Transfers - Practical

Question 1

Independent Transfer

Answer 1

The patient can perform a transfer without any type of verbal or manual assistance.

Question 2

Supervised Transfer

Answer 2

The patient requires verbal or tactile cues, or instructions from another person positioned close to, but not touching, in safe manner.

Question 3

Assisted Transfer

Answer 3

The patient requires assistance from another person to perform the activity safely in an acceptable time frame; physical assistance, with oral or tactile cues, directions, or instructions.

Question 4

Minimal Assistance

Answer 4

The patient performs 75% or more of the activity; 1 person needed for transfer.

Question 5

Moderate Assistance

Answer 5

The patient performs 50% to 74% of the activity; 2 people needed for transfer.

Question 6

Maximal Assistance

Answer 6

The patient performs 25% to 49% of the activity; with assistive device and at least 2 people.

Question 7

Dependent Transfer

Answer 7

The patient requires total physical assistance from 1 or more persons to accomplish the task safely; special equipment or devices is used.

Question 8

How are the limbs aligned and what support should be provided in supine position?

Answer 8

Pillow under head and shoulders.
Support of upper limbs - particularly in hemiplegic patients.
Induce slight knee flexion.
Make sure to keep heels off the bed.

Question 9

How are the limbs aligned and what support should be provided to patients in side lying?

Answer 9

Pillow behind patients back to prevent rolling back.
Bottom shoulder slightly forward.
Palm of bottom arm facing up next to the head pillow.
Knees flexed and aligned with a pillow between them.
Top foot resting on a pillow.

Question 10

How are the limbs aligned and what support should be provided in a seated position?

Answer 10

The back is supported so that hips are at a 90° angle.
The knees at a 90° angle and slightly separated to provide
relaxation and promote further alignment.
The arms are flexed and supported by the arms on the chair.
Feet flat and a 90°/90°/90° position

Question 11

How are the limbs aligned and what support should be provided in the Fowler’s position?

Answer 11

Patient sits upright at an angle between 30° and 90°.
The legs of the patient are either bent or straight.
The arms are flexed and supported by the bed or the rails.

Question 12

Positioning of Patient Post Lumbar Spine Surgery

Answer 12

Sitting avoided the first few weeks.
Advised to be in supine or side-lying.
Logrolling instead of segmental rolling to get in and out of bed.

Question 13

Logrolling

Answer 13

maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected or documented spinal injury. Roll entire body simultaneously.

Question 14

Safety Considerations

Answer 14

1. Hand hygiene
2. Check the environment (room) for additional precautions.
3. Listen and engage with your patient’s cues.
4. Respect patient’s privacy and dignity.
5. Assess observations (BP , Oxygen, temperature readings in the medical chart of patient)
6. Explain what you are going to do.
7. Make sure bed breaks are on.
8. Check if any equipment is needed (e.g sliding sheet,
   assistance of another person).
9. Ensure that call bell is within reach at the end of your treatment.

Question 15

What should be considered before rolling the patient?

Answer 15

Confused, agitated or uncooperative
Attached to medical equipment
Having frail shoulder, hip or knee joints
Having had recent hip surgery (if so, immobilize the hip
joint with strategically placed pillows)
Roll patient towards you, hands on hip and shoulder.
Make sure patient is not too close to the edge.

Question 16

When and why are sliding sheets used?

Answer 16

• For moving a patient up in bed or turning into their side

* Reduce friction and less force is required to move the patients

Question 17

Risk Assessment

Answer 17

Must be done before mobilizing a patient.
To determine: 
- Level of assistance
- State of patient
- Type of transfer
- Equipment needed
- Safety of environment

Question 18

Post Transfer Assessment - Questions

Answer 18

Assess how well the transfer technique worked. Could the transfer have been done better?
Is the patient’s dependency status accurate? Are any changes or qualifications needed on the client profile?

Question 19

Most commonly used position? Used mainly for general examination or physical assessment.

Answer 19

Supine

Question 20

What position promotes lung expansion?

Answer 20

Fowlers.
Useful for patients who have cardiac, respiratory, or
neurological problems and is often optimal for patients who have nasogastric tube in place.

Question 21

Which position relieves pressure on the sacrum and heels?

Answer 21

Side lying.

Question 22

Which level of assistance requires 2 therapists to help him/her to move to the edge of the bed?

Answer 22

Moderate

Question 23

Which level of assistance is needed when patient can on his/her own position himself/herself in bed and mobilize out of the bed.

Answer 23

Independant

Question 24

Which level of assistance requires verbal instructions to move to side-lying position from supine position?

Answer 24

Supervised.

Question 25

Which level of assistance is needed when the patient needs 1 therapist in order to be mobilized in the bed?

Answer 25

Minimal assistance.

Question 26

Which level of assistance is needed when patient must be hoisted in order to be repositioned?

Answer 26

Dependent.

Question 27

How should a patient be mobilized after a orthopedic surgery?

Answer 27

Not by rolling!
Sitting up in bed and moving legs to the edge of bed either with therapist mobilizing the operated leg or with a sling on the operated bed. Follow all precautions!
Use walking frame to mobilize from seated to seated.

Question 28

Procedures Associated with Standing Transfers

Answer 28

1. Patient’s mental and physical capacities.
2. Position, secure and stabilize wheelchair/other equipment.
3. Clear instructions and expectations during each step.
4. Flat feet parallel to each other.
5. Patient initiates the movement with trunk momentum (inclination forwards - “nose over toes”).
6. Proper use of upper and lower limbs to rise to standing.
7. Establish balance by brief stance.
8. Patient contacts chair/bed with upper and lower limb/s before lowering down.
9. Position the patient for proper support, stability and safety, at the end remove the safety belt.

Question 29

General Guidelines for Safe Transfers with a Wheelchair

Answer 29

Explain to a patient all the procedures
Position the wheelchair parallel or at 45- to 60-degree angle
Lock the wheelchair with the caster wheels facing forward.
Place the patient’s feet on the floor.
Remove the footrests out of the way.
Remove the armrest nearest to the bed if the bed is lower than the armrest.
Proper footwear is essential.