at Disabled Living Manchester

1 Day Moving & Handling of People Instructor CPD Refresher Course

Download our 1 Day Moving & Handling of People Instructor CPD Refresher Course Outline by clicking the PDF to the right

In December 2019, Osteopathic Solutions Moving & Handling Expert & Director Gareth Milner provided our 1 Day Moving & Handling of People Instructor CPD Refresher Course at Disabled Living, Redbank House in Manchester.

 

The Course began with Gareth questioning attendees about what they would like to get out of the day. Attendees all had varying answers; the first attendee mentioned they would like to readdress getting people out of confined spaces as well as going over hoisting transfers. Another attendee mentioned that they work with very complex needs with many of their clients having physical disabilities including scoliosis, deafness, blindness and an increasing level of bariatric clients.

Gareth began the Course by refreshing attendees´ knowledge on basic spinal anatomy using an imitation spine model in which all our Expert Moving & Handling Instructors always briefly use when teaching attendees during our Moving & Handling of People Courses.

Gareth informed attendees the areas of the spine which commonly get injured due to hazardous practices within the care industry, principally the lower back (lumbar spine). It is worth noting that when attendees who work in care homes begin their day, they are often moving and handling a person with differing and increasing handling needs towards the afternoon or end of the day. A person might wake up with mild joint pain in the morning, and as the day progresses this pain may worsen. This can lead to a sole carer having to weight bear more upon themselves, commonly leading to an eventual chronic back injury. Gareth also asked the group if they suffered from any back injuries themselves. One of the attendees had fractured their spine (in the past) from a moving and handling accident at work.

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The first transfer Gareth covered was Pushing and Pulling of Wheelchairs. He first asked attendees what natural, hazardous practices they were familiar with. Attendees took turns in demonstrating hazardous pushing practice, which involves a forward bend of the trunk, using body weight and the arms, with minimal use of leg muscles. Following this both Gareth and the attendees performed BackSafe Pushing and Pulling practices. 

 Pushing

     Once you have assessed the load and the environment is           safe, you should position yourself by:    

             

  • Facing the wheelchair with one foot in front of the other (the rear foot heel should be just in front of the rear foot toes)

  • Placing the feet your normal hip width apart

  • Bending both your knees (no more than a semi-squat)

  • Placing your hands safely on the wheelchair, gripping the handles

  • Keeping your elbows close to your body, level with the trunk keeping your spine upright, looking forward

​Pulling

   Once you have assessed the load and the environment is safe      behind you, you should position yourself by:

  • Facing the load with one foot in front of the other (The front foot heel should be level with the rear foot toes)

  • Placing the feet your normal hip width apart

  • Bending both your knees (no more than a semi-squat)

  • Placing your hands safely on the wheelchair, gripping the handles

  • Keeping your elbows close to your body, level with the trunk

  • Keeping your spine upright, avoiding a significant backward bend

For pulling the wheelchair, to initiate movement of the load from a standing start, drive your whole body backwards with your leg muscles (mainly the quadriceps and hip flexors) keeping your elbows in, your spine upright and your head looking forward. The wheelchair (and person) should only be pulled for a short distance, to then turn the wheelchair, so that a push can then be performed.

 

Next it was time to practise the transfer ´Sit to Stand – Minimal Assistance with verbal guidance'. This transfer may be simple in its application, however we commonly find even experienced Moving & Handling of People Instructors do not get everything right.

For this Sit to Stand transfer, the handler:

  • Applies the brakes, if standing from a wheeled seat

  • Makes sure the person is wearing proper footwear (so that they do not slip) and the floor is free from trip hazards such as slippers

  • Stands close to the person (at their weaker side) with their furthest foot in front of the other, feet slightly apart, adopting a semi-squat

  • Instructs the person to place both hands onto the arms of the chair, and shuffle their bottom close to the edge of the seat with their feet level on the floor under their knees

  • Places their nearest hand on the person’s lower back and their other hand on the person’s nearest upper chest just under the person´s collar bone. With 1 handler assistance, a palm to palm contact should not be practised with the other hand.

  • Instructs the person to initiate the stand (on the command of ‘stand’) by bending forwards (‘nose over toes’), and pushing themselves up with their arms

  • Gives the commands ‘Ready, Steady, Stand’

  • On ‘Stand’, places forward and upward pressure onto the person’s lower back to assist the movement. This should involve little physical exertion for the handler

  • Steps forward as the person stands

  • Stands next to the person for a moment, making sure the person is not feeling dizzy before asking them to move.

