Workbook Describe techniques for moving equipment and people in a health, disability or aged care context

Transcription

1 Workbook Describe techniques for moving equipment and people in a health, disability or aged care context US Level 2 Credits 4 Name:

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3 Contents Moving equipment and people... 7 General principles for moving Managing discomfort, pain and injury Moving loads and equipment Using normal movement patterns Supporting people to move

4 Before you start Welcome to this workbook for Unit standard 23452: Describe techniques for moving equipment and people in a health, disability or aged care context. For this unit standard you will have: this workbook. an assessment. In this workbook you will learn more about: general principles of moving people and equipment. how to move loads and equipment. techniques for supporting people to move. reducing the risk of discomfort, pain and injury. How to use this workbook This is your workbook to keep. Make it your own by writing in it. Use highlighters to identify important ideas. Do the learning activities included throughout this workbook. Write your answers in the spaces provided. You might find it helpful to discuss your answers with colleagues or your supervisor. Finish this workbook before you start on the assessment. 4

5 Workbook activities Learning activity You will come across learning activities as you work through this workbook. These activities help you understand and apply the information that you are learning. When you see this symbol, you are asked to think about what you know. This may include reviewing your knowledge or talking to a colleague. When you see this symbol, it gives you a hint, tip or definition. The glossary and study hints book has study hints for all trainees. It also explains key words and phrases from the compulsory unit standards for Foundation Skills and Core Competencies. You can download it from or order it from 5

6 Check your knowledge Before you begin, think about moving loads What would you need to know if you had to move equipment or a person? What would you have to prepare before you did the moving task? How would you look after yourself when doing the moving task? 6

7 Moving equipment and people A support worker needs to know how to safely and correctly move equipment and people in their care. This may also mean assisting people to move themselves. This is manual handling work which may require you to lift, lower, push, pull, slide, carry, move, hold, support or otherwise handle people or equipment. For example it may require you to: help a person to stand up. move a person in bed. do cleaning tasks. carry shopping bags. move and use equipment. Manual handling can lead to injuries and it is important that you look after yourself. You need to take care of your back and keep fit. When carrying out tasks that involve moving loads (equipment and/or people) you need to be aware of the safety of yourself and others at all times. Under the Health and Safety in Employment Act 1992: it is the employer s responsibility to provide a safe working environment. it is your responsibility to take all practicable steps at work to ensure your own safety and the safety of others. This workbook is based on the principles outlined in the Accident Compensation Commission 2012 publication: Moving and handling people: The New Zealand Guidelines. 7

8 Your back Our backs do a huge amount of work and self-care is very important. Back injury is one of the most common forms of workplace injury and a severe back injury can stay with you for life. The spine is made up of 33 small bones (the vertebrae) and discs that act as shock absorbers in between each vertebra. The discs are made up of a soft, elastic jelly-like substance which is held inside a tough,fibrous outer casing. When you move or transfer people or equipment, your back can be put under some degree of stress. If you twist or jerk when you move or transfer, you can injure the small facet joints which guide the movement of your back. You can also damage the discs which separate the vertebrae and the ligaments which hold them together. If you repetitively move/transfer unsafely, you may permanently damage your back. Combining these stress factors will increase the stress on your spine, for example: bending forward from the waist. moving and transferring quickly. the weight of the load you are moving. the distance you hold the load from your body. how long you hold the load for. 8

9 You can care for your back in a number of ways, by: maintaining good posture. supporting your back properly when not moving. exercising regularly by walking, swimming and biking. An exercise bike or a tread mill is also an excellent way to strengthen your back muscles. Avoid: slumping when you sit. bending or hunching up over a desk or bed. walking with your shoulders hunched over. Change your posture often throughout the day, for example, from sitting to standing. Plan and prepare for your task Warm up and stretch your muscles before you start work. When muscles are warmedup, it will help reduce the risk of harm to your back. For ideas on stretches, view the ACC Smart Tips Sheets on their website It is also a good idea to organise your environment in a way that will assist you when moving loads, whether equipment or people. Arrange things to minimise bending and reaching. Work at a comfortable height and raise or lower equipment, such as chairs, beds, where possible. Make sure loads that you move regularly are stored at safe heights. Waist height is a comfortable height. This prevents bending/twisting of the spine and also the danger of moving things from the floor or from a height. If you do a lot of moving, spread the tasks out and take frequent small breaks between each task. Vary the tasks that you do, so that you do not spend chunks of time doing the same moving or transferring tasks. Follow your organisation s policies and procedures. When moving a person, check their care plan, or moving and handling plan. Where possible, use aids and equipment to move or transfer heavy items. Follow the manufacturer s instructions for equipment use. Make sure your clothing and footwear are appropriate for the task. Clothes should allow free movement but have nothing loose that may get caught. Shoes should be non-slip, supportive and stable. Tie up long hair and do not wear rings or bracelets. 9

