Using Safe and Effective Transfer Techniques - Activity and Exercise

Question 1

Safe Patient Handling

Nurses are exposed to the hazards related to lifting and transferring patients in many settings, such as inpatient nursing units, long-term care facilities, and the operating room.

In most health care facilities, quality improvement programs and ___-___ policies have been implemented.

(Astle & Duggleby, 2024, p. 840)

Answer 1

no-lift

(Astle & Duggleby, 2024, p. 840)

Question 2

Safe Patient Handling

___ lifting and transferring patients contributes to the high incidence of work-related musculoskeletal and back injuries in nurses and members of the health care team.

(Gomaa etal., 2020 as cited in Astle & Duggleby, 2024, p. 840)

Answer 2

Manually

(Gomaa etal., 2020 as cited in Astle & Duggleby, 2024, p. 840)

Question 3

Safe Patient Handling

Implementing evidence-informed interventions and ___ training programs can reduce the number of work-related injuries, which improves the health of the nurse and reduces indirect costs to the health care system.

(Lee etal., 2021 as cited in Astle & Duggleby, 2024, p. 840)

Answer 3

ergonomics

(Lee etal., 2021 as cited in Astle & Duggleby, 2024, p. 840)

Question 4

Safe Patient Handling

Many provinces have implemented occupational health and safety legislation regarding lifting and moving loads.

For instance, in Alberta the law requires that employers provide equipment and training and that employees use that equipment and training (___ Health and Safety Act Alberta).

(Government of Alberta, 2020 as cited in Astle & Duggleby, 2024, p. 840)

Answer 4

Occupational

(Government of Alberta, 2020 as cited in Astle & Duggleby, 2024, p. 840)

Question 5

Safe Patient Handling

Health boards are implementing comprehensive safe ___-___ programs in all parts of Canada.

(Astle & Duggleby, 2024, p. 840)

Answer 5

patient-handling

(Astle & Duggleby, 2024, p. 840)

Question 6

Safe Patient Handling

Comprehensive safe patient-handling programs include the following elements:

• An ___ assessment protocol for health care environments
• Patient assessment criteria and algorithms for safe patient handling and movement
• Special equipment kept in convenient locations to help transfer patients
• Back-injury prevention and treatment resources for nurses
• An “___-___” review that allows the health care team to apply knowledge about moving patients safely in different settings
• A ___-___ policy

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 840]

Answer 6

ergonomics

after-action

no-lift

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 840]

Question 7

Safe Patient Handling

It is the responsibility of the nurse not only to implement existing safe handling policies within the workplace but also to ___ for enhancements to safety.

This includes identifying unsafe situations, such as broken equipment or the improper techniques of others.

It involves reviewing literature and government policy to remain current on best practices.

(Astle & Duggleby, 2024, p. 840)

Answer 7

advocate

(Astle & Duggleby, 2024, p. 840)

Question 8

Safe Patient Handling

Nurses need to assume an active role in their workplaces to ensure that a culture of safety exists and that appropriate ___-___ equipment is readily available for use.

The nurse must advocate for change within the workplace when safer options exist, for the benefit of all staff and patients.

(Lee etal., 2021; Roy etal., 2021 as cited in Astle & Duggleby, 2024, p. 840)

Answer 8

patient-handling

(Lee etal., 2021; Roy etal., 2021)

Question 9

Safe Patient Handling

Nurses often provide care for immobilized patients whose position must be changed, who must be moved up in bed, or who must be transferred from a bed to a chair or from a bed to a stretcher.

___ ___ alone do not protect nurses from injury to their musculoskeletal systems when they move or transfer patients.

(Astle & Duggleby, 2024, p. 840)

Answer 9

Body mechanics

(Astle & Duggleby, 2024, p. 840)

Question 10

Safe Patient Handling

Although nurses use many transfer techniques, knowledge of ___ and safe ___ ___ is crucial in maintaining caregiver and patient safety.

(Astle & Duggleby, 2024, p. 840)

Answer 10

ergonomics

patient handling

(Astle & Duggleby, 2024, p. 840)

Question 11

Safe Patient Handling

___ is an applied science concerned with designing and arranging workplace settings in such a way that people interact more effectively with the objects they encounter in that environment.

