Lifting, transferring and positioning of patients is frequently undertaken by nurses on each working day. This is necessary for patient comfort, medical reasons and completion of self care needs. Lifting can be done in numerous ways. In addition to the nurse physically lifting or moving patients, a number of devices are also available to assist in the transfer of patients. These range from straps that are attached to or placed under the patients, to mechanical hoists and lifters. Any assistance the nurse has is beneficial for both the patient and the health care worker, as patient's weights are generally heavier than the nurse's physical capabilities. This, combined with incorrect lifting techniques, can result in muscle strain, or more seriously, spinal injury for the nurse, and discomfort, muscle strain or further injury for the patient. INTRODUCTION When lifting, transferring or positioning patients, the most important consideration is safety. Any of these procedures need to be undertaken with that in mind. This safety is inclusive of both the patient and the health care worker. Communication is an important part of the lifting process as the nurse should elicit information from the client to find out how and when he/she prefers to be moved. This allows the patient to be involved in the decision making process and be fully aware of what is occurring. By communicating with the client, the nurse is also aware of whether or not the patient is experiencing any discomfort during or after the lift. The actions of lifting, transferring or positioning need to be completed for numerous reasons, including relief of pressure points. If a patient stays in one position continuously, he/she is prone to develop what is commonly known as "bed sores" which cause physical discomfort. In addition, a change in the immediate surroundings is also beneficial for the patient. It is also necessary for the patient to be moved for completion of his/her self care needs. This includes their hygiene needs, such as bathing or showering, elimination, hair, oral and nail care. METHOD When lifting, transferring or positioning patients manually, safety is the most important factor. This safety is for the nurse him/herself as well as for the patient. One aspect of safety is for the nurse to utilize "good body mechanics" (Kozier et al 1995, p.879). This refers to the nurse having balance, which can be achieved with the feet being spread approximately shoulder width apart, giving stability and a "wide base of support" (Kozier et al 1995, p.888). According to Kozier et al, (1995 p.879) balance is also achieved by correct body alignment and good posture. The use of correct body alignment reduces the strain on muscles and joints, and makes lifting the clients much easier. When lifting clients, the first thing the nurse should do is explain to the patient what will be happening and ask the patient if there is any particular way they would prefer to be moved. This allows the patient to have some opinion about what is being done to them. The next thing that should be done when moving a patient is a routine assessment. The nurse may assess the situation by observing the patient and reading the nursing care plan. The nurse needs to be aware of the patient's capabilities to see how much he/she can do or if he/she can assist in any way. Another important part of assessment is observing the surrounding environment, to be sure there is no obstructions or other hazards which may be injurious to the nurse or patient before, during or after the move. The next phase is that of planning the move. The nurse decides how the patient will be moved from the current position to where he/she is going. This may involve the nurse getting assistance for the lift, either from other health care workers or by mechanical devices, such as a lifter or hoist. When moving or lifting the client, wherever possible the nurse should have assistance. This assistance is necessary for both nurse and client safety. This is supported by Kozier (1995 p.910), who says, wherever possible, "the preferred method is to have two or more nurses move or turn the client". When moving clients physically, there are different types of moves that can be used. When moving a client up in bed, the client should be encouraged to help if possible. The nurse can ask the patient to bend his/her knees, so that when the nurse is ready, the patient can assist by pushing backwards. Two nurses stand on opposite sides of the bed facing each other. With knees bent and legs shoulder width apart, the nurses lock forearms underneath the patient's thighs and shoulders. The nurses, on the count of three, at the same time as the patient is pushing backwards, transfer the weight to the legs that are in the same direction that the patient is going to be moved. When moving a client from a lateral lying position to sitting at the side of the bed, the first thing that the nurse should do after assessment, is to get the patient in a side lying position. This is done by the nurse placing one hand on the client's hips and one hand on the client's shoulder. The nurse then transfers his/her weight onto the back foot while at the same time rolling the client towards them. The next step is to place one arm underneath the patient's shoulder and one arm underneath the knees. The nurse then turns on the balls of the feet while at the same time pulling the client's legs down onto the floor. The next move is transferring a client from the bed to a chair. Once