A gait belt is a belt, often with handles, used for transferring patients and assisting with ambulation. It is placed around the patient's waist and secured. The handles can be placed in a variety of configurations so the caregiver can have better access to, improved grasp, and control of the patient. Some belts are hand-held slings that go around the patient, providing a firm grasp for the caregiver and facilitating the transfer. The gait belt is used to steady the patient and provide stabilization during pivoting, not to pull the patient up or as a lifting device. Gait belts also allow the nurse to assist in ambulating patients who have leg strength, can cooperate, and require minimal assistance. Do not use gait belts on patients with abdominal or thoracic incisions or chest trauma. Gait belts should also not be used with patients exhibiting behavioral aggression, as the belt might be used as a weapon and for patients at risk for suicide, as the belt might be used for self-harm (Wintersgill, 2019). See Figure A for an example of a gait belt.

Some patients need minimal assistance to stand up. With an appropriate support to grasp, they can lift themselves. Many types of nonpowered standing assist and repositioning devices can provide leverage and help a patient to stand (VHACEOSH, 2016). These devices are freestanding or attach to the bed or wheelchair. One type of stand-assist aid attaches to the bed. Other aids have a pull bar to assist the patient to stand, and then a seat unfolds under the patient. After sitting on the seat, the device can be wheeled to the toilet, chair, shower, or bed. Sliding assists are useful for patients who are cooperative, partially dependent but have some weight-bearing capability, and have upper body mobility and strength sufficient to grip device handles.

Lateral-assist devices reduce patient-surface friction during lateral transfers. Roller boards, slide boards, transfer boards, inflatable mattresses, and friction-reducing, lateral-assist devices are examples of these devices that make transfers safer and more comfortable for the patient. An inflatable lateral-assist device is a flexible mattress that is placed under the patient. An attached, portable air supply inflates the mattress, which provides a layer of air under the patient. This air cushion allows nursing staff to perform the move with much less effort, but may place the care providers at an increased risk of injury because of the horizontal reach required, posture adopted during transfer, and lack of handles. Transfer boards are placed under the patient. They provide a slick surface for the patient during transfers, reducing friction and the force required to move the patient. Transfer boards are made of smooth, rigid, low-friction material, such as coated wood or plastic. In order to use a board for transfers to or from a chair, the chair must have retractable or removable arm rests (Smith et al., 2015). Another lateral-sliding aid is made of a special fabric that reduces friction. Some devices have long handles that reduce reaching by staff, to improve safety and make the transfer easier (Figure B).

Friction-reducing sheets can be used under patients to prevent skin shearing when moving a patient in the bed and to assist with lateral transfers. The use of these sheets when moving the patient up in bed, turning, and repositioning reduces friction and the force required to move the patient. They can also be used to assist patients to perform range-of-motion exercises in bed (Smith et al., 2015). However, use of these sheets may require excessive force and overexertion by the caregiver and increase the risk of musculoskeletal injuries for health care personnel (Battiste-McKinney & Halvorson, 2018; VHACEOSH, 2016).

Mechanical lateral-assist devices eliminate the need to slide the patient manually. Some devices are motorized, and some use a hand crank (Figure C). A portion of the device moves from the stretcher to the bed, sliding under the patient, bridging the bed and stretcher. The device is then returned to the stretcher, effectively moving the patient without pulling by staff members.

Chairs that can convert into stretchers are available. These are useful with patients who have no weight-bearing capacity, cannot follow directions, and/or cannot cooperate. The back of the chair bends back and the leg supports elevate to form a stretcher configuration, eliminating the need for lifting the patient. Some of these chairs have built-in mechanical aids to perform the patient transfer, as detailed above.

Powered stand-assist and repositioning devices can be used with patients who have some weight-bearing ability, can follow directions, and are cooperative. A simple sling is placed around the patient's back and under the arms (see Figure 2 in Skill 9-3). Standing/ambulation vests may be used instead of a sling (Boynton et al., 2020); a vest may provide additional stability and security in the upper body area, distributing pressure over a larger area, often with extra padding at potential pressure areas and/or leg straps (Enos, 2019). Once in the sling or vest, the patient's feet rest on the device's footrest and then the patient places their hands on the handle. The device mechanically assists the patient to stand, without any lifting by the nurse. Once the patient is standing, the device can be wheeled to a chair, the toilet, or bed. Some devices have removable footrests and can be used as a walker. Some have scales incorporated into the device that can be used to weigh the patient. The duration of time spent in slings should be limited to reduce risks for pressure injuries, especially for vulnerable populations (Peterson et al., 2015).

Powered full-body lifts are used with patients who cannot bear any weight to move them out of bed, into and out of a chair, and to a commode or stretcher. A full-body sling is placed under the patient's body, including head and torso, and then the sling is attached to the lift. The device slowly lifts the patient. Some devices can be lowered to the floor to pick up a patient who has fallen. These devices are available on portable bases and ceiling-mounted tracks (see Figure 6 in Skill 9-4). Note: For safe operation, a mobile lifts' wheels must be positioned under the patient, which makes them unsuitable for use with platform beds used typically in psychiatric units (Smith et al., 2015). The duration of time spent in slings should be limited to reduce risks for pressure injuries, especially for vulnerable populations (Peterson et al., 2015).