change on a chair or wheelchair the patient can independently or with your help. Opportunity change independently helps to restore independence and assert itself. Knowing how to do it right will help transplantation V wheelchair, when using the toilet, bathing and when getting into a car.
Self-transfer from bed to wheelchair
In the case of transferring from a bed, its height should be at the same level as wheelchair or a chair.
First, a dressing gown, slippers, a chair or a wheelchair are prepared for the patient;
Help the patient to dress and sit up in bed so that his feet touch the floor;
wheelchair or a chair is placed at a slight angle to the bed on the side of the patient that is physically stronger;
The bed is put on the brakes;
If sick moves on wheelchair, the brakes are fixed at the chair, the armrest is removed from the side close to the patient, and the footrest;
The patient should sit on the edge of the bed, lean on it with one hand, and grasp the armrest of the wheelchair with the other;
Then he gets out of bed, leaning with one hand on the bed, and with the other on the arm of the chair, turns his back to armchair and carefully sits in it.
At moving from wheelchairs in bed, the patient holds on to the armrest of the chair with one hand, and leans on the bed with the other, then gets up with wheelchairs leaning on the bed with one hand, and the other - holding on to the armrest armchairs, turns his back to the bed and carefully sits on it.
At moving from bed to chair and back, you can use the same techniques as with moving from bed to wheelchair. For the safety of the patient, it is better to use a chair with armrests.
Using a smooth board to move the patient from bed to chair or wheelchair and back
Such boards reduce sliding friction and may be useful for patients with strong arms, but unable to lean on their feet when transplanting.
- Armchair or the chair is moved close to the bed, the chair is put on the brakes, the armrest is removed from the chair from the side of the bed.
- The patient should sit in bed without taking his legs off her, so that the chair is on the side of him.
- The patient must transfer the weight of his body to the buttock farthest from the chair.
- The patient slips one end of the board under the buttock closest to the wheelchair.
- Leaning with one hand on the bed, and with the other on the free edge of the board, the patient slides into the chair along the board, pressing it to the seat.
- After sitting down in a chair, he takes out a board from under him.
- Sitting in armchair, He moves legs off the bed and puts them on the footrest. In the same way it is possible move from armchairs on the bed.
Moving from bed to chair and back with the help of a sitter
Explain your plan to the patient moving I and encourage his feasible help;
Prepare a bathrobe, slippers, a chair or wheelchair. The bed should be at the same height as the chair ( wheelchair);
Place the patient in bed with his feet touching the floor;
Set up a chair or wheelchair at a slight angle to the bed on the side that the patient is physically stronger;
Put the bed on the brakes. If you move the patient to wheelchair, remove the armrest, footrest and fix the brakes;
Help the patient to dress and put on shoes;
Your knees should be bent and your back should be straight. Place one hand under the patient's shoulders and the other under his hips. Do not turn your back at the waist;
Ask the patient to put his arm around your waist or shoulders (but not around your neck!), and you put your hands under his arms, leaning forward;
When your patient is ready for displacement, his buttocks should be on the edge of the bed so that he can keep his balance when you move its body weight forward. The patient's feet should be on the floor, and the heels should be slightly turned in the direction of movement. This is necessary so that his legs do not get tangled when he turns his body to sit in wheelchair or on a chair;
Bend your knees, tighten the muscles of your abdomen and buttocks, keep your back straight;
Get as close to the patient as possible. Warn him that on the count of "3" you will help him get up. Rock back and forth slightly for each count to create momentum. On the count of "3", pressing the patient to you and keeping your back straight, lift the patient, using your body as a lever;
Turn yourself at the same time as turning the patient's body until he takes a position directly in front of wheelchair. Ask the patient to warn you when he feels the edge armchairs back of the thighs;
Gently lower the patient into armchair. To do this, you need to bend your knees and keep your back straight. Sitting down in a chair, the patient can help you if he puts his hands on the armrest armchairs. After the patient sits down armchair, put the armrest and footrest in place, place the patient's legs on the stand.
