Target: preparation for transporting the patient
(performed by two people, the patient can help )
Equipment:
wheel chair,
skin antiseptic
gloves
functional bed
Preparation for the procedure:
establish a trusting relationship, explain the procedure to the patient, make sure that he understands it and obtain consent to perform it.
Assess the patient's condition and environment. Set the bed brakes. Place the wheelchair at the patient's feet. If possible, lower the bed to the level of the chair
Execution sequence:
One nurse stands behind the wheelchair and tilts it forward so that the footrest touches the floor.
The second nurse (assistant) stands opposite the patient sitting on the bed
with legs down, the sister’s legs are spaced 30 cm wide, knees bent.
Ask the patient to grab the nurse by the waist and hold him by the shoulders.
Pull the patient to the edge of the bed so that his feet (with non-slip shoes) touch the floor
Place one leg between the patient's knees, the other in the direction of movement.
Hold the patient in a “hug” position, gently lift him without jerking or turning. Do not put pressure on the patient's armpits!
Warn him that on the count of three you will help him get up.
While counting, swing slightly with it. On the count of three, stand the patient, turn with him until he is in a position with his back to the wheelchair. Ask the patient to alert you when he touches the edge of the gurney.
Lower the patient into the wheelchair; bending your knees, hold the patient’s knees with them;
keep your back straight. The patient may be able to help by placing his hands on the armrests of the wheelchair.
Release the patient, making sure he is securely seated in the chair.
Place the patient comfortably in the chair.:
If it is necessary to transport the patient, remove the brake.
Completing the procedure
Make sure the patient is sitting comfortably 
Wash and dry your hands
b
Target: Transferring the patient from the “sitting on the bed with legs down” position to a wheelchair.
4.3 Transferring the patient from the bed to a chair (wheelchair) using the “shoulder lift” method )
moving a patient unable to provide assistance:
wheelchair or chair, skin antiseptic, gloves, functional bed
Preparation for the procedure:
Explain the procedure to the patient, make sure he understands it and obtain consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Place a chair next to the bed.
Execution sequence:
Help the patient sit closer to the edge of the bed with his legs dangling.
Stand on either side of the patient, facing him. Both sisters place their hands under his hips and hold each other in a “wrist grip” (see Figure 2.10), supporting his hips.
Both nurses place their shoulders under the patient's shoulders, and he places his hands on the backs of the sisters. Bend your free arm at the elbow, resting it on the bed.
Legs apart, knees bent.
One of the sisters gives the command. On the count of three, both straighten their knees and elbows, stand up and lift the patient. Support the patient's back with your free hand while you carry him to a chair (wheelchair).
Place the patient comfortably in the chair.:
Each nurse places a supporting hand on the armrest or seat of the chair and lowers the patient onto the chair, bending the knees and elbow.
Completing the procedure
Make sure you lower the patient into the chair at the same time. The chair should not tilt back: one of the sisters holds the back of the chair.
Make sure the patient is sitting comfortably
Transferring the patient from bed to chair
(wheelchair) using the shoulder lift method
(Fig. 2-33)
Used when moving the patient if he can participate in it and control the position of his head and hands; the need to move the patient at a 90° angle from a chair to a wheelchair or other seat.
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it.
Assess your surroundings. Move both seats together, fixing the brakes and removing the side bars of the chairs.
Stand facing the patient.
Place your feet shoulder-width apart, hold the patient's feet with one foot, and the chair leg with the other.
Ask the patient to lean forward so that his shoulder rests against the nurse's chest.
Move the patient to the edge of the chair, rocking it from side to side and moving the legs forward. The patient's knees are at an angle of 90°. Knees and feet together.
Place one leg next to the patient and support his knees with the other.
Moving the patient from the “sitting on a chair” position to the “lying on the bed” position (performed by one nurse) (Fig. 2-34)
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it.
Restrain the patient using one of the methods known to you (see Fig. 2-10).
Warn the patient that on the count of three you will help him stand up.
Rice. 2-34. Moving the patient from a sitting position on a chair to a lying position on a bed
Counting to three, swing.
On the count of three, stand the patient, then turn with him, foot to foot, until his hips touch the edge of the bed.
Place the patient on the bed. Stand on the side facing him. Spread your legs 30 cm wide. Bend your knees. Keep your back straight!
Place your hand under your knees, grab them from above, and with your other hand grab the patient’s shoulders.
Raise the patient's legs onto the bed, turning his torso 90°, and lower his head onto the pillow.
Cover the patient and make sure he is lying comfortably.
Transferring a patient from a bed (bed with variable height) to a gurney and back (performed by four people) (Fig. 2-35)
After the operation, the patient remains in a state of anesthesia or consciousness for some time, but experiences pain. When starting to move onto a gurney (bed), you need to know in which area the operation was performed, as well as other restrictions.
