Patient safety and comfort during transfers in relation to nurses' work technique

Use of Simulation to Train Uncertified Hospital Orderlies in India

BACKGROUND

In India, orderlies are unlicensed hospital assistants instructed to perform delegated tasks under supervision by a licensed health-care giver. They receive on-the-job training, unlike certified nursing assistants. In this study, we have integrated a simulation session in our hospital orderly training program to promote the safe transfer of patients using a low-fidelity mannequin.

METHODS

We conducted an interventional study with a mixed methodology in which 280 orderlies were immersed in a simulation session of transferring a mannequin from a bed to either a wheelchair or stretcher. An observer completed a prevalidated 18-item checklist assessing the team's performance on a 3-point global rating scale. Quantitative analysis of the data was done using a Paired t-test of the mean scores of the pre- and posttest. Posttraining, the participants completed a satisfaction questionnaire. Structured interviews with their ward in-charges were conducted 3-month posttraining, and the data were analyzed by thematic coding.

RESULTS

The pre- and posttest scores of team performances for both groups were 33.22 and 45.3, respectively, indicating a statistically significant difference (P < 0.001). Posttraining, the session evaluation revealed that 100% of participants strongly agreed (mean score = 5) that the training was beneficial. The structured interviews revealed improvement in communication and patient interaction without much change in other skills. They found that, overall, this simulation-based training promoted the safe transfer of patients.

DISCUSSION

Improvement in the team performance scores shows the effectiveness of this methodology in ensuring the secure transfer of patients, as well as better teamwork and communication. The results demonstrate that low-fidelity, low-cost simulation can be used effectively to create a formal training program for hospital orderlies.

Preliminary evaluation of an automated robotic transfer assist device in the home setting

PURPOSE

The purpose of this study was to examine the effects of six weeks of routine use of a novel robotic transfer device, the AgileLife Patient Transfer System, on mobility-related health outcomes, task demand, and satisfaction relative to previous transfer methods.

MATERIALS AND METHODS

Six end users and five caregivers used the system in their homes for six weeks. Participants completed several surveys examining perceived demands related to preparing and performing a transfer and mobility-related health outcomes pre and post intervention. Participants were also asked about their satisfaction with using the technology compared to previous transfer methods.

RESULTS

Both end users and caregivers reported reduction in perceived physical demand (p = 0.007) and work (p ≤ 0.038) when preparing for and performing a transfer. End users indicated that the device intervention had a positive impact, indicating some improvements to health-related quality of life as well as improved competence, adaptability, and self-esteem post-intervention. All participants were highly likely to recommend the technology to others.

CONCLUSION

The AgileLife Patient Transfer System is a promising new form of transfer technology that may improve the mobility and mobility-related health of individuals with disabilities and their caregivers in home settings.Implications for rehabilitationRobotic transfer assistance reduced physical demand and work among end users and caregivers.The robotic device had a positive impact on some quality of life outcomes after 6 weeks of use.Users were highly likely to recommend the robotic transfer device to others.

Development and Validation of Robot Patient Equipped with an Inertial Measurement Unit and Angular Position Sensors to Evaluate Transfer Skills of Nurses

To more efficiently enhance the patient transfer skills of nursing students, this study aims to integrate a transfer skills evaluation system and a robot patient. The evaluation parameters, namely, the translational acceleration of the waist, rotational speed of the chest, and joint angles of the shoulder, hip, and knee, were selected on the basis of the pre-experimental results obtained with a simulated patient acted by the human individuals. To measure these parameters, inertial measurement unit (IMU) and angular position sensors were installed on the robot patient. An experiment was conducted with four nursing teachers to verify whether the robot patient could distinguish the incorrect methods of the transfer skills, determined to be a common mistake made by the nurses. According to the results, most transfer steps had the same effect on the simulated patient and the robot patient, which demonstrates that the robot patient is a suitable substitute for an actual patient. However, in certain steps, the robot patient was not able to distinguish between the correct and incorrect methods using the chosen parameters owing to the differences being insignificant. These insignificant differences were mostly attributed to the passive joint design of the robot patient.

