Evaluation of biochemical parameters in operating room staff exposed to radiation and anesthetic gases

Background

Exposure to ionizing radiations and other hazardous agents such as anesthetic gases pose serious risks to the health of healthcare workers. This study aimed to evaluate the changes in blood and biochemical parameters of the operating room staff exposed to ionizing radiations and remnants of anesthetic gas.

Methods

This cross-sectional study was performed at (Ayatollah Taleghani Hospital). The control group was selected from different parts of the hospital that were not exposed to ionizing radiations and anesthetics, including the office, services, and treatment. The case group included all operating room personnel. Hematopoietic parameters such as complete blood count and WBC differential, and parameters of liver function such as serum activity of liver enzymes (ALT, AST, ALP, LDH) and serum bilirubin levels, fasting blood sugar, serum lipid profile, level of vitamin D and magnesium were measured for the exposed and referent subjects. Additionally, a checklist was used to gather data regarding the occupational variables and medical histories of the studied subjects.

Results

The mean values of Hb, Hct, Vitamin D, and MCHC, as well as the RBC count, were significantly lower in the exposed individuals than in the referent subjects. In contrast, the proportion of smokers was significantly higher in the exposed group than in the referent group. No significant differences were noted between exposed and unexposed groups as far as other parameters were concerned. However, no significant differences were noted between the case and control groups as far as other measured parameters were concerned. Likewise, no significant differences were noted between exposed and referent groups as far as blood types, history of underlying diseases, work history, working hours per month, number of morning and evening shift hours, type of diet, consumption of a high-fat diet a day before blood sampling, X-ray in the recent year, history of radiotherapy, and therapeutic agents use was concerned.

Conclusions

Exposure of operating room staff to ionizing radiations and waste anesthetics gases is associated with subtle, subclinical prepathologic decreases in some hematopoietic parameters such as hemoglobin, hematocrit and MCHC levels, RBC count as well as vitamin D levels.

Comparison of the Physical Care Burden on Formal Caregivers between Manual Human Care Using a Paper Diaper and Robot-Aided Care in Excretion Care

Although the older population has been rapidly growing, the availability of formal caregivers remains limited. Assistance provided by care robots has helped lower this burden; however, whether using a care robot while providing excretion care (EC) is quantitatively increasing or decreasing caregivers' physical care burden has not been extensively studied. This study aimed to quantitatively compare the physical burden experienced by caregivers while providing manual excretion care (MC) using a paper diaper versus robot-aided care (RC). Ten formal caregivers voluntarily participated in the experiment. MC and RC tasks were structuralized according to phases and classified by characteristics. The experiment was conducted in a smart care space. The physical load of formal caregivers was estimated by muscular activity and subjective rating of perceived physical discomfort. The results demonstrated that although the physical load on the lower back and upper extremities during the preparation and post-care phases were greater in RC than MC, RC markedly alleviated caregivers' physical load when performing front tasks. In the preparation-care phases, the physical loads on the lower back and upper extremities were approximately 40.2 and 39.6% higher in the case of RC than MC, respectively. Similar to the preparation-care phases, the physical loads on the lower back and upper extremities during post-care phases were approximately 39.5 and 61.7% greater in the case of RC than MC, respectively. On the other hand, in the front-care phases, the physical loads on the lower back and upper extremities were approximately 25.6 and 34.9% lower in the case of RC than MC, respectively. These findings can quantitatively explain the effectiveness and features of a care robot to stakeholders and provide foundational research data for the development of EC robots. This study emphasizes the implementation and promotion of the dissemination, popularization, and development of care robots to fulfill formal caregiving needs.

Mental Workload and Job Satisfaction in Healthcare Workers: The Moderating Role of Job Control

Objective: The aim of this study was to investigate the moderating role of job control in relation to mental workload and job satisfaction of healthcare workers. Methods: This cross-sectional study was carried out on 480 nurses, midwives, and administrative workers in four educational hospitals of Ardabil, Iran. Research tools were included demographic information questionnaire, NASA-TLX questionnaire, job description index (JDI) questionnaire and job control inquiry. Results: Compared with administrative workers, mental workload of nurses and midwives was significantly higher and likewise mental workload of nurses was significantly difference compared to midwives (P < 0.001). Nurses and midwives had substantially higher job satisfaction than administrative workers (P < 0.001). Also, nurses and midwives had higher job control than administrative workers (P < 0.001 and P = 0.002, respectively). Based on the designed model, the correlation between mental workload and job satisfaction was negative and significant (r = -0.22); which in the presence of job control, the relationship between the two variables of workload and job satisfaction slightly increased (r = -0.19, P < 0.001). These conditions were the same in the three job groups separately. Conclusion: Mental workload is inversely related to job satisfaction and job control. Job control plays an important role in improving working conditions in healthcare workers.

