7.2 Transfers, Positioning, and the Gait Belt
Key Takeaways
- Gait belts must fit with two fingers between the belt and the resident — remove after transfer
- Position wheelchair at 45-degree angle on the resident's strong side for stand-pivot transfers
- Lock wheelchair brakes and bed wheels before every transfer
- Bed-bound residents must be repositioned every 2 hours to prevent pressure injuries
- Elevate head of bed 30-45 degrees for at least 30 minutes after meals to prevent aspiration
- Logrolling keeps the spine aligned — used for spinal injuries and hip replacements
Last updated: March 2026
Transfers, Positioning, and the Gait Belt
Transfers (moving a resident from one surface to another) and positioning (placing a resident in a specific position in bed or chair) are among the most common and important CNA skills. Several of the 21 mandated INACE performance skills involve transfers and positioning, making this a high-priority study area.
The Gait Belt (Transfer Belt)
A gait belt is a safety device worn around the resident's waist during transfers and ambulation:
| Gait Belt Guidelines | Details |
|---|---|
| Application | Place around the waist over clothing, snug but comfortable |
| Fit | You should be able to slip two flat fingers between the belt and the resident |
| Grip | Grasp the belt from underneath with an underhand grip |
| Position | At the resident's waist (not over the ribs or stomach) |
| Contraindications | Recent abdominal surgery, G-tube, colostomy, fractured ribs, pregnancy |
| Removal | Remove immediately after the transfer is complete |
Types of Transfers
| Transfer Type | When Used | Assistance Level |
|---|---|---|
| Stand-pivot | Resident can bear weight and assist with standing | 1-2 person assist |
| Sliding board | Resident has upper body strength but cannot stand | 1-2 person assist |
| Mechanical lift (Hoyer) | Resident cannot bear weight or assist | 2 person minimum |
| Draw sheet | Repositioning in bed | 2 person assist |
| Stand-up lift | Resident can bear some weight but needs mechanical support | 1-2 person assist |
Stand-Pivot Transfer: Bed to Wheelchair (INACE Skill)
Before the Transfer:
- Explain the procedure to the resident
- Wash your hands and apply gait belt
- Position the wheelchair at a 45-degree angle to the bed, on the resident's strong side
- Lock wheelchair brakes and move footrests out of the way
- Lock bed wheels and lower the bed to the lowest position
- Help the resident to a sitting position on the side of the bed
- Ensure the resident is wearing non-slip footwear
During the Transfer:
- Stand facing the resident with feet shoulder-width apart
- Bend your knees, keeping your back straight
- Grasp the gait belt with an underhand grip from both sides
- On the count of three, help the resident stand
- Allow the resident to gain balance before moving
- Pivot toward the wheelchair (do NOT twist — move your feet)
- Lower the resident slowly into the wheelchair by bending your knees
- Position the resident comfortably in the wheelchair
After the Transfer:
- Remove the gait belt
- Position footrests under the resident's feet
- Ensure the resident is comfortable and aligned
- Place the call light within reach
- Lock the wheelchair brakes if the resident is stationary
Bed Positioning (INACE Skill)
| Position | Description | Used For |
|---|---|---|
| Supine | Lying flat on back | Default position; sleeping |
| Lateral (side-lying) | Lying on one side | Pressure relief; feeding; breathing |
| Fowler's | Head of bed elevated 45-60° | Eating; breathing difficulty; tube feeding |
| Semi-Fowler's | Head of bed elevated 30-45° | Mild breathing difficulty; comfort |
| Prone | Lying face down | Rarely used in LTC; back pressure relief |
| Sims' (recovery) | Semi-prone on side | Unconscious residents; drainage |
Repositioning Schedule
Residents who cannot reposition themselves must be turned and repositioned:
| Frequency | Rationale |
|---|---|
| Every 2 hours | Standard repositioning schedule for bed-bound residents |
| More frequently | If the resident has existing pressure injuries or is at high risk |
| As per care plan | Some residents may have individualized schedules |
| After meals | Elevate head of bed 30-45° for at least 30 minutes after eating |
Logrolling Technique
Logrolling keeps the spine in alignment when turning a resident:
- Used for residents with spinal injuries, back surgery, or hip replacements
- Requires 2-3 assistants
- Move the head, trunk, and legs as one unit — no twisting
- Use a draw sheet for smoother, safer movement
- Always have a pillow between the knees after positioning on the side
Test Your Knowledge
When positioning a wheelchair for a stand-pivot transfer, it should be placed:
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D
Test Your Knowledge
How tight should a gait belt be when properly applied?
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B
C
D
Test Your Knowledge
How often should bed-bound residents be repositioned to prevent pressure injuries?
A
B
C
D