Sickness and absence related to moving and handling costs the NHS approximately £300 million per year and is responsible for approximately 40% of all sickness and absence in the NHS (National Health Service 2002). The reasons for this include lack of education, inadequate staffing, cumulative loads, poor postures, illness, stress and poor work practice (Retsas & Pinikahana 2000, Royal College of Nursing 2005).

Before this can be addressed the nurse needs to understand why the practice of safe handling is so important. Therefore you should review the following:

Manual Handling Operations Regulations (MHOR 1992), which came into force on the 1 January 1993

The RCN Code of Practice for Patient Handling (Royal College of Nursing 2002)

The EEC Directive 90/269/EEC (Commission of European Communities 1990)

The Health and Safety at Work Act (HSMO 1974), the lifting equipment regulations (LOLER; Health and Safety Executive 1998b) and provision and use of work equipment regulations (PUWER; Health and Safety Executive 1998c)

You should also review the anatomy and physiology of the spinal column and main joints and muscles of the body. Your focus should be on the curves of the spine and the make-up of vertebrae and discs as well as the inherent problems relating to ‘slipped’ discs and their presentation

Review your local policy on safer moving and handling as well as the current theories on safe and efficient moving and handling practices. The Guide to the Handling of People (Smith 2005) is a good place to start

You should also revise the Guidelines for Safer Handling during Resuscitation in Hospital (Resuscitation Council 2001)

Review incidence and demographics of manual handling injuries on the Health and Safety website (http://www.hse.gov.uk)

Review what is meant by unsafe moves such as drag lift, cradle lift, shoulder lift or Australian lift, pivot transfers, and moves where the handler is directly in front of the patient.

With this definition in mind, as a nurse, moving and handling encompasses all of our work practices and in order to practise safely all nursing tasks should be underpinned by the principles presented in this chapter. It is not solely about moving patients/clients who are unable to move themselves but it includes walking, moving equipment and furniture and even carrying small loads and it impacts on all aspects of our lives.

Before starting any moving and handling task you should first ask the question, ‘Do I need to do this task?’ Following this you should undertake a risk assessment. By undertaking a risk assessment you should be made aware of any potential problems and how big they might be. In assessing the risk you should not only consider what you are moving but also yourself, the environment and the task. An easy way to remember this is to use the acronyms LITE or TILE. These letters stand for:

These four areas of assessment are not independent of each other but should be assessed together. The implications of how they impact on each other should be considered. This is not an easy thing to do as in a survey of D and E grade nurses 82 variables were generated for the load alone (Cook & Nendick 1999).

When assessing the load, consider the size, shape and weight of it. If it is a patient/client ask yourself whether they can move themselves. All nurses have struggled at some point to move a patient only to discover them wandering up the corridor independently later. The stability of the load also needs consideration. If it is likely to behave unpredictably this puts you at the highest level of risk.

Once you have assessed the load you should assess yourself. Consider your state of health, because when we are ‘under the weather’ we do not work to our full capacity. Reflect on whether you fully understand what you are being asked to do and if you really know what is involved. If you intend using a piece of equipment ensure that you know what the weight limits are for it and how it operates.

When considering the task, i.e. what it is you want to do, identify whether it involves distances, variations in height, and/or use of equipment.

Your assessment of the environment should involve the type of floor, height and movability of furniture, the amount of space around the area and the visibility of the area.

Once this assessment has been completed it should be recorded in the patient’s handling record and only after all this has been completed are you ready to consider the move.

When starting the move you should ensure that taking an ergonomic approach means that the task is prepared to suit you and that does not mean you adapting to the task. This may mean ensuring that you have room to move, that beds/chairs that are height adjustable are altered to suit you. Next you need to think about your positioning and movement pattern (Box 25.1). Start by moving in close to your patient before finding your centre of gravity. By being close to your load you will make the load feel lighter. If you hold the load away from your body it will affect your centre of gravity and stability and make the load feel heavier and less stable. You can test this by holding a heavy folder at arms’ length for a minute. You will experience how heavy it begins to feel. If you then hold it close to your chest for the same length of time you will discover that the folder feels much lighter.