Safe Patient Transfers & Mobility

Moving a person is one of the most physically risky parts of care work. Nursing assistants and aides have high rates of back and shoulder injury, and a bad transfer can break a patient's hip or wrist. Good technique matters, but it has limits. Research behind safe patient handling sets a benchmark, not an official limit, of about 35 pounds lifted by hand, even in ideal conditions, so equipment and a second person are part of the skill, not a sign of weakness.

What You Will Be Able to Do

• Check the care plan and the person's ability before any move.
• Apply a gait belt and do a stand-pivot transfer.
• Use a slide board and a mechanical lift safely.
• Help a person walk with a cane or walker, and lower them safely if they fall.
• Reposition someone in bed and manage tubes and lines during a move.

Your Body During a Transfer

Use your legs, keep your back straight and keep the person close to you. Stand with feet apart, one slightly ahead of the other. Tighten your stomach muscles before you move.

Never twist your torso while you are lifting. Twisting under a load is a leading cause of disc herniation in the lower back. Move your feet to turn. Get help or use equipment if the person is too heavy, too dependent or unpredictable.

Plan Before You Move

Every transfer starts with a check of the person's current mobility and the plan.

• Weight-bearing status. Full weight-bearing (FWB) means the person can put 100 percent of their weight on the leg. Partial (PWB) means some. Toe-touch (TTWB) means only the toes for balance. Non-weight-bearing (NWB) means no weight at all on that leg.
• Thinking. Can they follow instructions, or might they grab or push?
• Strength. Which side is weak? Transfer toward the strong side when you can.
• Dizziness. After bed rest, blood pressure can drop on standing. This is called orthostatic hypotension and it is the most common cause of dizziness on getting up. Check blood pressure in different positions before a first walk if the plan calls for it.
• Tubes and equipment. IV lines, catheters, oxygen and drains must all be managed.
• The care plan. If it says mechanical lift, use the lift, even if it would be faster to do something else.

Preparing the Space

• Clear the path and remove rugs and cords.
• Lock all wheels on the bed, wheelchair and commode. Unlocked wheels can roll away mid-transfer and cause a fall.
• Set the bed height to the same height as the wheelchair seat or slightly higher, so that the person's feet touch the floor when they sit on the edge. This reduces how far they have to rise.
• Swing away the footrest and remove the armrest on the transfer side.
• Place the wheelchair at a 20 to 45 degree angle to the bed, on the person's strong side.
• Have the person wear non-slip gripper socks or closed-toe shoes with traction.

Gait Belt Transfers

A gait belt gives you a secure grip near the person's center of gravity so you can guide and support them. It is not a handle for lifting their full weight.

Applying the Gait Belt

1. Explain to the patient what you are doing and why. "I am going to put this belt around your waist. It helps me help you safely."
2. Place the belt around the patient's waist, over their clothing but under any tubes, lines, or drains.
3. Thread the belt through the buckle (or fasten the quick-release buckle, depending on the style).
4. Tighten until you can slide two flat fingers between the belt and the patient. Snug, not tight.
5. Position the buckle off-center in front. Never place it over the spine, a surgical incision, a feeding tube site, or a colostomy.
6. The belt stays on for the entire transfer and walking activity. Remove it only after the patient is safely seated and secure.

Do not use a gait belt, and check with the nurse for another method, if the person has:

• Recent abdominal or chest surgery
• A feeding tube (G-tube or J-tube) at the waist
• Severe rib fractures
• Abdominal aortic aneurysm
• Pregnancy (late stages)
• Any condition where pressure around the waist is contraindicated

Stand-Pivot Transfer: Bed to Wheelchair

This is the most common transfer for patients who can bear weight on at least one leg.

1. Position the wheelchair at a 20-45 degree angle to the bed, on the patient's strong side, with brakes locked and footrests removed.
2. Help the patient sit on the edge of the bed (dangling). Wait a moment and ask if they feel dizzy. Orthostatic hypotension is common in bed-bound patients.
3. The patient's feet should be flat on the floor, shoulder-width apart.
4. Apply the gait belt.
5. Stand directly in front of the patient, feet staggered, knees slightly bent. Your knees can gently block the patient's knees to prevent buckling.
6. Grasp the gait belt on both sides with an underhand grip. Do not grab the patient's arms, clothing, or waistband.
7. Have them scoot to the edge, place their feet flat and lean forward. On a count of three, they push up with their hands on the mattress while you guide up and forward with the belt, straightening your legs. They should not hold on to your neck.
8. Once standing, pause. Make sure the patient is stable.
9. Have the patient pivot (small steps or a pivot turn) until the back of their knees touch the front of the wheelchair seat.
10. Slowly lower the patient into the wheelchair by bending your knees and guiding them down with the belt.
11. Position the patient comfortably. Replace footrests and ensure feet are on them.
12. Remove the gait belt.
13. Lock the wheelchair if it will remain stationary.

