15.2 Transfer Belt: Ambulation and Wheelchair (Skills 3, 22)
Key Takeaways
- Skill 3 critical elements: non-skid footwear on before the stand, and the client sitting with feet flat on the floor before the stand.
- Skill 22 critical elements: lock the wheelchair wheels before the stand, and the same feet-flat sit before the stand.
- Both skills: belt at the waist over clothing, instructions plus a prearranged signal, face the client, count to three, upward grasp on both sides of the belt, knee-to-knee or toe-to-toe.
- Skill 3: walk slightly behind and to one side for 10 feet while holding the belt, then assist back to bed and remove the belt. Skill 22: wheelchair alongside the bed head-to-foot or foot-to-head, fold or remove footrests, turn so the back of the legs is against the chair, lower, hips to the back, belt off, feet on the footrests.
- Never let a falling client pull you down — protect the head and lower the person slowly. Do not bring your own gait belt to the Credentia test. Ask for help when the assignment is two-person.
15.2 Transfer Belt: Ambulation and Wheelchair (Skills 3, 22)
Quick Answer: Skill 3 (ambulate with a transfer belt) critical elements: non-skid footwear on before the stand, and the client sits with feet flat on the floor before the stand. Skill 22 (bed to wheelchair) critical elements: lock the wheelchair wheels before the stand, and the same feet-flat sit. Both skills: explain, privacy, bed at a safe height, lock the bed wheels, belt at the waist over clothing, instructions plus a prearranged signal, face the client, count to three, upward grasp on the belt, knee-to-knee or toe-to-toe, then either walk slightly behind and to one side for 10 feet holding the belt (Skill 3) or turn so the back of the legs is against the wheelchair, lower the client, hips to the back of the chair, remove the belt, and place feet on the footrests (Skill 22). Never let a falling client pull you down — protect the head and lower slowly. Do not bring your own gait belt to the Credentia test. Ask for help when the assignment is two-person.
Why these two skills sit together
Falls live in Chapter 8. This section is the scored motor pattern Colorado uses to test whether you can stand a person without creating the fall. Skill 3 and Skill 22 share the same sit-to-stand. They differ in the destination: a 10-foot walk versus a wheelchair.
On the 2024 NNAAP outline, these habits support I.C Self Care/Independence (walk with the person, do not haul the person) and I.B.2 Safety/Prevention/Emergency. The Skills Evaluation assigns 5 skills. If Skill 3 or Skill 22 is in your set, a missed bold critical element fails that skill, and you must pass all five.
Skill 3 — Assists to Ambulate Using Transfer Belt
- Explain, speaking clearly, slowly, and directly, face to face when possible.
- Provide privacy with a curtain, screen, or door.
- Critical element: Before assisting to stand, the client is wearing non-skid shoes/footwear.
- Before assisting to stand, the bed is at a safe level.
- Before assisting to stand, check and/or lock the bed wheels.
- Critical element: Before assisting to stand, the client is assisted to a sitting position with feet flat on the floor.
- Before assisting to stand, apply the transfer belt securely at the waist over clothing/gown.
- Before assisting to stand, give instructions so the client can help, including a prearranged signal to begin standing.
- Stand facing the client, positioned for safety. Count to three (or use the prearranged signal).
- On the signal, gradually assist the stand by grasping the belt on both sides with an upward grasp (hands in the upward position) and keep the client's legs stable by standing knee to knee or toe to toe.
- Walk slightly behind and to one side of the client for ten (10) feet, holding onto the belt.
- Assist the client back to bed and remove the transfer belt.
- Signaling device in reach and bed in the low position.
- After completing the skill, wash your hands.
Socks are not non-skid footwear. Bare feet are not non-skid footwear. A person who is still lying flat does not have feet flat on the floor. Those two critical elements are why Skill 3 fails even when the walk looks pretty.
Skill 22 — Transfers from Bed to Wheelchair Using Transfer Belt
- Explain, face to face when possible.
- Provide privacy.
- Before the stand, position the wheelchair alongside the bed, at the head of the bed facing the foot or the foot of the bed facing the head.
- Before the stand, fold up or remove the footrests.
- Critical element: Before assisting to stand, lock the wheels on the wheelchair.
- Before the stand, the bed is at a safe level.
- Before the stand, check and/or lock the bed wheels.
- Critical element: Before assisting to stand, the client is assisted to a sitting position with feet flat on the floor.
- Before the stand, the client is wearing shoes.
- Before the stand, apply the transfer belt securely at the waist over clothing/gown.
- Before the stand, give instructions and a prearranged signal.
- Face the client. Count to three (or the signal).
- On the signal, stand the client with an upward grasp on both sides of the belt, knee to knee or toe to toe.
- Assist the client to turn so the person stands in front of the wheelchair with the back of the client's legs against the wheelchair.
- Lower the client into the wheelchair.
- Position the client with hips touching the back of the wheelchair and remove the transfer belt.
