8.3 Transfers and Mobility Devices

The Transfer Safety Sequence

Most resident falls happen during transfers, so every transfer follows the same disciplined sequence. The Montana skills test includes both "Transfer bed to wheelchair with gait belt" and "Transfer wheelchair to bed with gait belt," and every key (critical) step must be performed along with at least 80% of the non-key steps:

1. Prepare: check the care plan for weight-bearing status and how much help the resident needs; gather equipment; explain the procedure.
2. Lock the brakes — on the bed and on both wheelchair wheels. An unlocked surface rolling away mid-transfer is a classic fall cause.
3. Position equipment: many textbooks teach placing the wheelchair alongside the bed at about a 45-degree angle on the strong side, and that is good practice — but Montana's scored step is to position the wheelchair at the foot or head of the bed. Either way, remove or swing away the footrests and set the bed to a height where the resident's feet rest flat on the floor.
4. Apply the gait (transfer) belt snugly around the waist over clothing, with room for your fingers underneath. Never place it over bare skin, and never use it on residents with abdominal or chest surgery, ostomies, or rib fractures per the care plan. Never pull on a resident's arms — pulling can dislocate a shoulder.
5. Block the weak knee with your knee or foot and brace the resident's feet.
6. Move on the count of three — the resident pushes up and you stand and pivot together on "three," holding the gait belt from underneath with an underhand grasp.
7. Lower the resident into the chair by bending your hips and knees (good body mechanics — your legs do the work, not your back), position them against the chair back, replace footrests, and remove the gait belt.

Direction Logic: Lead With the Strong Side

The resident always leads with the strong (unaffected) side, because the strong leg bears the weight during the stand-and-pivot. Practical consequences:

• Bed to wheelchair: place the wheelchair on the resident's strong side. The resident stands on the strong leg and pivots toward it, so the strong side moves first and does the work.
• Wheelchair to bed: position the chair so the resident's strong side is nearest the bed; again the resident pivots toward the strong side into the bed.

A memory hook for the exam: the good leg goes in the direction of travel — "strong side leads."

Assistive Devices

• Cane: held on the strong (unaffected) side — opposite the weak leg. The cane and the weak leg move forward together; then the strong leg steps through. This lets the cane and strong-side arm support the body while the weak leg swings. A quad cane (four prongs) gives more stability.
• Walker: the resident lifts or rolls the walker forward a short step, then steps the weak leg into the walker first, then the strong leg. Feet stay inside the walker's base; never let a resident walk so far into it that the back legs pass their feet.
• Wheelchair: know the parts — wheel locks (brakes), armrests, footrests, push handles. Safety rules: lock brakes for every transfer; move footrests out of the way so the resident never stands on them (the chair tips forward); back the chair through doorways and onto elevators; watch for foot clearance around furniture.

Ambulation With a Gait Belt

For walking a resident who needs support, apply the gait belt snugly around the waist and walk slightly behind and to the resident's weak side, holding the belt at the back with an underhand grasp. From this position you can support the weak side and react to a stumble. Encourage the resident to look ahead, stand tall, and take normal steps. Watch for fatigue, dizziness, shuffling, or shortness of breath, and plan the route with a chair available for rest.

If a Resident Begins to Fall

This scenario appears on nearly every CNA exam. If a resident starts to fall while you are ambulating them:

• Never try to catch, grab, or hold the resident up — you will injure your back and likely both of you will go down.
• Ease the resident to the floor: widen your stance, let them slide down along the front of your leg to the ground, supporting the head and torso as they descend. Use the gait belt to guide the descent.
• Once on the floor, call for the nurse and do not move the resident until the nurse assesses for injury. Getting an injured resident up can make injuries worse.
• Stay with the resident, keep them calm and covered, and complete an incident report afterward — document the facts: time, place, what you observed, not opinions or blame.

Anti-Embolic Stockings

Anti-embolic stockings (often called by the brand name TED hose) are elastic stockings that apply graduated pressure — tightest at the ankle — to promote venous blood return from the legs. Their purpose is to prevent deep vein thrombosis (DVT): blood clots that form in sluggish leg veins, especially in residents on bed rest or after surgery. A clot that breaks loose can travel to the lungs (pulmonary embolism), which is life-threatening. Montana's skills list includes "Anti-embolic stocking (one leg)."

Application rules:

• Apply before the resident gets out of bed in the morning, before blood pools in the legs from standing. Remove and reapply per the care plan (commonly once per shift) to check the skin.
• Gather the stocking down to the heel, work it over the foot so the heel sits in the heel pocket, then smooth it up the leg.
• No wrinkles, no rolling down at the top — wrinkles and rolled bands create tourniquet-like pressure points that damage skin and block circulation.
• Check toes for warmth and color; report coolness, blueness, numbness, or swelling — signs circulation is impaired.