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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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Cards on the table: eliminating the tissue damage gamble

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We live in an ageing society. 18% of the UK population in 2016 was aged 65 and over and 2.4% was aged 85 and over. More and more care is and will be taking place in the community, in homes and hospices. In 2017, community care accounted for approximately £1 in every £10 spent by healthcare commissioners in England.

The majority of care in the community is delivered by non-NHS providers, and often by the loved ones of the patient. In fact, Carers UK published that almost 1.3 million people in England and Wales aged 65 or older are carers and the number of older carers has risen by 35% since 2001.

Given that; it’s an ageing population, the initiative to move more care into the community, and the resulting care in the community is being given by more elderly care-givers. These, together with the reduction of the numbers of nurses available, has a significant, implicit and increased effect on the associated risks when caring for patients in bed.

Let’s take each of these implicit effects in turn.

The risk to ageing patients
Frailty is often associated with ageing. It is estimated that the overall prevalence of frailty in people aged over 60 is 14%. However, frailty is not actually a chronological age-induced condition but is due to innate, physiological changes that affects the susceptibility of a person confined to bed due to their reduced ability to prevent and repair cellular tissue damage.

As far back as 1976, Reswick* determined that force-related damage occurs when the tissue involved is not able to withstand the applied force. The extent of damage depends on the individual person’s cells and tissues ability to repair themselves.

One major issue however, is that it is not possible to predict whether an individual will become frail and if so, at which point in their lives it will happen. So whilst frailty is often linked to the elderly it isn’t exclusively limited to the elderly. It therefore needs be taken into account for both the person being cared for inbed as well as the person providing that care (the care-giver).

For all patients confined to bed, the procedures and products that are in place to support, stabilise and move them need to be synergetically compatible so they prevent force-related tissue damage in a frail, vulnerable patient.

To remove associated risk for patients who are frail, a logical approach is therefore needed that involves designing out those processes and products that put patients-confined-to-bed at risk from tissue damage when supporting, stabilising and moving them.

The risk to care-givers in the community
Whatever their age, care-givers are at risk of micro tears and muscular skeletal injuries when manually moving and stabilising the inbed patient.

Again, it is not possible to predict their frailty. However, with a greater number of carers in the community, it stands to reason that there is an increasing number who are frail. To eliminate their risk, removing the need to physically move their patient is a must.

The risk due to a shortage of nurses
It’s a fact that there are increasingly less registered nurses in the UK with more leaving the profession than joining it. The impact of this is two-fold.

Firstly, there are less nurses to care for patients confined to bed within hospitals so there is an increasing need to move, reposition and stabilise inbed patients single-handed. Each manual handling requirement brings the risk of tissue damage to both the nurse (from micro tears and muscular skeletal damage), and to the patient (from the use of products and processes that are not compatible to a synergetic approach to allow the patient’s innate, homeostatic prevention of tissue damage).

Secondly, a shortage of nurses in hospitals naturally pushes even more care into the community, with the consequences outlined above.

By changing the present products and processes to those that promote support surface / patient synergy will remove the need for the carer to physically move patients and make it safer for both patient and carer during inbed care.

The tissue damage gamble
A healthy individuals’ cells and tissues are constantly being challenged and damaged. Under normal circumstances, a healthy individual (or even someone in either a hospital bed or a wheelchair) will not normally develop tissue damage related to forces.

It would appear impossible to accurately anticipate and predict who might be more susceptible than others to tissue damage using the present protocols, procedures and practices (even with today’s technology).

However, each time a person confined to bed is being supported, stabilised and moved, a gamble of risk is taken if their inbed environment is not of the correct synergy and/or if they are frail.

Why does the gamble still exist?
Putting our cards onto the table; there is one main reason why patients confined to bed are still at risk of tissue damage: it is because the healthcare industry continues a view and trajectory that is based on a premise that tissue damage is caused by pressure theory.

This would appear to gloss over the role of fragility. It sidelines the role of the body’s innate protective mechanisms of fascia biotensegrity. It ignores the need to work with gravity.

Until this view is changed (and as a by-product the terms “pressure sore”/“pressure injury” are consigned to the history books) then patients – and their carers – will still be at risk. We need to design-out the tissue damage gamble from all our inbed patient care processes and products.

Why is the current view wrong?
Pressure and shear processes are not sufficient to explain the occurrence of injuries as we see in today’s clinical practice. Present wound care science struggles to diagnose and cure lesions due to the complexity and processes involved regarding tissue homoeostasis, damage and regeneration.

