Ergonomics and Injury Prevention in Nursing
Problem Description
This research seeks to present a description of innovative solution Safe Patient Handling and Mobility (“SPHM”) at many hospitals nationwide, including Swedish. Many nurses at the facility are out due to physical injuries at work. Such injuries either resulted from repeated patient repositioning and mobilization in addition to carrying out their daily activities. One of the biggest problems identified is that nurses are not adequately involved in the decision-making processes of proper equipment and training on ways as to prevent such injuries. Research into this area is, therefore, imperative. For these objectives to be realized and thereof create the greatest value for staff, patients, and communities; a comprehensive program must be built based on the radically distinctive general states of various hospitals who have not accepted this new culture. Nurses, need to be involved in SPHM programs which focus on the most dangerous tasks including effective ways to keep patients safe.
According to the Atlas Ergonomics White Paper (2009) publication, the American nursing workforce is aging (median age of 44 years). Compounded to this are the rise of obesity and patient acuity among the American population; more patients are acutely ill, have shorter hospitalization stays, and after discharge, they highly depend on others for physical assistance (Weinmeyer, 2015). Mayeda-Letourneau (2014) elaborates that the occurrence of Musculoskeletal disorders (MSD) related to patients handling has a high prevalence among the nursing staff and other patient care providers. Similarly, lift and transfer of patients rank among the most frequent causes of occupational injuries. Attendants, nursing aides, and orderlies had a “7% increase in MSD incidences in 2010 (U.S. Department of Labor Bureau of Labor Statistics 2011).
The American Nurses Association (2002) explains that the handling of patients and thereof their movements are physically demanding tasks, carried out under stressful conditions, and have more often proved unpredictable. Patients offer multiple hurdles as to physical disabilities, health fluctuations, size variations, impaired cognitive functions, and changes in the level of cooperation. Waters (2007) explains that patients (as a weight to be lifted) lack the convenience of even weight distribution, handles and commonly become combative during the mobility process. Female nurses largely perform these dangerous and physically demanding tasks (Vaughan et al. 2014).
Not only does hazardous lifting procedures risk the health of employees but also patients become injured from preventable falls, drops, and ulcers (Vaughan et al., 2104). According to the Occupational Safety and Health Administration (2014) study report, which examined a national survey conducted in 53 healthcare systems with approximately 1,000 hospitals in all 50 states, “patient handling injuries accounted for 25 percent of all workers’ compensation claims for the healthcare industry in 2011. Averagely, worker’s compensation on claims related to patient handling cost $15,600, and wage whereas wage replacements accounted for the largest share – $12,000” (Patient-handling injuries can be very costly to hospitals, par. 1). Furthermore, the Agency for Healthcare Research and Quality estimates that averagely the treatment cost of a Hospital Acquired Pressure Ulcer (HAPU) costs $37,800 per patient – directly translated to facilities (Danger of Manual Patient Handling, par. 3). Such reports are indicative that the most expensive type of hospital injuries regarding wage replacement are preventable patient handling injuries.
Fragala (2005) posits that highlighting the obvious health risk to the nursing staff, healthcare providers, the patients, and the apparent gains of the SPHM programs in general, regulation as to “minimal lift” have been passed in 12 American states. These Policies mandate that nurses be ineptly trained, certified, and be provisioned with equipment that they are obliged to use in practice. The legislation has thereof resulted in health facilities increment in the need to enlist, train, screen, staff, manage and consequently oversee consecrate SPHM professionals as efforts to comply with the regulatory requirements. These efforts are gaining increased importance, especially in areas where decreased patient mobility puts increased demand on caregivers. For benefits from such endeavors to be maximally realized, it is imperative that the nursing staff is included in decision-making processes regarding the implementation of SPHM programs.
The Question: Considering immobile patients in Cardiac Catheterization/Interventional Radiology Unit (P), is the implementation of an SPHM program that integrates technology, evidence-based practices, and safety (I) more efficient than the continued use of Manual Patient Lifting Techniques (C), in increasing levels of program effectiveness, patient and staff acceptance, return on investment, saving costs, job satisfaction, self- reporting of unsafe patient handling acts, decreased injury rates and fewer modified or lost work days (O) over a period of one year (T)?
Theory to Support the Proposed Solution
With changing working conditions and populations, health care providers are faced with preventable risks of suffering and pain. Trinkoff et al. (2008) explain that the wellness of nurses as to adverse work induced illnesses and injuries are paramount to the nurses, the patients, the health facility, and the community. The nursing work environment is strafed with many stressors including physical injuries and diseases, which encompass factors linked to the immediate work contexts, organization characteristics, and changes that not only occur external to the organization but also throughout the American healthcare industry (Trinkoff et al., 2008). Effective implementation of SPHM offers considerable advantages: curtailing injury related costs, reducing the prevalence of injuries among the hospital staff, enhancing patient safety and overall care, and accepting the overall value of nursing by promoting safety through culture change.
