POSITIONING

PATIENTS
Strong Point Educational and Training
Institute (SPETI)
Ms. Jennifer Jill Martinez-Libid RMRN, BSN Trainer
 IMPORTANCE OF ACTIVITY

 INCREASES MUSCLE STRENGTH

 MAINTAINS BODY FLEXIBILITY
 IMPROVES RESPIRATORY FUNCTION
 PREVENTS POOLING OF FLUID IN THE LUNGS
 IMPROVES CIRCULATION
 HELPS MAINTAIN HEALTHY SKIN
 PROMOTES EFFECTIVE ELIMINATION
 AIDS DIGESTION
 RELIEVES STRESS
 COMPLICATIONS OF BEDREST
Every Body System is Affected

 CONTRACTURE
An abnormal shortening of
the muscle due to lack of
use.

The muscle is fixed into

position, is deformed, and
cannot stretch.

The person with a

contracture is permanently
disabled
 COMPLICATIONS OF BEDREST
Every Body System is Affected

 ATROPHY
A decrease in size or a
wasting away of muscle
tissue.

Caused by lack of use.

 COMPLICATIONS OF BEDREST
Every Body System is Affected

 DECUBITUS ULCER
A breakdown in skin tissue
that occurs when blood
flow to an area is
interrupted
COMPLICATIONS OF BEDREST
Every Body System is Affected
 BODY ALIGNMENT

 The trunk of the person

should be in a straight
line when the patient is
lying down.
PROPER POSITIONIING IN A CHAIR
 RESTORATIVE EQUIPMENT
BED CRADELE
RESTORATIVE EQUIPMENT
Designed to help the patient maintain correct
body alignment and prevent complications.

BED CRADLE
Keeps the weight of the linens from pressing on
the patient’s body
 RESTORATIVE EQUIPMENT
FOOT BOARD

 Keep the foot in a

natural position to
prevent foot drop
(planter flexion).
 RESTORATIVE EQUIPMENT
FOOT DROP BOOT

 Helps prevent foot

drop.
 RESTORATIVE EQUIPMENT
HAND ROLL

 Permits the hand to flex

slightly and prevents
contractures of the
fingers.
 ASSISTING IN
POSITIONING AND TURNING

 • If the patient is unable to change position

independently , you will need to assist.

 • patients need to be turned every two hours.

 POSITIONING

 Means helping residents into positions that promote

comfort and good health.
BODY POSITIONS
BASIC BODY POSITIONS
 BASIC BODY POSITIONS
FOWLER’S POSITION (Sitting Position)
• Thespine is kept straight.
• The head is supported
with a small pillow.
• The arms are supported
with pillows.
Fowler's position is
typically used for neurosurgery
and shoulder surgeries. The
beach chair position is
often used for nasal surgeries,
abdominoplasty, and breast
reduction surgeries.
 BASIC BODY POSITIONS
SUPINE POSITION (Dorsal Recumbent)

The position is the back lying position.

•The bed is flat.
• The head and shoulders are supported on a pillow.
• Arms and hands are at the sides.
USE:
This is the most common position for surgery with a patient
lying on his or her back with head, neck, and spine in
neutral positioning and arms either adducted alongside the
patient or abducted to less than 90 degrees.
 BASIC BODY POSITIONS
PRONE POSITION

AIMS

• The person lies on the abdomen with the head turned to one side.
• The bed is flat.
• Small pillows are placed under the head, abdomen, and lower legs.
• Arms are flexed at the elbows with the hands near the head.
AIMS:
1) To improve oxygenation.
2) To improve respiratory mechanics.
3) To inhomogeneous distribution the pleural pressure gradient, the alveolar
inflation and the ventilation distribution.
4) To increase lung volume and reduce the amount of atelectatic regions.
5) To facilitate the improvement in clearance of secretions.
 BASIC BODY POSITIONS
LATERAL POSITION (Side-Lying)

• A pillow is under the head and neck.