Healthcare needs to be open to a change in thinking. The current thinking and practices are not preventing tissue damage to patients confined to bed. It would appear that they are so-designed to only manage the resulting force-related injuries that are occurring.

As such, injuries will never be prevented until there is a re-design (and implementation) of processes and products.

It’s time to start thinking differently to take into account the additional needs of the ageing population so that tissue damage is prevented for patients confined to bed and elderly carers are not put at risk of injury as they care-for their loved ones.

Of course, it’s been known for many years that there are increasing issues relating to the ageing population and frailty that need to be addressed. However, the thing most people are afraid of is change and the process of confirmation bias often means that we cherry-pick information that confirms our existing beliefs or ideas, so the need to change is avoided.

So what’s the solution?
Fundamentally, we need to go back to working with, rather against, nature. Firstly, we need to understand and appreciate the innate protective mechanisms of homeostasis and the role of fascia; that it allows tissues to move freely without transferring movement to surrounding structures. These mechanisms enable them to avoid exceeding their threshold of resistance at which tissues might be damaged. It is the body’s natural way of using homeostasis and biotensegrity to avoid tissue damage.

We then need to work WITH gravity Week Self Gravitation Bio.pdf as it is the building block of the universe that acts on ‘mass’ on an all time basis. Self gravity gravity – The major investigation gap in life sciences.pdf is the innate way the body works with gravity to protect itself from force-related harm.

Inbed care management systems therefore need to work with fascia (innate), self gravity (innate) and gravity (external) to enable patients to move / be moved without force-related tissue damage AND without risking harm to the carer.

In our blog, The missing synergy when moving patients being cared for ‘inbed’ – Part 2’, we discussed in detail how to achieve the philesynergetic approach needed for such change.

With frailty being a risk for many patients – as well as their loved-ones who have become carers- we need to stop relying on the present and traditional moving and handling practices. Just because they are currently accepted and recommended, DOES NOT mean that they are fundamentally correct and/or based on up-to-date science and therefore do not serve the best interest of those involved.

The video, The Safety Dance, explains how this approach can be achieved in real life. Using this approach, any external forces that may be generated can be managed in a controlled manner; to regulate their rate and effect as a means to avoid resting surface-patient skin interface “force focal spots”. In so doing, enables the patient’s internal homeostatic and tensegrity mechanisms to prevent any tissue / cell recovery thresholds, from being exceeded and prevents tissue damage whilst maintaining the patient’s tissue integrity.

By taking this approach, inbed patients (frail or not) are protected as their innate mechanisms prevent force-related tissue damage. By using the body’s natural way (homeostasis) of using self-gravity and biotensegrity, their fascia is able to avoid reaching the threshold of resistance at which their tissues might shear. This means no force-related tissue damage. A significant side-benefit is that no manual moving is required which protects both NHS and community care-givers from injury (the need to manually move their loved-ones is a massive risk for frail, ageing carers in their own homes).

In other words, care shouldn’t be a gamble. It should be safe. And there is a solution.

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

https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/july2017

http://www.health.org.uk/publication/provision-community-care-who-what-how-much

https://www.carersuk.org/images/Facts_about_Carers_2015.pdf

https://www.england.nhs.uk/2016/04/innovative-care-initiative/

https://www.nmc.org.uk/news/press-releases/new-figures-show-an-increase-in-numbers-of-nurses-and-midwives-leaving-the-professions

http://annals.org/aim/fullarticle/2668218/effect-physical-activity-frailty

https://www.england.nhs.uk/ourwork/ltc-op-eolc/older-people/frailty/

* Reswick, J. B. & Rogers, J. E. in Bed Sore Biomechanics 301–310 (Macmillan Education UK, 1976). doi:10.1007/978-1-349-02492-6_38

https://www.linkedin.com/pulse/uks-aging-population-time-adjust-our-thinking-centrobed-ltd/

https://m.youtube.com/watch?feature=share&v=w3IbKbDhfKw

https://www.fs.blog/2017/05/confirmation-bias/

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

http://selfgravitationbio.com/Books/Biophysics Week Self Gravitation Bio.pdf Week Self Gravitation Bio.pdf

http://selfgravitationbio.com/Books/Self%20gravity%20-%20The%20major%20investigation%20gap%20in%20life%20sciences.pdf

http://www.phil-e-slide-uk.com/news.php?s=matching-the-external-environment-to-the-patients-innate-protective-environment

http://www.phil-e-slide-uk.com/news.php?s=the-missing-synergy-when-moving-patients-being-cared-for-inbed-part-2

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

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