NCM 103A: FUNDAMENTALS OF NURSING (RLE)

Topic: Transferring clients from bed to wheelchair and vice versa and from bed to stretcher and
vice versa

Activate Prior Knowledge

Acquire New Knowledge

Learning Objectives:
At the end of the module, the learner will be able to:
1. Define Transferring
2. Identify the purposes of Transferring Patients from Bed to Wheelchair, Bed to
Stretcher and vice versa
3. Observe proper body mechanics in transferring clients
TRANSFERRING

Transferring is a nursing skill that helps the dependent client or the client with restricted
mobility attain positions to regain optimal independence as quickly as possible. Properly
helping a client from the bed to a chair is an important nursing function, in which the nurse
plays a vital role by giving the client physical support and encouragement.

One of the major concerns during transfer is the safety of the client and the nurse. The nurse
prevents self-injury by using correct posture, minimal muscle strength, and effective body
mechanics and lifting techniques.

The nurse must be aware of the client’s motor deficits, ability to aid in transfer, and body
weight. As a rule, nurses should always get assistance if in doubt about their ability to
transfer a client.

A. TRANSFERRING PATIENTS FROM BED TO WHEELCHAIR AND VICE

VERSA

Purposes:
1. To maintain and restore muscle tone.
2. To stimulate the respiratory and circulatory systems.
3. To improve elimination
4. To maintain body alignment.
5. To prevent injury.

Equipment:
Wheelchair or chair
Blanket to cover the patient in the chair
Clean gloves (optional)

Patient safety is often the main concern when moving patients from bed. But remember not to lift
at the expense of your own back. This transfer often requires the patient's help, so clear
communication is essential. If the patient can't help much, you'll need two people or a fully body
sling lift.

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 Remember: When patients are weak, brace your knees against theirs to keep their legs from
buckling. Also, transfer toward patient's stronger side if possible.

PREPARATION:

Think through the steps before you act, and get help if you need it. If you are not able to
support the patient by yourself, you could injure yourself and the patient.

Make sure any loose rugs are out of the way to prevent slipping. You may want to put non-
skid socks or shoes on the patient's feet if the patient needs to step onto a slippery surface.

The following steps should be followed:

 Explain the steps to the patient.

 Park the wheelchair next to the bed, close to you.
 Put the brakes on and move the footrests out of the way.

Sit the patient up

Before transferring into the wheelchair, the patient must be sitting.

Allow the patient to sit for a few moments, in case the patient feels dizzy when first sitting up.

 Position and lock the wheelchair close to the bed. Remove the armrest nearest to the
bed, and swing away both leg rests.
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  Help the patient turn onto his or her side, facing the wheelchair.
 Put an arm under the patient's neck with your hand supporting the shoulder blade; put
your other hand under the knees.
 Swing the patient's legs over the edge of the bed, helping the patient to sit up.

Stand the patient up

If you have a gait belt, place it on the patient to help you get a grip during the transfer. During the
turn, the patient can either hold onto you or reach for the wheelchair.

Stand as close as you can to the patient, reach around the chest, and lock your hands behind the
patient or grab the gait belt.

 Have the patient scoot to the edge of the bed.

 Assist the patient in putting on skid proof socks or shoes.

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  Put your arms around the patient's chest and clasp your hands behind his or her back.
Or, you may also use a transfer belt to provide a firm handhold.
 Supporting the leg farthest from the wheelchair between your legs, lean back, shift
your weight, and lift.

Pivot toward chair

 Have the patient pivot toward the chair, as you continue to clasp your hands around
the patient.
 A helper can support the wheelchair or patient from behind.

Sit the patient down

 As the patient bends toward you, bend your knees and lower the patient into the back
of the wheelchair.
 A helper may position the patient's buttocks and support the chair.
 Reposition the foot rests and the patient's feet.

Special considerations:

 Do not allow patients to place their arms around your neck. Have them place their
arms around your hips.
 Avoid lifting patients. Let them stand using their own strength.
 Stay close to your patient during the transfer to keep the patient’s weight close to
your centre of gravity
 If the patient has weakness on one side of the body (e.g., due to a cerebral vascular
accident — CVA — or stroke), place the wheelchair on the strong side.

Procedure and Rationale:

PROCEDURE RATIONALE
1. Before transferring, assess the Enables nurse to use client’s mobility,
client. strength and coordination.
Determines need for additional help.
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 Ensures client and nurse safety.

2. Implement pain relief measures so Pain relief before transfer enhances

that they are effective when the client participation.
transfer begins.

3. Assemble equipment and supplies. Preparation promotes efficient time

management and organized
performance of task.

