Patient Lifting /Moving and Handling

[backman]

 As this is my area of speciality which I have been involved in for far too many years,I thought it may be of interest to give a few historical perspectives on Nurses and Lifting.

.....The nurse "must be a good lifter." Lifting is seen as a thing which is absolutely essential for nurses to carry out.The fact of a nurse being able to easily and quickly raise a patient or change his position strikes those around as a sure proof that she is thoroughly capable in every respect,and at once raises her in their opinion.Yet we hear of many nurses who say they "cannot lift" and many,too, who have overstrained themselves in performing this important part of their work.An average amount of strength is of course needed,but the patient can do a great deal if guided by a nurse with skilful will power.Suppose we have a patient who can help himself just a very little,even that feeble effort can,by being guided in the right direction,do much to effect this own comfort,and to help his nurses movements.He can,when being lifted,perhaps,draw up the knees,pressing the heels on the bed,or he can raise his head,slightly off the pillow,and throw one arm around  the nurses shoulder.

A very important point with a helpless patient is to impress upon him not to stiffen himself.Tell him,above all,to "let himself go" at the moment of lifting; if he will do this it is a great help to the nurse.A nervous patient,with every muscle set like steel,clutching at the clothes,or clinging to the bed,is almost double the weight to move or lift as one whose muscles are relaxed and pliable.In the latter case he goes with the lifter,and can be raised with comparative ease,even by one of only moderate strength if possesssed of skill.

If we have a long heavy case,if the patient can still use the arms and hands,a pulley from the ceiling should be arranged.It should han conveniently from a screw-ring fastened firmly in a joist.A firm hassock at the foot of the bed is a great help to press against when pulling up.Or in some cases a thick soft cord can be fastened by a "half-hitch" to the foot rail of the bed;This is useful when the patient is being raised for finding,arrangement of pillows,sounding,etc.

British Journal of Nursing 1907.

[nursesue]

oh Pete my aching back is having sympathy pains!! I remember the australian lift very well . We used to use the old hard linen drawsheets to move patients as well - not a hoist in sight!! The worst bit was holding the hem of your dress to stop it riding up and losing your hat on the balkan beams.
Now I'm in GPland no lifting required and an electronic bed that goes up and down - oohh the luxuary of it all and we get to wear trousers...... ;)
sue

[backman]

 Thanks Sue,This thread should carry sponsorship from Ibruprofen as I too have good days and bad days!
As male nurses we were valued for our lifting ability,particularly in lifting 20 stone geriatrics off the floor back into bed on nights.
I too, found wearing trousers to be easier when lifting and rarely had to worry abour losing my hat ( although the cheap bits of folded paper that they callled hats didn't really merit the name)

Whilst we are certainly not perfect in our practices today ,we have still come  long way.

More historical bits to follow....

[backman]

                                         The Nurses Load

The adult human form is an awkward burden to lift or carry.Weighing up to 100kg or more,it has no handles,it is not rigid,and it is liable to severe damage if mishandled or dropped.In a bed a patient is placed inconveniently for lifting,and the placing of a load in such a situation would be tolerated by few industrial workers.Hospital beds vary in height and width,and their side bars may be at a height which stops the nurse's leg from passing beneath them and thus prevents the nurse from getting near to her patient.Most mattresses effectively prevent easy sideways movement,and force the nurse to lean far over the bed to obtain a reasonable grasp.The patient may be attached to various fragile tubes,splints or bags,all of which require simultaneous transport,and the area around the bed may be obstructed by pumps,receptacles,cylinders and stands of various sorts.In domiciliary practice a nurse may find conditions yet more difficult:the bed is usually much lower than in hospital,it is often wider,and the floor space may be severely restricted by furniture or the smallness of the room itself.Since much of the nurse's dayent in lifting patients,it is small wonder that orthopaedic wards often contain nurses with strained backs as patients and that ARCHER* has gone so far to say that nurses have weaker backs than other workers.....

*Archer L. B. Quoted in Nursing Times,June 11,1965

Article -the Lancet August 28,1965

[wilfb]

Hi.

An interesting comment by Archer - and there could have been something in it is some cases. However, I spent 37 years in nursing and did not acquire a bad back. I think that at some stage I was involved in lifting and moving most things found in hospitals, not only people. Was that, I wonder, due to luck or good training.

We certainly received a lot of training from expert 'lifters' (nurse specialists - teachers) and physio's on occasion, but then that probably differed between hospitals/authorities.  One thing I do believe - my lack of injury was not a matter of physique - I weighed but 10stones (6ft tall/slim) when I started and around 15stones (6ft tall /a little rotund!) when I finished. I worked in about 8 different AH's and lifted many (shapes/weights/sizes/people/things) including some grossly physically handicapped people.

I knew of several who reported sick with 'bad backs' but also worked with other nurses of all shapes and sizes (within Occupational health wide limits) who never had problems. A back injury was of course a matter for the industrial injuries accident report book.

Was I just lucky? I was never a body-builder!!

[backman]

 I would agree Will that,as with many things in life,a certain amount of luck was involved as to whether a nurse did end up with musculoskeletal health problems.The reality is of course that whilst most nurses survived intact (thankfully) a significant number didn't and I recall several colleagues who ended up with long term problems,some even being pensioned off at a young age. This created the whole back care industry with hoists & training etc in which I now find myself.Has it made any difference to sickness rates?,probably, but we still have many health problems which largely involve health care assistants who now perform most of the day to day care at the bedside.Trained staff now suffer more ill health around stress and depression than ever before,certainly within my organisation.
Health and Safety is always relative to the age.Many early radiographers sustained cancers from exposure to ionising radiation,and the death rate amogst nurses who cared for patients from infectious diseases in the pre antibiotic age was surprisingly high. I certainly remember mixing up buckets of Cidex/gluteraldehyde on open wards which today would require full respiratory protection.Latex allergies were extremely rare despite all the rubber tubing and mackingtoshes used in healthcare.

[SuzanneL]

An issue close to my heart having worked in orthopaedics for close to 30 years and cant say i ever 'injured' my back- my shoulder is another matter using the 'good old' australian lift. which relied heavily on a 'compliant patient'.

After careful consideration and assessment of the task, I developed a 'magic touch' technique in my rehabilitation of many patients. Good verbal instruction with a touch of encouragement and guilt if they didnt follow the instructions ie 'its only me and we dont want to hurt ourselves' many patientw were able to make 70% of the effort themselves. No hoists were necessary= the evil they can do by robbing an elderly and frightened post op fracture patient of their mobility. Tackiling the fear of finding was the first thing we had to manage if we were to get the patient mobile again. Its a trick 'modern' orthopaedic nurses seem to have lost, too quick to resort to the hoist ........ I remember the ritualisting comments of my first orthopaedic ward sister about tucking in our tummy when lifting we now 'engage our abs'. Who said we didnt know what we were doing because we didnt use research!!!!!!!!!!!!!!!!!!


(Or at least that is what one cheeky student told me last week when I said we were 'trained' not like too many modern students these days for my liking 'too educated and too idle to do the basics wanting to run before they could walk' followed by  'they need to see they are nurses not mini doctors whith their degrees' Personally degrees should come after 'basic training'to help them get their priorities right.- sorry off topic.)