Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel

Patient's Perception of the Role of Gym Activity in Abdominal Wall Herniation in Adults: A Prospective Study

BACKGROUND

Despite significant changes in healthcare, work practices, and leisure activity, the proposed precipitating factors for abdominal wall hernias have remained largely unchanged for almost two centuries. We aimed to investigate if there have been shifts in these factors over time by examining patients' perception of precipitating factors for abdominal wall hernia development. This study was conducted in the Royal College of Surgeons In Ireland Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, where patients with abdominal wall hernias completed a questionnaire  .

RESULTS

A total of 277 patients (mean age 55.7; 85.6% male) with abdominal wall hernia completed the questionnaire (66.1% inguinal; 10.8% umbilical; 6.9% paraumbilical; 10.5% epigastric; 3.2% incisional; 1.4% femoral, and 1.1% port-site). One hundred and twenty patients (43.3%) believed their hernia was due to lifting, 71 (25.6%) cited gym activity and 17 (6.1%) cited other sporting activities as the precipitating factor. Traditional factors - chronic cough and constipation - were cumulatively cited only by 11 patients (4.0%), while prostatic obstruction was not cited by any.

CONCLUSION

This study suggests that fitness pursuits may be an increasing contributor to the development of abdominal wall hernia. Greater attention should be paid to the proper use of gym equipment to minimise the risk of hernia development.

Evaluating the Effectiveness of a Training on Ergonomic Risks of Measuring Blood Pressure

Background: Musculoskeletal disorders (MSDs) occur as a result of long-term exposure to inappropriate working postures and repetitive use of body postures, leading to harmful consequences for patients, employees, and employers. Evaluating distinct working postures can contribute to effective interventions. Purpose: The aim of this study was to determine ergonomic risks of MSDs during repeated blood pressure measurement processes and to evaluate the effectiveness of a training on this topic. Methods: A pretest/posttest quasi-experimental design studied 64 nurses in a training and research hospital in Turkey. Participants were evaluated for the prevalence and risk of MSDs using the Nordic Musculoskeletal Questionnaire Extended Version and the Rapid Entire Body Assessment (REBA) Checklist, and by photographing them performing the procedure. Nurses with high risk for MSDs received an ergonomics training program and were followed up twice in 3 months. Results: Reduction in prevalence of MSDs in neck, shoulder, and hip/thigh areas, and in mean REBA scores after the training were statistically significant. Conclusion: Nurses should be trained about correct posture for specific high-risk activities that may cause MSDs, and offered exercise programs that support the musculoskeletal system.

Efficacy of an Omaha system-based remote ergonomic intervention program on self-reported work-related musculoskeletal disorders (WMSDs) - A randomized controlled study

Purpose

Heavy biomechanical loadings at workplaces may lead to high risks of work-related musculoskeletal disorders. This study aimed to explore the efficacy of an Omaha System-based remote ergonomic intervention program on self-reported work-related musculoskeletal disorders among frontline nurses.

Materials and methods

From July to October 2020, 94 nurses with self-reported pain in one of the three body parts, i.e., neck, shoulder, and low back, were selected and were randomly divided into two groups. The intervention group received a newly developed remote program, where the control group received general information and guidance on health and life. Program outcome was evaluated by a quick exposure check approach.

Results

After 6 weeks, the intervention group exhibited significantly less stress in the low back, neck, and shoulder/forearms, compared to the control group (p < 0.05). In addition, the occurrence of awkward postures, such as extreme trunk flexion or twisting, was also significantly reduced (p < 0.05).

Conclusions

The newly developed Omaha System-based remote intervention program may be a valid alternative to traditional programs for frontline nurses during the COVID-19 pandemic, reducing biomechanical loadings and awkward postures during daily nursing operations.

A tailored, interdisciplinary, multicomponent approach to decreasing workers' compensation claims and costs in a hospital system: A retrospective study

GOAL

Healthcare is the leading profession for risk of injury with workers face a number of potential risk factors leading to musculoskeletal disorders. One method to promote safety for healthcare workers is with body mechanics training and ergonomics. Evidence suggests multicomponent interventions are required for successful safe patient handling programs. While numerous studies have considered interventions for nurses and nursing programs, few have targeted both patient handling and non-patient handling employees simultaneously in a healthcare setting. Our main objective is to describe the implementation of a tailored multicomponent program (TMP) to address the needs of each department within a healthcare setting and examine the percentage of subsequent claims and overall costs reported.

METHODS

The TMP was designed to combine department specific and employee specific evaluations and interventions to address workplace needs for all employees. Physical therapists implemented a combination of tailored hands on inservices, orientations, ergonomic assessments, physical therapy screens, return to work appointments, and education sessions over a period of six years. By tailoring the approach for each department, the TMP could focus on employee safety and environmental awareness, ultimately lower the risk of injury, claims and costs.

PRINCIPAL FINDINGS

Results demonstrated a statistically significant decrease in workers' compensation claims and overall costs in the years following the implementation of the TMP. Changes were immediate and continued over several years, indicating the effectiveness of the TMP.

PRACTICAL APPLICATIONS

Healthcare continues to be the most dangerous profession, with workers facing risk of injury from a number of possibilities. The TMP effectively addressed those risks. As the health care institution grew and evolved, so, too, did the TMP, altering itself and the needs and risks for each department changed. Interdisciplinary collaboration and communication were key to the success of the program. Continued reassessment is required to address the changing needs and institutional growth to ensure future success.

The differences between normal and obese patient handling: re- structural analysis of two questionnaires

BACKGROUND

Precise causes of musculoskeletal complaints among nurses are not known well, but many studies have pointed to manual patient handling tasks. Subjective judgment and decision-making process for patient lifting is crucial for gathering data regards patient handling. The aim of this study was to consider reliability and validity and re-structure of two special tools for patient handling's tasks.

METHODS

In this cross- sectional study 249 nurses were fully participated. As recommended by literature for cultural adaptation of instruments, forward/backward translation method was applied. Reliability of the translated version was assessed by Cronbach's alpha coefficient. Validity testing for the two scales was based on content validity index/ratio analysis and also Exploratory Factor Analysis was run to extract latent factors.

RESULTS

Reliability estimated by internal consistency reached a Cronbach's Alpha of above 0.7 for all subscales of two questionnaires. After testing the validity, the final version of questionnaires was remained by 14 and 15 questions respectively.

CONCLUSIONS

These instruments evaluated for manual handling of normal and obese patients had acceptable validity and reliability in Iranian Nursing context. So, these tools can be used in further studies with the same cultures.

