Nursing: Lifting, Transferring and Positioning of Patients

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Nursing: Lifting, Transferring and Positioning of PatientsLab ReportStudent No. xxxxxxxxx}Group No. x}Marker’s Name: xxxxx xxxxxxxx}ABSTRACTLifting, transferring and positioning of patients is frequently undertaken bynurses on each working day. This is necessary for patient comfort, medicalreasons and completion of self care needs. Lifting can be done in numerous ways.

As well as the nurse physically lifting or moving patients, a number of devicesare also available to assist in the transfer of patients. These range fromstraps that are attached to or placed under the patients, to mechanical hoistsand lifters. Any assistance the nurse has is beneficial for both the patientand the health care worker, as patient’s weights are generally heavier than thenurses physical capabilities. This, combined with incorrect lifting techniques,can result in muscle strain, or more seriously, spinal injury for the nurse, anddiscomfort, muscle strain or further injury for the patient.

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INTRODUCTIONWhen lifting, transferring or positioning patients, the most importantconsideration is safety. Any of these procedures need to be undertaken with itin mind. This safety is inclusive of both the patient and the health careworker. Communication is an important part of the lifting process as the nurseshould elicit information from the client to find out how and when they preferto be moved. This allows the patient to be involved in the decision makingprocess and be fully aware of what is occurring. By communicating with theclient, the nurse is also aware of whether or not the patient is experiencingany discomfort during or after the lift.

The actions of lifting, transferring or positioning need to be completed fornumerous reasons, including relief of pressure points. Due to the patient beingin one position continuously, they are prone to the development of pressureareas. In terms of patient needs, being in the same position constantly isphysically uncomfortable. However, mentally, a change in the immediatesurroundings is also beneficial for the patient. It is also necessary for thepatient to be moved for completion of their self care needs. This includestheir hygiene needs, which include, bathing or showering, elimination, hair,oral and nail care.

METHODWhen lifting, transferring or positioning patients manually, safety is the mostimportant factor. This safety is for the nurse themselves as well as for thepatient. One aspect of safety is for the nurse to utilise “good body mechanics”(Kozier et al 1995, p.879). This refers to the nurse having balance, which canbe achieved with the feet being spread approximately shoulder width apart, whichgives stability and a “wide base of support” (Kozier et al 1995, p.888).

According to Kozier et al, (1995 p.879) balance is also achieved by correct bodyalignment and good posture. The use of correct body alignment reduces thestrain on muscles and joints, and makes lifting the clients much easier.

When lifting clients, the first thing the nurse should do is explain to thepatient what they are doing and ask the patient if there is any particular waythey would prefer to be moved. This allows the patient to have some opinionabout what is being done to them.

The next thing that should be done when moving a patient is a routine assessment.

The nurse may assess the situation by firstly observing the patient and readingthe nursing care plan. The nurse needs to be aware of the patients capabilitiesto see how much they can do or if they can assist in any way. Another importantpart of assessment is observing the surrounding environment, to be sure there isno obstructions or other hazards which may be injurious to the nurse or patientbefore, during or after the move.

The next phase is that of planning the move. The nurse decides how the patientwill be moved from their current position to where they are going. This mayinvolve the nurse getting assistance for the lift, either from other health careworkers or by mechanical devices, such as a lifter or hoist. When moving orlifting the client, wherever possible the nurse should have assistance. Thisassistance is necessary for both nurse and client safety. This is supported byKozier (1995 p.910), who says, wherever possible,”the preferred method is to have two or more nurses move or turn the client”.

When moving clients physically, there are different types of moves that can beused. When moving a client up in bed, the client should be encouraged to helpif possible. The nurse can ask the patient to bend their knees, so that whenthe nurse is ready, the patient can assist by pushing backwards when the nursesays. Two nurses stand on opposite sides of the bed facing each other. Withknees bent and legs shoulder width apart, the nurses lock forearms underneaththe patient’s thighs and shoulders. The nurses, on the count of three, at thesame time as the patient is pushing backwards, transfer the weight to the legsthat are in the same direction that the patient is going to be moved.

When moving a client from a lateral lying position to sitting at the side of thebed, the first thing that the nurse should do after assessment, is to get thepatient in a side lying position. This is done by the nurse placing one hand onthe client’s hips and one hand on the client’s shoulder. The nurse thentransfers their weight onto the back foot while at the same time rolling theclient towards them. The next step is the nurse places one arm underneath thepatient’s shoulders and one arm underneath the knees. The nurse then turns onthe balls of the feet while at the same time pulling the client’s legs down onthe floor.

