Preventing Musculoskeletal Disorders in Nurses

Appendices

APPENDIX C

SECTION 1: ERGONOMIC FOR PREVENTION OF MUSCULOSKELETAL DISORDER

Introduction

Nurses provide care to physically demanding patient and assist them in mobilization and other activities like bath, feeding etc. Patient handling tasks such as lifting, transferring or repositioning are contributing factors for MSP among nurses particularly the back being most prevalent.

These tasks can entail high physical strains due to different body size involved, leaning over a bed or working in cramped postures, supporting patient during gait activities, and many other factors. The risk factors that health care workers face include:

• Force: the amount of physical effort required to lift or to maintain control of heavy equipment or tools;
• Repetition: performing same task over and over continually or frequently; and
• Awkward postures assuming positions that put strain on the body, such as working above shoulder height, kneeling, squatting, leaning over a bed, or twisting the back while lifting.

Identifying Problems and Implementing Solutions for patient Lifting and Repositioning

Manual handling tasks such as lifting and repositioning can be variable, dynamic, and unpredictable in nature. In addition, factors such as patient self-esteem, safety, and medical contraindications should be taken into consideration. The analysis of any handling task involves an assessment of the requirements and capacities of the patient. The patient assessment should include an analysis of the following factors:

• The level of cooperation from the patient;
• The body size and weight of the patient;
• Any health anomalies that may influence the choice of lifting or repositioning techniques.

• Repositioning in Chair

Description: Variable position Geri chairs

When to Use: Repositioning partial- or non-weight-bearing patients who are cooperative.

Points to Remember: One caregiver can assist if patient has strength in both upper extremities of arms. If patient cannot assist in self-repositioning on chair, help from at least 2 caregivers and friction reducing device may be required. Ensure that chair is easily adjustable; wheels are freely movable flexible and steer. Lock wheels on chair before repositioning. Remove trays, footrests, and seat belts where appropriate. Ensure device correspond with patient weight.

• Various Activities of Daily Living and Bedside Assistance

Description: Work practices for feeding, dressing and grooming.

When to Use: During feeding, dressing, personal hygiene tasks, vital sign assessment, and other bedside assistance.

Bedside Assistance: Lower side rails, position patient as close as possible to edge for safety purposes. Sit or stand in front and near to side of patient. Adjust height of tables and electric beds to waist level and place supplies close by to prevent back flexion and bending. Collect supplies in advance and place them on a table that is located perpendicular to the patient. Avoid leaning across patient; rather, move to other side. Carry items close to the body. Provide adaptive equipment that offer independence to patients and reduce assistance from caregiver.

Feeding: Chop food into pieces before placing it in front of patient.

Dressing and grooming: Ensure that patient’s feet lie flat on the ground or a stool for stability when sitting. Place feebler limb in pant or sleeve first. Use suitable adaptive equipment for dressing, grooming and oral hygiene.

• Activities of Daily Living

Activity: Administrating medications

Description: Low profile medication cart and cartridge pill dispenser

When to Use: Dispensing medications. The cart increases precision and lessens time required to perform task.

Medications cart: Classify medications according to day and time. Low profile carts with easy side opening drawer are recommended to accommodate hand height of shorter nurses.

Cartridge dispenser: Use cartridges with a “flip top” for drug storage until administered rather than wrapping the doses individually in foil of paper or small container that require more finger forces and a sharp object to break the seal.

Bathtub, Shower, and Toileting activities

Description: Long-handled extension tools on hand-held showerheads wash or scrub brushes.

When to Use: When bathing or showering patients.

Points to Remember: These equipments limit the extent of bending, reaching, and twisting required when cleaning feet, legs, and trunk of patients. Patients who are autonomous can also use these devices to facilitate personal hygiene care.

Guiding and Slowing Falls

Description: Method for guiding and slowing falls.

When to Use: When patient is falling.

Points to Remember:

Utilization of transfer or gait belts may aid nurses in guiding the fall. Grip onto the belt/handles and slowly lower the patient to the floor using proper body mechanics. Reviewing patient assessments and monitoring for signs of weakness are effective strategies of preventing falls. Stand with back straight, tighten stomach muscles, bend legs, and stay adjacent to patient if it practical to do so. Don’t try to stop the fall abruptly as this may increase the risk of injury among nurses.

Lifting from the Floor

Description: Methods to lift patients from floor

When to Use: After a patient fall.

