Basic Principles of Transferring Clients

The aide should begin by first washing his or her hands and deciding whether the use of disposable gloves is needed. The aide should follow standard precautions by identifying the client and explaining to the client exactly what to expect.

The aide should consider the following points:

• Situation Assessment – The aide should begin by assessing the situation. This includes reviewing whether he or she has provided that specific type of transferring assistance before. An assessment should be made to determine how far the client will be transferred, what resources are available for transferring the client. The aide should determine how much time will be needed for this type of transfer assistance.

• Client Capabilities – A determination should be made of how much assistance the client will need during the transfer event. This requires an evaluation of how much help, if any, a client can or should provide to assist with his or her transfer. This evaluation includes considering the client’s condition: Does the client have any medical problems, physical limitations, or psychological issues that limit his or her ability to ambulate and move? Is moving the client unsafe?

• Fall Risk – The aide should always consider a client’s fall risk. Most situations in which the Aide is providing transfer assistance involves the potential for a fall, even a slight fall. Safety should be the priority of the Aide when transferring a client because even a small fall can have serious consequences.

A change in position, especially from lying to sitting or from sitting to standing, can cause changes in blood pressure (orthostatic hypotension), which increases a risk of falling. Having the patient sit on the edge of the bed for a few minutes before transferring will help decrease blood pressure issues.

• Maintaining good body alignment for a client during a move is essential to safety. In many situations in which an aide is assisting with the transfer, the client will be weak and will have difficulty walking. Often, the client cannot assist with the process.
• A fall is defined as an unplanned descent to the floor, with or without injury, and transferring a client is very often a situation in which a client fall is a risk.
• Falls are very common in the general community and in healthcare facilities. Approximately one-third of all older adults living in a community will fall at least once a year.

The aide should be familiar with important facts related to client falls, such as:

• The majority of falls are unwitnessed.
• Falls often happen when the client is being transferred from a bed to a chair.
• Most falls do not cause injuries but the injuries that do occur tend to be serious: bleeding, dislocations, fractures, and lacerations.
• Hip fractures suffered after falls are an especially serious injury.
• Approximately 25% of all clients who suffer a hip fracture after a fall die within a year and approximately 50% of these must be discharged to a long-term care facility and they never return home.
• Falls can cause anxiety, depression, lack of confidence in the ability to ambulate, and a fear of falling again. Falls increase the length of hospitalization and they increase healthcare costs.

Assessing a Client’s Risk of Falling

• Physical Issues and Limitations, Does the client have a medical condition or a physical limitation that would increase his or her risk of falling?
• Physical Issues and Limitations
• Does the client have a medical condition or a physical limitation that would increase his or her risk of falling? Examples would be balance disorders, muscular weakness, and stroke.
• Transferring a client can be quick, simple, and done without help. It can also take a lot of time, or require special equipment and several people. Regardless of what the client needs or what the situation requires, the key for safely transporting someone is to plan ahead by assessing the situation, assessing the client, and determining the fall risk.
• It is important, however, to avoid taking short cuts after becoming familiar with this basic transferring method. You should always follow the basic steps to avoid an accidental fall or injury to the client or to those assisting the client.
• The planning required prior to transferring a client safely and efficiently is a basic and essential part of this client care activity.

Caring For A Client Using Assistive Devices

Canes, Crutches, and Walkers Are Called Assistive Devices – Canes and walkers are often needed permanently. Crutches are usually needed for a short period of time to help clients ambulate while recovering from an injury; however, some clients do depend on crutches for their day-to-day ambulation. Assistive devices provide support, balance, and take the pressure off an affected leg. Physical therapists provide the initial instruction to clients on the proper use of assistive devices. The Aide may need to help someone who is using an assistive device and should know how they are used.

Assisting a Client Using a Cane – The Aide should make sure the top of the cane is at the level of the client’s wrist when he or she is standing. The client should be instructed to hold the cane in the hand opposite the affected leg. This may seem counter-intuitive but the cane provides the most support when used this way. The cane can then be used while moving the affected leg forward at the same time. The cane should be placed at the same distance from the body as the affected leg; it should not be placed too far forward. The client should stand straight and not lean noticeably to one side on the cane. Once the cane and the affected leg are solidly placed, the weight can be shifted to the cane and the unaffected leg moved forward.

Assisting a Client Using a Walker – Walkers are the most stable of the assistive devices, and clients who use a walker will typically only need assistance when they are standing up or sitting down. Ambulating with a walker is done in the same way as ambulating with a cane or crutches. The client places the walker a short distance from his or her body, uses the walker for support, and then moves forward.

Transferring Clients to a Sitting Position – One of the most basic techniques of transporting a client is to a sitting position. It is used prior to helping someone out of bed, helping someone up from an examining table, and in many other situations.

As noted previously, aides should follow basic hygiene practices by first washing their hands, and then follow facility standard safety policies of identifying the client prior to any activity intervention, and explaining to the client what is going to happen.