One theoretical framework that can influence staff behavior is based on behavioral intent and encompasses an overall culture and attitude that their behavior will make a difference to everyone. Some factors to consider in this theory would be behavioral beliefs, what is normal or expected (normative beliefs), and what would control these beliefs in a positive or negative way (Control beliefs) (Ajzen,2006). The theory of planned behavior takes into consideration the attitude toward the expected behavior and social influence (Ajzen, 2006). Presenting facts about the number and reasons why staff is injured, types of injury, and ways in which they can be prevented can be done by allowing them to participate in open discussions on old attitudes, common myths, biases, pre-existing attitudes or behaviors, and how new approaches can be implemented effectively (Ajzen, 2006). One way to apply the theory would be to give staff a questionnaire about what they like/dislike about the use of safety equipment, staff attitudes in regards to using safety equipment, whether they feel supported, how comfortable they are asking for help, available help, their views on better implementation and barriers to their safety and that of patients.
Weinmeyer (2015) adds that nurses and other health care providers go through substantial psychological and physical demands throughout their typical workdays, including work safety climate that has the potential to change adversely. Organizational pressures such as the turnaround time for patient care, use of alternative and employed nurses’ arrangements, and downsizing are some of the factors determined at organizational levels (Nelson, 2005). The hazards associated with the nursing work can impair the health of nurses in both the short term and the long term.
Vital scientific pieces of evidence as to technical risk factors exist and that effective interventions are available to reduce the potential adverse events to these workers (Trinkoff et al., 2008). The severity of conditions can be easily measured by data obtained from the number of restricted and lost work days related primarily to activities involving patient handling. Costs associated with such debilitating injuries are more than enough to provide levels of financial justification to calculate the return investment for the purchase of mechanical patient handling equipment (Vaughan et al., 2014).
Implementation Plan
Approval
The Cardiac Cath/IR lab has new equipment already installed. Necessary approval, therefore, would be needed as to assessing the cultural practices surrounding patient handling within the laboratory – such as inconsistencies with equipment use, or asking for external help. These will be followed by appropriate implementation of training and educational programs aimed at addressing compliance and cultural changes. Important evidence on cultural practices will be presented to the managerial staff for appropriate approval on away time to carry out training and appropriate practice on proper equipment use.
Secondly, proper approval will be sought when conducting pre-post assessments, issuance of lab questionnaires, assessment of safety practices and filling of the compliance log. An appropriate multiphasic plan of educating the staff on the importance of staff and patient safety will be drafted. Additionally, staff perception surveys on areas they feel a need for improvement, the level of support from both colleagues and the administration, and reasons they are less compliant on using the equipment or getting help will be conducted.
Problem Description
Evident from an observation of daily activities in our department was that many nurses miss work citing physical injuries suffered at work. Among some of the problems identified is that nurses/techs are not adequately involved in the decision-making processes on what equipment is needed, implementing proper equipment/usage in our lab, training on injury prevention and proper equipment use, accountability processes, and collaborating on safety concerns and successes. Within Swedish Cath/IR lab, mobility barriers noted included: insufficient equipment, non-compliance with use, value of safety and environment, inadequate staff acceptance, perceived weakness of needing assistance, human resources, time availability, staff attitudes, wait times, psychological/physical instabilities of patient’s, clinician fears and knowledge deficits, lack of perceived administrative support, and debunking pre-perceived biases.
The hospital has clear guidelines as ways to promoting ‘a culture of safety’ through the provision of a conducive environment for an SPHM program for all inpatients and hospital staff (Appendix A; Appendix B). The culture of safety will always be implemented to ensure safe, positive attitudes and having employees, managers and administrators to collaborate and share safety concerns and successes. All assessments, pre-and post-tests, educational hours, safety concerns, safety huddle meeting hours attended by staff, and compliance data sheets will be given to our department manager at the end of 12 months. These policies on the implementation of SPHM within the setting of the Swedish hospital are in line with the facility’s core purpose of promoting and maintaining a “culture of safety” by provisioning for an environment of an SPHM program for the staff and the patients.
Proposed Solution
An SPHM implementation program at the Swedish Hospital Edmonds incorporating policies and procedures from the Safe Moves, established March 2006 by State Governor Christine Gregoire requiring all hospitals to implement safe patient handling programs. This would include an interdisciplinary team of SPHM/Safe Moves to provide and distribute evidence-based hospital statistics, review of historical injury data, conducting a current assessment of equipment in the Cath/IR lab, and evaluating the staffs’ perception and knowledge of SPHM/Safe Moves. Additionally, development of metrics to measure program outcomes is necessary. Determining the number of patients to staff in the unit on a given day is a good starting point. The Cath/IR lab patients are entirely dependent on assisted mobilization. Many of the patients are post-procedure and have arterial access sites or arterial/venous sheaths that are left in place (many have had central line or pacemaker placement). Such does not take into consideration pre-existing co-morbidities such as decreased mobility, mental health, and age of our population. Cardiac and Vascular patients are often elderly with many co-morbidities such as musculoskeletal disabilities, diabetes, and dementia. Mobilization types for these patients are tabulated (Appendix G). The project, thereof seeks to address the issue of cultural practices surrounding the use of SPHM equipment within the Cath/IR lab.
