Moments of speaking and silencing: Nurses share their experiences of manual handling in healthcare

Nurses sustain manual handling risk assessment behaviours six-months after a training program to move patients safely: a pre-post study

PURPOSE

To determine if a patient manual handling training program focused on dynamic manual handling risk assessment for staff and patient safety, together with the patient's need for physical rehabilitation, can be transferred and sustained in clinical practice.

MATERIALS AND METHODS

Using a pre-post design, nurses (n = 72) from acute and rehabilitation wards participated in a 4-hour training session teaching dynamic manual handling risk assessment to safely move patients. Clinical observations audits of patient transfers were conducted prior to, and at 1-month and 6-months post training. Surveys determined experiences of training. Nurse musculoskeletal injuries and patient falls were measured 6-months after training.

RESULTS

Program patient handling skills were competently implemented 89% of the time 1-month following training and were sustained 6-months following training. There was no change in falls rates and staff injury rates were very low pre- and post-training. Training was well received and all nurses passed the competency assessment.

CONCLUSION

The patient handling training program taught nurses to better identify factors associated with risk to themselves and their patients and gave them improved skills to help patients move. Skills were incorporated safely into clinical practice and sustained at 6-months. It is uncertain whether training impacted musculoskeletal injuries.Implications for rehabilitationA dynamic manual handling risk assessment program for safely transferring and moving patients balances staff safety with the patient's need for physical rehabilitation.Nurses can be taught risk assessment skills to better identify factors associated with risk to themselves and their patients that can be translated to clinical practice.Thorough risk assessment at the point of the nurse-patient interaction can enable a patient to move at their highest level of function thus providing patients with opportunities to progress their rehabilitation at every interaction.

Biomechanical comparison between manual and motorless device assisted patient handling: sitting to and from standing position

Although lots of assistive devices have been studied to fight against caregivers' work-related musculoskeletal disorders, stand-and-turn devices effects on biomechanical constraints are still unknown. The aim of this study is to provide and compare quantitative data on loads in the low back area resulting from the use of a motorless stand-and-turn device and from manual patient handling. Nine caregivers participated to motion capture and ground reaction forces measurement sessions of three cases of handling: manual handling with one caregiver, manual handling with two caregivers, motorless device assisted handling. Forces and torques at the L5/S1 joint were computed through Inverse Dynamics process. Motorless device assisted handling required the smallest loads whereas manual handling with one caregiver required the biggest loads, the latter being in some cases twice as big as the former. Caregivers should use a stand-and-turn device when handling a patient from sitting/standing to standing/sitting position whenever it is possible.

Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study

AIMS AND OBJECTIVES

To investigate healthcare staff's views and experiences of caring for older hospitalised adults (aged 60+) with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis.

BACKGROUND

Osteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is a major global health problem. In the UK older hospitalised adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident, it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often suboptimal and specific manual handling implications are under-researched.

DESIGN

An exploratory qualitative content analysis research design informed by critical realism.

METHODS

The purposive sample comprised 26 nursing and allied health professionals. Semi-structured interviews addressed topics including knowledge of osteoporosis, implications for acute care, moving and handling and clinical guidelines. Qualitative content data analysis was used.

RESULTS

Awareness of osteoporosis prevalence in older populations varies and implications for nursing are indistinct to nonspecialists. In-hospital fractures potentially linked to suboptimal moving and handling seemed rare, but prospective studies are needed. Categories of 'Understanding moving and handling as routine care or as a healthcare intervention', with further categories 'healthcare practitioners' capacities and capabilities for dealing with people with osteoporosis' and 'the structural and organisational context for moving and handling' are reported alongside safety, frailty and dependency dimensions.

CONCLUSIONS

This study informs moving and handling in higher risk groups such as osteoporosis. Clinical knowledge/expertise is required when adapting generic manual handling guidelines to specific patients/contexts. Patients' experiences of moving and handling have received limited attention.

RELEVANCE TO CLINICAL PRACTICE

Increased focus on musculoskeletal conditions and moving and handling implications is required.

Musculoskeletal Injury Prevention for New Nurses

Nurses continue to sustain musculoskeletal injuries even with increased emphasis on safe patient handling and mobility (SPHM) and organizational cultures of safety to protect health care workers. Analysis of data from 2011-2014 registered nurse graduates explored hospital safety culture, SPHM education/training, and incidence of new-nurse musculoskeletal injury. Results indicated hospitals provided some type of SPHM education and training, but 46% of study participants were not informed or aware of national SPHM standards or guidelines. Merely 13.9% of participants stated a written “no manual lifting policy” had been implemented; only 32.9% indicated staffing was adequate for SPHM tasks; and only 39.4% stated the hospital had all of the equipment needed to perform SPHM safely. Thirty-nine percent of participants had already sustained a musculoskeletal injury with an additional 35% sustaining but not reporting an injury. More actions are needed to ensure a decrease in musculoskeletal injuries for new nurses.