CNA Skill: Assists to Ambulate Using Transfer Belt

Assisting your patient to ambulate regularly provides exercise and helps prevent mobility and circulation problems for the patient.  Many patients who need your assistance may have difficulty getting to a standing position and then walking without help.  Falls can be very dangerous for patients, particularly the elderly, and may result in severe injuries.  For this reason, the use of a transfer belt can make the process safer and more comfortable for the patient.  Before you begin, assist the patient into suitably warm and comfortable clothing that will not hamper movement, such as a robe.  Then, ensure the patient is wearing rubber-soled shoes or slippers that will provide traction.  If your patient requires oxygen or an IV, ensure that the proper equipment is available such as a portable oxygen tank or IV pole with wheels.  If necessary, provide the patient with a walker or cane to assist with movement.  Once you are ready, follow these steps to ensure safety:

Lower the patient’s bed to the lowest level, and lock the wheels.  Assist the patient in sitting, and then moving legs so that they hang over the edge of the bed.  Allow the person to remain in this position for a period of time to ensure the patient is not becoming dizzy.Apply the transfer belt around the patient’s waist.  Help the person to stand by first standing in front of the patient.  Have the patient place his/her hands on the bed alongside the legs, and feet on the floor.  Tell the patient to lean forward, while you grasp the transfer belt with an underhand grip.  Place your feet alongside the patient’s feet, and flex your knees slightly.  Assist the patient to a standing position by gently lifting and steadying the person.  Remain in this position for a brief period to ensure the patient does not feel dizzy and his/her respiration remains constant.Once you are certain the patient is steady, provide a cane or walker.  The patient should hold a cane using their strong side.  Assist the person to walk by standing slightly behind the patient on their weaker side and holding the transfer belt using an underhanded grip.As you walk, monitor the patient carefully.  If you notice changes in the persons respiration, or if the patient reports feeling dizzy or tired, you will need to discontinue the walk.  Be sure you do not rush the patient, and allow them to move at whatever pace is comfortable.  If the patient needs a rest, allow him or her to sit until they feel ready to walk again.  Use the same procedure for standing from a chair as you did when helping them get up from bed.After the patient is returned to his/her bed, be sure to again wash your hands.  Do not leave the transfer belt on the patient after they return to bed.

Assisting patients to remain mobile will speed the recovery process and help the patient remain independent.  The time you spend keeping the patient safe will pay off by preventing dangerous falls.

Examiner Checklist For This Skill:

-  Performed beginning tasks
-  Locked bed or chair wheels, if appropriate.
-  Ensured the person was appropriately attired including non-skid footwear.
-  Applied transfer belt firmly around person’s waist (should be adjusted to allow evaluator to place two fingers between the belt and the person.)
-  Assisted the person to standing position.
-  Stood at the person’s affected side (if applicable) while balance is gained.
-  Ensured the person stood erect with head up and back straight, as tolerated.
-  Assisted the person to walk. Walked to the side and slightly behind the person. Held transfer belt using under hand grasp.
-  Encouraged the person to ambulate normally with the heel striking the floor first. Discouraged shuffling or sliding, if noted.
-  Ambulated the required distance, if tolerated.
-  Assisted the person to return to bed or chair.
-  Removed transfer belt appropriately.
-  Performed completion tasks.

(This is a general checklist. It may vary depending on each state)

Expert Tip by Tanya Glover, CNA

When it comes to using a gait belt, many CNA’s do not do it correctly. There are several reasons for this. One of the main reasons is that while it is impressed upon us in school that these belts are an important part of our work, it is not uncommon to go into a nursing home and find that only a few, if any, CNA’s are wearing or using one.  Personally, I went through the first two years of being on the job before I really learned why it was so important to use it! Once I did start using it I was more comfortable doing patient care and wondered why I didn’t use it earlier!

Using a gait belt is not as easy as it may look. In fact, many newbies (and seasoned veterans) make mistakes. Improper use can cause you to injure yourself or your patient.

Mistake 1: Thinking that the belt is okay for walking a patient all the way to the dining room. Unless the dining room is less than 5 steps away, use another, safer means of transportation. Gait belts are not meant for long walks. They are meant for allowing the patient to take a few steps without much assistance. There are exceptions to this rule such as physical therapy, but that is not our forte.

Mistake 2: Putting the gait belt on the patient with it touching their skin can cause serious tears. Always make sure the belt is applied over the clothes only.

Mistake 3: Allow the patient to help you. If you can use the belt on them, it means that they can help with their movement, no matter how small that help is. Do not attempt to lift all their weight on your own as this will damage your body and leave you out of work without compensation. I say without compensation because if you are injured on the job and it is due to your improper use of equipment, you are at fault and get nothing.

Know the rules and be safe!