BACK CARE LAB.pdf

8/10/2019 BACK CARE LAB.pdf

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BACK CARE

&

PATIENT TRANSFERRING TECHNIQUES

LETHBRIDGE COMMUNITY COLLEGEHEALTH &ALLIED WELLNESS

Developed by Em M. Pijl Zieber RN, BSN

2002; Revised 2004


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Back Care and Patient Transferring Techniques Page 2Developed by Em M. Pijl Zieber RN, BSN (2002; Revised 2004)

INTRODUCTION

Welcome to the Back Care and Patient Transferring Techniques workshop. I amconfident that your time spent in this workshop will be extremely valuable to you.

You have chosen a line of work that is physically demanding. There are also manypsychological and emotional demands when working closely with people. As careproviders who work with individuals who have limited physical capabilities you areat risk for getting hurt. When you assist individuals who require help walking ortransferring (for example, from a bed to a wheelchair) you need to be very carefuland use techniques that protect your back. As you will learn in this workshop, theback is vulnerable, but there are methods you can use to minimize the risk ofpersonal injury while transferring and assisting individuals. These techniques aresome of the most valuable skills you will learn because they will prepare you for along, injury-free career and a disability-free life away from work.

This workshop will cover topics such as: basic back function, exercises to protect andstrengthen your back, body mechanics for lifting and transferring, assessing patientabilities, patient transfer criteria and transfer levels, no-lift policy, and a variety oftechniques used to move patients from one place or position to another.

This workshop consists of a short theory section, followed by extensive demonstrationand practice using the techniques. The accompanying manual contains both theory andprocedural elements to help you practice in between workshop days to learn thetechniques.

The purpose of this workshop is to prepare students for transferring patients safely inthe workplace, developing knowledge and competence through practice. Emphasis isplaced on the learning and practicing of techniques as described and demonstrated bythe instructor, and on thinking critically to explore why these techniques work, what theirshortfalls and requirements are, and what safe modifications can be made to them toaccommodate a variety of patients.

This workshop is intended to provide you with the knowledge and practice you need, soquestions are always welcome at any time during the presentation, demonstrations orpractice components.


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The spine is strengthened and made moveable bymuscles. This structure changes your back from a

rigid rod into a moveable spine.

Many injuries to the back are soft tissue injuries inwhich muscle tissue is damaged. Injured muscletissue can present as muscle spasms, searing pain,sciatica (pinched sciatic nerve) or immobility.

The spine carries the weight of the top half of thebody and transfers it to the pelvis. In addition itcarries any load being moved or handled.

Online source (diagram):http://www.shb.ie/content-525439453_1.cfm#Functions

Causes of back injuries:

Many factors affect back injuries among healthcare personnel: an aging workforce,sicker patients, staffing shortages, obesity in both patients and employees, gender, andstress. On an individual level, back pain and other work-related musculoskeletal injuriesmay be caused by:

A single traumatic event, such as a slip, fall or an incident involving a patienttransfer.

Other factors, such as genetics; age (older populations experience an increase inarthritis and disc degeneration); being out of shape or overweight; having poorposture; bending, standing, sitting, or lifting improperly; tension, emotionalproblems or personal stress; pregnancy; smoking; poor physical condition; andsports or hobbies.

Cumulative trauma to the spine and related structures. For example, overexerting

the spine (from lifting improperly or lifting patients that are too heavy for theworkers back to support) may cause small injuries that do not cause pain. If notallowed to heal, the damage may build up and result in a bulging or ruptureddisk, creating a cumulative injury marked by pain.


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WARM UP EXERCISES BEFORE YOU START WORK

Stand with knees slightly bent and feet apart, place palms on

lower back, fingers pointing downward. Gently push your palmsforward and gently bend your back backwards. Hold for 5-10seconds. Repeat 3-5 times.Then bend the knees and lower the body forward as far ascomfortable. Relax the neck, shoulders and arms. Hold 5seconds.Keep knees bent and slowly uncurl to an upright position.

Slowly roll your shoulders backward five times in a circular

motion. Slowly roll your shoulders forward five times in a circularmotion.

Interlace fingers. Turn palm upwards above your head as youstraighten your arms. Stretch and hold for 5-10 seconds.Repeat 3-5 times.

Fingers interlaced behind your back. Slowly turn your elbowoutward while straightening your arms. Hold for 5-10 seconds.Repeat 3-5 times.

Interlace fingers. With palms facing out, straighten arms out tothe front of you. Hold for 5-10 seconds. Repeat 3-5 times.


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Hold left elbow with right hand. Gently pull elbow behind headuntil you feel a stretch. Hold for 5-10 seconds. Repeat 3-5times. Repeat with other arm.

Gently pull your left elbow across your chest towards your rightshoulder until you feel a stretch. Hold for 5-10 seconds. Repeat3-5 times. Repeat with other arm.

Sit or stand upright. Interlace fingers and lift armsoverhead. Keeping the elbows straight, press arms as far backas you can. Slowly bend to the left side until you feel a stretch.Hold for 5-10 seconds. Slowly bend to the right side untilyou feel a stretch. Hold for 5-10 seconds. Repeat 3-5 times.

Sit with left leg across right leg. Rest elbow or forearm of rightarm on the outside of the left upper thigh. Gently apply pressurewith right elbow or forearm towards the right. As you applypressure, look over your left shoulder. Hold for 5-10 seconds.Repeat 3-5 times. Repeat with the other side.


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Stand upright with right hand supported on a wall or the back ofa stationary chair. Grab your left ankle with your left hand. Keepleft knee pointed towards the ground. Slowly pull the left legtowards the buttock until you feel a stretch in the front of thethigh. Hold for 5-10 seconds. Repeat 3-5 times. Repeat with theother leg.

Stand arms length from a wall or other support, feet facingforward. Place right foot forward and keep the left leg straightand the heel on the ground. Lean your body towards the walluntil you feel a stretch in the left calf. Hold for 5-10 seconds.Repeat 3-5 times. Repeat with the other side.

Adapted from University of Toronto, Office of Environmental Health & Safety.Found online at http://www.utoronto.ca/safety/ergoweb/exercise.html

Adapted for similarity to the Workers Compensation Board of Alberta 10-minute warm up produced bythe Rehabilitation Centre.


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BACK CARE 101 LIFTING MECHANICS AND SAFETY

Lifting mechanics:

Keep your back in balance and maintain good posture. Maintain the three natural

curves of your spine. Always lift with your quads. These are long and strong. If you bend at your waist

and extend your upper body to lift an object, you upset your backs alignment andyour center of balance. You also force your spine to support the weight of yourbody and the weight of the object you're lifting. Your lower back lifts 7-10 timesthe weight of an object. For example, if you bend over to pick up a 10 lb. box,your back is lifting 70-100 lbs., plus the weight of your upper body. This situationis called "overload". You can avoid overloading your back by using good liftingtechniques.

Maintain a wide base of support by keeping your feet apart. Avoid twisting your back. Twisting can overload your spine and lead to serious

injury. Make sure your feet, knees, shoulders and hips are pointed in the samedirection when lifting or transferring.

Do not lift heavy objects above shoulder level. Avoid reaching. Tuck your pelvis. By tightening your stomach you can tuck your pelvis which will help

your back stay in balance while you lift. Bend at your knees instead of at your waist. This helps you keep your centre of

balance and lets the strong muscles in your legs do the lifting. Lift with your legs. Hold the patient or object close to you and in line with your centre of gravity. If

necessary, hop onto a patients bed if you need to be closer to him for a move. Never work over a bedrail. Always lower it prior to providing any patient care. Always raise the bed to a good working level. Make sure you lower it once you are

done so your patient can safely get out of bed, or so if she falls, she will not fall asfar.

