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Ergonomics and Nursing in Hospital Environments
Abstract
This study describes workplace conditions, the environment, and activities that may contribute to musculoskeletal injuries among nurses, as well as identifies solutions to decrease these risks and improve work-related conditions. The study used a mixed-methods design. Participants included nurses and stakeholders from five hospitals. Several focus groups were held with nurses, walk-throughs of clinical units were conducted, and stakeholder interviews with key occupational health and safety personnel were conducted in each of the five hospitals, as well as with representatives from the American Nurses Association, Veterans Health Administration hospital, and National Institute for Occupational Safety and Health. Several key contributing factors, including the physical environment (e.g., layout and organization of work stations), work organization and culture (e.g., heavy workload, inadequate staffing, lack of education), and work activities (e.g., manual lifting of patients, lack of assistive devices), were identified. Recommendations included the need for a multifaceted and comprehensive approach to developing a sound ergonomics program. [Workplace Health Saf].
... Studies demonstrated that relations of PSFs and physical exhaustion have likely increased the risk of MSDs in nurses. High perceived workload, role conflicts, low job satisfaction, poor social support, time pressure, low justice and respect in the workplace were among those factors constantly effected these disorders in several studies [7,21,[30][31][32][33]. ...
... Some study samples included small proportions of nurses such as 42, 58, 76 nurses [18,30,40], some included large samples 5187, 3914 and 2851 nurses [14,22,47]. Many studies examined the all risk factors for MSDs, a few studies addressed only psychosocial factors for MSDs. ...
Nurses exposure many risk factors in the hospital setting. Musculoskeletal disorders (MSDs) is a common health problem between work related disabilities and injuries in nurses. The aim of this review was to examine the prevalence of MSDs in nurses and also summarize risk factors, outcomes, solutions. An electronic search was conducted in Pub Med in January 2017. Publications in the last ten years were researched using the key words: Work Related Musculoskeletal Disorders and Nurses. The initial electronic search identified 111 papers. Some articles were excluded since they were not related to our study topic (7 articles were review, 15 of them were related to the roles of nurses in some musculoskeletal disorders, 14 articles were about nurses who working outside the hospital or new graduated/student, 28 articles addressed work related other health problems, 3 of them were related to hospital ergonomics and risk factors and 7 articles were interventions studies). Three papers were not reached to full text or abstract. The total number of remaining articles was 34 and all of them were included the study. It was considered that reported musculoskeletal disorders in nurses were limited to the past 12 months. It had been found that the prevalence of MSDs varied between 33.0% and 88.0%. The most commonly affected body regions were lower back, shoulder, neck, knees, wrists/hands. Lower back pain complaints were found to vary between 49.0% and 84.0%. The findings indicated that the work related musculoskeletal disorders associated with cumulative trauma and repetitive tasks included: lifting, transferring or repositioning, prolonged standing and also awkward postures (stooping, bending and reaching). These work-related health problems in nurses were significantly associated with age, gender, body mass index, ward, shift working and working in a hospital. Studies showed that musculoskeletal disorders were most seen among the operation room nurses and intensive care nurses. Also, MSDs were found to be the main causes of absenteeism, demanding a change of duty or job and visiting a physician. The MSDs was more prevalent occupational health problem among nurses. The prevalence of MSDs was associated with both demographic characteristics of nurses and hospitals organizational factors. It was confirmed that making ergonomics interventions could improve the working environment in the hospital. [Med-Science 2018; 7(3.000): 479-85]
... [6] Musculoskeletal disorders entail costs for disabled workers, as well as costs for the society. [5,7,8] On the other hand, Norway in line with other western countries, face challenges in maintaining adequate capacity for care of a growing proportion of elderly people. [9,10] Patient transfer as a workload and health risk issue has had considerable attention from the early 1990s, when research began to demonstrate benefits from the use of mechanical lifting equipment and friction-reducing devices. ...
... [9,10] Patient transfer as a workload and health risk issue has had considerable attention from the early 1990s, when research began to demonstrate benefits from the use of mechanical lifting equipment and friction-reducing devices. [8,11] Research also pointed to single measures having little effect on quality of patient handling practices and work-related disorders. [1,2,[12][13][14][15] A body of research supports the need of multifaceted approaches to reduce the risk of patient handling injuries to caregivers. ...
Background: Nursing practice includes a lot of patient handling and transfer movement, with high risk of work related back injuries. The article discusses employee perspectives on the meaning of a multi-component intervention and its impact on ergonomic patient transfer practice and safety culture.
Method: This was a qualitative study using content analysis approach. Data were answers to open questions about patient transfer practice and the meaning of a multi-component intervention carried out in one Norwegian municipality. Research focus were on patient transfer skills, safety culture, and psychosocial climate at the workplace. Data gathered one and a half year after termination of the intervention. Purposive sampling included sixty-one health care personnel. All had been participating in the intervention.
Results: The analysis revealed the theme “Competence, practice and health impact” with sub themes “Measures facilitates change” and “Influence over time”. The intervention seemed to promote a safety climate with positive impact on employees’ health. Further, the transfer movements were more comfortable and safe for the patients and they became more self-reliant. Comprehensive, educational, and technical measures facilitated for change. After intervention termination, the intervention had persistent influence over time on daily ergonomic patient transfer practices. Findings also revealed some challenges.
Conclusion: The findings shed light on impact of management that focus on comprehensive educational measures for an entire staff at a local work place. The study do not provide transferability to other contexts, but nurse leaders can use study findings to inform their efforts on learning and culture change among the workforce.
... [2,3] In order to assess the fi t between a person and their work, ergonomists consider three main parameters, namely the job and the demands on the worker; the device used (its size, shape and how appropriate it is for the task); and the information used (how it is presented, accessed and changed). [2,4] A part from the industry, the principles of ergonomics have been extensively employed in multiple facets of healthcare delivery such as designing of physical environment/health care system (viz., layout and organization of workstations); [5] work organization and culture (viz., management of workload, inadequate staffi ng and lack of education); [6] design, development and deployment of interactive medical devices including robotic devices; [7] prevention of chronic diseases by minimizing job and psychological stress; [8] reducing or mitigating medication errors; [9] ensuring patient safety -to eliminate hazards that contribute to patient falls; [10,11] and marketing of safe medical products. [12] Currently, the main purpose of ergonomics is to reduce work stressors so that any untoward health consequence can be averted. ...
