The impact of workplace factors on filing of workers' compensation claims among nursing home workers

Underreporting of work-related low back pain among registered nurses: A mixed method study

BACKGROUND

Identifying and addressing work-related health problems early is crucial, but workers often perceive barriers in reporting these to management. This study aimed to investigate the factors associated with nurses' reporting of work-related low back pain to their managers and explored the reasons why nurses with patient handling injuries did not report them.

METHODS

This study is a concurrent mixed-method analysis of data from two statewide cross-sectional surveys of California registered nurses conducted in 2013 and 2016. The reporting of work-related low back pain to management (n = 288) was examined for associations with individual, occupational, and organizational factors. For qualitative analysis, the reasons for not reporting patient handling injuries were explored using open-ended responses (n = 42).

RESULTS

Reporting was associated with BIPOC (Black, Indigenous, and People of Color) men (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) compared to non-Hispanic White women; being a non-US educated nurse (AOR: 0.90, 95% CI: 0.80-1.01); experiencing greater low back pain (AOR: 1.07, 95% CI: 1.02-1.12); missing work (AOR: 1.38, 95% CI: 1.21-2.62); perceiving high physical workload (AOR: 0.89, 95% CI: 0.81-0.98); perceiving high people-oriented culture (AOR: 1.14, 95% CI: 1.04-1.25); and perceiving high ergonomic practices (AOR: 0.89, 95% CI: 0.81-0.98). Identified themes on the reasons for not reporting injuries included organizational-culture attitudes toward work-related injuries and injury characteristics of musculoskeletal disorders.

CONCLUSIONS

The findings indicate a need for management to remove structural barriers and improve organizational practices, and for a culture that promotes trust and open communication between workers and management.

Characterizing worker compensation claims in long-term care and examining the association between facility characteristics and severe injury: a repeated cross-sectional study from Alberta, Canada

BACKGROUND

Despite the physical demands and risks inherent to working in long-term care (LTC), little is known about workplace injuries and worker compensation claims in this setting. The purpose of this study was to characterize workplace injuries in LTC and to estimate the association between worker and organizational factors on severe injury.

METHODS

We used a repeated cross-sectional design to examine worker compensation claims between September 1, 2014 and September 30, 2018 from 25 LTC homes. Worker compensation claim data came from The Workers Compensation Board of Alberta. LTC facility data came from the Translating Research in Elder Care program. We used descriptive statistics to characterize the sample and multivariable logistic regression to estimate the association between staff, organizational, and resident characteristics and severe injury, measured as 31+ days of disability.

RESULTS

We examined 3337 compensation claims from 25 LTC facilities. Less than 10% of claims (5.1%, n = 170) resulted in severe injury and most claims did not result in any days of disability (70.9%, n = 2367). Most of the sample were women and over 40 years of age. Care aides were the largest occupational group (62.1%, n = 2072). The highest proportion of claims were made from staff working in voluntary not for profit facilities (41.9%, n = 1398) followed by public not for profit (32.9%, n = 1098), and private for profit (n = 25.2%, n = 841). Most claims identified the nature of injury as traumatic injuries to muscles, tendons, ligaments, or joints. In the multivariable logistic regression, higher staff age (50-59, aOR: 2.26, 95% CI 1.06-4.83; 60+, aOR: 2.70, 95% CI 1.20-6.08) was associated with more severe injury, controlling for resident acuity and other organizational staffing factors.

CONCLUSIONS

Most claims were made by care aides and were due to musculoskeletal injuries. In LTC, few worker compensation claims were due to severe injury. More research is needed to delve into the specific features of the LTC setting that are related to worker injury.

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).

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.

Face, content, criterion and construct validity assessment of a newly developed tool to assess and classify work-related stress (TAWS- 16)

INTRODUCTION

As work-stress, is associated with Non Communicable Diseases, and decreased work productivity, health and economic benefits are expected from periodic work-stress screening among employees using valid and reliable tools. Tool to Assess and classify Work Stress (TAWS- 16) was developed to overcome limitations in existing work-stress assessment tools in India. This study aims to test face, content, criterion and construct validity of TAWS- 16 in a sample of managerial-supervisory employees.

