ankles

o Grasp the client’s transfer belt

with the hand closest to the client
and with the other hand to
support the client’s elbows.

o When the client has an injured

lower extremity, movement
should always occur toward the
client’s unaffected side.

o For clients who cannot stand, use

a sliding board to help them move
with nursing assistance.

14. Document relevant information:

a. Clients ability to bear weight and pivot

b. Number of staff needed for transfer
c. Length of time up in wheelchair
d. Client’s response to transfer and being
up in wheelchair or chair

Revised June 2018

Procedure Guide for Transferring and Ambulating client from bed to stretcher

PROCEDURE RATIONALE
1. Explain the procedure to the client.

2. Wash the hands and observe other

appropriate infection control.

3. Provide client privacy.

4. Adjust the client’s bed in preparation

for transfer. Lower the head of the bed until
it is flat. Raise the bed so that it is slightly
higher than surface of the stretcher. Ensure
that the wheels on the bed are locked. Pull
the draw sheet out from both sides of the
bed.

5. Move the client to the edge of the

bed and position the stretcher. Roll the draw
sheet as close to the client’s side as possible.
Pull the client to the edge of the bed and
cover the client with a sheet or bath blanket.

6. Place the stretcher parallel to the bed

and lock the stretcher wheels.

7. Transfer the client securely to the

stretcher. In unison the other staff members,
press your body tightly against the client.
Flex your hips and pull the client on the pull
sheet in unison directly toward you and onto
the stretcher. Ask the client to flex the neck
during the move, if possible, place the arms
across the chest.

8. Ensure client comfort and safety.

Make the client comfortable, unlock the
stretcher wheels, and move the stretcher
away from the bed. Immediately raise the
stretcher side rails and/ or fasten the safety
straps across the client

Variations:

o This device may be used by one nurse or

up to four nurses together. Turn the
client to a lateral position away from you,
position the board close to the client’s
back, and roll the client on the board. Pull
the client and the board across the end
to the stretcher. Safety belts may be
place over the chest, abdomen and legs.
 o The arms of the lifters are placed under
the client at the head and shoulder and
hips and thighs, and upper and lower
legs. On the count of three, the lifters roll
the client onto their chest and step back
in unison. They then pivot around the
stretcher and lower the client by flexing
their knees and hips until their elbows
are on the surface of the stretcher. The
client is then released on the stretcher
and is aligned and covered and the
stretcher side rails are raised.
9. Document the relevant information.

Revised June 2018