Rationale
The culture of safety within a hospital setting varies widely across hospital settings, and thereof the performance of specific domains within organizations varies too. Exemplifying this is the fact that health facilities may have a high score on patient safety dimensions but lag behind in health worker safety. Similarly, studies conducted into the area of perception of hospital culture have had revelations that departmental culture may vary within a single hospital (Pediatric and ICU units may have a stronger culture of safety than Surgical/Medical Units) and the type of respondent (physicians may be more keen on their perceptions on safety culture than nurses).
Measurement of safety cultural practices within a hospital unit after implementation of and SPHM program is easier than implementing plans to improve them. Effective shifts in practices take time – months to years – and require specific interventions. In a systemic review conducted by Cochrane Collaboration (2013), examination of the effectiveness of strategies aimed at changing cultural practices within an organization to improve performances in healthcare identified over 4,000 publications based on their study criteria. Further, the authors applied the inclusion criteria of Randomized Clinical Trials and/or well-designed Quasi-Experimental Studies, none of the studies was revealed as eligible for inclusion. The authors were thus unable to draw any relevant conclusions on the effectiveness of the various undertakings aimed at improving pertinent organizational culture.
Evidence from Literature
With the evidence-backed information that biomechanical exposures significantly contribute to the high rates of musculoskeletal trauma in health-care professionals, mechanical patient transfer, and thereof handling techniques and devices have gained major focus on efforts of injury prevention (Weinmeyer, 2015; Tullar et al., 2010). The implementation of new patient handling techniques that strictly involved employee training and installation have moderate to inconclusive benefits in reducing lost work days, lowering employee injuries, and the cost of compensating workers (Gilbert et al., 2012; Alamgir et al., 2008.). Participatory and multi-component injury reducing approaches entailed the implementation of mechanical lifts as part of the process, but included elements that extended to involve employees in developing solutions, understanding the risks, and putting them as leaders of the implementation processes (D’Arcy et al., 2012; Hignett & Crumpton, 2007). Specifically, the use of change agents, coaches, or peer leaders from within organizations is a critical step to the success of such programs (Koppelaar et al., 2011).
Program Implementation Logistics
A six-step logarithm for decision-making will be developed to aid nurses to make decisions on the safest techniques and equipment basing such on patient characteristics and specific patient handling tasks (Appendix F). Over the next 12 months, the program is to be implemented by assessing the knowledge of our staff on our safe patient handling equipment, proper usage, improper usage, and observing hand on behavior. This information will be obtained from staff self-assessments, skills assessments, skills demonstrations, and compliance data sheets by selected staff in the department. This will help determine how well the employee understands the equipment and importance of implementation. An SPHM Setup Committee roles under these would include: initiating the project, educating staff by use of power point presentations, handouts, compliance logs, and various assessments that will be included.
If any safety concerns on procedures and policies, are noted, the Safe Moves coordinators will address and partner with the clinical nurse specialist, June. Altaras, RN, BSN at Swedish Hospital to address these issues. The policy and procedures on safe patient handling and staff education are to enhance the establishment and implementation of this plan to reduce injury, increase patient safety, promote compliance, and to establish a culture of healthy behavior. This is also to help empower staff by collaborating on the effectiveness of equipment, ease of use, the confidence of staff, and will be assessed during the initial orientation period of the team. Logistics are positive in that we have the appropriate equipment, but we must be sure that the staff is on board to implement the use.
After obtaining the leadership commitment, a structured process is to be instituted to build a unit wide (and later hospital wide) awareness and necessary support for implementation of the change. A toolbox of highly reliable behaviors grounded on outcomes form comprehensive unit wide assessment will be created with input from primary patient healthcare provision staff at the frontline. A rollout out of the toolbox will be accomplished through education (Appendix G); all associated stage will complete a 3.5 – 4 hours of mandatory training (in line with hospital policies) conducted by senior hospital leadership, inclusive of the hospital CEO alongside a key middle manager.
Medical staff education will commence with a three-day training that will focus on the safety and high reliability including actual physician-centric case studies of harm-related errors. Physicians who will volunteer to this program will also be trained on educating staff for the remaining hospital medical staff. For eligible reappointment into the medical management team, the hospital’s Medical Executive Committee (?) will be encourage to make a voting on ensuring that Reliability Safety Training is mandatory as a requirement for one to be eligible for reappointment.
For an effective support of the actualization of high reliability behaviors, to be implemented are a host of operational infrastructures. These will include meetings commencing on the topic of safety (including board meetings), coaches on safety unit based hurdles, daily in-house huddle, rounding of senior leaders, a robust system of root cause analysis of potential harm events, report of performance metrics via the intranet, or a dashboard, and encouragement of uttermost transparency on sharing happenings of safety events within the unit.
