NURSING Week 1- Transfers.

Moving and Positioning Patients In Bed Considerations- • Always see if there is any limitations for patients • Know when to request assistance Assessment Steps- 1. Identify the patient using identifiers (2) like name and birthdate or name and medical record 2. Assess patient’s body alignment and comfort level WHILE patient is lying down 3. Assess for risk factors that may contribute to complications of immobility such as: • PARALYSIS: hemiparesis resulting from cerebrovascular accident (CVA); decreased sensation • IMPARED MOBILITY: Traction or arthritis or other contributing disease • IMPAIRED CIRCULATION • AGE: Very young, older persons • SENSATION: decreased from CVA, neuropathy • LEVELS OF CONSCIOUSNESS • ASSESS CONDITIONS OF PATIENTS SKIN 4. Assess patient’s physical ability to help with moving and positioning • AGE • DISEASE PROCESS • STRENGTH, COORDINATION • ROM 5. Assess health care provider’s orders before positioning. Clarify whether any positions are contraindicated because of patient’s condition (ex. Spinal cord injury, respiratory difficulties) 5. Perform hand hygiene 5. Assess the presence of tubes, incisions, and equipment 5. Assess the ability and motivation of the patient, family members, and primary caregiver to participate in moving and positioning the patient in bed in anticipation of discharge to home Implementation Steps- 1) Assist patient in moving up in bed A. CAN PATIENT ASSIST? A1) Fully able to assist, nurse assistance not needed; nurse stands by to assist A2)Partially able to assist; patient can assist with nurse using positioning cues or aids (ex. Friction reducing transfer sheet) CRITICAL DECISION POINT: BEFORE LOWERING HEAD OF BED, ACCOUNT FOR ALL TUBING, DRAINS, AND EQUIPMENT TO PREVENT DISLODGING OR TIPPING IF CAUGHT IN THE MATTRESS OR BED FRAME AS BED IS LOWERED B. Assist patient in moving up in bed using friction-reducing transfer sheets ( two or more nurses ) 1) Position patient SUPINE with head oor bed flat or in Trendelenburg position in bed if this is tolerated. A nurse stands on each side of bed 2) Lower side rails. Remove pillow from under the head and shoulders, and place pillow at the head of the bed 3) Turn patient side to side to place repositioning device under patient. Ensure that patient’s shoulders and hips are on the repositioning device being used 4) Return patient to the supine position. Instruct patient to lie flat on back, cross arms on chest and bend the knees. If the patient is unable to bend knees, place a pillow under the lower legs to decrease friction during repositioning. 5) Fanfold repositioning device on both sides, with each nurse grasping firmly (palms up) near the patient 6) Nurses or workers assume a 6 checkpoint position 1. Elbows tucked in 2. Safe, effective grip (palms up) 3. Comfort Zone ( bend elbows and trunk elbows into sides, move hands to shoulders and to hips) 4. Weight transfer- stable base, transfer side to side and front to back 5. Grasp top sheet at the patient’s shoulder and hip level (palms up). Place feet shoulder-width apart and point foot nearest to the head of the bed in the direction of the move (Forward- Backward stance) 6. Instruct the patient to flex their neck, tilting chin towards chest 7) Instruct patient to assist moving by bending knees and pushing with feet on the bed surface 8) The Primary nurse counts “1-2-3-slide”. Instruct the patient to push with heels and elevate trunk while breathing out on the command word “slide”, thus moving towards the head of the bed 9) On command “slide”, rock and shift weight from back to front leg. At the same time, the patient pushes with heels and elevates trunk. 10) Tuck in top sheet of friction-reducing transfer sheet after repositioning. If using transitory slider sheet, remove from under patient 2) Position patient in one of the following positions using correct body alignment to protect pressure areas. Begin with patient lying supine and reposition in bed