Let's Talk Transfers

    A transfer is used to make a safe movement for an individual and bring them from one surface to another.  This could include transferring a patient from their wheelchair to the bed, to the shower, to a car, and so on. There are a few considerations that you would want to consider when performing a safe and efficient transfer as a therapist. 

    When achieving a successful and safe transfer, you want to consider having a gait belt. A gait belt is a safe and secure belt that is worn right above the waist and it helps you hold the client and their weight if they were to ever trip or fall. It is important that it isn't too tight, but just at the right snug level so it is comfortable for the client. When it comes to transferring a client, a gait belt can be essential for the therapist in order to prevent back injury and not have to lift the client with all their weight. If a client lost their balance during a transfer, the belt becomes an easy handle for the therapist to grip onto to stabilize the client.

    It is always important to practice good body mechanics when transferring a client just to prevent any further injuries for both parties. In class, it was mentioned that clients are to NEVER hold onto the therapist's neck or grab onto any part of them. If the client were to fall, this would leave the therapist to be unstable and cause them to fall as well, leading to injuries for both people. Instead, you want to use the gait belt and make sure the surface heights of wherever you are transferring the client are at an accessible level to make it an easy and comfortable transfer. Consider the client's position and position them to have their feet flat on the ground so equal weight is distributed. Keep their heels pointed in the direction of the desired destination surface so their pelvis and knee can follow along during the transfer.  

    Just as we have always been taught to make sure safety is key, as a therapist you want to make sure there are no further obstacles in the way when it comes to transferring the client. First and foremost, if transferring a client in a wheelchair, you must make sure all brakes are locked and the wheelchair does not move and make sure the castor wheels are out of the way from the client. Then proceed to remove footplates out of the way as well as any armrests depending on the type of transfer. It is important to make sure medical equipment items such as catheters, IV bags, connected tubes, and any other attached equipment are out of the way in order to make a clear and safe pathway to the next surface during the transfer. This would prevent any tripping, falling, or disconnections from the medical equipment and stray away from more issues that could occur.

    Adaptive equipment is another consideration to have as it can also help accommodate a safe transfer, such as using a tub bench, grab bars, etc. These types of equipment can help the client use to grab onto to help stabilize or ease their transfer. Other types of equipment such as a mechanical lift can help lift the client and reduce the risk of injury. An easier type of equipment known as a sliding board is a convenient and helpful way to get a client to slide to the other surface if they cannot properly get up and lift. If the client is strong enough, they can lift their bottom slightly off and scoot themselves from the wheelchair onto the board and then onto the next surface. It is important for a therapist to give clear directions on how to use these types of adaptive equipment and make sure the environment is safe. 

    One other consideration is to always be a clear communicator. I have seen through my shadowing experiences that some health professionals will never explain what exactly they are doing to a client, which can show bad rapport and lead to confusion on the client's end. It is important to clearly explain or demonstrate the task being done and cooperate with one another on how to complete the transfer. The therapist needs to be physically and mentally prepared to take on this task with the client and assure the client that they are strong enough to transfer the client safely and efficiently. Before the transfer, if the therapist does not feel strong enough to execute the transfer, they can ask for assistance beforehand and communicate that with the client so they can work together for a safe and efficient transfer. 

    Keeping these considerations in mind can help ensure a safe and efficient transfer. The therapist must consider their own capabilities and clearly communicate what is happening, considering using a gait belt, the use of adaptive equipment, noticing the client's position, and being aware of the client's environment are all useful considerations to implement in a transfer. 

References:

Gait belt. Kiero. (2021, April 7). https://www.keiro.org/fact-sheet/gait-belts 

Weisser- Pike, O, (2023). Lecture 10: Bed Mobility and Transfers [PowerPoint Slides]