Nursing : Lifting, Transferring And Positioning
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.
In addition to 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 nurse's 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.
When lifting, transferring or positioning patients, the most important consideration
is safety. Any of these procedures need to be undertaken with that 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 he/she prefers 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 actions of lifting, transferring or positioning need to be completed for
numerous reasons, including relief of pressure points. If a patient stays in
one position continuously, he/she is prone to develop what is commonly known
as "bed sores" which cause physical discomfort. In addition, 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 his/her self care needs.
This includes their hygiene needs, such as bathing or showering, elimination,
hair, oral and nail care.
When lifting, transferring or positioning patients manually, safety is the
most important factor. This safety is for the nurse him/herself as well as for
the patient. One aspect of safety is for the nurse to utilize "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, giving 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
When lifting clients, the first thing the nurse should do is explain to the
patient what will be happening 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 observing
the patient and reading the nursing care plan. The nurse needs to be aware of
the patient's capabilities to see how much he/she can do or if he/she 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 the current position to where he/she is 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 his/her knees, so that
when the nurse is ready, the patient can assist by pushing backwards.
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 his/her weight onto the back foot while at the same time rolling the
client towards them. The next step is to place one arm underneath the patient's
shoulder 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 onto 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. By using 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. He/she then places the belt around
the client's waist, and stands facing the client with his/her 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 the weight onto the back foot, lifting
the client up to a standing position. The nurse supports the client until a
steady balanced position is achieved. 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 make sure that 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 continues
the procedure in the same way. When transferring the patient from the chair
to the bed, the same procedure is implemented but in reverse. Before the transfer
is started, the nurse should make sure 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.
Although manually lifting patients is effective, it is advisable that the nurse
should lift or transfer with a mechanical lifter. It is especially effective
in reducing the risk of injury to both the client as well as the nurse. This
is supported by Seymour (1995 p.48) who says that, "more nurses are beginning
to realize 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, or 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 that may arise are that the lifter
is broken or unavailable. Therefore, the nurse should be aware of how to correctly
manually lift the client. 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 needs to be taught the correct way of using the lifters.
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). Another problem
with lifting patients manually, is that the correct lifting procedure may not
be carried out, leading 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.
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 that they are able to maximize 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 needs
to be educated on the use of the lifters and regular testing would ensure that
the staff is confident and competent in their use. This may lead to a decrease
in the amount of mismatched clients and nurses in terms of weight.
Kozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995, "Fundamentals of
Nursing", 5th Edition, Addison Wesley Publishing Company Inc., United States
Love, C. 1995, "Managing Manual Handling in Clinical Situations",
Nursing Times, vol. 91, no. 26, pp. 38-39.
Scott, A. 1995, "Improving Patient Moving and Handling Skills", Professional
Nurse, vol. 11, no. 2, pp. 105-110.
Seymour, J. 1995, "Handling Aids - Lifting and Moving Patients",
Nursing Times, vol. 91, no. 27, pp. 48-50.