METHODS

Nine domain experts rated face and content validity of TAWS- 16. Content validity was measured by Content Validity Indices (I-CVI, S-CVI) and Modified Kappa statistics. Empirical validity was tested by analysing data reported from 356 Information Technology (IT) professionals wherein Exploratory Factor Analysis was conducted for the assessment of Construct Validity. Self-reported data was collected in an unlinked and anonymous manner using a web-link, which was emailed to the study subjects, after initial introductory telephone or personal conversation. Criterion Validity was tested against stress sub-scale of DASS- 21. This study was approved by NIMHANS ethics committee.

RESULTS

Findings revealed that TAWS- 16 has good face validity. The content validity is acceptable (CVI = 0.829). Construct Validity is appropriate as 60.8% of the total variance was explained by the factors identified in our study. Criterion Validity was moderate (Kappa Value 0.208) due to inappropriate work-stress instrument for comparison with TAWS- 16.

CONCLUSIONS

Overall, TAWS- 16 demonstrated good face, content and construct validity. It measures work-stressors, coping abilities and psycho-somatic symptoms associated with work-stress. We recommend use of TAWS- 16 for periodic screening and classification of work-stress among employees.

Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study

Background

A work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun.

Objective

This study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L).

Methods

This study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities.

Results

A total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee.

Conclusions

Stakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation.

Filing a Workers' Compensation Claim for Low Back Pain and Associated Factors: Analysis of 2015 National Health Interview Survey

OBJECTIVE

The aim of this study was to examine the degree of reporting work-related low back pain (LBP) by workers' compensation (WC) claim filing and associated factors among US workers.

METHODS

We conducted multivariable logistic regression using the 2015 National Health Interview Survey data.

RESULTS

Among 1203 US workers with self-reported work-related LBP diagnosis, only 19.6% filed for WC. Compared with non-Hispanic White workers, Black, Asian, and Hispanic workers were less likely to file for WC. Workers' compensation filing was less frequent among workers in independent work arrangement and who stopped working, changed jobs, or made a change in work and more frequent among workers 45 to 64 years of age and having high LBP frequency.

CONCLUSIONS

Our study findings suggest underreporting of work-related LBP to the WC system is common. Barriers to WC filing should be addressed especially for racial/ethnic minorities and independent workers.

An Examination of Washington State Workers’ Compensation Claims for Home-Based Health Care Workers, 2006 to 2016: Part 2. Injury Rates and Trends

Research of home-based health care (HBHC) has shown that care providers suffer from a high rate of injuries. Analysis of workers’ compensation records, a reliable source for injury and illness data, enables the identification of trends within a specific working population. HBHC workers’ compensation compensable claims in Washington State from 2006 to 2016 were compared to clinical health care (CHC) claims. Injury event and source attributed to HBHC claims were also analyzed, with a focus on work-related musculoskeletal disorders (WMSDs). Though CHC had 5 times the number of full-time employees during the study period, HBHC grew by 61.1%, compared to 28.7% in CHC. Claim rates for all compensable claims and WMSD claims consistently decreased year-over-year for both HBHC and CHC. WMSD claims experienced a year-over-year decline of 5.3%; for all compensable claims the decline was 4.5%. Analysis of HBHC claim rates by injury event found WMSD had the highest rates, followed by falls from the same level. However, the largest annual change was for the injury event overexertion (−10.1%, 95%CI: −13.4, −6.8). HBHC injuries attributable to the health care patient were the most common. Claims with this injury source declined annually by 6.0%. Claim rates for injuries to the back region, and specifically back WMSDs, were consistently higher year-over-year compared to other body regions and WMSD types. Claims for injuries to the back declined by an annual rate of 6.6% (95% CI: −7.9, −5.3), while back WMSD claims decreased by 6.4% (94% CI: −7.8, −4.9).

Psychosocial influences in the development of cumulative trauma disorders

STUDY DESIGN

This study is a single-phase, qualitative study using grounded theory methodology.