An evaluation on the effects of safe person handling program implementation at long term care facilities for persons with complex intellectual, developmental, and medical conditions

BACKGROUND

This retrospective chart review sought to determine whether the introduction of a safe person handling and mobility (SPHM) program resulted in changes to the frequency, severity, cost, or profile of staff injuries incurred during person handling (PH) tasks at long-term care settings for persons with complex conditions.

METHODS

This study analyzed the SPHM program implementation at an organization providing long-term residential, day habilitation, and special education services for persons with complex conditions. Data covered two 4-year periods before and after implementation. Analyses compared the frequency, severity, and cost of staff PH injuries, as well as of the affected body area, staff role, level of treatment, and the incurred costs of Workers' Compensation (WC) claims.

RESULTS

There were substantive decreases in the total number of staff PH injuries and WC claims. Staff PH injuries affecting the trunk, the area most associated with PH injuries, decreased the most, followed by the upper extremities. Reductions were concentrated among direct care employees and their supervisors, job titles where PH exposures are most commonly seen. The proportion of staff injuries requiring medical treatment decreased significantly, as did injury severity. The number of lost workdays decreased by 94.6%. Incurred WC costs decreased by 91.1%. The proportion of WC claims associated with lost time decreased significantly.

CONCLUSIONS

Substantive reductions in the frequency, severity, and incurred WC cost of staff PH injuries followed implementation of the SPHM program. Likewise, proportional changes were identified among the programs where cases occurred, the need for medical treatment, and WC cost type.

The Effect of Interventions on Preventing Musculoskeletal Injuries Related to Nurses Work: Systematic Review

BACKGROUND

The 12-month prevalence of musculoskeletal disorders related to work (MDRW) in nurses rests between 71.8% to 84%, so it is urgent to develop preventive intervention programs with the purpose of avoiding negative physical, psychological, socioeconomic, and working aspects. There are several intervention programs aimed at preventing musculoskeletal disorders related to work for nurses, but few have successfully proven results. Despite the evidence pointing to the benefits of multidimensional intervention programs, it is essential to determine which interventions have positive effects on the prevention of this kind of disorder to create an effective intervention plan.

AIM

This review intends to identify the different interventions adopted in the prevention of musculoskeletal disorders related to work in nurses and to compare the effectiveness of these interventions, providing the appropriate and scientific basis for building an intervention to prevent musculoskeletal disorders in nurses.

METHOD

This Systematic Review was guided by the research question, "What are the effects of musculoskeletal disorders preventive interventions on nursing practice?" and carried out in different databases (MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials, SCOPUS, and Science Direct). Later, the results were submitted to the eligibility criteria, the appraisal quality of the papers, and the data synthesis was performed.

RESULTS

13 articles were identified for analysis. The interventions implemented to control the risk were: training patient-handling devices; ergonomics education; involving the management chain; handling protocol/algorithms; acquiring ergonomics equipment; and no-manual lifting.

CONCLUSIONS

The studies associated two or more interventions, the majority of which (11 studies) were training-handling devices and ergonomics education, therefore emerging as the most effective instruments in the prevention of MDRW. The studies did not associate interventions that cover all risk factors (individual, associated with the nature of the work, organizational, and psychological aspects). This systematic review can help with making recommendations for other studies that should associate organizational measures and prevention policies with physical exercise and other measures aimed at individual and psychosocial risk factors.

Musculoskeletal disorder (MSD) prevention practices by nurses working in health care settings: Facilitators and barriers to implementation

The incidence of musculoskeletal disorders (MSD) in the healthcare professional population is concerning. In particular, the high incidence of back injuries is an issue for nurses. Although many MSD prevention initiatives are being implemented, these practices are not succeeding in reducing MSDs. Why are these efforts struggling to close the gap between knowledge and practice? This article aims to report on individual and organizational factors that may influence nurses' implementation of MSD prevention practices. A survey was sent to nurses in the Quebec health and social services network. A total of 399 questionnaires were completed and analyzed. The results revealed that nurses have the required knowledge on MSD prevention practices, but have difficulty applying them in their professional context. It would appear that successful implementation of MSD prevention practices relies mainly on organizational factors, including management support, organizational culture, feedback mechanisms, and training that is adapted to the work environment.

Evaluation of MSOT students' didactic knowledge and practice vs. real-time performance in manual patient transfers

BACKGROUND

Due to the nature of its occupations, the healthcare industry recognizes that manually lifting, transferring, and handling patients are high-risk activities and leading factors for work-related musculoskeletal disorders. Research studies highlight that students are not receiving adequate training in manual patient transfer.

OBJECTIVE

The objective of this study was to examine the procedural knowledge in patient transfer of second-year Master of Science in Occupational Therapy students and their practical skills in performing a manual patient transfer.

METHODS

This observational, cross-sectional study included 23 occupational therapy students. Students completed the transfer technique knowledge assessment and subsequently performed a real-time manual patient transfer.

RESULTS

No significant association was found between the participants' knowledge and performance in MPT (x2(2) = 0.578, p = 0.749). All students scored highly on the knowledge assessment (μ= 9.3, SD =±1.02); however, the performance on real-time manual patient transfer was moderate (μ= 11.57, SD =±3.37) for the majority of students.

CONCLUSION

A gap exists between the results of students' knowledge and practice versus real-time performance in manual patient transfer. The practical training students receive on manual patient transfers in the academic setting may not equip them with the necessary skills and techniques to perform safe transfers.

Safe patient handling legislation and musculoskeletal disorders among California healthcare workers: Analysis of workers' compensation data, 2007-2016

BACKGROUND

California requires general acute care hospitals to have a comprehensive plan to prevent patient handling injuries (PHIs) among employees. The California safe patient handling (SPH) law took effect in 2012. This study assessed the impact of the SPH law on workers' compensation claims for musculoskeletal disorders (MSDs) in California hospital workers.

METHODS

We used California Workers' Compensation Information System data from 2007 to 2016 and analyzed claims for MSDs that occurred in acute care hospitals compared with nursing and residential care facilities. MSD claims were classified into PHI and non-PHI claims.

RESULTS

We identified 199,547 MSD claims that occurred during 2007-2016 in acute care hospitals (62.8%) and nursing and residential care facilities (37.2%). MSDs accounted for 42.8% of all claims. Of the MSD claims, 81.0% were strains or sprains and 33.5% of MSDs were related to patient handling activities. From 2011 to 2016, MSD claim rates showed significant reductions among both hospital and nursing/residential care workers. However, the MSD-PHI claim rate showed a significant reduction only among hospital workers (7.3% per year, incidence rate ratio [IRR] = 0.927, 95% confidence interval [CI] 0.903-0.952). There was no significant change among nursing/residential care workers (IRR = 0.990, 95% CI 0.976-1.005). The non-PHI claim rate showed no significant change among hospital workers (IRR = 0.982, 95% CI 0.956-1.009).

