Fundamentals Of Nursing Moving the client in & out of bed Presented by: Miss: Nourah al-khaledi.
OBJECTIVES: Definition of transferring. Discuss the reasons of transferring . Mention Methods of transferring. Discuss the action applicable to moving and lifting client before moving a client Mention required equipment. Demonstrate the steps of each procedure .
Definition of transferring: Moving a patient from place( refer to moving a patient from bed to a chair or stretcher or wheelchair with maximum comfort and safety for patient and nurse.
Reasons for transferring: • Improvement of the patient condition (from ICU to medicine unit). • Worsen of patient condition (to ICU). • The need for surgery or x-ray . • Transfer at the patient request.
Reason for moving: • Change position . • Reposition the client. • Client slide down in bed from fowlers position. • Changing the bed linen.
Methods of transferring: • Wheelchair. • Stretcher. • Movable bed.
Action applicable to moving and lifting client before moving a client… 1-Assess: • The client physical abilities. • Ability to understand instructions. • Degree of comfort or discomfort when moving.
Continue • Client weight. • Presence of orthostatic hypotension. • You own strength and ability to move the client.
Continue. 2-if indicated ,use pain relief modalities or medication prior moving the client. 3-preper support equipment (pillow ). 4-obtain required assistance . 5-explain the procedure to the client and listen to any suggestions the client. 6-provide privacy . 7-wash hands.
Continue. 8- rise the height of the bed to bring the client close to your center of gravity . 9-lock the wheels on the bed and raise the rail on the side of the bed opposite you to ensure client safety. 10-face in the direction of the movement to prevent spinal twisting .
Moving client up in bed Equipment : • Pillows. • Side rails. • Draw sheet. Purposes: To promote the client’s comfort.
Moving client up in bed • Performance: • Explain to the client and listen for his questions. • Wash hands and provide privacy . • Lower head of the bed and raise the bed to your center of gravity . • lock the wheels and raise the side rail opposite to you.
Performance cont: • Remove the pillows and place one only against the head of the bed • Ask client to flex hips and knees and position feet so that they can be used for pushing . • Ask client to :- • Grasp the head of the bed with both hands and pull during move or • Raise upper part of body on elbows and push with hands and forearm during the move.
Two nurses using a hand interlock Two people required to move clients who are unable to assist because of their condition or weight. • The second staff member on the opposite side of bed, both of you interlock your forearm under clients thighs and shoulders and lift client up in bed.
ASSISTING CLIENT TO SIT ON SIDE OF BED • Purpose:before walking, moving to chair, eating or performing other activates. • Performance : • Assist client to lateral position facing you . • Raise head of bed slowly to highest position.
Two Nurses Using a Turn Sheet • Place a draw sheet or a full sheet folded in half under the client, extending from the shoulders to the thighs. • Each person rolls up or fanfolds the turn sheet close to the client’s body on either side. • Both individuals grasp the sheet close to the shoulders and buttocks of the client. • Follow the method of moving clients with limited upper extremity strength, as described earlier.
Assisting client to sit on side of bed Purpose: • The client assumes a sitting position on the edge of the bed before walking , moving to a chair , eating, or performing other activities.
Assisting client to sit on side of bed • Stand beside clients hips and face far corner of bed • Lean your trunk forward and flex your hips , knees and ankles • Move client to sitting position (place one arm around client shoulder and other beneath both clients thigh near knees • Lift client thighs slightly.
continue • Pivot on balls of your feet in desired direction facing foot of bed while pulling client feet and legs off bed ( prevent twisting of nurse supine). • Support client well ( this movement may cause some clients to faint ). • Assess vital signs as indicated by clients health status.
Logrolling client • Purpose: to turn client whose body most all times be kept in straight alignment . • Performance: • Stand on the same side of bed and broad base of support with on foot ahead of other. • Place clients arms across chest. • Lean your trunk and flex your hips knees and ankles.
Logrolling • Place your arm under client. • Pull client to the side of the bed . • Move to the other side and place supportive devices. • Roll and position clients in proper alignment.
TRANSFARING BETWEEN BED AND CHAIR • Equipment : appropriate clothes and slipper –transfer belt . • Preparation : • Plan of what to do and how to do it. • Obtain equipment and check for function well. • Remove obstacles from areas. • Performance: • Place wheelchair parallel to bed as close as possible and lock the wheels and raise the foot plate .
continue • Assist client to sitting position on side of bed . • Place transfer belt around the waist of clients. • Ask client to: • move forward and sit on the edge of bed. • lean forward slightly from hips. • Place strong foot beneath edge of bed and the other forward . • Place client hands on bed surface or on your shoulders( so they can push while standing ). • Mirror the placement of the clients feet (prevent loss of balance during transfer).
continue • Encircle clients waist with your arms and grasp the belt at client back.. • Assist the client to stand, and then move together toward the wheelchair. • Assist the client to sit.
continue Ask the client to: • Back up to the wheelchair and place the legs against the seat. • Place the foot of the stronger leg slightly behind the other. • Keep the other foot forward • Place both hands on the wheelchair arms or on your shoulders. • Ask the client to push back into the wheelchair seat. • Lower the footplates, and place the client’s feet on them.
TRANSFERRING BETWEEN BED AND STRETCHER • Performance: • Lower the head of the bed . • Raise the bed slightly higher than the stretcher (easier for client to move down ). • Pull draw sheet out from both sides of bed . • Place the stretcher parallel to bed and fill the gap with blankets. • Roll the sheet against client ,flex hips and pull onto stretcher. • Ask client to flex neck and place arms across chest. • Ensure clients comfort and raise the side rails of stretcher .
Documentation Document all relevant information:- • Time and change of position moved from and position moved to. • Any signs of pressure areas. • Use of support devices. • Ability of client to assist in moving and turning. • Response of client to moving and turning.
References • Fundamentals of nursing concepts ,process and practice,7th edition written by kozier 2005 • Nurses guide to clinical procedures 5th edition written by jean smith temple and Joyce young Johnson 2007 • http://www.rehabpub.com/features/892005/3.asp • http://www.independentliving.co.uk/manual-handling.html