Whenever possible, utilize gravity instead of fighting against it. For example, iftransferring a patient from a bed to a chair, make sure the bed is slightly higher thanthe chair.

Pushing is easier than pulling, as the body weight can be used to help move theobject or person. When pushing, get close to the object/person, push with your legs,arms should be lock in a bent position, the back should be straight, and pushhorizontally.

When pulling, keep the back and arms straight, and use your legs and body weight

to pull.


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Other principles:

Plan ahead and make all preparations prior to moving the patient. This means

getting the wheelchair ready, the bed ready, and putting the brakes on the bed,wheelchair, lift or commode. Take the time to organize staff, equipment, and thearea. Have a contingency plan in case problems are encountered during thetransfer.

Utilize the patients abilities. Patients may change day to day or even hour to hour.Can he stand and for how long? Can he weight bear? Is he stable? Is he confusedor unreliable? How does he transfer? What else do I need to know?

Use the mechanical lifts. Mechanical lifts are safer for you and safer for the patient.Two staff are often required, depending on agency policy.

Ask for help. Spending five minutes helping a colleague can save them years ofdisability and pain. Ask for help beforeyou begin the move or transfer. While you

wait for someone to come and help you with a transfer, finish preparing yourself, theenvironment and the patient for the transfer, so when help comes, you arecompletely ready.

Know how to do the transfer that is being used. Is it safe? Can you do it safely?What is the shortfall of this method? What do I need to do to carry this out safely?

Advocate for your own safety. Make sure equipment is in good working order.Access help and request equipment if you need it.

Patient safety:

When working with the elderly, be cognizant that they are often frail. Osteoporosis,

which affects both males and females, renders bones fragile. It is unwise to grasp anelderly persons long bones across the shaft to transfer, support or move him/her. Many elderly patients suffer from arthritis, which renders joints painful, swollen and

in varying degrees of immobility. Caution and care is required to ensure that patientsare not injured or in discomfort during transfers.

Patients who are at risk for falling must receive diligent care to prevent falls. Hipfractures due to falls are common and also a cause of significant premature mortality(33.6% in five years).

Always return the bed to the height that is safe for the patient, which is usually thelowest position.

Always ensure bedrails are up when the patient is in bed, if required.

Never leave a patient unattended on the edge of a bed, unless she can fully supportherself and is able to walk. Never leave a patient with poor truncal support totteringon a bed.

Gather all needed supplies ahead of time, prior to beginning care, so the patient isnot left unattended.

Better to be safeusing a lift and having the help of a colleaguethan sorry. If you are helping a patient to walk or stand and he starts to fall, do not attempt to

stop him from falling. Instead, guide and support his fall and protect his head.


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About footwear:

Proper footwear is an essential part of a happy back. Not only can improper or

substandard footwear lead to sores, deformities, corns, calluses and ulcers, it can alsolead to back pain and back injury. Lets face it: Your feet are the unsung heroes of yourbody; you walk all over them and they hardly ever complain!

Working in health care is demanding. Many health care workers walk several mileseach shift, even though most of that time they are in one ward. When we work withpeople, we tend to be on our feet a lot. Our feet carry the weight of our bodies and bearthe strain of distance and speed. When we transfer and move patients, our feet takethat on, too. So, as you can see, good footwear is paramount. In addition, the WorkersCompensation Board requires that footwear worn in the workplace must be closed toeand closed heel.

Here are some tips for happy feet: Wear cotton socks. Cotton lets your feet breath and helps prevent sweating. If you have varicose veins, or if your feet feel tired after standing for a prolonged

time, try wearing support socks. This will put a spring back in your step! Provide your feet with excellent quality footwear. Dont be afraid to spend over $100

on a pair of shoes. Your feet will thank you. Shop for shoes in the early afternoon, since your feet tend to swell during the day

and by this time they will reach their maximum size.

What to look for when buying new shoes: Size:Your feet may be two different sizes. Always buy shoes to fit the bigger foot.

Forget vanity about the size of your feet and go with what feels and fits right. Insoles:Consider removable insoles to accommodate orthotics. Bring your orthotics

with you when buying shoes so you can be sure they will fit properly. Fasteners:Shoes should have a minimum of six laces (for best fit and control) or

Velcro straps (that pass through a loop and fastens back on itself). Fit:

Shoes should be (one thumb width) longer than your longest toe. Whenmeasuring, make sure your heel is placed into the back of the shoe.

The sole of the shoe should accommodate the widest portion of your foot.

Your foot should not be hanging over the edges of the sole. The shape of the toe box should mirror the shape of your toes. If the big and

little toes press against the side of the shoe, the toe box is too narrow. Avoidpointed toes.

The shoe should be deep enough through the toe box to accommodate theheight of your toes. If toes press against the roof of the shoe, it is too shallow


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Construction: Consider shoes with leather uppers and rubber soles. Leather allows the skin

to breathe. Athletic shoes with synthetic fabric uppers are light, washable andbreathable. Athletic shoes should have a padded tongue to cushion againstlace pressure and padded heel counter to cushion the ankle and help preventachilles tendonitis.

Make sure the shoe has a plastic heel counter that encompasses the heeland is well bonded to the show. This will stabilize the heel bone.

Shoes should be relatively flat, with a height difference of less than between the heel and forefoot area. With a greater incline than this the bodysweight is distributed further forward, which can lead to both foot and backproblems. Your foot was not designed to carry all of your weight on the ball.

The heel should be neutral or flare out. The heel of the shoe should not be

narrower than the heel counter. The shoe should have a straight last (it should not dip in at the arch). More

support is gained when more of the shoe is in contact with the ground. Thiscan also help prevent the foot from going over on its side.

A good walking shoe will have a comfortable soft upper, good shockabsorption, smooth tread and a rocker sole design that encourages thenatural roll of the foot during the walking motion.

Trying it on

If the shoe fits uncomfortably when you first try it on, do not buy it. It will most likelycontinue to be uncomfortable.

Try on several different makes and brand names before you make your decision. Walk around the store as much as you can. Do you feel pressure areas? Friction?

Or, do they feel like heaven?


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PATIENT ABILITIES KNOWING THE PATIENT

Rationale:Knowing the patient and what he is capable of doing is the first step

towards a safe transfer.

Questions to consider:

1. Can the patient weight bear sufficiently?2. How reliable is he? Is there a possibility he may become confused or dizzy or

tired once standing?3. Is she at high risk of falling?4. Is she able to follow verbal directions for transferring?

How to find out about the patients transferring status:

1. Check for a logo at the bedside. Transferring status can be upgraded to ahigher level (e.g. standing pivot transfer to Sara Lift) but notto a lower level

(e.g. Sara Lift to standing pivot transfer) at the discretion of assisting staff.Follow transfer status guidelines.

2. Check the patient chart or kardex. This will give you good backgroundinformation on your patient, but not current to-the-day status information.

3. Ask a staff person who knows the patient well. This will give you techniques andbackground information specific to a patient, based on daily experience with thatpatient. Information may be related to how the patient usually transfers, unlesscertain circumstances dictate that another method is used, and how to tell whichsituation best describes the patient at a given time.