Resources Required for Implementation
Equipping staff with adequate training, knowledge, and resources is paramount to staff compliance and safely and effectively mobilizing patients within the procedure units, without jeopardizing safety to staff or patient. Equipment vendors will be contacted to train on the Stryker beds and lifting devices correctly. Continuous staff education is to be conducted once a month for 30 minutes of time. Identifying problem areas by staff, modifying behaviors, increasing confidence and skills, and empowering staff to incorporate a culture of safety and confidence will be critical to change.
Education using evidenced based research in regards to injury prevention, ergonomics, infection control, patient and employee rights, guidelines for safe practice environments, equipment storage, and appropriate documentation will be provided. This will be done in our employee break room using the office area for PowerPoint presentations, in addition to handouts, and pamphlets. We will also instruct staff on how to fill out a safety concern, find policy and procedures via Swedish website, and how to attend a safety huddle in the hospital, which is held weekly. Stryker representatives will be available on specific dates to teach, demonstrate and assess the knowledge of the staff on the new electric stretchers and answer questions.
Assessment of the project is to be conducted through surveys, observation of compliance with documentation, safety huddle forms, questionnaires and pre-and post-implementation tests to assess the level of knowledge of the staff at the baseline and after implementation of the SPHM program. The team assigned to oversee the program will be tasked with calculating the cost – the cost of procuring educational materials, educating staff, gathering, and analyzing the data before, during and after implementation of the program. Procedure lab nurses and techs will be recruited to perform roles ranging from initiating, overseeing the implementation, and assisting the effectiveness of the change.
Provision of feedback is essential for monitoring and tracking the SPHM program to determine its effectiveness. Two types of feedback would be expected of the program: (a) compliance rate monitoring that provided some reassurance that caregivers use the SPHM technology when required to (Fitzpatrick, 2014, pg. 4-7). Such monitoring may be carried out indirectly through staff certification to ensure they are equipped with knowledge on how to use the equipment. Directly, the nursing unit can be observed to assess whether caregivers use the appropriate SPHM equipment. (b) Program result monitoring is dependent on the SPHM set goals (Fitzpatrick, 2014 pg. 4-7), and may include lower patient falls and pressure ulcers, reduced caregiver injuries from patient handling, improved staff retention, and increased patient and staff satisfaction.
Evaluation Plan
According to Zadvinskis, Willis, and Patterson (2013) the Donabedian Framework provides a triad of structure, processes, and outcome that healthcare leaders can use to select and evaluate appropriate program measures and thereof results. The structure-process-outcome is an example of a theoretical approach used to assess the quality of an SPHM process. Understandably, the assessment of the effectiveness of the SPHM program through research based on these theories than new conceptual models is desirable as it is more generalizable and health care providers can apply such findings to ranging situations. Variables:
- Individual factors – such as motivation and willingness to perform tasks.
- Occupational/workplace factors – comparison of the number of nurses who miss duty due to work related injuries before and after implementation of the program
- Pre and post implementation cost
Methods and Tools
The interest of the staff in using the equipment will be measured using a three-point Likert Chart Scale. The data will be analyzed to present the frequencies of interest of the staff within the unit on SPHM usage. A sample question would be: with appropriate knowledge on the prevalence of injuries within the workplace and necessary skills on how to use the installed equipment, do you find it interesting to use the equipment? Additionally, the Dichotomous Inventory Item Scale will be applied in assessing the staff’s personal choices to use the equipment. The survey questionnaire will entail a question stem follow by a two response formulated to entail a “yes” and a “no” response. Appropriately, the “yes” and “no” responses will be tabulated to give a quantitative overview of the personal staff choices on SPHM equipment use.
Extrinsic and intrinsic motivational factors affecting the use of SPHM equipment after training. A sample question in this section would be: what motivates the direct patient healthcare providers in the Swedish Interventional laboratory to use the SPHM Installed equipment? External motivational factors for equipment use would include supervision from colleagues and hospital administration, patient needs (patient weight), time constraints or peer pressure. Staff intrinsic motivation to use equipment would vary. Such would be assessed on matrices such as relevant knowledge on equipment use, need to reduce the risk of musculoskeletal injuries or expertise in the area. Paper questionnaire surveys with a list of external and internal motivational factors such as hospital supervision, knowledge on equipment use will be used.
Attitudes of the staff toward the use of the equipment will be measured after training will also be assessed. Sample questions would include: Please make an appropriate tick on the number of times you have used the equipment (an appropriate range of numbers will be drafted). A second sample question would also be: please make a rating of the effectiveness of the equipment installed within the unit: (appropriate scale questions here). Does the equipment installed meet your ambitions? Does the equipment offer a desirable environment to work? Additionally, the Semantic Differential Scale on a paper questionnaire will be used to measure the staff’s attitude toward the use of the new equipment. The Semantic Differential questions are used to ask the position of the respondent on a scale between two bipolar adjectives such as “Fun – Boring,” and “Happy – Sad.” The frequencies of the bipolar responses will be counted. Example: Please make a rating of the installed equipment on offering a suitable work environment: I feel the equipment offers a suitable environment to work in: A= “Strongly Disagree,” B = “Disagree,” C = “Neutral,” D = “Agree,” E = “Strongly Agree.”