During the transfer, visitors are asked to temporarily leave the room. You need to ask someone to hold the IV, drainage tubes and other devices.
You and your assistant stand on one side, the other two sisters on the other side of the bed. Secure the brakes.
Place the gurney on the side of the bed where you will be moving the patient. It is necessary to leave space to be able to stand between the bed and the gurney.
Cover the patient with a sheet or blanket.
Tell him to hold the sheet or blanket with his hands while you roll the sheet up at his feet.
Rice. 2-35. Transferring a patient from bed to gurney and back
Move the patient to the edge of the bed.
Unfold the sheet and leave it on the mattress (without tucking it in). Wrap the top sheet around the patient, tucking the ends under it. Stand close to the bed to prevent the patient from falling. Note. The head of the bed is in a horizontal position. Two nurses stand on the opposite side of the wheelchair and hold the patient; two other assistants move the gurney to the edge of the bed.
Note. Make sure the gurney is level with the bed. Do not leave space between the bed and the gurney. Check that the sheet is on the mattress.
Secure the brakes on the gurney.
Roll the sheet into a roll and hold it on all sides in your hands, palms up.
Two sisters kneel on the free part of the bed (after placing the protector).
On the count of “three” (the leader gives the command), all four lift the sheet and transfer the patient to the gurney along with the sheet.
Make sure the patient is lying in the middle.
Note. If the gurney is equipped with belts, secure the patient with them.
Transport the patient to the destination: one nurse is at the head of the bed, the other is at the patient’s feet.
When moving a patient from a gurney to a bed.
Place the gurney close to the bed, secure the brakes, and release the edges of the sheet on the gurney.
Two assistants kneel on the bed with the protector down.
All the sisters fold the edges of the sheet towards the center.
On the count of “three” (the leader gives the command), everyone lifts the sheet, holding it by the edges with their palms up, and moves the patient to the edge of the bed.
The nurses, kneeling on the bed, go down to the floor and hold the patient while others move the gurney.
Move the patient, tuck the sheet under the mattress and straighten it.
If necessary, place a small pillow under your head. If the patient experiences pain when moving, or the bandage gets wet, or there is blood in the drainage tubes, report to the doctor.
Transferring a patient from a regular bed to a gurney (and vice versa) is performed by three people (Fig. 2-36)
Place the gurney at an angle of at least 60° at the edge of the bed (at the feet).
Secure the brakes on the gurney and bed.
Everyone stand along the bed:
The strongest (physically) sister is in the center;
Place one leg forward, bending the knee, and put the other back.
Place your arms (up to the elbow) under the patient:
The sister at the head raises her head, supports her shoulders and top part backs;
The sister in the center supports the lower back and buttocks;
The nurse standing at the patient's feet supports the legs. Note. If the patient is very sick, more will be needed.
people and will have to redistribute the load.
Rice. 2-36. Transferring a patient from a regular bed to a gurney and back
Lifting the patient:
At the leader’s command “three”, transfer your body weight to the leg placed back;
Smoothly pull the patient to the edge of the bed;
To have a break;
On new team“three” roll the patient onto you, press him and lift him, straightening his knees and straightening his back (do not hold the patient on outstretched arms!).
Move backward to face the gurney:
The nurse holding the patient's legs takes wider steps;
The nurse holding the patient's head, shoulders and back is less wide, turning to face the gurney.
Move forward (towards the gurney).
On the count of three, bend your knees and carefully lower the patient onto the gurney.
Turning the patient onto his side using a pad and placing him in this position (performed by two people) (Fig. 2-37)
Usage
Explain the process of the upcoming procedure, make sure that the patient understands it, and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Have your assistant stand on the opposite side of the bed from you.
Lower the side rails (or one of them if the procedure is performed without an assistant).
Ask the patient to raise his head (if possible) or elevate his head and shoulders, remove the pillow.
Place a pillow against the head of the bed.
Make sure the patient is lying horizontally on the edge of the bed.
Ask the patient to cross his arms over his chest.
If you turn him over on his right side, he should put his left leg on his right.
Help him if necessary.
Stand on the side of the bed where you turn him over.
Rice. 2-37. Turning the patient on his side using a diaper
Place a protector next to the patient.
Stand closer to the bed, place your knee on the protector, the other leg serves as a support.
Place your hand on the patient’s shoulder, which is further from the nurse, and the other on the corresponding thigh, i.e. if the patient turns over on his right side, place your left hand on his left shoulder and your right hand on his left thigh.
Your assistant should pull the edge of the diaper out from under the mattress and roll it close to the patient’s body, then take the rolled end of the diaper with your palms up and, resting your feet, turn the patient on his side on the count of three.