4. Ask staff who are currently working with the patient. Patient status can changeon a daily basiseven an hourly basis. Sometimes a patients physical status

remains unchanged but psychologically he is unable to perform certain physicaltasks, perhaps due to a mood change.

5. Ask the patient. If your patient is highly reliable she is a good source oftransferring information (for example, young spinal cord injured individuals areusually able to direct transfers). Even if your patient is unreliable, she can stilltell you how she is feeling about a transfer, which can guide you to raise thetransfer level to ensure safety. For example, if the patient says she is feelingdizzy, you will delay a standing pivot transfer until her circulation has adjustedand she feels better and more ready to transfer.


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TRANSFER LEVELS PROMOTING SAFETY

Transfer levels: Transfer levels indicate the way a patient is transferred.

Transfer criteria considers the following factors:

Level of cooperation Level of assistance Need for verbal guidance or cueing Level of predictability Ability to bear weight (partial or full) through the extremities,

one or two legs Level of reliability Ability to follow instructions Ability to hold with one or two hands Level of difficulty to put patient in sitting position in bed Ability of patient to maintain a sitting position in bed Level of rigidity Weight of patient and extremities

Following transfer levels: You must follow patient transfer status guidelines, for

your own safety and for the safety of your patient.You can increase the level of transfer but you cannotdecrease it. (i.e. You can increase a stand-by supervisiontransfer to a one-person assist, but you cannot decreasea one-person assist to a stand-by supervision transfer.

Changes in patient transfer status: Patients change, over a long period of time and also within the day. Make sure you are aware of the current transfer of the patient you are working with.

Ask a Registered Nurse and the Aides who work with the patient how the patient hasbeen doing and how he is doing with transfers.

Notify the Registered Nurse if you notice any changes in the patients ability totransfer.


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TRANSFER LEVELS LEVELS, LOGOS AND CRITERIA

Source: This is a transfer level poster from Extendicare, Lethbridge, which maintains a

zero-lift policy.


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ZERO-LIFT POLICY NO MANUAL LIFTING!

What does zero-lift mean?

A is used for ALL patients assessed as a ONEPERSON TRANSFER.

Follow the posted at the bedside.

Assess and reassess patient . Discuss concerns with the RN.Document your concerns.

Transfer assessments are done by a Registered Nurse, Rehabilitation Therapist, or

Physiotherapist.

Transfer levels cannot be decreased by anyone except the above-mentioned staff.

Transfer assessments are ongoing with each transfer.

Transfer status is noted in the care plan, at the bedside and on assistive devices.

Use equipment as intended and in accordance with themanufacturers operating .

All transfers done with a will be done by a minimum of

who are actively participating in the use of the lift andthe completion of the transfer.

Activity staff will perform transfers as required for a scheduledprogram.

A patient who has fallen or who is found on the will not be moveduntil he is assessed by the .

When a chair lift is in use, all safety belts must be in place.


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TECHNIQUES GETTING STARTED

Be prepared:

1. Are YOU prepared?

Proper footwear (closed toe, supportive, rubber soled, comfortable) 10-minute warm up at start of shift Transfer belt (one or two, kept around your waist) Appropriate attire, hygiene and grooming Always have a contingency plan for if the patient tires or is otherwise unable

to complete a transfer as expected2. Is the ENVIRONMENT prepared?

Ensure the area is free of obstacles and hazards Position the wheelchair and apply the brakes Ensure bed brakes are applied

3. Is the PATIENT prepared? Apply any required splints, hearing aides and glasses. Ideally, the patient should be alert during a transfer. Always tell the patient what you are going to do and where she is going (Note:

This manual provides information and techniques concerning transferring butdoes not include aspects such as communication.)

Proper non-slip footwear should be on prior to the patients feet touching thefloor

Proper position prior to transfer Apply transfer belt Three progressive stages in providing assistance:

1. Verbal cueing (Hi, Mrs. Smith. The hairdressers ready for you now.Would you like to come with me?)

2. Manual cueing (Put your hands here, on your walker, and push yourselfup.)

3. Physical assist (On the count of three, you are going to stand and I willhelp you using the transfer belt.)

4. Is your PARTNER prepared?

Communicate with others involved in a transfer. Decide before initiating atransfer whether you will move on the count of three or count to three andthen lift. Always count out loud.

Plan out the sequence for a transfer before starting. Two caregivers are required when using a mechanical lift, when the patient is

combative or resistive, or for a patient who weighs over 150 lbs (CHR).


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TECHNIQUES USING A MECHANICAL LIFT: MAXI LIFT

Arjo MaxiPATIENT SELECTION CRITERIAUNRELIABLE

UNCOOPERATIVEUNPREDICTABLE

UNABLE TO FOLLOW INSTRUCTIONSUNABLE TO WEIGHT BEAR

USESALL NON-WEIGHT BEARING LIFTS:

FROM BEDFROM CHAIRFROM FLOOR

LIFTS TO TOILET (SPECIAL SLING)LIFTS TO REPOSITION IN CHAIRS/WHEELCHAIRS

MISUSESLONG DISTANCE TRANSPORT OF PATIENTS

INCORRECT SLING SIZE SELECTIONLEAVING PATIENT UNATTENDED

PATIENT POSITIONED IN UPRIGHT SITTINGPOSITION FOR PROLONGED PERIODS

APPLICATIONS WITH SPECIAL SLINGSTOILETINGBATHING

USE WITH AMPUTEES

PATIENT SAFETYTO ENSURE PATIENT SAFETY BEFORE AND DURING THE LIFT,ALWAYS

1.VISUALLY AND PHYSICALLY CHECK THAT ALL CLIPS ARE IN PROPER POSITION 2.MONITOR THE TENSION OF THE CLIPS AS THE PATIENTS WEIGHT IS TRANSFERRED TO THE LIFT.3.MONITOR CLOSELY IF PATIENT ACTIVITY RESULTS IN A RELEASE OF TENSION ON THE CLIPS.4.ENSURE PATIENT IS NOT IN THE WAY OF LOWERING EQUIPMENT.

5.ENSURE PATIENT WEIGHT DOES NOT EXCEED 440LBS.6.REMAIN WITH THE PATIENT AT ALL TIMES WHILE IN THE LIFT.NEVER LEAVE A PATIENT HANGING

UNSUPERVISED.7.HAVE A SECOND CAREGIVER PRESENT WHEN USING ANY MECHANICAL LIFT (CHRPOLICY).8.ENSURE YOU KNOW HOW TO ATTACH THE CORRECT SLING,AS THERE ARE MANY DIFFERENT KINDS.9.DO NOT LEAVE A SLING UNDERNEATH A PATIENT WHO HAS COMPROMISED SKIN INTEGRITY.

Before you start

Have you been trained to use this type of lift? Is the lift in good working condition? Do the brakes work?

Are the straps frayed? Is the battery charged? Do all the buttons work? Does it make strange noises? Is the sling in good condition? Do not use a mechanical lift that has broken parts; it puts both you and the

patient at risk.


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Number of staff required:2

Procedure:1. Get patient ready for lift. Acquire necessary equipment including the sling.

Ensure you are using the correct sling for the patient: Size, toileting versusregular sling. Ensure the patients mass can be accommodated by the lift andsling.

2. Position the patient and wheelchair/chair and the destinationbed/chair/wheelchair to ensure efficiency and accommodate the mechanical lift.

