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Are you sitting comfortably?

Robert Millett meets a group of physiotherapists who are determined to improve workers’ postural care skills

File 119560

Physiotherapists often witness the detrimental effects on older or relatively immobile patients who have been poorly moved or badly positioned.

The cause is not usually neglect, but rather a lack of adequate knowledge. Healthcare assistants usually do their best to move and position people safely and securely – but they frequently lack awareness of the importance of postural care.

With this in mind a group of volunteers, known as the Physiotherapists Care Skills Group, is seeking to improve the skills of carers.

The group consists of 17 physiotherapists from the Leeds and West Yorkshire area. They come from a variety of physiotherapy backgrounds, with members including a university professor, a specialist in learning disabilities and a superintendent physio.

The common strand is that all of them have witnessed examples of poor postural care. Additionally, they share a belief that there are viable ways to improve carers’ skills and so boost the wellbeing of service users.

For the past two years the group has met every month in Leeds, at the private practice of Jill Fisher, a specialist neurophysiotherapist who founded and now chairs the group.

The group started after Mrs Fisher gave a talk to Yorkshire members of the Association of Chartered Physiotherapists in Neurology.

‘We formed because, as physiotherapists, we know how a lack of appropriate care can lead to reduced health, wellbeing and independence,’ says Mrs Fisher.

The members also bonded, she notes, over their shared desire to promote dignity and person-centred care, and by doing so improve patients’ activity and independence.

Together they have been working to develop an educational resource for nursing and care staff, with the aim of ensuring that postural and movement opportunities are improved.

‘We thought we would put together a training package that would make it easier for physios to increase awareness among the staff and managers of care services,’ says Mrs Fisher.

‘We want to help them realise how important it is to carefully consider people’s postural management and how they can promote activity,’ Mrs Fisher explains.

As a result some members of the group have qualified as trainers in the adult education sector.

Others, meanwhile, have been conducting research and liaising with experts in the field.

The group has also benefited from having various guests at their meetings, included an occupational therapist, a Care Quality Commission inspector and a local authority officer.

Drivers for change

Mrs Fisher explains that poor sitting and bad positioning can potentially lead to discomfort, restricted function, tight muscles, choking and respiratory problems. But awareness of these associated health problems is not common among care staff.

‘People without disabilities often slouch or sit awkwardly in chairs,’ says Mrs Fisher.

‘So it’s not immediately apparent to carers that someone who can’t move or re-position themselves may suffer damage.’

The fact that postural care is so often overlooked is highlighted by the fact that many chairs in nursing homes are unsuitable. Mrs Fisher points out that many nursing homes look very neat, with matching chairs of equal sizes. But the uniformity of the furniture betrays a lack of postural awareness, as people are all different and a ‘one size fits all’ approach inevitably leads to some residents experiencing problems.

Karen Hull, a specialist neurophysiotherapist and a key member of the group, has developed a poster presentation about the group and their work, which she presented at last month’s Physiotherapy  UK conference.

Mrs Hull recently attended a Department of Health consultation event on improving care for vulnerable older people, and she says the aims of the group are well aligned with the current priorities of policymakers.

‘The work we are doing really feeds into a preventive healthcare agenda, and patients in care homes are some of the most vulnerable in society,’ says Mrs Hull.

Mrs Fisher agrees and points out that there is an opportunity in the current health and political climate, post-Francis report and with frequent media coverage of healthcare inadequacies, to promote the benefits of improving the skills of healthcare assistants.

She says these include potential cost benefits, because carers with appropriate skills help the people they support to become more independent, and they therefore require less help. Costly medical problems, such as bed sores, could also be avoided.

‘Often I think care homes live up to their name, in that the carers and staff really do want to care for the people, ‘says Mrs Fisher.

‘But we need to change that ethos to one where they want to enable people to be as active and independent as they would like to be – and really promote those opportunities for them.’

Promoting wellbeing

The group’s training package will be available as a multimedia resource, for any interested physiotherapists to deliver.

It will include PowerPoint presentations, video clips, guidance notes and references to research supporting the evidence base.

‘We plan to make the training material freely available to therapists throughout the UK via the society’s member networking website iCSP,’ says Mrs Fisher.

The group hopes that physios will be able to take the package and adapt it to the particular needs of any group they wish to train.

