Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: An analysis of cross-sectional survey data

The Effect of Foot Reflexology on Stress, Fatigue, and Low Back Pain in Intensive Care Unit Nurses: A Randomized Controlled Trial

OBJECTIVES

This study, which uses a randomized controlled design, aimed to determine the effect of foot reflexology on stress, fatigue, and low back pain (LBP) in intensive care unit (ICU) nurses.

METHODS

The study was conducted with intensive care unit nurses at two hospitals in a city between September 2022 and April 2023. The study sample consisted of 42 nurses, 21 of whom had low back pain for at least 3 months and 21 of whom were controls. In the study, foot reflexology was applied to the intervention group for 20 minutes (10 minutes on each foot) once a week for 4 weeks. There was no intervention applied to the control group. Data were collected using the Personal Information Form, the Perceived Stress Scale (PSS), the Fatigue Severity Scale (FSS), and the Visual Analog Scale (VAS).

FINDINGS

Based on the change in the mean scores of the scale in the intervention and control groups over time, a statistically significant decrease was found between the pre-test (before foot reflexology) and post-test mean scores of the LBP-VAS (from 6.33 to 2.24, respectively) and the Fatigue Severity Scale (from 4.81 to 3.60, respectively) in the intervention group. Although there was no statistically significant difference between the perceived stress scale pre-test and post-test scores, it was found that there was a decrease in favor of the intervention group.

CONCLUSION

Foot reflexology appears to offer promise as an effective method for ICU nurses to reduce lower back pain and fatigue.

The Risk Assessment of Patient Handling in Hospitals of Northeast of Iran

The study aim was to determine the risk of Manual patient handling (MPH) in Shahroud public hospitals, Iran. A cross-sectional study was performed in Imam Hossein (IHospital) and Bahar (BHospital) with 21 wards. MPH risk assessment was performed using MAPO (Movement and Assistance of Hospital Patient) index. The ratio of operator to disabled patient (NC/Op and PC/Op), lifting, minor aid, wheelchair, environmental, and training factor are evaluated to calculate MAPO index. Among studied wards 57%, 33.3%, and 9.5%, respectively, were in the high, moderate, and low risk exposure level. The maximum MAPO score were 16.7 in CCU of IHospital. Emergency ward of BHospital had the highest score of 9.8 and PC/OP ratio 17.5. The most risk factors were minor aid (90.5%), lifting factor (71.4%), and PC/OP (66.7%). Immediate ergonomic action is recommended.

Effectiveness and Safety of Inelastic Versus Elastic Lumbosacral Orthoses on Low Back Pain Prevention in Healthy Nurses: A Randomized Controlled Trial

STUDY DESIGN

A randomized controlled trial.

OBJECTIVE

To evaluate the effects of inelastic and elastic lumbosacral orthoses (LSOs) on the prevention of low back pain (LBP) in healthy nurses.

SUMMARY OF BACKGROUND DATA

Over 80% of people experience LBP during their lifetime. LSOs, as a device used to maintain lumbar stability, were widely used in LBP management. The effects of inelastic LSOs (iLSOs) and elastic LSOs (eLSOs) on the prevention of LBP are controversial.

METHODS

A randomized clinical trial recruiting healthy nurses was conducted from November 2011 to June 2013 at a tertiary hospital in China. A total of 300 eligible participants aged 20 to 25 years were randomly assigned to iLSO, eLSO, or control groups. The intervention period was 6 months, and follow-ups were continued for an additional 6 months. Participants in both iLSO and eLSO groups were required to wear LSOs daily. Outcomes included the incidence of LBP, changes in trunk muscle endurance, and spinal range of motion assessed at baseline, 6months, and 12 months from the starting date. The incidence of LBP among groups was analyzed by ANOVA. Wilcoxon rank-sum test, Kruskal-Wallis H test, etc. were used for secondary outcomes comparison across groups.

RESULTS

Two hundred seventy-eight out of 300 participants (92.7%) completed the trial. No statistically significant differences were observed in LBP incidence among the three groups. No difference was observed in abdominal/back muscle endurance among groups at 6 months. In secondary outcome analysis regarding spinal range of motion, flexion and extension improved in iLSO groups at 12 months compared with that at baseline (flexion, P  = 0.01; extension, P  = 0.01), whereas only extension motion improved at 12 months in the eLSO group (P  = 0.00).

CONCLUSIONS

Six-month wearing of LSO showed neither a significant difference in preventing LBP nor causing adverse effects to participants.Level of Evidence: 1.

