The influence of individual and organisational factors on nurses' behaviour to use lifting devices in healthcare.

AIMS: This study evaluates the influence of individual and organisational factors on nurses' behaviour to use lifting devices in healthcare. METHODS: Interviews among nurses were conducted to collect individual characteristics and to establish their behaviour regarding lifting devices use. Organisational factors were collected by questionnaires and walk-through-surveys, comprising technical facilities, organisation of care, and management-efforts. Generalised-Estimating-Equations for repeated measurements were used to estimate determinants of nurses' behaviour. RESULTS: Important determinants of nurses' behaviour to use lifting devices were knowledge of workplace procedures (OR = 5.85), strict guidance on required lifting devices use (OR = 2.91), and sufficient lifting devices (OR = 1.92). Management-support and supportive-management-climate were associated with these determinants. CONCLUSION: Since nurses' behaviour to use lifting devices is influenced by factors at different levels, studies in ergonomics should consider how multi-level factors impact each other. An integral approach, addressing individual and organisational levels, is necessary to facilitate appropriate implementation of ergonomic interventions, like lifting devices.

Static load in the nursing profession; the silent killer?

Traditionally back pain in the nursing profession is associated with heavy lifting of patients. Although there is a strong relationship between heavy loads on the spine and lifting patients, literature indicates that there is a major factor that should not be underestimated: static load. Static load can be defined as the result of static, not moving, not dynamic, working positions. For example when a caregiver is washing a patient on a bed which is too low, her back is in a static (bended) stooped position up to several minutes. Exposure to static load is an underestimated silent killer of nurses musculoskeletal system . There is evidence from this cross-sectional study that static load can be reduced by a combination of introducing the right equipment, creating awareness and education.

An international validation study of the care thermometer: a tool supporting the quality of ergonomic policies in health care.

Occupational back pain among nurses leads to high costs and personal suffering for nurses. It is difficult to assess the success of such initiatives and to monitor results in a practical way. Such a practical monitoring and web-based instrument was developed. This Care Thermometer (CT) allows the users to assess the current situation in their facility today, and, with regular use, it can help to track progress over time. The Care Thermometer is a further step in the development of the TilThermometer, a validated assessment tool that is used on a large, national scale in The Netherlands. The claims of the newly developed Care Thermometer are ambitious and an international validation study was performed in four countries: the UK, USA, Germany and the Netherlands. The instrument appears to be sufficiently valid, useful and practical. There are however some points to keep in mind when interpreting the results of the CT. Especially a careful, punctual and stringent data collection phase is crucial for accurate and useful results. Some recommendations to further improve the practical use both for the design of the instrument and the process of data-collection and -entering are given.

Flying through the hospital: efficiency and safety of an ergonomic solution.

In hospitals many horizontal transfers (from stretcher to bed etc.) are performed from the moment a patient is admitted (f.e. with an ambulance) through examination departments all the way to the wards. These transfers can be very strenuous and solutions may be to use a special lifting device that accompanies the patient on this route: a stretcher sling This is a specially designed disposable lifting sling for horizontal transfers and repositioning, the sling can easily be connected to a ceiling or mobile lift. The ambulance service, two hospitals and a manufacturer decided to study the effects. The stretcher sling travels with the patient. Does this provide an ergonomically sound solution and is this an effective and efficient solution? The results were positive, but a behavioral change was also necessary.

Designing the care environment in hospitals and nursing homes: a pilot for a new and reliable method for determining the optimum space to live in and work in.

One of the major problems encountered in health care during the process of implementing ergonomic changes is the lack of space. There is often not enough space to work with larger equipment like patient lifters and shower chairs or other medical devices necessary in a preventive program. This leads to undesirable extra physical load for nurses. Therefore it is imperative that in the process of designing the health care environment ergonomic considerations are taken into account. A method to assess the optimum size and shape of the space required is developed and the value of the method is tested in a pilot setting. The pilot is currently underway and the results will be presented on the final poster.

Assessments of patients with a 5-category or a 3-category practical classification system: validity and practicality.

In order to implement preventive programs to prevent back pain in nurses, assessments of the degree of passivity and mobility of patients is imperative. After all, the load in health care ergonomics, is often the patient. The degree of cooperation or resistance determines the load on the back for the nurses and the necessity of the use of lifting devices like patient lifters or sliding sheets. These assessments must be done in both a practical and a reliable way. For this purpose a 3-category and a 5- category system to assess the degree of patient mobility and passivity was developed and tested. The results are presented on the poster.

The businesscase for ergonomic changes in health care: calculating and predicting financial outcome for ergonomic changes and innovations in health care: interactive businesscase modelling.

Research can point to new opportunities and assist in the development of valid business cases to help nurse managers plan change and allocate their budgets to the most promising interventions. These business cases and their results will, in turn, pave the way for more in depth and more fundamental research into implementation processes. It will add to the body of knowledge of intervention research and ultimately hopefully also add to our understanding of why ergonomic interventions in the workplace will or will not be effective and what the impact of financial constraints is. It is difficult to develop and design a valid businesscase. This poster will present one of the possible strategies to develop one.

Individual and organisational determinants of use of ergonomic devices in healthcare.