3. Put sling around the back of the patient, securing any required buckles. If thepatient is in bed this will require turning him to one side, fanfolding the sling,then turning the patient the other way and pulling the fanfolded sling through tothe other side. Turn the patient onto his back and bring the leg straps under

each leg.4. Bring the lift in close, spreading the feet if necessary to accommodate a chair

and to enhance stability.5. Lower the bar that will support the patient in the sling. Be sure to not hit the patient

with it.6. Attach the sling to the lift (four loops). Ensure all loops are connected securely prior

to lifting. Different loops can be selected to assist positioning the patient once he islowered to where he is going.

7. Ensure the patients arms are in the sling (like in a cocoon) and that the patient is nottrying to hold on to the sling or the lift. This can result in injury to the patient.

8. Begin lifting. Always watch to ensure the patient is not falling out, and that all loops

are secure. Sometimes patients inadvertently remove a loop or two prior to lift off.9. Raise the patient only as high as necessary.10. Steer the lift and bring the patient to the destination bed/wheelchair/chair.

Remember, jerky movements make the sling swing, and this can be frightening forthe patient, not to mention unstable in general.

11. Upon arriving where the patient is to be transferred to, ensure the area is ready forthe patient. Begin lowering the patient. Ensure the patient does not get pinched or hitby the lift. Have a partner pull on the back loop to pull the patient to the back of thechair. You control the lift and push on the patients knees to help ensure his buttockis at the back of the chair. When lowering the lift, watch the patients head and feet.

12. Remove the loops from the lift. Remove the lift. Remove the sling from under the

patient. Position the patient.

Variations:

1. Tilting the wheelchair so that the footrests rest on the base of the Maxi Lift is usefulfor ensuring that when the patient is being lowered into the wheelchair she is certainto be seated properly at the back of the wheelchair.

2. When using a Maxi Lift to seat a patient into a Broda chair, recline the Broda chairand then access it with the Lift from the side.


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TECHNIQUES USING A MECHANICAL LIFT: SARA LIFT

Arjo SaraPATIENT SELECTION CRITERIARELIABLE

COOPERATIVEABLE TO FOLLOW INSTRUCTIONS

ABLE TO HOLD WITH AT LEAST ONE HANDABLE TO WEIGHT BEAR ON AT LEAST ONE LEG

ABLE TO ACTIVELY CONTRACT THEIR QUADRICEPSUSES

WEIGHT BEARING TRANSFERSTOILETING AND COMMODING

DRESSINGREPOSITIONING IN CHAIRS/WHEELCHAIRS

ADJUSTING SEAT CUSHIONS

MISUSESUSING WITH PATIENTS WHO DO NOT MEET

SELECTION CRITERIA

APPLICATIONS WITH SPECIAL SLINGSTOILETINGBATHING

USE WITH AMPUTEES

PATIENT SAFETYTO ENSURE PATIENT SAFETY BEFORE AND DURING THE LIFT,ALWAYS

1.VISUALLY AND PHYSICALLY CHECK THAT ALL CLIPS ARE IN PROPER POSITION 2.MONITOR THE TENSION OF THE CLIPS AS THE PATIENTS WEIGHT IS TRANSFERRED TO THE LIFT.3.MONITOR CLOSELY IF PATIENT ACTIVITY RESULTS IN A RELEASE OF TENSION ON THE CLIPS.4.ENSURE PATIENT IS NOT IN THE WAY OF LOWERING EQUIPMENT.

5.ENSURE PATIENT WEIGHT DOES NOT EXCEED 440LBS.6.REMAIN WITH THE PATIENT AT ALL TIMES WHILE IN THE LIFT,UNLESS THE PATIENT IS SITTING ON

THE TOILET.ALLOW FOR PRIVACY,BUT YOU MUST CHECK BACK AT LEAST EVERY FIVE MINUTES.7.HAVE A SECOND CAREGIVER PRESENT WHEN USING ANY MECHANICAL LIFT (CHRPOLICY).

Before you start

Have you been trained to use this type of lift? Is the lift in good working condition? Do the brakes work? Are the straps frayed? Is the battery charged? Do all the buttons work? Does it make strange noises? Is the sling in good condition? Do not use a mechanical lift that has broken parts; it puts both you and the

patient at risk.


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Number of staff required: 2

Procedure:1. Get patient ready for lift. Acquire necessary equipment including the sling. Ensure

the patients mass can be accommodated by the lift and sling. Position the patientand wheelchair/chair and the destination bed/chair/wheelchair to ensure efficiencyand accommodate the mechanical lift.

2. Assist the patient to a sitting position on the side of the bed. Put the sling around theback of the patient and secure the buckle or Velcro in the front securely at chestlevel.

3. Bring the lift in close, spreading the feet if necessary. Apply the brakes.4. Lower the bar that will support the patient in the sling. Be sure to not hit the patient

with it. The patient may find it helpful to hold onto the lift while sitting.

5. Secure the sling to the lift, choosing the correct loop for patient height.6. Ensure the patients feet are sitting squarely on the foot platform, and ensure the

patients knees are in line with the knee holders.7. Have the patient hold onto the appropriate place on the raising bar of the lift. Ensure

patients arms are outside of the sling. Do a final count to ensure secure positioningin the lift: 2 feet, 2 knees, 2 loops, 2 hands and a buckle.

8. Begin lifting. Always watch to ensure the loops remain secure.9. Raise the patient only as high as necessary and in one smooth motion. Many elderly

patients find standing completely upright painful.10. Steer the lift and bring the patient to the destination bed/wheelchair/chair.11. Begin lowering the patient. Have a partner guide the patient to the back of the chair.

You control the lift.12. Remove the loops from the lift. Remove the patients feet from the lift and remove

the lift. Remove the sling from around the patient. Position the patient. Ensure thepatients clothes are straight and not wrinkled behind his back.


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1.

TECHNIQUES USING A TRANSFER BELT

Preparation: Purchase your own transfer belt and wear it around your waist so that

you always have it when you need it!. Transfer belts with a plastic clip

in front, multiple handles on all sides and padding are recommended.Having two transfer belts is also helpful if you want the patient to havesomething to hold onto during transfers.

Procedure for general use in transfers:

1. Select a transfer belt of the size appropriate to your patient.2. Apply the transfer belt around the patients waist, close to or around the hips (the

centre of gravity).3. Hold the transfer belt with your fingers pointing up to support the patient during the

transfer.4. Always use a transfer belt when walking a patient who is unsteady. A transfer belt is

also called a gait belt when used to assist or guide patient ambulation.

Procedure for use in assisting ambulation:

1. Select a transfer belt of the size appropriate to your patient.2. Ensure the patient is wearing shoes with non-slip soles. Slippers or bare feet present

a falling hazard.3. Apply the transfer belt around the patients waist, close to or around the hips. The

belt should be loose enough for you to hold it without your knuckles digging into thepatients side.

4. To support the patient, hold the transfer belt with an underhand grasp (your fingerspointing up) around the back. Walk to the side and slightly behind the patient. Extra

support can be provided using two hands:

5. Encourage the patient to walk normally with his head up and back straight.Discourage shuffling. Walk only as far as required and as tolerated.


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TECHNIQUES MOVING THE PATIENT UP IN BED

Bed characteristics: Soaker pad or draw sheet under patient.

Patient characteristics:Unable to scoot self up in bed.


Procedure:

1. Raise the bed to a safe working level.2. Lower the head of bed (HOB) to flat. Remove pillow from under the patients

head and place it between the HOB and bed frame. The patient should be lyingflat on his back.

3. Ask the patient (and assist him if necessary) to bend his knees. Have him crosshis arms over his chest. Ask the patient to tuck his chin down.