(Astle & Duggleby, 2024, p. 840)

Answer 11

Ergonomics

(Astle & Duggleby, 2024, p. 840)

Question 12

Safe Patient Handling

Nurses must assess every situation that involves patient handling and movement, to minimize risk of injury.

After completing the assessment, the nurse will use an ___ to guide decisions about safe patient handling.

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 840]

Answer 12

algorithm

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 840]

Question 13

Safe Patient Handling

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 841]

Answer 13

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 841]

Question 14

Safe Patient Handling

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 841]

Answer 14

[Veterans Health Administration (VHA), 2014 as cited in Astle & Duggleby, 2024, p. 841]

Question 15

Safe Patient Handling

When transferring a patient, it is helpful to encourage (minimum/maximum) patient involvement.

(Astle & Duggleby, 2024, p. 840)

Answer 15

maximum

(Astle & Duggleby, 2024, p. 840)

Question 16

Safe Patient Handling

The nurse should use a patient’s ___ when lifting, transferring, or moving, when possible.

Involving the patient has the additional benefit of increasing participation in self-care and can promote a sense of accomplishment.

(Astle & Duggleby, 2024, p. 840)

Answer 16

strength

(Astle & Duggleby, 2024, p. 840)

Question 17

Delegation Considerations - Using Safe and Effective Transfer Techniques

The skill of effective transfer techniques can be delegated to ___ ___ ___ (___).

Patients who are transferred for the first time after prolonged ___ ___, extensive surgery, critical illness, or ___ ___ trauma usually require supervision by the nurse.

(Astle & Duggleby, 2024, p. 840)

Answer 17

unregulated care providers (UCP)

bed rest, spinal cord

(Astle & Duggleby, 2024, p. 840)

Question 18

Delegation Considerations - Using Safe and Effective Transfer Techniques

Instruct the unregulated care provider (UCP) about:

• Seeking assistance when moving or transferring a patient (e.g., when the patient is ___, ___, or ___)
• Patient limitations (e.g., changes in ___ ___, mobility restrictions) that affect safe transfer techniques

(Astle & Duggleby, 2024, p. 840)

Answer 18

overweight, medicated, confused

blood pressure

(Astle & Duggleby, 2024, p. 840)

Question 19

Equipment - Using Safe and Effective Transfer Techniques

• Transfer belt, sling, or lapboard (as needed)
• ___ shoes, transfer sheets, and pillows
• Wheelchair (position chair at a ___- to ___-degree angle to the bed, ___ brakes, remove ___, and ___ bed brakes)
• Stretcher (position next to bed, ___ brakes on stretcher, ___ brakes on bed)
• Mechanical/hydraulic lift (use frame, canvas strips or chains, and hammock or canvas strips)
• Stand-assist lift device

(Astle & Duggleby, 2024, p. 840)

Answer 19

Nonskid

45, 60, lock, footrests, lock

lock x 2

(Astle & Duggleby, 2024, p. 840)

Question 20

Assessment - Using Safe and Effective Transfer Techniques

Arrange the assessment steps for using safe and effective transfer techniques in the correct order:

1. Assess patient’s specific risk of falling or being injured when transferred (e.g., neuromuscular deficits, motor weakness, calcium loss from bones, cognitive and visual dysfunction, altered balance).
2. Assess activity tolerance, noting fatigue during activity.
3. Assess special transfer equipment needed for home setting and previous mode of transfer (if applicable).
4. Identify patient using two identifiers (e.g., name and birthday or name and medical record number) according to employer policy. Explain procedure.
5. Assess sensory status, including central and peripheral vision, adequacy of hearing, and presence of peripheral sensation loss.

CRITICAL DECISION POINT:patients with hemiplegia also often “neglect” one side of the body (inattention to or unawareness of one side of body or environment), which distorts perception of the visual field. If patient experiences neglect of one side, instruct them to scan all visual fields when transferring.

