Manual Handling: Yes it physical but also social and emotional

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MANUAL HANDLINGYes it is physical but its also social and emotional

Aideen Gallagher Risk Managed Pty Ltd Risk Managed Pty Ltd 2016

AAMHP 7TH BIENNIAL CONFERENCE, FREMANTLE, WA25 MAY 2016

IntroductionHow many of you in this room have achieved a safe manual handling routine but, looking back, feel its implementation fractured your relationship with the participant, family or support worker beyond recovery? I have and the most memorable was a gentleman I went to assess about ten years ago. He was born the same day as me and of course this made a slight connection with this client. We both started our lives on the same day and how different his life with Cerebral Palsy and that of his parents compared to me and my parents. His parents wanted to get some help with managing his care and I was sent in to assess for a safe service. I really wanted to give them all the help they needed and deserved. I had to give the family some news they did not want to hear and it resulted in the mans father asking me to leave their home. I decided that day, I never wanted that to happen again, there must be another way.My name is Aideen Gallagher and I have developed HoistED, a programme that aims to provide therapists with the skills to efficiently and effectively prescribe Hoists managing the social, emotional and physical considerations. Today I am going to talk about the social and emotional elements of manual handling in the context of the home environment. As well as identifying these elements I will provide a sample of some solutions I have found to be effective in managing some of these challenges from the negotiation skills literature. I wanted to start a conversation today as I think by not opening this box, we are missing some opportunities right in front of us for making the implementation of safe and efficient manual handling routines less traumatic on all parties involved as well as more time efficient. The context we will be looking as is providing assistance in the home environment.

This was presented at the 7th biennial conference of the Australian Association for the Manual Handling of People in Fremantle WA on 25 May 2016.

1 Risk Managed Pty Ltd 2016

Person Environment Occupation (PEO) Model (Law et al, 1996)

BEYOND SAFETY

This diagram illustrates the PEO model of occupational performance, which we all learn in university. It basically says that the person interacts with the environment, through the tasks they do and the way they do it. 2 Risk Managed Pty Ltd 2016

Person Environment Occupation (PEO) Model (Law et al, 1996)

BEYOND SAFETY

This diagram assumes that one person interacts with the environment through the task however in manual handling there is always at least two people and in bariatric care, sometimes more. What was a simple diagram now gets complicated and we feel somewhat surprised when manual handling is complicated.

If you look at this diagram it essentially includes everything you have to consider when addressing a manual handling issue and some of these factors are indeed more important than others. The tasks are manual handling transfers, the performance becomes how we do them and the aim in the middle is a safe and efficient transfer. This concept of efficiency is a key point I want to come back to later


UNPOPULAR INTERVENTION INEVATIBLE

BEYOND SAFETY

We need to recognise that an in this aim to get to a safe and efficient transfer, an unpopular intervention may be inevitable and we have to have prepared a strategy for that.

Is the process usually happens that a client starts to deteriorate in the community and a therapist is called in to find solutions to the problem to keep care giver and receiver safe.


ParticipantSupportWorker(s)THE PEOPLEFamily MemberBEYOND SAFETY

There are a number of people involved in the manual handling process5 Risk Managed Pty Ltd 2016

STRIVE FOR INDEPENDENCE

ACCEPTANCE

GRIEF AND LOSS

LACK OF CONTROL

LOSS OF HOPE

BEYOND SAFETY

Participants strive for independence and will fight for that. I can tell you, I will be one of those fighters

Intervention in relation to relation to manual handling involves in some way an acceptance that independence has not been achieved.In many cases once manual handling assistance commences, the participant as times can stop having choice and have to invite people into the most intimate parts of their lives.

Elephant in the room we are in the business of giving bad news. People want to hold onto weight bearing at all costs. I spoke with Jo from Tasmania a physio last night at dinner and she reminded me that every client will want to walk to the determent of every other skill sometimes. We need to be cognizant of what happens when we take that away.That hope for a parent, daughter, son, sister or brother a person

We know all these things in manual handling, this is nothing new but the question is what do we do about them? Is the lack of acknowledgment of these leading to increased time?___

Participants describe a path of no return where you give up one thing and you have to give up it all.

