Patients have two options when it comes to transferring onto a commode, say from a bed. They can either go towards their strong side or their weaker side. Intuitively, you may think it’s best to transfer onto their stronger side and patients often would think this as well. But when it comes to toileting, here’s why I think in general, transferring onto their weaker side first is better, especially when they are first doing this after for example, a hip replacement, a fall, whatever it may be.
We will assume that the commode is a stationary one that is placed 90 degrees next to the bed and not a rolling type on casters or wheels. The majority of commodes in the hospital, at nursing facilities, as well as the ones that patients get as DME in their home are stationary – that is, once a patient is on it, it cannot be easily moved without risking a fall.
So why is it a good idea to transfer onto their weaker side when first getting out of bed and onto the commode?
The reason is pain, fatigue, and other symptoms that may develop. When patients first get out of bed for toileting, they will likely have the most energy. If they are in pain, the pain could only get worse. Even with medications, it would take time for oral medications to reach therapeutic effect if given when patients are on the commode. Then there’s the aspect of anxiety and fear of falling mentally when patients have to go towards their weaker side back to bed when they are in a lot of pain, dizzy, tired, and so on.
Toileting can take a lot of effort and energy. Patients may be more tired – especially if they have constipation and difficulty passing stool. Their pain is likely to go up. So when it comes time to transfer back to bed, if they transferred on their stronger side first, they would have to transfer to their weaker side second.
Yes, one option is to transfer their stronger side again by doing a 270 degrees pivot back onto the bed, but overall, it is easiest for patients to do 90-degree pivots – as well as for therapists to be in a good position to assist as well. A 270-degree pivot adds more complexity and there is added risk of breaking precautions, e.g., posterior hip precautions. It’s not impossible, but it is not ideal especially if patients have to use a walker/platform walker, have ex-fixes, wound-vacs, chest tubes, lots of lines connected to them – you get the idea.
By transferring onto the weaker side first, patients get the hard part ‘over with’ and then are able to urinate or have a BM. When it comes time to transfer back to bed and they’re fatigued, in pain, or however they are put at a disadvantage compared to before, they will be able to transfer towards their stronger side.
Sometimes, environmental barriers such as space will promote or limit the placement of commodes and would dictate the direction that patients would have to transfer onto a commode. There’s usually a way to rearrange furniture and equipment, such as unlocking the bed, but this takes more time and more attention for safety. Sometimes, it is necessary to rearrange the environment to promote the safest transfer.
The key is to take your time, plan your moves, and also plan your moves back to the original surface that patients started from – wheelchairs, chairs, or their beds.
For more transfer tips, check out the super-transfer guide.