The effects of patient transfer devices on the risk of work-related musculoskeletal disorders (WMSDs): a systematic review

Objectives. This study aimed to evaluate the efficacy of patient transfer assistive devices in reducing the risk of work-related musculoskeletal disorders (WMSDs) among nurses. Methods. PubMed, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews were searched to identify studies with a quantitative assessment of the efficacy of patient transfer assistive devices on the incidence and injury claims of WMSDs as compared to the manual lifting of patients. A health impact analysis of the pre-post intervention of assistive device implementation was performed. The percentage of the reduction of forces, incidence of WMSDs, number of missed workdays and injury compensation claims were calculated, pooled and presented as boxplots. Results. A total of 25 studies met the inclusion criteria. The best post-intervention outcomes of assistive devices deployment in the healthcare setting included a reduction in WMSD incidence by 59.8%, missed workdays by 90.0% and workers' compensation claims by 95.0%. Additionally, hand force declined by 71% (p < 0.05) and 70% (p < 0.05) with the use of air-assisted devices and ceiling lifts respectively. Conclusions. Overall, the evidence suggests that patient transfer assistive devices, notably ceiling lifts and air-assisted devices, are effective in reducing the risk of WMSDs among nurses.

Career Development and Occupational Disease in Chinese Nurses: A Cross-Sectional Study

BACKGROUND

A high tendency of intention to leave has been noted for nurses in China. The nursing profession is currently unstable.

METHODS

A sample of 51406 nurses from 311 hospitals in China who completed the self-administered questionnaire online was recruited via the China Nursing Association by email and phone using a simple random sampling method. The recruitment occurred between July 2016 and July 2017.

RESULTS

The majority of the nurses had working experience ≤20 years and had to work on night shifts. A high percentage of nurses (71.8%) had insomnia, followed by 37.0% who developed varicose veins and 40.9% who experienced musculoskeletal-related disorders. The proportions of the nurses who developed gastrointestinal and urinary system diseases were 56.0% and 18.2%, respectively. Nearly half of the nurses did not have a clear goal for their future career development and intended to leave. Nurses with long working hours each week were positively associated with the development of occupational diseases. The prevalence of occupational diseases was independently associated with career development.

CONCLUSIONS

A high prevalence of occupational diseases was noted among nurses in China. The data indicated that 50% of the nurses were vague regarding their career planning. The data suggest that managers need to pay more attention and to prevent this problem. Appropriate interventions should also be provided.

Physical work conditions and disparities in later life functioning: Potential pathways

Research in the US on the social determinants of reduced physical functioning at older ages has typically not considered physical work conditions as contributors to disparities. We briefly describe a model of occupational stratification and segregation, review and synthesize the occupational health literature, and outline the physiological pathways through which physical work exposures may be tied to long-term declines in physical functioning. The literature suggests that posture, force, vibration, and repetition are the primary occupational risk factors implicated in the development of musculoskeletal disorders, through either acute injuries or longer-term wear and tear. Personal risk factors and environmental and structural work characteristics can modify this association. In the long-term, these musculoskeletal disorders can become chronic and ultimately lead to functional limitations and disabilities that interfere with one's quality of life and ability to remain independent. We then use data on occupational characteristics from the Occupational Information Network (O*NET) linked to the 2019 American Community Survey (ACS) to examine disparities among sociodemographic groups in exposure to these risk factors. Occupations with high levels of these physical demands are not limited to those traditionally thought of as manual or blue-collar jobs and include many positions in the service sector. We document a steep education gradient with less educated workers experiencing far greater physical demands at work than more educated workers. There are pronounced racial and ethnic differences in these exposures with Hispanic, Black, and Native American workers experiencing higher risks than White and Asian workers. Occupations with high exposures to these physical risk factors provide lower compensation and are less likely to provide employer-sponsored health insurance, making it more difficult for workers to address injuries or conditions that arise from their jobs. In sum, we argue that physical work exposures are likely an important pathway through which disparities in physical functioning arise.

Analysis of physical and physiological workloads of nursing in the surgical center

BACKGROUND

Operating room nursing professionals are exposed to different workload. It is necessary to recognize which situations resulting from their tasks interfere with the health of the professional.

OBJECTIVES

We aimed to identify the physical and physiological loads on operating room nurses and their impact on the health as well as trace ergonomic recommendations based on the literature and performed analysis.

METHODS

The is an exploratory, observational, descriptive research conducted in the surgical center of a university hospital between August 2017 and July 2018. Nursing staff of both genders who worked as transport professionals or room circulators were included in the study. Data collection in the OR went through stages of Ergonomic Workplace Analysis (EWA), through semi-structured interviews addressing the physical and physiological work issues and a worksheet of data collected from the observations of the practitioners' actions.

RESULTS

The study included 20 nursing workers of both genders with an average of 17.33±12.58 years of work experience. The most reported problematic factors were: lack of material, staff pressure, patient transporting, employment legal status with the institution, and lack of communication among the practitioners.

CONCLUSIONS

There was a physical effort during the activity and a high prevalence of workers with pain complaints, which justifies the investigation.