Chris Colivitti will be speaking later today about manual handling of the bariatric client looking at movement patterns. At an event on the manual handling of participants of size I was invited to earlier this month, participants described a culture where clinician knows best and no one has the time ask the person. This is where there can be a whole lot of unresolved grief for a participant of a manual handling routine


ASSESSMENTCREEPBEYOND SAFETY

We know this, it is nothing new, it is the lack of dealing that can lead to hidden consequences in my opinion. A part of my workshop called it assessment creep, we you have finished the assessment and continue to get call after call about this case where it takes a significant amount of our time post assessment.

Some people would argue the client centred practice is about being nice. Yes it is but there are so many more opportunities within it if we look for them7 Risk Managed Pty Ltd 2016

Nurses 21.9/100FTECare aids 37/100FTE (Alamgir et al, 2007)

Nurses (21.9 injuries per 100 full time staff) -Care aides (37 injuries per 100 full time staff) (Alamgir et al., 2007)-Care aides less training, lower status, less control or support in their workplace (Eriksen et al, 2004; Pompeii et al., 2008)


PARTICIPANTS TERRITORYBEYOND SAFETY

Lets look at the social environment under which the care giver is working. Care is usually provided in the clients home or castle. Once the care giver walks over the threshold of the door, it is the clients territory. If any of you have spent time in another persons home as an individual for even over the weekend, you will see the influence of culture on what you do. Whatever health and safety policy is there, it is still the clients home and just by that fact, the care giver is suddenly in a vulnerable situation.


BEYOND SAFETY

Secondly, the participant is completely dependent on the support worker and the support worker must achieve the outcome. There is no half positioned in the chair, the client is either positioned or not. Whether the client looses function or equipment does not meet the need, the care giver will fill the gaps and this is where the manual handling is occuring.


HAZARDREPORTFORM

BEYOND SAFETY

We have provided support workers with tools to address this gap and report potential hazards to management.

In the classes that I run, I often ask care givers how likely they are to report if they see a risk to themselves in the workplace? What do you think they say? No. Is this new information to you, or something that you find in your workplace?

Why dont you think they report?


BEYOND SAFETY

Yes, because they dont want to replace a manual handling risk with a stress risk as the stress risk is worse.

Dr Peter O Sullivan identified in his talk at the conference in Fremantle on the last day that stress is a significant contributor to people have sustained pain after a back injury. So stress is essentially worse than the back injury.

Support workers can form a significant relationship with the participants they provide care for. It has been found to be a significantly stressful job and when a support forms a positive relationship with clients, they dont want to rock that boat. One care giver talked about it almost like becoming a cancer on a service she would regularly had enjoyed, the trust is gone.12 Risk Managed Pty Ltd 2016

WHS Card

BEYOND SAFETY

How many of you have asked to do something innovative in your workplace and you are told that for OHS reasons you cant do that? How does it make you feel?

If we play this WHS card, we get quite a lot of backlash which I think can be avoided by the way we approach the situation.

It was because of this phrase the made my dart as far as I could for the Work Health and Safety space just after I finished my Masters because I found it so frustrating, demoralizing and exceptionally threatening.

This is all we sometimes give our care giver to facilitate them deal with OHS problems is this somewhat unique environment of the family home.


BEHAVIOURINTENTIONINTERPRETATIONBEHAVIOUR-INTENTION-INTERPRETATION

BEYOND SAFETY

Bringing it back to the hazard report form, as well as playing this WHS card, clients are mis-intrepreting these forms. They make assumptions and this is where miscommunications happen all the time

If you look at the behavior of the inputting the hazard report form, the intention of the support worker is to report a hazard. How can it be interpreted by the participant? An attack on them and their skills/home and this can be the underlying frustration that can bubble under the surface of the hazard reporting routine. Our initial psychological reaction with any threat is to defend and hence we enter a boxing ring of tension and one which takes a long time to get out of.

Just to be clear, I am not against the hazard report form. I think we are missing opportunities to make things easier on everyone involved by the way we engage with it.14 Risk Managed Pty Ltd 2016

BEYOND SAFETYCLIENT MIS-INTREPTRET CARE GIVERS INTENTION

CARE GIVERS DONT REPORT

DONT WANT TO REPLACE MANUAL HANDLING CLAIM WITH A STRESS CLAIM

3 CRITERA TO GOOD NEGOTIATON

PRODUCE WISE AGREEMENT IF AGREEMENT POSSIBLE

EFFICIENT

IMPROVE AS OPPOSET TO DAMAGE THE RELATIONSHIP BETWEEN PARTIEIS

(Fisher and Ury, 1977)

BEYOND SAFETY

So I wanted to introduce some ideas from the negotiation literature into this space.

