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Nursin' USA - Why don't UK wheelchairs go in the right direction?

Our favourite US import Sara Morgan is impressed by manual handling procedures in the UK - if only we were so forward-thinking when it came to wheelchairs

Last week, I sat through my fourth manual handling training session in less than three years. While this may not have been the best use of my time (as far as I could tell, the basic principles of safe manually handling had not significantly changed since my last training session), I understand the need for a little education so that we do not destroy our joints by the time we are 30. 

And in the arena of manual handling, the UK is leaps and bounds ahead of the US. Back home in my ER, there were no specifically designed sliding sheets (we just untucked the sheet that the patient was lying on and heaved the whole thing higher in the bed when the patient started slumping), not a hoist in sight (we defined patient weight by how many nurses it would require to shift them from trolley to bed) and I regularly pushed patients on trolleys all over the hospital by myself.  In short, my lumbar spine would like to thank the UK for looking out for the health of my back.

‘When I’m driving or riding my bike, I don’t go in reverse all the way to my destination, so why would wheelchair be any different?’

But with all of the time and effort devoted to promoting health and safety, I don’t understand the design of the wheelchairs that are scattered around the hospitals here. They are heavy, bulky, difficult to steer safely and strangest of all — more easily manoeuvred when being pulled BACKWARDS behind the nurse or porter. 

Backward motion

The first time I used one of the wheelchairs here, after getting the patient safely settled on the seat with his feet on the footrest, we set off for our ward with me pushing the patient from behind, so that he was facing forward. Call me crazy, but it just seems more logical that way — when I’m driving or riding my bike, I don’t go in reverse all the way to my destination, so why would wheelchair be any different? 

After a near miss with another patient walking in the opposite direction (which I blame entirely on the steering mechanism of the chair and not on any innate bad American driving habits), I relented and followed the advice of a passing nurse who suggested that I pull the chair backwards.  By the time we got to the ward, my shoulder had been pulled out of joint, I felt like I had whiplash from continually looking backwards to check the patient and then forwards again to ensure I wasn’t walking into a wall, and I had caught my heels twice on the chair when it was too close behind me. Not particularly healthy or safe. 

Dignity dilemma

Then I wondered about the patient: how dignified is it to be pulled along through the hallways backwards? You cannot see where you are going, cannot prepare for bumps or corners, and in an unfamiliar environment, it is probably an altogether frightening experience. And what about motion sickness?  I’m sure I’ve seen a few patients looking decidedly green as they were pulled through the hospital.

On the bright side, I am certain that this style of wheelchair saves the NHS loads of money, if for no other reason than the chairs are never ‘borrowed’ by patients. In my ER in Baltimore, where wheelchairs were always in short supply and few of the patients had insurance to provide a chair at home if they needed one, we had an ongoing contest among staff to see how far the hospital’s wheelchair fleet reached. 

City slickers

Each wheelchair had our hospital logo brightly stencilled on the back of the seat, so they were easy to spot. Driving through the city, it was not unusual to see former patients in our chairs wheeling themselves down the street, or to see mangled chairs abandoned in dark alleys after they had outlived their usefulness.  Sometimes, patients arrived in the ER already in one of our wheelchairs, almost as though they were bringing it back home. But, as of June 2007, the farthest from the hospital one of our chairs had been seen was 19 miles away — in the parking lot of a shopping mall. 

I’ve never bothered to look out for NHS wheelchairs roaming the streets of London.  They are so hard to steer on the smooth floors of the hospital that I suspect bumpy pavements would be practically impassable. But you can be sure that the next time my hospital is looking to buy more wheelchairs, I will be advocating on behalf of both my patients and my own joints and suggesting that we invest in a model that drives forward. I suspect that it will be an investment that yields rewards of increased satisfaction for both patients and staff.

Readers' comments (15)

  • Sara Morgan really gets on my nerves. It seems like every week shes got a different axe to grind with the NHS. Have to say I have never seen a patient being pulled along in our hospital or any of the 13 others that I have worked in. So find something worth arguing about please Sara Morgan, or go back to the US where it is all oh so wonderful.

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  • Me too - never seen anyone pull a wheelchair. I guess the one's she's talking about are the small wheeled rear-wheel steered type. A little practice and they're easy to use. They also aren't so easily nicked. Our hospital's new aluminium (or aluminum) ones were quickly purloined by the local lads to joy ride to the nearby Mc restaurant.

    It reminds me of Chiswick where the local refuse collectors regularly spotted a well-known supermarket's trolleys that had gone walk-about. So they returned them? Not at all, they tossed them straight in the compactor at the back.

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  • I actually think Sara has excellent observational skills, realising exactly the benefits of the NHS and the absurdities of it. Every hospital I have worked in, and they have all been central London ones, have all had those ridiculous wheelchairs, and I can't remember a time in my 17 year nursing career where I could push a person forwards! If you read her article properly Sara actaully credits the NHS with a lot!