Comparison of Healthcare Workers Transferring Patients Using Either Conventional Or Robotic Wheelchairs: Kinematic, Electromyographic, and Electrocardiographic Analyses

Objectives. The aim of this study was to compare the musculoskeletal and physical strain on healthcare workers, by measuring range of motion (ROM), muscle activity, and heart rate (HR), during transfer of a simulated patient using either a robotic wheelchair (RWC) or a conventional wheelchair (CWC). Methods. The subjects were 10 females who had work experience in transferring patients and another female adult as the simulated patient to be transferred from bed to a RWC or a CWC. In both experimental conditions, ROM, muscle activity, and HR were assessed in the subjects using motion sensors, electromyography, and electrocardiograms. Results. Peak ROM of shoulder flexion during assistive transfer with the RWC was significantly lower than that with the CWC. Values for back muscle activity during transfer were lower with the RWC than with the CWC. Conclusions. The findings suggest that the RWC may decrease workplace injuries and lower back pain in healthcare workers.

Translational Acceleration, Rotational Speed, and Joint Angle of Patients Related to Correct/Incorrect Methods of Transfer Skills by Nurses

Currently, due to shortages in the nursing faculty and low access to actual patients, it is difficult for students to receive feedback from teachers and practice with actual patients to obtain clinic experience. Thus, both evaluation systems and simulated patients have become urgent requirements. Accordingly, this study proposes a method to evaluate the nurse’s transfer skill through observation from the patient. After verifying the proposed method, it will be integrated with a robotic patient as a future work. To verify if such an evaluation is practical, a checklist comprising 16 steps with correct and incorrect methods was proposed by the nursing teachers. Further, the evaluation parameters were determined as translational acceleration, rotational speed, and joint angle of patient. Inertial sensors and motion capture were employed to measure the translational acceleration, rotational speed, and joint angle. An experiment was conducted with two nursing teachers, who were asked to carry out both correct and incorrect methods. According to the results, three parameters reveal the difference for a patient under correct/incorrect methods and can further be used to evaluate the nurse’s skill once the thresholds are determined. In addition, the applicability of inertial sensors is confirmed for the use of robot development.

Consistent Use of Assistive Devices for Patient Transfer Is Associated With Less Patient-Initiated Violence: Cross-Sectional Study Among Health Care Workers at General Hospitals

This study investigated whether factors related to bodily contact between health care workers and patients were associated with patient-initiated violence. This cross-sectional study surveyed 496 Danish health care workers measuring patient-initiated violence, use of assistive devices, body mass index, physical exertion, frequency of patient transfers, psychosocial work environment, gender, age, and seniority. Associations were modeled using logistic regression analyses using patient-initiated violence as the outcome. Twenty-five percent of the respondents had experienced physical or verbal violence during the past year. Infrequent use of assistive devices, high physical strain, and severe obesity all significantly increased the risk of physical violence (risk ratio [RR] = 1.18, RR = 1.18, and RR = 1.16, respectively), whereas only the lack of assistive device use significantly increased the risk of verbal violence (RR = 1.13 and RR = 1.08). Consistent use of assistive devices appears to reduce the risk of patient-initiated violence. Managers should require the use of assistive devices when designing work processes for patient transfers.

Validity and reliability of the HEMPA method for patient handling assessment

Specific methods currently exist to assess occupational hazards resulting from patient handling in the healthcare sector, according to ISO/TR 12296. They are all similar in nature, but with a different analysis perspective; for that reason a comparison of the most relevant methods was performed in a previous research. As a result, a basis of a new tool that integrates the complementary aspects of those methods was proposed. To verify the validity and reliability of that method, a study within a hospital setting was carried out in five medical and surgical units of a public health institution. Based on the obtained results, the analysed method (called HEMPA) proved to be valid and reliable. Also, this method reflects a positive correlation between risk and damage and correctly quantifies risks regarding patient's dependence.

Role of Bed Design and Head-of-Bed Articulation on Patient Migration

The ramifications of patient migration toward the foot of the bed in intensive care units are not well understood. Migration may cause shear and friction between the patient and the mattress, reduce elevation of the patient's torso, and require frequent repositioning of the patient. This study assesses how bed design impacts both the amount of migration that patients undergo during head section articulation to 30° and 45° and the extent of torso compression following the articulation.

A systematic review of observational instruments used to assess nurses' skills in patient mobilisation

AIMS AND OBJECTIVES

The aim of this study was to identify and describe the existing observation instruments that are used to assess nurses' skills in patient mobilisation and to evaluate the psychometric properties of the included instruments.

