4.4.2 Transferring Clients with Assistive Devices

We will cover in video each transfer (movement of client from one area/surface to another) scenario with the range of assistive devices that will help you complete your tasks.

In most situations involving transfers from one surface to another, the use of a transfer belt, also called a gait belt, is recommended.  The belt gives the client a feeling of security and allows the person assisting the client to have a steady guiding presence in the activity.  The belt should be snug but not tight, allowing the person assisting to fit two fingers under the belt on each side.

This video shows the placement of the belt. There are a variety of belts used. The kind depicted in the video is the standard type seen in most facilities.

Click here for a video transcript in .docx format: Video Transcript

Transfers to weight scales from bed

Weight scales (used to obtain the weights of clients as part of their care plan) come in two forms for bedridden clients. The first one we will discuss is a flat bed scale.  The scale is placed on a stretcher next to the client’s bed. The staff will stand one or two on each side depending on the size and weight of the client. A transfer sheet is placed under the client by completing a log-roll from side to side. The slippery material of the transfer sheet allows the staff on each side to slowly pull the client onto the flat weight scale without injury to either staff or client. The weight is then determined and the process is reversed for the return to the client’s bed. The transfer sheet is removed by log-rolling again to remove the sheet. The client is positioned for comfort, and the call light is left in reach of the client while they rest from the transfer.

This video details the transfer to the flat bed scale. What safety measures do they show during this process?

Click here for a video transcript in .docx format: Video Transcript

The other kind of weight scale for bedridden clients is the sling scale lift. The attachment to the lift to use it as a scale is at the top of the sling arm.  The process of use is the same for the operation of using a lift, discussed in the following section.

Manual lift / hydraulic lift and battery-operated lifts

The manual lift, or hydraulic lift, is used to lift clients from one surface to another. They have been used in facilities for more than 50 years, and have been a key part of the care delivery in hospitals, long-term care facilities and palliative care centers. The addition of battery-operated or electric mechanical lifts created a less physically demanding option with better control for client and staff operation.

The lift is made of heavy steel with an extendable base, which is manually widened to open around chairs and bed frames. The arm that holds the fabric sling, which cradles the client, extends both down and up, allowing the lift to be used for stretcher clients as well as clients who need to be lifted from the floor. Manual lifts use hydraulic power and a hand pump to go up, and a release valve to allow the sling to lower the client. The battery-operated mechanical models have a safety release button to stop the action of the machine for safety.   All lifts recommend two active participants in the transfer to maintain safety. Your facility will train you for the specifics using the brand of lift they have available and their lift policies.

When lifting, these are the typical guidelines:

1. Before you begin, always set up an area nearby to receive your patient. Plan for the closest transfer, avoiding long rides in the sling for safety considerations.
2. To place the sling under the client, you will need to log roll the client back and forth. All slings need to be centered behind the client at the level directed by the manufacturer (some have neck pads; others start below the neck). Each sling is designed for specific needs, and the pattern/cut of the sling will be different, you will need to learn the proper placement of the individual sling straps based on the use (some go between the clients leg and are crossed).
3. When lowering the sling bar to the client in order to secure the sling straps, be mindful of keeping the bar from resting close to the face or getting too close to the chest. The lift is a heavy piece of equipment and will injure the client if it impacts the head or chest.
4. Once the sling is in place, you will use the proper colour or level of strap to secure over the hooks at each end of the sling bar. The straps must be checked completely twice prior to lifting the client.
5. When lifting the client, keep them a few inches above the surface only. To clear the lift, transfer to the closest surface you have set to receive the client.
6. Lower the client completely, and remove the straps. Then, remove the sling/belt unless it is to stay under/around the client in the chair per the care plan for the return transfer.

Be aware of the following considerations for all lifts:

• Clients often feel insecure, so a calm, gentle, reassuring voice and demeanor is needed when transferring.
• There is potential for severe injury to a client if the lift is not operated correctly, or the sling is not secured properly for that client. Check the straps twice before rising.
• The client may bumping against nearby objects if the sling is not steady.
• Sling transfers need to be completed with concentration and without distractions due to the risks of injury to both staff and clients. Two-person transfers are the best option.
• There are several different slings for different tasks, including bathing and toileting. There are several sizes and several levels on each sling strap, which are to be noted on the care plan so they are consistently used for safety.
• Keep the chair/bed that you are transferring to or from near the point you are going to be to reduce the chance of issues and injuries.
• Always be aware of the lift sling/belt bar’s proximity to the client’s face and chest to prevent injury.

