CNA Training Advisor

Transcription

1 CNA Training Advisor Volume 11 Issue No. 10 october 2013 In the field of nursing, work-related musculoskeletal disorders (MSD), such as back and shoulder injuries, persist as the leading and most costly U.S. occupational health problem. Back injuries are the most common reason for work absenteeism next to colds and flu. A large body of evidence indicates that a substantial number of workrelated MSDs reported by nurses are due to the cumulative effect of repeated manual patient-handling activities and work done in extreme static awkward postures. In this lesson, you will learn about the importance of conducting safe transfers. You will also learn the difference between biomechanics and body mechanics, how to assess a patient for a transfer and create a safe transfer environment, and some important things not to do when transferring. The lesson will describe the types of transfers, such as transfers from the sitting position, side-to-side transfers, and repositioning. You will also learn how to use proper transfer equipment, such as gait belts and special bathroom equipment. Have a good day of training, and stay tuned for next month s issue of CNA Training Advisor on sepsis. A focus on observing and reporting Transfers and other movements require a great deal of your resident s energy. Watch for the resident s reaction and tell your supervisor if the resident experiences any excessive weakness. If the resident reports feeling light-headed, ensure a safe position and check his or her blood pressure when it s safe to do so. Report changes to your supervisor. Share information about the resident s activities during team conferences. Report any difficulties you may be having, and update the nurse and/or therapist about any problems with equipment.immediately report any falls or other accidents that you or the resident experience. Quiz answer key 1. a 2. b 3. d 4. b 5. d 6. c 7. b 8. a 9. d 10. a Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: Describe the importance of creating a safe transfer environment Properly assess a resident before transferring Explain how to perform several transferring techniques Preparation Review the material on pp. 2 4 Duplicate the CNA Professor insert for participants Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant s seat 2. Conduct the questionnaire as a pretest or, if participants reading skills are limited, as an oral posttest 3. Present the program material 4. Review the questionnaire 5. Discuss the answers see also hcpro.com/long-term-care

2 CNA Training Advisor October 2013 This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, any use, disclosure, forwarding, copying, or other communication of the contents is prohibited without permission. editorial advisory board Associate Editorial Director Todd Hutlock Editor Casey Pickering Stay connected Interact with us and the rest of the HCPro community at HCPro.com Become a fan at facebook.com/hcproinc Follow us at twitter.com/hcpro_inc us at customerservice@hcpro.com Questions? Comments? Ideas? Contact Editor Casey Pickering at cpickering@ hcpro.com or , Ext Don t miss your next issue If it s been more than six months since you purchased or renewed your subscription to CNA Training Advisor, be sure to check your envelope for your renewal notice or call customer service at Renew your subscription early to lock in the current price. Relocating? Taking a new job? If you re relocating or taking a new job and would like to continue receiving CNA Training Advisor, you are eligible for a free trial subscription. Contact customer serv ice with your moving information at At the time of your call, please share with us the name of your replacement. CNA Training Advisor (ISSN: [print]; [online]) is published monthly by HCPro, Inc., 75 Sylvan Street, Suite A-101, Danvers, MA Subscription rate: $149/year; back issues are available at $15 each. Copyright 2013 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call or fax For renewal or subscription information, call customer service at , fax , or customerservice@hcpro.com. Visit our website at Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. Opinions expressed are not necessarily those of CTA. Mention of products and serv ices does not constitute en dorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Many of the residents who require CNA services have problems that limit their mobility. Some of the common diagnoses that cause mobility problems include strokes, fractures, hip and knee replacements, leg problems caused by diabetes, and general weakness due to a chronic disease. Transferring residents is a frequent task for CNAs. It involves moving the resident from one area to another, either alone, with another person, or with the help of equipment. Manually lifting and transferring dependent residents are activities that may result in injury, especially back injuries, for both healthcare workers and the resident. Since movement is part of every activity, its risk is often overlooked. Following simple guidelines and maintaining awareness can make a big difference in resident and employee outcomes. Good body mechanics, maintaining a safe environment, and knowledge of appropriate equipment can help protect the resident as well as the CNA. Safe resident handling and movement concepts To help clarify the difference between biomechanics and body mechanics, we have provided the following definitions. Biomechanics: The study of the mechanics of muscular activity and how muscular activity leads to internal loading of body tissues, such as the ligaments, joints, and other soft tissues. Biomechanics is useful in determining whether a specific manual resident handling task will create unacceptably high forces inside the body and whether a manual lift is safe or not. Body mechanics: The belief that reliance on correct body positions or body movements will somehow provide protection from the force associated with lifting and moving residents. Body mechanics is also used to assess the alignment of residents when they are standing, sitting, or lying down. Body mechanics alone, however, is not sufficient to protect the nurse from the heavy weight, awkward postures, and repetition involved in manual handling. Safe manual handling techniques must be used in combination with equipment and technology for safe resident handling and movement. Assessing the resident Safe lifting and transferring is dependent upon good technique, proper equipment, and an accurate assessment of the resident. Some of the factors that the CNA should be aware of when assessing a resident include: Physical status, such as: 2 hcpro.com 2013 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or

