position, transfer and ambulation

position, transfer and ambulation

1. 10
Positioning, Transfers, and Ambulation
1. Review the principles of body mechanics
Define the following terms:
alignment
based on the word line; a body is in alignment when a
straight line could be drawn through the center of his body
and his center of gravity.
base of support
the foundation that supports an object.
center of gravity
the point in the body where the most weight is concentrated.
fulcrum and lever
a means of moving an object by resting it on a base of
support; a seesaw is an example of a fulcrum and lever.

2. 10
Positioning, Transfers, and Ambulation
1. Review the principles of body mechanics
NAs should remember these guidelines for using proper body
mechanics:
•Assess the load.
•Think ahead, plan, and communicate the move.
•Check base of support. Have a firm footing.
•Face what you are lifting.
•Keep back straight.
•Begin in squatting position. Lift with legs.
•Tighten stomach muscles when beginning.
•Keep object close to the body.
•Push rather than lift.

3. 10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
positioning
the act of helping people into positions that promote comfort
and health.
supine
body position in which a person lies flat on his back.
lateral
body position in which a person is lying on either side.
prone
body position in which a person is lying on his stomach, or
front side of the body.

4. 10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
Fowler’s
a semi-sitting body position, in which a person’s head and
shoulders are elevated 45 to 60 degrees.
Sims’
body position in which a person is lying on his left side with
the upper knee flexed and raised toward the chest.

5. 10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
draw sheet
an extra sheet placed on top of the bottom sheet; used for
moving residents.
shearing
rubbing or friction that results from the skin moving one way
and the bone underneath it remaining fixed or moving in the
opposite direction.

6. 10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
logrolling
moving a person as a unit, without disturbing the alignment
of the body.
dangle
to sit up with the legs hanging over the side of the bed in
order to regain balance and stabilize blood pressure.

7. 10 Positioning, Transfers, and Ambulation
Transparency 10-1: Five Basic Positions

8. 10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
NAs should know the following facts about the five basic body
positions:
•Supine Position
•Resident lying flat on back
•Pillows under head and shoulders, arms, hands; heels
should not be touching the bed
•Lateral Position
•Resident lying on either side
•Pillows support head, arm, and leg on upper side, back
and head. Upper knee on pillow.

9. 10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Facts about the five basic body positions (cont’d):
•Prone Position
•Resident lying on stomach
•Small pillow under head and to keep feet off bed
•Fowler’s Position
•Semi-sitting, head and shoulders elevated
•Pillows at flexed knees, at flexed feet, and under head
•Sims’ Position
•Variation on lateral side position, left side-lying position
•Lower arm behind the back, upper knee flexed
•Pillows under head, arms, flexed knee, and foot

10. Moving a resident up in bed
Equipment: draw sheet
When the resident can help you move her up in bed,
take the following steps:
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Adjust bed to a safe level, usually waist high. Lock bed
wheels.
6.Lower the head of bed to make it flat. Move the pillow to
the head of the bed.

11. Moving a resident up in bed
7.If the bed has side rails, raise the rail on the far side of
the bed.
8.Stand by bed with your feet shoulder-width apart, facing
the resident.
9.Place one arm under resident’s shoulder blades. Place the
other arm under resident’s thighs. Use proper body
mechanics.
10.Ask resident to bend her knees, place her feet firmly on
the mattress, and push her feet and hands on the count
of three.

12. Moving a resident up in bed
11.On the count of three,
shift your body weight,
and help move resident
while she pushes with
her feet. As always,
allow the resident to do
all she can for herself.
12.Make resident
comfortable. Put pillow
back under resident’s
head and arrange the
blankets for her.
13.Return bed to lowest
position. Remove privacy
measures.
14.Place call light within
resident’s reach.

13. Moving a resident up in bed
15.Wash your hands.
16.Report any changes in resident to the nurse. Document
procedure using facility guidelines.
When the resident cannot assist and there is no one
else around to help you move her up in bed, take the
following steps:
1.Follow steps 1 through 6 above.
2.Stand behind the head of the bed with your feet
shoulder-width apart and one foot slightly in front of the
other.
3.Roll and grasp the top edge of the draw sheet.