BACKGROUND

Structured knowledge about instruments for assessing nurses' skills in patient mobilisation is limited.

DESIGN

Systematic review.

METHODS

Studies were identified via electronic database searches and reference lists and were included based on the eligibility criteria. Data regarding the type of instrument, the number of items/domains and the psychometric properties of the instruments were extracted, and the quality of the instruments were appraised according to Zwakhalen et al.'s (BMC Geriatrics, 2006) proposed criteria.

RESULTS

A total of 26 studies, reporting on 16 instruments, were included in this review. The instruments differed in terms of: (1) type of patient-mobilisation task, (2) focus of the instrument, (3) level of structure and (4) use by the observer. Most of the instruments were developed and used in evaluation studies that measured nurses' mobilisation techniques as an outcome of an educational intervention. The total quality score of the included instruments varied between 6-11 points out of a maximum quality score of 19.

CONCLUSION

Although patient mobilisation is part of nurses' everyday work, we suggest from the results of this review that no common consensus exists about the best way to perform patient-mobilisation tasks. The results from this study further show that no instrument measured all of the important aspects of effective patient mobilisation.

RELEVANCE FOR CLINICAL PRACTICE

Most of the instruments that were reviewed were able to detect differences in patient-mobilisation techniques. However, convincing evidence is lacking with regard to the content, psychometric properties and practicability of these instruments for use in clinical practice. We suggest the development and validation of a new comprehensive instrument.

TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions

Patient handling interventions are complex and multi-factorial. It has been difficult to make comparisons across different strategies due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes and comparing performance across interventions. Focus groups were held with expert patient handling practitioners (n = 36) in four European countries (Finland, Italy, Portugal and the UK) to identify preferred outcomes to be measured for interventions. A systematic literature review identified 598 outcome measures; these were critically appraised and the most appropriate measurement tool was selected for each outcome. TROPHI was evaluated in the four EU countries (eight sites) and by an expert panel (n = 16) from the European Panel of Patient Handling Ergonomics for usability and practical application. This final stage added external validity to the research by exploring transferability potential and presenting the data and analysis to allow respondent (participant) validation.

PRACTITIONER SUMMARY

Patient handling interventions are complex and multi-factorial and it has been difficult to make comparisons due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes to compare performance across interventions.

Quantification of patient migration in bed: catalyst to improve hospital bed design to reduce shear and friction forces and nurses' injuries

OBJECTIVE

The study objective was to quantify the movement of hospital bed occupants relative to the bed in typical bed articulations.

BACKGROUND

Movement of a patient in bed results in two common adverse events: (a) increase in shear and friction forces between the patient and bed, which are extrinsic pressure ulcer risk factors, and (b) musculoskeletal injuries to nurses, resulting from repositioning patients who have migrated down in bed.

METHOD

The study involved 12 participants who lay supine in three hospital beds, which were articulated to common positions. Body movement relative to the bed was quantified with the use of motion capture. Cumulative movement, net displacement, and torso compression (shoulder to trochanter distance) were calculated for different bed types and bed movements.

RESULTS

Bed design and bed movement had a significant effect on most of the dependent variables. Bed design (e.g., type) influenced cumulative movement by up to 115%, net displacement by up to 70%, and torso compression by about 20%. Bed movement (e.g., knee elevation) reduced cumulative migration by up to 35%.

CONCLUSION

The quantification of patient migration provides a metric for evaluating the interaction between body and bed surfaces. Overall, the measures were sensitive to design changes in bed frames, bed articulations, and mattress inflation.

APPLICATION

Documentation of the cumulative movement, net displacement, and torso compression provides hospital bed designers quantifiable measures for reducing migration and potentially shear and friction forces when designing bed frames, bed articulations, and mattresses. Optimization of these metrics may ultimately have an impact on patient and caregiver health.

Adverse risk: a 'dynamic interaction model of patient moving and handling'

AIM

The aim of the present study was to examine patient adverse events associated with sub-optimal patient moving and handling.

BACKGROUND

Few studies have examined the patient's perspective on adverse risk during manual handling episodes.

EVALUATION

A narrative review was undertaken to develop the 'Dynamic Interaction Model of Patient Moving and Handling' in an orthopaedic rehabilitation setting, using peer-reviewed publications published in English between 1992 and 2010.

