Patient Handling: Restrictions & Conditions

Abstract

Injuries to healthcare personnel performing patient transfers are a worldwide problem and have been listed as a primary research interest by the National Institute for Occupational Safety and Health (NIOSH) since the 1980’s. Analyses of the last ten years of injury data show that in forty percent of these cases, injury to the back was sustained, and in most cases, patient handling was the primary cause. Research on patient handling has provided valuable insights, but very few of the subsequent interventions have resulted in long-term benefits. Hence, a research idea was developed around a fresh approach, which led to a progressive multi-part study to quantitatively define and test aspects of the patient handling problem. This approach was to structure a study based on the feedback of working nurses, allowing each progressive study to be defined by the previous. The outcome was a three part study examining conditions and restrictions of patient handling.

The first part of the study was purely descriptive. Its goal was to define and map the direct and indirect variables associated with both the decision making process of the patient handler and the transfer. Interviews, focus groups and published literature were used to define the people and environment of influence. Results mapped 25 variables that directly influenced a patient transfer.

The purpose of the second part of the study was to evaluate the level of importance of most of the previously defined 25 variables. For this purpose, a multi-section survey was developed to collect data from 1000 Alabama nurses who had been registered in the state for at least one year. Results of the 87 completed surveys returned confirm that nursing is a female dominated profession (92%). Analysis of the personal health of Alabama nurses revealed significant deficiencies in three of the eight outcomes measures compared against normative populations: Social Functioning; Physical Functioning; Bodily Pain. Further, the body mass index (BMI) for Alabama nurses indicated only 28% had a ""healthy"" BMI with 37% and 35% of the nurses being ""overweight"" or ""obese"", respectively. Analysis of environment variables showed nurses perceive four types of patient transfers as significantly difficult: floor to toilet, floor to chair, tub to chair or toilet, chair or toilet to tub. Additionally, locations perceived as difficult to perform transfers were the bathroom and a hallway or lobby. Self-reported work measurement showed nurses spend approximately 19 to 20 percent of their time performing patient handling tasks within a safety culture that gives first priority to patient safety. Analysis of factors influencing patient transfers showed that the size and weight of the patient and understaffing were most influential, but the size or shape of the room and/or congestion of usable space dictated the method of transfer attempted.

Finally in spring of 2007, ten actively working, healthy nurses participated in a biomechanical laboratory study. The objective was to evaluate the level of influence that space restriction has on a patient transfer. Results from previous studies suggested the apparatus should be a hospital bathroom and the event, a floor to toilet transfer. To achieve this objective, a bathroom mockup was built of clear Plexiglas from dimensions provided by a hospital. Patients were simulated by a dummy that had been weighted by body segment to a 5th percentile female. Hence, all protocols and equipment were designed to test the “best case scenario”. Data collection was accomplished using a five camera PEAK Motus Motion Capture system with an integrated AMTI forceplate. Results showed that for the environment tested when space was restricted, an average of 14% more time was spent in a medium to high risk postural position for which the average peak moment on the low back was estimated at 2880 N. Hence, this finding suggests that few “real