Unit 10

Team Talk: Coordinating and Confirming

Workplace English for Nursing Assistants

Meet Yvonne

Watch the video about Yvonne. Watch what happens.

Case Study Video — Yvonne

Yvonne — A Transfer That Went Wrong

Talk about it

  1. Why is it important to get Yvonne up and out of bed for meals?
  2. If Yvonne felt unwell or could not follow directions to stand, how could you safely transfer them to the wheelchair?
  3. How could you help Yvonne sit on the side of the bed WITHOUT lifting them?
Three panels show a gait belt around a standing client's waist, a trapeze bar hanging over a bed, and a flat slide device under a client in bed.
Figure 10.1 — We go on three.

Moving and repositioning clients safely requires the right equipment, enough help, and clear communication. Before beginning, healthcare workers must consider what the client can do independently and which tool will provide the safest support. The three tools below are used for different types of movement: helping a client walk or transfer, helping a client reposition themselves, and reducing friction when moving a client in bed. Choosing the correct tool protects both the client and the healthcare worker from injury.

The Three Tools

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The three tools
TermPlain meaning
Gait beltA belt around the client's waist that you hold when transferring or walking a client (a 1- or 2-assist).
TrapezeA bar that hangs over the bed; the client pulls on it to help move themselves up in bed.
Friction/shearing prevention deviceA special slide device that moves a client up in bed with almost no friction — protects fragile skin and your back (a 2- or 3-assist).
Three panels show a gait belt around a standing client's waist, a trapeze bar hanging over a bed, and a flat slide device under a client in bed.
Figure 10.2 — The three tools: gait belt, trapeze, and friction/shearing prevention device.

Practice 1

1.1 Match the term to its meaning

  • 1. Gait belt
  • 2. Trapeze
  • 3. Friction/shearing prevention device
  • A. An implement that attaches to the bed frame overhead; the client pulls on it to reposition in bed
  • B. A device placed around the client's waist for use when transferring and walking
  • C. A device to move a client up in bed with the least friction/shearing and the least effort for the student

The Six Patient Positions

Six small side-view drawings show a client in supine, side-lying, Fowler's, prone, Sims's, and tripod positions with pillow placement marked.
Figure 10.3 — The six positions. Pillows are marked in amber in every panel.

The Six Patient Positions

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These positions are used for comfort, pressure relief, breathing support, eating, treatments, and procedures. Learn what each position looks like and when it is used.

The six patient positions
Position What it is When it is used
Supine Lying on the back For resting or sleeping; often alternated with side-lying to relieve pressure
Side-lying Lying on one side, often with a slight 30-degree tilt to avoid direct pressure on the hip and sacrum For comfort and pressure relief; often alternated with supine
Fowler's Lying on the back with the head of the bed raised To make breathing easier; for eating, watching TV, or receiving tube feeding
Prone Lying on the stomach, usually with the head turned to one side For certain treatments, pressure relief, improved oxygenation, or comfort when permitted by the care plan
Sims' Lying partly on the stomach and partly on the left side, with the upper leg bent For giving an enema or performing another rectal procedure
Tripod Sitting and leaning forward, with the elbows or forearms supported on the knees or a table To make breathing easier and improve lung expansion

Pillows Relieve Pressure in Every Position

Common rules: a pillow under the head; a pillow under the lower legs so the heels do not touch the mattress (never directly behind the knees — it blocks blood flow and can cause a contracture); a pillow between the knees when side-lying; pillows under the elbows to reduce friction. A trochanter roll keeps the hip/leg from rolling outward after some surgeries.

A correct panel shows a pillow under the lower legs lifting the heels off the mattress; a crossed-out panel shows a pillow behind the knees.
Figure 10.4 — Put the pillow under the lower legs — never directly behind the knees.

