Practical Tasks for a Community Support Worker

Many care tasks involve moving and handling clients. Examples include:

• assisting a client into a shower
• helping with dressing
• assisting a client from a wheelchair to a bed
• repositioning a client in a bed or chair

Moving and handling needs to be performed in a way that protects both the client and the caregiver while also promoting client autonomy and dignity.

Case study

Talia is a community support worker assigned to assist Isa, who has limited mobility due to a recent hip injury. Read a step-by-step account of how Talia safely transfers Isa from her bed to a wheelchair.

Step 1: Assessment: Before attempting any transfer, it's essential to assess Isa's condition. Talia notes that Isa is currently in bed, unable to move her lower body due to her injury. She also notes that Isa is in some discomfort.

Step 2: Prepare the environment: Talia ensures the room is clear of any obstacles and hazards. She ensures the bed and the chair are at an appropriate height and angle for a smooth transfer.

Step 3: Explain the process: Talia explains the transfer process to Isa, ensuring she understands what will happen and asks for her cooperation.

Step 4: Gather necessary equipment: Talia has access to a transfer belt. She retrieves this item and checks that it is in good condition.

Step 5: Position Isa: With Isa's permission, Talia helps her sit up in bed. She places the transfer belt securely around Isa’s waist, making sure it's snug but not too tight.

Step 6: Carer position: Talia stands facing Isa with her knees slightly bent and her back straight. Her feet are shoulder-width apart for stability.

Step 7: Assist Isa to stand: Talia encourages Isa to push herself up using her arms while Talia supports her from behind. Talia ensures Isa’s feet are flat on the ground.

Step 8: Pivot and transfer: With the transfer belt in place, Talia pivots Isa to the side of the bed, ensuring her legs are hanging off the edge.

Step 9: Lower into the chair: Talia guides Isa to sit down gently into the wheelchair, making sure her legs are properly positioned and supported.

Step 10: Secure Isa: The wheelchair's safety belt is fastened, and Talia checks that Isa is comfortable.

Reflection

Reflect on the following questions.

• Why was it important for Talia to communicate with Isa throughout the process, including getting her permission to proceed?
• What steps did Talia take to ensure Isa's comfort and safety throughout the process, considering her limited mobility?

Watch: Assisting someone to move from bed to chair (2.48)

Watch the following video on how to help a person get from a bed to a wheelchair.

Watch: ACC New Zealand: Helping your patient go from sitting to standing with one carer (1.02)

Watch the following video on how to transfer a person from seated to standing.

Slings and hoists for transferring tangata

Slings and hoists are used to lift and transfer people, e.g. from a bed to a wheelchair. Safely assisting clients with mobility challenges is crucial, and understanding the correct procedures for using this equipment is essential.

A comprehensive risk assessment is mandatory before engaging in any moving and handling task involving slings and hoists. This assessment should consider various factors, including the client's current mobility, physical or health-related conditions that may affect the task's safety, and the number of carers required for the job. This is especially critical when working in the community, where you might be working alone.

Considerations when using slings and hoists

• Regular inspection: Before each use, thoroughly check the sling for any rips or tears.
• Safe Working Load (SWL): Verify the SWL, usually displayed on the sling. The SWL indicates the load capacity the hoist can handle. Do not exceed this limit.
• Maintenance checks: Ensure the sling's next maintenance check due date is valid. Never use an out-of-date sling.
• Sizing: Measure the client's length and girth to select the appropriate sling size. Make sure it's long enough to reach from the base of the spine upwards and can enclose the client safely.
• Documentation: Document the sling size in the client's notes and care plan.
• Positioning loops: For most sling types, position the lower sling loops to cross over between the client's legs, which helps maintain their dignity.
• Client's hand placement: Encourage the client to place their hands across their chest to reduce the risk of injury.
• Disposable slings: Disposable slings can be reused with the same client multiple times before disposal.
• Shower slings: Note that shower slings are designed to get wet.
• Specialized slings: If moving a bilateral above-knee amputee, use a specific amputee sling.

Applying a sling: two rolls method

Follow these steps when applying a sling using two rolls.

