How do I transfer non ambulatory pt from WC

Nurses General Nursing

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Good morning everyone, I have been currently working as a home health LVN for almost a year now and soon I will be working with a new client. My question is how would I be able to transfer a non ambulatory pt from wheelchair to a bed, from wheelchair to a shower chair, from shower chair to bed, and etc. My supervisor suggested that I ask for help and that it is not possible to transfer a dead weight pt alone. However I think there must be some way. Maybe I can use a small wooden board ? Any suggestions are welcome. All I know is that I have to bend at knees and wear a back support.

VivaLasViejas, I am so very happy I refused the case. I was suppose to start Today, but, I took it upon myselft to reach out to recruiter yesterday morning and tell him that I did not want to take a risk working in that unsafe environment. I am so glad my he understood my concern. Next week I will have a new ped assignment wich required no heavy lifting at all. Thank you again VivaLasViejas, for the encouragement and support.

2BS Nurse, you are so right! I need to take care of myself first before I can take care of someone else!

kp2016, thank you much for your input. From now when a take on a new one on one case wheither it will be a school setting or a home setting I will make sure that there will be a hoyer lift:) When i started my first assignment as a shcool LVN i had to ask the another nurses from different classes to help me if the nurses or the teacher assistants from my same class were busy. Even witht the help of my co worker i still hurt my lower back back then.

Forest2, you are right! The reacuring injuries could have cause the other nurses to be inconsistant on the job!

FashionablyL8, thank very much for another important reminder. I wont I would like to take this opportunity to thank you for your hard work and the differences you made in people life. You are so right on setting firm boundary there were oftentime that I went above and beyond to prove to my agencies and the families that I am a compassionate nurse. After i refused this assigment I felt more comfortable setting a limit and boundaries. Thank you to you and all the memers who reply to my topic. I will not risk my life, my back, and my license, and my career!

turtlesRcool, you are so right! I never think of it that way that parents can be in denial. i will certainly take my time to study about the OSHA and NIOSH regarding safetly lifting and hazzardouz work enviroment. I totally understand the feeling of mamy parents who want to lift the pt by him or herself in the past. I do admired their love and devotionn. But you are so right one day they gonna realize how unsafe it is when the child keep gaining weight. Some of of those parent are very old and I was concern they gonna hurt themself. There were often time I offered to help them, but they said they can do it all. I love all the agencies that I worked for so far and I am very thankful of all the traning they provided me such as g tube feeding, suctioning, seizure medications and etc. I just do not understand why many agency wont provided a training on hoyer lift. The only expericne i have as LVN was only when I did the clinical hours at differnt facilities.

Kitiger, you got a pretty good point there., thank you so so much. I never really think of that way before. I rather take 5 mins or even if it will take longer to transfer on the hoyer lift. There were many times that some parents came into school and I was about to call for help for another nurse to help me. But she would just trasnfer her death weight child by herself. I will certainly look into ceiling lifts and perhaps suggest it to the families or the agencies in the near future.

nursenmom3, I admired you a lot for being a super mom and a nurse! I remeberd my first school assigment where mom told me that it is important that I do everything on a schedule. Breathing treatment first thing in the morning, medication, diaper change, and g tube feeding. There were time that I wish i could just transfer my pt alone when there were changes to the schdule. But i took it upon myself to ask someome to help me. Sometime i do get attitude from asking for help., but i brushed it off and continue to care for my pt. Thank you to you and all the other members again. You all rock!

turtlesRcool, I do wish that the mom will realize sooner or later that she will need the hoyer lift!I do not want the family and the pt to get hurt. I am so glad that i will have a new assigment soon that required no lifting.

Queen Tiye, thank very much for sharing your opinion:) It is nice to know that your workplace wont allow you to lift more than 50 percent with out a lift or assistance. Also people keep telling me a lift can only by used with two peole . But you are right though that a lift can be safely used by one properly trained person. I saw one caregiver do it before, but he did not really have time to trained me when i took over his shift. NOw some of my friend suggest that I should even by my own portable hoyer lift. But I think that does not make any economic sence for me rigtht now and my car is too small. I will keep searching for resouces that provided the instuction on how one can safely use the hoyer lift alone. One time my supervisor RN told me that was able to transfer the Pt who weight 300 pounts by herself.She said there were no body there to help. But she was able to do it becuase the bed was adjustable and there were some other equipments that she was using I just could not remember the whold detail of it.

1 Votes
Specializes in Private Duty Pediatrics.

Ceiling lifts can have permanent tracts or temporary frames; they do not require permanent changes in the architecture. The upright "legs" of the frames can rest against the walls, so the horizontal tracts stretch across the room. OP's family could look into this.

As to requiring 2 people to safely transfer using a Hoyer lift; I just don't get it. In the home, that is not an option. Now, it is true that a manual hydraulic lift is not safe for all patients. If I am behind the lift, pumping it up or lowering it, I cannot also be steadying the patient. But a power lift is safe. I can hold the controller in my hand and guide the patient into place over the wheelchair or whatever.