You turn the patient towards you, placing your weight on the leg that is on the floor.
Help the patient raise his head and place a pillow. Note. Further actions depend on the purpose of the turn.
For example, in case placements:
Turn the patient so that he is not lying on his arm;
Place a folded blanket under your back for stability;
Place a pillow under the arm lying on top;
Bend the leg lying on top at the knee and place a pillow between the knees;
Straighten the lining diaper;
Raise the side rails;
Make sure the patient feels comfortable.
Turning the patient onto his side using the “joint log rolling” method and placing him in this position (performed by two people) (Fig. 2-38)
Usage when changing linen; placement in a lateral position; a preliminary stage for other movements.
Assess the patient's condition and environment. Set the bed brakes.
Ask your assistant to stand next to you.
Remove the pillow from under your head and place it at the head of the bed.
Place your hands under the patient's head and shoulders.
Tell your assistant to place his hands under the patient's hips.
Rice. 2-38. Turning the patient onto his side using the joint log rolling method
Place one foot slightly in front of the other, swing back on the count of three, shift your body weight onto the back leg, and move the patient to the edge of the bed.
Lower the bed so that one of the sister's knees is on the bed (on the protector), and the other leg is firmly on the floor.
Together with an assistant, move to the other side of the bed. Place a pillow between the patient's legs and cross his arms over his chest.
Both sisters place the protectors on the edge of the bed and place one knee on the protector.
Place one hand on the patient's shoulder, the other on the patient's pelvis, and ask the assistant to place their hands on the patient's thighs and legs.
On the count of three, turn the patient to face you, keeping his head, back and legs in line.
Bend your upper leg slightly.
Make sure the pillow remains between the patient's legs.
Place the support at the sole of the foot lying underneath.
Be sure to place a pillow under the patient's back to maintain this position.
Also place a pillow under your upper arm.
If possible, place a small pillow under the patient's head.
Cover him.
Raise the side rails.
Make sure the patient feels comfortable.
Turn the patient and place him in the lateral position. Performed on a bed with variable height (performed by one nurse, the patient can help) (Fig. 2-39)
Use when forced or passive position; risk of developing bedsores, changing position.
Prepare: extra pillow, footrest, sandbag.
Explain to the patient the process of the upcoming procedure, make sure that he understands it, and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Rice. 2-39. Turning the patient over and placing him on his side
Fully (if possible) lower the head of the bed; the patient should lie horizontally. Lower the bed to mid-thigh level.
Move the patient closer to the edge of the bed opposite to where he is being turned.
Tell the patient to cross his arms over his chest.
If you turn him over to his right side, he will put his left leg on his right (if he cannot do this, help him). Bend the patient's left leg: one hand covers the shin, the other - the popliteal cavity).
Stand on the side of the bed where you will turn the patient. Place the protector next to it.
Bend your leg at the knee and place it on the tread.
The second leg is a support.
If the patient needs to be turned on his right side, place your left hand on his left shoulder and your right hand on his left thigh.
Turn the patient onto their side, placing your weight on the leg on the floor.
Place a pillow under the patient's head. Note. The patient should lie on his or her arm.
Bend the patient's arms slightly.
The hand on top rests on the pillow.
Place a pillow under the patient's back.
Place a pillow under the patient's half-bent leg lying on top (from the groin area to the foot).
Place a sandbag (footrest) at the sole of the foot that lies underneath.
Unfold the diaper.
Turning and placing the patient in the “lying on his stomach” position is performed as prescribed by the doctor by one nurse; the patient cannot help (Fig. 2-40)
Performed on both a functional and a regular bed.
Usage in a forced or passive position; risk of developing bedsores, changing position.
Prepare: a rolled blanket or bath towel, a small pillow, bolsters.
Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent to perform it.
Assess the patient's condition and surrounding environment. Set the bed brakes.
Lower the side rails (if equipped) on the nurse's side.
Rice. 2-40. Moving the patient to a prone position
Lower the head of the bed (or remove the pillows). Make sure the patient is lying horizontally.
Gently lift the patient's head, remove the regular pillow and place a small one.
Move the patient to the edge of the bed.
Extend the patient's arm and press it to the body.
Raise the side rails. Go to the other side of the bed and lower the side rails there.
Place your knee on the bed.
Place a rolled blanket (towel) or small pillow under the patient's upper abdomen.
Place one hand on the shoulder and the other on the thigh, located further from you, place your knee on the patient’s bed, placing a small pillow (protector) under it.
Turn the patient onto his stomach towards the nurse. The patient's head is on its side.
Place a pillow under your shins so that your toes do not touch the bed.
Rice. 2-41. Moving the patient from back to stomach and back
Bend one arm of the patient at the elbow joint at an angle of 90°, and place the other along the body.