• Place a pillow under the client's head.
• Select the appropriate sling, considering any head support needed.
• Roll the client onto their side and place one half of the sling along their spine, starting from the base and moving upward.
• Roll the client back so they are now on one half of the sling.
• Unroll the remaining sling.
• Roll the client back onto their back.
• Ensure the client is correctly positioned on the sling ready for hoisting.
• Adjust the head support for comfort if necessary.

Applying a sling: one roll method

Follow these steps for the one-roll method.

• Roll the client onto their side.
• Fold the sling in half with labels and handles on the outside.
• Position the sling from the base of the spine upwards.
• Align the sling's neck seam with the base of the client's neck.
• Leave a gap between the sling and the client's body.
• Take the upper leg strap and feed it under the client's neck.
• Fold the upper shoulder loop/clip into the sling and roll the upper portion of the sling behind the client's back.
• Roll the client onto their back.
• Pull the loop or clip from under the client's neck smoothly towards you and down in the direction of the legs, using a lunge.
• Both carers should pull the sling towards themselves to remove any creases.
• Adjust the head support for comfort if needed.

Applying a sling to a client in a chair

Follow these steps when applying a sling to a client seated in a chair.

• Instruct the client to lean forward in the chair.
• Slide the sling down the back of the chair with the handles facing the chair's back.
• If the client can't lean forward or is in a moulded chair, use a slide sheet to reduce friction and prevent skin damage.
• Ensure the bottom of the sling reaches the base of the spine. Remove slide sheets once the sling is in place.
• Avoid having the client sit on the sling, as they may drop lower during hoisting, which can be unsafe.
• Some slings have a lower back pocket for the carer to place their hand to position the sling appropriately.
• Secure leg straps under each leg, one at a time.
• Adjust the hoist to accommodate the chair's width and attach the sling to the sling bar, preferably at sternum (chest) level.
• Ensure the sling bar is held continuously to prevent it from swinging into the client's face.
• Hoist the client to the desired height and encourage them to move slightly to check for comfort and enhance their confidence in the hoist.
• Recheck sling loops for secure attachment.
• Complete the hoisting process.

Applying a sling to a client on the floor

Follow these steps when applying a sling to a client on the floor.

• Roll the client onto their side and position the sling.
• Fold the upper loop into the sling and roll the upper portion of the sling behind the client's back.
• Push the rolled half of the sling under the client.
• Roll the client flat on their back and pull through the rolled half of the sling.
• Straighten each side of the sling and locate loops.
• Ask the client to bend their knees and pull loops through their legs and across the front.

Activity

Answer the following four questions.

Watch: Proper Sling Application When Using a Hoyer Lift (12.07)

Watch the following video on the use of a sling and complete the exercise that follows.

Showering

When it is time for showering, provide as much privacy as possible and use a shower chair if your client cannot support their own weight. Always encourage the person to do as much as possible independently and at their own pace. Respect the client's need for privacy and dignity.

• Set the supplies within reach. Ensure shampoo, soap, washcloths, and towels are prepared and ready. You may also have mobility aids such as a shower seat.
• Prepare the shower. Run the water and check for temperature.
• Guide the person into the shower while they hold the grab bar for support.
• Allow them to wash independently as much as they can. Step in and help them wash if needed.
• When considering privacy, stay outside the shower curtain or screen, but continue to talk to the person to remain aware of their responses and safety.
• Rinse off, then help them exit the shower safely onto a dry surface.

Watch: How To Assist Someone With A Shower (3.36)

Watch the following video on assisting a person to shower, then complete the activity that follows.

Activity

Bed baths

In some situations, individuals may not be able or willing to take a traditional shower. A bed bath can be a suitable alternative for maintaining personal hygiene. Let's explore a step-by-step procedure for conducting a bed bath:

1. Adjust the bed to the waist level of the tallest support worker.
2. Prepare a basin filled with warm water.
3. Use towels or a waterproof sheet to protect the bed.
4. Work in sections, in the same order as showering, keeping the rest of the person covered.
5. Roll the person to wash and dry their back and buttocks and to change their bedsheets.

Watch: How to give a Bed Bath in the Home (4.36)

Watch this video on how to assist with a bed bath, then complete the activity that follows.

