Transporting the patient from bed to chair, from chair to wheelchair. Transferring a patient from a bed to a chair Transferring from a wheelchair to a bed

(performed by two people, the patient can help) (Fig. 2-29)

Use for subsequent transportation.

Explain the procedure to the patient, make sure he understands it, and obtain consent to perform it.

Assess the patient's condition and environment.

Set the bed brakes.

Rice. 2-29. Moving the patient from a sitting position on the bed with legs down

in a wheelchair

Place the wheelchair at the patient's feet.

If possible, lower the bed to the level of the chair.

One nurse stands behind the wheelchair and tilts it forward so that the footrest touches the floor.

The second sister (assistant) stands opposite the patient sitting on the bed with his legs down, the sister’s legs are spaced 30 cm wide, knees bent.

Ask the patient to grab the nurse by the waist and hold him by the shoulders.

Pull the patient to the edge of the bed so that his feet (in non-slip shoes) touch the floor (Fig. 2-29 a).

Place one leg between the patient’s knees, the other in the direction of movement.

Hold the patient in a “hug” position and gently lift him without jerking or turning. Do not put pressure on the patient's armpits!

Warn him that on the count of three you will help him get up.

While counting, sway slightly with it.

On the count of three, place the patient, turn with him until he is in a position with his back to the wheelchair.

Ask the patient to alert you when he touches the edge of the gurney.

Lower the patient into the wheelchair: bend your knees and hold the patient’s knees with them; keep your back straight.

The patient may be able to help by placing his hands on the armrests of the wheelchair.

Release the patient, making sure he is securely seated in the chair.

Place the patient comfortably in the chair.

If it is necessary to transport the patient, remove the brake.

Placing the patient in a wheelchair (performed by two people) (Fig. 2-30)

Check that the brakes of the wheelchair are secure.

Stand behind the wheelchair behind the patient.

Provide yourself with reliable support: lean one leg on the back of the chair, put the other leg back. Bend your knees.

Ask the second nurse (assistant) to sit on one knee on the side of the patient, raise his legs to hip level and place them on his knee.

Support the patient's head with your chest or shoulder. Make an overhand grab. Keep your back straight, tensing your abdominal and buttock muscles.

Rice. 2-30. Placing the patient in wheelchair

Tell the patient and the assistant that on the count of three you will move the patient towards the back of the chair.

On the count of “three”: the assistant slightly lifts the patient’s hips and moves them to the back of the chair; you pull the patient to the back of the chair using a slide.

Make sure the patient is comfortable and remove the brakes on the wheels of the wheelchair.

Moving a patient from a bed to a chair (wheelchair) is performed by two or more people using the “shoulder lift” method; the patient can sit

but does not move independently (Fig. 2-31)

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it.

Place a chair next to the bed. Assess your surroundings.

Help the patient sit closer to the edge of the bed with his legs dangling.

Stand on either side of the patient, facing him. Both sisters place their hands under his hips and hold each other in a “wrist grip” (see Figure 2.10), supporting his hips.

Both nurses place their shoulders under the patient’s shoulders, and he places his hands on the sisters’ backs.

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 him to a chair (wheelchair).

Each nurse places a supporting hand on the armrest or seat of the chair and lowers the patient onto the chair, bending the knees and elbow.

Make sure you lower the patient into the chair at the same time.

The chair should not tilt back: one of the sisters holds the back of the chair.

Rice. 2-31. Transferring a patient from a bed to a wheelchair

Transferring a patient from a bed to a chair without armrests or backrest, performed by two or more people using the “over-the-arm” method, the patient can sit,

but does not move independently (Fig. 2-32)

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it. Introduce everyone involved in the move.

Set the height of the bed to the height of the chair. Assess your surroundings.

Help the patient sit down (the patient's legs are not lowered).

One of the nurses stands behind the patient, puts one knee on the bed and does an “over-arm grab.”

Move the patient to the edge of the bed. Support him by standing on the floor with both feet behind him.

The second nurse places the chair comfortably and close to the bed, but so that the patient does not rest his elbow on the bed when sitting on the chair.

The same nurse stands opposite the chair facing the patient. Legs are bent at the knees (squatting position), one leg is put forward.

She puts her hands under the patient’s knees and, on the count of three, drags his legs to the edge of the bed, while the other nurse lifts his torso and, bending her knees, lowers the patient onto a chair.

Place the patient comfortably on the chair.

Rice. 2-32. Transferring the patient from bed to chair

Transferring a patient from a bed (bed with variable height) to a gurney and back (performed by four people) (Fig. 2-35)

After the operation, the patient remains anesthetized or conscious for some time, but experiences pain. When starting to move onto a gurney (bed), you need to know in which area the operation was performed, as well as other restrictions.

During the transfer, visitors are asked to temporarily leave the room. You need to ask someone to hold the IV, drainage tubes and other devices.

You and your assistant stand on one side, the other two sisters on the other side of the bed. Secure the brakes.

Place the gurney on the side of the bed where you will be moving the patient. It is necessary to leave space to be able to stand between the bed and the gurney.

Cover the patient with a sheet or blanket.

Tell him to hold the sheet or blanket with his hands while you roll the sheet up at his feet.

Rice. 2-35. Transferring a patient from bed to gurney and back

Move the patient to the edge of the bed.

Unfold the sheet and leave it on the mattress (without tucking). Wrap the top sheet around the patient, tucking the ends under it. Stand close to the bed to prevent the patient from falling. Note. The head of the bed is in a horizontal position. Two nurses stand on the opposite side of the wheelchair and hold the patient; two other assistants move the gurney to the edge of the bed.

Note. Make sure the gurney is level with the bed. Do not leave space between the bed and the gurney. Check that the sheet is on the mattress.

Secure the brakes on the gurney.

Roll the sheet into a roll and hold it on all sides in your hands, palms up.

Two sisters kneel on the free part of the bed (after placing the protector).

On the count of “three” (the leader gives the command), all four lift the sheet and transfer the patient to the gurney along with the sheet.

Make sure the patient is lying in the middle.

Note. If the gurney is equipped with belts, secure the patient with them.

Transport the patient to the destination: one nurse is at the head of the bed, the other is at the patient’s feet.

When moving a patient from a gurney to a bed.

Place the gurney close to the bed, secure the brakes, and release the edges of the sheet on the gurney.

Two assistants kneel on the bed with the protector down.

All the sisters fold the edges of the sheet towards the center.

On the count of “three” (the leader gives the command), everyone lifts the sheet, holding it by the edges with their palms up, and moves the patient to the edge of the bed.

The nurses, kneeling on the bed, go down to the floor and hold the patient while others move the gurney.

Move the patient, tuck the sheet under the mattress and straighten it.

If necessary, place a small pillow under your head. If the patient experiences pain when moving, or the bandage gets wet, or there is blood in the drainage tubes, report to the doctor.

Transferring a patient from a regular bed to a gurney (and vice versa),

performed by three people (Fig. 2-36)

Place the gurney at an angle of at least 60° at the edge of the bed (at the feet).

Secure the brakes on the gurney and bed.

Everyone stand along the bed:

The strongest (physically) sister is in the center;

Place one leg forward, bending the knee, and put the other back.

Place your arms (up to the elbow) under the patient:

The sister at the head raises her head, supports her shoulders and top part backs;

The sister in the center supports the lower back and buttocks;

The nurse standing at the patient's feet supports the legs. Note. If the patient is very sick, you will need more people and you will have to redistribute the load.

Rice. 2-36. Transferring a patient from a regular bed to a gurney and back

Lifting the patient:

At the leader’s command “three”, transfer your body weight to the leg placed back;

Smoothly pull the patient to the edge of the bed;

Take a break;

On new team“three” roll the patient onto you, press him and lift him, straightening his knees and straightening his back (do not hold the patient on outstretched arms!).

Move backward to face the gurney:

The nurse holding the patient's legs takes wider steps;

The nurse holding the patient's head, shoulders and back is less wide, turning to face the gurney.

Move forward (towards the gurney).

On the count of three, bend your knees and carefully lower the patient onto the gurney.

Turning the patient onto his side using a pad and placing him in this position (performed by two people) (Fig. 2-37)

Usage

Explain the process of the upcoming procedure, make sure that the patient understands it, and obtain his consent to perform it.

Have your assistant stand on the opposite side of the bed from you.

Lower the side rails (or one of them if the procedure is performed without an assistant).

Ask the patient to raise his head (if possible) or elevate his head and shoulders, remove the pillow.

Place a pillow against the head of the bed.

Make sure the patient is lying horizontally on the edge of the bed.

Ask the patient to cross his arms over his chest.

If you turn him over on his right side, he should put his left leg on his right.

Help him if necessary.

Stand on the side of the bed where you turn him over.

Rice. 2-37. Turning the patient on his side using a diaper

Place a protector next to the patient.

Stand closer to the bed, place your knee on the protector, the other leg serves as a support.

Place your hand on the patient’s shoulder, which is further from the nurse, and the other on the corresponding thigh, i.e. if the patient turns over on his right side, place left hand on his left shoulder, and the right one on his left thigh.

