Handling training

first_imgBOXTEXT: Lifts classified as ‘unsafe’ RCN 1998 Comments are closed. Cross arm lift    Draw sheet lift Combine lift Handling trainingOn 1 Aug 2003 in Clinical governance, Musculoskeletal disorders, Personnel Today Shoulder slide   2 poles canvas lift (quantitative)     (qualitative) Through arm lift            Walkingperson linking arms Related posts:No related photos. Non-experimental         Ethnographic (quasi) strategy study    Grounded theory This article examines new RCN training guidance – both abook and a conference – on handling patients, by Greta Thornbory Musculoskeletal injuries top the list of cases caused or made worse by work,according to statistics from the Health and Safety Executive (HSE) 2001/2,especially those which result in injuries involving handling, lifting andcarrying.1 This is particularly relevant to those whose manual handlinginvolves handling people. The past 12 months have seen a renewal of thetraining guidance from the Royal College of Nursing (RCN 2003)2 and thepublication of the book Evidence-based patient handling (Hignet et al 2003).3With quality healthcare under the auspices of clinical governance, practiceshould be evidence-based and patient handling is no exception. The RCN followed up its guidance and the publication of Evidence-Basedpatient handling with a conference in London. Welcoming delegates to theconference, Carol Bannister, OH adviser RCN, said the event was designed toallow discussions around the book’s findings and to examine the potential ofthe work in affecting patient handling practice. The book aimed to ‘bringtogether all available research in a systematic literature review framework’(Evidence-based patient handling, p3) and covered the background to researchand research criteria, as well as the results from the literature. Three of the six contributing authors presented papers at the conference,together with Howard Richmond from the RCN legal services, Sally Williams fromthe HSE and Patricia Bartley, who introduced her work on a new approach topatient handling training. The papers were followed by five concurrentworkshops based on the issues raised. Dr Sue Hignett is a lecturer in ergonomics at the University ofLoughborough, and is leading a research project for the HSE to measure theeffectiveness of competency-based education and training programmes in changingthe manual handling behaviour of healthcare staff. At the conference, she gavea rundown of the different research methodologies, critical appraisal anddiscussed the nature of research evidence. By using the critical appraisalapproach, she has developed a systematic review of all the evidence to date onpatient handling for the book. Consequently, her work provides a much-needed resource for all healthcareprofessionals. One of the significant aspects of Dr Hignett’s paper was theacceptance of research that was different from the medical model’s ‘randomisedcontrol trials’ and it explored more suitable research designs (see box below).This session was an excellent refresher for those who do not have dailyinvolvement, or who are new to, research. The second speaker, Sue Ruszala, is a manual handling and ergonomics adviserto United Bristol Healthcare NHS Trust. She spoke on the ‘controversialissues’, reviewing the evidence and explaining why some techniques, onceaccepted practice, were now regarded as hazardous. Cartoon pictures ofcontroversial lifts from the illustrator, Moira Munro, supported her talk. Techniques were regarded as controversial if they were condemned,inappropriate, and unsafe or presented a risk of injury – see box below. One ofthe questions Ruszala asked was why, when there is research to support lifts ashazardous, are they still used? Emma Crumpton, consultant ergonomist for the RCN then presented her Back inWork project, ‘Changing practice, improving health’. (Crumpton et al 2001).4This work was funded by the Department of Health (England) and the HSE.Previously, projects had focused mainly on the moving and handling of patients.This project took place in three nursing homes in the Home Counties and wasbased on the three core concepts or themes of: – The prevention of injury – Identifying causes of musculoskeletal health – The promotion of good staff health and healthy backs The initial objectives were to raise staff awareness through focus groups,identifying problems and solutions by using a problem-solving approach andupdating resident’s care plans. Training played an important part, as did therationalisation of equipment provision. OH was also regarded as one of the core aspects, and identifying suitable OHprovision was a priority. Outcomes were measured by a database, withinformation from residents’ care plans, staff perceptions, a back questionnaireand also a StaDyMeter, which is a form of ‘frequency log’ or self completingdiary. Results of these interventions showed care had improved, and exposure tomanual handling had decreased. Other factors it was concluded, were that‘effective management is an absolute prerequisite for the change process to beeffective in reducing back symptoms in care staff’. This session concluded thepresentation from the authors of the book. Patricia Bartley from movement specialists Corpus shared information fromthe process of implementing outcome-based training. Bartley previously workedin one of the largest NHS trusts in the UK and had first-hand experience of thedifficulties associated with generic based patient handling training – time andmoney being key to the problems. She outlined how they had identified problems that could be overcome bypeople using the simple format of TILE (task; individual; load; environment)and highlighting the need for individuals to carry out risk assessments forthemselves. Simple factors that had been overlooked by practitioners were things such asencouraging patients to move for themselves and learning to use equipment, ieadjusting the