Kinesthetic patient transfers

1. Kinesthetic patient transfers Eija Mämmelä M.Ed., Physiotherapist Oulu University of Applied Sciences email: eija.mammela@oamk.fi Based on material produced in a project by

2. You need to let the patient to use her own resources • Give your patient time: old people need more time to react • Make your patient to feel herself safe • Let her see where to move • 80% of falling accidents occur because the patient was afraid of falling or did not know what to do • Cheer your patient: confidence is power • Speak clear, tell what to do (not what not to do) • Stimulate manually if needed • Use utilities and devices to make transfers more easy and safe • Organize the environment to be free and safe

3. Where do I stand while helping? How should I move? • Stand beside the patient, never in front of her • Use your whole body, not only your upper extremities and back • Quadriceps is the strongest muscle (it is an extersor, so bend your knees) • Be really near your patient – it makes patient to feel more safe • Avoid bending your back too much or reaching too far • Move side by side with your patient • The patient starts the movements • You follow (like a lady follows her dance partner) • Be ready to prevent false and unsafe movements

4. -Patient sees where to move Reaching to grap the handle shifts body weight, shows direction From sitting on bed to a wheel chair Support patients own movements

5. From wheel chair to toilet seat 2. Two persons helping • One person helping • Guiding pelvis from back (video) • Guiding forward from front (demonstration) Moving oneself from wheel chair to toilet seat (video 10, 1’15”)

6. Organize firm support to patient Stand beside patient, not in front of Patient can lean forward and move his weight to his legs Your hands: pelvis, shoulder, chest, maybe on quadriceps to stimulate muscle activation… Video 6 (4’16”)) From bed to wheel chair – via standing position

7. From bed to wheel chair –two persons helping Patient holds and pulls herself, Therapists’ hands are on the trunk Walking belt! Patient holds therapist arms – they do not lift from armpits!

8. From sitting on bed to a wheel chair- when the legs of patient are spastic or hypotonic • By rocking forward • glide board • push (on video 9) • or pull (demonstration) • 2. By rolling around (video 9, 2’10”) • glide board • therapist guides to right direction

9. From side-lying to sit on the bed • Patient pushes with her own arm • Stimulate the arm by tapping • Guide places for both arms • Your hands: on pelvis and on the upper shoulder (video 12, 1’34”)

10. Facilitating patient to move from back to his side • Roll the pelvis • little by little • 2. Glide shoulders • Put your arm under the trunk • to decrease friction

11. Transfering a lying patient upwards in bed video 3 (3’16”) 1. ”walking on one’s back” 3. Decrease friction with lifter Shift your own weight backwards 2. With extra sheet or mini-mover

12. With heavy or very painful patients use a lift or other shifting devices

13. Utilities and equipments for patient transfers Friction might be a problem – try to decrease it Easy glides -full size best for the weakest, painful or totally passive patients Decrease friction • A plate for turning • From sitting to sitting • Bed > wheel chair • In toilet • Glide boards • are used with lying and sitting patients

14. Utilities and equipments for patient transfers Lack of power might be a problem • A handle is fixed on bed and it turns 90º • For getting up from bed • For standing up • A robe with knots or a robe ladder • - Is fixed on the end of bed • - Patient pulls himself up • “Turner” • gives support to patient • getting up from a chair • - patient pulls himself up

15. Utilities and equipments for safe patient transfers Safety demands firm holding – you can’t pinch hard your patient - use equipments • Walking belt while • Walking • Standing up from sitting • Transfers from sitting to sitting • Patient has it on, or you have it! • Semiflexible mat with 4 or 6 handles • For moving patient lying in bed • to shower trolley Rehamed website

16. References and sources of pictures • Tamminen-Peter, Eloranta, Kivivirta, Mämmelä, Salokoski, Ylikangas. 2007. Potilaan siirtymisen ergonominen avustaminen. Opettajan käsikirja. STM Julkaisuja 2007:6 [Ergonomics in Patient Transfers. Handbook for Teachers. Published by Finnish Social and Health Ministry. Available in Finnish www.ttl.fi/potilassiirto] • Website for teaching ergonomic patient transfers. 2007 http://www.ttl.fi/Internet/Suomi/Aihesivut/Ergonomia/Ergonomiaa+eri+aloilla/Sosiaali+ja+terveydenhoitoala • were produced to develop teaching of Patient transfers in Finland. • Administrated by Finnish Institute of Occupational Health • Developed in a project nominated by Finnish Social and Health Ministry

17. Studies and researches about patient transfers and the work load related to them (indicated in this file) • Engvist 1997. Events and factors involved accidents leading to over-exertion back injuries among nursing personnel. Arbete och Hälsa 30. Arbetslivsinstitutet, Stockholm. • Garg & Owen1992. Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home. Ergonomics 35:1353-1375. • Hansson 2001. Ländryggsbesvär och arbete. In Hansson & Westerholm (Ed.) Arbete och besvär I rörelseorganen. En vetenskaplig värdering av frågor om samdand. Arbete och Hälsa 12. Arbetslivsinstitutet, Stockholm. • Jensen 1990. Back injuries among nursing personnel related to exposure. Appl Occup Environ Hyg 5 (1), 38-45. • Kumar 1990. Cumulative load as a risk factor for back pain. Spine 15, 1311-1316 • Laine ym. 2006. Työolot ja hyvinvointi sosiaali- ja terveysalalla 2005. Työterveyslaitos, Helsinki. • Vahtera ym. 2002. Työn hallinta ja työaikojen hallinta. In Vahtera ym. (Ed.) Työntekijöiden hyvinvointi kunnissa ja sairaaloissa: tutkittua tietoa ja haastetta. Työterveyslaitos, Helsinki. 29-35. • Videman ym. 1989. Patient handling skills, back injuries and back pain: an intervention study in nursing. Spine 41, 148-156. • Zhuang ym. 1999. Biomechanical evaluation of assistive devices for transferring residents. Applied Ergonomics 30, 285-294. Based on material produced in a project nominated and administrated by

18. Thank you for your interest – hope to meet you again! Skiing in Lapland, at Pallas 2007 You are warmly welcome to Oulu, Finland