INTRODUCTION

Cumulative trauma disorders (CTDs) are musculoskeletal disorders that impact health and productivity. CTD risk factors are present in the workplace, home, and community. Occupational and physical therapists specializing in hand and upper extremity rehabilitation (hand therapists) are widely involved with this population. Hand therapists often employ a medical model in the assessment and treatment of these conditions; however, the medical model has not proven to be consistently effective in relieving symptoms or producing a durable return to daily living activities.

PURPOSE OF THE STUDY

The purpose of this study was to explore the lived experiences of individuals diagnosed with CTD, and investigate the psychosocial phenomena influencing CTD development as an impediment to occupational performance.

METHODS

The principal investigator recruited 11 participants who met specific inclusion criteria, then used semi-structured interviews aimed at exploring the lived experiences of the participants while investigating the psychosocial phenomenon influencing CTD development. Interviews were transcribed and analyzed using a process of constant comparison, up until saturation occurred. Trustworthiness techniques were used in the data analysis phase and included peer reviews and member checking.

FINDINGS

The findings suggest that many psychosocial factors contribute to the development and impact of CTDs, at both onset of symptoms and throughout the duration of the condition. A significant number of contextual factors influence participants' function, behavior, relationships, and the course of medical care. Themes derived from the participants' expressions, included the following: 1) an initial strategy of "work through the pain," can be detrimental to symptom resolution and leads to progressive failure to meet role expectations, 2) a pervasive notion of CTDs as "an invisible disability," leaving participants feeling isolated and frustrated when significant others fail to offer support or reject them, 3) participants often delayed reporting symptom development to employers, family members, and medical personnel, risking permanent injury and disability, 4) a "stigma" is attached to CTDs that encourages isolation; however, the social support of even one significant other in a person's life can facilitate adaptation.

DISCUSSION AND CONCLUSION

All participants experienced hardship because of their conditions; however, two of the eleven participants capably navigated the process, using past experience and support from family and employer to successfully adapt. These findings offer support that CTDs are adaptive disorders. The study's conclusion suggests a new model to describe CTD dysfunction and presents new ways of thinking for clinicians who treat the CTD population.

Influence of Work-Related Safety and Health Guidelines on Knowledge and Prevalence of Occupational Back Pain among Rehabilitation Nurses in Saudi Arabia: A 6-Month Follow-Up Study

Background: Nurses are frequently involved in different types of patient handling activities in different departments of the hospitals. Mishandling the patients causes accumulative stress on their spine that results in occupational back pain (OBP), substantial morbidity, and incurred cost. Objectives: This study aimed to observe the influence of work-related safety and health guidelines on knowledge and prevalence of occupational back pain among rehabilitation nurses in Saudi Arabia. Methodology: This cohort study was conducted with the inclusion of a total of 116-registered rehabilitation nurses (97-female, 19-male, mean age = 39.6-years) from different regions of Saudi Arabia. After the invitation, these nurses attended an ergonomic workshop focusing on work-related safety and patient handling guidelines, risk assessment, and control of OBP. A self-administered questionnaire was used to assess the knowledge, risk, and prevalence of OBP at baseline and 6-months follow-up. Results: The perceived knowledge score significantly improved (95% CI; t = 4.691; p < 0.001; Cohen’s d = 0.72) at 6-month follow-up (mean ± SD = 81.6 ± 18.2) from its baseline score (mean ± SD = 68.2 ± 19.2). Likewise, the prevalence score of OBP markedly reduced from 71.5% (baseline) to 65.0% (6-month follow-up). Conclusion: The level of knowledge highly improved and the prevalence of OBP markedly reduced within a span of 6-month among rehabilitation nurses in Saudi Arabia after attending an ergonomic workshop. Importantly, the nurses learned and geared up themselves for practicing the safe patient handling guidelines to avoid occupational back pain in the future. Therefore, rehabilitation nurses should update their knowledge and awareness about occupational safety and health guidelines, risk assessments, and control of OBP at a regular interval for increasing the knowledge and reducing the prevalence of OBP among them.