10 General principles for moving It is important to apply safe bio-mechanical principles of posture, position and technique so you can minimise the risk of harm to yourself and any other person. Always bend your knees and your hips, not your back. This may mean sticking your bottom out! Never bend and twist at the same time. If moving heavy objects/loads, always have them close to your body. When moving and handling people and loads: make sure your grip is stable. maintain a good posture and spinal alignment. push rather than pull wherever possible. utilise your body weight, using your whole body, not just your arms. move your whole body when changing direction. keep your line of vision clear. stay focused on your task. Make sure that before you move or transfer anything, that your path is clear and the destination is ready, for example, the bathroom is unoccupied. If you need help with the moving task, make sure you get the help you need. Work with others where possible. If it is difficult, find another way, for example: use a trolley. use assistive equipment. use moving equipment. get another person to assist you. re-pack items to reduce the weight and size for easier moving/transferring. If it feels heavy, it is heavy. A person weighing 50 kg requires a 40 kg pulling force to re-position them. A slide sheet reduces this to 12 kgs. Remember Always bend from your knees and hips, not your back, and never bend and twist at the same time. 10

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12 Bio-mechanical principles Stand in a stable position. Your feet should be shoulder distance apart. The circle gives you a safe and stable base to work in. Moving out of this circle can put your safety at risk. Avoid twisting. Keep your feet pointing in the direction of movement. This is the step-stand position. Make sure your shoulders and pelvis stay in line with each other. This will avoid twisting your back. Bend your knees slightly. Maintain your natural spinal curve. Avoid stooping by bending slightly at the hips (bottom out). 12

13 Keep your elbows tucked in Keep the person or equipment close to your body. Avoid reaching - the further away from you the load is, the greater the potential for harm. Tighten your abdominal muscles to help support your spine. Keep your head raised. Keep your chin tucked in. Head, shoulders and hips should all be facing in the same direction. Move smoothly throughout the technique and avoid fixed holds. Move upper and lower body as one unit to avoid twisting at the waist. 13

14 The LITE principles These principles can be applied to any moving task involving people or equipment. Applying the LITE principles will enable you to: plan the task, check the environment, assess the risks and identify hazards. LITE = Load Individual Task Environment prepare for the task minimise hazards, get any equipment, prepare the people. apply safe bio-mechanical principles of posture, position and technique. Load Characteristics of the person or object being moved can affect the handling risk. For a person, consider age, gender, dependency, size, weight, diagnosis and disabilities, pain, fall risk, ability to understand and cooperate, ability for independent movement, medical attachments, moving and handling plan. For a load, consider its weight, shape, size, surfaces, and edges. Individual This relates to the capabilities and training of the support worker. For example, age, fitness level, size, fatigue, knowledge and training. Task This relates to the nature of the task, ie what has to be done. It may require supporting a person to sit up in bed, moving a bed, carrying laundry or a heavy piece of equipment. Consider the best handling method that will be needed, for example: pushing, pulling, or carrying. Environment This relates to the work environment, the space available for moving or transferring, the layout of the working area, the brightness of the lighting and the type of flooring surface. Before moving, check access ways are clear and that the destination is ready, for example, the bathroom is unoccupied. Check for hazards, such as furniture in the way, wet and/or slippery floors, uneven surfaces or steps, or tripping hazards like electrical cords and loose mats. In client s homes, children s toys and pets may get underfoot. 14

15 Learning activity Using the following scenario, answer the questions to complete a LITE analysis for the moving task. Scenario Doris is an older lady who uses a mobility frame to stand and walk. She has a shower chair for showering and there is a grab rail in the shower. With supervision and minimal support she is able to transfer. Her moving and handling plan says she is of moderate risk when moving. Today, carer Jay has been asked to shower Doris. What things about Doris might affect Jay s ability to handle her safely? Will Jay need any equipment or personal protective gear to carry out the task? Will Jay need assistance from another person? What will Jay need to check and prepare in the environment? What training would Jay need to carry out this task? 15

16 Managing discomfort, pain and injury A major injury prevention programme promoted within workplaces by ACC is Preventing and Managing Discomfort, Pain and Injury (DPI). ACC s approach encourages workplaces to focus on both prevention and management of musculoskeletal conditions. DPI can be prevented or managed if the pain and its contributory factors are addressed in the early stages. Where feasible, people should be able to stay at work, providing changes are made to address factors contributing to their conditions. There are seven contributing factors that may lead to DPI. They all interact with each other and all must be identified and addressed. Of these seven factors, there is no clear distinction between work and non-work contributory factors. 16

