Mental health and vitality predict spinal pain in healthcare workers

BACKGROUND

Despite extensive investigation of ergonomic risk factors for spinal pain in healthcare workers, limited knowledge of psychological risk factors exists.

AIMS

To assess the prospective association of mental health and vitality with development of spinal pain in healthcare workers.

METHODS

A prospective cohort study was carried out involving 1950 healthcare workers from 19 hospitals in Denmark. Assessments were done at baseline and at 1-year follow-up. Mental health and vitality were measured using the Short Form-36 Health Survey, while spinal pain intensity was measured using a 0-10 scale in the low-back, upper-back and neck, respectively. Cumulative logistic regressions adjusted for several confounding factors were applied, reporting risk estimates as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Using good mental health as reference, moderate (but not poor) mental health at baseline was associated with increased pain intensity in the low-back (OR: 1.41 [95% CI: 1.21-1.77]), upper-back (OR: 1.63 [95% CI: 1.31-2.02]) and neck (OR: 1.31 [95% CI: 1.07-1.61]) at 1-year follow-up. Likewise, using high vitality as reference, both moderate and low vitality at baseline were associated with increased pain intensity in the low-back (OR: 1.54 [95% CI: 1.22-1.94] and OR: 2.34 [95% CI: 1.75-3.12], respectively), upper-back (OR: 1.72 [95% CI: 1.34-2.23] and OR: 2.46 [95% CI: 1.86-3.25], respectively) and neck (OR: 1.66 [95% CI: 1.34-2.06] and OR: 2.06 [95% CI: 1.61-2.63], respectively) at 1-year follow-up.

CONCLUSIONS

Compared to healthcare workers with good mental health and high vitality, those with moderate mental health and low/moderate vitality, respectively, were more likely to increase spinal pain intensity at 1-year follow-up. These components should also be considered in the prevention of spinal pain in healthcare workers.

Underreporting of workers' injuries or illnesses and contributing factors: a systematic review

BACKGROUND

Accurate identification of work-related health problems is important to understand workplace safety issues and develop appropriate interventions. Although workers' reporting of work-related injuries or illnesses is the very first step of the reporting process, many workers may encounter challenges in reporting them to their management or workers' compensation (WC) programs. This systematic review aimed to identify the level of workers' underreporting of work-related injuries and illnesses and the contributing factors and reasons for underreporting among US workers.

METHODS

This study searched PubMed (Medline), PsycINFO (ProQuest), CINAHL (EBSCOhost), EMBASE (Embase.com), and Social Science Citation Index (Web of Science) using search terms related to underreporting of work-related injury or illness.

RESULTS

Twenty studies (17 quantitative and three mixed methods studies) were identified. The studies investigated reporting to management (n = 12), WC programs (n = 6), multiple organizations (n = 1), and not specified (n = 1). The timeframe used to measure reporting prevalence varied from three months to entire careers of workers, with the most common timeframe of 12 months. This review indicated that 20-91% of workers did not report their injuries or illnesses to management or WC programs. From quantitative studies, contributing factors for injury or illness underreporting were categorized as follows: injury type and severity, sociodemographic factors (e.g., age, gender, education, and race/ethnicity), general health and functioning, worker's knowledge on reporting, job and employment characteristics (e.g., work hour, job tenure, work shift, type of occupation, and physical demand), psychosocial work environment (e.g., supervisor support, coworker support, and safety climate), and health care provider factors. From the review of qualitative studies, the reasons for underreporting included the following: fear or concern, cumbersome time and effort in the reporting process, lack of knowledge regarding reporting, perceptions of injuries as not severe or part of the job, and distrust of reporting consequences.

CONCLUSIONS

The review findings indicated that low wage earners, racial/ethnic minority workers, and workers who perceive a poor psychosocial work environment encounter more barriers to reporting a work-related injury or illness. This review also identified variations in the measurement of work-related injury reporting across studies and a lack of standardized measurement.

TRIAL REGISTRATION

The review was registered in the PROSPERO, an international database of prospectively registered systematic reviews in health and social care (CRD42021284685).

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Bathing frail seniors at home: Home care providers' approaches

BACKGROUND

Home care providers assisting with seniors' personal care often experience high rates of musculoskeletal disorders, particularly affecting the lower back. Assisting with bathing is consistently identified as one of their most physically demanding activities.

OBJECTIVE

To identify and describe care providers' procedures for assisting a frail senior to bathe that are likely to contribute most to the development of back injuries.

METHODS

Eight community-based personal support workers (home care aides) assisted a frail senior (actor) to bathe in a simulated home bathroom. Video recordings of the activity were coded according to providers' postures and to characterize techniques for providing care.

RESULTS

Exposure to severe trunk flexion and high posture-induced back loads was greatest during transfers in and out of the bathtub. In particular, lifting the legs over the rim of the tub, assisting the client to shift across the bath transfer bench, and providing care to the legs and feet involved the care provider spending substantial time in highly flexed postures. No observed techniques for these activities showed substantially lower exposures.