height of beds. Personal injury litigation and human and disability rights are high on theagenda for many practitioners who have to undertake manual handling tasks inless than ideal environments. Recent litigation has highlighted these factors and raised the issue ofwhether one can refuse to lift patients who themselves refuse to be liftedusing a hoist. Howard Richmond, deputy director of legal services at the RCN, discussedseveral cases that had occurred over the past few years. One factor raised in a particular case was that the local authorities hadnot undertaken sufficient risk assessments and the courts ruled that it was notthe court’s place to do so, but that it was for the local authority as theemployer, to formulate manual handling policies. Within the same case, mention was made of the dignity of the patient when usinga hoist, as it was felt that it could be regarded as ‘undignified’. Therefore,the employers’ risk assessment for the employee was of great importance (HSE2002) if the patient or client was refusing to be lifted using a hoist.5 Sally Williams, HSE inspector, was the last speaker of the day, andexplained how the criminal statutory framework influences patient handlingpractice. Williams highlighted the six pieces of legislation which provide thelegal framework on patient/client handling in the UK: – Management of Health & Safety at Work Regulations 1999 – Manual Handling Operations Regulations 1992 – National Health Service and Community Care Act 1990 – Charter of Fundamental Rights of the European Union – European Convention for the protection of Human Rights and FundamentalFreedoms – Community Care (Direct Payments) Act 1996 She also identified the six factors necessary for the successfulimplementation of a risk management system: – Senior management commitment – Worker involvement – Risk assessment – Control measures – Instruction and training – Proper management of cases This was followed by some examples of prosecutions, and improvements noticesissued under the Manual Handling Operations Regulations over the last couple ofyears – 32 per cent of which were due to deficiency in training and 28 per centto risk assessment. To improve the situation, the HSE has made the following recommendations forsafer patient handling: – Better data on risk is needed as evidence for nursing practice – There needs to be greater focus on the patient’s needs and experience – Training needs to be more focused, with emphasis on core skills such ascommunication and body language – Much more needs to be done from an ergonomics perspective. A new word was introduced during the day: ‘haptonomics’. Haptonomy isderived from the Greek words ‘hapsis’, meaning tactile contact, sense, feeling;and ‘nomos’, meaning law, rule or norm. ‘Hapto’ means to establish arelationship through tactile contact in order to heal, to make whole, toconfirm the other’s existence. It is a science based on the observation of andexperimentation with phenomena, which can be produced or verifiedÉ whichcharacterises in a very specific way the emotional experiences of humans.(www.haptonomie.org/va/cirdh/origin.html). Subsequent searches of this topic in nursing/medical literature and internetsearch engines did not produce any more information, although the companyPatricia Bartley works for, Corpus, runs courses on the subject; seewww.arjo.com It is the six success factors that form the basis of the new RCN manualhandling training guidance (RCN 2003)2 developed from a series of focus groupsessions held with stakeholders throughout the UK. The main thrust of the guidance is the ‘Competencies for manual handling’section, which is divided into domains: – Domain 1: management of risk – Domain 2: creating a safe system of work – Domain 3: professional effectiveness and maintaining standards Each domain is subdivided again into competencies to be achieved by threegroups: – Back care advisers – Line managers/appointed manual handling supervisors/key workers – Patient/client handlers The booklet goes on to say that these competencies can be used to identifyeducational needs, underpin educational plans, curriculum and learning outcomesfor sessions and to assess competence. The conference concluded with feedback from the five workshops, whichenabled participants to discuss a variety of issues surrounding topics such asequipment, hygiene and other handling tasks in different settings. Conclusion Overall, the book, as a systematic review of patient handling research,together with the RCN guidance and the conference, provided a good basis onwhich to build and develop policies, and to update procedures and methods oftraining for a safer system of patient handling than has previously existed. Itdoes not mean however that research should stop, and all speakers at theconference agreed that more research into patient handling is needed. If your job involves giving OH support and advice to those involved withpatient or client handling, the book and guidance are for you. Greta Thornbory is a consultant in health and education References 1. HSE, 2002, Causes and kinds of occupational/work-related accident andinjury, 2001/2, www.statistics.gov.uk 2. RCN, 2003, Safer staff, better care: RCN manual handling guidance andcompetencies, publication code 001 975 3. Hignet S, Crumpton E, Ruszala S, Alexander P, Fray M, Fletcher B, 2003,Evidence-based patient handling: Tasks, equipment and interventions, London,Routledge 4. RCN, 2001, Changing practice – improving care: an integrated back injuryprevention programme for nursing and care homes, publication code 001 255 5. HSE, 2002, Handling home care, HSG 225 Research designs Source: Hignett et al, 2003 Fixed design     Flexible design Experimental strategy    Case study Previous Article Next Article 3 or more person lift Two-sling lift     Front assistedtransfer with 1 carer Leg and arm lift Flip turn on bedlast_img

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