A male client has right sided hemiplegia following a left cerebrovascular accident (CVA). His sitting balance has improved, and he is now able to sit in a wheelchair. To assist the client in transferring from the bed to a wheelchair, which action should the nurse take?
Explanation & Rationale
A. Instruct the client to look at his feet: While visual guidance can help with body awareness, instructing the client to look at his feet does not ensure safety or optimize leverage during a transfer. Proper positioning of the wheelchair relative to the client is more critical to prevent falls or injury. B. Have the client put both arms around the nurse's neck for support: This method is unsafe for both the client and the nurse. It increases the risk of falls and injury because the nurse cannot adequately support the client’s body weight or maintain control during the transfer. Safer transfer techniques involve assisting devices or supportive hand placement rather than relying on the nurse’s neck. C. Place the wheelchair on the client's left side: Since the client has right-sided hemiplegia, his left side is the stronger, unaffected side. Positioning the wheelchair on the left side allows the client to lead the transfer with his functional arm and leg, providing stability and leverage. This method maximizes safety and independence while minimizing the risk of falls. D. Instruct the client to take slow, deep breaths while transferring: Deep breathing can promote relaxation and improve oxygenation but does not directly address the mechanics or safety of a transfer. While useful for general comfort, it is secondary to proper wheelchair positioning and use of the stronger side during the transfer.