There is a perception out there that negotation skills is about Jedi min trick and so negotiation been given a really bad name. If you look at the clear aim of negotiation skills, it is based on ethical practice. Ethical practice only comes from the ethics of the person doing it whether they have negotiation skills or not really.

This is what we all want.

Negotiation has many negative connotations and often aligned with sale people and telling lies. I have included a couple of articles (again quite a business focus with a whole completely different culture to OT). All the literature on negotiation will conclude that professional ethics and ethical principles all come into any negotiation.


WINWINWE ALL WANT THE SAME THING

BEYOND SAFETY

So instead of framing it as this stand off, we have an opportunity to frame in terms of win win

You know the really exciting thing about manual handling is?


NO LIFTNO NEGOTIATIONMINIMAL LIFTLETS TALK ABOUT ITLETS WORK IT OUT

No lifting no negotiationMinimum lift lets talk about it18 Risk Managed Pty Ltd 2016

4 elements to negotiation (Fisher & Ury, 1977)People: Separate the people from the problem

Interests:Focus on interests, not positionsOptions:Generate a variety of possibilities before deciding what to do

Criteria:Insist that the result be based on some objective standards

BEYOND SAFETY


DOESNT HAVE TO BEFREUDS COUCH

There is a perception out there that effectively dealing with emotional difficulties of a client is timely and you are essentially get them to lie on Freuds couch and tell them all about themselves. It doesnt need to be. A previous job I worked in was in crisis care. Our role was to offer support after an ED presentation with suicidal ideation who went home into the community. These were people for various reasons were very distressed and our role was to offer therapeutic intervention to get them over this crisis period. I believe that I could offer an exceptionally therapeutic intervention in a very short period of time, many times in a 15 minute phone call when someone was very distressed. 20 Risk Managed Pty Ltd 2016

BEYOND SAFETYI HAVE 15 MINS TO TALK TO YOU TODAY

WHAT DO YOU NEED

FROM ME?

I did this was stating the time limit before I started. Mrs Brown, I have 15 minutes to talk to you today What do you need from me?This time statement gives you leverage if the conversation goes off therapeutic, you bring them back to the time. Mrs Brown we have about five minutes left to talk today, what do you need from me right now

It is very hard to reduce the time or stop the time you give you clients once you state itBUT YOU CAN ALWAYS GIVE MORE. So when a client is very distressed, I can use my clinical reasoning to say, this is the one that needs that hour and then I give the hour.

It can be referred to as opening this can of worms. Put a time limit on things before you start.

In a manual handling context, you could say, I have an hour today to do this assessment. I wanted to spend the first ten minutes talking to you.21 Risk Managed Pty Ltd 2016

Tell me one thing I can do today that will make it easier for you

BEYOND SAFETY

This statement says so many things and really easily fast track a therapeutic relationship with a client.


EMILE:I love ThomasGRANDAD:Oh, you love ThomasEMILE:I like Percy too, but he is green and I prefer Thomas because he is blueGRANDAD:Oh, you like Percy too and you prefer Thomas because he is blue

BEYOND SAFETYACTIVE LISTENING

When you ask a question, you need to be able to receive the answer. This takes skill and it is the basic skill of active listening.

Emile talking to my father Emile doesnt really engage with him, Emile talking to my father in law a completely different story and I started to figure out why.

This is an example of paraphrasing

Say what is in the slide

There is another active listening skill called reflecting and that is just think but an emotion onto it.


Picture of 7 month old child

7 month oldRecognises hisname LUKE

USING A PERSONS NAME

Do you have anyone in your workplace that can convince you of anything? You will do anything for them. What do you think they are doing that makes you want to do that? Some people might say a smile and yes that gets you somewhere, some people might suggest saying please but I think it is even simpler than that.

What is completely unique to you that is no one elses? What is something you would have first connected with at about 7 months old?

