Lifting, Transferring And Positioning Patients Essay, Research Paper
Lifting, Transferring and PositioningABSTRACTLifting, transferring and positioning of patients is frequently undertakenby nurses on each working day. This is necessary for patient comfort,medical reasons and completion of self care needs. Lifting can be done innumerous ways. As well as the nurse physically lifting or moving patients,a number of devices are also available to assist in the transfer ofpatients. These range from straps that are attached to or placed under thepatients, to mechanical hoists and lifters. Any assistance the nurse has isbeneficial for both the patient and the health care worker, as patient’sweights are generally heavier than the nurses physical capabilities. This,combined with incorrect lifting techniques, can result in muscle strain, ormore seriously, spinal injury for the nurse, and discomfort, muscle strainor further injury for the patient. INTRODUCTIONWhen lifting, transferring or positioning patients, the most importantconsideration is safety. Any of these procedures need to be undertaken withit in mind. This safety is inclusive of both the patient and the healthcare worker. Communication is an important part of the lifting process asthe nurse should elicit information from the client to find out how and whenthey prefer to be moved. This allows the patient to be involved in thedecision making process and be fully aware of what is occurring. Bycommunicating with the client, the nurse is also aware of whether or not thepatient is experiencing any 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 patientbeing in one position continuously, they are prone to the development ofpressure areas. In terms of patient needs, being in the same positionconstantly is physically uncomfortable. However, mentally, a change in theimmediate surroundings is also beneficial for the patient. It is alsonecessary for the patient to be moved for completion of their self careneeds. This includes their hygiene needs, which include, bathing orshowering, elimination, hair, oral and nail care. {PAGE BREAK}METHODWhen lifting, transferring or positioning patients manually, safety is themost important factor. This safety is for the nurse themselves as well asfor the patient. One aspect of safety is for the nurse to utilise “goodbody mechanics” (Kozier et al 1995, p.879). This refers to the nurse havingbalance, which can be achieved with the feet being spread approximatelyshoulder width apart, which gives stability and a “wide base of support”(Kozier et al 1995, p.888). According to Kozier et al, (1995 p.879) balanceis also achieved by correct body alignment and good posture. The use ofcorrect body alignment reduces the strain on muscles and joints, and makeslifting 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 particularway they would prefer to be moved. This allows the patient to have someopinion about what is being done to them. The next thing that should be done when moving a patient is a routineassessment. The nurse may assess the situation by firstly observing thepatient and reading the nursing care plan. The nurse needs to be aware ofthe patients capabilities to see how much they can do or if they can assistin any way. Another important part of assessment is observing thesurrounding environment, to be sure there is no obstructions or otherhazards which may be injurious to the nurse or patient before, during orafter the move. The next phase is that of planning the move. The nurse decides how thepatient will be moved from their current position to where they are going. This may involve the nurse getting assistance for the lift, either fromother health care workers or by mechanical devices, such as a lifter orhoist. When moving or lifting the client, wherever possible the nurseshould have assistance. This assistance is necessary for both nurse andclient safety. This is supported by Kozier (1995 p.910), who says, whereverpossible,”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 canbe used. When moving a client up in bed, the client should be encouraged tohelp if possible. The nurse can ask the patient to bend their knees, sothat when the nurse is ready, the patient can assist by pushing backwardswhen the nurse says. Two nurses stand on opposite sides of the bed facingeach other. With knees bent and legs shoulder width apart, the nurses lockforearms underneath the patient’s thighs and shoulders. The nurses, on thecount of three, at the same time as the patient is pushing backwards,transfer the weight to the legs that are in the same direction that thepatient is going to be moved. When moving a client from a lateral lying position to sitting at the side ofthe bed, the first thing that the nurse should do after assessment, is toget the patient in a side lying position. This is done by the nurse placingone hand on the client’s hips and one hand on the client’s shoulder. Thenurse then transfers their weight onto the back foot while at the same timerolling the client towards them. The next step is the nurse places one armunderneath the patient’s shoulders and one arm underneath the knees. Thenurse then turns on the balls of the feet while at the same time pulling theclient’s legs down on the floor. The next move is transferring a client from the bed to a chair. Once theclient is sitting on the edge of the bed, the nurse can easily move thepatient to a chair. This procedure therefore follows on from the procedureof sitting a client up in bed. This can be done by the use of a “transfer