CONCLUSIONS

Our study identified significant reductions of PHI claims among California hospital workers after the passage of the SPH legislation, suggesting that SPH legislation played a crucial role in reducing the risk of injury among healthcare workers.

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.

Occupational injuries and patient lift usage among physical rehabilitation therapists

BACKGROUND

Physical therapists (PTs) and physical therapist assistants (PTAs) are at high risk for work-related musculoskeletal pain and discomfort.

OBJECTIVE

Determine the prevalence and exposure risk factors for work-related injuries (WRIs) among rehabilitation PTs and PTAs.

METHODS

A cross-sectional research survey was conducted among 170 PTs and 67 PTAs at 51 free-standing rehabilitation hospitals and rehabilitation units embedded in general hospitals in the Midwestern states of Iowa, Kansas, Missouri and Nebraska. The prevalence of WRIs and significant risk factors for developing WRIs were determined for PTs and PTAs.

RESULTS

The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 29.5%. Multifaceted causes were identified including frequently bending/twisting, over-exerting force during patient handling activities, inadequate lifting devices, and lack of ongoing training for mechanical lifting device usage.

CONCLUSIONS

Equipment usage barriers point to a critical need for technology creation, research, and education to advance worker safety while simultaneously enhancing patient outcomes.

Does Postural Feedback Reduce Musculoskeletal Risk?: A Randomized Controlled Trial

Background: There is a high prevalence of musculoskeletal disorders among personnel working in the healthcare sector, mainly among nursing assistants and orderlies. Objective: The objective is to analyze the effectiveness of a multi-component intervention that included postural feedback in reducing musculoskeletal risk. Method: A total of 24 nursing assistants and orderlies in a hospital setting were randomly assigned to an intervention group or a control group. After collecting sociodemographic information, a selection of tasks was made and assessed using the REBA (rapid entire body assessment) method. A multi-component intervention was designed combining theoretical and practical training, including feedback on the postures performed by the professionals involved, especially those involving high musculoskeletal risk. This program was applied only to participants in the intervention group. Subsequently, eight months after the first assessment and intervention, the second assessment was carried out using the same method and process as in the first evaluation. Results: The results indicate that the musculoskeletal risk in the second assessment in the intervention group was significantly reduced. However, no significant changes were observed in the control group. Conclusion: The multi-component intervention applied can significantly reduce the musculoskeletal risk of nursing assistants and orderlies. In addition, it is a low-cost intervention with great applicability.

Identification of care tasks for the use of wearable transfer support robots - an observational study at nursing facilities using robots on a daily basis

BACKGROUND

To reduce the physical burden of caregivers, wearable transfer support robots are highly desirable. Although these robots are reportedly effective for specific tasks in experimental environments, there is little information about their effectiveness at nursing care facilities. The aim of this study was to identify care tasks and operations suitable for the use of these robots among caregivers in nursing facilities where these robots have been in use on a daily basis.

METHODS

A 1-min observational time-motion analysis was conducted to examine care tasks and operations in two nursing facilities where wearable transfer support robots, namely Muscle Suit or HAL® Lumbar Type for Care Support, have been used routinely on a daily basis for more than 24 months.

RESULTS

Analysis of the care tasks and their time ratio while wearing the equipment revealed that both robots were used conspicuously for direct care in over 70% of transits, especially during transfer assistance and toileting care. Furthermore, these robots were used intensively in the morning along with wake-up calls to care recipients, where pre-assigned wearers used them as part of their "routine work."

CONCLUSIONS

We found that these wearable transfer support robots enabled effective performance of care tasks and operations in nursing facilities where these robots have been used on a daily basis for an extended period of time. These results may lead to the effective implementation and sustained operation of other types of care robots in the future.

TRIAL REGISTRATION

UMIN Clinical Trials Registry no. UMIN000039204 . Trial registration date: January 21, 2020. Interventional study. Parallel, non-randomized, single blinded.

Deaths of Despair Among Healthcare Workers, Massachusetts, 2011 to 2015

OBJECTIVE

To explore mortality rates and trends according to the occupation of healthcare workers who died from the deaths of despair (DoD).

METHODS

Death certificates for deaths from 2011 to 2015 due to poisonings, suicides, alcholic liver disease and cirrhosis were collected and coded based on the decedent's occupation. Mortality rates and rate ratios were calculated according to occupations for healthcare workers.

RESULTS

There were 540 DoDs among Massachusetts healthcare workers, accounting for an average annual rate of 32.4 deaths per 100,000 workers. The highest mortality rate for DoDs were among medical assistants; nursing, psychiatric, and home health aides; miscellaneous; health technologists and technicians; emergency medical technicians, and paramedics.

CONCLUSIONS

Further research should examine factors contributing to elevated rates for DoDs among healthcare workers. Interventions targeted for these workers should be developed.

Safe patient handling and mobility (SPHM) for increasingly bariatric patient populations: Factors related to caregivers' self-reported pain and injury

This study was conducted at 5 Veterans Administration Medical Centers (VAMCs). A cross sectional survey was administered to 134 workers who routinely lift and mobilize patients within their workplaces' safe patient handling and mobility (SPHM) programs, which are mandated in all VAMCs. The survey was used to examine a comprehensive list of SPHM and non-SPHM variables, and their associations with self-reported musculoskeletal injury and pain. Previously unstudied variables distinguished between "bariatric" (≥300 lb or 136 kg) and "non-bariatric" (<300 lb or 136 kg) patient handling. Significant findings from stepwise and logistic regression provide targets for workplace improvements, predicting: lower injury odds with more frequently having sufficient time to use equipment, higher back pain odds with more frequent bariatric handling, lower back pain odds with greater ease in following SPHM policies, and lower odds of upper extremity pain with more bariatric equipment, and with higher safety climate ratings.

Biomechanical comparison between manual and motorless device assisted patient handling: sitting to and from standing position

Although lots of assistive devices have been studied to fight against caregivers' work-related musculoskeletal disorders, stand-and-turn devices effects on biomechanical constraints are still unknown. The aim of this study is to provide and compare quantitative data on loads in the low back area resulting from the use of a motorless stand-and-turn device and from manual patient handling. Nine caregivers participated to motion capture and ground reaction forces measurement sessions of three cases of handling: manual handling with one caregiver, manual handling with two caregivers, motorless device assisted handling. Forces and torques at the L5/S1 joint were computed through Inverse Dynamics process. Motorless device assisted handling required the smallest loads whereas manual handling with one caregiver required the biggest loads, the latter being in some cases twice as big as the former. Caregivers should use a stand-and-turn device when handling a patient from sitting/standing to standing/sitting position whenever it is possible.

