РефератыИностранный языкNuNursing Lifting Transferring And Positioning Of Patients

Nursing Lifting Transferring And Positioning Of Patients

Nursing: Lifting, Transferring And Positioning Of Patients Essay, Research Paper


Nursing: Lifting, Transferring and Positioning of Patients


Lab Report


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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 h

ave 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.

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