Practice 2

2.1 Which position? (supine / side-lying / Fowler's / prone / Sims's / tripod)

  1. A client with breathing problems will be most comfortable with the head of the bed raised. ________________
  2. A client needs an enema. ________________
  3. Lying on the back; the everyday sleeping position. ________________
  4. Sitting up, elbows on a table, head in the hands, to help breathing. ________________
  5. Lying on the stomach; used only if requested or medically needed. ________________

2.2 The Fowler's degree ladder

  1. Semi-Fowler's: head of bed raised to about ________________ degrees.
  2. Fowler's: head of bed raised to about ________________ degrees.
  3. High-Fowler's: head of bed raised to about ________________ degrees.
  4. The position with the GREATEST risk of shearing is ________________.

2.3 Safety

On which side must a client lie to receive an enema, and why?

______________________________________________________________

Moving a Client Up in Bed

When a client slides down (especially in Fowler's), you move them back to the head of the bed. Always ask them to help.

Log rolling: used when a spinal injury is suspected — the body must stay straight and move as one unit. It takes three staff, and a pillow goes between the legs first. One person holds the head in alignment; all move on the count of three.

Bed to stretcher: match heights, lock both, at least four staff; a suspected spinal injury needs a backboard and a fifth person at the head.

🗣 Speaking Toolbox: Getting the people you need

Practice 3

3.1 Fill in the blank

  1. The head of the bed must be ________________ before moving a client up in bed.
  2. When two staff members move a client up, they grasp the draw sheet ________________ the client's body.
  3. One healthcare worker can move a client up in bed only if the client has a ________________ secured to the bed.
  4. Before log rolling, place a pillow ________________ the client's legs.

3.2 How many healthcare workers?

  1. Log rolling a client with a suspected spinal injury: ________________
  2. Moving a client from bed to stretcher (no spinal injury): ________________
  3. Moving a client up in bed with a friction/shearing prevention device: ________________
  4. Operating a mechanical lift: ________________

The Transfer Ladder

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Before any transfer of an ambulatory client, do three things in order: dangle (sit on the edge of the bed so blood pressure settles), put on proper footwear (nonskid), then apply the gait belt. Then match the method to the client's ability.

Three numbered panels show a client sitting on the edge of the bed, putting on nonskid shoes, and having a gait belt fastened.
Figure 10.5 — Before Any Transfer, Three Steps: Always in this order: dangle, nonskid footwear, then the gait belt.
The transfer ladder
LevelDevice# People needed
IndependentNone (offer cane/walker)None; help if asked
Stand-by assist (SBA)NoneOne, watching and cueing
One assistGait beltOne (a hand on the belt at all times)
Two assistGait beltTwo (a hand on the belt at all times)
Sit-to-standSit-to-stand device + sling (no gait belt)One (two if agitated/confused)
Mechanical liftLift + sling (no gait belt)Two, always

Practice 4

4.1 Order the three preparation steps (1–3)

  1.   Apply the gait belt.
  2.   Let the client dangle on the side of the bed.
  3.   Put nonskid footwear on the client.

4.2 Which method?

  1. A client needs help and is a "two assist." What device is required? ________________
  2. A client cannot bear weight at all. Which device is used — gait belt or mechanical lift? ________________
  3. A "stand-by assist" client suddenly feels weak. May you use a gait belt? (yes/no) ________________

Communication Strategies

The Language of a Team Move

Every move in this unit happens on a count. Two, three, four, or five people and the client all have to move at the same instant. If one person moves early, or the client does not move at all, somebody gets hurt.

That means the count is not just a habit. It is a check that everybody heard the same instruction.

⚠ Agree the Count BEFORE You Move

Facilities and trainers differ. Some move ON three ("one, two, three" — go on three). Some count three and then say "go" ("one, two, three, go").

These are both correct — and mixing them in one team is how a client gets dropped. Before any team move, say it out loud: "We go ON three — is everybody clear?"

🗣 Speaking Toolbox: Directing the move

Did They Actually Hear You?