4. Remove obstacles from the area A clear pathway from the bed to the
used for the transfer. chair facilitates transfer.

5. Introduce yourself, and verify the Patient identification validates the

client’s identity. Explain to the correct client and correct procedure.
client what you are going to do, Discussion and explanation help allay
why it is necessary, and how the anxiety and prepare the client for
client can cooperate. what to expect.

6. Perform hand hygiene and Hand hygiene and gloving prevent

observe other appropriate
infection control procedures.
7. Provide for client privacy.
Transferring from bed to wheelchair
8. Place the wheelchair at a 45-
degree angle facing the head part
on the stronger side of the client.
Position the footstool.
9. Lock the bed and wheelchair and
adjust the bed to an appropriate
working height.
the spread of microorganisms.
Promotes sense of well-being.
This will allow the patient to pivot on
the stronger leg.
Locking brakes prevent movement
during transfer and increases stability
and client safety.

10. Move the patient to the side The nurse’s center of gravity is placed
closest to you, by section, starting near the patient’s greatest weight to
with head and shoulders. Make safely assist the patient to a sitting
sure to support the client’s head position.
and neck. Followed by the middle
section, supporting the client’s
pelvis. Lastly, move the lower
section supporting the client’s
knees.

11. Place the client’s weak leg on top Support weaker extremities to
of the stronger leg and assist the prevent injury.
client to clasp hands, the thumb
of the weaker hand should be on
top of the stronger hand. Place
the client’s clasped hands over
your neck. Slide one arm under
the client’s leg and place the other
arm behind the patient’s back.

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 12. Help the client in a sitting position
supporting the client’s neck and
nape. Turn the client towards the
edge of the bed while supporting
the neck and knees. Allow the
client to sit for a few minutes.
13. Position the client’s feet slightly
apart on the footstool. Take a
wide stance, bend your knees,
and grasp the client at the sides
of the belt. While in a wide
stance support the client’s knees
with your own knees.
14. Inform the client that you will
assist him or her in a standing
position on the count of “one,
two, three, STAND.” On the
count of three, straighten your
knees, assisting the client on a
standing position.
15. Stand close to the client, and
pivot to the chair. Lower the
client to the seat. Be sure the
client’s body is positioned firmly
back in the seat.
16. Place the client’s arm over the
armrest and assist in placing feet
over the footrest.
Transferring from wheelchair to bed
17. In transferring the client back to Positions chair within easy access for
bed, move the wheelchair and
place at a 45-degree angle facing
the footpart on the stronger side
of the client.
18. Lock the bed and wheelchair and Locking brakes prevent movement
adjust the bed to an appropriate
working height.
19. Assist the client in removing feet
from the footrest. Ask the client
to clasp hands, making sure that
the thumb of the weak hand is
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Supporting the client’s shoulders
prevents the client from falling
backward during the movement.
Supporting the client’s knees reduces
friction of the thighs against the bed
surface during the move. Allowing
the client to sit for a few minutes will
prevent light-headedness or
orthostatic hypotension which can
occur with sudden change in
circulation caused by lowering the
legs and raising the head.
This position avoids injury to the
nurse if the patient should fall and
grasp the nurse around the neck.
This helps prevent loss of balance
during the transfer.
This allows the nurse and the client
to extend the joints and provides the
nurse with an opportunity to ensure
that the client is stable before moving
away from the bed.
Sitting well back on the seat provides
a broader base of support and
greater stability and minimizes the
risk of falling from the wheelchair.
Promotes comfort.
transfer back to bed.
during transfer and increases stability
and client safety.
To maintain stability.
 over the stronger hand.

20. Slide one arm under the client’s To maintain stability.

back. Position the client’s feet
slightly apart. Take a wide
stance, bend your knees, and
grasp the client at the sides of the
belt. Take a wide stance.
Support the client’s knees with
your own knees.

21. Inform the client that you will This allows the nurse and the client
assist him or her in a standing to extend the joints and provides the
position on the count of “one, nurse with an opportunity to ensure
two, three, STAND.” On the that the client is stable before moving
count of three, straighten your away from the chair.
knees, assisting the client on a
standing position.
22. Stand close to the client, and Maintains support of client while
pivot towards the bed. Make sure allowing adequate space for client to
to have wide stance and support move.
the client’s weak knees. Assist
the client up the footstool and
lower the client on the edge of
the bed.

23. Place the client’s weak leg over Support weaker extremities to
the stronger leg. Lift both legs prevent injury.
supporting the client’s knees.
While supporting the client’s neck,
assist client in a supine position.

24. Move the client toward the center Prevents injury to the client while
of the bed by section, starting moving in bed.
with the head and shoulders,
followed by the trunk while
supporting the client’s pelvis and
the lower extremities while
supporting the client’s knees.
25. Place the client’s top covers and Blanket provides warmth and privacy.
put up side rails. Ensure client’s
comfort.
B. TRANSFERRING PATIENT FROM BED TO STRETCHER AND VICE VERSA

A bed to stretcher transfer requires a minimum of three to four people, depending on the
size of the patient and the size and strength of the health care providers. Patients who
require this type of transfer are generally immobile or acutely ill and may be unable to
assist with the transfer.

