Moving and handling infants, children and young people is an integral part of nursing practice, and competent handling is an essential component of holistic care – but the nurse needs to be acutely aware of the risk of manual handling.

The risk of musculoskeletal damage and injury must be considered by all who work in the clinical environment, irrespective of the activity being undertaken. Twenty-four per cent of NHS staff regularly experience back pain, and one in four nurses will have taken time off work at some time with a back injury sustained at work (DH, 2004).

The need to look after one’s back is paramount, and this has been addressed through training, the introduction of medical aids to assist with manual handling, safe-handling policies and campaigns to promote safe working practices. Safe-handling policies often state that nurses should not lift at all (RCN, 2002). This does not fully reflect the needs of the infant and child in hospital.

Height-adjustable cots are not readily available. Parents often accompany their child to hospital and a bed for the parent alongside the child’s bed or cot often restricts access for the nurse to perform nursing care, particularly at night-time when he or she is trying not to disturb the parent or child.

When working with infants and children, much time is spent working at the level of the child and holding infants and children. This is either to perform nursing care such as feeding or medication administration or to comfort them. In these circumstances, the ‘no lifting’ principle advocated by the guidelines needs careful consideration. This type of moving and handling is often referred to as therapeutic handling since it is necessary in order to be able to deliver patient care. It would seem terribly cruel to leave an unaccompanied child crying in a cot when a cuddle would pacify them. Education, having height adjustable beds and cots and individual ‘child specific’ risk assessment forms will enable the practitioner to determine appropriate safeguards whether in hospital, community or home environments.

Before undertaking the activity of moving and handling, you need to understand the musculoskeletal system and how this functions. Safe-handling practice can be defined as an ergonomic approach to handling people, encouraging independence where possible and the appropriate use of equipment while promoting independence (Brown-Wilson, 2001).

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Play has been referred to as one of the ‘most important aspects of a child’s life’ (Wong et al., 1999, p. 1171).This chapter will explain the rationale behind this statement, and how the student can contribute to this vital aspect of a child’s world. It is intended that by the end of the chapter the student will have gained a greater understanding of the relationship between play and cognitive, social, psychological and emotional development. Chapter 3 of this text also addresses the important issue of play, from a different but complementary perspective.

Bruce (1996, p. 1) describes play as a ‘reservoir full of water.The deeper the reservoir, the more water can be stored in it, and used during times of drought.’ This time of drought referred to by Bruce could reflect those instances in a child’s life when he or she may experience distress due to illness, injury or any other times of physical or emotional trauma. As a result of reading this chapter and working through its scenarios, it is anticipated that you will feel more confident in using play as a form of communication during therapeutic interventions, as a resource that can be used in preparing children for clinical procedures and as a form of distraction therapy.

Developing skills of assessment is an essential prerequisite for those involved in the care of children. Observing how a child plays and interacts can offer valuable information in relation to their condition and relationship experiences (Wong et al., 1999). Developing an understanding of the purpose of play, and what can be expected in relation to engaging in play at various developmental stages, provides the reader with an opportunity to contribute to the multidisciplinary team and assist with appropriate care planning for individual children.

Before examining play in relation to child development and the importance of ensuring that all children are offered the opportunity for play, the immense benefits will be considered. Bruce (1996, p. 3) suggests that play helps children to become ‘whole people’, who are ‘physically healthy, co-ordinated, mentally healthy, manage feelings and ideas and co-ordinate ideas’. If children are permitted to use play during childhood, they can continue to use the resource to live full lives contributing to the mental and physical well-being of others, becoming creative, sensitive and imaginative adults who have secure relationships with others. Bax et al. (1990) remind us that the significance of play to a child’s life is not a new phenomenon. Aristotle believed that it was the highest form of human activity; this belief reinforces the need to be able to promote and provide play wherever children are cared for.

The exploration of the importance of play will begin with an understanding of its relationship with physical and cognitive development and what can be expected of children when engaging in play. Cognitive development is discussed in the next section of this chapter.

Caring for Children and Families. Edited by I. Peate and L.Whiting © 2006 John Wiley & Sons Ltd

