Common Foundation Programme - Moving and Handling

A guide to the Moving and Handling sessions in the Common Foundation Programme (module 2) for both staff and students.

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Ergonomics

ERGONOMICS ~ study of workplace design: 

 The study of how a workplace and the equipment used there can best be designed for comfort, safety, efficiency, productivity and fitting the job to the person and with the design of safe systems of work. 

[Mid-20th century. Coined from Greek ergon "work" on the model of economics.]

Ergonomic Principles applied to Moving and Handling

 ‚        Base Movement

                mobility with stability

 ‚        Relaxation of the Hips & Knees

enabling use of leg power

 ‚        Natural Spine shape

vertical position ~ avoid twisting

~ head leads movement

 ‚        Hold

the load comfortably, close to the centre of gravity 

 ‚        Use of Body Weight

lowering the load effect

 ‚        Timing

critical

Introduction to ergonomic theory

Click here for more details on ergonomics

This has identified the flexibility and strength of the spine and body and considered the following individual differences:

• Relevance of muscle strength

• Body Build

• Height

• Weight

We must be aware of the following issues in relation to moving and handling in the caring environment:

• There is an inherent risk of injury for people who are involved in the regular handling of loads.

• As a carer, your most common load will probably be people.

• For numerous obvious reasons, people are amongst the most difficult and demanding of all loads.

• In fact as a carer you are more at risk from injury caused by manual handling than people in any other occupation.

• The following charts highlight exactly how many nurses have been injured.

Handling and Injury (source: Health & Safety Executive, 1992)

Pressure put on the spinal cord is called the load, the increase in load will depend on the position of your body.

It is therefore important that we consider our posture at all times for the health of our spine but especially when we are moving the patients.

We can see from the following graph how position can alter the load.

Click here to see the forces involved explained.

Posture is essentially the position of the body in space. Optimal posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity, whether at work or rest. Correct posture involves the positioning of the joints to provide minimum stress on the joints of the body. 

 Faulty posture increases stress on the joints. Strong muscles can compensate for this increased stress, but if they are weak or the joints lack mobility or are too mobile joint wear, damage and changes to the surrounding tissues can occur. 

The effects of posture can be far reaching, involving respiratory, digestive, and circulatory systems as well as the musculoskeletal system. But how is poor or faulty posture developed? 

Causes of poor posture 

The causes of poor posture can be divided into two categories: positional and structural. Structural causes are basically permanent anatomical deformities not amenable to correction by conservative treatments. Positional causes of poor posture include ~

 €       poor postural habit--for whatever reason, the individual does not maintain a correct posture. 

€       psychological factors, especially self-esteem. 

€       normal developmental and degenerative processes. 

€       pain leading to muscle guarding and avoidance postures. 

€       muscle imbalance, spasm, or contracture. 

€       respiratory conditions. 

€       general weakness. 

€       excess weight. 

€       loss of the ability to perceive the position of your body. 

Causes of back pain

Click here for details of back pain.

Primary

Results from the damage to the soft tissue around the spine from:

• Trauma

• Fatigue

• Pathological changes

• Postural stresses

Secondary

Results from interference with the spine nerves, from:

• Pressure from the disc on the nerve

• Osteophytes, from the vertebrae

Referred

Pain originates not in the spine but in the pelvis, or abdomen, which have the same segmental nerve supply.

The spine is still growing and developing up to around the age of eighteen. Up to this point both the spine and the general musculature are usually unfamiliar with the stresses and strains of prolonged manual work.

As we get older, other factors come into play. Whilst the spine is fully developed once people reach adulthood, the ageing process continues and can precipitate weakness both in the skeleton and musculature. Usually, after the age of fifty five, the average level of degeneration in the skeleton significantly increases the risk of injury during manual handling.

• Smoking - has been linked to increased degeneration in the vertebral discs.

• Steroids - can cause long term weakening of the musculo skeletal system.

• Drugs/alcohol - which induce either muscular relaxation or tension.

• Menstruation - causes a hormone imbalance which can lead to increased stress and tension.