Moving plank from bed to wheelchair with the help of a sitter
Armchair or move a chair close to the bed, armchair put on the brakes, remove the armrest from armchairs from the side of the bed;
The patient must sit in bed without taking his feet off her, in order to armchair was on the side of him;
The patient must bear the weight own body farthest from armchair buttock;
Slide one end of the board under the nearest wheelchair buttock;
Stand behind the patient and put your hands on his waist;
With one hand, the patient should lean on the bed, and with the other - on the free edge of the board;
Then, leaning on the free edge of the board and bending it to armchair, the patient, with your help and the help of the other hand, should move to armchair;
Pull the board out from under it;
Move his legs off the bed and place them on the footstool. In the same way, you can move from armchairs on the bed.
Self-transfer from chair to chair
- Move armchair, on which you want to transfer, as close as possible to yourself from the healthy side and at right angles to armchair on which the person sits;
- Move to the edge armchairs. Put the foot of the diseased leg straight in front of you, closer to the edge of the seat, the foot of the healthy one -
closer to the far leg armchairs to which you need to transfer; - Lean forward and slightly to the side of the desired armchairs;
- With a healthy hand, grasp the remote armrest of the second armchairs;
- Rise up from the seat and shift your body weight to good leg turning back to armchair in which to sit;
- Get down in armchair, controlling the correctness and comfort of landing.
Heating pad setting
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Neurological diseases
Neurological diseases- These are pathological changes that occur in a certain area of \u200b\u200bthe nervous system. These diseases are classified as chronic and are divided into two types:
Target: preparation for patient transport
(performed by two people, the patient can help )
Equipment:
wheel chair,
skin antiseptic
gloves
functional bed
Preparation for the procedure:
establish a trusting relationship, explain the procedure to the patient, make sure that he understands it and obtain consent to the procedure.
Assess the patient's condition and environment. Attach the bed brakes. Place the wheelchair at the patient's feet. If possible, lower the bed to the level of the chair
Execution sequence:
One sister stands behind the wheelchair and tilts it forward so that the footstool touches the floor.
The second sister (assistant) stands in front of the patient sitting on the bed
with legs down, sister's legs spaced 30 cm wide, knees bent.
Ask the patient to grab the sister by the waist, hold him by the shoulders.
Pull the patient to the edge of the bed so that their feet (in non-slip shoes) touch the floor
Place one leg between the patient's knees, the other in the direction of movement.
Press the patient in the “hug” position, gently lift him, without pulling or turning. Do not put pressure on the patient's armpits!
Warn him that on the count of three you will help him up. While counting, sway slightly with it. On the count of three, put the patient, turn with him until he takes a position with his back to the wheelchair. Ask the patient to warn you when he touches the edge of the gurney.
Lower the patient into a wheelchair; bending your knees, hold the patient's knees with them; keep your back straight. The patient can help by placing their hands on the armrests of the wheelchair.
Release the patient, making sure that he is securely seated in the chair.
Place the patient comfortably in the chair.
If necessary, transport the patient - remove the brake.
Completion of the procedure:
Make sure the patient is sitting comfortably
Wash and dry your hands
b 
Transferring the patient from the “sitting on the bed with legs down” position to the wheelchair.
4.3 Moving the patient from bed to chair (wheelchair) using the “shoulder lift” method
Target: relocation of an unresponsive patient
(performed by two or more people the patient can sit but does not move independently )
Equipment:
wheelchair or chair, skin antiseptic, gloves, functional bed
Preparation for the procedure:
Explain to the patient the course of the procedure, make sure that he understands it and obtain consent to the procedure.
Assess the patient's condition and environment. Attach the bed brakes.
Put a chair next to the bed.
Execution sequence:
Help the patient to sit closer to the edge of the bed with legs dangling.
Stand on both sides of the patient facing him. Both sisters put their hand under his hips and hold each other in a "wrist grip" (see figure 2.10), supporting his hips.
Both sisters put their shoulders under the shoulders of the patient, and he puts his hands on the backs of the sisters. Bend your free arm at the elbow, resting it on the bed. Legs apart, knees bent.
One of the sisters gives the command. On the count of three, both straighten their knees and elbows, stand up and lift the patient. Support the patient's back with your free hand while you carry them to the chair (wheelchair).
