Concordia Home Care and Nursing Services LLC Concordia Health Mobile Lab
Lifting and Transferring Patients
A participant in this lesson will be able to:
• Demonstrate safe lifting and transferring techniques
• Practice skills that will prevent injuries
• Use devices to make tasks safer
Caring for people who are not very mobile tends to involve a great deal of lifting. You may need to assist them from the bed to the chair or the wheelchair and back to bed, and at times, you may need to help a person who has fallen onto the floor.
Improper lifting could injure your back and jeopardize your future ability to work. Do you know the correct techniques for lifting and transferring that might keep you from injuring yourself or the person you are assisting?
Practice preventive care, which includes:
• Good posture
• Stretching and exercise
• Lifting and transferring skills
• Proper lifting devices
Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of workers. It is the science of fitting the job to the worker.
When the physical requirements of the job and the physical capacity of the worker do not match, then work-related injuries can result. Stress on the musculoskeletal system causes the majority of job injuries. Some of these muscular injuries have been linked to work habits that result in temporary or permanent disability.
Using ergonomic methods can mean:
• Using equipment that will take the strain out of lifting and transferring
• Organizing work in new ways, such as storing items that are used daily on easy-to-reach shelves rather than near the floor or above the shoulders
• Changing how tasks are done
Ergonomics can prevent injuries by helping us understand which tasks and body movements can hurt us and by finding new ways to do these tasks. Keeping your back strong, stretched, and healthy is good. Good posture and mobility, proper lifting skills, and exercises are very important, but they are not enough to prevent injuries. Too much lifting and lifting in awkward ways can lead to injuries. Teamwork is important so you do not lift and transfer by yourself
Posture and Work-Related Injuries
Good posture means more than just sitting up straight, particularly when speaking of protecting workers from work-related musculoskeletal disorders. How does good posture affect the musculoskeletal system? Good posture ensures that muscles will receive a good blood supply, thereby allowing the muscles to eliminate waste, receive nourishment, and repair damage caused by stress. Good posture helps the body work more effectively and efficiently.
Since the body is designed to be in motion, standing or sitting in the same position for an extended period puts strain on the musculoskeletal system as tendons are pulled and joints are compressed. This leads to a reduction of the blood supply to these areas, causing inflammation and pain.
Bad postures increase the risk of injury, so do not:
• Push the head forward beyond the plane of the shoulders
• Stand in an awkward position that unevenly distributes your weight
• Hold the head in an awkward or twisted position
Good postures decrease the risk of injury, so:
• Sit or stand tall
• Keep the ears over the shoulders
• Keep the shoulders over the hips
• Hold the head straight, not tilted
• Position the head over the neck
• Keep your abdomen and buttocks tucked in
The proper way to sit includes the following:
• Always sit all the way back on a chair.
• Your lower back can be supported with a pillow.
• Try to keep your knees at the same height as your hips. If necessary, elevate your knees by putting your feet on the rungs of a chair or stool, or support your feet on a phone book.
• You may need to raise the height of the seat in order to keep your knees at the same height as your hips. If possible, adjust the height of the chair, or sit on a phone book if necessary.
The proper way to stand includes the following:
• Spread your feet at shoulder width and put equal weight on each foot.
• Put one foot up on something stable, such as the rung of a chair or stool.
The proper way to sleep includes the following:
• Never sleep on your stomach
• Sleep on your side with the knees slightly bent and one pillow between the knees
• When sleeping on your side, pull your pillow down toward the shoulder to support the neck
• When sleeping on your back, place two pillows under the knees to reduce stress to the middle and lower back and the neck
• When on your back, support the neck with a pillow under the back of the head and neck
Poor posture can create problems by destroying the balance of the spine’s natural curves. The strain on muscles adds stress to the spine that may harm the discs. Poor body mechanics upset the balance of the natural curves of the spine. Good body mechanics keep your spine balanced during movement.
Exercise relieves stress through activity. Stretching and strengthening exercises combine to balance the strength and tone of the muscles and ligaments. The muscles and ligaments are the supporting structure of the spine, so fitness benefits spinal health.