A Corporate Wellness Program and Nursing Home Employees' Health

Background: Many employed Americans suffer from chronic conditions like obesity, diabetes, and cardiovascular diseases. Worksite wellness programs provide opportunities to introduce health promotion strategies. While there is evidence of the effectiveness of workplace health promotion, this is tempered by concern that benefits may be less available to low-wage workers with inflexible working conditions. Objective: The aim was to evaluate a workplace health promotion (WHP) in the long-term care sector (skilled nursing facilities). Methods: Nursing home employees from 18 facilities within a single company were surveyed by a standardized, self-administered questionnaire. A company-sponsored WHP program was offered to the facilities, which were free to take it up or not. We categorized the facilities by level of program adoption. Cross-sectional associations were estimated between program category and prevalence of individual-level worker health indicators, adjusting for center-level working conditions. Results: A total of 1,589 workers in 5 job categories completed the survey. Average levels of psychological demands and social support at work were relatively high. Supervisor support stood out as higher in centers with well-developed WHP programs, compared to centers with no programs. There were no differences among program levels for most health outcomes. Workers in centers with well-developed programs had slightly lower average body mass index and (unexpectedly) slightly lower prevalence of non-smoking and regular aerobic exercise. Conclusions: Only small health benefits were observed from well-developed programs and working conditions did not appear to confound the negative results. This low-intensity, low-resourced workplace health promotion program may have benefited a few individuals but seems to have had only modest influence on average levels of the measured health indicators. Many nursing home employees experience obstacles to health behaviors; approaches that provide more environmental and economic supports for healthy behaviors, such as Total Worker Health®, may yield larger health benefits.

Workers' compensation injury claims of aviation industry worker injuries in Alaska, 2014-2015

Aviation operations in Alaska often occur in remote locations and during inclement weather. Limited infrastructure and staff in some locations often requires aviation workers to perform tasks outside of their specific job descriptions. Researchers identified workers' compensation claims as a valuable data source to characterise nonfatal injuries among Alaskan aviation workers. Keyword searches of injury claim narrative fields and industry codes were used to identify potentially aviation-related workers' compensation claims during 2014-2015. These claims were manually reviewed to verify whether aviation related and manually coded according to the US Bureau of Labour Statistics' Occupational Injury and Illness Classification System. There were 875 aviation-related injury claims accepted during 2014-2015. Ramp/baggage/cargo agents incurred the most injuries (35%), followed by mechanics/maintenance workers (15%). Among all workers, Overexertion and Bodily Reaction (40%) was most often cited as the injury event, followed by Contact with Objects and Equipment (28%), and Falls, Slips, Trips (22%). Sprains, strains, tears were the most frequent nature of injury (55%). Cargo/freight/luggage was the most frequent source of injury (24%). The 3 most frequently identified injury event types were responsible for over 90% of all injuries, which indicates that preventive interventions should be directed towards tasks rather than occupational groups.

Musculoskeletal disorders in aged care workers: a systematic review of contributing factors and interventions

BACKGROUND

There is limited evidence on contributing factors and effective interventions for musculoskeletal injuries in aged care workers.

PURPOSE

To systematically review the factors that contribute to musculoskeletal disorder risk amongst workers in the aged care industry, and to undertake a qualitative comparison of the interventions designed and implemented to prevent injury within this workforce.

METHODS

A systematic review of the literature was conducted in Web of Science, Scopus, ProQuest, Medline, and PubMed. Relevant grey literature was also examined. Articles that reported factors that contribute to musculoskeletal injuries, or interventions to prevent and manage musculoskeletal injuries in residential aged care workers were included.

FINDINGS

Of the 864 articles and 35 grey literature publications found, 63 and 29 were included in the review respectively. Results indicate that physical factors such as manual handling of people, use of assistive devices, and physical work environment are most commonly associated with musculoskeletal disorders in this population. Limited evidence of organisational and psychosocial factors considered staffing issues, work schedules, and violence. The heavy emphasis on physical factors is echoed in the grey literature in relevant guidance material and codes of practice focused on assessment and control of risks. There was limited evidence for interventions specific to aged care; existing evidence focused on equipment, training and education, policy and procedure. Interventions incorporating a combination of approaches, such as equipment and training, showed promise while preliminary evidence of the effectiveness of participatory approaches are positive.

