Care giver kneeling on the floor

[Eleanor Barrett]

Todays question for you to consider – is it OK for nurses/care givers to kneel on the floor in order to provide hands on assistance to patients? The assistance I have in mind is when the patient needs help to get their feet up into or out of bed (think swollen, oedematous legs or paraplegic patient moving from wheelchair to bed). Another transfer that may need hands on assistance is when helping a patient move from lying to sitting when the bed is not an electric assist bed, and the care giver may need to kneel on the floor to get close enough and be well balanced with a stable base of support to help the patient.
Your thoughts and comments are welcomed please.

[Julie Moffett]

I think there are lots of time when kneeling, especially a half kneel, will give a carer better biomechanics for carrying out a transfer.

[Anna-Marie Howe]

Re lifting legs up onto a bed
I think it depends on how heavy the client;s legs are as to whether kneeling on the floor is safe for the carer .Half kneeling to lift the legs is better than bending the back if no other options are available. However a height adjustable bed, manual or electric leg lifters or a hoist with leg support sling would be better options
Ann Newsom

[Aleebell@hotmail.com]

I know that our DN do a lot of kneeling and do complain about sore knees and trouble getting up (aging workforce). I understand that there are times kneeling maybe needed so we did supply kneeling pads etc for them but also reminded them that some task can be done seated instead. I’m not a fan of lifting from kneeling, as they will only be using their upper body to lifting and not their legs for all or part of the lift, also its not easy to get to your feet from kneeling while still holding on to a leg. In a lot of cases a manual leg lifter can be used by the patient and they are not expensive or a limb sling.

Angela

[Anna-Marie Howe]

If we are talking about DNs there is an Ergo Kneeler ( contact me for supplier )which is better than knee pads A better idea is to support the leg on an ergo stool. There is some research to show that kneeling for more than 15 mins can lead to increased knee pain.Remembering to stop and stretch regularly is also important.
Ann

[Anne McMahon]

My preference would be either slide sheets under the calves to reduce the friction and allow the person to pull their own legs up or using a limb sling with a hoist. The staff shouldn’t be lifting legs, it is detrimental to their and the patient safety. If the person can’t get one leg up at a time (with these aids and the right positioning) I would be questioning their ability to stand and/or walk, do they need a hoist? The positioning of the patient and the bed is crucial. Lowering the bed to an optimal level, getting the patient to the right point of the mattress, putting the back of the bed up and using any handles the bed has built in e.g. hill rom has multiple points allowing the patient to safely assist in propelling themselves backwards. Then getting the person to sit back into the middle of the mattress and bring one leg up at a time. I think often this task doesn’t need assistance when the person is instructed correctly and given the time to do it.

Possibly the inability to get legs back onto a bed is the justification to have more automation, particularly in the home setting. A bed that is electrically height adjustable, a sit to stand aid allowing better positioning or even a ceiling hoist allowing limb assistance without making the floor space of a room unmanageable. If the patient cannot get their legs onto a bed they are likely to require some level of assistance for other tasks. The weight of legs, especially in the presentations mentioned, will be in excess of any kind of ‘safe’ load limit.

[Aleebell@hotmail.com]

Hi Ann

I have just had a looked up the Ergo kneeler as I hadn’t heard of it before, it a neat idea but the DN will not use it as it looks too big and bulking for them to carry around. The kneeling pads not knee pads that they are using a easy and quick for them to wipe down and put in there bag and have had good feedback from them so far. It would be rear for them to be kneeing for more than 15 mins its more the amount of times they knee not how long they knee for. Thanks any way.
Angela

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