Lifting and Transferring Techniques
Serious back, shoulder, and neck injuries occur as a result of poor lifting and transferring habits. The following are some tips to reduce the strain on your back and the possibility of injuries. Protecting your back is working smarter, not harder.
General tips for lifting and transferring include the following:
• When lifting and transferring, the most important consideration is safety for yourself and the patient.
• Ask for help and use teamwork. Talk to your helpers about what you plan to do, and talk to each other about what you are doing as you do it.
• When needed, use the right equipment.
• Plan the job. Move anything that is in the path.
• Maintain the correct posture: Keep your back straight and knees bent. If you must bend from the waist, tighten your stomach muscles while bending and lifting. Bending your knees slightly will put stress on your legs, not your back.
• Never twist when lifting, transferring or reaching. Pick up your feet and pivot your whole body in the direction of the move. Move your torso as one unit. Twisting is one of the leading causes of injuries.
• Maintain a wide base of support. Keep your feet at least shoulder width apart or wider when lifting or moving.
• Hold the person or object close to you, not at arm’s length. Holding things close to your body can minimize the effects of weight.
• Pushing is easier than pulling because your own weight adds to the force.
• Use repeated small movements of large objects or people. For example, move a person in sections, by moving the upper trunk first and then the legs. Repeated small movements are easier than lifting things or people as a whole all at once.
• Always face the patient or object you are lifting or moving.
• Always tell a patient what you are planning to do, and find out how he or she prefers to be moved.
Take the following steps when transferring from the bed to a wheelchair or bedside chair:
• Plan the job and prepare to lift.
• Place the chair at a slight angle to the side of the bed.
• If using a wheelchair, lock both brakes. Fold up the foot pedals and remove the footrests.
• Stabilize the bed so it will not move.
• Put footwear on the patient.
• Lower the bed so the patient’s feet will reach the floor.
• Move the person to the edge of the bed. First, move the upper trunk and then the legs one at a time.
• Place the person’s legs over the side of the bed.
• Place your arms around the person, circling the back in a sort of hug.
• Raise the person to a sitting position on the side of the bed.
• Place a gait belt around the patient’s waist if you so desire (recommended).
• Gradually slide or “walk” the person’s buttocks forward until his or her feet are flat on the floor. “Walk” the buttocks by grasping both legs together under the knees and swinging them gently back and forth as the buttocks move forward.
• Place your feet on both sides of the person’s feet for support. Your feet should be far enough apart to give you a good base of support.
• Have the person lean forward and if possible place his or her arms around your shoulders. Do not allow the person’s arms to encircle your neck, as this can injure your neck.
• Allow the person to reach for the far wheelchair arm.
• Bend your hips and knees while keeping your back straight.
• Place your arms around the person’s waist. If using a gait belt, grasp the belt at the sides of the back with both hands. Do not hold the person under the arms—this can cause injury to the patient.
• Keep the person’s knees stabilized by holding your knees against the person’s.
• Pull up to lift the patient, straightening your knees and hips as you both stand.
• Keep the patient close to your body. Keep your knees and hips slightly bent.
• When the person is high enough to clear the armrest or chair surface, turn by taking small steps. Keep the person’s knees blocked with your own knees.
• When turned, bend your hips and knees to squat, lowering the patient to the seat.
• Replace the footrests. Adjust the height of the foot pedals so the person will be sitting with a 90-degree angle at the hips and knees.
• When transporting a person in a wheelchair, pull it back up steps or curbs.
• Follow the same principles to return the person to bed.
If a patient begins to fall, keep the following in mind:
• Once a patient has started to fall, it is almost impossible to stop the fall
• Instead of trying to stop the fall, try to guide the patient to the floor
• Once the patient is on the floor, get help to lift him or her
Take the following steps when lifting from the floor:
• You might find that someone has slipped to the floor but is not seriously injured. He or she may be able to assist you in getting up.
• Always get a coworker to help you get a patient up if the patient cannot assist you. The assistance of four to six people may be required. When appropriate, use a mechanical lift or hoist to raise a patient.
• Roll the patient onto a blanket or lift sheet.
• Have two or more people stand on each side. Each person should kneel on one knee and get a secure hold on the blanket. On the count of three, everyone should lift the patient and stand up, moving the patient onto a bed or stretcher.
