If a patient is unable to bear weight at all or needs assistance with disrobing or dressing

On certain occasions, a patient who has had a stroke will need assistance in dressing themselves due to weakness on one side of the body or in certain limbs.  Assisting your patient with daily activities helps the patient to feel that they are in control of their situation.  Before you assist a patient with dressing, wash your hands carefully to avoid transmission of germs.  Ensure that a clean set of clothes is available and ready to wear.  Greet your patient, and explain that you want to help them get dressed or change clothes.  Then, follow these steps to assist your patient:

  1. Teach the patient that the safest way to get dressed is to undress the weak side of the body first.  While your patient will need your help at first, you can increase the patient’s independence and reduce the risk of falls later on by teaching the proper way to change clothes.
  2. Assist your patient in removing clothes as needed.  You will want to let the patient complete as much of the task as possible without your assistance.  Set the dirty clothes aside and move the clean clothes within easy reach of the patient.
  3. Throughout the process, you will need to monitor you patient to ensure they do not become fatigued or dizzy.  Be ready to help the patient sit or lie down if needed.
  4. Instruct the patient to dress the strong side of the body first.  For example, if the patient is stronger on the right side, have him or her place their right arm in the right sleeve first.  Again, allow the patient to complete as much of the task as possible without assistance.

When the task is complete, ensure dirty clothes are placed in the appropriate receptacle.  Wash your hands again.  Helping your patient learn self-care skills such as dressing will allow the patient to regain their independance and will speed recovery.

If a patient is unable to bear weight at all or needs assistance with disrobing or dressing

Expert Tip By Tanya Glover, CNA

Dressing a dependant patient can be a challenge, and each one is different. What works for one may not work for another. Our patients are all individuals and this is something that we sometimes forget. During this part of your skills test, it is important to remember not to pull, push or otherwise roughly manipulate your “patient”. For me it helped to talk to my “patient” during the process, letting them know each thing I was doing and allowing them time to help or respond to the care I was providing. In fact, talking to your “patient” during any of the skills you are tested on (aside from hand washing) is a good idea. It will help you feel less nervous and allow you to talk yourself through each step aloud.

The main thing, aside from patient safety, is to allow your patients to do as much dressing as they are able to do. A mistake we all make at one point or another is doing every little thing for them. This takes away from their independence. Even if your patient likes this type of care, encourage as much self care as possible. If you don’t let them do the things they can, their muscles will atrophy and then they really will be helpless. Even dependant patients can do a little something to help with their dressing activities. If they can lift their arm a few inches to get their shirt on, let them do it! If they can help slide their feet into their own shoes, allow it! Keep their bodies as active as possible and you will have preformed a job well done.

Chapter 3. Safe Patient Handling, Positioning, and Transfers

When patients are recovering from illness, they may require assistance to move around in bed, to transfer from bed to wheelchair, or to ambulate. Changing patient positions in bed and mobilization are also vital to prevent contractures from immobility, maintain muscle strength, prevent pressure ulcers, and help body systems function properly for optimal health and healing (Perry et al., 2014). The amount of assistance each patient will require depends on the patient’s previous health status, age, type of illness, and length of stay (Perry et al., 2014).

Types of Assistance

At times, patients are assessed and given a “level of assistance” required for transferring. This is most common in residential care settings. The level of assistance is based on the patient’s ability to transfer and stand. The terms describing different levels of assistance are used by health care providers to communicate with each other so everyone understands what type of assistance is required. The assistance needed is usually charted on the patient’s Kardex, above the head of the bed, and/or on the patient’s chart. Table 3.4 describes different types of assistance in the hospital and community setting.

Table 3.4 Level of Assistance
Level of Assistance Description
 Independent The patient is able to transfer independently and safely.
Standby supervision The patient requires no physical assistance but may require verbal reminder.

This type of patient may also be learning to transfer independently using a wheelchair, walker, or cane.

Minimal assist The patient is cooperative but needs minimal physical assistance with the transfer.
One-person standing pivot The patient can bear weight on one or both legs and is cooperative and predictable.

The patient also can sit with minimal support on the side of the bed.

Two-person standing pivot The patient can assist with weight bearing, but may be inconsistent.

The patient is cooperative and predictable.

One-person assist with transfer board The patient is cooperative, follows directions, and has good trunk control.

The patient can use their arms, but cannot bear weight on both legs.

Two-person assist with transfer board The patient is cooperative and can follow directions.

The patient can use their arms, but cannot bear weight on both legs. The patient does not have good trunk control.

The patient’s wheelchair has removable arms.

Mechanical stand The patient may have some ability to stand, but is unreliable.

The patient may be unpredictable (due to cognitive changes, medications).

The patient is a heavy two-person transfer and requires toileting or pericare.

The patient does not have severe limb contractures or injuries where movement is medically contraindicated (e.g., spinal injury).

Use of a mechanical lift.

Data source: Winnipeg Regional Health Authority (WRHA), 2008
Special considerations:
  • Assess the patient every time before a move as a patient’s condition may worsen or improve throughout the hospital stay.
  • Results of assessments should be properly documented according to agency policy to ensure safe transfers for all health care providers.
  • Any patient-handling injuries must be reported using the British Columbia Patient Safety and Learning System (BCPSLS), a web-based tool used to report and learn about safety events, near misses, and hazards in health care settings (BCPSLS, 2015).

If the patient is cooperative, able to bear weight, and has some balance to sit (see Checklist 24: Risk Assessment), the health care provider must decide how much assistance the patient needs. Table 3.5 provides guidelines to consider.

Table 3.5 Assistance Required for Transfer

Assess

Description

Minimal

One-person transfer with gait belt

The patient is able to perform 75% of the required activity on their own.

Moderate

Two-person transfer with a gait belt, a stander, or a two-person transfer with a slide board and a gait belt

The patient is able to perform 50% of the required activity on their own.

Maximum

Stander or a two-person transfer with a slide board and gait belt

The patient is able to perform 25% of the required activity on their own.

 Data source: WRHA, 2008
Special considerations:
  • The weight, height, and general physical, mental, or emotional condition of the patient all influence the potential for injury.
  • If the patient is uncooperative or unable to follow commands, there is an increased risk for injury. It is recommended that a mechanical lift or assistive device be used to prevent injury to the health care provider and patient.
  • If there is any question about the patient’s ability, always reassess.

  1. A patient requires no assistance from the health care provider except for the occasional reminder to lift feet while walking. Is the patient’s level of assistance considered independent or a minimal assist?
  2. A patient is assessed as a one-person pivot. As the health care provider begins the transfer, the patient suddenly becomes uncooperative. What should the health care provider do next?

Which type of footwear is advised for a patient to wear during a transfer procedure?

The person should also wear shoes, or socks with nonslip soles. This will help prevent you or the person from slipping. Check that equipment will not move during a transfer. Lock the wheels of a wheelchair or walker before you move the person.

What should the patient be wearing on the feet during a transfer quizlet?

The patient must be physically able to bear weight on the body and to ambulate. What should be on the patient's feet during a transfer? The patient's feet should have non-skid shoes or slippers on.

What is a two person assist?

Two-person assist with transfer board. The patient is cooperative and can follow directions. The patient can use their arms, but cannot bear weight on both legs. The patient does not have good trunk control. The patient's wheelchair has removable arms.

Which procedure should be used to turn patient who have arthritis or spinal injuries?

To turn persons with arthritis in their spines, hips, and knees, logrolling is preferred.