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Posture during home visits and nursing home rounds

Discussion in 'General Issues and Discussion Forum' started by t5christie, Dec 17, 2009.

  1. t5christie

    t5christie Member

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    Hi everyone,

    Just finished my 1st day as a qualified Podiatrist:D. Anyhow, the reason for my thread is that a fair amount of my work will be undertaken seeing patients in their home as well as doing nursing home rounds. I am very mindful of my posture most of the time, however frequent bending and kneeling is sometimes unavoidable.

    I'm sure someone has brought this query up before on Arena, however what handy hints or posture devices do Podiatrists use that makes treating patients that little bit more comfortable.

    On a side note, does anyone have any experiences as a newly graduated Podiatrist or any advice that they would like to pass on which may be helpful to me and any other new graduates. Any advice or experiences would be appreciated.

    Regards Tom.
  2. charlie70

    charlie70 Active Member

    I bought myself a collapsible stool and a footrest for home visits (I work in the NHS: if you do you'll find they don't supply any of these things if they can avoid it!).
    The footstool is a little lower than my old knees would like, but patients often can't lift their legs high enough to see the plantar surface of the feet if you're on a higher stool.

    Home visits - especially nursing homes - ARE physically taxing. Halfway through a session, if you can, its a good idea to do neck and back stretches and to just shake the legs out a bit.
    Also, don't be shy to get staff in the homes to move bed-bound patients for you: I spent the first few years contorting myself to reach the feet of people lying in a foetal position. Don't do it: get the staff involved!
  3. Geoff Hull Footman

    Geoff Hull Footman Active Member

    There is no ideal solution.

    I bought a 12"plastic stool ,from IKEA, £5 uk. I use a laser-level's tripod £30 uk. I then had a local engineer put a slightly curved stainless steel plate on it instead of the level about 6" square. I had a vp patient who did dry powder coating and we swapped a tt for covering it.

    IMO it is more practical than proprietry cushioned ones available.

    As you leave your car invert the stool , put tripod into it , and anything extra that you may wish to carry.With your case in one hand and the stool and tripod in the other you have better balance as you walk . Adjust the tripod to your required height and close to pt's seating comfort.
    Use pt's own clean towel on the foot rest for comfort and equal to their own hygene.

    Never as good as your pt chair in surgery , but adaptable to both types of visit and situ's. 18 years practice , 4 stools and 2 tripods later still using this method.
    Dont forget most NH beds will rise to a better height to avoid difficult bending down to reach.

    ;) I hope this has merit for you and good luck

  4. Admin2

    Admin2 Administrator Staff Member

  5. twirly

    twirly Well-Known Member

    Hi Tom,

    Congratulations on your 1st day :D

    My tip:

    Hosiery. Always insist when booking a nursing home that a member of staff is allocated to you to accompany you during your visit. Request the staff member removes & replaces all residents socks, tights, pop socks or support stockings during your visit. The staff member may also be invaluable in comforting the resident during what for some individuals can be a distressing experience if they are a little confused.

    Never be tempted to accept no assistance if the staff are busy. You only get one back. :empathy:

    If treating an individual in their own home see if it's possible to arrange your visit when a carer is available.

    PS. Always wise to ask quietly if any residents bite ;)

    Take it as read the staff might if provoked :D

    Good luck in your career.


  6. Congrates on the 1st day.

    This might be a bit negative but...

    Stop doing DOM work as soon as possible, your back maybe great now but every Pod I know has back problems and this is made much worse by positions that you get yourself in a nursing homes and home visits.

    Remember it it your back and as Twirly wrote you only get one of them.
  7. Paul_UK

    Paul_UK Active Member

    Well done on getting through your 1st day!

    What are you currently using re: stool, footrest etc?

    I spent ages trying out various stools to sit on and none of them seem to be any good until one day I was browsing in a camping shop and found a perfect camping tripod stool. It folds down completely and is easy to carry and lightweight. We also have a foot rest in the clinic that is very similar to a camera tripod that is perfect, everything adjustable etc but I am unsure of the maker, Ill try and find out for you.

