1980's elderly care: Australian lift and the coming of Roper

During my three years I was fortunate to see a wide variety of specialties and experience a wide range of nursing challenges. My first placement was in an elderly care ward where I worked for 12 weeks. The ward was in a one storey building, a modern addition to the old Mid Herts. site on Church Crescent close to our accommodation (St.Albans City Hospital if you haven't been on this journey before!). The ward was set out in a traditional nightingale style, with beds lining the walls either side of the ward and ancillary rooms such as the kitchen, bathroom, treatment and sluice rooms situated at either end. All of the patients were female and over the age of 65 with a high prevalence of conditions such as stroke and cancer and chronic disorders such as Parkinson’s disease, diabetes, chronic obstructive airways disease, emphysema, rheumatoid and osteoarthritis and heart disease. Patients with multiple pathologies were as common then as now in elderly care wards often requiring complex treatment programmes from a range of professionals such as nurses, dieticians, physiotherapists, pharmacists, speech and language and occupational therapists and of course the physicians.

Work in elderly care was physically demanding and then, as now, space in each bed area tended to be limited making it hard to work efficiently; equipment aids were also in relatively poor supply when compared with today’s NHS hospitals. We had a bathroom hoist with a couple of slings to accommodate different sized patients (one often in the wash or on loan to our counterparts in the male elderly care ward), monkey poles above the beds and pump up variable height beds. Some patients were issued with turning or sliding boards to aid transfer but for most patients manual handling was the norm with lifting techniques such as the Australian lift in common use. This lift entailed two people standing one either side of the upright, bed-bound patient. Each person would then put their shoulder beneath the axilla of the patient, link their hands beneath the patient’s upper thighs and together lift the patient up the bed. This lift required co-ordination, strength and a fair amount of trust on the part of the patient. Unfortunately for the nurse it was highly likely to put a strain on the neck or spine and thankfully, in the UK at least, it is now recognised as an unsafe lift for both nurse and patient (shoulder injuries, skin damage through shearing) and should therefore never be used. Back then though, most of our patients were highly dependent and there were many occasions when nurses were at risk of back injury because of poor equipment, training, staffing and/or awareness.

The Australian Lift - not as funny as they seem to think!

Working in an elderly care ward was hard but it gave us an opportunity to develop core nursing skills which stood us in good stead throughout our nursing careers. The ‘back-round’ system of care ensured that every patient was visited on a regular basis, re-positioned if necessary, toileted and given a drink or fed. Mouth, hair and skin care were routinely carried out along with general hygiene care and mobility support  (today's use of Intentional Rounding is not as innovative as some would make out).

However, the regulated, task-oriented approach which had been in use for so many years fell out of favour as the profession moved in the 1980’s to adopt a more individualized approach to care. The work of nurse theorists such as Nancy Roper, the UK born nurse who defined nursing in the context of a model of daily living, provided a framework for care which allowed the nurse to adopt an individualised, holistic approach to care which encompassed all the patient’s needs from eating and drinking to sleeping, working and playing, breathing, maintaining a safe environment through to expressing sexuality, controlling temperature, elimination, mobilization, communication and dying. When used effectively the model, which is in widespread use around the world today, ensures important elements of care are not overlooked. The work of others such as Dorothea Orem and Virginia Henderson was equally influential, although it was usually the case that there were many years between the development of the theory and the implementation in practice.

However, delivering individualised care in the way Roper and others envisaged it is difficult in a modern healthcare environment. The pressures of time, staffing, targets and the complexity of patient’s needs often reduce nursing to a list of key priorities, the things that must be done rather than the things that should be done. The modern dilemma (in the UK anyway) is how to keep to an indivudalised approach to nursing and still ensure essential care for all is carried. 

Next week: Fleas and more in A+E