The manual handling procedure to help a seated patient into a standing position.
Sue Thompson, RGN, is moving/handling coordinator; Phil Jevon, PGCE, BSc, RN, is resuscitation officer/clinical skills lead; both at Manor Hospital, Walsall, West Midlands.Authors
Thompson, S (2008) Manual handling 1 - assisted stand, Nursing Times, 104, 50/51, 36-37
Manual handling can be defined as the transporting or supporting of a load by hand or another part of the body. It can include lifting, lowering, pushing, pulling, carrying and intentional throwing of a load. Manual handling is an integral part of nursing care.
An estimated one-third of all reported accidents in healthcare settings result from moving and handling, and approximately 40% of all sickness absences in the health service are attributed to moving and handling accidents (Department of Health, 2002). Some 80,000 nurses sustain back injuries at work each year (National Audit Office, 2003).
According to the Health and Safety Executive, NHS staff are more likely to suffer back pain or injury than those in any other industry in the UK. Staff and managers understand there is a need to reduce the risks of manual-handling injury.
The Health and Safety at Work Act 1974 imposed a duty on all employers to ensure, as far as is reasonably practicable, the health, safety and welfare at work of all staff. This should be done by the provision of:
A safe workplace;
Safe systems of work;
Training, information, instruction and supervision in health and safety;
A written health and safety policy.
It also outlined requirements for staff.
The following outlines the procedure for assisted stand (one nurse) from a sitting position from a chair without a handling belt.
Before undertaking any manual-handling procedure, it is important to be wearing appropriate non-slip regulation footwear and an appropriate uniform.
Ensure any sharp objects, for example scissors, are securely stored and not protruding in a way that may cause injuries.
Perform a risk assessment. Assess the patient for standing - check their mobility care plan and consult colleagues.
Ascertain whether the patient has some function in the knee joint. For example, ask them if they are able to pick their foot up or move their leg to test for knee strength - if you are uncertain, request assistance from colleagues.
Wash and dry hands.
Explain the procedure to the patient
Advise them that they will need to push up from the chair arm and keep their head up. It is usual practice to follow a simple prompting regime, for example ‘ready, steady, stand’, in order to ensure coordination.
Ensure the patient’s privacy. In some situations it may be necessary to screen the area or ensure the patient is adequately clothed and is not going to be exposed during the procedure.
Make sure the environment is safe by removing any obstructions.
Ensure the chair is secure and not going to move. If the chair has wheels ensure the brakes are on. Ensure there are no clothes on the back of the chair that could cause it to overbalance and fall backwards when the patient stands up.
Check the patient is wearing adequate non-slip footwear which is secure (ill-fitting footwear, backless and novelty slippers can be dangerous for those with mobility problems). If patients require assistance to put on footwear, remember your posture and flex your knees rather than bending over at the waist.
Ask the patient to position themselves to prepare them for standing. Ask them to move forward in the chair and then to wriggle or shuffle to the front of the chair, bringing shoulders forward and not leaning backwards.
Ensure the patient’s feet are flat on the floor, slightly apart, usually hip width, and with one foot slightly in front of the other.
Ask the patient not to look down at the floor when standing but to lift their head up.
Stand to one side of the patient facing the same way, with the leg nearest the chair slightly backwards and the other leg slightly forwards, with both feet facing the same way. You may need to flex your knees to prevent poor posture, if you are taller.
Place an arm across the patient’s back at waist level. Do not grasp their clothing or trouser belt.
Place your other hand gently on the patient’s near shoulder for reassurance (never under the armpit).
Ask the patient to position their hands on the chair arms.
Advise the patient to push up from the chair arm and rise to a stand position on the prompt ‘ready, steady, stand’.
When the patient is ready, say ‘ready, steady, stand’ (or similar - follow local protocols), advising them to stand by pushing up from the chair arms.
Transfer the weight from your back foot to the front foot then bring the back leg forward so you are standing at the side of the patient.
Make sure to check that the patient is not feeling light-headed before releasing them.
It will sometimes be necessary to document the manual handling procedure, for example if problems were encountered (BackCare, 2005).
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
BackCare (2005) Guide to Patient Handling. Teddington: Backcare.
Department of Health (2002) Campaign Launched to Cut Lost Days Through Back Injury - Hutton. London: DH.
National Audit Office (2003) A Safer Place to Work - Improving the Management of Health and Safety Risks to Staff in NHS Trusts. London: NAO.