Transfer Equipment Resource Preamble
This is the transfer equipment resource preamble document. View and download the transfer equipment resource.
Purpose and Scope
In general, assisting a person to stand with two caregivers is used as a short term or occasional strategy, perhaps to manage the task at a particular time of day, to support a rehabilitation program or pending the provision of appropriate equipment. (Smith et al, 2023)
This preamble and transfer equipment resource are designed to provide assessors with an organized, diverse range of transfer equipment to aid in the identification of options which promote independence/ rehabilitation for the client. These may minimize the need for 2-person transfers. This document is a thought aid to be used by a regulated mobility professional (e.g., Physiotherapist, Occupational Therapist, Kinesiologist) and used in conjunction with a full assessment that considers factors related to the client (e.g., preferences, restorative goals, cognition, physical abilities, medical conditions), the care provider (e.g., abilities, training) and the environment.
Emphasis is placed on person centred restorative care, and balanced ethical decision making that promotes the needs and choices of the client in both the selection of transfers and equipment.
This document addresses equipment which can support clients who have some ability to bear weight and the personal abilities to complete the selected transfer.
Transfer Resource Development and Acknowledgement
This resource was developed with the engagement of the CRE-MSD/PSHSA Client/Patient Handling Community of Practice (CoP), which is composed of over 800 healthcare providers from across the healthcare continuum. It is informed by a literature review, legislation, healthcare regulations, scopes of practice, assessment practices, standardized tools, resources provided by CoP members and feedback from the project’s Advisory Committee. The Advisory Committee is comprised of 33 healthcare practitioners and client handling specialists from a wide range of disciplines including occupational therapy, physiotherapy, ergonomics, kinesiology, ethics, healthcare leadership and education.
Care Philosophy
Restorative Approach
The use of this transfer equipment resource is guided by a restorative approach as the best practice in providing care. The approach features maintenance, restoration, and optimal client function. Engaging a client to the greatest possible extent in their own mobility and daily activities improves self-rated health and supports dignity of risk and quality of life. Conversely, care not focused on client choices and their capabilities may contribute to the disablement process. A restorative approach to transfers and use of any equipment are components of a holistic restorative care approach that facilitates exercises, ongoing activity and mobility throughout the day. Restorative care may initially increase time demands but has been shown in the long-term to be more time efficient than non-restorative care.
Ethical Considerations
Ethical considerations are crucial for supporting optimal client functioning and quality life. Ethical decision making is a dynamic process where there are no absolute truths to guide what is right and wrong. The choice of transfer raises many significant ethical issues for both the client and the care provider. Transfer choices shape the future quality of life and function for the client, who requires recognition not just as a bearer of rights but as an interdependent member of a larger community. Care providers of today must be autonomous moral agents, who embrace relational ethics, critical thinking and self-reflection when participating in decision making with clients.
Individuals should not be labelled as incapable because they refuse options offered by health professionals. The issue is not that the individual chooses to live at risk but whether they understand and appreciate the consequences of their decision. The choice of a transfer provides a significant opportunity for care providers to ensure balanced decision making includes both rule-based (normative) and relational ethics. The inclusion of ethics in this project recognizes the important role of ethical skills in the delivery of skilled, compassionate healthcare and promotes balanced choices that enhance optimal function and quality of life for both clients and care providers.
Questions for Care Provider Supervising Transfer Choice to Stimulate Ethical Reflection
- What steps have been taken to preserve the client’s autonomy and dignity?
- What are the risks from the different perspectives of the client and care provider involved? (e.g., organizational, client environment, social factors)
- How do you manage a client’s competent decision that may differ from your assessment of the situation?
- Will the choice of transfer change increase the restorative goal of optimal function?
- Are clients who value information differently labelled as non-compliant or difficult?
- Are you considering the difference between capacity (i.e., understand and appreciate consequences of their actions) and competence (i.e., ability to change and adapt to the environment)?
Key Terms
Autonomous Moral Agent
A person who has reached the stage of moral development in which they think for themselves in critical and general terms.
Normative/Rule Based Ethics
This approach uses a systematic way of thinking about ethical situations based on, values, duties, rights and character traits.
Relational Ethics
This approach emphasizes connections between humans and the respect for individual autonomy. Individuals are depicted as interdependent agents who have both autonomy and membership within broader communities. Theoretical knowledge of normative ethics is integrated with concrete situations faced by care providers and clients and how they make ethical decisions. Two concepts are essential to relational ethics: connectedness and agency.
Both the care provider and the client have webs of association and do not make decisions in isolation. A relational approach considers the importance of interactions between people and their social, economic, political, and environmental contexts.
Agency describes the ability of individuals to act as ethical agents, and act upon or influence a situation. Ethical agents must demonstrate a strong sense of self awareness, the ability to self-reflect critically, and the courage to act as autonomous moral agents.
Ethical care decisions cannot be predetermined, they must include knowledge of the situation and context.
References
Baker, D.I., Gottschalk, M., Eng, C., Weber, S., & Tinetti, M.E. (2001). The Design and Implementation of a Restorative Care Model for Home Care. Gerontologist, 41(2) 257-63. https://doi.org/10.1093/geront/41.2.257
Care Services Efficiency Delivery (2010). Homecare Re-ablement Toolkit. https://webarchive.nationalarchives.gov.uk/ukgwa/20120907090351/http://www.csed.dh.gov.uk/homeCar eReablement/Toolkit/
Glendinning, C., & Newbonner, E. (2008) The Effectiveness of Home Care Reablement – Developing the Evidence Base. Journal of Integrated Care, 16(4):32-39. https://doi.org/10.1108/14769018200800031
Lumsden, K., & Ball, D. (2015) Central West Community Care Access Centre (CCAC) Home Independence Program (HIP), GTA Rehab Network. https://gtarehabnetwork.ca/wpcontent/uploads/2022/10/RPP6_Home_Independence_Program_Karyn_Lumsden_Daniel_Ball .pdf
Orthopaedic Specialists of North Carolina. Weight-Bearing Restrictions. https://orthonc.com/uploads/pdf/Weight-Bearing_Restrictions.pdf
Smith, J. (2011). The Guide to the Handling of People: A Systems Approach 6th Edition. BackCare.
Smith, J., Simpson, P., Fray, M., (Eds.). (2023). The Guide to the Handling of People: Person-centred practice 7th Edition. BackCare.
Social Policy Research Unit, University of York. (2010). Care services efficiency delivery: Homecare re-ablement prospective longitudinal study – final report. Summary. Department of Health.
Wagner, F., Handelman, M., & Ibarra, K. Supporting Clients’ Choices: Developing a Policy to Support Clients’ Choices and Support Our Staff. [PowerPoint slides] Toronto Central Community Care Access Centre. https://www.lco-cdo.org/wp-content/uploads/2011/01/ccel-presentations_4D%20- %20Mark%20Handelman%20and%20Frank%20Wagner.pdf