Sunshine People Training

Susie Constantine

Moving & Positioning

What is Manual Handling?

Manual Handling at Work involves:

Lifting,

Lowering,

Pulling,

Pushing or

Carrying.

Supporting People:

Get in or out of bed

Turn over in bed

Sit up in bed

Bathe

Shower

Use the toilet

Sit in a chair

Standing

Walking

Get up from the floor after a fall, or

Get in and out of a vehicle.

LegislationThere are laws about safety at work. Those laws inform our policies and

procedures. Workers as well as managers must Health and Safety law:

Health and Safety at Work Act 1974 (HASAWA)

Manual Handling Operations Regulations 1992 (2002)

Provision and Use of Work Equipment Regulations

1998.

Reporting of Injuries, Diseases and Dangerous

Occurrences Regulations 1995. (RIDDOR)

Health and Safety (First Aid) Regulations 1981.

Lifting Operations and Lifting Equipment Regulations

1996

Your SpineThe intervertebral discs are under

constant pressure. As discs degenerate

and weaken, cartilage can bulge or

be pushed into the space containing

the spinal cord or a nerve root, causing

pain.

Studies have shown that most

herniated discs occur in the lower,

lumbar portion of the spinal column.

Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve,

the large nerve that extends down the

spinal column to its exit point in the pelvis

and carries nerve fibres to the leg. This

compression causes shock-like or burning

low back pain combined with pain through

the buttocks and down one leg to below the

knee, occasionally reaching the foot

1. Healthy disc2. Nerve3. Slipped disc4. Damaged disc5. Spinal cord

A slipped disc occurs when the outer case of

the disc ruptures (splits), resulting in the gel

inside bulging and protruding out of the disc.

The damaged disc can put pressure on the

whole spinal cord or on a single nerve root.

This means that a slipped disc can cause pain

both in the area of the protruding disc and in

the area of the body that is controlled by the

nerve that the disc is pressing on.

It is not always clear what causes a disc to

break down, although age is a common

factor in many cases.

As you get older, your spinal discs start to lose

their water content, making them less flexible

and more likely to rupture

M.S.D’s• Osteoporosis is a metabolic bone disease marked by progressive

decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or

absorbs too much existing bone. Women are four times more likely than men

to develop osteoporosis. Caucasian women of northern European heritage are at the highest risk of developing the condition.

• Fibromyalgia is a chronic disorder characterized by

widespread musculoskeletal pain, fatigue, and multiple “tender

points,” particularly in the neck, spine, shoulders, and hips. Additional

symptoms may include sleep disturbances, morning stiffness, and

anxiety.

• Spondylitis refers to chronic back pain and stiffness caused by

a severe infection to or inflammation of the spinal joints. Other painful

inflammations in the lower back include infection in the bones of the

spine and inflammation in the sacroiliac joints

Gout-

Is a type of arthritis, crystals of sodium urate (which should be expelled

through kidneys, builds up in tiny crystals) forms around the joints.

There is usually swelling, severe pain, redness and affects the big toe.

Develops rapidly to its worst in 6-24hours and lasts for 3-10 days.

Contributory factors are age, gender (men 4xmore likely), obesity, high blood

pressure, eating sardines and liver frequently, or drinking beer/spirits. Men who

drink 2 or more sugar sweetened drinks a day are 85% more at risk.

Treatment is exercise, balanced diet and taking NSAID’s.

Osteoarthritis-

Most common MSD, 1 million people visit their GP every year. Symptoms

include Mild inflammation around joints, cartilage damage, ‘knobbly’ bony

growths.

Affects the knees, hips, spine, big toe and hands. Most common in women

over 50. Signs include grating sound, ‘knobbly’ joints, weakness and muscle

wastage.

Rheumatoid Arthritis:Is pain and swelling in the joints. Especially hands, feet and wrists. Most

common in women, between the age of 40-70 around 580,000 in the

UK are sufferers.

It is an autoimmune disease(immune system attacks itself), it disposes

cells in the lining of the joints. Joints become swollen, stiff and painful.

Carpal Tunnel Syndrome:

Is pain, numbness and tingling in fingers and thumb.

It is the compression of the median nerve that controls sensation and

movement. The Carpel Tunnel is a narrow passage in the wrist that

controls the small bones and tough tissue.

50% of pregnant women get CTS but it does disappear about 3 months

after birth.

Wrist splints are usually worn to support the area.

Surgery may be required to reduce to pressure in severe cases but a lot

of cases disappear on their own.

Back PainBack pain (also known as dorsalgia) is pain felt in the

back that usually originates from the muscles, nerves,

bones, joints or other structures in the spine.

acute (less than 4 weeks), sub acute (4 – 12 weeks), chronic (greater than 12

weeks

half the adult population of the UK (49%) report low

back pain lasting for at least 24 hours each year

FOUR out of every FIVE adults WILL experience back pain

at some stage in their life. 50% of those will experience another attack.