Your assistant should pull the edge of the diaper out from under the mattress and roll it up close to the patient’s body, then take the rolled end of the diaper with your palms up and, resting your feet, turn the patient on his side on the count of three.

You turn the patient towards you, placing your weight on the leg that is on the floor.

Help the patient raise his head and place a pillow.

Note. Further actions depend on the purpose of the turn.

For example, in case placements:

Turn the patient so that he is not lying on his arm;

Place a folded blanket under your back for stability;

Place a pillow under the arm lying on top;

Bend the leg lying on top at the knee and place a pillow between the knees;

Straighten the lining diaper;

Raise the side rails;

Make sure the patient feels comfortable.

Turning the patient onto his side using the “joint log rolling” method and placing him in this position (performed by two people) (Fig. 2-38)

Usage when changing linen; placement in a lateral position; preliminary stage for other movements.

Explain to the patient the process of the upcoming procedure, make sure that he understands it, and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Ask your assistant to stand next to you.

Remove the pillow from under your head and place it at the head of the bed.

Place your hands under the patient's head and shoulders.

Tell your assistant to place his hands under the patient's hips.

Rice. 2-38. Turning the patient onto his side using the joint log rolling method

Place one foot slightly in front of the other, swing back on the count of three, shift your body weight onto the back leg, and move the patient to the edge of the bed.

Lower the bed so that one of the sister's knees is on the bed (on the protector) and the other leg is firmly on the floor.

Together with an assistant, move to the other side of the bed. Place a pillow between the patient's legs and cross his arms over his chest.

Both sisters place the protectors on the edge of the bed and place one knee on the protector.

Place one hand on the patient's shoulder, the other on the patient's pelvis, and ask the assistant to place their hands on the patient's thighs and legs.

On the count of three, turn the patient to face you, keeping his head, back and legs in line.

Bend your upper leg slightly.

Make sure the pillow remains between the patient's legs.

Place the support at the sole of the foot lying underneath.

Be sure to place a pillow under the patient's back to maintain this position.

Also place a pillow under top hand.

If possible, place a small pillow under the patient's head.

Cover him.

Raise the side rails.

Make sure the patient feels comfortable.

(Fig. 2-33)

Used when moving the patient, if he can participate in it and control the position of his head and hands; the need to move the patient at a 90° angle from a chair to a wheelchair or other seat.

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it.

Assess your surroundings. Move both seats together, fixing the brakes and removing the side bars of the chairs.

Stand facing the patient.

Place your feet shoulder-width apart, hold the patient's feet with one foot, and the chair leg with the other.

Ask the patient to lean forward so that his shoulder rests against chest sisters.

Move the patient to the edge of the chair, rocking it from side to side and moving the legs forward. The patient's knees are at an angle of 90°. Knees and feet together.

Place one leg next to the patient and support his knees with the other.

Start smoothly rocking, moving your body weight back and forth, keeping the patient close to you.

Lift the patient and move him at a 90° angle to another chair (chair).

Moving the patient from the “sitting on a chair” position to the “lying on the bed” position (performed by one nurse) (Fig. 2-34)

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it.

Restrain the patient using one of the methods known to you (see Fig. 2-10).

Warn the patient that on the count of three you will help him stand up.

Rice. 2-34. Moving the patient from a sitting position on a chair to a lying position on a bed

Counting to three, swing.

On the count of three, stand the patient, then turn with him, foot to foot, until his hips touch the edge of the bed.

Place the patient on the bed. Stand on the side facing him. Spread your legs 30 cm wide. Bend your knees. Keep your back straight!

Place your hand under your knees, grab them from above, and with your other hand grab the patient’s shoulders.

Raise the patient's legs onto the bed, turning his torso 90°, and lower his head onto the pillow.

Cover the patient and make sure he is lying comfortably.

Transferring a patient from a bed (bed with variable height) to a gurney and back (performed by four people) (Fig. 2-35)

After the operation, the patient remains anesthetized or conscious for some time, but experiences pain. When starting to move onto a gurney (bed), you need to know in which area the operation was performed, as well as other restrictions.

During the transfer, visitors are asked to temporarily leave the room. You need to ask someone to hold the IV, drainage tubes and other devices.

You and your assistant stand on one side, the other two sisters on the other side of the bed. Secure the brakes.

Place the gurney on the side of the bed where you will be moving the patient. It is necessary to leave space to be able to stand between the bed and the gurney.

Cover the patient with a sheet or blanket.

Tell him to hold the sheet or blanket with his hands while you roll the sheet up at his feet.

Rice. 2-35. Transferring a patient from bed to gurney and back

Move the patient to the edge of the bed.

Unfold the sheet and leave it on the mattress (without tucking). Wrap the top sheet around the patient, tucking the ends under it. Stand close to the bed to prevent the patient from falling. Note. The head of the bed is in a horizontal position. Two nurses stand on the opposite side of the wheelchair and hold the patient; two other assistants move the gurney to the edge of the bed.

Note. Make sure the gurney is level with the bed. Do not leave space between the bed and the gurney. Check that the sheet is on the mattress.

Secure the brakes on the gurney.

Roll the sheet into a roll and hold it on all sides in your hands, palms up.

Two sisters kneel on the free part of the bed (after placing the protector).

On the count of “three” (the leader gives the command), all four lift the sheet and transfer the patient to the gurney along with the sheet.

Make sure the patient is lying in the middle.

Note. If the gurney is equipped with belts, secure the patient with them.

Transport the patient to the destination: one nurse is at the head of the bed, the other is at the patient’s feet.

When moving a patient from a gurney to a bed.

Place the gurney close to the bed, secure the brakes, and release the edges of the sheet on the gurney.

Two assistants kneel on the bed with the protector down.

All the sisters fold the edges of the sheet towards the center.

On the count of “three” (the leader gives the command), everyone lifts the sheet, holding it by the edges with their palms up, and moves the patient to the edge of the bed.

The nurses, kneeling on the bed, go down to the floor and hold the patient while others move the gurney.

Move the patient, tuck the sheet under the mattress and straighten it.

If necessary, place a small pillow under your head. If the patient experiences pain when moving, or the bandage gets wet, or there is blood in the drainage tubes, report to the doctor.

Transferring a patient from a regular bed to a gurney (and vice versa) is performed by three people (Fig. 2-36)

Place the gurney at an angle of at least 60° at the edge of the bed (at the feet).

Secure the brakes on the gurney and bed.

Everyone stand along the bed:

The strongest (physically) sister is in the center;

Place one leg forward, bending the knee, and put the other back.

Place your arms (up to the elbow) under the patient:

The sister at the head raises her head, supports her shoulders and upper back;

The sister in the center supports the lower back and buttocks;

The nurse standing at the patient's feet supports the legs. Note. If the patient is very sick, more will be needed.

people and will have to redistribute the load.

Rice. 2-36. Transferring a patient from a regular bed to a gurney and back

Lifting the patient:

At the leader’s command “three”, transfer your body weight to the leg placed back;

Smoothly pull the patient to the edge of the bed;

Take a break;

On the new command “three”, roll the patient onto you, press him and lift him, straightening his knees and straightening his back (do not hold the patient on outstretched arms!).

Move backward to face the gurney:

The nurse holding the patient's legs takes wider steps;

The nurse holding the patient's head, shoulders and back is less wide, turning to face the gurney.

Move forward (towards the gurney).

On the count of three, bend your knees and carefully lower the patient onto the gurney.

Turning the patient onto his side using a pad and placing him in this position (performed by two people) (Fig. 2-37)

Usage

Explain the process of the upcoming procedure, make sure that the patient understands it, and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Have your assistant stand on the opposite side of the bed from you.

Lower the side rails (or one of them if the procedure is performed without an assistant).

Ask the patient to raise his head (if possible) or elevate his head and shoulders, remove the pillow.

Place a pillow against the head of the bed.

Make sure the patient is lying horizontally on the edge of the bed.

Ask the patient to cross his arms over his chest.

If you turn him over on his right side, he should put his left leg on his right.

Help him if necessary.

Stand on the side of the bed where you turn him over.

Rice. 2-37. Turning the patient on his side using a diaper

Place a protector next to the patient.

Stand closer to the bed, place your knee on the protector, the other leg serves as a support.

Place your hand on the patient’s shoulder, which is further from the nurse, and the other on the corresponding thigh, i.e. if the patient turns over on his right side, place your left hand on his left shoulder and your right hand on his left thigh.

Your assistant should pull the edge of the diaper out from under the mattress and roll it up close to the patient’s body, then take the rolled end of the diaper with your palms up and, resting your feet, turn the patient on his side on the count of three.

You turn the patient towards you, placing your weight on the leg that is on the floor.

Help the patient raise his head and place a pillow. Note. Further actions depend on the purpose of the turn.

For example, in case placements:

Turn the patient so that he is not lying on his arm;

Place a folded blanket under your back for stability;

Place a pillow under the arm lying on top;

Bend the leg lying on top at the knee and place a pillow between the knees;

Straighten the lining diaper;

Raise the side rails;

Make sure the patient feels comfortable.

Turning the patient onto his side using the “joint log rolling” method and placing him in this position (performed by two people) (Fig. 2-38)

Usage when changing linen; placement in a lateral position; a preliminary stage for other movements.

