Month: February 2018

What can research papers tell us about objective assessment?

I wanted to present a study this week to show an example of objective assessment of equipment solutions for manual handling.

Weiner et al. (2017).  Repositioning a passive patient in bed:  Choosing an ergonomically advantageous assistive device.  Applied Ergonomics, 60 (2017), 22-29. 

I love looking at studies like this as although they are for research and research is not what we are trying to do in practice, they give us a really great template for making clinical reasoning decisions.

The study aims to evaluate how the use of three devices for repositioning a person (of 75kg) in bed impacts the loading on the back of the care worker.

The three conditions were:

  1. Cotton sheets
  2. Regular slide sheet
  3. Molift Multitrans with lifting handles on the side

They measured the risk of loading on the lower back using

  1. Electro-gomiometer – this measures the physical deviation from neutral body and is an observation tool
  2. Borg Scale of Perceived Exertion – this measure the care workers experience of the task

We all know what neutral body looks like.  Breaking the task down into pieces you could easily do a checklist for how many times a person deviated from this neutral state when using device 1.  You could compare it with the second device you are looking at.

Secondly, you don’t need to use a borg scale, you can just get a care worker to rate their experience – 1 being really easy and 10 being really hard – what was the task like with device one versus device two?

What’s more, there is a table on page 28 of the study that gives a really nice argument of the products from that softer qualitative side that is also very important.  The data is clean as it is based on findings from the people who use it as opposed to the author’s opinion.  You can therefore use it to justify clinical reasoning too.

The conclusion of the study was that slide sheets are better than traditional cotton sheets and carrier for moving someone up the bed.  The carrier had the disadvantage of being hard to fit and remove while the slide sheet could be left under the person.  I don’t even think they were talking about in situ slide sheets designed to be left under the person here.  This study provides a great justification for these.

The Importance of Why
I was completing a manual handling assessment a few months ago with a client with a physical and intellectual disability.  I was asked to come in and assess whether the service was a one person or a two-person service as staff were starting to have difficulty.  I concluded that, in its current state, two people would be needed to provide personal care safely.  I also concluded that with an investment in some equipment we could reduce care to one.  The equipment was going to be over $1000 and I had to deliver this message to her parent. 

When I mentioned that the service would need to be two people, the client’s mother almost broke down.  She was devastated.  Her position was she did not want two people to have to deliver the service to her daughter.  I expressed my empathy with that situation, understanding what putting care up to two people can mean in terms of client budgets and resources.  The alternative of the equipment was still going to be a cost to the family.

I assumed this was fundamentally a financial stress for her.  I started voicing this to her and she looked at me and said, no, it is not about that at all.  She was so fearful that putting care up to two meant that she would not get a service from this company as they were already struggling with getting staff to provide services when one was needed.  She felt this had implications for respite care and beyond.  She needed care to be provided by one.

People take up a certain position all the time – “I want one person to look after my daughter”.    For us as assessors it is really important to know the interests behind those positions – the why.  Without knowing the why we can miss out on many opportunities to provide exceptional quality care.

Once I knew that attracting care workers to the service was a challenge, I was able to mold my intervention accordingly.

When writing my clinical reasoning for investment in equipment to the funder:

  • I was able to explain the cost savings for all parties by keeping care to one and so the return on the investment.
  • I was able to explain this was much more than cost, this was about the capability of a service to provide care to the family.

Similarly we were also able to identify and then address some of the other reasons why care was challenging:

  • The client had challenging behaviours such as hitting and screaming.  The staff did not know the strategies for managing these behaviours and so felt overwhelmed.  They found this added to the manual handling problems.
  • We were able to brainstorm some options to distract the client using sensory interventions such as soft sensory toys, music and fruit to eat (as a last resort).  This distracted her so personal care routines could take place with less stress.

Don’t forget to always ask why.