My aching back: Don’t let aides injure themselves
Show staff correct lifting techniques
A Texas home care agency decided that if its aides had even three to five back injuries causing lost work time a year, it was too many.
The injuries weren’t serious. But even minor back injuries were a sign that aides had some poor habits in lifting and moving patients, so something had to be done. The agency’s education manager decided to solve the problem through extensive inservices and hands-on training.
"Any large home care agency is going to have some injuries, but the way to reduce them is through education," says Shonna DeFoy, RN, EMT, director of education for Country Nurses Inc. of Mineola, TX.
DeFoy studied lift techniques and put together an educational program that incorporated back safety and ergonomics, which is the science of fitting the job to the worker to reduce the chance of injury.
Since DeFoy held inservices for aides in September, there have been no reports of back injuries or problems with lifting and transferring patients.
Back injuries account for one in five workplace injuries and illnesses, according to the Bureau of Labor Statistics of Washington, DC. And about 75% of these back injuries occur when an employee is lifting.
The Occupational Safety and Health Administration (OSHA) of Washington, DC, is in the process of developing a standard for ergonomics, which includes lifting, that likely will affect home health agencies.
"We’re very early on and have no timetable set for the standard," says Susan Hall Fleming, OSHA spokesperson.
Education managers can stay a year or two ahead of any such federal requirements by giving inservices now on the safest ways to lift and transfer patients.
DeFoy says her inservices were popular with the staff.
"The aides came back to me and said, This is so much easier, and the patients feel so much more confident,’" DeFoy says. Country Nurses is a full-service agency that serves a mostly small-town and rural part of eastern Texas.
"Being an aide is really hard work because they’re doing all the physically hard work," says DeFoy, who developed a healthy appreciation for the work aides do when she was 18 and began a career in health care as an aide.
DeFoy trained to become an aide so she could take care of her sick grandmother. Later, she studied to be a nurse, working her way through a registered nursing degree program.
Shelly Rowe, a certified home care aide with Country Nurses, says she was very impressed with the training. "I learned a whole lot, and I’ve been working [as an aide] since 1987," she adds.
Rowe says she was especially pleased to learn how to do a segment move, which is where one section of the body is moved at a time. For example, first the shoulders are moved, and then the waist, and finally the lower extremities.
"I found this easy to do on a very large patient I have," Rowe says.
Breaking out of old habits
Before she had to use a draw sheet and pull the sheet with the patient on top. "If I had a patient who was bed-bound, I would be pulling on the bed sheet," Rowe explains. "The bed sheet would bunch up and gather up under them, and I would try to straighten it out, and it’d put them through misery."
Rowe says it was hard at first to break herself out of the old habits, "but after a few times, I had learned an easier way to do things, and I thought, Why am I doing it the hard way?’"
DeFoy offers the following guideline on how to set up a comprehensive and effective lift-and-transfer training program:
1. Research lifting and transferring techniques, using library and Internet resources.
The federal agency has an ergonomics page on the World Wide Web (www.osha.gov) and has a special outreach program on ergonomics in nursing homes.
DeFoy spent hours leafing through reference manuals and encyclopedias, and she watched videos on lifts and transfers. But her work didn’t stop there. "I got on the Internet and found information, such as reports on back injuries," she says.
She organized her reference material in a way that would answer specific questions such as: "What actually is a Hoyer hydraulic lift?" and "What is pivoting?" (See Pivoting transfers, inserted in this issue.)
2. Develop an outline with lifting instructions, beginning with what they do first, then second, etc.
"I went through steps in my mind of what I would do if I were out there as a nurse or aide," DeFoy explains.
She worked with a lift at the agency office, practicing with it until she was certain she could perform the lift perfectly. (See Mechanical lift steps, p. 89.)
DeFoy wrote down the steps, making sure she recorded every single action she had to take before, during, and after the lift. (See Country Nurses’ outline, inserted in this issue.)
3. Hold an inservice on lifting and transfers, including hands-on training.
About 20 aides attended the original inservices set up by Country Nurses. DeFoy first concentrated on training the aides who work with wheelchair-bound or bed-bound patients.
But her plans are to train all aides on lifting and transfers at the same time she gives them the aides’ National Certification Program established by the nonprofit Foundation for Hospice and Homecare of Washington, DC. (See January 1997 issue of Homecare Education Management for an article on setting up a certification program.)
The Hoyer lift inservice lasted from 2.5 to four hours depending on the class size, DeFoy says. "I like to keep the inservice small with six to eight aides because if you have too many, you won’t get enough participation."
Trading places with patients
The aides paired up and watched each other train with a lift in the office training room. They used a checklist DeFoy had prepared to make sure everyone followed the procedures correctly. (See Hydraulic lift checklist and skills procedure for pivot, inserted in this issue.)
That part of the training served a second important purpose, DeFoy explains. Each aide had a turn at portraying a patient on a lift so they could see how it felt.
"The device is very scary to a lot of patients," she says.
DeFoy followed up the inservice with a post-test on using mechanical, hydraulic, or Hoyer lifts. (See lift post-test, p. 90.)
4. Accompany aides on visits, carefully noting and correcting the way they lift and transfer patients.
"It’s helpful to visit the home with them and say, Show me how you’ve been doing it,’" she explains.
DeFoy suggests education managers observe how comfortable the patients are during transfers.
She cautions education managers to refrain from telling the aides what they are doing wrong while they’re in patients’ homes. "I’d say, How about we do this and I can assist you doing it this way,’ or We could do this better this way,’" she says.
"Most of the time, the patient would know the aide was going through training, and if there were any complications with the patient’s care, I would intervene immediately," DeFoy explains.
5. Focus any follow-up training on aides’ poor habits or on the mistakes they made during the hands-on training.
Old habits proved difficult to break in some cases, DeFoy recalls.
"I had to retrain their minds how to use devices and how to follow through the proper way," DeFoy says.
Elevate the head of the bed
She had at least two aides per training session who failed to elevate the head of the patients’ beds before moving a patient because that wasn’t the way they originally were trained.
Rowe says before DeFoy’s inservice she had always been taught to move patients when they were flat on the bed.
"Even though I had done it many, many times, they were still scared," Rowe says. "When I’d raise them up out of the bed it would strain their necks because they were going from a flat position to a sitting position. They’d complain, but I thought it was the right way to do it."
DeFoy taught Rowe and other aides that it is very important to elevate the patient’s head because if they start the lift while the patient is lying flat on the bed, then the patient is at a greater risk for injury. "When they’re lying down, their blood pressure is higher," she explains. "Then when you make a sudden move with them, their blood pressure will drop down as they’re moved up."
To prevent this, the aides were taught to elevate the head of the bed to 45 to 60 degrees to give the patient’s body a chance to adjust to the blood pressure and position change, DeFoy says.
Another advantage to this technique is that the patient is easier to move in a sitting position.
"One person can do it successfully by moving their legs," she says. If the patient is moved from a prone position, then it can only be safely done by having two aides move the patient.
"Once the aides saw this, it made so much sense to them," DeFoy says. "They said, Why didn’t we think of this?’"
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