DISCUSSION

Interventions which address multiple types of contributing factors are needed to adequately prevent musculoskeletal injuries in aged care workers. Tweetable abstract: Review of contributing factors, interventions, and application of knowledge for work-related musculoskeletal injuries in aged care.

Risk of mental illness after the diagnosis of occupational injury or disease: a retrospective cohort study

OBJECTIVES

As studies on mental disorders in victims of occupational injury or disease are limited, this study aims to evaluate the risk of, and factors associated with, the development of mental illness in patients with occupational injury or disease using insurance claims data from Taiwan.

METHODS

This retrospective cohort study analyzed insurance records in Taiwan to identify 18,285 adults who experienced occupational injury or disease in 2002-2013 and 18,285 adults without occupational injury or disease who were matched by propensity score. The risks of mental disorders during a follow-up period of up to 2 years were estimated and compared between the two cohorts.

RESULTS

After controlling for other variables, the odds of mental illness in patients with occupational injury or disease was significantly higher compared to patients without occupational injury or disease. Additional factors associated with higher odds of mental disorders included female gender, age ≥ 30 years (vs. 20-29 years), Charlson comorbidity index ≥ 1, occupation category of labor union member, soldier, insured by social security, religious group member (vs. private or government employee), lower premium-based monthly salary (≤ 576 US$), treatment at a district hospital or clinic (vs. medical center), treatment at a publically-owned or consortium-owned hospital (vs. private hospital), and central or southeast geographic location (vs. Taipei). The main types of mental illness were anxiety disorder (2.79%) and other psychoses (3.29%).

CONCLUSION

The risk of mental illness slightly increased during the 2-year period after the diagnosis of occupational injury or disease.

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.

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.

Linking Incidents in Long-Term Care Facilities to Worker Activities

This article reports on a study examining staff activities being performed when incidents were reported to have occurred. The risk for injury among health care providers who engage in patient handling activities is widely acknowledged. For those working in long-term care, the risk of occupational injury is particularly high. Although injuries and injury prevention have been widely studied, the work has generally focused on incident rates and the impact of specific assistive devices on worker safety. The purpose of this study was to examine reported staff incidents in relation to staff activities. A multicenter cross-sectional exploratory study used retrospective data from reported staff incidents (2010, 2011, and 2012) and prospective data from 360 hours of staff observations in five long-term care facilities during 2013. Descriptive statistics were used to analyze data. A total of 898 staff incidents were reviewed from the facilities. Incidents were most likely to occur in resident rooms. Resident aides were more likely to be engaged in high-risk activities than other care providers. Times when staff incidents were reported to have occurred were not associated with periods of high staff-to-resident contact. Safe handling during low and moderate risk activities should be promoted. Education on what constitutes a reportable incident and strategies to ensure compliance with reporting policies and procedures may be needed to ensure accuracy and completeness of incident data.

The quality of work life of registered nurses in Canada and the United States: a comprehensive literature review

BACKGROUND

Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses.

OBJECTIVE

The aim of this paper was to perform a comprehensive literature review on nurses' quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada.

METHODS

Using publications from 2004-2014, contributing factors to American and Canadian nurses' QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis.

RESULTS

Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses' quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation.

CONCLUSIONS

This review's findings support the importance of QWL as an indicator of nurses' broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system.

The prevalence differences of musculoskeletal problems and related physical workload among hospital staff

BACKGROUND

The musculoskeletal problems (MSP) vary among different occupations since they had different characteristics and physical workloads. Therefore, it is important to know the difference between the occupational groups to design preventing physiotherapy interventions.

OBJECTIVE

To investigate the prevalence differences of MSPs and related physical workload among hospital staff.

METHODS

In this cross-sectional study, 416 hospital staff completed the Nordic Musculoskeletal Questionnaire for MSP and Physical Workload Questionnaire for assessing the physical workload.

RESULTS

One-year prevalence of low back, neck, upper back, and shoulders were 73.8%, 59.9%, 59.4%, and 52.2%, respectively. The most preventing MSPs from work found in the low back (39.2%), upper back (26.7%), and the neck (24.5%). MSP of low back impacted nurses the most with a 1-year prevalence of 81.3% and 57.1% of nurses were prevented from working. Nurses, service and cleaning staff had significantly more physical workload than secretaries and physicians.

