Transfer training is a huge part of what we do in the SNF. The use of safe and appropriate body mechanics during all transfers is crucial for maximizing both patient and staff safety.
The biggest rule of thumb when it comes to transfer training: use a gait belt.
Sometimes people think that grabbing a patient up under the arm or by the pants is the best way to assist with a transfer. But the truth is, grabbing someone by the arm pit does not allow the therapist or nurse to control the patient’s center of gravity. If the patient loses his or her balance and the therapist only has them by the armpit, the process of assisting with the maintenance of balance in the event that the patient begins to fall could result in an orthopedic injury to the glenohumeral joint or the brachial plexus.
A gait belt allows the therapist or nurse to easily and safely control the patient’s center of gravity, thereby resulting in a decreased risk of fall or injury when performing transfers. Gait belts are often made of thick, heavy duty material that will not tear or stretch like the patient’s pants might if the waist of the pants is used in lieu of a gait belt.
When teaching a patient how to transfer, there are a few basic rules:
1. When standing, push up from the surface you’re sitting on. Patients often try to pull on their walkers when attempting to stand. The problem with this is that walkers are light-weight and not attached to the floor. So if the patient loses his or her balance during the transfer, that walker will not support them, it will go right down with ’em.
2. If using a wheelchair, align the wheelchair and the bed/toilet/shower chair in a 90 degree angle to decrease how far you have to pivot your body during the transfer. The illustration below by Netter shows this technique perfectly.
3. When sitting, back up to the chair until you can feel the chair on the back of both legs. This will prevent sitting on the armrest or the very front edge of the seat, which will thereby result in a safe landing.
If the patient is not cognitively or physically able to learn and apply proper transfer techniques, the same techniques should be used by nursing and therapy staff when assisting the patient. Ultimately, if the patient is difficult to transfer because of these physical and/or cognitive deficits, the use of a mechanical lift may need to be considered.
One final thing about transfer training in the SNF setting: a patient’s transfer status can and will wax and wane. This is why we as the clinician need to constantly be aware of how a transfer should look, how the patient’s transfers look, and how the patient’s medical diagnoses and conditions will impact all functional transfers in all contexts.