Older clients may be hard of hearing. Clients with dementia may not be attending to you. Someone lying flat with their back to you cannot see your face, and a room can be noisy. A client who did not hear "push on three" will simply not push — or will push at the wrong moment.

🗣 Speaking Toolbox: Checking that the client heard you
Check Your Knowledge Chattybot · Check Your KnowledgeScan to answer these questions out loud.
  1. Which position eases breathing? Which is used for an enema, and on which side?
  2. Which Fowler's position causes the most shearing?
  3. Where does the pillow go so the heels float — and where must it NOT go?
  4. How many staff for a log roll? For a bed-to-stretcher move?
  5. When may ONE healthcare worker move a client up in bed?
  6. Where must the head of the bed be before you boost someone up?
  7. Which comprehension-check phrases should you NOT use with a client? Why?
  8. Instead of "Did you hear me?", what is a better question before a transfer?

Dialogue Practice

Read these dialogues out loud with a partner.

Two people having a scripted workplace dialogue.

Dialogue 1 —"What are we doing on three?"

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Mr. Okonjo, 86, is hard of hearing and has slid down in bed. He is in Fowler's and needs boosting up. Tomas is working the other side of the bed with you, and you have a draw sheet.

You: Tomas — could you give me a hand with the draw sheet? He's slid right down.

Tomas takes the far side of the draw sheet.

You: (moving round so he can see your face) Mr. Okonjo — we're going to move you up the bed. Can you hear me okay?

Mr. Okonjo: Eh? — yes. Yes, a bit.

You: I'll come round this side so you can see me. First, I'm going to lay the bed flat. Then bend your knees and put your feet flat on the mattress.

Mr. Okonjo: (bends knees) Like this?

You: Exactly like that. Next, put your hands across your chest — so nothing gets caught. On three, push down with your feet.

Mr. Okonjo: Right you are.

You: Before we start — what are we going to do on three?

Mr. Okonjo: ... Push. With my feet.

You: Perfect. Tomas — we go ON three, yes? Not after. Grasp close to his hip.

Tomas repeats "on three" and sets his grip close to the body.

You: Wide stance, bend your knees. Ready? One — two — three.



Two people having a scripted workplace dialogue.

Dialogue 2 —Halfway up

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You and Bram are transferring Mr. Adeyemi from the bed to a wheelchair. Gait belt on, footwear on, chair locked. Halfway to standing, his knees give.

You: One — two — three.

Mr. Adeyemi: (rising, then) Oh — oh, I'm going...

You: Bram — watch out! His knees are going! Don't lift — lower him. Back onto the bed. Nice and easy.

Bram calls back that he has the belt. They lower him to sitting on the edge of the bed. Nobody lifts against the weight.

You: You're safe. You're sitting on the bed. Just breathe for a minute.

Mr. Adeyemi: I'm sorry. My legs just went.

You: Don't worry about it. That's exactly why there were two of us. Can you hear me all right? Are you dizzy, or was it just the legs?

Mr. Adeyemi: Dizzy. A bit swimmy.

You: Then we'll sit here and let it pass. Bram — you stay with him, I'll get the nurse, and we'll use the lift for the chair. Have you got that?

Bram repeats the plan back: lift for the chair, and you are telling the nurse.

You: That's right. Don't leave him.

Roleplays

Work with a partner.

An older woman sitting on the edge of her bed.

Roleplay 1 —The client who says yes

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Situation

Mrs. Bergqvist, 91, is hard of hearing, wears one hearing aid, and has slid down in bed. She agrees with everything anyone says. You have a partner and a draw sheet. Boost her up safely.

Your Goals:

  1. Check she can hear you at all.
  2. Give the instruction one action per sentence.
  3. Check she heard by asking for the CONTENT, not for a "yes."
  4. Agree the count with your partner out loud.
An agency worker in scrubs, new to the team.

Roleplay 2 —A stranger on the team

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Situation

A client is being moved from bed to stretcher for transport to hospital. There are four of you, including an agency worker you have never met and who trained somewhere else. You are the one who notices nobody has agreed anything.

