PROTECTING YOUR BODY FROM INJURY
As a caregiver, you lift and move people and things all day long. This can place a great deal of strain on your muscles and joints, causing pain and injury. Today, many employers seek to limit on-the-job injuries by providing training and resources to make lifting and repositioning people easier and safer for the caregiver.
Always follow your employer’s policies and the person’s care plan when you are determining how to assist a person with moving, and use the equipment that is available to you. Ask for help from co-workers when you need it. And learn and practice good body mechanics and lifting technique.
Practicing Good Body Mechanics
When you practice good body mechanics, you use your body in a safe and efficient way to accomplish tasks such as lifting, pushing and pulling. Good body mechanics are all about alignment, balance and coordination.
Alignment is good posture. If you have ever driven a car that is out of alignment, you know that it’s hard to steer, the tires wear down unevenly and it’s unsafe. Human bodies that are out of alignment have similar problems. Body parts get pulled out of shape, which leads to discomfort and injury. Holding your body in alignment reduces strain on your joints and muscles.
Standing. To practice good alignment while standing, keep your knees slightly bent and stand with your feet shoulder-width apart. Put your weight evenly on both legs. Keep your shoulders straight and centered over your hips, your stomach muscles tightened and buttocks tucked under, your head up and your chin level.
Sitting. To practice good alignment while sitting, sit with your knees level with your hips, your back straight, your stomach muscles tightened, and your shoulders straight and centered above your hips.
Balance is stability achieved through the even distribution of weight. Having a wide base of support and keeping the heaviest part of your body (your center of gravity) close to your base of support helps you to stay balanced. When you are standing, your feet and legs are your base of support, and your torso is your center of gravity. Therefore, spreading your legs apart and bending your knees to bring your torso lower helps you to remain stable on your feet.
Coordination is the use of direction and force for purposeful action. For example, when you are moving a person up in bed, you will place one of your feet in front of the other. Shifting your weight from your back foot toward your front foot gives you additional power and helps you to move the person toward the head of the bed.
Coordination also means working with someone, rather than against them. For example, when you are repositioning a person, encourage the person to help you as much as possible. Similarly, if you are working with another caregiver or family member to reposition a person, you will want to use good communication to make sure you are both performing the same movements at the same time. This will give you twice the power and make the move easier.
As a caregiver, you will be required to lift people and equipment frequently. If you don’t use proper technique when lifting, you put yourself at risk for injuring your back. Back injuries can be painful and difficult to treat. They can prevent you from participating in activities that you enjoy, and they may even end your career in home care.
Proper lifting technique involves using the powerful muscles of your legs and buttocks to drive yourself, and whatever you are lifting, upward. To practice proper lifting technique:
Plan your lift, and get help if you need it.
se to the person or object you are lifting. Avoid leaning over or reaching.
Place your feet about 12 inches apart, with one foot slightly in front of the other. This position provides a broad base of support and helps you maintain your balance.
Avoid bending over at the waist. Instead, bend your knees and keep your back straight. Keeping the person or object close to your body, tighten your stomach muscles and drive yourself upward, using the muscles of your legs and buttocks.
To turn, pivot with your feet. Avoid twisting your body at the waist when your arms are loaded.
USING EQUIPMENT SAFELY
As a caregiver, you use equipment that makes your job easier and helps to ensure the safety of the people in your care. But because most equipment has moving parts, you can cause serious injuries if you do not use it properly.
Before using any piece of equipment, be sure you understand how it works. Read the user’s manual and follow instructions exactly. Before using the equipment with a person in your care, practice using it by yourself. If you are not completely confident about using the equipment, ask for help rather than risk injuring yourself or the person in your care.
Equipment with Wheels
Many pieces of equipment that you will use in the home care setting, such as beds, shower chairs and wheelchairs, have wheels. The brakes provided on equipment with wheels prevent the equipment from rolling. Imagine how unsafe and difficult it would be to help someone into a piece of equipment that kept moving. Before using a piece of equipment that has wheels, try out the brakes. Make sure you know how they work and that they work properly. If they do not work properly, do not use the equipment. Report the equipment problem to the office or to a family member.
