Client Transfer Considerations
A transfer is a safe movement of an individual from one surface to another such as, a tub, shower, toilet, vehicle, bed, chair, or the floor (Weisser-Pike, 2023). There are many things one has to consider before performing a transfer. The first thing to consider is the client's capabilities. Does the client have good balance and strength? Depending on the answer, is what tells the therapist what kind of transfer would be the best course of action.
The second thing to consider is the therapist's capabilities. Is the therapist strong enough to transfer the client with good body mechanics or do they need to ask for assistance? If the therapist thinks they will need assistance, they need to acquire that before setting up the transfer.
Another thing to consider before performing a transfer is the environment. When performing a wheelchair transfer the therapist needs to apply a gait belt to the client, make sure the wheels are locked, remove the footrests, and move the caster wheels out of the way. All of these things are done to ensure client safety. If the client were to fall without a gait belt on, the therapist might not be able to catch them and the client could get injured. If the wheels are not locked, footrests not removed, and caster wheel are not out of the way, then the client could trip or fall.
The fourth item to consider when performing a transfer is the equipment being used. This would include the hospital bed, wheelchair, mechanical lift, slide board, and/or shower chair. If the client is in a hospital bed, the bed needs to be lowered to allow for the clients comfort. When a mechanical lift is used the therapist needs to make sure the client is correctly positioned and that the machine is working properly prior to use. If the client will be using a sliding board, then the wheelchair needs to be perpendicular to the surface. When transferring a client out of a shower chair, the therapist needs to be aware of how wet the floor is and if that will affect the wheelchair.
One final item to consider when performing a transfer is the client's position. In order for the client to get to standing, the therapist needs to have them scoot to the edge of the surface to allow for a smaller base of support. The client also needs to have their feet flat on the ground with their knees over their toes, and their heels angled toward their destination. The therapist also needs to position the client's hand where they should push off to prevent them from grabbing onto the therapist. Finally, the therapist should instruct them to shift their center of gravity forward to aid in getting up.
In order to ensure a safe and efficient transfer the therapist needs to do four things. First, instruct and demonstrate. If the client does not know what they need to be doing, they will not be able to do it. Second, transfer toward unaffected side. This allows you to be on the affected side so you can provide assistance as needed. Thirdly, check clothes, footwear, footrests, railings, and attached equipment such as a catheter bag or IV. Fourth, adjust the transfer surface height for the client's comfort. The client should be at a comfortable position where both feet are ready to accept weight.
Weisser-Pike, O. (2023, May 16). Lecture 10: Bed Mobility & Transfers. [Lecture]. OT 430, Biomechanics, University of Tennessee Health Science Center, Memphis, TN, United States.
