Patient’s Transferring,

Moving, positioning and

mobility
By
Dr. Khalil El Aajam
PhD. M.Sc. RN
Introduction

Many patients are unable to move at

all or need some assistance in
moving.
It is the nurse’s responsibility to help
by moving patients, directing them
in the best technique for self
movement
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 Transferring

- It means moving a patient from place

( moving a patient from bed to chair
or stretcher, or wheelchair).
- Maximum comfort and safety for the
patient and nurse is needed.

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Reasons for transferring

 Improvement of patient condition.

 Worsens of the patient’s condition
 The need of special care
 The need of surgery or x-ray
 Transfers at the patient’s request

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Key points to remember before
moving and lifting.
• Firstly, take correct Rationale :- To
position before starting. •reduce strain
– Stand facing the direction
of object to be made. •prevent injury
– Place the feet wide •maintain balance and
enough apart to have keep good alignment
good balance.
– Place one foot well in
•to promote wide
front of the other. base of support.

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2- Always keep your back straight.
3- Bend the knees to lower body to level you
are working
4- Keep elbow close to your body when lifting
to decrease strain on arms muscles.
5- Slide the patient on bed instead of lifting
whenever possible.
6- Give signal " ready" to patient and your
helper (if all work together at exactly the
same time).

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7- Ask for help when patient is too heavy or too
hard for you to manage.
8- Know that most strains (and fatigue) caused
by lifting are due to using the wrong group
of muscles (use the big, strong leg muscles,
not your back muscles).
9- Maintain body alignment of patient at all
times and protect him from injury.
10- Support patient's muscles and joints well and
properly.
11- Always explain to patient what are to do so
will be better able to cooperate.
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 Moving the patient to a stretcher
• Objectives:-
• To transfer the patient
to any department in the
hospital (e.g. operating
room-X ray-lab.) and vice
–versa.

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Lifting patient to wheelchair

• Objectives:-
• To put in sitting position.
• To transfer patient from
place to place

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Positioning
• Positioning the patient is performed
frequently; every 2 hours or less and aims to:
a. promote comfort and relaxation.
b. restore body functions such as:
 gastrointestinal function.
 respiratory function through:
o It allows for greater lung expansion.
o It relieves pressure on the diaphragm.

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c. To prevent deformities.
- When one lies in bed for long periods of
time, muscles become atonic and atrophy.
- Prevention of deformities will allow the
patient to ambulate when his activity level is
advanced.
d. To relieve pressure and prevent strain.
e. To stimulate circulation.
f. To give treatments ( range of motion
exercises).

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Maintaining proper body alignment with the
patient on his back
• The paraplegic and quadriplegic may not be able
to tell you if their position is uncomfortable. You
must be especially attentive in this case to
prevent possible problems from malalignment.
• Pillows can be used to support the patient's
head, neck, arms, and hands legs and a foot.
• The footboard is slanted to support the feet at
right angles to the leg (a normal angle) and
prevent foot drop.
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Conditions may make it impossible to turn the
patient.

• (a) Turning may be impossible if the patient has

fractures that require traction appliances.
• (b) Turning may be harmful to patients with spinal
injuries.
• (c) In these cases, you need to rub the back by lifting
the patient slightly off the bed and massaging with
your hand held flat.
• (d) It is especially important to prevent skin
breakdowns in the person who lies on his back for
long periods of time.

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Moving patient in bed toward you and away
• Objectives:
• To change patient's position.
• To make occupied bed.
• To make back care.
• Start with you weight on the front
•

Move patient by shifting your weight to back foot.

Start with your weight on both feet. Bend knees to level
you are working. Raise patient. straightening your knees..
Keep elbows close to your body. 17
• Lifting patient:-
• Keep equal weight on both feet. Bent Knees to
level you are working. Raise patient by
straightening your knees. Keep elbows close
to your body.
• Lowering patient:-
• Keep equal weight on both feet. Start with
knees straight or slightly flexed. Lower patient
by bending your knees. Keep elbows close to
your body.

