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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Wiley Series on Cognitive Dynamic Systems
- Sprache: Englisch
Moving and Handling Patients at a Glance
The market-leading at a Glance series is popular among healthcare students and newly qualified practitioners for its concise and simple approach and excellent illustrations.
Each bite-sized chapter is covered in a double-page spread with clear, easy-to-follow diagrams, supported by succinct explanatory text. Covering a wide range of topics, books in the at a Glance series are ideal as introductory texts for teaching, learning and revision, and are useful throughout university and beyond.
Everything you need to know about Moving and Handling Patients …at a Glance!
From the publishers of the market-leading at a Glance series comes a succinct and visual guide to the topic of moving and handling. Wide-ranging yet easy to read, Moving and Handling Patients at a Glance provides an accessible introduction to the key theoretical underpinnings of moving and handling, including the legal aspects, biomechanics, risk assessment and safe principles of handling. It then explores the practical aspects of handling, supported by clear and straightforward illustrations and photographs.
- A clear, concise and comprehensive guide to moving and handling patients
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Moving and Handling Patients at a Glance is ideal for nursing students, health care assistants, newly qualified nurses, as well as physiotherapists and occupational therapists.
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Library of Congress Cataloging-in-Publication Data
MacGregor, Hamish, author. Moving and handling patients at a glance / Hamish MacGregor. p. ; cm. (At a glance) Includes index. Summary: “Moving and Handling Patients at a Glance provides an accessible introduction to the key theoretical underpinnings of moving and handling, including the legal aspects, biomechanics, risk assessment and safe principles of handling”–Provided by publisher. ISBN 978-1-118-85343-6 (paperback) I. Title. II. Series: At a glance series (Oxford, England). [DNLM: 1. Moving and Lifting Patients methods. 2. Moving and Lifting Patients nursing. WY 100.2] RM700 615.8’2 dc23
2015033803
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: Photograph courtesy of Hamish MacGregor
Contents
Preface
Acknowledgments
Part 1 Theory
1 Legislation: I
2 Legislation: II
3 Structure and function of the spine
4 Posture and back care
5 Safe principles of moving and handling
6 Controversial techniques
7 Risk assessment: moving and handling
8 Risk assessment: general
9 Individual patient handling assessment
Part 2 Practice
Load handling and practical application of ergonomics
10 Lifting a load
11 Pushing a bed
12 Good workstation set-up
13 Postural issues with laptops and tablets
Moving a patient in and out of a chair and walking
14 Assessing the patient before standing from a chair
15 Moving a patient forwards in a chair
16 Standing a patient: with one handler
17 Standing a patient: with two handlers
18 Seating a patient
19 Moving a patient back in a chair
20 Walking with handler(s)
21 Tips for using walking frames
22 Assisting a patient off the floor: verbal
Sitting a patient up, and in and out of bed
23 Sitting a patient using an electric profiling bed
24 Sitting a patient using a non-profiling bed
25 Sitting a patient onto the side of an electric profiling bed
26 Sitting a patient onto the side of a non-profiling bed
27 Lying down a patient from the bed edge
28 Standing a patient up from the bed edge
29 Standing a patient up from the bed edge using a profiling bed
Moving a patient within the bed
30 Turning a patient in bed: verbal
31 Turning a patient in bed: one handler
32 Turning a patient in bed: two handlers
33 Inserting two flat slide sheets under a patient: unravelling technique
34 Inserting two flat slide sheets under the patient: by rolling patient
35 Inserting a roller slide sheet under a patient
36 Moving a semi-independent patient up the bed with a roller slide sheet
37 Moving a patient up the bed with a roller slide sheet
38 Moving a patient up the bed with two flat slide sheets
39 Turning a patient in bed with roller slide sheets
40 Turning a patient in bed with two flat slide sheets
41 Moving a patient's legs into bed with a slide sheet
Use of hoists and slings
42 Types of hoist
43 Types of sling
44 Insertion of sling into bed
45 Removal of sling from bed
46 Insertion of sling into chair
47 Removal of sling from chair
48 Insertion of sling into bed with slide sheets
49 Insertion of sling into chair with slide sheets
50 Hoisting from bed to chair with a mobile hoist
51 Hoisting from chair to bed with a mobile hoist
52 Hoisting from the floor with a mobile hoist
53 Using a standing hoist
Lateral transfers
54 Lateral transfer from bed to bed/trolley
55 Transfer from chair to bed using a transfer board
Other handling equipment
56 Assisting a patient to use a rota-stand: one handler
57 Assisting a patient to use a rota-stand: two handlers
58 Use of standing and raising aids (non-mechanical)
59 Use of equipment for bariatric patients
60 Kneeling and working at floor level
Case studies
Case study 1: Assessing a bariatric patient
Case study 2: Managing leg ulcer dressings in the community (kneeling)
Index
EULA
List of Tables
Chapter 9
Table 9.1
Case study 1
Table CS1
Case study 2
Table CS2
Guide
Cover
Table of Contents
Preface
Pages
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Preface
The purpose of this book is to act as a reminder of how some moving and handling techniques are carried out. It is not a substitute for moving and handling training where you have had an opportunity to discuss, observe, practise and ask questions related to moving and handling. There may be some techniques that may differ in their execution from ones you have received during training or carried out in practice. This does not necessarily mean that one is right and the other is wrong, but there are often some minor differences in the way that techniques are carried out. As long as the safe principles of handling can be applied and a rigorous risk assessment has been carried out in the case of an individual patient, then the technique should be acceptable.
