MANUAL HANDLING for Nurses Care Staff Manual Handling

MANUAL HANDLING for Nurses & Care Staff

Manual Handling Is the use of force exerted by a person to: § § § Lift Move Push Pull Carry Living or non living object

Manual Handling Aged care is a high risk industry for injuries § Manual handling involved at work § Working with Residents (who are not always predictable) § Trips and falls at work Most injuries are accumulative in nature whilst some injuries are from a more obvious incident

WHS Legislation Employer responsibilities § § § Providing a safe work environment – free of hazards and risks Provision of Induction Provision of Information Provision of Training Provision of Supervision of employees

WHS Legislation Employee responsibilities § Maintain a safe work environment – clean and tidy and ensure their actions do not create an unsafe working environment § Only perform tasks that you have been trained in (including using or operating equipment) § Follow Standard Operating Procedures (SOP) § Wear protective equipment if required by the SOP § Follow reasonable instructions

WHS Legislation § Report hazards – if you see something that is unsafe, advise your supervisor/manager § Report accidents – when you or another worker is injured (and near misses), be sure to report § Make sure you are not under the influence of drugs or alcohol § Protect your own health and safety at work § You have a duty of care in the workplace, so don’t put other workers at risk

The ‘Hidden’ Impact Of Work Injury § Research claims up to 80% of Australians will experience low back pain in their lifetime § LBP and Occupational Overuse Injuries* cost Australia the most § Pain and discomfort can last for years, affecting work, everyday life, family and relationships Safe Work Australia

Reducing the Risks 3 stages to safe manual handling (a) Hazard Identification (b) Risk Assessment (c) Risk Control Identifying hazards A hazard is any situation that has the potential to cause harm to life, health or property

How can we identify a hazard? ? § On observation/completion of tasks § Communication with staff § Analysis of workplace injury records § Client assessments

Risk Assessment Evaluate the likelihood of injury or illness due to the hazard High / Medium / Low

Consider Risk Assessment § The environment – furniture, space, equipment § Work practices – training, adequate staff numbers, mechanical assistance § Resident ability to assist – cognitive signs, physical signs, behavioural signs

Risk Controlling the If a risk, our aim is to preferably § Eliminate or where not possible, minimise the risk of injury or illness Is there a better way? Evaluate and then suggest a solution to the problem

Manual Handling Principles § § § Stand/sit upright, maintaining a 3 normal curves of the spine Feet wide apart Bend at the hips and knees Avoid twisting and bending of the back Point feet in the direction of movement Keep the load close to the body Firm secure grip Tighten core Use the legs Push rather than pull Safe working height at all times

Lifting the wrong vs the right way

Manual Handling Principles – applies when lifting any object

Back Injuries Occurs when too much STRESS is applied to the back DO NOT lift § With an unsupported back § Twist § Avoid sudden movements § Work in prolonged poor postures

Changes in disc pressure according to position or activity

Spinal Anatomy Vertebra and joints Intervertebral discs are the shock absorbers Ligaments connect bone to bone Tendons connect muscles to bone Muscles and bones provide posture

Posture There is no such thing as a straight back 3 spinal curves

Transversus Abdominis Muscle

Resident Manual Handling Care Plans § Residents are assessed as to their physical capabilities and manual handling needs § Change from time to time and are frequently revised and updated § Familiarity and compliancy by staff to a resident’s Manual Handling Care Plan will ensure resident and staff safety

Performing the Manual Handling Task Check the Care Plan Collect equipment (if necessary) Organise the working area: ‘de-clutter’ Prepare and organise the resident/resident and co-worker if required Perform the Manual Handling technique Can we further minimise the risk by using equipment? § Lifters § Slide sheets

Residents with Behaviours Residents can present with challenging behaviours during MH Strategies to gain assistance from residents § Approach in a calm manner § Introduce yourself (eye level, position yourself off centre, maintain eye contact) § Providing as much cueing and explanation as possible (verbal/physical) § Providing diversion tactics (discussing interests, family members) § Offering rewards (promising a nice hot cup of tea if assisting to get out of bed) Should the above not be successful § Re-attend at later time (negotiate if possible) § Re-attend with another care staff (someone with good history with resident, maybe a favourite care staff) § Re-attend with alternative care staff

Posture § Importance of work specific exercise § Strong back and abdominal muscles § Flexible back and leg muscles minimize the risk of injuries as the physical job demands are more easily met § Individual differences § Home and work - 24 hour back care

Rolling in bed Technique requires 2 x assists § First assist places their hands at shoulder and hip level guiding the movement § Second assist places their hands on top of the first assistant’s hands § Adopt a lunge position engaging the core muscles. The technique is performed by rolling the resident toward the first assistant (ie. push away from self)

Slide Sheets ADVANTAGES § § Prevents chaffing of skin Assist with repositioning of residents and hence prevent pressure area/sores Provide less physical strain Inexpensive DISADVANTAGE Time consuming?