Prevalence of low back pain among intensive care nurses: A meta-analysis

BACKGROUND

Low back pain (LBP) is a ubiquitous health problem affecting most of healthcare staff. However, there have been not effort to derive robust prevalence estimates of LBP among intensive care unit (ICU) nurses.

AIMS AND OBJECTIVES

To determine the prevalence of LBP among ICU nurses.

METHODS

A systematic review and meta-analysis was conducted. Five databases were searched: Web of Science, PubMed, MEDLINE (Ovid), Embase, and CINHAL databases. Original research that reported the prevalence of LBP among ICU nurses using a 12-month recall period were included. In order to assess methodological quality, we used a quality rating system which is specifically developed for LBP studies. Cochran's Q and the I² test were applied to assess heterogeneity. Subgroup analysis was applied to identify factors that may contribute to heterogeneity. Presence of potential publication bias was assessed by using Egger's test and visual inspection of the symmetry in funnel plots.

RESULTS

Twenty-seven studies reporting data from 2004 to 2020 on the prevalence of LBP in a defined ICU nurses were included (participants:6258; range: 3-1345). Twenty-one (77.8%) studies were of "high" quality. Among the included studies, the lowest and the highest prevalence were found to be 34.5% and 100.0%, respectively. Meta-analysis of included studies yielded a pooled prevalence of 12-month LBP at 76.0% (95% CI, 69.0%-81.8%). (I²  = 96.0%, Chi-squared = 722, P-value < .01).

CONCLUSION

LBP is prevalent among ICU nurses. Greater attention is urgently needed to address this burdensome health problem among ICU nurses, particularly with an emphasis to develop preventive strategies.

RELEVANCE TO CLINICAL PRACTICE

The results of our meta-analysis have important consequences for ICU nurse managers. Our finding of high prevalence rate of LBP among ICU nurses suggests that more attention should be devoted to develop and apply prevention programs for ICU nurses to manage this global issue.

Female Sex is Associated With Increased Reported Injury Rates and Difficulties With Use of Orthopedic Surgical Instruments

INTRODUCTION

Orthopedic instrumentation is generally made as one-size-fits-all. The purpose of this study was to evaluate the effects of hand size and sex on ease of use and injury rates from orthopedic tools and surgical instruments.

METHODS

An anonymous 21-item online survey was distributed to orthopedic trainees and attendings. Questions regarding demographics, physical symptoms and treatment, perceptions, and instrument-specific concerns were included. The analysis included statistics comparing responses based on sex, height, and glove size, with significance as p<0.05.

RESULTS

There were 204 respondents: 119 female and 84 male. Male and female respondents differed significantly in height (mean difference 5.4 in, p<0.001) and glove size (median size 6.5 size for females, size 8 for males, p<0.001). While 69.8% of respondents reported physical discomfort or symptoms they attributed to their operating instruments, female surgeons were significantly more likely to endorse symptoms (87.3% female vs. 45.2% male, p<0.001). Of those reporting symptoms, 47.7% had undergone treatment, with no significant difference by surgeon sex (p=0.073). Female surgeons were significantly more likely than their male counterparts to have negative attitudes toward orthopedic surgical instruments and to report specific surgical instruments as difficult or uncomfortable to use.

CONCLUSION

Female orthopedic surgeons are more likely than their male counterparts to report physical symptoms attributed to orthopedic surgical instruments, to have negative attitudes toward instruments, and to identify a larger number of common instruments as difficult or uncomfortable to use. Further emphasis on ergonomic instrument design is needed to allow all orthopedic surgeons to operate as safely and effectively as possible.

Impact of California Safe Patient Handling Legislation: Health Care Workers' Perspectives

BACKGROUND

Musculoskeletal injuries from patient handling are significant problems among health care workers. In California, legislation requiring hospitals to implement safe patient handling (SPH) programs was enacted in 2011. This qualitative study explored workers' experiences and perceptions about the law, their hospital's SPH policies and programs, patient handling practices, and work environment.

METHODS

Three focus groups were conducted with 21 participants (19 nurses and 2 patient handling specialists) recruited from 12 hospitals located in the San Francisco Bay Area and San Joaquin Valley. Qualitative content analysis was used for data analysis.

RESULTS

Multiple themes emerged from diverse experiences and perceptions. Positive perceptions included empowerment to advocate for safety, increased awareness of SPH policies and programs, increased provision of patient handling equipment and training, increased lift use, and improvement in safety culture. Perceived concerns included continuing barriers to safe practices and lift use such as difficulty securing assistance, limited availability of lift teams, understaffing, limited nursing employee input in the safety committee, blaming of individuals for injury, increased workload, and continuing injury concerns. Participants indicated the need for effective training, sufficient staffing, and management support for injured workers.

CONCLUSIONS/APPLICATION TO PRACTICE

This study identified improvements in hospitals' SPH programs and practices since the passage of California's SPH law, as well as continuing challenges and barriers to safe practices and injury prevention. The findings provide useful information to understanding the positive impacts of the SPH law but also notes the potential limitations of this legislation in the view of health care workers.

