REPORT: May 2006

Research News You Can Use: Base Your Practice on Evidence

On the Job Injuries: What is the Evidence?

by Jeanne-Marie E. Havener, PhD, RN, CNS, FNP; associate professor and nurse researcher, Hartwick College and Bassett Healthcare; Council on Nursing Research

For a long time, direct patient care has been known to be risky business. During the 1980s, researchers found a positive relationship between musculoskeletal injuries and the delivery of patient care in nursing personnel (Menzel, 2004).

Evidence since that time suggests that nursing personnel may sustain injuries through the performance of a number of routine patient care tasks, among them: transfers, lifting, repositioning, and lifting and holding a patient’s extremities. Other risky tasks include weighing patients, changing bed linens in an occupied or unoccupied bed, dressing and undressing patients, feeding and bathing patients, standing for long periods of time, moving equipment, and so forth (Owen & Garg, 1991; Nelson, Lloyd, Menzel, & Gross, 2003). Aside from job tasks, other factors such as characteristics of the nurse, the patient, and the work environment can contribute to the risk for injury or chronic pain in nursing personnel (Nelson et al., 2003).

What is the Evidence?

Nursing is one of the occupations most frequently suffering from musculoskeletal disorder injuries. Indeed, labor statistics suggest that injuries are particularly severe in hospitals and nursing homes, where incident rates are as high as 8.3 and 9.7 injuries per 100 full time workers, respectively (U.S. Dept of Labor, 2004). Workplace injuries, primarily musculoskeletal disorders, contribute significantly to nursing satisfaction and the nursing shortage (ANA, 2004).

In a recent study, of a randomly selected, nationally representative sample of 509 hospital nurses providing direct patient care, 56% reported they were living with chronic pain related to the repetitive physical demands of the job or work-related injuries from lifting, moving, or repositioning patients (Hart, 2006). Nearly one in four nurses reported lost work time due to chronic pain (24%) or injury (22%). Further, 47% reported they considered leaving patient care because of the physical demands of their jobs, regardless of whether they had sustained an injury (Hart, 2006). Given the nursing shortage and the rise in obesity, these results have implications for nurses and nursing personnel.

While the use of patient handling equipment appears to reduce the risk of injury and chronic pain by 24%, one-third of the professionals in Hart’s report (2006) indicated they did not have access to such equipment. In addition, 63% reported that even when equipment was available they did not use it. Ignoring available equipment has been attributed to patient aversion to its use as well as difficulty in its use, inconvenient storage locations, poor maintenance, time constraints, weight limitations, incompatibility of equipment, and lack of availability, training, and space to properly use the equipment (Nelson & Baptiste, 2004). All of this needs to change.

What Can Be Done?

Research suggests that minimizing the risk for injury and promoting safer work environments requires that nurses and healthcare organizations change the way they do things.

In 2003, recognizing the severity of the problem, the American Nurses Association (ANA) announced the launch of a safe patient handling program, “Handle with Care,” to prevent back and other musculoskeletal disorders among nurses. This campaign as well as other ergonomic research encourages staff nurses who provide direct patient care to spearhead local efforts using the following tips:

• Create an ergonomics committee to look at the problem in your work setting
• Analyze internal injury data, conduct a walk through, and survey employees about injuries
• Assess risky patient care activities
• Develop and adopt protocols and algorithms for assessing the patient, the number of personnel, and the type of equipment needed to safely handle patients
• Research, evaluate, select, pilot, and institute patient handling equipment and devices
• Provide comprehensive and interactive competency-based training for staff on the proper use of patient handling equipment and devices
• Implement a patient lift team
• Develop improved reporting mechanisms to track work-related injuries (de Castro, 2004; Nelson et al., 2003, Nelson, Fragala, & Menzel, 2003).

The Handle With Care program, available on-line, through the ANA Web site provides access to many useful resources to those interested in acting as champions of safe patient handling.

References

American Nurses Association (2004). Handle With Care. Online at www.NursingWorld.org/handlewithcare

de Castro, A.B. (2004). Actively preventing injury. American Journal of Nursing, 104 (1), 104.

Hart, P.D. Associates, Inc. (2006). Safe Patient Handling: A Report. AFT Healthcare, AFT, AFL-CIO. Online at
www.aft.org/topics/nolift/download/PeterHartSurvey-final-03-16-06.pdf

Menzel, N.N. (2004). Back pain prevalence in nursing: Measurement issues. AAOHN Journal, 52 (2), 54-65.

Nelson, A., Baptiste, A. (Sept. 30, 2004). Evidence-based practices for safe patient handling and movement. Journal of Issues in Nursing, 9 (3). Online at
www.nursingworld.og/ojin/topic25/tpc25_3.htm

Nelson, A., Fragala, G., & Menzel, N. (2003). Myths and facts about back injuries in nursing. American Journal of Nursing, 103 (2), 32-40.

Nelson, A.., Lloyd, J.D., Menzel, N., & Gross, C. (2003). Preventing back injuries. AAOHN Journal, 51 (3), 126-134.

Owen, B.D., & Garg, A. (1991). Reducing risk for back pain in nursing personnel. AAOHN Journal, 39 (1), 24-33.

Trinkoff, A.M., Lipscomb, J.A., Geiger-Brown, J., Storr, C.L., & Brady, B.A. (2003). Perceived physical demands and reported musculoskeletal problems in registered nurses. American Journal of Preventive Medicine, 24, (3,) 270-275.