Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study

• Published in: Journal of clinical nursing Vol. 25; no. 19-20; pp. 2906 - 2920
• Main Authors: Smith, Margaret Coulter, O'May, Fiona, Tropea, Savina, Berg, Jackie
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-10-2016; Wiley Subscription Services, Inc
• Subjects: Accidental Falls - prevention & control; Adult; Aged; Attitude of Health Personnel; Content analysis; Female; Fractures; Fractures, Bone - nursing; Fractures, Bone - prevention & control; Geriatrics; Health Services for the Aged; Humans; Interviews as Topic; Male; Middle Aged; Mortality; moving and handling patients; Nursing; Nursing Staff, Hospital - psychology; older people; Osteoporosis; Osteoporosis - nursing; patient safety; Practice Patterns, Nurses; Prospective Studies; Qualitative research; Risk Assessment; Scotland; Young Adult; United Kingdom > UK; Scotland; patient safety; older people; qualitative research; osteoporosis; moving and handling patients
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.13344

Aims and objectives
To investigate healthcare staff's views and experiences of caring for older hospitalised adults (aged 60+) with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis.
Background
Osteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is a major global health problem. In the UK older hospitalised adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident, it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often suboptimal and specific manual handling implications are under‐researched.
Design
An exploratory qualitative content analysis research design informed by critical realism.
Methods
The purposive sample comprised 26 nursing and allied health professionals. Semi‐structured interviews addressed topics including knowledge of osteoporosis, implications for acute care, moving and handling and clinical guidelines. Qualitative content data analysis was used.
Results
Awareness of osteoporosis prevalence in older populations varies and implications for nursing are indistinct to nonspecialists. In‐hospital fractures potentially linked to suboptimal moving and handling seemed rare, but prospective studies are needed. Categories of ‘Understanding moving and handling as routine care or as a healthcare intervention’, with further categories ‘healthcare practitioners’ capacities and capabilities for dealing with people with osteoporosis’ and ‘the structural and organisational context for moving and handling’ are reported alongside safety, frailty and dependency dimensions.
Conclusions
This study informs moving and handling in higher risk groups such as osteoporosis. Clinical knowledge/expertise is required when adapting generic manual handling guidelines to specific patients/contexts. Patients’ experiences of moving and handling have received limited attention.
Relevance to clinical practice
Increased focus on musculoskeletal conditions and moving and handling implications is required.