1. health and fitness
2. disease

Sunshine Care Training
Sarah Yorwerth & Tara Hollinshead
What is Manual Handling?
Manual Handling at Work involves:
Lifting,
Lowering,
Pulling,
Pushing or
Carrying.
Supporting People:
 Get in or out of bed
 Turn over in bed
 Sit up in bed
 Bathe
 Shower
 Use the toilet
 Sit in a chair
 Standing
 Walking
 Get up from the floor after a fall, or
 Get in and out of a vehicle.
Legislation
There are laws about safety at work. Those laws inform our policies and
procedures. Workers as well as managers must Health and Safety law:
 Health and Safety at Work Act 1974 (HASAWA)
 Manual Handling Operations Regulations 1992 (2002)
 Provision and Use of Work Equipment Regulations
1998.
 Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations 1995. (RIDDOR)
 Health and Safety (First Aid) Regulations 1981.
 Lifting Operations and Lifting Equipment Regulations
1996
Your Spine
The intervertebral discs are under
constant pressure. As discs degenerate
and weaken, cartilage can bulge or
be pushed into the space containing
the spinal cord or a nerve root, causing
pain.
Studies have shown that most
herniated discs occur in the lower,
lumbar portion of the spinal column.
Sciatica is a condition in which a herniated
or ruptured disc presses on the sciatic nerve,
the large nerve that extends down the
spinal column to its exit point in the pelvis
and carries nerve fibres to the leg. This
compression causes shock-like or burning
low back pain combined with pain through
the buttocks and down one leg to below the
knee, occasionally reaching the foot
A slipped disc occurs when the outer case of
the disc ruptures (splits), resulting in the gel
inside bulging and protruding out of the disc.
The damaged disc can put pressure on the
whole spinal cord or on a single nerve root.
This means that a slipped disc can cause pain
both in the area of the protruding disc and in
the area of the body that is controlled by the
nerve that the disc is pressing on.
It is not always clear what causes a disc to
break down, although age is a common
factor in many cases.
1. Healthy disc
2. Nerve
3. Slipped disc
4. Damaged disc
5. Spinal cord
As you get older, your spinal discs start to lose
their water content, making them less flexible
and more likely to rupture
M.S.D’s
• Osteoporosis is a metabolic bone disease marked by progressive
decrease in bone density and strength. Fracture of brittle, porous bones in the
spine and hips results when the body fails to produce new bone and/or
absorbs too much existing bone. Women are four times more likely than men
to develop osteoporosis. Caucasian women of northern European heritage
are at the highest risk of developing the condition.
• Fibromyalgia is a chronic disorder characterized by
widespread musculoskeletal pain, fatigue, and multiple “tender
points,” particularly in the neck, spine, shoulders, and hips. Additional
symptoms may include sleep disturbances, morning stiffness, and
anxiety.
• Spondylitis refers to chronic back pain and stiffness caused by
a severe infection to or inflammation of the spinal joints. Other painful
inflammations in the lower back include infection in the bones of the
spine and inflammation in the sacroiliac joints
GoutIs a type of arthritis, crystals of sodium urate (which should be expelled
through kidneys, builds up in tiny crystals) forms around the joints.
There is usually swelling, severe pain, redness and affects the big toe.
Develops rapidly to its worst in 6-24hours and lasts for 3-10 days.
Contributory factors are age, gender (men 4xmore likely), obesity, high blood
pressure, eating sardines and liver frequently, or drinking beer/spirits. Men who
drink 2 or more sugar sweetened drinks a day are 85% more at risk.
Treatment is exercise, balanced diet and taking NSAID’s.
OsteoarthritisMost common MSD, 1 million people visit their GP every year. Symptoms
include Mild inflammation around joints, cartilage damage, ‘knobbly’ bony
growths.
Affects the knees, hips, spine, big toe and hands. Most common in women
over 50. Signs include grating sound, ‘knobbly’ joints, weakness and muscle
wastage.
