Faizal and Nadia Case Study: Single-handed care for a stroke patient

Faizal is 62 and had a stroke five years ago. Consequently, he has been left with a left-sided weakness leaving him unable to stand. Faizal lives with his 60-year-old wife, Nadia; they have been married for 30 years and have two children, both of whom are away at university. Faizal is hoisted for all transfers, a transition which he and Nadia have found difficult, particularly allowing paid carers into the family home to support Faizal with personal care.

Nadia works from home and, through the day, supports her husband by preparing all his meals and maintaining the family home. Nadia uses care calls as an opportunity to go out and attend to shopping.

Over the last six months, Faizal has been experiencing issues with his continence. Before this, Faizal was well-regulated and hoisted onto a T40 commode/shower chair to open his bowels and pass urine; however, more frequently, Faizal can’t wait. This has become a concern for Faizal, Nadia and the district nursing service, who are increasingly concerned about pressure damage. Nadia’s primary concern is that overnight, she struggles to move Faizal, which means he is lying in his soiled pad all evening.

Faizal and Nadia were visited the following week by an OT from social services, and they discussed the potential for Nadia to be able to support her husband overnight. It is agreed that hoisting is unrealistic as Faizal states he isn’t always aware when he has opened his bowels or passed urine. The OT discusses a strategy of making it possible for Nadia to turn her husband, clean him and change his pad on her own overnight.

Nadia discusses with the carers the possibility of hoisting Faizal onto the commode overnight on her own. The carers advise her that it is illegal to hoist single-handedly, and they will have to report this to social services if they think this is what she is doing. Nadia discusses this with the district nurse when she visits, who advises that the carers’ advice doesn’t sound quite right and refers her to the local social services team for an urgent Occupational Therapy (OT) assessment to see how Nadia can support her husband overnight.

Faizal and Nadia agree to try a satin sheet bed management system and a gantry hoist. The OT shows the couple how the combination of the two (in conjunction with a positional wedge) can enable Nadia to turn Faizal, allowing Nadia to attend to her husband’s personal care. Faizal and Nadia trialled this for two weeks, and although initially, it was quite an adjustment for them both, the trial was successful. Nadia described the process as “easy”, and Faizal stated the turn is smoother than when the carers do it! Following this initial success, Faizal and Nadia allow the OT to look into installing a permanent Ceiling Track Hoist. They also discuss Nadia’s potential to hoist Faizal into a chair in the future.

This case study is based on a real-life situation that OTs come up against regularly. In this case, the carers in the area are not trained in single-handed care; however, this does not stop the OT from empowering the client and his wife. Using systems such as gantry hoists, bed management systems and wedges can reduce the strain on carers in handling operations. This could reduce the number of carers required at each call.

Case study courtesy of our friends at Athena Handling Ltd.

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