Thursday, January 18, 2018

Are Patient Lifting Devices Inhumane?

Cecil, a 26 year old quadriplegic reclines in bed waiting for a pair of nurses to transfer him to his waiting mobility device, an electric wheelchair. Standard operating procedure calls for the nurses to wrestle him to a sitting position with his legs dangling over the bedside.  The nurses then assume a position on either side of Cecil with their muscled arms hooked under his armpits.  A  Cape Canaveral countdown commences and at the conclusion we have a lift off as the stalwart  nurses heft Cecil's limp body into the wheel chair. A solid plop down completes the mission. The source of that ominous cracking noise is a toss up - a nurses back or shoulder joint popped.

The sensitive nurses recognize Cecil's vulnerable state of affairs and take measures to minimize the progression from helplessness to hopelessness by understating the difficulty of the manual transfer. No complaining or grunting and groaning by the nurses when the critical lift is at the peak of their muscular endurance. Pseudo smiles mask the aching backs and burning biceps. Cecil replies with a heartfelt "thank-you," as the nurses ignore their wounded backs and secure him to his electric chariot of a wheel chair.

When hospital administrators could reward nurses with service pins and non-monetary tokens there was little concern about nurse's damaged intervertebral discs or wrenched shoulders sustained while lifting patients. Angels in white were there to serve without concerns for remuneration.

Change was about to come when nurses had financial benefits like workman's  compensation and paid sick leave. Nurse's manual efforts to overcome gravity for their patients suddenly became an expensive commodity and red ink on hospital balance sheets demanded immediate action.

Hospitals began to institute a no lift policy and resorted to devices like the Hoyer mechanical lift for patient transfers. This handy dandy device had a hydraulic pump much like a car jack to lift patients. Straps or a sling were applied under the patients arm and legs and the operator initiated the lift by pumping a lever which resulted in having the patient suspended in mid air.

Cecil and most all patients that were accustomed to human lifts hated these mechanical monsters and pronounced them "inhumane." The herkey - jerkey movement of the Hoyer was offensive to some patients, but there was more to their aversions. Cecil related that here was nothing to hang on to and the feeling of being suspended in mid air was frightening.

I tried to understand Cecil's objection and related the lift experience to my climbing adventures as a foolish youngster. Climbing open structures like fire towers was indeed much more terrifying than scaling a solid rock face. Having a fixed object in front of you  as a reference took some of the fear out of the elevation. It's the  reason that mountain climbers don't necessarily make good workers on cell phone towers. The tactile presence of the nurse lifters added a measure of security to the precarious gravity defying adventure.

Old time nurses like me were falsely advised we were capable of lifting just about any patient if  "proper body mechanics"  were used.  Keep your back straight and let your legs do the work was the mantra. Science does not support this whacky notion. The spinal vertebrae can take only a limited amount of stress and damage to their fibrous structure is cumulative. Nurses have one of the highest occurrences of musculoskeletal injuries of any occupation.

The only inhumane aspect of lifting is  the high injury rate of manual lifters.


  1. Oh, lordy... the memories of Hoyer lift adventures! One I recall vividly was a (ahem) a gentleman who had a VERY prominent set of 'grape' 'rrhoids. I believe there were more than several of us who hurt ourselves holding in our merriment! And he then proceeded to prove that his gut was in fine condition by blowing at us a substantial amount of of both flatus, and Ensure tube-feeding generated 'muck'.
    We all agreed later that none of us had ever laughed do hard!
    OK ~ possibly TMI ~ feel free to edit PRN, O.Fool ~

  2. Back in the mid 70s I was an orderly on a surgery floor and was appalled by the 20-something nurses that were essentially walking wounded. I was only 6' and 185, but strong for my size so I tried to be there as much as possible for any heavy lifting. The awkward positions one has to get into in order to lift someone out of a bed were not good, but there were limited options. Trying not to hurt someone already in pain was a challenge and only exacerbated by attempting "proper body mechanics". Everyone did the best they could and always being short staffed didn't help. The job often couldn't pay enough for the risks and damage being done. I was lucky to come out of it unscathed.

  3. There was something magical about Hoyer lifts and their action on bowel function. An old post "Hoyer lifts a Boon for Peristalsis has the unpleasant details.

    Jono-Being an orderly was indeed, a very challenging task. Your pay should have been based on the total amount of weight lifted. You and me would probably be millionaires.

  4. In my original nursing textbook (Nursing Care of the Patient, Smith & Lew, Hogbin Poole, Australia, 1968) - our Bible on the wards - I just counted ten lines in the entire book about dangers to nurses when lifting patients.

    My back is cactus and so are the spines of many nurses of my era that I know of! I was tall and trying to find another nurse approximate to my height to help lift a patient was difficult! Sue.

  5. Actually lifts are safer for the patient as well, IF used correctly...

    1. Mechanical lifting devices are safer for all parties. It's sad that it took a large cohort of injured nurses seeking remuneration for things to change. Thanks so much for taking the time to comment on my foolishness.

  6. My Mom and I used a Hoyer lift with my Dad for the last 18 months of his life. Dad was big man who had lost his ability to walk, and the lift allowed him to remain in his own home instead of a nursing home. Dad did not like being helpless, at he put it, but I never heard him complain abut the lift.
    Mom did most of the work taking care of Dad, and it was very difficult for. It would have been impossible without the lift. That thing was a godsend.

  7. Your Mom must have been a very dedicated, loving care giver. Folks always do better in their home and those 18 months must have been very precious for your Dad.

    Patients that had difficulty with accepting mechanical lift devices like the Hoyer had become accustomed to manual lifts by nursing personnel. Dependent people have a very difficult issue with any change in their care. I had a long term, care giver relationship with a quad (Cecil) and even little things like a change in color of his bedding was enough to throw him for a loop. I understood where he was coming from and did my best to accommodate his whims. The fact that for the grace of God, I could have been the one lying there helpless in bed crossed my mind many times.

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