Points to Remember: Assess patient for injury prior to lifting and use a powered portable or ceiling-mounted lift device to move patient with minimal assistance. If patient can maintain standing position with minimal assistance, use gait or transfer belt with handles to support patient. If manual assistance is required ensure a team lift are s are available to provide assistance as needed. Use 2 or more caregivers when assisting heavy patients. Stand with back straight, bend legs, and stay near to patient as possible.

Ambulation

Description: Ambulation assist device

When to Use: For patients, who are able to support their body weight, cooperative, need extra security and assistance when ambulating. Increases patient safety and reduces risk of falls during ambulation

Points to Remember: Typically needs one caregiver. The device provides assistance to patients as they walk and pushes it along during ambulation. Ensure device is in good working condition with height adjusted correctly before use and rated for the load weight to be lifted. Apply brakes before positioning patient in or releasing patient from device.

Implementing solutions for patient lifting and repositioning

Ergonomics is the science of designing equipment and work tasks to conform to the capability of the worker and provides a means of adaptation to work environment and work practices to prevent injuries. Ergonomic solutions are proposed to reduce musculoskeletal disorders among the staff nurses. The recommended solutions brought forward are not intended to be an exhaustive list, nor do all of them will be used in any given set up. The material signifies a variety of options available that a facility can consider using. Many of the solutions are simple to implement and do not require substantial time or resources such as modification in procedures or equipment. Others may require more significant efforts. The integration of various solutions into hospital management, can lead to beneficial outcome in the long run.

Patient and Equipment handling solutions

Lateral Transfer

Description: Ceiling-mounted device with horizontal frame system or litter

When to Use: Moving patients who are totally helpless, non-weight bearing, has other physical impairment, or are very big in size and cannot be safely shifted by staff between 2 horizontal surfaces, such as from bed to stretcher or gurney in supine position.

Points to Remember: Motors can be fixed or portable (lightweight). Device can be functioned by hand-held control attached to unit or by infrared remote control. Always ensure lifting device is in good working condition before use and is assessed for the load weight to be lifted.

Lateral Transfer

Description: Gurneys with transfer devices

When to Use: Transferring a partial- or non-weight-bearing patient between 2 horizontal sides, such as from bed to stretcher or gurney in supine position.

Points to Remember: Two nurses are required to achieve this type of transfer. Additional assistance may be required depending on patient status, e.g., for heavier or uncooperative patients. Motorized height-adjustable gurneys with built-in slide boards are preferred to those adjusted by crank mechanism to lessen physical effort required by caregiver. Always ensure that lifting device is in good working condition before use and is evaluated for the load weight to be shifted. Ensure wheels on equipment are locked and transfer surfaces are same level to at waist level of caregivers in order to avoid over reached and back flexion

Lateral Transfer; Repositioning

Description: Air-assist lateral sliding aid; flexible mattress inflated by portable air supply

When to Use: Transporting a partial- or non-weight bearing resident between two horizontal sides such as from bed to stretcher or gurney in supine position. It can also be used for repositioning a patient in bed, increase patient well-being and reduces risk of tissue injury during transfer.

Points to Remember: Two caregivers are needed to achieve this type of transfer. Additional assistance may be required depending on patient ability, e.g., for heavier or uncooperative patients. Ensure wheels on equipment are locked and transfer surfaces are at level and height that permits nurses to work at waist level to avoid over reach and back flexion. Count down and coordinate the transfer motion between caregivers.

Patient Lifting

Description: Ceiling-mounted lift device

When to Use: Lifting patients who are totally helpless, are partial- or non-weight bearing, very heavy, or have other physical impairment. Transfers from bed to chair (wheel chair, Geri or cardiac chair), chair or floor to bed, or for bathing and toileting.

Points to Remember: May need 2 or more nurses. Some patients can use the device quicker than portable device without assistance. Motors can be fixed or portable (lightweight). Device can be activated by hand-held control attached to unit or by infrared remote control. Ensure lifting device is in good working condition before use and is assessed for the load weight to be lifted.

Transfer from Sitting to Standing Position

Description:

Stand-assist devices; can be fixed to bed or chair or be free-standing

When to Use: Transferring patients who are able to support their weight and cooperative and can pull themselves up from sitting to standing position. It can be used for independent patients who need extra lift to stand and aid patient independence.

Points to Remember: Check that device is constant before use and is evaluated for patient weight to be held. Ensure frame is firmly attached to bed, or if depend on mattress support that mattress is big enough to support the frame.

1