Rheumatoid Arthritis:
Is pain and swelling in the joints. Especially hands, feet and wrists. Most
common in women, between the age of 40-70 around 580,000 in the
UK are sufferers.
It is an autoimmune disease(immune system attacks itself), it disposes
cells in the lining of the joints. Joints become swollen, stiff and painful.
Carpal Tunnel Syndrome:
Is pain, numbness and tingling in fingers and thumb.
It is the compression of the median nerve that controls sensation and
movement. The Carpel Tunnel is a narrow passage in the wrist that
controls the small bones and tough tissue.
50% of pregnant women get CTS but it does disappear about 3 months
after birth.
Wrist splints are usually worn to support the area.
Surgery may be required to reduce to pressure in severe cases but a lot
of cases disappear on their own.
Back Pain
Back pain (also known as dorsalgia) is pain felt in the
back that usually originates from the muscles, nerves,
bones, joints or other structures in the spine.
half the adult population of the UK (49%) report low
back pain lasting for at least 24 hours each year
FOUR out of every FIVE adults WILL experience back pain
at some stage in their life. 50% of those will experience
another attack.
Back pain is just as common in adolescents as in adults
These chronic patients have considerable discomfort and
account for approximately 80% of the social and health
care costs.
£512 million on hospital costs for back pain
patients.
acute (less than 4 weeks), sub acute (4 – 12 weeks), chronic (greater than 12
weeks
NHS Top Tips
Top 10 tips for a healthy back, including lifting advice, how to sit properly and
back-strengthening exercises.
1. Exercise your back regularly. Walking, swimming (especially backstroke) and
using exercise bikes are all excellent ways to strengthen your back muscles.
2. Always bend your knees and your hips, not your back.
3. Never twist and bend at the same time.
4. Always lift and carry objects close to your body.
5. Try to carry loads in a rucksack and avoid sling bags.
6. Maintain a good posture. Avoid slumping in your chair, hunching over a desk
or walking with your shoulders hunched.
7. Use a chair with a backrest. Sit with your feet flat on the floor or on a footrest.
Change how you sit every few minutes.
8. Quit smoking. It is thought that smoking reduces the blood supply to the discs
between the vertebrae and this may lead to degeneration of these discs.
9. Lose any excess weight
10. Choose a mattress suited to your height, weight, age and sleeping position.
Risk Assessing
Before attempting to move someone, ask yourself:
• Does the person need help to move?
• Does the person require help or supervision?
• Have you told the person you're moving them?
• How heavy is the person you're moving?
• Are you healthy and strong enough to move
them?
• Is there anyone who could help you?
• How long will it take?
• Is there enough space around you?
• Are there any obstacles in the way?
• Are you wearing suitable clothing and shoes?
Think: P.E.A.C.E
P.E.A.C.E
• PERSON- Your Client
• ENVIRONMENT – Look around you, is it
safe?
• ACTIVITY- What are you doing?
• CARE WORKER- Freshness or Fatigue?
• EQUIPMENT- What is available?
Hazard or Risk
You are stood at the side of the road. You want to cross. You look
left, it is clear, you look right and there is a lorry approaching
about 1500metres away. In that instance you perform a risk
assessment. The hazard is coming towards you, you try to
assess the vehicles speed, you assess that the risk of the
vehicle hitting you is minimal, so you cross, and continue on
your way.
Hazard: Is any with the potential to cause
harm.
Risk: The chance that harm will occur and its
severity
Hazards
The Risk Assessment
CATEGORIES: LOW
MEDIUM
HIGH
Eliminating :
If you identify a HIGH risk activity,
then you must TAKE ACTION to reduce the level of
risk or try to remove it. Then you MUST REPORT it
Reducing: You must however also give priory to
LOW &
MEDIUM risks too. Sometimes you cannot
eliminate risk factors, but you can manage to
reduce the risk to more acceptable level.
Always read the care plan.
Client characterises grading
Completion of this section is to
enable staff to assess what level of
risk is apparent when handling the
client, and considering all factors.
