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Safe Patient Handling Trainingfor Schools of NursingCurricular MaterialsThomas R. Waters, Ph.D., NIOSHAudrey Nelson, Ph.D., VHANancy Hughes, Ph.D., ANANancy Menzel, Ph.D., University of Las Vegas, NVCurriculum developed in partnership with the National Institute for Occupational Safety and Health (NIOSH),the Veterans Health Administration (VHA), and the American Nurses Association (ANA)11RYHPEHU 2009

DisclaimerThis document is in the public domain and may be freely copied or reprinted.Mention of any company or product does not constitute endorsementby the National Institute for Occupational Safety and Health (NIOSH). Inaddition, citations to Web sites external to NIOSH do not constitute NIOSHendorsement of the sponsoring organizations or their programs or products.Furthermore, NIOSH is not responsible for the content of these Web sites.All web addresses referenced in this document were accessible as of thepublication date.Ordering InformationTo receive documents or other information aboutoccupational safety and health topics, contactNIOSH at1-800-CDC-INFO (1-800-232-4636)TTY: 1-888-232-6348E-mail: [email protected] visit the NIOSH Web site atwww.cdc.gov/nioshFor a monthly update on news at NIOSH,subscribe to NIOSH eNews by visitingwww.cdc.gov/niosh/eNewsDHHS (NIOSH) Publication No. 2009-127November 20094Safe Patient Handling Training for Schools of NursingCurricular Materials

Table of ContentsBackgroundPg 6Tool Kit for Safe Patient Handling and MovementTraining ProgramPg 8Implementing the Curriculum Module for the First TimePg 9Using the CurriculumPg 9Required Student ReadingPg 10Required Student Viewing and Listening (narrated slide show)Pg 10Required Student Laboratory ActivitiesPg 11Optional Background Didactic Material for FacultyPg 11Optional Laboratory MaterialsPg 14Quiz for Didactic SPHPg 15AppendicesAppendix A- VHA Safe Patient Handling and Movement AlgorithmsPg 16Appendix B - Assessment Criteria and Care Plan forSafe Patient Handling and MovementPg 38Safe Patient Handling Training for Schools of NursingCurricular Materials5