Determining the Efficiency of Ergonomic Belt During Patient Handling and its Effect on Reducing Musculoskeletal Disorders in Nurses

INTRODUCTION

Nursing personnel are always at risk for work-related musculoskeletal disorders, and patient transportation is one of the major risk factor for these disorders.

OBJECTIVE

The aim of this study was to evaluate the ergonomic belt to improve patient transferring conditions.

METHODS

The subjects included 60 health care workers (HCW) of a hospital with patient transfer experience. The ergonomic belt was examined to help move the patient from one bed to another. The prevalence of musculoskeletal disorders was assessed through the Nordic questionnaire, the degree of perceived exertion through the Borg criterion, and the patient's movement through the MAPO index before and after the intervention.

RESULTS

The results showed a significant decrease in Borg scale scores and MAPO index in two factors of education and auxiliary tools and overall scores of this index. We also saw a significant reduction in musculoskeletal disorders in the neck, shoulders and arms, waist, hands and wrists, thighs, knees and legs. There were no significant differences in the elbow and forearm before and after using the ergonomic belt.

CONCLUSION

In general, it can be concluded that the use of ergonomic belt had helped to reduce the risk of musculoskeletal disorders, as well as reducing the perceived exertion of nurses and other relevant personnel.

Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study

BACKGROUND

Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs.

METHODS

By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure.

RESULTS

Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively.

CONCLUSIONS

Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

Biomechanical load during patient transfer with assistive devices: Cross-sectional study

This study utilised a cross-sectional design to perform measurements of muscle activity as well as forward - and lateral trunk inclination angle during a full workday among 52 female healthcare workers from 16 different departments at five Danish hospitals. Using linear mixed models, the 95th percentile ranks of the normalised root mean square (nRMS) values were analysed for the different types of assistive devices. Compared to no assistive device (mean nRMS 27.9%, 95% CI 24.8%-31.0%), the use of intelligent beds (23.9%, CI 20.2%-27.6%) and ceiling-lifts (24.0%, CI 20.3%-27.7%) led to lower erector spinae nRMS values across all types of patient transfers. Conversely, the use of bedsheets (30.6%, CI 27.1%-34.2%), sliding-sheets (30.3%, CI 26.8%-33.9%) and sliding-boards (33.5%, CI 29.5%-37.6%) were associated with higher levels of erector spinae muscle activity.Consistent use of ceiling-lifts and intelligent beds reduces the physical workload and may thereby decrease the risk of musculoskeletal disorders among healthcare workers. Practioner Summary: Frequent patient transfer is associated with an increased risk of back pain and injury among healthcare workers. This analysis compares the level of physical load during patient transfer with commonly used assistive devices. The results show that use of the ceiling-lift and intelligent bed is associated with relatively low physical load during patient transfer. Abbreviations: RMS: root mean square; nRMS: normalized root mean square; EMG: electromyography; MSD: musculoskeletal disorder; LBP: low-back pain; VAS: visual analogue scale; MVC: maximal voluntary contraction.

An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers

Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.

Perspectives on preventing musculoskeletal injuries in nurses: A qualitative study

AIMS AND OBJECTIVES

To explore the perspectives of nursing and physiotherapy academics regarding techniques designed to prevent musculoskeletal pain and injury in nurses.

BACKGROUND

High rates of musculoskeletal injuries are evident in nurses, yet there is an absence of research identifying effective interventions to address this problem. Exploring the perspectives of individuals with specialist knowledge in the area could help identify barriers to musculoskeletal injury prevention, and innovative strategies to investigate in future studies.

DESIGN

Cross-sectional qualitative descriptive study.

METHODS

Between October-December 2017, group and individual face-to-face semi-structured interviews were used to collect data. All interviews were audio-recorded. A thematic analysis was performed, with two researchers coding audio files using NVivo software. The Consolidated Criteria for Reporting Qualitative Research Checklist was consulted to ensure complete reporting of all methods and findings.

RESULTS

Nursing and physiotherapy academics (N = 10) were aware of a range of techniques to prevent musculoskeletal injuries in nurses, including education, equipment, health and safety policy and multi-disciplinary collaboration. However, several barriers to using these techniques were identified, including age, knowledge and availability of equipment, personal and contextual factors, staffing and time pressures. Several strategies were recommended for further investigation and implementation in clinical practice, such as the sharing of personal experiences, orthopaedic assessments and changes to workplaces that foster a culture of safety.

CONCLUSIONS

Further research is required to reduce musculoskeletal pain and injury among nurses. This research should account for the barriers to current prevention strategies and consider investigating novel interventions.

RELEVANCE TO CLINICAL PRACTICE

These findings highlight strategies for preventing musculoskeletal injuries among nurses that are likely to be most effective in clinical practice.

