Small but mighty

A while ago something happened which I never thought would (and yes, I just got around to writing about it). After I transferred  a max-total assist patient (meaning this patient is pretty close to dead weight) to a chair, about twenty minutes later I got called back to the floor to transfer said patient back to the bed. Transferring to a chair is easier than transferring back to bed for reasons I’ll describe below, but the reason this is almost miraculous is because I’m not exactly the strongest looking person. In fact, many patients actually make statements like “are you sure you can lift me? You don’t look that strong.” I tolerate such comments. I may not be as strong as Jillian Michaels and am nothing close to looking like her, but I am smart in a way at which therapists excel-  in setting up transfers.

As I said before, it’s easier to transfer from a bed to a chair, for several reasons:

– You can raise the height of the bed

-You can maximally inflate the bed to add extra height to the mattress

-You can pull up bed rails for the patient to hold on to during the sit/stand transition

When you do all of this or any of it as you need, the less you need to actually lift your patient into a standing or squat position. You can essentially raise the height of the bed so high that your patient kind of slides off into a stand. However, this is only necessary for two reasons: 1. your patient is really tall, and 2. your patient has no leg or abdominal strength whatsoever. If you are working with the latter case, it is important to be close to your patient for safety. When I have to do a max transfer with that much assist, I never use a walker- there is too much difference between me and the patient for me to have a good hold on him/her.

Here are some other transferring techniques I’ve picked up on that make me small but mighty:

-When I sit up a patient at the edge of the bed who doesn’t have good trunk control and needs a lot of assist to stay balanced, I tend to deflate the mattress by pulling out the cords even before I begin the bed mobility. Chances are, we won’t get to standing up anyway- and if we do, I can easily re-inflate the bed to make standing easier by plugging the cords back in. I’ve just been in a couple sticky situations where the patient has started sliding off the bed if it remains inflated, and I’ve had to call for help to get the patient back in- but if people don’t come in time to help you, there’s only so much you can do by physically placing your body in front of the patient to keep them from completely sliding off.

– As I said above, in trying to set up a max assist supine to sit transition, I always get help because I don’t have the same leverage to pull up at the trunk as some of my taller co-workers. However, as the therapist I am still mainly responsible for setting up the transfer, so I usually swing the patient’s legs over the edge of the bed and use the sheets/chuck to pull up on the patient’s trunk (instead of pulling at their arms) and have someone push from behind the patient as I pull. It is so much easier to pull up on the sheet than even pull up behind the scapula.

– Sometimes bed mobility with a patient who has just undergone a shoulder arthroplasty is really difficult, not because of the lack of trunk control but because the patient can’t assist enough with just one upper extremity being functional. In those situations, I’ve always found it really helpful to actually go towards the affected side, so that the patient may reach across with their functional arm and help pull up in to sitting that way. They won’t have to worry about this at home because we always prefer they sleep in a recliner until healed.

– Speaking of going to the affected side, I actually always go to the affected side- it is less distance to move the painful or paralytic extremity.

-Always put pillows down on the chair seat if the patient is really tall, has hip precautions, or has less trunk control/weak legs- it will give you some leverage to help get the patient up out of the chair, since it is a lower surface.

Everyone has their own techniques that work for their own reasons, but I just thought I would share some of my experiences to make the inpatient experience less intimidating.

So what happened to the patient I had to help transfer back?  Well, I guess I shouldn’t have put her in a chair anyway, because she doesn’t bear any weight on her legs. So I had to get to other people to help me squat-pivot her onto the bed, and deflate the bed before I did that. Moral of the story: before you transfer your patient anywhere, make sure that  the following people can handle it: 1.) patient themselves, 2.) you, 3.) the staff who has to transfer the patient back.

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