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Adverse risk: a 'dynamic interaction model of patient moving and handling'.

AIM
The aim of the present study was to examine patient adverse events associated with sub-optimal patient moving and handling.


BACKGROUND
Few studies have examined the patient's perspective on adverse risk during manual handling episodes.


EVALUATION
A narrative review was undertaken to develop the 'Dynamic Interaction Model of Patient Moving and Handling' in an orthopaedic rehabilitation setting, using peer-reviewed publications published in English between 1992 and 2010.


KEY ISSUES
Five predominant themes emerged from the narrative review: 'patient's need to know about analgesics prior to movement/ambulation'; 'comfort care'; 'mastery of and acceptance of mobility aids/equipment'; 'psychological adjustment to fear of falling'; and 'the need for movement to prevent tissue pressure damage'.


CONCLUSION
Prevalence of discomfort, pain, falls, pressure sores together with a specific Direct Instrument Nursing Observation (DINO) tool enable back care advisers to measure quality of patient manual handling. Evaluation of patients' use of mobility aids together with fear of falling may be important in determining patients' recovery trajectory.


IMPLICATIONS FOR NURSING MANAGEMENT
Clinical governance places a responsibility on nurse managers to consider quality of care for their service users. 'Dynamic Interaction Model of Nurse-Patient Moving and Handling' provides back care advisers, clinical risk managers and occupational health managers with an alternative perspective to clinical risk and occupational risk.