A Moving and Handling Assessment: Reflection by Alex Wood

For the purposes of this reflection, I have chosen to talk about a moving and handling (M&H) case. I have found myself doing more M&H work since lockdown and I was asked to carry out a M&H assessment for a lady with profound learning disability who was discharged from hospital. She was unable to fully weight-bear but had previously been quite mobile with support.

 Following the initial assessment, I arranged for an equipment provider to attend with several items of equipment. After some time we managed to hoist her into a wheelchair. The initial transfer was difficult as she wasn’t sure what was happening and despite efforts to simply communicate this to her she was understandably reluctant. Luckily we managed to transfer her safely and with little agitation. Once she was sat out, she was able to have fish and chips while sat in the wheelchair watching her television, which is something that she has not done for a couple of months and clearly enjoyed.

 On discussion with the equipment representative regarding the track hoist, we identified that the Robin overhead track hoist, a two-loop system, would be safest, as the client tended to reach up and get hold of the spreader bar which is something that could potentially cause injury to herself or one of her carers.

 I was glad and relieved that we managed to transfer her onto the equipment, although I wasn’t confident at the beginning that this was going to happen. The equipment representative and I had to leave her with her familiar carers to support her for 15-20 minutes at one stage, as she was starting to become overwhelmed and agitated.

 Whilst we were able to proceed with the assessment as planned, on reflection I think that preparing the client may have been useful. For example; showing her a video of somebody being hoisted in the days up to the assessment so that she was more prepared.

 It’s difficult to know whether this would have had any impact at all and may possibly have made the situation worse. I was also unsure what the client was able to understand as she was unable to communicate or follow instruction and had a history of becoming agitated and occasionally grabbing at her carers. Interestingly, during the second assessment she was much more compliant which made the process easier. This indicated that she had retained some of the information from the previous assessment and was keen to get out of bed again.

 I’m glad that we thought to organise the assessment to enable her to sit out for a period and have her lunch, as this appeared to be of significance to her. I considered that she may have become agitated that she was not able to be out of bed for any significant time otherwise. I’m also glad that I chose equipment representatives that were sensitive to the situation and that I briefed them as to the plan before we entered the property. This helped to reduce interaction between those present which contributed to overwhelming the client.

 Should the situation arise again I would identify a short clear video of somebody being hoisted. Should the client not have any negative reactions to this than I would ask the carers to show them this several times in the days running up to the assessment.

 Completing this assessment has made me review my current M&H knowledge and training and as this is an area that I am working in more and more and with increasingly complex cases. I have investigated further training through a couple of different companies. During this research I identified that my knowledge was quite limited with regards to single-handed care and I am in the process of arranging further training as this is an area that I am also quite interested in.

 Writing this piece has reinforced in my mind how reflection is an integral part of my practice, just a less conscious one than it used to be! My usual reflections are around engaging with someone who has suffered a brain injury and how to build a therapeutic rapport with those who have cognitive impairment and awareness issues, which can be extremely challenging.

Alex Wood.