When the Hoyer lift is ordered, the insurance company needs to be told when a power lift is medically necessary. Medicaid will pay for this.

0 Votes
12 hours ago, nursenmom3 said:

I have kids both weights too, they just both happen to be 9. So, believe me, I understand the difference.

I'm absolutely not saying that the agency should expect or allow their nurses to lift this child. I agree 100% that it's a dangerous expectation and can't continue. But I do think that coming at it from the perspective that the parents are unreasonable for wanting things to continue, doesn't help with compassionate problem solving. I imagine if it was larger son, rather than my little one, who needed this, I'd still have all the same feelings, and having someone come in say that yes, the ability to play on the floor are keep are routines are important, so let's problem solve how we can figure out safe transfers and protect those things; or if that's not possible let's acknowledge that it's just another thing that sucks about this situation and provide the parent some space and permission to grieve.

I think those of us who have worked private duty for some time have come to have a 6th sense about families. My spidey senses are screaming heck no to this mom. I've read through your posts, and you seem to be reasonable. This mother does not. She was presented with the reality that a nurse needs to use a hoyer, and she disregarded the nurse's safety concerns with "wear a back brace."

I don't think it's fair to say that nurses haven't come at the situation with empathy. And you bet when they don't return the empathy when it comes to my back, I'm going to nope right on out of there and take my empathy with me to another family who values what I'm contributing to that family.

3 Votes
4 hours ago, Kitiger said:

Ceiling lifts can have permanent tracts or temporary frames; they do not require permanent changes in the architecture. The upright "legs" of the frames can rest against the walls, so the horizontal tracts stretch across the room. OP's family could look into this.

As to requiring 2 people to safely transfer using a Hoyer lift; I just don't get it. In the home, that is not an option. Now, it is true that a manual hydraulic lift is not safe for all patients. If I am behind the lift, pumping it up or lowering it, I cannot also be steadying the patient. But a power lift is safe. I can hold the controller in my hand and guide the patient into place over the wheelchair or whatever.

When the Hoyer lift is ordered, the insurance company needs to be told when a power lift is medically necessary. Medicaid will pay for this.

I did not realize that there were temporary ceiling lift options! Can you tell me more? Is it something one can rent for a temporary period? For us, it seems like it would solve a lot of the issues with the Hoyer.

Do people usually have separate ceiling lifts in each room, or tracks that run from room to room, or do they just take the patient back to their bedroom for every transfer?

1 Votes
3 hours ago, Orion81RN said:

I think those of us who have worked private duty for some time have come to have a 6th sense about families. My spidey senses are screaming heck no to this mom. I've read through your posts, and you seem to be reasonable. This mother does not. She was presented with the reality that a nurse needs to use a hoyer, and she disregarded the nurse's safety concerns with "wear a back brace."

I don't think it's fair to say that nurses haven't come at the situation with empathy. And you bet when they don't return the empathy when it comes to my back, I'm going to nope right on out of there and take my empathy with me to another family who values what I'm contributing to that family.

I think there were a variety of responses, and I was mostly responding to a specific post that accused mom of being in denial.

I have huge advantages over this mom, in that I'm a nurse so I can see the other side. I've also seen a hoyer, and operated a hoyer. I also have a super verbal kid, which means that if someone was using it wrong, he'd tell me. And yet, when a hoyer was first suggested to me, in the PDN forum, my initial reaction was "heck no". It was a really scary and overwhelming thought when it involved a stranger and my own child. There are nurses on here who have remarked that a hoyer with just one person was scary to them. If someone had been in the room and seen my face when I red that post, they probably would have thought that I wasn't empathetic, or I was in denial too! But luckily there are no cameras here.

To be clear I'm NOT saying that this kid doesn't need a hoyer or a ceiling lift. Of course he does. But what he also needs is someone who can sit with his parents, hear their concerns, validate those concerns, and problem solve. I'm not saying that person is Cutescrubs, I think it should probably be someone with more seniority from the agency, and a long term relationship. If there isn't someone from the agency who has built that relationship and brought up this issue before the kid reached 85 lbs (assuming this isn't a new relationship or medical situation), then I think that reflects on the agency, and not the parent.

1 Votes
Specializes in Private Duty Pediatrics.
56 minutes ago, nursenmom3 said:

I did not realize that there were temporary ceiling lift options! Can you tell me more? Is it something one can rent for a temporary period? For us, it seems like it would solve a lot of the issues with the Hoyer.

Do people usually have separate ceiling lifts in each room, or tracks that run from room to room, or do they just take the patient back to their bedroom for every transfer?

My experience is with permanent ceiling tracts; I don't know the logistics of renting one. Your durable medical supplier should know.

Some people have permanent ceiling tracts in several rooms; one for transfers to bed, one in the bathroom, and one in the living room. One home had a permanent tract that went from over the bed to the bathroom across the hall.