Backgroundindicates that adoption of safe patient handling (SPH)techniques, where nurses use assistive equipment duringtransfers, is effective in reducing the incidence of MSDsrelated to the handling of patients (Nelson et al., 2009).Educators at schools of nursing, however, continueto teach outdated techniques for patient handling. Theseapproaches rely on “proper” body mechanics—when therereally is no safe method to manually lift another adult humanbeing. The two-person lift and the hook-and-toss methodspersist as primary approaches taught to student nurses forlifting and moving patients (Nelson et al., 2009). Expertsand advocates of safety in handling patients consider thesetechniques unsafe (Nelson et al., 2009).Likely reasons that SPH techniques have notbeen widely accepted nor incorporated into fundamentalnursing education include the fact that (1) the knowledgebase for applying ergonomics to handling patients has onlyrecently evolved and (2) available evidence-based teachingmaterials and resources targeted toward faculty are lacking.This SPH curricular material, developed by cooperativeeffort among the National Institute for Occupational Safetyand Health (NIOSH), the Veterans Health Administration(VHA), and the American Nurses Association (ANA), willhelp instructors design training programs that encourage theuse of safe approaches to handling patients and contributeto the prevention of MSDs. History of frequent injuriesThe entire program is designed to be implemented High proportion of dependent patientsas a 1- or 2-day training module in schools of nursing. Lack of use of lifting equipment in good repairEach element of the program is designed to support and Low staffing levelsreinforce the other elements. The model for the SPHThe high physical demands associated with handling training program is focused on student learning, facultyand moving patients—who are getting heavier as obesity development in effective teaching and student assessment,rates in the United States climb—are probably the largest and it is based on three primary concepts:contributing factor to high rates of MSDs among practicingnurses. The aging of the workforce likely contributes to 1. Opinion leader(s) (Dean or Instructors) incorporatesthe SPH training program into the fundamentalsthe problem; the average age of a registered nurse in thenursing course.United States is approximately 47 years. Also contributingto the negative health consequences of manual handling 2. Instructor or school negotiates with practice settingsto support safer patient-handling practices throughis the shortage of nurses—Peter Buerhaus, a researcher atpurchasing equipment and instituting low-lift policies.Vanderbilt University Medical Center, has estimated thatthere will be a shortage of 285,000 nurses by the year 2020 3. Nursing schools permanently adopt the SPH moduleas part of the curriculum.and 500,000 by the year 2050 in the US—likely resultingin longer work hours and more demanding schedules forThe effectiveness of the SPH training program waspracticing nurses.More than 30 years of evidence has demonstrated evaluated in a field study by partner educators at 29 schoolsthat manual patient handling and relying on body mechanics of nursing. Nelson et al. [2007] describe the findings fromis unsafe (Nelson et al., 2009). Furthermore, this evidence the evaluation study. (An overview of the process used toIn the field of nursing, work-related musculoskeletaldisorders (MSDs), such as back and shoulder injuries,persist as the leading and most costly U.S. occupationalhealth problem (Nelson et al., 2009). A large body ofevidence indicates that a substantial number of work-relatedMSDs reported by nurses are due to the cumulative effectof repeated manual patient-handling activities and workdone in extreme static awkward postures. In a list of at-riskoccupations for musculoskeletal disorders in 2007, nursingaides, orderlies, and attendants ranked first in incidencerate with a case rate of 252 cases per 10,000 workers, a rateseven times the national MSD average for all occupations.Emergency medical personnel ranked second, followedby laborers and material movers, ticket agents and travelclerks, and light and heavy truck drivers among the topsix at-risk occupations [Department of Labor, Bureau ofLabor Statistics (BLS), 2009]. The nursing occupationalso typically ranks in the top ten in yearly incidence rateof sprain and strain injuries.In most industries MSD injury rates have declinedin recent years, yet MSD rates for nurses in the healthcareindustry have not declined during the same period.Healthcare units at high risk for back and other injuries tocaregivers have certain characteristics:6Safe Patient Handling Training for Schools of NursingCurricular Materials

develop the curriculum is described in a paper by Menzelet al. [2007].)Equipment vendors participated in the evaluationproject by providing state-of-the-art equipment to use inthe clinical component of the training curriculum. Thevendors also often provided a trained staff person to helpthe school during the clinical training phase of the trainingimplementation. The evaluation involved a pre- and postdesign with a group of schools of nursing. Nurse educatorsat 26 nursing schools received curricular materials andtraining; nursing students received the evidence-basedcurriculum module. There were three control sites.Questionnaires were used to collect data on knowledge,attitudes, and beliefs about safe handling of patients forboth nurse educators and students, before and after training.The authors found that knowledge about SPH conceptsimproved considerably among both nurse educators andstudents at intervention schools. Also, both groups at theintervention schools indicate they are more likely to usemechanical lifting devices when they are available.With a new curriculum that addresses theprevention of biomechanical hazards of patient handling,nurse educators can impart this knowledge directly tostudents who will soon be entering the labor force asprofessional nurses. As such, nurse educators are pivotal inchanging perceptions throughout the nursing and healthcareindustry in order to place a higher value on preventionof MSDs through safe patient-handling methods. Frompools of students come individuals who eventually take onroles and positions of leadership as directors of nursing,supervisors of nursing departments, unit charge nurses, andheads of committees (e.g., safety and health committee)—all with some degree of decision-making authority. Further,nursing students who become front-line workers may serveas important advocates among facility staffs to adopt safepatient-handling methods, equipment, and policies. Thepotential impact of this influence throughout the range ofhealthcare settings—from acute care hospitals to nursinghomes—can be extensively diffuse.To date, approximately 90 nurse educators havebeen trained to teach the new training materials. More than1,500 students have been through the training program.Based on requests for the SPH training materials fromnumerous schools of nursing, within the next 5 years anestimated 60,000 additional students could be trained usingthe new materials. If the training materials are adapted foruse by healthcare groups for retraining current nurses andother caregivers, many healthcare workers who currentlyperform patient-handling tasks may be positively affectedby this training program. In the future, it is likely thathealthcare facilities will adopt SPH programs. Having ahighly trained workforce will increase the effectiveness ofthese programs.The training program has four main objectives:1. Provide evidence-based training on SPH to instructorsat schools of nursing so that they can teach SPHmethods to students.2. Ensure that the training is sound and that the curriculumis effective in improving the knowledge, attitudes, andbeliefs of the students.3. Provide a full range of educational tools nursingeducators can use to increase effectiveness of thetraining program (see Tool Kit for Safe PatientHandling and Movement Training Program).4. Encourage all nursing educators at schools of nursingto use the evidence-based, safe-patient-handlingcurriculum module and recommended laboratoryactivities for nurse training.The ultimate goal is to move students beyondsimply knowing content to applying what they’ve learnedin a clinical setting.Safe Patient Handling and MovementConceptsIn order to clarify the difference between the terms“biomechanics” and “body mechanics,” we haveprovided the following definitions. Biomechanics isthe study of the mechanics of muscular activity. andhow muscular activity leads to internal loading of bodytissues, such as the ligaments, joints, and other softtissues. Biomechanics is useful in determining whethera specific manual patient handling task will createunacceptably high forces inside the body and whethera manual lift is “safe” or not. Body mechanics, on theother hand, is a belief that reliance on “correct” bodypositions or “body movements” will somehow provideprotection from the force associated with lifting andmoving patients. Body mechanics is also used to assessthe alignment of patients when they are standing, sitting,or lying down. Body mechanics alone, however, is notsufficient to protect the nurse from the heavy weight,awkward postures, and repetition involved in manualhandling. Safe manual handling techniques must be usedin combination with equipment and technology for safepatient handling and movement. There are four primarySafe Patient Handling Training for Schools of NursingCurricular Materials7