Back pain is just as common in adolescents as in adults

These chronic patients have considerable discomfort and

account for approximately 80% of the social and health

care costs.

£512 million on hospital costs for back pain

patients.

NHS Top Tips Top 10 tips for a healthy back, including lifting advice, how to sit properly and back-strengthening exercises.1. Exercise your back regularly. Walking, swimming (especially backstroke) and using exercise bikes are all excellent ways to strengthen your back muscles.2. Always bend your knees and your hips, not your back.3. Never twist and bend at the same time.4. Always lift and carry objects close to your body.5. Try to carry loads in a rucksack and avoid sling bags.6. Maintain a good posture. Avoid slumping in your chair, hunching over a desk or walking with your shoulders hunched.7. Use a chair with a backrest. Sit with your feet flat on the floor or on a footrest. Change how you sit every few minutes.8. Quit smoking. It is thought that smoking reduces the blood supply to the discs between the vertebrae and this may lead to degeneration of these discs.9. Lose any excess weight10. Choose a mattress suited to your height, weight, age and sleeping position.

Risk AssessingBefore attempting to move someone, ask yourself:

• Does the person need help to move?

• Does the person require help or supervision?

• Have you told the person you're moving them?

• How heavy is the person you're moving?

• Are you healthy and strong enough to move them?

• Is there anyone who could help you?

• How long will it take?

• Is there enough space around you?

• Are there any obstacles in the way?

• Are you wearing suitable clothing and shoes?

Think: P.E.A.C.E

P.E.A.C.E

• PERSON- Your Client

• ENVIRONMENT – Look around you, is it safe?

• ACTIVITY- What are you doing?

• CARE WORKER- Freshness or Fatigue?

• EQUIPMENT- What is available?

Hazards

The Risk Assessment

Eliminating : If you identify a HIGH risk activity,

then you must TAKE ACTION to reduce the level of

risk or try to remove it. Then you MUST REPORT it

Reducing: You must however also give priory to

LOW & MEDIUM risks too. Sometimes you cannot

eliminate risk factors, but you can manage to

reduce the risk to more acceptable level.

CATEGORIES: LOW MEDIUM HIGH

Always read the care plan.

Client characterises grading

Completion of this section is to

enable staff to assess what level of

risk is apparent when handling the

client, and considering all factors.

A high risk client may require hoisting

or more manual handling.

The Assessor must take action to

make the risk as a low a reasonably

practical

Detailed Assessment

•T=

• I=

•L=

•E=

TASK- What has to be done, how and when and

why?

INDIVIDUAL- who is providing the task? Can this

be safely managed by each member of staff?

LOAD- The person or object be move, and

factors which affect this

ENVIRONMENT- Where is the activity taking

place?

INANIMATE LOADS

Fall Prevention…Falls in the elderly are a problem for two reasons.

They are more likely to happen than falls in younger people

They are more likely to result in serious injury; e.g. 2 common fractures

as a result: Wrist fractures (Colle’s fracture or dislocation), Femur

fractures.

Recurrent falls are defined as those occurring at least three times a year.

Two or more illnesses/conditions, is a serious problem both in terms of

contributing to the cause of the fall and outcome.

Falls are DEVASTATING but also EXPENSIVE. Falls can lead to more illnesses and death.

Loss of self-confidence and Reduced quality of life.

NICE estimate falls cost NHS £2.3 Billion pounds per year.

Risk Factors…Risk factors include:

High Age.

Female gender

Low weight

Previous falls

Dependency on a Care giver.

Orthostatic Hypotension (69% increased risk of having an injurious fall within 45

days after antihypertensive treatment)

Medication (especially psychotropic)

Polypharmacy (taking lots of medication!)

Alcohol Abuse

Diabetes Mellitus

Confusion and Cognitive impairment

Disturbed vision

Disturbed balance or co-ordination

Gait disorders.

Urinary Incontinence

Inappropriate footwear.

Risk of Injury…

Weak bones:

With increasing age, conditions with predispose to weakness & fracture occur:

Osteoporosis (metabolic bone disease)

Osteomalacia (softening of the bone)

Paget's Disease (bones become enlarged and weakened)

Metastases/Mets.(to bone)(tumour spreads to the bone)

Predisposition to falls:

This includes the risk factors above. Dementia is a particular, impaired Visuospatial ability is an increased risk.

Poor self-protection:

Lack of protective subcutaneous fat.

Neurological problems (forgetting to cushion the fall)

Loss of Consciousness (fainting)

Motor and Sensory problems.

Multiple Contributory factors (stiff joints, drugs and environmental)

The Scope…Consideration of some of the common conditions and risk factors

predisposing falls in the elderly.

Environment.

Loose rugs or mats

Electric leads

Wet Surface

Lighting

Furniture

Fittings

Power and balance:

Encourage to keep active. Strengthens muscles and maintain joint

position sense and balance.

Elderly people who have had a fall lose confidence and become less

active.

Activity must be encouraged.

Modifications for individual’s needs

Develop power and balance.

Accessing the community.

