Essay/Term paper: Nursing: lifting, transferring and positioning of patients

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Nursing: Lifting, Transferring and Positioning of Patients


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ABSTRACT

Lifting, transferring and positioning of patients is frequently undertaken by
nurses on each working day. This is necessary for patient comfort, medical
reasons and completion of self care needs. Lifting can be done in numerous ways.
As well as the nurse physically lifting or moving patients, a number of devices
are also available to assist in the transfer of patients. These range from
straps that are attached to or placed under the patients, to mechanical hoists
and lifters. Any assistance the nurse has is beneficial for both the patient
and the health care worker, as patient's weights are generally heavier than the
nurses physical capabilities. This, combined with incorrect lifting techniques,
can result in muscle strain, or more seriously, spinal injury for the nurse, and
discomfort, muscle strain or further injury for the patient.

INTRODUCTION

When lifting, transferring or positioning patients, the most important
consideration is safety. Any of these procedures need to be undertaken with it
in mind. This safety is inclusive of both the patient and the health care
worker. Communication is an important part of the lifting process as the nurse
should elicit information from the client to find out how and when they prefer
to be moved. This allows the patient to be involved in the decision making
process and be fully aware of what is occurring. By communicating with the
client, the nurse is also aware of whether or not the patient is experiencing
any discomfort during or after the lift.

The actions of lifting, transferring or positioning need to be completed for
numerous reasons, including relief of pressure points. Due to the patient being
in one position continuously, they are prone to the development of pressure
areas. In terms of patient needs, being in the same position constantly is
physically uncomfortable. However, mentally, a change in the immediate
surroundings is also beneficial for the patient. It is also necessary for the
patient to be moved for completion of their self care needs. This includes
their hygiene needs, which include, bathing or showering, elimination, hair,
oral and nail care.

METHOD

When lifting, transferring or positioning patients manually, safety is the most
important factor. This safety is for the nurse themselves as well as for the
patient. One aspect of safety is for the nurse to utilise "good body mechanics"
(Kozier et al 1995, p.879). This refers to the nurse having balance, which can
be achieved with the feet being spread approximately shoulder width apart, which
gives stability and a "wide base of support" (Kozier et al 1995, p.888).
According to Kozier et al, (1995 p.879) balance is also achieved by correct body
alignment and good posture. The use of correct body alignment reduces the
strain on muscles and joints, and makes lifting the clients much easier.

When lifting clients, the first thing the nurse should do is explain to the
patient what they are doing and ask the patient if there is any particular way
they would prefer to be moved. This allows the patient to have some opinion
about what is being done to them.

The next thing that should be done when moving a patient is a routine assessment.
The nurse may assess the situation by firstly observing the patient and reading
the nursing care plan. The nurse needs to be aware of the patients capabilities
to see how much they can do or if they can assist in any way. Another important
part of assessment is observing the surrounding environment, to be sure there is
no obstructions or other hazards which may be injurious to the nurse or patient
before, during or after the move.

The next phase is that of planning the move. The nurse decides how the patient
will be moved from their current position to where they are going. This may
involve the nurse getting assistance for the lift, either from other health care
workers or by mechanical devices, such as a lifter or hoist. When moving or
lifting the client, wherever possible the nurse should have assistance. This
assistance is necessary for both nurse and client safety. This is supported by
Kozier (1995 p.910), who says, wherever possible,

"the preferred method is to have two or more nurses move or turn the client".

When moving clients physically, there are different types of moves that can be
used. When moving a client up in bed, the client should be encouraged to help
if possible. The nurse can ask the patient to bend their knees, so that when
the nurse is ready, the patient can assist by pushing backwards when the nurse
says. Two nurses stand on opposite sides of the bed facing each other. With
knees bent and legs shoulder width apart, the nurses lock forearms underneath
the patient's thighs and shoulders. The nurses, on the count of three, at the
same time as the patient is pushing backwards, transfer the weight to the legs
that are in the same direction that the patient is going to be moved.

When moving a client from a lateral lying position to sitting at the side of the
bed, the first thing that the nurse should do after assessment, is to get the
patient in a side lying position. This is done by the nurse placing one hand on
the client's hips and one hand on the client's shoulder. The nurse then
transfers their weight onto the back foot while at the same time rolling the
client towards them. The next step is the nurse places one arm underneath the
patient's shoulders and one arm underneath the knees. The nurse then turns on
the balls of the feet while at the same time pulling the client's legs down on
the floor.

