Transferring the Clients from a Bed to a Wheelchair
Name of Student: ________________________ Date of Exposure: ___________________
Area of Assignment: _____________________ Clinical Instructor: ______________________
Directions: Please rate the students’ level of competency on each expected skill using the scale
provided.
0 – NOT DONE (Student did not exhibit competency)
1 – DONE WITH ASSISTANCE (Student demonstrates fair strength in
demonstrating skills with close supervision)
2 – DONE INDEPENDENTLY (Student demonstrates excellent skills, exhibits
competency independently)
Nursing Implementation
Rating Scale
Nursing Action
0 1 2
1. Introduce self and verify the client’s identity using
agency protocol. Inform client of the purposes. Perform
hand hygiene provide privacy.
2. Assess client’s ability to participate with the transfer
participate with the transfer and for presence of
cognitive or sensory deficits.
3. Lower the bed and ensure that brakes are applied. Place
the wheelchair next to the bed at a 45-degree angle and
apply brakes. If a patient has weakness on one side,
place the wheelchair on the strong side.
4. Allow client to dangle the lower extremities for few
minutes(specific)
5. Bring wheelchair close to the side of the head part,
facing the foot of the bed.
6. Lock wheelchair brakes and raise the foot pedals.
7. Assist client to side of bed until feet touch the floor.
8. Assess client for dizziness Remain in front of client
until dizziness has subsided if present.
9. Apply gait belt if necessary
10. Reach under client’s both axillae and place hands on
client’s scapulae (or grasp gait belt).
11. Assist the client to a standing position and provide
support
12. Pivot clients so that client’s back the wheelchair
13. Instruct client to place both hands on the arm supports
of the wheelchair.
14. Bend on the knees, assisting the client into a sitting
position.
15. Assist client to maintain proper posture.
16. Secure the safety belt, place client’s feet on feet pedals,
and release brakes.
COMPUTATION OF GRADES
STEP 1: Get the sum of all the points for the entire procedure
STEP 2: Use the formula below to get the final grade for the particular competency
Checklist
FORMULA: RAW SCORE / PERFECT SCORE X 75 + 25 = FINAL GRADE
Evaluated by: Conforme:
Signature over Printed Name Signature over printed name
Clinical Instructor Student
Date: ___________________ Date: ___________________
REMARKS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Assisting a Client with Crutch Walking
Name of Student: ________________________ Date of Exposure: ___________________
Area of Assignment: _____________________ Clinical Instructor: ______________________
Directions: Please rate the students’ level of competency on each expected skill using the scale
provided.
0 – NOT DONE (Student did not exhibit competency)
1 – DONE WITH ASSISTANCE (Student demonstrates fair strength in
demonstrating skills with close supervision)
2 – DONE INDEPENDENTLY (Student demonstrates excellent skills, exhibits
competency independently)
NURSING PROCEDURE
NURSING ACTION Rating Scale
0 1 2
1. Inform client that you will be assisting with ambulation
using crutches.
2. Assess client for strength, mobility, range of motion, visual
acuity, perceptual difficulties, and balance.
3. Adjust crutches to fit the client. With the client supine,
measure from the heel to the axilla. With client standing, set
the crutch position at a point 4 to 5 in. lateral to the client
and 4 to 6 in. in front of the client. The crutch pad should fit
1.5 to 2 in. below the axilla. The hand grip should be
adjusted to allow for the client to have elbows bent at 30°
flexion.
4. Lower the height of the bed.
5. Dangle the client at the side of bed for several minutes.
Assess for vertigo.
6. Instruct client on method to hold the crutches; that is, with
elbows bent 30° and pad 1.5 to 2 in. below the axilla.
Instruct the client to position crutches lateral to and forward
of feet. Demonstrate correct positioning.
7. Apply the gait belt around the client’s waist if balance and
stability is impaired.
8. Assist the client to a standing position with crutches.
Support as needed.
Four- Point Gait
9. Position the crutches 4.5 to 6 in. to the side and each foot.
Move the right crutch forward 4 to 6 in. and move the left
foot forward, even with the left crutch forward 4 to 6 in. and
move the right foot forward, even with the right crutch.
Repeat the four-point-gait.
Three-Point-Gait
10. Advance both crutches and the weaker leg forward together
4 to 6 in. Move the stronger leg forward, even with the
crutches. Repeat the three-point-gait.
Two-Point-Gait
11. Move the left crutch and right leg forward 4 to 6 in. Move
the right crutch and left leg forward 4 to 6 in. Repeat the
two-point-gait.
Swing-Through-Gait
12. Move both crutches forward together 4 to 6 in. Move both
legs forward together in a swinging motion, even with the
crutches. Repeat the swinging-through-gait.
13. Set realistic goals and opportunities for progressive
ambulation using crutches.
14. Consult with a physical therapist for clients learning to walk
with crutches.
COMPUTATION OF GRADES
STEP 1: Get the sum of all the points for the entire procedure
STEP 2: Use the formula below to get the final grade for the particular competency
Checklist
FORMULA: RAW SCORE / PERFECT SCORE X 75 + 25 = FINAL GRADE
Evaluated by: Conforme:
Signature over Printed Name Signature over printed name
Clinical Instructor Student
Date: ___________________ Date: ___________________
REMARKS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Assisting a Patient with Ambulation Using a Walker
Name of Student: ________________________ Date of Exposure: ___________________
Area of Assignment: _____________________ Clinical Instructor: ______________________
Directions: Please rate the students’ level of competency on each expected skill using the scale
provided.
