Challenges and Optimised Approaches in Manual Handling Practice for Patient Positioning Among Uk-based Healthcare Staff

Research Objectives: To explore experts’ opinions and healthcare staff's experiences of challenges in patient manual handling and optimised approaches to promote patient safety and reduce the burden on healthcare staff.

Design: A two-phase study, using the semi-structured interview and online cross-sectional survey.

Setting: UK-based Healthcare staff.

Participants: Nine manual handling expert interviews
70 UK-based healthcare workers participated in phase two.

Interventions: Interviews were audio recorded, transcribed, and analysed thematically with NVivo software (USA).
The phase two survey elicited data on the practice areas and challenges for manual handling, analysed using the inferential statistics of ANOVA and two-way Pearson Chi-square tests (X2) using SPSS software (USA).

Main Outcome Measures: Musculoskeletal Health Questionnaire (MSK-HQ)
Nordic musculoskeletal questionnaire

Results: Six overarching themes highlighted the major challenges in phase one: (1)Bed mobility, (2)Fowler’s position, (3)Postural care, (4) Repositioning and turning, (5)Side-lying, and (6)Training issues. Healthcare staff were reported to often lack adequate skills in these areas. Suggested optimised approaches included involving the patient in their care, time to build rapport, and ensuring realistic, comprehensive training. Findings from phase two revealed a high (56.30%) prevalence of WRMSDs with the majority occurring at the lower back (37.50%). Healthcare staff with WRMSDs were not simplifying and splitting the movement/task (p < 0.001), had a majority caseload of patients with muscle tone issues (p=0.043), did not consider supporting patients in symmetric postures (p=0.020), and did not receive training on supporting patients in side-lying positions (p=0.036).

Conclusions: Healthcare tasks in bed can be challenging due to the frequent need for hands-on, more so with marked limitations in training, and poor practice of bed mobility, side-lying, and posture care. There are currently no safe approaches to rolling and turning a completely dependent patient. Optimised approaches were highlighted, including using low-tech and commonly available devices such as wedges, slide sheet systems, hoists, and firm support surfaces, as well as ergonomically safe handling techniques. Optimised positioning techniques currently lack empirical evidence and UK-based healthcare staff showed low awareness of their practice. The future phase of this work will evaluate the ergonomics of these optimised approaches as single-handed care implementation with a 4-way slide sheet with hooks attached to mobile hoists for patient sliding, turning, and repositioning into side-lying. Findings from the study will aim towards improving manual handling training and practices thereby reducing sick leaves, injury claims, staff turnovers, early retirement, and the consequent staff shortages with their impact on the quality of healthcare.

Author(s) Disclosures: The authors declare no conflict of interest.