NHS Training for Physiotherapy Support Workers Workbook 15 Transfers
Contents Workbook 15 Transfers 1 15.1 Aim 3 15.2 Learning outcomes 3 15.3 Lying sitting transfer 4 15.4 Teaching a patient to move up and down the bed 7 15.5 Wheelchairs 8 15.6 Teaching patients to transfer safely in and out of a bed or chair 9 15.7 Teaching a patient to manoeuvre a wheelchair 11 15.8 Transfers workbook completion 12 15.9 Transfers reflection 13 NHS Education for Scotland 2012. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.
Workbook 15 Transfers 15.1 Aim The aim of this workbook is to provide the Healthcare Support Worker (HCSW) with the knowledge and skills required to help patients transfer. 15.2 Learning outcomes By the end of this workbook you will be able to: Describe, demonstrate and teach the normal sequencing of movement to assist or facilitate bed mobility with patients. Assist in teaching patients to transfer safely in and out of a wheelchair using appropriate aids and from different surfaces and be able to dismantle and reconstruct a wheelchair for transportation. Manoeuvre a chair and carry out prescribed practice of manoeuvres with a patient. Workbook 15 Page 3
15.3 Lying sitting transfer As therapists, one of the most important parts of our role is to promote physical independence. As a support worker, you may be involved in practicing everyday tasks with a patient to enable them to be independent again. A simple but important task is the ability to move around the bed and get in and out. There are aids to assist with this if required, but our concern here is to assist a patient to get up from lying by re-educating a normal sequence of movement. You would only do these activities with a patient who has been assessed as capable by the therapist. You must not attempt this with a patient who cannot participate. Activity With your supervising therapist, have a look at how you would sit up to sit from lying on your back. Watch a couple of colleagues do the movement. Describe what they do You may notice that the person turns their head to the side, then rolls over bringing the rest of their body with them, whilst pushing up onto the elbow, sitting up and swinging the legs over the side of the bed. There will be variations some will do it differently, but the components above are common. Workbook 15 Page 4
Activity Watch your supervising therapist teach a patient how to get out of bed to sit on the side in this way. Once you are ready, your supervisor will watch and correct as you teach a patient to get up from lying in this way. Describe the instructions you gave to the patient You may tell them to: turn their head and reach over the side of the bed to turn onto their side now to lift their head up and push onto their elbow now swing their legs over the side and come up to sit The patient may get stuck at any one of these stages; therefore you should know where to place your hands to assist. You may also need someone on the bed behind the patient when they get to sitting, to ensure that the patient does not fall backwards. You must ensure that: your own position is safe that you are working within your base of support your spine is in a line the bed is at the right height to ensure that you are not flexing too much You may wish to assist the patient by placing your hands at the shoulder girdle and pelvis to assist them to roll over. Workbook 15 Page 5
Activity Practice this with a model, try assisting them to roll over. You will notice that by placing your hands on their pelvis and shoulder, you can bring them on to their side more easily. You may need to assist to bring the legs over the side also. From your manual handling training, what handling aids might you use to assist a patient to come out of bed independently? A fabric turntable or a slide sheet under the patient s hips may assist them to sit round over the side. A slide sheet under the legs may assist the patient to bring them over the side of the bed. Evidence Provide an example of having practiced lying to sitting or sitting to lying with a patient in the gym or on the ward. Describe what you told the patient to do and what aids you used and why What went well, what went not so well, what would you do differently next time? Workbook 15 Page 6
15.4 Teaching a patient to move up and down the bed One difficult movement for patients can be moving up the bed in a seated position. You may be required to assist the patient to do this prior to carrying out some therapy. Again this can be done with one or two members of staff depending on the outcome of your risk assessment. Remember to speak to the patient and the nurse caring for the patient, and to observe the patient carefully before making a decision about how to move the patient. It is important for the rehabilitation of the patient to encourage him or her to be as independent as possible. If the patient can come to a sitting position independently, encourage him to do so. If not, you may have to use your body weight or a towel behind the patient s back, to assist the patient to come to sitting. To move the seated patient up or down the bed, it may be necessary to: instruct the patient in use of handling blocks assist with the patient placing his hands on the bed either side of his body, his knees bent and feet flat on the bed, hold the patient s feet to provide him with purchase as he moves himself up the bed by straightening his knees use a slide sheet under the patient s buttocks to assist the manoeuvre with the assistance of two staff. Evidence With your supervising therapist, conduct a risk assessment and assist a suitable patient to move up or down the bed. Assess the risk in moving individual patients in bed. Assist the patient to sitting with one. Assist the patient to sitting with two. Assist the patient to move up or down the bed independently. Assist the patient to move up or down the bed with one. Assist the patient to move up or down the bed with two. Use appropriate handling aids safely. Workbook 15 Page 7