Medication:

Drugs can contribute to falls in many ways- need to be reviewed

regularly.

Sedative medication, including Hypnotics. There is a particular risk of

falls in agitated patients with cognitive impairments.

Confusion from Psychotropic medication.

Polypharmacy is common in elderly.

Hypotension caused by:

• Diuretics, Vasodilators, Alpha-blockers, Beta-blocks, Insulin

Neurological… Minor strokes can cause significant weakness

Parkinson’s disease impairs mobility (abnormal posture, freezing,

frontal impairment, poor leaning balance and leg weakness) Parkinson’s

Gait

Parkinson’s Improvement

Neuropathy may occur (e.g. Diabetes)

Proximal myopathy- muscles become weak and slow to relax

(Overactive thyroid, Cushing's syndrome and use of steroids.

Impairment of co-ordination.

Cognitive impairment e.g. Dementia.

Loss of consciousness… Syncope

Dizziness

Arrhythmias (cardiac output)

Convulsions (epilepsy)

Drop attacks…Falls are called ‘drop attacks’ if there is no known cause.

Cardiovascular disease

Carotid Sinus Hypersensitivity (quick ‘low’ in blood pressure, or 3

second pause in the heart beat)

Transient Ischaemic Attacks (mini-stroke)

Orthostatic Hypotension (fall of at least 20mm Hg blood pressure)

Dehydration

Visual Disturbance… Cataracts

Macular Degeneration

Central Retinal Artery/Vein occlusion

Visual field defects.

Prevention…This means taking measures to prevent falls before they happen!

Increasing exercise and physical activity

Reviewing medication

Changing adverse environmental factors

Improving management of any medical conditions.

A good history… Was it tripping over something or loss of balance?

Loss of Consciousness?

History of falls?

Drug history

Alcohol?

Home assessment, Risk Assessment and falls prevention.

Examination:

Cardio vascular, neurological, functional (gait), MMSE, Vision.

NICE (National Institute for Clinical Excellence)

People at Risk of Falls:

All patients over 65 years.

All patients between 50-64 judged by a clinician due to their condition.

An assessment should include:

Cognitive impairment

Continence problems

Falls history

Footwear

Health Problems

Medication

Postural instability, mobility/balance problems

Syncope syndrome

Visual impairment.

ABUSIVE PRACTICE

• Many of the manoeuvres and lifts passed

on over the years are no longer

acceptable in every day practice.

• A number of these techniques are now

considered to be harmful to the client

and carers, and also regarded in some

instances as physical abuse and rough

handling

The Nursing & Midwifery Council (2002) defines physical abuse as:

‘Any physical contact which harms clients or is likely to cause them

unnecessary and avoidable pain and distress.’

Such abuse can occur due to health and care staff handling clients in a

rough manner, often due to ignorance or poor application of manual

handling techniques.

The Drag Lift.It can be

defined as any

method of

handling where

the carer places

a hand or arm

under the clients

armpit.

The use of this lift

can cause

damage to the

carer’s spine,

shoulders, wrist and knees.

Condemned

technique in

1981

For the client,

there is the

potential of

injury to the

should and

armpit. Risk of

fractures to the

upper arm and dislocation of

the shoulder

The orthodox (cradle lift)The Orthodox lift

involves two

carers placing

their hands

beneath the

arms or behind

the back and

underneath the

client’s leg.

The involves

carer lifting at

arms length

whilst twisting at

the trunk and

hold the load

away from the

centre

Condemned

technique since

1987.

This is likely to

cause injury to

the clients

shoulders and

knee’s.

The ‘Through arm’ Lift/slideThe through-arm

lift/slide often

occurs whereby

two health or

care professionals

work together at

either side of the

client to move or

slide them into a

sitting position on

the bed.

It can also pose a

risk to the carer in

relation to their

posture and

position whilst

handling on bed.

Condemned

technique in 1998.

Damage could

occur to pressure

areas. This lift

applies pressure to

the clients forearm

and underarm.

This can make the

manoeuvre

potentially painful.

The Shoulder lift/slideThe shoulder or

Australian slide/lift

is another

manoeuvre

whereby a client

can be moved on

a bed by two

carers working

together.

This technique

results in dangers to the carer due

to an uneven

loading, with force

applied to one shoulder.

Condemned

technique in 1996.

Bear HugThis lift involves

moving or support

a client with their

arms or hands

around the

handlers neck.

This is particularly

dangerous.

If the client does

not stand, or

collapses when

his or her arms are

around the

handlers neck, all their weigh is

hung around the

neck

Condemned

Technique.

If the client falls

backwards their

instinct will be to

remain clamped

around the

handlers neck,

so causing them

to fall.

Follow Guidelines

• Back injuries cost the UK £5billion in all sectors.

• Over 119 million working days are lost each year.

• Each year at least 5000 employees in health and social care need time off.

• Half of all injuries in the health care sector are related to handling loads.

• Every year 4000 nurses are forced into retirement because of back related problems.