4. One helper stands on each side of the bed. Roll the soaker pad close to the patienton either side, with your wrists straight and palms down. One of your hands shouldbe at the patients shoulder, and the other at his hip; the same for your assistingpartner.

5. Place your knee that is closest to the HOB on the bed (in the direction of travel).6. Lower your hips as if you were sitting down.7. Count out loud to ensure a team lift. (Ensure comprehension: On 3: 1, 2, 3).8. With your arms and back straight and chin tucked in, use body leverage to tighten

the soaker pad. Then move your entire body towards the HOB, sliding the patient upas you go. You can move the patient up incrementally or if he is light, all in onemove.

9. If the patient is continually sliding down (not uncommon in high fowlers position) youmay wish to put a second soaker pad partially under the primary soaker pad, underthe patients hips. This way you will have a soaker pad that is closer to the correctposition when you return to reposition the patient next time.

10. Replace the pillow and ensure patient comfort. Return the bed to a lower level forpatient safety and readjust bed for patient comfort. Replace side rails if required.

For heavy patients:

1. Involve more staff.2. Place a garbage bag under the soaker pad to provide a sliding surface. Place it

under the patient by turning him side to side. Remove it afterwards and store itsafely.


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TECHNIQUES MOVING A PATIENT TO THE SIDE OF THE BED

Uses: Preparing to turn a patient in bed on to her side.

Patient abilities:Ask the patient to move as much as she can.

Procedure for 1:

1. Raise the bed to a good working level.2. Lower head of bed (HOB) to flat. Remove the pillow from under the patients head.

She should be lying flat on her back.3. Stand on the side of the bed to which you will move the patient.4. Lower the bedrail near you.5. Cross the patients arms over her chest.6. Place one knee up on the bed. Flex your other leg behind you.7. Place your arm under the patients neck and shoulders. Grasp the far shoulder.

Place your other arm under the midback.

8. Move the upper part of the patients body toward you by rocking backward andshifting your weight from your knee (pressing into the mattress) to your other leg.

9. Repeat steps 7 & 8 for moving the patients waist and thighs, and then thighs andcalves. Moves will likely be incremental, so you will have to return to each segmentand gradually move each to the desired location.

10. Ensure patient comfort, return the bed to a lower level and replace bedrails forpatient safety.

Procedure for 2:

1. Raise the bed to a good working level.2. Lower the HOB to flat. Remove the pillow from under the patients head. The patient

should be lying flat on her back.3. You and your partner each stand on one side of the bed and lower the bedrails.4. Cross the patients arms over her chest.5. Roll the lift sheet up close to the patient, grasping near the patients shoulders and

hips.6. Each partner places one knee on the bed.7. Communicate with your lifting partner and count out loud to ensure lifting as a team.8. Rock backward, moving the person toward you. Your partner rocks backward slightly

and then forward toward you.9. Unroll the lift sheet and tuck it in.10. Ensure patient comfort, return the bed to a lower level and replace bedrails for

patient safety.


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TECHNIQUES TURNING A PATIENT IN BED

Number of staff required: 1 or 2

Purpose:To relieve pressure and provide for comfort.

Procedure:

1. Raise the bed to a good working level.2. Lower head of bed (HOB) to flat. Move the patient to the side of the bed as

previously described. You will be turning the patient towards the centre of the bed.3. Cross the patients arms over his chest. Cross the far leg over the leg near you, or

bend the far knee, leaving the near let straight.4. Place one knee on the bed. Your other leg should be flexed behind you.5. Place one hand on the patients far shoulder and the other on the far hip (or, place

your arm along the femur with your hand on the patients hip).6. Roll the patient toward you gently while rocking backward.

7. Support the patient using a pillow behind the back, under the upper leg, and underthe head and neck. A pillow may also be used under the upper hand and arm.

8. Ensure patient comfort, return the bed to a lower level for patient safety and replaceside rails.


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TECHNIQUES LOGROLLING A PATIENT

Bed characteristics: Soaker pad or draw sheet under patient.

Patient characteristics: Rotation of spine contraindicated (e.g. spinal cord injury)

Number of staff required: 3-5 (depending on patient diagnosis and size)Requires special training in some institutions.

Procedure:

1. Raise the bed to a safe working level. Ensure bed brakes are applied.2. Using the draw sheet, move the patient to the side of the bed as follows:

a. One person (the Lead) maintains neck alignment (if required) bybeing stationed at the head. (You may have to move the bed awayfrom the wall.) The Lead places her elbows against the mattress andplaces one forearm on either side of the patients head, with herhands grasping the patients shoulders.

b. Place the patients arms across his chest.c. Place a pillow between the patients knees.d. Two people stand on either side of the patient and roll the draw sheet

up close to the patients body. Clarify with the others which directionyou will be moving the patient. Get into position, using a broad baseof support with one foot in front of the other.

e. The Lead directs the move, saying, Ready? On 3: 1-2-3. Gently andin one smooth motion (or a series of small moves) move the patientas a unit to one side of the bed.

3. Using the draw sheet, turn the patient while keeping his body in straightalignment as follows:

a. The Lead directs the move, saying, Ready? On 3: 1-2-3. With theLead at the patients head and the other helpers at the shoulder, hipsand legs, gently turn the patient as a unit in one smooth motion.

b. The helper that is to the patients back organizes pillows and othersupportive devices to maintain the side lying position and proper bodyalignment.

c. The Lead stabilizes and supports the patients head and ensures thepatients neck remains in proper alignment using pillows.

4. Ensure the patient is comfortable. Reapply bed rails.


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TECHNIQUES MOVING A PATIENT FROM LYING TO SITTING


Patient characteristics:Must have good truncal support.

Equipment:An overhead trapeze bar assists many patients going from lying to sitting.Important safety considerations:

Make sure the patient is sitting far enough back on the bed to ensure stability.The patients knees should be at the edge of the bed, not the thighs orbuttocks.

Have the patient hold onto the edge of the mattress. Do not leave him alonebut remain in front of him. Support him as necessary by placing your handson his shoulders. This position is called dangling.

Because going from a lying to a sitting position can cause a drop in bloodpressure, monitor your patient. Ask her how she feels and if she feels dizzy orlightheaded. Watch her pulse and respirations, and note any difficultybreathing, pale skin, or cyanosis. Help her lie down if necessary.

Procedure: Utilizing high fowlers

1. Place the patient in high fowlers.2. Lower the bed rail hear you.3. Stand near the patients waist, on the side of the bed the patient will be sitting.4. Standing at the patients lower legs, place one of your feet in front of the other. Slide

your hands and forearms under the patients lower legs. Rocking backwards fromyour front foot to your back foot, pull the patients lower legs towards you until theyare hanging slightly off the bed.

5. Place one knee on the bed, closest to the HOB. Place the hand that is closest to thepatients head under his far shoulder blade, grasping the shoulder.6. Grasp the patients hip with your other hand and roll him toward you, keeping your

hips low. Cradle the patients shoulders with your arm, bringing him close to yourchest.

7. Place your hand closest to the patients legs over and behind his knees.8. Pushing through your bent knee, rock the patient to a sitting position. The dropping

knees will aid the leverage.9. Straighten your body as the patient load decreases.


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Procedure: For flat bed

1. Lower the bed rail on the side of the bed the patient will be sitting.

2. Standing at the patients lower legs, place one of your feet in front of the other. Slideyour hands and forearms under the patients lower legs. Rocking backwards fromyour front foot to your back foot, pull the patients lower legs towards you until theyare hanging slightly off the bed.