The next move is transferring a client from the bed to a chair. Once the client
is sitting on the edge of the bed, the nurse can easily move the patient to a
chair. This procedure therefore follows on from the procedure of sitting a
client up in bed. This can be done by the use of a "transfer belt" (Kozier 1995
p.924). Before commencing the lift, the nurse must have the wheelchair ready
and parallel to the bed. The nurse must make sure the client's feet are placed
flat on the floor with one foot slightly in front of the other. The nurse then
places the belt around the client's waist. The nurse stands facing the client
with their arms around the client's waist, holding onto the belt. The nurse
asks the patient to assist by transferring the weight onto the front foot on the
count of three, while at the same time, the nurse transfers their weight onto
the back foot, lifting the client up to a standing position. The nurse supports
the client until they are balanced when standing. The nurse and client, when
ready, pivot in the direction of the chair. The client then holds the arms of
the chair as a means of support and to assist when lowering into the chair. The
nurse then lowers the client into the chair, bending at the knees. The transfer
belt is then removed when the nurse has assessed that the client is comfortable
and secure in the chair. The nurse should also ensure the client has suffered
no ill-effects as a result of the move.

When the transfer belt is not available, Kozier (1995 p.925), recommends that
the nurse puts both hands at the sides of the patient's chest and continue the
procedure in the same way.

When transferring the patient from the chair to the bed, the same procedure is
implemented but in reverse. However, the transfer is started, the nurse should
ensure that the bed is clean and dry. The client is then moved from the chair
to the bed and then assisted to a lying down position.

Manually lifting patients is effective, however, when able, the nurse should
lift or transfer with a mechanical lifter. These are especially effective in
reducing the risk of injury. This is supported by Seymour (1995 p.48) who says
that,

"more nurses are beginning to realise the equipment's potential for protecting
both client and carer from injury."

When using these devices, the nurse should tell the patient what is being done
and how it is being done. Mechanical lifters either have two slings, one sling
for underneath the shoulders and one for underneath the thighs or buttocks.
Other lifters have an all in one sling which extends from the client's upper
back to lower thighs. The lifters substantially reduce the strain on the nurse
and the patient and are able to be used for all transfers. The nurse places the
sling underneath the patient and attaches the slings to the lifter with hooks,
and the nurse then controls the lifter for the desired action.

When using a mechanical lifter, some problems which may arise include the lifter
being broken or unavailable. The nurse should therefore be aware of how to
correctly manually lift the client in the event of this occurring. Another
problem with mechanical lifters, according to Scott, (1995 p.106) was that
mechanical devices were,

"often left because staff did not feel confident enough to use them."

This highlights the fact that all staff need to be taught the correct way that
the lifters are used.

The problem with lifting patients physically, is that nurses are often required
to lift loads greater than they are physically able. This is due to,

"the likely mismatch between the size of a patient to be lifted and the physical
capabilities of the nurses on duty." (Love 1995, p.38).

This can lead to potential injury for nurse and client.

Another problem with lifting patients manually, is that the correct lifting
procedure may not be carried out. This can lead to patient discomfort, as well
as long term back problems for the carer involved. One problem which may also
arise from incorrect lifting techniques is the development of pressure areas,
due to the patient being dragged and not lifted across the sheets. This
friction can lead to the patient developing reddened skin which may lead to skin
breakdown.

DISCUSSION

By the health care worker implementing the correct lifting techniques, the nurse
and the patient's safety is not compromised in any way. Nurses should be
constantly aware of any new methods of lifting or transferring which arise, so
they are able to maximise the level of safety for themselves as well as for the
patients. By the nurse using the correct lifting techniques, and not dragging
the patient, the risk of the patient sustaining further injury, such as pressure
areas, is reduced. By communicating with the client, the nurse is also made
aware of any problems the client has with any aspect of the lift.

Regular maintenance of equipment is essential so that the equipment does not
breakdown frequently. Hooks, straps and slings need to be constantly checked to
ensure optimum working order, as well as ensuring client safety.

Staff need to be educated on the use of the lifters and regular testing would
ensure that the staff are confident and competent in their use. This may lead
to a decrease in the amount of mismatched clients and nurses in terms of weight,
as if staff are more confident of using the lifters there may not be as much
manual lifting necessary.

Education about manual handling is also vital to ensure correct lifting
techniques are used. Constant re-evaluation of the staff's abilities and
methods would ensure safety for both parties involved. This would make staff
aware that the least amount of strain placed on the muscles and joints as
possible is beneficial to them.

The re-evaluation is also important in the fact that it allows the health care
worker to be constantly up to date on any new procedures which may be developed.

REFERENCES

Kozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995, {italics on} Fundamentals
of Nursing {italics off}, 5th Edition, Addison Wesley Publishing Company Inc.,
United States of America.

Love, C. 1995, 'Managing manual handling in clinical situations', {italics on}
Nursing Times {italics off}, vol. 91, no. 26, pp. 38-39.

Scott, A. 1995, 'Improving patient moving and handling skills', {italics on}
Professional Nurse {italics off}, vol. 11, no. 2, pp. 105-110.

Seymour, J. 1995, 'Handling Aids - Lifting and moving patients', {italics on}
Nursing Times {italics off}, vol. 91, no. 27, pp. 48-50.