Paul Harrison Interview – The Controversy of Manual Handling

 

In the European guidelines on manual handling there is an emphasis that before we start employing manual techniques, we should always try to mechanize the operation.  The biggest solution in the NHS is using hoists to actually do transfers between services.

No nurse these days would think about doing a manual transfer of a dependent patient from bed to chair as we used to do in the past, without reaching for a hoist. This is regardless of whether it is in hospital, at home or using some kind of sliding device to transfer the patient across.

We’ve mechanized so many of the operations; the only mechanization you will find in turning patients is generally to use the sliding sheets. We haven’t really gone to the same extent in bringing in fully mechanical equipment. This is where Guttman who developed the first bed for spinal cord injuries came in because he was worried about his nurses’ backs.

He also worried that it wasn’t always possible to get the right number of nurses because if we emphasize that the patient needs turning, then nurses being nurses will attempt to turn using what they’ve actually got; if it was safe for the patient.

We emphasize things like it needs five people to do a safe spinal protective turn, but that’s only if you’ve got an actual spinal or spinal cord injury. Equally, some people because of their complex injuries can need just as much support to make sure they are not in pain or compromising repair operations or to do it safely so that the patient turns as a body rather than a number of parts.

One of the controversial things is that governments started the debate on complex people having mechanical turning, not just for the benefits of turning, but for the benefits of staffing numbers and the staff safety.

When we have a technique that’s safe manually, we believe it’s safe but we are still putting nurses under stain. It’s also controversial because when you get more people working together there is a greater emphasis on coordination.  The more nurses you need, the more you need them to work as a team and many of these teams of what we call scratch teams. That is, for example if you take the patient down to the MRI you may be working with one or two nurses, a couple of radiographers and a couple of porters and those people may not always train together.

Some hospitals are good and they train all of their staff together in these scratch teams for safe log rolling and handling a patient, but in others they don’t. You get people that don’t work together on a frequent basis but also don’t even access the same training. That can be quite difficult for both the staff and for the patient, so sometimes the patient is safe but the staff aren’t and sometimes both the staff and the patients are compromised.

For routine turning in bed, we haven’t seen the investment in turning beds in the same way as in hoists.  If you go into a hoist hospital and count the number of tracking hoists, the number of floor hoists and the number of aids for transfers, that’s an investment because of its link to specific moving and handling injuries.

Routine turning doesn’t seem to have attracted the same attention, but if we were to apply the regulations in principle to routine turning, we are not actually following the regulations with the same investment that we were doing before. We have spent an awful lot of money on hoists, but we haven’t seen a similar investment in mechanizing turning beds.