Beds used in health care facilities may be equipped with side rails that can be raised to prevent the person from falling out of bed. Some people may also use raised side rails as an assistive device for repositioning themselves in bed. Today, use of side rails is becoming less common, because side rails are considered a form of restraint. In addition, side rails can cause serious injury. A confused person may try to climb over the side rail and fall. Entrapment is also a concern when side rails are in use, especially with older people who are confused or disoriented. In entrapment, the person’s head or another body part gets trapped between, under, or on the side rails, or between the mattress and the side rail. This can lead to suffocation (an inability to breathe), serious injuries and death.
The person’s care plan will state whether the side rails are to be lowered or raised when the person is in bed. Always follow the person’s care plan! If side rails are in use for a person in your care, make sure that the side rails have been installed properly, and check the bed frame, side rails and mattress to find areas where a person may become entrapped.
KEEPING THE PEOPLE IN YOUR CARE SAFE
The key to safety is prevention, or trying to keep things from going wrong by considering the things that can go wrong and taking steps to avoid them. By using common sense and your knowledge of the person in your care, you can think about things that might go wrong and take steps to prevent them from happening.
Risk Factors for Injury
Many of the people in your care will have one or more risk factors that put them at increased risk for injury. Understanding each person’s risk factors for injury will allow you to take steps to prevent injuries from occurring.
Sensory impairment. Our five senses — sight, smell, touch, hearing and taste — give us information about our environment and help to keep us safe. Think about how often you rely on your senses to maintain your own safety. For example, you read a label on a bottle to determine what is inside, and you look both ways before you cross the street. You listen for alarms and other sounds that alert you to danger. A food’s odor or taste might tell you that the food is spoiled. You test the water in the shower before stepping in to see if it is too hot, or not hot enough. A person with sensory impairment (for example, as a result of a stroke, complications of diabetes or advanced age) is at increased risk for injuries because the sensory impairment affects his ability to detect potential dangers in the environment.
Confusion and disorientation. A person who is confused (for example, as a result of dementia, medication effects or being in an unfamiliar place) is not able to make good, safe choices. The person might try to stand up when it is not safe for her to do so. She might drink or eat something poisonous because she confuses it for something that is safe to drink or eat. She might go outside without putting on a coat to offer protection from bad weather.
Poor mobility. A person who is physically weak, unsteady on her feet, or paralyzed is more likely to trip or fall. Disorders such as Parkinson’s disease or a stroke can cause a person to shuffle, which increases the risk for tripping. A person who is weak (for example, due to illness or advanced age) will tire easily when moving, which can cause her to fall.
Preventing Common Injuries
As a caregiver, there are many things you can do to prevent the people in your care from being accidentally injured. Let’s take a closer look at common accidents that might occur.
Falls happen to all human beings. As people age, factors such as declining eyesight, decreased strength and increased difficulty moving can increase a person’s risk for falling. Certain disorders (such as Parkinson’s disease) and the effects of medications can also increase a person’s risk for falling. Falls can cause serious, even fatal injuries. Because falls can have such serious consequences, prevention is key.
The care manager is responsible for assessing the person to evaluate the risk for falling when the person is admitted to the agency, and periodically thereafter. Strategies for addressing and minimizing the risk factors are then written into the person’s care plan.
The key to managing and preventing falls is to realize that a fall is nothing more than the result of a motivated behavior. In other words, if the person does not get up, she won’t fall down! The key then is to work to find out what the person wants to do and then help her to do it safely. Use your knowledge of the person to think about why she might try to get up without help, or what might cause her to fall. Then think about ways you can meet the person’s need and reduce or eliminate the risk for falling. For example:
You know that Mrs. Williams will try to get up to get a book or magazine or other item that she needs, rather than ask for help. To help reduce Mrs. Williams’ risk of falling, you can make sure the items she might want are within easy reach. This can be accomplished by moving the table closer to Mrs. Williams, rearranging the items on the table so that what she needs is within easy reach, or providing her with a grabber she can use to reach the items.
Lately, Mr. McDaniels has been complaining of feeling dizzy whenever he sits up. To help reduce his risk of falling, you can make sure the care manager knows about the dizziness, so that the cause can be determined by a physician and addressed. Details about the person’s dizziness — such as the level (mild to severe), the length of time it lasts (from a few seconds to 5 minutes or more), and what the person was doing when the dizziness occurred (for example, moving his head, trying to sit up or stand) — are also helpful to report.