6. Assess level of comfort (e.g., joint discomfort, muscle spasm) and measure level of pain on a 0–10 scale. Offer prescribed analgesic 30 minutes before transfer.
7. Assess vital signs.
8. Assess patient’s level of motivation, such as eagerness versus unwillingness to be mobile and perception of value of exercise.
9. Assess patient’s specific risk for falling or being injured during transfer (e.g., neuromuscular deficits, visual loss, motor weakness, fear of falling, or bone loss).
10. Assess proprioceptive function (awareness of posture and equilibrium), including ability to maintain balance while sitting in bed or on side of bed and tendency to sway toward one side.
11. Assess for weakness, dizziness, or orthostatic (postural) hypotension or risk for orthostatic hypotension (e.g., previously on bed rest, first time arising from supine position following surgical procedure, history of dizziness when arising).
12. Assess patient’s cognitive status, including ability to follow verbal instructions, short-term memory, and recognition of physical deficits and limitations to movement.
13. Assess the patient’s physiological capacity to transfer.

A) Joint mobility (range of motion [ROM]) and contracture formation
B) Bone continuity
C) Paralysis or paresis (spastic or flaccid)
D) Muscle strength (legs and upper arms)

14. Assess patient using employer algorithm to determine plan for safe patient handling and transfer.

CRITICAL DECISION POINT:patients with head trauma or cerebrovascular accident may have perceptual cognitive deficits that create safety risks. If the patient has difficulty comprehending, simplify instructions by providing one step at a time and maintain consistency.

15. Assess previous mode of transfer or currently assigned movement algorithm (if available).

(Astle & Duggleby, 2024, pp. 842, 843)

Answer 20

4.

13. D, A, C, B

11.

2.

5.

7.

12.

8.

1.

15.

9.

3.

14.

(Astle & Duggleby, 2024, pp. 842, 843)

Question 21

1. Identify patient using two identifiers (e.g., name and birthday or name and medical record number) according to employer policy. Explain procedure.
2. Assess the patient’s physiological capacity to transfer.

A) Muscle strength (legs and upper arms)
B) Joint mobility (range of motion [ROM]) and contracture formation
C) Paralysis or paresis (spastic or flaccid)
D) Bone continuity

3. Assess for weakness, dizziness, or orthostatic (postural) hypotension or risk for orthostatic hypotension (e.g., previously on bed rest, first time arising from supine position following surgical procedure, history of dizziness when arising).
4. Assess activity tolerance, noting fatigue during activity.
5. Assess proprioceptive function (awareness of posture and equilibrium), including ability to maintain balance while sitting in bed or on side of bed and tendency to sway toward one side.
6. Assess sensory status, including central and peripheral vision, adequacy of hearing, and presence of peripheral sensation loss.

CRITICAL DECISION POINT:patients with hemiplegia also often “neglect” one side of the body (inattention to or unawareness of one side of body or environment), which distorts perception of the visual field. If patient experiences neglect of one side, instruct them to scan all visual fields when transferring.

7. Assess level of comfort (e.g., joint discomfort, muscle spasm) and measure level of pain on a 0–10 scale. Offer prescribed analgesic 30 minutes before transfer.
8. Assess vital signs.
9. Assess patient’s cognitive status, including ability to follow verbal instructions, short-term memory, and recognition of physical deficits and limitations to movement.

CRITICAL DECISION POINT:patients with head trauma or cerebrovascular accident may have perceptual cognitive deficits that create safety risks. If the patient has difficulty comprehending, simplify instructions by providing one step at a time and maintain consistency.

10. Assess patient’s level of motivation, such as eagerness versus unwillingness to be mobile and perception of value of exercise.
11. Assess patient’s specific risk for falling or being injured during transfer (e.g., neuromuscular deficits, visual loss, motor weakness, fear of falling, or bone loss).
12. Assess previous mode of transfer or currently assigned movement algorithm (if available).
13. Assess patient’s specific risk of falling or being injured when transferred (e.g., neuromuscular deficits, motor weakness, calcium loss from bones, cognitive and visual dysfunction, altered balance).
14. Assess special transfer equipment needed for home setting and previous mode of transfer (if applicable).
15. Assess patient using employer algorithm to determine plan for safe patient handling and transfer.