Acceptable and Unacceptable Techniques

After assessing the patient

• Are they being nursed on the most suitable bed and mattress.

Then, each time you attend to the patient to move them:

• Encourage them to do what they can for themselves, and give them time to do so.

To perform the following moves:-

• Rolling side to side – a minimum of two people are required (more depending on the size and condition of the patient) to roll the patient, if they require to be positioned on either side or moved across the bed use sliding sheets, to reduce the effort required by the staff.

• Lying to sitting – use the bed to raise the patient into sitting. Ensure the patient's hips are positioned over the “break” in the bed, if the patient has slid further down the bed, lower the backrest, slide the patient up the bed to place their hips in the right position, then use the bed to sit them up. This also applies to trolleys. DO NOT DRAG THE PATIENT UP THE BED BY PULLING ON THEIR ARMS.

• Move up the bed – slide recumbent patients up the bed using sliding sheets, and a minimum of two people (more may be required depending on assessment). Another alternative, if there are insufficient numbers of staff, is to use the hoist.

• Lying to sitting over the edge of the bed – if the patient is lying flat, roll them onto their side, then ease them up into sitting. If semi-recumbent or sat up in bed, use the bed to sit them as upright as possible. Have the members of staff positioned one behind the patient to support the patient’s trunk, and the other in front to support the patient’s legs.

• Sitting to standing – the patient must be able to bear their weight, if not use assistance. Staff is to position themselves on either side of the patient, one arm supporting the patient’s trunk, the other supporting the patient’s upper arm, block the feet if necessary, and “rock” the patient onto their feet. DO NOT DRAG THE PATIENT UPRIGHT BY PULLING ON THEIR ARMS.

• Transfer to a chair – once on their feet, allow the patient time to stand as upright as possible, and get their balance, before asking them to step around to sit down in a controlled fashion, Turning them quickly, results in the patient losing their balance and not being able to help you.

If you cannot get the patient onto their feet with two members of staff, either from the bed or from the chair back to bed, asking for more staff is not the most appropriate thing to do. To be surrounded by staff and manhandled into a bed or a chair, is not SAFE, DIGNIFIED, OR NOT OFFERING THE BEST QUALITY OF CARE TO THE PATIENT, NEITHER IS IT SAFE FOR THE STAFF

• Support whilst walking – you are there to provide support and guidance, not hold the patient upright. If they use a walking aid use this, and you stand to the side. They can see you, but you are not in the way.

• Emergencies/life-threatening situations- if out of bed (including sitting on a chair, commode, or wheelchair) lower the patient to the floor. Try to protect their head, but imperatively you do not put yourself at risk. Once on the floor deal with resuscitation there.

• Fallen/falling patient – contact emergency services while keeping the patient as comfortable as possible until help arrives

These moves were identified in 1980 as being dangerous to staff and patients, they were condemned by the RCN in 1984 as a means of moving patients, and MUST NOT be employed.

• Lying to sitting – pulling the patient's arms, is painful and damaging to the patient and can cause harm to the staff’s neck, shoulder, and back muscles.

• Move up the bed – pulling the patient’s arms, causes damage to the shoulders and can lead to the development of pressure areas. It also strains the staff’s neck, shoulder, and back muscles.

• Sitting to standing – pulling the patient’s arms, this will cause the same problems as above. The patient is in danger of falling as the staff does not have full control of the situation.

• Manually lifting a patient out of a bed or chair – the staff are carrying the whole weight of the patient and may drop the patient.

• Manually lifting a patient off the floor – unless in exceptional circumstances, because of the potential harm to patient and staff alike.

Always assess the situation first, then use the most appropriate and safe technique to move the patient. Use equipment to help you – it may take more time, but both you and the patient will be safe