• The upper leg, ankle, and thigh are supported with pillows.
• A pillow is positioned against the person’s back.
• A small pillow is under the upper arm and hand.
USE:
• Increased patient comfort.
• Prevention of pressure injury.
• Reduced deep vein thrombosis, pulmonary emboli,
atelectasis, and pneumonia.
 BASIC BODY POSITIONS
ORTHOPNEIC POSITION

 Frequently used by
patients with respiratory
problems helps expand
the chest and lungs to
allow more oxygen to
enter.
AIMS:
To help expand the chest
and lungs to allow more
oxygen.
 MOVING PERSON IN BED

 Protect the skin when moving the person.

• Friction is the rubbing of one surface
against another.
• Shearing is when the skin sticks to a
surface while muscles slide in the direction
the body is moving.

 To reduce friction and shearing:

• Roll the person or use assist devices.
• Use a lift sheet (turning sheet), turning
pad, large incontinence product, slide board,
or slide sheet.
 SHEARING

 The skin sticks to the surface

but the internal structures
(bone and muscle) slide in
the direction the body is
moving occurs when the
patient slides down in bed.
 ASSISTING A PATIENT
RAISING THE HEAD AND SHOULDER
1. Identify yourself by name.
Identify the resident. Greet the
resident by name.

2. Wash your hands.

3. Explain procedure to resident.

Speak clearly, slowly, and directly.
Maintain face-to-face contact
whenever possible. Encourage
resident to assist if possible.

4. Provide for the resident’s

privacy with a curtain, screen, or
door.
 ASSISTING A PATIENT
RAISING THE HEAD AND SHOULDER
5. Practice good body mechanics.
Adjust the bed to a safe level, usually
waist high. Lock the bed wheels.

6. Place pillow at the head of bed

against the headboard.

7. Lower the side rail (if bed has one

and if it is not already lowered) on
side nearest you.

8. Stand at the side of the bed and

face the head of bed.
 ASSISTING A PATIENT
RAISING THE HEAD AND SHOULDER
9. Spread feet shoulder- width
apart and slightly bend the knees
to protect your back.

10. Avoid trauma or pain to the

resident throughout the
procedure.

11. Gently slide one hand under

the resident’s closest shoulder.

12. Gently slide the other hand

under the resident’s upper back.
 ASSISTING A PATIENT
RAISING THE HEAD AND SHOULDER
13. At the count of three, slowly
raise the resident’s head and
shoulders. Give necessary care.

14. Replace pillow under the

resident’s head.

15. Make resident comfortable.

16. Return bed to low position if

raised. Ensure resident’s safety.
Return side rails to ordered
position. Remove privacy
measures.
 ASSISTING A PATIENT
RAISING THE HEAD AND SHOULDER
17. Leave call light within
resident’s reach.

18. Wash your hands.

19. Be courteous and respectful

at all times.

20. Report any changes in the

resident to the nurse.
Document procedure using
facility guidelines.
RAISING THE SHOULDERS
WITH TWO HELPERS
 ASSISTING A PATIENT
TO MOVE UP IN BED
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):
6. Lower the head of bed. Move the pillow to the
head of bed.

7. Lower the side rail (if bed has one and if it is not
already lowered) on side nearest you.

8. Stand by bed with feet shoulder-width apart.

Face the resident. Point foot closest to the head of
the bed towards the head of the bed.

9. Avoid trauma or pain to the resident throughout

the procedure.

10. Place one arm under the resident’s shoulder

blades. Place the other arm under the resident’s
thighs.
 ASSISTING A PATIENT
TO MOVE UP IN BED
11. Ask resident to bend knees, brace
feet on the mattress, and push feet on
the count of three.

12. Keep your back straight. At the count

of three, shift body weight to move
resident while resident pushes with her
feet.

13. Replace pillow under the resident’s

head.

14. Make resident comfortable. Keep

your back straight and your knees bent.

FOLLOW 15 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
TO MOVE UP IN BED

IF THE PATIENT CAN ASSIST:

• Have the patient grasp the
headboard and bend his
knees.

• Place your forearms under his

shoulders and knees.

• Lift at the count of three.

 ASSISTING A PATIENT
TO MOVE UP IN BED
USING TRAPEZE
• If the patient has a trapeze on the
bed.

