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

All students have undertaken an Ergonomic Practical Session with the Physiology Laboratory

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.

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

The spinal column

• The spinal column is composed of 33 protective vertebrae, providing attachments for ligaments, muscles and ribs.
  Click here for further details of the spinal column.

• The spinal column and cord components are a unique design. For good posture, the spine needs to be maintained in normal alignment. The following movements should be avoided:

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.

Intervertebral discs

The function of the disc is to act as a "shock absorber".

If the pressure on the disc is too great it will herniate - pain may be felt and nerves trapped.

Click here to see examples of disc herniation.

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.

 Why do risk assessments? - THE REGULATIONS REQUIRE IT!

The Manual Handling Operations Regulations 1992 require risk assessments to be carried out if the employer cannot avoid the need for a manual handling which involves a risk of injury. Once assessments are made, the employer must take appropriate steps to reduce the risk of injury to the lowest level reasonably practicable. "Reasonably practicable" means reducing the risk until the cost of any further precautions - in time, trouble or money - would far outweigh the benefits.

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

An example of a Risk Assessment tool

A variety of different scores are given depending on the angle of bend, the angle of twist, loads or forces applied and muscles use either static or repetitive.

Elements of a Risk Assessment

Task

Individual Capability

Load

Working Environment

We often refer to TILE

DURATION, FREQUENCY AND JOB DESIGN

THE WORKING ENVIRONMENT

RCN Guide 1996

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

Analysis of a repetitive task

IS THIS REASONABLE?

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