Your Goals:

  1. Stop the move BEFORE it starts, not during.
  2. Agree the count explicitly with everyone.
  3. Confirm the number of people needed for this move.
  4. Check the client heard what is about to happen.
  5. Use an urgent warning if the move starts to go wrong.

Cumulative Review

Vocabulary Review

Use a word from the word bank. Each is used once.

Workbank

repositioned • flat • Sims's • sleeping • muscles • ligament • safety • semi-Fowler's • Fowler's • shearing • trochanter roll • tripod • waist • bed frame • transferring

  1. Clients must be

    ______________________________________________________________

    every 2 hours in bed and every 1 hour in a wheelchair.
  2. The head of the bed must be

    ______________________________________________________________

    before moving a client up in bed.

  3. ______________________________________________________________

    is a side-lying position used when a client needs an enema.
  4. Supine is a comfortable

    ______________________________________________________________

    position for most people.
  5. The healthcare worker uses the large

    ______________________________________________________________

    of the hips, thighs, and buttocks to prevent self-injury.
  6. A contracture is the physical shortening of a

    ______________________________________________________________

    .
  7. Nonskid footwear during transfers is an important

    ______________________________________________________________

    consideration.
  8. The head of the bed is raised to about 35–40 degrees in the

    ______________________________________________________________

    position.
  9. The head of the bed is raised to 45–60 degrees for the

    ______________________________________________________________

    position.

  10. ______________________________________________________________

    across the bed linens should be limited as much as possible.
  11. A

    ______________________________________________________________

    keeps the client's hip, leg, and foot in a neutral position.
  12. Clients with respiratory disorders often assume a

    ______________________________________________________________

    position.
  13. A gait belt is placed around the client's

    ______________________________________________________________

    during transfers.
  14. A trapeze attaches to the

    ______________________________________________________________

    and is used by the client for leverage.
  15. A gait belt is used when

    ______________________________________________________________

    or ambulating a client.

Multiple Choice

Vocabulary Review Tip

Cover the answers, try from memory, then cross out the choices you know are wrong.

  1. A client with breathing problems would be MOST comfortable in which position?

    1. prone
    2. supine
    3. Fowler's

  2. The nurse says Stanley needs an enema. What position should you use?

    1. Sims's (left side)
    2. supine
    3. prone

  3. For semi-Fowler's, the head of the bed should be raised

    1. 45–60 degrees
    2. 35–40 degrees
    3. 80–90 degrees

  4. The position with the GREATEST risk of shearing to the back, sacrum, and coccyx is

    1. supine
    2. high-Fowler's
    3. semi-Fowler's

  5. Proper wheelchair positioning helps to

    1. prevent pressure injuries
    2. reduce the risk of a fall
    3. do all of the above

  6. Anna has very fragile skin and must be moved up in bed. The BEST device is a

    1. draw sheet
    2. trapeze
    3. friction/shearing prevention device

  7. Freida needs an alternating-pressure pad, but then cannot put their feet flat on the floor. You should

    1. talk with the nurse about the wheelchair size
    2. search for another wheelchair yourself
    3. slide them forward in the seat

  8. Before log rolling a client, a pillow is placed

    1. under the legs
    2. between the legs
    3. behind the hips

  9. When a client is in Fowler's position, pillows should be placed

    1. under the head and upper arms
    2. under the head and lower legs
    3. behind the knees

  10. One healthcare worker can move a client up in bed if

    1. the client has a trapeze secured to the bed
    2. the client grabs the student's arms
    3. never; it always takes two

  11. When two staff members move a client up in bed, they should grasp the draw sheet

    1. 4 inches from the body
    2. 6 inches from the body
    3. as close to the body as possible

  12. You are about to transfer a hard-of-hearing client. The BEST check is

    1. "Did you hear me?"
    2. "Got that?"
    3. "What are we going to do on three?"

