Assist movement Flashcards
Assist with movement
“Manual handling of people” refers to:
any activity that requires the use of force by a person to lift, hold, push, pull, shift, support, carry, lower, move, transfer or restrain another person.
(6) Principles for safe and injury-free manual handling:
Eliminate or reduce the amount of manual handling needed;
Reduce the amount of bending, forward reaching and twisting in all tasks;
Reduce worker fatigue;
Keep all equipment in good working order;
Keep the workplace environment safe;
Ensure that suitable training and education in manual handling is provided to all staff.
Three direct risk factors for manual handling (of people) injuries:
forceful exertion;
working postures (awkward, static);
repetition and duration.
If none of these direct risk factors are found to be associated with the people handling task or action, there is no risk and no need to assess the task or
action
Six contributing risk factors and modifying risk factors for manual handling injuries:
The contributing risk factors are: work area design; work environment; handling procedure. characteristics of the person being handled.
The modifying risk factors are:
characteristics of the worker;
work organisation.
It is the contributing and modifying risk factors that are controlled to manage the risk of injury
Before moving a client:
Use positive communication skills to confirm that you understand your supervisor’s instructions. Discuss any risks, or other concerns that you may have
When you receive the instructions, check the following:
Where the client is being moved from;
Where the client is being moved to;
Why the client is being moved;
The client care plan;
The surrounding environment;
The equipment required to move the client;
The number of staff needed to safely move the client.
Duty of Care responsibilities of employers:
Must provide a ‘safe’ work environment for employees and others;
Must provide suitable manual handling equipment or aids, e.g. slip sheets, walk belts, hoists etc;
Ensure there is sufficient staff to assist with client movement;
Provide education and training in manual handling policies and procedures.
Duty of Care responsibilities of employees:
Follow workplace manual handling policies;
Report any potential hazards;
Use the manual handling equipment provided i.e. slip sheets, walk belts, hoists etc;
Maintain current education and training;
If in doubt - don’t proceed until the issue has been clarified;
Seek advice when necessary;
Continually assess client abilities and report;
Report injuries immediately;
Enable clients to assist when possible;
Adhere to principles of body mechanics when performing any manual handling.
When being assisted to move, clients have the right to know that:
They will be treated with dignity and respect;
They should be comfortable in the care offered to them and they can refuse at any time;
Their concerns and suggestions will be listened to;
They will be acknowledged/included in decision-making;
Their personal information will not be shared without their consent;
All decisions regarding their care will be discussed with them first.
Open disclosure is:
a discussion that occurs after an incident.
If something goes wrong in the process of moving a client you must firstly ensure that the client is safe. Once the client is safe, you need to immediately inform your supervisor.
An open disclosure discussion may include the client, their carers, family and relatives. Open disclosure seeks to determine the cause of the incident and to put measures in place to prevent a recurrence of the incident.
Open disclosure should include:
An apology or expression of regret;
A factual explanation of what occurred, including actual consequences;
An opportunity for the affected patient to relate their experience;
A description of the steps taken to manage the event and prevent its recurrence.
Two main categories of equipment/aids used when assisting client movement:
Aids and devices to assist with manual handling
Mechanical lifting equipment
Aids and devices to assist with manual handling:
Used when the client is able to assist staff with their movement from one place to another. Includes: Slide/slip sheets Pat slide Transfer/slide board Monkey/trapeze ring Bed rails Walk/transfer belt Slings Stretchers/trolley Hoist Walking frame Crutches Wheelchair Shower chair Portable turntable
Mechanical lifting equipment:
Often used when the client is unable to assist with movement and is unable to weight-bear. An example would be raising a resident from a bed or from the floor. This equipment may also be used for a client whose weight makes it difficult for workers to lift them, even if they are able to partially assist with movement. Includes: Standing hoist and slings Standing hoists Mechanical hoists
Hoisting - what can go wrong?