Take the following steps when transferring in and out of a car:
• Put the front seat of the car as far back as possible.
• Position the wheelchair at a 90-degree angle to the car seat.
• Bend your knees and hips in a squat.
• Place your arms underneath the person’s armpits and around the upper part of his or her back. The person may place his or her arms around your shoulders but not your neck. Grasp the person’s upper back and do not pull under the person’s arms. Hold him or her close to you.
• Straighten your legs and hips slightly as you smoothly lift the person’s torso into the car, placing his or her buttocks on the seat. Move your feet to turn; do not twist.
• Be sure the person’s buttocks are as far back toward the driver’s side as possible before lifting his or her legs into the car. When lifting his legs, keep your back straight.
Take the following steps when pulling a patient up in bed:
• Always get help when pulling a patient up.
• Place a draw or lift sheet under the patient.
• Remove the patient’s pillow from under his or her head and place it against the head of the bed to provide a cushion between the patient’s head and the headboard.
• Place the bed at a comfortable height for you and your coworker.
• Both you and the coworker should bend your knees and push with your feet.
• Grasp the draw or lift sheet firmly, holding the sheet close to the patient’s body.
• Lean in the direction you want to move the patient.
• Instruct the patient to lower the chin to the chest if possible. If the patient cannot hold his or her head up, be sure the lift sheet is supporting the person’s neck and head.
• Ask the patient to bend his or her knees to assist by pushing backward.
• On the count of three, lift the draw sheet and pull the patient up.
Take the following steps when pulling a patient up in a chair:
• Have the patient fold his or her arms across his chest. Lock the wheelchair brakes.
• Stand behind the patient, bend your knees, and wrap your arms around him or her, hugging the person’s torso securely by folding your arms just under the person’s in front.
• Straighten your legs, lifting the patient’s torso up and back in the chair.
Take the following steps when turning a patient from side to side:
• Stand at one side of the bed, with the bed raised to waist height.
• Place your arms under the patient’s shoulders and hips, or grasp the lift sheet.
• Pull the patient to the edge of the bed, trunk first, and then legs.
• Cross the patient’s leg closest to you over the other leg.
• Place your hands on the patient’s shoulder and hip closest to you.
• Lean in toward the patient and push the patient’s torso away from you.
• Place the top leg in front of the bottom leg.
• Support the patient’s shoulders, back, and hips with pillows. Place a pillow between the patient’s legs to support the top leg. Adjust for comfort.
Devices that can help you work smarter, not harder, include the following:
• Draw sheets make it easier to pull people up in bed or move them to the side. To place a draw sheet under a patient, turn the patient on his or her side and lay the draw sheet on the bed. Roll half of the draw sheet up against the patient. Turn the patient to his or her other side, rolling him or her over the rolled-up draw sheet, and pull the rolled draw sheet out and straighten it on the bed. The lift sheet should extend from above the shoulders to below the hips and should support the neck and head if the patient cannot do so.
• Bed controls raise or lower the bed to a comfortable and safe position for you, your coworker, and the patient.
• Slide boards help to reduce friction so the patient can slide from the bed to another surface.
• A trapeze over the bed can allow patients to help you move them. They can grasp the trapeze, pull themselves up, and assist as you move them.
• A gait belt is made from heavy canvas with a sturdy buckle. Place the belt around the patient’s waist and use it to assist you in moving him or her.
• Mechanical lifters/hoists can lift a patient who is heavy or one who has fallen. Ask your supervisor for instructions before using these devices.
• Work in teams
• Call for support to prevent unsafe transfers
• Use lifting equipment
• Exercise to maintain a strong, healthy back
• Use proper posture and body mechanics
Most companies have an ergonomic plan to prevent back sprain and strain injuries from happening. These plans should include:
• Regular inspections to discover hazards that might lead to strain and sprain injuries
• Training for everyone on how to prevent injuries
• Safe staffing levels so workers don’t get hurt lifting heavy patients alone
• Useful and safe lifting devices
Your body has natural limits. Some tasks can lead to injuries when you go beyond these limits. Jobs should
be designed to fit the worker. This is ergonomics. This is working smarter, not harder.