Movement awareness and communication in patient transfer : an educational intervention

Background: This thesis addresses patient transfer, i.e., assisting the physical movement of patients with disabilities. Patient transfer is the primary cause of work-related disorders in healthcare providers. It has mainly been viewed as a physical work task, although the providers' own movement awareness and communication skills may be as important to support the patient to mobilise remaining resources. In response to this, Natural Mobility has been developed as an experiential educational method in patient transfer, inspired by physiotherapists' tacit knowledge. The aim of the education is to create a learning environment where healthcare providers can train body and movement awareness and communication skills to be able to guide the patient to move independently.

Aim: The overall aim of the thesis was to explore and evaluate healthcare providers´ changes in patient transfer after participation in Natural Mobility regarding type and number of changes and the sustainability of the changes.

Methods: In total, 462 healthcare providers from health facilities (nursing homes, hospitals) in different municipalities and county councils in Sweden were recruited voluntarily to the studies. The intervention consisted of a course in Natural Mobility. Study I (n=212), used a pre-post design; Study II (n=20) was an interview study, and in Study III (n=250) and IV (n=192) a quasi-experimental pre-post design with control groups was used. Outcome was measured with both quantitative (questionnaires) and qualitative (interviews, weekly notes) methods.

Results: About two thirds (68%) of the providers had changed something in their transfer habit after a year. They also reported less strain and higher work satisfaction (Study I). The reasons for changes seemed to be related to whether the provider focused the patient, their own body or the communication with the patient (Study II). Providers' perceived strain and reported disorders decreased one year after the education, while their movement awareness increased, and they gave more detailed instructions (Study III). The communication mode with the patient, changed in some providers from a physical to a more verbal mode. The providers described the patients performance instead of their own (Study IV). This was in line with the course content.

Conclusion: Participation in training in patient transfer according to the Natural Mobility method can enable some healthcare providers to increase their movement awareness and communication skills to support patients' independent movements during transfer, and thereby also reduce physical strain and disorders. More research is needed to fully understand the role of communication in patient transfer and how training can be optimised.

List of scientific papers

I. Kindblom-Rising K, Wahlström R, Stenström CH (2002). Effects of staff training in Natural Mobility: A long-term follow-up. Advances in Physiotherapy. 4: 136-44.

II. Kindblom-Rising K, Wahlström R, Ekman SL (2007). Nursing staffs perception of changes in patient transfer habits after a course - a phenomenological-hermeneutic study. Ergonomics. 50(7): 1017-25.
https://pubmed.ncbi.nlm.nih.gov/17510820

III. Kindblom-Rising K, Wahlström R, Nilsson-Wikmar L, Buer N (2009). Nursing staffs movement awareness, attitudes and reported behaviour in patient transfer before and after an educational intervention. [Submitted]

IV. Kindblom-Rising K, Wahlström R, Sirkka-Liisa Ekman, Buer N, Nilsson-Wikmar L (2009). Nursing staffs communication modes in patient transfer before and after an educational intervention. [Manuscript]