Proning Patients With COVID-19: A Review of Equipment and Methods

OBJECTIVE

To identify and critically evaluate methods for proning patients with COVID-19 in the intensive care unit (ICU).

BACKGROUND

Acute respiratory distress syndrome (ARDS) is common in hospitalized patients with COVID-19. Proning improves blood oxygenation and survival rates in these patients but is not commonly performed due to the difficulty of the procedure.

METHODS

An academic literature review, internet video search, and consultation with five subject-matter experts was performed to identify known methods for proning. Evaluation of each method considered the number of healthcare workers required, physical stresses on staff, risk of adverse events to patients, and equipment cost and availability.

RESULTS

Several variations of manual techniques and-lift assisted techniques were identified in addition to a specialized proning bed. Manual methods require more healthcare workers, higher physical stresses, and greater risk of adverse events than lift-assisted methods or the proning bed.

CONCLUSION

Both the specialized proning bed and a lift-assisted method using straps largely eliminated manual forces required for proning while allowing for a controlled lowering and positioning of the patient.

APPLICATION

This review will guide practitioners to the most suitable methods for proning patients in the ICU.

Safe patient handling legislation and changes in programs, practices, perceptions, and experience of musculoskeletal disorders by hospital characteristics: A repeated cross-sectional survey study

BACKGROUND

Safe patient handling legislation has been enacted in 11 states in the United States to protect healthcare workers from patient handing injuries. Implementations and outcomes may vary across hospitals by the characteristics of the institution.

OBJECTIVES

This study was to investigate the changes in safe patient handling programs in hospitals, and nurses' perceptions, work practices, and musculoskeletal symptoms by hospital characteristics after the passage of California's safe patient handling legislation.

DESIGN

Repeated cross-sectional surveys.

SETTINGS

Two statewide surveys of registered nurses were conducted in California, where a safe patient handling law became effective in 2012. Random samples were selected from the lists of the California Board of Registered Nurses (2000 nurses in 2013 and 3000 nurses in 2016).

PARTICIPANTS

Among survey respondents (26% in 2013 and 20% in 2016), the study sample included 254 nurses in 2013 and 281 nurses in 2016, who met the eligibility for this study: nurses employed in a hospital and had direct patient care or patient handling duties.

METHODS

Data were collected by postal and on-line surveys. Data were compared by hospital size, geographic area, hospital teaching status, and ownership (for-profit, non-profit, government).

RESULTS

Between 2013 and 2016, nurses' reports showed improvements in safe patient handling policies and programs across the different characteristics of hospitals. In 2016, nurses in large, teaching, non-profit, and rural hospitals reported slightly better scores for safe patient handling program variables than their counterparts; however, changes in the use of mechanical lifting devices and experiences of musculoskeletal symptoms and injury were not significantly different by hospital characteristics. Overall, teaching hospitals consistently showed greater improvements than non-teaching hospitals for both hospital-level (safe patient handling programs and organizational practices) and individual-level (perceptions and symptoms) variables.

CONCLUSIONS

Our findings indicate overall improvements of safe patient handling programs in California hospitals after the passage of safe patient handling legislation. Positive changes appear to be greater among teaching, non-profit, and rural hospitals. However, greater positive changes in safe patient handling programs shown in certain hospital characteristics were not necessarily linked to more improvements in nurses' safe work practices and experiences of musculoskeletal symptoms or injuries.

Effect of an Ergonomics Educational Program on Musculoskeletal Disorders in Nursing Staff Working in the Operating Room: A Quasi-Randomized Controlled Clinical Trial

Background: Nursing staff working in the operating room are exposed to risk factors that can cause musculoskeletal disorders (MSDs) and work-related disabilities. The use of ergonomics principles can help with the prevention of MSDs. This study aimed to examine the effect of an ergonomics educational program on MSDs among nursing staff working in the operating room. Methods: In this pragmatic parallel group quasi-randomized controlled clinical trial, 74 nursing staff working in the operating rooms of two teaching hospitals participated. The hospitals were randomly assigned to either the intervention or the control group and all nursing staff working in the operating room of each hospital were invited to take part in this research. They were initially assessed for the prevalence and risk of MSDs by using the Nordic questionnaire and the rapid entire body assessment (REBA) checklist. The intervention group received the ergonomics educational program and were assessed in two-week intervals over a period of three months. At the end of the study, the risk and prevalence of MSDs were compared between the intervention and control groups. Results: Statistically significant differences were reported between the groups in terms of the prevalence and risk of MSDs. The overall risk of MSDs decreased in the intervention group after the educational program (p = 0.03). The reduction in the prevalence of MSDs in the different parts of the body in the intervention group was as follows: ankle (p = 0.005), hand/wrist (p = 0.041), low back (p = 0.000), the neck (p = 0.003), hip (p = 0.001) and shoulder (p = 0.043). Conclusion: The education of nursing staff about ergonomics can influence the prevalence and risk of MSDs. Therefore, it should be incorporated into the degree education and on-the-job training initiatives for nurses working in the operating theatre in order to reduce workplace injuries and associated absences, and increase the quality of care delivered by them. This clinical trial has been registered in the Iranian Registry of Clinical Trials: IRCT2015081823677N1.

Development and Feasibility Testing of a Contextual Patient Movement Intervention

INTRODUCTION

Nurses and emergency medical services workers frequently suffer musculoskeletal injuries at a disproportionate rate in relation to the rest of the population. The most common form of this musculoskeletal injury is lumbar spine injury. The purpose of this study was to develop and conduct phase 1 feasibility testing of a contextual lifting intervention that reduces the risks of low back injury.

METHODS

This study was an intervention development and phase 1 feasibility test. The intervention was created on the basis of weightlifting techniques to specifically reduce the incidence injury related to valgus knee, asymmetrical lifting technique, and rotation of the trunk and pelvis. Motion capture technology (Xsens; Xsens Technologies) was used while 17 nursing students completed the direct patient lift from the floor, the lift from the floor with a manikin attached to a rigid spine board, the push portion of the horizontal transfer, and the pull portion of the horizontal transfer. Pre- and postintervention data were collected. Linear mixed model regression, with pairwise comparisons, was conducted for each lift at the time points of preintervention, immediately after the intervention, and 1-month postintervention.