Use the links provided below to review a number of videos that will demonstrate the different lifts currently used for client care in long-term care facilities.  These videos will familiarize you with the looks and uses of the lifts. These videos do not replace personal instruction on the lifts you may be experiencing and individual training for these lifts.

• How to use a Hoyer Lift. This video shows a manual lift, and the process to position the sling in the chair and complete a lift using one person. Review your facility’s policy for lifts prior to using a one-person lift even if trained to do so by staff.
• Hydraulic Full Body Lifts: Full Video. This video shows the battery-operated lift with the preferred two-person method transferring into a chair. It also shows different slings and information about the lift.
• Hill-Rom | Liko® Lifts & Slings | Lifting from Floor-to-Bed / Floor Rescue. This video shows a floor-to-bed client lift to show the versatility of these lifts.
• Molift Air – How to lift from a bed to a toilet chair with ceiling hoist. This video shows an overhead track lift used to transfer from one surface to another surface. These track lifts may be installed throughout the living space of one or several rooms to allow seamless movement for the clients in their homes.

Sit-to-Stand Lifts

Sit-to-stand lifts assist clients who are able to weight bear on at least one leg. They help clients transfer easily without needing to attempt to pivot.  As noted in Chapter 4.2, these lifts have a standing pad for the feet, knee pads to secure the knees during transfer, a handle for the client to hold on to for the transfer, and they usually have a belt to wrap around the client under the arms to secure the client during the transfer as a safety measure.

Follow these steps:

1. Before you start the transfer, tell the client what will be happening.
2. Have the client sitting at the edge of the bed or seat.
3. Position the belt around them securely, but not tightly. Different models have different belts; become familiar with your model prior to using the belt on a client.
4. Position the sit-to-stand model in front of the client, placing their feet on the standing pad, and their knees secured in the knee pads. Then, attach the belt to the machine, and the client will place their hands on the grip holds.
5. Raise the machine to hold the client in a standing position.
6. Position the client over the destination seat area and lower.
7. Once the client is seated comfortably, they let go of the grip, you will remove the belt , and the machine is pulled away from the client.

Here are two videos which show different types of sit-to-stand models being used to transfer a client:

1. 1. Hill-Rom | Liko® Lifts & Slings | Sit-to-Stand
   2. Battery Powered Stand-Up Lifts: Transfer from Wheelchair to Recliner

Each of these lifts can be used to transfer onto a toilet with the proper sling.

Transfer to toilet using a slide sheet

The slide sheet is a long sheet of material that produces minimal friction to items sliding over the surface. Because of the low-friction material, it is ideal for helping to slide clients from one surface to another with less strain on the caregiver, and it can be used for most transfers from surface to surface. Watch this video to view how the sheet is used in a toilet transfer.

Click here for a video transcript in .docx format: Video Transcript

Transfer Boards

Another device used is a transfer board, also called a slider board.  The transfer board is a smooth, shaped board that is used to allow for a transfer via sliding from one surface to another.  It is polished or finished to reduce the friction, and some models are shaped with curves to allow for easier transfers around corners or in difficult positions.   Many clients can use the transfer board themselves, but it is helpful to have someone assist with placement.  You will need to be trained on using the transfer board for each client.

The transfer board is placed between the two surfaces: the surface they are sitting on, and the surface they are transferring onto. The end of the board next to the client is wedged under their hip and thigh, making sure the other end has four inches resting on the surface they are transferring onto. Transferring from a higher seating area to a lower seated area works best. If doing so in reverse, make short slides to the goal. It is considered best practice to transfer the client fully clothed so their skin will not be compromised during the transfer by pulling or shearing the surface of their skin. The most challenging slide is onto the commode or toilet, as the client will need to remove their pants and undergarments while sitting on the toilet and replace them prior to moving, in order to reduce shearing of the skin.

The client may transfer themselves by placing one hand on the surface they are transferring onto and one hand on the surface they are transferring from, sliding themselves over until completely sitting on the surface, and then removing the board. They are not to curl their fingers under the board, in order to reduce injury. You can assist the client by helping them slide over slowly.

These videos demonstrate the slide/transfer board in use.

• • Slide board transfer to bed
  • Slide board transfer to toilet
  • Long slide board-to-car transfer
  • One- and two-person transfer with leg amputee, using slide board
  • Beasy board transfer (this is an easier transfer if the client is not able to assist)
  • Slide board transfer into a small sedan