Each nurse places a supporting hand on the chair arm or seat and lowers the patient into the chair by bending the knees and elbow. Make sure you lower the patient into the chair at the same time. The chair should not lean back: one of the sisters holds the back of the chair.
Completion of the procedure:
Make sure the patient is sitting comfortably
Wash and dry your hands
Transferring the patient from bed to chair
(wheelchair) using the “shoulder lift” method
On the bed
Sequencing
The trolley is filled with individual bed linen.
Methods for shifting a patient in a group (two / three of us):
1. Get closer to the bed at the level of the head, lower back, legs.
2. Half squat down with one leg forward.
3. Bring your hands under the patient's body at the same time:
Fix the three of us:
■ head and shoulder blades of the patient;
■ pelvis and upper part hips;
■ the middle of the thighs and lower legs.
Fix together:
■ the patient's head and torso;
■ pelvis and middle of the thighs.
4. Hold the patient close to you and at the expense of “one, two, three” immediately lift the patient, turn around and transfer to the surface of the gurney/bed.
5. Cover the patient.
Moving the patient from lying on his side to sitting with legs down
Sequencing:
2. Lower the side rails on the nurse's side.
3. Stand in front of the patient.
4. left hand bring under his shoulders, right - under his knees, covering them from above.
5. Raise the patient, lower the legs down and at the same time turn him on the bed in a horizontal plane at an angle of 90 °.
6. Sit the patient down, continue to face him, hold the shoulder with the left hand, the body with the right hand.
7. Place a back support, make sure the patient's posture is stable.
8. Put on the patient's shoes or fix the legs on the bench.
Moving the patient from a sitting position on the bed
With legs down on a wheelchair
Sequencing:
1. Block the bed brake.
2. Put wheelchair on the brake next to the bed.
3. Use the patient restraint method:
■ grip "under the elbow" - the sister fixes the patient's knees with her legs, the patient leans forward so that his shoulder rests on the sister's torso; the nurse holds him, pressing her bent arms by the elbows;
■ capture "under the elbow" - the nurse holds the patient not by the elbows, but under the armpits.
4. Put the patient on his feet, turn with him at the same time to the wheelchair.
5. Lower the patient onto the wheelchair, bend your knees and support the patient's knees.
6. Fix the patient's arms on the armrests.
7. Sit comfortably, release the brake and transport.
PATIENT TRANSFER BY TWO OR MORE NURSES
When the patient is lifted by two or more nurses, the importance of coordination increases.
In this case, a lifting and moving team is formed. Before starting work, you need to determine the leader. They are assigned the most experienced nurse who owns the technology of lifting and moving.
Team rules:
All work is led by a leader.
The leader gives orders clearly and concisely, but only after making sure that each nurse and patient is fully prepared to be lifted or moved.
The leader makes sure that interfering equipment is removed, as well as the facial expression of the patient.
The leader sets a certain rhythm of work in the team.
The physically strongest nurse takes on the heaviest part of the patient's body (thighs and torso).
When all the above aspects are taken into account, you can proceed to the direct lifting. It is necessary to stand as close to the patient as possible and take a stable position on the floor.
KEEPING THE PATIENT WALKING
Starting posture: nurses stand on the side. The patient is in the center. A palm-to-palm grip is used with a grip thumb into the ring.
Working posture: at the command of the leader, the movement begins. Near standing feet nurse and the patient take a step at the same time.
Instructions to the patient: the leader explains to the patient on which foot he starts the movement.
HELP THE PATIENT WHEN FALLING
Starting posture: the nurses and the patient move while stepping with adjacent feet.
Working posture 1: if the patient is in danger of falling, the nurses stand on the side of the patient and carry out an axillary grip - the arm of the lever. A squat is performed.
Working pose 2: nurses do deep squat and transfer their weight to the front leg, helping the patient to get down on all fours.
End of procedure: the patient is placed on the floor comfortable posture. You can put a pillow on.
PATIENT TRANSFER
TO THE HEAD OF THE BED
Initial position: two nurses seat the patient in bed using a second shoulder grip.
