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- 1. TRAINING OF CAREGIVERS IN POSITIONING, LIFTING AND TRANSFERRING IN PHYSICALLY AND MENTALLY DISABLED PEOPLE LIVING IN NURSING HOME AND GENERAL HEALTH SCREENING OF ADULTS WITH INTELLECTUAL DISABILITY UMMP STAGE 3.2 2015/2020 UNIVERSITY OF MALAYA Group 4A Ari Aran, Sabrina, Azmina, Iqbal, Hamka, Afifah, Toh Jia Yong, Lok Yun Wen supervisor:AP DR MAS AYU
- 2. DEFINITION • A caregiver is a person who gives care to people who need help taking care of themselves. Examples include children, the elderly, or patients who have chronic illnesses or are disabled. Caregivers may be health professionals, family members, friends, social workers, or members of the clergy. They may give care at home or in a hospital or other health care setting.(National Cancer Institute) • Intellectual disability is defined as neurodevelopmental disorders that begin in childhood and are characterized by intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living.(DSM-5)
- 3. 92.2 % - No proper training of how to manage the disabled patients. Regular training should be emphasized to encounter this problem. In this study, 65.4% of them wished to be trained properly. The type of training should include bed positioning, providing meals, position change and transferring of the patients.
- 4. OBJECTIVES Phase 1 1.To describe the sociodemographic characteristics of the caregivers. 2.To determine the past medical history and anthropometric parameters among the caregivers. 3.To assess the job scope and explore the challenges in taking care of disabled people. Phase 2 1.To educate the caregivers on the correct way of lifting, transferring and positioning the patients. 2.To describe health status of adults with intellectual disability 3.To identify health conditions that needs immediate attention.
- 5. BACKGROUND The prevalence of mentally disabled people had shown an increasing in number. This was shown in a survey in Korea, the population of the mentally disabled people was increasing with • 3.09% in 2000, • 4.59% in 2005 and • 5.61% in 2011. (Kim 2017) Despite the trend of increasing in numbers, their health issues not prioritized. Most of the them had not received the adequate quality of care. Hence, patients with intellectual and developmental disability require proper care by the trained caregivers to improve their physical and mental well-being. Kim, DeokJu. 2017. “Relationships between Caregiving Stress, Depression, and Self-Esteem in Family Caregivers of Adults with a Disability.” Occupational Therapy International.
- 6. BACKGROUND Based on survey of caregivers knowledge about caring for physically disabled, • 92.2 % - No proper training of how to manage the disabled patients. • Regular training should be emphasized to encounter this problem. • In this study, 65.4% of them wished to be trained properly. • The type of training should include bed positioning, providing meals, position change and transferring of the patients. (Lee et al. 2015) There is no published paper for the musculoskeletal disorder among the caregivers. Based on a study from Aslam et.al, even healthcare providers which are properly trained suffered from musculoskeletal disorder due to lifting mechanism while transferring the patients. Hence, with the limitation of knowledge and skills among the caregivers, the magnitude of musculoskeletal disorder is actually bigger. (Aslam et al. 2015) . Aslam, Imran, Scott A. Davis, Steven R. Feldman, and Willis E. Martin. 2015. “A Review of Patient Lifting Interventions to Reduce Health Care Worker Injuries.” Workplace Health and Safety. Lee, Kyeong Woo, Su Jin Choi, Sang Beom Kim, Jong Hwa Lee, and Sook Joung Lee. 2015. “A Survey of Caregivers’ Knowledge about Caring for Stroke Patients.” Annals of