Cost Benefit Analysis
Siddharthan et al. (2005) explain that in a hospital setting where the allocation of resources is well documented – such as the Swedish hospital – the usefulness of evaluating the effectiveness of the SPHM program using the cost-benefit and cost-effectiveness evaluation method is paramount. Costs incurred indirectly can be characterized as diminution of hospital income due to premature mortality or morbidity, and the value of output lost in light to the same reasons.
Included in the evaluation will be monetary estimated cost of travel time related to transport to access healthcare and the cost of pain and suffering to injured employees. The administrative expenses related to the billing of hospital staff compensation for the injuries sustained at work, and the total expenditure of medical treatment sought after outside the hospital will also be included in the evaluation (Siddharthan et al., 2005). Elements of the cost-benefit analysis to be used are as summarized below:
- Training costs – the costs of training direct patient care providers (including the nurses) who will be using the installed equipment over its lifetime.
- Initial investment/capital costs – costs of acquiring, installing and maintaining SPHM equipment within the unit.
- Costs directly incurred by the hospital in relation to the treatment of work injuries sustained by health care providers and subsequent loss of productivity:
- Workers compensation (WC) given to injured caregivers.
- Total amount of medical treatment expenditure incurred at the Swedish hospital: including any ancillary diagnostic procedures and services, medical care, physical/occupational therapists and medications.
- The accrued cost of lost productivity when injured direct healthcare providers to patients on limited duty or sick days.
Dissemination
McCormack et al. (2013) define dissemination as a targeted distribution of intervention materials and information to key hospital stakeholders and target audience; including the nursing community, other hospital employees, equipment suppliers, potential users such as students, the local community, and the administration. The intent of this, therefore, is to spread knowledge gained from implementation of the project and associated evidence-based interventions. In a hospital setting, dissemination would take place in a variety of settings, by use of various channels in a myriad of social contexts. The broad goals that such dissemination targets to achieve would include: increase the staff’s ability to use and apply gained information, increase the nursing staff’s motivation of using the implemented SPHM program, and to expand the reach to evidence (Wyatt et al., 2013; McCormack et al., 201; Finn et al., 2014).
Dissemination strategies are aimed at spreading evidence-based interventions and associated knowledge in a broad scale of practice settings, or networks, and other social users such as primary patient health care providers and patients (Wyatt et al., 2013; the World Health Organization, 2014). In relevance to the Swedish hospital setting, passive information dissemination is not as useful as active information dissemination. Active multifaceted approaches to information dissemination, on the other hand, more often than not prove useful (McCormack et al., 2013). In light to this, the project’s dissemination strategies would aim at turning the whole idea of dissemination into a real participation thing, effectively ensuring that the hospital staff as a whole feel a sense of responsibility, and ownership for the activities, goals and eventual outcome of the endeavor. Established method of communication within the hospital will be used in addition to exploring other media that may augment the impact of the information on the target population – including the nursing community – who may not be particularly aware or responsive for the work that the undertake.
Table 1: Information dissemination methods to hospital stakeholders
| Stakeholdres | Vehicle/Method | Reasons |
| Nominated nursing staff, individuals expressing interest in the project, nurses within the nursing unit, the SPHM committee, patients, the hospital administration | Mailing list | Present target audience with project information and materials. |
| Email/ Mail-base lists | Reaches many of the hospital’s stakeholders. | |
| Newsletters | Timely basis to keep the audience informed on project progress; keep them stimulated | |
| Briefings | Presents a summary of the project. Used to make updates on project progress. | |
| Website | Allows for easy access to project information. Easily updated. | |
| Project reports | Publishing and disseminating findings from the project. Form part of project’s deliverables. | |
| One to one | Expensive. Used only to target people believed to enhance the success of the project. |
Conclusion
Prioritizing staff and patient safety as part of the cultural practices within the Swedish hospital setting will only be realized is a comprehensive organization approach to addressing policies and procedures is put in place. Such will entail a detailed description of metrics such as prevalent organization’s structures (lines of authority, committees, departments), allocation of resources (equipment, hospital staffing and capital expenditure), effective systems on surveillance and analysis of adverse events, assessments of risks and hazards to both patients and staff, and measurement of performances through data collection, analysis, and eventual use. To optimally prevent errors associated with equipment use, safety behaviors are to be appropriately matched with error prevention tools to support actions taken by individuals and promotion of teamwork. Importantly, positive behavior modification will also entail rewarding of successes with immediate recognition. As highlighted above, these can be obtained from feedback performance metrics made available on the hospital’s intranet. Posters strategically placed to display measurement outcomes, such as the number of days without incidences of injury, will continually provide a visual reminder of the success of the program. Whereas reliability behavior may be particularly being more quickly adopted by for patient, relentless pursuit and persistent focus on ways to eliminate associate harm will become a standard to core safety work.