Mrs. Jones has dementia. You know that because of her memory loss, she has trouble understanding her environment. You also know from talking to Mrs. Jones that she had dogs as pets up until she came to live at the nursing home. Lately, Mrs. Jones has been trying to get up in the middle of the night unassisted to “take the dog out.” To help reduce Mrs. Jones’ risk for falling, you could look at pictures of her dogs with her before she goes to bed to bring back good memories, and reassure her that her dogs are being well taken care of. This might help her to feel calm and contented, and reduce her tendency to get up in the middle of the night to take care of the dog.
Mrs. Lukins is a very private person. You know that she is embarrassed to ask for help using the bathroom. You make it a point to check on Mrs. Lukins frequently and ask her if you can help her to the bathroom.
In each of these examples, your knowledge of the person as an individual gives you information you can use to help lower the person’s risk for falling.
As you go about your daily routine, you will use many pieces of electrical equipment, from grooming appliances (hairdryers, curling irons, electric shavers) to furniture (adjustable beds, lamps). Always inspect electrical devices before you use them to make sure that they are in good working order and that cords are intact. A piece of equipment that is not working properly or that has a frayed cord can give the person (or you) an electrical shock. Always follow the manufacturer’s directions for using the piece of equipment, and avoid getting the equipment near water.
Shocks can also occur at electrical outlets. Use care when inserting and removing plugs, and advise those in your care to do the same. Use plastic outlet covers to prevent confused adults from sticking their fingers or other objects into the outlet. Avoid overloading outlets. Use a surge protector if it is necessary to plug more than two items into a standard outlet. Avoid using extension cords, except on a temporary basis.
A person can easily be burned if the water used for bathing is too hot. Turn hot water on last and off first, and check the temperature of the water coming out of the faucets. You can test the temperature of the water using your wrist, but remember that a person with impaired sensation may not be able to tell if the water coming out of the faucet is too hot.
Teach people with impaired sensation to use a thermometer to measure the temperature of the water before getting in the bathtub or shower. The temperature of hot tap water should be less than 115°F.
Foods and beverages that are too hot can also cause burns. If food is steaming or a plate is too hot to touch, wait until the food stops steaming or the plate has cooled a little before serving the meal. Also make sure hot beverages have cooled a bit before serving them. If a person has trouble keeping a firm grip on the cup, spills can occur, leading to burns. Serving the beverage in a cup with handles and a lid can help the person hold the cup more securely.
Some people may use heating pads to promote comfort. Place the heating pad in its cloth cover or wrap a towel around it before placing it against the person’s skin. Set the temperature accordingly and avoid leaving the heating pad in place for longer than 20 minutes. Check the skin underneath the pad every 5 minutes for excessive redness or blisters. Do not allow the person to lie on top of the heating pad, because this increases the likelihood of burns.
A poison is any substance that causes injury, illness or death if it enters the body. Cleaning supplies, fluids used for car and home maintenance, and certain plants can all cause poisoning if a person swallows them. Poisoning can also occur if a person takes the wrong medication, or too much of it. To reduce the risk for accidental poisoning, make sure all containers are clearly and accurately labeled. Store all medicines, cleaning materials and other potentially poisonous substances in locked cabinets and closets.
An incident is something unusual that happens to a person receiving care and has the potential to cause harm. You must verbally report all incidents, even those that do not result in injury, to the office. In addition, you must complete a written incident report, per your employer’s policy.
When reporting an incident and completing an incident report, it is important to provide facts, not opinions. The goal is not to assign blame. It is to provide a factual account of what happened so that appropriate steps can be taken to prevent a similar incident from happening in the future. Report the incident and complete the incident report promptly, while the details of what happened are still fresh in your mind. A complete incident report contains answers to the following questions:
Who was the person involved in the incident?
Was the person confused before or after the incident?
Was the person alone?
What happened to the person? Was the person injured? If so, describe the injury.
What caused the incident? (For example, was water on the floor?) Remember to state only facts, not opinions.
Where did the incident happen?
When did the incident happen (time, date)?
Who gave assistance?
What kind of assistance was given?
Were there witnesses to the incident? If so, who?
Did the person receive medical treatment?
Also include other information that would be a useful part of the record or that is required by your employer.