17 Individual factors These factors relate to things a person can t change about the way they are, such as their gender, age and height. They also relate to things a person can change, such as their strength, physical fitness, skills and training. Psychosocial factors These relate to the issues that may affect a person, and how the person deals with them, both at work and outside of work. These factors include the development of a culture of safety at work. Workplace layout/awkward postures This relates to the way the workplace is set up and the physical working positions that workers adopt, which may be as a result of the facility design and available space. Workplace layout should aim to minimise workers having to bend and reach. Work organisation This relates to how work is arranged and carried out. For moving and handling people this includes adequate rest breaks, length of shift hours, management policies and support and good training. Task invariability This relates to how much a task varies. Is it repetitive, or does it involve holding positions for long periods of time? Is it boring? Or too challenging? Load/forceful movements These relate to what a person handles and the forces they have to apply to use them. This also includes the use of specific client handling techniques and equipment. Environmental issues These relate to the conditions in which a person works, including room temperature, noise, lighting, workplace size, resources and staff skill levels. 17

18 Moving loads and equipment Carrying objects is a common everyday situation and it is important to protect your back and joints. It could be carrying shopping bags, moving household loads or moving deliveries of supplies. When moving objects, always have them close to your body. Keep your elbows in and keep your abdominal muscles tight. Where possible, break loads down into smaller loads. Consider using a trolley with brakes and locks. Ideally things should be kept at waist height, but often some things are stored under benches, for example, household cleaning gear, household waste, heavy bulk supplies. When reaching down: maintain good posture. keep your back straight. avoid hunching your shoulders. crouch in a stable position, resting on one knee with one foot forward to create a stable base. 18

19 In everyday tasks such as vacuuming and hanging out the washing, support your joints and spine. When vacuuming, keep your back straight and elbows tucked in. Where possible raise or lower items to prevent you from having to reach up or down repeatedly. When hanging out the laundry, minimise the need to reach by: putting the clothes basket on a box or stool. using a tall, wheeled trolley. using a height adjustable clothesline. Keep your back straight and: bend your knees slightly. maintain your natural spinal curve. avoid stooping by bending slightly at the hips (bottom out). 19

20 When handling bed linen and other laundry split the load if necessary so that you have a smaller load to carry, especially if it is wet. Do not overfill linen bags. Make sure you can clearly see your way when moving equipment and furniture like a bed. Use brakes on equipment when you stop. 20

21 You need to be able to see over anything you are pushing or pulling. Keep the load on your trolley below your eye height. This trolley is loaded too high. The same things apply when moving people in wheelchairs or other mobility aids like a shower chair. Make sure you apply the brakes when you stop. This is especially important when you are transferring a person from the wheelchair to another seat or to a vehicle. It is also important to put brakes on in the shower with a wheeled shower chair. Remember, when moving loads: maintain a good posture and spinal alignment. push rather than pull wherever possible. utilise your body weight, using your whole body, not just your arms. keep your line of vision clear. 21

22 Learning activity Using the following scenario, complete a LITE analysis for the moving task, taking account of the DPI Framework. Scenario Nicky is a support worker. During the day the courier has delivered some boxes of supplies at the front entrance, which have to go to the office. These are very bulky and awkward to move. What does Nicky need to think about to do this task safely, minimising discomfort, pain and injury? Explain what Nicky should plan to do about this load. How will this affect how Nicky does the moving task? Does Nicky need any equipment or personal protective gear to carry out the task? Is this an individual task or does Nicky need assistance from another person? What will Nicky need to check and prepare in the environment? Is there anything else that Nicky needs to do before she carries out this task? 22

23 Using normal movement patterns Mobility is the ability to move or be moved freely and easily. It is a key aspect of a person s independence to be able to complete some tasks for themselves and to move within their home and around their neighbourhood, such as to the shops or the doctor. A person may need some support with their mobility, for example: to stand up or sit down. to move up in bed and/or roll over in bed. to move from one place to another, for example from a chair to their bed. to transfer to or from their mobility aid, such as their walker or wheelchair. Mobility aids include specialised assistive equipment that is used to help people: walk, especially to support speed and evenness of stride. For example, walking frames and wheeled walkers. maintain an upright body posture, for example, walking sticks and canes. redistribute their weight when walking, from their legs to the arms of a walking frame or stick as it is leant on for support. Before a person is moved or assisted, you must explain to them what is going to happen and how you are going to support them. You also need to think about the person you are assisting and what might affect your ability to assist them safely. Do they understand and will they cooperate? Make sure their clothing and footwear is appropriate for moving. Check if they have any medical attachments that need to be taken into account. Remember to take any aids they need with them. You must follow the person s service plan and/or moving and handling plan if they have one and work within your organisation s policies and procedures. The plan will outline the support the person may need and how that support should be given. The equipment used is based on the individual s needs and will be documented in their plan. Make sure you know what equipment a person needs, what the equipment is used for and how the equipment is used. 23

