9.3 Pennsylvania Transfer, Ambulation & Elastic-Stocking Skills

Transfer-belt principles

Use the care plan to confirm weight bearing, assistance level, transfer direction, belt permission, footwear, and equipment. A transfer belt goes securely at the waist over clothing or gown. Do not place it over a wound, tube, ostomy, recent incision, or another contraindication; ask the nurse for the planned method. Explain a prearranged standing signal so the resident and aide move together.

The Pennsylvania evaluator uses the exact steps below. Extra textbook rules can cause confusion, so distinguish the test script from resident-specific workplace technique.

Skill 22: Bed to wheelchair using transfer belt

1. Explain the procedure and provide privacy.
2. Position the wheelchair alongside the bed, either at the head of the bed facing the foot or at the foot facing the head.
3. Fold up or remove footrests and lock wheelchair wheels.
4. Put the bed at a safe level and check and/or lock its wheels.
5. Assist the client to sit with both feet flat on the floor and ensure shoes are on.
6. Apply the transfer belt securely at the waist over clothing/gown.
7. Give instructions and agree on a signal to begin standing.
8. Stand facing the client in a safe position. Give the signal.
9. Grasp both sides of the belt with an upward grasp and gradually assist to stand, maintaining leg stability knee-to-knee or toe-to-toe.
10. Help the client turn until the back of the legs is against the wheelchair.
11. Lower the client into the chair, position the hips at the back, and remove the belt.
12. Put the feet on the footrests, place the signal within reach, and wash hands.

The published PA list does not direct a 45-degree chair angle, mandatory placement on the stronger side, or blocking one weak knee. Those may be part of an individualized therapy plan but are not universal evaluator steps.

Skill 3: Assist to ambulate using transfer belt

1. Explain and provide privacy.
2. Before standing, ensure nonskid footwear, a safe bed level, checked/locked bed wheels, and sitting with feet flat.
3. Apply the belt securely at the waist over clothing/gown.
4. Explain the prearranged signal. Face the client, give the signal, and gradually assist to stand by grasping the belt on both sides with hands upward while maintaining leg stability knee-to-knee or toe-to-toe.
5. Walk slightly behind and to one side of the client for 10 feet while holding the belt.
6. Assist the client back to bed and remove the belt.
7. Place the signal within reach, leave the bed low, and wash hands.

The checklist says “one side,” not always the weaker side, and it does not direct a single hand at the center back. Use both sides for the rise and maintain the belt during the walk.

Skill 2: Apply one knee-high elastic stocking

1. Explain and provide privacy. Keep the client supine while applying the stocking.
2. Turn the stocking inside-out at least to the heel.
3. Place it over toes, foot, and heel, then pull the top over foot, heel, and leg.
4. Move the limb gently without force or overextension.
5. Finish with no twists or wrinkles. Place any heel portion over the heel; a toe opening may sit over or under the toe area as the product allows.
6. Place the signal within reach, leave the bed low, and wash hands.

Do not roll a tight band at the top. Observe toes and skin and report pain, numbness, discoloration, swelling, or pressure. At work, use the size, schedule, and skin-check plan ordered for the resident.

Canes, walkers, and workplace transfers

A common cane sequence for unilateral weakness is cane, weaker leg, then stronger leg, with the cane in the opposite hand—but use the therapy plan because devices, weight-bearing restrictions, and gait patterns vary. A walker must be correctly sized; the resident should not pull to stand on an unstable walker unless the plan and equipment are designed for it. Do not invent a device sequence for the standardized PA transfer-belt skills.

If dizziness or weakness occurs, stop, protect from falling, return to a safe surface if possible, and call for help. If a fall begins, do not wrench the resident upward by the belt. Use trained lowering technique, protect the head, remain with the resident, and follow post-fall policy without lifting until assessed.