• Have the patient grasp the trapeze

and bend at the knees.
 ASSISTING A PATIENT
TO MOVE UP IN BED With Assistance
USING LIFT/DRAW SHEET
FOLLOW 1 TO 5 STEPS
(To Move Up in Bed):
6 TO 7 STEPS
(Raising the Head and Shoulder):

8. Stand on the opposite side of the

bed from your helper. Each of you
should be turned slightly toward the
head of the bed. For each of you, the
foot that is closest to the head of the
bed should be pointed in that
direction. Stand with feet about 12
inches apart. Bend your knees. Keep
your back straight.

9. Avoid trauma or pain to the

resident throughout the procedure.
 ASSISTING A PATIENT
TO MOVE UP IN BED With Assistance
USING LIFT/DRAW SHEET
10. Roll the draw sheet up to the
resident’s side. Have your helper do
the same on his side of the bed. Grasp
the sheet with your palms up at the
resident’s shoulders and hips. Have
your helper do the same.

11. Shift your weight to your back foot

(the foot closer to the foot of the bed).
Have your helper do the same. On the
count of three, both shift your weight
to your forward feet. Both workers
shift their weight to their back feet
and prepare to move.
 ASSISTING A PATIENT
TO MOVE UP IN BED With Assistance
USING LIFT/DRAW SHEET
Slide the resident toward the head of the bed.

Replace pillow under the resident’s head.

Make resident comfortable.

Unroll the draw sheet.

Leave it in place for the next repositioning.

Return bed to low position if raised.

Ensure resident’s safety.

Return side rails to ordered position.

Remove privacy measures.

Both workers shift their weight to their back feet and prepare to
move.

FOLLOW 17 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
TO MOVE UP IN BED With Assistance
USING LIFT/DRAW SHEET
• A lift sheet makes lifting easier.

• Helps prevent friction against

the patient’s skin.

• Takes two workers to lift .

• If patient can help have him

bend his knees.

• Use for persons who can not

help with the move
 ASSISTING A PATIENT
Moving a Patient to the Side of the Bed
The Person is Moved in Segments
FOLLOW 1 TO 5 STEPS
(To Move Up in Bed):

6. Lower the head of bed. Move the pillow to the

head of bed.

7. Stand on one side of the bed. Lower the side rail

(if bed has one and if it is not already lowered) on
side nearest you.

8. Stand with feet about 12 inches apart. Bend your

knees. Keep your back straight.

9. Avoid trauma or pain to the resident throughout

the procedure.

10. Gently slide your hands under the resident’s

head and shoulders and move toward you. Gently
move the head and shoulders toward you.
 ASSISTING A PATIENT
Moving a Patient to the Side of the Bed
The Person is Moved in Segments
11. Gently slide your hands under the
resident’s midsection and move
toward you.

12. Gently slide your hands under the

resident’s hips and legs and move
toward you (Fig. 11-16).

13. Make resident comfortable.

Reposition pillow under head. Gently
move the hips and legs toward you.

FOLLOW 16 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
Moving a Patient to the Side of the Bed
USING DRAW SHEET
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Lower the head of bed. Move the pillow to the

head of bed.

7. Lower the side rail (if bed has one and if it is not
already lowered) on side nearest you.

8.Stand on the opposite side of the bed from your

helper. Each of you should be turned slightly
toward the head of the bed. For each of you, the
foot that is closest to the head of the bed should be
pointed in that direction. Stand with feet about 12
inches apart. Bend your knees. Keep your back
straight.

9. Avoid trauma or pain to the resident throughout

the procedure.
 ASSISTING A PATIENT
Moving a Patient to the Side of the Bed
USING DRAW SHEET
10. Roll the draw sheet up to the resident’s side. Have your helper do the
same on his side of the bed. Grasp the sheet with your palms up at the
resident’s shoulders and hips. Have your helper do the same.

11. Shift your weight to your back foot (the foot closer to the foot of the
bed).
- Have your helper do the same.

- On the count of three, both shift your weight to your forward feet.

- Both workers shift their weight to their back feet and prepare to move.

- Slide the resident toward the head of the bed. Replace pillow under the
resident’s head.

- Make resident comfortable.

- Unroll the draw sheet.

- Leave it in place for the next repositioning.

- Return bed to low position if raised.

- Ensure resident’s safety.

- Return side rails to ordered position.

- Remove privacy measures.

- Both workers shift their weight to their back feet and prepare to move.