The training is designed to be highly practical and involves demonstrations, role-plays and practice sessions in small groups.

Care has also been taken to ensure that the syllabus does not imply blame or focus on past mistakes.

‘The training aims to build and develop around what works rather than focusing on gaps and inadequacies,’ says Mrs Fisher.

‘It’s also important to respect their knowledge base. So we are not just lecturing and saying “this is what you do”. Instead we are giving background information and drawing out ideas from them about the best way to do things – and then reinforcing that.’

The course has been structured to develop improved handling skills and effectively communicate the principles of person-centred care.

Practical techniques are combined with interpersonal skills, designed to encourage a sense of collaboration between care staff and their clients.

‘For example, very typically when someone is turned over in bed the carers will do a log roll – just keeping the person in a straight line and pulling them over,’ says Mrs Fisher.

‘But if they know how to assist them to bend their legs, rotate them from their lower body,  and just say “can I help you turn over?” then the person will join in.’

The essential difference, Mrs Fisher says, is that the techniques taught on the course empower people to make choices and to have an opportunity, even if limited, ‘to do whatever they can do for themselves’.

‘This type of training is rarely provided for carers,’ she notes.  ‘It’s mandatory for healthcare staff to receive some moving and handling training, but that is mainly about keeping themselves safe rather than about how best to improve residents’ wellbeing.’

The group has recently delivered a seven-and-a-half hour pilot course of the training. This was taught in three separate sessions at Moorfield Care Home in Leeds.

The training was provided free of charge and delivered on a weekly basis to 10 care staff employed by the home.

After the course all the participants were invited to take part in interviews, conducted a few weeks after the training.

The results revealed that the staff felt the course had enabled them to make people feel more comfortable. Participants reported that they were able to position people better in bed, and others noted that their clients were no longer crying out when they moved them.

‘The feedback we’ve got from people who did the course is absolutely tremendous,’ says Mrs Fisher.

‘They really appreciated it and now they feel they can do a better job for their clients.’

Staff also commented that they had gained a better understanding of how to position tight, contracted limbs and that fewer of their clients were experiencing choking or swallowing problems.

Collectively, they also felt they had gained an increased awareness of how to appropriately encourage activity.

Mrs Hull says the follow-up evaluations clearly indicated that the training had succeeded in changing the working practices of the staff involved.

‘Over the three weeks their confidence grew and by the end of the course they were working with one another to improve the sitting positions of their clients,’ says Mrs Hull.

‘If this was mirrored in nursing homes across the UK, I’m confident that we would see a huge improvement in the lives of older people.’

Raising awareness

The group is currently researching potential sources of funding, with the hope that the training might one day be commissioned by primary care trusts or social services.

They also hope they will be able to increase both public and professional awareness of the need to improve postural care and implement good physical management.

In the first instance they aim to achieve this by attending care conferences, forging links with service managers, and gaining publicity. There are also plans to liaise with carers and relatives, and groups of care home residents.

‘Hopefully we will be able to roll it out nationally – as it could equally apply to people in a hospital environment, or those who work in the community or within intermediate care,’ says Mrs Fisher.

‘Anyone who isn’t able to move themselves around is subject to these types of issue, and they should be managed by people who understand how to position and move them well.’

The group is currently writing up the results of their pilot training course and will be making the results available, by request, in the next few months. fl

Feedback from the pilot course

Comments from participants, who were interviewed within four weeks of completing the course, included:

  • ‘It’s good because it’s more comfortable for them [the residents] and we’re explaining what we’re going to do and we’re suggesting that we help them so we’re not just like taking over.‘ (Talking about how a particular resident had benefited)
  • ‘I’ve tried to encourage the staff to try and sit him up even if it’s just a bit but now he sits up straight up in bed and he eats and he doesn’t choke anymore ... he enjoys his meals a lot better now.‘
  • ‘The way I was moving people I was constantly in pain ... but I haven’t been in pain since, it’s really helped.’
  • ‘For me the awareness brings a responsibility ... I have a responsi-bility to these people to make sure they are in the best position they should be each night.’


For further information

Email: physiotherapistsCSG@groupspaces.com

To find out more about the Association of Chartered Physiotherapists in Neurology, visit:  www.csp.org.uk/professional-networks/acpin

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