Look at the list you have made and identify any evidence to suggest Pinja is predisposed to back discomfort and link the evidence to your list of Pinja’s risk factors.

Risk factors include:                                         

• Unknown work history for ten years in Estonia including safer handling training.
• Ten years’ work in community setting – higher risk working in varied settings increases risk of musculoskeletal disorders (MSD) – risk includes lone worker.
• Current work place and work conditions includes balance of workload and staffing levels.
• Working nights interferes with circadian rhythms, deprivation of sleep and rest – impacts on health including eating patterns.
• Spends two hours per shift driving to and from work – may add to postural stress and concentrations levels for driving may be impaired, especially after a night shift.
• Age (56) the physical process of aging impacts on health of bone including intervertebral disc. Bone density decreases with age, but can be maintained if the individual remains physically active. Bone density is reduced in sedentary people but Pinja is active at work and you should have identified other risk factors for Pinja’s health:

• Overweight
• Smokes
• Menopause
• Family history of osteoporosis. You should have identified the causal links of osteoporosis and/or other bone degenerations with increased reporting of MSD.
• The impact of three pregnancies to term may impact on spinal and pelvic alignment.
• From a psychological perspective, positive aspects are she enjoys her job but misses her colleagues and the interaction with others when working nights and prefers day work.
• Social demands placed on her to care for her mother – her days off may not be restful and the demands of family life add additional stress. If you review sickness reporting in 2011–2012 health workers had the highest sickness rate of stress-related disorders than any other occupation. www.hse.gov.uk .

Suggest how Pinja could improve her work/lifestyle in order to improve her musculoskeletal health

• Attending well women’s clinic to help support and motivate to review lifestyle and health such as referral to smoking cessation programme. Consider family history of osteoporosis with referral to General Practitioner.
• Meet with dietician for health eating plan and guidance on weight reduction with ongoing support.
• Exercise(s) to improve back muscles may reduce current back discomfort.
• Refer to Back Care Advisor in her workplace to review Pinja’s ability to attain safer handling techniques and review working practices in her current workplace.
• Ward audit of safer handling techniques including equipment audit to improve handling methods to reduce MSD’s amongst the workers.
• Pinja could contact her manager/Occupational Health Department to review her physical wellbeing to make adjustments in her workplace.
• Sourcing care support for Pinja’s mother would reduce Pinja’s workload and therefore more recovery time when away from the workplace.

Charlie needs assistance to turn in bed every two hours and prefers to be moved on a slide sheet. He has a height-adjustable profile bed, with one side placed against the wall. A ceiling track hoist to move between his bed and bathroom is fitted above his bed. The floor covering is carpet. The free floor space is about 2 m x 1 m 40 cm, and this is the space in which the carers work. Charlie’s personal space and belongings are organized by him, so his family and carers must gain his permission to change his environment. 

• Use the risk assessment criteria as described to plan your answer.
• First identify and justify the optimal safe handling manoeuvre for Charlie.

Turn using a full-length glide sheet to reduce friction of the skin and maintain skin integrity, prevent pressure ulcers and reduce infection. Equally, immobility increases the risk of Charlie developing thrombo-embolic disorders especially in the lower limbs. Choice of equipment is less invasive than hoisting. Charlie’s choice.

Having decided how Charlie is moved in bed, now refer to the risk assessment criteria to identify possible risk factors associated with your selected move. Note there may be some sections of the assessment you cannot complete given this is a scenario. The aim of this exercise helps you to identify possible hazards and risks when required to move Charlie.

Risk Assessment using TILEE

Task: Turn to reposition for comfort and adjust Charlie’s view. Requires two people to complete manoeuvre. Adjust height of bed for the carers’ working comfort.

Individual Capability: Consent from Charlie, Safeguarding of Children, consider language skills, communication aimed at Charlie’s age group.

Load: Charlie compliant and understands rationale for being turned frequently. Consider privacy and dignity as adolescent. Consider Charlie’s physical needs i.e. muscle wasting, may not be able to assist, supporting limbs, able to breathe when repositioned.

Environment: Risk factors include bed against the wall, no access for workers. Carpeted floor, risk of injury pulling and pushing bed away from wall, every two hours. Consider negotiating with Charlie to alter layout of his room, to allow carers access around his bed.

Equipment: Choice of glide sheet may not be the best option given the limited access to the bed. May have to recommend use of overhead hoist.

Charlie is not legally an adult, how does legislation such as Children Act 1989 section 17 help him in terms of available services to assist him?

Legislation section 17 covers Local Authority Support for Children & Families

Safeguarding of children: 

• Ascertain child’s wishes – due regard
• Provide accommodation
• Provide assistance for Charlie to meet his daily needs
• Ensure standards to maintain Charlie’s health

Evidence: http://www.legislation.gov.uk/ukpaga/1989/41/section/17