Ergonomics is a human factor with the application of scientific information concerning objects, systems and environment for human use. The field of ergonomics is an applied science that also studies the effects of fatigue and discomfort on the body and designs protective equipment to keep operators safe and efficient. Specifically, physical ergonomics deals with the human body's responses to physiological stress. This article refers to the systems and scientific knowledge applied to lifting, turning and guiding heavy objects, namely patients.
Patient handling and movement tasks are physically demanding, generally performed under unfavorable conditions and often unpredictable in nature. Patients offer multiple challenges including variations in size, physical disabilities, cognitive function, level of cooperation and fluctuations in condition. As a given weight to be lifted, they are awkward packages, lack even weight distribution and have been known to become combative during the lift process.
According to Tuohy-Main, the cumulative weight lifted by nurses, nurse's aides, orderlies and attendants in one typical 8-hour shift is equivalent to 1.8 tons. 1 No wonder we're exhausted and so prone to back, neck and other musculoskeletal or neurological injuries.
Based on information from the American Nurses Association, Bureau of Labor Statistics and DeCastro, the statistics regarding occupational injury seem staggering. 2
Nursing has one of the highest occupational injury rates of any profession. National nursing injury rates are more than 12.5 percent, which is higher than auto manufacturing, mining and construction worker injuries. Nurses and other bedside healthcare workers are at greater risk for sustaining musculoskeletal disorders than most U.S. workers. For comparison, consider that truck drivers ranked second and construction workers eighth. Twelve percent of nurses nationwide leave the profession annually because of back injuries and more than 52 percent of U.S. nurses complain of chronic back pain.
Oregon's State Accident Insurance Fund manager, Chuck Easterly, admits that, "For all of the technological advances in healthcare, the vast majority of healthcare facilities still rely on antiquated, physically challenging techniques. If you were a mason, or a carpenter or a factory worker who had to move 150 or 250 or 300 pounds, you'd get a dolly or a lift of some kind. You wouldn't try to do it by hand. But that's what we do in healthcare when we move people." 3
The lifting problem has become so detrimental to bedside healthcare personnel that many private hospitals, nursing homes, and state and government healthcare agecies have set forth no-lift policies and procedures in an attempt to drastically cut the number of injuries, time away from work, initial and chronic pain, need for pain alleviation treatment, and loss of staff.
No-Lift Policies
So what are these no-lift policies all about? First, they are designed to be implemented. This may sound elemental, but how many nurses do you know who believe it's just easier and faster to "do it myself." The gap from the first Nursing Arts course to hands-on application of movement of patients in the clinical setting is often of astronomical proportions.
Central to all national no-lift policies is that manual lifting of patients should be eliminated in all but exceptional or life-threatening situations. To clarify this intent, several other key factors have been noted by Hignett: 5
Patients should be encouraged to assist in their own transfers and handling aids must be used whenever possible to help reduce risk, if this is not contrary to a patient's needs.
Manual lifting may only be continued if it does not involve lifting most or all of a patient's weight (lifting a leg or arm to apply topical medication or bandaging would be acceptable).
A no-lift policy does not mean healthcare providers will never transfer or reposition any resident manually, but rather needs to be based on patients' physical and cognitive status as well as medical conditions.
Proper infrastructure must be in place before a no-lift policy is enforced. Infrastructure is defined as management commitment and support, availability of patient-handling equipment, equipment maintenance, employee training, advanced training for resources and a culture of safety.
The culture of safety approach includes collective attitude of employees at all levels taking a shared responsibility for safety in the work environment and, by doing so, providing a safe environment for themselves and patients.
