A safe transfer from a wheelchair to a bed is a controlled process of moving a person between two surfaces, minimizing the risk of a fall or injury. Mastering this technique is fundamental to maintaining a person’s independence and allowing them to participate in their daily routine. Proper transfer methods also significantly reduce the physical strain and potential for musculoskeletal injury on the caregiver. Precision and preparation are paramount because improper technique is a leading cause of accidents for both the person being moved and the assistant.
Essential Safety and Preparation
The physical transfer should only begin after preparation of the environment has been completed. Ensure the area between the wheelchair and the bed is clear of obstacles, such as rugs, electrical cords, or clutter, which could create a tripping hazard. Position the wheelchair as close to the bed as possible, ideally at a 30- to 45-degree angle, to minimize the travel distance during the pivot.
Locking the brakes on both the wheelchair and the bed is necessary to prevent movement during the transfer, which is a common cause of falls. Remove the wheelchair’s footrests and the armrest closest to the bed to create a clear path for the person’s feet and body. The height of the bed should be adjusted to be level with the wheelchair seat, or slightly lower, to facilitate an easier and safer descent onto the mattress.
The Stand-Pivot Transfer Method
The stand-pivot transfer is the preferred technique when the person can bear some weight on their legs and actively assist in the movement. Begin by assisting the person to scoot forward to the edge of the wheelchair seat, ensuring their feet are flat on the floor and positioned slightly behind their knees. The person’s feet should be pointed toward the direction of the transfer to facilitate the turning motion.
The caregiver should stand directly in front of the person with a wide, staggered stance, placing their knee against the person’s knee closest to the bed to block it and provide stability. On a count of three, the person should lean their “nose over toes,” shifting their weight forward and pushing up with their hands from the wheelchair armrests or the bed surface. This forward momentum is necessary to lift the hips and achieve a standing position.
As the person stands, the caregiver guides the movement with a firm hold, often using a gait belt placed around the person’s waist. Once standing, the person takes a few small, shuffling steps or pivots on their feet to turn toward the bed until the backs of their legs lightly touch the mattress. The caregiver then instructs the person to reach back for the bed surface or armrest before slowly lowering themselves in a controlled descent by bending their hips and knees.
Transfers Using Assistive Devices
For individuals with limited weight-bearing capacity or upper body strength, assistive devices like a gait belt or a sliding board are necessary to perform a safe transfer. The gait belt, a sturdy canvas or leather strap, provides the caregiver with a secure handhold around the person’s center of gravity, typically their waist or hips. The belt should be fastened snugly over clothing, allowing only enough room for the caregiver’s fingers to grasp it firmly from underneath.
The gait belt is used to stabilize and gently guide the person during the stand or pivot, offering support without pulling on their limbs or clothing, which can cause injury. For people who cannot stand at all, a sliding board provides a bridge for a seated lateral transfer from the wheelchair to the bed. The board is positioned with one end securely under the person’s thigh and the other end resting flat on the transfer surface, ensuring the board is stable and not pinching the skin.
The person uses their arms to bear weight and lift their hips slightly while the caregiver assists with small, controlled movements across the slick surface of the board. This technique converts the vertical lifting requirement into a horizontal, sliding motion, greatly reducing the muscular effort needed from both the person and the caregiver. The use of a gait belt is still recommended during a sliding board transfer to ensure the caregiver can control the person’s trunk for safety and balance.
Preventing Caregiver and Patient Injury
Caregivers must focus on proper body mechanics to prevent the musculoskeletal injuries that are common in patient handling. Always establish a wide base of support by standing with feet shoulder-width apart and one foot slightly ahead of the other to maintain balance. The lifting force should always be generated by bending the knees and using the powerful leg muscles, keeping the back straight and in a neutral position.
It is crucial to keep the person being transferred as close to the caregiver’s body as possible to reduce strain and leverage on the back. Twisting the torso should be strictly avoided; instead, the caregiver should pivot their entire body by moving their feet when changing direction. For the person being transferred, clear communication about the steps and timing is important, and they should be encouraged to assist as much as their ability allows.
Before and during the transfer, the person should be monitored for any signs of discomfort, pain, or orthostatic hypotension, which is a drop in blood pressure that can cause dizziness upon sitting or standing. Allowing the person to sit on the edge of the bed for a moment after rising helps the circulatory system adjust before attempting to stand. Never pull on the person’s arms or shoulders, as this can cause joint damage; instead, use a gait belt or transfer board for a secure and distributed grip.