Occupational Factors Causing Pain Among Nurses in Mainland China

BACKGROUND Pain is a common problem affecting the wellbeing of nurses. This study investigated physical pain of nurses and their pain self-management in mainland China. MATERIAL AND METHODS A total of 2458 full-time nurses working in 18 hospitals across mainland China were studied from May 2016 to July 2016, of which a total of 1269 nurses (51.63%) experienced pain during the duration of this study. RESULTS Of the nurses reporting pain, most had general chronic pain (936 cases, 73.8%). Many nurses also had moderate to severe pain (904 cases, 71.2%). Another type of pain that was common was back and lower-limb pain (740 cases, 58.3%). Of the diagnosable symptoms, lumbar spondylosis was the most prominent, with 258 cases (33.1%). Nearly 50% of the nurses reported that their lives and sleep had been disrupted by pain, and 33.9% of the subjects are unsatisfied with their level of self-management of pain. Only 13.4% said that they would seek formal medical attention after feeling pain. Multivariate logistical analysis showed that factors such as the level of the hospital, years of experience, and shift schedule have a strong correlation with the incidence of pain among nurses. CONCLUSIONS The main cause of pain among nurses in mainland China is occupational factors, and the current status of this problem is not satisfactory.

Factors associated with lift equipment use during patient lifts and transfers by hospital nurses and nursing care assistants: A prospective observational cohort study

BACKGROUND

Despite wide availability of patient lift equipment in hospitals to promote worker and patient safety, nursing staff do not consistently use equipment.

OBJECTIVE

To determine the influence of factors on the use or non-use of lift equipment during patient lifts/transfers.

DESIGN

Prospective observational cohort study.

SETTING

One university teaching hospital and two community hospitals in a large health system in southeastern United States.

PARTICIPANTS

77 nurses and nursing care assistants with patient handling duties in critical care, step-down and intermediate care units.

METHODS

Participants recorded information about all patient lifts/transfers during their shifts during a 1 week period per month for three months: type of lift/transfer, equipment use, type of equipment, and presence of 20 factors at the time of the lift/transfer. With the patient lift/transfer as the unit of analysis, the association (risk ratios (RR) and 95% confidence intervals (CI)) between factors and equipment use was examined using multivariate Poisson regression with generalized estimating equations.

RESULTS

Seventy-seven participants (465 person-shifts) reported 3246 patient lifts/transfers. Frequent lifts/transfers included bed-to-toilet (21%), toilet-to-bed (18%), bed-to-chair (13%), chair-to-bed (13%), chair-to-toilet (6%), and toilet-to-chair (6%). Equipment was used for 21% of lifts/transfers including powered floor based dependent lift (41%), powered sit-to-stand lift (29%), non-powered sit-to-stand lift (17%), air-assisted lateral transfer device (6%), ceiling lift (3%), and air-assist patient lift (3%). Factors associated with equipment use included: availability of equipment supplies (RR = 9.61 [95%CI: 6.32, 14.63]), staff availability to help with equipment (6.64 [4.36, 10.12]), staff preference to use equipment (3.46 [2.48, 4.83]), equipment required for patient condition (2.38 [1.74, 3.25]), patient inability to help with lift/transfer (2.38 [1.71, 3.31]), equipment located in/by patient room (1.82 [1.08, 3.06]), sling already under patient (1.79 [1.27, 2.51]), and patient size/weight (1.38 [0.98, 1.95]). Lower patient mobility score (3.39 [2.19, 5.26]) and presence of physical or mental impairments (2.00 [1.40, 2.86]) were also associated with lift equipment use. Factors associated with non-use of equipment included: patient/family preference (0.31 [0.12, 0.80]), staff assisting with lift did not want to use equipment 0.34 ([0.17, 0.68]), patient condition (0.48 [0.20, 1.20]), and patient almost fell (0.66 [0.45, 0.97]).

CONCLUSIONS

Patient, worker, equipment, and situational factors influence whether nursing staff used equipment to lift/transfer a patient. Quantifying and understanding these factors associated with lift equipment use and non-use provides specific information for hospitals and safety professionals to enhance effectiveness of future organizational and ergonomic intervention efforts to prevent work-related patient-handling injuries.

Personal Safety of the Plastic Surgeon: Keeping Yourself Healthy While You Work

LEARNING OBJECTIVES

After reading this study, the participant should be able to: 1. Recognize the primary physical and mental risks faced by the practicing plastic surgeon. 2. State the primary risk factors for cervical spine disease and back pain. 3. State the critical steps for protection from ionizing and nonionizing radiation. 4. List the characteristics of a surgeon exhibiting signs of burnout. 5. Develop a plan for mitigating personal risk of musculoskeletal, exposure, and other injuries.