  13. Your partner counts "one, two, three, go" but you go ON three. You should

    1. move anyway and hope for the best
    2. agree the count out loud BEFORE the move
    3. count faster next time

Back to Yvonne

Read the case and answer in complete sentences. Use the sentence starters if you wish.

The Case: Yvonne

Yvonne is a bariatric client with a stage-3 pressure injury on their sacrum. They are expected to be out of bed at meal times. Their care plan says to transfer them with a two-person assist, a gait belt, and a walker.

  1. Why is it important to get Yvonne up and out of bed for meals?

    ______________________________________________________________

  2. You must reposition Yvonne every 2 hours. What supplies could help you move them up in bed safely?

    ______________________________________________________________

  3. How could you help Yvonne sit on the side of the bed WITHOUT lifting them?

    ______________________________________________________________

  4. If Yvonne felt unwell or could not follow directions to stand, how could you safely transfer them to the wheelchair?

    ______________________________________________________________

  5. Yvonne is hard of hearing. Write exactly what you would say to check they heard the count.

    ______________________________________________________________

For the instructor — not part of the student pages

Instructor Answer Key

Unit 10 — Team Talk: Coordinating and Confirming

This unit focuses on the teamwork and communication required to move and reposition clients safely. Learners study gait belts, trapezes, slide devices, common patient positions, moving a client in bed, log rolling, stretcher transfers, and levels of transfer assistance. A case study about Yvonne connects safe movement to obesity, pressure-injury prevention, hearing loss, and the care plan. Through illustrated readings, flashcards, knowledge checks, dialogues, and role-plays, learners practice explaining the plan, assigning each person’s job, requesting enough help, agreeing on the count, checking what the client heard, and stopping a move when the team is not coordinated.

Practice 1.1: 1-C, 2-A, 3-B.

Practice 2.1: 1. Fowler's 2. Sims's 3. supine 4. tripod 5. prone. Practice 2.2: 1. 35–40 2. 45–60 3. 80–90 4. high-Fowler's. Practice 2.3: the LEFT side, because it follows the flow of the intestines; the right side could perforate the bowel.

Practice 3.1: 1. flat 2. as close to 3. trapeze 4. between. Practice 3.2: 1. three 2. four 3. two 4. two (and you must be 18+).

Practice 4.1 (order): 1. Dangle 2. Footwear 3. Gait belt. Practice 4.2: 1. a gait belt 2. mechanical lift 3. yes.

Vocabulary Review (fill in): 1. repositioned 2. flat 3. Sims's 4. sleeping 5. muscles 6. ligament 7. safety 8. semi-Fowler's 9. Fowler's 10. shearing 11. trochanter roll 12. tripod 13. waist 14. bed frame 15. transferring.

Multiple Choice: 1-c, 2-a, 3-b, 4-b, 5-c, 6-c, 7-a, 8-b, 9-b, 10-a, 11-c, 12-c, 13-b.

Back to Yvonne Case Study (sample): (1) Being upright helps eating and digestion, prevents aspiration, relieves sacral pressure, and supports dignity and quality of life. (2) A friction/shearing prevention device (best for fragile skin) or a draw/lift sheet with two staff members; a trapeze if available. (3) Raise the side rail and ask Yvonne to grasp it and roll to their side, use the substitute draw sheet (top sheet/blanket) to help, then raise the head of the bed toward high-Fowler's to help them come to sitting — no lifting. (4) Use a bariatric-approved mechanical lift with a sling and two staff members, since they cannot follow directions or bear weight safely. (5) Answers vary — must ask for the CONTENT, e.g. "What are you going to do on three?", not "Did you hear me?"

Suggested drill — the agreeable client

One student plays a client who answers "Yes, dear" to every yes/no question and then does nothing. The learner must get them to actually perform an action ("put your hands across your chest").

Suggested drill — the count

Split the class in two and tell them to work together to drape a blanket over a table, on three ON three. Let them figure out who sets the count.