belt” (Kozier 1995 p.924). Before commencing the lift, the nurse must havethe wheelchair ready and parallel to the bed. The nurse must make sure theclient’s feet are placed flat on the floor with one foot slightly in frontof the other. The nurse then places the belt around the client’s waist. The nurse stands facing the client with their arms around the client’swaist, holding onto the belt. The nurse asks the patient to assist bytransferring the weight onto the front foot on the count of three, while atthe same time, the nurse transfers their weight onto the back foot, liftingthe client up to a standing position. The nurse supports the client untilthey are balanced when standing. The nurse and client, when ready, pivot inthe direction of the chair. The client then holds the arms of the chair asa means of support and to assist when lowering into the chair. The nursethen lowers the client into the chair, bending at the knees. The transferbelt is then removed when the nurse has assessed that the client iscomfortable and secure in the chair. The nurse should also ensure theclient has suffered no ill-effects as a result of the move. When the transfer belt is not available, Kozier (1995 p.925), recommendsthat the nurse puts both hands at the sides of the patient’s chest andcontinue the procedure in the same way. When transferring the patient from the chair to the bed, the same procedureis implemented but in reverse. However, the transfer is started, the nurseshould ensure that the bed is clean and dry. The client is then moved fromthe chair to 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 effectivein reducing the risk of injury. This is supported by Seymour (1995 p.48)who says that,”more nurses are beginning to realise the equipment’s potential forprotecting both client and carer from injury.”When using these devices, the nurse should tell the patient what is beingdone and how it is being done. Mechanical lifters either have two slings,one sling for underneath the shoulders and one for underneath the thighs orbuttocks. Other lifters have an all in one sling which extends from theclient’s upper back to lower thighs. The lifters substantially reduce thestrain on the nurse and the patient and are able to be used for alltransfers. The nurse places the sling underneath the patient and attachesthe slings to the lifter with hooks, and the nurse then controls the lifterfor the desired action. When using a mechanical lifter, some problems which may arise include thelifter being broken or unavailable. The nurse should therefore be aware ofhow to correctly manually lift the client in the event of this occurring. Another problem with mechanical lifters, according to Scott, (1995 p.106)was that mechanical 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 waythat the lifters are used. The problem with lifting patients physically, is that nurses are oftenrequired to lift loads greater than they are physically able. This is dueto,”the likely mismatch between the size of a patient to be lifted and thephysical capabilities 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, aswell as long term back problems for the carer involved. One problem whichmay also arise from incorrect lifting techniques is the development ofpressure areas, due to the patient being dragged and not lifted across thesheets. This friction can lead to the patient developing reddened skinwhich may lead to skin breakdown. {PAGE BREAK}DISCUSSIONBy the health care worker implementing the correct lifting techniques, thenurse and the patient’s safety is not compromised in any way. Nurses shouldbe constantly aware of any new methods of lifting or transferring whicharise, so they are able to maximise the level of safety for themselves aswell as for the patients. By the nurse using the correct liftingtechniques, and not dragging the patient, the risk of the patient sustainingfurther injury, such as pressure areas, is reduced. By communicating withthe client, the nurse is also made aware of any problems the client has withany aspect of the lift. Regular maintenance of equipment is essential so that the equipment does notbreakdown frequently. Hooks, straps and slings need to be constantlychecked to ensure optimum working order, as well as ensuring client safety. Staff need to be educated on the use of the lifters and regular testingwould ensure that the staff are confident and competent in their use. Thismay lead to a decrease in the amount of mismatched clients and nurses interms of weight, as if staff are more confident of using the lifters theremay not be as much manual 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 makestaff aware that the least amount of strain placed on the muscles and jointsas possible is beneficial to them. The re-evaluation is also important in the fact that it allows the healthcare worker to be constantly up to date on any new procedures which may bedeveloped. {PAGE BREAK}REFERENCESKozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995, {italics on}Fundamentals of Nursing {italics off}, 5th Edition, Addison WesleyPublishing Company Inc., United States of America. Love, C. 1995, ‘Managing manual handling in clinical situations’, {italicson} 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’, {italicson} Nursing Times {italics off}, vol. 91, no. 27, pp. 48-50.