Throughout the book I have used the term handler. The reason for this is to use a neutral descriptive term that covers carer, nurse, therapist or anyone who is involved in the moving and handling of people.
I have also used the term patient. This term is to cover not only patient but client, service user, resident or anyone requiring assistance to be moved and handled.
The book is organised primarily as a practical textbook with the theory section at the beginning kept to a minimum. The reason for this is that there are other publications out there that deal with the theory of moving and handling extensively. I am often asked in training, ‘Do you have any pictures of that?’ hence the emphasis for this book. The techniques described are broken down into their component parts; therefore you may have to read a few chapters to get all the information on moving a patient in a particular situation. This is deliberate and is to maximise the amount of information given in as succinct a way as possible.
To use this book effectively, always read the text first as you are following the pictures on the opposite page. Looking at the pictures and their captions alone will not give you sufficient information.
The primary audience for this book is student nurses, but students of occupational therapy and physiotherapy could also find the book useful. The book may also be a good reference guide for anyone working in health and social care.
Acknowledgments
I would like to thank Keith Parkinson, my partner and co-director of Docklands Training Consultants Ltd, for his support in compiling this book and assisting greatly in the taking of hundreds of photographs. I would also like to thank Penny Clayden, Lyn Maddams, Glynis Watson and Teresa Yiannaco, freelance trainers with the company for their input in the development of this book — without this, the book would not have come to fruition. Finally I would like the thank Lewisham and Greenwich NHS Trust for allowing us to use their training rooms to take the photographs.
Hamish MacGregor
Part 1Theory
Chapters
1 Legislation
2 Legislation
3 Structure and function of the spine
4 Posture and back care
5 Safe principles of moving and handling
6 Controversial techniques
7 Risk assessment: moving and handling
8 Risk assessment: general
9 Individual patient handling assessment
1Legislation: I
This chapter covers three areas of legislation that relate to moving and handling. Chapter 2 will deal with four other areas. This is not a complete list but examples of the major pieces of legislation affecting moving and handling practice.
The Health and Safety at Work Act 1974 (HSWA)
This act and its regulations impose a duty of care on every employer to ‘ensure as far as is reasonably practicable, the health, safety and welfare at work of all employees’. It not only puts duties on the employer but the employees too. A résumé of the act is given in Figure 1.1
The HSWA is a broad piece of legislation and could be described as an umbrella that covers a raft of other legislation that is more specific in its nature to moving and handling. The key areas are two-fold: first, the provision of equipment and a safe system of work to accompany this; second, the provision of information, instruction, training and supervision. The key to good moving and handling practice is not only good training. This should provide the handler with the skills to handle patients safely without injuring the patient or themselves. As important is that the handler has sufficient competent supervision in the workplace to ensure that good practice is maintained.
In addition the employees have to be willing to receive training. This puts responsibilities on the handler to ensure that they attend moving and handling training if it has been provided and they have been given the time to attend. The specifics of training are not defined, but terms such as ‘understandable’ and ‘suitable and sufficient’ are often used. This allows for a degree of creativity in delivering training so that on the job training can be as effective, if not more, than classroom-based training. The important thing is that any training carried out must be documented as to its content, date of delivery and where, with the handler and the trainer signing a document confirming this. If this does not happen then in the case of injury to staff or patient it is not possible to prove what training has taken place.
For more information on the HASWA see link below:
www.hse.gov.uk/legislation/hswa.htm
The Management of Health and Safety at Work Regulations 1999 (MHSWR)
These regulations set out broad duties for improving health and safety, and introduce the requirements for risk assessment and health and safety.
The MHSWR require employers to carry out risk assessments on tasks considered to be hazardous in the workplace and reduce risks to a reasonably practicable level. These risk assessments must be carried out by a competent person.
A résumé of the main terms of the regulations is given in Figure 1.2. The term reasonably practicable is used in the regulations and there is a definition of this term below.
Reasonably practicable means that which is, or was at a particular time, reasonably able to be done to ensure health and safety, taking into account and weighing up all relevant matters including:
The likelihood of the hazard or the risk concerned occurring.
The degree of harm that might result from the hazard or the risk.