RESULTS

Significant changes were noted between the initial lifting techniques used and those used after the intervention. The maximum lever arm distance, defined as the distance from L5-S1 to the center of the force applied to the load, showed a significant reduction after the intervention in 3 of the 4 movements.

DISCUSSION

Our results support the idea that injury risk can be reduced through appropriate contextual training methods.

Evaluation of the Minnesota Safe Patient Handling Act: trends in workers' compensation indemnity claims in nursing home workers before and after enactment of the law

OBJECTIVES

The 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention.

METHODS

Workers' compensation indemnity claims for years 2005-2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention.

RESULTS

The patient handling indemnity claim rate declined by 25% in years 4-6 and 38% in years 7-9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7-9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate.

CONCLUSIONS

Results suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts.

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.

The effects of "Workplace Health Promotion Program" in nurses: A randomized controlled trial and one-year follow-up

In this study, the authors examined the effects of the "Workplace Health Promotion Program" (WHPP) on pain, fatigue, stress, professional quality of life (Pro-QoL), and coping skills for nurses. The authors conducted a randomized control trial in 30 nurses who agreed to participate in this study. Progressive relaxation training, posture and breath exercises, and ergonomic suggestions as a WHPP were applied to the intervention group (n = 15) during the five weeks. The intervention group showed decrease in pain (p = .001), fatigue (p = .001), and stress levels (p = .003) and increase in coping skills and Pro-QoL (p < .05). In contrast, the authors observed no improvement in the control group. The authors concluded at the end of the study that WHPP remains effective in nurses.

Design and evaluation of a simple and affordable transfer assistive device for wheelchair users in the context of developing country

PURPOSE

The present study aimed at designing a simple, affordable, yet safe transfer assistive device (TAD) for lower limb impaired individuals in the context of a developing country.

METHODS

The preliminary study carried out, comprising a pilot survey with the involvement of stakeholder's views to design and develop the proposed device that had a unique feature. To evaluate the present TAD in terms of user's comfort of use and level of physical strain, subjects including 19 healthy students serving as "patients" have participated in a laboratory-simulated setting. Data was collected based on user's physiologic effort and rate of perceived exertion using Heart rate monitoring device (Polar RS 400 heart taster) and Borg's scale, respectively.

RESULTS

The data were analysed statistically and revealed that the regression equation for predicting the RPE from HR showed 31.3% of the variance in RPE was predictable from the level of HR. The ANOVA significance also indicates the model is statistically significant with (p < 0.013). Similarly, the estimated strain level has computed in terms of %HRR, and the physical strain averaged over the subjects who performed the task (n = 19) was expressed in terms of (mean ± SD) %HRR were (16.21±7.64%) which was a relatively smaller strain level as compared to the previous research report.

CONCLUSION

The present device found a potentially affordable solution for reducing fatigue and strain level that might develop during unassisted transfer. Similarly, the unique feature of the armpit support has contributed to dynamic contact force reduction and as double safety support.Implications for rehabilitationThe use of transfer assistive device is associated with increased patient satisfaction and privacy of usersImproved patient adherence and cooperation with caregivers in rehabilitation center.Encourages the rehabilitation settings to use transfer assistive devices instead of manual handling there by increase the recovery period.

Healthcare Workers and Manual Patient Handling: A Pilot Study for Interdisciplinary Training

Manual patient handling (MPH) is a major occupational risk in healthcare settings. The aim of this study was to propose an MPH training model involving interdisciplinary aspects. A scheduled training program was performed with 60 healthcare workers (HCWs) from a hospital in Naples, Italy, providing training divided into three sections (occupational health—section one; physical therapy—section two; psychosocial section—section three) and lasting six hours. Fifty-two HCWs performed the training session. In section one, a questionnaire about risk perception related to specific working tasks was administered. Section two provided specific exercises for the postural discharge of the anatomical areas most involved in MPH. The last section provided teamwork consolidation through a role-playing exercise. The training program could also be useful for risk assessment itself, as they can examine the perceptions of the specific risk of the various workers and incorrect attitudes and therefore correct any incorrect procedures, reducing exposure to specific risks in the field. This pilot study proposes a training model that explores all aspects related to MPH risk exposure and also underlines the need for standardization of this formative model, which could represent a useful tool for studying the real effectiveness of training in workplaces.

The biomechanical evaluation of patient transfer tasks by female nursing students: With and without a transfer belt

This study was to examine the kinematics, muscle activities, and perceived physical exertion in different regions of the spine during patient transfers by nursing students between a bed and a wheelchair, with or without a transfer belt in a laboratory setting. Results showed that with the effect of the belt, the % maximum voluntary contraction of the lumbar erector spinae was reduced significantly by nearly 10%. Muscle activity was significantly increased in thoracic erector and multifidus spinae during wheelchair-to-bed transfer, compared to bed-to-wheelchair transfers. There was no significant effect of belt or task on the spinal angular displacement in different spinal regions. Using the transfer belt was associated with a significantly decreased score for perceived exertion. In conclusion, this study supports the use of a transfer belt contributing to lower muscle activity and lower perceived physical exertion in the low back.

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Person transfer assist systems: a literature review

OBJECTIVE

Novel developments in the robotics field have produced systems that can support person wheelchair transfers, maximize safety and reduce caregiver burden. The purpose of this study was to identify and describe these systems, their usability (or satisfaction), the context for which they have been or can be used and how they have been evaluated to determine evidence for their effectiveness.

METHOD

Available research on Person Transfer Assist Systems (PTAS) was systematically gathered using similar standards to the PRISMA guidelines. The search terms were derived from common terms and via exploring similar review articles. Initial search terms displayed 1330 articles and by using the inclusion/exclusion criteria 96 articles were selected for abstract review. After full- text reviewing 48 articles were included.

RESULTS

29 articles concerned research in robotic transfer systems, 10 articles used both ceiling and floor-mounted lifts and 9 articles used only floor-mounted lifts as an intervention/control group. The results of this analysis identified a few usability evaluations for robotic transfer prototypes, especially ones comparing prototypes to existing marketed devices.

CONCLUSION

Robotic device research is a recent development within assistive technology. Whilst usability evaluations provided evidence that a robotic device will provide better service to the user, the sample number of subjects used are minimal in comparison to any of the intervention/control group articles. Experimental studies between PTASs are required to support technological advancements. Caregiver injury risk has been the focus for most of the comparison articles; however, few articles focus on the implications to the person.IMPLICATIONS FOR REHABILITATIONCeiling mounted lifts are preferred over floor-based lifts due to lower injury rates.Many robotic transfer systems have been developed; however, there is a paucity of quantitative and qualitative studies.Based on the results of this review, rehabilitation settings are recommended to use ceiling over floor assist systems, and it is recommended to provide training on using devices to assist with patient transfers to lower the risk of injuries.

