The Pain and Strains of Helping Others

In December 2008 our Ergo Tip of the Month focused on Ergonomics & Agriculture. Another non-automotive field gaining a lot of attention from the ergonomics community is nursing.  The prevalence of work-related musculoskeletal disorders among health care providers and especially registered nurses has been extensively reviewed in the literature (Seikhzadeh, Gore, Zuckerman and Nordin, 2009). 

In 2006, private nursing care facilities had lost-work-time sprains and strains over three times the national average (162 per 10,000 workers) and back injuries 3.9 times the national average (106 per 10,000 workers) (Park, Bushnell, Bailer, Collins, and Stayner, 2009).With this reported prevalence of injury, the question arises: Are people sacrificing their own well being for the sake of others? If so…what role does an ergonomist or the sciences of ergonomics as a whole have in helping?

A study was completed by Martin, Harvey, Culvenor, and Payne (2009) that evaluated the effects of introducing a "No lifting Policy" on back injuries to nurses across an entire health care system.  The scope and quality of data was limited by the system-wide and retrospective nature of the study.  Despite the methodological challenges associated with this type of study it was still concluded by the authors that there was a statistically significant decline in back injury claims rates during the study compared with no statistically significant trends within the periods before and after the implementation of the policy. 

There was not a detailed description of what modern hoists or other patient transferring devices were utilized yet there was a 24% reduction in back injury claims.  Results from this study showed ergonomic principles encouraged changes to the working environment in order to suit the worker and substantial improvement in the safety of a critical aspect to the work environment for nurses. 

Other studies in the nursing field deal more directly with good ergonomic designs.  A study completed by Kim, Barker, Jia, Agnew and Nussbaum (2009) looked at the effects of two hospital bed design features on physical demands and usability during brake engagement and patient transportation. 

Simulated brake engagement tasks were the main focus of the study.  Three brake pedal locations (head-end vs. foot-end vs. side of a bed) were conditions tested (Fig 1) along with the manipulation of two hand conditions (hands-free vs. hands-occupied).  Testing environments included both in-room and corridor transportation tasks while two patient masses were controlled.

Figure 1

Results showed that brake pedal location did have a significant effect on the physical demands of nurses and their efficiencies.  A brake at the head-end of the bed caused an increase of trunk flexion from 74-224% and completion time by 53-74%, compared to the other locations.  Also, participants subjectively reported a greater overall perceived difficulty and less postural comfort with the brake pedal at the head of the bed.  From this study we can see that good ergonomic design can improve productivity and efficiency in the work environment while actually making work a safer place. 

Often when people think of nursing and ergonomics the first thing that comes to mind is the lifting and transportation of patients.  However, there are physical stresses in different environments that nurses may experience in their career.  A study completed by Sheikhzadeh et al (2009) quantified ergonomic risk factors in a surgical environment based on the perception of perioperating nurses and technicians. 

The subjective data received in this study demonstrated a high prevalence of work-related musculoskeletal disorders among nurses with lower back pain the most prevalent (84%) complaint, followed by ankle/foot (74%) and shoulder (74%) pain.  Also, lower back pain (31%) followed by ankle/knee (24%) pain were found to be the main causes of absenteeism from work. 

Figure 2 Perioperative nurses and technicians hold a heavy drill (with rechargeable battery) and wait for the surgeon to take it.  This posture can last up to 15 seconds at one time, with several repetitions during the entire length of the surgery.

Risk factors identified in this study were the preparation of open surgical procedures, transportation of surgical carts, poor workplace design, inadequate communication, and static postures (Fig 2).  All solutions to these risk factors were ergonomic and/or engineering in nature and fairly simple to construct and implement.  These included job workstation layout redesigns, increased maintenance checks on carts, alternative work schedules, re-design of carts, administrative work solutions and a "sit/stand" policy allowing for variation of postures.  In this study an abundant amount of issues were identified and then solutions and implementation processes were constructed

The research presented identifies risks of injury to those in the nursing profession as they carry out their roles helping others. However, it is also evident that by applying good ergonomic principles, concepts, designs and information improvements can be implemented to lessen the physical demands and the risk of injury to nursing professionals.   

References

Kim, S., Barker, L., Jia, B., Agnew, M., & Nussbaum, M.  (2009).  Effects of two hospital bed design features on physical demands and usability during brake engagement and patient transportation:  A repeated measures experiment study.  International Journal of Nursing Studies, 46, 317-325.

Martin, P., Harvey, J., Culvenor, J., & Payne, W.  (2009).  Effects of a nurse back injury prevention intervention on the rate of injury compensation claims.  Journal of Safety Research, 40, 13-19.

Park, R., Bushnell, T., Bailer, J., Collins, J., and Stayner, L.  (2009).  Impact of Publicly Sponsored Interventions on Musculoskeletal Injury Claims in Nursing Homes.  American Journal of Industrial Medicine, 52, 683-697.

Sheikhzadeh, A., Gore, C., Zuckerman, J., & Nordin, M.  (2009).  Perioperating nurses and technicians' perceptions of ergonomic risk factors in the surgical environment.  Applied Ergonomics, 40, 833-839.