Assess the patient's condition and environment. Set the bed brakes.

Ask your assistant to stand next to you.

Remove the pillow from under your head and place it at the head of the bed.

Place your hands under the patient's head and shoulders.

Tell your assistant to place his hands under the patient's hips.

Rice. 2-38. Turning the patient onto his side using the joint log rolling method

Place one foot slightly in front of the other, swing back on the count of three, shift your body weight onto the back leg, and move the patient to the edge of the bed.

Lower the bed so that one of the sister's knees is on the bed (on the protector) and the other leg is firmly on the floor.

Together with an assistant, move to the other side of the bed. Place a pillow between the patient's legs and cross his arms over his chest.

Both sisters place the protectors on the edge of the bed and place one knee on the protector.

Place one hand on the patient's shoulder, the other on the patient's pelvis, and ask the assistant to place their hands on the patient's thighs and legs.

On the count of three, turn the patient to face you, keeping his head, back and legs in line.

Bend your upper leg slightly.

Make sure the pillow remains between the patient's legs.

Place the support at the sole of the foot lying underneath.

Be sure to place a pillow under the patient's back to maintain this position.

Also place a pillow under your upper arm.

If possible, place a small pillow under the patient's head.

Cover him.

Raise the side rails.

Make sure the patient feels comfortable.

Turn the patient and place him in the lateral position. Performed on a bed with variable height (performed by one nurse, the patient can help) (Fig. 2-39)

Use when forced or passive position; risk of developing bedsores, changing position.

Prepare: extra pillow, footrest, sandbag.

Explain to the patient the process of the upcoming procedure, make sure that he understands it, and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Rice. 2-39. Turning the patient over and placing him on his side

Fully (if possible) lower the head of the bed; the patient should lie horizontally. Lower the bed to mid-thigh level.

Move the patient closer to the edge of the bed opposite to where he is being turned.

Tell the patient to cross his arms over his chest.

If you turn him over on his right side, he will put his left leg on his right (if he cannot do this, help him). Bend the patient's left leg: one hand covers the shin, the other - the popliteal cavity).

Stand on the side of the bed where you will turn the patient. Place the protector next to it.

Bend your leg at the knee and place it on the tread.

The second leg is a support.

If the patient needs to be turned on his right side, place your left hand on his left shoulder and your right hand on his left thigh.

Turn the patient onto their side, placing your weight on the leg on the floor.

Place a pillow under the patient's head. Note. The patient should lie on his or her arm.

Bend the patient's arms slightly.

The hand on top rests on the pillow.

Place a pillow under the patient's back.

Place a pillow under the patient's half-bent leg lying on top (from the groin area to the foot).

Place a sandbag (footrest) at the sole of the foot that lies underneath.

Unfold the diaper.

Turning and placing the patient in the “lying on his stomach” position is performed as prescribed by the doctor by one nurse; the patient cannot help (Fig. 2-40)

Performed on both a functional and a regular bed.

Usage in a forced or passive position; risk of developing bedsores, changing position.

Prepare: a rolled blanket or bath towel, a small pillow, bolsters.

Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent to perform it.

Assess the patient's condition and surrounding environment. Set the bed brakes.

Lower the side rails (if equipped) on the nurse's side.

Rice. 2-40. Moving the patient to a prone position

Lower the head of the bed (or remove the pillows). Make sure the patient is lying horizontally.

Gently lift the patient's head, remove the regular pillow and place a small one.

Move the patient to the edge of the bed.

Extend the patient's arm and press it to the body.

Raise the side rails. Go to the other side of the bed and lower the side rails there.

Place your knee on the bed.

Place a rolled blanket (towel) or small pillow under the patient's upper abdomen.

Place one hand on the shoulder and the other on the thigh, located further from you, place your knee on the patient’s bed, placing a small pillow (protector) under it.

Turn the patient onto his stomach towards the nurse. The patient's head is on its side.

Place a pillow under your shins so that your toes do not touch the bed.

Rice. 2-41. Moving the patient from back to stomach and back

Bend one of the patient's arms elbow joint at an angle of 90°, the other one should be placed along the body.

Place pillows (or foam in a cover) under your elbows, forearms and hands.

Place small cushions next to your feet (outside).

Straighten the sheet and diaper.

Make sure the patient is lying comfortably. Raise the side rails.

Figure 2-41 shows the technique for moving a patient onto his stomach and back using two nurses.

TOXIC SUBSTANCES

In a health care facility, nursing staff are exposed to various groups toxic substances contained in medicines, disinfectants, detergents, gloves.

They enter the body in the form of dust or vapor in various ways (Fig. 2-42). The most common manifestation of the side effects of toxic substances is “occupational dermatitis” - irritation and inflammation of the skin of varying severity.

In addition to occupational dermatitis, toxic substances cause damage to other organs and systems.

Preventive measures reducing the impact of toxic substances are quite multifaceted.

Firstly, You should be aware that chemicals that have disinfectant properties can be replaced by cleaning agents and disinfection using high temperatures. They are equally or even more effective and are cheaper.

Secondly, Protective clothing such as gloves, gowns, aprons, face shields and goggles, and shoe covers reduce skin contact with toxic substances, while masks and respirators provide a certain level of protection from toxic dust and aerosols. If rubber gloves cause dermatitis in people with hypersensitivity, you can wear silicone or polyvinyl chloride gloves with a cotton lining. You should only work with powders using cotton gloves, but they do not protect your skin well when working with liquid chemicals.

Thirdly, the preparation of disinfectant solutions should be carried out in specially equipped rooms with supply and exhaust ventilation.

Fourthly, You should carefully study the guidelines on the use of certain protective equipment when working with toxic substances.

Fifthly, You need to carefully care for the skin of your hands, lubricate all wounds and abrasions. It is better to use liquid soap and dry your hands well after washing. Protective and moisturizing creams can help restore the skin's natural oil layer that is lost when exposed to certain chemicals.

Sixth, If a chemical gets into your eyes, you should rinse them immediately and thoroughly. a large number cold water. If any chemical substance got into your mouth, you need to rinse your mouth with water, in some cases it is recommended to drink large number water. Chemicals that come into contact with the skin must be washed off immediately, and if they come into contact with clothing or workwear, they must be changed.

Many drugs have side effects, about which there is information in the annotations. But, unfortunately, the effect of these unusual harmful factors on nursing staff is often ignored.

Medicines affect the sister’s body in various ways: with direct contact - the use of creams and ointments without gloves, contact of solutions with the skin and eyes; when inhaled - crushing or counting tablets; when using aerosols; when hitting digestive system- through the hands or accidentally into the mouth.

It has been established that 1-5% of nursing personnel become sensitized after exposure to antibiotics, especially penicillin, neomycin and streptomycin.

Antihistamines (promethazine), chlorpromazine, aminophylline can also cause skin reactions.

Some antibiotics (actinomycin D, mictomycin C, streptomycin) have a teratogenic effect.

Cytotoxic drugs have a negative impact on the health of nursing staff when the necessary safety conditions are not met.

Indication: transport to the operating room for surgery.
Equipment: gurney, pillow, mattress, sheets.
Sequence of actions:
1. Determine how the patient’s bed is located in the room.

Read about how to prepare yourself and the surgeon for the upcoming operation.

3. Place the gurney close to the patient’s bed; one nurse should stand on the side
gurney, the other - from the side of the bed.
4. Ask the patient to assist health care providers in moving from the bed to the gurney.
Place the patient's pillow from the bed onto the gurney, observe the position of the patient's hands
(arms should lie along the body; if the patient is obese, then place your hands on the front surface of the thigh).
6. Cover the patient with a sheet or blanket and tuck the ends under the mattress on the gurney.
7. Transport the patient to the operating room, one nurse is at the head of the gurney, the other is at the foot end of the gurney.

Note. In the preoperative room, the patient takes off his clothes. The patient is transferred from the department gurney to the operating gurney in the same way as from the bed to the gurney.

Transferring the patient from the gurney to the operating table and back

Sequence of actions:
1. Explain to the patient the course of the upcoming manipulation.
2. Introduce the gurney with the patient into the operating room.
h. Place the gurney close to the operating table (head end to head end).
4. Stand from the side of the gurney for two nurses (from the surgical department) and from the side of the table - for two operating nurses.
5. Bring both hands up to the forearm towards each other:
those standing at the patient's head place right hand under the patient's neck and shoulders, left arm - under the chest (the nurses' hands should be connected under the patient); standing at lower limbs patient, place the right hand under the pelvis, the left hand under the patient’s knees (the nurses’ hands should be joined under the patient).
6. Transfer the patient to the count of “three” (the command is given by one of the nurses). All four lift the patient and transfer him from the gurney to the operating table.
Note. The patient is also transferred from the operating table to a gurney.
After surgery, the patient may remain under anesthesia for some time or, while conscious, experience pain. When starting to shift a patient, you need to know in which area the operation was performed, and also remember about the IV or drainage that was installed.