This is a picture of my second son at about 7 months old. It was at that time that he could have starting connecting a certain word with himself and that was his name Luke. Luke is unique to him and when they use it, he knows that the person using it is talking to him and just him.

- in times of conflict it would bring the conflict down a notch- In times when people were going off the point it would get them back on trackIn delivering bad news it would soften it

______

Many of you described really great communicators in your negotiation idol from Julie Bishop, Gandi, Jamie Oliver. You described a few things and one that came to the fore. I think the wording is really important here. The idea of feeling valued versus being valued. Consistently in management people want to feel valued. They know that the first step in being valued is feeling valued. How do we communicate this? And is it as difficult as we think it is?

Some of you in your negotiation idols described people who could make you do anything by making you want to do that for them. That is an example of one of my first managers. She was brilliant, I wanted to work hard for her. I assumed all managers were like this but not so. So what is it?

I wanted to tell you a story of when the first skills I am going to introduce to you really stood out to me and it took me almost a year for the penny to drop

I recall going away with a large group of friends for a few days (pre kids). There were 16 of us who rented two houses by the beach. We all knew each other except for two couples. John and Mary lets call them. After two days with John, everyone thought he was lovely. He wasnt really all that funny or didnt have any extroverted characters and everyone talked about how great he was. How could John get a group of 12 people to think he was totally great in a very short amount of time. That was about ten years ago and my husband and I have since become very good friends with this couple. It was when I started to study negotiation that it clicked with me, why everyone loved John and John could do that in such a short period of time.

This is a picture of the source of those screams on day one of my lecture series. My now 14 month old son Luke. Here is a picture of him at seven months, a time when babies start to see patterns in communication. It is at this point that Luke starts to associate a word with himself that is just his and on one elses, a way that he feels valued in the world he lives in. What is it? Its his name.

John, in our previous example constantly used our names when talking to us. When I talked to him about this and my discovery he smiled and said it was something hammered into him by his Dad. Always say a persons name. As a project manager he used it:


4 elements to negotiation (Fisher & Ury, 1977)People: Separate the people from the problem

Interests:Focus on interests, not positionsOptions:Generate a variety of possibilities before deciding what to do

Criteria:Insist that the result be based on some objective standards


OBJECTIVE MEASURE

BEYOND SAFETY

We need to make some though decisions when working in manual handling and sometimes all people want is a fair and reasonable solution.

One way is which we can ensure a fair and reasonable solution is to introduce an objective measure to the discussion.

This where I think e can further promote policy and safe work as that objective measure26 Risk Managed Pty Ltd 2016

TIMING

The timing of this is really important. There is no point introducing policy and SWPs when the horse is bolted, they need to be introduced before there is a problem.27 Risk Managed Pty Ltd 2016

POLICY

SAFE WORK PROCEDURESCANT DO CAN DO

With this minimal lift policy there is a bit of room for discussion

A policy draws a line in the sand of what can and cant be done. If we change our language to what we can do, we can then I know all of you are going to be screaming at me saying, yes we already have policies and we already have safe work procedures. I know they are there, I am interested in how you are using them. A policy provides a really great tool to separate the support worker from the task they are doing. They can therefore position themselves as a robot where they can only do what the policy says they can do. Similarly, safe work procedures offer an even more powerful objective measure.

Going back to this idea of being mis-interpreted, I feel a policy and SWPs are a way in which the care giver can protect themselves

Fair and reasonable

Written down28 Risk Managed Pty Ltd 2016

BOUNCE THE PROBLEM OFF

CAN DOLETS TRYLETS WORK TOGETHERYES LANGUAGE

POLICY

SAFE WORK PROCEDURES

You can use policy to provide a boundary for your problem solving or a care workers problems solving

This is the boundary of what we can do

Lets tryLets see what will workLets work together to solve this problem

CHOICE AND CONTROL

I always encourage care workers to have the policy in their pocket

When they are asked to do 29 Risk Managed Pty Ltd 2016

APPEAL TO THEIR INTERESTS

BLAME AN EXTERNAL

Recognising the misintrpeation that we talked about that can happen in reporting hazards, I feel there are opportunities to give care workers other tools to negotiate with their clients.

When I ask this open question about an aim of submitting a hazard and getting the client on board care givers always come up with some really good examples again alligned in ethical practice

APPEAL TO THEIR INTERESTS What can they gain?