OBJECTIVE: This study aims to identify individual and organisational determinants associated with the use of ergonomic devices during patient handling activities. METHODS: This cross-sectional study was carried out in 19 nursing homes and 19 hospitals. The use of ergonomic devices was assessed through real-time observations in the workplace. Individual barriers to ergonomic device use were identified by structured interviews with nurses and organisational barriers were identified using questionnaires completed by supervisors and managers. Multivariate logistic analysis with generalised estimating equations for repeated measurement was used to estimate determinants of ergonomic device use. RESULTS: 247 nurses performed 670 patient handling activities that required the use of an ergonomic device. Ergonomic devices were used 68% of the times they were deemed necessary in nursing homes and 59% in hospitals. Determinants of lifting device use were nurses' motivation (OR 1.96), the presence of back complaints in the past 12months (OR 1.77) and the inclusion in care protocols of strict guidance on the required use of ergonomic devices (OR 2.49). The organisational factors convenience and easily accessible, management support and supportive management climate were associated with these determinants. No associations were found with other ergonomic devices. CONCLUSIONS: The use of lifting devices was higher in nursing homes than in hospitals. Individual and organisational factors seem to play a substantial role in the successful implementation of lifting devices in healthcare.

Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review.

OBJECTIVE: This systematic review aims (1) to identify barriers and facilitators during implementation of primary preventive interventions on patient handling in healthcare, and (2) to assess their influence on the effectiveness of these interventions. METHODS: PubMed and Web of Science were searched from January 1988 to July 2007. Study inclusion criteria included evaluation of a primary preventive intervention on patient handling, quantitative assessment of the effect of the intervention on physical load or musculoskeletal disorders or sick leave, and information on barriers or facilitators in the implementation of the intervention. 19 studies were included, comprising engineering (n = 10), personal (n = 6) and multiple interventions (n = 3). Barriers and facilitators were classified into individual and environmental categories of factors that hampered or enhanced the appropriate implementation of the intervention. RESULTS: 16 individual and 45 environmental barriers and facilitators were identified. The most important environmental categories were "convenience and easy accessibility" (56%), "supportive management climate" (18%) and "patient-related factors" (11%). An important individual category was motivation (63%). None of the studies quantified their impact on effectiveness nor on compliance and adherence to the intervention. CONCLUSION: Various factors may influence the appropriate implementation of primary preventive interventions, but their impact on the effectiveness of the interventions was not evaluated. Since barriers in implementation are often acknowledged as the cause of the ineffectiveness of patient handling devices, there is a clear need to quantify the influence of these barriers on the effectiveness of primary preventive interventions in healthcare.

Prevalence of back pain and characteristics of the physical workload of community nurses.

A research project is described that analyses the back pain prevalence and physical working conditions of community nurses. The purpose was to compare the position of nurses working in institutional care with the specific situation of nurses working in the private homes of their patients. The results of a questionnaire showed that the back pain prevalence was relatively high as compared to other occupations and also when compared to other health care sectors. The home care organization is influenced not only by sick leave due to back pain, but also its efficiency is hampered by nurses with back pain who continue to work. It appeared that the total sick leave incidence due to musculoskeletal disorders other than back pain exceeds that due to back pain alone. The physical exposure level not only consisted of frequent and heavy lifting and transferring of patients but also a substantial static workload was present. The onset of back pain seems to result from a gradual build up of overload reaching its maximum. A preventive approach should take these differential loading factors into account. The consequences for preventive interventions are discussed resulting in recommendations towards a (participatory) ergonomic approach. This material forms the baseline of a controlled prospective trial in home care.

Efficiency and effectiveness of stoop and squat lifting at different frequencies.

The study investigated the effects of frequency (10 and 20 lifts/min) and technique (squat and stoop) of repetitive lifting of a barbell (19 kg) on the relationship between mean power output (Pm) and energy cost in 9 male power-lifters. Oxygen uptake (VO2) was measured directly and continuously and power output was deduced from film analysis using an inverse dynamic analysis. Power output and VO2 were significantly greater for squat than for stoop lifting at the same frequency. The mechanical efficiency (ME), defined as Pm divided by the energy equivalence of VO2, increased from 12% at rate 10 to 18.5% at rate 20, but there was no significant difference between the two techniques. The effectiveness (EF), defined as the productive external power output (only work done on the barbell) divided by the energy equivalence of VO2, was significantly higher for the stoop lift than for the squat lift. EF is judged as a more useful measure than ME for characterizing the relative energy cost of a lifting task.

The physical and physiological workload of refuse collectors.

In order to secure a safer and healthy work situation, the heavy physical loads imposed on 23 refuse collectors (aged 26-54) working in the city of Haarlem, in The Netherlands, were studied in a series of three experiments between 1984 and 1987. The aims were respectively (1) to study the load for workers collecting dustbins or polythene bags; (2) to introduce changes to reduce the load to avoid exceeding the overload criteria by individual refuse collectors; and (3) to investigate the effects of interventions to improve the efficiency of refuse collecting. The maximal isometric lifting force (Fmax) and the maximal aerobic power (VO2max) of 23 refuse collectors were measured in the laboratory. Fmax was measured with an isometric dynamometer pulling with one arm from the floor; the mean value was 912 (+/- 127)N. VO2max was measured running on a treadmill; the mean value was 43.3 (+/- 0.8)ml O2 per kg body mass per min. The physical load on the oxygen transport system was measured through work analysis and by a continuous registration of the heart rate over three working days. Criteria for overload were set at a mean external load of 20% Fmax and a mean energy expenditure of 30% VO2max and an energy expenditure of 50% VO2max or more for a maximum of 60 min per day. Replacement of dustbins by polythene bags resulted in a 70% increase in the total amount of refuse collected, an increase in throwing frequency, but a lower mean load per throw, and no significant differences in the mean heart rate over the working day. When polythene bags were used the mean values did not exceed the overload criteria, but 39% of the individual collectors did have a workload that was too high with respect to one of the criteria. In the last experiment the collectors were advised to reduce their work load by (a) lifting no more than two bags at a time; (b) reducing their walking pace; and (c) taking more breaks. Although compliance with the recommendations was good, and the weight lifted and the walking speed decreased, the physiological load remained the same. This may have been caused by a 15% increase in the total amount of refuse that had to be collected at that time.