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Biomechanical Exposure to Upper Extremity Musculoskeletal Disorder Risk Factors in Hospital Laboratories. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010499. [PMID: 35010757 PMCID: PMC8744870 DOI: 10.3390/ijerph19010499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 02/04/2023]
Abstract
Exposure to ergonomic risk factors has been reported for laboratory workers over decades. However, these exposures are not well characterized with respect to the type of laboratory or work organization. This study compared biomechanical exposure to upper extremity (UE) postures and hand activity levels (HALs) in general hospital laboratories by job, work, and laboratory type. The study used observational data gathered using a revised version of the Posture, Activity, Tools, and Handling (PATH) method, generating frequencies of categorized exposures. Eighteen workers were observed in 11 job titles (seven laboratories) in a single hospital by two investigators over a 7 month period. A taxonomy was constructed to categorize the extent to which the laboratory operations were automated. Overall, there were markedly high exposures to postural strain for the distal UE, especially wrist/forearm deviation (73% of observations), gross grasp (71%), and pinch grip (49%). For the HAL categories, 61% of the observations were in the moderate range (3.3–<6.7). Shoulders and elbows tended to remain in the neutral postural range. Posture frequencies were similar among the job categories studied and laboratory types. HAL was higher when the hand was in a pinch grip. Manual operations represented a higher proportion of work time than semi-automated or automated operations. Biomechanical exposure can be documented more extensively and diversely when using the revised PATH approach along with the taxonomy, with respect to exposure variables, such as the type of job, work, or organization in the industry including the hospital laboratories.
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Gideon Asuquo E, Tighe SM, Bradshaw C. Interventions to reduce work-related musculoskeletal disorders among healthcare staff in nursing homes; An integrative literature review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kurowski A, Pransky G, Punnett L. Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:286-294. [PMID: 29785467 PMCID: PMC6422723 DOI: 10.1007/s10926-018-9785-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.
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Affiliation(s)
- Alicia Kurowski
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA.
| | - Glenn Pransky
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Laura Punnett
- Department of Biomedical Engineering, University of Massachusetts Lowell, 1 University Ave., Lowell, MA, 01854, USA
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Hajaghazadeh M, Marvi-milan H, Khalkhali H, Mohebbi I. Assessing the ergonomic exposure for construction workers during construction of residential buildings. Work 2019; 62:411-419. [DOI: 10.3233/wor-192876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mohammad Hajaghazadeh
- Department of Occupational Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Marvi-milan
- Department of Occupational Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamidreza Khalkhali
- Department of Biostatistics and Epidemiology, Inpatient’s Safety Research Center, Urmia University of Medical Sciences, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Occupational Medicine Center, Urmia University of Medical Sciences, Urmia, Iran
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Kotejoshyer R, Punnett L, Dybel G, Buchholz B. Claim Costs, Musculoskeletal Health, and Work Exposure in Physical Therapists, Occupational Therapists, Physical Therapist Assistants, and Occupational Therapist Assistants: A Comparison Among Long-Term Care Jobs. Phys Ther 2019; 99:183-193. [PMID: 31222334 DOI: 10.1093/ptj/pzy137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/01/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems. OBJECTIVE This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff. DESIGN This was a cross-sectional study. METHODS Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities. RESULTS About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands. LIMITATIONS Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others). CONCLUSIONS MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.
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Affiliation(s)
- Rajashree Kotejoshyer
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA 01854 (USA)
| | - Laura Punnett
- Department of Biomedical Engineering, Department of Work Environment, University of Massachusetts Lowell
| | - Gerard Dybel
- Department of Physical Therapy, University of Massachusetts Lowell
| | - Bryan Buchholz
- Department of Biomedical Engineering, Department of Work Environment, University of Massachusetts Lowell
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Plaku-Alakbarova B, Punnett L, Gore RJ. Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes. Saf Health Work 2018; 9:408-415. [PMID: 30559988 PMCID: PMC6284169 DOI: 10.1016/j.shaw.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/08/2017] [Accepted: 12/09/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. METHODS Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. RESULTS A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. CONCLUSION Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.
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Affiliation(s)
- Bora Plaku-Alakbarova
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPHNEW), University of Massachusetts Lowell, Lowell, MA, USA
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Gold JE, Kurowski A, Gore RJ, Punnett L. Knee pain in nursing home workers after implementation of a safe resident handling program. Am J Ind Med 2018; 61:849-860. [PMID: 30156000 PMCID: PMC6430608 DOI: 10.1002/ajim.22902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Approximately 25-30% of nursing personnel experience knee pain (KP). We sought to identify physical and psychosocial work exposures, and personal factors related to prevalent, incident, and persistent KP 5-8 years after safe resident handing program (SRHP) implementation in nursing homes. METHODS Health and exposure information was obtained from worker surveys 5-6 years ("F5") and 7-8 years ("F6") post-SRHP implementation. Prevalent KP correlates were examined at F5; persistent and incident KP predictors were analyzed at F6, utilizing robust Poisson multivariable regression. RESULTS F5 KP prevalence (19.7%) was associated with combined physical exposures, and with either high job strain or low social support, in separate models. Two-year persistent KP was similarly associated with these psychosocial exposures. Being overweight was associated with KP in all analyses. CONCLUSIONS The SRHP program did not eliminate knee physical loading, which should be reduced to prevent nursing home worker KP. Workplace psychosocial exposures (high job strain, low social support) also appeared germane.