■Selection of the wrong size sling – resulting in discomfort if the sling is too small and a risk of the person slipping through the sling if it is too large.*
■Selection of the wrong type of hoist or sling for the individual, or for the specific task – resulting in inadequate support and increased risk of falling from the sling. For example, access/toileting slings give a great degree of access but very little support and their use should therefore be restricted to toileting purposes, where appropriate.*
■Incompatibility of the hoist and sling – resulting in insecure attachment between the two. For example, incorrectly attaching a loop on a sling to a spreader bar designed for a clip attachment, or attaching a clip on a sling to a spreader bar designed to take a loop attachment. Follow the manufacturer’s advice and refer any concerns about sling/hoist design, supply, manufacturer’s instructions or compatibility claims to the MHRA, the regulator for medical devices (www.mhra.gov.uk).
■Failure of equipment due to poor maintenance, lack of inspection, inappropriate laundering processes or as a result of inadequate repair or modification.
■Leaving a vulnerable person unattended in a hoist, or in a position where they might be at risk of falling from the bed or chair.
■Hoist overturning when manoeuvring over difficult surfaces, transporting an individual over a long distance on a hoist, or not following manufacturer’s instructions for use or safe systems of work.
■Not using the safety harness/attachment (if the sling specified for the individual has one).
■Instability when moving someone on a mobile hoist – resulting in them striking objects. This is likely to cause injury, especially to those with vulnerable skin, and will increase the risk of a fall or overturn. In many cases, assessment will show that two handlers are required: one to operate the hoist; the other to help steady things and, where needed, support the person’s lower legs to keep them in a safe position when moving from one place to another. Importantly, they can also provide direct reassurance to the person being hoisted to maintain their co-operation and reduce the likelihood of them contributing to unstable movement.
Things to take into account when selecting equipment:
The physical ability of the client.
The ability of the client to understand.
The weight of the client.
The height of the client.
The environment.
The type of movement or transfer required.
Preparing the equipment:
Ensure that the equipment is clean and in correct working order. You must also be trained in how to use that piece of equipment.
You may also be required to adjust the equipment, to tailor it for each client.
(It is important to regularly assess and review each client, as their needs can change dramatically. AHP should do this)
To prepare the area in which and through which the move is going to take place:
Think about the layout of the furniture and any other obstacles in the area where the client is at present.
Move anything that could obstruct the clear path through which you intend to move the client. Remember that if you are moving the client to another room or area, you will also need to check that your intended path in that room or area is also clear.
Example: if taking a client to the shower, you will need to check that the shower is not currently in use, that any equipment (such as a shower chair) is available and that there is a clear walkway to move through.
If you are working with another staff member, be sure to work as a team in order to carry out the procedure safely and efficiently.
Explaining a procedure to the client:
Use effective communication skills:
Position yourself face to face with the client.
Introduce yourself to the client.
Be aware of your body language - communication without words.
Speak in a clear voice.
Use a calm tone of voice.
Explain the procedure that is about to take place.
Explain why the move is necessary.
Check the client’s understanding of what you told them by asking them if they know what you are about to do.
Use active listening skills when they respond to you:
show interest in what they are saying;
be patient - don’t interrupt as they speak;
paraphrase;
answer the client’s questions clearly and honestly.
Seeking consent:
Ensure that you have fully prepared the client for the move that is about to take place.
This involves explaining the procedure as clearly as possible and discussing why the move is necessary. If the client understands the necessity and the benefits of the move, they are more likely to consent to the procedure and to co-operate with health care workers.
Be aware that in some situations, clients may not be able to fully understand or cooperate with staff because of physical or cognitive challenges. These may include hearing or sight loss, or confusion. An inability to understand or cooperate may also be due to the client being in pain. It may be that the client may not understand your explanations because of their limited proficiency with the English language.
If a client refuses to give consent for your intervention you should refer the issue back to the supervisor.
Steps to follow when moving a client:
1) Confirm instructions (from the registered nurse or team leader). Consult the care plan regarding movement of the client. Check the identity of the client and any special needs
2) Explain the procedure to the client and enlist their consent and cooperation.
3) Wash your hands before carrying out the move.
4) Gather the equipment that you require for the move
5) Enlist the help of other staff if required.
6) Plan the procedure with the other staff.
7) Respect the client’s risk and dignity throughout the move. Close the door if appropriate; ensure that the client is covered with clothing etc.
8) Minimise risks to the client and workers by using safe manual handling techniques and team work.
9) Carry out the procedure in a safe and efficient manner (follow PsandPs).
