Performing Safe Transfers

By arhospice on September 12th, 2022

Every day in the United States, thousands of healthcare workers sustain a disabling injury while performing work-related tasks. According to the Bureau of Labor Statistics, nearly 80% of all injuries to professional caregivers are the result of lifting, pulling, pushing, holding, carrying and turning.

Undoubtedly, many family caregivers are also injured while caring for loved ones – especially when helping reposition a person in bed or transferring them from beds to chairs or vice versa.

Risk factors for injury

Once you have injured your back, you have an 80% chance of hurting it again. To prevent a back injury, it’s important to understand the risk factors:

  • Bending and lifting frequently
  • Rushing while transferring a person
  • Ignoring pain
  • Poor posture
  • Being 10 pounds or more overweight
  • Lack of exercise
  • Smoking

Body mechanics

One of the keys to preventing an injury during a transfer is use proper body mechanics and lifting with your biggest, strongest muscle groups – your hips, thighs and buttocks. Body mechanics are the way your whole body moves to keep its balance during movement and rest. When you practice good posture and use the right muscles to lift and/or transfer, you are performing your work with proper body mechanics.

Below are some suggestions for using proper body mechanics when preparing for transfers:

Think before you act.

  • Plan how you are going to perform a transfer. Don’t just rush into it. Go through the entire transfer in your mind before you begin.
  • Before you start, be sure you know if the person is physically able to participate in the transfer.
  • If the person is alert, let him or her know what you plan to do – step by step. Talk about how the person can help and encourage him or her to assist as much as possible.
  • Taking time to plan is worth it. Remember, it’s tough to ask for help when you have a person half in and half out of bed.

Get help if you need it.

  • Be realistic about how much weight you can safely lift.
  • Gather transfer equipment if the person is too heavy or too difficult for you to move yourself.

Set the stage.

  • Make sure there are no obstacles in your way. For example, keep the path clear between the person’s bed and wheelchair.
  • Place your equipment where it needs to be so that the distance is as short as possible. For example, make sure the wheelchair is close to the bed and that the wheels are locked.
  • Check that neither you nor the person has any loose clothing that might get stuck in a bed rail or a wheelchair during the transfer.

Balance it out.

  • Stand so your weight is centered over your feet. Don’t put more weight on one foot than the other.
  • Keep feet shoulder-width apart. If you stand with your feet too close together, you might lose your balance.
  • Don’t “lock” your knees. Keep them loose and flexible.
  • Wear shoes with non-slip soles and try to have the person do the same. Wearing only socks could cause both of you to end up on the floor.

Tighten it up.

  • ­Pull in your abdominal muscles and tighten your buttocks at the same time to create a “girdle” that supports your lower back.
  • Don’t round your back when you tighten your buttock muscles. Instead, keep your back arched inward slightly.
  • To prevent injury, work to keep your abdominal, back and buttock muscles in good shape with daily exercise.

Use your big muscles.

  • If you bend over at the waist to lift or move a person, your back muscles lift the weight of the person and the weight of your upper body. When you bend at the knees, you use the big muscle groups in your buttocks and thighs instead.
  • Bending at your knees also helps you keep your balance during a transfer.
  • If you need to bend forward, bend from the hips, not the waist.

Don’t do the twist.

  • Plan your transfer so that you don’t have to twist your body. Twisting your lower back puts you at risk for muscle strain – or even a more serious back injury.
  • To avoid twisting, keep your shoulders and hips facing the same direction. Turn your feet first, and then follow with your shoulders and hips at the same time.

Get close.

  • Keeping the person close to you helps use your large muscle groups and prevents straining the smaller arm and back muscles.
  • Keep a secure hold on the person, but don’t grip so hard that it hurts. If appropriate, gait belts are one way to keep a good grip on the person.

Take the breath test.

  • If you can’t lift and breathe at the same time, the person is too heavy for you. Ask for help.
  • Use smooth, steady movements during a lift or transfer. Try not to jerk. This can frighten the person, and it can cause injury to both of you.
  • Don’t be in a hurry. It can take only a second to injure your back and years for it to heal.

Performing safe transfers

This section contains general guidelines for performing safe transfers. However, every situation can be different. Do not attempt to transfer the person if you are concerned about your safety or the person’s.

Using a Drawsheet

A drawsheet can be a useful tool for moving a person up in bed or transferring them from a bed to a stretcher. Special drawsheets are available, or you can make a drawsheet out of a regular sheet by folding the sheet in half from top to bottom. Place the folded sheet on the bed making sure the fold is toward the head of the bed.

Two people moving a person up in bed with a drawsheet

  • Make sure the drawsheet is placed so that it supports the person from the neck to the calves.
  • One person stands on each side of the bed. Untuck the edges of the drawsheet and roll them up as close as possible to the person’s body. These rolls become the “handles” for moving the person.
  • Make sure the person lifts his or her head or that a third person supports the head during the move. Remember to use proper body mechanics.

