Describe the process of safely transferring a patient who has recently undergone hip replacement surgery from a bed to a chair, considering mobility limitations and post-operative precautions.
Transferring a patient who has recently undergone hip replacement surgery from a bed to a chair requires a meticulous and careful process to ensure the patient's safety and prevent any complications. The procedure must accommodate the patient's mobility limitations and adhere strictly to post-operative precautions to avoid dislocation of the new hip joint, minimize pain, and promote healing. This transfer process involves several key steps that prioritize the patient's comfort and safety, as well as the safety of the CNA.
Before initiating the transfer, assess the patient's current condition. This includes checking their vital signs to ensure they are stable enough for the transfer. Evaluate the patient's pain level and administer pain medication if needed, allowing sufficient time for the medication to take effect. Assess the patient's level of consciousness and their ability to follow instructions. Check the patient's weight-bearing status as indicated by their doctor; typically, patients are either non-weight bearing, touch-down weight-bearing, partial weight-bearing, or full weight-bearing on the operated leg. Verify if there are any other specific precautions or limitations by referring to their chart or instructions from the nurse. For example, if the patient has recently taken pain medication, it would be wise to wait for the medication to start working before transferring the patient. If the patient is experiencing significant pain, the transfer should be delayed until the pain is better managed.
Gather all necessary equipment. This includes a sturdy chair with armrests, which is preferably the appropriate height for the patient. Be sure that the chair is placed near the bed and facing the patient so they don't have to turn or move unnecessarily when they are transferring to the chair. Gather assistive devices that the patient may be using such as a walker, cane, or slide board, as well as a gait belt. Make sure there is a clear pathway between the bed and the chair, removing any clutter or obstacles that may cause tripping or falls. If the bed or chair has wheels, make sure they are locked in place. For example, check the surrounding area and remove any objects that could cause a fall, such as a loose rug.
Explain the procedure to the patient clearly and calmly before you begin the transfer. Describe each step and ensure the patient understands their role in the transfer and any limitations that must be followed. Explain the precautions they need to adhere to, such as not crossing their legs, not bending the hip more than 90 degrees, and avoid twisting the hip. Provide reassurance to the patient and encourage them to communicate any discomfort or concerns during the transfer. For example, ensure they know that you are there to support them and will guide them through every step.
Position the bed to a safe working height, usually around waist level, which will prevent both the patient and you from straining or over reaching. Help the patient move to the edge of the bed, using the log-rolling technique if needed. If the patient is unable to assist, use assistive devices such as a slide sheet, or get assistance from another staff member. Ensure that the patient's feet are flat on the floor, and that the operated leg is supported by the non-operated leg. For example, if the patient is having difficulty scooting to the edge of the bed, use a slide sheet to move them, or assist them as needed while protecting their hip joint.
Apply a gait belt around the patient's waist, ensuring it is snug but not too tight, with enough room to grasp it firmly and safely. Grasp the gait belt with an underhand grip on each side of the patient. This grip should be secure and will allow you to guide the patient during the transfer. With one hand grasp the gait belt and with the other hand, gently assist the patient by placing your hand under the patient’s knee on the non-operated leg. The purpose of this hand is to help and guide the patient and not to pull on them or lift them. For example, ensure you can comfortably hold the gait belt while also being able to provide assistance to the patient’s legs without having to overextend or twist yourself.
Instruct the patient to lean forward slightly from their hips, while you block the patients non-operative knee with yours to prevent the patient from sliding or falling forward. This leaning action will help shift the patient's center of gravity forward, aiding in the standing process. For example, as the patient is about to stand, lean forward slightly to bring their body weight in a more forward position. If the patient is unable to stand with minimal assistance, use a mechanical lift or get assistance from another staff member.
Using a coordinated movement, assist the patient to a standing position while ensuring they are not twisting, and they are keeping their hip precautions in mind. You can use the gait belt to help the patient stand but not to lift them. Stand straight to avoid back injuries and do not twist at the waist. Ensure they are not bearing weight on the operative leg if they are non-weight bearing, but do allow them to stand for a few moments if their doctor's instructions allow it. For example, if the patient is partial-weight bearing, instruct them to put minimal weight on the operated leg and assist them to stand slowly.
Once the patient is standing, pivot slowly with the patient towards the chair. Avoid twisting at the waist; instead, pivot your entire body with the patient, being very careful not to twist the patient's hip. Encourage the patient to take slow, small steps. If using a walker, ensure they use it properly for support. Be sure to maintain eye contact with the patient throughout this process to ensure that the patient is stable and they feel comfortable. For example, if they are having trouble pivoting, make sure that they take very slow, small steps and do not twist their body.
Assist the patient in lowering themselves slowly into the chair, making sure they do not bend too much at the hip. As they sit, make sure they are positioned correctly in the chair, and that they are not slouching. Ensure they are comfortably seated at the proper height and that their operated leg is well supported. For example, make sure that the patient sits back in the chair completely, and that their feet are flat on the floor.
After the transfer, assess the patient for any discomfort or signs of pain. Ensure that the patient is comfortable and secure in the chair, within easy reach of necessary items. If the patient's physician's orders allow, encourage the patient to continue exercises given to them by the physical therapist, as tolerated. Remove the gait belt and make sure the patient is left in a safe and comfortable position. Document the details of the transfer, including any difficulties experienced and the patient's tolerance of the procedure, including any verbalized complaints. For example, document any assistance the patient may have required, or if the patient expressed any pain or discomfort during the transfer.
In summary, safely transferring a patient post hip replacement surgery involves careful planning, proper use of equipment, clear communication with the patient, and adherence to post-operative precautions. The process requires attention to detail and a methodical approach to avoid injury to the patient and the CNA, promoting a safe and successful transfer.