It is the responsibility of the student nurse upon beginning a clinical placement to seek out the relevant moving and handling procedures for the ward they are on. Most wards have a trainer to implement the appropriate training program and to ensure that all staff members are fully up to date and competent with current moving and handling techniques. The care plan for each patient that the student will be involved in the care of, should be read by the student and the risk assessment noted.
The author’s clinical placement was a twenty-seven bedded elderly mental health ward divided into four bays and three single rooms. Upon beginning the placement an induction was given, this was very useful as the name of the moving and handling trainer was given. Upon approaching the trainer the relevant training was arranged and given the next day. It was explained that every patient was individually risk assessed and this was reinforced with reference to the patients care plan. However the author still felt that it was left to the student to seek out the relevant training. In the authors opinion this matter should be addressed by making it compulsory at ward level to train the student nurse on the second day of the clinical placement to ensure safety for all concerned.
The training session for the student nurse should be more intense as it was found that elements of uncertainty still existed after the training session. A two hour session in the author’s opinion is not sufficient time to create a competent student. Although the student is supervised at all times during moving and handling of patients it was often left to the student and one qualified nurse to carry out the duty. This could possibly create a danger as the student is not as competent as the qualified nurse and must still follow instructions. Whilst moving a patient is hardly the correct time to be giving instruction on the basics of moving and handling. This matter could be addressed in the authors opinion by using staff as a substitute for the patient until a high level of skill has been acquired by the student nurse. Of course this all depends on the experience of the student. A student on their second or third year should obviously have a higher degree of skill. However it would still need to be established if this was the case. A first year student especially on their first placement should be given a great deal more time to become acquainted with how patients on the ward are handled. This would be addressed by letting the student nurse observe the moving and handling procedures used on the ward. Once the student had gained confidence they could begin to assist in the lifting of the patient whilst more than one staff member was present. This way the safety of the patient could be assured and that of the staff.
It was observed that all patients had individual needs with regard to lifting. The role of the student should be to educate themselves to meet all the moving and handling needs of all patients on the ward on an individual basis. This is addressed by observation on the part of the student nurse. When the student nurse has reached the correct degree of competence working with one qualified nurse is acceptable as they can both work in harmony. Depending on the client group there may be a need for additional training, patients that suffer from mental health problems for example.
Patients that suffer from dementia require a great deal more skill to handle; this was the case on the author’s first clinical placement. Mr Smith was a patient with dementia and was wheelchair bound. He could feed himself but needed help with personal hygiene and getting into and out of bed. However he could not walk unaided and special care had to be taken because of a severe rupture. The student must ensure that they have read the patient care plan and understand the patient’s requirements, as Mr Smith had to be reviewed daily as his lifting needs varied. Some days he could “weight bear” that is to take the weight or some of it himself. It was the use of the hoist that aided Mr Smith from his bed most mornings. It was observed that this was a relatively easy task with the use of the hoist. It was explained to Mr Smith by the author that the hoist would be used upon this occasion. Communication is all part of the clinical skills that are developed and used by the student nurse. Before developing these skills the task of moving Mr Smith would have been more difficult and fraught with danger. Mr Smith was assisted to swing his legs out of the bed and sit as straight as reasonably possible. The sling was then put around him just under the arms and fastened by the author. This was then checked by the qualified nurse to ensure the sling was securely fastened. The sling was then attached to the hoist and it was explained to Mr Smith that he would now be lifted. It became very clear to the author that the skills that had been gained by completing the manual handling training had now come into use. Mr Smith was very confident, as he was aware that he was safe and the lifting and handling was being carried out correctly and with confidence by the staff. Mr Smith was then safely lifted and then lowered into his wheelchair. It was observed that one of the main skills were that of communication. This was the skill that gave Mr Smith his confidence as everything was clearly explained to him before being implemented.
