Page 182 - MD 18-4-2018

180 I SCTOENTSHUOLSTCAONPCEYS& TRAINING DILIGENT Ergocoach
Patient Handling Programme
It is an education programme which provides identified caregivers with the knowledge and skills that will enable them to become peer leaders in people handling within their own facility. During the 5 day course, emphasis is placed upon the seamless integration of theory and practice, using a coaching approach as opposed to formal classroom training.
Why choose the Ergocoach Programme?
• Nurtures a coaching approach, advocating workplace competency in safer people handling practices
• Encourages caregivers to maximise independence of the people they care for whilst ensuring their own and their colleagues safety
• Evidence based using national and international best practice from leading experts and organisations
• Training in the use of people handling equipment to meet current legislative requirements
• Utilises robust training records and documentation processes
• Use of standardised assessment ‘tools’ such as the Mobility
GalleryTM and the Handbook of Transfers to assist with pragmatic handling assessments as well as solution identification
Topics include:
• The Positive Eight, Static Load, Push and Pull • Mobility Gallery and Active Patients
• Active Hoists and Transfers
• Passive Hoists and Repositioning in Bed
• Transfers, Managing Change and the Ergocoach
Each delegate is provided with the following:
• Ergocoach study file – a complete resource for the Ergocoach to use for coaching and educating their caregivers (and an evidence base for training content)
• Handbook of Transfers with accessory pack – a theoretical and practical pictorial guide and an evidence base for all practical transfers
• A3 workplace wall charts – to record staff education and competency
• Workplace posters – Mobility Gallery
• Equipment competency training records (relevant to the equipment used within the organisation)
Additional training materials may be purchased from Arjo if required.
We can offer:
• Dates and times to suit your needs
• Training courses are your own facility or
provide training venue at no extra cost
Ergocoach Study File – Day One
Ergocoach Study File – Day One
8
© Copyright 2011, DILIGENT
© Copyright 2011, DILIGENT
9
high pressure . Such a turning motion also pushes the contents of the intervertebral discs towards the outside . In the long term this can really come ‘outside’ and we than talk about a ‘herniated disc’ or a ‘slipped disc’ .
Crouching and kneeling
StatMan©
Working in accordance with the ‘Principle of Moderation’ is clearly described in Chapter 4 and is also known as ‘The Reasonableness Principle’ . This ‘Principle of Moderation’ also applies when searching for solutions to prevent excessive static loads . We are concerned here with the following hierarchical sequence:
Oxygen starvation
1. Prevention
2. Replacement
3. Management
The best solutions are the solutions in the first category . That means that loads which occur are at the minimum if the action can be prevented . For example: If a patient can put on her support stockings alone then let her do so .
If this is not possible, look for a solution in the second category: Try to replace the current way of working with a better way . Take for example a seat in a chair when you hold a conversation with a patient in a wheelchair .
If no solution can be found in the second category, try and manage the activity as well as possible . For example, when showering a patient in a fixed shower chair do not continually bend over forwards, but intermittently stand upright and stretch your back .
Equipment
In order to avoid static loads, ergonomic modifications are preferred . In other words, this means that the work surroundings must be adapted to the carer . This can be achieved by using the correct auxiliary aids, for example beds, baths, shower chairs and stools that can be adjusted in height . However there are also numerous other smaller aids . There are often more aids on the market than you realise . Work methods
If these ergonomic modifications are possible, then you must not forget to make use of them . That sounds obvious but too
In addition to the enormous pressure on the contents of the intervertebral discs, the muscles also have to provide a great deal of power when bending over forwards . The muscles must be able to hold the upper body up against gravity, otherwise you would fall over . The further you bend over, the greater the muscle power you require for this . If that posture is held for a long period, you quickly experience muscle fatigue . And this gives a painful sensation in the back or in the neck, However, this usually disappears when you take up another posture/ position .
Preventing static loads
That painful feeling can be explained as follows . In order to move, the muscles have to work . With normal muscle functioning, a muscle contracts and relaxes again . At that moment fresh oxygen-rich blood is pumped into the muscle by new blood flow . Old blood, which has been depleted of oxygen but which does however transport away waste materials, leaves the muscle .
How often do people work with a posture that subjects them to static posture?