- 7. METHODOLOGY STUDY DESIGN STUDY LOCATION STUDY POPULATION STUDY DURATION STUDY VARIABLES MEASURES Phase 1 - Caregiver qualitative study in-depth interview. Phase 2- Caregiver pre and post intervention study design Persatuan Penjagaan Kanak-kanak Terencat Akal Negeri Selangor, Kuala Langat Inclusion criteria - ALL caregivers regardless of nationality PHASE 1 - 1ST JULY 2019 PHASE 2- 8TH JULY 2019 1.Sociodemographic characteristics • Age • Sex • Nationality • Education level 2.Height 3.Weight 4.BMI 1.In-depth interview -Using open ended semi-structured interview guide 2.Training -Structured questionnaire for assessing knowledge -Checklist for skills i)Positioning ii)Lifting and transferring
- 8. METHODOLOGY STUDY DESIGN STUDY LOCATION STUDY POPULATION STUDY DURATION STUDY VARIABLES MEASURES Phase 2-Cross- sectional study on disabled people Persatuan Penjagaan Kanak-kanak Terencat Akal Negeri Selangor, Kuala Langat Inclusion criteria - All adults with intellectual disability 1ST July 2019, 5TH July 2019 1.Sociodemographic background 2.ADL & mobility 3.Anthropometric parameters 4.BP and glucose level 5.Common health conditions(history) 6.Physical examinations 7.Behavior and mental health 1.History taking from person in- charge 2.Physical examination by nurses and researchers
- 9. 1. PRE-ASSESSMENT -KNOWLEDGE -SKILLS 2. INTERVENTION -LECTURE -VIDEO -DEMONSTRA TION 3. POST-ASSESSMENT Questionnaire consist of 14 questions to assess knowledge Demonstration from physiotherapist on positioning, lifting and transferring followed by hands on practice by caregiver on students as simulated patients Tools same as pre-assessment Lecture given by physiotherapist METHODOLOGY Demonstration from caregiver on positioning and lifting & transferring patient Video presentation from MyHEALTHKKM on Youtube titled “Cara mengangkat dan mengalih pesakit yang terlantar”
- 10. SOCIODEMOGRAPHIC OPEN-ENDED QUESTIONS BMI PHASE 1;Open ended semi- structured interview guide
- 11. FINDINGS OF PHASE 1 QUALITATIVE ANALYSIS OF IN-DEPTH INTERVIEW JOB SCOPES -BATHING, FEEDING, DRESSING THE PATIENTS -SWEEPING AND MOPPING THE HOUSE -WASHING CLOTHES CHALLENGES -LANGUAGE BARRIER -HYGIENE ISSUES -SHORTAGE OF CAREGIVERS -LOW BACK PAIN DUE TO CARRYING PATIENTS AREAS THAT NEED MORE KNOWLEDGE AND SKILLS -FIRST AID IN SEIZURE -BED SORE MANAGEMENT -PREVENTION OF FALL -PERSONAL HYGIENE -PROPER TECHINIQUE IN CARRYING PATIENTS SOCIODEMOGRAPHIC MALE: 4 FEMALE :6 AGE RANGE: 20-37 YEARS OLD NATIONALITY: 2 MALAYSIANS 5 INDONESIANS 2 INDIANS 1 PHILIPINOS EDUCATION LEVEL: SECONDARY AND TERTIARY BMI SOCIODEMOGRAPHIC MALE: 4 FEMALE :6 AGE RANGE 20-37 YEARS OLD NATIONALITY 2 MALAYSIANS 5 INDONESIANS 2 INDIANS 1 FILIPINO EDUCATION LEVEL PRIMARY TO TERTIARY BMI 1 UNDERWEIGHT 4 NORMAL 4 OVERWEIGHT 1 OBESE CLASS 1
- 12. PHASE 2;ASSESSMENT TOOL FOR KNOWLEDGE PRE AND POST INTERVENTION -CONSIST OF 5 DOMAINS -CLOSED ENDED AND MCQ -14 MARKS IN TOTAL -QUESTIONS DERIVED FROM LECTURE SLIDES
- 13. PHASE 2;ASSESSMENT TOOL FOR SKILLS PRE AND POST INTERVENTION -CONSIST OF 3 DOMAINS -CHECKLIST IN NATURE -36 MARKS IN TOTAL FIRST DOMAIN:POSITIONING
- 14. FINDINGS OF PHASE 2 Knowledge and Skill Mean Score for Pre and Post Intervention Item Pre Post P-Value Mean Standard Deviation Mean Standard Deviation Knowledge 9.40 1.955 10.30 2.111 0.324a Skill 9.90 3.479 32.30 2.406 0.005b a. Paired T-Test b. Wilcoxon Signed Ranks Test
- 15. Item Pre Post Mean Standard Deviation Mean Standard Deviation Domain 1: Importance of Correct Positioning Question 1a 0.90 0.316 0.90 0.316 Question 1b 0.80 0.422 0.90 0.316 Question 1c 0.30 0.483 0.10 0.316 Question 1d 0.20 0.422 0.30 0.483 Domain 2: Precautions when Lifting Patients of Certain Conditions Question 2 0.50 0.527 0.50 0.527 Question 3 0.80 0.422 0.90 0.316 Domain 3: Prevention of Bed Sore Question 4 0.40 0.516 0.80 0.422 Domain 4: Technique of Lifting Patients Question 5 0.80 0.422 0.80 0.422 Question 6 0.60 0.516 0.80 0.422 Question 7 0.80 0.422 0.90 0.316 Question 8 1.00 0.000 1.00 0.000 Question 9 0.40 0.516 0.50 0.527 Question 10 0.90 0.316 1.00 0.000 Domain 5: Importance of Correct Technique in Lifting Patients Question 11 1.00 0.000 0.80 0.422