FOLLOW 17 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
TURNING A RESIDENT AWAY FROM YOU
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Lower the head of bed.

7. Stand on side of bed opposite to where person will be

turned. The far side rail should be raised (if bed has one).

8. Lower side rail nearest you if it is up.

9. Avoid trauma or pain to the resident throughout the

procedure.

10. Move resident to side of bed nearest you using

previous procedure.

11. Cross resident’s arm over his or her chest. Move arm
out of the way on side toward which resident is being
turned. Cross leg nearest you over the far leg.
 ASSISTING A PATIENT
TURNING A RESIDENT AWAY FROM YOU
12. Stand with feet about 12 inches
apart. Bend your knees.

13. Place one hand on the resident’s

shoulder. Place the other hand on the
resident’s nearest hip.

14. While supporting the body, gently

push resident toward other side of bed.
Shift your weight from your back leg to
your front leg. Make sure resident’s face
is not covered by the pillow. Gently push
resident toward other side of bed while
shifting your weight from your back leg
to your front leg.
 ASSISTING A PATIENT
TURNING A RESIDENT AWAY FROM YOU
15. Position resident properly in good
alignment:
- head supported by pillow
- shoulder adjusted so resident is not lying
on arm
- top arm supported by pillow
- back supported by supportive device
- hips properly aligned
- top knee flexed
- supportive device between legs with top
knee flexed; knee and ankle supported.

16. Cover resident with top linens and

straighten.

FOLLOW 15 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
TURNING A RESIDENT TOWARD YOU
FOLLOW ALL THE STPES
(Turning a Resident Away from You)
EXCEPT! No. 13 and 14:

13. Place one hand on the

resident’s far shoulder. Place the
other hand on the resident’s far
hip.

14. While supporting the body,

gently roll the resident toward
you. Make sure resident’s face is
not covered by the pillow. Gently
roll the resident toward you.
 ASSISTING A PATIENT
LOGROLLING A RESIDENT WITH ASSITANCE
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Lower the head of bed.

7. Both co-workers stand on the same side of the

bed. Lower the side rail (if bed has one and if it is
not already lowered) on side nearest you.

One person stands at the resident’s head and

shoulders. The other stands near the resident’s
midsection.

8. Avoid trauma or pain to the resident throughout

the procedure.

9.Place a pillow under the resident’s head to

support the neck during the move.
 ASSISTING A PATIENT
LOGROLLING A RESIDENT WITH ASSITANCE
10. Place the resident’s arms across his or her chest. Place
a pillow between the knees.

11. Stand with feet about 12 inches apart. Bend your

knees.

12. Grasp the draw sheet on the far side

13. On the count of three, gently roll the resident toward

you. Turn the resident as a unit (Fig. 11-22).

14. Reposition resident comfortably in good alignment.

Place pillow under head. Cover resident with top linens
and straighten.

15. Return bed to low position if raised. Ensure resident’s

safety. Return side rails to ordered position. Remove
privacy measures. Fig. 11-22. On the count of three, both
workers should roll the resident towards them, turning the
person as a unit.

FOLLOW 17 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
TO SIT UP ON THE SIDE OF THE BED (DANGLING)

FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Avoid trauma or pain to the resident

throughout the procedure.

7. Raise the head of bed to sitting position. Fold

linen to the foot of the bed. Lower the side rail
(if bed has one and if it is not already lowered)
on side nearest you.

8. Stand at the side of the bed with feet about

12 inches apart. Bend your knees. Keep your
back straight. Help resident slowly move toward
the side of the bed on which you are standing.

9. Place one arm under resident’s shoulder

blades. Place the other arm under resident’s
thighs.
 ASSISTING A PATIENT
TO SIT UP ON THE SIDE OF THE BED (DANGLING)

10. On the count of three, gently and slowly

turn resident into sitting position with legs
dangling over the side of bed.

11. Ask resident to sit up straight and push both

fists into the edge of mattress. Assist resident to
put on robe. The resident should remain sitting
with legs dangling over the side of bed for as
long as ordered.

12. Have resident dangle as long as ordered.

Place a pillow or other supporting device behind
resident’s back during dangle. Stay with the
resident at all times. Check for dizziness. If
resident feels dizzy or faint, help her lie down
again and make sure she is secure. Tell the nurse
at once.