Place pillows (or foam in a cover) under your elbows, forearms and hands.
Place small cushions next to your feet (outside).
Straighten the sheet and diaper.
Make sure the patient is lying comfortably. Raise the side rails.
Figure 2-41 shows the technique for moving a patient onto his stomach and back using two nurses.
TOXIC SUBSTANCES
In a health care facility, nursing staff are exposed to various groups toxic substances contained in medications, disinfectants, detergents, and gloves.
They enter the body in the form of dust or vapor in various ways (Fig. 2-42). The most common manifestation of the side effects of toxic substances is “occupational dermatitis” - irritation and inflammation of the skin of varying severity.
In addition to occupational dermatitis, toxic substances cause damage to other organs and systems.
Preventive measures reducing the impact of toxic substances are quite multifaceted.
Firstly, You should be aware that chemicals that have disinfectant properties can be replaced by cleaning agents and disinfection using high temperatures. They are equally or even more effective and are cheaper.
Secondly, Protective clothing such as gloves, gowns, aprons, face shields and goggles, and shoe covers reduce skin contact with toxic substances, while masks and respirators provide a certain level of protection from toxic dust and aerosols. If rubber gloves cause dermatitis in people with hypersensitivity, you can wear silicone or polyvinyl chloride gloves with a cotton lining. You should only work with powders using cotton gloves, but they do not protect your skin well when working with liquid chemicals.
Third, the preparation of disinfectant solutions should be carried out in specially equipped rooms with supply and exhaust ventilation.
Fourthly, You should carefully study the methodological recommendations on the use of certain protective equipment when working with toxic substances.
Fifthly, You need to carefully care for the skin of your hands, lubricate all wounds and abrasions. It is better to use liquid soap and dry your hands well after washing. Protective and moisturizing creams can help restore the skin's natural oil layer that is lost when exposed to certain chemicals.
At sixth, If a chemical gets into your eyes, you should immediately and thoroughly rinse them with plenty of cold water. If any chemical gets into your mouth, you should rinse your mouth with water, and in some cases it is recommended to drink large amounts of water. Chemicals that come into contact with the skin must be washed off immediately, and if they come into contact with clothing or workwear, they must be changed.
Many drugs have side effects, about which there is information in the annotations. But, unfortunately, the effect of these unusual harmful factors on nursing staff is often ignored.
Medicines affect the sister’s body in various ways: with direct contact - the use of creams and ointments without gloves, contact of solutions with the skin and eyes; when inhaled - crushing or counting tablets; when using aerosols; if it enters the digestive system - through the hands or accidentally into the mouth.
It has been established that 1-5% of nursing personnel become sensitized after exposure to antibiotics, especially penicillin, neomycin and streptomycin.
Antihistamines (promethazine), chlorpromazine, aminofilin can also cause skin reactions.
Some antibiotics (actinomycin D, mictomycin C, streptomycin) have a teratogenic effect.
Cytotoxic drugs have a negative impact on the health of nursing staff when the necessary safety conditions are not met.
(performed by two people, the patient can help) (Fig. 2-29)
Use for subsequent transportation.
Explain the procedure to the patient, make sure he understands it, and obtain consent to perform it.
Assess the patient's condition and environment.
Set the bed brakes.
Rice. 2-29. Moving the patient from a sitting position on the bed with legs down
in a wheelchair
Place the wheelchair at the patient's feet.
If possible, lower the bed to the level of the chair.
One nurse stands behind the wheelchair and tilts it forward so that the footrest touches the floor.
The second sister (assistant) stands opposite the patient sitting on the bed with his legs down, the sister’s legs are spaced 30 cm wide and bent at the knees.
Ask the patient to grab the nurse by the waist and hold him by the shoulders.
Pull the patient to the edge of the bed so that his feet (in non-slip shoes) touch the floor (Fig. 2-29 a).
Place one leg between the patient's knees, the other in the direction of movement.
Hold the patient in a “hug” position, gently lift him without jerking or turning. Do not put pressure on the patient's armpits!
Warn him that on the count of three you will help him get up.
While counting, sway slightly with it.
On the count of three, place the patient, turn with him until he is in a position with his back to the wheelchair.
Ask the patient to alert you when he touches the edge of the gurney.
Lower the patient into the wheelchair: bend your knees and hold the patient’s knees with them; keep your back straight.
The patient may be able to help by placing his hands on the armrests of the wheelchair.
Release the patient, making sure he is securely seated in the chair.
Place the patient comfortably in the chair.
If it is necessary to transport the patient, remove the brake.
Placing the patient in a wheelchair (performed by two people) (Fig. 2-30)
Check that the brakes of the wheelchair are secure.