Are Work-Related Musculoskeletal Disorders Claims Related to Risk Factors in Workplaces of the Manufacturing Industry?

OBJECTIVES

Varied work-related musculoskeletal disorders (WMSDs) claim rates were found between companies even when they were in the same sectors with similar sizes. This study aimed to (i) identify common risk factors for back, shoulder, hand/wrist, and knee WMSDs among manufacturing jobs, and (ii) characterize the biomechanical exposures in jobs and work organizational practices between high and low WMSD claim rate companies so that more focused, industry-specific intervention strategies may be developed.

METHODS

Using historical workers' compensation data, manufacturing companies were divided into two paired groups (low and high in the lower 25%ile and higher 75%ile, respectively). On-site job evaluations were conducted in 16 companies to determine job biomechanical risk levels. Management and workers' representatives in 32 paired companies were interviewed to identify possible differences between management strategies and management/worker relationships. A total of 39 injured workers were also interviewed to gather information of self-reported injury causes and suggested preventive measures.

RESULTS

Analyses of 432 job evaluations showed that more jobs had higher risk levels of prolonged standing and heavy lifting in the high back WMSD claim rate companies than the low claim rate ones. No high biomechanical risk factors were found to be associated with jobs in high shoulder claim rate companies. High repetition, pinch force, and Strain Index were associated with high hand/wrist WMSD claim rate companies. High work pace and job stress were common among high knee WMSD claim rate companies. There were no statistically significant differences for the organizational factors between high and low WMSD claim rate companies. Heavy lifting, fast work pace, high hand/wrist repetition, high hand force, and awkward shoulder postures were identified as major contributing factors by the injured workers.

CONCLUSIONS

High WMSD claim rate companies appeared to have more high biomechanical exposure jobs than low WMSD claim rate companies. Available job evaluation methods for the low back and hand/wrists are satisfactory in quantifying job risk levels in the manufacturing industry. Research into more sensitive job evaluation methods for the shoulder and knee are needed.

Musculoskeletal injuries and absenteeism among healthcare professionals-ICD-10 characterization

INTRODUCTION

Healthcare workers account for 10% of the EU's total workforce, with a significant proportion of those employed in hospitals. Musculoskeletal injuries are the predominant group of injuries in healthcare professionals due to the physical demands of their work, such as the mobilization and positioning of the dependent patients. The management of this type of problem should take into account direct and indirect costs, such as periods of incapacity for work due to illness, hiring and training of new employees during periods of absence, reduced levels of productivity and the effects on production and quality of work.

OBJECTIVES

1-Characterization of injuries resulting from occupational accidents in hospital workers according to the International Classification of Diseases ICD-10; 2-Identification of the predictive factors of absenteeism duration due to temporary work incapacity in workplace accidents.

METHODS

A retrospective observational study was conducted based on the analysis of 1621 cases of work-related accidents of employees of Centro Hospitalar São João from January 2011 to December 2014. An ICD-10 classification code was associated with each of the accident cases, based on pre-established criteria for classification of the specific diagnoses of musculoskeletal injuries. The duration of temporary work incapacity was compared between the categories of sociodemographic variables, among six categories of ICD-10 primary diagnosis (reclassification), and between the two major chapters of ICD-10 classification-chapter XIX (direct trauma) and chapter XIII (indirect trauma-strain injuries). The sociodemographic predictors of the occurrence of strain injuries were determined by logistic regression. A multinomial logistic regression analysis was conducted with selection of duration of work incapacity as the dependent variable.

RESULTS

A total of 824 cases of musculoskeletal injuries occurred on hospital premises during the study period, which corresponded to a total of 22159 lost workdays in the context of temporary work incapacity due to work injury. According to the ICD-10 reclassification, the three most frequent diagnostic groups were direct lower limb trauma (n = 230, 27.9%), spinal strain injuries (n = 194, 23.5%) and direct upper limb trauma (n = 174, 21.1%). Significant differences were observed in temporary work incapacity duration among the ICD-10 diagnostic categories: spinal strain injuries were the diagnostic group associated with longer duration of temporary work incapacity, with a median = 14.0 (25-75th percentile: 6.0-35.0). The only variable that demonstrated to be significantly predictive of temporary work incapacity less than or greater than 20 days was the ICD-10 diagnostic group. The regression results revealed a 5-fold increase in risk in the case of spinal strain injuries for temporary work incapacity durations of less than or greater than 20 days (OR = 5.58 and OR = 5.89 respectively).