A high risk client may require hoisting
or more manual handling.
The Assessor must take action to
make the risk as a low a reasonably
practical
Detailed Assessment
INANIMATE LOADS
•T=
•I=
•L=
•E=
TASK- What has to be done, how and when and
why?
INDIVIDUAL- who is providing the task? Can this
be safely managed by each member of staff?
LOAD- The person or object be move, and
factors which affect this
ENVIRONMENT- Where is the activity taking
place?
Fall Prevention…
Falls in the elderly are a problem for two reasons.
 They are more likely to happen than falls in younger people
 They are more likely to result in serious injury; e.g. 2 common fractures
as a result: Wrist fractures (Colle’s fracture or dislocation), Femur
fractures.
Recurrent falls are defined as those occurring at least three times a year.
Comorbidity is a serious problem both in terms of contributing to the
cause of the fall and outcome.
Falls are
DEVASTATING but also EXPENSIVE.
 Falls can lead to morbidity and mortality.
 Loss of self-confidence and Reduced quality of life.
 NICE estimate falls cost NHS £2.3 Billion pounds per year.
Risk Factors…
Risk factors include:












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
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High Age.
Female gender
Low weight
Previous falls
Dependency on a Care giver.
Orthostatic Hypotension (69% increased risk of having an injurious fall within 45
days after antihypertensive treatment)
Medication (especially psychotropic)
Polypharmacy (taking lots of medication!)
Alcohol Abuse
Diabetes Mellitus
Confusion and Cognitive impairment
Disturbed vision
Disturbed balance or co-ordination
Gait disorders.
Urinary Incontinence
Inappropriate footwear.
Risk of Injury…
Weak bones:
With increasing age, conditions with predispose to weakness & fracture
occur:
 Osteoporosis (metabolic bone disease)
 Osteomalacia (softening of the bone)
 Paget's Disease (bones become enlarged and weakened)
 Metastases/Mets.(to bone)(tumour spreads to the bone)
Predisposition to falls:
This includes the risk factors above. Dementia is a particular, impaired
Visuospatial ability is an increased risk.
Poor self-protection:
 Lack of protective subcutaneous fat.
 Neurological problems (forgetting to cushion the fall)
 Loss of Consciousness (syncope)
 Motor and Sensory problems.
 Multiple Contributory factors (stiff joints, drugs and environmental)
The Scope…
Consideration of some of the common conditions and risk factors
predisposing falls in the elderly.
Environment.
Loose rugs or mats
Electric leads
Wet Surface
Lighting
Furniture
Fittings
Power and balance:
Encourage to keep active. Strengthens muscles and maintains joint
position sense and balance.
Elderly people who have had a fall lose confidence and become less
active.
Activity must be encouraged.
Modifications for individual’s needs
Develop power and balance.
Accessing the community.
Medication:
Drugs can contribute to falls in many ways- need to be reviewed
regularly.
 Sedative medication, including Hypnotics. There is a particular risk of
falls in agitated patients with cognitive impairments.
 Confusion from Psychotropic medication.
 Polypharmacy is common in elderly.
 Hypotension caused by:
•
Diuretics, Vasodilators, Alpha-blockers, Beta-blocks, Insulin
Neurological…
 Minor strokes can cause significant weakness
 Parkinson’s disease impairs mobility (abnormal posture, freezing,
frontal impairment, poor leaning balance and leg weakness) Parkinson’s
Gait
Parkinson’s Improvement
 Neuropathy may occur (e.g. Diabetes)
 Proximal myopathy- muscles become weak and slow to relax
(Overactive thyroid, Cushing's syndrome and use of steroids.
 Impairment of co-ordination.
 Cognitive impairment e.g. Dementia.
Loss of consciousness…


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
Syncope
Dizziness
Arrhythmias (cardiac output)
Convulsions (epilepsy)
Drop attacks…
Falls are called ‘drop attacks’ if there is no known cause.