13. Take vital signs as ordered.

 ASSISTING A PATIENT
TO SIT UP ON THE SIDE OF THE BED (DANGLING)

14. Gently assist resident back into bed.

Place one arm around resident’s shoulders.
Place the other arm under resident’s
knees. Slowly swing resident’s legs onto
bed.

15. Make resident comfortable. Cover

resident with top linens and straighten.
Replace pillow under the resident’s head.

FOLLOW 16 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A PATIENT
TO SIT UP ON THE SIDE OF THE BED (DANGLING)

Dangling refers to sitting on the side of the bed

with the feet hanging down.

Do not leave the patient alone when dangling.

Have the patient cough, deep breath, and exercise

their leg muscles when dangling.

If the patient becomes dizzy – lie him down.

Check the persons pulse and respirations.

 HOW TO SAFELY TRANSFER
RESIDENTS

ERGONOMICS is the science of designing equipment and

setting up areas to make them safer and to suit the
worker’s abilities.

TRANSFER BELT is a safety device used to transfer residents

who are weak, unsteady, or uncoordinated. A transfer belt
is called a gait belt when it is used to help residents walk.
 APPLYING A
TRANSFER BELT EQUIPMENT

• Apply the belt around the person’s waist,

over the clothing.

• Tighten the belt so it is snug. It should not

cause discomfort or impair breathing. You
should be able to slide your open hand
under the belt.

• Place the buckle slightly off center in the

front.

• Do not use with patients with fractured ribs,

abdominal surgery, or having breathing
difficulties.
•
 APPLYING A
TRANSFER BELT EQUIPMENT
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Supporting the back and hips, assist resident to a sitting

position with feet flat on the floor.

7. Put on and properly fasten non-skid footwear on resident.

8. Place the belt over the resident’s clothing

 TRANSFERRING A RESIDENT
From Bed to a Chair or Wheelchair
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Remove wheelchair footrests close to the bed.

7. Place wheelchair near the head of the bed with arm

of the wheelchair almost touching the bed.

Wheelchair should be placed on resident’s

stronger, or unaffected, side. Lower the side rail
(if bed has one and if it is not already lowered)
on side nearest you.

8. Lock wheelchair wheels.

9. Raise the head of the bed. Adjust bed level.

The height of the bed should be equal to or
slightly higher than the chair. Lock bed wheels.
 TRANSFERRING A RESIDENT
From Bed to a Chair or Wheelchair
10. Avoid trauma or pain to the resident throughout
the procedure.

11. Assist resident to sitting position with feet flat on

the floor. Let resident sit for a few minutes.

12. Put non-skid footwear on resident and securely

fasten.

13. WITH TRANSFER (GAIT) BELT:

a. Stand in front of resident.
b. Stand with feet about 12 inches apart. Bend
your knees. Keep your back straight.
c. Place belt below the rib cage and above the
waist. Do not put it over bare skin. Grasp
belt securely on both sides.
 TRANSFERRING A RESIDENT
From Bed to a Chair or Wheelchair
WITHOUT TRANSFER BELT:
a. Stand in front of resident.
b. Stand with feet about 12 inches apart. Bend your
knees. Keep your back straight.
c. Place your arms around the resident’s torso under
the arms, but not in the armpits (axilla).
d. Repeated pressure in the axilla may cause
nerve damage. Do not allow resident to
grasp your shoulders or around your neck.
This may cause you to lose your balance.

14. Provide instructions to allow resident to

help with transfer. Instructions may include:
“When you start to stand, push with your hands
against the bed.”

“Once standing, reach for the chair with your

stronger hand.”
 TRANSFERRING A RESIDENT
From Bed to a Chair or Wheelchair
15. With your legs, brace resident’s lower legs to prevent
slipping (Fig. 11-29).

16. Count to three to alert resident.

17. On three, slowly help resident to stand. Bracing the

resident’s lower legs with your legs helps prevent slipping.

18. Help resident to pivot to front of wheelchair

with back of resident’s legs against wheelchair.

19. Ask resident to put hands on wheelchair

armrests if able.