What the person concerned knows, or ought reasonably to know, about the hazard or risk, and ways of eliminating or minimising the risk.
The availability and suitability of ways to eliminate or minimise the risk.
Assessing if the cost of eliminating or reducing the risk is grossly disproportionate to the actual risk.
The general terms of the MHSWR can be easily applied to moving and handling activities, but the Manual Handling Operations Regulations 1992 as amended in 2002 (MHOR) are regulations that apply directly to the area.
Manual Handling Operations Regulations 1992 as amended 2002 (MHOR)
These regulations again define the responsibilities of employers and employees.
The MHOR also gives us a definition of manual handling:
Any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or bodily force.
The definition of a load by the Health and Safety Executive (HSE) defines it as ‘a discrete moveable object. This includes, for example, a human patient receiving medical attention… ’
A résumé of the MHOR is given in Figure 1.3.
The interpretation of the MHOR directly affects all moving and handling practice. Avoiding patient handling is usually about maximising patient independence and constitutes the first key safe principle of moving and handling (see Chapter 5, Key safe principles of moving and handling). Assessing risk is key to all good patient handling and forms a cornerstone of good practice and the MHOR gives us a framework to carry this out (see Chapter 7, Risk assessment). The understanding of the risk assessment process allows the handler not only to ‘follow appropriate systems provided for the handling of loads by the employer’ but give them the tools to change the way the patient is moved as the patient condition changes.
For more information on the MHOR see link below:
www.hse.gov.uk/pubns/books/l23.htm
2Legislation: II
Lifting Operation and Lifting Equipment Regulations 1998 (LOLER)
This regulation is aimed at ensuring that all lifting operations are properly planned, lifting equipment is used in a safe manner and that, where necessary, it is thoroughly examined by a competent person.
To decide whether LOLER applies it is necessary to answer two questions – is it work equipment and, if so, is it lifting equipment? The fact that equipment is designed to lift or lower a load does not automatically mean that LOLER applies. The equipment needs to be defined as ‘work equipment’ which is defined under the Provision and Use of Work Equipment Regulations 1998 (PUWER) (see below).
The definition of ‘lifting equipment’ is where the equipment lifts and lowers as its principal function.
Examples of the equipment that come under this definition are:
Patient hoists. (Mobile, ceiling tracking, gantry, bath, standing and bed head.) See Chapter 42, Types of hoist, for more information.
Slings.
Stair lifts.
Equipment such as a variable height bed does not come under the regulations as its principal function is as a bed.
A résumé of the regulations is given in Figure 2.1.
In practice, the key issues here are:
Equipment has to be marked indicating its safe working load.
This means that the handler needs to check the weight of the patient against the safe working load of the hoist and sling. This should be part of the hoist use protocol. It is also important to remember that even if the hoist is able to take the weight of the patient, due to their size and shape it may be necessary to source an alternative hoist and sling.
Equipment which lifts people to be examined by a competent person at six-monthly intervals.
All hoists should have a sticker on them indicating when they were last serviced and checked and when the next service/check is due. Although it may be the organisation that arranges the servicing schedule, it is the responsibility of the individual handler to check the hoist each time before use.
Provision and Use of Work Equipment Regulations 1998 (PUWER)
The definition of work equipment is ‘any machinery appliance, apparatus, tool or installation for the use at work (whether exclusively or not)’.
A résumé of the regulations is given in
Figure 2.2
. The instruction ‘Ensure work equipment is used for operations for which it is suitable’, is the one that is most commonly ignored. An example of this is where a bed sheet is used to move a patient rather than a slide sheet, for example in a lateral transfer (see Chapter 54, ‘Transfers from bed to bed/bed to trolley’). Bed sheets are not moving and handling equipment and are not designed for this purpose therefore their use contravenes this regulation.
For clear guidance on the equipment used under LOLER and PUWER please see the HSE website:
www.hse.gov.uk/pubns/hsis4.pdf
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)
A résumé of the regulations is given in Figure 2.3 and full information is available on the HSE website. See link below:
www.hse.gov.uk/riddor/
RIDDOR places responsibilities on employers to report injuries deemed ‘reportable’ under the act. In relation to back or other musculoskeletal injuries that can happen to patient handlers, Part 4 of the regulation is the one that most commonly applied.
Over-seven-day incapacitation of a worker
Accidents must be reported where they result in an employee or self-employed person being away from work, or unable to perform their normal work duties, for more than seven consecutive days as the result of their injury. This seven-day period does not include the day of the accident, but does include weekends and rest days. The report must be made within 15 days of the accident.
Over-three-day incapacitation
Accidents must be recorded, but not reported where they result in a worker being incapacitated for more than three consecutive days. If you are an employer, who must keep an accident book under the Social Security (Claims and Payments) Regulations 1979, that record will be sufficient.
