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Contents
Overview of moving and handling techniques
Preparations for moving and handling people
Sitting and standing
Technique 1 Supervised repositioning in a chair, page89
Technique 2 Supervised sit to stand, page90
Technique 3a Sit to stand with one carer, page91
Technique 3b Sit to stand with two carers, page93
Technique 3c Sit to stand with two carers bariatric client, page95
Technique 4 Sit to stand with a standing hoist, page96
Technique 5 Supervising a fallen client who is conscious and uninjured, page100
Technique 6 Moving a fallen client in a restricted space using slide sheets, page102
Lateral transfers
Technique 17 Supervised sittingtositting transfer, page122
Technique 18 Sittingtositting transfer using walking frame, page124
Technique 19 Sittingtositting transfer with one carer, page126
Technique 20 Lateral transfer using a transfer board and slide sheets, page127
Technique 21 Transfer from a vehicle to a walking frame, page129
Technique 22 Transfer from a vehicle to a wheelchair, page131
Using hoists
Technique 23 Applying a sling using two rolls, page135
Technique 24 Applying a sling using one roll, page137
Technique 25 Applying a sling to a client in a chair, page139
Technique 26 Applying a sling to a client on the floor, page141
Technique 27 Repositioning client in a chair using a hoist, page143
Technique 28 Sitting up in bed using a hoist, page145
Technique 29 Hoisting a client from bed to chair, page146
Technique 30 Hoisting from the floor, page148
Emergency situations
References and resources.
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83
Make sure clothing and footwear are appropriate for the task. Clothes should
allow free movement and shoes should be nonslip, supportive and stable
Choose a lead carer: If more than one carer is involved when moving or
handling a client, identify who should be the lead carer during the move by
giving instructions (e.g. ready, steady, move). The lead carer checks the client
profile and coordinates the move
General practice
Know your limits: Know your own capabilities and do not exceed them. Tell
your manager if you need training in the technique to be used
Seek advice: Talk to your manager or the moving and handling adviser if you
need advice on the techniques and equipment you should be using.
Risk assessment
Most of the techniques described in this section apply to clients who cannot move
themselves, or who need some supervision or assistance during movement. The
transfer technique needed will vary depending on the level of client ability and
dependency. Before deciding which specific technique is most appropriate to transfer
a client, it is necessary to assess the clients level of mobility, cognitive ability and
need for assistance.
Prior to using any technique, there should be an assessment of the clients current
mobility and any other factors that affect the safety of the planned movement of
the client. These assessments are described in Section 3 Risk assessment (see Risk
assessment and Table 4.3).
84
The mobility assessment should cover the clients ability to move, sit and balance,
and any other relevant factors. The assessment should lead to a decision on the
number of carers and equipment needed to transfer the client. This assessment
is particularly important in community settings where sole carers are working in
isolation. If the assessment indicates that more than one person is required to move
the client or operate equipment, that is what should happen. A robust assessment
is essential and carers must use moving and handling techniques consistent with
the risk assessment. The risk assessment should determine the number of carers
needed, equipment or modifications of the environment. It should be seen as a
costeffectiveprocess.
Check the client profile and carry out a premovement risk assessment
(seePremovement risk assessment in Section 3 Risk assessment)
Plan the movement, including the order of specific tasks and who will carry out
each task
Prepare the environment: Position furniture, check that route and access ways
are clear and that the destination is ready
Prepare the client: Tell the client what will happen, gain their permission,
and let them know what they are expected to do. Ensure that the clients
clothes and footwear are appropriate for the task, and that they have any aids
theyneed.
Posttransfer assessment
Assess how well the transfer technique worked. Could the transfer have been
done better? Add your comments to the client profile.
If you identify issues that affect client handling, report them to your manager
and add them to the workplace plan for moving and handling clients. This will
provide evidence for changes that are needed and may benefit all carers and
clients in the organisation.
