MANUAL HANDLING for Nurses & Care Staff

Manual HandlingIs 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 willexperience low back pain in their lifetime

LBP and Occupational Overuse Injuries* cost Australiathe 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

Risk AssessmentConsider

The environment – furniture, space, equipment

Work practices – training, adequate staff numbers, mechanical assistance

Resident ability to assist – cognitive signs, physical signs, behavioural signs

Risk ControlControlling the Risk

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 jointsIntervertebral discs are the shock absorbers Ligaments connect bone to boneTendons connect muscles to boneMuscles 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 TaskCheck 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 BehavioursResidents can present with challenging behaviours during MHStrategies 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 bedTechnique requires 2x 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 sheetTechnique requires 2x 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 theresident is rolled

Remove the slide sheet by pulling the bottomlayer of the sheet out at one corner

Moving a resident up the bedTechnique requires 2x 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 Sitting1 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 Sitting2 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

2x 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

2x 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 SIDEStand 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 willget you in the end!

If you feel there is a problem report it– if it is a risk toyou it is probably a risk to others