Friday, February 5, 2016

Patient Lifting and Transfers





"What was that loud cracking noise Susie? My back or your shoulder?"

 
 
Patient transfers are to nurses what traffic stops are to police officers, unpredictable and very dangerous. I have known more nurses being disabled from lift related injuries than any other cause. The above photo must have been created by a workman's compensation attorney trying to drum up business. I quickly noted these problems: nurses legs too close together (you want a broad base of support), nurses bent over at waist (my lumbar spine aches just looking at this impending disaster), and the bed should be lowered as close to the floor as possible to minimize the distance of the lift. Fork lift trucks have transmissions and can carry heavy loads in reverse; nurses should never lift in reverse, we evolved to lift facing forward.  Have you ever seen a primate at the zoo lugging anything and walking backwards?  It might also be prudent to equip the patient with some footwear.
 
In nursing school we were actually presented with a procedure manual for the various lifting techniques . Some of the lifts such as the dreaded Australian Lift were prohibited at our hospital as a result of the number of nurses crippled by the lift. Our beloved instructors like Miss Bruiser explained that  we should learn about the dangerous lifts just so we knew them. This was the same logic applied to Professional Adjustments Class where we were told it would be wise to learn how to smoke a cigarette to be sociable with patients. The learned action could cripple or kill you, but at least you knew how to do it.

The above illustration is a variant of the Australia Lift of which the key elements are 2 nurses with their arms linked together in a wrist lock (death grip) and then lifting together in a coordinated effort. I think the term "Australian" was applied because the lifting force was applied from down under or perhaps it referred to the way a disabled nurse could walk upon completion of the lift - by hopping like a kangaroo. Thankfully, hospitals  in the civilized world have banned this type of lift.

Another dangerous technique is the bear hug lift. The lone nurse approaches the seated patient placing both arms around the chest under the arms and hugs (actually squeezes) the patient as she lifts. Not recommended for recent thoracotomy patients and if any SNAFUS crop up during the execution of this lift 2 people wind up on the floor. This lift may have been the source of the idea for semi-private rooms. A nurse was lifting a patient in his private room fell down with the patient and someone in hospital administration decided to kill 2 birds with one stone and wheeled in an additional bed for the injured nurse.

Another unpleasant lift especially for the patient is the trouser or as we affectionately called it "the wedgie " lift. This procedure mandates the patient wearing pants. With the patient seated and pant zipper down, the nurse grabs the patient's waistband through the unzippered fly and with the other hand on a back belt loop applies the lifting force. With the weight centered, the nurse lifts the patient to a standing position and pivots him into a chair. Good bathroom hygiene is essential or you will definitely mark the patients laundry with this one.

For safe transfer practices, I always found physical therapists to be good resource persons. The key to safety in patient transfers is to avoid lifting completely. Think lateral movement and sliding rather than lifting. My favorite safe transfer technique is called the "demon drop." This involves removing the arm of the chair if possible and positioning it as close to the bed as possible. Elevate the bed so that it is 1-2 inches higher than the chair and slide the patient from the bed to the chair or litter. For a chair to bed transfer position the bed all the way down and slide the patient from the chair to bed.
 
When I was a young nurse it seems like we were lifting all the time. Every procedure from X-ray to physical therapy required a trip to another hospital department and a lift out of bed into a wheelchair. This was long before workmen's comp and if you did get injured, you were really on your own. I think when nurse injuries from patient lifting cost the corporate hospital money, things began to change. Today patients receive more services in their room so fewer transfers are needed. Toward the end of my life as a nurse, mechanical lifts were in widespread use and manual lifting was not permitted.

 
There was one instance that I never used a mechanical lift. When transferring a patient's body to the morgue cart, I always felt obligated to personally, with help,  move the body onto the cart. Physically, I never had a difficult time with this. Maybe a body does weigh less after the soul departs or the patient was badly debilitated from illness. In the OR it was possible to raise the table to a level above the cart and it was relatively easy to slide the body onto the cart. Most of these cases were failed trauma cases and as I moved the body to the cart I always thought to myself - "I hope that this poor soul can find the peace that eluded them in this life.











 

5 comments:

  1. I can just see the patients arms sliding down the nurses' back, until the patient takes a nose dive to the floor, face first ~ YOUCH!!!

    Biggest patient I ever had to deal with was 900+ pounds.It took 10+ of us to turn her. Ack. i felt so sorry for the ER nurse TEAM who had to put a Foley in her!!

    My bedside nursing career was ended by a 250+ pounder. The nurse helping me said I turned white as the bedsheets, and I haven't been back to ICU since.
    I still get POed when I think about it!!!

    ReplyDelete
  2. When I first saw the picture, I thought it was some weird wedding reception ritual.

    The computers in our squad cars displayed runs to police, fire, and ambulance. It was not uncommon to see fire and/or ambulance dispatched for "lifting assistance". I assume it's the same issue.

    ReplyDelete
  3. That picture is kind of hard to decipher, especially with the nursing cap so tightly cropped. It was clear to me because I knew what was going on, but it really is
    kind of ambiguous. I got that lifting is dangerous like a traffic stop analogy by watching the videos on your blog! But, I suspect in real life traffic stops are much higher risk judging from some of the characters you have to deal with.

    So sorry, Bobbie, about your injury. I was lucky because back in my day, 250 pounders were few and far between. I did get very sore from lifting, but escaped serious disability. I have arthritic knees that I blame on standing in one place too long as a scrub nurse, but that might have happened regardless.

    ReplyDelete
  4. Just as you mentioned, my back just aches looking at this picture! YIKES!

    ReplyDelete
  5. Earn faucet bitcoins at Easy Bitcoin Faucet. Up to 33 satoshis every 10 minutes.

    ReplyDelete