CONCLUSIONS

The study findings support the benefits of the characterization of workplace injuries by medical diagnostic groups, namely in the interpretation of the sequelae of the accidents and the medical contextualization of the accidents. Association of ICD-10characterization can improve the analysis of workplace accidents at an institutional level, and promote the implementation of preventive measures and control of absenteeism.

Prevention of Nurses’ Work-Related Musculoskeletal Disorders Resulting From Repositioning Patients in Bed

Repositioning patients in bed to promote comfort and prevent impairments caused by continuously lying in a prone position is a task frequently performed by nurses and nursing assistants. Repositioning is a high-risk activity, frequently causing occupational injuries. These occupational injuries are attributed to excessive physical demands on nurses due to patients’ weight and awkward nurse postures. During repositioning, risk of injury can be lowered by reducing friction between the patient and the bed. Hence, certain friction-reducing devices have been developed to reduce the manual force required to move patients. Nevertheless, further research is needed to evaluate the potential effectiveness of these devices. Therefore, the aim of this review was to present current research about the risk factors, prevention strategies, and assistive devices that could reduce work-related musculoskeletal disorders caused by repositioning patients in bed.

The effect of working position on trunk posture and exertion for routine nursing tasks: an experimental study

Objectives:

To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion.

Methods:

Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for ‘computer-assisted recording and long-term analysis of musculoskeletal loads’) measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion).

Results:

If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P < 0.001). Bathroom tests: compared with the standing work method, the kneeling and sitting work methods led to a significant increase in the proportion of time spent in an upright posture, by 19.4% points (P = 0.003) and 25.7% points (P < 0.001), respectively. The greater the proportion of time spent in an upright position, the lower the Borg rating (P < 0.001) awarded.

Conclusions:

The higher the proportion of time that nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-adjustable beds are provided in healthcare institutions.

Association of age and physical job demands with musculoskeletal disorders in nurses

A cross-sectional study design was applied on 273 nurses to investigate associations of physical job demands, age, and musculoskeletal disorders (MSDs) in nursing. Concurrently, participants reported on various physical job demands with a standardized questionnaire for Hospital Work. As a special contribution, this investigation illustrates findings on MSDs provided by a standardized physical examination to questionnaire data. MSD located in the lower back (8.7%) had the highest frequency, followed by the neck (7.3%), the shoulders (6.9%), and the knees (2.2%). There were significant differences in the frequencies of MSD between the young/middle age-group and the old age-group in most locations, while the only significant difference between the young and the middle age-group was found for shoulder-MSD. Furthermore high levels of physical job demands increased the risk of MSD significantly (OR = 5.7, 1.55-20.96) in all age-groups. The study provides further indication for development of age-adapted preventive measures.

Lumbar-load analysis of manual patient-handling activities for biomechanical overload prevention among healthcare workers

Manual patient handling commonly induces high mechanical load on the lower back of healthcare workers. A long-term research project, the 'Third Dortmund Lumbar Load Study' (DOLLY 3), was conducted to investigate the lumbar load of caregivers during handling activities that are considered 'definitely endangering' in the context of worker's compensation procedures. Nine types of handling activities in or at a bed or chair were analysed. Measurement of action forces via specifically developed devices and posture recording by means of optoelectronic marker capturing and video recordings in order to quantify several lumbar-load indicators was previously described in detail. This paper provides the results of laboratory examinations and subsequent biomechanical model calculations focused on lumbar load and the potentials of load reduction by applying biomechanically 'optimized' transfer modes instead of a 'conventional' technique and, for a subgroup of tasks, the supplementary usage of small aids such as a sliding mat or a glide board. Lumbosacral-disc compressive force may vary considerably with respect to the performed task, the mode of execution, and individual performance. For any activity type, highest values were found for conventional performance, lower ones for the improved transfer mode, and the lowest compressive-force values were gathered when small aids were applied. Statistical significance was verified for 13 of these 17 comparisons. Analysing indicators for asymmetric loading shows that lateral-bending and torsional moments of force at the lumbosacral disc may reach high values, which can be reduced considerably by implementing an improved handling mode. When evaluating biomechanical loads with respect to age- and gender-specific work-design limits, none of the analysed tasks, despite execution mode, resulted in an acceptable load range. Therefore, applying a biomechanically adequate handling mode combined with small aids to lower the friction between patient and surfaces is highly recommended, especially to prevent overload in older caregivers.