3. Bend the patients far leg, as when preparing to turn a patient onto her side.4. Position the patients near arm to allow for her body to turn. Position the patients far

arm bent across her chest.5. Place your knee closest to the HOB on the bed. Place your arm closest to the

patients legs across the shaft of the femur, with your hand on her hip. Place yourother arm (closest to the HOB) on the patients far shoulder.

6. Turn the patient onto her side.

7. Have the patient place the hand of her upper arm, palm down on the bed to pushherself up.

8. Place your hand that is closest to the patients head, under the patients far shoulder.Place your hand that is closest to the patients legs over and behind her knees.

9. Communicate with your patient that on the count of 3, she is going to push up withher hand as you assist her.

10. On the count of 3, pushing through your bent knee, rock the patient to a sittingposition. The dropping knees will aid the leverage.

11. Straighten your body as the patient load decreases.


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TECHNIQUES ASSISTING A PATIENT TO STANDING, SITTING


Patient requirements: Must be able to weight bear. Must be able to balance.

Equipment: Transfer belt on patient.Variables: Patient may require use of wheelchair armrests to push himself up.

Patient may benefit from having wheelchair armrests removed.Patient may require physical space to complete a transfer.Patient may feel crowded by the assisting caregiver.Patients with one-sided weakness (i.e. due to a stroke) should lead with theunaffected side. For example, during a bed to wheelchair transfer the sidewith active movement should be closest to the wheelchair.

Wheelchair cushions: When transferring a patient to a wheelchair, ensure that the

wheelchair cushion is ready, as follows: Properly placed in the wheelchair, with the buttock indentation towards the rear

and the raised area towards the front. Sometimes cushions are improperlyreplaced by staff who change the cushion cover. This can result in serious injuryto the patient.

ROHO or air-filled cushions are properly inflated. Gel cushions are kneaded to soften them. Patients with skin problems should be using special cushions in the wheelchair,

and to glean the most benefit from this equipment they need to be sitting directlyon it without a sling, soaker pad or any other materials between them and thepressure relieving cushion.

Procedure: Minimal assist1. The patient should be wearing rubber-soled shoes.2. Adjust the height of the bed so the patients knees are at an angle greater than 90

degrees. This will bring the patients legs into a position closer to standing,increasing the ease of moving into standing.

3. Position the transfer belt around the patients waist.4. Have the patient use the bedside pole (Saskapole) as she stands, or ask her to lean

forward, placing the palms of her hands against the edge of the mattress, enablingher to push off.

5. As needed, place your foot against the end of her toes to prevent her from slippingand to give her something to brace against.

6. Hold the transfer belt in case she needs support.7. For a weak or unsteady patient, have one caregiver on each side.


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Procedure: One-person assist / Standing pivot transfer

1. The patient should be wearing rubber-soled shoes.

2. Provide the patient with clear directions.3. Prepare the transfer destination. For example, place a wheelchair at a right angle to

where the patient is transferring from.4. Position the transfer belt around the patients waist or hips.5. Standing directly in front of the patient, brace your knees against her knees

(cushioning with a towel may make this more comfortable) and hold her feet in placewith your feet.

6. Holding on to the transfer belt, put yourself in the position of sitting down in midair(bending your knees and lowering your hips). Make sure the patients arms areinside yours and not holding on to your shoulders or behind your neck. If you arewearing a second transfer belt around your waist, have the patient hold onto it, with

his arms inside yours.7. Communicate clearly with the patient, stating that on the count of 3 she is going to

stand.8. As the patient stands, stand with her. Do not pull the patient up. Instead, your body

position will provide leverage. Pulling the patient up can strain your back.9. If transferring to a nearby chair, pivot (slow dance) the patient 90 to the waiting

chair, allowing her feet room to manoeuvre. Provide verbal cueing, such asTurnturnand sit.

10. Pivot until the patients knees touch the wheelchair. Instruct the patient to reach backfor the wheelchair armrest and slowly sit down on the count of three. Then, holdingthe transfer belt and again anchoring her feet and knees between yours, sit down as

she sits down. This enables a controlled and gentle descent into the chair.11. Ensure the patients buttocks are all the way to the back of the wheelchair topromote good posture and prevent sliding down in the chair.


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Procedure: Patient stands using a walker

1. Place the walker so the patient can reach it easily. If the walker has a braking

mechanism, employ it.2. Apply a transfer belt if required.3. Let the patient position the walker.4. If transferring from a wheelchair, ensure brakes have been applied.5. Ask the patient to scoot to the edge of the bed or chair and ask him to lean forward

slightly so that his head is over his feet. Ensure he has a wide base of support.6. As needed verbally or manually guide the patient to hold on to the walker.7. Help the patient to rise to standing as needed.

Procedure: Patient sits using a walker

1. If transferring to a wheelchair or commode, apply the wheel locks. If transferring to

bed, raise the head of the bed to a sitting position.2. Ask the patient to stand with his back to the chair and back up with the walker until

his knees touch the seat.3. Ask the patient to take one hand off the walker and to use that hand to reach and

grasp the armrest or grab bar, or to reach for the bed. If armrests or grab bars arenot available and the patient is unsteady or weak, use a transfer belt to assist thepatient.

4. Help the patient sit down slowly. The patients buttocks should be at the back of theseat.

Procedure: Two-person transfer

1. The patient should be wearing rubber-soled shoes.2. Provide the patient with clear directions.3. Prepare the transfer destination. For example, place a wheelchair at a right angle to

where the patient is transferring from.4. Apply the transfer belt at the patients waist or hips.5. You and your partner stand on either side of the patient, facing the patient squarely.

Both of you will be doing the identical (but mirror image) actions.6. Block the side of the patients foot nearest you using the outside of your nearest foot.

Your partners foot pressed against the other side will secure the patients feet.Ensure the patients knees are secured likewise.

7. Using the hand closest to the patient, grasp the transfer belt at the patients side.

Keep your arms and wrists straight. Place the hand of your outer arm on the back ofthe patients shoulder. The patient can hold on to your arm if necessary.

8. Tuck your chin in. Bend your knees and lower your hips.9. Count out loud to ensure a team lift.10. Keeping your body, arms and wrists straight, lean back for leverage.11. When the patient reaches the standing position, bend your arm and straighten your

body to release the leverage.


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TECHNIQUES REPOSITIONING ELDERLY PATIENT IN A CHAIR

Proper position in a chair:

The patients back and buttock should be against the back of the chair.

The patients back should be straight. He should not be leaning to the side. The patients feet should be flat on the floor or on wheelchair footrests. The backs of the knees and calves should be slightly away from the edge of the

seat. Paralyzed arms should be supported on pillows. Follow the nursing care plan. Some patients have specialized supportive and positional devices. Make sure you

know their correct use. Some patients are unable to hold their upper body erect and require the use of

postural supports such as pelvic holders or torso supports.Number of staff required: 1 or 2

Patient situation:The patient has slid down in his wheelchair, resulting in poor

posture, compromised alignment and susceptibility of skin and softtissues to injury. Some patients are not able to repositionthemselves.

Patient ability:Often a patient is able, with cueing, to scoot his buttocks into the backof the chair. This method of restoring posture and alignment promotesindependence and range of motion.