14. Moving a resident up in bed
4.Bend your knees and
keep your back straight.
Rock your weight from
the front foot to the back
foot in one smooth
motion, while pulling the
draw sheet and resident
toward the head of the
bed.
5.Make resident
comfortable. Put pillow
back under resident’s
head and arrange the
blankets for her. Unroll
the draw sheet and
leave it in place for the
next repositioning.

15. Moving a resident up in bed
6.Return bed to lowest position. Remove privacy measures.
7.Place call light within resident’s reach.
8.Wash your hands.
9.Report any changes in resident to the nurse. Document
procedure using facility guidelines.
When you have help from another person, you can
modify the procedure as follows:
1.Follow steps 1 through 6 above.
2.Stand on the opposite side of the bed from your helper.
Each of you should be turned slightly toward the head of
the bed. For each of you, the foot that is closest to the
head of the bed should be pointed in that direction. Stand
with your feet about shoulder-width apart. Bend your
knees. Keep your back straight.

16. Moving a resident up in bed
3.Roll the draw sheet up to the resident’s side, and have
your helper do the same on her side of the bed. Grasp
the sheet with your palms up, and have your helper do
the same.

17. Moving a resident up in bed
4.Shift your weight to your
back foot (the foot closer
to the foot of the bed)
and have your helper do
the same. On the count
of three, you and your
helper both shift your
weight to your forward
foot. Slide the draw
sheet and resident
toward the head of the
bed.

18. Moving a resident up in bed
5.Make resident
comfortable. Put pillow
back under resident’s
head and arrange the
blankets for her. Unroll
the draw sheet and
leave it in place for the
next repositioning.

19. Moving a resident up in bed
6.Return bed to lowest position. Remove privacy measures.
7.Place call light within resident’s reach.
8.Wash your hands.
9.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

20. Moving a resident to the side of the bed
Equipment: draw sheet
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Adjust bed to a safe level, usually waist high. Lock bed
wheels.
6.Lower the head of bed.
7.Stand on the same side of the bed to where you are
moving the resident. Stand with feet shoulder-width
apart, and bend your knees.

21. Moving a resident to the side of the bed
8.With a draw sheet: Roll the draw sheet up to the
resident’s side, and grasp the sheet with your palms up.
One hand should be at the resident’s shoulders, the other
about level with the resident’s hips. Apply one knee
against the side of the bed, and lean back with your
body. On the count of three, slowly pull the draw sheet
and resident toward you.

22. Moving a resident to the side of the bed
Without a draw sheet :
Gently slide your hands
under the head and
shoulders and move
toward you. Gently slide
your hands under her
midsection and move it
toward you. Gently slide
your hands under the
hips and legs and move
them toward you.

23. Moving a resident to the side of the bed
9.Make resident comfortable.
10.Return bed to lowest position. Remove privacy measures.
11.Place call light within resident’s reach.
12.Wash your hands.
13.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

24. Turning a resident
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Adjust bed to a safe level, usually waist high. Lock bed
wheels.
6.Lower the head of bed.
7.Stand on side of bed opposite to where resident will be
turned. If the bed has side rails, raise the far side rail.
Lower side rail nearest you if it is up.
8.Move resident to side of bed nearest you using previous
procedure.

25. Turning a resident
9.Turning resident away
from you:
a.Cross resident’s arm
over her chest. Move
arm on side resident is
being turned to out of
the way. Cross the leg
nearest you over the far
leg.
b.Stand with feet
shoulder-width apart.
Bend your knees.
c.Place one hand on the
resident’s shoulder.
Place the other hand on
the resident’s nearest
hip.

26. Turning a resident
d.Gently push the resident
onto side as one unit,
toward the other side of
bed (toward raised side
rail if present). Shift
your weight from your
back leg to your front
leg.
Turning resident toward
you:
a.Cross resident’s arm
over his chest. Move arm
on side resident is being
turned to out of the way.
Cross the leg furthest
from you over the near
leg.

27. Turning a resident
b.Stand with feet
shoulder-width apart.
Bend your knees.
c.Place one hand on the
resident’s far shoulder.
Place the other hand on
the far hip.
d.Gently roll the resident
toward you. Your body
will block resident and
prevent him from rolling
out of bed.