Musculoskeletal pain and psychological distress in hospital patient care workers

PURPOSE

The aim of the study was to assess the association of psychological distress and musculoskeletal pain, how it is related to pain interference with work and multiple pain areas, and potential differences between the different pain areas in hospital patient care workers.

METHODS

Data were collected from a cross-sectional survey of patient care workers (n = 1,572) from two large hospitals.

RESULTS

Patient care workers with musculoskeletal pain reported significantly more psychological distress than those without pain. Psychological distress was significantly related to pain interference with work, even after adjusting for pain and demographics (OR = 1.05; CI = 1.01-1.09). The association was strongest for those with both upper- and lower body pain (OR = 1.12; CI = 1.06-1.18). Psychological distress was also independently associated with multiple pain areas.

CONCLUSIONS

Psychological distress was found to be higher in workers with musculoskeletal pain, and highest among workers with both upper and lower body pain. Distress was further significantly associated with pain interference with work as well as number of pain areas. The findings may be followed up with a longitudinal design to better determine the direction of the associations, and to investigate if psychological distress increases the risk of work disability and injuries.

On the quantitative relationships between individual/occupational risk factors and low back pain prevalence using nonparametric approaches

OBJECTIVES

To explore dual quantitative relationships between low back pain (LBP) prevalence and different individual and occupational risk factors, and detect the most important ones which can be used as weighted input data in LBP prediction diagnosis models, providing effective tools to help with the implementation of protection and prevention strategies among hospital staff.

METHODS

Fourteen predictor individual risk factors (e.g., age, gender, body mass index BMI [kg/m(2)], domestic activity, etc.) and 17 occupational risk factors (e.g., job status, standing hours/day, sufficient break time, job dissatisfaction, etc.) were collected using self-reported questionnaire among the staff of Sacré-Coeur hospital - Lebanon (used as a case study), and correlated with LBP prevalence using Kendall's tau-b bivariate nonparametric approaches.

RESULTS

This study indicates that among the investigated occupational risk factors, job status, working hours/day, and standing hours/day are the most influencing on LBP prevalence (highly correlated with other factors at 1 and 5% confidence levels). It also shows that strong positive (between 0.25 and 0.65)/negative (from -0.38 to -0.26) statistical correlations to LBP prevalence exist between these risk occupational factors and working days/week, sitting hours/day, job stress, job dissatisfaction, children care, and car driving. The weekly hours of domestic activity, the staff height, and gender type have proven also to be the strongest individual factors in aggravating LBP disease. These individual factors are highly correlated at 1% significance level (ranging between 0.28 and 0.49 for positive correlations, and from -0.49 to -0.25 for negative ones) to children care, weight, extra professional activity, and use of handling techniques.

CONCLUSIONS

These obtained bivariate correlations can be used successfully by expert physicians in their decision making for LBP diagnosis.

Effect of transfer, lifting, and repositioning (TLR) injury prevention program on musculoskeletal injury among direct care workers

Musculoskeletal injuries among health care workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results, and strong evidence for intervention effectiveness is lacking. The purpose of our study was to evaluate the effectiveness of a Transfer, Lifting and Repositioning (TLR) program to reduce musculoskeletal injuries (MSI) among direct health care workers. This study was a pre- and post-intervention design, utilizing a nonrandomized control group. Data were collected from the intervention group (3 hospitals; 411 injury cases) and the control group (3 hospitals; 355 injury cases) for periods 1 year pre- and post-intervention. Poisson regression analyses were performed. Of a total 766 TLR injury cases, the majority of injured workers were nurses, mainly with back, neck, and shoulder body parts injured. Analysis of all injuries and time-loss rates (number of injuries/100 full-time employees), rate ratios, and rate differences showed significant differences between the intervention and control groups. All-injuries rates for the intervention group dropped from 14.7 pre-intervention to 8.1 post-intervention. The control group dropped from 9.3 to 8.4. Time-loss injury rates decreased from 5.3 to 2.5 in the intervention group and increased in the control group (5.9 to 6.5). Controlling for group and hospital size, the relative rate of all-injuries and time-loss injuries for the pre- to post-period decreased by 30% (RR = 0.693; 95% CI = 0.60-0.80) and 18.6% (RR = 0.814; 95% CI = 0.677-0.955), respectively. The study provides evidence for the effectiveness of a multifactor TLR program for direct care health workers, especially in small hospitals.