24 It is helpful to know the normal sequence for an action, such as standing-up or rolling over in bed so that you can encourage the person to help. You can coach the person in their movement, providing guidance. Encourage normal actions and movement. Help the person with any movements the person has difficulty with. Be adaptable when assisting them. Encouraging independent movement, if possible, benefits the person and makes the moving task safer. There is a continuum from dependent to independent. You need to match the technique and/or level of assistance with the ability of the person. Dependent Independent mechanical 2 carers 1 carer assistive assistance equipment If more than one carer is needed for moving or handling a person, it is important to have a recognised leader. They will consult the person s moving and the handling plan, check on the person s capabilities, including mobility, cognitive ability and their need for assistance. The leader will coordinate the move and give instructions, like Ready. Steady. And a following action word like stand, sit-up, move, roll, slide etc. Throughout the moving process, privacy, dignity and respect for the person must be maintained at all times. Make sure the person is comfortable during and after the move. Ask them for feedback. This is a great way to learn about the effects of what you are doing and to get suggestions for improvement in your moving techniques. 24

25 Supporting people to move In your role as a support worker you will support people to move and use equipment to move and handle them. You may help a person move in their bed, sit down or stand up, or transfer to and use their walking frame or wheelchair. Some common moving activities are pictured on the following pages. Many of these techniques are from the ACC Moving and handling people: The New Zealand Guidelines. It is online and can be downloaded from the ACC website: Another excellent resource is the ACC videos which cover many of these procedures. Go to and search for the moving and handling people videos. Handling belts You may use a transfer or handling belt to give you a secure hold on the person as you assist them to move. Make sure a layer of clothing is between the person s skin and the belt to avoid abrasion. Ensure the belt is securely fastened and cannot be easily undone during use. Handles on the belt are positioned so that the support worker does not have to hold onto the person s clothing or directly onto their body. Belts with padded handles are easier to grip and increase security and control. Keep the person as close as possible to you. Support workers are advised not to place their full hand through the handle of the belt as this will prevent the release of their hold of the person in the event of a sudden movement. More than one caregiver may be needed. In most cases the far handle should be used and with two carers, the arms would be crossed. Always transfer to the person s strongest side. Use good bio-mechanical principles and a rocking and pulling motion. Handling belts should not be used for lifting people. Handling belts can be used to provide support in walking. However, all manufacturers and suppliers provide warnings regarding inappropriate use and advise carers to undertake a specific risk assessment in respect of the weight bearing ability of the person and other relevant factors. 25

26 Specific equipment People may have equipment specific to their own needs which you may need to help them use or transfer to. Mobility aids help people feel more confident, steady and balanced. 26

27 Repositioning a person There are two basic techniques care workers need to be familiar with. Instruct the person to look in the direction of the move. This helps the movement. The lunge position is a basic position for care workers. The lunge is not just a position, but a movement. You shift your whole body weight from one foot to another in the same plane. Using the whole body increases strength and makes a move safer and easier. 27

28 Sitting to standing The chair height must allow the person to place their feet firmly on the ground, with their hips and legs at right angles. The chair should ideally have arm rests, but if it doesn t the person can push down on the edge of the chair. Use instructions like ready, steady, stand and get the person to rock gently forward on each word. Or, gently rock the person backwards and forwards to build up momentum. Standing to sitting Have the person stand with the back of their legs against the chair or edge of the bed. Ask them to keep their head up, to lean forward slightly and put their hands on the chair armrests or on the edge of the chair or bed. Tell them to slowly sit down with their bottom as far back in the chair or on the bed as possible. The person then needs to straighten up, with maybe a slight adjustment or repositioning for comfort. 28

29 Moving in bed 29

30 A person can use an overhead pole or monkey bar to move themselves in bed, provided they have upper arm strength. The person should firmly pull on the bar, bend their knees and lift their buttocks off the bed, while pushing their feet into the bed. This moves their body up the bed. 30

31 Completion and assessment Congratulations! You have come to the end of the workbook. Please check over all the activities in this workbook to make sure you have completed them. Your assessment is next. You need to complete the assessment successfully to be credited with this unit standard. Acknowledgements Careerforce thanks the people who have contributed to this workbook by: researching and validating content. providing advice and expertise. testing the activities. sharing personal experiences. appearing in photographs. The images contained in these workbooks are visual illustrations only and are not representative of actual events or personal circumstances. Careerforce thanks ACC for permission to use images from their 2012 publication Moving and handling people: The New Zealand Guidelines. Creative Commons This work is licenced under a Creative Commons Attribution-NonCommercial Licence. You are free to copy, distribute and transmit the work and to adapt the work. You must attribute Careerforce as the author. You may not use this work for commercial purposes. For more information contact Careerforce 31

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