Lab Report
NURSING

Lifting, Transferring and Positioning

Student No.
{xxxxxxxxx}

Group No.
{x}

Marker's Name: {xxxxx xxxxxxxx}


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ABSTRACT

Lifting, transferring and positioning of patients is frequently undertaken
by nurses on each working day.  This is necessary for patient comfort,
medical reasons and completion of self care needs.  Lifting can be done in
numerous ways.  As well as the nurse physically lifting or moving patients,
a number of devices are also available to assist in the transfer of
patients.  These range from straps that are attached to or placed under the
patients, to mechanical hoists and lifters.  Any assistance the nurse has is
beneficial for both the patient and the health care worker, as patient's
weights are generally heavier than the nurses physical capabilities.  This,
combined with incorrect lifting techniques, can result in muscle strain, or
more seriously, spinal injury for the nurse, and discomfort, muscle strain
or further injury for the patient.


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INTRODUCTION

When lifting, transferring or positioning patients, the most important
consideration is safety.  Any of these procedures need to be undertaken with
it in mind.  This safety is inclusive of both the patient and the health
care worker.  Communication is an important part of the lifting process as
the nurse should elicit information from the client to find out how and when
they prefer to be moved.  This allows the patient to be involved in the
decision making process and be fully aware of what is occurring.  By
communicating with the client, the nurse is also aware of whether or not the
patient is experiencing any discomfort during or after the lift.

The actions of lifting, transferring or positioning need to be completed for
numerous reasons, including relief of pressure points. Due to the patient
being in one position continuously, they are prone to the development of
pressure areas. In terms of patient needs, being in the same position
constantly is physically uncomfortable.  However, mentally, a change in the
immediate surroundings is also beneficial for the patient. It is also
necessary for the patient to be moved for completion of their self care
needs.  This includes their hygiene needs, which include, bathing or
showering, elimination, hair, oral and nail care.


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METHOD

When lifting, transferring or positioning patients manually, safety is the
most important factor.  This safety is for the nurse themselves as well as
for the patient.  One aspect of safety is for the nurse to utilise "good
body mechanics" (Kozier et al 1995, p.879).  This refers to the nurse having
balance, which can be achieved with the feet being spread approximately
shoulder 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) balance
is also achieved by correct body alignment and good posture.  The use of
correct body alignment reduces the strain on muscles and joints, and makes
lifting the clients much easier.

When lifting clients, the first thing the nurse should do is explain to the
patient what they are doing and ask the patient if there is any particular
way they would prefer to be moved.  This allows the patient to have some
opinion about what is being done to them.

The next thing that should be done when moving a patient is a routine
assessment.  The nurse may assess the situation by firstly observing the
patient and reading the nursing care plan. The nurse needs to be aware of
the patients capabilities to see how much they can do or if they can assist
in any way.  Another important part of assessment is observing the
surrounding environment, to be sure there is no obstructions or other
hazards which may be injurious to the nurse or patient before, during or
after the move.

The next phase is that of planning the move.  The nurse decides how the
patient will be moved from their current position to where they are going.
This may involve the nurse getting assistance for the lift, either from
other health care workers or by mechanical devices, such as a lifter or
hoist.  When moving or lifting the client, wherever possible the nurse
should have assistance.  This assistance is necessary for both nurse and
client safety.  This is supported by Kozier (1995 p.910), who says, wherever
possible,

"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 can
be used.  When moving a client up in bed, the client should be encouraged to
help if possible.  The nurse can ask the patient to bend their knees, so
that when the nurse is ready, the patient can assist by pushing backwards
when the nurse says.  Two nurses stand on opposite sides of the bed facing
each other. With knees bent and legs shoulder width apart, the nurses lock
forearms underneath the patient's thighs and shoulders.  The nurses, on the
count 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 the
patient is going to be moved.

When moving a client from a lateral lying position to sitting at the side of
the bed, the first thing that the nurse should do after assessment, is to
get the patient in a side lying position.  This is done by the nurse placing
one hand on the client's hips and one hand on the client's shoulder. The
nurse then transfers their weight onto the back foot while at the same time
rolling the client towards them.  The next step is the nurse places one arm
underneath the patient's shoulders and one arm underneath the knees.  The
nurse then turns on the balls of the feet while at the same time pulling the
client's legs down on the floor.  