3 October 2013 CNA Training Advisor Strength Areas of weakness Balance Ability to bear weight Level of pain during a transfer Ability to communicate/understand Height and weight Diagnosis and medical history Attached equipment Mental status, such as: Previous willingness to assist Aggressiveness Fear Predictability Creating a safe environment The design or layout of the workplace can make a big difference in ensuring safety. More and more offices and factories are being designed with ergonomics and safety in mind. To stay safe, keep these points in mind: Before working with a resident, have a plan for dealing with the surroundings and problems. Look at the size and shape of the room and look for safety hazards, such as narrow hallways, doors, and other items that may block your path. Also, think about what you would do if this resident were to fall. Prepare the area for movement. Place equipment correctly and check that you ve chosen the shortest distance to transfer the resident. Move furniture if necessary to position the wheelchair next to a bed. Remove arms from wheelchairs, if possible. Use safety equipment and devices if they re available, such as grab bars in the bathroom if the resident has installed them. Know that some devices may not be suitable for heavier residents. Whenever possible, work at the highest level that will prevent the need to bend. If the resident is in a hospital bed, be sure to raise it to a comfortable working level. Adjust lighting to the best level, which will help you clearly see your tasks. Check the status of the floors. Watch out for wet or otherwise slippery floors. If something spills, immediately clean and dry the area to prevent falls. During the transfer: Stand as close to the resident as possible, place both of your feet toe-to-toe with the resident, or one foot sideways immediately in front of both of the resident s feet. Look into the resident s eyes and talk about the transfer. Count out loud, 1-2-3, so that you both begin to move at the same time. Do not grab the resident under the arms; reach completely around the resident to get a firm grip. Side-to-side transfers and repositioning This technique is used when transferring a partial- or non-weight-bearing resident between two flat surfaces such as a bed to a stretcher, or when repositioning the resident in bed. For safety, it requires more than one caregiver. Additional assistance may be needed depending on the resident s status, such as a heavier or uncooperative resident. Use of a draw sheet or slide board may reduce friction and the amount of manual strength needed from the caregivers. A draw sheet is a narrow single sheet, or regular sheet folded in half, which is placed across the bed under the resident. It can assist with transfers or be used as additional protection under the resident. A slide board allows the resident to move or slide between two surfaces. Sometimes a combination of equipment will make the transfer even easier. When repositioning in bed, adjust the height of the bed, if possible, to allow you to work at waist level, avoiding reaching and bending. Keep the head of the bed flat, making it easy to move in that direction by avoiding the need to move uphill. If moving between two surfaces, be sure that both surfaces are at the same level and are flat. Position the draw sheet or slide board under the resident s trunk, centered for balance. If using a draw sheet, make a good handhold by rolling up the sheet as close to the resident s body as possible. This prevents the sheet from forming a hammock, which 2013 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or hcpro.com 3

