Manual Handling

Question 1

What is Manual Handling?

Answer 1

Procedures and strategies regarding the movement of partially and fully immobilised patients with risk averse methods to protect them and their carers

Question 2

What is Bariatrics?

Answer 2

Field of medicine concerning weight loss and applies to the care for obese patients

Question 3

Which Act provides a legal framework for manual handling procedures?

Answer 3

The Workplace Health and Safety Act (WHS) 2012

Question 4

What’s the difference between a hazard and a risk?

Answer 4

A hazard is any situation that could possibly harm someone like a trip hazard or electricity. A risk is the possibility of harm that arises when exposed to a hazard

Question 5

What are the 3 components of the Hierarchy of Risk Control?

Answer 5

Level 1: Eliminated the hazard EG removing clutter or safely disposing of sharps

Level 2: Substitute the hazard for something safer EG using a hoist or trolley to avoid manual lifting

Level 3: Do not control the hazard but rely on human action to reduce risk EG using PPE to create a barrier between the person and the hazard

Question 6

What are the principles of Manual Handling to mitigate injury?

Answer 6

Stand with feet shoulder width apart
Brace from lower back
Bend from knees
Lift with thighs
Keep elbows and load close to your body
Keep back straight
Use 2 hands to carry
Keep head facing forward
Push rather than pull
Avoid lifting over shoulder height
Avoid repetitive movements
Avoid holding same positions for long periods
Use mechanical aids correctly
Carry at waist height

Question 7

Describe how to verbally assist a patient from the floor

Answer 7

• If the patient is independent and has been assessed as uninjured by RN or doctor you can assist them to get up.
• Instruct the patient to roll onto their stomach and push themselves up to their knees
• Push a chai in front of them and ask them to place their hands flat on the chair seat
• Push a second behind them so that the seat touches their buttocks
• Instruct them to raise one knee with their foot flat on the floor
• Ask the patient to push up on their foot, raising their buttocks up
• Slide the chair under their buttocks
• Instruct the patient to slide into a seated position on the chair

Question 8

Describe how to assist a patient in standing from a seated position

Answer 8

• Stand behind the patient facing the same direction
• Encourage the patient to carefully move their bottom to the edge of the chair
• Ensure their feet are below their knees, hip width apart
• In the lunge stance, place one hand on their lower back and the other hand on the front of their shoulder
• Ask the patient to push down on the arm rests to achieve a standing position on the count of three
• Simultaneously, on the count of three, assist by applying slight pressure to the centre of their lower back as they make a forward lunge.

Question 9

Describe how to assist a patient with walking

Answer 9

• Should only an option when a patient can reliably weight bear. If they need significant help to walk you should question whether they should be walking at this point.
• Allow the patient to walk to the nearest wall or handrail
• Walk beside the patient and allow them to rest their wrist on your near side arm for guidance/reassurance only
• Do not allow the patient to hold your hand
• Do not use the patient’s trousers or belt
• Position a chair for the patient to aim towards
• Do not allow the patient to use you as a prop
• Some stand aid hoists can be used for walking patients and are specifically designed for this use

Question 10

Describe how to assist a semi-independent patient out of bed

Answer 10

• Ask the patient to shuffle over to the edge of the bed and roll onto their side facing the edge of the bed
• Instruct them to place their top hand flat on the bed by their shoulder
• Stand in front of the bed whilst raising the head of the bed fully
• Instruct the patient to simultaneously swing their legs over the side of the bed while pushing with their upper hand against the raised head rest to achieve a sitting position
• Once in an upright sitting position lower the bed and ask the patient to shuffle their bottom towards the edge of the bed
• Ensure the patient’s feet are under their knees and flat on the floor, hip width apart
• Raise the bed up to assist the patient to a standing position
• Steady the patient with one hand on the front of their shoulder