Lateral Transfer Assist Robot (LTAR): Development of a proof-of-concept prototype

BACKGROUND

Falls during transfer to and from a wheelchair are associated with numerous problems. Factors responsible for difficulty in transferring include horizontal/vertical gaps between surfaces; obstacles, such as armrests; and complicated brake/footrests configurations before transferring. Moreover, controlling a wheelchair sufficiently close to the transfer surface within the confined home space is difficult.

OBJECTIVE

We described the design of the novel Lateral Transfer Assist Robot (LTAR) for solving problems during transfer. Furthermore, the effectiveness and usability of the robot were preliminary examined in healthy adults.

METHOD

The transfer problems and basic designs were organized. The effectiveness of the prototype was measured by three-dimensional motion analysis and questionnaire.

RESULTS

The prototype LTAR was developed. With just a push on a button, the footplate lowers to the floor and the seat and armrest lowers to the height of the seating surface to fill the gap between the surfaces. Using these features, users can transfer by simply shifting their buttocks sideways. Additionally, LTAR has omnidirectional wheels that help move it within a narrow space. The LTAR was confirmed to reduce the physical and subjective burden, except for maneuverability.

CONCLUSION

The LTAR was found to be effective for home use and reducing burden of transfer.

CE: Original Research: Patient Handling and Mobility Course Content: A National Survey of Nursing Programs

: Purpose: Despite the evidence supporting safe patient handling and mobility (SPHM) practices, anecdotal evidence suggests that such practices are not universally taught in academic nursing programs. The primary goal of this cross-sectional descriptive study was to understand what nursing programs teach students about lifting, turning, transferring, repositioning, and mobilizing patients.

METHODS

Faculty from baccalaureate and associate's degree nursing programs in the United States were invited via e-mail to complete a 64-item survey questionnaire, which was accessible through an online link. Participants were also invited to send documents related to SPHM course content to the research team.

RESULTS

Faculty from 228 baccalaureate and associate's degree nursing programs completed the questionnaire. Most curricula included outdated manual techniques, taught reliance on body mechanics to reduce the risk of musculoskeletal injuries, and made use of nonergonomic aids such as draw sheets. Elements of SPHM in the curricula were less common, and nearly half of the respondents didn't know whether their affiliated clinical facilities had an SPHM program.

CONCLUSIONS

The survey results suggest many possibilities for improvement-such as partnering with faculty in physical and occupational therapy departments, clinical partnering, and working with equipment vendors-to better incorporate evidence-based SPHM principles and practices into nursing curricula.

Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury

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.

Priority approaches of occupational safety and health activities for preventing low back pain among caregivers

Objectives

The incidence of occupational low back pain (LBP) is high among caregivers. The use of care equipment and training about care methods could prevent LBP among caregivers. However, in care facilities in Japan, these measures are not adequately employed. Moreover, the care facilities have faced issues regarding poor staffing in recent years. The present study investigated the relationship between LBP and occupational safety and health activities (OSHAs) for preventing LBP among caregivers and aimed to validate the priority approaches of OSHA.

Methods

This cross‐sectional study was conducted in care facilities for the elderly in Japan. Questionnaires for administrators and caregivers were distributed to 1,000 facilities and 5,000 caregivers, respectively. Questionnaires completed by 612 facilities and 2,712 caregivers were analyzed.

Results

No direct association was observed between severe LBP and OSHA, but indirect association was done. A significant relationship was noted between severe LBP and the care methods. Direct factors causing severe LBP were lifting a resident using human power and taking an unsuitable posture. These care methods were associated with the following OSHAs: promoting the use of care equipment, training about care methods, and consultation regarding the use of care equipment and employing an appropriate care method with the person in charge.

Conclusions

These OSHAs decreased lifting a resident using human power and taking an unsuitable posture, which are the primary risk factors of LBP. Therefore, these OSHAs should be implemented as priority approaches to prevent LBP among caregivers in care facilities for the elderly.

Effectiveness of a multifactorial ergonomic intervention and exercise conditioning kinesiology program for subsequent work related musculoskeletal disorder prevention

BACKGROUND

Health care workers are known to be at high risk for occupational musculoskeletal disorders and injuries. Many different intervention strategies have been implemented in order to reduce the risk of injury to health care workers, however not many have been proven to be effective. A continuing care establishment in Ottawa, Canada, implemented a multidimensional kinesiology intervention program for injured employees.

OBJECTIVE

To evaluate the effectiveness of the kinesiology intervention program on reducing subsequent rates for the nursing personnel and analyze the impact of age, position (RN, RPN, PCA) and sex on subsequent injuries.

METHODS

The number of recorded work related musculoskeletal disorders (WRMSD) for each patient care worker was counted from 2007-2011. The control group included injured employees that were not referred to the kinesiologists, or who chose not to participate in the program. The intervention group included injured employees that were referred to the kinesiology service and followed their treatment program.

RESULTS

The intervention group showed a statistically significant reduction of subsequent acute cases when compared to the control group. Nevertheless there was no significant impact regarding age, position or sex on subsequent acute cases.

CONCLUSION

The kinesiology intervention program within the health care facility was effective at reducing subsequent WRMSD rates within the nursing personnel.

Use of Assistive Devices to Lift, Transfer, and Reposition Hospital Patients

BACKGROUND

Devices to lift, transfer, and reposition patients are recommended for healthcare workers' and patients' safety, but their intended use has yet to be fully realized.

OBJECTIVE

The aim of this study was to describe hospital nursing staff use of lift/transfer devices and the presence of factors at the time of lifts/transfers with potential to influence whether devices are used.

METHODS

Participants were 108 US nursing staff in a university-based medical center and two community hospitals. A self-completed questionnaire was used to collect demographic and work characteristics, typical frequency of patient lifts/transfers, training in and typical use of lift equipment, and specific factors that could influence use. Proportional distributions of lifting/transferring and repositioning frequencies in a typical shift, amount of equipment use, and factors present were examined overall and across worker and work-related characteristics.

RESULTS

Although trained in equipment use, only 40% used equipment for at least half of lifts/transfers. During lifts/transfers, factors often present included patient unable to help with lift/transfer (91.3%) or of a size/weight where participant needed assistance to help lift/transfer (87.5%); availability of others who could assist with manual lift (86.3%) or use of lift equipment (82.4%); and equipment functioning properly (86.4%), having supplies available (82.5%), and being easy to retrieve from storage (81.6%). During repositioning tasks, physical assistance was "always/almost always" provided from coworkers (83.3%) and often perceived as "very helpful" (92.6%) in reducing physical demands. Physical assistance from patients was less common (14.0% "always/almost always") yet perceived as "very helpful" by 66.3%. One fifth always used friction-reducing devices.