28. Turning a resident
10.Position the resident properly, comfortably, and in good
alignment. Proper positioning includes the following:
•Head supported by pillow
•Shoulder adjusted so resident is not lying on arm
•Top arm supported by pillow
•Back supported by supportive device
•Top knee flexed
•Supportive device between legs with top knee flexed; knee
and ankle supported
11.Return bed to lowest position. Remove privacy measures.
12.Place call light within resident’s reach.
13.Wash your hands.
14.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

29. Logrolling a resident
Equipment: draw sheet,
co-worker
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Adjust bed to a safe level, usually waist high. Lock bed
wheels.
6.Lower the head of the bed.
7.Both people stand on the same side of the bed. One
person stands at the resident’s head and shoulders. The
other stands near the resident’s midsection.

30. Logrolling a resident
8.Place the resident’s arms
across his chest. Place a
pillow between the
knees.
9.Stand with your feet
shoulder-width apart.
Bend your knees.
10.Grasp the draw sheet on
the far side.

31. Logrolling a resident
11.On the count of three,
gently roll the resident
toward you. Turn the
resident as a unit. Your
bodies will block the
resident and prevent him
from rolling out of bed.
12.Make resident
comfortable. Arrange
pillows and covers for
comfort.
13.Return bed to lowest
position. Remove privacy
measures.
14.Place call light within
resident’s reach.
15.Wash your hands.

32. Logrolling a resident
16.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

33. Assisting a resident to sit up on side of bed: dangling
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Adjust bed to lowest position. Lock bed wheels.

34. Assisting a resident to sit up on side of bed: dangling
6.Raise the head of bed to
sitting position. Fanfold
(fold into pleats) the top
covers to the foot of the
bed. Ask the resident to
turn onto his side, facing
you. Assist as needed
(see earlier procedure).
7.Tell the resident to reach
across his chest with his
top arm and place his
hand on the edge of the
bed near his opposite
shoulder. Ask him to
push down on that hand
to raise his shoulders up
while swinging his legs
over the side of the bed.

35. Assisting a resident to sit up on side of bed: dangling
8.Always allow the
resident to do all he can
for himself. However, if
the resident needs
assistance, follow these
steps:
a.Stand with your legs
shoulder-width apart.
Bend your knees.
b.Place one arm under the
resident’s shoulder
blades. Place the other
arm under the resident’s
thighs.

36. Assisting a resident to sit up on side of bed: dangling
c.On the count of three,
slowly turn resident into
sitting position with legs
dangling over side of
bed. The weight of the
resident’s legs hanging
down from the bed helps
the resident sit up.
9.Ask resident to hold onto
the edge of mattress
with both hands. Assist
resident to put on non-
skid shoes or slippers.

37. Assisting a resident to sit up on side of bed: dangling
10.Have resident dangle as long as ordered. The care plan
may direct you to allow the resident to dangle for several
minutes and then return him to lying down, or it may
direct you to allow the resident to dangle in preparation
for walking or a transfer. Follow the care plan. Do not
leave the resident alone. If the resident is dizzy for more
than a minute, have him lie down again and report to the
nurse.
11.Take vital signs as ordered (you will learn how to take
vital signs in Chapter 14).
12.Remove slippers or shoes.
13.Gently assist resident back into bed. Place one arm
around resident’s shoulders and the other arm under the
resident’s knees. Slowly swing resident’s legs onto bed.

38. Assisting a resident to sit up on side of bed: dangling
14.Make resident comfortable.
15.Leave bed in lowest position. Remove privacy measures.
16.Place call light within resident’s reach.
17.Wash your hands.
18.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

39. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
Define the following terms:
ergonomics
the science of designing equipment, areas, and work tasks to
make them safer and to suit the worker’s abilities.
transfer/gait belt
a belt made of canvas or other heavy material that is used to
help people who are weak, unsteady, or uncoordinated to
stand, sit, or walk.
slide board
a wooden board that helps transfer people who are unable to
bear weight on their legs; also called a transfer board.

40. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
REMEMBER:
Many facilities have adopted no-lift, zero-lift, or lift-freepolicies.
It is important that NAs follow facility policy carefully.

41. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
REMEMBER:
When assisting residents NAs must know which side is stronger
and which is weaker and move the stronger side first. NAs should
never refer to a “bad side” or a “bad” leg or arm.

42. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
REMEMBER:
Transfer belts must be applies over the clothing and not on bare
skin. It is important to check and ensure no skin is caught in the
belt.

43. Applying a transfer belt
Equipment: transfer belt, non-skid footwear
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Adjust bed to lowest position. Lock bed wheels.
6.Assist the resident to a sitting position with feet flat on
the floor.
7.Put non-skid footwear on resident and make sure laces
are tied.
8.Place the belt over the resident’s clothing and around the
waist. Do not put it over bare skin.

44. Applying a transfer belt
9.Tighten the buckle until it is snug. Leave enough room to
insert flat fingers/hand comfortably under the belt.
10.Check to make sure that skin or skin folds (for example,
breasts) are not caught under the belt.
11.Position the buckle slightly off-center in the front or back
for comfort.

45. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know the following guidelines for wheelchairs:
•Know how to use brake, armrests, and footrests.
•Lock before transfer; unlock after.
•Open by pulling on both sides. Close by lifting center of seat.
•Remove armrests by releasing lock.
•Remove footrests by pulling back on lever and swinging out
toward side of chair.
•Lift or lower footrest by squeezing lever and pulling up or
pushing down.
•Resident must use side of body that can bear weight and lift
side that cannot.

46. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
Guidelines for wheelchairs (cont’d):
•Resident must be wearing non-skid footwear before
transferring.
•Keep resident safe and comfortable during transfers.
•Assist resident as needed by having chair close and wheels
locked. Use transfer belt and check alignment in chair.
•To move resident to back of chair, stand behind resident with
arms under resident’s arms; resident pushes, NA pulls gently.
Reposition resident at least every hour.

47. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
When a resident starts to fall, the NA should respond in this way:
•Widen stance.
•Bring resident’s body close.
•Bend knees and support resident.
•Lower resident to floor.
•Do not try to stop the fall.
•Call for help.
•Do not attempt to get resident up.

48. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know these guidelines for using stretchers:
•Lock wheels before transferring.
•Keep safety belts fastened while in stretcher.
•Raise safety rails.
•Keep resident covered.
•Keep wheels locked except when moving stretcher.
•Get help.

49. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
Guidelines for stretchers (cont’d):
•Move slowly and carefully.
•Push stretcher from head end.
•Go through doorways by opening door, entering first, and
pulling stretcher through.
•Do not hit walls or doorways.
•Be cautious while going down sloping areas.
•Stay with resident at all times.

50. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know these guidelines for mechanical lifts:
•Safer for two people to transfer with these lifts.
•Keep chair or wheelchair close to bed to only move resident a
short distance.
•Make sure valves are working.
•Check sling and straps for tears or fraying. Do not use
mechanical lift if there are tears or holes.
•Open legs of stand to widest position before helping resident
into lift.
•Pump up lift only to the point where the resident’s body clears
the bed or chair.

51. Transferring a resident from bed to wheelchair
Equipment: wheelchair, transfer belt, non-skid footwear, and
lap robe or folded blanket
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door. Check the area to be certain it is uncluttered and
safe.
5.Remove both wheelchair footrests close to the bed.
6.Place wheelchair near the head of the bed with arm of
the wheelchair almost touching the bed. Wheelchair
should be facing the foot of the bed. The wheelchair
should be placed on resident’s stronger, or unaffected,
side.
7.Lock wheelchair wheels.

52. Transferring a resident from bed to wheelchair
8.Raise the head of the bed. Adjust bed to lowest position.
Lock bed wheels.
9.Assist resident to sitting position with feet flat on the floor.
Let resident sit for a few minutes to adjust to the change
in position.
10.Put non-skid footwear on resident and fasten securely.
11.Stand in front of resident with your feet about shoulder-
width apart. Bend your knees.
12.Place the transfer belt around resident’s waist over
clothing (not on bare skin). Grasp belt securely on both
sides.
13.Provide instructions to allow resident to help with transfer.
Instructions may include: “When you start to stand, push
with your hands against the bed.” “Once standing, if
you’re able, you can take small steps in the direction of
the chair.” “Once standing, reach for the chair with your
stronger hand.”

