Mr. Finn, who weighs 295.5 kg (650 lb), has been admitted to a bariatric medical center for assessment regarding 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 to relocate a person from one place to another and, therefore, may not be 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 healthcare professional is 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. Many early programs used the term zero-lift to designate transfers or patient mobility that utilized moving and lifting devices. Safe patient handling and mobility, or safe patient handling and movement (both abbreviated SPHM) are now the more common terms used to describe these programs and techniques. This chapter primarily serves as a guide for SPHM while performing mechanically assisted transfers during which the individual being transferred contributes little or no lifting power. When the transfer is intended as a practice session for the patient, a manually assisted transfer may be appropriate, which is covered in Chapter 11.
Risks Inherent in Manual Dependent Lifts
Statistics from the U.S. Department of Labor clearly demonstrate an elevated risk of physical injury among healthcare workers engaged in lifting and moving patients. The U.S. Department of Labor, Bureau of Labor Statistics (BLS) classifies strains and tears due to orthopedic and neurological disorders related to ergonomic issues as musculoskeletal disorders (MSDs).1 The injuries can range from back strain and pulled muscles to carpal tunnel syndrome and hernias. MSDs have been strongly associated with moving and lifting patients in the healthcare setting.
In 2013, the occupational group ranking first in the frequency of work-related MSDs was that of nursing assistants2—people whose jobs typically involve manually lifting and moving dependent patients. Fifty-five percent of the MSDs recorded for nursing assistants were associated with overexertion and bodily reaction (poor positioning and/or repetition) and resulted in a median of 11 days out of work.2