Postural analysis of paramedics simulating frequently performed strenuous work tasks.

Paramedics who perform emergency rescue functions are highly susceptible to musculoskeletal injuries. Through an interview and survey process firefighters, many of whom are cross-trained paramedics in a consortium of 14 suburban fire departments, identified and rated tasks that were perceived to be both strenuous and frequently performed. The objective of the current study was to describe the working postures and the forces applied as firefighter/paramedics (FF/Ps) simulated specific roles within the following tasks identified by the survey: (1) transferring a patient from a bed to a stretcher using bedsheets, (2) transferring a patient from the ambulance stretcher to a hospital gurney, (3) carrying a victim down a set of stairs and around a landing using a stairchair, (4) carrying a victim down a set of stairs and around a landing using a backboard, and (5) carrying a victim down a set of stairs using a stretcher. Ten two-person teams of FF/Ps participated and were videotaped to obtain postural data for the upper and lower extremities as they performed each role in the simulated two-person tasks. Trunk postures were obtained using lumbar motion monitors. Static hand forces were estimated using a hand-held dynamometer at the most physically demanding points for each role within each task. The postural and force data were averaged across subjects performing identical roles to quantify the postures assumed by the FF/Ps at the most strenuous moments during task performance. Based on these analyses we concluded that: (1) when transferring victims from a bed to a stretcher the FF/P on the bed was able to maintain an upright and more stable posture by standing as opposed to kneeling, (2) an interface board should be used to reduce the frictional forces when transferring victims from a bed to a stretcher or from a stretcher to a gurney, thereby reducing the need to lift the victim with flexed torsos and/or shoulders, and (3) equipment and training that encourages the FF/P in the leader role to walk facing forward during victim transport, especially when descending stairs, potentially results in safer transit.

Biomechanical analyses of paramedics simulating frequently performed strenuous work tasks.

Firefighters performing emergency rescue functions are at an elevated risk of musculoskeletal injuries. The objective of the current study was to analyze the biomechanical stresses placed on the body based on simulations of the following strenuous and frequently performed emergency rescue tasks: (1) transferring a patient from a bed to a stretcher using bedsheets, (2) transferring a patient from the ambulance stretcher to a hospital gurney, (3) carrying a victim down a set of stairs and through a landing using a stairchair, (4) carrying a victim down a set of stairs and through a landing using a backboard, and (5) carrying a victim down a straight set of stairs using a stretcher. Postural data were analyzed using the University of Michigan's Three-Dimensional Static Strength Prediction Program and the relative risk of low back disorder (LBD) was quantified using the trunk motion model published by Marras et al. (1993, spine 18, 617-628). Peak compression values and the probabilities from the Marras et al. (1993) model indicated that the most hazardous tasks performed as part of this simulation included pulling a victim from a bed to a stretcher, the initial descent of a set of stairs when using the stretcher, and lifting a victim on a backboard from the floor. Overall, the two models were well correlated in their assessment of the task components modelled (r = 0.78). These data indicate where engineering changes to equipment regularly used by emergency rescue personnel would have the greatest impact in reducing the risk of musculoskeletal injury.

Initiating an ergonomic analysis. A process for jobs with highly variable tasks.

Occupational health nurses play a vital role in addressing ergonomic problems in the workplace. Describing and documenting exposure to ergonomic risk factors is a relatively straightforward process in jobs in which the work is repetitive. In other types of work, the analysis becomes much more challenging because tasks may be repeated infrequently, or at irregular time intervals, or under different environmental and temporal conditions, thereby making it difficult to observe a "representative" sample of the work performed. This article describes a process used to identify highly variable job tasks for ergonomic analyses. The identification of tasks for ergonomic analysis was a two step process involving interviews and a survey of firefighters and paramedics from a consortium of 14 suburban fire departments. The interviews were used to generate a list of frequently performed, physically strenuous job tasks and to capture clear descriptions of those tasks and associated roles. The goals of the survey were to confirm the interview findings across the entire target population and to quantify the frequency and degree of strenuousness of each task. In turn, the quantitative results from the survey were used to prioritize job tasks for simulation. Although this process was used to study firefighters and paramedics, the approach is likely to be suitable for many other types of occupations in which the tasks are highly variable in content and irregular in frequency.

Nurse managers' role in injury prevention.

A review and survey of nurse managers responsibility for monitoring and preventing occupational injuries.

Are first-line nurse managers prepared for team building?

Traditional managerial skills are no longer enough; first-line managers need to learn team-building skills and practice the spirit of teamwork. A survey shows how many first-line managers understand and practice team-building skills, where they learn these skills, and if they want to learn more.

Musculoskeletal injury: ergonomics and physical fitness in firefighters.

As a means of reducing the increasing incidence of musculoskeletal injuries in firefighters, the authors offer a framework for a program that would integrate hazard control and health promotion approaches. Particular focus is placed on the role of ergonomics and physical fitness factors in preventing these injuries.