Everybody probably recognises that irritating ‘nagging’ feeling in the back . As long as it continually disappears you don’t worry about how often it recurs in a day .
If a muscle contracts but doesn’t relax again, no fresh blood is supplied to the muscle . Old blood (with waste materials) remains behind in the muscle . These waste materials build up and quite quickly you experience a nagging, painful feeling: the muscle is starved of oxygen . That can cause damage to the body . This happens for example when you work bent over forwards for long periods . The moment the muscle reacquires the rhythm of contracting and relaxing, the blood is again replenished: the waste materials are transported away and the feeling of pain disappears .
Studies have been carried out to find out about the static loads which carers are subjected to in the healthcare sector . These studies show how often carers stand or sit with a posture that subjects them to static loads . The results are different for different sectors .
9
Engels et al, 1994
10 Knibbe et al, 1994
11 Hagberg et al, 1995
©
12 The StatMan : background and justification
Excess static loads are not only experienced in the back, neck and shoulders, although for carers it is most likely that problems will arise in these places .
The moment a carer crouches or kneels for a long period the transport of blood to the knees is hindered, for example when caring for a patient’s feet, bandaging a patient’s lower legs, showering a patient on a fixed shower seat or wiping a floor . In addition there is the fact that if there is not a stable supporting surface a lot of extra muscle power is required to be able to keep adopting a particular posture/position . The joints are often fixed in extreme positions and this can also result in health problems .
The StatMan©12 is an auxiliary aid for determining whether the load when working with a certain posture is acceptable or not . By placing this figure in the position used for carried out
Studies in nursing homes have shown that carers adopt a posture that subjects them to static loads for 21% of the total working time .9 A district nurse stands (or sits) for 29 .6% of her work time bending over forwards . At weekends that percentage is even a little higher: 31% .10
Excessive static loads are often believed to be an underestimated risk . These figures show that they cause major and long-term problems . The above-mentioned studies took into account all activities carried out by carers during a whole day . It must be remembered here that in care homes carers spend almost 60% of their time on non-patient related work . Even with these activities there if often a risk of excessive static loads . Think, for example, about administering drugs and doing the administrative work with an incorrect body posture .
certain activities, it is possible to read off whether the load is acceptable .
It is clear from this that when the back is subjected to static loads it is not only the degree of bending of the head and torso that is significant but also the position of the hands has a big influence on the load . The closer your hands are to the spine, the better .
Standards
The StatMan© can be used in situations when no lifting is being carried out . It does not however recognise twisting of the spine . Although the StatMan© does have these limitations it does bring to light risky postures .
Introduction
Rules of thumb
Luckily, static load does not by definition mean excessive strain . Excessive strain always means harm to the body . The adverse effects of excessive static loads often only manifest themselves in the long term, literally after years, and the absence of health problems in the short term does not necessarily mean that the situation from a health point-of- view is acceptable .11 You do however want to prevent health problems occurring in both the short and long term . This is possible if health standards are not exceeded . It must be stressed that these health standards are not statutory standards .
It is not recommended to work for longer than 1 minute with the torso bent over forwards by more than
30 degrees.
A maximum of 30 seconds in succession can be worked in crouching and kneeling positions.
How can excess strain be avoided?
The ‘Principle of Moderation’
3.5
From sitting to sitting with a mobile standing device
GENERAL
ACTION
• Of course, if using during toileting you should always fold away the sit supports. Always ask the person to stand up as straight as possible before you fold away the supports or remove the seat. Also do this when the person stands up again from the toilet.
This is a useful aid for people who need some help with standing up, but are limited in their ability to walk or turn when standing. However, these persons must have sufficient stability and balance to remain standing for a short time while holding on to the device. This is therefore an aid whose suitability for use by a particular person must be carefully established. This aid is often used in the transition between mobility classes B and C. It addresses the capabilities of
PREPARATION
this group of people and thus encourages them to use these capabilities. Another great advantage is that with this aid you can also easily carry out actions such as further dressing (trousers), changing incontinence materials or washing at the washbasin while the person is standing briefly.
• Ask the person to put both feet on the footrest, then to rest their knees against the knee support and to take hold of the support bar in front of them. Move the device until the feet are below the knees and apply the brakes.