Question 11

Describe how to move a patient up the bed using slide sheets

Answer 11

• Explain the procedure and gain the patient’s consent
• Adjust the bed height to the pelvic level of the smaller nurse, the taller nurse can bend their knees and brace their thighs against the bed
• To roll the patient onto their left side, instruct the patient to position their right arm across their body to their left shoulder (the sight which they are going to roll)
• Instruct the patient to raise their opposite knee (right) with their foot flat on the bed
• Nurse one on the patient’s left side positions a hand the patient’s right shoulder and their other hand the patient’s right knee
• Nurse two on the patient’s right-side places one hand on the patient’s right hip and their other hand on the patient’s right shoulder
• On the count of three, nurse one will exert downward pressure on the patient’s raised knee as nurse two exerts a pushing pressure on the patient’s hip and shoulder
• Nurse two positions the gathered slide sheet (either folder, with open ends facing in the direction of movement or two whole slide sheets on top of each other) taking care to tuck at least half of the sheet into the patient’s back. If using only one sheet, take care that it’s positioned under the patient’s buttocks and shoulders
• Nurse one rolls the patient away from them, the patient raises their left knee and places their left hand on their left hand on their right shoulder to the reverse the roll onto the opposite side.
• Nurse one pulls through the gathered slide sheet, repositions and the patient is rolled onto their back
• NOTE: An independent patient can use their legs to push themselves up the bed once the slide sheets have been safely put in place. Semi-independent may only be able to use one leg if safe to do so.
• Nurses one and two grip the slide sheet level with the patient’s shoulder and hip, keeping palms facing upwards.
• Ensure elbows are braced and tucked into your sides with back feet facing each other and front feet facing the top of the bed,
• On agreed count of 1,2,3 both nurses lunge towards the top of the bed with the patient pushing their feet on the mattress if safe to do so.
• To remove the slide sheet, simply reverse the rolling process. DO NOT drag the slide sheet out from the patient as this could damage skin integrity.
• NOTE: If the patient is completely dependent you should use a lifting aid or hoist

Question 12

Describe how to move a patient across the bed using slide sheets

Answer 12

• Position the slide sheet under the patient with open ends facing the opposite side of the bed
• Raise the bedrails on the opposite side of the bed
• Both nurses brace elbows at their sides, and thighs up against the bed, feet hip width apart.
• Nurse one places a hand on the side of the patient’s shoulder and hip
• Nurse two places a hand on the patient’s hips and legs
• On an agreed count of three both nurses push, keeping themselves braced as the patient slides across the bed

Question 13

Describe how to use a hoist to transfer a patient

Answer 13

• Make sure you are familiar with how to use hoists and slings and follow standard operating procedure. Also ensuring that the hoist has been serviced in the last twelve months, if not, refrain from using it and report it.
• Check that the weight limit of the hoist is appropriate
• Slings come in different sizes, the right slight must match the hoist
• Never use the hoist for transporting patients
• Never hoist a patient alone
• Leave the brakes OFF when the hoist is operational, this is essential for the hoist to maintain equilibrium
• Maintain patient’s dignity
• Explain to them what you are doing and reassure them
• Do not leave them hoisted for any longer than necessary
• Ensure that the hoist in plugged into the socket when not in use or the battery will drain

Question 14

Describe how to use a stand aid hoist

Answer 14

• Position the patient on the side of the bed or chair
• Place the Stand Aid Hoist in front of the patient
• Ask the patient to place their feet on the foot plate
• Fit the knee straps if the hoist has one
• Position the sling and tighten the strapped
• Raise the hoist and move the new location
• Lower to the new chair or bed and unfasten

Question 15

Describe how to assist a patient from the floor using a sling hoist

Answer 15

• If the patient is on the floor due to a fall they need to be assessed by a RN or doctor
• If the patient is dependent or the accountable person has assessed that they need to be hoisted:
• Roll them onto their side and fit a full body sling
• Keep them in a safe posture
• Position the hoist into the side of the patient
• Ask the patient to bend their knees up
• Widen the hoist’s legs to roll under the patient’s knees and neck
• Attach the hoist slings
• Raise with the hoist to a bed or chair
• NOTE: If the patient is awaiting an ambulance due to a hip or head injury for example, leave them on the floor and make them as comfortable as you can