Musculoskeletal injuries in the fire service: views from a focus group study.

1. The focus group is a qualitative data collection method involving carefully planned small group discussions designed to obtain perceptions on a defined area of interest. Focus groups can be used by occupational health nurses for gathering ecologically based, in-depth needs assessment information from workers prior to program planning. 2. Occupational health nurses can be guided in their needs assessments by an ecological framework that considers the person, workplace, and situational factors that contribute to occupational health problems. 3. A focus group study of fire chiefs and firefighters used an ecological framework to elicit participants' perceptions of the factors that contribute to musculoskeletal injury and the preventive strategies that would be acceptable to them. Participants shared their insights, motivations, and feelings about the factors, thus suggesting concepts and hypotheses to be explored further. 4. The occupational health nurse needs to consider the differing meanings that management and workers attach to an occupational health problem.

Nursing care hours of patients receiving varying amounts and types of consultation/liaison services.

Psychiatric comorbidities in the general hospital population have been found to increase the cost of health care. This descriptive study provides an in-depth analysis (including nursing hours), of general hospital patients receiving low, medium, and high intensity consultation/liaison (C/L) services from C/L psychiatrists and C/L nurses using computerized databases and the medical record. The results show that there are significant differences among the subgroups receiving varying amounts of C/L services. This study has particular significance for C/L nursing as many C/L nursing interventions are focused on both the patient and the delivery of nursing care by the staff nurse.

Chief nurse executive incentive compensation.

More and more chief nurse executives (CNEs) are receiving incentive compensation plans. The authors report trends in incentive compensation and discuss what 184 CNEs in multihospital systems said about their incentive compensation plan.

Nurse practitioner and physician care compared for nonurgent emergency room patients.

This experimental field study compared knowledge, satisfaction and compliance in 62 nonurgent emergency room (ER) patients based on whether they were cared for by a nurse practitioner (experimental group) or a physician (control). Data were collected via structured interviews in the ER, two weeks later by phone and three months later by phone, mail and chart review. No significant differences were found between groups in overall short- and long-term compliance scores, appointment-keeping scores for the three-month study period, number of health recommendations recalled, resolution of health problem or satisfaction ratings of ER care. It was also found that: referrals were the recommendation least complied with; 60 percent of appointments were kept; frequent reasons for noncompliance were inconvenience and lack of perceived need; experimental subjects showed greater comprehension of diagnostic recommendations and therapeutic applications, while controls had better knowledge of medications; 77 percent of experimentals were completely satisfied with NP care, as compared to only 48 percent of the controls with MD care; and reasons for satisfaction centered on the quality of care, while reasons for dissatisfaction focused on unresolved problems and slow care.

Coital and contraceptive behavior of female adolescents.

Structural interviews conducted with 532 female clients of a teen contraceptive clinic revealed a moderate level of coital activity i(in terms of both frequency of intercourse and number of partners) which typically began at age 15. Prior use of contraception was sporadic and almost exclusively confined to nonprescription methods. Primary reasons for nonuse of birth control included fear of lessening the pleasure of intercourse and lack of access to contraception. The data indicate that a combination of comprehensive sex education and ready access to birth control is necessary to prevent unintended adolescent pregnancy.

PIP: In 1975, a survey of 532 teenage women (under 18) was conducted at a teen center in a large midwestern town. The sample was 70% white, the rest mostly black, and averaged age 16.1 years. 4% had dropped out of school. 92% of the 423 sexually active women were engaged in a monogamous relationship. 56.1% had intercourse with only 1 partner in 1 year; 23.2% had 2 partners. The average age at first sexual experience is 15. Prior use of contraception was sporadic and almost exclusively confined to nonprescription methods. Lack of access to contraception and fear of lessening sexual pleasure were the primary reasons for nonuse of birth control. Data indicates that a combination of comprehensive sex education and ready access to birth control is necessary to prevent unintended adolescent pregnancy. 40% had used withdrawal; 36.9% spermicides; and 60% condoms. Those teenagers who are older at first intercouse tend to use contraception more than younger teenagers.

Two measures of nurses' attitudes toward abortion as modified by experience.

Random samples of nurses in two states which differed in abortion statues were sent questionnaires. Content areas included experience with 12 specific nursing activities associated with abortion, willingness to participate in the same activities, and extent of agreement with statements related to abortion. Attitudes toward abortion were inferred from the willingness-to-participate items and from the agreement section. These two measures correlated highly suggesting a common underlying dimension. However, the two samples differed significantly in extent of agreement but did not differ in willingness to participate. These results were interpreted as supporting the position that attitudes derived from items using situational contexts might bear a better relationship to behavior. The findings also suggest that abortion facilities can probably be staffed without violating personal preferences since so many expressed willingness to participate in at least some of the activities. Comparison across the two samples suggest that increased experience or even the potential for experience with abortion patients tended to increase the favorableness of attitudes toward this issue.