A client who recently experienced a cerebrovascular accident has residual right-sided weakness. The nursing staff is planning to assist the client from the bed into a wheelchair for the first time. Arrange the following steps in the correct chronological sequence to execute a safe stand-pivot transfer.
- 1Position the wheelchair on the client's left side at a 45-degree angle to the bed and lock the wheels.
- 2Assist the client to sit on the edge of the bed with feet flat on the floor and apply a transfer belt.
- 3Stand facing the client and brace their right knee and foot with your own knee and foot.
- 4Grasp the transfer belt, assist the client to a standing position, and guide them to pivot on their left foot.
- 5Instruct the client to reach back with their left hand to grasp the wheelchair armrest before lowering into the seat.
Answer
The correct sequence is to first position the wheelchair on the unaffected left side, then assist the client to sit and apply the transfer belt, brace the weak right leg, assist the client to stand and pivot on the strong left foot, and finally instruct the client to reach back with their left hand before sitting.
The correct sequence prioritizes client safety by leveraging their intact mobility. Placing the wheelchair on the unaffected (left) side ensures the client can bear weight and pivot safely on their strong leg. Once the environment is prepared, the client is brought to a seated position to safely apply the transfer belt. The nurse must then brace the hemiparetic right leg to prevent it from buckling during the standing phase. Finally, the client uses their strong left arm to reach for the armrest, which prevents them from falling abruptly into the chair.
Step-by-Step Solution
Key Concept
During a bed-to-chair transfer for a client with hemiparesis, equipment must be placed on the unaffected side, and the nurse must brace the affected extremity to prevent buckling.