Safe Patient Handling
Transferring from a Bed to a Stretcher
Select a Skill:
- » Assisting with Moving a Patient in Bed
- » Assisting with Positioning a Patient in Bed
- » Transferring from a Bed to a Wheelchair Using a Transfer Belt
- » Transferring from a Bed to a Stretcher
- » Performing Passive Range-of-Motion Exercises
- » Applying Elastic Stockings
- » Assisting with Ambulation Using a Gait Belt
- » Using a Sequential Compression Device
- » Using a Hydraulic Lift
Take the Review Test:
Safety
- Use a friction-reducing device if any caregiver will be expected to lift more than 35 pounds of the patient’s body weight. Do not start the procedure until all required caregivers are at the bedside.
- The person with the heaviest load coordinates the efforts of the personnel involved in lifting or transferring.
- Determine if the patient can fully or partially assist.
- Ensure that the brakes are locked on the bed and the stretcher.
- Position an assistant at the head of the bed to protect and support the head and neck if the patient is weak or unable to assist with the transfer.
- Use appropriate body mechanics to avoid injury of the nursing staff.
- Keep the weight to be lifted as close to the body as possible; this action places the weight in the same plane as the lifter and close to the center of gravity for balance.
- The best height for vertical lifting is approximately 2 feet off the ground and close to the lifter’s center of gravity.
- Know the pathological conditions that affect a patient’s body alignment and mobility. Postural abnormalities affect body mechanics.
- Control factors that indirectly affect body mechanics by altering the safety of the environment.
Equipment
(Roll cursor over items to see labels)
Slide board or other friction-reducing device
Draw sheet and blanket
Stretcher
PrintableDelegation
The skill of transferring a patient from a bed to a stretcher can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- How to assist and supervise when moving patients who are transferred for the first time after prolonged bed rest, extensive surgery, critical illness, or spinal cord trauma
- Report any changes, such as the patient's mobility restrictions, changes in blood pressure, sensory alterations, or any factors that may affect a safe transfer.
Preparation
- Determine the number of people needed to assist with transfer. Do not begin the procedure until all required caregivers are available.
- Determine whether any caregiver would be required to lift more than 35 pounds of a patient’s weight. If so, the patient is considered fully dependent, and an assist device is used.
- Assess whether a nurse needs to be positioned at the head of the patient’s bed to protect and support the head and neck if the patient is weak or unable to assist.
- Assess the patient’s physiological capacity to transfer and the need for special adaptive techniques.
- Assess for the following:
- Muscle strength (legs and upper arms)
- Joint mobility and contracture formation
- Paralysis or paresis (spastic or flaccid)
- Bone continuity (trauma, amputation)
- Assess for the presence of weakness, dizziness, or postural hypotension.
- Assess the patient’s level of endurance, including level of fatigue during activity and vital signs.
- Assess the patient’s proprioceptive function (awareness of posture and changes in equilibrium), including the following:
- Ability to maintain balance while sitting in bed or on the side of the bed
- Tendency to sway to one side or to position himself or herself to one side
- Assess the patient’s sensory status, including adequacy of central and peripheral vision, adequacy of hearing, and presence of peripheral sensation loss.
- Assess the patient for pain (e.g., joint discomfort, muscle spasm), and measure the level of pain using a scale from 0 to 10. Offer a prescribed analgesic 30 to 60 minutes before transfer.
- Assess the patient’s cognitive status, including the following:
- Ability to follow verbal instructions
- Short-term memory
- Recognition of physical deficits and movement limitations
- Assess the patient’s level of motivation, such as eagerness versus unwillingness to be mobile.
- Assess for conditions such as neuromuscular deficits, motor weakness, calcium loss from long bones, cognitive and visual dysfunction, and altered balance.
- Assess for previous mode of transfer (if applicable).
Follow-up
- Monitor the patient’s vital signs. Ask if the patient feels dizzy or fatigued.
- Note the patient’s behavioral response to the transfer.
- Ask if the patient experienced pain during the transfer.
Documentation
- Record the procedure, including pertinent observations such as patient weakness, ability to follow directions, number of personnel needed to assist, and amount of assistance (muscle strength) required.
- Report the patient’s transfer ability and the amount of assistance needed to the next shift or to other caregivers.
Review Questions
1. The nurse is preparing to use a slide board to transfer a patient from the bed to a stretcher. How many additional people will the nurse need to help with this transfer?
INCORRECT. The nurse does not need four additional people to help transfer this patient. Three nurses are recommended for a slide board transfer.
CORRECT. The nurse will need two additional people to help move this patient. Three nurses are recommended for a slide board transfer.
INCORRECT. Three nurses are recommended for a slide board transfer. The nurse needs more than one additional person to help move this patient.
INCORRECT. The nurse cannot perform this move without assistance. Three nurses are recommended for a slide board transfer.
2. The nurse is preparing to move a patient from a bed to a stretcher. What is the first action of the nurse?
Cross the patient’s arms over his or her chest. - Lower the side rails of the bed.
Make sure the bed brakes are locked.- Fanfold the draw sheet.
INCORRECT. Crossing the patient's arms over the chest is done after the head of the bed is lowered.
INCORRECT. Lowering the side rails of the bed occurs after the bed brakes are locked.
CORRECT. The nurse's first action would be to verify the bed brakes are locked prior to moving the patient.
INCORRECT. The draw sheet would be fanfolded after the bed brakes are locked.
3. When turning a patient to place a slide board, where do the assistants stand?
- At the side of the bed to which the patient will be turned
- At the side of the bed from which the patient will be turned
- At the head and foot of the bed
- At the foot of the bed only
CORRECT. When turning a patient to place him or her on a slide board, the assistants stand on the side of the bed to which the patient will be turned.
INCORRECT. When turning a patient to place him or her on a slide board, positioning assistants on the side of the bed from which the patient will be turned is not helpful.
INCORRECT. When turning a patient to place him or her on a slide board, positioning assistants at the head and foot of the bed is not helpful.
INCORRECT. When turning a patient to place him or her on a slide board, positioning assistants at the foot of the bed is not helpful.
4. The nurse and his or her assistants are using a slide board to move a patient from the bed to a stretcher. The nurse, standing alone on the side of the bed opposite the stretcher, will perform which action during this move?
- Hold the slide board stationary in place.
- Pull the draw sheet.
- Hold the patient’s head stationary.
- Lock the brakes on the stretcher.
CORRECT. The nurse, standing alone, will hold the slide board in place as the two assistants pull the draw sheet.
INCORRECT. The two assistants will pull the draw sheet.
INCORRECT. The nurse will not hold the patient’s head during the move; this action may be performed by an optional assistant.
INCORRECT. The nurse cannot lock the brakes on the stretcher while standing on the opposite side of the bed. The brakes should be locked prior to the transfer of the patient.
5. After moving a patient from the bed to a stretcher, the nurse raises the head of the stretcher. What will the nurse do next?
- Lock the wheels on the stretcher.
- Cover the patient with a blanket.
- Raise the side rails on the stretcher.
- Unlock the wheels of the bed.
INCORRECT. The wheels of the stretcher will have been locked before moving the patient from the bed to the stretcher.
INCORRECT. Covering the patient with a blanket will occur after the side rails are raised on the stretcher.
CORRECT. The nurse will raise the side rails after adjusting the head of the stretcher.
INCORRECT. Unlocking the wheels of the bed is not an action the nurse will take after transferring a patient from the bed to the stretcher.
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