Occupational Safety for the Nursing Profession: Can training in ergonomics help?

1. Occupational Safety for theNursing Profession: Can training in ergonomics help? Presentation by Jamila Hamudu Hospital Quality Improvement Unit Muhimbili National Hospital

2. Nursing profession and ergonomic stressors • It is a well known fact allover the world that working in a nursing environment is the second most dangerous job in the health sector. The nursing profession is always at risk of injuries.

3. Ont: • Typical Injuries • Exposures to Blood-borne Pathogens • Muscular-Skeletal Disorders (MSD) • Injuries as a result of Workplace violence (Patient related)

4. Reflection • Imagine, what lifting and repositioning patients many times a day does to the back over time. No one needs to draw a picture for nurses and nursing assistants. They know about the pain of musculoskeletal disorders (MSDs). • Imagine, what a psychiatric nurse feels having to face and calm an aggressive patient who is totally violent.

5. Reflection continues : • Imagine, a nurse trying to save the life of a person who is severely bleeding after a motor accident and no immediate access to hand gloves. Many organizations are adopting the concept of Safety and Ergonomics in nursing.

6. What ergonomics is? • Ergonomics is the science of designing the job, equipment, and workplace to fit the worker. • Proper ergonomic design is necessary to prevent repetitive strain injuries, which can develop over time and can lead to long-term disability

7. Definition continues … • In other words. ergonomics is concerned with the ‘fit’ between people and their work. It takes account of the worker's capabilities and limitations in seeking to ensure that tasks, equipment, information and the environment suit each worker.

8. Definition continues … • To assess the fit between a person and their work, ergonomics consider the job being done and the demands on the worker; the equipment used (its size, shape, and how appropriate it is for the task), and the information used (how it is presented, accessed, and changed.

9. Definition continues … Ergonomics in the workplace has to do largely with the safety of employees, both long and short-term; and ultimately the comfort of the patient.

10. Ergonomic stressors that nurses face in hospitals/nursing homes • Force - the amount of physical effort required to perform a task (such as heavy lifting) or to maintain control of equipment or tools, • Repetition - performing the same motion or series of motions continually or frequently,

11. Cont : • Awkward postures - assuming positions that place stress on the body, such as reaching above shoulder height, kneeling, squatting, leaning over a bed, or twisting the torso while lifting,

12. Cont…. • Vibration - rapid oscillation (swing to and fro) of the body or part of the body, often caused by use of powered hand tools or equipment, • Contact stress - pressing the body or part of the body against a hard or sharp edge, such as using the hand as a hammer.

13. Impact of ergonomic stressors • Exposure to these stressors in the workplace can result in a variety of disorders in affected workers (particularly nurses), including muscle strains and tears, ligament sprains, joint and tendon inflammation, pinched nerves, herniated spinal discs, and other conditions.

14. Cont: • These conditions, collectively referred to as musculoskeletal disorders (MSDs), may develop gradually over time or may result from instantaneous events such as a single heavy lift. • Pain, loss of work, and disability may result.

15. The impact of nurse shortage • In a review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. • The profession of nursing as a whole is overloaded because there is a nursing shortage which compounds ergonomic stressors.

16. The impact of nurse shortage • Individual nurses are overloaded: - They are overloaded by the number of patients they oversee. - They are overloaded by the number of tasks they perform. - They work under cognitive overload, engaging in multitasking and encountering frequent interruptions

17. Cont: - They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. - They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs.

18. Can the overload be reduced? • In short, the nursing work system often exceeds the limits and capabilities of human performance. • Hospitals should conduct studies to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated.

19. Cont: • However, when reducing the overload, it should be kept in mind that under loads also can be detrimental to performance. • Considering both overloads and under loads are important to consider for improving performance."

20. Ergonomic process It is recommended in contemporary nursing practice that: • Manual lifting of Patients/residents be minimized in all cases and eliminated when feasible. • Employers implement an effective ergonomics process that:

21. Ergonomic process • provides management support; • involves employees; • identifies problems; • implements solutions; • addresses reports of injuries; • provides training; and • evaluates ergonomics efforts.

