Patients putting Nurses at Risk

Patient transfers are common tasks and present a variety of hazards for direct patient caregivers. In this example, we see a nurse involved in the task of lifting a patient from the floor. Note the bend, twisted position of the torso which places the lower back at risk for injury. The tendons in the right shoulder are at risk for strain and the left knee is hyperextended. In this example, the same situation; the nurse is being helped by her staff members or by the Institution's lift team. The full body sling is probably the most common lifting aid device. They may or may not be motorized and they may be mounted on a portable base or on overhead tracks. No members of the team performing the task of lifting the patient are at risk for jury and more importantly, the patient is not at risk.

Here, the nurse is repositioning a patient in a bed that has not been raised to help her perform the task. Not only is she placing her lower back at risk, this manoeuvre places the patient at risk for injury. Now the nurse has enlisted the aid of a team member. The bed is raised and they are using a friction reducing sliding device to help reposition the patient. There is no risk of injury to anyone involved in this task. Current bed technologies have innovative designs to reduce the amount of slippage down to the foot of the bed experienced by patients when raising the head of the bed. Some beds can even convert into chairs and other beds use air bladders incorporated into the mattress surface to help aid in rotation and patient movement.

Daily activities of direct patient care require many repetitive actions that can place any part of the body at risk but the primary hazard depicted in these scenes involves the hand and the wrist. Successful preventive action for such conditions as carpel tunnel syndrome are exercise and attention to ergonomics. Some devices designed to support the wrist may help limit movement and help reduce pain. In contrast to injuries occurring through immediate trauma or over time because or repetitive motions or the hazards of holding static positions for lengthy periods of time.

Kim, LVN: As I was holding her leg, my lower right muscle in my back, it started burning. It felt like it was burning and by the time I finished the delivery I literally had to walk sort of leaning over because it hurt so bad.

Amy, LVN: Three to four years ago I noticed that in my work day as I was bending over and helping with this 20 to 30 minute feeding, I would have pain running down my shoulder and into my lower back and numbness out to my fingers.

Although internal loading is usually associated with repetitive stress, cumulative trauma can occur while maintaining a static position. Due to individual human frailties, factors such as the weight of the load or the length of time a position is held are situational.

 Here's a routine patient transfer from a wheelchair to a bed. This has developed into hazardous situation due to poor body mechanics, the improper height of the bed, the lack of a gait transfer belt and the precarious reliance on the patient to help accomplish the task. The use of improper body mechanics has placed the nurse at risk for injury to the lower back, the shoulder and the knee. However, the proper use of body mechanics by the nurse in this situation will do very little to assure the safety of the patient.

 Now the bed is at a proper height and the nurse has provided a sliding board, allowing the patient to take a more active and safer role in performing the task. While substantially reducing the manual lifting required of the nurse to move the patient. Direct patient care involving these high risk activities can be safely achieved but all too often the help or equipment needed to ensure the safety of both the nurse and the patient is simply unavailable. The majority of healthcare safety studies have focused on patient safety and only recently has a focus shifted to consider the safety of the health care professional. Today, only a handful of states have passed safe patient handling legislation that requires hospitals and other health care facilities to provide policies or programs to reduce work related injuries. States that do have regulation addressing safe patient handing have begun with research and support from large organizations such as OSHA or NIOSH.