In the above image, the attendee from Anchor Hanover Group (performing the transfer) initially had incorrect hand positioning. Gareth corrected this hand positioning, reminding attendees that the middle of the lower back (lumbar spine) was the ideal place of support for the person, with the handler's nearest hand to the person.


Handling Belts can be beneficial to extend the handler's reach in confined spaces, and to stabilise the person on standing without having to grip the person’s body. Gareth asked attendees what handling practices (with handling belts) they would normally avoid; with one attendee mentioning that it was important not to place the whole of their hand through the handle of the belt in case the person falls, as this would likely cause injury to the handler, and increasing the possibility of the handler falling on top of the person.

Below, we see Gareth and attendees carrying out this transfer in the first two images. Emma Farrell, Osteopathic Solutions Training Coordinator & Social Media Manager is pictured in the far right image. When using a handling belt, the handler’s nearest hand to the person grips the nearest loop of the handling belt with four fingers through the loop.

Upon completion of the demonstration, Gareth questioned an attendee on the pros and cons of using a handling belt. Some cons mentioned by the attendee were that underweight people may find it digs in to their chest area and it also may cause discomfort with people who have abdominal problems. Aside from these cons, following Risk Assessment, Osteopathic Solutions advocates the use of handling belts.

After covering assisted walking, it was time to look at Stand Aids. Disabled Living Manchester had a wide variation of Stand Aids so it was great to give attendees a look at the many different ones available. Stand Aids allow transfers between the bed and the chair, the bed and the commode, chair to commode, chair to chair and wheelchair to toilet. Below we see attendees experimenting with the varying Stand Aids at Disabled Living Manchester.

Gareth asked attendees if their Care Employees were familiar with using this piece of equipment within their daily roles. He mentioned that the use of a stand aid requires a person to have good upper body strength and grasp, with the ability to maintain a standing balance. Gareth then gave all attendees the chance to practise (using the equipment) with one another. Each attendee pushed the stand aid into position (in front of the chair) so that the other attendee’s feet were fully on the platform, and their lower legs gently against the lower leg supports. The brakes were locked before the attendee grasped the stand aid with both hands and stood using their arms and legs. The handler should stand with one foot in front of the other with the knees slightly bent when the person is initiating the stand.

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Gareth asked attendees if they were familiar with using this piece of equipment within their job roles daily before making a few useful points. He mentioned that the use of a stand aid requires a person to have good upper body strength and grasp, with the ability to maintain a standing balance.

 

He then gave all attendees the chance to practice (using the equipment) with one another. Each attendee pushed the stand aid into position (in front of the chair) so that the other attendee’s feet are fully on the platform and their lower legs are gently against the lower leg supports. The brakes were locked before the person grasped the stand aid with both hands and stands by pulling themselves up with their arms and pushing up with their legs. The handler should stand with one foot in front of the other with knees slightly bent when the person is initiating the stand.

Gareth then produced a piece of equipment called a Transfer Board. Attendees were familiar with this and one by one, each of them tried it out by transferring themselves from chair to wheelchair. He mentioned that Transfer Boards are used if a person is unable to bear weight on their feet but have good upper body strength.

Next it was time to look at managing falls. A discussion began amongst attendees as to how common their clients falling was. Attendees mentioned falls commonly occurred when a person would slide off the mattress and end up beneath the bed itself. Concerning the person falling whilst being assisted walking, Gareth advised attendees that it is sometimes possible to guide and support the person when they fall (to the floor) by slowing their fall and sliding them down your body, between your legs. He also reminded the attendees, as always, that it is important to remember your posture if this incident ever occurs, stabilising yourself by standing with a wide base and bending your hips and knees.

It was now time to go over to the profiling bed to learn more about use of profiling beds to protect your musculoskeletal system. Profiling beds are essential in the care industry as they greatly help to reduce postural strain for the handler. As Gareth began to discuss the benefits of using a profiling bed, a discussion arose about whether it was acceptable to kneel on the bed in each attendee’s working environment while carrying out certain bed transfers. Osteopathic Solutions recommends handlers putting one knee on the bed as it is beneficial to posture, but it can only be done if the total weight does not exceed the safe working load of the bed.