Transferring a patient from a gurney to a bed after surgery

Sequence of actions:
1. Determine how the patient’s bed is located in the room (the gurney is located in relation to the bed: at an angle, parallel, in series, close to each other).
2. Explain to the patient the course of the upcoming manipulation.
h. Choose one of the proposed methods for positioning the gurney in relation to the bed. Leave enough space to stand between the bed and gurney.
4. Prepare the patient's bed.
Note. If the operation was performed under local anesthesia, you should place a pillow at the head of the room. If under general anesthesia, remove the pillow. The patient should be without a pillow for 6-8 hours.
5. Have three nurses stand between the bed and the gurney. Place your hands under the patient up to the forearm:
the nurse standing at the patient's head places her right hand under the patient's neck and shoulders,
with the left - covers the patient’s opposite hand, as if hugging him;
the nurse standing in the middle places her right hand under the patient’s shoulder blades, her left hand under the lumbar region;
the nurse standing at the patient's pelvis places her right hand under the lumbar region, and her left hand under the patient's knees.
6. Transfer the patient from the gurney to the bed on the count of “three” (the command is given by one of the nurses).
The nurse standing at the head of the bed turns around and the health workers carry the patient in their arms.
7. Carefully place the patient on the bed, cover warmly and remove the gurney from the room.
Note. If the patient has a chest tube or other device in place, another staff member will be required to hold the drain in place.

E.V. Barkhatova

Collection of manipulations

on ergonomics

E.V. Barkhatova, ergonomics teacher at KBMK.

Reviewers:

I.V. Bayko, chief nurse of the Kaluga Regional Hospital;

L.G. Polkovnikova, deputy director for medical treatment, teacher of therapy at KBMK of the highest category;

M.D. Kubacheva, methodologist, teacher of infectious diseases at KBMK of the highest category.

E.V. Barkhatova

Collection of manipulations on ergonomics. Methodical recommendations for independent preparation of students for practical classes. 2005. 40 p.

Annotation.

The collection of manipulations is intended for work in practical classes, for self-training of students of medical schools and colleges in the subject “Fundamentals of ergonomics and safe movement of the patient.” Recommended for nurse practitioners. Techniques and pictures explaining them are presented for each type of patient movement.

Introduction. Methods of holding, lifting, moving a patient by one, two or more persons.

Lifting the patient.

Holding the patient while lifting.

Holding the patient using the “over-arm” method.

Restraining the patient using the “elbow-raised grip” method.

Holding the patient using the “Underarm grip” method.

Holding the patient by the belt.

Supporting the patient while walking.

Raising the patient's head and shoulders.

Shoulder Raise Method.

Lifting a patient in a bed with variable height.

Lifting and moving the patient to the head of a low bed.

Moving the patient to the head of the wide bed.

Moving the patient using a diaper to the edge of the bed with varying heights.

Moving the patient to the head of the bed. Performed by two people.

Moving the patient to the head of the bed. Performed by one sister.

Moving the patient to the head of a drop-down bed using a sheet.

Moving the helpless patient to the head of the bed.

Moving the patient to the edge of the bed.

Moving the patient from the “lying on his side” position to the “sitting with legs down” position.

Moving the patient from the “sitting on the bed with legs down” position to a chair.

Transferring the patient from the “sitting on the bed with legs down” position to a wheelchair with a non-removable footrest.

Placing the patient in a wheelchair.

Transferring the patient from bed to chair (wheelchair).

Transferring a patient from a bed to a chair without armrests or backrest.

Moving the patient from the “sitting on a chair” position to the “lying on the bed” position.

Transferring the patient from bed to gurney and back.

Transferring a patient from a regular bed to a gurney and vice versa.

Turning the patient onto his side using a pad and placing him in this position.

Turning the patient onto his side using the “joint log roll” method and placing him in this position.

Turn the patient and place him in the lateral position.

Turn over and place the patient in the prone position.

1 Introduction

Techniques for holding, lifting, moving a patient by one, two or more persons

The medical profession is humane in its essence. Regardless of the hardships, the health worker goes to any lengths to solve the problem. Often these difficulties are directly related to risks to one’s own health.

There are objective data on occupational hazards associated with chemical, epidemiological, and ergonomic factors in the work of a medical worker.

Of the ergonomic factors, doctors and nurses most often identified eye strain. The overload of the musculoskeletal system was higher among junior medical personnel, which is explained by the need to move seriously ill patients “in the operating room, intensive care, resuscitation.”

Lack of various aids for working with seriously ill patients, one of the causes of pain in the lumbosacral region and accidents.

Ergonomics is a scientific discipline that studies labor processes with the aim of optimizing tools and working conditions, increasing the efficiency of a person’s work activity and preserving his health.

Knowledge and use of special methods and techniques in the process of caring for patients that reduce the load on the spine can reduce the risk of injuries and injuries in nurses.

Today there are more than thirty techniques movements that are relatively safe for the sister’s health.

Remember! Never lift the patient in front of you (in front of your knees), as you will have to do this with your arms outstretched. Never lift a patient from your side, as this will significantly bend the spine!

The position of the sister's hands. The method of restraint used during transfer depends on the patient's painful areas and how much assistance will be provided during transfer. It is necessary to control the patient's body position and movement as much as possible.

Patient position. Before lifting (moving) the patient, you need to help him lie down or give him a comfortable position, taking into account the biomechanics of the body during subsequent movement.

Sister's back position and spine must be straight during movement. The shoulders, as far as possible, should be in the same plane as the pelvis. When lifting the patient with one hand, the other, free, maintains the balance of the torso and, therefore, the position of the back, serving as a support for relieving the load from the spine.

Some patients can help themselves to lift if, with the help of a nurse, they make several rocking movements to create a driving force. In this case, the actual force expended by the nurse to lift the patient to a standing position may be minimal.

When dealing with even a helpless patient, gentle rocking of him and the nurse can encourage movement and make the lifting process easier. These skills can be learned, but require a sense of rhythm, coordination, and patient understanding and cooperation.

Working in a team. Patient movement can only be successful ifcoordination of movements. For example, one sister plays the role of leadergives orders, makes sure that everyone involved in the process and the patient is completelyready to move, She assesses the safety of the environment, observesgives behind the patient's facial expression as he moves. The physically strongest nurse in the team (regardless of position) must take on the heaviest part of the body– the patient's hips and torso.

2 Lifting the patient

When starting the lift, you need to: make sure that your sister’s legs are in stable position on the floor.

Choose the most best way holding the patient.

Get as close to the patient as possible. Keep your back straight.

Make sure that the team and the patient perform movements in the same rhythm.

3 Holding the patient while lifting

(performed by two or more persons)

a) with your right hand, grab your assistant’s right wrist from the front- This carpal or single grip.

b) clasp each other’s right hand in the area of ​​the right wrist, placingbrush on the front surface- This double wrist grip.

Fig. 1 Methods of restraining the patient.

c) take each other with your right hand, as if shaking hands- This hand grip.

d) cover 1-4 fingers of each other with your right hand- This finger grip.

4 Restraining the patient using the “over-the-arm” method

(done by one nurse, patient can help)

Usage: support and movement to the back of a chair (armchair) of a patient who is able to provide assistance.

Fig. 2 Restraining the patient using the “Grasp by hand” method.

Ask the patient to cross his arms and press them to his chest (if one arm is weak, the patient grabs the wrist weak hand stronger).

Stand behind the patient (the chair or stool he is sitting on).

The nurse should wrap her hands around the patient’s arms as close to the wrists (behind the chest) as possible (Fig. 2).

Support or move the patient to the back of a chair.

5 Restraining the patient using the “elbow-raised grip” method

Usage: support and movement of the patient who is able to provide assistance.

Fig.3 Restraining the patient using the “Grip with the elbow raised” method.

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess the patient's condition and environment.

Stand on the side of the patient sitting on a chair (low bed), facing him, place one foot next to the chair, the other, slightly turning the foot, in front of the patient’s legs, fixing his knees with your foot.

Make sure you can move your body weight freely from one leg to the other and are standing comfortably.

Ask the patient (or help him) to lean forward so that one shoulder closer to you rests firmly on your torso.

Bend slightly forward behind the patient's back and firmly grasp his elbows, supporting them from below (Fig. 3).

Substitute the other shoulder so that the patient's other shoulder rests on your hand.

6 Holding the patient using the “Underarm grip” method

(performed by one nurse, patient can help)

Usage: support and movement of the patient who is able to provide assistance.

Fig.4 Holding the patient using the “Underarm grip” method.

Assess the patient's condition and environment (Fig. 4).

Stand on the side facing the patient sitting on a chair (low bed): onePlace your foot next to the chair, the other with your foot slightly turned out,- in front of the legs the patient, fixing his knees with your leg.

Place your hands in the patient’s armpits: one hand in the direction front - back, palm up, thumb outside the armpit; another - towards the rear– forward, palm up, thumb outside,outside the armpit.

Make sure you are moving your weight freely from one leg to the other and are standing comfortably. Ask the patient (or help him) to lean forward so that the shoulder closest to you rests firmly on your torso.

7 Holding the patient by the belt

(performed by one nurse, patient can help)

Usage: support and movement of the patient who is able to provide assistance.

Fig.5 Holding the patient by the belt.

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess the patient's condition and environment.