... [2] The proposed measure ranges from ensuring proper layout of the establishment; creating awareness among the hospital staff about the occupation hazards and need of using personal protective equipments/following the standardized protocol; implementing appropriate measures to maintain sanitation within the premises and thus control of infectious diseases; developing a protocol for conducting a medical examination of the health care workers, especially nursing and housekeeping staff, to permit early recognition of signs and symptoms of occupation-induced illnesses; and by adopting suitable engineering measures to facilitate mechanization, reduce human workload, and simultaneously ensure patient safety. [1,2,6,10,11] To conclude, the scope of ergonomics has signifi cantly expanded in the health sector over the years and thus there is an indispensable need to develop a comprehensive strategy to ensure safety of both health professionals and patients. ...
... It is also vital for sustainable development because it contributes to the social and economic dimensions of sustainability (Radjiyev et al., 2015). However, ergonomic approach in the built environment is not well recognizes in the academia (Attaianese & Duca, 2012;Costa et al., 2012;Fross, 2014) with few exceptions in health care architecture (for example Codinhoto et al., 2009;Pinto et al., 2000;Rogers et al., 2013;Villeneuve, 2000;Yeoman & Ashmore, 2018). Accepting the scarcity of ergonomic approach, the necessity of integrating ergonomics into architecture is recognized by scholars (Attaianese, 2012(Attaianese, , 2017Attaianese & Duca, 2012;Garneau & Parkinson, 2016;Olguntürk & Demirkan, 2009). ...
Human factors and ergonomics are very important considerations for the built environment. Usually, such issues are taught in the design studio courses in architecture education. Traditional design studio in architecture program follows the ideology of learning by doing. Design studio is more than a physical space, it is a culture with particular focus on one-to-one interaction and lateral learning. This learning program had to be suddenly switched to distant learning mode during the COVID-19 outbreak. Teaching human factors in design studio usually takes thorough exercise for both the instructors and learners, unsurprisingly in the online studio this exercise gets even more challenging. This article portrays the experience of such a challenging task and responses to the emergency situation of online learning. This article is based on participant observation and qualitative analysis of the observation protocols. The experiences can be useful for both designing human factors and distance learning in studio-based programs.
... Pagrindinis dalykas, į kurį norime atkreipti dėmesį, yra tas, kad Europos lygmeniu nėra nacionalinių rekomendacijų dėl saugaus pacientų kūno padėties keitimo. Pacientų kėlimo, perkėlimo taisyklių nepakanka, nes paciento kūno padėties keitimas yra gana daugialypis manevras (Rogers, Buckheit, Ostendorf, 2013). ...
Pagrindimas. Sveikatos priežiūros specialistai dažnai patiria su darbine veikla susijusius kaulų ir raumenų pažeidimus dėl netinkamų paciento kūno padėties keitimo padėčių arba judesių. Todėl svarbu studentus, kurie mokosi sveikatos priežiūros srityje, išmokyti teisingų būdų ir metodų. Pablogai tokios žinios suteikiamos ergonomikos dalyke. Skirtingos mokymo institucijos turi skirtingas mokymo programas ir neaišku, ar jas baigusieji gavo vienodas arba panašias žinias bei įgūdžius. Tikslas – išanalizuoti skirtingų Lietuvos aukštųjų mokyklų, rengiančių sveikatos priežiūros specialistus, ergonomikos dalyko mokymo turinį ir nustatyti mokymo skirtumus tarp skirtingų institucijų. Metodai. Atlikta anketinė apklausa, kurioje dalyvavo dešimties Lietuvos aukštųjų mokyklų, rengiančių kineziterapeutus, ergoterapeutus ir slaugytojus, atstovai. Apklausa atlikta įgyvendinant ES projektą „Ergonominio švietimo atnaujinimas“ sveikatos priežiūros studentams Europos aukštosiose mokyklose (angl. Reniewing of Ergonomic Education RENE in European HEIs), kuriame dalyvauja šešios šalys partnerės: Ispanija, Portugalija, Suomija, Estija, Lietuva ir Slovėnija. Šiuo projektu siekiama sukurti tarptautinį saugaus pacientų kūno padėties keitimo ir perkėlimo mokymų kursą. Rezultatai. Nustatyta, kad daugumoje (70 proc.) aukštojo mokslo institucijų, rengiančių sveikatos priežiūros specialistus, ergonomikos dalykas pateikiamas kaip atskira disciplina, jam skirtingose mokymo įstaigose skiriamas skirtingas kreditų skaičius: nuo vieno iki penkių kreditų (ECTS), kai kuriose institucijose (30 proc.) ergonomikos žinios integruotos į kitus dalykus. Ergonomikos dalyko mokymo turinys ir metodologija skiriasi tarp institucijų. Išvados. Lietuvos aukštosiose mokyklose, rengiančiose kineziterapeutus, ergoterapeutus ir slaugytojus, ergonomikos mokymo turinys, metodologija ir turimos priemonės skiriasi. Siekiant, kad visi absolventai įgytų vienodas žinias ir įgūdžius, reikėtų praplėsti ir suvienodinti mokymo turinį. Raktažodžiai: ergonomika, paciento priežiūra, mokymo turinys, metodai
... Morishima[15] administered a questionnaire to two groups of health professionals, one in 2008 and one in 2010, on the subject of radiation: whether there are different types (24.5% responded positively in 2008 and 40.3% in 2010), about the external protection procedure (17.6% and 26.7% positive responses respectively), the correct distance to the machine (31.5% and 41.5%) and the correct position of the dosimeter (60.8% and 55.1%). Rogers[16] conducted an investigation into the ergonomic risks of the nursing profession through focus groups, interviews and workplace observations of 42 registered nurses in five hospitals in North Carolina, finding training to be one of the main tools in preventing ergonomic risks. Finally, Srikrajang[17] conducted a study on a group of 24 emergency and laboratory health workers (including a control group of 12), demonstrating improvements with the use of training tools in preventing needlestick injuries.DiscussionThe literature review identified few sources, most agreeing that participants in the various studies show structural deficiencies in occupational health and safety training, calling for thorough training interventions. ...
Introduction: The prevention of occupational accidents in the sphere of occupational health and safety is an important issue in the Italian work setting; health workers, and especially nurses, are continually exposed to the risk of work-related accidents, which can affect the quality of care provided.
Aim: The aim of this review is to investigate the nurse's perceived level of preparedness with regard to occupational safety.
