Transfers, Ambulation, Positioning and Range of Motion

Safe Transfer Techniques and Equipment

A transfer involves assisting a resident to move from one surface to another, such as from a bed to a wheelchair. Safety begins before any movement starts. A nurse aide must lock the bed brakes before beginning any transfer. When transferring a resident into or out of a wheelchair, the nurse aide must lock the wheelchair brakes as well. In addition, the wheelchair footrests must be folded up or swung out of the way before the transfer takes place. Clearing the footrests prevents tripping and provides a clear, open space for the resident's feet to touch the floor securely.

Before standing, have the resident sit with their legs dangling at the edge of the bed so they can adjust to the position change. While the resident is dangling, watch them closely for dizziness. If a resident becomes dizzy or faint while dangling, the nurse aide must assist them back to a lying position and report it to the nurse. When the resident is ready to stand, position the wheelchair on the resident's stronger side. During the transfer, instruct the resident to lead with or step toward their stronger side, which allows them to use their existing strength to support the movement.

Use a transfer belt for a standing pivot transfer when the care plan directs its use and it can be applied safely; if it may be unsafe for the resident, report this to the nurse before transferring. A transfer belt must be applied over clothing and never directly on bare skin. Position the buckle slightly off-center over the resident's abdomen so it does not press directly against the spine or navel. When adjusting the belt, make sure it fits securely: a properly fitted transfer belt allows two flat fingers to slip comfortably between the belt and the resident's body. When performing a standing pivot transfer, the nurse aide should grasp the transfer belt with an underhand grip on both sides to guide the resident safely.

Some residents require mechanical lifts for transfers. Operating a mechanical lift typically requires at least two trained staff members. Before using a mechanical lift, the nurse aide must inspect the lift sling for tears, fraying, or broken stitching. If a mechanical lift appears damaged or malfunctions in any way, the nurse aide must not use it and must report it immediately to ensure everyone remains safe.