Preventing Injuries Using an Ergonomic Approach
By Bernice D. Owen, from AORN Journal, December 2000
The saying "work can be dangerous to your health" is an important phrase in the nursing profession. In hospital settings, there are several dangers that especially affect nursing personnel. Although needle-stick injuries are the most frequently reported injury among hospital nurses, the most costly for health care facilities are overexertion injuries to workers' shoulders or backs. These problems have been studied, and progress has been made to decrease their prevalence. For example, the number of needle-stick injuries has decreased significantly in hospitals that use ergonomically designed syringes.
Ergonomics is the scientific study of human work. It involves matching the job to the worker, rather than attempting to fit the worker to the job. The goal in ergonomics is to identify aspects of the job that are particularly hazardous and redesign them to be safer. This can be accomplished by redesigning the task, product, work station, environment, or overall work organization. In the example of needle-stick injuries, the product (i.e., syringe) was redesigned so that the needle is shielded or retracted into the barrel immediately after the injection. In this way, nurses cannot self-inject themselves with a used needle, and the product now better fits the worker.
Many approaches to decreasing back and shoulder problems have been tried in general industry, as well as in health care settings. Emphasis primarily has been on education and training, with a definite focus on body mechanics. These approaches, however, have had little effect on the problem, as the aim has been to change the worker instead of the job or the task. Studies indicate that an ergonomic approach involving the assessment of stressful tasks and the development of alternative methods to decrease this stress can reduce the number of overexertion injuries. As a result, the assumption that reducing physical stress reduces injuries was true.
INJURIES INCREASE IN FREQUENCY
NURSES CHANGE JOBS DUE TO BACK PAIN
TRIGGERS TO BACK PAIN AND INJURY
Although all of these tasks need to be studied to determine how to decrease their physical stressfulness, this author first focused on the task of transferring patients on and off OR beds by studying the perceived physical stressfulness of the similar task of transferring patients from beds to stretchers.
AN ERGONOMIC APPROACH TO TRANSFERRING PATIENTS
The method used with each of these devices involved turning the patient to the side, placing the assistive device under the draw sheet, placing the patient on his or her back, and using the draw sheet to pull the patient to the bed or stretcher.
Researchers found that the nurses perceived significantly less physical exertion (P [is less than] .01), and, as patients, the nurses were significantly more comfortable (P [is less than] .01) when the friction-reducing pad was used. By using this device, the nurses had to pull only lightly on the draw sheet because there was no friction impeding the process. As a result, the nurses chose the friction-reducing pad for use with actual patients.
The next step of the study took place in two hospitals, one as a control
and one as an experimental site. At the control site, the nurses used
their usual method of transferring patients from bed to stretcher and
from stretcher to bed (i.e., at least two nurses used a draw sheet to
lift and pull the patient). After completing each task, the nurses rated
the physical stress caused to their backs and shoulders. The perceived
At the experimental site, nurses used the friction-reducing pad to transfer patients from bed to stretcher and from stretcher to bed. In this setting, nurses again rated their perceived physical stress to the back and shoulders after each patient transfer, and patients rated their comfort.
Findings. Findings indicate that perceived physical stress can be decreased significantly by using a friction-reducing pad under the draw sheet. These findings are statistically significant (P [is less than] .01) in favor of the friction-reducing pad for transferring patients from bed to stretcher and from stretcher to bed. In addition, patient response is statistically significant; patients were more comfortable when they were transferred by nurses who used the friction-reducing pads under the draw sheet, as compared to when they were transferred by nurses who used only the draw sheet for transfer (P [is less than] .01).
Perioperative implications. These findings can be useful to perioperative nurses, as the type of horizontal transfers performed in the OR are similar to those performed on medical-surgical units. In fact, at the experimental site, the friction-reducing pads kept disappearing from the medical-surgical units where the study was conducted. Some detective work found that perioperative nurses were taking the assistive devices to use at their site for transferring patients on and off OR beds.
ERGONOMIC APPROACH TO REPOSITIONING PATIENTS
Researchers found all three of these tasks to be in the high-risk category for injuries; all of them surpassed the maximum safe level of compressive force to the [L.sub.5][S.sub.1] disk, as determined by the National Institute for Occupational Safety and Health. The amount of force produced by these tasks to the [L.sub.5][S.sub.1] disk ranged from 3,819 newtons (N) to 6,570 N; the maximum level for safety is 3,400 N.
In another laboratory study, researchers compared the use of the friction-reducing pad to the use of the draw sheet method for repositioning patients in bed. Again in this study, perceived physical stress to nurses' shoulders and backs was reduced significantly (P [is less than] .01) when using the friction-reducing pad, and patients rated their comfort significantly higher when the pad was used, compared to when the draw sheet was used (P [is less than] .01).
WHY ARE ASSISTIVE DEVICES NOT USED?
Other studies, however, indicate that nurses use and have positive
comments about the devices when the nurses
In the Netherlands, researchers found that nurses actually ranked assistive devices as their number one choice--over increased staffing, additional lifting and transferring courses, and sports or physical fitness classes--for the prevention of back and shoulder problems. Many assistive devices (e.g., transfer belts, stand-up mechanical lifts, full-body mechanical lifts) are available today for the majority of patient-handling tasks performed in health care settings.
WILL ERGONOMIC APPROACHES BE MANDATED?
Nurses must remember that the majority of overexertion injuries are the result of cumulative trauma. Nurses must develop and share an attitude of making workplaces as safe and healthy as possible for health care workers, as well as patients. It is important to determine which tasks are physically stressful and experiment with different approaches to decrease that stress. Nurses must be encouraged to solve problems and work with managers to make changes that could alleviate overexertion problems. All nurses should take responsibility to protect themselves from injury by implementing improved techniques for performing patient-handling tasks.
Bernice D. Owen, RN, PhD, is a professor at the University of Wisconsin-Madison School of Nursing, Madison, Wis.
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