Chapter 3. Safer Patient Handling, Positioning, Transfers and Ambulation

3.4 Levels of Assistance

Some patient conditions result in a decreased ability to perform activities of daily living including one’s ability to be mobile. Some patients may require assistance to move around in bed, or to transfer from bed to wheelchair or bed to stretcher. Others may need assistance to ambulate. Changing patient positions in bed and mobilization are also vital to prevent contractures from immobility, maintain muscle strength, prevent pressure injury, and to help body systems function properly for optimal health and healing (Perry et al., 2018). 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., 2018).

General Description—Levels of Assistance

Commonly in acute and residential care settings, patients are assessed and assigned with a “level of assistance” designation. The level of assistance required is based on the patient’s ability to transfer, stand, and cooperate in care activities. Terms to describe different levels of assistance are one way for health care providers to communicate with each other how much and what kind of assistance is required.

The terms may differ from one institution to the next and as such it is the healthcare provider’s responsibility is to know the correct terms in the institutions they are working in (South Island Alliance, n.d.). The level of assistance needed is somewhat subjective can change over time. Thus, the need for constant reassessment and communication by and among the healthcare team (South Island Alliance, n.d.).

The level of assistance should be documented where healthcare providers can easily access the information. This might include the patient’s Kardex, above the head of the bed, and/or in the patient’s chart. Table 3.3 describes general levels of assistance and the terminology sometimes used in hospital and community settings to describe them.

Table 3.3 General Levels of Assistance

Level of Assistance Terminology


 Independent The patient:

  • is able to transfer independently and safely.
Standby Supervision / One Person Assist
  • requires no physical assistance but may require verbal reminder.
  • may also be learning to transfer independently using a wheelchair, walker, or cane.
Minimal Assist / One Person Assist
  • is cooperative and reliable, but needs minimal physical assistance with the transfer.
  • requires minor physical exertion from healthcare worker during re-positioning, assisting to stand / sit, and when ambulating.
  • can consistently fully weight bear when standing.
  • is able to perform 75% of the required activity on their own.
Two Person Assist
  • requires more than minor physical assistance.
  • often needs equipment to assist with transfers or mobilization.
  • is able to perform 50% of the required activity on their own.
Total Assist
  • requires full physical assistance for re-positioning, standing, turning, transfers, and/or mobility.
  • may be unpredictable and uncooperative.
  • requires equipment to assist with re-positioning and transfers
  • is able to perform 0-25% of the required activity on their own.
Data sources: South Island Alliance, n.d.; Winnipeg Regional Health Authority (WRHA), 2008; Worksafe BC, 2006
Special considerations:
  • The weight, height, and general physical, mental, or emotional condition of the patient all influence the potential for injury to the patient and healthcare worker.
  • If the patient is uncooperative or unable to follow commands, there is an increased risk for injury. In these cases, a mechanical lift or assistive device should be used to prevent injury to the healthcare provider and/or patient.
  • 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 healthcare settings (BCPSLS Central, 2015).

Critical Thinking Exercises

  1. A patient requires no assistance from the healthcare provider except for the occasional reminder to lift their feet while walking. What level of activity designation would you give to this patient?
  2. A patient is assessed as needing a one-person pivot transfer. As the healthcare provider begins the transfer, the patient suddenly becomes uncooperative. What should the healthcare provider do next?


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Clinical Procedures for Safer Patient Care Copyright © 2018 by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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