Transportation of 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 that he understands it, and obtain consent to the procedure.

Assess the patient's condition and environment.

Attach 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 sister stands behind the wheelchair and tilts it forward so that the footstool touches the floor.

The second sister (assistant) stands in front of the patient, sitting on the bed with his legs down, the sister's legs are spaced 30 cm apart, knees bent.

Ask the patient to grab the sister by the waist, hold him by the shoulders.

Pull the patient to the edge of the bed so that 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.

Press the patient in the “hug” position, gently lift him, without pulling or turning. Do not put pressure on the patient's armpits!

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

While counting, sway slightly with it.

On the count of three, put the patient, turn with him until he takes a position with his back to the wheelchair.

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

Lower the patient into a wheelchair: bending your knees, hold the patient's knees with them; keep your back straight.

The patient can help by placing their hands on the armrests of the wheelchair.

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

Place the patient in the chair comfortably.

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

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

Check if wheelchair brakes are engaged.

Stand behind the wheelchair behind the patient.

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

Ask the second sister (assistant) to sit on one knee to the side of the patient, raise his legs to the level of the hips and put them on her knee.

Support the patient's head with your chest or shoulder. Make a hand grip. Keep your back straight, tensing the muscles of the abdomen and buttocks.

Rice. 2-30. Placement of the patient in wheelchair

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

On the count of "three": the assistant slightly raises the patient's hips and moves them to the back of the chair; you pull the patient to the back of the chair using the slide.

Make sure that the patient feels comfortable, remove the wheels of the wheelchair from the brakes.

Moving the patient from the 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 (Figure 2-31)

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

Put a chair next to the bed. Assess the environment.

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

Stand on both sides of the patient facing him. Both sisters put their hand under his hips and hold each other in a "wrist grip" (see figure 2.10), supporting his hips.

Both sisters put their shoulders under the shoulders of the patient, and he puts his hands on the backs of the sisters.

Bend your free arm at the elbow, resting it on the bed.

Legs apart, knees bent.

One of the sisters gives the command.

On the count of three, both straighten their knees and elbows, stand up and lift the patient.

Support the patient's back with your free hand while you carry them to the chair (wheelchair).

Each nurse places a supporting hand on the chair arm or seat and lowers the patient into the chair by bending the knees and elbow.

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

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

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

Transferring the patient from bed to a chair without armrests or backrest, performed by two or more people using the "hand grip" method, the patient can sit,

but does not move independently (Figure 2-32)

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

Set the height of the bed to the height of the chair. Assess the environment.

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

One of the sisters stands behind the patient - puts one knee on the bed and makes a "grab through the hand."

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

The second sister places the chair comfortably and close to the bed, but in such a way that the patient does not rest his elbow on the bed when she sits on the chair.

The same nurse stands in front of the chair facing the patient. The legs are bent at the knees (squatting position), one leg is put forward.

She also brings 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 into a chair.

Position the patient comfortably in a chair.

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

Moving a patient from bed (adjustable height bed) to stretcher and back (performed by four people) (Fig. 2-35)

After the operation, the patient remains for some time in a state of anesthesia or in consciousness, but experiences pain. When starting to move to a stretcher (bed), you need to know in which area he underwent surgery, 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. Fasten the brakes.

Place the wheelchair on the side of the bed where you will move the patient. Space must be left to be able to stand between the bed and the wheelchair.

Cover the patient with a sheet or blanket.

Tell him to hold the sheet or blanket with his hands, and fold the sheet at his feet.

Rice. 2-35. Transferring a patient from bed to wheelchair and vice versa

Move the patient to the edge of the bed.

Straighten the sheet and leave it on the mattress (without tucking). Wrap the top sheet around the patient, tucking the ends under him. Stand close to the bed so that the patient does not fall. Note. The head of the bed is in a horizontal position. Two sisters 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 wheelchair is level with the bed. Leave no space between the bed and the wheelchair. Check that the sheet is on the mattress.

Attach the brakes to the wheelchair.

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 putting the protector).

On the count of "three" (the command is given by the leader), all four lift the sheet and transfer the patient to the stretcher along with the sheet.

Make sure the patient lies in the middle.

Note. If the stretcher is equipped with straps, secure the patient with them.

Transport the patient to the destination: one sister is at the head, the other is at the patient's feet.

When transferring a patient from a wheelchair to a bed.

Put the wheelchair close to the bed, fixing the brakes, release the edges of the sheet on the wheelchair.

Two assistants kneel on the bed with the protector on.

All 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, palms up, and moves the patient to the edge of the bed.

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

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

Place a small pillow under your head if necessary. If the patient experiences pain during transfer, or the dressing gets wet, or there is blood in the drainage tubes, report to the doctor.

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

performed by three people (Fig. 2-36)

Position the wheelchair at an angle of at least 60° at the edge of the bed (at the feet).

Attach wheelchair and bed brakes.

Everyone stand along the bed:

The strongest (physically) sister is in the center;

Put one leg forward, bending at the knee, put the other back.

Put your hands (up to the elbow) under the patient:

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

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

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

Rice. 2-36. Transferring a patient from a regular bed to a stretcher and vice versa

Lifting the patient:

At the command of the leader “three”, transfer the mass of your body to the leg set back;

Gently pull the patient to the edge of the bed;

To have a break;

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

Move backward to turn around to face the wheelchair:

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

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

Move forward (to the wheelchair).

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

Turning the patient on his side with the help of a diaper and placing in this position (performed by two people) (Fig. 2-37)

Usage

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

Ask your assistant to 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 raise his head and shoulders, remove the pillow.

Rest the 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 their arms over their chest.

If you turn him over on his right side, then he must put left leg to the right.

Help him if necessary.

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

Rice. 2-37. Turning the patient to the side with a diaper

Place a protector next to the patient.

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

Put a hand on the patient's shoulder, which is farther from the sister, the second - on the corresponding thigh, i.e. if the patient rolls over on the right side, put left hand on his left shoulder and the 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 the palms up and, resting their feet, turn the patient on their side on the count of three.

You turn the patient towards you, transferring your weight to the standing leg on the floor.

Assist the patient to raise their head and place a pillow.

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

For example, in the case accommodation:

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

Place a folded blanket under your back for stability;

Put 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 is comfortable.

Turning the patient on his side using the method of "joint log rolling" and placing in this position (performed by two people) (Fig. 2-38)

Usage when changing linen; placement in a position on the side; preliminary stage for other movements.

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

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

Ask your assistant to stand next to you.

Remove the pillow from under the head and place it at the head.

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

Tell your assistant to put his hands under the patient's thighs.

Rice. 2-38. Turning the patient on his side by joint rolling of the log

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

Lower the bed so that one knee of the sister is on the bed (on the protector), and the other leg is firmly on the floor.

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

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

Put one hand on the shoulder, the other on the patient's pelvis, ask the assistant to put his hands on the patient's thighs and shins.

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

Bend the top leg slightly.

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

Place an emphasis at the sole of the foot lying below.

Be sure to place a pillow under the back to keep the patient in this position.

Place a pillow under upper hand.

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

Cover him.

Raise the side rails.

Make sure the patient is comfortable.

(Figure 2-33)

Used when moving the patient, if he can participate in it and control the position of the 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 that he understands it, and obtain his consent to the procedure.

Assess the environment. Move both seats together, fixing the brakes and removing the side rails of the chairs (chairs).

Stand facing the patient.

Spread your legs 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 their shoulder rests on the chest sisters.

Move the patient to the edge of the chair, rocking it from side to side and moving the legs forward. Patient knees at 90°. Knees and feet together.

Put one foot next to the patient, fix his knees with the other.

Start smooth rocking, moving the mass of your body back and forth, keep the patient next to you.

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

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

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

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

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

Rice. 2-34. Transferring a patient from sitting on a chair to lying on a bed

Counting to "three", swing.

On the count of three, put the patient, then turn with him, leg to leg, until he touches the edge of the bed with his hips.

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!

Bring a hand under the knees, grasp them from above, with the other hand grasp the patient's shoulders.

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

Cover the patient, make sure he is comfortable.

Moving a patient from bed (adjustable height bed) to stretcher and back (performed by four people) (Fig. 2-35)

After the operation, the patient remains for some time in a state of anesthesia or in consciousness, but experiences pain. When starting to move to a stretcher (bed), you need to know in which area he underwent surgery, 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. Fasten the brakes.

Place the wheelchair on the side of the bed where you will move the patient. Space must be left to be able to stand between the bed and the wheelchair.

Cover the patient with a sheet or blanket.

Tell him to hold the sheet or blanket with his hands, and fold the sheet at his feet.

Rice. 2-35. Transferring a patient from bed to wheelchair and vice versa

Move the patient to the edge of the bed.

Straighten the sheet and leave it on the mattress (without tucking). Wrap the top sheet around the patient, tucking the ends under him. Stand close to the bed so that the patient does not fall. Note. The head of the bed is in a horizontal position. Two sisters 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 wheelchair is level with the bed. Leave no space between the bed and the wheelchair. Check that the sheet is on the mattress.

Attach the brakes to the wheelchair.

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 putting the protector).

On the count of "three" (the command is given by the leader), all four lift the sheet and transfer the patient to the stretcher along with the sheet.

Make sure the patient lies in the middle.

Note. If the stretcher is equipped with straps, secure the patient with them.

Transport the patient to the destination: one sister is at the head, the other is at the patient's feet.

When transferring a patient from a wheelchair to a bed.

Put the wheelchair close to the bed, fixing the brakes, release the edges of the sheet on the wheelchair.

Two assistants kneel on the bed with the protector on.

All 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, palms up, and moves the patient to the edge of the bed.

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

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

Place a small pillow under your head if necessary. If the patient experiences pain during transfer, or the dressing gets wet, or there is blood in the drainage tubes, report to the doctor.

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

Position the wheelchair at an angle of at least 60° at the edge of the bed (at the feet).

Attach wheelchair and bed brakes.

Everyone stand along the bed:

The strongest (physically) sister is in the center;

Put one leg forward, bending at the knee, put the other back.

Put your hands (up to the elbow) under the patient:

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

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

The nurse, standing at the feet of the patient, supports the shins. Note. If the patient is very severe, more

people and will have to redistribute the load.

Rice. 2-36. Transferring a patient from a regular bed to a stretcher and vice versa

Lifting the patient:

At the command of the leader “three”, transfer the mass of your body to the leg set back;

Gently pull the patient to the edge of the bed;

To have a break;

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

Move backward to turn around to face the wheelchair:

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

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

Move forward (to the wheelchair).

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

Turning the patient on his side with the help of a diaper and placing in this position (performed by two people) (Fig. 2-37)

Usage

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

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

Ask your assistant to 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 raise his head and shoulders, remove the pillow.

Rest the 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 their arms over their chest.

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

Help him if necessary.

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

Rice. 2-37. Turning the patient to the side with a diaper

Place a protector next to the patient.

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

Put a hand on the patient's shoulder, which is farther from the sister, the second - on the corresponding thigh, i.e. if the patient rolls onto 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 close to the patient’s body, then take the rolled end of the diaper with the palms up and, resting their feet, turn the patient on their side on the count of three.

You turn the patient towards you, transferring your weight to the standing leg on the floor.

Assist the patient to raise their head and place a pillow. Note. Further actions depend on the purpose of the rotation.

For example, in the case accommodation:

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

Place a folded blanket under your back for stability;

Put 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 is comfortable.

Turning the patient on his side using the method of "joint log rolling" and placing in this position (performed by two people) (Fig. 2-38)

Usage when changing linen; placement in a position on the side; preliminary stage for other movements.

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

Ask your assistant to stand next to you.

Remove the pillow from under the head and place it at the head.

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

Tell your assistant to put his hands under the patient's thighs.

Rice. 2-38. Turning the patient on his side by joint rolling of the log

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

Lower the bed so that one knee of the sister is on the bed (on the protector), and the other leg is firmly on the floor.

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

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

Put one hand on the shoulder, the other on the patient's pelvis, ask the assistant to put his hands on the patient's thighs and shins.

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

Bend the top leg slightly.

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

Place an emphasis at the sole of the foot lying below.

Be sure to place a pillow under the back to keep the patient in this position.

Place a pillow under your upper arm as well.

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

Cover him.

Raise the side rails.

Make sure the patient is comfortable.

Turning the patient and placing him in a position on his side. Performed on a bed with adjustable height (performed by one nurse, the patient can help) (Fig. 2-39)

Use at forced or passive position; the risk of developing bedsores, a change in 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 the procedure.

Assess the patient's condition and environment. Attach 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 turned.

Tell the patient to cross his arms over his chest.

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

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

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

The second leg is the support.

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

Turn the patient on their side, transferring their weight to the leg that is on the floor.

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

Bend the patient's arms slightly.

The hand on top rests on the pillow.

Place a pillow under the patient's back.

Under the bent leg of the patient, lying on top, put a pillow (from the inguinal region to the foot).

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

Unfold the lining.

Turning over and placing the patient in the “lying on the stomach” position is performed by one sister as prescribed by the doctor; the patient is unable to help (Figure 2-40)

It is performed both on a functional and on a regular bed.

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

Prepare: a rolled-up 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 the procedure.

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

Lower the side rails (if any) from the side where the nurse is.

Rice. 2-40. Transferring the patient to the prone position

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

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

Move the patient to the edge of the bed.

Unbend the patient's arm, press it to the body.

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

Put your knee on the bed.

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

Put one hand on the shoulder, and the other on the thigh, which are farther from you, put the knee on the patient's bed, placing a small pillow (protector) under it.

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

Place a pillow under your shins so your toes don't touch the bed.

Rice. 2-41. Transferring the patient from back to abdomen and vice versa

Flex one arm of the patient elbow joint at an angle of 90 °, put the other along the body.

Place pillows (or foam rubber in a case) under the elbows, forearms and hands.

Place small rollers next to the feet (on the outside).

Straighten the sheet and underclothes.

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

Figure 2-41 shows the technique of transferring the patient by two nurses to the abdomen and back.

TOXIC SUBSTANCES

In a healthcare setting, 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 vapors in various ways (Fig. 2-42). The most common side effect of toxic substances is "professional 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 have equal or even greater efficiency and are cheaper.

Secondly, protective clothing such as gloves, gowns, aprons, face shields and goggles, shoe covers reduce skin contact with toxic substances, and masks and respirators provide some level of protection against toxic dusts and aerosols. If rubber gloves in people with hypersensitivity provoke dermatitis, you can wear silicone or PVC with a cotton lining. Powders should only be handled with cotton gloves, but they do not protect the skin well when working with liquid chemicals.

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

Fourth, you should carefully study the guidelines for the use of certain protective equipment when working with toxic substances.

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

At sixth, If a chemical gets into your eyes, rinse them immediately and thoroughly. big amount cold water. If any Chemical substance got into the mouth, you need to rinse your mouth with water, in some cases it is recommended to drink a large number of water. Chemical preparations that have got on the skin should be washed off immediately, and if they got on clothes or overalls, change it.

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

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

It has been estimated that 1-5% of nursing staff are sensitized after contact with antibiotics, especially penicillin, neomycin and streptomycin.

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

Some antibiotics (actinomycin D, myctomycin C, streptomycin) are teratogenic.

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

Indication: transport to the operating room for surgery.
Equipment: wheelchair, pillow, mattress, sheets.
Sequencing:
1. Determine how the patient's bed is located in the ward.

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

3. Place the wheelchair close to the patient's bed; one nurse should stand on the side
wheelchairs, the other - from the side of the bed.
4. Ask the patient to help healthcare workers move from bed to stretcher.
Put the patient's pillow from the bed on the stretcher, follow the position of the patient's hands
(hands should lie along the body; if the patient is obese, then place your hands on the front 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 - At the head, the other - at the foot end of the gurney.

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

Transferring a patient from wheelchair to operating table and vice versa

Sequencing:
1. Explain to the patient the course of the upcoming manipulation.
2. Bring the gurney with the patient into the operating room.
h. Place the gurney close to the operating table (head end to head end).
4. Get up from the side of the gurney for two nurses (from the surgical department) and from the side of the table - for two operating sisters.
5. Bring both hands to the forearm towards each other:
standing at the head of the patient enclose right hand under the neck and shoulders of the patient, the left arm - under the chest (the hands of the nurses should join under the patient); standing by lower extremities patient, put the right hand under the pelvis, the left hand under the patient's knees (the hands of the nurses should join 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 them from the gurney to the operating table.
Note. The patient is also transferred from the operating table to a stretcher.
The patient after surgery may remain for some time in a state of anesthesia or, being conscious, experience pain. When starting to shift the patient, it is necessary to know in which area the operation was performed, and also to remember about the delivered dropper or drainage.

Transferring a patient from a wheelchair to a bed after surgery

Sequencing:
1. Determine how the patient's bed is located in the ward (the wheelchair is located in relation to the bed: at an angle, parallel, sequentially, close).
2. Explain to the patient the course of the upcoming manipulation.
h. Choose one of the proposed methods for positioning the wheelchair in relation to the bed. Leave enough space to stand between the bed and the wheelchair.
4. Prepare the patient's bed.
Note. If the operation was performed under local anesthesia, you need to put a pillow at the head. If under general anesthesia, remove the pillow. The patient should be without a pillow for 6-8 hours.
5. Stand between the bed and the gurney for three nurses. Bring hands under the patient to the forearm:
the nurse standing at the head of the patient puts her right hand under the neck and shoulders of the patient,
left - covers the opposite hand of the patient, as if hugging him;
a nurse standing in the middle puts her right hand under the patient's shoulder blades, her left hand under the lumbar region;
a nurse standing at the patient's pelvis puts her right hand under the lumbar region, the left hand under the patient's knees.
6. Transfer the patient from the wheelchair to: the bed on the count of "three" (one of the sisters gives the command).
The nurse at the head turns around and the paramedics carry the patient in their arms.
7. Carefully place the patient on the bed, cover with heat and take the gurney out of the room.
Note. If the patient has a drain tube or other devices, another person is required to hold the drain.

E.V. Barkhatova

Collection of manipulations

ergonomics

E.V. Barkhatova, teacher of ergonomics at KBMK.

Reviewers:

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

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

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

E.V. Barkhatova

Collection of manipulations in ergonomics. Guidelines 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 practicing nurses. Methods and drawings explaining them are presented for each type of patient movement.

Introduction. Techniques for holding, lifting, moving the patient by one, two or more persons.

Lifting the patient.

Holding the patient while lifting.

Holding the patient with the "Grip through the arm" method.

Holding the patient with the method of "Capture with a raised elbow".

Holding the patient with the “Axillary grip” method.

Holding the patient by the belt.

Supporting the patient while walking.

Elevate the patient's head and shoulders.

Shoulder lift method.

Elevating the patient in a height-adjustable bed.

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

Moving the patient to the head of a wide bed.

Moving the patient with the help of a diaper to the edge of the bed with variable height.

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

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

Transferring the patient to the head of a bed with a fold-down headboard using a sheet.

Moving the helpless patient to the head of the bed.

Move the patient to the edge of the bed.

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

Transferring the patient from a sitting position on the bed with legs down to a chair.

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

Placement of the patient in a wheelchair.

Moving the patient from bed to chair (wheelchair).

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

Moving the patient from a sitting position to a lying position.

Transferring a patient from bed to wheelchair and vice versa.

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

Turning the patient on their side with a diaper and placing in this position.

Turning the patient on his side using the method of "joint log rolling" and placing in this position.

Turning the patient and placing him in a position on his side.

Turning and placing the patient in the prone position.

1 Introduction

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

The medical profession is inherently humane. Regardless of the hardships, the health worker goes to any difficulties to solve the problem. Often these difficulties are directly related to the risk to their own health.

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

Of the ergonomic factors, doctors and nurses most often distinguished 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 "operating unit, intensive care, resuscitation".

Lack of various aids to work with seriously ill patients is one of the causes of pain in the lumbosacral region and accidents.

Ergonomics is a scientific discipline that studies labor processes in order to optimize tools and working conditions, increase the efficiency of a person’s labor activity and preserve his health.

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

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

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

Sister's hand position. The chosen method of holding during transfer depends on the presence of painful areas in the patient and what kind of assistance will be provided to him during transfer. It is necessary to control the position of the body and the movement of the patient as much as possible.

The position of the patient. 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 during movement must be straight. Shoulders, as far as possible, should be in the same plane with the pelvis. When lifting the patient with one hand, the other, free, maintains the balance of the body and, consequently, the position of the back, being a support for relieving the load from the spine.

Some patients may be helped to raise themselves by doing a few rocking movements with the help of a nurse to create propulsion. In this case, the actual force expended by the nurse to lift the patient into a standing position may be minimal.

When dealing with even a helpless patient, gentle rocking of him and his sister can kick-start the movement and facilitate the lifting process. These skills can be learned, but this requires a sense of rhythm, coordination of movements, as well as understanding and cooperation on the part of the patient.

Team work. Patient movement can only be successful ifcoordination of movements. For example, one sister plays the role of a leader in givingno orders, makes sure that everyone involved in the process and the patient is fullyready to move, She evaluates the safety of the environment, observesgives behind the facial expression of the patient when he moves. The physically strongest sister in the team (regardless of position) should take on the heaviest part of the body– hips and torso of the patient.

2 Lifting the patient

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

Choose the most The 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, grasp the front of the right wrist of your assistant- This carpal, or single grip.

b) embrace each other with the right hand in the region of the right wrist, placingbrush on the front- This double wrist grip.

Fig.1 Ways to hold the patient.

c) take each other with your right hand, as in a handshake- This hand grip.

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

4 Holding the patient with the arm grip method

(performed by one nurse, patient can help)

Usage: support and moving to the back of the chair (chair) of the patient, able to provide assistance.

Fig. 2. Holding the patient with the “Grip through the hand” method.

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

Stand behind the patient (chair or chair on which he sits).

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

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

5 Holding the patient with the Elbow Raised Grip method

Usage: support and transfer of a patient able to provide assistance.

Fig. 3 Holding the patient with the "Grapple with raised elbow" method.

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

Assess the patient's condition and environment.

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

Make sure you can freely shift your body weight from one foot to the other and stand comfortably.

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

Lean slightly forward behind the patient's back and firmly grab him by the elbows, supporting them from below (Fig. 3).

Substitute the other shoulder so that the other shoulder of the patient rests on your arm.

6 Holding the patient with the “Axillary grip” method

(performed by one nurse, the patient can help)

Usage: support and transfer of a patient able to provide assistance.

Fig. 4 Holding the patient with the “Axillary grip” method.

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

Stand on the side facing the patient sitting on a chair (low bed): oneput one foot next to the chair, the other, slightly turning the foot,- in front of the legs patient, fixing his knees with his foot.

Insert the hands into the armpits of the patient: one hand in the direction nii front - back, palm up, thumb outside the armpit; another - towards the rear– forward, palm up, thumb out,outside the armpit.

Make sure you are able to move your body weight freely from one leg to the other and stand 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, the patient can help)

Usage: support and transfer of a patient able to provide assistance.

Fig.5 Holding the patient by the belt.

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

Assess the patient's condition and environment.

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

Place the thumbs of both hands behind the waistband of the patient's trousers (the patient's skirt), then grasp the clothing with all fingers (Fig. 5). (It is possible to put on the patient an additional wide belt).

Make sure the belt is securely fastened.

Ask the patient to support himself by putting his hands on your lower back or by wrapping your belt around you.

8 Supporting the patient while walking

(performed by one sister)

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

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

Fig.6 Supporting the patient while walking.

Assess the environment (humidity of the floor, slippers, foreign objects on the floor, equipment that stands in the way of the patient's movement). Stand next to the patient.

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

Support the patient with the other hand under the elbow or under the arm, or grab the patient around the waist.

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

Stand as close to the patient as possible, supporting his knees with his right foot (if the sister is standing on the right), if the patient feels insecure (Fig. 7)

Move around with the patient until he feels insecure.

9 Elevate the patient's head and shoulders

(performed by one sister)

Usage: fix the pillow; straighten clothes; as a stage when changing clothes.

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

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

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.

Put your hand under the patient's arm, located closer to you, put the other under his shoulders and neck.

Raise the head and shoulders of the patient, shifting your weight back to his feet. The patient must not be rotated while the patient is being lifted!

Fig.8 Raising the head and shoulders of the patient.

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

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

10 Shoulder lift method in a height-adjustable bed

(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; injuries or pain in the shoulder, chest, upper back.

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

Help the patient to sit up: one nurse supports the patient; the other puts a pillow against the headboard (or raises the headboard).

Stand on both sides of the bed:

facing each other;

close to bed

legs apart;

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

bend your knees;

keep your back straight.

Substitute 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 thighs. The patient places his hands on the sisters' backs (Fig. 9).

Fig. 9 Shoulder raise method (Australian raise).

If it is not possible to place the shoulder in the patient's axilla or if the patient can put their hand on the sister's back, place your hand between the patient's torso and shoulder. Bring the hand of this hand under the patient's thighs.

Lean with one hand on the head of the bed (elbow bent), with the other, spreadplaced under the hips, take the assistant by the wrist (“double wrist grip”)– fig.9,b.

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

Straighten the leg located at the feet of the patient, and transferring the weight of your body to the other leg, located closer to the head, lift the patient. The elbow, providing emphasis, unbend.

Lift the patient completely off the bed, move him a short distance and lower him back onto the bed, bending the leg closest to the headboard and the arm that provides support.

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

Ensure the patient is in the correct position in bed.

11 Raising a patient in a height-adjustable bed with a stretched sheet (performed by two or more people, the patient can help)

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

Fig. 10 Raising a patient in a height-adjustable bed.

Explain the procedure to the patient, make sure that he understands it and get his consent to the reduction.

Assess the patient's condition and environment

Lower the bed to the middle of your thigh. Attach 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;

the shoulders of the sisters at the level of the back of the patient;

legs apart,

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

legs bent at the knees;

the back is straight.

Lightly roll up the sheet (up to the level of the chest on one side and under thigh - with another). Raise the patient

take the top corners of the sheets,

take the bottom corners of the sheets,

put the foot in the direction of movement, gradually move the patient toupright position in bed (on the count of "three"– the leader commands) (Fig. 10).

Further actions depend on the purpose of lifting the patient.

12 Lifting, 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 that he understands it and obtain his consent to the procedure. Introduce a person helping with the move.

Assess the patient's condition and environment.

Help the patient to sit up, one sister supports him, the second- lays down 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).

Put a diaper on the edge of the bed. Turn around to face the head of the bed. Put one knee parallel to the edge of the bed on the laid diaper, move the lower leg as close to the patient as possible. The foot on the floor is the support when lifting the patient).

Apply "Australian elevation".

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

Fig.11 Raising, moving the patient to the head of a low bed.

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

13 Moving the patient to the headboard on a wide bed

(performed by two people)

"Australian uplift" is used.

Explain the procedure to the patient, make sure that he understands it and obtain his consent to carry it out. Introduce a person helping with the move.

Assess the patient's condition and environment.

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

Help the patient to sit up.

One of the sisters kneels next to the patient on the vacated part of the bed, placing her legs along the patient's thighs (previously lay a diaper on the bed) (Fig. 12). The second sister stands on the floor in the Australian Raise position.

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

Raise the patient off the bed using the shoulder and move him a short distance towards the headboard.

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

Create a comfortable position for the patient.

14 Transferring the patient with a diaper to the edge of the bed with adjustable height

(performed by two people)

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

Fig. 13 Moving the patient with the help of a diaper to the edge of the bed with variable height.

Explain the procedure to the patient, make sure that he understands it and obtain his consent to carry it out. Introduce a person helping with the move.

Make sure the patient lies horizontally in the middle of the bed. Lower the handrails (if any).

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

Ask the patient to raise his head (if he is not able to do this, carefully raise it), remove the pillow. Place a pillow at the head of the bed.

Roll up the edges of the diaper lining towards the patient until your hands touch the patient's body.

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

Have your helper stand in a 30 cm wide leg-spread position, one leg in front, knees slightly bent.

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

Grasp the edges of the rolled up diaper with your palms up.

Tighten the muscles of the abdomen, buttocks and back. On the count of three, gently lift the patient and move him to the edge of the bed using a diaper pad.

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

During the lift, transfer your weight from the leg on the floor to the knee on the bed; your helper shifts his weight from the forward leg to the back leg.

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

Tuck in the edges of the diaper lining.

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; the patient can help)

Make sure the patient is lying horizontally. Ask him to raise his head and shoulders, if he cannot, gently raise 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 from different parties facing the head of the bed.

Both sisters put one hand under the patient's shoulders, the other- under the hips (unsafe way); or one nurse stands at the top of the patient's torso. Brings the hand under the neck andpatient's shoulder. With the other hand, she wraps her arms around the arm lying next to her and pa's shoulder.cent. The second sister stands at the lower part of the patient's torso and brings her handsunder his waist and thighs.

Spread your legs 30 cm apart with one leg slightly back.

Ask the patient to bend their knees without taking their feet off the bed.

Ask the patient to press the chin to the chest.

Make sure the patient can assist in moving by pushing off the bed with their feet.

Bend your knees so that your forearms are at the level of the bed.

Ask the patient to push off from the bed on the count of three and, exhaling, lift the torso and move to the headboard.

On the count of "three" swing and transfer the body weight to the leg set back. At this time, the patient pushes off with his heels and raises his torso.

Raise the patient's head and shoulders and place a pillow. Make sure it lies comfortably in the right position.

16 Moving the patient to the head of the bed

(performed by one nurse, the patient can help)

Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent. Introduce a person helping with the move.

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

Assess the environment o 6installation. Lower the side rails, if equipped. Attach the bed brakes.

Make sure the patient is lying horizontally. Ask him to raise his head and if he cannot, gently raise 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 - on the bed, palms down.

Place one hand under the patient's shoulders, the other– under his buttocks. Notlean forward. Keep your back straight. Bend your legs at the 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 take hold of the head of the bed with his hands, on the count of “three”, exhaling, help his sister, pulling himself up.

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

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

17 Transferring the patient to the head of a bed with a fold-down head using a drape

(performed by one sister)

Indications helplessness of the patient; absence of an assistant.

Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent. Assess the environment. The bed should be without a hard headboard and moved away from the wall. Attach the bed brakes (if any).

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

Pull the sheets out from under the mattress.

Remove the pillow and put 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 put one foot slightly forward. Don't lean over the headboard.

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

Fig. 16 Transferring the patient to the head of a bed with a drop head using a sheet.

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

Bend your knees, keep your back straight!

Ask the patient to help in moving, after exhaling. On the count of "three", tilting the body back, pull the patient up to the head of the bed.

Put a pillow under your head, straighten the sheet. Make sure it lies comfortably.

18 Moving the Helpless Patient to the Head of the Bed

(performed by one sister)

Contraindications: spinal injury; spinal surgery; epidural anesthesia.

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

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

Make sure the patient is lying horizontally. Ask him to raise his head, if he cannot, gently raise 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 headboard, set aside a little back;

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 to the headboard.

Move the patient's pelvis diagonally to the head.

Move by bending your knees so that your arms are at the level of the patient's torso.

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

Move the head and upper body of the patient diagonally to the headboard.

Raise the side rail if it exists. Go to the other side of the bed and lower the side rail.

Move from one side of the bed to the other, repeating the 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, legs.

Raise 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 stage for other movements.

Contraindications: spinal injury, spinal surgery, epidural anesthesia.

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

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

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

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

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

Ask the patient to clasp his elbows.

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

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

Put your hands under the shins and feet of the patient and on the count of "three" move them towards you.

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

Perform the procedure for which the patient was transferred.

20 Moving the patient from the side lying position

in a sitting position with legs down

(performed by one sister)

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

It can be performed both on the functional and on the normal one.used in a forced and passive position.

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

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

Lower the side rails (if any) on the side where the nurse is.

Stand in front of the patient: bring the left hand under the 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 °.

Have the patient sit down with one hand on the shoulder and the other- for the body.

Make sure the patient is seated steadily and confidently. Place a back support.

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

21 Moving the patient out of position

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

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

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

It 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 that he understands it and obtain his consent to the procedure.

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

Put a chair (wheelchair) next to the bed. If possible, lower the bed to the level of a chair. At the wheelchair, move the footrest, fix the brakes.

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

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

Inform the patient that on the count of three, you will help him to his feet. Counting, sway slightly. Having put the patient on the count of "three" on his feet, turn with him until he is with his back to the wheelchair (chair). Ask the patient to tell you when they touch 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 by placing his hands on the handle of the wheelchair (on the edge of the chair) and lowering himself into it.

Seating the patient in a chair (on a chair) is comfortable.

22 Transferring a patient from a “sitting on a 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 to the patient the course of the procedure, make sure that he understands it and obtain consent to the procedure.

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

One sister stands behind the wheelchair and tilts it forward so that the footstool touches the floor.

The second sister (assistant) stands in front of the patient, sitting on the bed with his legs down, the sister's legs are spaced 30 cm apart, knees bent.

Ask the patient to grab the sister by the waist, hold him by the shoulders.

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

Place one leg between the patient's knees, the other- in the direction of travel.

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

Press the patient in the “hug” position, gently lift him, without pulling or turning. Do not put pressure on the patient's armpits!

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

Lower the patient into a wheelchair: bending your knees, hold the patient's knees with them; keep your back straight. The patient can help by placing their hands on the armrests of the wheelchair.

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

Place the patient in the chair comfortably.

If necessary, transport the patient, release the brake.

23 Positioning the patient in a wheelchair

(performed by two people)

Check if wheelchair brakes are engaged.

Stand behind the wheelchair behind the patient.

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

Ask the second sister (assistant) to sit on one knee to the side of the patient, raise his legs to the level of the hips and put them on your knee.

Support the patient's head with your chest or shoulder. Make a hand grip. Keep your back straight, tensing the muscles of the abdomen and buttocks.

Tell the patient and assistant that on the count of three you will move the patient to 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 the slide.

Fig.21 Placement of the patient in a wheelchair.

Make sure that the patient feels comfortable, remove the wheels of the wheelchair from the brakes.

24 Moving the patient from bed to 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 that he understands it and obtain his consent to the procedure.

Put a chair next to the bed. Assess the environment. Fig.22.

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

Stand on both sides of the patient facing him. Both sisters put their hand under his hips and hold each other in a "wrist grip" (Fig. 1), supporting his hips.

Both sisters put their shoulders under the shoulders of the patient, and he puts his hands on the backs of the sisters. Bend your free arm at the elbow, resting it on the bed. Legs apart, knees bent.

One of the sisters gives the command. On the count of three, both straighten their knees and elbows, stand up and lift the patient. Support the patient's back with your free hand while you carry them to the chair (wheelchair).

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

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

Position the patient comfortably in a chair.

25 Transferring a patient from a bed to a chair without armrests or a back (performed by two or more people using the “grab through the arm” method, the patient can sit, but does not move independently)

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

Set the height of the bed to the height of the chair. Assess the environment.Help the patient to sit up (the patient's legs are not lowered). One of the nurses stands behind the patient– puts one knee on the bed andmakes a "grab through the hand."

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

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

The second sister places the chair comfortably and close to the bed, but in such a way that the patient does not rest his elbow on the bed when she sits on the chair.

The same nurse stands in front of a chair facing the patient. The legs are bent at the knees (squatting position), one leg is put forward.

She also brings 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 into a chair. Position the patient comfortably in a chair.

26 Lifting the patient from the chair using

rocking and moving to 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 that he understands it and obtain his consent to the procedure.

Assess the environment. Move both seats together, fixing the brakes and removing the side rails of the chairs (chairs).

Stand facing the patientSpread your legs shoulder-width apart, with one foot hold the patient's feet, the other- a chair leg.

Ask the patient to lean forward so that his shoulder rests on his sister's chest.

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

Move the patient to the edge of the chair by rocking it from side to side and moving the legs forward. Patient's knees at a 90° angle. Knees and feet together.

Put one foot next to the patient, fix his knees with the other. Start smooth rocking, moving the mass of your body back and forth, keep the patient next to you.

Inform the patient that on the count of three, you will help him to his feet.

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

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

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

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

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

Inform the patient that on the count of three, you will help him to his feet. Counting to "three", swing. On the count of three, place the patient, then turn with him, leg to leg, until he touches the edge of the bed with his hips.

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

Rice. 25 Transferring the patient from the "sitting on a chair" position to the "lying on the bed" position.

Bring a hand under the knees, grasp them from above, with the other hand grasp the patient's shoulders.

Raise the patient's legs on the bed, turning his torso 90 °, lower his head on the pillow. Cover the patient to ensure that he lies comfortably.

28 Transferring a patient from bed to stretcher and back

(performed by four people, height-adjustable bed)

After the operation, the patient remains for some time in a state of anesthesia, or in consciousness, 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 to a stretcher (bed), you need to know in which area he underwent surgery, as well as other restrictions.

You and your assistant stand on one side, the other two sisters- with a friend goy side of the bed. Fasten the brakes. Fig.26.

Place the wheelchair on the side of the bed where you will move the patient. Space must be left to be able to stand between the bed and the wheelchair.

Cover the patient with a sheet or blanket. Tell him to hold the sheet or blanket with his hands, and fold the sheet at his feet.

Move the patient to the edge of the bed.

Straighten the sheet and leave it on the mattress (without tucking). Wrap the top sheet around the patient, tucking the ends under him. Stand close to the bed so that the patient does not fall.

Fig. 26 Transferring the patient from bed to wheelchair and vice versa.

Note.The head of the bed is in a horizontal position. Two sisters 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 wheelchair is level with the bed. Leave no space between the bed and the wheelchair. 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 putting the protector).

On the count of "three" (the command is given by the leader), all four lift the sheet and transfer the patient to the stretcher along with the sheet. Make sure the patient lies in the middle.

Note. If the stretcher is equipped with straps, secure the patient with them.

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

When moving it from the wheelchair to the bed, place the wheelchair close to the bed, fixing the brakes, release the edges of the sheet on the wheelchair.

Two assistants kneel on the bed with the protector on.

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

On the count of three (the command is given by the leader), everyone lifts the sheet, holding it by the edges, palms up, and moves the patient to the edge of the bed.

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

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

Place a small pillow under your head if necessary. If the patient experiences pain during transfer, or the dressing gets wet, or there is blood in the drainage tubes, report to the doctor.

29 Transferring a patient from a regular bed to a stretcher

(and vice versa) (performed by three people)

Position the wheelchair 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 wheelchair and vice versa.

Attach wheelchair and bed brakes.Everyone stand along the bed. Samaya strong (physically) sister- in the center.

Put one leg forward, bending at the knee, put the other back. Put your hands (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,

a nurse standing at the patient's feet supports the shins.

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

Lifting the patient:

at the leader's command "three", transfer the mass of your body to the leg set back,

gently pull the patient to the edge of the bed;

to have a break,

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

Move backward to turn around to face the wheelchair:

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

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

Move forward (to the wheelchair). On the count of three, bend your knees and gently lower the patient onto the gurney.

30 Turning the patient on his side with a diaper and placing him in this position

(performed by two people)

Usage when changing linen; placement in a position on the side; preliminary, stage for other travels.

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

Assess the patient's condition and environment. Attach the bed brakes. Ask your assistant to 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 raise his head and shoulders, remove the pillow. Rest the 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 their arms over their chest.

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

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

Place a protector next to the patient.

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

Rice. 28 Turning the patient on their side with a diaper and placing them in this position

Put a hand on the shoulder of the patient, which is farther from the sister, the second- on corresponding thigh, i.e. if the patient rolls over to the right side,put your left hand on his left shoulder, and your right– on his left thigh.

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

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

For example, in the case accommodation:

turn the patient so that he does not lie on his arm;

put a folded blanket under your back for stability;

put 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 on his side using the method of "joint log rolling" and placing in this position

(performed by two people)

Usage when changing linen; placement in a position on the side; preliminary stage for other movements.

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

Fig. 29 Turning the patient on his side using the method of "joint log rolling" and placing in this position.

Ask your assistant to stand next to you.

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

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

Lower the bed so that one knee of the sister is on the bed (on the protector), and the other leg is firmly on the floor.

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

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

Put one hand on the shoulder, the other– on the patient's pelvis, ask the landowner to put his hands on the patient's thighs and shins.

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

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

Place an emphasis at the sole of the foot lying below.

Be sure to place a pillow under the back to keep the patient in this position. Place a pillow under your upper arm as well. If possible, place a small pillow under the patient's head. Cover him.

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

32 Turning the patient and placing him in a position on his side. Performed on a height-adjustable bed (performed by one nurse, patient can help)

Usage at forced or passive position; the risk of developing bedsores, a change in 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 the procedure.

Assess the patient's condition and environment. Attach 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 turned.

Tell the patient to cross his arms over his chest.

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

Stand on the side of the bed where you turn the patient. Put the protector next to it. Bend your leg at the knee and place it on the protector. The second is the support.

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

Turn the patient on their side, transferring their weight to the leg that is on the floor. Place a pillow under the patient's head.

Fig. 30 Turning the patient and placing him in a position on his side. It is performed on a bed with a variable height.

Note. The patient should lie on his arm.

The patient's arms are slightly bent. The upper arm lies on the pillow.

Place a pillow under the patient's back.

Under the bent leg of the patient, lying on top, put a pillow (from the inguinal region to the foot).

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

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

It is performed both on a functional and on a regular bed. Use at forced or passive position; the risk of developing bedsores, a change in position. Rice. 31.

Prepare: a rolled-up 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 the procedure.

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

Lower the side rails (if any) from the side where the nurse is.

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

Rice. 31 Turning and placing the patient in the prone position (performed by one nurse as prescribed by the doctor; the patient cannot help).

Gently raise the patient's head, remove the normal one and put a small pillow.

Move the patient to the edge of the bed.

Unbend the patient's arm, press it to the body.

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

Put your knee on the bed. Place a folded blanket (towel) ornot a large pillow under the patient's upper abdomen. Put one hand on the squareecho, and the other– on the hip farthest from you, put your knee on the bed papatient by placing a small pillow (protector) under it.

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

Place a pillow under your shins so your toes don't touch the bed.

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

Place pillows (or foam rubber in a case) under the elbows, forearms and hands.

Place small rollers next to the feet (on the outside).

Straighten the sheet and underclothes.

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

Rice. 32 Technique of turning the patient on the stomach together.

Bibliography

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-methodical manual on OSD. Moscow, 2003.

Journals "Medical Sister", "Nursing"

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

Selecting the method of moving the patient.

The type of transportation (determined by the doctor) and the way the patient is placed on the stretcher depends on the disease and its location. It is necessary to move the patient in bed, on a stretcher, in a wheelchair, as well as in the hands of one or two assistants (in the absence of means for transportation) with the utmost care and safety.

Capture of Rautek. This method is most often used in first aid. Rautek's grip allows you to lift and move critically ill patients. It happens that the patient, having fallen, lies on the floor. The capture of Rautek will allow, by lifting, seating or laying down the fallen.

Description of actions performed by one person.

1. Approach the patient from behind and sit down.
2. Support the back of the head and shoulders of the patient with both hands.
3. Move the patient to a sitting position with one gentle pumping motion.
4. To prevent the patient from falling again, support his back with his knees.
5. Take the patient from behind by the armpits.
6. Apply the so-called "monkey grip", embracing with one hand carpal joint, the other - the patient's forearm so that his arm is bent.
7. The thumbs of the nurse are directed upwards.
8. Gradually straightening up, lift the patient with you, supporting him with your hips.

This position allows you to move the patient back or seat him 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 the stretcher from the bed.

Place the stretcher perpendicular to the bed so that the head of the stretcher fits the foot of the bed.
Bring the patient under the arms as follows: one person should bring his hands under the shoulder blades and the head of the patient, the second brings his hands under the pelvis and upper thighs, the third - under the lower leg and middle part of the thighs. When carrying out transportation by two people, one should bring his hands under the shoulder blades and neck of the patient, the other - under the knees and lower back.
Having coordinated the movements, simultaneously lift the patient, turn 90 degrees to the stretcher and lay him on them.

Transportation of the patient on a stretcher.

The patient is carried slowly and without shaking, the step should be short, out of step.
On the stairs, the patient should be lowered forward with their feet, raising 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 a stretcher on his shoulders, the one walking in front - on straightened arms.
Up the stairs, the patient is carried head first, the horizontal position of the stretcher is also observed. The one walking behind carries a 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.

Set the head end of the stretcher perpendicular to the foot edge of the bed. Parallel to the bed, the stretcher should be placed if the area of ​​\u200b\u200bthe room is small.
Having coordinated the movements, simultaneously lift the patient, turn with him 90 degrees towards the bed. In case of parallel setting of the stretcher, turn 180 degrees. Lay 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 us pull the patient on the sheet to the edge of the stretcher, slightly lift him up and put him on the bed.

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

The following is carried out:

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 must be connected at an acute angle.
3. Take the patient with both hands under the armpits.
4. Pull it up slowly.
5. Open 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 the "monkey grip" from behind.
9. The patient takes a step with his healthy leg.

Lifting the patient from the side and leading him with support from the side.

If the patient has unilateral paralysis, the nurse may act alone.

The following is carried out:

1. Approach the patient from the non-paralyzed side.
2. Place your leg at an angle in front of the patient's healthy leg to prevent slipping.
3. On the non-paralyzed side, take the patient's armpit with one hand.
4. With the other hand, grab the patient's back and put your hand behind the armpit.
5. Carefully lift the patient from the chair and help him straighten up.
6. After making sure that the patient is standing confidently, remove the leg.
7. Move the chair away from the patient with the other foot.
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 good leg.
11. The nurse pushes his immobilized leg with her foot.
12. Continuing the movement in this way, bring the patient to the bed or chair.

Sitting the patient in a wheelchair.

For safety, explain to the patient the upcoming actions.

Put the wheelchair next to the bed. Slightly tilt the chair forward by pressing on the footrest.

The patient is asked to stand on the footrest and is seated with support. If the patient is unable to stand up, he is moved by an assistant.

Return the wheelchair to its original position.

To give the desired position (reclining or sitting) to the patient. For this, a frame is used, which is located behind the back of the wheelchair.

Observe the position of the patient's hands. To avoid injury, the arms should not go beyond the armrests.