HELP!!! How to 'transfer' pts (physio)

[rice_boy]

Hi,

i'm a med student and have got OSCE exams in the next few days.

I need some urgent help on how to transfer a disabled person from bed to chair AND chair to standing. I know this is very much the realm of physiotherapy - but for some stupid reason, this may be an OSCE station.

I have searched the net far and wide and have yielded nothing.

please, enlighten me.

thanks.

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[Bertelman]

Tell them it's not on Step2 CS, so you shouldn't have to do it, either.

 

[delicatefade]

I can't believe that would be at one of your stations. It depends on what condition the patient has and how severe their disability. That's why you can't find anything on the web.

 

[DoctorFunk]

I need some urgent help on how to transfer a disabled person from bed to chair AND chair to standing. I know this is very much the realm of physiotherapy - but for some stupid reason, this may be an OSCE station.

"Nurse! Oh, nuuuuuuuurse!"

 

[JimmyG]

Be more specific. What type of disabled person? CVA? SCI? deconditioned elderly man? it depends. I'll be glad to help, but be specific...

 

[rice_boy]

well.. it is a ******ed station... but you see, i come from a ******ed australian medical curriculum.

Ok.. so how would you transfer:

1) An aged care patient (assuming no limb paresis, apart from the usual frailty and lack of balance) from bed-->chair AND chair--> standing ?

2) A pt with hemiparesis from stroke from wheelchair --> bed/chair ?

thanks for your input

 

[bivwack]

hmm....usualy i ask the pt to do it and assist where necessary. I have done this many times. w/ pt of varying disability, but im a 5'8" 225lbs and stronger than average, i dont have a problem transfering most of the pts weight for them if needs be.

i would be interested in knowing what "proper" technique would be.

 

[Cat48100]

well.. it is a ******ed station... but you see, i come from a ******ed australian medical curriculum.

Ok.. so how would you transfer:

1) An aged care patient (assuming no limb paresis, apart from the usual frailty and lack of balance) from bed-->chair AND chair--> standing ?

2) A pt with hemiparesis from stroke from wheelchair --> bed/chair ?

thanks for your input

I am not even in med school yet but I do currently work on a PM&R unit and help transfer patients such as these. What we do is we usually have a gait belt around the waist of the patient. It allows leverage on holding and supporting the patient. We take off the feet of the wheel chair first so that they don't get into the way. We have the patient get and sit at the edge of the bed, then we put the wheel chair which is right along the bed, next to the patient in that if the patient is facing North, the wheelchair is facing east. We try to get the patients to put their left arm on the left side of the wheel chair, in order to aid with the transfer. And while supporting the patient through either the gait belt or holding onto the patient in the arm pit, the patient is moved to the chair in one swoop.

In order to help a patient stand, simply use your gait belt (if you have one) or simply help them stand by putting your hands/arm under their arm pit and helping them stand.

Sometimes if you have a patient that is paralyzed and unable to move. You can put the wheel chair next to the bed and next to the patient as done in the previous example where the patient is facing north and the wheel chair is facing east. Take off the arm on the wheel chair which is next to the bed. The physical therapy department actually has a transfer board that they use as a "bridge" between the wheelchair and the bed. One side goes on the wheelchair and one side is on the bed. With that, the patient is able to slide themselves into the wheelchair.

Remember, that these patient transfers are done from the perspective of rehabilitation of the patient. The point of these transfers is to teach the patient how to transfer themselves into a wheelchair for when they go home. Other units such as med/surg, etc, might do transfers differently. These transfers are usually at the guidance of physical therapy as well so if you have questions on transfers, some of the best people to talk to are physical therapists. It always helps to utilize and be colleagues with all staff at a hospital or in a nursing unit because you never know when you are going to need them. Good luck! And I hope this helped.

 

[Antiviral22]

I am not even in med school yet but I do currently work on a PM&R unit and help transfer patients such as these. What we do is we usually have a gait belt around the waist of the patient. It allows leverage on holding and supporting the patient. We take off the feet of the wheel chair first so that they don't get into the way. We have the patient get and sit at the edge of the bed, then we put the wheel chair which is right along the bed, next to the patient in that if the patient is facing North, the wheelchair is facing east. We try to get the patients to put their left arm on the left side of the wheel chair, in order to aid with the transfer. And while supporting the patient through either the gait belt or holding onto the patient in the arm pit, the patient is moved to the chair in one swoop.

In order to help a patient stand, simply use your gait belt (if you have one) or simply help them stand by putting your hands/arm under their arm pit and helping them stand.

Sometimes if you have a patient that is paralyzed and unable to move. You can put the wheel chair next to the bed and next to the patient as done in the previous example where the patient is facing north and the wheel chair is facing east. Take off the arm on the wheel chair which is next to the bed. The physical therapy department actually has a transfer board that they use as a "bridge" between the wheelchair and the bed. One side goes on the wheelchair and one side is on the bed. With that, the patient is able to slide themselves into the wheelchair.

Remember, that these patient transfers are done from the perspective of rehabilitation of the patient. The point of these transfers is to teach the patient how to transfer themselves into a wheelchair for when they go home. Other units such as med/surg, etc, might do transfers differently. These transfers are usually at the guidance of physical therapy as well so if you have questions on transfers, some of the best people to talk to are physical therapists. It always helps to utilize and be colleagues with all staff at a hospital or in a nursing unit because you never know when you are going to need them. Good luck! And I hope this helped.

Hi Everyone ... I happen to be a physical therapist turned medical student with several years of ICU and acute care work experience. What Cat has mentioned above is all very good advice, but please keep in mind that the transfer strategy for each patient will be different based on a thorough physical exam of neuro and muscular function AND cognition. It is inadequate and unsafe, for example, to say that every patient with L side hemiparesis should perform a slide board transfer into a wheelchair. A word about gait belts: gait belts are exactly what the name implies - for gait. A gait belt is insufficient for most moderate and maximal assistance transfers mainly because they always slide up the wait to the axilla AND because a patients true center of gravity is much lower (more around the pelvis etc). Consequently, in addition to using a gait belt, I often end up getting very close to patients with one hand on their buttocks to pull their hips forward and the other hand on the gait belt (sometimes both hands on the buttocks). There are all kinds of tricks like blocking the knees, pivoting, using slide boards, T-transfers, and sling-method the therapists have developed to help us safely and functionally transfer patients. Also remember that even something as simple as a walker can make the difference between a maximal assistance transfer and a minimal one. One last word ... particularly for acute care settings, make sure you know where all the lines (e.g. IV's, catheters, ventilator tubing, rectal bags, arterial lines, chest tubes etc) are coming and going. It is important to arrange the chair/WC and lines in such a way that during the transfer nothing gets caught or dislodged.

This is a situation where physical therapists can be excellent consultants to nurses AND doctors. We are function and transfer experts, much like a nephrologist is the go to guy/gal for complicated renal issues. Mobility and transfers are things never addressed properly in medical school (this is okay because doctors have other priorties to deal with, like running codes). I once walked in on an intern trying to help this little old lady s/p knee replacement to the bathroom and let me say she was seconds away from going back into the OR.

Feel free to private message me if you would like specific advice about a particular scenario ... I'll be happy to do what I can. Good luck.