53. Transferring a resident from bed to wheelchair
14.With your legs, brace
(support) resident’s
lower legs to prevent
slipping. This can be
done by placing one or
both of your knees in
front of the resident’s
knees.
15.Count to three to alert
resident. On three, with
hands still grasping the
transfer belt on both
sides and moving
upward, slowly help
resident to stand.

54. Transferring a resident from bed to wheelchair
16.Tell the resident to take
small steps in the
direction of the chair
while turning his back
toward the chair. Or, if
more assistance is
needed, help the
resident pivot (turn) to
stand in front of
wheelchair with back of
resident’s legs against
wheelchair.

55. Transferring a resident from bed to wheelchair
17.Ask the resident to put hands on wheelchair arm rests if
able. When the chair is touching the back of the
resident’s legs, help the resident lower himself into the
chair.
18.Reposition resident so that his hips touch the back of the
wheelchair seat. Remove transfer belt if used.
19.Attach footrests and place the resident’s feet on the
footrests. Check that the resident is in proper alignment.
Make resident comfortable. Place a lap robe or folded
blanket over the resident’s lap as appropriate.
20.Remove privacy measures.
21.Place call light within resident’s reach.
22.Wash your hands.

56. Transferring a resident from bed to wheelchair
23.Report any changes in resident to the nurse. Document
procedure using facility guidelines.
When transferring back to bed from a wheelchair, the height
of the bed should be equal to or slightly lower than the chair.
Help the resident pivot to the bed. When the resident feels the
bed with the back of his legs, help him sit down slowly.

57. Transferring a resident from bed to stretcher
Equipment: stretcher, blanket, draw sheet
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Lower the head of bed so that it is flat. Lock bed wheels.
6.Fold linens to the foot of the bed. Cover resident with a
blanket.
7.Move the resident to the side of the bed. Have your co-
workers help you do this. Refer to the procedure Moving
a resident to the side of the bed earlier in this chapter.

58. Transferring a resident from bed to stretcher
8.Place stretcher solidly against the bed, and lock stretcher
wheels. Bed height should be equal to or slightly above
the height of the stretcher. Move stretcher safety belts
out of the way.

59. Transferring a resident from bed to stretcher
9.Two workers should be
on one side of the bed
opposite the stretcher.
Two more workers
should be on the other
side of the stretcher.
10.Each worker should roll
up the sides of the draw
sheet and prepare to
move the resident.
Protect the resident’s
arms and legs during the
transfer.

60. Transferring a resident from bed to stretcher
11.On the count of three,
the workers lift and
move the resident to the
stretcher. All should
move at once. Make sure
the resident is centered
on the stretcher.
12.Place a pillow under the
resident’s head. Make
sure resident is still
covered with the
blanket.
13.Place the safety straps
across the resident.
Raise side rails on
stretcher.

61. Transferring a resident from bed to stretcher
14.Unlock stretcher’s wheels. Move resident to proper place,
staying with him until another staff member takes over.
15.Wash your hands.
16.Report any changes in resident to the nurse. Document
procedure using facility guidelines.
To return the resident to bed, the bed height should be equal
to or slightly below the stretcher.

62. Transferring a resident using a mechanical lift
Equipment: wheelchair or chair, co-worker (if available),
mechanical or hydraulic lift
The following is a basic procedure for transferring using a
mechanical lift. Ask someone to help you before starting.
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Lock bed wheels.
6.Position wheelchair next to bed. Lock brakes.

63. Transferring a resident using a mechanical lift
7.Help the resident turn to one side of the bed. Position the
sling under the resident, with the edge next to the
resident’s back, fanfolding if necessary. Adjust the
bottom of the sling so that it is even with the resident’s
knees. Help the resident roll back to the middle of the
bed, and then spread out the fanfolded edge of the sling.

64. Transferring a resident using a mechanical lift
8.Roll the mechanical lift
to bedside. Make sure
the base is opened to its
widest point. Push the
base of the lift under the
bed.
9.Position the overhead
bar directly over the
resident.