SUMMARY

Health care workers are exposed to significant occupational hazards, and have a risk of injury similar to that of construction, mining, and manufacturing employees. Plastic surgeons must have a clear understanding of the types of risks they face and the techniques for mitigating them. Exposure to some risks is attributable to unavoidable occupational conditions, but others can be avoided completely. The sources of injury risk from musculoskeletal, exposure, and other causes are discussed in this article, and evidence-based recommendations to ameliorate these risks are presented.

Critical-Care Nurses' Pain Experiences and the Prognostic Factors

OBJECTIVE

The objective of this study was to determine the emergence of pain in critical-care nurses and the prognostic risk factors.

DESIGN

This study is a cross-sectional descriptive research.

SETTING AND SUBJECTS

This study was conducted with the participation of 111 critical-care nurses in Zonguldak province, Turkey.

INTERVENTIONS

The data were collected using a survey form and the Cornell Musculoskeletal Discomfort Questionnaire between August and November 2015. The data were evaluated using frequency, average, Pearson correlation analysis, χ, logistic regression, and odds ratio tests.

RESULTS

The critical-care nurses were found to experience pain mostly in their lower backs (88.3%), upper backs (77.5%), right (76.6%) and left (78.4%) feet, necks (73.9%), and most infrequently in the right (28.8%) and left (28.8%) lower arms. Changing bed linens while the patient remained in bed and lifting, pulling, or pushing heavy materials caused those nurses who felt despondent and tired to feel significant pain in the shoulder, neck, upper arm, wrist, and knee (P < .05).

CONCLUSIONS

These results were significant for placing emphasis on maintaining body mechanics while caring for patients, providing appropriate environmental conditions, and ensuring ergonomics to preserve the health of critical-care nurses who work in hospitals.

Reducing Intensive Care Unit Staff Musculoskeletal Injuries With Implementation of a Safe Patient Handling and Mobility Program

The purpose of this safety initiative was to reduce work-related injuries through the implementation of a safe patient handling and mobility (SPHM) program in a medical intensive care unit. An SPHM program was implemented on a critical care medicine unit in February of 2017. Nursing and assistive personnel completed education via hands-on and online educational modules regarding SPHM equipment and techniques and an SPHM policy. All staff were expected to follow SPHM practices. Critical care medicine unit nursing leadership and unit-based SPHM peer coaches rounded to ensure staff compliance with the program. A 1-year evaluation demonstrated a reduction of 86% in work-related injuries. In 2016, there were 7 injuries while in 2017, only 1 injury occurred. Lost and restricted days away from work were reduced by 54% or from a total of 112 days in 2016 to 52 days in 2017. The implementation of an SPHM program in a medical intensive care unit appears to be highly effective at reducing health care worker injuries. More research is needed to identify the best and most effective ways to provide care to our most critical patients. Positive behaviors from the staff regarding the SPHM program have helped reduce injuries and lost workdays.

Upper extremity posture and muscle activity during IV pole interaction

Background. The physical demands associated with patient handling activities have been well documented in healthcare. However, many activities contribute to the physical demands of caregivers. Our purpose was to evaluate upper extremity muscle activity and kinematics during intravenous (IV) pole interaction. Materials and methods. Muscle activity was measured from six muscles using surface electromyography and joint kinematics were measured using motion capture. Participants performed two IV pole tasks: loading an IV bag and a medical device onto the pole. Two poles were evaluated: a traditional IV pole and a redesigned pole with ergonomic considerations. Results. Cervical extensor activity was significantly greater for the bag task with the traditional pole (43.29 ± 5.10% maximal voluntary exertion) compared to the redesigned pole (28.55 ± 3.42% maximal voluntary exertion). Peak right shoulder flexion was reduced from 102.88° ± 32.42° with the traditional pole to 55.44° ± 19.59° with the redesigned pole. Conclusion. Interactions with a traditional pole are comparable to upper extremity muscle activity during manual patient handling transfers. The redesigned pole reduced shoulder flexion during bag attachment, leading to less time in an overhead posture. Caregivers frequently interact with IV poles and reducing the physical demands associated with pole use could aid in a reduction of musculoskeletal disorders.

Health, workforce characteristics, quality of life and intention to leave: The 'Fit for the Future' survey of Australian nurses and midwives

AIM

To examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave.

BACKGROUND

Few studies have examined nurses' and midwives' quality of life and little is known of its effects on workforce longevity.

DESIGN

This was a cross-sectional survey conducted in 2014-2015.

METHOD

The "Fit for the Future" electronic survey, delivered to nurses and midwives, examined demographic, work and health-related factors, which were compared with Australian general population normative values for physical and mental components of quality of life (the Short Form-12). Univariate and multivariate logistic regression models assessed associations with workforce intention to leave.

