The process of moving a bedridden person, often called a patient transfer, requires careful planning and technique to protect both the individual and the caregiver. Improper transfers can lead to significant injuries, such as falls for the patient or musculoskeletal strain, particularly back injuries, for the person assisting. Before attempting any movement, assess the patient’s physical state and ensure the environment is secure. This preparation minimizes risk and allows the transfer to be executed with stability.
Essential Safety Preparation Before Transfer
A thorough assessment of the patient’s physical condition is the starting point for any transfer. The caregiver must determine the person’s level of cooperation, weight-bearing ability, and any pain points that might be exacerbated by movement. Clear communication about the process reduces anxiety and encourages the patient’s participation, contributing to overall safety.
Environmental hazards must be removed from the transfer path before proceeding. This includes clearing rugs, loose wires, or other tripping obstacles between the bed and the destination chair or wheelchair. The transfer surfaces, including the bed and the receiving chair or commode, must have their brakes securely locked to prevent unexpected movement that could result in a fall.
Proper footwear for the patient is required, as it provides stable support and tread to prevent slipping during the pivot or standing phase. Caregivers must use proper body mechanics to prevent injury, including standing with a wide base of support and bending at the knees rather than the back. A transfer or gait belt should be applied snugly around the patient’s waist, over clothing, to provide a firm, secure grip point. This belt is a tool for control and support, not a lifting device, and allows the caregiver to maintain balance without pulling on the patient’s limbs.
Step-by-Step Manual Transfer Techniques
The manual transfer begins by preparing the patient to sit on the edge of the bed. Roll the patient onto their side, positioning yourself on the side of the bed toward which they will be moving. Place one hand under the patient’s shoulders and the other behind their knees, then use the momentum of swinging the patient’s legs off the bed to help them sit up.
Once the patient is sitting, allow them a brief period to ensure they do not experience orthostatic hypotension (dizziness) from the change in position. The bed height should be adjusted so the patient’s feet are flat on the floor, allowing them to use their legs to assist with standing. The caregiver should stand directly in front of the patient, positioning their feet in a staggered stance, with one foot placed between the patient’s knees for stability.
The caregiver grasps the gait belt firmly on both sides, while the patient leans forward to shift their weight over their feet. The transfer is executed by counting to three and using strong leg muscles to lift and guide the patient into a standing position. The goal is a controlled rise, utilizing the patient’s ability to push off the bed surface with their hands to minimize strain on the caregiver.
The movement to the wheelchair or chair involves a controlled pivot, not a lift-and-carry action. Keep the patient close to your body and pivot your feet toward the destination, avoiding twisting at the waist, which can cause back injury. The receiving surface, such as a wheelchair, should be placed at a 45-degree angle to the bed to minimize the distance and degree of turn required. Once the patient feels the chair against the back of their legs, the caregiver guides the descent by bending their knees and shifting their weight, ensuring the patient sits down safely.
Utilizing Specialized Transfer Equipment
If a patient is non-weight-bearing, exceeds the caregiver’s capacity, or cannot cooperate, specialized equipment is necessary to prevent injury. These devices reduce the exertion of lifting and moving a person, replacing manual force with mechanical or low-friction assistance.
Mechanical patient lifts, such as a Hoyer lift, use a sling system to safely raise and move an individual. The lift allows a smooth, controlled transfer from the bed to a chair or commode. This often requires positioning the sling underneath the patient while they are still lying down. Proper training is required for safe operation, including selecting the correct sling type and ensuring the lift’s base is widened for maximum stability before raising the patient.
Slide sheets offer a low-tech solution for repositioning or lateral transfers by reducing friction between the patient and the bed surface. These slippery fabric tubes can be placed under the patient, allowing one or two caregivers to gently slide the person across the bed with less effort. Slide sheets are useful when moving a patient up or down the bed or preparing them for a mechanical lift, but they are not used for bed-to-chair transfers.
Post-Transfer Positioning and Comfort
Once the transfer is complete, ensure the patient is securely and comfortably seated in the receiving chair or wheelchair. The patient should be positioned fully back in the seat to distribute body weight evenly and prevent slouching. Proper alignment means the patient is sitting upright with their feet supported, ideally flat on the floor or on the footrests.
Pressure relief is a concern for individuals with limited mobility, as prolonged pressure on bony prominences can lead to skin breakdown and pressure ulcers. Cushions or specialized pressure-redistributing surfaces should be checked and adjusted to properly support the patient’s weight, particularly around the sacrum and hips. Repositioning the patient slightly every hour, if possible, helps the skin recover from sustained pressure.
A final check involves ensuring the patient has access to anything needed immediately, such as a call bell, drinking water, or a blanket. Confirming that the patient feels secure and comfortable completes the transfer process. The wheelchair brakes should remain locked until the patient is ready to move again.