Stand on the side facing the patient, place one leg next to his leg with the other– in front of his legs, fixing his knees.

Place the thumbs of both hands behind the waistband of the patient’s trousers (patient’s skirt), then grasp the clothing with all fingers (Fig. 5). (An additional wide belt can be placed on the patient.)

Make sure the belt is securely fastened.

Ask the patient to support himself by placing his hands on your lower back or holding your belt.

8 Supporting the patient while walking

(performed by one sister)

Usage: helping a person walk after an injury, stroke, etc.

Explain the principle of restraint to the patient and make sure he understands it. Assess the patient's condition and capabilities:

Fig.6 Supporting the patient while walking.

Assess the surrounding environment (floor moisture, slippers, foreign objects on the floor, equipment standing in the path of the patient’s movement). Stand next to the patient.

Apply a “thumb grip”: hold the patient’s right hand in your right (or left in your left) hand; the patient’s hand is straight, resting the palm on the sister’s palm with the thumbs closed (Fig. 6).

Use your other hand to support the patient under the elbow or armpit, or grab the patient around the waist.

Fig.7 Support the patient's knees right foot.

Stand as close to the patient as possible, supporting his knees with his right leg (if the nurse is standing on the right), if the patient feels unsure (Fig. 7)

Move around the patient as long as he feels unsure.

9 Raising the patient's head and shoulders

(performed by one sister)

Usage: adjust the pillow; straighten clothes; as a step when changing linen.

Explain the procedure to the patient, make sure he understands it, and obtain his consent to the procedure. Set the bed brakes.

Lower the side rails on one side (if equipped).

Stand on the side of the bed, facing the headboard, spread your legs 30 cm wide (Fig. 8).

Bend your knees. Don't lean forward!

Ask the patient to help you (if he can): put his arm around your shoulder, put his hand under yours, or grab the bed rails.

Insert your hand under the patient’s arm, located closer to you, and place the other under his shoulders and neck.

Raise the patient's head and shoulders, shifting your weight back toward their legs. Do not turn the patient while lifting him!

Fig.8 Raising the patient's head and shoulders.

Ask the patient to help you with his free hand. Adjust the pillow with the hand supporting the patient's shoulders and neck.

Lower the patient's shoulders and head onto the pillow. Make sure it lies comfortably.

10 Shoulder lift method in a bed with varying heights

(Australian uplift)

(performed by two or more people, the patient can help)

Usage: lifting the patient in bed; moving from bed to chair and vice versa. Contraindications: the patient cannot sit; damage or pain in the shoulder, chest, upper back.

Explain the procedure to the patient, make sure he understands it and obtain consent to perform it. Assess the patient's condition and environment.

Help the patient sit up: one nurse supports the patient; the other places a pillow at the head of the bed (or raises the head of the bed).

Stand on both sides of the bed:

facing each other;

close to the bed;

legs apart;

the leg closest to the head is turned in the direction of movement;

bend your knees;

keep your back straight.

Place the shoulder closest to the patient into the armpit and to the patient’s torso. The hand of this hand is brought under the patient's hips. The patient places his hands on the nurses' back (Fig. 9).

Fig.9 Shoulder lift method (Australian lift).

If it is not possible to place your shoulder in the patient's armpit or if he can place his hand on the nurse's back, place your hand between the patient's torso and shoulder. Place the hand of this hand under the patient’s hips.

Lean with one hand on the head of the bed (elbow bent), with the otherplaced under the hips, grab the assistant's wrist (“double wrist grip”)– Fig.9,b.

Warn your colleague (if you are a leader) and the patient that on the count of three you will raise him.

Straighten the leg located at the patient's feet, and transferring the weight of your body to the other leg, located closer to the head, lift the patient. The elbow, which provides support, is straightened.

Completely lift the patient over the bed, move him a short distance and lower him back onto the bed, bending the leg closest to the head of the bed and the arm that provides support.

Move the patient to the desired distance, repeating the previous two steps.

Provide the patient with the necessary position in bed.

11 Lifting a patient in an adjustable-height bed using a taut sheet (two or more people can do it, the patient can help)

Usage: lifting in cases where it is not possible to use a shoulder lift.

Fig. 10 Raising a patient in a bed with variable height.

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform the procedure.

Assess the patient's condition and environment

Lower the bed to the middle of your thigh. Set the bed brakes.

Stand on both sides of the bed facing each other (if the patient is obese, 2 people stand on each side of the bed):

stand close to the bed;

nurses' shoulders at the level of the patient's back;

legs apart

the leg closest to the head is turned in the direction of movement,

legs bent at the knees;

back straight.

Lightly roll up the sheet (to chest level on one side and under hip - on the other). Lift the patient -

take the top corners of the sheet,

grab the bottom corners of the sheet,

place your foot in the direction of movement, gradually move the patient intovertical position in bed (count of three)– the leader commands) (Figure 10).

Further actions depend on the purpose of raising the patient.

12 Lifting and moving the patient to the head of a low bed (performed by two people)

"Australian uplift" is used. Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it. Imagine a person helping you move.

Assess the patient's condition and environment.

Help the patient sit down, one nurse supports him, the second- places a pillow.

Stand on both sides close to the bed, facing each other and behind the patient so that your shoulders are level with the patient's back (Fig. 11).

Place a diaper on the edge of the bed. Turn your face towards the head of the bed. Place one knee parallel to the edge of the bed on the diaper placed, move the lower leg as close to the patient as possible. The leg standing on the floor is a support when lifting the patient).

Apply "Australian lift".

Carefully move the patient a short distance to the head of the bed.

Fig. 11 Lifting and moving the patient to the head of a low bed.

Having finished moving, remove the diapers, creating a comfortable position for the patient

13 Moving the patient to the head of a wide bed

(performed by two people)

"Australian uplift" is used.

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it. Imagine a person helping you move.

Assess the patient's condition and environment.

Help the patient move to the edge of the bed, moving first his legs, then his buttocks, torso and head.

Help the patient sit up.

One of the nurses kneels next to the patient on the vacant part of the bed, placing her shins along the patient’s hips (first lay a diaper on the bed) (Fig. 12). The second sister stands on the floor in the Australian lift position.

Fig. 12 Moving the patient to the head of the wide bed.

Lift the patient off the bed using your shoulder and move him a short distance towards the head of the bed.

Gradually move the patient to the desired distance, lifting him above the bed. Remove the diaper.

Create a comfortable position for the patient.

14 Moving the patient using a pad to the edge of a bed with varying heights

(performed by two people)

Usage: change of linen; as a preliminary stage for other movements. Contraindications:

Fig. 13 Moving the patient using a diaper to the edge of a bed with varying heights.

Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it. Imagine a person helping you move.

Make sure the patient is lying horizontally in the middle of the bed. Lower the handrails (if equipped).

Tell your assistant to stand on the other side of the bed. Rice. 13.

Ask the patient to raise his head (if he is unable to do this, carefully lift it), remove the pillow. Place a pillow at the head of the bed.

Roll the edges of the padding towards the patient until your hands touch the patient's body.

Place a pad (protector) in front of you on the vacant part of the bed along the patient.

Your assistant stands in a 30cm-wide leg-spread position, one leg in front, knees slightly bent.

Stand as close to the bed as possible, place one knee on the protector lying on the bed, the other leg firmly on the floor.

Hold the edges of the rolled up diaper with your palms facing up.

Tighten the muscles of your stomach, buttocks and back. On the count of three, carefully lift the patient and move him to the edge of the bed, using a pad.

Move it slowly, without jerking, lifting it high enough so that it does not slide on the bed.

When lifting, transfer your weight from your foot on the floor to your knee on the bed; your assistant shifts his weight from the forward leg to the backward leg.

Help the patient raise his head and neck and place a pillow under it.

Tuck in the edges of the padding.

Perform a procedure for which the patient was moved to the edge of the bed.

15 Moving the patient to the head of the bed

(performed by two people; patient can help)

Make sure the patient is lying horizontally. Ask him to raise his head and shoulders; if he cannot, gently lift his head and remove the pillow; lean it against the head of the bed.

Fig. 14 Moving the patient to the head of the bed. Performed by two people.

Get up with different sides facing the head of the bed.

Both nurses place one hand under the patient's shoulders, the other- under the hips (unsafe way); or one nurse stands at the patient's upper torso. He puts his hand under his neck andpatient's shoulder. With her other hand she clasps the arm and shoulder lying nearby.patient. The second nurse stands near the patient’s lower torso and brings her arms upunder his lower back and hips.

Spread your legs 30 cm wide, placing one leg slightly back.

Ask the patient to bend his knees without lifting his feet from the bed.

Ask the patient to press their chin to their chest.

Ensure that the patient can assist in ambulation by pushing off the bed with their feet.

Bend your knees so that your forearms are level with the bed.

Ask the patient to push off from the bed on the count of three and, exhaling, raise his torso and move towards the head of the bed.

On the count of “three”, swing and transfer your body weight to the leg placed back. At this time, the patient pushes off with his heels and lifts his torso.

Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably in the desired position.

16 Moving the patient to the head of the bed

(performed by one nurse, patient can help)

Explain to the patient the process of the upcoming procedure, make sure he understands it and obtain his consent. Imagine a person helping you move.

