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Comment on Column article "Coping with patient Obesity in hospitals" by Anne Murray

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following on from the short report in my newsletter this is a more detailed look a the article in Column Vol 21.1 2012 pp8 - 13 Coping with patient obesity in hospitals by Anne Murray

In this she states that 'in 2009 in Scotland 26.9% of med and 26.4% of women were obese compared to 15.9% and 17.3% respectively in 1995' this is a very scarey statistic and means that the likelihood of caring for obese people is rising rapidly. It is worth remembering, as Anne points out, bariatric patients can present with a range of medical conditions which can complicate their treatment and affect their mobility and moving and handling.  These problems can include cardiovascular disease, diabetes, liver and kidney problems and can include mental health issues.

Moving and handling bariatric patients carries its own risks and Anne cites that in 2010 there were 107 recorded staff injuries as a result of patient handling in a particular organisation. She also reminds us that low back pain is the most common and costly work related injury.

In the article Anne points out that there are concerns relating to the provision of appropriate equipment to manage patient's pain, safety, dignity and comfort.

One of the main points that stood out to me in her article was the issue that good training on its own is ineffective in preventing problems. What is needed is a  cultural change in the organisation to incorporate the training into good practice. The good training should include training problem solving and encouraging people to do ongoing risk assessments in the moment and identify the risks and then manage them.

A very interesting article that was easy to read and raised many points and reminded us as moving and handling trainers that our job is to give people the tools to do their own risk assessments in the moment and manage their own risks appropriately and look out for their colleagues.

It also gets us thinking about the provision of equipment for the bariatric patient and how it is procured as needed.

Lots of food for thought.

Way of the Roses

at the weekend we joined some friends to cycle part of the Way of the Roses. Having had a month on holiday I could not take the friday off to start at Morcambe with them but got the train to Skipton on friday evening to cycle to Burnsall to meet them at the Wharfe View Guest House.
It was very scarey cycling up on the moors in the dark with low cloud causing foggy conditions, black ice on the road and snow all around. It took around 1 and half hours to cycle (and walk) 10 miles.
Saturday was cold and crisp as we set off around 9am. The Dales were looking beautiful with the snow cover and the ice on the road proved interesting.

After a teacake in Pately Bridge we went onto Rippon for Lunch and went through the grounds of Fountains Abbey. We were so lucky with the weather and scenery.
After stopping for the night in York with a friend we set off again on Sunday aiming for Bridlington. The weather was not so kind it started very cold and damp and during the day we had strong cold head winds and on and off sleet.

the triumphant team who arrived cold and happy in Bridlington around 3:15 just before fish and chips to warm us up.

case study

The case study of Miss S undertaken by Symmetrikit and Positive Positioning is now available to view on the Symmetrikit website 

http://www.symmetrikit.com/downloads/downloads.aspx?gid=9809a408-30af-4d3e-9f5c-23d0a89ffc7d

Details of the the training, offered free to therapists, is also on the Symmetrikit website

http://www.symmetrikit.com/training/training.aspx

Kids Up North Exhibition

Yesterday I attended the Kids Up North Exhibition to update on new equipment for kids with disabilities and meet people I have not seen for a while. This was a very good day as there is a lot of new exciting equipment available. Some of the most exciting was the Leckey Mygo Standing frame www.leckey.com/products it has the ability to accommodate some knee flexion contracture allowing the spine to remain in more natural curves. This seems like a good idea and I am looking forward to trying it with clients.
It was interesting meeting with solicitors from Pannone and Irwin Mitchell and hearing their work in getting appropriate rehabilitation services for people who have been injured.
It was a very busy exhibition and the speakers were interesting. I managed to get to a talk by Moira Draper from Cerebra's talk about sleep and issues that can arise for children with neurological disorders. I found this very interesting and informative. http://www.cerebra.org.uk/English/Pages/home.aspx
 Overall a very good day.

