This reflective essay will be about moving and handling skill, which took place during my placement where I was supposed to learn and practicalised my nursing skills. In describing the event, I will be using Gibb’s reflective cycle (1988) (see appendix: 1) to analyse my actions and feelings. For the purpose of confidentiality, the name of the service user and place where the event took place as been made anonymous (Nursing and Midwifery Council 2009).
I was on placement in a nursing home when my mentor asked me to transfer John from his bed to a wheel chair. John is 60 years old man, who suffered from osteoarthritis. Before I carried out the task, my mentor had explained to me what I need to do when transferring a service user from the bed to the wheel chair. My mentor was also present at the scene to provide me with guidance and support; as the procedure required more than one person. When I approached John room I closed his door in order to maintain his dignity and privacy. Having done that, I obtained his consent and explained to him what I was going to do. However, I assessed the task ahead of me by completing a moving and handling assessment form. This enables me to provide for the appropriate equipment (wheelchair and full body hoist sling) needed to transfer John. I ask my mentor to assist me to fix the sling on John, as the task required more than one carer. I then required John to tilt to one side of the bed so I can fix the sling under his body and the same process was carried out by my mentor on the other side putting John’s independence into consideration. The full body sling hook was attached to the hoist stand and John was carefully transferred from the bed to the wheelchair with maximum care without causing him further pain. When John was finally comfortable on the wheelchair, I asked him if he had experienced any pain as a result of the transfer he replied that the task was perfectly executed.
At first, I was nervous about causing John any further pain knowing that his osteoarthritis condition is severe. However, I was pleased that John was satisfied at the end with the way the task was carried out as he appraised our effort. In addition, I felt piteous for John knowing his condition could be very painful.
It was good that I completed a moving and handling assessment form, as this enables me to transfer John with the appropriate equipment without causing him any pain. Dougherty and Lister (2009) postulated that the risk of injury to both carers and service users can be reduced by fully assessing the task and identifying the right equipment and procedure. They further warn that moving service users in bed without using appropriate equipment can cause friction and shearing to their skin, which is a common cause of pressure ulcers. Haslam et al (2007) supports the above view and went on to say that for moving and handling to be considered successful, the carer needs to employ minimal effort and the service user needs to experience minimal discomfort. However, Iggulder et al (2009) affirmed that assessment of task and training are not sufficient on their own to minimise the incidence of back pain. I was also satisfied that I obtain John’s consent and explained to him what I was going to do, which makes him to be cooperative throughout the task.
Hogston and Simpson (2002) suggest that service users should be asked of their informed consent before administering any form of treatments to them. He further emphasised that this will allow the service users to have adequate information about their treatment and also promote a sense of independence.
However, it was bad that I did not wear personal protective equipment before carrying out the task. According to the Department of Health (DH 2006) and the National Institute for Health and Clinical Excellence (NICE 2003) state that using protective equipment will reduce the risk of acquiring contamination from potentially infectious body fluids and transmitting microorganisms through hands or clothing. Health and Safety Executive (2004) supports this and went on to say that disposable apron and gloves should be worn for all direct care procedures with service user when there is likelihood of contact with blood, secretions and excretions or body fluids.
The Health and Safety Executive (HSE 2004) describe moving and handling as any transporting or supporting of a service user (including sliding, rolling and tilting) with suitable equipment and technique. As a result, I used a full body hoist sling to transfer John to the wheelchair, due to his inability to stand on his both knees. Mandelstam (2003) affirmed that service user’s with painful knee injury such as osteoarthritis often have difficulty with mobility. Alternatively, I could have used a sliding board to transfer John as proposed by Pellatt (2005), but the nursing home has not got such equipment available. I required John to tilt as much as possible in order to maintain his independence while I affixed the full body hoist sling round his body. Gibson (1991) explains that empowering service users has benefits which include positive self-concept, increased personal satisfaction, a sense of control and improved quality of life. I was satisfied to have adopted the appropriate technique and used the right equipment to transfer John, as my mentor was present to support and guide me throughout the procedure. Royal College of Nursing (RCN 2007) states that mentor is a key support for students in practice in order to facilitate competence for registration.
On reflection, if the appropriate equipment had not been used to transfer John, he could have secured further injury. The Health and Safety Executive (2004) supports this view and states that service users are at risk of shoulder injury, musculoskeletal disorder and tissue injury from inappropriate lifting into the sitting or standing position, or lowering them into the sitting position. However, Chell (2003) warns that undertaking unsafe handling practice could be construed as a form of abuse.
John was comfortably transferred without causing him any further pain which was the initial motive. On reflection, there is nothing significant I could have done differently as regards to moving and handling skill, my mentor was present to provide me with guidance and support throughout the task. However, I need to reflect on similar situation and develop my moving and handling skills so that I can independently carry out such task should the need arise again. In addition, It is imperative for me to wear protective clothing during such task in order to prevent cross infection (DH 2006 and NICE 2003).
In future situation as such, I will ensure that the service user is transfer without causing him/her any form of injury. However, it is imperative for me to reflect on similar event and further develop my moving and handling skill by taking part in annually training. As this will facilitate a better practice in the future and also make me an independent expert practitioner (Benner 1984). In addition, should the situation resurface again I ensure that I wear protective clothing, so as to protect myself and the service user against infectious diseases.