The next move is transferring a client from the bed to a chair. Once the clientis sitting on the edge of the bed, the nurse can easily move the patient to achair. This procedure therefore follows on from the procedure of sitting aclient up in bed. This can be done by the use of a “transfer belt” (Kozier 1995p.924). Before commencing the lift, the nurse must have the wheelchair readyand parallel to the bed. The nurse must make sure the client’s feet are placedflat on the floor with one foot slightly in front of the other. The nurse thenplaces the belt around the client’s waist. The nurse stands facing the clientwith their arms around the client’s waist, holding onto the belt. The nurseasks the patient to assist by transferring the weight onto the front foot on thecount of three, while at the same time, the nurse transfers their weight ontothe back foot, lifting the client up to a standing position. The nurse supportsthe client until they are balanced when standing. The nurse and client, whenready, pivot in the direction of the chair. The client then holds the arms ofthe chair as a means of support and to assist when lowering into the chair. Thenurse then lowers the client into the chair, bending at the knees. The transferbelt is then removed when the nurse has assessed that the client is comfortableand secure in the chair. The nurse should also ensure the client has sufferedno ill-effects as a result of the move.

When the transfer belt is not available, Kozier (1995 p.925), recommends thatthe nurse puts both hands at the sides of the patient’s chest and continue theprocedure in the same way.

When transferring the patient from the chair to the bed, the same procedure isimplemented but in reverse. However, the transfer is started, the nurse shouldensure that the bed is clean and dry. The client is then moved from the chairto the bed and then assisted to a lying down position.

Manually lifting patients is effective, however, when able, the nurse shouldlift or transfer with a mechanical lifter. These are especially effective inreducing the risk of injury. This is supported by Seymour (1995 p.48) who saysthat,”more nurses are beginning to realise the equipment’s potential for protectingboth client and carer from injury.”When using these devices, the nurse should tell the patient what is being doneand how it is being done. Mechanical lifters either have two slings, one slingfor underneath the shoulders and one for underneath the thighs or buttocks.

Other lifters have an all in one sling which extends from the client’s upperback to lower thighs. The lifters substantially reduce the strain on the nurseand the patient and are able to be used for all transfers. The nurse places thesling underneath the patient and attaches the slings to the lifter with hooks,and the nurse then controls the lifter for the desired action.

When using a mechanical lifter, some problems which may arise include the lifterbeing broken or unavailable. The nurse should therefore be aware of how tocorrectly manually lift the client in the event of this occurring. Anotherproblem with mechanical lifters, according to Scott, (1995 p.106) was thatmechanical devices were,”often left because staff did not feel confident enough to use them.”This highlights the fact that all staff need to be taught the correct way thatthe lifters are used.

The problem with lifting patients physically, is that nurses are often requiredto lift loads greater than they are physically able. This is due to,”the likely mismatch between the size of a patient to be lifted and the physicalcapabilities of the nurses on duty.” (Love 1995, p.38).

This can lead to potential injury for nurse and client.

Another problem with lifting patients manually, is that the correct liftingprocedure may not be carried out. This can lead to patient discomfort, as wellas long term back problems for the carer involved. One problem which may alsoarise from incorrect lifting techniques is the development of pressure areas,due to the patient being dragged and not lifted across the sheets. Thisfriction can lead to the patient developing reddened skin which may lead to skinbreakdown.

DISCUSSIONBy the health care worker implementing the correct lifting techniques, the nurseand the patient’s safety is not compromised in any way. Nurses should beconstantly aware of any new methods of lifting or transferring which arise, sothey are able to maximise the level of safety for themselves as well as for thepatients. By the nurse using the correct lifting techniques, and not draggingthe patient, the risk of the patient sustaining further injury, such as pressureareas, is reduced. By communicating with the client, the nurse is also madeaware of any problems the client has with any aspect of the lift.

Regular maintenance of equipment is essential so that the equipment does notbreakdown frequently. Hooks, straps and slings need to be constantly checked toensure optimum working order, as well as ensuring client safety.

Staff need to be educated on the use of the lifters and regular testing wouldensure that the staff are confident and competent in their use. This may leadto a decrease in the amount of mismatched clients and nurses in terms of weight,as if staff are more confident of using the lifters there may not be as muchmanual lifting necessary.

Education about manual handling is also vital to ensure correct liftingtechniques are used. Constant re-evaluation of the staff’s abilities andmethods would ensure safety for both parties involved. This would make staffaware that the least amount of strain placed on the muscles and joints aspossible is beneficial to them.

The re-evaluation is also important in the fact that it allows the health careworker to be constantly up to date on any new procedures which may be developed.

REFERENCESKozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995, italics on} Fundamentalsof Nursing italics off}, 5th Edition, Addison Wesley Publishing Company Inc.,United States of America.

Love, C. 1995, ‘Managing manual handling in clinical situations’, italics on}Nursing Times italics off}, vol. 91, no. 26, pp. 38-39.

Scott, A. 1995, ‘Improving patient moving and handling skills’, italics on}Professional Nurse italics off}, vol. 11, no. 2, pp. 105-110.

Seymour, J. 1995, ‘Handling Aids – Lifting and moving patients’, italics on}Nursing Times italics off}, vol. 91, no. 27, pp. 48-50.

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