Self Care Week

this week is Self Care Week 2011, it aims to help people take care of themselves and where to find help to help take care of their health. This year's theme is Technology. You can find out more by visiting http://www.nhs.uk/Planners/Yourhealth/Pages/Helpathome.aspx

Technology is changing the way we look after our health with apps like NHS Direct allowing you to check your symptoms if you are unwell. 

For people with limited mobility and those with disabilities technology and the right equipment can help you to care more for yourself and increase independence. 

What do we mean by 'self care'? It means keeping fit and healthy, if you have a long term condition it is about knowing about your condition and how to manage it day to day. If you have a long term condition you health your way 
http://www.nhs.uk/Planners/Yourhealth/Pages/Yourhealth.aspx may be helpful. http://www.nhs.uk/Tools/Pages/Longterm.aspx can help you to see if you are getting the right support for your condition.

Learning and teaching styles

It is well worth planning any training to be carried out and working out what are the learning outcomes to be achieved and what methods will be used to get there. Honey and Mumford suggest there are 4 dominant learning styles Activist, Pragmatist, Theorist and Reflectivist. It is important to ensure that the teaching methods mean that all the learning styles are catered for and all people are able to learn according to their preferred style.   

I carried out manual handling (of people) train the trainers update training in Wakefield for social services care staff. Using the Honey and Mumford learning styles questionnaire of the 6 people attending the training 4 or them were dominantly 'Reflectors'. This is interesting as the I am an 'Activist' these appear to be opposites and it can be difficult for a trainer to engage people with a different learning style to their own as it is easy to plan the training around the way you personally like to learn. 

Any good train the trainers course will address how to ensure that you engage with all the learners in the room and that they all receive training that appeals to their unique combination of learning styles. When asked about the training they had received on the day they all agreed that the day had appealed to them and engaged them. 

This made the trainer feel confident that the hours of planning lesson plans and looking at what the training intended to achieve and the methods used to deliver the messages were well spent!

example of lesson plan 

Duration 30 mins	Lesson title Relevant Legislation			Lesson no: 1.2
	Learning outcomes (LO) – By the end the candidates should be able to: 1.      Be able to quote what legislation applies to moving and handling 2.      Provide a definition of manual handling 3.      State the employer and employee duties 4.      Describe what s risk assessment is and why they are important in law 5.      Describe what RIDDOR is and how to report through it 6.      State how LOLER and PUWER affect their place of work 7.      Discuss how the Human Rights Act and Disability and Equality act affect MH
Materials required: Power Point, case studies, flip chart and pens, objects for CoG
Topic	LO	Teaching Points	Method	Assessment
Manual Handling Operations Regs 1992 amended 1999	1, 2 and 3	Definition of manual handling and load Duty of employers Duty of employees	Power Point Gesture Flip chart Objects for centre of gravity	Q and A
Health and Safety at Work Act 1974	1 and 3	Purpose of Act and how it applies in workplace Establishment of HSE and HSC Duty of employers	Power Point	Q and A
Management of health and safety at work regulations	4	Risk assessments Special cases for risk assessments	Power Points Hand outs	Q and A
RIDDOR	5	What is RIDDOR What and How to report Timescales	Q and A Power Point	Q and A
LOLER 1998	6	Application of regulations in workplace Recording of inspections Who carries out inspections Frequency of inspections	Q and A Power Point	Q and A

PUWER 1998	6	Application of regulations in workplace What it covers	Power Point Q and A	Q and A
Human Rights Act and Disability 1998 and Equality Act 2010	7	Apparent conflict between HR and DE and MH Rights within the law Protection of vulnerable adults and children What classifies as abuse	Dissuasions Case studies Power Point	Q and A

Evaluation of Lesson

Get candidates to call out all relevant legislation and definition of MH Point out duties of employer / employee Discuss how LOLER and PUWER affect the workplace and discuss Human Right and Disability and Equality discussion to encourage interaction Describe what a risk assessment is and why it is important and what is included