As Mr Smith was in the very early stages of dementia he could comprehend what was being said to him. If on the other hand he had been in the later stage things would have been different. A patient that is not confused can listen to and understand what is being said and assist in any way they can. This does not usually apply to mental health settings where patients are confused and cannot understand what is being explained to them. This requires the staff and student nurse to have a greater understanding of lifting techniques for patients with dementia and related illnesses. Upon standing a patient with dementia they can just collapse at any time due to there cognitive impairment. This could result in back injury to the staff and certain injury to the patient.
In the authors opinion this is where a lot of the current moving and handling training falls short. The training received at a nursing college for example would be within current guidelines and would be appropriate for most clinical placements. However should these methods be employed on a mental health placement injury could occur to both the student and the patient. According to the NMC (2002) “You will find yourself at times in a position where you may not be directly accompanied by your mentor, supervisor or another registered colleague. However, as a student, do not participate in any procedure for which you have not been fully prepared or in which you are not adequately supervised”. It is part of the student nurse role to realise this fact and update their training with more appropriate techniques for the mental health environment. Patient safety is of utmost importance as is that of the staff and student (Corlett E et al 1992). The student should therefore observe and listen very carefully to the trained staff. The student should only assist in moving and handling when they are confident to do so. The student could be risking their career by injuring themselves by inappropriate lifting techniques.
Mrs Gates was an early stage dementia patient, and was able to communicate her need for the toilet. The qualified nurse and the author decided to take her as the nurse had decided the author was now competent in moving and handling techniques for dementia patients. Mrs Gates was walked to the toilet being supported at both sides to give her the confidence she needed. She appeared to be very happy walking, knowing that the nurse and the author were at her side. On reaching the toilet it was explained to Mrs Gates that her clothing would be lifted up and then she could slowly sit onto the toilet. By keeping a straight back and a good foot position the author found that there was no strain at all on the lower back. In fact it felt very comfortable whilst adopting the correct position as explained to the author during moving and handling training. After Mrs Gates had finished she was asked to stand by the author then was walked back to her chair. The nurse explained to the author how well the duty had been carried out. The nurse then stated “by handling patients like that you will never hurt your back and the patient and yourself will always remain safe”.
Patient handling activities have long been known as a major contributor to the high incidence of low back pain in nursing staff (Smedley et al 1995). In the authors opinion his is due to a lack of appropriate training. One of the difficulties in managing moving and handling risks for nurses is the wide range in levels of mobility assistance that patients require during care and treatment. According to Hignett (1996)”There have been many recommendations for changing practice, but the debate about how to reduce and manage the risks associated with musculoskeletal injuries continues”. This is being addressed by local ward policies that must by law included a section on manual handling techniques appropriate to the client group. This had a profound affect on the authors ward as no back injuries had been reported in the last five years. This included student nurses and shows that students are receiving and listening to appropriate training for the ward. Although the author was surprised at this, as stated earlier in the authors opinion the initial training is not comprehensive enough to give the student the required level of skill needed.
The author observed that there was very little importance given to the clinical skill of hand washing. Although after toileting a patient all staff washed their hands, no emphasis was placed upon hand washings importance. The author asked the nurse in charge the reason for this. The nurse explained that “it was assumed that the student would already possess this skill so it was felt unnecessary to explain the importance of it”. In the authors opinion hand washing is a very important skill and this should be explained to the student to reinforce the lessons they have received at university. Cross infection can occur with severe consequences should hands not be washed correctly. Hand washing should always be carried out before and after the moving and handling of a patient.
In conclusion the fact still remains that back injury is the most common type of illness among nursing staff. The author feels this is due to lack of training. Many instances of very poor handling techniques were observed on the author’s clinical placement. This appeared to be more prevalent among the older nursing staff. Although the training facilities are in place it appears that the older staff are not changing their ways. As a student nurse the author feels it is up to the student to take these new moving and handling techniques into clinical practice and attempt to educate the staff that do not follow the appropriate procedures. As mentioned in the introduction today’s students are tomorrow’s nurses. Therefore the role of the student nurse is to take their newly acquired skills and good practice into the work place, to benefit the patients and the staff. This way, moving and handling will be carried out with a high degree of skill and safety.
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