Stand-Pivot Transfer: Back to Bed or to a Toilet

Reverse the steps. Place the wheelchair with the person's strong side toward the bed or toilet, lock the brakes and put on the gait belt. Have them scoot forward, stand on your count and pivot until the backs of their knees touch the surface. Lower them by bending your knees.

At a toilet, help with clothing, give as much privacy as is safe and stay within earshot. Do not leave a person who is a fall risk alone.

Slide Board Transfers

Slide boards, also called transfer boards, are for people with good upper body strength who can sit upright but cannot stand, such as some people with spinal cord injuries or leg amputations.

Procedure

1. Position the two surfaces as close together and as level as possible. Lock all wheels.
2. Remove the armrest on the transfer side of the wheelchair.
3. Help the patient lean slightly away from the transfer direction.
4. Slide one end of the board under the patient's buttock (about one-third of the way under). Place the other end securely on the destination surface.
5. The board should bridge the gap completely with no risk of slipping.
6. The patient places one hand on the board and one hand on the destination surface.
7. In small scooting movements, the patient slides across the board. Guide them with a hand on the gait belt. Do not lift.
8. Once across, lean the patient away and remove the board.
9. Position comfortably.

Tips

• The transfer surface should be close to the same height. If the wheelchair seat is much lower than the bed, the patient will struggle to slide uphill.
• Keep the board dry. Moisture makes it slippery and uncontrollable. A pillowcase over the board can help patients slide more easily while maintaining control.
• Coach the patient through each scoot. "Good, now one more scoot toward me."
• For patients who are learning, a physical therapist should assess and train the technique initially.

Mechanical Lift Transfers

A mechanical lift, often called a Hoyer lift, moves a person who cannot bear weight using a sling and a lifting arm. It takes at least two people: one to run the controls and one to guide the person. Follow the manufacturer's instructions for your model, because lifts and slings differ.

Full-Body Sling Lift: Bed to Wheelchair

1. Explain the procedure to the patient. Knowing what to expect reduces anxiety.
2. Roll the patient onto their side (log-roll technique). Place the sling on the bed behind them, with the top of the sling at shoulder level and the bottom at knee level.
3. Roll the patient onto their back over the sling. Center the patient on the sling and smooth out wrinkles.
4. Position the lift over the patient with the base spread wide. Follow your lift's manual on its casters. Many makers say to leave them unlocked while lifting, because locked casters can tip the lift.
5. Attach the sling straps to the lift arm as the sling's instructions show.
6. With one person operating the lift controls and one person guiding the patient, slowly raise the patient until they clear the bed surface.
7. Swing the patient's legs off the bed as the lift raises them.
8. Roll the lift to the wheelchair (one person steers, one guides the patient).
9. Position the patient over the wheelchair. Slowly lower.
10. Ensure the patient is seated properly before disconnecting the sling straps.
11. You may leave the sling under the patient for the return transfer if it does not cause discomfort.

Critical Safety Points for Mechanical Lifts

• Check the sling for tears, fraying, or damage before every use. A failed sling drops a patient.
• Check the weight limit of the lift and the sling. Never exceed it.
• Keep the base spread wide during the lift for stability.
• Never leave a patient suspended in the lift for any reason. If something goes wrong, lower them back down immediately.
• The straps must be secure before lifting. Tug each one to verify.
• Go slowly. The patient may be frightened, so stay calm and reassuring.
• Check underneath the patient after lowering for wrinkles in the sling or clothing that could cause skin breakdown.

Assisting with Ambulation (Walking)

Preparation

1. Check the care plan for the prescribed activity level and any precautions.
2. Apply a gait belt.
3. Make sure the patient is wearing proper footwear (non-slip soles).
4. Clear the walking path of obstacles, cords, rugs, and wet spots.
5. Have the patient sit on the edge of the bed for a minute. Check for dizziness. Ask them to rate their pain.

Walking Technique

1. Stand slightly behind and to the side of the patient, on their weaker side.
2. Hold the gait belt with one hand (underhand grip on the back of the belt).
3. Your other hand is free to provide support if needed, but do not hold the patient's arm unless they are very unsteady.
4. Walk at the patient's pace, not yours. Match their stride.
5. Stay alert for signs of fatigue, unsteadiness, or pain.
6. If the person uses a cane, it goes on the side opposite the weak leg. A walker moves about an arm's length ahead with each step, and the person steps into it. Wheeled walkers roll, and standard walkers are lifted and placed.