Work related musculoskeletal disorders amongst therapists in physically demanding roles: qualitative analysis of risk factors and strategies for prevention

Background

Physiotherapy and occupational therapy are two professions at high risk of work related musculoskeletal disorders (WRMD). This investigation aimed to identify risk factors for WRMD as perceived by the health professionals working in these roles (Aim 1), as well as current and future strategies they perceive will allow them to continue to work in physically demanding clinical roles (Aim 2).

Methods

A two phase exploratory investigation was undertaken. The first phase included a survey administered via a web based platform with qualitative open response items. The second phase involved four focus group sessions which explored topics obtained from the survey. Thematic analysis of qualitative data from the survey and focus groups was undertaken.

Results

Overall 112 (34.3%) of invited health professionals completed the survey; 66 (58.9%) were physiotherapists and 46 (41.1%) were occupational therapists. Twenty-four health professionals participated in one of four focus groups. The risk factors most frequently perceived by health professionals included: work postures and movements, lifting or carrying, patient related factors and repetitive tasks. The six primary themes for strategies to allow therapists to continue to work in physically demanding clinical roles included: organisational strategies, workload or work allocation, work practices, work environment and equipment, physical condition and capacity, and education and training.

Conclusions

Risk factors as well as current and potential strategies for reducing WRMD amongst these health professionals working in clinically demanding roles have been identified and discussed. Further investigation regarding the relative effectiveness of these strategies is warranted.

The incidence of low back problems among nursing students in Hong Kong

AIMS

To determine the cumulative incidence (CI) of and risk factors for musculoskeletal problems among nursing students in Hong Kong.

BACKGROUND

Although low back problems have been identified internationally as one of the major work-related hazards among nursing personnel, only a few studies have examined the problem among nursing students.

DESIGN

Two-year prospective cohort study; data collected at baseline and 2 (T1), 12 (T2) and 26 (T3) months after baseline.

METHODS

Three cohorts [i.e. two full-time (FT) and one part-time (PT) cohorts] of nursing students were recruited from one of the universities in Hong Kong. They were invited to complete a baseline and three follow-up questionnaires. CIs of low back problems among the three cohorts were calculated and tested for their association. The multivariate logistic regression was also used to identify the risk factors for low back problems.

RESULTS

Initially, the seven-day, 30-day and 12-month prevalence in baseline as well as the T1 (64%) and T2 (94%) CIs of low back problems for the PT cohort were significantly higher than those of the two FT cohorts (their CIs ranged from 45-67%). However, the CIs for the FT cohorts were increased from 45% at T1-83% at T3, while the CIs for the PT cohort was only increased from 64-80%, respectively. At T3, the CIs for both FT cohorts caught up with the CI for the PT cohort (chi(2) = 0.068, p = 0.07). As expected, the risk factors for low back problems were multifactorial, i.e. personal, psychosocial and physical.

CONCLUSION

Nursing students had similar CI of low back problems as registered nurses 26 months after baseline, i.e. during their nursing training and before becoming a registered nurse.

RELEVANCE TO CLINICAL PRACTICE

The results of this study, for the first time, identified that low back problems were developed during the period of nursing school training rather than after nurses enter the workforce. These findings have crucial implications for reducing low back problems among nursing personnel. There is a need to evaluate nursing students' experience in their nursing study and provide appropriate support to them to reduce their personal, physical and psychosocial stress. The ability of nursing students to deliver high quality patient care depends in part on their ability to conserve their own health and well-being.

Tai Chi for older nurses: a workplace wellness pilot study

PURPOSE

The purpose of this pilot study was to assess the feasibility of a Tai Chi workplace wellness program as a cost effective way of improving physical and mental health, reducing work related stress, and improving work productivity among older nurses in a hospital setting Design A randomized control trial of two groups (control and Tai Chi group).

DESIGN

A randomized control trial of two groups (control and Tai Chi group).

SETTINGS

Northeastern academic medical center.

SUBJECTS

A convenience sample of eleven female nurses (mean age 54.4 years).

INTERVENTION

The Tai Chi group (n = 6) was asked to attend Tai Chi classes once a week offered at their worksite and to practice on their own for 10 minutes each day at least 4 days per week for 15 weeks. Controls (n = 5) received no intervention.

MEASURES

SF-36 Health Survey, Nursing Stress Scale (NSS), Perceived Stress Scale (PSS), Sit-and-Reach test, Functional Reach test, the Work Limitations Questionnaire, workplace injury and unscheduled time off.