65. Transferring a resident using a mechanical lift
10.With the resident lying
on his back, attach one
set of straps to each side
of the sling. Attach one
set of straps to the
overhead bar. If
available, have a co-
worker support the
resident at the head,
shoulders, and knees
while being lifted. The
resident’s arms should
be folded across his
chest. If the device has
S hooks, they should
face away from resident.
Make sure all straps are
connected properly and
are smooth and straight.

66. Transferring a resident using a mechanical lift
11.Following manufacturer’s
instructions, raise the
resident two inches
above the bed. Pause a
moment for the resident
to gain balance.
12.If available, a lifting
partner can help support
and guide the resident’s
body while you roll the
lift so that the resident is
positioned over the chair
or wheelchair.

67. Transferring a resident using a mechanical lift
13.Slowly lower the resident into the chair or wheelchair.
Push down gently on the resident’s knees to help the
resident into a sitting, rather than reclining, position.
14.Undo the straps from the overhead bar to the sling.
Remove sling or leave in place for transfer back to bed.
15.Be sure the resident is seated comfortably and correctly
in the chair or wheelchair. Remove privacy measures.
16.Place call light within resident’s reach.
17.Wash your hands.
18.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

68. Transferring a resident onto and off of a toilet
Equipment: 2 pairs of gloves, toilet paper or disposable wipes,
wheelchair
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible. Make sure resident is wearing non-skid shoes.
4.Provide for the resident’s privacy with curtain, screen, or
door.
5.Position wheelchair at a right angle to the toilet to face
the hand bar/wall rail. Place wheelchair on the resident’s
stronger side.
6.Remove wheelchair footrests. Lock wheels.
7.Put on gloves.
8.Apply a transfer belt around the resident’s waist over
clothing (not on bare skin). Grasp belt securely on
both sides.

69. Transferring a resident onto and off of a toilet
9.Ask resident to push
against the armrests of
the wheelchair and
stand, reaching for and
grasping the hand bar.
Move wheelchair out of
the way.

70. Transferring a resident onto and off of a toilet
10.Ask resident to pivot her
foot and back up so that
she can feel the front of
the toilet with the back
of her legs.
11.Help resident to pull
down pants and
underwear. You may
need to keep one hand
on the transfer belt while
helping to remove
clothing.

71. Transferring a resident onto and off of a toilet
12.Help resident slowly sit down onto the toilet. Ask resident
to pull on the emergency cord if she needs help. Remove
and discard gloves. Wash your hands. Leave bathroom
and close door.
13.When called, return and don clean gloves. Assist with
perineal care as necessary (see Chapter 13). Ask her to
stand and reach for the hand bar.
14.Use toilet paper or disposable wipes to clean the resident.
Make sure she is clean and dry before pulling up clothing.
Remove and discard gloves.
15.Help resident to the sink to wash hands.
16.Wash your hands.
17.Help resident back into wheelchair. Be sure the resident
is seated comfortably and correctly in the wheelchair.
Replace footrests.

72. Transferring a resident onto and off of a toilet
18.Help resident to leave the bathroom. Make sure resident
is comfortable. Remove privacy measures.
19.Place call light within resident’s reach.
20.Wash your hands again.
21.Report any changes in resident to the nurse. Document
procedure using facility guidelines.

73. Transferring a resident into a vehicle
Equipment: wheelchair
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to the resident. Speak clearly, slowly,
and directly. Maintain face-to-face contact whenever
possible.
4.Place wheelchair close to the vehicle at a 45-degree
angle. Open the door on the resident’s stronger side.
5.Lock wheelchair.

74. Transferring a resident into a vehicle
6.Ask the resident to push
against the arm rests of
the wheelchair and
stand.
7.Ask the resident to
stand, grasp the vehicle,
and pivot his foot so the
side of the seat touches
the back of the legs.
8.The resident should then
sit in the seat and lift
one leg, and then the
other, into the vehicle.

75. Transferring a resident into a vehicle
9.Carefully position the resident comfortably in the vehicle.
Help fasten seat belt.
10.Safely shut the door.
11.Return the wheelchair to the appropriate place for
cleaning.
12.Wash your hands.
13.Document procedure using facility guidelines.

