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Principles of Moving and Handling Patients

Manual handling is defined as ‘the lifting, lowering, pushing, pulling, carrying, transporting or supporting by hand or bodily force any object including a person’.

The emphasis for movement and handling must be to undertake an efficient movement, using a suitable and appropriate method whilst maintaining client safety and comfort. An efficient movement is one that achieves the objective by employing minimal effort to do so with the minimum of strain.

The term ‘lifting’ has previously been widely used to refer to movement and handling activities. However, this term has been seen to indicate the need to take the client’s full weight as part of movement and handling. In recent years it has become readily apparent that to undertake such a manoeuvre is potentially dangerous for both the nurse and the client. For these reasons, ‘lifting’ is now considered an inappropriate term and its use to describe movement and handling activities is discouraged. Indeed the manual lifting of clients is now deemed unsafe in most institutions and is not generally recommended under any circumstances.

Care of self
Back injury is the largest single cause of long-term sickness, with reported back pain being most common in those with skilled manual, partly skilled and unskilled jobs. The true cost of back injury to industry is difficult to define.

There is now a great deal of legislation relating to manual handling, which sets out responsibilities and gives guidance for both employers and employees. The dangers of manual handling to the nurse are now well understood: ‘One in four qualified nurses has taken time off with a back injury sustained at work and for some it has meant the end of their nursing career’. All nurses and carers must be aware of and consider these risks and adopt safe principles of manual handling. The need for safety in practice has now been recognized as a fundamental necessity.

The UKCC (1996) stated: ‘although the most important consideration must be the patient’s safety and well being, this must not be at the expense of the nurse’s health and safety’.

The importance of looking after one’s back is vitally important, not only at work but also at all other times during the day. An injury sustained outside of work will still have the same effect on a career involving movement and handling activities as one sustained during these duties. Caring for oneself and one’s back should therefore be a 24-hour responsibility and the reader is reminded that the adoption of safe movement and handling techniques outside of work is just as important as undertaking these at work. By avoiding top-heavy postures and following simple principles of safe movement and handling, it is possible to maintain a fit and healthy back and consequently look forward to a long and rewarding career.

Top-heavy posture
Top-heavy posture relates to positions where the individual is leaning slightly forwards or bending forward with the spine arched and not in its natural line. This position is often adopted unconsciously, with the individual being unaware of the fact that they are bending and arching the spine. Although immediate problems may not be felt, both short- and long-term effects and injury can occur with the recurrent use of a top-heavy posture.

Simple principles of safe manual handling
Thinking through each individual situation and applying the following simple principles when moving and handling will enable you to maintain health and safety whilst undertaking the task.
• Assessment of the task
A full and comprehensive assessment should be made of the task before undertaking the move. This assessment of all aspects of the task will enable you to identify risks and hazards and to problem solve to enable the undertaking of safe manoeuvres.
• Maintain a stable base
Position the feet slightly apart, with the lead foot pointing in the direction of movement. Stability provided by positioning the feet in such a way will prevent loss of balance and falling or twisting during the manoeuvre. When moving and handling a client, for example from one bed to another, it may seem impossible to keep both feet on the floor to provide a stable base without over stretching. It is possible and the situation should be reassessed so as to ensure a stable base whilst undertaking the move. If this is difficult seek guidance from the in-house moving and handling trainer.
• Lower the centre of gravity
By bending or flexing the knees slightly, the centre of gravity will be lowered. This bending of the knees will not only help the posture to be more relaxed and less taut but also provide more stability.
• Keep the spine in line
The spine’s natural curves should be maintained in their normal position, often referred to as ‘in line’, to prevent the occurrence of injury during movement and handling activities. Keeping the spine ‘in line’ also means avoiding top-heavy postures and positions where the spine is twisted or rotated at any point.
• Keep the load close to your body
Keeping the load close to the body reduces the strain/effort involved in the manoeuvre, by having the load closer to the centre of gravity. It increases efficiency of the movement. It reduces the likelihood of injury.
• Move your head up
Raising the head in an upward direction/movement when undertaking a move leads the body in its movement and helps maintain good posture throughout.
• Holds
Holds used should be relaxed palm-type holds or stroking. Grasping or direct holds should not be used. Using indirect holds allows the hold to be released should the manoeuvre be beyond one’s abilities and reduces the likelihood of injury. Stroking down clients’ limbs to aid in their movement is gentler for the client and they are less likely to respond by suddenly withdrawing the limb, which could result in one being jerked or injured.
• Remember individual capabilities
Remember to consider the individual capabilities of all concerned in the manoeuvre; this includes you and your colleagues as well as the client. Those who have had previous injuries, or pregnant women, may be at greater risk when moving and handling.
• Know the equipment
It is important to know not only what equipment is available, but also how to use it correctly and to its fullest potential. One should also be aware of the correct methods for sizing of slings/accessories to ensure these are used correctly. The maximum safe working load of all pieces of equipment used in the area should be known. Equipment should be well maintained and serviced regularly. Do not use if faulty and ensure that faulty equipment is labelled as such and reported immediately. All equipment should be checked at least annually and a record kept.
• Good communication
Good communication is important so that everyone involved in the manoeuvre is aware of what their responsibilities are in relation to the move, and when the manoeuvre is to take place. This will also help to ensure that the move is carried out at the correct time in an organized manner. Communication with the client is also vital not only to ensure their co-operation but also to maintain their trust and confidence.
• Controlled manoeuvres
Remember that manoeuvres need to be controlled and taken in stages if necessary to avoid over-stretching for those undertaking the move and to avoid discomfort or fear for the client.
• Wear appropriate clothing and footwear
Wearing correctly fitting and appropriate clothing will enable free movement without being restricted. Correct footwear will ensure good stability and grip and thus prevent over-balancing or slipping.
• Avoid manual handling
Manual handling, that is, physically moving objects or persons, should be avoided if at all possible.

Remembering these principles and being able to apply them in the variety of movement and handling tasks undertaken both in the workplace and in everyday life will enable problem solving and the identification of safe solutions in respect of movement and handling.

Adopting these principles will provide a more flexible approach to manual handling than learning a specific move for a specific situation, where in real life other factors involved often make such specific manoeuvres learnt unsuitable or unachievable in the practice setting.

Legally, every employer must ensure that his or her employees receive adequate health and safety training including manual handling training. This training should be repeated periodically where appropriate, usually annually, and adapted to take into account any new or changed risks. Therefore, any changes made after assessing a manual handling operation should be accompanied by a degree of training. The employee is duty bound to attend these training sessions.
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