Kinesthetic patient transfers Valencia 10.-13.2008

1. Kinesthetic patient transfersValencia 10.-13.2008 Eija Mämmelä M.Ed., Physiotherapist Oulu University of Applied Sciences email: eija.mammela@oamk.fi Based on material produced in a project by

2. Kinesthetic patient transfers What does it mean? Why? How? • Main target is to • Make the work more safe to therapists and nurses • Permit patients to use and increase their own resources (rehabilitation) • Basic principles • Applying patient’s natural movement patterns • Controlling therapist own body: mid-line, shifting weight, lowering body mass • Kinesthetic patient transfer does not demand power – it demands skills • Skills are for learning – Learning is understanding and a result of repetitions Tekijä, pvm

3. Why to make transfers easier? Are transfers really too heavy and dangerous? • After 1970 working has lightened almost everywhere • Not in health care – the work in hospitals is heavier now than 20 years ago • Good medical and health care: people live longer, old people have more limitations and sicknesses, are heavier to take care • Accidents in health care are 30% more common than mean • Every 10th employer works in health care institutes • 82% of nurses’ accidents occurred during patient transfers (Engvist 1997) • Long term geriatric wards are most problematic (Laine etc. 2006) • Transfers in toilet and from bed to wheel chair are heaviest (Garg ym. 1992)

4. The risk for accidents is bigger, if you • Lift continuously weights over 15-20 kg (Hansson 2001) • Transfer a lot of patients (Jensen 1990) • Bend and rotate your back repetitively (Hansson 2001) • Have a lot of other heavy periods in your working day (Kumar 1990) • You think the work is too difficult for you (Vahtera ym. 2002) • Don’t have or if you don’t know how to use equipments made for patient transfers (Zhuang ym. 1999, Videman ym. 1989) • How to reduce this risk?

5. Firm rail on the wall close by gives support Has to be close enough You need 70-80 cm space on the side Rarely needed behind the seat You need space to be able to facilitate your patient

6. Your own balance and control of your body is the basis for harmony during safe and light patient transfers 2.Sense and control the midline of your body • Lower your body mass • “tail down” Rotations Antero-posterior movents

7. Push hand –exercises (video 2, 2’07”) Sense your own mid-line and balance Follow your “patient’s” movements Tail down Exercise in different planes With knees flexed Rotations Close your eyes → sensation ↑ You need to exercise to improve your body control Also strengthen your muscles and take care of your physical condition

8. To be a human being is to be as lazy as possible It is natural to move with minimum energy Analyze your own movements and a child’s and an elderly person’s movements (video 1, 1’12”) http://vanhemmat.mll.fi/images/JKK/vauva_iloinen.gif You need to recognize natural movement patterns

9. You need to let the patient to use her own resources • Give your patient time: old people need more time to react • Make your patient to feel herself safe • Let her see where to move • 80% of falling accidents occur because the patient was afraid of falling or did not know what to do • Cheer your patient: confidence is power • Speak clear, tell what to do (not what not to do) • Stimulate manually if needed • Use utilities and devices to make transfers more easy and safe • Organize the environment to be free and safe

10. So – how to do it safely? How to learn the correct way?First notice HOW NOT to do it!

11. Good contact is a basis for kinesthetic patient transfers • Have good contact with your patient • Tell what she does and what you are going to do • Stimulate and facilitate manually: active muscles, direction, body mass • Think where you put your hands • YES: trunk, pelvis, under scapulas (where there is weight or friction) • NO: armpit, clothes, joint areas needed for movement

12. Where do I stand while helping and should I move? • Stand beside the patient, never in front of her • Use your whole body, not only your upper extremities and back • Quadriceps is the strongest muscle (it is an extersor, so bend your knees) • Be really near your patient – it makes patient to feel more safe • Avoid bending your back too much or reaching too far • Move side by side with your patient • The patient starts the movements • You follow (like a lady follow her dance partner) • Be ready to prevent false and unsafe movements

13. From side-lying to sit on the bed • Patient pushes with her own arm • Stimulate the arm by tapping • Guide places for both arms • Your hands: on pelvis and on the upper shoulder (video 12, 1’34”)

14. -Patient sees where to move Reaching to grap the handle shifts body weight, shows direction From sitting on bed to a wheel chair Supporting patients own movements

15. From sitting on bed to a wheel chair- when the legs of patient are spastic or hypotonic • By rocking forward • glide board • push (on video 9) • or pull (demonstration) • 2. By rolling around (video 9, 2’10”) • glide board • therapist guides to right direction