CONCLUSIONS

MSP of low back had the highest prevalence among hospital staff and it was the leading cause which prevented from working. Nurses were the most in danger in terms of MSPs among hospital staff. Physical workload was significantly higher in nurses, service and cleaning staff than secretaries and physicians.

Health Behaviors and Overweight in Nursing Home Employees: Contribution of Workplace Stressors and Implications for Worksite Health Promotion

BACKGROUND

Many worksite health promotion programs ignore the potential influence of working conditions on unhealthy behaviors.

METHODS

A study of nursing home employees (56% nursing aides) utilized a standardized questionnaire. We analyzed the cross-sectional associations between workplace stressors and obesity, cigarette smoking, and physical inactivity.

RESULTS

Of 1506 respondents, 20% reported exposure to three or more workplace stressors (physical or organizational), such as lifting heavy loads, low decision latitude, low coworker support, regular night work, and physical assault. For each outcome, the prevalence ratio was between 1.5 and 2 for respondents with four or five job stressors. Individuals under age 40 had stronger associations between workplace stressors and smoking and obesity.

CONCLUSIONS

Workplace stressors were strongly associated with smoking, obesity, and physical inactivity, even among the lowest-status workers. Current working conditions affected younger workers more than older workers. Although this study is cross-sectional, it has other strengths, including the broad range of work stressors studied. Strenuous physical work and psychosocial strain are common among low-wage workers such as nursing home aides. Workplace health promotion programs may be more effective if they include measures to reduce stressful work environment features, so that working conditions support rather than interfere with employee health.

Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care: A Comprehensive Review

OBJECTIVE

The aim of this study was to determine the prevalence of musculoskeletal pain and reported injuries for nurses and nursing aides.

BACKGROUND

Nurses and nursing aides suffer from work-related pain and musculoskeletal disorders (MSDs). Although there have been a plethora of studies on MSDs, an overall understanding of the prevalence of MSDs and pain can lead to better prioritization of research needs with respect to the health care industry.

METHOD

A total of 132 articles on prevalence of MSD pain and injuries were included in the review. All articles were published in peer-reviewed English-speaking journals and subjected to a quality review.

RESULTS

Reported prevalence of MSD pain for nurses and nursing aides was highest in the low back, followed by shoulders and neck. However, the majority of the studies have been concentrated on 12-month pain in the low back and predominantly in hospitals. Few researchers have investigated pain in the upper and lower extremities (less than 27% of the studies). Even fewer researchers have evaluated reported injuries or even subjective lost-time injuries (less than 15% of the studies).

CONCLUSION

MSD pain in the nursing profession has been widely investigated worldwide, with a major focus on low-back pain. Given new directions in health care, such as patients who live longer with more chronic diseases, bariatric patients, early mobility requirements, and those who want to be at home during sickness, higher prevalence levels may shift to different populations--home health care workers, long-term care workers, and physical therapists--as well as shift to different body regions, such as shoulders and upper extremities.

Obesity as a Possible Risk Factor for Lost-time Injury in Registered Nurses: A Literature Review

Time-loss injuries are still a major occurrence in Canada, injuring thousands of Canadian workers each year. With obesity rates on the rise across the country, as well as around the world, it is important that the possible effects of obesity in the workplace be fully understood, especially those effects linked to lost-time injuries. The aim of this paper was to evaluate predictors of workplace lost-time injuries and how they may be related to obesity or high body mass index by examining factors associated with lost-time injuries in the health care sector, a well-studied industry with the highest number of reported time loss injuries in Canada. A literature review focusing on lost-time injuries in Registered Nurses (RNs) was conducted using the keywords and terms: lost time injury, workers' compensation, occupational injury, workplace injury, injury, injuries, work, workplace, occupational, nurse, registered nurse, RN, health care, predictors, risk factors, risk, risks, cause, causes, obese, obesity, and body mass index. Data on predictors or factors associated with lost-time injuries in RNs were gathered and organized using Loisel's Work Disability Prevention Management Model and extrapolated upon using existing literature surrounding obesity in the Canadian workplace.