CNA - Safely Moving Residents - Lifting and Transferring (0.5)

  https://www.youtube.com/watch?embeds_referring_euri=https%3A%2F%2Fwww.snfclinic.com%2F&source_ve_path=Mjg2NjQsMTY0NTA0LDE2NDUwNg&feature=emb_share&v=2gQ_vKJE7yU

CNAs are on their feet all day, lifting and transferring heavy equipment and patients. It's easy to take for granted the danger of improper posture and mechanics in potential injuries. The CNA must be well educated on body mechanics, mechanical lifts, and teamwork to protect themselves and prevent injury to make their job easier and safer.

Good lifting and transferring habits are the best way to protect oneself from a serious back, shoulder, or neck injury. Following your facility's policies will help you protect your back and ensure you work smarter, not harder.

Here are some general lifting and transferring tips to help keep you and your residents safe, which is the most important consideration:

    Plan the move out well and make sure the area is cleared.
    Find out how the resident prefers to be moved, and always make sure to tell them what you are planning to do
    Your weight adds force to pushing, so it's always easier than pulling.
    When you lift or move an object or resident, always face it/them directly.
    The feet should be shoulder-width apart, providing a wide base of support when you lift or move.
    Determine the correct equipment or supplies needed for the move/lift and make sure to have it ready and use it as needed.
    To minimize the effect of a lifted weight on your body, hold the person or object close to you, not at arm's length.
    Use teamwork by asking your teammates for help and talking with them about what you do as you plan and while doing it.
    Moving people or things all at once is much harder than using repeated, small movements. For example, move a person in sections by moving the upper trunk first and then the legs.

·    One of the leading causes of injury during lifting or moving is twisting. Move your torso as one unit and never twist when lifting, transferring or reaching. Pivot your whole body toward the move by picking your feet up.

·         Always maintain correct posture:

o   Less stress is put on your back when bending your knees slightly while lifting. It will put stress on your legs.

o   Knees bent and back straight is the correct posture!

o   If you must bend from the waist, engage your core and tighten your stomach muscles while bending and lifting to help support your back.

Working smarter, not harder, can also include the use of assistive devices to aid us in moving and lifting residents and objects:

    Use the resident's bed as an assistive device. Raise and lower the height as needed to make the position safe for you, the resident, and your teammates. Utilizing rails temporarily for a resident's "handhold" can also help residents assist in their movement.
    Transfers can also be a time when a resident's skin can inadvertently be sheared or torn. Using a slide board can help reduce friction and allows the resident to move from the bed to another surface more easily
    A heavy canvas gait belt placed around a resident's waist is a good tool to assist in moving residents that provides a solid grip for the staff and avoids injury to resident's limbs
    Draw or lift sheets make it easier to move patients in bed. They may interfere with skin-protecting mattresses and shouldn't be left under the resident. Turn the resident to one side to place a draw/lift sheet. Roll half of the sheet up and place it against the resident, smoothing the side closest to the bed. Roll the resident over the roll, back to the other side, and smooth out the sheet. If the resident cannot manage or lift their own head or neck, be sure that the sheet extends high enough to support the head fully while still supporting the hips.
    Residents with upper-body mobility and strength may benefit from a trapeze above their bed, allowing them to lift and assist you in their movement.
    Mechanical lifts and hoists are also very valuable in lifting a heavy resident or one who has fallen to the floor to avoid injuries. Make sure you have completed all training on the appropriate and safe use of the devices in your facility before using them. Use your teammates to assist with these transfers.

Many transfers in our environment involve transferring from the bed to a chair or wheelchair.  Here are safety tips for this type of transfer

    As always, think through the lift and plan the job before beginning to execute it.
    Make sure the bed is in a low and locked position so it will not move.
    If transferring to a chair, place it slightly to the side of the bed.
    If transferring to a wheelchair, remove the footrests, fold up the foot pedals, and ensure the brakes on both wheels are locked.
    Put non-slip footwear on the resident.
    Move the resident to the edge of the bed in stages by first moving the upper trunk and then the legs one at a time and place the resident's legs over the side of the bed.
    Raise the resident to a sitting position on the side of the bed by placing your arms around them and circling their back.
    At this point, a gait belt is recommended.  Place it around the resident's waist.
    Assist the resident in moving forward until their feet are flat on the floor. This can be done by sliding or "walking" them forward. Grasping both legs under the knees, swinging them gently back and forth, and moving the buttocks forward is called "walking."
    Using a wide stance for good support, place your feet on both sides of the resident's feet.
    Do not have the resident put their arms around your neck. This is likely to injure you. Instead, ask the resident to slightly lean forward and place their arms around your shoulders if they can do so.
    Keep your back straight, bend at the hip and knee and allow the resident to reach for the far chair arm.
    Avoid injuring the resident by NOT holding them under the arms. Instead, place your arms around their waist, or grasp the gait belt at the sides of the back with both hands.
    Stabilize the resident's knees by holding your knees against theirs.
    Straighten your hips and knees while pulling the resident up as you both stand, keeping the resident close to your body and your hips and knees slightly bent.
    When the resident is high enough to clear the armrest or chair surface, keep their knees blocked with your own and turn them toward the chair seat by taking small steps together. Once turned, squat by bending your hips and knees to lower the resident to the seat.
    If transferred to a wheelchair, replace the footrests and adjust the pedals, so the resident's hips and knees are at a 90-degree angle. If transferred to a chair, make sure the resident can maintain their feet flat on the floor to avoid sliding.
    Follow the same principles to return the resident to their bed.