20. Gently lower resident into wheelchair.

21. Reposition resident with hips touching back of

wheelchair. See previous guidelines on how to do
this. Remove transfer belt, if used. Pivoting is safer
than twisting.
 TRANSFERRING A RESIDENT
Back to Bed from a Chair or Wheelchair
PERFORM STEPS 1 THROUGH 8 ABOVE.

2.Adjust bed level to a low position. The height of the

bed should be equal to or slightly lower than the chair.
Lock bed

3. Avoid trauma or pain to the resident throughout the

procedure.

4. Perform steps 13 through 17 above.

5. The resident should be allowed to stand until he

feels stable enough to move toward the bed. If the
transfer belt is used, do not let go of it during this time.

6.Help resident to pivot to bed with back of resident’s

legs against bed. When he feels the bed, he should
slowly sit down on the side of the bed.

FOLLOW 15 TO 20 STEPS!
(Raising the Head and Shoulder)
 TRANSFERRING A RESIDENT
From Bed to Stretcher with Assistance
6. Fold linens to foot of the bed. Cover resident with bath
blanket. Do not expose resident during the procedure.

7. Lower the side rail on side to which you will move

resident (if in use for resident).

8. Avoid trauma or pain to the resident throughout

the procedure.

9. Move the resident to the side of the bed. Have

your co-workers help you do this. Refer back to the
procedure “Moving a resident to the side of the
bed” earlier in this chapter.

10. Place stretcher solidly against the bed. Lock

stretcher wheels. Bed height should be equal to or
slightly above the height of the stretcher. Move
stretcher safety belts out of the way.
 TRANSFERRING A RESIDENT
From Bed to Stretcher with Assistance
11. Two workers should be on the side of the bed opposite
the stretcher. Two more workers should be on the outside
of the stretcher.

12. Each worker should roll up the sides of the draw sheet
and prepare to move the resident. Protect the resident’s
arms and legs during the transfer. If facility policy permits,
two workers may actually get up on the bed on their knees
to protect their backs. With two workers on each side, roll
up the sides of the draw sheet and prepare to move the
resident.

13. On the count of three, the workers should lift

and move the resident to the stretcher. All should
move at once. Make sure the resident is centered
on the stretcher.

14. Raise the head of the stretcher or place a pillow

under the resident’s head if allowed. Make sure
bath blanket still covers the resident. On the count
of three, all workers should lift and move at once.
 TRANSFERRING A RESIDENT
From Bed to Stretcher with Assistance

15. Place safety straps across the resident. Raise side

rails on stretcher.

16. Unlock stretcher’s wheels. Take resident to

appropriate site. Stay with the resident until another
team member takes over.

FOLLOW 18 TO 20 STEPS!
(Raising the Head and Shoulder)
 MECHANICAL LIFT
HYDRAULIC LIFT/HOYER LIFT

 Used to transfer patients

who are paralyzed, very
heavy or difficult to move.

 You need at least 2 staff

members to safely use a
mechanical lift.
 TRANSFERRING A RESIDENT
Using a Mechanical Lift with Assistance Equipment
WHEELCHAIR or CHAIR, MECHANICAL or HYDRAULIC LIFT, WASHCLOTH

Before performing this procedure, check the weight

limit of the lift to make sure the resident is within the
weight limit. Make sure you know how to use this lift.
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Remove wheelchair footrests close to the bed.

7. Position wheelchair next to bed. Lower the side rail

(if bed has one and if it is not already lowered) on side
nearest you. Lock wheelchair brakes.

8. Avoid trauma or pain to the resident throughout the

procedure.
 TRANSFERRING A RESIDENT
Using a Mechanical Lift with Assistance Equipment
WHEELCHAIR or CHAIR, MECHANICAL or HYDRAULIC LIFT, WASHCLOTH
9. Help the resident turn to one side of the bed. Pad
the sling where the neck will rest with a washcloth for
resident’s comfort. A sheet may be used over the sling
to protect it from soiling. Position the sling under the
resident, with the edge next to the resident’s back.
Fanfold if possible.

FANFOLDING means folding several times into pleats.

Make the bottom of the sling even with the resident’s
knees (some slings only come to the top of the
buttocks).

Help the resident roll to his opposite side. Spread out

the fanfolded edge of the sling, then roll back to the
middle of the bed.