Working posture 1: both nurses take the following position: one leg on the floor, the other knee on the bed, to the side of the patient. With the near hand to the patient, the nurse picks up the patient under the buttock and thigh. The other hand rests on the surface of the bed. Both nurses lean on their shins. The patient's hands are on the backs of both nurses.
Working pose 2: nurses simultaneously move forward, straightening the hip and moving the patient to the head of the bed.
End of manipulation: The patient is placed on the bed in a comfortable position.
Shoulder lift. The method is used to move a patient who is able to sit.
A chair or boat seat is placed close to the bed. Help the patient to sit up, legs hanging freely from the bed, close to the edge of the bed. Together with another nurse, a wrist grip is used to keep the hips closer to the buttocks. They put their shoulders under the shoulders of the patient, he puts his hands on the backs of the nurses.
Place the supporting arm on the bed behind the patient's buttocks, bending it at the elbow; legs apart, knees bent. Then one of the nurses gives the command to lift the patient. The knees and elbow are extended until the body is straightened. When carrying to a chair, support the patient's back with their free hand. Place the supporting hand on the armrest or chair seat and lower the patient by bending the knees and elbow. This must be done at the same time as another nurse. The chair should not tilt back under the pressure of the helping hand. One of the nurses can support the back of the chair for safety reasons.
Lifting through the hand. The method is used to transport a patient from a bed to a chair or boat seat without armrests or a backrest.
Set the height of the bed equal to the height of the chair. Help the patient to sit up. One of the nurses stands with one knee on the bed behind the patient and grabs through her arm. Move the patient to the edge of the bed, leaving his legs in the middle. Continue to support the patient, but now stand on the floor with both feet directly behind him while he is at an angle to the side of the bed. -.. >
The role of the second nurse is to place the chair comfortably and close to the bed, without allowing too much space between them, but not too close, so that the patient does not elbow into the bed when he is lowered into the chair. They stand on the side of the bed, put one leg forward, put their hands under the patient's legs, and prepare to pull them towards themselves. The nurse behind the patient gives the command to rise. The patient's legs are dragged to the edge of the bed while the nurse standing behind the patient lifts the patient's torso off the edge of the bed. Both nurses squat gently to lower the patient into a chair.
Transfer of the patient by one person. Lifting with swing. The technique is used to help the patient get up and move to another place, provided that he can participate in the movement and control the position of the head and hands.
You can reduce the effort to lift the patient by gently rocking the patient. They begin by helping him move to the edge, gently rocking him from side to side and alternately moving his legs forward. The patient's knees are at a 90° angle, knees and feet together. They stand with one foot next to the patient and the other in front of him, fixing his knees. In this position, you can:
help the patient to stand up;
move its floor at a 90" angle from a chair to a wheelchair;
turn it 180" from the wheelchair.
In any case, the rocking is carried out according to the same principle: they rhythmically begin to move, moving their body weight back and forth, keeping the patient close to themselves. By doing this, a rocking impulse is transmitted to the patient. There is no need to lift the patient: with the help of body mass, enough kinetic energy is accumulated to move. Do a few preparatory swings to set the rhythm; then they move more intensively, stimulate the patient, and the movement is made.
Underarm grips or pelvis or waist-strap techniques can be used to help the patient stand up or move them from a 90° sitting position to another position.
To transfer a patient from a wheelchair to a toilet seat, move both seats together, corner to corner, block the wheels, and remove the backrests.
To transfer a patient from a functional height-adjustable bed to a chair, place the chair next to the bed so that there is no space between them. If possible, lower the bed and move the patient as previously described.
M3
Grab with a raised elbow. This is the optimal technique for peg, paving the patient at 90 or 180°. At the same time, the movements of the patient are well controlled. With the correct implementation of this technique, the patient will feel comfortable. Moving 180° will require more energy to swing.
Transferring a patient from bed to wheelchair. The method is used when lifting a patient from a bed to a stretcher and vice versa only in the absence of a lifting mechanism or stretcher and aids for smoothly rolling the patient from one surface to another.
Position the wheelchair at an angle of at least 60° to the bed. If possible, place the bed on maximum height and put the wheelchair and bed on the brake.
