Home Health Aide w/ VERY difficult transfer case

[FashionablyL8, CNA, LPN]

R trHi everyone,

This site is awesome- so glad i found it. I might not be posting this in the correct section, but the Home Health Specialty seemed more for nurses. I'm a new CHHA, waiting to retake my CNA state test (ugh, failed the 1st skills part but that's another subject altogether!). I have PCA experience but not real major handson like washing patients, toileting and transfers.

I just started a new private case- i was referred by a friend who is a self trained PCA. She trained me, but herttransfers are nothing like i was taught. The client has is very tall, nearly 6' and not obese but large frame, between 200-225 lbs at my best guess. She cannot move her right leg or arm. The right hand is contracted but can grip if placed on a bar- right lower leg/foor in a brace. Client is in power wheelchair, needs to be transferred to/from bed and toilet. My PCA trained me, but her transfers are nothing like I was taught. She stands behind client, client grabs bar and PCA supports client around back to stand and under buttocks once standing-no gait belt. The PCA and myself are around 5'2" tall and 150 lbs. There is another who is more the client's size- i havent seen her transfer but was told she does not use a gait belt but sometimes uses a slide board.

Sorry for the loooong post- anyway, yesterday was my first day alone. I did the tranfers as shown by the PCA and felt ok with that until it was time for WC to bed transfer. Client was not strong enough to stand (i was told this happens sometimes at night) . The slide board didnt feel safe to me with no gait belt, so i finally just used a very clumsy version of the squat & pivot manauver. I got her to bed safely but that did not feel right. Client has fallen with both the PCA and the HHA, and i do not want to let tha jappen with me. Obviously i will bring and use my gait belt next time, but does anyone have any advice for me? I feel that in. Facility, the client woukd be a two person transfer or use a lift, but that's not an option. Is this not a safe match due to our size difference? Client and family are lovely ppl amd i want to do my best to keep her safe. Thanks for any advice and sorry again for the endless post!!

[i_love_patient_care]

You can use a gait belt with a sliding board. Sliding boards are a little funky at first. Hope it's going to be a decent job for you

[shortlilgirl02]

Size isn't necessarily an issue, depending on your level of strength. Because I'm 4'11, I have had to modify my own techniques for patient transfers. That being said, I would use a similar technique to what your PCA showed you if the patient is tall and has the ability to use one side of their body to assist. I usually keep to the weak side of the patient in case something gives out. Gait belts do not always prevent falls in my experience - slippery floors and pulling on the gait belt without having your foot in front of the patient's feet can also result in a fall. Because of that, I tend to go toward what would keep the patient safest in the event of a fall, which would be breaking the fall myself and guiding them to the floor.

The most important thing to consider with the slide board is the level of assistance the patient will give you with the transfer, and about how much of your own strength you're going to have to use. If it's a wooden slide board, try putting a sheet onto it to assist the patient from wheelchair to bed - it makes the slide much easier. Also remember that gravity is your friend - keep the bed lower than the wheelchair if possible. When I worked with quads and used slideboards for certain transfers, I stayed to their front with the wheelchair as close to the bed as I could get it, that way if they were to take a fall backward or forward there was something to break it. I rarely ever use a gait belt, and depending on the type I've actually seen them break - we as a class snapped 4 in nursing school. In 7 years, I've never had a legitimate fall (one patient shoved me into a shower and fell from his own momentum, another was about 5'11 and tried throwing herself onto the floor but I caught her and guided her down so she wasn't injured.)

[FashionablyL8, CNA, LPN]

Hi I-love-patient-care and Shortlilgirl,

Thanks so much for your replies and advice. I feel better having heard from.you both. The gravity remark gave me a great idea- the client WC seat can be raised/lowered. If i put it right next to the bed, raise it up a bit, then use the slide board with a gait belt, i should be able to trannsfer the client with much less effort. And, just like you as said, Shortlilgirl, my client will have me in front of her and the bed in back, so any big falls should be prevented.

:) thanks again!

[Glycerine82, LPN]

Make sure the patient is turning twords his strong side. reverse the wc if you have to. Whenever you use the sb make sure the bed is as low as it will go.

I sometimes give bear hugs while holding the gb or back ofnthe pants and use my legs to help the patient stand while "dancing" if you will, in a circular motion twords the bed this only works if the patient can support his weight with his strong side

Make sure when doing stand pivot that you are boocking his knees

Feel free to PM me if you need to