Challenges and Optimized Approaches in Manual Handling Practice for Patient Positioning Among UK-based Health Care Staff

Abstract

Objectives
To explore experts’ opinions and health care staff's experiences regarding challenges in patient manual handling and optimized approaches to promote patient safety and reduce the burden on health care staff.

Design
Two-phase study using a semistructured interview and online cross-sectional survey.

Setting
UK-based health care staff.

Participants
Nine manual handling expert interviews 70 UK-based health care workers participated in phase 2.

Interventions
Interviews were audio-recorded, transcribed, and analyzed thematically with NVivo software. The phase 2 survey elicited data on the practice areas and challenges for manual handling, analyzed using the inferential statistics of analysis of variance and 2-way Pearson chi-square tests using SPSS software.

Main Outcome Measures
Musculoskeletal Health Questionnaire and Nordic musculoskeletal questionnaire.

Results
Six overarching themes highlighted the major challenges in phase 1: (1) bed mobility; (2) Fowler's position; (3) postural care; (4) repositioning and turning, (5) side-lying; and (6) training issues. Health care staff often lacked adequate skills in these areas. Suggested optimized approaches included involving the patient in their care, time to build rapport, and ensuring realistic, comprehensive training. Findings from phase 2 revealed a high (56.30%) prevalence of work-related musculoskeletal disorders, with the majority occurring in the lower back (37.50%). Health care staff with work-related musculoskeletal disorders were not simplifying and splitting the movement/task (P<.001), had a majority caseload of patients with muscle tone issues (P=.043), did not consider supporting patients in symmetric postures (P=.020), and did not receive training on supporting patients in side-lying positions (P=.036).

Conclusions
Health care tasks in bed can be challenging due to the frequent need for being hands-on, more so with marked limitations in training, and poor practice of bed mobility, side-lying, and posture care. There are currently no safe approaches to rolling and turning a completely dependent patient. Optimized approaches were highlighted, including using low-tech and commonly available devices such as wedges, slide sheet systems, hoists, and firm support surfaces, as well as ergonomically safe handling techniques. Optimized positioning techniques currently lack empirical evidence, and UK-based health care staff showed low awareness of their practice. The future phase of this work will evaluate the ergonomics of these optimized approaches as single-handed care implementation with a 4-way slide sheet with hooks attached to mobile hoists for patient sliding, turning, and repositioning into side-lying. Findings from the study will aim toward improving manual handling training and practices, thereby reducing sick leaves, injury claims, staff turnovers, early retirement, and the consequent staff shortages with their effect on the quality of health care.

Disclosures
none.