Tool Kit for Safe Patient Handlingand Movement Training Programprinciples of manual patient handling that should beused in conjunction with SPH techniques when handlingand moving patients. The four principles include:This tool kit contains didactic content andclinical laboratory content required to incorporateevidence-based patient handling into a nursingschool curriculum.The four principles include:1. Maintain a wide, stable base with your feet.2. Put the bed at the correct height (waist level when The curriculum consists of four main elements:providing care; hip level when moving a patient.)1. A narrated, approximately 2-hour slide presentation3. Try to keep the work directly in front of you to avoidrotating the spine.2. A series of algorithms (i.e., decision tools thathelp nurses assess patient needs to decide which4. Keep the patient as close to your body as possible toequipment is appropriate for a specific patientminimize reaching.handling activity)Preparing for the Patient Handling Activity3. Didactic materials1. Take responsibility for knowing how equipment worksand whether it’s available.4. Laboratory activitiesFor more extensive information about SPH,2. Assess the client and the environment using the consult the 2006 publication Handle with Care:Assessment Criteria and Care Plan for Safe Patient A Practice Guide for Safe Patient HandlingHandling and Movement.and Movement, A. Nelson editor, or, the 2009publication An Illustrated Guide to Safe Patient3. Select the appropriate algorithm.Handling and Movement, A Nelson, K. Motacki,and N. Menzel.4. Gather the appropriate equipment and other staffmembers, if needed.After taking training based on this curriculum, studentsshould be able to:5. Organize the physical environment and theequipment to ensure safe completion of the task. define healthcare ergonomics;This includes locking the wheels of the bed or chair,putting the bed or stretcher at the correct height, recognize high-risk, patient-care activities;removing clutter, and making sure any mobileequipment is charged. identify risks in patient-care environments;6. Make sure other team members, if any, know their roles; rehearse if necessary.state why mechanical aids are needed when movingand handling pat

n the field of nursing, work-related musculoskeletal I disorders (MSDs), such as back and shoulder injuries, persist as the leading and most costly U.S. occupational health problem (Nelson et al., 2009). A large body of evidence indicates that a substantial number of work-related MSDs reported by nurses are due to the cumulative effect of repeated manual patient-handling activities and work .