Methods: A narrative review of the literature was conducted using some of the main databases such as PubMed, CINAHL and Cochrane.
Results: The studies analysed show that Italian nurses have little knowledge about occupational health and safety legislation.
Conclusions: Establishing specific postgraduate training events and identifying specific legislation for healthcare personnel could represent essential steps towards implementing this specific knowledge.
... Akibat luka-luka tersebut 600.000 pekerja kehilangan pekerjaannya setiap tahunnya, (Malone, 2000;Maul, Läubli, Klipstein, & Krueger, 2003, dalam Sharafkhani et al., 2014. Menurut Gropelli & Corle, 2010 dalam (Buckheit & Ostendorf, 2013) 12% perawat meninggalkan profesinya setiap tahun karena nyeri punggung akibat kerja. ...
Most of the health workers are nursing staff, nursing profession demands high physical activity ranks second after industrial workers. Musculoskeletal disorders often occur in health workers, nurses have a higher risk of experiencing the disorder. Musculoskeletal disorders are disorders that occur in the muscles, bones, tendons, blood vessels, nervous system, and other soft tissues. The purpose of this study was to determine the picture of musculoskeletal disorders in nurses in General Hospital. Dr. M. Djamil Padang. Research Methods: The method used in this research is descriptive. The number of samples in this study were 132 people. The sample selection in this study was the proportional random sampling method. The results showed that more than half (81.1%) nurses experienced musculoskeletal disorders. Musculoskeletal disorders complained of body parts: shoulders 49.2%, neck and lower back 41.7%, and upper back 32.6%. It is expected that nurses can identify the incidence of musculoskeletal disorders due to work and immediately report to management for further prevention.
... While there are several drivers of workload, patient acuity and nurse-patient ratio are two of the most important contributors; Canadian Institute of Health Information, 2017;Rogers, Buckheit, & Ostendorf, 2013). This chapter further addresses the need of focusing on HCP to improve the healthcare system, outlined in editorial of the recent special issue: 'Ergonomics and Human Factors in Healthcare System Design' in IISE Transactions in Occupational ...
Intensive workload for nurses due to high demands directly impacts the quality of care and nurses’ health. To better manage workload, it is necessary to understand the drivers of workload. This multidisciplinary research provides an adaptable nurse-focused approach to discrete event simulation (DES) modelling that can quantify the effects of changing technical design and operational policies in terms of nurse workload and quality of care.
In the first phase of this research, a demonstrator model was developed that explored the impact of nurse-patient ratios. As the number of patients per nurse (nurse-patient ratio) increased, nurse workload increased, and the quality of care deteriorated. In the second phase of this research, the DES model tested the interaction of patient acuity and nurse-patient ratios. As the levels of patient acuity and number of patients per nurse increased, nurse workload increased, and quality of care deteriorated – a result that was not surprising but an ability to quantify this proactively, was conceived. In the third phase of this research, the DES model was validated by means of an external field validation study by adapting the model to a real-world unit. The DES model showed excellent consistency between modelling and real-world outcomes (Intraclass Correlation Coefficient = 0.85 to 0.99; Spearman Rank-order Correlation Coefficient = 0.78). The fourth phase of this research used the validated simulation model to test the design implication of geographical patient bed assignment. As nurses were assigned to patient beds further away from the center of the unit or spread further apart, nurse workload increased as the nurse had to walk more leading to a deterioration in the quality of care. The DES modelling capability showed that both aspects of assignment were important for patient bed assignment. The fifth phase of this research combined Digital Human Modelling (DHM) and DES to produce a time-trace of biomechanical load and peak biomechanical load (‘activity’) for a full shift of nursing work. As the nurse was assigned to beds further away from the center of the unit, the cumulative biomechanical load decreased as the nurse spent more time walking yielding a reduced biomechanical load in comparison to the task group ‘activity’. As patient acuity is increased, a decrease in L4/L5 moment is observed as the task duration and frequency of most care task increase. Due to increased care demands, nurses must now spend more time delivering care. Since the care demands are much higher than the current capability of nurses, quality of care is deteriorated. As number of patients per nurse, increased a ‘ceiling’ effect on biomechanical load can be observed as nurses do not have the time to attend to this extra demand for care. The use of this adaptable DES modeling approach can assist decision makers by providing quantifiable information on the potential impact of these decisions on nurse workload and quality of care. Thereby, assisting decision makers to create technical design and operational policies for hospital units that do not compromise patient safety and health of nurses.
... Patient transfer as a workload and health risk issue has had considerable attention from the early 1990s, when research began to demonstrate benefi ts from the use of mechanical lifting equipment and friction-reducing devices. 20,21 The most common symptom resulting from injury amongst caregivers was back pain. Back pain is common in health professionals, especially amongst nurses and physiotherapists. ...
Background: Ageing is an inevitable process. The population of elderly is increasing in Nepal. Caring of elderly at geriatric care homes is becoming popular. Caregivers take care of the elderly in the geriatric care homes. Occupational injuries are very common and no study has been done to document the injuries sustained by caregivers working in geriatric care homes in Nepal. This study has been conducted to determine the prevalence of work related musculoskeletal disorders and the injuries sustained among care givers working in geriatric care homes in Nepal. Methods: This is a descriptive cross-sectional study design. A convenience sample of 41 caregivers among geriatric care homes in Kathmandu valley aged between 20-45 years were included in the study. The Nordic musculoskeletal questionnaire was adapted to measure Musculoskeletal Disorders in the study population. Descriptive analysis of data was done. Type of injury was classified and their consequences observed. Results: Caregivers (n=41) reported work related musculoskeletal disorders in six areas of the questionnaire: Neck 4 (9.75 %), Shoulder 8(19.5%), Elbow 4(9.75%), Low back 22(53.65%), Knee 5(12.19%) and ankle 3(7.31%). Common types of injuries sustained were muscle strain, ligament sprain, joint pain, hernia etc. In most of the cases, caregivers had to take interventions like taking medications, exercises, rest while some were able to get away with minor symptoms. Conclusion: The incidence of occupational injuries among caregivers is high. The existing training programs are not enough. A revision of the course work for training of caregivers is necessary
... Målet var å sikre at utstyr, gjenstander, arbeidsplassens utforming, arbeidsoppgaver og omkringliggende arbeidsmiljø ikke utsatte arbeidstakeren for helseskadelig belastning. Utviklingen har siden dreid seg mer mot ergonomisk forflytning uten løfting, friksjonsredusering, bruk av forflytningsutstyr og pasientens friske bevegelsesmønster (Andersen et al., 2014;Baptiste, Boda, Nelson, Lloyd & Lee, 2006;Lunde, 2011;Rogers, Buckheit & Ostendorf, 2013). Ergonomisk pasientforflytning er i dag en del av utdanningen for helsepersonell (Hellesø, Nordtug & Brataas, 2016;Lunde, 2011). ...
