1. MANUAL HANDLING for Nurses & Care Staff

2. Manual Handling Is the use of force exerted by a person to: Lift Move
Push
Pull
Carry
Living or non living object

3. 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

4. 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

5. 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

6. 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

7. The ‘Hidden’ Impact Of Work Injury
Research claims up to 80% of Australians will experience low back pain in their lifetime
LBP and Occupational Overuse Injuries* cost Australia the most
Pain and discomfort can last for years, affecting work, everyday life, family and relationships
Safe Work Australia

8. Reducing the Risks 3 stages to safe manual handling
Hazard Identification
Risk Assessment
Risk Control
Identifying hazards
A hazard is any situation that has the potential to cause harm to life, health or property

9. How can we identify a hazard??
On observation/completion of tasks
Communication with staff
Analysis of workplace injury records
Client assessments

10. Risk Assessment
Evaluate the likelihood of injury or illness due to the hazard High / Medium / Low

11. Risk Assessment Consider The environment – furniture, space, equipment
Work practices – training, adequate staff numbers, mechanical assistance
Resident ability to assist – cognitive signs, physical signs, behavioural signs

12. Risk Control Controlling 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

13. 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

14. Lifting the wrong vs the right way

15. Manual Handling Principles – applies when lifting any object

16. 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

17. Changes in disc pressure according to position or activity

18. Spinal Anatomy Vertebra and joints
Intervertebral discs are the shock absorbers
Ligaments connect bone to bone
Tendons connect muscles to bone
Muscles and bones provide posture

19. Posture
There is no such thing as a straight back
3 spinal curves

20. Transversus Abdominis Muscle

21. 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

22. Performing the Manual Handling Task
Check 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

23. Residents with Behaviours
Residents can present with challenging behaviours during MH
Strategies 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

24. 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

25. Rolling in bed Technique 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)

26. 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?

27. Rolling with a slide sheet
Technique 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 the resident is rolled
Remove the slide sheet by pulling the bottom layer of the sheet out at one corner

28. Moving a resident up the bed
Technique 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

29. 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

30. Assisting with Lying to Sitting
1 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 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

31. Assisting with Lying to Sitting
2 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

41. WALKING STICK / QUAD STICK Static or Rollator FRAME / 4 WHEEL WALKER
Walking Aids
WALKING STICK / QUAD STICK
Hold walking stick or quad stick on their STRONGER SIDE
Stand 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

42. Take home message We are not invincible
Adhere to manual handling care plans
Don’t take short cuts or unnecessary risks – they will get you in the end!
If you feel there is a problem report it– if it is a risk to you it is probably a risk to others