- Position feet on the footrests.
- Signaling device is within reach.
- After completing the skill, wash your hands.
An unlocked wheelchair that rolls backward as the person sits is the classic Skill 22 fail. Sitting the person on the front two inches of the seat is the other: hips must touch the back. Then the belt comes off. Then the feet go on the footrests — you cannot put feet on footrests you never folded back down or replaced.
Shared sit-to-stand rules
| Step | Skill 3 | Skill 22 |
|---|---|---|
| Non-skid footwear / shoes before stand | Critical element | Required (shoes) |
| Sit with feet flat before stand | Critical element | Critical element |
| Lock bed wheels; safe bed height | Required | Required |
| Lock wheelchair wheels | Not the destination | Critical element |
| Belt over clothing at the waist | Required | Required |
| Count / prearranged signal | Required | Required |
| Upward grasp; knee-to-knee or toe-to-toe | Required | Required |
| After the stand | Walk 10 feet, slightly behind and to one side, holding the belt | Turn, back of legs against chair, lower, hips to back |
| Finish | Back to bed, belt off, call light, bed low, wash | Belt off, feet on footrests, call light, wash |
The belt is a handle on clothing, not a tourniquet on skin and not a lifting strap for a person who cannot bear weight. Palms face up (upward grasp). You stand close enough that a buckle of the knees does not become a collapse to the floor.
Give the person a moment at the edge of the bed. Dizziness after a sit is orthostatic hypotension. If the person is gray or says the room is spinning, sit them back, stay, and get the licensed nurse. You do not count to three through a faint.
When the client starts to fall
Never let a falling client pull you down. You are no help if you are on the floor with a broken wrist. Hold the belt, pull the person toward your body, protect the head, and lower the person slowly down your leg to the floor. Stay. Call for the licensed nurse. Do not haul the person back up to spare embarrassment (Chapter 8).
On the written exam, hold them up at all costs is the trap. On the skills exam, a volunteer will not usually collapse — but the body position (knee-to-knee, upward grasp, close stance) is how you would control a slump.
One-person versus two-person — ask for help
The care plan, not your confidence, decides the number of people.
- One-person with a belt: the person bears weight, follows directions, and the assignment says one-assist.
- Two-person: weakness on both sides, unpredictable balance, or the assignment says two-assist. Ask for help. Do not just try a one-person stand.
- Mechanical lift: non-weight-bearing or the plan says lift. A gait belt is not a substitute for a lift.
If you are not sure, ask the licensed nurse before the stand. A failed hero transfer is how both of you get hurt.
Do not bring your own gait belt to the test
Credentia Colorado test-day rules: no personal gait belts or equipment. The site supplies what the skill needs. A favorite belt in your tote can be treated as unauthorized equipment. On the unit, use the facility belt that is clean, intact, and the right size. A frayed belt is taken out of service — you do not leave a confused person on the edge of the bed while you hunt a replacement in the hall (Chapter 8).
Independence during a walk or transfer
Tell the person the plan. On three we stand. You push with your legs. I will hold the belt. Let the person scoot to the edge, place their own feet, and reach for the chair arm if that is safe and assigned. You are assisting a walk, not dragging a sack 10 feet. After Skill 3, the person returns to bed; you do not wander into the hallway to show they can go farther on the test.
Colorado scenario
You are testing in a Colorado Springs Credentia site. Skill 22 is in your set. You park the wheelchair beside the bed but leave the wheels unlocked, keep the footrests down, and stand Mr. Ruiz from a half-lying position in socks. You used the gait belt from your backpack because you trust that one. He pivots, the chair rolls, and he sits on the front edge. You leave the belt on and never put his feet on the footrests.
That is a failed skill. Lock the wheelchair. Fold or remove the footrests. Shoes on. Sit with feet flat. Use the site's belt over clothing. Count, upward grasp, knee-to-knee, turn until the back of the legs is against the chair, lower, hips to the back, belt off, feet on footrests, call signal, wash.
Later that week on a Greeley unit, the same Mr. Ruiz starts to slump during a one-person walk. You do not let him pull you down. You protect his head, lower him slowly, stay, and call the nurse. His care plan already said two-assist. You should have asked for help before the stand.
Exam traps
- Standing a client in socks or from a lying position.
- Unlocked wheelchair.
- Belt on bare skin.
- Downward or overhand grip on the belt.
- Walking in front of the client or letting go of the belt.
- Sitting the person on the front edge of the wheelchair.
- Bringing a personal gait belt to the test.
- Trying a one-person transfer when the plan says two.
- Letting a falling person pull you to the floor.
Which two steps are critical elements on Colorado Skill 3 (assist to ambulate using a transfer belt)?
You are assigned Colorado Skill 22, bed to wheelchair with a transfer belt. What must you do before the stand, and how do you finish the sit?
During a transfer the client starts to fall, and you are packing for the Colorado skills test. Which pair of rules is correct?