0 – NOT DONE (Student did not exhibit competency)
1 – DONE WITH ASSISTANCE (Student demonstrates fair strength in
demonstrating skills with close supervision)
2 – DONE INDEPENDENTLY (Student demonstrates excellent skills, exhibits
competency independently)
NURSING PROCEDURE
NURSING ACTION Rating Scale
0 1 2
1. Review the medical record and nursing plan care for
conditions that may influence the patient’s ability to move
and ambulate, and for specific instructions for ambulation
such as distance. Assess for tubes, IV lines, incisions, or
equipment that may alter the patient’s knowledge and
previous experience regarding the use of walker. Identify
any movement limitations.
2. Identify the patient. Explain the procedure to the patient.
Tell the patient to report any feelings of dizziness, weakness
or shortness of breath while walking. Decide how far to
walk.
3. Perform hand hygiene.
4. Place the bed in the lowest position.
5. Encourage the patient to make use of a stand-assist aid,
either free standing or attached to the side of the bed, if
available, to move to the side of the bed.
6. Assist the patient to the side of the bed, if necessary. Have
the patient sit on the side of the bed. Assess for dizziness or
lightheadedness. Have the patient stay sitting until he or she
feels secure.
7. Assist the patient to put on footwear and a robe, if desired.
8. Wrap the gait belt around the patient’s waist, based on
assessed need and facility policy.
9. Place the walker directly in front of the patient. Ask the
patient to push himself or herself off the bed or chair, make
use of the stand-assist device, or assist the patient to stand.
Once the patient is standing, have him or her hold the
walker’s hand grip firmly and equally. Stand slightly behind
the patient, on one side.
10. Have the patient move the walker forward 6” to 8” and set it
down, making sure all four feet of the walker stay on the
floor. Then, tell the patient to step forward with either foot
into the walker, supporting himself or herself on his or her
arms. Follow through with the other leg. If one leg is
weaker or impaired, have the patient step forward with the
involve leg and follow with the uninvolved leg, again
supporting himself or herself on his or her arms.
11. Move the walker forward again, and continue the same
pattern. Continue with ambulation for the planned distance
and time. Return the patient to the bed or chair based on the
patient’s tolerance and condition, ensuring that the patient is
comfortable and call light is within reach.
12. Remove gait belt. Perform hand hygiene.
COMPUTATION OF GRADES
STEP 1: Get the sum of all the points for the entire procedure
STEP 2: Use the formula below to get the final grade for the particular competency
Checklist
FORMULA: RAW SCORE / PERFECT SCORE X 75 + 25 = FINAL GRADE
Evaluated by: Conforme:
Signature over Printed Name Signature over printed name
Clinical Instructor Student
Date: ___________________ Date: ___________________
REMARKS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Assisting a Patient with Ambulation Using a Cane
Name___________________________________________________Rating_______________
Year Level______________________________ Group__________ Date_________________
Inclusive dates of clinical rotation ________________________________________________
Directions: Please rate the students’ level of competency on each expected skill using the scale
provided.
0 – NOT DONE (Student did not exhibit competency)
1 – DONE WITH ASSISTANCE (Student demonstrates fair strength in
demonstrating skills with close supervision)
2 – DONE INDEPENDENTLY (Student demonstrates excellent skills, exhibits
competency independently)
NURSING EVALUATION TOOL:
NURSING ACTION RATING SCALE
0 1 2
1. Review the medical record and nursing plan care for
conditions that may influence the patient’s ability to move
and ambulate, and for specific instructions for ambulation
such as distance. Assess for tubes, IV lines, incisions, or
equipment that may alter the patient’s knowledge and
previous experience regarding the use of cane. Identify any
movement limitations.
2. Identify the patient. Explain the procedure to the patient.
Tell the patient to report any feelings of dizziness, weakness
or shortness of breath while walking. Decide how far to
walk.
3. Perform hand hygiene.
4. Encourage the patient to make use of a stand-assist aid,
either free standing or attached to the side of the bed, if
available, to move to the side of the bed.
5. Wrap the gait belt around the patient’s waist, based on
assessed need and facility policy.
6. Encourage the patient to make use of the stand-assist device
to stand with weight evenly distributed between the feet and
the cane.
7. Have the patient hold the cane on his or her stronger side,
close to the body.
8. Tell the patient to advance the cane 4” to 12” (10-30 cm)
and then, while supporting his or her weight on the stronger
leg and the cane, advance the weaker foot forward, parallel
with the cane.
9. While supporting his or her weight on the weaker leg and
the cane, have the patient advance the stronger leg forward
ahead of the cane (heel slightly beyond the tip of the cane).
10. Tell the patient to move the weaker leg forward until it is
even with the stronger leg, and then advance the cane again.
11. Continue with ambulation for the planned distance and
time. Return the patient to the bed or chair based on the
patient’s tolerance and condition, ensuring the patient’s
comfort and that call light is within reach.
12. Perform hand hygiene.
COMPUTATION OF GRADES
STEP 1: Get the sum of all the points for the entire procedure
STEP 2: Use the formula below to get the final grade for the particular competency
Checklist
FORMULA: RAW SCORE / PERFECT SCORE X 75 + 25 = FINAL GRADE
Evaluated by: Conforme:
Signature over Printed Name Signature over printed name
Clinical Instructor Student
Date: ___________________ Date: ___________________
REMARKS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