Review of Literature
D’Arcy, P., Sasai, Y., & Stearns, S. C. (2012). Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants. Journal of Advanced Nursing, 68(4), 836-845
D’Arcy, Sasai, and Stearns (2012) conducted a study to establish the link between workplace injuries that nursing assistants in nursing homes experienced and four factors that that may have had an effect on the rate of the injuries: lifting devices, initial training that the nursing assistants received, the current training offered at the facilities, and the amount of time spent executing daily activities. The authors estimated a survey-weighted logical model employing data from the 2004 National Nursing Assistant Survey. The odds of getting injured in the previous year (41%) were less among nursing assistants who had reported as to always having a lift available when needed, the presence of training within the facility to reduce workplace injuries (39%), and had sufficient time to complete their daily training (35%). Relevantly, the project concluded that area equipped with lifting devices have lower injury rates. Hinging the findings of the project on the SPHM program at the Grand Canyon university, the potential for reducing injury rates within the US can be potentiated from ensuring adequate time for resident care and offering proper training as most facilities have lifts in place.
Mayeda-Letourneau, J. (2014). Safe Patient Handling and Movement: A Literature Review. Rehabilitation Nursing, 39 (3), 123-129.
Mayeda-Letourneau’s (2014), study plowed into the topic of the impact of SPHM program on healthcare costs, healthcare worker injuries and job satisfaction. In this report, the author critically reviewed literature on safe patient handling. It was revealed that in overall, SPHM programs reduce the overall work injury costs and improves jobs satisfaction in healthcare. The authors showed that decreasing the cost of injuries, reducing incidences of injuries, improved patient outcomes, and employees’ perception of employer support all add up to a program that catapults an organization towards a culture of safety – issues that can never be overemphasized as relevant to the theme of the project.
Mazurek Melnyk, B., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Igniting a spirit of inquiry: An Essential Foundation for evidence-based practice. The American Journal of Nursing, 109(11), 49-52
Mazurek Melnyk, Fineout-Overholt, Stillwell, and Williamson’s (2009) article posts that evidence-based practice (EBP) is an approach seeking to address problems within the heath care sector and integrates the finest of evidence from research and data on patient care encompassing patient preferences and clinician expertise. When such is delivered in the circumstances of a supportive and caring organizational structure, achievement of the highest level of patient care is realized. Relevantly, the paper, among a series of others, purposed to present nurses with a novel of ideas and skills for the effective implementation of EBP in a consistent manner. Hinging on the project, the proposal for the implementation of the SPHM program at the Grand Canyon University is an evidence based endeavor.
Nelson, A., Matz, M., Chen, F., Siddharthan, K., Lloyd, J., & Fragala, G. (2006). Development and Evaluation of a Multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International Journal of Nursing Studies, 43(6), 717-733.
Nelson et al. (2006) outlined that the prevalence of musculoskeletal injuries among nurses is high compared to any other professions. The past three decades have seen unsuccessful efforts at alleviating musculoskeletal disorders among nurses. The researchers primarily sought to create safer working environments for nurses who were tasked with providing direct patient care. The intervention entailed six programs: state of the art equipment, ergonomic assessment protocol, peer leader roles, decision algorithms and patient handling evaluation criteria, no lift policies, and an after action review. The methods used were pre/post designs devoid of a control group was employed to evaluate the usefulness of patient care ergonomics in 23 high-risk units in 7 facilities. Lost work days, job satiation, injury rates among other outcomes were measured over a period of two nine months. Data was prospectively collected through cost logs, weekly process logs and surveys. The authors reported that the program led to a significant decrease in musculoskeletal injuries – including the number of off-duty days per injury. The program has its effect extended to nurse recruitment and subsequent retention, which is a focus of this project.
Waters, T. R. (2007). When is it safe to manually lift a patient? AJN The American Journal of Nursing, 107(8), 53-58
Waters (2007) examined the 1994 NIOSH revised revision of the NIOSH lifting equation. The author points out that in the revised version, the NIOSH excluded the equation of the assessment of patient handling tasks, and continues to argue that such tasks have many compounded variables. Waters goes ahead to use the equation to calculate the recommended weight limit for a myriad of patient handling tasks that entail a cooperative patient who is less likely to move during tasks. The revision importantly yields a 35 lb. Recommended maximum weight limit for handling patients. Echoing the SPHM project, when such weight limits are exceeded, employment of assistive devices is imperative.
Weinmeyer, R. (2015). Safe Patient Handling Laws and Programs for Health Care Workers. American Medical Association Journal of Ethics, 18(4), 416-421.
