Mr. Finn, who weighs 650 lbs., has been admitted to a bariatric medical center for assessment for a weight loss and fitness program. The examination requires that he spend two nights in the hospital for procedures necessitating mild to moderate anesthesia. He is unable to walk more than 10 steps independently because of his general deconditioning. From the time his wife drops him off at the medical center until he leaves, what mobility needs must be considered?
As always, before any mobility effort is attempted, the purpose of the movement needs to be clear. This is especially true in the case of patient transfers. In some cases, a transfer is solely for the purpose of having a person in one place rather than another; this process is not intended as a mobility training opportunity. In such a case, how you choose to complete the transfer is dictated by what is safest and most efficient for all involved. When the safety of both the patient and the health-care professional are considered, the ideal equipment for simply lifting or moving a heavy object is rarely the human body.
In recent years, many developments in moving and lifting devices have greatly improved options for performing dependent transfers safely in the hospital, in the clinic, and even in the home. This chapter primarily serves as a guide for performing mechanically assisted, or “zero-lift,” transfers, in which the individual being transferred provides little or no lifting power. When the transfer is intended to be a practice session for the patient, a manually assisted transfer may be appropriate (see Chapter 11).
Risks Inherent in Manual Dependent Lifts
U.S. Department of Labor statistics clearly demonstrate an elevated risk of physical injury among healthcare workers engaged in lifting and moving patients. The U.S. Department of Labor classifies strains and tears due to orthopedic and neurological disorders related to ergonomic issues as musculoskeletal disorders (MSD).1 The injuries can range from back strain and pulled muscles to carpal tunnel syndrome and hernias. MSDs have been associated with moving and lifting patients in the health-care setting.
In 2008, the occupational group ranking third in the frequency of work-related MSDs was that of nursing aides, orderlies, and attendants2—people whose job typically involves manually lifting and moving dependent patients. (Being third on the list is actually an improvement. In the 1999 report, this group ranked first—above construction workers and manual movers and handlers.) In 2008, 45% of the MSDs in education and health services employees were due to overexertion, resulting in being out of work for a median of 6 days.2
While transfers may come readily to mind as a potential source of injury, ergonomic and nursing studies have identified the global areas of manual lifting and ...