15.5 Wheelchairs Backrest; folds down backwards and collapses inwards. Armrest; these are removed by releasing the catch. They can then be pulled up and out. Seat; is pulled upwards which folds the chair inwards for transportation. Foot-plates; these can fold upwards. Foot-plates; Release of this mechanism enables the foot-plates to swing outwards. Evidence Demonstrate to your supervising therapist that you can dismantle the chair for transportation. Workbook 15 Page 8
15.6 Teaching patients to transfer safely in and out of a bed or chair using appropriate aids Part of your job may be to help the patient to practice transferring from the bed to the chair or wheelchair, so that they can become strong enough to do it by themselves. Activity Assuming that the patient can get themselves up to sitting over the side of the bed, before starting to practice the transfers, what safety factors should you think about? Correct positioning of chair For a lateral transfer, bed to chair, the chair should be positioned as close to the bed as possible. Application of brakes You must ensure that any brakes are applied prior to moving the patient to or from any chair. Removal of sides of chair The patient may need to practice removing the side of the chair so he can do this himself. You should be familiar with the release mechanism, and know how to remove the side of the chair. Repositioning of footplate Similarly, any footplates should be moved out of the way to enable the patient to come into or out of the chair. Make sure you know how to do this. Application of sliding aid/transfer board You may require to assist the patient to use a sliding aid. The aid may be used to bridge the gap between the chair and bed. A transfer board or slide sheet may be required However the patient should as much as possible use his arms and legs to raise his buttocks to transfer to prevent shearing of the skin. Application and removal of safety belt The patient should use a safety belt when moving around in the wheelchair. Do not forget to remove before the transfer and reapply afterwards. Activity With your supervising therapist, practice performing chair to bed, and chair to chair transfers yourself. Also practise teaching a model the steps to go through to transfer from bed to chair or chair to chair. Workbook 15 Page 9
Evidence When you are ready, your supervising therapist will supervise you teaching a patient to transfer. Depending on where you work this may be a neurological patient or an amputee. Describe the transfers practiced on your unit. What difficulties do the patients have? What precautions must you take? Remember You must inform your supervising therapist if there is a change in the condition of the patient that requires reassessment. Workbook 15 Page 10
15.7 Teaching a patient to manoeuvre a wheelchair Patients need to practise using and manoeuvring with the wheelchair. You may be given the task of supervising their practice. Activity Find a wheelchair to practise with. Have a go at: moving the chair backwards and forwards going through doorways getting close to a bed as if you were about to transfer onto it going through an obstacle course Once you feel confident doing this, your supervising therapist will supervise you helping to teach a patient to perform these manoeuvres. Acknowledgements NHS Tayside Workbook 15 Page 11
15.8 Transfers workbook completion Your supervising physiotherapist will sign your portfolio to indicate that you have completed this workbook successfully. Objective Physiotherapist s signature Date Describe, demonstrate and teach the normal sequencing of movement to assist or facilitate patients from a lying and from a sitting position Assist a patient to move up and down the bed Dismantle and reconstruct a wheelchair for transportation Assist in teaching patients to transfer safely in and out of a wheelchair using appropriate aids Demonstrate your ability to teach patients to safely manoeuvre their wheelchair Identify change in the patient s condition that requires reassessment Support worker (name) Support worker s signature Physiotherapist (name) Physiotherapist s signature Date Workbook 15 Page 12
15.9 Transfers reflection Suggested KSF Dimensions: C2, C3, HWB2, HBW7 This form should be placed in the appropriate section of your portfolio. What did you learn from this module? How has this influenced your work? Date module completed Date module completed Workbook 15 Page 13
Greater Glasgow and Clyde Tayside