• Pregnancy - induces hormone imbalance and alteration of ligaments, cartilages and muscle tension.

• increases in weight

• relaxation of ligaments surrounding the pelvis

• Menopause - the hormonal imbalance can cause osteoporosis which weakens the musculo skeletal system

Forward bending	Side bending	Rotating	Extending

These are examples of not keeping the body in normal alignment.

• Persistent poor posture, pushing and handling loads incorrectly will eventually damage the spine.

What is a risk assessment?

Firstly, assessing risk means being aware of the problem areas. It then helps determine how concerned you need to be about the problem. For instance, does it place many staff at risk? Is the problem met frequently or rarely? Is it likely to cause a major injury, or could it be one of the many tasks where each time it is carried out it contributes to cumulative strain? But a risk assessment is useless unless it leads to action on reducing risks. This could be an immediate decision to change a simple work practice, or it could be the basis for budgeting over several years to purchase a large number of handling aids.

Any procedure carried out that involves moving anything must be risk assessed and reduced as far as reasonably practicable (see Legislation).  Proper risk assessments should identify the safest handling method, the equipment, environment and technique must reduce the risk to the lowest level reasonably practicable (BackCare & RCN, 1998).

BackCare and Royal College of Nursing (1998) The guide to the handling of patients
:introducing a safer handling policy. Revised 4^th ed. London: BC..

Click here for further details about risk assessment.

There are three levels of assessments:

• Patient Based

Assessments should be developed so that the patient care plan contains clear information on the patients movement, abilities and needs. Where necessary to include specific instructions for the use of lifting aids.

• Department or Ward Level

An assessment at ward level only needs to be done occasionally (annually).

• Top Level

Whenever senior management considers the requirements of the organisation:

• Decisions on training
• Uniforms
• Handling Aids

Risk Assessment Tools

There are a variety of Risk Assessment or Ergonomic Tools in use, examples are:

 RULA:         Rapid Upper Limb Assessment.

OWAS:         Ovako Working posture Analysis System.

 REBA:         Rapid Entire Body Assessment.

 These are used to analyse posture as an element of an ergonomic workplace assessment. 

Checklist for assessing risks

To assess risk before commencing a Moving and Handling task, the commonly used risk assessment tool is TILE. 

 Problems to look for when making an assessment are:

Task              Does the task involve ~

 ‚        unpredictable movement of the load?

 ‚        twisting, stooping or stretching?

 ‚        holding the load away from the trunk?

 ‚        repetitive handling

 ‚        strenuous effort?

 ‚        insufficient rest or recovery time?

 ‚        prolonged effort?

  Individual capacity                 Does the job ~

 ‚        require unusual capability?

 ‚        endanger those with a health problem?

 ‚        endanger pregnant women?

 ‚        a team of similar height?

 ‚        call for special information?

 ‚        require particular skills or training?

 ‚        restrictions on movement or posture from unsuitable clothing and/or footwear? 

Load      

‚        What can the patient do for themselves, with or without encouragement?

Is the load ~

‚        heavy, bulky or unwieldy?

‚        difficult to grasp? 

‚        unstable or unpredictable?  

‚        potentially damaging, e.g. sharp or hot?

  Working Environment.             Are there ~

 ‚        restrictions preventing a good posture?

 ‚        uneven, slippery, cluttered floors?

 ‚        changes in floor and work surface levels?

 ‚        hot, cold or humid conditions?

 ‚        poor lighting conditions?

 ‚        equipment, attachments, personal belongings?

Client handling criteria

1. The client’s condition.
2. Any attachments he or she might have.
3. Any special problems.
4. The client’s ability to assist in the procedure.
5. Whether the client can be moved without causing pain.
6. The condition of the client’s skin with regard to contact points needed during the manoeuvre.

1. Friction
2. Joint damage
3. Resistance from the client
4. Falls

Emergency situations where people are being cared for, are foreseeable and Risk Assessments should be carried out for these:

Static load Assess Risk        Stable base         Hold load close

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These pages have been prepared by Colin Baker, Safety Co-ordinator.