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Affiliation(s)
- Judith E. Gold
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
- Gold Standard Research Consulting, Bryn Mawr, Pennsylvania
| | - Alicia Kurowski
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Rebecca J. Gore
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
| | - ProCare Research Team
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Laura Punnett
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, Lowell, Massachusetts
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Boakye-Dankwa E, Teeple E, Gore R, Punnett L. Associations Among Health Care Workplace Safety, Resident Satisfaction, and Quality of Care in Long-Term Care Facilities. J Occup Environ Med 2017; 59:1127-1134. [PMID: 28945639 PMCID: PMC6525336 DOI: 10.1097/jom.0000000000001163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. METHODS Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. RESULTS Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. CONCLUSION The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.
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Affiliation(s)
- Ernest Boakye-Dankwa
- College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Drs Boakye-Dankwa, Teeple, Gore, Punnett); and Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia (Dr Boakye-Dankwa)
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Gold JE, Punnett L, Gore RJ. Predictors of low back pain in nursing home workers after implementation of a safe resident handling programme. Occup Environ Med 2017; 74:389-395. [PMID: 27919063 PMCID: PMC5860804 DOI: 10.1136/oemed-2016-103930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/13/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Healthcare workers have high rates of low back pain (LBP) related to handling patients. A large chain of nursing homes experienced reduced biomechanical load, compensation claims and costs following implementation of a safe resident handling programme (SRHP). The aim of this study was to examine whether LBP similarly declined and whether it was associated with relevant self-reported occupational exposures or personal health factors. METHODS Worker surveys were conducted on multiple occasions beginning with the week of first SRHP introduction (baseline). In each survey, the outcome was LBP during the prior 3 months with at least mild severity during the past week. Robust Poisson multivariable regression models were constructed to examine correlates of LBP cross-sectionally at 2 years (F3) and longitudinally at 5-6 years (F5) post-SRHP implementation among workers also in at least one prior survey. RESULTS LBP prevalence declined minimally between baseline and F3. The prevalence was 37% at F3 and cumulative incidence to F5 was 22%. LBP prevalence at F3 was positively associated with combined physical exposures, psychological job demands and prior back injury, while frequent lift device usage and 'intense' aerobic exercise frequency were protective. At F5, the multivariable model included frequent lift usage at F3 (relative risk (RR) 0.39 (0.18 to 0.84)) and F5 work-family imbalance (RR=1.82 (1.12 to 2.98)). CONCLUSIONS In this observational study, resident lifting device usage predicted reduced LBP in nursing home workers. Other physical and psychosocial demands of nursing home work also contributed, while frequent intense aerobic exercise appeared to reduce LBP risk.
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Affiliation(s)
- Judith E Gold
- Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Laura Punnett
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Rebecca J Gore
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - ProCare Research Team
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Kurowski A, Gore R, Roberts Y, Kincaid KR, Punnett L. Injury rates before and after the implementation of a safe resident handling program in the long-term care sector. SAFETY SCIENCE 2017; 92:217-224. [PMID: 34744312 PMCID: PMC8570319 DOI: 10.1016/j.ssci.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Manual resident handling (RH) tasks increase risk of musculoskeletal disorders (MSDs) for clinical staff in nursing homes. To reduce the incidence and cost of MSDs, a large healthcare corporation instituted a Safe Resident Handling Program (SRHP) comprising purchase of mechanical lifting equipment, worker training, and detailed usage/maintenance protocols. The program was initially administered by a third-party company; after three years, program responsibility shifted to individual centers. Workers' compensation claim rates were compared before and after SRHP implementation. Claims and FTEs were classified as "pre-SRHP," "first post period" (up to 3 years post-SRHP), or "second post period" (4-6 years post-SRHP), based on claim date relative to implementation date for each center. Complete data were available for 136 nursing homes with average annual employment of 18,571 full-time equivalents. Over the 8-year period, 22,445 claims were recorded. At each time period, the majority of RH claims affected the back (36% low, 15% other) and upper extremity (26%). Workers' compensation claims were reduced by 11% during the first post period and 14% during the second post period. RH-related claims were reduced by 32% and 38%, respectively. After six years, the rate for all claims had decreased in 72% of centers, and RH claim rates decreased in 82%. Relative risk for post-/pre-SRHP injury rates increased for centers with less developed wellness programs, unionized centers, and centers with higher LPN turnover pre-SRHP. Injury reduction among these nursing home workers is plausibly attributable to the introduction of mechanical lifting equipment within the context of this multi-faceted SRHP.
