Systematic review of patient handling activities starting in lying,sitting and standing positions

BACKGROUND: Over the last 20 years a number of methods have been recommended in professional guidelines for moving patients. This review was undertaken as it was recognized that there was a need for clinical work involving handling patients (systems of work and equipment) to be based on scientific evidence. AIMS: The aim of this paper is to report the methodology, search strategy and results relating to work involving the care, treatment and transfer of patients starting in lying, sitting and standing positions. METHODS: An unusual philosophical stance has been taken by appraising studies within a study type rather than comparatively. This facilitated the inclusion of a wide range of study designs (quantitative and qualitative). A string search was run on eight databases and supplemented by other search strategies. A published checklist was selected and inter-rater reliability established before the main review commenced. A systematic process for inclusion, exclusion, appraisal, extraction and synthesis was undertaken. RESULTS: Thirty-two studies were included: nine for activities with the patient starting in a lying position and 23 for the sitting position. No studies were found with respect to patient handling activities starting in a standing position. These data were synthesized into evidence statements. CONCLUSIONS: The evidence statements support the use of hoists (for nonweight bearing patients), standaids, sliding sheets (double thickness rollers), lateral transfer boards, walking belts and adjustable height beds and baths. It is suggested that these items should constitute a minimum equipment list for any clinical environment where patient handling takes place on a regular basis. The lack of research relating to patient handling in standing is of particular concern and it is recommended that this area should be a high research priority to address concerns about patient handling in rehabilitation activities.     

Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review

Methods: A search strategy was devised to seek out research between 1960 and 2001. Inclusion/exclusion criteria limited the entry of papers into the review process. A checklist was selected and modified to include a wide range of study designs. Inter-rater reliability was established between six reviewers before the main review process commenced. Each paper was read by two reviewers and given a quality rating score, with any conflicts being resolved by a third reviewer. Papers were grouped by category: multifactor, single factor, and technique training based interventions.

Results: A total of 2796 papers were found, of which 880 were appraised. Sixty three papers relating to interventions are reported in this paper. The results are reported as summary statements with the associated evidence level (strong, moderate, limited, or poor).

Conclusion: There is strong evidence that interventions predominantly based on technique training have no impact on working practices or injury rates. Multifactor interventions, based on a risk assessment programme, are most likely to be successful in reducing risk factors related to patient handling activities. The seven most commonly used strategies are identified and it is suggested that these could be used to form the basis of a generic intervention programme, with additional local priorities identified through the risk assessment process. Health care providers should review their policies and procedures in light of these findings.

     

Testing gloves used for common nursing tasks

Nursing tasks often require high levels of dexterity. Gloves should not hinder hand function. Gloves bought for use by nurses need to be tested in ergonomic trials based on nursing tasks.     

High rates of perforation are found in endovaginal ultrasound probe covers before and after oocyte retrieval forin vitro fertilization-embryo transfer

Objectives To study perforation rates of sterile transvaginal ultrasound probe covers before and after oocyte retrieval (OPU) in an IVF-ET program.Methods Transvaginal ultrasound probe sheaths from two different manufacturers were studied, Cook Innoray (Cook-Canada #TTUPS-100) and Swemed Lab (Frolunda Sweden #715). After controlled ovarian stimulation, OPU was done using the needle guide of a sterile sheathed 5-MHz transvaginal ultrasound transducer (ATL Bothell, Washington, USA). A newer designed Cook probe cover supplied by the manufacturer was also tested after the company was made aware of our initial perforation results. Following each OPU, probe covers were examined for perforations by filling them with water and checking for leaks. If perforations were found, the vaginal transducer was disinfected by soaking for 20 min in 2% gluteraldehyde (Formac ^®).Twenty unused sterile probe covers from each manufacturer were also tested for perforations.Results After OPU we found 10/13 (75%) old Cook, and 35/43 (81%) Swemed probe covers to be perforated (NS). Only 5/20 (25%) of the new design Cook probe covers were perforated post OPU (P =0.000005). Analysis of unused probe covers revealed 13/20 (65%) Cook, and 5/20 (25%) Swemed probe covers to be perforated (P =0.02). None of 10 new design unused Cook probe covers were perforated before use.Conclusions Sterile transvaginal ultrasound probe covers have a very high rate of perforation even before use. It is important to examine probe covers for perforations after OPU procedures and to disinfect them as necessary to avoid the risk of sexually transmitted disease. Quality control between brands seems to vary and efforts should be made to develop a cooperative relationship with manufacturers to improve design and quality control in production of ultrasound probe covers used for IVF procedures.Presented at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, April 3–7, 1995, Vienna, Austria.     

Finding ergonomic solutions--participatory approaches

This paper gives an overview of the theory of participatory ergonomics interventions and summary examples from a range of industries, including health care, military, manufacturing, production and processing, services, construction and transport. The definition of participatory approaches includes interventions at macro (organizational, systems) levels as well as micro (individual), where workers are given the opportunity and power to use their knowledge to address ergonomic problems relating to their own working activities. Examples are given where a cost-effective benefit has been measured using musculoskeletal sickness absence and compensation costs. Other examples, using different outcome measures, also showed improvements, for example, an increase in productivity, improved communication between staff and management, reduction in risk factors, the development of new processes and new designs for work environments and activities. Three cases are described from Canada and Japan where the participatory project was led by occupational health teams, suggesting that occupational health practitioners can have an important role to play in participatory ergonomics projects.     

Uniforms: a comparative evaluation of tunic tops

AIM: The aim of this study was to produce a recommendation for selection of a tunic top for female nurses, based on previously established ergonomic criteria. METHOD: Four tunic top designs were evaluated using functional tests, including anthropometry, body-part discomfort charts, product feature questionnaires and comparative ranking. A convenience sample of nurses from one trust wore the tunics during the study tests. The trial draws heavily on previous research on nurses' uniforms and applies ergonomic criteria to tunic top design. RESULTS: The researchers were not able to identify on optimum design using the results of the trial. The tunics compared were relatively restrictive, with one tunic being identified as the least restrictive of the four. CONCLUSION: The researchers are now taking this initiative forward in a participatory ergonomics project with nursing staff to try to produce a uniform design that will meet functional ergonomic criteria. Prototypes will be evaluated using the protocol from this trial.     

Work-related back pain in nurses

This summary draws together the findings from over 80 studies published over three decades The studies reviewed are categorized into three groups (a) epidemiological, (b)'testing out', and (c) exploratory There has been agreement on a number of points, in particular that nursing is among the high risk occupations with respect to low back problems, with a point prevalence of approximately 17%, an annual (period) prevalence of 40–50% and a lifetime prevalence of 35–80% When considering the contributory factors there is some divergence, but one of the popular notions is generally proven, that more frequent patient handling appears to correlate with increased incidence of low back pain However, the traditional approach of training in lifting and handling techniques alone has been shown to be of little, or no, long-term benefit and the value of ergonomics remains to be seen Much work has also been done by taking aspects of nursing work into the laboratory, using experimental studies which have mostly focused on specific sub-tasks (of the generic task of patient handling), looking at specific transfers and procedures (e g bed to chair) or transfer techniques ('stoop versus squat') Although a level of quantification can be made about the different techniques, it is questionable whether this is of any practical use, especially when considering the wide variation of loads encountered during manual handling of patients The limitations of using quantitative methodologies is revealed in the very small number of exploratory studies All of the studies cited in this review used methodologies based in the positivist paradigm There does not appear to be any published work using participative or interview methods to obtain qualitative data which might identify contributory factors in the onset of occupational low back pain in nursing staff