Healthcare workers' self-reported evaluation of ergonomic transfer training, use of techniques and aids in a municipality - a longitudinal pilot study
Healthcare workers’ self-reported evaluation of ergonomic transfer training, use of techniques and aids in a municipality – a longitudinal pilot. Traditionally, healthcare work in nursing homes is regarded as physically strenuous work with a risk of back injuries stemming from adverse movement techniques. The purpose of the study was to analyse healthcare workers’ self-reported evaluation of ergonomic transfer training in a municipality in Norway. The training aimed to improve healthcare personnel’s ergonomic patient handling. N = 73 health care employees from a nursing home and homes to the disabled. Mean response rate during the three points of measurement was 77 %. Data were collected by questionnaire at baseline, at the end of the training, at 18 months, and 36 months after baseline. Then the data were compared using quantitative analysis at group level. Participants reported adequate training, improved availability of transferrelated resources, and increased use of transfer techniques over the course of the measurement periods. Respondents who asked transfer experts for guidance used transfer techniques more than others did.
... [6][7][8] Fiziksel güç gerektiren hasta taşıma ve kaldırma uygulamaları fiziksel, biyolojik, kimyasal, sosyal, psikolojik ve ergonomik açıdan uygun olmayan çalışma koşullarında gerçekleştirildiğinde kas iskelet sisteminde rahatsızlıklara neden olarak, hastalar, kurum ve hemşireler açısından olumsuz etkilere neden olabilmektedir. [9][10][11][12][13] Bunlar; H Ha as st ta al la ar r A Aç çı ıs sı ın nd da an n E Et tk ki il le er ri i: : Hastaların hareket etme yeteneğini kaybetmesi sonucunda yaşam aktivitelerine ilişkin bağımsızlık duygusu etkilenmekte ve yaşam kalitesi düşmektedir. Sağlık bakımında kalite göstergeleri olan ağrı şiddeti, düşme ve basınç yarası oranlarındaki düzelme manuel hasta taşıma tekniklerinin hemşireler tarafından iyi uygulandığını ortaya koyan göstergelerdir. ...
ÖZET
Hemşireler, sağlık sorunlarına bağlı hareket etme sınırlılıkları olan bireylere bakım verdikleri için diğer sağlık bakımı profesyonellerine oranla kas-iskelet sistemi sorunları açısından daha fazla risk altındadır. Hemşirelerin çalıştıkları birimlere göre farklı sıklık ve şiddette maruz kalınan kas-iskelet sistemi ile ilgili sorunlar, ortopedi hemşireleri arasında önemli ölçüde artış göstermektedir. Ortopedik sorunları olan hastaların bakımında yoğun fiziksel güç gerektiren yatak içinde çevirme, total kalça protezi uygulanan ya da ekstremitede alçısı/ateli olan hastaların taşınması, ekstremiteleri kaldırma ve tutma ile yürütme gibi hareket ettirmeye yönelik uygulamalar, hemşirelerde kas-iskelet sistemi sorunları açısından ciddi riskler oluşturmaktadır. Araştırma sonuçları doğrultusunda geliştirilen çeşitli algoritmalarda, ortopedi hastalarını hareket ettirmeden önce hastaların işbirliği yapabilme durumlarının, hareket sınırlılıklarının ve ağırlıklarının tanılanması gerektiği belirtilmektedir. Tanılama sonrasında hastaların hareket etme düzeyine ve hareket etmesi istenen pozisyona göre manuel kaldırılması ya da mekanik cihazlardan destek alınması gerektiği önerilmektedir.
Anahtar Kelimeler: Hasta taşıma; hasta güvenliği; hemşirelik; ortopedi
ABSTRACT
Nurses are at greater risk than other healthcare professionals to musculoskeletal problems for providing care to individuals having trouble moving limitations due to health problems. While the frequency and severity of exposure to occupational musculoskeletal system problems vary according to the working unit, orthopaedic nurses have serious problems with musculoskeletal disorders by the reason of being faced with different occupational hazards. Turning an orthopaedic patient in bed, vertical transfers of a postoperative total hip replacement patient or a patient with an extremity cost/splint, lifting and holding limb in the care of orthopaedic patients pose a serious risk for musculoskeletal problems among nurses. It is stated that patients' cooperation to movement, weights, moving limitations must be assessed at various algorithms developed in accordance with the results of research. Then, it is recommended that nurses can move patients manuel or get support from mechanical devices according to desired position and patients' movement level.
... One nurse respondent reported frequently moving furniture that obstructed access to the patient before administering intravenous medications. The lifting and moving of awkward equipment and furniture combined with the high incidence of obesity and the ageing workforce places these HHNs at increased risk for occupational MSD injuries (Rogers et al. 2013, Phillips & Miltner 2015. ...
Aim:
To identify occupational exposures for home health-care nurses and aides.
Background:
Home health-care workers' occupational injury rates in the USA are higher than the national average, yet research on causative exposures and hazards is limited.
Methods:
Participants were interviewed about annual frequency of occupational exposures and hazards. Exposure and hazard means were compared between home health-care nurses and aides using a Wilcoxon two-sample test.
Results:
A majority of the sample was over 40 years old and obese, potentially increasing injury risks. Home health-care nurses performed more clinical tasks, increasing exposure to blood-borne pathogens. Home health-care aides performed more physical tasks with risk for occupational musculoskeletal injuries. They also dispensed oral medications and anti-cancer medications, and were exposed to drug residue at a frequency comparable to home health-care nurses. Both groups were exposed to occupational second-hand smoke.
Conclusions:
Establishing employee safety-related policies, promoting healthy lifestyle among staff, and making engineered tools readily available to staff can assist in decreasing exposures and hazards.
Implications for nursing management:
Implications for nursing management include implementation of health-promotion programmes, strategies to reduce exposure to second-hand smoke, ensuring access to and education on assistive and safety devices, and education for all staff on protection against drug residue.