If the Patient Starts to Fall

Do not try to catch a falling person or hold them upright with your arms. Their weight is more than you can safely stop, and you can herniate a disc or break a wrist.

1. Hold the gait belt firmly with both hands.
2. Step behind them and widen your stance.
3. Bend your knees and ease them down to the floor, letting them slide down your leg.
4. Protect their head.
5. Stay with them and call for help.
6. Do not get them up until they have been checked for injury.
7. Report and document what happened.

Bed Mobility

Turning a Patient in Bed

Logroll, for patients with spinal precautions:

1. Two people on the same side of the bed.
2. Cross the patient's arms over their chest. Place a pillow between their knees.
3. On a count of three, both people roll the patient toward them as a single unit (head, trunk, and legs move together).
4. Position pillows to maintain alignment.

Standard turning:

1. Stand on the side the patient will face after turning.
2. Cross the patient's far arm over their chest and bend their far knee.
3. Place one hand on the patient's far shoulder and one on the far hip.
4. Gently roll the patient toward you.
5. Position with pillows between the knees, behind the back, and under the top arm.

Moving a Patient Up in Bed

Sliding down in bed causes skin shear, and pulling a person up by the arms can injure their shoulders. Use a draw sheet or a slide sheet and a second person.

1. Lower the head of the bed flat if the person can tolerate it, and remove the pillow.
2. Stand on opposite sides of the bed.
3. Roll the draw sheet close to the body for a firm grip.
4. On a count of three, slide the person up by shifting your weight. If they can, they bend their knees and push with their feet.
5. Replace the pillow and raise the head of the bed.

Special Situations

Transferring a Patient with an IV

• Move the IV pole with the patient. Only a nurse disconnects an IV line.
• Keep the IV bag above the insertion site at all times.
• Watch that the tubing does not get caught on wheels, bed rails, or armrests.
• Check the insertion site after the transfer for any pulling or dislodgement.

Transferring a Patient with a Catheter

• Keep the catheter bag below the level of the bladder at all times (gravity drainage).
• Secure the tubing so it does not pull on the catheter during the transfer.
• Hook the bag on the wheelchair frame, below the bladder, not on the floor or the person's lap.
• Check that urine is flowing after the transfer (no kinks in the tubing).

Transferring a Patient with Oxygen

• If on a portable tank, secure it to the wheelchair or keep it close.
• If on a long nasal cannula tubing connected to a concentrator, make sure there is enough slack.
• Never disconnect oxygen during a transfer without the nurse's explicit instruction.
• Check the nasal cannula placement after the transfer.

Transferring a Patient of Larger Size

Use equipment rated for the person's weight, including the bed, wheelchair and sling. Get more staff, and check skin folds afterward for moisture and pressure.

Documenting Transfers and Mobility

Record the type of transfer, how many people helped, the equipment used, how the person did, how far they walked, and any near-falls or equipment problems.

Range of Motion Exercises

If the care plan includes range of motion (ROM) exercises, do them gently. They keep joints flexible, prevent contractures (permanent tightening of muscles and tendons) and help circulation, so they are especially important for people who stay in bed or at home.

• Active ROM: The patient moves their own joints. You encourage and coach.
• Active-assistive ROM: The patient moves as much as they can, and you help complete the motion.
• Passive ROM: You move the patient's joints for them (for patients who cannot move on their own).

For all ROM exercises:

• Support the joint and the limb above and below it
• Move smoothly and slowly, never force
• Stop if the patient reports pain
• Perform each movement 5-10 times per joint per session, or as prescribed
• Common joints to exercise: shoulders, elbows, wrists, fingers, hips, knees, ankles

Common Mistakes

Check Your Understanding

1. A patient with a stroke has a weak left side. Where do you put the wheelchair?

On the right side, the person's strong side, at a 20 to 45 degree angle to the bed with the brakes locked.

2. A man who had recent stomach surgery needs help to the chair. The nurse usually uses a gait belt. What do you do?

Check with the nurse first. A gait belt over a recent surgical site can do harm, and another method may be needed.

3. The care plan says to use a mechanical lift, but your coworker is on break and the patient wants to get up now. What do you do?

Wait for a second person. A mechanical lift always needs at least two people.

4. A walking patient's knees buckle. What do you do?

Hold the gait belt, step behind them and ease them to the floor while protecting their head. Do not try to hold them up. Stay with them and call for help.

Key Takeaways

• Check the care plan and the person's ability before every move.
• Lock wheels, set the bed height and use the strong side.
• Keep gait belts snug, with room for two flat fingers, and use an underhand grip.
• Mechanical lifts need at least two people and a checked sling.
• Guide a falling person down. Never try to catch them.