10. Roll the mechanical lift to bedside. Make sure the

base is opened to its widest point. Push the base of the
lift under the bed. Lock lift wheels.

11. Place the overhead bar directly over the resident.

Be careful so the swing does not hit anyone.
 TRANSFERRING A RESIDENT
Using a Mechanical Lift with Assistance Equipment
WHEELCHAIR or CHAIR, MECHANICAL or HYDRAULIC LIFT, WASHCLOTH
12. With the resident lying on her back, attach one set
of straps to each side of the sling. Attach one set of
straps to the overhead bar (Fig. 11-34). If available,
have a co- worker support the resident at the head,
shoulders, and knees while being lifted. The resident’s
arms should be folded across her chest. If the device
has “S” hooks, they should face away from resident.
Make sure all straps are connected properly. Fig. 11-34.
Attach straps to overhead bar.

13. Following manufacturer’s instructions, raise the

resident two inches above the bed. Pause a moment
for the resident to gain balance.

14. If available, a lifting partner can help support and

guide the resident’s body (Fig. 11-35). You can then
move the lift so that the resident is positioned over the
chair or wheelchair. Fig. 11-35. Make sure that one
person supports and guides the resident’s body to help
prevent injury.
 TRANSFERRING A RESIDENT
Using a Mechanical Lift with Assistance Equipment
WHEELCHAIR or CHAIR, MECHANICAL or HYDRAULIC LIFT, WASHCLOTH
15. Slowly lower the resident into the chair or
wheelchair. Push down gently on the resident’s knees
to help the resident into a sitting position.

16. Undo the straps from the overhead bar. Leave the
sling in place for transfer back to bed (some slings can
be easily removed when resident is seated).

17. Be sure the resident is seated comfortably and

correctly in the chair or wheelchair. Put non-skid
footwear on resident and fasten. Replace footrests.
Cover the resident with a lap cover or robe if he
requests it.

18. Remove privacy measures.

FOLLOW 17 TO 20 STEPS!
(Raising the Head and Shoulder)
 TRANSFERRING A RESIDENT
Using a Mechanical Lift with Assistance Equipment
WHEELCHAIR or CHAIR, MECHANICAL or HYDRAULIC LIFT, WASHCLOTH

 Many facilities have

NO LIFT policies.

 A Special Lift is used to

stand and move residents
if your facility have this
restrictions.
 TRANSFERRING A RESIDENT
Using a Mechanical Lift with Assistance Equipment
WHEELCHAIR or CHAIR, MECHANICAL or HYDRAULIC LIFT, WASHCLOTH

 Paralyzed persons used a

TRANSFER BOARD for the
transfer from wheelchair to bed.

 SAFETY MEASURES OF A
WHEELCHAIR
- Always lock the brakes when
transferring.

- Clean the wheelchair on a

regular basis.

- Move the footrests out of the

way when transferring.
WHEELCHAIR
 REPOSITIONING A RESIDENT
IN A WHEELCHAIR

 Lock the wheels and move

the footrests out of the way.

 Do not pull the resident up

by the arms.

 To avoid injury to the

resident – use two staff
members.
MOVING A RESIDENT
IN A WHEELCHAIR
TRANSFERRING A PATIENT
IN A STRETCHER
 GUIDELINES FOR TRANSFERRING A
PATIENT BY A STRETCHER

 Push the stretcher with the

patient’s feet forward.

 Pull it head-first into

elevators.

 Pull it feet-first down ramps.

 Never leave a patient on a

stretcher unattended.
 ASSISTING A RESIDENT
Onto and Off a Toilet Equipment
Disposable Gloves, Toilet Tissue, Wheelchair, Transfer Belt, Non-
skid Shoes

FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Position wheelchair at a right angle to the toilet to face the

hand bar/wall rail. Place wheelchair on the resident’s stronger
side, if possible.

7. Remove wheelchair footrests. Lock wheels. Put on and

properly fasten non-skid footwear on resident.

8. Avoid trauma or pain to the resident throughout the

procedure.

9. Apply a transfer belt around the resident’s waist. Grasp the

belt. Put one of your hands toward the resident’s back and one
toward the resident’s front.