Moving a person up in bed with no drawsheet

Moving a person up in bed without help and without a drawsheet is possible in some situations. Before trying to transfer a person by yourself, stop and consider:

  • The size of the person – Ask yourself if the person is smaller than you.
  • Compliance – Is the person predictable? Can he or she follow directions?
  • Ability – Can the person help in some way? For example, can he push with his feet? Can she pull with her arms?

If you can answer these questions satisfactorily, the following are recommended steps for moving a person up in bed by yourself with no drawsheet:

  • Stand alongside the bed at the person’s waist, with your body facing the head of the bed.
  • If the bed has side rails, lower the one near you.
  • Keep your feet at least 12 inches apart and bend your knees.
  • Reach under the person’s buttocks or upper thighs and shoulders at the same time.
  • If the person is able, ask her to bend her knees and push against the mattress with her feet – or to grab the side rail, headboard or trapeze and pull with her arms.
  • Tighten your abdominal and buttock muscles at the same time.
  • Count to three out loud, then lift and slide them up in bed, keeping your knees bent and your back slightly arched.
  • Shift your weight from the back to the front foot. (Several small moves can be made instead of one big one.)

Two people moving a person up in bed with no drawsheet

  • One person should be on each side of the bed.
  • Grasp forearms under the person’s upper thighs and shoulders.
  • Lift at the count of three.

Moving a person from a bed to a chair

Before attempting to move a person from a bed to a wheelchair by yourself, stop and consider:

  • The size of the person – Ask yourself if the person is smaller than you.
  • Mobility – How well can the person move? Can he or she assist you?
  • Equipment – Is the person hooked up to equipment such as an IV or a catheter bag?

If you can answer those questions satisfactorily – and if the person can stand – below are steps for moving a person from a bed to a chair:

  • Help the person sit up and adjust slowly to the change of position. Allow legs to dangle while you help put on non-skid slippers or shoes.
  • Be sure the bed is at its lowest position.
  • Position the chair near the bed. If the person has a weak side, place the chair on the stronger side. If the chair has wheels, lock them. If there are footrests, put them up.
  • Now, support the person’s knees by putting your knees right in front of them. And keep the person’s feet from sliding by putting your feet in front of them. Do not lock your knees.
  • If recommended by the person’s healthcare provider, apply a gait belt. Ask the person to lean forward and push off the bed at the count of three. Or, rock the person forward to a standing position.
  • It’s OK to have a person hold onto your shoulders or waist, but never around your neck.
  • Bend your knees slightly. First, pivot your feet. Then, turn your body, along with the person.
  • Make sure the chair seat touches the back of the person’s legs before he or she begins to sit. He or she should also reach back for the armrests, if able.
  • Lower the person slowly to the chair without rounding your back.

Note: If the person cannot stand, it is best to transfer with a mechanical lift.

Moving a person from a chair to a bed

The same steps can be followed in reverse to transfer a person from a chair to a bed. These steps can also be used for couches and toilets, if necessary.

Remember to:

  • Lock the wheelchair brakes and to move the footrests out of the way of the feet.
  • Help the person scoot to the front of the chair so his or her feet are flat on the floor.
  • Assist the person to lean forward over his or her feet. Ask him or her to use their hands to push up, if able.
  • Slowly sit the person back down.

Tips for Performing Safe Transfers

  • Try to stretch and loosen your muscles every day before caring for your person. Even 5 minutes of stretching can help save your back.
  • If you must lean forward, support the weight of your upper body on your free hand and arm to relieve the pressure on your lower back.
  • Just because a person is small doesn’t mean that he or she will be easy to transfer. Be sure to think about the person’s flexibility, range of motion and overall strength. All these things together affect how easy a transfer will be.
  • If recommended, make use of assistive devices like mechanical lifts, transfer belts, sliding boards or drawsheets. It may take a few more minutes to get these devices in place – but it will be worth it in the long run. Remember to practice using the equipment before using it with an actual person.
  • If you’ve felt pain or discomfort while moving your person, then don’t do it again in the same way. Change your technique or get help when it’s time to move the person again.
  • Practice good posture. Your ears, shoulders and hips should all be in a straight line –along with the front of your knees and ankles.
  • You can try to improve your posture by standing against a wall. Keep your heels about 2 inches away from the wall. There should be a space between your waist and the wall about as thick as your hand. Keep your chin parallel to the floor.
  • When possible, encourage the person to practice good posture, too. This might help him or her have fewer aches and pains – and have a better quality of life.
  • As you go about your daily life, remember to push, pull or roll heavy objects – rather than lifting them – whenever possible.
  • Remember that a back injury can change your life. It can keep you from caring for the person, doing your job if employed, and from doing the things you love. A back injury can also give you a lifetime of chronic pain.
  • If you hurt your back, let your physician know if pain persists.

More Caregiver Tips

Preventing Bed Sores
Fall Prevention
Pain in the Elderly
Bathing Tips

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