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88
1.
figure 4.2
Instructing client to look in direction
of move
89
90
4. C
lient pushes themselves up to a
standingposition
91
Figure 4.5
Sit to stand with one carer (Technique 3a)
92
5. Client stands
93
Figure 4.6
Sit to stand with two carers (Technique 3b)
94
3. A
sk client to lean forward so upper body is
above knees
5. Client stands
6. Completion of stand
Figure 4.7
Sit to stand with two carers bariatric client (Technique 3c)
1. Client has hands on armrests, sitting on
edge of seat, looking straight ahead
5. Client stands
6. Completion of stand
95
96
If the client is being moved to sit on a bed so they can lie down, but cannot do this
independently, you will need to use a profiling bed and/or handling equipment.
Extra care is needed if transferring a stroke client with a standing hoist, as support
may be needed for the strokeaffected arm to prevent damage to the shoulder.
Some hoists have arm slings attached for this purpose. Standing hoists are often not
suitable for stroke clients with painful shoulders.
Figure 4.8
Sit to stand with a standing hoist (Technique 4)
1. Apply hoist sling
5. Reposition hoist
97
Box 4.2
Why you should not try to catch a
fallingclient
Physiotherapist and ergonomist DrMike Fray
calculated that the force required to catch a
falling client is 480 kilograms (kg) for a 60kg
person. This means that if you were to catch
a 60kg falling client you will have a force
equivalent to 480kg to hold by the time the
patient falls to the floor.
Source: Smith, 2005, p. 272
2. If you are able, make sure that the area around the client is safe and that no
further harm can occur; for example, clear any spills or objects away
3. Continue the assessment as needed, using approved first aid procedures, and
decide if the client can be moved
4. If the client is injured, make them comfortable on the floor and seek further
medical advice
5. If they are uninjured, stay with the client and stay calm; do not hurry them to
get up. This will help the client to stay calm and relaxed
6. Choose the right technique to help them up, explain the procedure and talk
with them throughout the move to provide reassurance
7. Remember, moving them without assessing the situation carefully could cause
injury to you and the client.
The following techniques (Techniques 5 and 6) are relevant to assisting fallen clients
without or before the use of a hoist. The use of a hoist to assist fallen clients is
described later in Technique 30.
99
100
Figure 4.9
Supervising a fallen client who is conscious and uninjured (Technique 5)
1. Assess client
101
102
Figure 4.10
Moving a fallen client in a restricted space using slide sheets (Technique 6)
1. Assess client and environment
103
The easiest way to reposition a client in bed, if they are able, is to get them up
and off the bed, move along the bed and get back in
Profiling beds reduce the repositioning of clients in bed because these beds can
be adjusted easily. Use the knee brace position. It can reduce the likelihood of
the client sliding down the bed
Use pillows to support and prop the client and to help stop them
becominguncomfortable
104
Figure 4.11
Supervised turning or rolling (Technique 7)
1. Ask client to turn head in direction of roll
105
figure 4.12
Adjust the bed height before moving
a client
Before rolling the client, check the clients condition. Consider extra measures if they:
Have had recent hip surgery (if so, immobilise the hip joint with strategically
placed pillows)
Are obese.
Always turn the client towards you. Direct the turn or roll with your hands on the
clients outside shoulder and hip. These are the key points of contact. Make sure the
client is not too close to the edge of the bed before turning.
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107
108
Figure 4.15
Turning a bariatric client with three carers (Technique 8c)
1. Client flexes outside knee
4. Roll completed
6. C
lient stabilised with pillows, bed
railingsraised
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110
111
112
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Box 4.3
Protect client with a bed sheet
overslidesheets
A patient from another hospital came to us
with friction burns down one side of his torso.
When asked what had caused the burns he
told us it was where staff had been inserting
slide sheets under his bare skin. Although he
tried to make sure his pyjamas were protecting
him, it was much more comfortable when slide
sheets were used underneath a bed sheet.
3. If the bed is large, consider large slide sheets or using more of them
4. Roll client on to their side, pull sheet out other side and straighten.
Figure 4.19
Placing slide sheets (Technique 12)
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115
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Figure 4.22
Turning client on to their side using slide sheets and two carers (Technique 15)
118
Technique 16a Moving client up the bed with two carers using
slidesheets
1. Place an extra pillow at the head of the bed
2. Move the bed away from wall, or furniture away from bed, if necessary, before
moving the client
3. Adjust the height of bed to shortest person, one carer either side
4. Apply slide sheets, making sure the pillow is also on the slide sheets
5. Choose lead carer. Stand where you want the clients head to end up
6. Step forward with outside leg and place both hands at level of clients hip,
keeping both arms straight and hands on the bed
7. Hold bed sheet and top slide sheet tightly and as near hip as possible
8. Practise first to ensure you are in time, say back on ready and ready, steady,
slide, and rock back on each word
9. Only go as far as the shortest person can comfortably manage. The procedure
may take more than one movement. If so, reposition and repeat; keeping your
arms straight will avoid twisting or rotating
10. Remove slide sheets, put bed back against wall and return furniture.
Note: Technique 16 (a and b) is one of several techniques that can be used to move a
client up the bed using slide sheets.