CONCLUSIONS

Further tools and/or techniques must be identified or developed to improve caregiver safety during these strenuous activities.

Poor Sleep Is a Risk Factor for Low-Back Pain among Healthcare Workers: Prospective Cohort Study

This study aimed to investigate the association between poor sleep and risk of low-back pain (LBP) in healthcare workers. Using a prospective cohort design with 1-year follow-up, a total of 1955 healthcare workers (60% nurses) from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Associations between sleep scores (0-100) at baseline and LBP intensity (0-10) at follow-up were modelled using cumulative logistic regression accounting for clustering at the department level and adjusted for lifestyle and psychosocial confounders. In the full population of healthcare workers, 43.9% and 24.4% experienced moderate and poor sleep, respectively. In the fully adjusted model with good sleep as reference, moderate, and poor sleep increased the risk of LBP at follow-up, with odds ratios (OR's) of 1.66 (95% confidence interval (CI) 1.35-2.04) and 2.05 (95% CI 1.57-2.69), respectively. Three sensitivity analyses including healthcare workers free from LBP, nurses, and nurses free from LBP at baseline, respectively, yielded similar results. In conclusion, poor sleep constitutes a potent risk factor for LBP among healthcare workers. The presented results provide strong incentives to evaluate and weigh current prevention policies against an updated biopsychosocial framework.

Developing Evidence-Based Design Guidelines for Medical/Surgical Hospital Patient Rooms That Meet the Needs of Staff, Patients, and Visitors

OBJECTIVES

This research investigated medical/surgical (Med/Surg) patient room design to accommodate the needs of hospital staff, while at the same time accommodating the needs of patients and their visitors.

BACKGROUND

Designing hospital patient rooms that provide a comfortable healing experience for patients, while at the same time meeting the needs of the hospital staff, is a challenging process. Prior research has shown that many hospital patient room designs adversely affect the ability of hospital staff to perform their tasks effectively, efficiently, and safely.

METHOD

Twenty-seven design sessions were conducted in which 104 participants, representing 24 different occupations, worked in small mixed occupational groups to design an ideal single patient Med/Surg patient room to fit their collective needs using a full-scale mock-up. During analysis, the investigators reduced the resulting 27 room designs to 5 hybrid designs that were sequentially reviewed by patients and visitors and by staff to address design conflicts.

RESULTS

This design process identified 51 desirable room design features that were incorporated into 66 evidence-based design guidelines for the different areas within the Med/Surg patient room including the entry way (16 guidelines), the patient clinical area (22 guidelines), the bathroom (17 guidelines), the family area (8 guidelines), and storage areas for patients and their visitors (3 guidelines).

CONCLUSIONS

The guidelines developed through this study identified many opportunities for improving the design of hospital Med/Surg rooms to allow staff to be more effective, efficient, and safer, while at the same time addressing the design needs of patients and their visitors.

Association of musculoskeletal disorders and workload with work schedule and job satisfaction among emergency nurses

BACKGROUND

The emergency department is a highly demanding work environment, considered by high workload and stress. The impact of work-related factors on musculoskeletal disorders (MSDs) in emergency nurses (ENs) are not yet well understood. We investigated the association of MSDs and workload with work schedule (permanent day and night work) and job satisfaction in ENs.

METHOD

Data were collected through a questionnaire including individual and work-related factors, workload (National Aeronautics and Space Administration-Task Load Index [NASA-TLX]) and MSDs (Standardized Nordic Questionnaire) from 380 ENs in five hospitals.

RESULTS

The findings revealed that work schedule and job satisfaction levels were significantly associated with the MSDs in different body regions. Work schedule was significantly related to physical demand, performance, frustration, and overall workload, whereas it was not to the mental and temporal demands and effort. Job satisfaction level was negatively associated with mental demand and frustration. A high prevalence of musculoskeletal problems, particularly in knees, upper back, lower back, neck and shoulders were found.

CONCLUSION

MSDs are highly prevalent among ENs involved in night work and with low job satisfaction levels. The results are discussed in terms of their implications for emergency hospital nurses. The findings can help to better understand the working conditions and emphasize the need for ergonomic interventions in order to reduce MSDs and workload. Also, the study findings highlight the importance of mental aspects of workload in this occupational group.

Claim Costs, Musculoskeletal Health, and Work Exposure in Physical Therapists, Occupational Therapists, Physical Therapist Assistants, and Occupational Therapist Assistants: A Comparison Among Long-Term Care Jobs

BACKGROUND

Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems.

OBJECTIVE

This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff.

DESIGN

This was a cross-sectional study.

METHODS

Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities.

RESULTS

About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands.

LIMITATIONS

Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others).

CONCLUSIONS

MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.

Changing the Perceptions of a Culture of Safety for the Patient and the Caregiver: Integrating Improvement Initiatives to Create Sustainable Change

Evidence indicates that chances for a successful patient mobility program, prevention of pressure injury and falls, and safe patient handling are enhanced when an organization possesses an appropriate culture for safety. Frequently, these improvement initiatives are managed within silos often creating a solution for one and a problem for the others. A model of prevention integrating early patient mobility, preventing pressure injuries and falls while ensuring caregiver safety, is introduced. The journey begins by understanding why early mobility and safe patient handling are critical to improving overall patient outcomes. Measuring current culture and understanding the gaps in practice as well as strategies for overcoming some of the major challenges for success in each of these areas will result in sustainable change.