4 CNA Training Advisor October 2013 would allow the resident to hang in the middle, putting more weight on the caregivers. Use a gentle push and pull motion to move the resident to the new surface. If using a slide board, grasp it securely, count to three with your coworker, and together slide the resident in the direction you want to go. Transfers from sitting position These transfers are for residents who are unable to stand and must transfer in a sitting position. The resident must have good sitting balance and be able to cooperate when moving from one surface to another, such as from the bed to a wheelchair, or wheelchair to toilet seat. A transfer board or movable seat may be used. Lower the bed appropriately to the height of the chair so both surfaces are at the same level. For a bed-towheelchair transfer, lock the wheels on the bed and the chair. Position the slide board as a bridge between the two surfaces and assist the resident onto one end of the board, making sure that the resident s clothing is between the resident s skin and the board. Assist the resident to slide onto the other surface, and then gently reposition the resident while removing the board from underneath. Special equipment and transfer techniques Many types of lifts and supports are available to make moving residents easier. Studies have shown that the use of this type of equipment reduces worker injuries. While not all residents will have this equipment, it s important to be familiar with the equipment. Do not attempt to use such equipment unless you ve been trained to do so. Using a gait belt A gait belt can assist residents who are partially dependent, have some weight-bearing ability, and are cooperative with transfer and ambulation. Do not use a belt for residents with recent abdominal or back surgery, or for residents with a history of abdominal aneurysm. Double-check your care plan. Before beginning the activity, place the belt around the resident s waist, making sure that clothing is completely under the belt. Fasten the belt snuggly, leaving just enough room to grasp the belt easily between the resident s body and your fingers. Some belts include handles, which make it easier to grasp; without handles the caregiver simply grasps the belt itself. Tell the resident which direction you will be moving, always transferring to the resident s strongest side if he or she is weaker on one side. Stand in front of the resident, bracing his or her feet with your own feet. Use good body mechanics. Rather than using the belt to lift the resident, rock and pull smoothly in the direction you wish to go. Once the resident is standing, if using the belt to ambulate, stand next to the resident and hold the belt in the back. For additional stability, hold onto the resident s hand that s closest to you. Always be alert to the possibility of the resident becoming weak and falling. If a resident starts to lose balance or fall while walking with the gait belt, continue to grasp the belt and lower the resident gently to the floor. Bathtub, shower, and toileting activities Special bathroom transfer equipment includes toilet seat risers, raised toilet seats, and grab bars. These may be used for toileting partially weight-bearing residents who can sit up unaided and who have the ability and strength to use their arms and hands. Residents must also be able to bend at the hips, knees, and ankles. Sometimes, even residents who are very independent also use this equipment for added safety. Raised toilet seats and risers decrease the distance and amount of effort it takes for the resident to lower him- or herself to the toilet. Grab bars near the toilet make it safer to lower to and rise from the seat, adding stability and allowing the resident to move slowly. Check that the device is stable and can hold the resident s weight and size. A word of caution: Do not assume that a towel bar can take the place of a grab bar. Towel bars are frequently not sturdy enough to be used in this way. H 4 hcpro.com 2013 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or

5 october 2013 Volume 11 Issue No. 10 CNA Professor Mark the correct response. Name: Date: 1. Back injuries are the major cause of work-related injury and lost work for healthcare workers. 2. is the belief that reliance on correct body positions or body movements will somehow provide protection from the force associated with lifting and moving residents. a. Biomechanics b. Body mechanics c. Ergonomics d. Safe transferring 3. When assessing the resident before performing a transfer, the CNA should assess for. a. physical status b. pain level c. ability to communicate and understand d. all of the above 4. Facilities are always safe, so a CNA can assume that the environment is ready for a transfer. 5. What are some things the CNA can do to make a transfer safer? a. Before starting the transfer, explain exactly what the aide and resident will do 6. A transfer is used when transferring a partial- or non-weight-bearing resident between two flat surfaces such as a bed to a stretcher, or when repositioning the resident in bed. a. Sitting b. Bedridden c. Side-to-side d. None of the above 7. A gait belt may be used for all patients. 8. The CNA should transfer a patient who is weak on one side toward his or her strong side. 9. Special bathroom transfer equipment includes. a. grab bars b. raised toilet seat c. toilet seat risers d. all of the above 10. can reduce rehospitalizations. b. Count out loud to make sure that the resident and caregivers will move at the same time c. Maintain eye contact with the resident d. All of the above A supplement to CNA Training Advisor