Fig. 15 Moving the patient to the head of the bed. Performed by one sister.

Assess the surrounding environment. Lower the side rails, if equipped. Set the bed brakes.

Make sure the patient is lying horizontally. Ask him to raise his head, and if he cannot, gently lift his head and remove the pillow, lean it against the head of the bed.

Spread your legs 30 cm wide. Turn the toe of the leg closest to the headboard towards the headboard.

Ask the patient to bend their knees and press their feet firmly against the mattress, and hands - palms down towards the bed.

Place one hand under the patient's shoulders, the other– under his buttocks. Notlean forward. Keep your back straight. Bend your knees.

Ask the patient to push off the bed with his feet and palms on the count of “three,” after exhaling, or ask him to grab the head of the bed with his hands, on the count of “three,” after exhaling, help the sister by pulling himself up.

Repeat these steps until the patient takes the appropriate position. Move it gradually, over a short distance, so as not to hurt your back.

Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably.

17 Moving the patient to the head of a bed with a drop head using a sheet

(performed by one sister)

Indications patient helplessness; lack of assistant.

Explain to the patient the process of the upcoming procedure, make sure he understands it and obtain his consent. Assess your surroundings. The bed should not have a hard headboard and should be set back from the wall. Secure the bed brakes (if equipped).

Ask the patient (if possible) how he can help.

Pull the edges of the sheet out from under the mattress.

Remove the pillow and place it next to you. Lower (remove) the head of the bed.

Make sure the patient is lying horizontally.

Stand at the head of the bed, spread your legs 30 cm wide and place one foot slightly in front. Do not lean over the headboard.

Roll the sheet over the patient's head and shoulders. Ask him to bend his knees (if possible) and press his feet into the mattress.

Fig. 16 Moving the patient to the head of a bed with a drop-down headboard using a sheet.

Take with both hands, palms up, the rolled edges of the sheet on both sides of the headboard.

Bend your knees and keep your back straight!

Ask the patient to help with the movement, after exhaling. On the count of three, tilt the body back and pull the patient to the head of the bed.

Place a pillow under your head and straighten the sheet. Make sure it lies comfortably.

18 Moving a helpless patient to the head of the bed

(performed by one sister)

Contraindications: spinal injury; spine surgery; epidural anesthesia.

Explain the procedure to the patient (if possible), make sure he understands it, and obtain his consent.

Assess your surroundings. Lower the side rails, if equipped. Set the bed brakes.

Make sure the patient is lying horizontally. Ask him to raise his head; if he cannot, gently lift his head and remove the pillow, lean it against the head of the bed. Fig. 17.

Start the transfer procedure from the patient’s feet:

stand at the patient’s feet at an angle of 45°;

spread your legs 30 cm wide;

leg towards the head, set back a little;

bend your knees so that your hands are at the level of the patient’s legs, move the center of gravity to the leg set back; move the patient's legs diagonally towards the headboard.

Move the patient's pelvis diagonally towards the head of the bed.

Move with your knees bent so that your arms are at the level of the patient’s torso.

Place one hand under the patient's neck, supporting his shoulder, and the other hand- under his back.

Move the patient's head and upper torso diagonally toward the head of the bed.

Raise the side rail, if present. Move to the other side of the bed and lower the side rail.

Move from one side of the bed to the other, repeating previous operations until the patient’s body reaches the desired height in bed.

Move the patient to the middle of the bed, alternately moving the upper body, pelvis, and legs.

Elevate the patient's head and shoulders and place a pillow. Make sure it lies comfortably.

Fig. 17 Moving a helpless patient to the head of the bed using the “snake method”.

19 Moving the patient to the edge of the bed

(performed by one nurse, the patient can help)

ANDusage: change of linen as a preliminary step for other movements.

Contraindications: spinal trauma, spinal surgery, epidural anesthesia.

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Make sure the patient is lying horizontally. Lower the side rails on the sister's side

Raise the patient's head and shoulders, remove the pillow and lean it against the headboard

Stand at the head of the bed. Spread your legs 30 cm wide, bend your knees without leaning forward.

Ask the patient to grab his or her elbows.

Place one hand under the patient's neck and shoulders, the other– under the top his back.

On the count of three, tilt your body and pull the patient’s upper back towards you.

Change the position of the hands, put one hand under the waist, the other- under the hips.

On the count of three, tilt your body and pull your lower body towards you.

Place your hands under the patient's legs and feet and, on the count of three, move them towards you.

Help the patient raise his head and place a pillow. Raise the side rails (if equipped).

Perform the procedure for which the patient was moved.

20 Moving the patient from the side-lying position

into the “sitting with legs down” position

(performed by one sister)

Fig. 18 Moving the patient from the “lying on his side” position to the “sitting with legs down” position.

Can be performed on both functional and regular ones.Used in a forced and passive position.

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Secure the brake; beds.

Lower the side rails (if equipped) on the nurse's side.

Stand opposite the patient: place your left hand under your shoulders, right- under knees, covering them from above. Bend your knees. Don't bend over!

Raise the patient by lowering his legs down and at the same time turning him on the bed in a horizontal plane at an angle of 90°.

Place the patient in a seated position, holding the shoulder with one hand and the other- for the body.

Make sure the patient is sitting firmly and confidently. Place a back support.

Put slippers on the patient if his feet touch the floor, or place a bench under his feet if they do not touch the floor.

21 Moving the patient from position

"sitting on the bed with legs down" on a chair

(functional wheelchair with a removable footrest) (performed by one nurse, patient can assist)

Fig. 19 Moving the patient from the “lying on his side” position to the “sitting with legs down” position.

Can be used when moving from a functional bed to a functional wheelchair with a movable (removable) footrest and to a chair.

Used when changing position; transportation. Fig. 19.

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Place a chair (wheelchair) next to the bed. If possible, lower the bed to the level of the chair. Move the footrest of the wheelchair and secure the brakes.

Use one of the ways to restrain the patient (Fig. 1).

Stand on the side where the wheelchair (chair) is located. Do not put pressure on the patient's armpits!

Warn the patient that on the count of three you will help him stand up. While counting, swing slightly. Having placed the patient on his feet at the count of three, turn with him until his back is to the wheelchair (chair). Ask the patient to tell you when he touches the edge of the wheelchair (chair).

Lower him into a wheelchair (on a chair): bend your knees and hold the patient’s knees with them, keep your back straight. The patient will help you if he puts his hands on the handle of the wheelchair (on the edge of the chair) and lowers himself into it.

Make the patient sit comfortably in a chair (chair).

22 Transferring the patient from the “sitting on the bed with legs down” position to a wheelchair with a non-removable footrest

(performed by two people, the patient can help)

Use for subsequent transportation.

Explain the procedure to the patient, make sure he understands it and obtain consent to perform it.

Assess the patient's condition and environment. Set the bed brakes. Place the wheelchair at the patient's feet. If possible, lower the bed to the level of the chair.

One nurse stands behind the wheelchair and tilts it forward so that the footrest touches the floor.

The second sister (assistant) stands opposite the patient sitting on the bed with his legs down, the sister’s legs are spaced 30 cm wide, knees bent.

Ask the patient to grab the nurse by the waist and hold him by the shoulders.

Pull the patient to the edge of the bed so that his feet (in non-slip shoes) touch the floor (Fig. 20 a).

Place one leg between the patient's knees and the other– in the direction of movement.

Rice. 20 Moving the patient from the “sitting on the bed with legs down” position to a wheelchair with a non-removable footrest.

Hold the patient in a “hug” position and gently lift him without jerking or turning. Do not put pressure on the patient's armpits!

Warn him that on the count of three you will help him get up. While counting, sway slightly with it. On the count of three, stand the patient, turn with him until he is in a position with his back to the wheelchair. Ask the patient to alert you when he touches the edge of the gurney.

Lower the patient into the wheelchair: bend your knees and hold the patient’s knees with them; keep your back straight. The patient may be able to help by placing his hands on the armrests of the wheelchair.

Release the patient, making sure he is securely seated in the chair.

Place the patient comfortably in the chair.

If necessary to transport the patient, release the brake.

23 Placing the patient in a wheelchair

(performed by two people)

Check that the brakes of the wheelchair are secure.

Stand behind the wheelchair behind the patient.

Provide yourself with reliable support: lean one leg on the back of the chair, put the other leg back. Bend your knees.

Ask the second nurse (assistant) to sit on one knee on the side of the patient, lift his legs to hip level and place them on your knee.

Support the patient's head with your chest or shoulder. Make an overhand grab. Keep your back straight, tensing your abdominal and buttock muscles.

Tell the patient and assistant that on the count of three you will move the patient toward the back of the chair.

On the count of “three”: the assistant slightly lifts the patient’s hips and moves them towards the back of the chair; you pull the patient to the back of the chair using a slide.

Fig. 21 Placing the patient in a gurney.

Make sure the patient is comfortable and remove the brakes on the wheels of the wheelchair.

24 Transferring a patient from a bed to a chair (wheelchair) (performed by two or more people using the “shoulder lift” method; the patient can sit, but does not move independently)

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Place a chair next to the bed. Assess your surroundings. Fig.22.

Help the patient sit closer to the edge of the bed with his legs dangling.

Stand on either side of the patient, facing him. Both sisters place their hand under his hips and hold each other in a “wrist lock” (Figure 1), supporting his hips.

Both nurses place their shoulders under the patient's shoulders, and he places 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 him to a chair (wheelchair).

Rice. 22 Transferring a patient from a bed to a chair (wheelchair).

Each nurse places a supporting hand on the armrest or chair seat and lowers the patient onto the chair, bending the knees and elbow. Make sure you lower the patient into the chair at the same time. The chair should not tilt back: one of the sisters holds the back of the chair.

Place the patient comfortably on the chair.

25 Moving a patient from a bed to a chair without armrests or backrest (performed by two or more people using the “over-the-arm” method; the patient can sit, but does not move independently)

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it. Introduce everyone involved in the move.

Set the height of the bed to the height of the chair. Assess your surroundings.Help the patient sit down (the patient's legs are not lowered). One of the nurses stands behind the patient– puts one knee on the bed andmakes an “over-arm grab.”

Move the patient to the edge of the bed. Support him by standing on the floor with both feet behind him.

Fig. 23 Transferring a patient from a bed to a chair without armrests or backrest.

The second nurse places the chair comfortably and close to the bed, but so that the patient does not rest his elbow on the bed when sitting on the chair.

The same nurse stands opposite the chair facing the patient. Legs are bent at the knees (squatting position), one leg is put forward.

She puts her hands under the patient’s knees and, on the count of three, drags his legs to the edge of the bed, while the other nurse lifts his torso and, bending her knees, lowers the patient onto a chair. Place the patient comfortably on the chair.

26 Lifting the patient from a chair using

rocking and moving onto a chair (bed)

(performed by one sister)

Used for the need to move the patient at an angle of 90 0 from a chair to a wheelchair or other seat.

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess your surroundings. Move both seats together, fixing the brakes and removing the side bars of the chairs.

Face the patientplace your feet shoulder-width apart, hold the patient’s feet with one foot, and the other- a chair leg.

Ask the patient to lean forward so that his shoulder rests against the nurse's chest.

Fig.24 Lifting the patient from a chair by rocking and moving onto a chair (bed).

Move the patient to the edge of the chair, rocking the chair from side to side and moving the legs forward. The patient's knees are at a 90° angle. The knees and feet are together.

Place one leg next to the patient and support his knees with the other. Start smoothly rocking, moving your body weight back and forth, keeping the patient close to you.

Warn the patient that on the count of three you will help him stand up.

Lift the patient and move him at a 90° angle to another chair (chair).

27 Moving the patient from the “sitting on a chair” position to the “lying on the bed” position (performed by one nurse)

Hold the patient using one of the methods known to you (see Fig. 1).

Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Secure the bed brakes

Warn the patient that on the count of three you will help him stand up. While counting to three, swing. On the count of three, stand the patient, then turn with him, foot to foot, until his hips touch the edge of the bed.

Place the patient on the bed. Stand on the side facing him. Spread your legs width 30 cm. Bend your knees. Keep your back straight

Rice. 25 Moving the patient from the “sitting on a chair” position to the “lying on the bed” position.

Place your hand under your knees, grab them from above, and with your other hand grab the patient’s shoulders.

Raise the patient's legs onto the bed, turning his torso 90°, and lower his head onto the pillow. Cover the patient and make sure he is lying comfortably.

28 Transferring a patient from bed to gurney and back

(for four people, bed with variable height)

After the operation, the patient remains anesthetized for some time, or conscious, but experiences pain.

During the transfer, visitors are asked to temporarily leave the room. You need to ask someone to hold the IV, drainage tubes and other devices.

When starting to move onto a gurney (bed), you need to know in which area the operation was performed, as well as other restrictions.

You and your assistant stand on one side, the other two sisters- from another goy side of the bed. Secure the brakes. Fig.26.

Place the gurney on the side of the bed where you will be moving the patient. It is necessary to leave space to be able to stand between the bed and the gurney.

Cover the patient with a sheet or blanket. Tell him to hold the sheet or blanket with his hands while you roll the sheet up at his feet.

Move the patient to the edge of the bed.

Unfold the sheet and leave it on the mattress (without tucking it in). Wrap the top sheet around the patient, tucking the ends under it. Stand close to the bed to prevent the patient from falling.

Fig. 26 Moving the patient from the bed to the gurney and back.

Note.The head of the bed is in a horizontal position. Two nurses stand on the opposite side of the wheelchair and hold the patient; two other assistants move the gurney to the edge of the bed.

Note.Make sure the gurney is level with the bed. Do not leave space between the bed and the gurney. Check that the sheet is on the mattress.

Roll the sheet into a roll and hold it in your hands on all sides, palms up.

Two sisters kneel on the free part of the bed (after placing the protector).

On the count of “three” (the leader gives the command), all four lift the sheet and transfer the patient to the gurney along with the sheet. Make sure the patient is lying in the middle.

Note. If the gurney is equipped with belts, secure the patient with them.

Transport the patient to the destination: one nurse- at the head, the other - at the patient’s feet.

When moving it from the gurney to the bed, place the gurney close to the bed, secure the brakes, and release the edges of the sheet on the gurney.

Two assistants kneel on the bed with the protector down.

All the sisters fold the edges of the sheet towards the center.

On the count of “three” (the leader gives the command), everyone lifts the sheet, holding it by the edges with their palms up, and moves the patient to the edge of the bed.

The nurses, kneeling on the bed, go down to the floor and hold the patient while others move the gurney.

Move the patient, tuck the sheet under the mattress and straighten it.

If necessary, place a small pillow under your head. If the patient experiences pain when moving, or the bandage gets wet, or there is blood in the drainage tubes, report to the doctor.

29 Transferring a patient from a regular bed to a gurney

(and vice versa) (performed by three people)

Place the gurney at an angle of at least 60° at the edge of the bed (at the feet). Rice. 27.

Fig. 27 Transferring a patient from a regular bed to a gurney and vice versa.

Secure the brakes on the gurney and bed.Everyone stand along the bed. SaMay is a strong (physically) sister- in the center.

Place one leg forward, bending the knee, and put the other back. Place your arms (up to the elbow) under the patient:

the sister at the head raises her head, supports her shoulders and upper back,

the sister in the center supports the lower back and buttocks,

the nurse standing at the patient's feet supports the legs.

Note. If the patient is very sick, more people will be needed and the workload will have to be redistributed.

Lifting the patient:

at the leader’s command “three”, transfer your body weight to the leg set back,

gently pull the patient to the edge of the bed;

take a break

on the new command “three”, roll the patient onto you, press him and lift him, straightening his knees and straightening his back (do not hold the patient on outstretched arms!)

Move backward to face the gurney:

the nurse holding the patient's legs takes wider steps,

the nurse holding the patient's head, shoulders and back - less wide, turning to face the gurney

Move forward (toward the gurney). On the count of three, bend your knees and carefully lower the patient onto the gurney.

30 Turning the patient on his side using a pad and placing him in this position

(performed by two people)

Usage when changing linen; placement in a lateral position; preliminary, stage for other movements.

Explain the process of the upcoming procedure, make sure the patient understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes. Have your assistant stand on the opposite side of the bed from you.

Lower the side rails (or one of them if you are performing the procedure without an assistant).

Ask the patient to raise his head (if possible), or raise his head and shoulders, remove the pillow. Place a pillow against the head of the bed.

Make sure the patient is lying horizontally on the edge of the bed.

Ask the patient to cross his arms over his chest.

If you turn him over on his right side, he should put his left leg on his right. Help him if necessary.

Stand on the side of the bed where you turn him over.

Place a protector next to the patient.

Stand closer to the bed, place your knee on the protector, the other leg serves as a support.

Rice. 28 Turning the patient onto his side using a pad and placing him in this position

Place your hand on the patient's shoulder, which is further from the nurse, the other– on the corresponding hip, i.e. if the patient turns over on the right side, halfplace your left hand on his left shoulder, and your right– on his left thigh.

Your assistant should pull the edge of the diaper out from under the mattress and roll it close to the patient's body, then take the rolled end of the diaper with your palms up and, resting your feet, turn the patient on his side on the count of three. You turn the patient towards you, placing your weight on the leg that is on the floor. Help the patient raise his head and place a pillow.

Note. Further actions depend on the purpose of the turn.

For example, in case placements:

turn the patient so that he is not lying on his arm;

place a folded blanket under your back for stability;

place a pillow under the arm lying on top;

Bend the leg lying on top at the knee and place a pillow between the knees.

Unfold the diaper.

31 Turning the patient onto his side using the “joint log roll” method and placing him in this position

(performed by two people)

Usage when changing linen; placement in a lateral position; a preliminary stage for other movements.

Assess the patient's condition and environment. Set the bed brakes.

Fig. 29 Turning the patient on his side using the “joint log rolling” method and placing him in this position.

Ask your assistant to stand next to you.

Remove the pillow from under your head and place it at the head of the bed. Place your hands under the patient's head and shoulders. Tell your assistant to place his hands under the patient's hips.