The bed should always be locked prior to transferring the client to a sitting position. The client should be helped to move close to the edge of the bed and to turn onto her side. The side rails should be down and the Aide should be positioned to prevent the client from falling out of bed.

The bed should be raised so that it is level with the aide’s hips and the head of the bed should be slowly brought up to 45 degrees. The client should be asked if this change in position is tolerable. If the patient reports feeling dizzy or lightheaded, the head of the bed should be lowered. If the client can tolerate this change of position, the Aide can help the client put his or her legs over the edge of the bed (the legs should be supported if needed) and the head of the bed elevated as much as possible.

The aide should place one hand on the client’s hip and the other hand on the shoulder and then slowly pull until the client is upright. Contact with the client should be maintained, and the Aide should not let go of the client until the Aide is certain the client is stable sitting up. If the bed has split side rails, one of the rails should be positioned for client support. The bed should be lowered so that the client’s feet are touching the floor. The Aide should stay with the client for the prescribed amount of time.

Helping Clients Ambulate

This section discusses methods to help clients ambulate, which is defined here as getting out of bed or up from a chair or a wheelchair and then walking.

There are different ways of helping a client to ambulate. The step-by- step process used will depend on the situation and the client’s needs. The client may need to use an assistive device, a transfer belt may be needed, or perhaps he or she will only need the person assisting with ambulation to hold onto an elbow for support.

Regardless of what the situation requires, the following principles should be used when helping a client to ambulate. These principles can be applied to almost all situations in which an aide is transporting a client. The Aide should:

• Assess the client’s fall risk and any client issues that may affect transferring.
• The Aide should plan the path of ambulation, and make sure the path is clear.
• Assistance should be available in case it is needed. Ambulating some clients can require several people in order to do it safely.
• Standard hygiene practices should be followed: handwashing.
• The bed or wheelchair should always be locked before starting ambulation.
• After a client is standing up, the client should be asked if he or she feels dizzy or lightheaded. The client should also be observed closely for any sign of unsteadiness. If the client feels dizzy or lightheaded or appears unsteady, the Aide should not continue to ambulate the client. Instead, the client should be returned to bed or to the chair.
• When assisting a client, the aide should always walk slightly behind him or her. This will put the aide in the best position to help in case of a fall. A transfer belt may be used, as well.
• The client should be helped to ambulate for the prescribed amount of time but discontinue ambulation if he or she is not tolerating it or the situation becomes unsafe. Safety is the priority, not completing the task.

The aide should also be prepared to support a client if he or she falls. If ambulating a client without a second person to assist and the client begins to fall, the aide should place his or her legs firmly apart to establish a base of support. One leg should be placed forward between the client’s legs, holding the client under his or her arms, and guiding the client’s body to slide down the leg. The client should be lowered gently and slowly to the floor.

Moving a Client from a Bed to A Chair

Moving a client from a bed to a chair can put the client at risk for a fall. When not sure this move can be performed safely, assistance is necessary.

• Standard hygiene practices should be followed by washing hands.

• The wheels of the bed should be locked, and the client helped to move close to the edge of the bed and turn onto his or her side. The side rails should be down and the Aide should be positioned to prevent the client from falling out of bed.

• The bed should be raised so that it is level with the Aides hips and then the head of the bed slowly elevated to 45 degrees. The client should be asked if this is tolerable. If he or she reports feeling dizzy or lightheaded, the head of the bed should be lowered. If the client is not dizzy, the client needs to be helped to put his or her legs over the edge of the bed (the legs should be supported if necessary) and the head of the bed elevated as much as possible. One hand should be placed on the client’s hip and the other hand on the shoulder, then the aide should slowly pull until the client is upright, and not let go. Contact with the patient should be maintained until it is certain the client is stable.

• If the client reports feeling dizzy or lightheaded or appears unsteady, the client should be lowered back down, the side rails placed back up.

• If the client can tolerate being upright, the bed should be lowered until his or her feet are touching the ground. The client’s shoes should be placed on the client’s feet. The aide should face the client and establish a firm base of support. If needed, a transfer belt should be applied. The client should be instructed to slide forward to the edge of the bed. 

• Once in this position, the client should be asked to move his or her legs apart to shoulder width and then lean forward slightly so that his or her weight is centered over the legs and feet.

• Whatever level of support is needed should be used to lift the client. This could be placing one or two arms under the client’s armpits, the arms around the client’s waist, a transfer belt, or the client’s hands on the Aide’s shoulders. The client should be lifted up under the arms, by the waist, or with a transfer belt, and once the client is standing he or she should be asked if there is dizziness or lightheadedness. The client should be observed closely to see if he or she is steady. If the client reports feeling dizzy or lightheaded or appears unsteady, the activity should be discontinued. The client should be helped back down.

• When the client is standing, the Aide should help him or her pivot and to slowly lower into the chair. The pivoting motion can be slightly awkward, especially if the client is weak, so time should be taken to give as much support as needed.

• Clients should always have appropriate footwear with rubber soles on when transferring or Ambulating.

• Remember SAFETY FIRST!