Stand behind the wheelchair behind the patient.
Provide yourself with reliable support: lean one leg on the back of the chair, put the other leg back. Bend your knees.
Ask the second nurse (assistant) to sit on one knee on the side of the patient, raise his legs to hip level and place them on his knee.
Support the patient's head with your own chest or shoulder. Make an overhand grab. Keep your back straight, tensing your abdominal and buttock muscles.
Rice. 2-30. Placing the patient in wheelchair
Tell the patient and the assistant that on the count of three you will move the patient towards the back of the chair.
On the count of “three”: the assistant slightly lifts the patient’s hips and moves them to the back of the chair; you pull the patient to the back of the chair using a slide.
Make sure the patient is comfortable and remove the brakes on the wheels of the wheelchair.
Moving a patient from a bed to a chair (wheelchair) is performed by two or more people using the “shoulder lift” method; the patient can sit
but does not move independently (Fig. 2-31)
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it.
Place a chair next to the bed. Assess your surroundings.
Help the patient sit closer to the edge of the bed with his legs dangling.
Stand on either side of the patient, facing him. Both sisters place their hands under his hips and hold each other in a “wrist grip” (see Figure 2.10), supporting his hips.
Both nurses place their shoulders under the patient’s shoulders, and he places his hands on the sisters’ backs.
Bend your free arm at the elbow, resting it on the bed.
Legs apart, knees bent.
One of the sisters gives the command.
On the count of three, both straighten their knees and elbows, stand up and lift the patient.
Support the patient's back with your free hand while you carry him to a chair (wheelchair).
Each nurse places a supporting hand on the armrest or seat of the chair and lowers the patient onto the chair, bending the knees and elbow.
Make sure you lower the patient into the chair at the same time.
The chair should not tilt back: one of the sisters holds the back of the chair.
Rice. 2-31. Transferring a patient from a bed to a wheelchair
Transferring a patient from a bed to a chair without armrests or backrest, performed by two or more people using the “over-the-arm” method, the patient can sit,
but does not move independently (Fig. 2-32)
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it. Introduce everyone involved in the move.
Set the height of the bed to the height of the chair. Assess your surroundings.
Help the patient sit down (the patient's legs are not lowered).
One of the nurses stands behind the patient, puts one knee on the bed and does an “over-arm grab.”
Move the patient to the edge of the bed. Support him by standing on the floor with both feet behind him.
The second nurse places the chair comfortably and close to the bed, but so that the patient does not rest his elbow on the bed when sitting on the chair.
The same nurse stands opposite the chair facing the patient. Legs are bent at the knees (squatting position), one leg is put forward.
She puts her hands under the patient’s knees and, on the count of three, drags his legs to the edge of the bed, while the other nurse lifts his torso and, bending her knees, lowers the patient onto a chair.
Place the patient comfortably on the chair.
Rice. 2-32. Transferring the patient from bed to chair
Transferring a patient from a bed (bed with variable height) to a gurney and back (performed by four people) (Fig. 2-35)
After the operation, the patient remains in a state of anesthesia or consciousness for some time, but experiences pain. When starting to move onto a gurney (bed), you need to know in which area the operation was performed, as well as other restrictions.
During the transfer, visitors are asked to temporarily leave the room. You need to ask someone to hold the IV, drainage tubes and other devices.
You and your assistant stand on one side, the other two sisters on the other side of the bed. Secure the brakes.
Place the gurney on the side of the bed where you will be moving the patient. It is necessary to leave space to be able to stand between the bed and the gurney.
Cover the patient with a sheet or blanket.
Tell him to hold the sheet or blanket with his hands while you roll the sheet up at his feet.
Rice. 2-35. Transferring a patient from bed to gurney and back
Move the patient to the edge of the bed.
Unfold the sheet and leave it on the mattress (without tucking it in). Wrap the top sheet around the patient, tucking the ends under it. Stand close to the bed to prevent the patient from falling. Note. The head of the bed is in a horizontal position. Two nurses stand on the opposite side of the wheelchair and hold the patient; two other assistants move the gurney to the edge of the bed.
Note. Make sure the gurney is level with the bed. Do not leave space between the bed and the gurney. Check that the sheet is on the mattress.
Secure the brakes on the gurney.
Roll the sheet into a roll and hold it on all sides in your hands, palms up.
Two sisters kneel on the free part of the bed (after placing the protector).
On the count of “three” (the leader gives the command), all four lift the sheet and transfer the patient to the gurney along with the sheet.
Make sure the patient is lying in the middle.
Note. If the gurney is equipped with belts, secure the patient with them.
Transport the patient to the destination: one nurse is at the head of the bed, the other is at the patient’s feet.
When moving a patient from a gurney to a bed.