KEY ISSUES

Five predominant themes emerged from the narrative review: 'patient's need to know about analgesics prior to movement/ambulation'; 'comfort care'; 'mastery of and acceptance of mobility aids/equipment'; 'psychological adjustment to fear of falling'; and 'the need for movement to prevent tissue pressure damage'.

CONCLUSION

Prevalence of discomfort, pain, falls, pressure sores together with a specific Direct Instrument Nursing Observation (DINO) tool enable back care advisers to measure quality of patient manual handling. Evaluation of patients' use of mobility aids together with fear of falling may be important in determining patients' recovery trajectory.

IMPLICATIONS FOR NURSING MANAGEMENT

Clinical governance places a responsibility on nurse managers to consider quality of care for their service users. 'Dynamic Interaction Model of Nurse-Patient Moving and Handling' provides back care advisers, clinical risk managers and occupational health managers with an alternative perspective to clinical risk and occupational risk.

Moving and handling education in the community: technological innovations to improve practice

Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than sound educational theory. The purpose of this article is to summarize current evidence for educational interventions designed to reduce primary care staff injuries: a significant problem for decades. Evidence suggests that the current 'classroom' teaching of moving and handling is ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal injuries in health professionals (Freitag et al, 2007). The authors discuss potential solutions through moving and handling-related motion capture simulation and the use of e-learning to promote an understanding of the principles associated with patient handling tasks.

Learning safe patient handling skills: student nurse experiences of university and practice based education

INTRODUCTION

Poor patient handling practices increase nurse injuries and reduce patients' safety and comfort.

BACKGROUND

UK Universities have a duty to prepare student nurses for patient handling activities occurring during clinical placements. This study examines students' experiences of moving and handling education in academic and clinical settings.

METHODS

A 34 item questionnaire was distributed to student nurses at one School of Nursing (n=432, response rate of 75%).

RESULTS

Many students undertook unsafe patient handling practices and provided reasons for this. There was a medium statistically significant correlation between the variables 'provision of supervision' and 'awareness of patient handling needs' (r(s)=.390, p=.000). 40% of students stated that their M&H competency was assessed through direct observation. Twenty six percent of the total sample (n=110), said they had begun to develop musculo-skeletal pain since becoming a student nurse. Forty-eight stated that this was caused by an incident whilst on placement.

DISCUSSION

Inadequate patient handling practices threaten student nurse safety in clinical settings. Although some students may be overly confident, they should be supervised when undertaking M&H activities.

CONCLUSIONS

Though important, University based M&H education will only be beneficial if students learn in clinical settings that take safe patient handling seriously.

Erasing the word 'lift' from nurses' vocabulary when handling patients

The incidence of back injuries is catastrophic to the nursing profession. It is paramount that individual practitioners attempt to significantly reduce the number of back injuries in nursing teams. Erasing the word 'lift' from nurses' vocabulary when handling patients can empower patients and promote good safe practice. This article offers a literature-based discussion of patient handling in relation to safety for both patients and nurses. Nurses' handling practice is governed by legislation and NHS Trust policies. This article suggests ways of developing safe practice that is empowering for both nurses and patients, advocating team working and safeguarding the interests of the patient and handler.

Nurses' Expectations, Experiences and Attitudes towards the Intervention of a ‘No Lifting Policy’

The aim of the study was to evaluate expectations and attitudes towards a No Lifting Policy programme, the "No Lift system", among nurses at hospitals where an introduction of the intervention was planned (PreNLS hospitals), and to make a comparison with nurses' experiences and attitudes at one hospital where the intervention had already been implemented (NLS hospital). A cross-sectional study of nurses at two PreNLS hospitals and one NLS hospital was performed. Most nurses at both the PreNLS hospitals and the NLS hospital were positive or very positive to the intervention. The expected and experienced obstacles differed between nurses at the PreNLS hospitals and the NLS hospital; however, there was more agreement concerning benefits. The most frequently expected obstacles at the PreNLS hospitals were organisational issues and obstacles related to the facilities, while most obstacles identified at the NLS hospital concerned specific transfers or were patient-related. A decrease in the number of injuries was the most often considered benefit among most nurses. Nurses at the NLS hospital rated their physical exertion as lower in seven out of nine specific patient transfers compared with nurses at the PreNLS hospitals. They also reported increased well-being at work and an improved ability to manage their daily work. The comprehensive approach and participatory design, including all levels of staff and extensive support from the nurses' own union and management, is probably one important explanation for the positive attitudes and successful introduction of the intervention.