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Adherence to the principles of moving and handling are paramount if we are to ensure the safety of the patient, their family members, our colleagues and ourselves. You must adhere to your Trust’s policy on manual handling. The key principles of safe moving and handling infants, children and young people are as follows.
1. Do not lift if at all possible.
2. If a child needs to be moved, appropriate equipment should be utilized where necessary. It is important to communicate the procedure to the child and family beforehand. The child and family need to be involved in discussions and their preferences identified.
3. Encourage the child to help as much as they possibly can themselves; ultimately, this may avoid the need for manual handling. It is important that the child feels that they are not being transported from one place to another with little or no say. For example, a child on bed rest might be able to do a bridge when they require a bedpan or having their clothes changed. If transferring a child from a bed to a chair, they may well be able to edge their way to the side of the bed, thus completing the first part of the process, or a sliding sheet may be placed beneath them to help them move more independently.
Any independence that can be encouraged is important as it will increase the child’s feelings of security, well-being and self-esteem.
4. Do not try to perform other tasks while lifting or handling a child.
5. There is no such thing as a quick lift or a ‘simple assist’.
6. Many children are too heavy to be lifted and equipment is required.
7. If lifting cannot be avoided, the risk needs to be assessed. Refer to the child’s care plan. Identify handling hazards and regularly review this care plan.
8. Consider the task, individual, load, environment and equipment before progressing with handling the child, ensuring the correct skills are possessed by all those involved in the handling process.

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• A hazardous material is a material capable of causing a harmful physical or health effect. Hazardous wastes can be liquids, solids, contained gases, or sludges.
• Resource Conservation and Recovery Act (RCRA) identifies a hazardous waste as one that exhibits at least one of the four characteristics—ignitability, corrosivity, reactivity, or toxicity.
• Federal, state, and local agencies oversee the handling of hazardous materials to protect the public from harm.

HANDLING AND STORAGE
• Hazardous materials need to be stored correctly to prevent spills and uncontrolled reactions, and to minimize employee exposure.
• Three principles form the basis of the plan for safe handling of hazardous materials:
—minimize exposure to harmful materials through product substitution and keeping limited quantities on hand.
—assume all chemicals are hazardous and handle accordingly.
—use proper control measures, such as, written policies and procedures, education, and protective equipment.
• Hazardous materials need to be stored based on their compatibility and not necessarily in the alphabetical order.
Substances need to be stored in their original containers.
• To decrease individual exposure to hazardous materials, common engineering controls, such as, local exhaust and general ventilation can be used. Other protective items that could be employed are safety glasses, gloves, and/or hearing protection.
• Development of a plan for safe handling of the hazardous or infectious material needs to include five elements.
—Element one requires maintenance of a current hazardous- waste inventory listing, which should include the full chemical name, storage location, quantities, and information regarding the hazard.

—Element two speaks of the labeling of all containers.
—Element three addresses maintaining a Material Safety Data Sheet(s).
—Element four plans for employee education and training.
—Element five provides for regular review and updating of the plan.

Biological Agents
• Agents of concern are highly pathogenic bacteria and viruses.
• The Center for Disease Control (CDC) has classified specific agents as category A, B, or C.
—Category A agents are the most dangerous (anthrax, botulism, plague, smallpox, tularemia, viral hemorrhagic fever viruses, etc.). These agents are given the highest priority in disaster planning as they pose the most potential threat to the public.
—Category B agents are the second most dangerous agents (brucellosis, salmonella, melioidosis, psittacosis, Q fever, typhus fever, viral encephalitis, etc.).
—Category C represents “emerging” agents (Nipah fever, Hantavirus, etc.).
• Client history and physical condition are key tools in assessing the client’s exposure to a biological agent, when making a diagnosis.
• Principles of infection control, beginning with universal precautions, are essential to managing the client.
Radiation
• Radiation is “energy emitted by atoms that are unstable.”
• Radioactive contamination is the “presence of radiation emitting substances in a place where it is not desired.”
• Radiological incident is when people or the environment is exposed to radiation or radioactivity through accident or misuse. The exposure may lead to death but more commonly, exposure only requires decontamination and monitoring of the client.
• Nurses need to limit the time spent with radioactive clients, to remain at a distance whenever possible, and to wear protective devices

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All nursing personnel within the geriatric unit should adhere to the set standards of care in rendering quality and effective care to the patients.

The following are the standards of care:

1.Necessary forms needed for admission should be checked, as well as consent forms should be secured before any patient to undergo any procedures. Patients or their significant others should be oriented and be well explained about the treatment that they can receive, about certain procedures and the like.
2.Privacy should at all times be observed in performing any procedures to the patient regardless of gender, political affiliations, race and religion.
3.Appropriate and timely care should be given to every patient and care should be in holistic approach. Every problem or any inquisitions of patients and their significant others should be addressed and dealt with aptly.
4.All personnel should be skilled in operating the health facilities and equipment within the unit it should be readily available when needed, assist for patient’s fast recovery.
5.Unit’s environment should be conducive and well modified for patient’s fast recuperation:
Patient’s safety must be observed always.
Provision of peaceful and stress free environment must be maintained.
All personnel should strictly observe infection control in rendering care to every patient; this is to prevent putting each patient to further risk.
All personnel should strictly adhere to the proper waste segregation policy.

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