In the hospital, clients are often transported by stretcher to other areas for tests or
procedures. Care must be taken when moving someone from a bed to a stretcher or from

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 a stretcher to a bed to prevent injury to the client or staff. This technique usually require
a three-person carry.

Another way is by using a lift sheet placed under the client. The lift sheet serves as a
“cradle” while the client in being transferred to the stretcher. In this technique, the nurses
are on opposite, nurse need to be on opposite sides of the bed and holding onto the lift
sheet when transferring the client to the stretcher. The stretcher and bed are placed side
by side so that the client can be transferred quickly and easily using a lift sheet.

Caution is used when the client has or is suspected of having spinal cord trauma.

Patient safety is often the main concern when moving patients from bed. But remember
not to lift at the expense of your own back. And, never move a patient by yourself. Two
people usually can do this move safely. The leader, who pulls, should be the stronger of
the 2. The helper holds the draw-sheet, neither pushing nor lifting. An additional assistant
could hold the patient's head and neck during the transfer. Use additional assistants or a
mechanical transfer device if the patient is over 200 pounds (90.7 kg).

PROCEDURE RATIONALE
1. Review the medical record and This validates the correct client and
identify conditions that may limit correct procedure. Identifying the
the client’s movement. client’s limitation of movements will
reduce the risk of injury.

2. Identify the client and explain the Validates the correct client and correct
procedure. procedure. Explanation allays anxiety
and prepares the client for what to
expect.

3. Wash hands and put on gloves, if Hand hygiene and gloving prevents the
necessary. spread of microorganisms.

4. Close the room door or curtains. Closing the door or curtains provide
Raise the bed to the same height privacy. Proper bed height and
as the stretcher. Lower the side lowering side rails make transfer easier
rails. and decrease the risk for injury.

5. Place a drawsheet under the A drawsheet supports the client’s

patient, if one is not already there. weight, reduces friction during the lift,

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 Have client fold arms across chest and provides for a secure hold.
and move chin to chest. Using the
drawsheet, move the client to the
side of the bed where the stretcher
will be placed.

6. Place the bath blanket over the Bath blanket provides privacy and
client and remove the top covers warmth.
from underneath.

7. Position the stretcher next to and Positioning equipment makes the

parallel to the bed. Lock the transfer easier and decreases the risk
wheels on the stretcher and the for injury. Locking the wheels keeps
bed. the bed and stretcher from moving.

8. Remove the pillow from the bed Team coordination provides for patient
and place it on the stretcher. The safety during transfer.
2 nurses should stand on the
stretcher side of the bed and the
third nurse should stand on the
opposite side of the bed without
the stretcher.

9. Fold or bunch the drawsheet close
to the client before the grasping it
securely in preparation for the
transfer. Use a transfer board if
one is available.
The nurse use major group muscles to
assist in moving the client. A transfer
board makes it easier to move the
client and minimizes the risk for injury
to the client and nurses.

10. One of the nurses on the stretcher This supports the client’s head and
side reaches across the stretcher upper body.
and grasp the drawsheet at the
head and chest areas of the client.

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 11. The other nurse on the stretcher This supports the lower part of the
side reaches across the stretcher client’s body.
and grasp the drawsheet at the
client’s waist and thigh area.

12. At a signal given by one of the Working in unison distributes the work
nurses, the nurses standing on the of moving the client and facilitates the
stretcher side of the bed pull the transfer.
sheet. At the same time, the nurse
opposite the bed should lift the
client from the bed to the
stretcher.

13. Once the client is transferred to Side rails promote safety; blanket
the stretcher, secure the client and promotes comfort and warmth.
raise the side rails. Ensure client’s
comfort. Cover the client with a
blanket. Leave the drawsheet in
place for the transfer back to bed.

14. Perform hand hygiene and Hand hygiene prevents the spread of
document the time and client’s microorganisms. Documentation
destination. promotes continuity of care and
communication.

Reminders:

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 References:
 Fundamentals of Nursing Concepts, Process and Practice by Kozier & Erb; 10th
edition
 https://www.mountnittany.org/articles/healthsheets/5113
 https://www.mountnittany.org/articles/healthsheets/5114
 https://medlineplus.gov/ency/patientinstructions/000428.htm
 https://opentextbc.ca/clinicalskills/chapter/3-7-transfers-and-ambulation/
 https://www.nursingcenter.com/journalarticle?
Article_ID=762231&Journal_ID=54016&Issue_ID=762186

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