The motor that runs on the tracts can be moved from room to room. Each track has a slider with a large hook. The motor can be placed on this hook using the attached bar that even a short person can reach.

https://www.rehabmart.com/post/how-to-choose-the-best-ceiling-lift

Medicaid will pay for the ceiling lift and the cost to install it.

1 Votes
15 minutes ago, Kitiger said:

My experience is with permanent ceiling tracts; I don't know the logistics of renting one. Your durable medical supplier should know.

Some people have permanent ceiling tracts in several rooms; one for transfers to bed, one in the bathroom, and one in the living room. One home had a permanent tract that went from over the bed to the bathroom across the hall.

The motor that runs on the tracts can be moved from room to room. Each track has a slider with a large hook. The motor can be placed on this hook using the attached bar that even a short person can reach.

https://www.rehabmart.com/post/how-to-choose-the-best-ceiling-lift

Medicaid will pay for the ceiling lift and the cost to install it.

Thanks! I will definitely look into that.

2 Votes

I realize I am totally hijacking this thread, and I apologize.

What are people's thoughts about weight limits and transferring people who need assistance but can bear some of their weight?

My kid can usually help with a transfer by bearing most or all of his weight on his feet and pivoting, but needs someone's hands on him to steady him. He's got upcoming surgery where he'll be completely non-weight bearing on both feet for a few months, and I've been thinking about lifts for that period, but this thread is making me wonder whether we'll eventually need a lift anyway.

1 Votes
Specializes in Private Duty Pediatrics.

The weight limit is for a non-weight bearing person. It does not apply to a person who can fully bear his own weight.

However, if that person sometimes cannot fully bear his own weight, I would use a mechanical lift. A sit-to-stand lift works well for a person who doesn't fully bear his own weight, but they are BIG machines, and awkward to use in close quarters.

I would still go for the ceiling lift.

0 Votes
1 hour ago, Kitiger said:

The weight limit is for a non-weight bearing person. It does not apply to a person who can fully bear his own weight.

However, if that person sometimes cannot fully bear his own weight, I would use a mechanical lift. A sit-to-stand lift works well for a person who doesn't fully bear his own weight, but they are BIG machines, and awkward to use in close quarters.

I would still go for the ceiling lift.

Thanks Ktiger!

I don't see how a sit to stand lift would work for our specifics anyway. I like the idea of a ceiling lift. The question is whether they'd qualify him. It can't hurt to ask.

0 Votes
34 minutes ago, nursenmom3 said:

Thanks Ktiger!

I don't see how a sit to stand lift would work for our specifics anyway. I like the idea of a ceiling lift. The question is whether they'd qualify him. It can't hurt to ask.

Agree with all above and enjoy the dialogue on here and multiple responses especially Ktiger spot on information- ceiling lifts are often the ideal solution for space, ease of use, limited disruption of the environment and events (besides applying the sling which becomes second nature - it’s not so disparate from carrying your own child when that’s no longer a safe and feasible option)

I know you’re reluctant on the sit to stand but based on your child’s baseline mobility - if he uses or could benefit from the use of a gait trainer - I have seen great benefit in the Rifton TRAM https://www.rifton.com/products/lift-and-transfer-devices/rifton-tram

You would need to trial it when he is weight bearing and decide if it makes sense for your home environment (yes you still need pathways but I find it significantly more maneuverable than most hydraulic lifts), the real advantage if it suits his abilities is it allows the child to participate in the transfer process and as I’ve been told is much less “scary” than being suspended in a traditional lift

Thank you for the reminder of needing compassionate and thoughtful dialogue, this is something I consider a critical component of managing long term care needs for our patients and one of the examples of how delicate and “real” the emotional and practical aspects of this necessary intrusion are

1 Votes

Hmmm, that tram does look interesting.

He doesn't use a gait trainer. The biggest things that prevent him from walking more are severe end stage arthritis in his feet, and very low exercise tolerance due to cardiac and pulmonary issues, but he also has arthritis in his hips which makes anything that removes from weight bearing from the feet to support at the hips would need a lot of input from his P.T..

My first concern with the sit to stand, would be that it just increases the length of time that he's standing on his feet. If standing on his feet to do a pivot transfer is too painful, then using a sit to stand doesn't seem like the solution. But the tram would address that because it could lift him sitting. The other concern would be that he's tiny, and the sit to stand seems to be assuming that the seat is low enough that you can sit down on it with your feet close to the floor. For him, that's not the case on a regular toilet, or a regular dining chair, etc . . . Obviously, we hope he grows and that changes but right now, I don't see how the sit to stand would work. But the tram seems to have the ability to lift vertically, which would address that.

Clearly, the first conversation I need to have is with his PT, because of the question of what kinds of slings would work with his hips is a big one. But you guys have given me two different ideas (ceiling, and tram) to ask about.

0 Votes
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