76. 10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know these guidelines for stand-up lifts:
•Used when resident can bear some weight on his legs but has
poor leg strength and/or balance
•Resident must be able to stand and have some arm strength.
•Manual and battery-powered lifts are different types.
•Brakes must be locked before using.
•Resident in sitting position, with feet on foot plate and knees
against knee pads
•Resident grasps support bar and pulls himself up.
•Lower sides of seat into position, adjust straps, and resident
lowers himself into seat while holding bars.

77. 10 Positioning, Transfers, and Ambulation
Handout 10-1: Transferring a Resident to Bed from Wheelchair
Transferring a resident to bed from wheelchair
1. Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly.
Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door. Check the
area to be certain it is uncluttered and safe.
5. Remove both wheelchair footrests close to the bed.
6. Place wheelchair near the head of the bed with arm of the wheelchair almost
touching the bed. Wheelchair should be facing the foot of the bed. The
wheelchair should be placed on resident’s stronger, or unaffected, side.
7. Lock wheelchair wheels.
8. Adjust bed level. The height of the bed should be equal to or slightly lower
than the chair. Lock bed wheels.
9. Stand in front of resident with your feet about shoulder-width apart. Bend
your knees.
10.Place the transfer belt around resident’s waist over clothing (not on bare
skin). Grasp belt securely on both sides.
11.Provide instructions to allow resident to help with transfer.

78. 10 Positioning, Transfers, and Ambulation
Handout 10-1: Transferring a Resident to Bed from Wheelchair (cont’d.)
12.With your legs, brace resident’s lower legs to prevent slipping. This can be
done by placing one or both of your knees in front of the resident’s knees.
13.Count to three to alert resident. On three, with hands still grasping the
transfer belt on both sides and moving upward, slowly help resident stand.
14.Tell the resident to take small steps in the direction of the bed while turning
his back toward the bed. Or, if more assistance is needed, help the resident
pivot to stand in front of bed with back of resident’s legs against bed. When
he feels the bed, help him sit down on the side of the bed.
15.Make resident comfortable. Remove transfer belt.
16.Return bed to lowest position. Remove privacy measures.
17.Place call light within resident’s reach.
18.Wash your hands.
19.Report any changes in resident to the nurse. Document procedure using
facility guidelines.

79. 10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
Define the following terms:
ambulation
walking.
ambulatory
capable of walking.

80. 10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
REMEMBER:
NAs should check the care plan before helping a resident to
ambulate and must always keep the resident’s limitations in
mind.

81. Assisting a resident to ambulate
Equipment: gait belt,
non-skid shoes
1.Identify yourself by name. Identify the resident by name.
2.Wash your hands.
3.Explain procedure to resident. Speak clearly, slowly, and
directly. Maintain face-to-face contact whenever possible.
4.Provide for resident’s privacy with curtain, screen, or
door.
5.Adjust bed to lowest position so that the feet are flat on
the floor. Lock bed wheels.
6.Before ambulating, put non-skid footwear on the resident
and securely fasten.
7.Stand in front of the resident, facing the resident, with
your feet about shoulder-width apart.
8.Place gait belt around resident’s waist over clothing
(not on bare skin). Grasp belt securely on both sides.

82. Assisting a resident to ambulate
9.Always allow resident to
do whatever he is able
to do for himself. If the
resident is unable to
stand without help,
brace (support) the
resident’s lower
extremities. Bend your
knees. If the resident
has a weak knee, brace
it against your knee.

83. Assisting a resident to ambulate
10.Hold the resident close to your center of gravity. Provide
instructions to allow resident to help with standing. Tell
the resident to lean forward, push down on the bed with
his hands, and stand on the count of three. On three,
with hands still grasping the gait belt on both sides and
moving upward, slowly help resident to stand.

84. Assisting a resident to ambulate
11.Walk slightly behind and
to one side of resident
for the full ordered
distance, while holding
onto the gait belt. If the
resident has a weaker
side, stand on the
weaker side. Use the
hand that is not holding
the belt to offer support
on the weak side. Ask
resident to look forward,
not down at the floor,
during ambulation.

