Dwellness • Bed Transfers

Bed Transfers

Dwellness customization for:

Your Patient

General Principles

[NOTE: Before you undertake this routine, please study and practice the principles of Safe Body Dynamics for your patient’s transfers and ambulation.]

→ Breathe! Never hold your breath and bear down when exerting yourself ←
→ Stretching helps prevent injury… stretch before work, and stretch every day ←
→ Keep a low center of gravity during transferring or lifting ←
→ When not transferring or lifting, stand and walk fully erect with abdominals engaged ←
→ Think carefully about each move you make ←
→ Prompt your patient's movements, prepare, and wait for a response before moving yourself ←
→ When in doubt, pause and reconsider your next move ←
→ If your patient decides to go down to the floor, do not resist; gently lower your patient ←

Transfer into the bed
  • The bed and bedroom is used not only for sleep, but for physical activity

→ CAUTION: Your patient can be in the bedroom alone, whether your patient is sleeping or playing. But check on your patient every few minutes to be sure your patient is safe and does not need help with positioning. See "Bed Comfort, Safety, and Mobility" for positioning instructions.  ←

  • Prepare the bed and bedroom
    1. Clear the walking space on the right (N) side of the bed
    2. Be sure there is room on the bed for your patient to lie down (head toward the South)
    3. Be sure the room is safe, with no hard surfaces exposed
  • Execute the Safe Walk to get in bed
    1. Approach the bed along the side and turn so your patient is facing the bed
    2. Help your patient place the left foot on the bed, and encourage your patient to “push” so your patient steps up
    3. When your patient is standing on the bed, step up with your patient
    4. Carefully lower your patient onto the front, and rotate to lying on the right side
    5. Use covers that are appropriate for the time of day or intended activity level

→ CAUTION: Be very careful of your patient's leg positions as your patient goes to the down into bed or onto the floor. Your patient's hips are vulnerable, and a position that is out of alignment can dislocate the hips. ←

Bedroom activities
  • Activities in the bedroom can be for PT, relaxation, and learning fun
  • If it’s not alone-time or time to sleep, participate in activities with your patient in the bedroom
Bedtime comfort
  • After he is placed in bed for overnight sleep or nap, cover appropriately for the weather
    • Cold weather
      • Down comforter
      • Cover entire body
      • Tuck in feet
      • Medium cotton shell on top
    • Hot weather
      • Heavy cotton blanket
      • Cover up to sternum
      • Tuck in feet
    • Transitional weather
      • Change covers overnight
      • Move covers
      • Increase or decrease covers
  • Comfort items for overnight
    • Drum Machine
      • In front of your patient's face so your patient can manipulate the buttons with the left hand
    • Winnie the Pooh large talking animal
      • Behind the head, toucing the neck
    • Tigger large talking animal
      • In front of your patient so your patient can push the button and make it talk

      [NOTE: After your patient is sound asleep during nighttime shifts, move the drum machine about 3 feet away and turn it off to avoid bumping into it. Move Tigger away too so your patient doesn't activate the voice during the night; it might wake your patient up. Pooh can stay against the neck for comfort.]

  • Comfort items for napping
    • Comfort items are the same for napping as for sleeping overnight
    • For naps, do not move any of the comfort items away as during sleep
    • As soon as you hear your patient wake up, check that the drum machine is in a safe position
    Transfer out of bed
    • Most often your patient will spend time just sitting in the bed
    • Usually your patient gets out of bed independently
      • Keep an eye on your patient so your patient doesn’t get in a problematic position
      • Monitor the bedroom conditions so there are no exposed hard surfaces
    • If you have to get your patient out of bed
      1. Roll your patient near the edge of the bed
      2. Place your patient's legs over the edge, both feet on the floor
      3. Help your patient sit up at the edge of the bed
      4. If your patient is strong enough, hold your patient's hands and let your patient pull up to standing
      5. If your patient needs help getting to standing, lift your patient under your patient's armpits to standing
    • If your patient gets out of bed independently
      1. When your patient reaches up, take both of hands
      2. Do not pull on the arms, but just hold steady so your patient knows to initiate standing up
      3. When your patient initiates, tilt a little to your left so your patient can put the left foot forward
      4. Your patient will push with the left leg and come to standing
      5. [NOTE: About 10% of the time, your patient may have a neurological physical "stutter" with the left foot. When your patient initiates the left foot to step and stand up, the left foot does a slight spasm and can’t be placed squarely on the floor. Your patient usually moves it back in place under your patient, and immediately tries again. The second time almost always works well and your patient stands up. This does not change anything you should do, except keep a steady hold and encourage your patient to try again.]

      1. Still just holding the hands, allow your patient to bear weight
      2. Transfer your position from in front to in back of your patient
      3. Perform The Safe Walk toward your goal
    Limits to floor time

    [NOTE: Watch carefully when your patient spends time alone on the floor in the bedroom. Even though there are mats, if your patient sits in one place, then feet and legs will fall asleep. If your patient is crawling around, there will be no limit to the time spent on the floor. If your patient is sitting up in bed, there is no time limit.]

    • Sitting still on the floor mats
      • After about 15-20 minutes, get your patient up and out of the bedroom
      • Optional — put your patient in bed to sit
        • No time limit
    • Crawling around in your patient's room on the mats
      • No time limit
    • Sitting up in bed
      • The bed is soft enough, there is no time limit

HPCA Input

Dwellness input from HPCA and family caregivers can serve to improve the ongoing support system. Feel free to speak up!