Table 2 Approaches to reducing the pain related to caregiving[31]]

Timely warnings

- Place grab bars, transfer poles, and bed canes to assist with transfer and aid in self-directed care.

- Before a potentially painful movement or activity, give a warning, such as ‘I’m going to move your feet and put on your socks. Are you ready?’

- Brace painful knees during transfers.

- Use a non-skid mat at the bedside to prevent sliding during transfers.

- Allow the resident to prepare for the action or movement.

- If the patient appears to be in pain, assess the usual transfer method for alternative, more comfortable ways of transferring. For example, beginning with two people, try the ‘carry transfer’ technique or use a mechanical lift.

- Wait for the resident to give permission (if she or he is able) before beginning the task.

- Evaluate the possibility of raising low beds from the floor to reduce pain associated with transfers, using a winged mattress to reduce the risk of falling.

- Request an occupational therapy consultation for individualized techniques for transfers from low beds.

Movement in bed

- Do not pull on arms when rolling or moving a resident in bed. Instead, grasp shoulders and hips, using a ‘log-roll’ technique to keep the body in proper alignment.

- Use draw sheets to roll the patient from side to side rather than pulling and pushing on various parts of the body.

Transferring

Seating and positioning

- If a patient has insufficient upper-body strength, raise the head of the bed and help the patient onto her or his side before bringing her or him to a sitting position.

- Get an individualized wheelchair assessment from a physical or occupational therapist.

- Ensure that footrests are fitted to the patient.

- Do not pull on the patient’s neck when moving or transferring.

- Pad areas of wheelchairs that cause pressure.

- Evaluate comfort of wheelchair cushions; provide comfortable inserts.

- Allow a patient time at the edge of the bed to get her or his bearings before completing the transfer.

- Adjust tilt-in-space wheelchairs every 1 to 2 hours to relieve pressure and change position.

- Raise electric beds high enough that legs are bent at the knee at slightly more than 90° to assist patients in coming to a standing position.

- Provide a variety of seating options throughout the day; avoid using ‘geri-chairs’ which lack support and do not offer a functional position.

- Make sure the patient’s feet are touching the floor before transferring from bed to chair, to allow the patient to bear as much weight as possible.