 Cardiovascular disease
 Carotid Sinus Hypersensitivity (quick ‘low’ in blood pressure, or 3
second pause in the heart beat)
 Transient Ischaemic Attacks (mini-stroke)
 Orthostatic Hypotension (fall of at least 20mm Hg blood pressure)
 Dehydration
Visual Disturbance…
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Cataracts
Macular Degeneration
Central Retinal Artery/Vein occlusion
Visual field defects.
Prevention…
This means taking measures to prevent falls before they happen!
 Increasing exercise and physical activity
 Reviewing medication
 Changing adverse environmental factors
 Improving management of any medical conditions.
A good history…
 Was it tripping over something or loss of balance?
 Loss of Consciousness?
 History of falls?
 Drug history
 Alcohol?
 Home assessment, Risk Assessment and falls prevention.
 Examination:
Cardio vascular, neurological, functional (gait), MMSE, Vision.
NICE (National Institute for Clinical Excellence)
People at Risk of Falls:
 All patients over 65 years.
 All patients between 50-64 judged by a clinician due to their
condition.
An assessment should include:
 Cognitive impairment
 Continence problems
 Falls history
 Footwear
 Health Problems
 Medication
 Postural instability, mobility/balance problems
 Syncope syndrome
 Visual impairment.
ABUSIVE PRACTICE
• Many of the manoeuvres and lifts passed
on over the years are no longer
acceptable in every day practice.
• A number of these techniques are now
considered to be harmful to the client
and carers, and also regarded in some
instances as physical abuse and rough
handling
The Nursing & Midwifery Council (2002)
defines physical abuse as:
‘Any physical contact which harms
clients or is likely to cause them
unnecessary and avoidable pain and
distress.’
Such abuse can occur due to health
and care staff handling clients in a
rough manner, often due to ignorance
or poor application of manual
handling techniques.
It can be
defined as any
method of
handling where
the carer places
a hand or arm
under the clients
armpit.
The use of this lift
can cause
damage to the
carer’s spine,
shoulders, wrist
and knees.
The Drag Lift.
Condemned
technique in
1981
For the client,
there is the
potential of
injury to the
should and
armpit. Risk of
fractures to the
upper arm and
dislocation of
the shoulder
The orthodox (cradle lift)
The Orthodox lift
involves two
carers placing
their hands
beneath the
arms or behind
the back and
underneath the
client’s leg.
The involves
carer lifting at
arms length
whilst twisting at
the trunk and
hold the load
away from the
centre
Condemned
technique since
1987.
This is likely to
cause injury to
the clients
shoulders and
knee’s.
The ‘Through arm’ Lift/slide
The through-arm
lift/slide often
occurs whereby
two health or
care professionals
work together at
either side of the
client to move or
slide them into a
sitting position on
the bed.
It can also pose a
risk to the carer in
relation to their
posture and
position whilst
handling on bed.
Condemned
technique in 1998.
Damage could
occur to pressure
areas. This lift
applies pressure to
the clients forearm
and underarm.
This can make the
manoeuvre
potentially painful.
The Shoulder lift/slide
The shoulder or
Australian slide/lift
is another
manoeuvre
whereby a client
can be moved on
a bed by two
carers working
together.
This technique
results in dangers
to the carer due
to an uneven
loading, with force
applied to one
shoulder.
Condemned
technique in 1996.
This lift involves
moving or support
a client with their
arms or hands
around the
handlers neck.
This is particularly
dangerous.
If the client does
not stand, or
collapses when
his or her arms are
around the
handlers neck, all
their weigh is
hung around the
neck
Bear Hug
Condemned
Technique.
If the client falls
backwards their
instinct will be to
remain clamped
around the
handlers neck,
so causing them
to fall.
Follow Guidelines
• Back injuries cost the UK £5billion in all
sectors.
• Over 119 million working days are lost
each year.
• Each year at least 5000 employees in
health and social care need time off.
• Half of all injuries in the health care sector
are related to handling loads.
• Every year 4000 nurses are forced into
retirement because of back related
problems.