ANALYSIS

The two study groups were compared descriptively and changes across time in the intervention versus control were compared.

RESULTS

The Tai Chi group took no unscheduled time-off hours, whereas, the control group was absent 49 hours during the study period. There was also a 3% increase in work productivity and significant improvement in functional reach (p=0.03) compared to the control group. Other outcomes were not statistically significant.

CONCLUSION

This pilot study demonstrates the feasibility of Tai Chi with older female workers as a cost effective wellness option in the workplace; thus encouraging replication with a larger sample. Methodological implications were also addressed.

Perceived demands and musculoskeletal disorders in operating room nurses of Shiraz city hospitals

Excessive demands on Operation Room (OR) nurses may result in high rates of Musculoskeletal Disorders (MSDs). This study was conducted among Shiraz city hospital OR nurses to determine the prevalence of MSDs and to examine the relationship between perceived demands and reported MSDs. In this cross-sectional study, 375 OR nurses participated (response rate: 80%). The Nordic Musculoskeletal Disorders Questionnaire and the Job Content Questionnaire were used as collecting data tools. Lower back symptoms were found to be the most prevalent problem in the OR nurses studied with a past year prevalence of 60.6%. Perceived physical demands were significantly associated with musculoskeletal symptoms (odds ratio ranged from 2.04 to 7.24). Manual material handling (MMH) activities were most frequently associated with reported symptoms. Association was also found between perceived psychological demands and reported symptoms (odds ratio>1.68). Based on the findings of this study, it could be concluded that operation room was not only a physically but also psychologically demanding environment. Any interventional program for preventing or reducing MSDs among OR nurses had to focus on reducing physical demands, particularly excessive MMH demands as well as considering psychological aspect of working environment.

Psychosocial factors contributing to occupational injuries among direct care workers

Direct care workers have the highest injury rate in the United States, primarily due to work-related musculoskeletal disorders. This study examined the effect of psychosocial factors (i.e., stress, job satisfaction, organizational climate, safety climate, and training) on direct care workers' injuries. On the basis of divergent work characteristics of direct care workers in facilities versus private homes, injury rates were found to be significantly different between workplaces (x(2) = 4.179, df = 1, p = .041). Tenure (77% of injuries occurred after 1 year of tenure) was significantly correlated with training, satisfaction, organizational climate, and stress. Because of the chronic nature of musculoskeletal disorders, tenure was used to choose cases for injury prediction using logistic regression. When tenure was greater than 1 year, job satisfaction [Exp(B) = 0.048, p = .028] was a predictor of injury and when tenure was greater than 3 years, both job satisfaction [Exp(B) = 0.002, p = .033] and training [Exp(B) = 31.821, p = .044] were predictors of injury. Psychosocial factors and home- versus facility-based workplaces should be considered to improve injury rates and retention among direct care workers.

Injuries occurring in hospital staff attending medical emergency team (MET) calls--a prospective, observational study

BACKGROUND

Clinical emergency response systems such as medical emergency teams (MET) have been implemented in many hospitals worldwide, but the effect that these systems have on injuries to hospital staff is unknown. The objective of this study was to determine the rate and nature of injuries occurring in hospital staff attending MET calls.

METHODS

This study was a prospective, observational study, using a structured interview, of 1265 MET call participants, in a 650 bed urban, teaching hospital. Data was collected on the number and the nature of injuries occurring in hospital staff attending MET calls.

RESULTS

Over 131 days, 248 MET calls were made. An average of 8.1 staff participated in each MET call. The overall injury rate was 13 (95% confidence interval (CI) 7-20) per 1000 MET participant attendances, and 70 (95% CI 38-102) per 1000 MET calls. One injured participant required time off-work, an injury requiring time off-work rate of 1 (95% CI 0-4) per 1000 MET participant attendances, or 4 (95% CI 0-27) per 1000 MET calls. The relative risk of sustaining an injury if the MET participant performed chest compressions, contacted patient body fluids on clothing or protective equipment, without direct contact to skin or mucosa, or lifted the patient or a patient body part was 11.0 (95% CI 4.2-28.6), 8.7 (95% CI 3.4-22.0) and 5.5 (95% CI 2.1-14.2), respectively.

CONCLUSION

The rate of injuries occurring to hospital staff attending MET calls is relatively low, and many injuries could be considered relatively minor.

Performance in Nursing

Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse's work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses' work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.