Weinmeyer (2015) posits that health-related work dangers are frequent among orderlies, nurses, and other patient health care providers. Changing working condition and population demographics present health care workers with unprecedented challenges that bring about suffering and pain. Relevantly, and in relation to the SPHM project, programs and laws directed toward enhancing are patient handlings present numerous benefits including curtailing injury costs, improving care and safety of patients, and reducing injury rates among health care workers.
Gilbert, J. H., Vermillion, B., & Chase, L. K. (2012). Stop the pain. Reinforcing a successful ergonomics. Nursing Management, 43(7), 18-20.
Gilbert, Vermillion, and Chase’s (2012) report addresses various mechanism as to the effective implementation of an ergonomics program within a hospital. Some of the mechanisms outlined include putting mechanisms in place for effective communication, assessing individual needs of a nursing unit, championing patient safety, busting identified barriers to effective implementation, maintaining modifications, and supporting subsequent growth and necessary reinforcements. These mechanisms form a hinge of the Grand Canyon University SPHM project and further explain the basics of its implementation plan.
Tullar, J. M., Brewer, S., Amick III, B. C., Irvin, E., Mahood, Q., Pompeii, L. A., Wang, A., Van Eerd, D., Gimeno, D., Evanoff, B. (2010). Occupational safety and health interventions to rescue musculoskeletal symptoms in the health care sector. Journal of occupational rehabilitation, 20(2), 199-219.
Tullar et al. (2010) systematically reviewed available literature to determine whether prevalent health and professional safety interventions have an effect on the status of musculoskeletal health. The search identified 8, 465 articles published between 1980 and 2006 that were reduced to 16 studies based on relevant content. Observations were made on multicomponent patient handling techniques and exercise interventions. Evidence on updated articles between 2006 and 2009 indicate that (1) training of effective patient handling alone and (2) training on cognitive behavior alone shows no positive outcome on musculoskeletal health. In conclusion, provided the level of available evidence, multi-component patient handling interventions (MCPHI) and exercise are recommended as to effective practices to consider. A multi-component organization intervention thereof would entail policies that define organizational commitments to purchasing appropriate equipment to lift and mobilize patients to lower biomechanical hazards, the mechanism to lowering injuries related to patient handling, and the outlining of a broad scope ergonomics training program that would entail safe equipment use and patient handling – crucial to the Grand Canyon University SPHM project.
De Castro, A. B., Hagan, P., & Nelson, A. (2006). Prioritizing safe patient handling: The American Nurses Association’s Handle with care campaign. Journal of Nursing Administration, 36(7-8), 363-369.
De Castro, Hagan, and Nelson (2006) note that nurses within the American health care system continue to experience debilitating injuries that are secondary to lifting patients manually. Importantly, ergonomics on patient care is emerging as a field aimed at redesigning patient care to lower exposure to dangerous risks. Within the healthcare system, SPHM is becoming more accepted as a way of preventing occupational injury and enhancing care directed to patients. Relevantly, the authors examine the national efforts garnered at promoting patient care ergonomics principles, SPHM impacts and their effect on patient care and addressing nursing shortages within the country. Such information is crucial to determining the specific needs that the Grand Canyon University has to consider before implementing an SPHM program.
Alamgir, H., Yu, S., Fast, C., Hennessy, S., Kidd, C., & Yassi, A. (2008). The efficiency of overhead ceiling lifts in reducing musculoskeletal injury among care workers working in long-term care institutions. Injury, 39(5), 570-577
Alamgir et al. (2008) conducted a longitudinal survey of three long-term medical facilities to examine the cost of benefit and effectiveness of using overhead lifts in lowering the incidences of musculoskeletal injury prevalent among health care workers. The authors analyzed trends for a span of six years before the intervention and four years after the intervention with revelations that a significant sustained decrease in the claims posed by workers per number of beds and the number of working days lost per bed. Findings included that the payback period varied up to a maximum of 6.3 years if they included direct claim costs and a high of 3.20 years if indirect costs were summated. Considering that the project entails implementation of an SPHM program, such significant findings indicate that reductions in compensation claims and injury rates support the implementation of overhead ceiling lifts.
Koppelaar, E., Knibbe, J. J., Miedema, H. S., & Burdorf, A. (2011). Individual and organizational determinants of use of ergonomic devices in healthcare. Occupational and environmental medicine, 68(9), 659-665.
Koppelaar et al. (2011) identified organizational and individual determinants of ergonomic devices in patient care. A cross-sectional study was carried out in nineteen hospitals and nineteen nursing homes. Assessment of the use of ergonomic devices was done through real-time observations. Individual barriers were determined using structured interviews with nurses, while organizational limitations were identified through questionnaires filled by managers and supervisors. Determinants of ergonomic use were estimated using multivariate logistic analysis techniques. Results of 670 patients and 247 nurses that required ergonomic use were examined. It was revealed that 68% of the time the ergonomic devices were used in 59% of health facilities. Determinants of using the lifting devices included the presence of back complaints among nurses in the past year, the nurses’ motivation and the inclusion of strict guidance in the care of patients that entailed the use of ergonomic devices. Supportive management, easy of accessibility and a supportive management climate were all determined as organizational factors. Relevantly, the use of lifting devices was found to be lesser in hospitals as compared to nursing homes. Relating to the project at hand, organizational and individual factors play a role in the successful implementation of patient ergonomic devices in a health facility.