22. Facts worldwide According to a number of studies, • Employees in nursing and personal care facilities suffer over 200,000 work-related injuries and illnesses a year • Many of these are serious injuries leading to permanent disabilities and more than half require time away from work. • Work injuries cost employers an estimated of over $1 billion dollars a year

23. Cont: • Back pain affects up to 38 percent of nurses • About 12 percent of nurses leave the profession annually because of back injuries • An unknown number of nurses acquire nosocomial infection including HIV from nursing settings.

24. Controlling ergonomic stressors • To adequately identify and control ergonomic stressors and minimize the severity of workplace injuries, nurses and all people who work in hospitals and nursing homes, should receive training

25. Cont: • Ergonomics training should enable employees at all levels of the facility administrators, charge nurses, nursing assistants, maintenance workers, and equipment purchasers—to further the ergonomics program

26. Ergonomic Training Goals • Teach employees to recognize the signs and symptoms of MSDs so that they can report them early and respond to them appropriately; • Identify those jobs or tasks that have ergonomic stressors capable of causing MSDs

27. Cont: • Know how to control ergonomic stressors. Success of the ergonomics program depends to a great extent on the effectiveness of ergonomics training

28. Keys to Points for EducatingEmployees • Back Pain and Possible Causes • Safe Patient Handling Techniques • Alternate Methods for Patient Handling • Work Practice and Engineering Controls • Safe and appropriate use of equipment • Workplace safety

29. NON-WORK RELATED CAUSES OFMSD and BACK PAIN • Employees should also be educated that there are other non-work related causes of MSD and back pains such as: • Genetic causes • Age • Physical capabilities

30. Cont: • General Health • Other factors such as psychosocial factors like as job dissatisfaction, monotonous work, and limited job control. These should also be considered and investigated when discussion the issue of ergonomics stressors

31. Facts about lifting hazards • Unsafe lifting practices account for a majority of back injuries • Most back injuries occur as a result of twisting and turning while bearing a load • Unassisted lifts account for over half Of all neck, back and shoulder injuries There is a need of developing and adhering to guidelines related to preventing muscular skeletal disorders (MSD)

32. Blood-borne PathogenExposures According to American centre for disease control 1992 • 800,000 (estimates) needle-stick injuries occur each year in the United States • 16,000 (estimates) healthcare workers a year contract HIV as a result of exposure incidents

33. Cont: • HBV and HCV pose greater risk than HIV in USA Although we don’t have statistics in Africa, yet the risk of health workers, particularly nurses, contracting Blood-borne pathogens is high.

34. Majority of needle-sticks occur when health care workers: • Dispose of needles • Administer injections • Draw blood • Recap needles • Handle trash and dirty linens

35. Patient Aggression andWorkplace Violence Issues Common Causes may include: • Drugs and Substance Abuse • Psychological Reasons • Stress of Aging • Breakdown in Communication Systems • Criminal Intent

36. Types of Aggressive Behavior • Immediate Confrontations Hitting, kicking, pushing grabbing, pinching, biting, verbal abuse • Distance Attacks Striking or stabbing at someone with an object, use of a firearm or other weapon

37. Patient Aggression andWorkplace Violence Issues Tools to PREVENT Incidents • Workplace Violence Policies • Employees awareness • Physical Barriers / Security Presence

38. Ont: • Employee Training in Crisis intervention techniques • Workplace discrimination policies • Training on conflict management

39. Patient Aggression andWorkplace Violence Issues Potential Sources for Conflict • Client, patient or customer • Family member or significant other • Current or Former Employee, • Manager or Supervisor • Stranger on Stranger

40. Summary` The nursing community has many “hidden” occupational hazards. The leading causes of employee injury claims in the nursing profession include: • Muscular-skeletal disorders (back or shoulder pain) • Exposures to blood-borne pathogens

41. Cont: • Injuries that are the result of workplace violence or patient aggression By reducing the risk of ergonomic stressors, it will facilitate retention of nurses