Nelson and Baptiste have found strategies to prevent or minimize work-related musculoskeletal injuries associated with patient handling often are based on tradition and personal experience rather than scientific evidence. The most common patient-handling approaches include manual patient lifting, classes in body mechanics, training in safe-lifting techniques, and back belts. There is strong evidence each of these commonly used approaches is not effective in reducing caregiver injuries. A major paradigm shift is needed toward the following evidenced-based practices: patient-handling equipment/devices, patient care ergonomic assessment protocols, no-lift policies, training on proper use of patient-handling equipment/devices, and patient lift teams." 6
Providing you adopt the shift toward evidence-based safe ergonomic techniques, no-lift policies and the addition of lift teams, you may be able to remain pain-free while assisting your patient's movements. The American Academy of Orthopedic Surgeons, with corroboration from R. Crouthamel, OT, gives ergonomically correct guidelines for several of the most frequently encountered patient movements. 7,8 These guidelines may become the basis for your patient care ergonomic assessment and protocols.
Why Injuries Happen?
There are multiple reasons why thousands of nursing injuries occur each year. Slip and slide injuries are related to everything from a leaky urine collection bag to improper signage following the damp cleaning of floors. Even the nursing shortage is being blamed for many forms of nurse injuries. The fourth most commonly reported injury during times of nursing staff shortages is injury related to poor ergonomics. 4
Simply stated, nurses and bedside healthcare workers are moving patients in unsafe conditions because a second pair of hands or helpful lifting equipment is just not available. In sharp contrast are lifting techniques adhered to by physical and occupational therapists, regardless of a dearth of willing and able hands and bodies for patient movement and transfers.
Today, caregivers who fall into nurse-like caregiving include loved ones caring for the patient in the home. With this one-to-one care, laypersons are lifting loved ones in and out of bed, tubs, chairs, cars and more. Integrating devices, such as Hoyer lifts and others, to help the home caregiver lift a loved one safely and with less fear would be not only an advantage to the caregiver, but encourage more care in the home. Without initial and ongoing training of home healthcare givers, risk of back injury is imminent. Pulling on the arms of a reclining person or leaning over a person in a regular height bed leads to early strain and weakening. One added
twist-and-turn injury while
transferring a loved one out of bed may be the proverbial straw to break the
caregiver's back.
Deborah X. Brown, herself a casualty
of an ergonomic disaster, believes there are no ergonomically safe ways to lift
patients and indicates experts have known this for more than 15 years. 4 Nurses
hurt not only themselves, but also the patients in their charge. Hoisting
patients under their arms or bending and twisting to place a patient in a
wheelchair from the bed leads to dislocations, shearing injuries,
musculoskeletal and nerve damage, and the opportunity for internal injuries as
well. Following our ergonomically savvy European colleagues, adopting a no-lift
policy in your facility can reduce lift and strain injuries across the
population who lifts people as part of a daily occurrence.
Helping patients out of bed
To move a person lying in bed to a wheelchair, put the chair close to the bed and lock the wheels. The chair should be on the patient's strongest side. Bed wheels also should be locked.
Adjust the bed height so you are comfortable while moving the patient. A slightly higher bed than necessary for patient sitting is helpful during transfers. Let the physical therapist and occupational therapist transfer the patient at the lower heights while the person is learning.
If the person is not strong enough to push up with his hands to a sitting position, put your hands under the person's legs, shifting the patient's weight forward. If in an electric hospital bed, use the head-raising controls.
Move the person's legs over the edge of the bed while pivoting his body so the person ends up sitting on the edge of the bed. Pivoting on a freely moving bed sheet or underpad limits shearing.
Keep your feet shoulder-width apart, your knees bent toward the patient's knees and your back in a natural, straight position.Helping the Patient Stand
If the person needs assistance getting into the chair, face the patient, place your feet shouder-width apart and bend your knees.
Position the person's feet on the floor and slightly apart. The person's hands should be on the bed, the arm of the wheelchair or armchair, or on your shoulders.
Place your arms around the person's back and clasp your hands together. Nurses, physical therapists and others in hospitals often use lifting belts, which are fastened around a patient's waist. The caregiver grasps the belt when lifting the patient.
Hold the person close to you, stand tall and shift your weight.