Competency assessment of healthcare workers in moving and

Competency assessment of healthcare workers in moving and handling Hamish Mac. Gregor RN, BA (Hons), MSc Docklands Training Consultants Ltd www. docklandstraining. com

Who are we? • We are a company that specialises in moving and handling training and consultancy. • We work with health, social care, education and individuals with complex needs. • We offer training, service management, training needs analysis, complex risk assessment and development of handling plans.

Where are we with moving and handling training? • Less time to carry out the training? • Less frequency in training. Up to 3 years between updates? • Competing with other mandatory training subjects. • Can we justify that we need more time and more frequent training because we are more important than other topics?

How effective is the training that you provide? • Are you truly assessing competency? • Is it a tick box exercise? • Is there a synergy between classroom and the practice area, whether it be health or social care? • How many of you issue a certificate of competence? Or is it just a certificate of attendance?

Some terms used • Handler • Patient • Clinical area

Definition of competency • The ability to do something successfully or efficiently. • Successfully –accomplishing a desired aim or result • Efficiently - In a well organised and competent way (Oxford English Dictionary)

Successfully and efficiently • Immediately after the training? • When the handler returns to the clinical area? • Three months or six months after the training? What if it is a technique that is not used often by this handler? • Or another measurement?

Competency in relation to moving and handling • Will not cause the patient any harm. • Will maximise patient dignity and comfort. • Will maximise patient independence. • Will not potentiate musculoskeletal disorders in the handler by adopting poor postures during the technique.

Hoist Example Is the handler competent when 1. They can assess if the patient is suitable for this handling technique? 2. They know how the hoist works and can check it? 3. They can safely insert a sling and attach to a hoist? 4. They can safely move the patient from one surface to another? 5. They can remove the hoist and sling safely? 6. They maintain good posture and apply good principles of safe handing? 7. All of above and more?

And more? • With dignity and respect • Is the patient in a good functional position at the end of the technique? • Did the patient experience any fear or anxiety? • Did the patient experience any pain and/or discomfort? • If any of the above happened does the handler know what action to take?

Your experience of hoist training • How long was the session? 1. Less than 30 minutes 2. Between 30 minutes and 1 hour 3. Between 1 hour and 2 hours 4. More than 2 hours

Your experience of hoist training • How often were you updated? 1. 2. 3. 4. Yearly 18 months 2 years 3 years

Competency assessment “checklist” • Part of Medical Devices Training Look at assessment document in pairs and discuss • Is it adequate or not? • Is there anything missing? • Any other comments?

Let’s look at the issue of competence more widely. • I am going to introduce you to Di. NO. Which is not a Pokemon character or a cartoon dinosaur.

What is Di. NO? • A Direct Observation Instrument for Assessment Of Nurses’ Patient Transfer Techniques. (Johnsson, C et al (2004)). • Observational checklist. • Checking competent compliance.

Why Di. NO? • A tool that is easy to use. • Encompasses moving and handling from a patient focus (maintaining safety and dignity) as well as a postural analysis aspect for the nurse.

Description of Di. NO? • 16 sections divided into 3 phases. 1. Preparation phase. 2. Actual performance phase. 3. Results phase.

Di. NO score sheet Name. . . . Ward/Dept. . . . . Date. . . . Item Score 0 1 Information Remarks categories 1. Is the patient encouraged to cooperate? No Yes 2. Is there enough room prepared for the transfer? No Yes 3. Wheelchair, and other objects that the patient is transferred between, positioned and locked in the correct way? No Yes 4. Is the height of the bed/trolley correct? No Yes Already correct Not possible to correct Not relevant 5. Use of the transferring aids(s)? No Yes No aids available Not needed 6. Correct use of transferring aids (s)? No Yes Not relevant 7. Are there enough nurses? No Yes No more nurses are available Preparation phase Already enough. Not possible to make more space. Already correct Not possible to correct Not relevant

Di. NO score sheet Name. . . . Ward/Dept. . . . . Date. . . . Item Score 0 1 Not at all fulfilled Totally fulfilled Not at all fulfilled High Totally fulfilled 12. To what extent are the criteria in communication and interaction with the patient fulfilled? a Not at all fulfilled Totally fulfilled 13. Is the patient allowed to participate according to her /his ability to perform voluntary movements? a Not at all fulfilled Totally fulfilled Actual performance phase 8. Good balance a 9. Good coordination a 10. Good economy of movement a 11. How is the load on the back and shoulders a Totally fulfilled Low Information categories Remarks

Scale used in “Actual Performance Phase” Bipolar rating scales from 0 to 4 with endpoints indicated in the table. Endpoint 0 corresponds to a score of 0, 1 = 0. 25, 2 = 0. 5, 3 = 0. 75 and endpoint 4 corresponds to a score of 1.

Di. NO score sheet Name. . . . Ward/Dept. . . . . Date. . . . Item Score 0 1 14. Does the transfer technique chosen by the nurse cause any pain to the patient? Yes No 15. Does the transfer technique chosen by the nurse cause any feelings of fear or uncertainty in the patient? Yes No 16. Is the patient in a functional position at the end of the transfer? No Yes Results phase Information Remarks categories

External factors • Organisational culture and climate • Management expectations

Organisational culture and climate • Culture can be described as the ground level attitudes, in this case, this is at clinical level. E. g. Pressures of workload, skill mix, feeling overwhelmed or alienated, etc. • Climate is imposed by the organisation and includes interventions such as policies, procedures, training targets and compliance with regulatory bodies.

Management Expectations • In interviews with managers over half expressed a preference for clinically based training. • Reason being “Did not have to release staff from the ward for training”.

Comparing preferences by discipline for location of manual handling training.

Some other factors • Clinically based training can be more costly as teaching time can be limited and often curtailed or cancelled. • Alternatives to direct training in clinical areas such as key trainers can be affected adversely by staff turnover, lack of time and a willingness of staff to participate.

Some conclusions • Becoming familiar with Di. NO provided us with a user friendly and effective competency assessment tool. • Training models need to be more flexible. • Internal and external organisational pressures can have profound effects on training interventions.

Any questions? Hamish Mac. Gregor www. docklandstraining. com

References and acknowledgments • Dr Mike Fray, Loughborough University. • Johnsson C, et al (2004). A Direct Observation Instrument for Assessment Of Nurses’ Patient Transfer Techniques. • Johnsson C, (2005). The Patient Transfer Task. Methods for Assessing Work Techniques. • Hignett S, et al (2007) Competency based training for patient handlers.