Pauline White lives in an extended care facility. She moved to the facility after being hospitalized for malnutrition, dehydration, and pressure injuries that were the result of neglect by her care partners 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 from the bed to a chair and requires total assistance.
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. In selecting methods for patients to practice, the clinician must also consider whether the goal is recovery of previous skills or compensation for those skills.
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, clinicians must give special attention to establishing their own core stability, maintaining good posture, and using proper body mechanics during these transfers.
Planning ahead is also essential for a safe and effective manual transfer. Because the transfer typically requires the clinician’s full and continuous involvement, the clinician will not be able to interrupt the process to take care of details such as removing a wheelchair armrest or unhooking a catheter bag from a bed rail.
General Procedure for Manual Dependent Transfers
In general, the procedure for manual dependent transfers is as follows: