Question

I am doing a paper for my nursing clinical class and I need help with this SKILL Impaired Mobility

.DESCRIPTION OF SKILL: –

Transferring a pt from bed to a wheel chair

INDICATIONS

EXPECTED OUTCOMES

EVALUATION

NURSING INTERVENTIONS

CLIENT EDUCATION

POTENTIAL COMPLICATIONS

NURSING INTERVENTIONS

Can someone just help please

Answer 1

TRANSFERRING PATIENT FROM BED TO WHEELCHAIR

IT IS ALSO CALLED PIVOT TURN

IT IS USUALLY PERFORMED BY SINGLE HEALTH PROVIDER BUT IN CASE WE. IF THE PROCEDURE CANNOT BE PERFORMED BY ONE PERSON THEN HELO IS TAKEN FROM OTHER STAFF IN SHIFTING THE PATIENT

INDICATIONS

• PRE operative patients
• Anaemic patients because of risk of fall and breathlessness
• Geriatric patients
• To take patients for any referrals or investigation with in hospital
• Patients with limited Range of motion
• Patients with movement induced shortness of breath
• Patients with movement induced tremor
• Patients with uncoordinated or jerky movements
• Rehabilitation patients
• As part of physiotherapy
• Patients who cannot perform motor skills
• Gynaec patients

CONTRA INDICATIONS

• critically ill patient
• Spinal injury patients
• Fracture patients
• Cessarean patients
• Head injury
• Semi conscious, unconscious, coma patients

EXPECTED OUTCOMES

• patients will achieve highest level of independence with wheel chair use
• Safety is maintained
• Patients will adopt to alterations in ability
• Patients will maintain or improve muscle strength
• Patient's risk for complications like skin breakdown, contractures,depression,falls etc is reduced

EVALUATION

• evaluation is again based on expected outcomes
• At the end of procedure we evaluate whether the. Expectedoutcomes have Been met or not
• This procedure is to be evaluated by asking patient about the difference they feel... For example if our expected outcome was PATIENT WILL ADOPT TO ALTERATIONS IN ABILITY if this is attained then evaluation will be PATIENTS ADOPTED TO ALTERATIONS IN ABILITY

NURSING INTERVENTIONS AND PROCEDURE

• Intraduce your self
• Listen and attend to patient cues
• Ensure privacy
• Check saturation
• Ensure all the tubings
• Perform hand hygiene
• Explain procedure
• Apply socks, non-skid shoes to the patient's feet
• Lower the bed and ensure beakers or applied
• Place wheelchair next to bed at 45 degree angle and apply brakers if patient's right side weak, then place wheel chair on the left side and viceversa
• Make the patient to seat on the bed with his are her leg on floor if they are able to do
• If the patient is not able to do it on their own then roll the patient on the same side of wheel chair, put one arm under shoulder and one more arm under knees... Swing patient's legs down and make him sit by using momentum
• Push one of the foot rest inside... The one which is on the patient's side like the image below

• Apply gait belt if available
• Make sure patient's feet are in between your feet because it supportepatient in case they slip and helps in weight distribution
• As the patient leans forward grasp the gait belt.. Your arms should be outside the patient's arms and legs outside the patients legs
• Patient's feet should be flat on the floor
• 
• Count 1,2,3 and using rocking motion, help her stand by keeping elbows in and back straight
• Make patient to have a few steps back,feel the wheel chair
• Help her to grasp the wheel chair arm and lean forward slightly
• As the patient sits down, shifting your weight from back to front,...bend knees, bend elbows slightly... This helps to shift weight from back to front and prevents back injury
• Once patient sits comfortably in the wheel chair, secure her with seat belt and keep her foot on the foot rest

CLIENT EDUCATION  

• educate them regarding importance of ambulation
• Educate regarding complications of immobility
• Educate about safety measures while shifting from bed to wheelchair
• Educate about the procedure or show them the procedure by performing on others
• Educate hermit to place their arms around providers neck because it is a risk factor for neck injury of provider
• Educate them about what exactly it feels like after shifting to wheelchair and ask them to tell you the difference if any
• Educate them about the position they need to adopt while sitting in wheelchair

POTENTIAL COMPLICATIONS

potential complication during the process of shifting patient from bed to wheel chair is FALLS AND INJURIES

patients cannot be lifted like loads... they should be lifted or shifted very gently

FALLS occur when provider fails to act in concert or when they use improper lifting techniques

INJURIES... This may occur because of falls.... Complete fall or near fall may or may not be accompanied by injuries.... But this is always a risk

Many of The injuries reported are head injuries which in itself is a complication

Injuries to health care provider is also a complication... Back injury, back pain, neck injuries are the common ones

NURSES RESPONSIBILITY

• ensure safety of the patient
• Assemble all the things needed before shifting the patient
• Do not hesitate to ask for a help
• Follow correct protocol of procedure
• Maintain body mechanism
• Do not allow the patient to hold your neck...allow them to hold you at your waist level
• Stay close to the patient as this helps to keep patient's weight close to your center of gravity
• Keep wheel chair on the patient's stronger side
• Avoid lifting the patients
• Apply brakers to bed and wheel chair before starting procedure
• Apply seat belt once patient sits in the wheelchair
• Apply socks or non skid shoes when you are shifting patient on a slippery floor
• Perform risk assessment every time you shift the patient
• Raise a incident report if any complications arise
• Incident report will help the management to know the reason ,act on it and prevent it from happening in future
• Do not allow the patient to move from bed to wheelchair on their own

All these would help to reduce the complications associated with shifting patient from bed to wheelchair