- 16. EVALUATION OF SUCCESS PLANNING • Discussion with PKD Kuala Langat and Dr Wan was done to come up with a topic for our project • A visit to the OKU center was done to get an overview of the situation & environment • We came up with a semi-structured questionnaire and seek opinion from Prof Julia (HOD of Rehab Medicine UMMC) IMPLEMENTATION • In depth interview was done to identify the challenges by the caregiver • We managed to conduct a workshop for the caregivers with the help of PKD Kuala Langat and the OKU center • All medical students participated actively throughout the workshop as simulated patients, facilitators, translators, videographer and etc FEEDBACK • Most of the caregiver showed significant improvement of knowledge and skills post-training • They were grateful to be able to learn on the correct technique of lifting & transferring patient as they have never receive any proper training before • They are looking forward to more training in the future
- 17. STRENGTH, LIMITATION & RECOMMENDATION LIMITATION • Language barrier with the caregivers • Education level among the caregivers • Lack of coordination with the external trainers in terms of timing and execution of training RECOMMENDATION • Training of caregivers for positioning, lifting and transferring patient with physical deformity & contracture • Use lifting aids such as sliding sheet, lifting board, etc. to reduce workload • Suggest back care for caregivers for long term prevention of occupational health related MSK problem • Provide other training for caregiver (first aid in seizure, bed sore management, prevention of fall, personal hygiene) • Recruit more caregivers to match standardized caregiver to patient ratio STRENGTH • Proper in-depth interview was done to identify areas of concern for the caregivers • Able to obtain expert help for our project and work together with the center’s administrators to make this project a success • Able to provide an individualized training.
- 18. DISCUSSION
- 19. CONCLUSION
- 22. Level of disability & diagnosis ADL & MOBI LITY
- 26. Assessing behavioura l & mental ill health Any change in risk, if yes proceed to next question Any recorded mental illness. If yes proceed to next question
- 27. FINDINGS PHASE 2-HEALTH SCREENING
- 30. DIAGNOSIS
- 31. ACTIVITY OF DAILY LIVING (ADL) – MODIFIED BARTHEL INDEX
- 44. EXAMINATIONS
- 47. PRESENCE OF BEHAVIOURAL AND MENTAL ILL HEALTH
- 49. RECOMMENDATIONS
- 50. Issues Interventions BMI > 23 kg/m2* - 13 out of 45 Physical inactivity - 37 out of 49 * CPG On Management of Obesity 2003 • Dietary education on food preparation -Limits fat and oil during cooking -Reduction of portion size -Reduction of high calorie foods (both high fat and high carb food) • Physical activity for mobile residents - At least 30 minutes a day of moderate intensity physical activity is recommended* - Physical activities which are more interesting to attract their attention * Health care in People with Intellectual disability , produced by Centre for Developmental Disability Studies BMI < 18.5 kg/m2* - 13 out of 45 * CPG On Management of Obesity 2003 • Refer to dietician Poor dental health - 60 out of 60 ( 100 % ) • Send dentists to perform dental check-up
- 51. Issues Interventions Joint contractures - 5 out of 60 ( upper limbs ) - 8 out of 60 ( lower limbs ) • Increase number of physiotherapists for neurological physiotherapy treatment to reduce the impact of contractures Abnormal skin condition - 28 out of 60 ( 46.7 % ) • Send dermatologist and prescribe them with appropriate medication Abnormal Breast - 1 resident found to have breast lump • Refer to medical officer in Klinik Kesihatan Telok Datok • Annual breast examinations with 2 yearly mammograms for women over the age of 50 years are recommended* * Health care in People with Intellectual disability , produced by Centre for Developmental Disability Studies Polypharmacy ( 5 or more )* - 2 residents *Slabaugh et al.,2010 • Review all medications 3-6 monthly – re-assess the need for continuing the medication, dose, side effects and compliance.*
- 52. ACKNOWLEDGEMENT
- 53. REFERENCE