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Manual handling of patients has been a continuous issue of safety among nurses. In fact, the Department of Health(2007) has called for an end in the manual handling of patients due to the injury that it has caused among nurses. The "no lifting policy" has been imposed as a strict rule in all hospitals and the principles of body mechanics has been stressed among all hospital employees to prevent back pain & muscle strain among healthcare staff.
In the surgical ward where I am presently working, utilising the ideal way of moving & handling patients is an important part of my everyday work especially that we deal mostly with orthopaedic patients. The proper use of manual handling aids and proper body mechanics are very important principles that we keep in mind everyday to ensure safety not only for our patients but for ourselves as well.
Schön, D.Â (1983) definedÂ reflective practiceÂ as "the capacity to reflect on action so as to engage in a process of continuous learning". This reflective essay will focus on my experiences while I worked to attain my goal of becoming more proficient in moving and handling surgical patients. Using the Gibbs (1988) Reflective Model, I would be reflecting on my practice to promote more avenues of learning about this topic in the future.
The Reflective Cycle
I have not had much experience with taking care of orthopaedic patients before I came to this country. But, when I started my adaptation program in a surgical ward of a private hospital, I was bombarded with patients who had hip, knee and foot surgeries. I came across manual handling aids like crutches, frames, and sticks in helping patient's mobility and focused on promoting patient's independence. During the first few weeks, I was not very confident with handling these patients knowing that I was not well equipped with the knowledge & skills. Thus, I was motivated to find a way to be better in this aspect.
I started by researching about postoperative care for orthopaedic patients and proper usage of manual handling/ mechanical aids & equipment. I attended the mandatory training about manual handling as well and improved my knowledge about the principles of body mechanics and the different manual handling aids. We were also taught on how to move & handle patients especially in difficult or emergency situations.
In the next few weeks, I worked hand in hand with the physiotherapists and I carefully observed how they facilitate mobility and independence among postoperative patients. As cited in the NICE guidelines (draft for consultation, October 2010), the rapid restoration of physical and self care functions is critical to recovery from surgery, particularly where the goal is to return to the patient to pre-operative levels of function and residence. Therefore, it is very important to assist patients in returning to their optimal level of well being by motivating them to be independent as soon as possible as safety allows.
During the first few weeks of my exposure, I looked at orthopaedic patients as very delicate in terms of mobilisation. I was aware of the restrictions that each type of surgery has, I knew what aids they need to facilitate their movement and I knew by theory the techniques that nurses & physiotherapists apply when assisting them with their mobility. I was competent in knowledge due to the extra time I did with research and with my effort at working with the physiotherapists. Yet, I was not confident with the actual thing. Every time I assist these patients in getting out of bed, sitting on a chair, or going to the toilet, I ensured that I had some other health care professional with me to assist the patient. I had fears within me especially when handling hip patients knowing that these patients commonly experience fainting episodes during the first few days after the operation. I was very careful and very keen with my patient's safety and every time I do something, I make sure that I follow the principles of body mechanics to protect myself as well.
As time went on and as busier the ward gets, I developed more confidence in handling these patients and in giving instructions to aid in their mobility & regaining their independence. As time went on, I experienced more incidents which gave me more learning. I experienced a few incidences wherein these hip patients lose their consciousness not only when the patient was about to lie back on bed but also when the patient just had a shower in the assisted bathroom. Those experiences made me very cautious from then on and they enhanced my skills in carrying out immediate interventions during emergency situations.
The whole experience taught me to be confident and I was able to achieve a sense of control over every situation I encountered. I always regard safety as priority in doing every action.
While assisting patients in regaining independence, there were times wherein I cared for patients who were very stubborn and who wanted to do things their own way. There were instances wherein the patients become overconfident that they do things on their own, not thinking about the risks that they put themselves into. No matter what instructions we give to these patients, they still hesitate to cooperate.
In contrast, I also have this tendency of making my patients very dependent at times. As influenced by my culture, I sometimes tend to offer myself to my patients too much that they get used to having other people do things for them, thus conflicting the principle of promoting independence.
Examining deeply the experiences I had made me grasp the reality that we should always act accordingly and think about what's best for our patients. These decisions might not always please them but we, as nurses, have to show to them that we are in control of the situation and act as patient advocates. These incidences taught me to be firm and be authoritative as the situation allows and that I should assist the patients in attaining their goal of being able to do their activities of daily living (ADLs) on their own.
As the age, weight, and infirmity of patients being hospitalized increase in our society, the people responsible for caring for them face greater risk for developing musculoskeletal injury during the routine moving, transferring, and repositioning of those charged to their care. This risk is intensified by the growing median age of nurses (Bureau of Labor Statistics, 2010) and the fact that many of those caregivers suffer daily from previous injuries related to the physical tasks of patient care (Peter D. Hart Research Associates, Inc., March, 2006). There is increasing evidence (Nelson & Baptiste, 2004;Â Nelson, Motacki, & Menzel, 2009) to indicate that safe patient-handling and movement strategies are effective in reducing the risk of musculoskeletal injuries and pain.
This entire experience made me realise the importance of safety while helping the patient achieve optimum health and faster recovery. If I were to make changes about the whole situation to improve myself, I could have worked with the physiotherapists by practically getting involved in using the different manual handling aids. Aside from that, I could have exposed myself to the use of other manual handling aids that were not commonly used in the ward where I am working.
In the future, I intend to make myself more familiar with other mechanical devices by exposing myself to the medical wards. I would also plan to attend any trainings and seminars about manual handling to update me with the knowledge and skills. Upon handling orthopaedic patients in the future, I intend to promote independence as much as possible and be more firm to perverse patients.
Bureau of Labor Statistics. (2010). Career guide to industries, 2010-11 edition, Healthcare. US Department of Labor. Retrieved February 21, 2010, fromhttp://www.bls.gov/oco/cg/Â [Context Link]
Peter D. Hart Research Associates, Inc. (2006, March). Safe Patient Handling: A Report Based on Quantitative Research Among Nurses and Radiology Technicians. [Conducted on Behalf of AFT Healthcare By Peter D. Hart Research Associates, Inc.] Retrieved February 21, 2010,Â www.aft.org/pdfs/healthcare/safepatienthandling0306.pdf[Context Link]
Nelson A., Baptiste A. (2004, September 30). Evidence-based practices for safe patient handling and movement. Online Journal of Issues in Nursing, 9, 3, Manuscript 3. Retrieved May 17, 2010, fromhttp://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/EvidenceBasedPractices.aspx[Context Link]
Nelson A., Motacki K., Menzel N. (2009). The illustrated guide to safe patient handling and movement. New York: Springer.Â [Context Link]
^Â Schön, D.Â (1983)Â The Reflective Practitioner, How Professionals Think In Action, Basic Books.Â ISBN 0465068782.[