Psychosocial Factors Contributing to Occupational Injuries among Direct Care Workers

Direct care workers have the highest injury rate in the United States, primarily due to work-related musculoskeletal disorders. This study examined the effect of psychosocial factors (i.e., stress, job satisfaction, organizational climate, safety climate, and training) on direct care workers' injuries. On the basis of divergent work characteristics of direct care workers in facilities versus private homes, injury rates were found to be significantly different between workplaces (χ2 = 4.179, df = 1, p = .041). Tenure (77% of injuries occurred after 1 year of tenure) was significantly correlated with training, satisfaction, organizational climate, and stress. Because of the chronic nature of musculoskeletal disorders, tenure was used to choose cases for injury prediction using logistic regression. When tenure was greater than 1 year, job satisfaction [Exp(B) = 0.048, p = .028] was a predictor of injury and when tenure was greater than 3 years, both job satisfaction [Exp(B) = 0.002, p = .033] and training [Exp(B) = 31.821, p = .044] were predictors of injury. Psychosocial factors and home- versus facility-based workplaces should be considered to improve injury rates and retention among direct care workers.

Musculoskeletal problems experienced by older nurses in hospital settings

The effects of musculoskeletal problems on older nurses working in hospital settings was examined, including what contributed to the problems, and preferred treatments selected. Inadequate sleep was significantly related to musculoskeletal symptoms in all regions of the body. Most frequent problems were in lower and upper back, neck, and shoulder areas. Rotating and/or 12-hr shifts, inadequate sleep, frequent patient handling, and nurses who felt little control over their work reported more lower back symptoms. Surprisingly, nurses relied on over-the-counter medications to treat their problems. Implications for supporting the nursing workforce and minimizing musculoskeletal problems are discussed.

Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries—results from the European NEXT-Study

BACKGROUND

Musculoskeletal disorders are a widespread affliction in the nursing profession. Back or neck-pain-related disability of nursing staff is mainly attributed to physical and psychosocial risk factors.

OBJECTIVES

To investigate which-and to what extent-physical and psychosocial risk factors are associated with neck/back-pain-related disability in nursing, and to assess the role of the type of health care institution (hospitals, nursing homes and home care institutions) within different countries in this problem.

DESIGN

Cross-sectional secondary analysis of multinational data of nurses and auxiliary staff in hospitals (n=16,770), nursing homes (n=2140) and home care institutions (n=2606) in seven countries from the European NEXT-Study.

METHODS

Multinomial logistic regression analysis with raw models for each factor and mutually adjusted with all analysed variables.

RESULTS

Analysis of the pooled data revealed effort-reward imbalance as the predominant risk factor for disability in all settings (odds ratios for high disability by effort-reward ratio: hospital 5.05 [4.30-5.93]; nursing home 6.52 [4.04-10.52] and home care 6.4 [3.83-10.70] [after mutual adjustment of psychosocial and physical risk factors]). In contrast, physical exposure to lifting and bending showed only limited associations with odds ratios below 1.6; the availability and use of lifting aids was-after mutual adjustment-not or only marginally associated with disability. These findings were basically confirmed in separate analyses for all seven countries and types of institutions.

CONCLUSIONS

The findings show a pronounced association between psychosocial factors and back or neck-pain-related disability. Further research should consider psychosocial factors and should take the setting where nurses work into account.

Ergonomic assessment of a critical care unit

Although direct patient care providers in all settings suffer musculoskeletal injuries at unacceptable rates, high-risk tasks in nursing homes are the most frequently researched. Less is known about the high-risk tasks performed by critical care nurses. To identify the tasks in critical care that differ from those in nursing homes, this qualitative study used the Ergonomic Workplace Assessment Protocol for Patient Care Environments to assess a medical ICU. Results and recommendations for change are presented.

Quantitative Measurement of Stressful Trunk Postures in Nursing Professions

INTRODUCTION

The evaluation of stress to the spinal column in the provision of care has mostly concentrated on the handling of loads. However, awkward body postures alone, without load transfer, can also be stressful for the spinal column. Therefore in this study all the body postures and movements of nurses were quantitatively measured within a working shift.

METHODS

The body postures were recorded with the CUELA measurement system (computer-assisted recording and long-term analysis of musculoskeletal loads), coupled to the individual, and this detected all movements of the trunk and the legs. These measurements were supported by video recordings, so that exact allocation of the measured data to the tasks performed was possible. In all, 24 shift measurements were carried out in 8 wards. Extent, frequency and duration of trunk postures were measured in three planes and assessed on the basis of several standards (DIN EN 1005-1, DIN EN 1005-4, ISO 11226).