RESULT

Physical and mental component scores, calculated for 4,592 nurses and midwives, revealed significantly higher physical but lower mental component scores than the general population. Physical component scores decreased with increasing age; higher scores were seen in nurses with better health indices and behaviours. Mental well-being scores increased with increasing age; in nurses who reported job satisfaction, no work injury, sleep problems or frequent pain and non-smokers. The odds of intention to leave decreased with increasing mental well-being.

CONCLUSION

Managers and decision-makers should heed study recommendations to implement health promotion strategies for nurses and midwives, aiming to improve mental health, specifically to promote workforce retention.

Management of Acute Work-Related Shoulder Injuries by an Early Shoulder Assessment Program: Efficiency of Imaging Investigations

Purpose: There has been a significant increase in the number of costly investigations of the shoulder joint over the past decade. The purposes of this study were to (1) describe the diagnostic imaging investigations ordered for injured workers seen at an Early Shoulder Physician Assessment (ESPA) program, (2) evaluate the impact of these investigations on final diagnosis and management, and (3) examine how efficient the program was by determining the appropriateness of referrals and whether costly imaging was justified. Methods: This was a retrospective review of the electronic files of injured workers who had been referred to an early assessment program because they had not progressed in their recovery or return-to-work plan within 16 weeks of the injury or reoccurrence. Results: The data of 750 consecutive patients-337 women (45%) and 413 men (55%), mean age 49 (SD 11) years-were reviewed. A total of 183 patients (24%) had been referred for further investigation. Of these, 90 (49%) were considered candidates for surgery (group 1), 58 (32%) had a change in diagnosis or management (group 2), and 17 (9%) had no change in diagnosis or management (group 3); 18 (10%) patients were lost to follow-up. We noticed a pattern in the type of diagnosis and the groups: full-thickness rotator cuff (RC) tear was the predominant diagnosis (Fisher's exact test [FET]=0.001, p<0.0001) for group 1. No statistically significant differences were found among the groups in the prevalence of labral pathology (FET=0.010, p=0.078), impingement syndrome (FET=0.012, p=0.570), partial-thickness RC tear (FET=0.004, p=0.089), or biceps pathology (FET=0.070, p=0.149). Ultrasound investigations were more prevalent in group 2 (FET=0.004, p=0.047). No pattern was found for use of magnetic resonance imaging and group allocation. However, all magnetic resonance arthrogram investigations (FET=0.007, p=0.027) had been ordered for patients who required labral or instability-related surgery. Conclusions: Of the injured workers we studied, 24% had further investigation, and the type and severity of pathology had affected the type of investigation. For the 165 patients who were included in groups 1-3, the ESPA was 90% efficient, with only 10% of patients not having had a change in diagnosis or management.

Sit-To-Stand Lift: Effects of Lifted Height on Weight Borne and Upper Extremity Strength Requirements

To prevent back and shoulder injuries to nursing personnel, sit-to-stand lifts are used to transfer partial-weight-bearing patients with upper extremity strength. However, the weight-bearing capacity and upper extremity strength required of patients have not been defined. The objectives of this study were to determine: (a) the percentage of body weight borne by the patient when lifted to different heights in the lift and (b) whether a patient needs upper extremity strength. Nineteen healthy normal-weight volunteers (ages 19-39) were transferred from a hospital bed to a wheelchair using (a) a gait belt and (b) a sit-to-stand lift. With legs secured in the lift, participants were lifted to five different heights (knee angles 120-180 degrees) while holding and not holding the lift handles. Participants supported a greater percentage of body weight as they were lifted higher, increasing from 60% to almost 100% (p < .01). Holding the handles did not have an effect on weight borne overall. At low heights, slightly less weight was borne when not using the handles than with them, and no difference in weight borne was found at heights near standing (p < .01). All participants felt more comfortable and safer transferring from bed to wheelchair with the mechanical lift than with the gait belt (p < .01). Results are limited to normal-weight patients but suggest that sit-stand lifts can be used in patients without upper extremity strength. Patients with limited weight-bearing capacity can be transferred by not raising them high in the lift. © 2016 Wiley Periodicals, Inc.

Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study

BACKGROUND AND OBJECTIVE

Adverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity among nurses.

METHODS

This study used cross-sectional data of 394 nurses (mean age 48 years, 91% females, 61% white) randomly selected from the California Board of Registered Nursing list. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013.

RESULTS

Of the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥ 150 min/week) and 57% performed regular muscle-strengthening activity (≥ 2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m(2)) was significantly more common among nurse managers/supervisors (OR=2.54, 95% CI: 1.16-5.59) and nurses who worked full-time (OR=2.18, 95% CI: 1.29-3.70) or worked ≥ 40 h per week (OR=2.53, 95% CI: 1.58-4.05). Regular aerobic physical activity was significantly associated with high job demand (OR=1.63, 95% CI: 1.06-2.51). Nurses with passive jobs (low job demand combined with low job control) were significantly less likely to perform aerobic physical activity (OR=0.49, 95% CI: 0.26-0.93). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR=0.55, 95% CI: 0.34-0.89). Physical workload was not associated with obesity and physical activity.