Watch Best Practice Bed Transfers on

Osteopathic Solutions YouTube Channel

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The first bed transfer covered with the group was Sitting to Lying Down Supine (images above). The Transfer:

  • Ensure the bed’s brakes are on

  • 2 handlers are best practice, although one handler may be possible

  • Adjust the bed to a height that ensures the person’s feet are flat on the floor

  • Raise the head end of the profile bed

  • Fold the flat sheet and place it on the bed so that half of the sheet comes off the bed. Tuck this between the bed and the mattress. Make sure the person does not sit on 2 sliding surfaces

  • One handler is behind the person gripping the folded flat sheet with both hands with one knee bent on the bed (this reduces the forward bending of the spine)

  • The other handler now frees the flat sheet from under the mattress and with a squatting posture, facing square on to the person´s legs, brings the flat sheet to scoop the person’s lower legs

  • The handler behind the person maintains their support of the folded sheet

  • The person is encouraged to push with their arms into the mattress to to move themselves into the centre of the mattress towards the raised head end of the profile bed

  • At the same time the handler ‘lifts’ the legs with a squat lift and moves their feet as the person pushes themselves to the centre of the mattress

Next it was time to look at all things Slide Sheets. Gareth reminded attendees to adjust the bed to a safe working height before ensuring the bed’s brakes are on. 2 attendees were needed for fitting 2 flat sheets under the supine person. Gareth watched as attendees placed the flat slide sheets together lengthways, across the legs of the person. After the folding was completed, the sheets were positioned underneath the supine person’s head, with Gareth making sure to correct any postural errors along the way. Both attendees ensured there were equal amounts of slide sheet either side of the person. The main corrections along the way were ensuring foot positioning was correct with knees bent into a semi squat. On the command of ‘’Ready, Steady, Pull’’ the team leader of the 2 attendees instructed the other handler to pull the folds under the person on ‘’pull.’’

The next bed transfer covered was Moving the Person up the Bed using Minimal Assistance with 2 Handlers Pulling. It was noted by Gareth that If the person understands and is physically able, handlers should encourage the person to push themselves up the bed, using their arms (pushing on the mattress to the sides of the slide sheets), and if possible using their legs (with one or both knees bent) pushing themselves up the bed. Gareth also reminded them that if the person is fully dependent, heavy or has poor compliance then 2 handlers will be needed to safely and effectively transfer the person up the bed. 

The day moved onto fitting Slings and Hoisting. Gareth began by showing attendees the types of slings. A discussion then took place on how one would individually risk assess a person. Consideration when choosing a sling choice and style should be given to:

  • Amount of support needed including the legs

  • Persons sitting balance, trunk and head control

  • The position in which the person is comfortable – reclined or sitting

  • Person’s skin condition

  • The seat/ bed in which the person is being transferred to

  • Unpredictable movements

  • Necessity for easy removal of the sling

  • Does the sling need to be left under the person

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After learning everything there is to learn about slings, it was on to hoisting. For this area of the CPD/ Refresher Course, Gareth questioned attendees on what checklist they would have in place before operating a hoist. Attendees quickly responded with the many important factors that need to be addressed which include (to name a few):

  • Always applying the brakes when attaching the sling

  • Ensuring the equipment is nearby

  • Ensuring the path is clear

  • Checking the sling is in the right place and smooth under a person’s legs

  • Checking the hoist legs have been widened to the right width

  • Placing the loops securely and evenly on each side

In the video to the left, we see an attendee being hoisted by 2 attendees with Gareth videoing and assisting. The person must have:

  • An ability to remain seated on the edge of the bed/ chair without assistance

  • An ability to stand on one leg

  • Sufficient core strength and balance to support themselves in the sling

  • An ability to cooperate with instructions

  • Place the sling in position making sure it sits low on the person’s back. Fasten the waist belt

  • Open the hoist legs and push the hoist into position, close to the person

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  • Instruct the person to put their feet on the footplate. Their shins should be touching the lower leg pads which may need adjusting.

  • Apply the hoist’s brakes

  • Lower the hoist’s boom to its lowest position

  • Attach the sling to the hoist’s spreader bar. Check the loops are secure and the person is comfortable.

  • Instruct the person to grasp the hoist’s supports

  • Release the brakes

  • Raise the hoist until the person is more or less standing upright. The person needs to be encouraged to sit back in the sling, otherwise it may ride up.

  • Maintain eye contact with the person, always checking that they are comfortable.

  • Pull the hoist away from the bed/chair

Upon completion of all bed transfers and hoisting transfers, Gareth asked the attendees if they had any questions and also what they had felt they had learned from the 1 Day Course. All mentioned that they had gained improved postural awareness during their technique demonstrations as well as fully refreshing and developing their range of practical techniques and transfers.

Osteopathic Solutions Ltd

T:  0845 299 3513

E:  handling@osteopathicsolutions.co.uk

Company Registration Number: 07743200

VAT Registration Number: 139 388572

CPD Certification Service Member Number: 12602

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