RESULTS

A mean of 1131 (+/-377) trunk inclinations of >20 degrees were performed in each shift. This corresponds to a frequency of 3.5 min(-1). A total of 237 of these inclinations lasted for >4 s. A total of 72 (+/-35) min was spent bending forward with an inclination of >20 degrees . However, the mean time spent in transferring patients (counting only the lifting process) and heavy materials was only 2 min per shift. Postures with trunk inclination of >60 degrees were adopted for a mean of 175 (+/-133) times. The main tasks responsible for this were 'bed making' (21%), 'basic care' (16%) and 'clearing up/cleaning' (16%).

CONCLUSIONS

It could be shown that many stressful trunk postures are assumed in nursing work during a shift. Future preventive measures should therefore consider not only load handling but also tasks with awkward postures.

Back pain in direct patient care providers: early intervention with cognitive behavioral therapy

Back pain and injury are a widespread problem for direct care providers and can lead to disability and job loss. Although most intervention studies focus on the number of reported injuries as the outcome variable, pain is a leading indicator of impending injury. More secondary prevention interventions focusing on early detection and treatment of pain are needed to reduce injuries. The primary aim of this study was to assess the feasibility and effect size of a cognitive behavioral therapy (CBT) intervention to reduce the measures of back pain, stress, and disability in direct care providers working with back pain. The secondary aim was to assess the association between affect and outcome variables, particularly unscheduled work absence, which is a component of disability. This randomized clinical trial recruited 32 registered nurses and nursing assistants with a history of back pain in the past year and assigned them to either an intervention or a control group. The CBT intervention was a weekly stress and pain management session over 6 weeks led by a clinical psychologist. Data for both groups were collected at baseline and at 6 weeks, with work absence data caused by back pain self-reported for 12 weeks. Pain intensity scores declined in the intervention group, indicating a large effect. However, stress scores increased. Depression scores accounted for one-third of the variance in hours absent because of back pain. Although there was a high dropout rate in the intervention group, a cognitive-behavioral intervention shows promise as a secondary prevention intervention.

Musculoskeletal complaints among a group of Turkish nurses

The aim of the present study was to describe the prevalence and distribution of symptoms of musculoskeletal complaints among Turkish nurses who are practicing general nursing. The study population consisted of 120 nursing staff from four large general hospitals in Erzurum, Turkey. In every hospital six departments (surgery, medical, obstetric and gynecology, psychiatry, pediatric, and neurology) were selected. A Nordic standardized questionnaire described by Kuorinka et al. (1987) about complaints of the musculoskeletal system and a self-administered questionnaire involved information on the respondent's job and employment history, individual characteristics, physical and psychosocial risk factors at work, and general health status, were used by the researchers. Test data were analyzed for the difference between two population proportion and percentage. In the total population, 90% of all nurses reported at least one musculoskeletal complaint, 60% reported at least two, and 36% reported spells of three complaints in the past 6 months. Low back complaints were the most prevalent of musculoskeletal complaints, reported by 69% of the nurses. Neck complaints were less prevalent than shoulder (46% and 54%, respectively). Nurses with back complaint more often reported neck (28%) and shoulder (34%) complaints. Chronic low back, neck, and shoulder complaints were experienced by 41%, 25%, and 33% nurses, respectively. On the other hand, chronic complaints showed a correlation with working departments. The nurses working in surgery and obstetric and gynecology departments have more chronic complaints than the nurses working in other department (p<.05). The article's findings do not differ from those of other countries. Despite its limitations, this study points to the importance of perceived worked-related physical demands in relation to reported neck, shoulder, and back musculoskeletal complaints in Turkish nurses. But, further inquiries are needed to identify other physical exposures that may be related to musculoskeletal complaints.

The physical workload of nursing personnel: association with musculoskeletal discomfort

Direct care-nursing personnel around the world report high numbers of work-related musculoskeletal disorders. This cross-sectional study examined the association between the performance of high-risk patient-handling tasks and self-reported musculoskeletal discomfort in 113 nursing staff members in a veterans' hospital within the United States. Sixty-two percent of subjects reported a 7-day prevalence of moderately severe musculoskeletal discomfort. There was a significant association between wrist and knee pain and the number of highest-risk patient-handling tasks performed per hour interacting with the load lifted. On units where lifting devices are readily available, musculoskeletal risk may have shifted to the wrist and knee.