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Affiliation(s)
- Alicia Kurowski
- Corresponding author at: 1 University Ave., Kitson Hall, Room 200, Lowell, MA 01854, USA, (A. Kurowski)
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Kurowski A, Gore R, Mpolla N, Punnett L. Use of Resident Handling Equipment by Nursing Aides in Long-Term Care: Associations with Work Organization and Individual Level Characteristics. AMERICAN JOURNAL OF SAFE PATIENT HANDLING & MOVEMENT 2016; 6:16-24. [PMID: 34721944 PMCID: PMC8552405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low back pain is prevalent among nursing home personnel. Safe resident handling programs (SRHP) reduce injuries and costs. Previously, we reported variability in effectiveness and sought to identify reasons for differences among workers in resident handling equipment (RHE) use. In 8 nursing homes, nursing aides' (NAs) frequency of RHE use and reasons for inconsistent use were assessed by questionnaire up to 4 times after SRHP implementation. Ordered multinomial models examined correlates of RHE-usage frequency. At least two-thirds of NAs reported "often" or "always" lift use. Higher RHE use was related to higher SRHP commitment, higher prior SRHP expectations, older age, higher health self-efficacy, and lower supervisor support. "Device not available when needed" and "residents dislike" were major reasons consistently cited for not using RHE. While this program has been effective, attention to device availability, education of residents and family members on SRHP importance, and worker empowerment might increase usage further.
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Affiliation(s)
- Alicia Kurowski
- Department of Work Environment at the University of Massachusetts Lowell
| | - Rebecca Gore
- Department of Work Environment at the University of Massachusetts Lowell
| | - Nadine Mpolla
- Department of Work Environment at the University of Massachusetts Lowell
| | - Laura Punnett
- Department of Work Environment at the University of Massachusetts Lowell
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Yuan L, Buchholz B, Punnett L, Kriebel D. An integrated biomechanical modeling approach to the ergonomic evaluation of drywall installation. APPLIED ERGONOMICS 2016; 53 Pt A:52-63. [PMID: 26674404 DOI: 10.1016/j.apergo.2015.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 06/05/2023]
Abstract
Three different methodologies: work sampling, computer simulation and biomechanical modeling, were integrated to study the physical demands of drywall installation. PATH (Posture, Activity, Tools, and Handling), a work-sampling based method, was used to quantify the percent of time that the drywall installers were conducting different activities with different body segment (trunk, arm, and leg) postures. Utilizing Monte-Carlo simulation to convert the categorical PATH data into continuous variables as inputs for the biomechanical models, the required muscle contraction forces and joint reaction forces at the low back (L4/L5) and shoulder (glenohumeral and sternoclavicular joints) were estimated for a typical eight-hour workday. To demonstrate the robustness of this modeling approach, a sensitivity analysis was conducted to examine the impact of some quantitative assumptions that have been made to facilitate the modeling approach. The results indicated that the modeling approach seemed to be the most sensitive to both the distribution of work cycles for a typical eight-hour workday and the distribution and values of Euler angles that are used to determine the "shoulder rhythm." Other assumptions including the distribution of trunk postures did not appear to have a significant impact on the model outputs. It was concluded that the integrated approach might provide an applicable examination of physical loads during the non-routine construction work, especially for those operations/tasks that have certain patterns/sequences for the workers to follow.
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Affiliation(s)
- Lu Yuan
- Department of Computer Science and Industrial Technology, Southeastern Louisiana University, SLU 10847, Hammond, LA, 70402, USA; Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA.
| | - Bryan Buchholz
- Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA.
| | - Laura Punnett
- Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA.
| | - David Kriebel
- Department of Work Environment, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA, 01854, USA.
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Miranda H, Gore RJ, Boyer J, Nobrega S, Punnett L. Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion. ScientificWorldJournal 2015; 2015:915359. [PMID: 26380373 PMCID: PMC4561990 DOI: 10.1155/2015/915359] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/13/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors. METHODS A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity. RESULTS Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity. CONCLUSIONS Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.
