一位85歲女性病患體重 110 公斤 (242 磅)，近期因左側腦血管意外 (CVA) 導致右側偏癱。她意識清楚、能夠配合，且左側肢體擁有完整肌力。護理師與一位 UAP 正準備將她從臥床轉位至輪椅上。護理師必須採用下列哪些人體工學原則與安全病患搬運處置？（多選題）
An 85-year-old female patient weighs 110 kg (242 lbs) and has right-sided hemiplegia secondary to a recent left cerebrovascular accident (CVA). She is alert, cooperative, and has full strength in her left extremities. The nurse and a UAP are preparing to transfer her from the bed to a wheelchair. Which ergonomic principles and safe patient handling actions must the nurse employ? (Select all that apply.)
- APosition the wheelchair at a 45-degree angle on the patient's strong side (the left side).✓ 正解將輪椅置於患者健側（左側）呈45度角
- BInstruct the UAP to grasp the patient tightly under her axillae (armpits) to hoist her upward.指示UAP緊抓患者腋下將其抬起
- CEnsure the patient uses her strong left arm to grasp the right armrest of the wheelchair during the pivot.確保患者在轉動時用健側左手抓住輪椅右側扶手
- DUtilize an electronic full-body mechanical lift or stand-assist device given the patient's weight and significant right-sided deficit.✓ 正解考慮到患者的體重及顯著的右側功能障礙，使用電子全身機械式 lifts 或站立輔助裝置
- EMaintain a wide base of support and bend at the knees, not the waist, if physical pivoting assistance is deemed necessary.✓ 正解若認為需要物理轉位協助，請保持寬廣的支撐基礎並在膝蓋彎曲而非腰部彎曲
本題測試人體工學與偏癱轉位（Hemiplegia Transfer）。護理師轉位首先評估病患重量（110 kg）及局部無力（右側偏癱）。為了避免護理人員職業傷害及病患墜落，面對過重且有巨大神經學缺損的病患，最適當且最優先的「安全搬運法則（Safe Patient Handling）」是使用電動機械吊繩（Mechanical Lift或企鵝機）（選項D正確）。若環境評估允許短距旋轉，必須將輪椅放置在病患的「健康側」（由於右癱，健康側為左側），呈 45 度角，如此她才能以健康的左腳為樞紐旋轉（選項A正確）。在搬運過程中，不論病患重量為何，緊抓腋下往上提（Under the axillae）會導致神經叢受損與肩關節脫臼，是嚴格禁止的錯誤手法（應使用移位腰帶 Gait belt）（選項B錯誤）。若仍需少量近身輔助樞軸旋轉，護理師應雙腳打開採寬底面（Wide base of support），彎曲膝蓋以使用大腿肌肉發力，而非彎腰（選項E正確）。選項C錯誤，病患左手應去抓離她較近的『左側』扶手以建立穩定重心，而非跨越身體去抓右側扶手導致重心偏移。
This question tests ergonomics and hemiplegia transfer. The nurse must first assess the patient's weight (110 kg) and focal weakness (right-sided hemiplegia). To prevent occupational injury to staff and falls of the patient, the most appropriate and highest-priority 'safe patient handling' approach for a heavy patient with a major neurologic deficit is to use an electric mechanical lift or stand-assist device (option D is correct). If environmental assessment permits a short pivot transfer, the wheelchair must be placed on the patient's strong side (since the right side is paralyzed, the strong side is the left) at a 45-degree angle, so that she can pivot on her strong left leg (option A is correct). During the transfer, regardless of the patient's weight, grasping under the axillae to lift upward can cause brachial plexus injury and shoulder dislocation; this is strictly prohibited (a gait belt should be used instead) (option B is incorrect). If close manual assistance for pivoting is still required, the nurse should adopt a wide base of support with feet apart and bend at the knees to use the thigh muscles for power rather than bending at the waist (option E is correct). Option C is incorrect because the patient's left hand should grasp the closer 'left' armrest to establish a stable center of gravity, rather than reaching across the body to the right armrest, which would shift the center of gravity unsafely.
美國法規強烈保護勞工（遵循 OSHA 重視 Zero Lift Programs），絕不鼓勵護理師徒手搬運大於 15kg 固定負重，強制要求使用機械吊管。台灣因設備採購成本及床邊空間限制，臨床上護理師腰椎職災比例仍高，常常只能仰賴自備移位帶結合雙人搬運。