Human Rights Act 1998
In Figure 2.4, two areas of the Human Rights Act are highlighted.
Article 3: Prohibition of torture
This may not immediately spring to mind as relating to patient handling, but patient handling that is not carried out correctly could be regarded as ‘treatment which is inhuman or degrading’. Hoisting a patient with an incorrectly fitting or incorrect type of sling could be termed degrading.
Article 8: Right to respect for home, private and family life
With all aspects of patient handling, the handlers should always be aware of being respectful and maintaining dignity and privacy. The nature of many of the moving and handling tasks means that we may be using equipment to physically move people. It is important to remember the person that is being moved may be anxious or fearful and in an environment that is alien to them.
A short guide on the act is given in:
www.justice.gov.uk/downloads/human-rights/human-rights-making-sense-human-rights.pdf
3Structure and function of the spine
The spine runs from the base of the skull to the pelvis. It is a double S shape and its main functions are:
To support the body’s weight.
To protect the spinal cord.
The vertebrae
Thirty-three vertebrae make up the spine and these are divided into four areas (Figure 3.1):
The cervical spine (neck) consists of seven vertebrae numbering C1–C7 from top to bottom. Vertebra C1 is also known as the
Atlas
and sits between the skull and the rest of the spine. Vertebra C2, is known as the
Axis
, has a bony projection (odontoid process), the
Dens
, that fits within a hole in the
Atlas
to allow rotation of the neck (
Figure 3.2
). The remaining cervical vertebrae bend inwards in a C shape and form the cervical lordosis.
The thoracic spine consists of 12 vertebrae numbered T1–T12 from top to bottom. The ribs attach to the vertebrae in this section of the spine restricting the range of movement in this area, known as the thoracic kyphosis.
The lumbar spine consists of five large vertebrae numbered L1–L5 from top to bottom (
Figure 3.3
). This area takes the weight of the upper body as well as having a full range of movement. This area, known as the lumbar lordosis.
Sacrum and coccyx consist of nine separate segments which are united in the adult so as to form two bones, five entering into the formation of the sacrum, four into that of the coccyx. This is fused and there is no movement. On the whole the sacrum and coccyx are not too problematic as they are fused together. Sometimes if people fall backwards hard they may crack the coccyx.
The intervertebral discs
There are 23 intervertebral discs in the human spine and these are situated between the vertebrae as follows:
6 in the cervical spine
12 in the thoracic spine
5 in the lumbar spine.
Their function is three-fold:
To act as a shock absorber
To act as a spacer between the vertebrae
To allow movement. Individual disc movement is very limited, however considerable motion is possible when several discs combine forces.
The disc consists of two layers (Figure 3.4): the outer part is the annulus and the inner part the nucleus.
The disc is attached firmly to the vertebra above and below by the ligaments. The disc is oval in shape as it fits on the vertebral body. It is made up of an outer wall (the annulus and an inner nucleus.
The outside wall is made up of 16–20 C-shaped rings of cartilage. They are laid down in opposite directions. This gives the disc good torsional strength.
When you bend forward you place more pressure on the front of the disc. When used correctly it is a good system. Problems occur however when the discs are loaded unevenly. Continued pressure eventually causes the fibres at the back of the disc wall to bulge. This is usually due to the same repeated forces being applied to the same fibres, for example, through repeated bending or through a sudden movement, usually a combination of full forwards and sideways bending. The nucleus works its way through the outside wall and eventually causes the disc to bulge. This is called a slipped disc, prolapsed disc or herniated disc (Figure 3.5). There are no internal nerves in the disc so we are unable to feel this process. However, there are nerves in the very outer layers, so this is when we begin to feel discomfort. Once the bulge presses on surrounding structures that are full of nerves, we feel more severe pain.
The facet joints
The facet joints are like hinges in a dynamic structure which does not lock. They are situated at the back of each vertebra, and they have two key tasks, namely, to allow the spine to bend and twist, and to give the spine stability. When the spine is working well, about 25% of our body weight rests on the facet joints. The facet joints essentially move in three directions forward and backwards (Figure 3.6), sideways and rotation.
Ligaments
The ligaments are tough fibrous connecting tissue that connect the vertebrae (Figure 3.7). Lower back pain is often caused by these ligaments being stretched too far or torn.
Muscles
Back muscles are divided into two specific groups: the extrinsic muscles that are associated with upper extremity and shoulder movement, and the intrinsic muscles that deal with movements of the vertebral column (Figure 3.8).
The extrinsic muscles
Superficial extrinsic muscles connect the upper extremities to the trunk, and they form the V-shaped musculature associated with the middle and upper back. Most of their function is involved with respiration.
The intrinsic muscles
Intrinsic muscles, which stretch all the way from the pelvis to the cranium, help to maintain posture and move the vertebral column. They are divided into three groups: the superficial layer, the intermediate layer, and the deep layer.