PREPARATION
• If the person is getting up from the bed, it can be helpful to set the bed a little higher to make it easier to stand up.
• If the person is getting up from a chair or wheelchair, make
THE MOVEMENT ITSELF
sure that the foot supports do not get in the way of the aid.
RISK AREAS
• Ask the person to stand up straight and to look ahead rather than down.
• Bottom area.
• Next, fold out the sit supports. The person can now sit down again if they want to, but ask them to always keep hold of the support bar.
PRESSURE INJURY ATTENTION POINTS
• After going to the toilet, moisture can also increase the risk of pressure injury.
RISKS OF THE ACTION
• If the person slides and therefore does not come free from the surface, friction occurs between the skin and the bed surface as well as between different tissue layers. The support bar makes it easier to ease the pressure briefly.
• Finally, release the brakes. You can now move. Move the equipment by making good use of your body weight. Do not push from your shoulders or neck, and start off smoothly.
NOTES
156 Part 2 – Handbook of Transfers
Part 2 – Handbook of Transfers 157
• Explain what the person needs to do themselves, and indicate that with this transfer they must stand up independently.
• When the person goes to sit down again, instruct them to keep holding the support bar with one hand; have the person’s other hand find support from an armrest, toilet support or the edge of the bed, for example. In this way you invite the person to perform a normal sitting movement, so that they also sit back better in the wheelchair, on the toilet or on the bed.
• Fold the sit supports out of the way and move the aid as close as possible to the person.
• Encourage the person to first bring their torso forward and to take hold of the support bar with one hand.
• Ensure that any tension remaining in the person’s body is relieved by gently rocking back and forth or by using the support bar to stand up briefly.
• Have the person put their other hand on the arm of the (wheel)chair or the edge of the bed.
• Ask the person to move their weight forward by pulling on the support bar with one hand and using their other hand to push forward and up. Do not help the person with this movement: it is usually too taxing and you are not standing in the correct position. If the person is unable to stand themselves, this device is unsuitable.
• Ensure a large contact surface area and that the person is sitting comfortably and securely.
THE COMPLETION
• Apply the brakes on the equipment if you leave the person alone in the toilet. If the brakes are not applied, there is a high risk that the device will suddenly and unintentionally start to move.
• When you reach the chair, toilet or shower, apply the brakes again. At the toilet, push the device backwards over the toilet. You may also help the person with undressing and showering. Allow them to do as much as possible themselves.
• There are also additional back strap supports for
this equipment that provide the person with extra security and support for the lower torso.
• To clean the bottom area you can ask the person to stand again, and to give yourself better access, fold away the sit supports. Stand with feet splayed, shoulder width apart, to avoid overloading yourself. However, with an unsteady person you can also leave the sit supports in position to provide more security. Reduce the static load when providing care to a standing person by positioning the standing aid so that you can also reach the person from behind.
• It may be necessary for the person to move back in order to sit back properly in the chair, on the bed or on the toilet. See the techniques for group 5. You can also use the support bar to this end if the person has strong arm muscles.
BARBARA CARL
DILIGENT
Ergocoach Trainer Competency Assessment
Name of Ergocoach Trainer Organisation
Name of Diligent Consultant (Assessor)
Dates of Assessed Course
COMPETENCY DESCRIPTORS: 1 = NOT COMPETENT, 2 = COMPETENT, 3 = GOOD, 4 = VERY GOOD, 5 = EXCELLENT
ITEM DESCRIPTION
DELIVERED YES NO
COMPETENCY
COMMENTS
Setting the Scene oo Risks of the Job oo Hazards of the Job oo Legislation Quiz oo Safer Handling Policies oo Unsafe Practices oo Static Load
Muscles – Discs oo Standards for Lifting
Loads oo Push/Pull oo Positive 8 oo Additional Items/comments
Supervision Record Day 1
DAY 1
DILIGENT
Ergocoach Name Ergocoach Name Ergocoach Name
Ergocoach Name Date/Year Ergocoach Name
Ergocoach Name
STAFF NAME
WORKPLACE MANUAL HANDLING INSTRUCTION RECORD
For more info please call 0800 0855617
Special price of £2,995 for 3 – 9 delegates