Limitation of independent movement between two nearby surfaces

Difficulty transferring between bed and chair

Difficulty transferring between bed and standing position

Difficulty transferring between car and chair

Difficulty transferring between chair and floor

Difficulty transferring between chair and standing position

Difficulty transferring between floor and standing position

Difficulty transferring between uneven levels

Difficulty transferring in or out of bathtub

Difficulty transferring in or out of shower stall

Difficulty transferring on or off a bedside commode

Difficulty transferring on or off a toilet

Cognitive dysfunction

Environmental constraints

Impaired postural balance

Inadequate knowledge of transfer techniques

Insufficient muscle strength

Neurobehavioral manifestations

Obesity

Pain

Physical deconditioning

Musculoskeletal impairment

Neuromuscular diseases

Vision disorder

Level 1 Extended Focused Assessment

Refer to assessment under Impaired Physical Mobility.

The individual will demonstrate transfer to and from the wheelchair as evidenced by the following indicators:

• Identifies when assistance is needed.
• Demonstrates ability to transfer in varied situations (e.g., toilet, bed, car, chair, uneven levels).

Level 1 Fundamental Focused Interventions (accompanied by an experienced nurse)

Consult with and Refer to a Physical Therapist to Evaluate the Individual's Ability to Transfer

• Consider weight, strength, movement ability, tolerance to position changes, balance, motivation, and cognition.
• Use manual transfer or device-assisted lift.
• Consider ratio of staff to individuals.

Proceed with Established Plan to Transfer

• Before transferring, assess the number of personnel needed for assistance.
• The individual should transfer toward the unaffected side.
• Position on the side of the bed. His or her feet should be touching the floor, and he or she should be wearing stable shoes or slippers with nonskid soles.
• For getting in and out of bed, encourage weight-bearing on the uninvolved or stronger side.
• Lock the wheelchair before the transfer. If using a regular chair, be sure it will not move.
• Instruct to use the arm of the chair closer to him/her for support while standing.
• Use a gait belt (preferred) or place your arm around the person's rib cage and keep the back straight, with knees slightly bent.
• Tell the person to place his/her arms around your waist or rib cage, not the neck.
• Support legs by bracing theirs with yours. (While facing them, lock their knees with your knees.)
• Instruct those with hemiplegia to pivot on the uninvolved foot.

For an Individual with Lower Limb Weakness or Paralysis, a Sliding Board Transfer May Be Used

• The individual should wear pajamas so he or she will not stick to the board.
• The individual needs good upper extremity strength to be able to slide the buttocks from the bed to the chair or wheelchair. (Wheelchairs should have removable arms.)
• When the individual's arms are strong enough, he or she should progress to a sitting transfer without the board if he or she can lift their buttocks enough to clear the bed and chair seat.
• If their legs give out, guide him or her gently to the floor and seek additional assistance.
• Consult and refer individual and family to home health nurses for a home evaluation and to access resources for discharge.