Friction-reducing devices for lateral patient transfers: a clinical evaluation

The purpose of this study was to assess the performance of lateral transfer devices compared with the traditional draw sheet method in acute care settings through subjective feedback of caregivers actually using the devices. Every 2 weeks, the eight participating acute care units each received one of the devices, which had been randomly selected. Data were collected through caregiver surveys, which rated comfort, ease of use, perceived injury risk, time efficiency, and patient safety. An overall performance rating was calculated as the sum of these five categories. Caregivers rated air-assisted devices significantly higher (p < .05) than other devices. Lateral transfer devices are recommended over the traditional draw sheet method for performing lateral patient transfers. These friction-reducing devices are a cost-effective solution to the load of lateral patient transfers and should be favorably considered when purchasing patient-handling technologies.

Evaluation of nursing students' work technique after proficiency training in patient transfer methods during undergraduate education

The aim of this study was to investigate if nursing students improved their work technique when assisting a simulated patient from bed to wheelchair after proficiency training, and to investigate whether there was a correlation between the nursing students' work technique and the simulated patients' perceptions of the transfer.

METHOD

71 students participated in the study, 35 in the intervention group and 36 in the comparison group. The students assisted a simulated patient to move from a bed to a wheelchair. In the intervention group the students made one transfer before and one after training, and in the comparison group they made two transfers before training. Six variables were evaluated: work technique score; nursing students' ratings of comfort, work technique and exertion, and the simulated patients' perceptions of comfort and safety during the transfer. The result showed that nursing students improved their work technique, and that there was a correlation between the work technique and the simulated patients' subjective ratings of the transfer. In conclusion, nursing students improved their work technique after training in patient transfer methods, and the work technique affected the simulated patients' perceptions of the transfer.

The safety and dignity of patients and nurses during patient handling

Since the implementation of the Moving and Handling Operations Regulations (Health and Safety Executive, 1992) there has been considerable effort to reduce back injury among nurses by developing patient handling policy that eliminates actual manual handling. Recently, however, there have been challenges to 'no manual handling' policies by patients as an issue of dignity and human rights. This article offers a literature-based discussion of patient handling in relation to safety and dignity for both patients and nurses. The literature does not offer a solid evidence base for handling practice, and research, involving patents, is limited. However, nurses' handling practice is governed by legislation and NHS Trust policies. Patient handling that is safe and dignified for both patient and handler is a vital skill that requires knowledge and competence. This article suggests ways of developing practice that is safe and dignified for both patient and handler.

Bariatric Programs in Nursing Homes

The increase in prevalence of obesity in older individuals and the association of obesity with increased morbidity, functional decline, hospitalization, and complications is expected to increase the number of individuals who have obesity requiring nursing home care, particularly subacute and short-term rehabilitation. Providing appropriate nursing home care to residents who have obesity requires environmental modifications, specialized equipment, and staff training. Effective nursing home care of residents who have obesity is interdisciplinary and requires special nursing, medical, nutritional, psychosocial, and rehabilitation considerations.

A direct observation instrument for assessment of nurses' patient transfer technique (DINO)

The aim of this project was to develop a direct observation instrument to assess the work technique of nursing personnel during patient transfers and to test the validity and reliability of the instrument. An expert group developed this instrument, called DINO (DIrect Nurse Observation instrument for assessment of work technique during patient transfers), which contains 16 items divided into three phases of a transfer: the preparation, performance and result phases. To quantify the assessments a scoring system was constructed, giving an overall score for each transfer, depending on the level of musculoskeletal health and safety. Four observers assessed 45 patient transfers at hospital wards and showed in an evaluation that the inter-observer reliability and criterion-related validity of DINO was satisfactory. The assessments with the DINO instrument are done directly when the transfer occurs, without costly equipment. Therefore, it has a wide range of applications. For example, when evaluating training in work technique or when identifying an unsafe work technique as a risk factor for musculoskeletal problems in epidemiological studies.