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The first in a series of articles and research papers proposing an alternative trajectory. Identifying the manual and mechanical handling link to force-related tissue damage in both patients and carers during present inbed care practices. Click here to view the paper.

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Banishing bad backs and making 'inbed' patient care safer for nurses and carers

Introduction

When caring for patients ‘inbed’, nurses and carers are responsible for the safety of both themselves and those in their care. With healthcare having the highest number of reported handling injuries in the UK, a rethink is needed so the physical impact on those giving the ‘inbed’ care (the nurses and carers) is eliminated.

This rethink needs to cover the ways ‘inbed’ care is given by nurses and carers. It needs to ensure that musculoskeletal risk to the nurse/carer is prevented and that the products and processes used do this intuitively.

There are many recognised and accepted practices, protocols and procedures for care providers – hospitals, agencies, care homes, etc – to follow and adhere to. Whilst recognising that legislation and regulation is a necessity (i.e. in Einstein’s words being ‘faithful servants”), it is rarely recognised that these are often dictated through new product development. Such product development should be based on research and therefore be ahead of legislation in terms of best-practice and the use of pioneering technology.

In reality, however, care providers expect their staff to use the historically-accepted processes and legislative-standard products which are available and provided; whether or not they are best-practice in terms of the technology and/or processes available.

The physical impact of ‘inbed’ care on the care giver

Moving patients physically ‘inbed’ is always a risk to the care-giver. They need to ensure both their own and the patient’s health and safety.

Most currently accepted products and processes for moving and restabilising patients ‘inbed’ work against the gravitational forces that are keeping the patient stable on their support surface. As such, it requires physical effort from care-givers to move their patient and in doing so, creates a high risk of compromising their own posture. This in turn increases the risk of musculoskeletal injuries to their backs (micro tears to tissues).

However, worker and patient safety have reciprocal effects on each other. Promoting a culture of safety (for both patient and their nurse/carer) also generates other benefits such as lower staff absenteeism, higher engagement and a more positive work environment.

The current reliance on training and care-givers getting it ‘right every time’

Currently accepted products and practices are reliant on both mechanical and manual handling of patients, with training and compliance checks being considered sufficient to keep both the cared-for* and the care-giver safe.

In previous blogs we have discussed why despite these, there are continuing tissue integrity issues for patients and explain how a philesynergetic approach eliminates force-related tissue damage in our Safety Dance video.

The National Research Council concluded in 2001 that, “The panel’s review of the research literature in epidemiology, biomechanics, tissue mechanobiology, and workplace intervention strategies has identified a rich and consistent pattern of evidence that supports a relationship between the workplace and the occurrence of musculoskeletal disorders of the low back and upper extremities. This evidence suggests a strong role for both the physical and psychosocial aspects of work.” One conclusion drawn from this and other research is that physical handling training “ is not an effective control measure”. This is because Health and Safety, plus training and compliance is still over-reliant on human behaviour; trusting that people will follow the ‘right’ methods each and every time.Yet however stringent training and compliance is, behavioural drift will always occur.

In addition, human beings are “ quite efficient at bipedal travel but our bodies are not very efficient for standing to perform tasks… Everyone has internal body sway that constantly corrects for balance and gravity.” The major physical control of this is fascial biotensegrity, but the act of manually handling patients “inbed” compromises this innate internal body protective mechanism by exceeding the tissues’ protection and recovery thresholds.

It stands to reason therefore that nurses/carers should be provided with – and be expected to use – processes and products that intuitively use their natural biotensegrity to protect them from injury whilst being compliant with safe patient care expectations and regulations.

Intuitive Products

Intuitive design is common place in consumer products. Apple for example, spend as much time on the user experience as the features within their design process. It enables them to deliver new yet familiar products – because they are designed to be intuitive so users instinctively know what to do and how to use them.

To avoid behavioural drift, ‘shortcuts’ (workarounds) and lack of adoption, healthcare products need to become more intuitive too. This will allow nurses and carers to use them the right way, instinctively, each and every time.

Using an ergonomic and biomechanical approach

Ending the epidemic of nurses/carers’ lower back and neck pain is going to be difficult according to Dr Andrea Furlan (co-ordinating editor of Cochrane Back and Neck report): “The spine is a part of the body that is so fragile. People have no idea,” she said. “It is unbelievable what the spine does”.

Using a philesynergetic approach combines ergonomic and biomechanical methods to remove the risks to both carers and patients associated with “inbed” care and movement. It manages the forces that are at work when a patient is moved and eliminates the effect these have on the care-giver.

By working with (rather than against) gravity removes the need for care-givers to physically move patients. Nurses/carers have no need to manually handle a patient as they can be supported, repositioned and stabilised in a controlled manner using an intuitive “inbed” care management system. This video explains in more detail how this approach works.

In this context, intuitive design within the Biotechsis range makes the care-givers’ lives easier by providing an ideal inbed care environment which:

  • minimises the physical impact on the care-giver, by providing an environment that removes/significantly reduces the need to move patients manually by handling them.
  • avoids conscious and subconscious behavioural drift ensuring correct use each and every time
  • enables single carers to safely move and restabilise a patient being cared for ‘inbed’
  • Uses soft surfaces which are anti-microbial, self-sanitising and stops both further colonisation cross-infection from fomites.

Conclusion

As discussed above, all the tools for this approach exist and are both available and within our control. Yet, the challenge of its adoption in health and social care remains. Often there is a knowledge gap between the products that nurses/carers know are available and the expectations of care providers regarding the products and processes to be used.

However, by simply using the philesynergetic care approach for patients confined in bed, it is possible to banish bad backs and make”‘inbed” patient care safer for nurses and carers.

Please click on “coloured text” above for related links. Alternatively, please use the links below:

http://www.hse.gov.uk/statistics/causinj/handling-injuries.pdf

http://www.phil-e-slide-uk.com/news.php?s=an-open-letter-to-the-presidents-of-npuap-and-epuap

https://krausebellgroup.com/organization-integrate-worker-safety-patient-safety/

http://www.phil-e-slide-uk.com/news.php?s=the-missing-synergy-when-moving-patients-being-cared-for-inbed-part-1

http://www.phil-e-slide-uk.com/news.php?s=force-related-tissue-damage-prevention-rather-than-treatment

https://player.vimeo.com/video/191134199

https://www.linkedin.com/pulse/evidence-work-relatedness-msds-robin-burgess-limerick

http://www.phil-e-slide-uk.com/news.php?s=unconscious-and-behavioural-drift

https://www.linkedin.com/pulse/here-real-reason-standing-hurts-its-what-you-think-jerry-sitek

http://www.phil-e-slide-uk.com/news.php?s=inbed-care-management-an-alternative-view

https://www.theguardian.com/society/2017/feb/10/epidemic-of-untreatable-back-and-neck-pain-costs-billions-study-finds

http://www.phil-e-slide-uk.com/safety_dance.php

http://www.phil-e-slide-uk.com/biotechsis.php

http://www.phil-e-slide-uk.com/news.php?s=is-the-ideal-inbed-care-environment-fantasy-or-a-possibility

http://www.phil-e-slide-uk.com/news.php?s=the-challenge-of-innovative-product-adoption-in-health-social-care

http://www.phil-e-slide-uk.com/news.php?s=improving-safe-patient-care-the-knowledge-gap

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