The next move is transferring a client from the bed to a chair.  Once the
client is sitting on the edge of the bed, the nurse can easily move the
patient to a chair.  This procedure therefore follows on from the procedure
of 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 have
the wheelchair ready and parallel to the bed.  The nurse must make sure the
client's feet are placed flat on the floor with one foot slightly in front
of 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's
waist, holding onto the belt.  The nurse asks the patient to assist by
transferring the weight onto the front foot on the count of three, while at
the same time, the nurse transfers their weight onto the back foot, lifting
the client up to a standing position.  The nurse supports the client until
they are balanced when standing.  The nurse and client, when ready, pivot in
the direction of the chair.  The client then holds the arms of the chair as
a means of support and to assist when lowering into the chair.  The nurse
then lowers the client into the chair, bending at the knees.  The transfer
belt is then removed when the nurse has assessed that the client is
comfortable and secure in the chair.  The nurse should also ensure the
client has suffered no ill-effects as a result of the move.

When the transfer belt is not available, Kozier (1995 p.925), recommends
that the nurse puts both hands at the sides of the patient's chest and
continue the procedure in the same way.

When transferring the patient from the chair to the bed, the same procedure
is implemented but in reverse.  However, the transfer is started, the nurse
should ensure that the bed is clean and dry.  The client is then moved from
the chair to the bed and then assisted to a lying down position.

Manually lifting patients is effective, however, when able, the nurse should
lift or transfer with a mechanical lifter.  These are especially effective
in 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 for
protecting both client and carer from injury."

When using these devices, the nurse should tell the patient what is being
done and how it is being done.  Mechanical lifters either have two slings,
one sling for underneath the shoulders and one for underneath the thighs or
buttocks.  Other lifters have an all in one sling which extends from the
client's upper back to lower thighs.  The lifters substantially reduce the
strain on the nurse and the patient and are able to be used for all
transfers.  The nurse places the sling underneath the patient and attaches
the slings to the lifter with hooks, and the nurse then controls the lifter
for the desired action.

When using a mechanical lifter, some problems which may arise include the
lifter being broken or unavailable.  The nurse should therefore be aware of
how 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 way
that the lifters are used.

The problem with lifting patients physically, is that nurses are often
required to lift loads greater than they are physically able.  This is due
to,

"the likely mismatch between the size of a patient to be lifted and the
physical 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 lifting
procedure may not be carried out.  This can lead to patient discomfort, as
well as long term back problems for the carer involved.  One problem which
may also arise from incorrect lifting techniques is the development of
pressure areas, due to the patient being dragged and not lifted across the
sheets.  This friction can lead to the patient developing reddened skin
which may lead to skin breakdown.


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DISCUSSION

By the health care worker implementing the correct lifting techniques, the
nurse and the patient's safety is not compromised in any way.  Nurses should
be constantly aware of any new methods of lifting or transferring which
arise, so they are able to maximise the level of safety for themselves as
well as for the patients.  By the nurse using the correct lifting
techniques, and not dragging the patient, the risk of the patient sustaining
further injury, such as pressure areas, is reduced.  By communicating with
the client, the nurse is also made aware of any problems the client has with
any aspect of the lift.

Regular maintenance of equipment is essential so that the equipment does not
breakdown frequently.  Hooks, straps and slings need to be constantly
checked to ensure optimum working order, as well as ensuring client safety.

Staff need to be educated on the use of the lifters and regular testing
would ensure that the staff are confident and competent in their use.  This
may lead to a decrease in the amount of mismatched clients and nurses in
terms of weight, as if staff are more confident of using the lifters there
may not be as much manual lifting necessary.


Education about manual handling is also vital to ensure correct lifting
techniques are used.  Constant re-evaluation of the staff's abilities and
methods would ensure safety for both parties involved.  This would make
staff aware that the least amount of strain placed on the muscles and joints
as possible is beneficial to them.

The re-evaluation is also important in the fact that it allows the health
care worker to be constantly up to date on any new procedures which may be
developed.


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REFERENCES

Kozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995, {italics on}
Fundamentals of Nursing {italics off}, 5th Edition, Addison Wesley
Publishing Company Inc., United States of America.

Love, C. 1995, 'Managing manual handling in clinical situations', {italics
on} 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', {italics
on} Nursing Times {italics off}, vol. 91, no. 27, pp. 48-50.