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  • I totally agree with Sara. I have worked in the NHS for the past three years, and I too am impressed with the training provided to staff generally. However, constuctive critisizm should never be frowned up on; it is called feedback, and is necessary for improvement of services.
    I have given up on trying to push wheelchairs, as they are impossible to steer forwards. Recently I saw a brand new wheelchair on my ward, and grabbed it quickly to take a patient to his waiting taxi. I thought that being new, the chair would move easily forward, as opposed to the older ones; and was I wrong! I felt like I was doing an obstacle exercise, and was left with pains in my hands, back and feet. Surely this problem needs to be addressed, for safety of patients, staff, and those walking through hospital corridors. It may be a manufacturing fault and should be pointed out, not shoved under the carpet.

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  • The hospitals deliberately buy those bulky difficult to steer wheelchairs to stop people from stealing them.
    Not a stupid plan, given that at a recent car boot sale, i saw loads of NHS wheelchairs and zimmer frames for sale. If people would stop stealing NHS equipment, we wouldn't have this problem. Maybe the way forward is to have people pay a large deposit so they bring the stuff back when they've used it. We rarely have enough equipment in a correct state of use at the hospital where i work because anything that isn't nailed down goes for a walk.

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  • Have to agree about patient chairs on all fronts. I've never come across one that is easy to steer or use while in the forward mode. All work so much better when pulled along behind while dislocating your shoulder or back.

    Yes they are so heavy and akward as it does stop the public from taking them home with them. We did have some that had a chain and a slot for a pound coln as with supermarket trolleys. They didn't last long, it's surprising how many people carry bolt cutters in their back pocket these days.

    So the solution??? We could try getting bright yellow ones with a tracking device in them somewhere or actually not hiding them away for use later. . .

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  • I too wondered when I worked in a London hospital. In fact it was one of my very first observation. Coming from Sweden were thank God wheelchairs do move in the right direction, I have never came across the type of wheelchairs that are used in the UK. I must say that the UK wheelchairs are a hazard to both patients and hospital staff. As far as theft is concerned, I have never heard of any of the right direction moving wheelchairs in the Swedish hospitals ever been reported stolen during my 5 years of working in hospitals.

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  • I know the type of wheechairs she's talking about, the ones with 4 small wheels - and it's true, they are easier to PULL.

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  • I visited my Dad in Aberdeen Royal Infirmary last week in coronary care and saw a patient with IV attached being wheeled backwards along the corridor. I thought it was so undignified and treated the patient more like a piece of baggage than a person. I agree - in all my years of nursing, and being a manual handling trainer, pulling is taking a high risk of injuring the person who is pulling, and causing an accident due to the position of the handler. If you are pulling a wheelchair you will be twisting your body whilst you are pulling as you cannot comfortably look forwards to see where you are going.
    I must admit, I did what most people do and walked past whilst tut tutting. However, with health and safety high on our priority list and risk assessment a must, someone should be doing something to address this highly risky practice.

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  • My rural hospital solved the problem of disappearing wheelchairs by gaving an high bar welded across the backs. This makes it very difficult for anyone to put them in a car trunk or suv.

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  • This is so true, why do corridor wheelchairs work best backwards!? Porters seem to be able to push them forwards but no one else, very strange. When I see a visitor struggling with them I tell them they work better backwards, and they look at you as if you crazy lol. Shower chairs are the same.

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  • Latterlife Midwife

    Just yesterday, I had to escort a patient from my hospital to another for a procedure. Whilst waiting in A&E to return home, I helped her make use of one of their wheelchairs which looked identical to the ones I was used to using with much difficulty (clunky with four tiny wheels). I was completely surprised to find it moved with great ease, even gliding smoothing around a tight corner into a bathroom and out again. So perhaps it's all been down to poor maintenance and ageing parts!

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  • It is true that the standard NHS wheelchair is both cumbersome and difficult to steer... however, having used them for so many years I am no proficiant in their use. (I have only taken down two Zimmer frame uses in the past year) :) However, following a move to a new PFI hospital, the more traditional wheelchair that is much easier to handle, was purchased as standard..... The result.... Theft basically. Perhaps the Manual Handling lectures should actually have a wheelchair proficiency licence for medical staff.... I wonder if I could get CPD credits??

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  • I've never found the patient wheelchairs difficult to use and we too have the bulkier, Staxi wheelchairs which are more heavy duty and nestable.

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  • As a patient, I agree that it's undignified to be wheeled backwards. You feel like baggage and you miss the attention of somebody who can see you during the journey and knows when bumpy surfaces are causing you pain, or when you've just sustained a glancing blow from a passing trolley.

    As a nurse, I never found the chairs hard to manoeuvre, but they do need a bit of strength to steer. Those leg rests look a bit vulnerable too! But at least we couldn't remove and lose the foot rests, unlike the folding wheelchairs, where patients often risk foot injuries when they're moved.

    Somewhere, an engineer is sharpening her pencil and working on a better idea!

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