... Nursing profession globally has highest risk of musculoskeletal disorders (MSDs) due to their work demands and others inevitably performances at work such as patient or object handling, 1,2 awkward postures, as well as individual, psychosocial and organization factors. [3][4][5][6][7] In Eastern country, perceived physical demands were associated with MSDs (OR = 2.04 to 7.24). 8 Studies in Western countries reported that highly demands at work increased MSDs (OR = 12.0). ...
p class="Pa1"> Background Health, safety, and well being have been known to be influenced by occupational characteristics. Nurses constantly encounter musculoskeletal disorders (MSDs) from work demands worldwide. Nevertheless, there is insufficient of knowledge regarding causes of musculoskeletal disorders among nurses in Thailand.
Objective To investigate factors associated with musculoskeletal disorder among registered nurses in Thailand.
Method This study is part of the 2009 Thai Nurse Cohort Study which consisted of 18,756 nationally representative sample of registered nurses. Data collection was performed via postal self-administered questionnaires. Manifesting musculoskeletal disorders was self-reported by registered nurses, 1,070 nurses were excluded since they were unemployed during previous 12 months. Multiple logistic regression was used for data analysis.
Result Of 17,686 registered nurses, the overall 12 months prevalence of musculoskeletal disorders was 47.8%. It was found that workplace violence was the strongest factor which statistically significant associated with musculoskeletal disorders (adjusted odds ratio, OR, 2.01; 95% confidence interval, 95% CI, 1.42 to 2.83; P < 0.001), anxiety/depression (OR = 1.96: 95% CI: 1.78 to 2.15; P < 0.001), perceiving job required a lot of physical effort (OR = 1.69; 95% CI: 1.52 to 1.87; P < 0.001), every 10 years increased of age (OR = 1.40; 95% CI: 1.22 to 1.62; P < 0.001), overweight (OR = 1.39; 95% CI: 1.01 to 1.52; P = 0.015).
Conclusion Registered nurses were most vulnerable of musculoskeletal disorders especially those who experienced workplace violence, anxiety/depression, strenuous work, older age, and overweight. Consequently, recommending safety practices to nurses should be considered for musculoskeletal disorders (MSDs) prevention by ergonomics and workplace design.</p
The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.
Workplace environment can have a considerable impact on the physical, psychological and maternal health of pregnant healthcare workers. This article aimed to summarise the impact of work-related ergonomic stressors on pregnancy outcomes for healthcare workers, along with potential interventions to resolve these stressors. A narrative review analysis using the Pearl Growing Strategy was conducted between February 2019 and June 2020 to identify English-language articles published between 2000 and 2020. A total of 89 studies were identified from the SCOPUS (Elsevier, Amsterdam, Netherlands), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) databases and Google Scholar (Google LLC, Menlo Park, California, USA). The results indicated that poor work-related ergonomics had detrimental effects on pregnancy outcomes, resulting in spontaneous abortions, preterm delivery, low birth weight babies and infertility. Policymakers and employers should conduct ergonomic assessments and implement appropriate practices to ensure the safety of pregnant healthcare workers. Keywords: Healthcare Workers; Physical Ergonomics; Pregnancy Outcomes; Occupational Health; Occupational Exposure.
The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalized and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses’ wellbeing and on care quality.
PRACTITIONER SUMMARY: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches.
Os fatores humanos e a ergonomia tem como cerne o domínio dos cuidados de saúde com foco na maximização do desempenho global dos sistemas. As atuais pesquisas sobre saúde e segurança do paciente tem centrado esforços na amplitude do termo resiliência do sistema. Assim dado o aumento de pesquisas de intervenção ergonômica na área da saúde e da importância dos fatores humanos e da ergonomia no âmbito hospitalar esse estudo tem por objetivo apresentar os principais problemas biomecânicos relacionados a atividade dos enfermeiros, por meio de uma revisão básica da literatura. Como resultado o estudo apresenta um dossiê dos estudos mais relevantes sobre riscos biomecânicos na atividade laboral dos enfermeiros. Conclui-se que ao setor da saúde no Brasil, não há ainda uma dispersão em grande escala dos equipamentos que visam prevenir os riscos biomecânicos relacionados a atividade laboral dos profissionais da saúde.
Background
Demographic, labor market and economic forces are combining to produce increases in the number and percentage of U.S. workers 55 and older. In some ways these workers will be our most skilled and productive employees but in others the most vulnerable.Methods
The literature on aging and work was reviewed, including demographic trends, physical and cognitive changes, safety and performance, work ability, and retirement patterns.Results and Conclusions
Older workers have more serious, but less frequent, workplace injuries and illnesses than younger ones. There is evidence that many of these problems can be prevented and their consequences reduced by anticipating the physical and cognitive changes of age. Many employers are aware that such efforts are necessary, but most have not yet addressed them. There is a need for implementation and evaluative research of programs and policies with four dimensions: the work environment, work arrangements and work-life balance, health promotion and disease prevention, and social support. Employers who establish age-friendly workplaces that promote and support the work ability of employees as they age may gain in safety, productivity, competitiveness, and sustainable business practices. Am. J. Ind. Med. 51:269–280, 2008. © 2008 Wiley-Liss, Inc.
Repositioning patients in bed presents an occupational hazard to direct care nursing staff. Much research has been conducted in the area of safe patient handling and movement. However, little progress has been made in reducing risks associated with patient repositioning, especially pulling patients toward the head of the bed. This laboratory study investigated risk reduction achieved by introducing the gravity assist feature into bed system design for post-acute health care. Through the application of gravity assist, the amount of work required to reposition a simulated 200-pound patient was reduced by 67%. This reduction in work should reduce some of the occupational risk for nurses.
Recognition related to the need for ergonomic design improvements among health care workers, management and administration, and equipment manufacturers is growing. The future should bring new concepts and innovations which can provide many benefits. Beyond the potential reduction in caregiver injuries, many possibilities exist to improve patient outcomes through better equipment design. As an additional benefit, applying the principles of ergonomics may enhance and increase caregiver productivity through a reduction of patient transfers required, and by minimizing staff required to ambulate patients. Another added value to applying ergonomics to equipment design is the development of convertible furnishing which could create a reduction in operating and capital expenses by reducing the need for some furnishings. Equipment such as cardiac chairs, sling scales, patient chairs, special rental surfaces, and other features might be incorporated into bed design. Ergonomic programs make sense and provide opportunities to create win-win situations throughout the health care industry. Current and future innovations will provide improvements resulting in outcomes from which everyone will benefit. These benefits include a higher quality of work life for health care workers and an improved quality of care for patients.
