Home > RNJ > 2008 > January/February > Guest Editorial: Promoting Safe Patient Handling

Guest Editorial: Promoting Safe Patient Handling
Audrey Nelson, PhD RN FAAN, Guest Editor

Patient-handling tasks in rehabilitation are often performed at high risk to nursing staff. Nursing has been identified as one of the top 10 high-risk occupations in the United States since the Bureau of Labor began collecting these data in the 1980s. Several factors have contributed to a more recent focus on this 30-year-old problem.

The recruitment and retention of nurses has emerged as a critical national problem because the demand for nurses far exceeds the available supply. Safe patient-handling programs can directly affect the nursing shortage by (1) improving nurse recruitment through the offer of appealing “no-lift” work environments; (2) reducing the number of nurses who leave the workplace—either temporarily or permanently—because of occupational injuries; and (3) reducing the number of nurses on “light duty” or “modified duty” by providing mechanical lifting devices that make it easier for injured nurses to return to the workplace.

For several decades, the scientific evidence base supporting the effectiveness of programs for safe patient handling did not exist. Most of the studies published in the 1980s and 1990s focused on the epidemiology of injuries, supporting the premise that manual patient handling was a high-risk activity. In the past 5–7 years, several studies have been published supporting evidence-based practices for safe patient handling. In addition, recent advances in technology have addressed many practical issues related to safer work environments for nurses without diminishing patient dignity or safety.

This issue of Rehabilitation Nursing focuses on an international approach to safe patient handling, targeting people with disabilities of all ages across the care continuum. One article, “Myths and Facts About Safe Patient Handling in Rehabilitation,” is a product of partnerships between the Association of Rehabilitation Nurses (ARN), the Veterans Health Administration (VHA), and the American Physical Therapy Association (APTA). Two articles, “Using Technology to Promote Safe Patient Handling and Rehabilitation” and “Proper Sling Selection and Application While Using Patient Lifts,” focus on new and emerging technologies for safer patient handling. With an emphasis on pediatric rehabilitation, “Special Approaches for Safe Handling of Disabled Children in the Netherlands” outlines innovations and approaches that we can possibly adapt for use in the United States. The final article, “Link Between Safe Patient Handling and Patient Outcomes in Long-Term Care,” strengthens the case for safe patient handling by outlining the possible links between safe patient handling and quality of care in nursing home settings—specifically involving mobility- and immobility-related adverse events.

We have a long journey ahead before we are able to state that rehabilitation facilities in the United States actively protect nurses from occupational injuries. Critical next steps include

  1. discontinuing traditional classes in body mechanics, training in manual patient handling, the use of back belts, and the use of other strategies deemed not effective in preventing injuries associated with patient handling. Persistence in use of these unsafe practices perpetuates the dangers plaguing the nursing workforce.
  2. implementing evidence-based solutions for safe patient handling, including patient- handling equipment and devices, unit-based patient care ergonomic assessment protocols, “no-lift” policies, training on proper use of patient-handling equipment and devices, and other evidence-based approaches for preventing occupational injuries associated with patient handling. Promising new interventions still being tested include the use of peer leaders and algorithms to standardize decisions about which devices should be used for individual patients’ needs.
  3. continuing to develop and refine new patient-handling technologies that specifically support rehabilitation principles
  4. using an interdisciplinary approach to streamline processes to effectively and efficiently implement safe patient-handling programs in rehabilitation settings
  5. defining strategies to institutionalize technologies and techniques and sustain safe patient-handling programs over time
  6. updating the curriculum in schools of nursing to reflect evidence-based practices, given that undergraduate nursing students are taught unsafe manual patient-handling techniques and are rarely exposed to the newest patient-handling devices. This step is critical in educating a new generation of rehabilitation nurses about safe patient handling.

ARN can play a critical role in advocating for safer work environments for rehabilitation nurses through ongoing partnerships with the American Nurses Association (ANA), APTA, and VHA.

For Further Reading

Collins, J. W., Wolf, L., Bell, J., & Evanoff, B. (2004). An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Injury Prevention, 10, 206–211.

Edlich, R. F., Winters, K. L., Hudson, M. A., Britt, L. D., & Long, W. B. (2004). Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems. Journal of Long Term Effectiveness of Medical Implants, 14(6), 521–533.

Hignett, S., Crumpton, E., Ruszala, S., Alexander, P., Fray, M., & Fletcher, B. (2003). Evidence-based patient handling: Tasks, equipment, and interventions. New York: Routledge.

Menzel, N. N., Hughes, N. L., Waters, T., Shores, L. S., & Nelson, A. L. (2007). Preventing musculoskeletal disorders in nurses: A safe patient handling curriculum module for nursing schools. Nurse Educator, 32(3), 130–135.

Nelson, A. L. (Ed.). (2005). Handle with care: A practice guide for safe patient handling and movement. New York, NY: Springer Publishing.

Nelson, A. L., & Baptiste, A. (2006). Evidence-based practices for safe patient handling and movement. Orthopedic Nursing, 25(6), 366–379. Reprinted from Online Journal of Issues in Nursing, 19(3) Manuscript 3. Retrieved November 27, 2007, from www.nursingworld.org/ojin/topic25/tpc25_3.htm.

Nelson, A. L., & Fragala, G. (2004). Equipment for safe patient handling and movement. In W. Charney & A. Hudson (Eds.), Back injury among healthcare workers (pp. 121–135). Washington, DC: Lewis Publishers.

Nelson, A. L., Matz, M., Chen, F., Siddharthan, K., Lloyd, J., & Fragala, G. (2006). Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International Journal of Nursing Studies, 43(6), 717–733.

Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education, National Research Council, and Institute of Medicine. (2001). Musculoskeletal disorders and the workplace: Low back and upper extremities. Washington, DC: National Academies Press.

Smedley, J., Egger, P., Cooper, C., & Coggon, D. (1995). Manual handling activities and risk of low back pain in nurses. Occupational and Environmental Medicine, 42, 160–163.

U.S. Department of Labor, Bureau of Labor Statistics. (2005). Lost-worktime injuries and illnesses: Characteristics and resulting time away from work, 2004. Retrieved March 29, 2006, from ftp://ftp.bls.gov/pub/news.release/History/osh2.12132005.news.