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 Raising shoulder of the patient

• Objectives:
• To arrange pillow.
• To help the patient to change his gown.
• To assist the patient to a sitting position

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Range-of-Motion (ROM) Exercises
1. Movements to maintain joint mobility
and function.
2. Help prevent permanent shortening of
muscle, tendons, and ligaments that
ultimately limits joint mobility
(contracture).
3. Applying heat before ROM may relax
muscles and increase contractility.
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 Types of ROM exercise.
a. Active ROM.
 ROM performed by a patient.
 Requires muscle contraction that improves muscle
strength.
b. Active-assistive ROM.
ROM initiated by a patient that is completed by another.
Requires some muscle contraction that eventually
improves muscle strength.
c. Passive ROM.
 ROM performed for a patient by another person.
 Passive ROM does not contract muscles and, therefore,
does not improve muscle strength.

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d. Continuous-passive ROM.
ROM achieved for a patient by a machine.
An extremity is placed in a mechanical device
that supports the limb from distal to proximal
and sequentially flexes and extends a joint at a
prescribed speed and degree of joint flexion
(e.g., a machine placed under the upper thigh
to the foot flexes the knee and hip).
Continuous-passive ROM improves extent of
joint movement and prevents contractures.

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Nursing care when providing ROM exercises.
• Review the primary health-care provider’s restrictions and
orders for the type and extent of ROM exercises to ensure that
the exercises are permitted and not contraindicated.
• Schedule ROM exercises to permit adequate time to complete
the planned routine.
• Wash your hands, identify the patient, introduce yourself,
explain the procedure to the patient, and provide privacy.
• Assess the patient’s status, such as presence of joint stiffness,
swelling, or pain; physical ability to perform or assist with
exercises.
• Assess the patient’s response to ensure that ROM exercises do
not cause pain.
• Encourage the patient to perform active ROM exercises.
• Put each joint through ROM.

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• Place hands distal and proximal to the joint to support
the joint while it is being put through ROM.
• Implement ROM slowly, smoothly, and rhythmically to
limit stress on the patient’s anatomical structures;
repeat each movement three to five times to stretch
muscle fibers.
• Monitor the patient’s physical, verbal, and nonverbal
responses to interventions to provide data that influence
continuation of or future implementation of ROM.
• Perform other assessments, (e.g. condition of the skin).
• Document interventions, extent of mobility of joints,
and patient’s responses.

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 Negative Effects of Immobility
• Immobility is a decrease in the amount and
control of movement. It can have major
negative effects on many body systems.
• The longer the inactivity, the greater the risk
of the development of a complication of
immobility.
• Nurses can implement a variety of dependent
and independent interventions to prevent the
negative consequences of immobility.

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A. Musculoskeletal System
atrophy
• Muscles that are not used decrease in size and physiological
ability (atrophy).
• Muscle begins to lose contractile strength after 24 to 36 hours of
inactivity.
• Inactivity or bed rest can lead to 7 to 10 percent loss of muscle
strength in 1 week.
Contractures
•When a muscle does not contract and relax, it eventually
permanently shortens (contracture). Contractures limit joint
mobility.
Joint stiffness and pain
• Inactive muscles cause connective tissue at joints to become
permanently immobile.
• Osteoporosis occurs because of lack of weight bearing.
• Calcium deposits in joints contribute to stiffness and pain.
• May become deformed or fracture easily.

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B. Cardiovascular System
– Orthostatic hypotension.
– Increased workload of the heart.
– Thrombus formation.
C. Respiratory System
– Decreased respiratory movement.
– Stasis of respiratory secretions.
– Oxygen–carbon dioxide imbalance.
D. Integumentary System
– Reduced skin turgor.
– Skin breakdown.
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E. Gastrointestinal System
– Constipation.
– Decreased appetite (anorexia).
G. Urinary System
– Urinary stasis.
– Urinary retention or incontinence.
– Urinary tract infection (UTI).
– Renal calculi.
H. Psychoneurologic System
– Psychosocial changes.
– Mental changes.
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