85. Assisting a resident to ambulate
12.Observe the resident’s strength while you walk together.
Provide a chair if the resident becomes dizzy or tired.
13.After ambulation, remove gait belt. Help resident to the
bed or chair and check that the resident is in proper
alignment. Make resident comfortable.
14.Leave bed in lowest position. Remove privacy measures.
15.Place call light within resident’s reach.
16.Wash your hands.
17.Report any changes in resident to nurse. Document
procedure using facility guidelines.

86. 10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
REMEMBER:
When an NA assists a visually-impaired resident with ambulation,
the resident should walk beside and slightly behind him. The NA
should warm the resident when approaching corners or steps.

87. 10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
Define the following terms:
C cane
a straight cane with a curved handle at the top.
functional grip cane
cane that has a straight grip handle.
quad cane
cane that has four rubber-tipped feet and a rectangular base.
walker
adaptive equipment used for people who are unsteady or who
lack balance; usually has four rubber-tipped feet and/or
wheels.

88. 10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
NAs should remember the following guidelines for cane or walker
use:
•Make sure cane or walker is in good condition.
•Make sure resident is wearing securely fastened non-skid
footwear.
•Resident should place cane on stronger side.
•Resident should place both hands on the walker, and walker
should be placed no more than six inches in front of resident.
•Stay near resident on weaker side.
•Do not hang purses or clothing on walker.
•Report to nurse if cane or walker seems to be the wrong
height.

89. Assisting with ambulation for a resident using a cane, walker, or crutches
Equipment: gait belt,
non-skid shoes, cane, walker, or crutches
1.Identify yourself by name. Identify resident by name.
2.Wash your hands.
3.Explain procedure to resident. Speak clearly, slowly, and
directly. Maintain face-to-face contact whenever possible.
4.Provide for resident’s privacy with curtain, screen, or
door.
5.Adjust bed to lowest position so that the feet are flat on
the floor. Lock bed wheels.
6.Before ambulating, put non-skid footwear on the resident
and securely fasten.
7.Stand in front of the resident, facing the resident, with
your feet about shoulder-width apart.
8.Place gait belt around resident’s waist over clothing
(not on bare skin). Grasp belt securely on both sides.

90. Assisting with ambulation for a resident using a cane, walker, or crutches
9.If the resident is unable to stand without help, brace
(support) the resident’s lower extremities. Bend your
knees. If the resident has a weak knee, brace it against
your knee. Help the resident to stand as described in the
previous procedure.

91. Assisting with ambulation for a resident using a cane, walker, or crutches
10.Help as needed with
ambulation.
a.Cane: Resident places
cane about six inches, or
a comfortable distance,
in front of his stronger
leg. He brings weaker
leg even with cane. He
then brings stronger leg
forward slightly ahead of
cane. Repeat.

92. Assisting with ambulation for a resident using a cane, walker, or crutches
b.Walker: Resident picks
up or rolls the walker
and places it about six
inches, or a comfortable
distance, in front of him.
All four feet or wheels of
the walker should be on
the ground before
resident steps forward to
the walker. The walker
should not be moved
again until the resident
has moved both feet
forward and is in a
steady position. The
resident should never
put his feet ahead of the
walker.

93. Assisting with ambulation for a resident using a cane, walker, or crutches
c.Crutches: Resident
should be fitted for
crutches and taught to
use them correctly by a
physical therapist or
nurse. The resident may
use the crutches several
different ways,
depending on what his
weakness is. No matter
how they are used,
weight should be on the
hands and arms. Weight
should not be on the
underarm area.

94. Assisting with ambulation for a resident using a cane, walker, or crutches
11.Walk slightly behind and to one side of resident. Stay on
the weaker side if resident has one. Hold the gait belt if
one is used.
12.Watch for obstacles in the resident’s path. Ask resident to
look forward, not down at the floor, during ambulation.
13.Encourage the resident to rest if he is tired. When a
person is tired, it increases the chance of a fall. Let the
resident set the pace. Discuss how far he plans to go
based on the care plan.
14.After ambulation, remove gait belt. Help resident to the
bed or chair and check that the resident is in proper
alignment. Make resident comfortable.
15.Leave bed in lowest position. Remove privacy measures.
16.Place call light within resident’s reach.
17.Wash your hands.
18.Report any changes in resident to nurse. Document
procedure using facility guidelines.