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NRI 95-150 – HSR Study

NRI 95-150
Redesigning Patient Handling Tasks to Prevent Nursing Back Injuries
Audrey L. Nelson, RN PhD FAAN
James A. Haley Veterans' Hospital, Tampa, FL
Tampa, FL
Funding Period: October 1997 - December 1999
This study is one of several initiated by the investigators to reduce musculoskeletal injuries in patient care providers. Nurses have one of the highest incidences of work related back injuries of any profession. Over the past 20 years, efforts to reduce work-related injuries in nursing have been largely unsuccessful.

The goal of this study is to reduce the incidence and severity of occupational musculoskeletal injuries in nursing through the redesign of stressful patient handling tasks. This study addresses three objectives: 1) conduct a quantitative, biomechanically based, ergonomic evaluation of the eleven "at risk" tasks in nursing practice; 2) redesign the techniques or equipment needed to perform these tasks safely or with reduced risk of musculoskeletal injury; and 3) conduct laboratory- based assessment of the biomechanical benefit of the proposed intervention strategies.

Using a randomized experimental design with a control group, ten "at risk" tasks will be evaluated. The sample included 160 experienced nursing staff. Data were collected using: 1) Caregiver Data Form and Anthropometry Data Sheet; 2) 3-D Electromagnetic Tracking System; 3) EMG; and 4) modified Borg Scale for Perceived Comfort. Include: caregiver characteristics, joint torque, spinal forces, spinal tolerance limit and damage load limit, erector spinae surface EMG, joint angles, percent of population capable of performing each task by gender, velocity of lift, reach, heart rate, and perceived comfort.

We completed a quantitative, biomechanically based, ergonomic evaluation of the eleven "at risk" tasks in nursing practice. A total of five nursing assistants were videotaped completing each of the eleven "at risk" tasks on patients in the clinical setting. This data was used to determine the relative working postures and restrictions for each task. From the five sets of postures, the exact task was replicated in the Biomechanics Laboratory. Next, 15 nursing staff performed each of the eleven "at risk" tasks in the laboratory setting. To standardize the weight lifted, a weighted mannequin (95th percentile US adult male based upon weight) was used instead of a patient. After the initial assessment of data from five subjects from September, 1998 to November, 1998, an interdisciplinary expert panel was convened January 11-13, 1999 to participate in the redesign of each of the stressful tasks chosen for the study. Once the recommended intervention strategies were selected, the researchers purchased off the shelf or experimental equipment to meet redesign requirements and designed training and education for intervention subjects. Of the 142 experienced nursing staff participating in the study, 68 performed each of the 11 redesigned tasks; the remaining 68 nursing staff (control group) performed the tasks using traditional techniques in the lab setting. Measures of Erector spinae EMG, joint angles, joint forces and torques, velocity of lift, reach, heart rate and perceived comfort will be compared between the control and experimental groups for each of the eleven "at risk" tasks to ensure that our ergonomic interventions, aimed at minimizing risk of back injury, did not introduce any other undue biomechanical stresses.

Findings from this study were used to develop a VHA Guide, "Safe Patient Handling and Movement," through the Office of Occupational Health in VA Central Office and Healthcare Analysis & Information Group in Milwaukee. Building on this project, a new program initiative was funded for $2 million entitled "VISN-Wide Deployment of a Back Injury Prevention Program for Nurses: Safe Patient Handling and Movement." This project will implement the redesigned tasks in VISN 8 and evaluate the impact on incidence and severity of job-related injuries in nursing.

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DRA: Health Systems, Acute and Combat-Related Injury
DRE: Treatment - Observational, Prevention
Keywords: Back pain, Nursing, Staffing
MeSH Terms: Nursing, Back Pain

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