Pauline White, 75 years old, lives in an extended care facility. She was moved to the facility after being hospitalized for malnutrition, dehydration, and pressure injuries that were the result of neglect by her caregivers at home. Ms. White has also developed severe hip and knee flexion contractures. The small extended care facility has not yet purchased any mechanical lifts, citing budgetary concerns. Ms. White needs to be transferred (level 4, total dependence) between bed and chair.
Why might these transfers be necessary?
How can they be accomplished without mechanical lifts and with minimal risk to the caregiver?
What about Ms. White’s condition will affect your decision-making?
Although mechanical lifts are most appropriate for carrying out point-to-point dependent or total-assist transfers, there are circumstances in which dependent transfers must be performed manually. In an emergency situation or in a home or facility that is not equipped with powered hoists or reduced-friction devices, for example, manual dependent transfers may be required. Manual dependent transfers can also be an important part of transfer training for a patient who is progressing toward greater independence. This chapter describes these manually performed lateral transfers in the seated position and using pivot techniques.
Manual lateral transfer techniques can be modified to accommodate various levels of patients’ strength, motor control, and weight-bearing (WB) abilities. They may be performed with or without transfer equipment and with varying degrees of physical and cognitive assistance from the clinician.
As with other mobility activities, the patient, the task, and the environment must be considered when selecting a transfer method. As a patient’s ability to transfer improves, the technique of choice will generally progress toward more independent methods and from more stable to more mobile methods.
No transfer is complete until the patient is secure and comfortable. The following tasks are all part of conducting a successful transfer:
Replacing wheelchair armrests and legrests and placing the patient’s feet on the footplates when the patient ends the transfer in a wheelchair
Raising upper bed rails, if needed, when the patient is in bed
Making sure the patient has access to important items such as water, phone, glasses, and so on
Providing the patient with a way to ask for help such as a call bell or cell phone
The risk of injury to the clinician during a manual transfer is greater than that generally encountered during mechanical lift transfers.1 The heavier the patient and the less the patient is able to assist, the greater the risk of injury, requiring clinicians to apply their specialized knowledge of body mechanics and patient behavior to each situation. In particular, the clinician must give special attention to establishing core stability, maintaining good posture, and using proper body mechanics during these transfers.