DISCUSSION

Despite training in their use, nursing staff use of available lift equipment and assistive devices is limited. Factors present at the time of lifts/transfers that may influence equipment/device use reflect a complex mix of patient, worker, equipment, and situational characteristics.

Effectiveness of re-education based on appropriate care methods using welfare equipment on the prevention of low back pain among care workers: a 1.5 year follow-up study

Many care workers at elderly care facilities in Japan suffer occupational low back pain (LBP) despite the utilization of welfare equipment. When introducing welfare equipment such as hoists and sliding boards, education on appropriate care methods using welfare equipment is usually conducted, but the effect of education diminishes with time. This intervention study aimed to examine the effect of re-education on appropriate care methods using welfare equipment on the prevention of care workers' LBP at an elderly care facility. At the intervention facility, 49 care workers were enrolled in ergonomic education program for 1.5 yr in order to improve care methods using welfare equipment. At the non-intervention facility, 33 care workers were not enrolled in the program. Rates of severe LBP were not significantly different between the facilities. However, during the study period, the rate of severe LBP among care workers did not increase at the intervention facility, while it doubled among care workers at the non-intervention facility. The care workers at the intervention facility showed improvement in care methods using welfare equipment during the study period. Hence, we think that re-education regarding appropriate care methods using welfare equipment has the potential to prevent exacerbation of LBP.

Outcomes of safe patient handling and mobilization programs: A meta-analysis

BACKGROUND

Variability in patient care settings and the range of patient handling tasks present challenges in developing and evaluating safe patient handling and mobilization (SPHM) programs.

OBJECTIVE

We performed a systematic meta-analysis of SPHM program evaluations.

METHODS

Systematic literature review identified published SPHM program evaluations. Injury Rate Ratios (IRR), pre- to post-intervention, were used to estimate intervention effects and to examine the influence of patient care level, program components, and follow-up time using meta-regression.

RESULTS

27 articles reported evaluations from 44 sites. Combined effect estimate for all SPHM programs was 0.44 (95% CI 0.36, 0.54), reflecting substantial injury reductions after program implementation. While specific program components were not associated with greater effectiveness, longer follow-up duration was associated with greater injury rate reduction (p = 0.01) and intervention effects varied by level of care (p = 0.01), with the greatest effect in intensive care unit interventions (IRR 0.14; 95% CI 0.07, 0.30).

CONCLUSIONS

SPHM programs appear to be highly effective in reducing injuries. More research is needed to identify the most effective interventions for different patient care levels.

Social Network Analysis of peer-specific safety support and ergonomic behaviors: An application to safe patient handling

This study applied Social Network Analysis (SNA) to test whether advice-seeking interactions among peers about safe patient handling correlate with a higher frequency of equipment use. Patient-care workers (n=38) at a community hospital in Oregon nominated peers they would consult for advice regarding safe patient handling. Results show a positive correlation between identifying more peers for safe patient handling advice and using equipment more frequently. Moreover, nurses with more reciprocal advice seeking nominations used safe patient handling equipment more frequently. However, employees who would be more consulted about safe patient handling by their peers did not use equipment more frequently than nurses with fewer nominations. Despite the small sample size, the magnitude of the adjusted regressions coefficients ranged between 3 to 4 standard deviations. These results suggest that having more or reciprocal sources of peer-based support may trigger ergonomic related behaviors such as frequent utilization of equipment.

Biomechanical Evaluations of Bed-to-Wheelchair Transfer: Gait Belt Versus Walking Belt

Nursing personnel, particularly caregivers who frequently perform manual patient transfer tasks, are at risk for work-related musculoskeletal disorders (WMSDs). The purpose of this study was to perform biomechanical evaluations of bed-to-wheelchair transfer using two low-cost assistive devices: walking belt and gait belt. Twenty-eight college students, serving as caregivers, transferred 14 students, serving as patients. "Caregiver" spinal loading and strength requirements at major joints were measured using a 3D Static Strength Prediction Model. "Caregiver"-perceived stresses were assessed using the Borg CR-10 Scale. "Patient" safety and comfort ratings were determined using Likert-type scales. The findings indicated that transferring "patients" using walking belts with a pulling technique produced significantly lower biomechanical stress than using gait belts. "Patients" also felt more comfortable and safer during walking belt transfers. It is recommended that health care facilities should consider use of walking belts in place of gait belts to transfer partially weight-bearing patients.

Patient Transfers and Risk of Back Injury: Protocol for a Prospective Cohort Study With Technical Measurements of Exposure

Background

More than one third of nurses experience musculoskeletal pain several times during a normal work week. Consistent use of assistive devices during patient transfers is associated with a lower risk of occupational back injuries and low back pain (LBP). While uncertainties exist regarding which type of assistive devices most efficiently prevent LBP, exposure assessments using technological advancements allow for quantification of muscle load and body positions during common work tasks.

Objective

The main objectives of this study are (1) to quantify low back and neck/shoulder muscle load in Danish nurses during patient transfers performed with different types of assistive devices, and (2) to combine the exposure profile for each type of assistive device with fortnightly questionnaires to identify the importance of muscle load (intensity and frequency of transfers) and body position (degree of back inclination and frequency) on LBP intensity and risk of back injury during a patient transfer.

Methods

A combination of technical measurements (n=50) and a prospective study design (n=2000) will be applied on a cohort of female nurses in Danish hospitals. The technical measurements will be comprised of surface electromyography and accelerometers, with the aim of quantifying muscle load and body positions during various patient transfers, including different types of assistive devices throughout a workday. The study will thereby gather measurements during real-life working conditions. The prospective cohort study will consist of questionnaires at baseline and 1-year follow-up, as well as follow-up via email every other week for one year on questions regarding the frequency of patient transfers, use of assistive devices, intensity of LBP, and back injuries related to patient transfers. The objective measurements on muscle load and body positions during patient handlings will be applied to the fortnightly replies regarding frequency of patient transfer and use of different assistive devices, in order to identify risk factors for back injuries related to patient transfers and intensity of LBP.

Results

Data collection is scheduled to commence during the winter of 2017.

Conclusions

The design of this study is novel in its combination of technical measurements applied on a prospective cohort, and the results will provide important information about which assistive devices are associated with intensity of LBP and risk of back injury related to patient transfers. Furthermore, this study will shed light on the dose-response relationship between intensity, duration, and frequency of patient transfers and the intensity of LPB in Danish nurses, and will thereby help to guide and improve electronic health practices among this population.