    Doms are never easy but it does get a little better the more you do them, but I couldnt agree more with M Weber, try and get into a clinic as soon as you can, your back will thank you for it!
  8. Maureen Hillier

    Maureen Hillier Welcome New Poster

    Nursing home beds should be adjustable for height. Get the bed as high as possible to prevent bending and remove the bed end. If you have a stool to use adjust the bed height appropriately. The ideal would be for homes to have a designated treatment area with couch available and where you can use the equipment that the home has available.
    If you are working for the NHS, don't forget they have a responsibility to provide you with all necessary equipment to ensure that the home setting is as close to the clinic setting as possible.
    The home setting can be very rewarding in that the patient is generally more comfortable in their surroundings and less distressed esp the EMI patients. Advice re commandeering one of the resident staff memebrs is excellent and makes for a smoother identification of patients.

    Well done on qualifying and getting a job.

    Mo Hillier
  9. efuller

    efuller MVP

    When possible, and needed, try squatting instead of bending. It will keep your back straight. At first it will tend to cut circulation off below the knee. However, over time, you should develop the colateral arteries around the knee and you will be able to squat longer.

  10. t5christie

    t5christie Member

    First of all, thanks for the responses. The suggestions are of great help in trying to make my part time DOM work more comfortable.

    - In the home visits I am currently using an adjustable tripod foot rest for the patient while I either kneel or sit on the floor.

    - Nursing home visits I have been mostly using the patient's adjustable electric beds to avoid exaggerated bending.

    Paul, using an adjustable tripod stool is a great idea. I'll look out for anything similar in my area (Melbourne) or even on-line? Being able to sit during home visit treatment would definitely improve comfort and prevent abnormal posture.

    Being a new graduate Podiatrist the last thing I want is to request a Work-Cover claim for work related lower back pain.

    I will keep these suggestions in mind. Your shared experiences are valuable.

    Regards Tom.
  11. diana

    diana Welcome New Poster

    Please take care, not only of your back, but your neck too. I gave up doms and nursing homes a few years ago due to neck problems which now trouble me daily. I wish I had taken more care in the early days. I used a folding stool for myself, but always had the patient's foot on my lap, which involves awkward bending and twisting of the neck to see the plantar surface. The taller you are, the worse it will be.
  12. Kyrret

    Kyrret Active Member

    This is my preferred working position also - with the patient's foot on my lap. Whilst working in a clinic environment is much preferable there are many elderly people who are house bound for one reason or another and doms are vital for them.
  13. fixurfeet

    fixurfeet Member

    I only do rest homes and have never had a sore back. I have a gardening stool that has a soft foam on top. I mainly use this for the patients foot stool but it is sturdy enough for sitting at the end of a hospital bed. I also have a small plastic foot stool to sit on, lower than the gardening stool. Sometimes though you just have to get closer and sit on the floor to get a good look, unavoidable. These stools both fit onto my wheely trolley, so no lifting during my working day. :)
  14. Aldrin C

    Aldrin C Member

    I just started recently seeing home visits and nursing homes and it is a killer in the back. Using the electronic beds are handy. When doing home visits or when the patient is sitting down i usually just sit crossed leg in the floor. I think that helps the back but i do not know if it will be good for me when i get older and im only 22. But congrats on your first Day. I think if we work well in our Biomechanics we may not have to do nails at nursing homes and home visits.

  15. Ross

    Ross Welcome New Poster

    After 4 years at uni to sit on the floor for Rx of a client in a nursing home or hospital. One may ask where is our profession, heading and where can we head if we have people sitting on the floors of nursing homes. Some may not be aware of what can and does actually go on a floor of a nursing home or hospital. Oh they usually look clean but if you really new what may have been in that spot one hour ago would you really want to sit there and work? For how much.
    Perhaps some negotiations with admin on both sides to set up an electric pod chair in a treatment room. This does prevent injury, plus a more professional aproach to our work and usually pays for it self quickly. Just a thought. Cheers Ross
  16. timjn

    timjn Welcome New Poster

    We employ Nursing Assistants at several locations: Home Care, Three Links Care Center, Millstream Commons and The Villages of Lonsdale Assisted Living, The Cottages Memory Care and Reflections Care Suites.
    Nursing Assistants help residents and tenants to perform basic daily tasks. They work under a nurse’s supervision, and since they have extensive daily contact with each resident, they play a key role in their lives and in keeping the nursing staff up to date on vital information about the residents’ conditions.
    Contact me if you want try it :)

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