Caution: Avoid tilting the bed to use gravity. This is dangerous in combination with
slide sheets, has less control, and can be frightening for the client. Adding an extra
slide sheet folded under the legs will minimise the dragging. If the client cannot lie
flat for this procedure (e.g. if they have breathing problems), support with multiple
pillows and apply slide sheets under pillows.
119
Figure 4.23
Moving client up the bed with two carers using slide sheets (Technique 16a)
120
Figure 4.24
Moving client up the bed with three carers using slide sheets bariatric client
(Technique 16b)
1. Apply slide sheets and pillow at top ofbed
5. A
pply third slide sheet halved under
lowerlimbs
121
122
Figure 4.25
Supervised sitting to sitting transfer (Technique 17)
1. Client leans forward and slides their bottom
to front of chair
123
124
Figure 4.26
Sitting to sitting transfer using walking frame (Technique 18)
1. With client sitting forward in chair, carer
rocks forward with ready, steady, stand
125
126
127
Figure 4.28
Lateral transfer using a transfer board and slide sheets (Technique 20)
1. One carer rolls client on to side facing away
from direction of transfer
128
Figure 4.29
Transfer from a vehicle to a walking frame (Technique 21)
130
wheelchairs to the floor of the vans. For emergency retrieval, see the later section on
emergencies (Section 4.7).
Some mobile hoists can be used for extracting clients from vehicles. This function
would be useful for facilities with emergency departments.
Figure 4.29
Transfer from a vehicle to a wheelchair (Technique 22)
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133
Standard slings
Once the sling size is known, write this in the relevant client notes and
careplan
For most sling types, the lower sling loops should be positioned so they cross
over between the clients legs, which also helps to maintain the clientsdignity
Get the client to put their hands across their chest to reduce the risk of injury
A disposable sling can be used many times with the same client before it is
disposed of
figure 4.32
Fitting of sling so lower loops cross
between clients legs
134
figure 4.31
figure 4.33
Client in sling with loops attached to
hoist sling bar
135
Figure 4.34
Applying a sling using two rolls (Technique 23)
136
137
Figure 4.35
Applying a sling using one roll (Technique 24)
138
139
Figure 4.36
Applying a sling to a client in a chair (Technique 25)
140
4. R
oll client flat on their back and pull through
rolled half of sling
141
Hoist brakes: Do not use the brakes on a mobile hoist at any point in a moving
procedure, as the hoist needs to be able to move as a client is being hoisted,
otherwise it may tip over.
142
143
Figure 4.38
Repositioning client in a chair using a hoist (Technique 27)
144
6. L
ower client and remove sling from hoist bar
and client
145
146
Figure 4.40
Hoisting a client from bed to chair (Technique 29)
1. Lower sling bar above clients chest
147
148
Figure 4.41
Hoisting a client from the floor (Technique 30)
1. Apply the sling to the client
149
2.
3.
See Sturman (2011) and Resuscitation Council (2009) in the references list.
See National Patient Safety Agency, 2011.
Box 4.5
Planning for emergency situations
At Waitemata District Health Board all crash trolleys have slide sheets on them and are
part of the daily checklist to make sure they stay on them. This means in an emergency
situation staff dont have to look for equipment to move patients out of tight spots in order
to resuscitate them and this has been viewed as a positive addition by the staff regularly
attending arrests.
There is an emergency retrieval board in the hydrotherapy pool area and a training DVD has
been made by us to educate staff on how to deal with an arrest in that area. Other areas we
are looking at are birthing pools in maternity and getting people out of vehicles.
Source: Moving and handling coordinator, Waitemata District Health Board
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