Back disorders among nursing personnel are associated with the worktask of assisting patients during transfers. The objectives of the study were to explore the work technique applied by nursing personnel in patient transfer tasks and to determine whether different personal factors were associated with work technique safety.
The work technique used by 102 nurses to perform two common patient transfer tasks in orthopedic wards, transfer higher up in bed and transfer from bed to wheelchair, was examined with the use of video recordings and an observation instrument. A work technique score was calculated for each performed transfer. It indicated the level of musculoskeletal safety and hazard for the nurse. The participants also filled out a questionnaire concerning different personal factors.
A variety of strategies was used by the nurses to perform the transfer tasks. Being older and suffering from low-back symptoms were factors associated with the use of poor work technique in both tasks. There was also an association between male gender and poor technique in transferring patients from bed to wheelchair.
The results indicate an association between poor work techniques and low-back symptoms. Special attention should be paid to older nurses, nurses with low-back problems, and possibly also to male nurses when training programs on patient transfer technique are designed, as these groups seem to apply comparatively poor work techniques in patient transfer tasks.
This study has ranked industries using estimated total costs and costs per worker.
This incidence study of nationwide data was carried out in 1993. The main outcome measure was total cost for medical care, lost productivity, and pain and suffering for the entire United States (US). The analysis was conducted using fatal and nonfatal injury and illness data recorded in large data sets from the US Bureau of Labor Statistics. Cost data were derived from workers' compensation records, estimates of lost wages, and jury awards. Current-value calculations were used to express all costs in 1993 in US dollars.
The following industries were at the top of the list for average cost (cost per worker): taxicabs, bituminous coal and lignite mining, logging, crushed stone, oil field services, water transportation services, sand and gravel, and trucking. Industries high on the total-cost list were trucking, eating and drinking places, hospitals, grocery stores, nursing homes, motor vehicles, and department stores. Industries at the bottom of the cost-per-worker list included legal services, security brokers, mortgage bankers, security exchanges, and labor union offices.
Detailed methodology was developed for ranking industries by total cost and cost per worker. Ranking by total costs provided information on total burden of hazards, and ranking by cost per worker provided information on risk. Industries that ranked high on both lists deserve increased research and regulatory attention.
Knowledge of costs is essential to allocate medical resources efficiently. The authors' goal was to estimate and compare costs across occupations, industries, gender, race, and types of nonfatal injuries and illnesses. This is an incidence study of nationwide data, 1993. Nonfatal incidence data were drawn from the Bureau of Labor Statistics Annual Survey. Medical costs were from the Detailed Claims Information data set. Productivity (wage) costs were calculated using the Current Population Survey. Pain and suffering costs were estimated from data on jury verdicts. Injuries and illnesses to nursing aides and orderlies cost 2,200 million dollars; costs were 900 million dollars for registered nurses and 40 million dollars for licensed practical nurses. The ranking of health services industries in terms of costs was: hospitals (52 percent of all costs), nursing care facilities (38 percent), home care services (6 percent), physicians' offices (4 percent), and laboratories (<1 percent). Types of injuries (sprains, strains, fractures) were similar across occupations and industries, but types of illness (carpal tunnel syndrome, respiratory diseases) varied. The most costly injured body parts were: back, shoulder, knee, wrist, and neck. Injuries and illnesses comprised roughly 90 percent and 10 percent, respectively, of total costs. The hospital industry was the third most expensive of 313 U.S. industries. Costs of occupational injury and illness in the health services industry were high and varied across occupation, industry, disease, race, and gender.
This study assessed the impact of ergonomic intervention on rates of low-back pain among hospital nurses.
Altogether 1239 female nurses from two hospitals in southern England completed a baseline postal questionnaire about low-back pain and associated risk factors. Between 18 and 28 months after the baseline survey, major intervention was implemented at one hospital to minimize unassisted patient handling and high-risk nursing tasks. At the other, no intervention was initiated, and efforts to improve patient handling were more limited. Thirty-two months after the baseline survey, a second postal survey was carried out in both hospitals (1,167 respondents) to reassess the prevalence of symptoms and risk factors.
After adjustment for nonoccupational risk factors, prevalent low-back pain at baseline was associated with low job satisfaction and the performance of patient-handling activities without mechanical aids. After the intervention, the prevalence of occupational risk factors was somewhat lower, but similar improvements occurred at the comparison hospital. At the intervention site the prevalence of symptoms increased slightly (from 27% to 30%), whereas at the comparison site there was no change, the prevalence remaining constant at 27%. Calculations based on the association of risk factors with symptoms at baseline and the observed changes in their prevalence indicated that the change in risk factors was insufficient to produce a substantial reduction in back pain.
These findings cast doubt on the means by which many hospitals are attempting to improve the ergonomics of nursing activities. More effective methods of implementing changes in work systems are needed.
A systematic literature review was undertaken to assess the effectiveness of interventions that aim to prevent back pain and back injury in nurses. Ten relevant databases were searched; these were examined and reference lists checked. Two reviewers applied selection criteria, assessed methodological quality and extracted data from trials. A qualitative synthesis of evidence was undertaken and sensitivity analyses performed. Eight randomised controlled trials and eight non-randomised controlled trials met eligibility criteria. Overall, study quality was poor, with only one trial classified as high quality. There was no strong evidence regarding the efficacy of any interventions aiming to prevent back pain and injury in nurses. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There is conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. This review highlights the need for high quality randomised controlled studies to examine the effectiveness of interventions to prevent back pain and injury in nursing populations. Implications for future research are discussed.
Nursing schools in the United States have not been teaching evidence-based practices for safe patient handling, putting their graduates at risk for musculoskeletal disorders (MSDs). The specific aim of this study was to translate research related to safe patient handling into the curricula of nursing schools and evaluate the impact on nurse educators and students' intentions to use safe patient handling techniques. Nurse educators at 26 nursing schools received curricular materials and training; nursing students received the evidence-based curriculum module. There were three control sites. Questionnaires were used to collect data on knowledge, attitudes, and beliefs about safe patient handling for both nurse educators and students, pre- and post-training. In this study, we found that nurse educator and student knowledge improved significantly at intervention schools, as did intention to use mechanical lifting devices in the near future. We concluded that the curriculum module is ready for wide dissemination across nursing schools to reduce the risk of MSDs among nurses.
