“When the Book Don’t Work!”
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Jackie Napier NZROT Clinical Leader of Therapy Services, Community Living Trust (P47, Thursday, NZI 6 Room, 4.15-5)
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“When the Book Don’t Work!”
- 1. Community Living Trust Therapy Team Jackie Napier & Liz English Challenging the Boundaries 2012
- 3. Who We are B Community Living Trust Therapy Services Jackie Liz
- 4. L termInology L Patients: service users, clients, people we support, subjects, residents Helpers: Support people, paid workers, volunteers, family members, friends, nurses Leaders: therapists, educators, team leaders, managers, service co-ordinators
- 5. PatIent dIgnIty J Patients are not just loads. They don’t have handles. They come in different shapes and sizes. They have feelings. They need to be handled safely, with care and dignity. Patient handling and quality of care are dependent on staff safety and competence. Quote from Section 2 Why Moving and Handling Programmes are Needed June 2011 Draft.
- 6. decISIon makerS J Clients Families Organisations Policy –service providers Audits
- 8. Who IS the clIent? J Person referred Person's family Paid support people – home and vocational Friends or anyone else who assists transfers
- 9. JugglIng PrIorItIeS Safety Independence Maintaining ability to stand Duty of care Dignity of risk Family/ethnic culture Dignity Level of understanding Right to work in a safe environment. A home becomes a work environment. Who makes the decision?
- 10. BehavIoural ISSueS L Communication Timing Motivation Medication Natural rhythms Hitting, biting, head banging Underlying issues for Behaviour
- 11. IdeaS
- 12. Peter L Peter is very frail and unable to transfer on his own Lives in own home with family support Family do not want a hoist in the home Also has paid carer coming into his home He needs regular position changes when the book don't work challenging the boundaries 2012
- 13. Sam J • Not walking • Was using standing hoist to remove pants and go to the toilet • No longer weight bearing effectively for standing hoist. Relying on extensor tone. • Full hoist now required, however cannot get pants down even in a hygiene sling • To use the full hoist requires clothing to be managed on the bed, this now involves many transfers to use the toilet when the book don't work challenging the boundaries 2012
- 14. mary-Jane J Elderly woman with CP Very frail skin ‘tissue paper’ Decreasing physical and cognitive ability Too unsafe for standing hoist, has had falls and staff want/need to use full hoist Mary-Jane very distressed about change when the book don't work challenging the boundaries 2012
- 15. Jack L 18 year old man with C.P. Significant I.D. + P.D. – no reliable communication Loss of ROM in all joints Low bone density “density of a 90 yr old”. #’s on movement. Currently #R patella #L humerus High pressure risk – currently ulcer on sacrum and gluteal crease Frequent seizures Lives with his mother. Goes to several places for respite care when the book don't work challenging the boundaries 2012
- 16. BIll L Lives in residential service Varied level of ‘skill’ in the team “easy to lift” Refusal from team to use hoist and sling “hoist too hard, not enough space, takes too long” Staff’s right to choose to do this? when the book don't work challenging the boundaries 2012
- 17. rangI J • Mobile but occasionally falls • Once on floor difficult to get up • There is no hoist – and does not meet funding criteria for one in the home when the book don't work challenging the boundaries 2012
- 18. hoW do you? B Transfer from seat onto a prone wedge?
- 19. Assist a person into a swimming pool where there is no pool hoist?
- 20. Position someone in a contoured seating system without lifting, bending and twisting?
- 21. IS there more to conSIder aBout?...... Physical closeness “Therapeutic handling” Essentials of life Dignity of risk Fitness of support person Gender considerations Cultural considerations
- 22. Solutions needed
Notas del editor
- Jackie Therapy Services + self Liz self introduce self
- Liz
- Jackie
- Jackie Families for those living at home + in residential
- Jackie – risks for support person -Not evaluating the situation LITE Liz Risks for clients Injury clients losing function Losing independence and Risk of closing peoples lives down Losing opportunity to gain strength and skills e.g. Corey dignity motivation Pressure risks, seizures, medical
- Jackie
- LIZ Duty of care Dignity of risk - Liz story Right to choose Cognitive ability of client, family, support people Tension between home and work
- Liz These effect how we approach MH
- Handouts given out here break into groups here Use these as starting points for discussions
- Liz Peter does not like it Hoist takes up too much space Family not confident in using hoist What are the concerns? List questions for participants to answer e.g why might they not want a hoist in the home? How can this be resolved? Employer policy is not to lift Who’s concern is priority? Ceiling hoist Size of house Ability of family to learn to use the hoist
- Jackie Sam is a woman Mechanical solutions? Look up “she wee” Risk of wheeling person around house in hoist
- Jackie What is priority? Can Mary-Jane choose not to use the hoist? Options other than a hoist? “ duty of care”? Friction and shear Sleeves and cuffs (bring example) skin care
- Liz Reduced transfers but also needing to change position Need to support legs during transfers – often only one person present. weight of cast put pressure on femur as it became a fulcrum therefore had to support femur to prevent further # at school leg carried How do you get sling on him? Para-silk sling reduced need to put sling under him Spinal rod inserted for scoliosis – not able to lie prone for 1 year. Not able to lie on right due to # humerus or left due to # patella Seizures triggered by pain and stress All ulcers occurred following hospital admission Transported in hoist !!!! From bed to wheelchair in lounge as wheelchair with leg extensions would not go through door. Foot up on battery pack of hoist Used tilt in WC, + tilt to get him seated correctly in WC obtained equipment to use in other settings + lazy-boy, encouraged weight increase by supplementing intake, work with hospital, slide sheet Alternating air increased seizures – sound proof bag Used cushions to support humerus when that was the only #
- Spare Is there room to compromise?
- Spare What do you do? Decrease option for mobility? Call an ambulance? Staff training on how to get up – maybe a ‘lift’? Jackie to check with Enable re funding question
- Some prone wedges on floor height
- Getting sling in place