10) Ensure comfort. On completion of the procedure, leave the client in a comfortable position.
11) Leave the area tidy.
12) Wash your hands after the move has been completed.
13) Clean equipment before storage.
14) Store equipment according to workplace policies.
The falling client:
If a client is falling it is important that workers do not put themselves at risk trying to ‘save’ the client.
Risk factors for falls:
Age (elderly);
Sensory-perception alteration;
Cognitive impairment (decreased LOC, confusion);
Poly-pharmacology;
Urinary incontinence;
Ability to communicate (language barriers);
Lack of safety awareness (height of bed, attachments and tubes);
Environmental factors (dim light, tripping hazards, uneven floors).
Fall prevention strategies and safety measures:
Look for fall risk factors in all patients. Identifying specific factors helps you implement specific preventive measures. Risk factors include age, weakness on one side, the use of a cane or walker, history of dizziness or lightheadedness, low blood pressure, and weakness.
Follow hospital guidelines for transfers.
Transfer guidelines provide a good baseline for further patient risk assessments.
Orient patient to surroundings.
Orient patients to bed, surroundings, location of bathroom and call bell, and tripping hazards in the surrounding environment.
Answer call bells promptly.
Long wait times may encourage unstable patients to ambulate independently.
Ensure basic elimination and personal needs are met.
Provide opportunities for patients to use the bathroom and to ask for water, pain medication, or a blanket.
Ensure patient has proper footwear and mobility aids.
Proper footwear prevents slips.
Communicate with your patients.
Let patients know when you will be back, and how you will help them ambulate
Keep bed in the lowest position for sedated, unconscious, or compromised patients.
This step prevents injury to patients.
Avoid using side rails when a patient is confused. Side rails may create a barrier that can be easily climbed and create a fall risk situation for confused patients.
Keep assistive devices and other commonly used items close by.
Allow patients to access assistive devices quickly and safely. Items such as the call bell, water, and Kleenex should be kept close by, to avoid any excessive reaching.
Lowering a Patient to the Floor:
A patient may fall while ambulating or being transferred from one surface to another. If a patient begins to fall from a standing position, do not attempt to stop the fall or catch the patient. Instead, control the fall by lowering the patient to the floor.
- If a patient starts to fall and you are close by, move behind the patient and take one step back.
Look and be attentive to cues if a patient is feeling dizzy or weak. - Support the patient around the waist or hip area, or grab the gait belt. Bend your leg and place it in between the patient’s legs.
Hand placement allows for a solid grip on the patient to guide the fall. - Slowly slide the patient down your leg, lowering yourself at the same time. Always protect the head first.
Lowering yourself with the patient prevents back injury and allows you to protect the patient’s head from hitting the floor or hard objects. - Once the patient is on the floor, assess the patient for injuries prior to moving.
Assesses patient’s ability, or need for additional help, to get off the floor. - Provide reassurance and seek assistance if required.
If required, stay with the patient and call out for help. - If patient is unable to get up off the floor, use a mechanical lift.
If patient still feels dizzy or weak, using a mechanical lift will prevent injury. - Complete an incident report according to agency policy.
An incident report helps identify and manage risks related to patient falls.
Safety considerations when dealing with falls:
There is always a potential fall risk during transfers and ambulation. Prevention is key.
If a patient begins to feel dizzy, have them sit on a chair or the floor to avoid a fall.
The head is the most important part of the body; always protect it as much as possible.
In the event of a fall, stay with the patient until help arrives.
After a fall, always assess a patient for injuries prior to moving them. If the patient remains weak or dizzy, do not attempt to ambulate them. Seek help.
Special considerations:
Use a falls risk assessment tool for all patients according to agency policy;
Younger patients may not be aware of the effects of medication and treatments leading to dizziness and orthostatic hypotension;
Inform patients and family members about the potential risks for falls in the hospital. If informed, people are more likely to call for assistance;
Always ensure call bell is in place. Many falls occur due to incontinence issues. The call bell allows patient and family to obtain assistance quickly;
If appropriate, educate patient about home maintenance and safety to prevent falls when returning home;
Fall prevention is interdisciplinary. Proper communication by the care team is required to prevent falls.