CONCLUSIONS

Our study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health promotion programs targeting physical activity and obesity among nurses.

Examining outcome of early physician specialist assessment in injured workers with shoulder complaints

Background

There is minimal research on demographics, type of injury and diagnosis of injured workers with shoulder problems. The purposes of this study were: 1) to document the demographics of patients with shoulder complaints referred to an Early Shoulder Physician Assessment (ESPA) Program and to describe the recommended management, and 2) to examine the relationship between patient characteristics and their subjective complaints of pain and functional difficulty.

Methods

This study involved a retrospective review of electronic files of injured workers mostly seen within the first 16 weeks of injury or recurrence. Measures of functional difficulty and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numeric Pain Scale (NPS).

Results

Files of 550 consecutive patients, 260 females (47%), 290 men (53%) were examined. The average age was 49 (SD = 11, range 22–77), with 28 (5%) patients being 65 years of age or older. Patients who were not working were the most disabled group based on Quick DASH (F = 49.93, p < 0.0001) and NPS (F = 10.24, p = 0.002). Patients who were working full time performing regular duties were the least disabled according to both measures, the QuickDASH (F = 10.24, p = 0.002) and NPS (F = 7.57, p = 0.006).

Patients waiting more than 16 weeks were slightly older (53 years of age vs. 49, p = 0.045) than those who met the criteria for early assessment with similar levels of pain and functional difficulty. Biceps pathology had the highest prevalence (37%). Full thickness tear had a prevalence of 14%. Instability, labral lesions and osteoarthritis of glenohumeral joint were uncommon conditions (3, 2 and 1% respectively). Fifty-five patients (10%) were surgical candidates and had higher scores on QuickDASH (F = 7.16, p = 0.008) and NPS (F = 4.24, p = 0.04) compared to those who did not require surgery.

Conclusions

This study provides information on characteristics and prevalence of important variables in injured workers with shoulder problems and highlights the impact of these characteristics on pain and disability.

Interprofessional teaching project with nursing and physical therapy students to promote caregiver and patient safety

Nurse educators must adjust curricula to meet the dynamic and critical changes in the health care environment, and to recognize the risk of injury our educational approach has on safety, team effectiveness, and culture change. Interprofessional collaboration and simulation are key components in the preparation of our students. Utilizing the interprofessional alliance model, an experience to promote collaborative relationships among nursing and physical therapy (PT) students to improve patient and caregiver safety was developed. Through this model, PT students taught safe patient-handling skills in a simulated setting to undergraduate nursing students. The majority of nursing students (N=351) from 2009–2014 strongly agreed or agreed that they were confident in the skills taught by the PT students and provided an overall course rating of outstanding or above average. This educational model, which includes simulation and safe patient handling, was a valuable addition to the curriculum, reinforcing the significance of developing collaborative relationships.

Effects of the Workplace Health Promotion Activities Soccer and Zumba on Muscle Pain, Work Ability and Perceived Physical Exertion among Female Hospital Employees

OBJECTIVES

This 40-week workplace physical training RCT investigated the effect of soccer and Zumba, respectively, on muscle pain intensity and duration, work ability, and rating of perceived exertion (RPE) during work among female hospital employees.

METHODS

107 hospital employees were cluster-randomized into two training groups, and a control group. The training was conducted outside working hours as two-three 1-h sessions per week for the first 12 weeks, and continued as one-two 1-h sessions per week for the last 28 weeks. Muscle pain intensity and duration, work ability, and RPE during work were measured at baseline and after 12 and 40 weeks.

RESULTS

After 12 weeks, both the soccer (-1.9, 95% CI, -3.0, -0.8, P = 0.001) and the Zumba group (-1.3, 95% CI, -2.3, -0.3, P = 0.01) reduced the pain intensity (on a scale from 0 to 10) in the neck-shoulder region (eta squared = 0.109), whereas only the soccer group (-1.9, 95% CI, -3.2, -0.7, P = 0.002, eta squared = 0.092) showed a reduction after 40 weeks referencing the control group. After 40 weeks, both the soccer (-16.4 days, 95% CI, -29.6, -3.2, P<0.02) and the Zumba group (-16.6 days, 95% CI, -28.9, -4.2, P<0.01) reduced the pain duration during the past 3 months in the neck-shoulder region (eta squared = 0.077). No significant effects on intensity or duration of pain in the lower back, RPE during work or work ability were found.

CONCLUSIONS

The present study indicates that workplace initiated soccer and Zumba training improve neck-shoulder pain intensity as well as duration among female hospital employees.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number Register ISRCTN 61986892.

Interventions to reduce injuries when transferring patients: a critical appraisal of reviews and a realist synthesis

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.