Place the gurney close to the bed, secure the brakes, and release the edges of the sheet on the gurney.
Two assistants kneel on the bed with the protector down.
All the sisters fold the edges of the sheet towards the center.
On the count of “three” (the leader gives the command), everyone lifts the sheet, holding it by the edges with their palms up, and moves the patient to the edge of the bed.
The nurses, kneeling on the bed, go down to the floor and hold the patient while others move the gurney.
Move the patient, tuck the sheet under the mattress and straighten it.
If necessary, place a small pillow under your head. If the patient experiences pain when moving, or the bandage gets wet, or there is blood in the drainage tubes, report to the doctor.
Transferring a patient from a regular bed to a gurney (and vice versa),
performed by three people (Fig. 2-36)
Place the gurney at an angle of at least 60° at the edge of the bed (at the feet).
Secure the brakes on the gurney and bed.
Everyone stand along the bed:
The strongest (physically) sister is in the center;
Place one leg forward, bending the knee, and put the other back.
Place your arms (up to the elbow) under the patient:
The sister at the head raises her head, supports her shoulders and upper back;
The sister in the center supports the lower back and buttocks;
The nurse standing at the patient's feet supports the legs. Note. If the patient is very sick, more people will be needed and the workload will have to be redistributed.
Rice. 2-36. Transferring a patient from a regular bed to a gurney and back
Lifting the patient:
At the leader’s command “three”, transfer your body weight to the leg placed back;
Smoothly pull the patient to the edge of the bed;
To have a break;
On the new command “three”, roll the patient onto you, press him and lift him, straightening his knees and straightening his back (do not hold the patient on outstretched arms!).
Move backward to face the gurney:
The nurse holding the patient's legs takes wider steps;
The nurse holding the patient's head, shoulders and back is less wide, turning to face the gurney.
Move forward (towards the gurney).
On the count of three, bend your knees and carefully lower the patient onto the gurney.
Turning the patient onto his side using a pad and placing him in this position (performed by two people) (Fig. 2-37)
Usage
Explain the process of the upcoming procedure, make sure that the patient understands it, and obtain his consent to perform it.
Have your assistant stand on the opposite side of the bed from you.
Lower the side rails (or one of them if the procedure is performed without an assistant).
Ask the patient to raise his head (if possible) or elevate his head and shoulders, remove the pillow.
Place a pillow against the head of the bed.
Make sure the patient is lying horizontally on the edge of the bed.
Ask the patient to cross his arms over his chest.
If you turn him over on his right side, he should put his left leg on his right.
Help him if necessary.
Stand on the side of the bed where you turn him over.
Rice. 2-37. Turning the patient on his side using a diaper
Place a protector next to the patient.
Stand closer to the bed, place your knee on the protector, the other leg serves as a support.
Place your hand on the patient’s shoulder, which is further from the nurse, and the other on the corresponding thigh, i.e. if the patient turns over on his right side, place your left hand on his left shoulder and your right hand on his left thigh.
Your assistant should pull the edge of the diaper out from under the mattress and roll it close to the patient’s body, then take the rolled end of the diaper with your palms up and, resting your feet, turn the patient on his side on the count of three.
You turn the patient towards you, placing your weight on the leg that is on the floor.
Help the patient raise his head and place a pillow.
Note. Further actions depend on the purpose of the turn.
For example, in case placements:
Turn the patient so that he is not lying on his arm;
Place a folded blanket under your back for stability;
Place a pillow under the arm lying on top;
Bend the leg lying on top at the knee and place a pillow between the knees;
Straighten the lining diaper;
Raise the side rails;
Make sure the patient feels comfortable.
Turning the patient onto his side using the “joint log rolling” method and placing him in this position (performed by two people) (Fig. 2-38)
Usage when changing linen; placement in a lateral position; a preliminary stage for other movements.
Explain to the patient the process of the upcoming procedure, make sure that he understands it, and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Ask your assistant to stand next to you.
Remove the pillow from under your head and place it at the head of the bed.
Place your hands under the patient's head and shoulders.
Tell your assistant to place his hands under the patient's hips.
Rice. 2-38. Turning the patient onto his side using the joint log rolling method
Place one foot slightly in front of the other, swing back on the count of three, shift your body weight onto the back leg, and move the patient to the edge of the bed.
Lower the bed so that one of the sister's knees is on the bed (on the protector), and the other leg is firmly on the floor.
Together with an assistant, move to the other side of the bed. Place a pillow between the patient's legs and cross his arms over his chest.
Both sisters place the protectors on the edge of the bed and place one knee on the protector.
Place one hand on the patient's shoulder, the other on the patient's pelvis, and ask the assistant to place their hands on the patient's thighs and legs.