Hignett, S., & Crumpton, E. (2007). Competency-based training for patient handling. Applied Ergonomics 38(1), 7-17.
Hignett and Crumpton (2007) investigated the connection between different levels of safety culture based on the competency of training, which resulted in different physical and cognitive behavior on how patients were handled. The authors identified sixteen primary and healthcare facilities within the UK to participate in the study. Precious data of each institution was benchmarked against the standard Royal College of Nursing Set Standards on manual handling of patients. Two set of patient handling techniques were used to collect behavioral data; repositioning in sitting and sitting to standing using interviews and observations. Results indicated that organization that had a positive patient handling culture among the nursing staff had a complex decision-making process on patient handling that resulted in lower levels of postural risk. The results, therefore, echo the projects aims of inclusion of nurses in hospital decisions – such as the implementation of an SPHM program.
Graham, P., & Dougherty, J. P., (2012). Oh, their aching backs! Occupational injuries in nursing assistants. Orthopedic Nursing, 31(4), 218-223.
Graham and Dougherty (2012) explored the less studied area of the extent and reasons for the occurrence of musculoskeletal/ergonomic injuries among Certified Nurse Aides. Employing the systematic random technique, the authors selected 200 Nurse Aides from State Board of Nursing’ – a public list with more than 2000 names. A survey email was sent to each of them with the question of whether they had experienced any injuries as they worked. Method: Successfully, 35 participants completed the nineteen-item self-survey on back injuries they incurred during work, any work injury training received during training and labor and circumstances under which the nurses experienced these injuries. Findings: n=16 (46%) of the participants positively indicated that they had hurt themselves while moving, lifting, or mobilizing a patient, n=14 (40%) correctly reported experiencing back injury. 79% (11) of the injured participants suffered injuries when carrying out their duties at nursing homes. Poor working relationships were also identified as a factor that influenced their perceptions of work. In agreement with the project proposal, injury among nursing aides related to patient mobilization is a definite cause for alarm and necessitates for further research into interventions to reduce such injuries.
Lee, S. J., Lee, J. H., & Gershon, R. R. (2015). Musculoskeletal symptoms in nurses in the early implementation phase of California’s safe patient handling legislation. Research in Nursing & Health, 38(3), 183-193.
In light of musculoskeletal injuries among the nursing staff, the state of California enacted legislation in 2011 requiring acute care hospitals to implement SPH programs and policies. The authors then conducted an early assessment of the laws among 396 randomly sampled nurses. Among those whose duties include hospital patient handling (n=220), the 12-month prevalence rates of back injuries were 69% (54% lower neck, 41% neck, 34% shoulders,26% hands and wrists). 22% reported their hospital had not implemented any lift policies, 37% indicated their hospitals had lift teams, 61% indicated their facilities employed mechanical equipment. Facilities with lift teams had their nurses less likely to report low back (OR = 0.54, 95% CI [0.30-0.97]). 60% of the participants were aware of the SPH policies, 33% indicated their hospital’s hand changed patient handling programs and policies on effecting the law. In relation to the project, the reported SPH practices were suboptimal, with positive indicators of elements necessary for the legislation of SPH programs. Legislation of SPHM programs across the American states is a positive gesture toward patient and staff safety and reduction of organizational costs.
Thomas, D. R., & Thomas, Y. L. N. (2014). Interventions to reduce injuries when transferring patients: A critical appraisal of reviews and a realist synthesis. International Journal of Nursing Studies, 51(10), 1381-1394.
Thomas and Thomas (2014) conducted a critical appraisal of systematic reviews and a realist synthesis to point out practices best designed for handling and moving patients. The authors obtained their data from five major databases – CINAHL, PsycINFO, Medline, ScienceDirect, and EMBASE – that included 150 reports that had assessed SPHM programs between the years 2000 and 2013. The analytical appraisal technique involved six systematic reviews. The realist synthesis, on the other hand, included 47 research that provided descriptive information on program results. The five and six systematic reviews included interventions that involved either training and equipment or staff training. One of the reviews entailed examining of multi-component interventions. The research concluded that staff training alone was ineffective. Importantly, differing conclusions arose as to the effectiveness of multicomponent programs and training and equipment interventions. In relation to the proposal, the realist synthesis revealed that the need for support and commitment from management, and six other core program components: protocols on risk assessment, ergonomic assessment of spaces, transfer equipment, policies on safe patient transfer, human resource in the form of coordinators and coaches and adequate staff training. Relevantly, these components function in a synergistic manner; omission of one weakness the other elements.
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