Objective Criteria is the bad guy


SOC!ALPhysicalHandlingManual

BEYOND SAFETY

In conclusion, Ergonomics and biomechanics is about fit of man to machine. In the manual handling of people, we account for the fact that they have uncontrolled movements but they also have uncontrolled emotional and feelings as do the people working around them.

Today, we examined some of the reasons why there are social and emotional elements to manual handling in the family home. Firstly we identified from the clients perspective, the grief and loss they present with when manual handling is involved. Secondly for the care worker who can be an in vulnerable position in the family home. I presented a negotiation model by Fisher and Ury. Using this model we identified the power of a time, active listening, using time frames and using policy and safe work procedures as the objective measure.

Yes manual handling is physical but it is also social. By viewing manual handling in this way, I think we have many opportunities to strategically invest our time in addressing these elements efficiently to prevent the concept of assessment creep which causes us to waste exceptional amounts of time, money and energy.

Risk Managed Pty Ltd 2016

CONTACT

E: [email protected]:www.riskmanaged.com.au Risk Managed Pty Ltd 2016

CO

If any of you have any questions about the presentation or are interested in any of the courses we have to offer both face to face or online, we can be contacted below.

Thank you for your time.


REFERENCESAlamgair, H., Cvitovich, Y. & Yassi, A. (2007). Work related injury among direct care occupations in British Columbia, Canada. Occup Environ Med, 64, 769-775.Fisher & Ury, (1977). Getting to yes.Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L (1996) The Person-Environment-Occupation Model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9-23. - Diagram reproduced with permission from CAOT

MEDIAOpportunity by Quinn Dombrowski https://creativecommons.org/licenses/by-sa/2.0/ - addition of text PEO Model reproduced with permisson from CAOT coloured changed to green and grey wording changed to specify manual handlingElephant By Art G https://creativecommons.org/licenses/by/2.0/ addition of text Intrigued by Nicolas Alejandro Is licenced under CC by 2.0 addition of text Man in hoist Shutterstock used with permission -Scream and shout by Mindaugas Danys https://creativecommons.org/licenses/by/2.0/ - addition of text Care giver istock used with permisson Leederville house 1 by vagawi - https://creativecommons.org/licenses/by/2.0 - addition of text

MEDIAMarking Pile 1/X by Sam https://creativecommons.org/licenses/by-sa/2.0/ addition of text Gap by Kevan - https://creativecommons.org/licenses/by/2.0/ addition of text Stressed Out by Thomas Haynie - https://creativecommons.org/licenses/by/2.0/ addition of text Playing cards by Fredrik Rubensson https://creativecommons.org/licenses/by-sa/2.0/ - addition of text Discussion by Project Morpheus https://creativecommons.org/licenses/by/2.0/ - addition of text Head in the sand by John VanderHaagen - https://creativecommons.org/licenses/by/2.0/ addition of text Star Wars Weekends 2011-Last Day by Gordon Tarpley https://creativecommons.org/licenses/by/2.0/ addition of text

MEDIAStand off #2 by Nilah https://creativecommons.org/licenses/by-sa/2.0/ addition of text Occupational Therapist by Isle of Man Government https://creativecommons.org/licenses/by/2.0/ addition of text Painting With Children by Andr Hofmeister - https://creativecommons.org/licenses/by-sa/2.0/ -addition of text Couch By Zach Welty https://creativecommons.org/licenses/by-sa/2.0/ addition of text Stopwatch by William Warby Is licenced under CC by 2.0 addition of text My daughter in her wheelchair by Glenn Beltz https://creativecommons.org/licenses/by/2.0/ addition of text Thomas the Tank Engine - Watercress Line by Georgeowensfx Is licenced under CC by 2.0 addition of text Midnight Mariah Runs In The Snow by Pete Markham https://creativecommons.org/licenses/by-sa/2.0/ - addition of text Tool Box & Levels by Dylan Foley https://creativecommons.org/licenses/by/2.0/ - addition of text Bouncing Ball by Dave Murphy https://creativecommons.org/licenses/by-sa/2.0/ - addition of text Shopping! By joe jukes Is licenced under CC by 2.0 - addition of text Books istock reproduced with permission - addition of text

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Manual Handling: Yes it physical but also social and emotional

Health & Medicine