Activity

Dressing and undressing

The following tips will help when dressing or undressing a client.

• Prepare ahead: Have clothing and essentials ready in advance.
• Prioritize comfort: Keep the person comfortable throughout. Be respectful and gentle; avoid pulling or pushing.
• Communication: Let your client know what you are going to do. Engage in conversation to ensure the client’s comfort and wellbeing.
• Order matters: Begin with the upper body, then proceed to the lower body.

Watch: How to Help with Getting Dressed – Caregiver Tips (3.12)

Watch the following video about helping with getting dressed and undressed, then complete the activity that follows.

Oral hygiene and assisting with oral care

Oral care should be performed at least twice a day, in the morning and evening. Wash your hands and wear gloves when performing oral care. Remember that the person should be encouraged to care for their teeth in whatever way they can do themselves.

Be on the lookout for signs of mouth pain in the tangata you are caring for. If they report mouth or tooth pain, escalate this to the appropriate person in the multidisciplinary team.

Natural teeth and gums

• Cover clothing and linens with a towel.
• Use a wet toothbrush and toothpaste.
• Use a gentle horizontal back-and-forth motion for brushing the inside and outside of the teeth.
• When brushing the inside of the front teeth, hold the brush at an angle and use a side-to-side motion.
• Be careful not to cause choking or gagging by putting the brush too far into the mouth.
• Allow the tangata to rinse with a glass of water and spit it out, then wipe their mouth.

Denture removal, cleaning and insertion

• Handle with gauze, so you have a good grip on the dentures.
• Use only cold water to wash and soak dentures. Hot water can warp them.
• Use denture cleaner to brush the dentures.

Watch: Care of dentures (4.38)

The following video demonstrates how to remove and clean dentures.

Shaving a person

There may be times when you are required to shave a person's face for them. For some people, having a clean-shaven face provides a sense of dignity.

Here are some great tips for wet shaving a person.

1. Before beginning, put a towel under the tangata's chin to catch stray drops of water. Wash the face with warm water to soften the hair. Alternatively, you can use a wet cloth to wash the stubble.
2. Apply shaving cream. Creams are easier to apply since they don’t require much lathering like a shave soap.
3. Use a safety razor. It gives a clean and close shave without the heightened risk of being cut by a straight razor.
4. Shave along the direction of the hair growth. If you shave against the hair, it can cause ingrown hairs and irritate the skin. Use short and slow strokes.
5. Use the safety razor’s weight to shave the hair off and use gentle strokes. Always ask the person how it feels and adjust accordingly.
6. Be careful around the Adam’s apple, mouth, nose, and chin. 
7. Rinse the blade after every few strokes.
8. Use a warm, moist face cloth to remove leftover lather. Dry the skin with a clean cloth.
9. An aftershave is optional as the astringent’s sting may be too much for the tangata's skin. Ask the tangata whether they like to use aftershave.

Watch: Helping Someone Shave (3.32)

Watch the following video on shaving a person and complete the activity that follows.

Mealtimes should be pleasurable experiences where the tangata’s nutritional requirements are met while consuming food they enjoy. The tangata’s personal plan may contain information on food preferences and what help they need with eating or drinking. Sometimes, you will have clients who only need help heating their food and can quite easily feed themselves. Other clients will need more support, such as spoon-feeding. Some will need specific equipment, such as sippy cups.

The following are some tips to use during meal routines:

• Make the eating environment a pleasant one.
• Promote self-determination by giving the tangata a choice of food.
• Help the person to see and smell the food before feeding.
• Have the person sit upright — never try to help a person to eat or drink while they are slumped, lying down or reclined.
• Offer small mouthfuls at a time.
• Wait for the person to chew and swallow.
• Provide a sip of fluid between each mouthful if this helps the person to swallow.
• If the person has difficulty swallowing or chewing or refuses their meal, escalate the problem to the appropriate person in the multidisciplinary team.

Watch: How to help with Eating & Drinking as a Caregiver (3.20)

Watch the following video which provides tips on how to help a client with eating and drinking, then complete the activity that follows.

Activity