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. 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. 

INTRODUCTION 

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 lift. 

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. 

METHOD 

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 much
easier. 

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. 

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 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. 
 
REFERENCES:
 
Kozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995,
"Fundamentals of Nursing", 5th Edition, Addison Wesley
Publishing Company Inc., United States of America.
 
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.