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Affiliation(s)
- Helena Miranda
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPH-NEW), University of Massachusetts Lowell, Lowell, MA 01854, USA
- School of Health Sciences, University of Tampere, 33014 Tampere, Finland
| | - Rebecca J. Gore
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPH-NEW), University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Jon Boyer
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPH-NEW), University of Massachusetts Lowell, Lowell, MA 01854, USA
- Boston Children's Hospital, Boston, MA 02115, USA
| | - Suzanne Nobrega
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPH-NEW), University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Laura Punnett
- Department of Work Environment & Center for the Promotion of Health in the New England Workplace (CPH-NEW), University of Massachusetts Lowell, Lowell, MA 01854, USA
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Kurowski A, Buchholz B, Punnett L. A physical workload index to evaluate a safe resident handling program for nursing home personnel. HUMAN FACTORS 2014; 56:669-83. [PMID: 25029893 PMCID: PMC8566024 DOI: 10.1177/0018720813509268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to obtain a comprehensive analysis of the physical workload of clinical staff in long-term care facilities, before and after a safe resident handling program (SRHP). BACKGROUND Ergonomic exposures of health care workers include manual handling of patients and many non-neutral postures. A comprehensive assessment requires the integration of loads from these varied exposures into a single metric. METHOD The Postures, Activities, Tools, and Handling observational protocol, customized for health care, was used for direct observations of ergonomic exposures in clinical jobs at 12 nursing homes before the SRHP and 3, 12, 24, and 36 months afterward. Average compressive forces on the spine were estimated for observed combinations of body postures and manual handling and then weighted by frequencies of observed time for the combination. These values were summed to obtain a biomechanical index for nursing assistants and nurses across observation periods. RESULTS The physical workload index (PWI) was much higher for nursing assistants than for nurses and decreased more after 3 years (-24% versus -2.5%). Specifically during resident handling, the PWI for nursing assistants decreased by 41% of baseline value. CONCLUSION Spinal loading was higher for nursing assistants than for nurses in long-term care centers. Both job groups experienced reductions in physical loading from the SRHP, especially the nursing assistants and especially while resident handling. APPLICATION The PWI facilitates a comprehensive investigation of physical loading from both manual handling and non-neutral postures. It can be used in any work setting to identify high-risk tasks and determine whether reductions in one exposure are offset by increases in another.
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Thomas DR, Thomas YLN. Interventions to reduce injuries when transferring patients: a critical appraisal of reviews and a realist synthesis. Int J Nurs Stud 2014; 51:1381-94. [PMID: 24767612 DOI: 10.1016/j.ijnurstu.2014.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/05/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES There has been extensive investment in programmes to reduce injuries among health care staff caused by moving and handling patients or residents. Given conflicting evidence regarding the effectiveness of such programmes, the present paper conducted a critical appraisal of systematic reviews assessing the effectiveness of interventions in reducing back pain and injuries among healthcare staff. A realist synthesis was conducted on a second set of reports to identify best practices for moving and handling programmes. DESIGN A critical appraisal of systematic reviews and a realist synthesis to identify best practices for moving and handling programmes. DATA SOURCES A literature search of five databases (Medline, EMBASE, CINAHL, PsycINFO and ScienceDirect) located 150 reports assessing programme outcomes published in refereed journals between 2000 and 2013. REVIEW METHODS The critical appraisal included six systematic reviews. The realist synthesis included 47 studies that provided descriptive information about programme mechanisms. RESULTS Five of the six systematic reviews covered interventions involving either staff training or training and equipment supply. One review covered multi-component interventions. All concluded that training staff by itself was ineffective. There were differing conclusions regarding the effectiveness of training and equipment interventions and multi-component programmes. The reviews provided little information about the content of programme components. The realist synthesis noted the need for management commitment and support, and six core programme components; a policy requiring safe transfer practices, ergonomic assessment of spaces where people are transferred, transfer equipment including lifts, specific risk assessment protocols, adequate training of all care staff, and coordinators coaches or resource staff. These programme components are likely to be synergistic; omitting one component weakens the impact of the other components. CONCLUSIONS Five systematic reviews provided little information regarding the core components of effective programmes. Given the absence of experimental trials for multi-component programmes, the best available evidence for the effectiveness of multi-component programmes is from pre-post studies and large-scale surveys. The realist synthesis provided detailed information about the core components for effective programmes. Further studies, which include qualitative data, are needed to provide evidence about the specific mechanisms through which components contribute to effective patient handling programmes.
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Affiliation(s)
- David R Thomas
- Social and Community Health, School of Population Health, University of Auckland, New Zealand.
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Lahiri S, Latif S, Punnett L. An economic analysis of a safe resident handling program in nursing homes. Am J Ind Med 2013; 56:469-78. [PMID: 23203729 PMCID: PMC5884063 DOI: 10.1002/ajim.22139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective. METHODS The company provided data on program costs, compensation claims, and turnover rates (2003-2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the "net-cost model." RESULTS Among 110 centers, the overall benefit-to-cost ratio was 1.7-3.09 and the payback period was 1.98-1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22-$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22-$308). However, at 49 centers costs exceeded benefits. CONCLUSIONS Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity.
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Affiliation(s)
- Supriya Lahiri
- Department of Economics, University of Massachusetts Lowell, Lowell, MA 01854, USA.
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