Place one leg slightly in front of the other, swing back on the count of three, shift your body weight onto the leg placed back and move the patient to the edge of the bed.

Lower the bed so that one of the sister's knees is on the bed (on the protector) and the other leg is firmly on the floor.

Together with an assistant, move to the other side of the bed. Place a pillow between the patient's legs and cross his arms over his chest.

Both sisters place the protectors on the edge of the bed and place one knee on the protector.

Place one hand on your shoulder, the other– on the patient's pelvis, ask the landowner to place his hands on the patient's thighs and legs.

On the count of three, turn the patient to face you, keeping his head, back and legs in line. Bend your upper leg slightly.

Make sure the pillow remains between the patient's legs.

Place the support at the sole of the foot lying underneath.

Be sure to place a pillow under the patient's back to maintain this position. Also place a pillow under your upper arm. If possible, place a small pillow under the patient's head. Cover him.

Raise the side rails. Make sure the patient feels comfortable.

32 Turning the patient and placing him in a lateral position. Performed on a bed with variable height (performed by one nurse, the patient can help)

Usage at forced or passive position; risk of developing bedsores, changing position.

Prepare: extra pillow, footrest, sandbag. Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Fully (if possible) lower the head of the bed; the patient should lie horizontally. Lower the bed to mid-thigh level.

Move the patient closer to the edge of the bed opposite to where he is being turned.

Tell the patient to cross his arms over his chest.

If you turn him over on his right side, he will put his left leg on his right.vuyu (if he can’t do this, help him), and whether bend the patient's left leg: one hand covers the shin, the other- popliteal cavity.

Stand on the side of the bed where you are turning the patient. Place the protector next to it. Bend your leg at the knee and place it on the tread. The second is a support.

If you turn the patient on his right side, place your left hand on hisleft shoulder, and right– on his left thigh.

Turn the patient onto their side, placing your weight on the leg on the floor. Place a pillow under the patient's head.

Fig. 30 Rotating the patient and placing him in a lateral position. Performed on a bed with variable height.

Note. The patient should lie on his or her arm.

Bend the patient's arms slightly. The arm on top lies on the pillow.

Place a pillow under the patient's back.

Place a pillow under the patient's half-bent leg lying on top (from the groin area to the foot).

Place a sandbag (footrest) at the sole of the foot that lies underneath. Unfold the diaper.

33 Turning over and placing the patient in the “prone” position (performed as prescribed by the doctor by one nurse; the patient cannot help)

Performed on both a functional and a regular bed. Use when forced or passive position; risk of developing bedsores, changing position. Rice. 31.

Prepare: a folded blanket or bath towel, a small pillow, bolsters.

Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent to perform it.

Assess the patient's condition and environment. Set the bed brakes.

Lower the side rails (if equipped) on the nurse's side.

Lower the head of the bed (or remove the pillows). Make sure the patient is lying horizontally.

Rice. 31 Turning over and placing the patient in the “lying on his stomach” position (performed as prescribed by the doctor by one nurse; the patient cannot help).

Gently lift the patient's head, remove the usual one and place a small pillow.

Move the patient to the edge of the bed.

Extend the patient's arm and press it to the body.

Raise the side rails. Move to the other side of the bed and lower the 5m side rails.

Place your knee on the bed. Place a folded blanket (towel) ora small pillow under the patient's upper abdomen. Place one hand on the squareyes, and the other– on the thigh farthest from you, place your knee on the bedpatient by placing a small pillow (protector) under him.

Turn the patient onto his stomach towards the nurse. The patient's head is on its side.

Place a pillow under your shins so that your toes do not touch the bed.

Bend one arm of the patient at the elbow joint at an angle of 90°, the other– Bylay along the body.

Place pillows (or foam in a cover) under your elbows, forearms and hands.

Place small cushions next to your feet (outside).

Straighten the sheet and diaper.

Make sure the patient is lying comfortably. Raise the side rails.

Rice. 32 Technique for turning the patient onto his stomach together.

References

Mukhina S.A., Tarnovsky I.I. Practical guide to the subject “Fundamentals of Nursing”, Moscow, 2002.

Atlas of Human Anatomy, Moscow, Medicine, 1978.

Atlas of Human Anatomy, Moscow, Onyx Alliance, 2002.

Educational and methodological manual on OSD. Moscow, 2003.

Magazines "Nursing", "Nursing"

Important: If a seriously ill patient needs to be moved over significant distances, then the type of transportation must be chosen by the doctor!

Selecting a method for moving the patient.

The type of transportation (determined by the doctor) and the method of placing the patient on a stretcher depend on the disease and its location. It is necessary to move the patient in a bed, on a stretcher, in a wheelchair, or in the arms of one or two assistants (in the absence of means of transportation) with the utmost care and safety.

Capture of Rautek. This method is most often used when providing first aid. The Rautek grip allows you to lift and move patients in serious condition. It happens that the patient, having fallen, lies on the floor. The Rautek grip will allow you to lift, sit or lay down the fallen person.

Description of actions performed by one person.

1. Approach the patient from behind and sit down.
2. Support the back of the patient's head and shoulders with both hands.
3. Place the patient in a sitting position with one gentle rocking motion.
4. To prevent the patient from falling again, support his back with your knees.
5. Grab the patient from behind by the armpits.
6. Apply the so-called “monkey grip”, grasping with one hand carpal joint, the other is the patient’s forearm so that his arm is bent.
7. The nurse's thumbs are pointing upward.
8. Gradually straightening up, lift the patient with you, supporting him with your hips.

This position allows the patient to be moved backwards or seated on a chair or the edge of the bed. Immobilized patients must be transported in a wheelchair or on a stretcher.

Transferring the patient to a stretcher from the bed.

Place the stretcher perpendicular to the bed so that its head part approaches the foot part of the bed.
Place the patient's arms in the following way: one person should place his hands under the patient's shoulder blades and head, the second person should place his hands under the pelvis and upper thighs, the third should place his hands under the lower leg and the middle part of the thighs. When transporting by two people, one should place his hands under the patient’s shoulder blades and neck, the other should place his hands under the knees and lower back.
Having coordinated the movements, simultaneously lift the patient, turn 90 degrees towards the stretcher and lay him on it.

Transporting the patient on a stretcher.

The patient is carried slowly and without shaking, the step should be short, not in step.
The patient should be lowered down the stairs feet first, lifting the foot end of the stretcher and lowering the head end so that the stretcher is in a horizontal position. The one walking behind carries the stretcher on his shoulders, the one walking in front carries the stretcher on straightened arms.
The patient is carried up the stairs head first, and the horizontal position of the stretcher is also maintained. The one walking behind carries the stretcher on his shoulders, the one walking in front holds the handles of the stretcher on his arms, straightened at the elbows.

Transferring the patient from the stretcher to the bed.

Place the head end of the stretcher perpendicular to the foot edge of the bed. A stretcher should be placed parallel to the bed if the area of ​​the room is small.
Having coordinated the movements, simultaneously lift the patient and turn him 90 degrees towards the bed. If the stretcher is positioned parallel, turn 180 degrees. Place the patient on the bed.
If the stretcher is located close to the bed, then holding the stretcher at its level, two or three of you pull the patient on the sheet to the edge of the stretcher, lift him up a little and transfer him to the bed.

Lifting the patient from the front and guiding him with support from behind.

The following is done:

1. Approach the patient from the front, to the healthy side of the body.
2. Place your feet in front of the patient's feet. To prevent the patient from slipping, the heels should be connected at an acute angle.
3. Hold the patient's armpits with both hands.
4. Slowly pull it up.
5. Unlock the feet when the patient is firmly on his feet.
6. Change hands.
7. Change position by approaching the patient from behind.
8. Grab him with a monkey grip from behind.
9. The patient takes a step with his healthy leg.

Lifting the patient from the side and guiding him with lateral support.

If the patient has unilateral paralysis, the caregiver can act alone.

The following is done:

1. Approach the patient from the non-paralyzed side.
2. Place your foot at an angle in front of the patient's healthy leg to prevent slipping.
3. On the non-paralyzed side, grasp the patient's armpit with one hand.
4. Using your other hand, grab the patient's back and insert your hand from behind the armpit.
5. Carefully lift the patient from the chair and help him straighten.
6. After making sure that the patient stands confidently, remove the leg.
7. Use your other foot to move the chair away from the patient.
8. Remove the hand holding the patient’s armpit on the healthy side. Go to the patient from behind.
9. Support the patient's armpits with both hands.
10. Ask him to take a step forward with his healthy leg.
11. The nurse pushes his immobilized leg with her foot.
12. Continuing the movement in this way, bring the patient to a bed or chair.

Seating the patient in a wheelchair.

For safety, explain the upcoming actions to the patient.

Place the wheelchair next to the bed. Slightly tilt the chair forward while pressing on the footrest.

The patient is asked to stand on a footrest and is seated with support. If the patient is unable to stand, an assistant moves him.

Return the wheelchair to its original position.

Place the patient in the desired position (reclining or sitting). For this purpose, a frame is used that is located behind the back of the wheelchair.

Observe the position of the patient's hands. To avoid injury, keep your arms away from the armrests.