Safely repositioning resident in a chair:

    If the resident is in a wheelchair, ensure the brakes are engaged.
    Have the resident fold their arms across their chest.
    Stand behind the chair and wrap your arms around the resident while bending your knees. Fold your arms just under the resident in front, hugging their torso securely.
    Lift the resident's torso up and back in the chair while straightening your legs.

Utilize these safety methods when pulling a resident up in bed:

    Always get help. This seems an easy maneuver but is one that often injures the staff or resident.
    Remove the resident's pillow and place it between their head and the headboard. Place a draw sheet or lift pad under the resident.
    Raise the bed to a height comfortable for you and your teammate
    On either side of the bed, both you and your teammate should bend your knees and push with your feet while grasping the draw or lift sheet firmly, close to the resident's body
    If the resident can, ask them to hold their head up, chin to chest. If they are unable, ensure that the lift sheet supports their head.
    Have the resident assist by pushing backward by bending their knees while you and your teammate lean in the direction you want to move the resident's body.
    Simultaneously on the count of three, have the resident push with their heels while you and your teammate lift the draw or lift the sheet and pull the resident up.

In addition, turning the resident from side to side when in bed should also not be taken for granted as a simple movement.

    Raise the bed to waist height and while standing at one side, place your arms under the resident's shoulders or hips and grasp the draw or lift sheet.
    Moving trunk first and then legs, pull the resident to the edge of the bed and cross the resident's closest leg over the other leg.
    Lean in toward the resident, place your hands on their shoulder and hip, and push the resident's torso away from you.
    Place the top leg in front of the bottom leg.
    Make sure the resident is supported along their hips, back, and shoulders with pillows or bolsters. The resident may also benefit from a pillow between their legs to support the top leg but be sure to adjust for comfort.

Often we have to assist in transferring residents in and out of a car for appointments or discharge.  Here are safety tips to assist you:

    Make sure the front seat of the car is back as far as possible, and the wheelchair is positioned at a 90-degree angle to the seat.
    Using a wide stance for good support, place your feet on both sides of the resident's feet.
    Do not have the resident put their arms around your neck. This is likely to injure you. Instead, ask the resident to slightly lean forward and place their arms around your shoulders if they can do so.
    Keep your back straight, bend at the hip and knee in a squat and grasp the person's upper back. Do not pull under the arms.
    Move your feet to turn, being sure not to twist. Straighten your legs and hips slightly while lifting the resident's torso into the car and placing their buttocks on the seat.
    Before lifting the resident's legs in, ensure their buttocks are back as far as possible toward the driver's side to avoid sliding out.

You may find a resident on the floor.  Perhaps they just slipped to the floor, or perhaps they fell.  Here are some key safety tips for assisting a resident on the floor:

    Make sure to follow all facility policies for falls before assisting the resident up, such as a witnessed lowering to the floor vs. a resident found on the floor with a potential fall-related injury.
    If the resident is not seriously injured, they may be able to assist in getting up, but you should ALWAYS enlist a teammate to help you.
    Enlist as many people as necessary to execute the lift safely. This may be 4 to 6 people or require a mechanical lift.
    Once the resident is cleared for movement, roll them onto a lift sheet or blanket
    With two or more people on each side, get a secure hold on the blanket and have everyone kneel beside the resident. On the count of three, everyone should stand up, lifting the resident to the bed or stretcher.
    Be sure to complete any documentation required by facility policies related to the resident's fall.

Avoiding staff injuries is always the best choice, and the best way to avoid injury is to make sure to:

    Fully understand the task at hand. What or who are we lifting, what is its weight, do I need help to do this, should I use a mechanical lift for this? Can the resident help at all? Is there a potential they are injured?
    Take care of yourself by not getting in a hurry, attempting something you shouldn't because "it's easier to do by myself than wait on someone to help me," or "it takes too long to get the lift on the other unit," etc.  Your employer wants you to be as safe and healthy as you do, and following these safety tips will help you stay that way.