Procedure for a frail, elderly patient who is unable to follow verbal cues:

1. Unbuckle patient lap belt. Apply wheelchair brakes.

2. Place the patients feet firmly on floor and arms on the armrests to assist (if able) orarms on his lap (if not able to assist) or on a transfer belt around your waist.3. Apply a transfer belt around the patients waist.4. Placing your feet about one foot apart, place the patients knees between your

knees.5. Have the patient lean forward over his knees, while you assume a sitting position

and place your hands on either side of the transfer belt.6. On the count of 3, roll your feet onto your toes and push with your knees against

the patients knees. The counter balance results in the patients buttock being raisedoff the cushion so it can be slid into position against the back of the chair. Always begentle. Do not lift the patient.

7. Release the patient back into a sitting position and reapply the lap belt.8. Ensure the patient is comfortable prior to leaving him.


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TECHNIQUES PARAPLEGIC TRANSFER FROM CHAIR TO BED


Patient requirements: Must be familiar with transferring

Equipment: Transfer board, removable armrest on wheelchair, footrests

Procedure:

1. Lower the bed to below the level of the wheelchair cushion.2. Place the wheelchair beside the bed at a slight angle. Apply wheelchair brakes.

Remove the armrest closest to bed.3. Apply transfer belt around patients waist or hips.4. Wedge a transfer board under the patients buttock closest to bed by having

him lean in the opposite direction (away from bed). The transfer board shouldbe partially under the patient and partially on the bed.

5. Ensure the patients feet are on the wheelchair footrests.6. Stand directly in front of the patient with your feet about a foot apart and as close to

the footrests as possible.7. Have the patient lean forward and to the side of you, so that his head is beside your

hip. Have the patient put his hand that is closest to the bed on the far end of thetransfer board.

8. With your knees and hips flexed, reach over to the patients beltline or transfer beltand grasp.

9. Communicate with the patient for a count. On the count of 3, rock your bodybackwards while turning the patients buttocks towards the bed, along the transferboard. You should not be bearing any weight, only acting as a pivot. The majority ofthe patients weight is above his feet, permitting his body to pivot against yours.

10. The pivot transfer can be completed in more than one move if necessary.11. Once complete, remove the transfer board and stow near the bed or on the

wheelchair. Remove the transfer belt. Attend to patient comfort and safety.

Variation:Using a towel as a sling

1. Have the patient sit forward and place a towel under the patients buttocks, leavingthe long ends for you to hold onto.

2. Follow steps 1 through 7 with the exception of the transfer belt. A transfer board isoptional.

3. With your knees and hips flexed, grasp the towel.4. Communicate with the patient for a count. On the count of 3, rock your body

backwards while turning the patients buttocks towards the bed using the towel as asling. You should not be bearing any weight, only acting as a pivot. The majority ofthe patients weight is above his feet, permitting his body to pivot against yours.

5. The pivot transfer can be completed in more than one move if necessary.6. Once complete, remove the towel and stow near the bed or on the wheelchair.

Attend to patient comfort and safety.


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TECHNIQUES REPOSITIONING PARAPLEGIC IN A CHAIR

Proper position in a chair:

The patients back and buttock should be against the back of the chair.

The patients back should be straight. He should not be leaning to the side. The patients feet should be flat on the floor or on wheelchair footrests. The backs of the knees and calves should be slightly away from the edge of the

seat. Paralyzed arms should be supported on pillows. Follow the nursing care plan. Some patients have specialized supportive and positional devices. Make sure you

know their correct use.


Patient situation: The Patient has slid down in his wheelchair, resulting in poor

posture, compromised alignment and susceptibility of skin and softtissues to injury.This procedure applies to paraplegics and low quadriplegics whoare unable to reposition withoutassistance.

Procedure:

1. Unbuckle the patient lap belt. Apply wheelchair brakes.2. Ensure the patients feet firmly on footrests.3. Placing your feet about one foot apart, place the patients knees between your

knees.4. Have the patient lean forward and place his head to the side of your upper leg.

5. Place your hands on either side of his mid-back.6. On the count of 3, roll your feet onto your toes and push with your knees against

the patients knees. The counter balance results in the patients buttock being raisedoff the cushion so it can be slid into position against the back of the chair. Always begentle. Do not lift the patient.

7. Release the patient back into a sitting position and reapply the lap belt.8. Ensure patient is comfortable prior to leaving him. Ensure the male patients testicles

are sitting in front of him and not underneath him, as this can lead to a spike in bloodpressure that can be fatal.


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TECHNIQUES GUIDING A PATIENT FALL

Prevention of falls:

When getting a patient out of bed to go for a walk, make sure you let her dangle on

the edge of her bed so she can adjust to the position change. Monitor the patient for signs of dizziness, light-headedness, confusion or weakness.

Ask the patient, How are you doing? and How are you feeling? frequently. Apply a transfer belt prior to walking. Have another staff assist you as you help the patient walk. If the patient is tired, unreliable or weak, have another staff person follow behind

in a wheelchair as you help the patient walk. When helping a patient walk, always be mentally and physically prepared for a fall,

and have a contingency plan.

When a patient starts to fall:

Do not try to stop him from falling. This will likely result in you getting hurt. Instead, easehim to the floor, working with gravity and controlling the direction of the fall andprotecting the patients head. The goal is to cushion the fall and prevent serious injury.1. Stand with your feet apart and keep your back straight.2. Bring the person close to your body using the transfer belt. (If a transfer belt is not in

use, put your arms around the patients waist or hold the patient under the arms.3. Move your leg so the patients buttocks rest on it and your other leg is flexed and

braced behind you.4. Let the patient slide down your leg to the floor. Bend at the hips and knees as you

lower him. Go down with the patient as gently as possible.5. Get help and document the fall.

After a patient has fallen, or if you find a patient on the floor, call for help. Call the RN toassess the patient prior to moving or transferring him.

Report all falls to the RN or your supervisor. Complete an incident report if required bythe agency.


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If you are working in a private home you may not have an RN present to assess thepatient after a fall. Follow procedures as required by your employer. Assess the patient

and determine course of action:1. Call 911 if the patient has Lost consciousness Uncontrollable bleeding Stopped breathing Injury for which medical attention is required immediately

If you feel overwhelmed by the patients situation, call 911 or call your supervisor.2. Check for signs of a fracture which may include:

The patient reports pain, tenderness or hearing a bone snap or pop Visible swelling or bruising The patient has difficulty moving a limb.

Classic signs of a hip fracture include: Leg shortening External rotation of hip Hip crepitations (assess for this by placing your palm on each greater

trochanter and rotating)Nevermove or attempt to mobilize a patient with a suspected hip fracture.

3. Check for signs of head injury such as confusion, head pain, altered level ofconsciousness or changes in speech.

4. Complete a head-to-toe assessment. Check for other injuries such as cuts. Checkfor bleeding. Check the patients arms and shoulders for injury by having him reachup.

5. Consider the cause of the fall: Did the patient lose consciousness or have a seizure?Did he trip? Did she suddenly become weak? What signs preceded the fall?

6. If you observe signs of a fracture, or if you suspect a head, neck or spinal injury donot move the patient. Call your supervisor for help and keep the patient warm andcalm. Stay with the patient until help arrives. Call 911 if necessary.

7. If the patient is unhurt and able to assist, help him up to a nearby chair. (Techniquesare in following section.)

8. Always chart if a patient has fallen. Always chart your complete assessment andwhat steps you took, such as phoning for help. If the patient is unhurt and able to getup, chart in detail: Pt. able to weight bear. Able to take 3 steps and sit in chair. Thisindicates that serious injury was not sustained, an important determinant in liability if

the patient falls again and is hurt.