On the count of three, turn the patient to face you, keeping his head, back and legs in line.
Bend your upper leg slightly.
Make sure the pillow remains between the patient's legs.
Place the support at the sole of the foot lying underneath.
Be sure to place a pillow under the patient's back to maintain this position.
Also place a pillow under your upper arm.
If possible, place a small pillow under the patient's head.
Cover him.
Raise the side rails.
Make sure the patient feels comfortable.
Important: If a seriously ill patient needs to be moved over significant distances, then the type of transportation must be chosen by the doctor!
Selecting a method for moving the patient.
The type of transportation (determined by the doctor) and the method of placing the patient on a stretcher depend on the disease and its location. It is necessary to move the patient in a bed, on a stretcher, in a wheelchair, or in the arms of one or two assistants (in the absence of means of transportation) with the utmost care and safety.
Capture of Rautek. This method is most often used when providing first aid. The Rautek grip allows you to lift and move patients in serious condition. It happens that the patient, having fallen, lies on the floor. The Rautek grip will allow you to lift, sit or lay down the fallen person.
Description of actions performed by one person.
- Approach the patient from behind and sit down.
- Support the back of the patient's head and shoulders with both hands.
- Place the patient in a sitting position with one gentle rocking motion.
- To prevent the patient from falling again, support his back with your knees.
- Grab the patient from behind by the armpits.
- Apply the so-called “monkey grip”, clasping the wrist joint with one hand and the patient’s forearm with the other so that his arm is bent.
- The nurse's thumbs are pointing upward.
- Gradually straightening up, lift the patient with you, supporting him with your hips.
This position allows you to move the patient backwards or sit him on a chair or the edge of the bed. Immobilized patients must be transported in a wheelchair or on a stretcher.
Transferring the patient to a stretcher from the bed.
Place the stretcher perpendicular to the bed so that its head part approaches the foot part of the bed.
Place the patient's arms in the following way: one person should place his hands under the patient's shoulder blades and head, the second person should place his hands under the pelvis and upper thighs, the third should place his hands under the lower leg and the middle part of the thighs. When transporting two people, one should place his hands under the patient’s shoulder blades and neck, the other should place his hands under the knees and lower back.
Having coordinated the movements, simultaneously lift the patient, turn 90 degrees towards the stretcher and lay him on it.
Transporting the patient on a stretcher.
The patient is carried slowly and without shaking, the step should be short, not in step.
The patient should be lowered down the stairs feet first, lifting the foot end of the stretcher and lowering the head end so that the stretcher is in a horizontal position. The one walking behind carries the stretcher on his shoulders, the one walking in front carries the stretcher on straightened arms.
The patient is carried up the stairs head first, the same is observed horizontal position stretcher The one walking behind carries the stretcher on his shoulders, the one walking in front holds the handles of the stretcher on his arms, straightened at the elbows.
Transferring the patient from the stretcher to the bed.
Place the head end of the stretcher perpendicular to the foot edge of the bed. The stretcher should be placed parallel to the bed if the area of the room is small.
Having coordinated the movements, simultaneously lift the patient and turn him 90 degrees towards the bed. If the stretcher is positioned parallel, turn 180 degrees. Place the patient on the bed.
If the stretcher is located close to the bed, then holding the stretcher at its level, two or three of you pull the patient on the sheet to the edge of the stretcher, lift him up a little and transfer him to the bed.
Lifting the patient from the front and guiding him with support from behind.
The following is done:- Approach the patient from the front, to the healthy side of the body.
- Place your feet in front of the patient's feet. To prevent the patient from slipping, the heels should be connected at an acute angle.
- Hold the patient's armpits with both hands.
- Slowly pull it up.
- Unlock the feet when the patient is firmly on his feet.
- Change hands.
- Change position by approaching the patient from behind.
- Grab him with a monkey grip from behind.
- The patient takes a step with his healthy leg.
Lifting the patient from the side and guiding him with lateral support.
If the patient has unilateral paralysis, the caregiver can act alone.
The following is done:- Approach the patient from the non-paralyzed side.
- Place your foot at an angle in front of the patient's healthy leg to prevent slipping.
- On the non-paralyzed side, grasp the patient's armpit with one hand.
- Using your other hand, grab the patient's back and insert your hand from behind the armpit.
- Carefully lift the patient from the chair and help him straighten.
- After making sure that the patient stands confidently, remove the leg.
- Use your other foot to move the chair away from the patient.
- Remove the hand holding the patient’s armpit on the healthy side. Go to the patient from behind.
- Support the patient's armpits with both hands.
- Ask him to take a step forward with his healthy leg.
- The nurse pushes his immobilized leg with her foot.
- Continuing the movement in this way, bring the patient to a bed or chair.
