title: Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study.
abstract: OBJECTIVE
  To investigate healthcare staff's views and experiences of caring for older hospitalised adults (aged 60+) with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis.
  
  
  BACKGROUND
  Osteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is a major global health problem. In the UK older hospitalised adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident, it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often suboptimal and specific manual handling implications are under-researched.
  
  
  METHODS
  An exploratory qualitative content analysis research design informed by critical realism.
  
  
  METHODS
  The purposive sample comprised 26 nursing and allied health professionals. Semi-structured interviews addressed topics including knowledge of osteoporosis, implications for acute care, moving and handling and clinical guidelines. Qualitative content data analysis was used.
  
  
  RESULTS
  Awareness of osteoporosis prevalence in older populations varies and implications for nursing are indistinct to nonspecialists. In-hospital fractures potentially linked to suboptimal moving and handling seemed rare, but prospective studies are needed. Categories of 'Understanding moving and handling as routine care or as a healthcare intervention', with further categories 'healthcare practitioners' capacities and capabilities for dealing with people with osteoporosis' and 'the structural and organisational context for moving and handling' are reported alongside safety, frailty and dependency dimensions.
  
  
  CONCLUSIONS
  This study informs moving and handling in higher risk groups such as osteoporosis. Clinical knowledge/expertise is required when adapting generic manual handling guidelines to specific patients/contexts. Patients' experiences of moving and handling have received limited attention.
  
  
  CONCLUSIONS
  Increased focus on musculoskeletal conditions and moving and handling implications is required.
authors.affiliation: Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh, East Lothian, UK. msmith1@qmu.ac.uk.
authors.forename: Margaret Coulter
authors.initials: MC
authors.lastname: Smith
authors.affiliation: Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh, East Lothian, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: O'May
authors.affiliation: Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh, East Lothian, UK.
authors.forename: Savina
authors.initials: S
authors.lastname: Tropea
authors.affiliation: Osteoporosis Nurse Specialist Osteoporosis and Fracture Liaison Services, University Hospitals Division, WGH, NHS Lothian, Edinburgh, Scotland, UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Berg
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D050723:Fractures, Bone / Q000451:nursing / Q000517:prevention & control; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010024:Osteoporosis / Q000451:nursing*; D057184:Practice Patterns, Nurses'; D011446:Prospective Studies; D018570:Risk Assessment; D012606:Scotland; D055815:Young Adult
keywords: moving and handling patients; older people; osteoporosis; patient safety; qualitative research