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.
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.
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.
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.