Seating the patient in a wheelchair.
The patient can transfer from bed to chair or wheelchair independently or with your help. The height of the bed should be at the same level as the wheelchair or chair.
Moving independently from bed to wheelchair
- First, prepare a robe, slippers, chair or wheelchair for the patient;
- Help the patient get dressed and sit up in bed so that his feet touch the floor;
- The wheelchair or chair is placed at a slight angle to the bed on the side of the patient that is physically stronger;
- The bed is put on the brakes;
- If the patient is moved to a wheelchair, the brakes on the chair are fixed, the armrest on the side close to the patient and the footrest are removed;
- The patient should sit on the edge of the bed, lean on it with one hand, and grab the armrest of the wheelchair with the other;
- Then he gets out of bed, leaning on the bed with one hand and the other on the armrest of the chair, turns his back to the chair and carefully sits down in it.
When moving from a wheelchair to a bed, the patient holds on to the armrest of the chair with one hand, and leans on the bed with the other, then gets up from the wheelchair, leaning on the bed with one hand, and holding the armrest of the chair with the other, turns his back to the bed and carefully sits on her.
When moving from bed to chair and back, you can use the same techniques as when moving from bed to wheelchair. For the safety of the patient, it is better to use a chair with armrests.
Using a smooth board to move a patient from a bed to a chair or wheelchair and back
Such boards reduce friction when sliding and can be useful for patients with strong hands, but unable to lean on their legs when transplanting.
- The armchair or stool is moved close to the bed, the chair is put on the brakes, and the armrest is removed from the chair on the side of the bed.
- The patient should sit in bed, keeping his feet on it, so that the chair is on his side.
- The patient should transfer his body weight to the buttock farthest from the chair.
- The patient places one end of the board under the buttock closest to the stroller.
- Leaning with one hand on the bed and the other on the free edge of the board, the patient slides into the chair along the board, pressing it against the seat.
- After sitting down in a chair, he takes out the board from under him.
- Sitting in a chair, he moves his legs off the bed and places them on the footrest. You can move from a chair to a bed in the same way.
Transferring from bed to chair and back with the help of a caregiver
- Explain your transfer plan to the patient and encourage him to help as much as possible;
- Prepare a robe, slippers, chair or wheelchair for the patient. The bed should be at the same height as the chair (wheelchair);
- Place the patient in bed so that his feet touch the floor;
- Place a chair or wheelchair at a slight angle to the bed on the side that the patient is physically stronger;
- Put the bed on the brakes. If you are transferring a patient to a wheelchair, remove the armrest, footrest and lock the brakes;
- Help the patient get dressed and put on shoes;
- Your knees should be bent and your back straight. Place one hand under the patient's shoulders and the other under his hips. Don't twist your back at the waist;
- Ask the patient to hug you around the waist or shoulders (but not around the neck!), and you put your hands under his arms, leaning forward;
- When your patient is ready to move, his buttocks should be on the edge of the bed so that he can maintain balance as you move his body weight forward. The patient's feet should be on the floor, and the heels should be slightly turned in the direction of movement. This is to ensure that his legs do not get tangled when he turns his body to sit in a wheelchair or on a chair;
- Place your leg, which is further from the chair, between the patient’s knees with your knee facing him, and the other in the direction of movement;
- Bend your knees, tighten your abdominal and buttock muscles, keep your back straight;
- Stand as close to the patient as possible. Warn him that on the count of 3 you will help him get up. On each count, rock back and forth slightly to create momentum. On the count of 3, holding the patient close to you and keeping your back straight, lift the patient, using your body as a lever;
- Turn yourself at the same time as the patient's body until he is positioned directly in front of the wheelchair. Ask the patient to alert you when he feels the edge of the chair on the back of his thighs;
- Carefully lower the patient into the chair. To do this, you need to bend your knees and keep your back straight. When lowering into a chair, the patient can help you if he places his hands on the armrest of the chair. After the patient sits in the chair, put the armrest and footrest in place, and place the patient's feet on the stand.
Moving along the board from a bed to a wheelchair with the help of a nurse
- Move the armchair or chair close to the bed, put the brakes on the chair, remove the armrest from the chair on the side of the bed;
- The patient should sit in bed, keeping his feet on it, so that the chair is on his side;
- The patient must bear weight own body on the buttock farthest from the chair;
- Place one end of the board under his buttock closest to the stroller;
- Stand behind the patient and place your hands on his waist;
- The patient should lean on the bed with one hand, and with the other on the free edge of the board;
- Then, leaning on the free edge of the board and bending it towards the chair, the patient, with your help and the help of the other hand, should move into the chair;
- Pull the board out from under it;
- Move his feet off the bed and place them on the footrest. You can move from a chair to a bed in the same way.