Underreporting of Musculoskeletal Injuries in the US Army: Findings From an Infantry Brigade Combat Team Survey Study

Background:

Musculoskeletal injury is a significant threat to readiness in the US Army. Current injury surveillance methods are constrained by accurate injury reporting. Input into electronic medical records or databases therefore may not accurately reflect injury incidence. The purpose of this study was to evaluate injury reporting among active-duty US Army soldiers to explore potential limitations of surveillance approaches.

Hypothesis:

A significant number of injuries go unreported to medical personnel.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 4.

Methods:

Surveys were completed by soldiers assigned to an Army Infantry Brigade Combat Team. Survey questions inquired about injuries sustained in the previous 12 months, injury onset, and whether injuries were reported to a medical provider. Participants were asked to rank reasons for accurately reporting, underreporting, and/or exaggerating injuries. Chi-square analyses were used to compare differences among underreported injuries in terms of injury onset (gradual vs acute) and sex.

Results:

A total of 1388 soldiers reported 3202 injuries that had occurred in the previous 12-month period, including 1636 (51%) that were reported and 1566 (49%) that were identified as not reported to medical personnel. More than 49% of reported injuries were described as acute and 51% were described as chronic. Injury exaggeration was reported by 6% of soldiers. The most common reasons for not reporting injuries were fear that an injury might affect future career opportunities and avoidance of military “profiles” (mandated physical restrictions).

Conclusion:

Approximately half of musculoskeletal injuries in a Brigade Combat Team were not reported.

Clinical Relevance:

Unreported and untreated injuries can lead to reinjury, chronic pain, performance decrements, and increased costs associated with disability benefits. Additionally, unreported injuries can undermine injury surveillance efforts aimed at reducing the musculoskeletal injury problem in the military.

Records review of musculoskeletal injuries in aeromedical evacuation personnel

BACKGROUND

Aeromedical evacuation providers care for patients during air transport. By applying standard medical practices, oftentimes developed for ground care, these practitioners perform their mission duties under additional physical stress in this unique medical environment. Awkward postures and excessive forces are common occurrences among personnel operating in this domain. Additionally, anecdotal reports highlight the risk of developing musculoskeletal injuries for these providers. Currently, there is limited research focusing on musculoskeletal injuries in aeromedical evacuation providers.

PURPOSE

To determine the prevalence of musculoskeletal injuries and associated symptoms in aeromedical evacuation providers to understand the risk and burden of these injuries to military personnel.

METHODS

This study utilized a retrospective review of military medical records containing ICD-9 codes to investigate the incidence of musculoskeletal injuries within flight nurses and medical technicians compared to their non-flying counterparts from 2006 through 2011. Data were analyzed from 2013 through 2014.

RESULTS

Although musculoskeletal injuries were identified within the test populations, results showed fewer injuries for aeromedical evacuation populations compared to non-aeromedical evacuation counterparts.

CONCLUSIONS

One contributing factor may be a potential under-reporting of musculoskeletal injuries resulting from the fear of being placed on limited flying status. As flyers, aeromedical evacuation personnel must undergo yearly medical examinations and complete training courses that emphasize proper lifting techniques and physical requirements necessary for the safe and efficient transport of patients on various platforms. These additional requirements may create a healthy worker effect, likely contributing to lower musculoskeletal injuries.

Understanding Work-related Musculoskeletal Injuries in Rehabilitation from a Nursing Perspective

PURPOSE

The incidence and prevalence of work-related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context-specific patterns of nursing injuries.

DESIGN

Using a cross-sectional descriptive research design, 58 rehabilitation nurses participated in this study.

METHODS

Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit.

FINDINGS

Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication.

CONCLUSIONS

Nursing input is critical in understanding and reducing context-specific work-related musculoskeletal injuries. Further research that includes nursing voices is advocated.

CLINICAL RELEVANCE

Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.

Use of occupational health services in a Cyprus oncology center

Use of occupational health services in the hospital environment is an important parameter for annual health care planning. The objective of this study was to evaluate the clinic utilization at a Cyprus oncology center. All visits to the occupational health clinic during an 18-month period were reviewed and analyzed. During the study period, the center had, on average, 161 employees and offered 67 occupational health clinic sessions. Employees had 338 clinic visits, of which 294 were primary and 44 were follow-up visits, with 5 employees, on average, visiting the clinic at each session. Nurses most frequently visited the center (33.4%), followed by the administrative staff (28.6%) and the employees of the Medical Physics and Radiology Department (22.4%), corresponding to the largest groups of employees. The most frequently cited reason for the visits was administrative purposes (23.6%), including updating health records, followed by pre-placement examinations (14.7%) and vaccinations (10.3%). Administrative and clinical reasons were given for occupational health clinic use at the oncology center across all categories of employees.