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Nursing and Skilled Care
According to national statistics, six of the top 10 professions at greatest risk for back injury are: nurse's aides, licensed practical nurses, registered nurses, health aides, radiology technicians, and physical therapists. In fact, nursing has the second highest incidence of all types of non-fatal work-related injuries in the U.S.A. Nursing aides, orderlies, and attendants--a subset of the occupational group nursing, psychiatric, and home health aides--consistently ranked among the detailed occupations reporting the most cases of workplace injuries and illnesses over a 10-year period from 1995 to 2004. During that time span, approximately 800,000 nursing, psychiatric, and home health aides were injured or became sick while on the job, with musculoskeletal disorders the most common type of nonfatal injury or illness reported. A 2001 study made by William Charney , Department of Health, stated that, "Every day in the USA, 9,000 health care workers sustain a disabling injury while on the job." However, a report by Bernice Owen, RN, Ph.D., former professor at the University of Wisconsin-Madison School of Nursing, estimates that as many as one-third of nurses who sustain work-related back injuries do not even report them. The largest proportion of workplace injuries and illnesses among nursing, psychiatric, and home health aides are by sprains, strains, and tears . More than half of the work-related injuries and illnesses were related to overexertion. There are two main risk factors for back injury among nurses: lifting and transferring patients, and bed- making. Greater than one third of back injuries among nurses are attributed to handling patients and the frequency with which they are required to manually move patients. Nurses are lifting up to thousands of pounds every day: during a typical shift, on average a hospital staff nurse will lift 20 patients into bed, and transfer 5-10 patients from bed to a chair. At an average of 150 lbs per patient, nurses move more weight than some warehouse laborers. Unlike warehouse laborers, nurses do not lift static, geometric packages, but patients are live and dynamic loads that move and shift or even struggle and resist during the transfer. Nor do patients come equipped with special carrying handles. Also, nurses and skilled care workers must consider the comfort of the patient during transfers.
In additon, the task is all the more challenging because often the rooms are small and crowed with medical devices, and access to the bed is limited. This makes it difficult for the healthcare worker to easily access the patient. Bed- making also increases the risks of back injury because of the bending and stretching involved in putting sheets onto a bed. Also, the beds are not always as easily accessible as the bed in a typical home and are often surrounded by delicate monitoring instruments. Most work-related musculoskeletal injuries are a result from cumulative injuries, and are therefore called "cumulative trauma disorders" (CTDs). Improper lifting of a patient causes small damage to the spine, such as a microtear in a spinal disk. This small injury by itself may not cause pain, but as the nurse continues to lift improperly day after day, the damage accumulates as the injury is not allowed to heal, and the injury will worsen and at some point, will cause pain. By the time the pain is felt however, the damage will have been done. The nurse injury problem has become acute, especially with the shortage of nurses and skilled care workers. When a nurse or skilled care worker is absent from the job due to an injury, hospitals and care facilities are not able to replace that worker, and as such, must shift the burden to their remaining staff, thereby increasing the physical pressure to other care givers. There has been a move to reduce the problem by requiring nurses and skilled care workers to use assistive devices for any tasks that involves moving a patient, and for hospitals to create formal and written safe lifting policies. Indeed, in Texas, there is legislation being introduced that requires hospitals to have safe lift policies, such as providing lifting equipment for and training to employees to avoid debilitating back and other musculoskeletal injuries.
Biomechanics – effective body mechanics methodologies for safe patient handling exist. PSR®, Professional Safeguard Response®, has reduced back injuries for 25 years in the emergency services and labor intensive work arenas in the U.S. PSR®, is a unique methodology of training into core strength through the intra truncal pressure and autonomic reflex control of the breath or diaphragmatic mechanism (as in birthing, singing, or Judo). The program has reduced the number of back injuries in major at risk organizations by 80% with substantially reduced human capital losses and associated costs. The severity of injuries is often significantly reduced as well, thus making it less likely that careers would be derailed. This has been well proven in tested municipal and federal entities particularly in the emergency services EMS, paramedic agencies in the U.S. Though there is no training method that is 100 percent fool proof in avoiding on the job injuries, we have come up with a training program that has been very effective in reducing injuries when doing lifting and moving of limp human weight as in patient handling and transfers. What makes the PSR® program unique from all others is that it specializes in those work arenas where changing the work environment is impractical or impossible. Yes, assistive devices area good idea, but in many cases, one does not have immediate access to them, as in reaching over a bed in a hurry for somebody turning blue. That is where PSR injury reduction programs shine. Moreover, with our new licensing program, any health care or skilled care facility can offer this training to their health care workers in house on a continuous basis.
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However, this is at best a partial remedy, because in a real life work environment, there is not always time to wait for someone to locate and bring over the correct assistive device or to adhere to the safe lifting policy. When a patient stumbles, a caregiver may have to jump forward to break the fall. Leaving the patient on the floor for several minutes while waiting for a lift is not an option either. In the real world, care givers need to respond immediately, and this almost always means that they need to lift and move patients manually.