Nurses should stand on the side of the gurney that faces the bed, facing the patient, with the strongest nurse in the center. Put one leg forward, bend it at the knee and stand as close to the bed as possible. Put the other leg back to maintain balance. Gently place your hands up to the elbow under the patient. The nurse at the patient's head lifts the patient's head and supports the shoulders and upper back. The nurse in the center supports the lower back and buttocks, while the third nurse supports the lower legs and legs. If the patient is very sick, it may be necessary more people and have to redistribute the load.
The patient is raised in two steps: first, they gently roll to the edge of the bed, then they lift it and transfer it to a stretcher. When one of the nurses gives the command, the weight of the body is transferred from the forward leg to the backward leg in order to smoothly roll the patient to the edge of the bed. Pause to change the grip of the patient and their own posture for the lift itself. At the second command (coordination of movements is crucial), the patient is rolled over, pressed to the chest and lifted. (The closer the nurse holds the patient to her during the lift and the straighter she stands, the less physical exercise experiences.) Then they move back. One of the nurses holding her legs takes wider steps while everyone else stands parallel to the gurney. At the third command, the legs are bent at the knees and the patient is carefully lowered onto the gurney.
Health care workers are injured when they release one hand in a series of lifting actions, such as placing a vessel on a patient. You should always try to find another person who will perform an additional procedure.
Transferring the patient to a chair or wheelchair. Place a chair or wheelchair by the patient's bed next to
oboe and make sure they are well positioned and will not budge or fall off in the process of moving.
They help the patient to sit on the edge of the bed, for which he is offered to lie on his side facing the nurse and bend his knees. This position allows you to easily hang the patient's legs over the edge of the bed.
With one hand, gently support the patient under the back and pull up. If the patient is able, he can support himself by leaning his hand on the bed.
You should never pull the patient by the hand, especially the affected one. This will not only weaken the ligamentous apparatus shoulder joint and will lead to dislocation, which is highly undesirable, but will not help to move the patient.
After the patient has taken vertical position he is allowed to sit quietly for a while - he will be able to get used to the sitting position and his blood pressure will stabilize, which may change in response to a change in body position.
They stand directly in front of the patient, then come close to him, so that the knees rest on his knees. Crouching a little and bending their knees, they grab the patient by the waist and offer him to hold on to his shoulders or neck.
Count aloud to three and at the expense of "three" straighten up with the patient. Continuing to rest their knees on him, they take a break. Ask the patient to help fix the legs in a standing position.
After a break, the patient is told that he will turn at the same time as the nurse.
When turning, always look at the patient's face, do not bend. As soon as the back of the knees (popliteal region) of the patient has touched the chair (wheelchair), he is gently lowered into the seat.
To turn a lying patient and reduce the load on the back of a nurse, a special bedding is used. To do this, an ordinary sheet is folded two or three times, placed along the bed under the shoulders and hips of the patient. This allows you to change the position of the patient without lifting him. To turn the patient from the back to either side, stand on the opposite side of the bed from the direction of rotation and put the corresponding arm and leg of the patient on the other arm and leg, then pull the bedding and carefully turn the patient to the desired side. It is important to remember that the patient should remain in the middle of the bed. To fix this position, special pads and foam pads are used.
If it becomes necessary to lift the patient, this manipulation should be performed only by two people, holding the edges of the bedding on both sides. But there are situations when the patient needs
complete without anyone's help. If you follow the above recommendations, you can significantly reduce the risk of injury to both the patient and the nurse.
If the patient is able to communicate, before the manipulation he is told about the intended actions. Immediately before lifting the patient and during the manipulation, the legs are bent at the knees so that the center of gravity of the body is as low as possible. In this position, part of the load is redistributed from the muscles of the back and spine to the muscles of the thighs, which are quite hardy and less prone to injury. To increase the area of \u200b\u200bsupport, the legs are placed shoulder-width apart.
Immediately before lifting the patient, a deep breath is taken, then the abdominal muscles are strongly strained and exhaled during the manipulation. Breathing should not be held. Before starting the action, count up to three: this usually helps the patient to coordinate his movements with the movements of the nurse, to perform them in the same rhythm. In the course of the manipulation, the patient is told what and when he needs to do in order to facilitate the lifting process.