10.Ask resident to push against the armrests of the wheelchair

and stand, reaching for and grasping the hand bar with his
stronger arm (Fig. 11-36). Fig. 11-36. Ask the resident to push up
using the armrests of the wheelchair, stand and grasp the hand
bar.
 ASSISTING A RESIDENT
Onto and Off a Toilet Equipment
11. Ask resident to pivot her feet and back up so that
she can feel the front of the toilet with the back of her
legs (Fig. 11-37).

12. Help resident to pull down underwear and pants.

You may need to keep one hand on the transfer belt
while helping to remove clothing. Fig. 11-37. Have the
resident pivot and feel the toilet with the back of her
legs.

13. Help resident to slowly sit down onto the toilet.

Remove transfer belt. Allow privacy unless resident
cannot be left alone. Ask resident to pull on the
emergency cord if she needs help. Close bathroom
door. Stay near the door until resident is finished.

14. When the resident is finished, apply gloves. Assist

with perineal care as necessary (see Chapters 12 and
16). Reapply transfer belt if removed. Ask her to stand
and reach for the hand bar.
 ASSISTING A RESIDENT
Onto and Off a Toilet Equipment
15. Use toilet tissue or damp cloth to clean the
resident. Make sure he or she is clean and dry before
pulling up clothing. Remove and dispose of gloves.

16. Pull up resident’s clothing. Help resident to the sink

to wash hands. Wash your hands.

17. Help resident back into wheelchair. Be sure the

resident is seated comfortably and correctly in the
chair or wheelchair. Replace footrests.

18.Help resident to leave the bathroom.

FOLLOW 17 TO 20 STEPS!
(Raising the Head and Shoulder)
 ASSISTING A RESIDENT
Into a Car Equipment
Car, Wheelchair
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Place wheelchair close to the car at a 45-degree angle. Open

the door on the resident’s stronger side.
7. Lock wheelchair.

8. Ask the resident to push against the arm rests of the

wheelchair and stand.

9. Ask the resident to stand, grasp the car or dashboard, and

pivot his foot so the side of the car seat touches the back of the
legs.

10. The resident should then sit in the seat and lift one leg, and
then the other, into the vehicle (Fig. 11-38).
11. Carefully position the resident comfortably in the car. Help
secure seat belt. Fig. 11-38. After resident sits in the car seat, he
should put his legs in one at a time.

12.See that door can be safely shut. Shut the door.

13.Return the wheelchair to the appropriate place for cleaning.

14.Wash your hands.

15.Document procedure using facility guidelines.

 DISCUSS AMBULATION
Regular ambulation and
exercise help improve these
things:
- Quality and health of the
skin
- Circulation
- Strength
- Sleep and Relaxation
- Appetite
- Elimination
- Oxygen Level
 ASSISTING A RESIDENT
To Ambulate
FOLLOW 1 TO 5 STEPS
(Raising the Head and Shoulder):

6. Help resident move to a dangling position as

described in earlier procedure.

7. Practice good body mechanics. Adjust bed to a low

position so that the resident’s feet are flat on the floor.
Lock bed wheels.

8. Put on and properly fasten non-skid footwear for

resident.

9. Stand in front of and face the resident.

10. Brace the resident’s lower extremities. Bend your

knees. If resident has a weak knee, brace it against
your knee.

11. With transfer (gait) belt: –Place belt around

resident’s waist. Grasp the belt while assisting resident
to stand.
 ASSISTING A RESIDENT
To Ambulate
WITHOUT TRANSFER BELT:
– Place arms around the resident’s torso under the arms,
but not in the armpits (axillae), while assisting resident to
stand.

12. With transfer belt: –Walk slightly behind and to one

side of resident for the full distance, while holding onto the
transfer belt (Fig. 11-39). If the resident has a weaker side,
stand on the weaker side. Fig. 11-39. Walk slightly behind,
standing on the weaker side, when assisting a resident to
ambulate. Hold onto the transfer belt, if used, for the full
distance.

Ask resident to look forward, not down at floor, during

ambulation. If resident becomes dizzy or faint, help him to
a nearby seat and call nurse for help.

13. After ambulation, make resident comfortable. Remove

transfer belt, if used.

FOLLOW 16 TO 20 STEPS!
(Raising the Head and Shoulder)