the client is sitting on the edge of the bed, the nurse can easily move the patient to a chair. By using a "transfer belt" (Kozier 1995 p.924). Before commencing the lift, the nurse must have the wheelchair ready and parallel to the bed. The nurse must make sure the client's feet are placed flat on the floor with one foot slightly in front of the other. He/she then places the belt around the client's waist, and stands facing the client with his/her arms around the client's waist, holding onto the belt. The nurse asks the patient to assist by transferring the weight onto the front foot on the count of three, while at the same time, the nurse transfers the weight onto the back foot, lifting the client up to a standing position. The nurse supports the client until a steady balanced position is achieved. The nurse and client, when ready, pivot in the direction of the chair. The client then holds the arms of the chair as a means of support and to assist when lowering into the chair. The nurse then lowers the client into the chair, bending at the knees. The transfer belt is then removed when the nurse has assessed that the client is comfortable and secure in the chair. The nurse should also make sure that the client has suffered no ill-effects as a result of the move. When the transfer belt is not available, Kozier (1995 p.925), recommends that the nurse puts both hands at the sides of the patient's chest and continues the procedure in the same way. When transferring the patient from the chair to the bed, the same procedure is implemented but in reverse. Before the transfer is started, the nurse should make sure that the bed is clean and dry. The client is then moved from the chair to the bed and then assisted to a lying down position. Although manually lifting patients is effective, it is advisable that the nurse should lift or transfer with a mechanical lifter. It is especially effective in reducing the risk of injury to both the client as well as the nurse. This is supported by Seymour (1995 p.48) who says that, "more nurses are beginning to realize the equipment's potential for protecting both client and carer from injury." When using these devices, the nurse should tell the patient what is being done and how it is being done. Mechanical lifters either have two slings, one sling for underneath the shoulders and one for underneath the thighs or buttocks, or one sling which extends from the client's upper back to lower thighs. The lifters substantially reduce the strain on the nurse and the patient and are able to be used for all transfers. The nurse places the sling underneath the patient and attaches the slings to the lifter with hooks, and the nurse then controls the lifter for the desired action. When using a mechanical lifter, some problems that may arise are that the lifter is broken or unavailable. Therefore, the nurse should be aware of how to correctly manually lift the client. Another problem with mechanical lifters, according to Scott, (1995 p.106) was that mechanical devices were, "often left because staff did not feel confident enough to use them." This highlights the fact that all staff needs to be taught the correct way of using the lifters. The problem with lifting patients physically, is that nurses are often required to lift loads greater than they are physically able. This is due to, "the likely mismatch between the size of a patient to be lifted and the physical capabilities of the nurses on duty." (Love 1995, p.38). Another problem with lifting patients manually, is that the correct lifting procedure may not be carried out, leading to patient discomfort, as well as long term back problems for the carer involved. One problem which may also arise from incorrect lifting techniques is the development of pressure areas, due to the patient being dragged and not lifted across the sheets. This friction can lead to the patient developing reddened skin which may lead to skin breakdown. DISCUSSION By the health care worker implementing the correct lifting techniques, the nurse and the patient's safety is not compromised in any way. Nurses should be constantly aware of any new methods of lifting or transferring which arise, so that they are able to maximize the level of safety for themselves as well as for the patients. By the nurse using the correct lifting techniques, and not dragging the patient, the risk of the patient sustaining further injury, such as pressure areas, is reduced. By communicating with the client, the nurse is also made aware of any problems the client has with any aspect of the lift. Regular maintenance of equipment is essential so that the equipment does not breakdown frequently. Hooks, straps and slings need to be constantly checked to ensure optimum working order, as well as ensuring client safety. Staff needs to be educated on the use of the lifters and regular testing would ensure that the staff is confident and competent in their use. This may lead to a decrease in the amount of mismatched clients and nurses in terms of weight. REFERENCES: Kozier, B., Erb, G., Blais, K., Wilkinson, J.M. 1995, "Fundamentals of Nursing", 5th Edition, Addison Wesley
Inc., United States of America. Love, C. 1995, "Managing Manual Handling in Clinical Situations", Nursing Times, vol. 91, no. 26, pp. 38-39. Scott, A. 1995, "Improving Patient Moving and Handling Skills", Professional Nurse, vol. 11, no. 2, pp. 105-110. Seymour, J. 1995, "Handling Aids - Lifting and Moving Patients", Nursing Times, vol. 91, no. 27, pp. 48-50.