Implementation of a Safe Patient Handling Program in a Multihospital Health System From Inception to Sustainability: Successes Over 8 Years and Ongoing Challenges

Musculoskeletal injuries, especially back injuries, are among the most frequent injuries sustained by direct caregivers who lift, transfer, and reposition patients. These injuries can be debilitating and, for some caregivers, career ending. In the first year following implementation of the safe patient handling program in a multihospital health care system, an 82% reduction in Occupational Health and Safety Administration (OSHA) recordable patient handling injuries was realized, a 94% decrease in days away from work, an 85% reduction in restricted duty days, and an 82% reduction in incurred workers’ compensation costs. These reductions have been sustained for an 8-year period since the program’s implementation in 2008. The primary focus of the program’s first year was training and education. Compliance and retraining efforts began in the second year, followed by a gradual transition to the present emphasis on sustainability. This article describes the development and implementation of a safe patient handling program in a multihospital health system and the impact on caregiver injuries over 8 years. Also presented are key strategies that were used to achieve sustainability.

Predictors of low back pain in nursing home workers after implementation of a safe resident handling programme

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.

Effects of intervention program for systematic use of transfer equipment on care workers' low back pain in elderly care facilities

OBJECTIVE

The purpose of this study was to investigate the effects of an intervention program to prevent care workers' low back pain by the systematic use of transfer equipment at elderly care facilities.

METHODS

Questionnaire surveys were administered to administrators and care workers before (baseline), 1 year after, and 2.5 year after starting the program at two elderly care facilities. Care workers at the intervention facility were requested to ensure the use of a transfer's hoist, sliding board, and sliding sheet when assisting in the transfer of residents who were judged as appropriate to use the equipment (27.5% of residents living the intervention facility). Care workers at the control facility received no instructions on the use of transfer equipment.

RESULTS

The average response rate of administrators and care workers was 100% and 90.3%, respectively. The number of care workers who responded during all three survey periods was 29 at the intervention facility and 23 at the control facility, and they were subjected to the current analysis. At baseline, transfer equipment was already introduced in both facilities, but it was found that the care workers did not regularly use it for assisting transfer. At 2.5-year follow-up, 31.0% of the intervention group and 4.3% of the control group always used the transfer's hoist. Similarly, 27.6% of the intervention group and 4.3% of the control group always used the sliding board and sliding sheet. Further, 60%-70% of the care workers at both facilities reported of having low back pain, but no statistically significant difference was found between the facilities or over the measurement periods. Among the intervention group, however, the care workers who reported an active use of the transfer's hoist, sliding board, and sliding sheet showed an improvement in low back pain. In the control group, no significant association was found between the active use of transfer equipment and low back pain.

CONCLUSION

These results indicated that the prevention of care workers' low back pain requires the introduction of transfer equipment in facilities and its regular use under the implementation program. If the number of residents requiring transfer equipment increases, its systematic use is expected to improve low back pain in care workers. This improvement can translate into safer and healthier workplaces for elderly care.

Injury rates before and after the implementation of a safe resident handling program in the long-term care sector

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.

Designing, prototype making and evaluating a mechanical aid device for patient transfer between bed and stretcher

INTRODUCTION

The present study aimed at designing, prototype making and evaluating a new assistive device to improve patient transfer conditions.

METHODS

A new aid device for patient transfer was designed and its prototype was made. Comfort and perceived physical exertion of users and stability and applicability of the device were examined. The test subjects included 37 healthcare workers from a hospital with patient transfer experience. The data collection tools consisted of visual analog scales (VAS) and Borg's rating physical effort scale. The rapid entire body assessment (REBA) method was applied to evaluate working posture.

RESULTS

The results showed that in 70% of the wards, patient transfer was performed manually more than five times per shift. While using the newly designed device, the mean (SD) of the users' comfort, and the clients' comfort and safety, was measured as 8.59 (0.87), 8.46 (0.92) and 8.67 (0.71), respectively, as reported by VAS. The results revealed a significant reduction in the users' rating of perceived exertion (p < 0.001). Additionally, the REBA score was lower in mechanical transfer.

CONCLUSION

The new assistive device increased the users' and the clients' comfort, reduced the users' physical exertion and improved working postures.

Participatory organizational intervention for improved use of assistive devices for patient transfer: study protocol for a single-blinded cluster randomized controlled trial

Background

Epidemiological studies have shown that patient transfer is a risk factor for back pain, back injuries and long term sickness absence, whereas consistent use of assistive devices during patient transfer seems to be protective. While classical ergonomic interventions based on education and training in lifting and transferring techniques have not proven to be effective in preventing back pain, participatory ergonomics, that is meant to engage and motivate the involved parties while at the same time making the intervention maximally relevant, may represent a better solution. However, these findings are largely based on uncontrolled studies and thus lack to be confirmed by studies with better study designs. In this article, we present the design of a study which aims to evaluate the effect and process of a participatory organizational intervention for improved use of assistive devices.

Methods

The study was performed as a cluster randomized controlled trial. We recruited 27 departments (clusters) from five hospitals in Denmark to participate in the study. Prior to randomization, interviews, observations and questionnaire answers (baseline questionnaire) were collected to gain knowledge of barriers and potential solutions for better use of assistive devices. In April 2016, the 27 departments were randomly allocated using a random numbers table to a participatory intervention (14 clusters, 324 healthcare workers) or a control group (13 clusters, 318 healthcare workers). The participatory intervention will consist of workshops with leaders and selected healthcare workers of each department. Workshop participants will be asked to discuss the identified barriers, develop solutions for increasing the use of assistive devices and implement them in their department. Use of assistive devices (using digital counters -, primary outcome, and accelerometers and questionnaire - secondary outcome), perceived physical exertion during patient transfer, pain intensity in the lower back, occurrence of work-related back injuries during patient transfer, organizational readiness to change, knowledge on how to perform proper patient transfer, social capital and work ability (secondary outcomes) were assessed at baseline and will also be assessed at 1 year follow-up. Process evaluation will be based on qualitative and quantitative data to assess the implementation, the change process, and the impact of context aspects.

Discussion

The study will evaluate the effect and process of a participatory intervention on improving the use of assistive devices for patient transfer among hospital healthcare workers. By using cluster-randomization, as well as process- and effect evaluation based on objective measures we will contribute to the evidence base of a promising intervention approach.

Trial registration

ClinicalTrials.gov (NCT02708550). March, 2016.

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.