16. From wheel chair to toilet seat 2. Two persons helping • One person helping • Guiding pelvis from back (video) • Guiding forward from front (demonstration) Moving oneself from wheel chair to toilet seat (video 10, 1’15”)

17. Facilitating patient to move from back to his side • Roll the pelvis • little by little • 2. Glide shoulders • Put your arm under the trunk • to decrease friction

18. Transfering a lying patient upwards in bed video 3 (3’16”) 1. ”walking on one’s back” 3. Decrease friction with lifter Shift your own weight backwards 2. With extra sheet or mini-mover

19. Organize firm support to patient Stand beside patient, not in front of Patient can lean forward and move his weight to his legs Your hands: pelvis, shoulder, chest, maybe on quadriceps to stimulate muscle activation… Video 6 (4’16”)) From bed to wheel chair – via standing position

20. From bed to wheel chair –two persons helping Patient holds and pulls herself, Therapists’ hands are on the trunk Walking belt! Patient holds therapist arms – they do not lift from armpits!

21. With heavy or very painful patients use a lift or other shifting devices

22. Utilities and equipments for patient transfers Friction might be a problem – try to decrease it Easy glides -full size best for the weakest, painful or totally passive patients Decrease friction • Plate for turning • From sitting to sitting • Bed > wheel chair • In toilet • Glide boards • are used with lying and sitting patients

23. Utilities and equipments for patient transfers Lack of power might be a problem • Handel is fixed on bed and it turns 90º • For getting up from bed • For standing up • A robe with knots or robe ladder • Fix on the end of bed • Patient pulls • himself up from bed • Gives support to patient • getting up from a chair • Patient pulls • himself up

24. Utilities and equipments for safe patient transfers Safety demands firm holding – you can’t pinch hard your patient - use equipments • Walking belt while • Walking • Standing up from sitting • Transfers from sitting to sitting • Patient has it on, or you have it! • Semiflexible mat with 4 or 6 handles • For moving patient lying in bed • to shower trolley Rehamed website

25. References and sources of pictures • Tamminen-Peter, Eloranta, Kivivirta, Mämmelä, Salokoski, Ylikangas. 2007. Potilaan siirtymisen ergonominen avustaminen. Opettajan käsikirja. STM Julkaisuja 2007:6 [Ergonomics in Patient Transfers. Handbook for Teachers. Published by Finnish Social and Health Ministry. Available in Finnish www.ttl.fi/potilassiirto] • Website for teaching ergonomic patient transfers. 2007 http://www.ttl.fi/Internet/Suomi/Aihesivut/Ergonomia/Ergonomiaa+eri+aloilla/Sosiaali+ja+terveydenhoitoala • were produced to develop teaching of Patient transfers in Finland. • Administrated by Finnish Institute of Occupational Health • Developed in a project nominated by Finnish Social and Health Ministry

26. Studies and researches about patient transfers and the work load related to them (indicated in this file) • Engvist 1997. Events and factors involved accidents leading to over-exertion back injuries among nursing personnel. Arbete och Hälsa 30. Arbetslivsinstitutet, Stockholm. • Garg & Owen1992. Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home. Ergonomics 35:1353-1375. • Hansson 2001. Ländryggsbesvär och arbete. In Hansson & Westerholm (Ed.) Arbete och besvär I rörelseorganen. En vetenskaplig värdering av frågor om samdand. Arbete och Hälsa 12. Arbetslivsinstitutet, Stockholm. • Jensen 1990. Back injuries among nursing personnel related to exposure. Appl Occup Environ Hyg 5 (1), 38-45. • Kumar 1990. Cumulative load as a risk factor for back pain. Spine 15, 1311-1316 • Laine ym. 2006. Työolot ja hyvinvointi sosiaali- ja terveysalalla 2005. Työterveyslaitos, Helsinki. • Vahtera ym. 2002. Työn hallinta ja työaikojen hallinta. In Vahtera ym. (Ed.) Työntekijöiden hyvinvointi kunnissa ja sairaaloissa: tutkittua tietoa ja haastetta. Työterveyslaitos, Helsinki. 29-35. • Videman ym. 1989. Patient handling skills, back injuries and back pain: an intervention study in nursing. Spine 41, 148-156. • Zhuang ym. 1999. Biomechanical evaluation of assistive devices for transferring residents. Applied Ergonomics 30, 285-294. Based on material produced in a project nominated and administrated by