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1.

TECHNIQUES ASSISTING A PATIENT UP OFF THE FLOOR

Patient assessment:When a patient falls he needs to be assessed by a

Registered Nurse prior to his getting up off the floor.

Remember:The floor is a safe place for a patient to remain until help arrives.

Procedure for weight-bearing and ambulatory patients who are unhurt:

1. Place a chair beside the patient. Have the patient use the armrests for support.2. If the patient is lying on his back, help him to roll over onto his stomach.3. Support the patients hips and assist him into a kneeling position, facing the chair.4. Have the patient rest his forearms on the chair. Apply a transfer belt.5. Tell the patient to lift one knee and place the foot on the floor. Assist as required.6. One the count of 3, help the patient push up, stand, and pivot into the chair, while

holding onto the armrests.7. Once in the chair, let the patient rest before assisting him up again.

Procedure for non weight-bearing, non-ambulatory or injured patients:

1. Prepare the patient for transfer using the Maxi Lift (a Maxi Lift can reach all the wayto the floor) by placing the correct sling under the patient. You will need two staff toassist you.

2. Have the patients wheelchair or bed ready nearby to receive the patient.3. Spread the legs of the Maxi Lift to accommodate the patient. Lower the lift to enable

securing the sling loops. Double check loops prior to lifting and at start of lifting.4. Begin raising the patient from the floor. Raise the patient only as far as necessary to

be placed into a waiting wheelchair or bed.5. Follow Maxi Lift procedures.

6. Ensure the patient is secure following the transfer (i.e. bedrails, lap belt, etc.).


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Procedure for weight-bearing patients who are unhurt but unable to rise, and

a mechanical lift is notavailable:

This technique can be hazardous to the worker and is not advised except in anemergency in which all other methods have been ruled out. You will need the help of atleast one other person. If you are in a situation in which a patient falls and you have nomeans of assistance, consider calling emergency services for help.1. With the patient on his back, squat down and assist the patient to bend his knees.

Apply a transfer belt around his waist.2. With your partner on the other side of the patient, grasp hands behind the patients

shoulders and on a count of 3 assist him to a sitting position.3. In a wide stance, flexed at the knees, anchor the patients near foot with your foot.

Your partner will do the same on her side. Your other foot will be near the patientstorso.

4. Grasp the transfer belt. Instruct the patient to reach forward and assist by pushingup on the count of 3. A third helper may be useful to support the patient frombehind.

5. On the count of 3, assist the patient to a standing position by pushing through yourquads. Maintain a straight back at all times.

6. Enable the patient to sit to recover.


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2.

TECHNIQUES EMERGENCY EVACUATION

Use:Patients must be evacuated immediately and wheelchairs and beds cannot be

used. To be used in dire emergencies only.

Procedures:

1. Assisted walk:Faces the patient and put arms around him under his arms (like ahug) then walk backward supporting the patient to safety.

2. Cradle:Place a blanket on the floor parallel to the bed. With the patient in supineposition, put your arms under the patients armpits. Your partner, facing thepatients feet, stations herself between the patients legs and grabs the patientaround the legs under the knees. Lift and lower the patient gently onto the blanketon the floor. Using the blanket, one person pulls the patient headfirst to safety.

3. Two-person carry:With the patient in the supine position (face upward), put yourarms around the patient from behind and under the patients armpits. Your partner,

facing the patients feet, stations herself between the patients legs and grabs thepatient around the legs under the knees. Carry the patient to safety.


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BACK EXERCISE BEING GOOD TO YOUR BACK

Back exercises are one of the most important things you can do to strengthen your backand help protect it from accidental injury. The more fit you are, the less likely you are to

have back or neck pain. The following exercises, when done on a daily basis, can helpkeep your back in condition. (Remember, though, if you are experiencing back pain ofany sort, check with a healthcare professional before doing these or any exercises.)

Pelvis Tilt

Lie as shown with knees bent and flat on the floor.Slowly tighten your stomach and buttocks as you pressyour lower back onto the floor. Hold for 10 seconds andthen release. Repeat the sequence 5-10 times.

Hamstring Stretch

Lie on your back with one leg straight in front of you andthe other bent. Hold onto the ankle of your bent leg andslowly try to straighten your leg. (Keep your lower backon the floor.) Hold for 10 seconds. Relax. Repeat 5-10times, and then switch sides.

Bent-Knee Sit-Ups

Lie as shown with knees bent and feet and lower backon the floor. Place your arms as shown and slowly raiseyour shoulders, using your stomach muscles. (Do notstretch with your neck or arms.) Hold for 10 seconds.Relax. Repeat 5-10 times.

Leg Lift

Lie on the floor with one leg straight in front of you andthe other bent as shown. Slowly raise your straightenedleg as far as you can. Hold for 10 seconds. Slowly loweryour leg to the floor. Relax. Repeat 5-10 times, thenswitch sides.


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BACK CARE RIOT ACT THE WAY IT IS, FOLKS!

Prevention:

Take your time and think each transfer through. No one ever died from being

transferred a little slower, but quick transfers that were not thought out have hurtand disabled many.

Assess every situation. If you feel uncomfortable with doing or assisting in aparticular lift or transfer, voice your concerns and find remedies to make the situationbetter.

Do not try to be a back hero. There is no such thing.

If you hurt your back at work:

It may result in a permanent, painful and chronic condition. Workers Compensation may not cover you, depending on the situation and if they

can determine that you had a pre-existing condition, thus making you appear to

have made a poor career choice and that this is really all your fault. You will be susceptible to more injuries, resulting in further disability and chronic

problems and pain. Your colleagues probably wont send flowers or frozen dinners to cheer or help you,

no matter what your level of disability. Your colleagues will suffer themselves as they will work short-staffed. Your boss will step over your body to get to the next person to get the job done. It is

cruel and impersonal, but thats the way it is. You MUST fill out an incident report and injury form within 24 hours . Tell someone,

like your supervisor or the RN, that you have been hurt. Do not complete your shift ifyou have been hurt. See your physician the same day as your injury.

Final words:

Guard your back like it is gold. Your life and wellbeing hinge upon it. No one caresabout your back like you do. Guard it, protect it, and be very, very good to it. Its the onlyone you will ever have.


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REFERENCES

Canadian Back InstituteChinook Health Region, Continuing Care Program. Mobility Safety: Lifts, transfers,

repositioning and back injury prevention manual for continuing care in theChinook Health Region.

Mosbys Textbook for Nursing Assistants, 2000, Sheila A. SorrentinoSt. Michaels Health Centre Occupational Therapy Department, Lethbridge, ABUniversity of Toronto, Office of Environmental Health & Safety (Found online:

http://www.utoronto.ca/safety/ergoweb/exercise.html)Vancouver Hospital and Health Sciences Centre: GF Strong Rehabilitation (Spinal Cord

Injury Program)Wisdom Back Care ProgramWorkers Compensation Board of Alberta 10-minute warm up produced by the

Rehabilitation Centre.

Workers Compensation Board (Alberta) Safety Publications

Online sources:http://apha.confex.com/apha/130am/techprogram/paper_46121.htmhttp://www.backrelief.com/diagnosis/anatomy.htmlhttp://www.drmcbain.com/shoes.htmlhttp://www.emc.maricopa.edu/academics/physed/wellness/Proper_Footwear.htmlhttp://www.premierinc.com/all/safety/resources/back_injury/http://www.shb.ie/content-525439453_1.cfm#Functions

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