Assisting Clients to Transfer
Key Points
- Most resident and staff injuries occur during transfers, so transfer safety is a highest-priority CNA responsibility.
- Transfer method must match care-plan transfer status and therapist recommendations.
- Key safeguards include brake checks, gait-belt fit, nonskid footwear, orthostatic monitoring, and hazard clearance.
Pathophysiology
Transfer events combine high musculoskeletal load with balance instability and cardiovascular adaptation demands. Rapid position change can trigger orthostatic hypotension, reducing cerebral perfusion and increasing fall risk.
Improper transfer mechanics also increase shear and skin injury risk, especially in frail older adults. Uncontrolled load shifts during lift use can cause tip events and severe injury.
Safe transfer practice reduces trauma, preserves resident confidence, and supports functional mobility maintenance.
Classification
- Independent: No transfer assistance required.
- Contact-Guard-Assist (CGA): Continuous balancing contact by one assistant.
- 1 assist (1A)/2 assist (2A): One or two assistants with gait belt support.
- Sit-to-Stand lift: Partial weight-bearing mechanical support.
- Full-body mechanical lift: Non-weight-bearing transfer method, typically with two trained assistants.
Nursing Assessment
NCLEX Focus
Priority questions ask which transfer method is safest for current weight-bearing ability and dizziness risk.
- Review current care-plan transfer status before every transfer.
- Screen for dizziness/vertigo after dangling and before standing.
- Verify gait-belt contraindications, skin vulnerability, and fit around body contours.
- Confirm environment safety: bed/wheelchair brakes, clear path, and equipment positioning.
Nursing Interventions
- Assist resident to dangle before standing to reduce orthostatic hypotension risk.
- Apply gait belt snugly (two-finger fit) and secure excess strap length.
- Position transfer target on resident’s stronger side when indicated.
- For mechanical lifts, use ordered sling type/loop setup and follow facility training.
- Keep lift brakes off while resident is suspended or standing in lift to avoid tip from load shift.
Transfer Method Mismatch Risk
Using an incorrect transfer method for resident weight-bearing status can cause falls, staff back injury, and resident skin or limb trauma.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antihypertensives | Blood-pressure lowering therapies | Can increase orthostatic symptoms during position changes; reassess dizziness before standing transfer. |
| sedatives | Sleep or anxiety medications | May reduce balance and reaction time, requiring stricter transfer support and supervision. |
Clinical Judgment Application
Clinical Scenario
A resident ordered for 1A transfer reports dizziness after sitting at bed edge and begins leaning backward when standing.
Recognize Cues: Orthostatic symptoms and unstable posture at transfer initiation. Analyze Cues: Current physiologic tolerance is insufficient for immediate standing transfer. Prioritize Hypotheses: Preventing fall and reassessing transfer readiness are immediate priorities. Generate Solutions: Re-seat resident, reassess symptoms, notify nurse, and consider increased assist method per plan update. Take Action: Abort transfer safely and escalate objective findings. Evaluate Outcomes: Resident remains injury-free and transfer method is adjusted appropriately.
Related Concepts
- moving-and-positioning-clients - Repositioning and transfer safety principles overlap.
- body-mechanics-and-safe-equipment-use - Proper mechanics reduce caregiver injury during transfer tasks.
- fall-prevention - Transfer controls are a major component of fall-risk reduction.
- documenting-and-reporting-data - Transfer tolerance and abnormal responses require clear documentation.
- measuring-weight-for-ambulatory-residents - Similar brake, gait-belt, and assist-safety workflow elements.
Self-Check
- Why should residents dangle before standing transfer when indicated?
- Which transfer-safety checks must be verified before movement starts?
- Why should lift brakes remain off while a resident is suspended in a mechanical lift?