Rehabilitation nurses are well aware of the risks for musculoskeletal injuries related to patient handling tasks. Repetitive lifting, turning, and repositioning of patients with mobility limitations can take a toll on the nurse. This article chronicles integration of ceiling lift technology for patient-handling tasks into nursing practice on a spinal cord injury inpatient unit.
A systematic review of the published literature was carried out in order to identify the most important risk factors for musculoskeletal disorders (MSD) in the nursing profession. A standardized checklist was used in order to assess the methodological quality of the publications selected for the review. Specific criteria were established to assess the strength and consistence of evidence for potential risk factors for MSD. The results support a notion of the importance of physical work-related factors for the development of musculoskeletal problems in nursing. Lifting in awkward and forward-bent postures were especially high-risk tasks that resulted in variety of reported musculoskeletal problems. This review also revealed that psychosocial factors, especially work organization issues and "social relations at work" were strongly related to the musculoskeletal outcomes in the studied population. Such risk factors as psychological job demands and job control were also associated with musculoskeletal problems; however, the evidence concerning these factors were weak and inconsistent. Further research is needed to establish the moderating and combined effects of different risk factors for musculoskeletal disorders in the nursing profession.
Many health care institutions are faced with challenges associated with safe patient handling and movement. Musculoskeletal disorders associated with patient handling can have a deleterious effect on staffing levels, clinical experience, and ultimately patient care. The cost of these injuries can be staggering, having a direct impact on the afflicted persons and the institution. Bariatric patient handling can be particularly challenging. Through use of our Expanded OSHA 300 Log, we learned that the obese present caregivers with a heightened level of risk of injury. Couple this with the nonreimbursement of nosocomial skin breakdown and pneumonia as pertains to patient repositioning and transfers from bed and the need for reducing the risk of injury becomes paramount. After evaluation of alternative means of reducing the risk of caregiver injury in conjunction with the need for more frequent patient handling, a commitment was made to invest in ceiling lifts as a means to an end. This article describes the business case and process that was used for the selection of a ceiling lift manufacturer with which to partner in this endeavor.
This study was undertaken to evaluate an education program to prevent low back pain among nurses. This interventional study used a one-group, pretest/posttest design and was conducted in four hospitals in Bolu, Turkey. Nurses' knowledge was assessed before and after training; 60 nurses were evaluated while performing five procedures that can lead to low back pain using an observation form. These forms were given to the nurses 3 months after the training to assess their knowledge and observations of the five specified behaviors were repeated. The mean knowledge and procedures scores of the nurses were higher just after and 3 months after the training compared to before training.
Objective:
To determine the utility of a safe lifting program index and a measure of lift inventory to predict workers' compensation claim frequency and costs in long-term care facilities in 23 states.
Methods:
Workers' compensation claims and cost data were matched to Center for Medicare and Medicaid Services (CMS)-certified facilities (N = 656). Facility safe lifting program index were derived from interviews with directors of nursing in a subset (N = 271).
Results:
The higher the safe lift index score, the lower the claims and costs. An increase of one lift per 100 residents is associated with a 5% decrease in claims frequency and an 11% decrease in total costs on average.
Conclusion:
In this national study, we find that a comprehensive safe lift program, endorsed and promoted by directors of nursing, reduces caregiver injury as measured by workers' compensation claims frequency and costs.
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The aim of this study was to evaluate the implementation fidelity of a multidimensional ergonomic program designed to prevent back pain injuries among healthcare personnel. The program, provided by peer trainers included training intended to modify patient handling and transfer behaviour, trainee follow-up, prevention activities aimed at work environment improvements and follow-up monitors training. Two hundred twenty-one peer trainers at 139 Quebec healthcare institutions participated in our study. Only 61.5% were involved in training; most of them taught safe patient handling, positioning, transfer, and preparation techniques, which are the cornerstones of the program; 72.7% were involved in prevention activities, 46.1% in follow-up activities, and 10.7% in follow-up monitors training. The study results should help organizations anticipate and prevent potential discrepancies between prescribed and implemented programs.
The objective was to evaluate changes after a two half-day patient transfer course regarding nursing staff's movement and body awareness, attitudes, reported behaviour, strain, disorder and sick leave. The course aimed at increasing staff's self-awareness of movements and body, and their communication competence, with the intention to promote the patient's independent mobility. Ninety-nine staff in an intervention group and 77 staff in two control groups answered a questionnaire before and after the intervention. After one year there was a significant increase in the number of instructions given and nursing staff's movement awareness in the intervention group compared to the control group. Reported physical disorders decreased significantly in the intervention group compared with both control groups. Increased movement awareness and frequent use of instructions during transfers may encourage patients to move independently and thereby reduce the strain in nursing staff.
With the aging of the current nursing work force, nursing leaders must develop strategies to maintain current employment levels and improve availability of nurses to care for patients. One way to maintain current levels is to retain older nurses at the bedside by adapting the current working environment to meet the needs and the limitations associated with aging. This article includes a review of literature on the effects of aging on the human body, cognitively, physically, and psychosocially; current trends in the aging population; the advantages and disadvantages of employing aging nurses; retention strategies to keep aging nurses at the bedside; methods to adapt the work environment to aging nurses' needs; policies that address the needs of aging nurses; and implications for occupational health nursing practice. This article is limited to aging as it relates to nurses employed in hospitals.
Occupational musculoskeletal injuries are costly to the health care industry. It is estimated that 12% of nurses leave the profession annually because of back injuries. With the use of grounded theory methodology, 15 nursing personnel and physical therapists were interviewed about their perceptions of occupational musculoskeletal injuries. Analysis of the data identified major themes, including feelings of fear and frustration; chronic issue and part of the job; love of the profession and concerns about continuing in the profession; increased risk of injury; compliant with treatment; negative impact on quality of life; negative feelings about the occupational health department; and educational needs. A theory began to emerge in which health care workers accepted occupational injuries as part of the job and took no action or initiated only minor interventions to prevent work-related injuries. The study indicates a need for education and better communication.