Rolling with a slide sheet Technique requires 2 x assists § § § § Fold sheet in half or use 2 slide sheets Position under the person by rolling them Folded edge is placed under the person Open edges of the sheet FACE YOU Grasp top layer with palms facing upwards Adopt a squat position, pull upwards while the other carer assists at the side the resident is rolled Remove the slide sheet by pulling the bottom layer of the sheet out at one corner

Moving a resident up the bed Technique requires 2 x assists § Bed flat § Slide sheet in half or use 2 slide sheets § Open edges facing head of the bed § Slide sheet placed between shoulder level and hip level § § Position self mirroring partner opposite, one hand at shoulder level, other hand at hip level § Grasp top layer palm facing upwards

Moving a resident up the bed § § § Pull the sheet to make it taught Feet facing in the direction of the movement – toward bed head, side lunge position, back straight, knees bent, eye contact with partner Determine when to slide 1… 2… 3… Resident can assist – bend legs/chin to chest Move with lunging movement from the foot nearest the foot end of bed, to the foot nearest to the head end of the bed Remove the sheet by rolling resident

Assisting with Lying to Sitting 1 x assist – verbal / physical cueing § § § Stand on the side of the bed where the resident will get out of the bed Ask resident to bridge towards the side where they will be getting up from Ask resident to roll onto their side (if possible) Raise the bed head up to a suitable height, approx 30 -50 degrees Ask them to push up with one arm while digging up from the mattress with the other arm, while lowering their legs simultaneously to assist with manoeuvre 1 x assist – physical assistance § § § Repeat above however some physical assistance at the upper trunk or lower limbs is required throughout the whole process (bridging, rolling, pushing up, lowering legs) Ensure correct posture is adopted, abdominal bracing, hips and knees are bent. Raising bed to a higher level may help (if tolerated by resident), ensure bed is then lowered

Assisting with Lying to Sitting 2 x assists – physical assistance § Both care staff to stand on the side that the resident will get out of the bed § Repeat above however physical assistance will be required at both the upper trunk and lower trunk for all steps (bridging, rolling, pushing up, lowering legs) § Ensure correct posture is adopted, abdominal bracing, hips and knees are bent. § Raising bed to a higher level may help (if tolerated by resident), ensure bed is then lowered § Should any of the steps cause potential strain to resident or yourself, refer to Nursing / Physiotherapy staff where the resident can be reviewed

Lifters § § § ADVANTAGES For heavy clients and/or who lack mobility Minimal training Less physical demands on staff DISADVANTAGES Require adequate and accessible storage Expensive Time consuming

Stand Lifters § § § Weight bearing capability Able to lift their feet onto the foot plate Must have 90 degrees of shoulder elevation Grip handles with both hands Predictable and reliable when sitting Need stand by or independent sitting balance

Stand Lifters 2 x staff assist at all times § Client sitting up and able to rest feet on footplate and place shins against shin pad § Apply brakes once into position § Waist strap positioned appropriately § Lower the lifter arms and assist resident to place their arms on the outside of the sling

Stand Lifters § Place cord onto hooks so they are the same length § Do not raise resident too high as this will cause pressure under their arms § Release brakes and move resident to their new position § When client is located to new position apply brakes and loosen sling cords and remove sling

Sling Lifters § § § Dependent residents – chair or bedfast residents 2 x assists are required at all times Position the resident in the sling by rolling them side to side or sitting the resident forward with aid of electric bed

Sling Lifters § Adjust the loop fittings - sitting or lying § Raise slightly off the bed - ensure they are comfortable before proceeding further § When off the bed move the lifter § One staff holds onto the client and ensures they are steady and safe § Other staff manoeuvers the lifter

Assisting with Sit to Stand Verbal Cues Only § Feet behind knees, shoulder width apart § Lean forward having nose over toes § Push up using upper limbs, using bed or arms of chair § Do not allow resident to pull on the PCA or walking aide § PCA may need to stabilise once resident is upright

Assisting with Sit to Stand Providing 1 or 2 x Physical Assists § Stand side on, your front foot in front of their foot to stop slips § Front knee can also be used to block their knee* § Place cupped hand on resident’s shoulder § Rock resident if needed to assist with bringing their ‘nose over toes’ and aid momentum

Walking Aids WALKING STICK / QUAD STICK Hold walking stick or quad stick on their STRONGER SIDE Stand on their WEAKER SIDE Static or Rollator FRAME / 4 WHEEL WALKER Have one hand at the back of the person holding onto either their trousers or supporting the waist Use the other hand to steady and move the frame if necessary Check aids regularly

Take home message § We are not invincible § Adhere to manual handling care plans § Don’t take short cuts or unnecessary risks – they will get you in the end! § If you feel there is a problem report it– if it is a risk to you it is probably a risk to others