Despite the well-documented evidence for preventing musculoskeletal injuries among nurses providing patient handling tasks using ergonomic principles, faculty in nursing schools continue to rely on the teaching of body mechanics which fails to reduce the risk of musculoskeletal injuries. In this article the authors report the qualitative data from a parent study designed to develop and test an evidence-based curriculum module in nursing schools. Focus groups were conducted with participating faculty to elicit their perceptions of facilitators and barriers for implementing a new, evidence-based, safe patient handling curriculum module at their nursing schools. Content analysis was used to analyze the data. Faculty, who were overwhelmingly positive about the curriculum module, related numerous implementation facilitators and recommendations for overcoming barriers. Findings from this study can be used to facilitate implementation of the curriculum module at other nursing schools and thus promote the use of safe patient handling throughout healthcare.
Manual handling activities and injuries among nurses: an Australian hospital study
The aims of this study were to identify patterns of manual handling activities and their associated injuries and consequences among nurses working at a large teaching and referral medical centre in Melbourne, Australia. A self-report 140-item questionnaire was distributed to 523 registered nurses working full time at the medical centre. Of the 269 (51·4%) nurses who completed the questionnaire, 108 (40·1%) retrospectively reported an injury associated with manual handling activity, of which 75·9% (82) comprised back injuries. When all full-time nurses working at the medical centre are considered, the prevalence of all manual handling injuries was 20·6% (n=108) and 15·7% (n=87) for back injuries. About two-thirds (67·6%) of all manual handling injuries were associated with direct patient care activities and another third (32·4%) with non-direct patient care activities. Approximately one-third (34·3%) of all injuries were associated with lifting patients and this activity comprised one half of all causes associated with injuries arising from direct patient care activities. The consequences of injuries were significant. Recommendations for reducing manual handling activities and injuries are made and future research directions are discussed.
The effectiveness of replacing floor lifts with mechanical ceiling lifts was evaluated in the extended care unit of a British Columbia hospital. Sixty-five ceiling lifts were installed between April and August 1998. Injury data were abstracted from injury reports for all staff musculoskeletal injuries (MSI) occurring in the unit during a 3 year period prior to installation and a 1.5 year follow up period. Descriptive statistics were calculated for injuries pre- versus post-installation. Rates were calculated as number of injuries per 100,000 worked hours. Rates for three pre- and three post-installation intervals were compared using Poisson regression. The rate of MSI caused by lifting/transferring patients was significantly reduced (58% reduction, p = .011) after installation, but rates of all MSI and MSI caused by repositioning did not statistically decline (p > .05). Further follow up is necessary to determine whether or not ceiling lifts also can be effective for decreasing injuries related to repositioning patients on this unit.
Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful.
The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment.
The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy.
A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001-January 2002) and post-intervention (March 2002-November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs.
The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of 'unsafe' patient handling practices performed daily. Nurses ranked program elements they deemed to be "extremely effective": equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation.
This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.
To synthesize the current literature on care of obese, critically ill, and bariatric surgical patients.
A MEDLINE/PubMed search from 1966 to August 2005 was conducted using the search terms obesity, bariatric surgery, and critical illness, and a search of the Cochrane Library was also conducted.
An increase in both the prevalence of obesity and the number of bariatric procedures performed has resulted in an increased number of obese and, specifically, bariatric surgical patients who require intensive care unit care. Obesity is a chronic inflammatory state with resultant effects on immune, metabolic, respiratory, cardiovascular, gastrointestinal, hematologic, and renal function. Principles of care of the critically ill obese patient are reviewed and then applied to critically ill bariatric surgical patients. Pharmacotherapy, vascular access, and the presentation and management of both pressure-induced rhabdomyolysis and anastomotic failure after bariatric surgery are also reviewed.
Obesity causes a range of pathologic effects on all major organ systems. Knowledge of these effects and issues specific to the intensive care unit care of bariatric patients can help to predict and manage complications in this population.
Nurses continue to suffer debilitating injuries secondary to manual patient handling. Patient care ergonomics has emerged to redesign patient care with reduced exposure to physical hazards. Safe patient handling programs are being increasingly accepted by healthcare organizations to prevent occupational injury and to enhance patient safety. The authors discuss national-level efforts to promote patient care ergonomics principles and safe patient handling programs and their impact on nursing shortages and quality patient care.
In 1994 the National Institute for Occupational Safety and Health (NIOSH) released the Revised NIOSH Lifting Equation-an ergonomics assessment tool that can be used to calculate the recommended weight limit for two-handed manual-lifting tasks. However, NIOSH excluded assessment of patient-handling tasks from the uses of the revised equation, arguing that such tasks involve too many variables. The equation in fact can be used to calculate a recommended weight limit for a limited range of patient-handling tasks in which the patient is cooperative and unlikely to move suddenly during the task. In general, the revised equation yields a recommended 35-lb. maximum weight limit for use in patient-handling tasks. When weight to be lifted exceeds this limit, assistive devices should be used.
The aim of this paper is to consider the process of ageing, the effects of ageing and research related to ageing.
In most countries of the world, the UK being no exception, the population is ageing in terms of the absolute numbers of and relative proportion of older people. This has resulted from economic, scientific and medical progress. However, it poses challenges for health and social services.
Selective review of the literature.
Ageing is an inevitable part of life and, while not in itself debilitating, can be accompanied by a range of debilitating physical and mental conditions which lead to frailty and dependency. There is limited evidence that the ageing process can be alleviated, as such, but there is some evidence that choices and circumstances in early life can influence the extent to which we age successfully.
Nurse managers have two responsibilities with regard to age: they are increasingly engaged in organizing care for older people in acute and long-term settings and in nursing homes and the more they need to understand the process of ageing. They also have responsibilities towards their workforce and can facilitate lifestyle choices which may help their workforce to age successfully.
A longitudinal study was conducted in three long-term care facilities to evaluate the effectiveness and cost benefit of overhead lifts in reducing the risk of musculoskeletal injury among healthcare workers. Analysis of injury trends spanning 6 years before intervention (1996-2001) and 4 years after intervention (2002-2005) found a significant and sustained decrease in workers' compensation claims per number of beds and in working days lost per bed. The payback period was estimated under various assumptions and varied from 6.3 to 6.2 years if only direct claim-cost savings were included, and from 2.06 to 3.20 years when indirect savings were added. The significant reductions in injury rates and compensation claims support intervention with overhead ceiling lifts. A more comprehensive evaluation of such programmes should incorporate in the analysis important variables such as staffing ratios, job stresses, injury reporting systems and compensation policies during the study period.