2. Background:
• Mixed methods study - association between
decisions and MH injuries (Nurses)
• Health Belief Model – explain and predict
health behaviour
• Epidemiological approach
3. The Health Belief Model …
To adopt a health message individuals
must perceive it to be a health threat
i.e. a serious problem to which they
are susceptible
4. Injury Epidemiology claims …
“as injuries are predictable they are
also preventable … and …
to a large extent society (hospitals)
chose the injury rate it has”
(Christoffel et al 1999)
5. Injury Epidemiology uses …
• Host-agent-
Host
(human)
environment triad
to identify
problems,
interaction and
where to direct
Environment
interventions Agent = mechanical
energy (physical, social)
(vector, vehicle)
6. Injury Epidemiology uses …
The Haddon Host Agent Environment
Matrix to (human) (vehicle (social
vector) physical)
analyse injury
and plan Pre-event
interventions
Event
Post-event
7. Injury Epidemiology uses …
A structured approach to injury prevention
Haddon’s 10 countermeasures
Passive or Active
Engineering, Education, Enforcement
8. Aim of this presentation …
• To consider the findings of manual
handling research
• From an injury prevention framework
perspective
9. Mixed Methods Study
• Focus groups (x5)
• Case-control questionnaire (n=368)
– Analysed injuries (n=82)
– Analysed Comments (n=90)
MH decision and their effect on injury
RN/EN in clinical positions
10. Triangulation …
• Combines research methodologies
• To strengthen results
• Improve accuracy and interpretation
• Identifies consistent, convergent results
• Correlations demonstrate strong
relationship
11. • Host – those most at
risk, i.e. who to target
• Environment –
hazards to eliminate
from the injury area
• Agent - what delivers
the energy
12. Host (those most at risk)
• Did not perceived MH as a health threat
• Pre-injury less likely to aches/pain related
to MH
• Post-injury
↑ awareness of susceptibility to injury
Safer MH practice
Ongoing exercise programs
14. Environment (hazards to eliminate)
Physical
workspace
Social
staffing numbers
time limits / workload
expectations (problem in 21% injuries)
15. Injury prevention interventions
• By Haddon’s countermeasures (x10)
• If passive or active
• By approach: education, engineering,
enforcement
• If in the pre-event or event phase
16. #1: prevent the initial creation of the hazard
• Cannot avoid patients – but can avoid routine
manual lifting
• No-lift, minimal lift, safe lift, zero-lift etc. policies
Requires enforcement (pre/event - passive)
Requires equipment (pre/event)
Requires education (pre)
• Substantial evidence base
17. #2 reduce the amount of energy in the hazard
• Reduce the energy transferred by using MH
equipment (event - active)
e.g. Hoists, slide sheets, etc.
• Equipment alone ↓ risk factors
• More effective in multifaceted approach
• Substantial evidence ↓injuries ↓costs
18. #3 prevent release of a hazard that already exists
Contain the hazard by:
• Assess hazards and how to manage them
(algorithms, Red Dots)(pre/event - active)
• Dedicated wards for specific pt – spinal,
bariatric etc. (pre - passive)
• Close beds if staffing unsafe (pre - passive)
• Some evidence (assessment), dedicated
wards – cautious recommendation
19. #4 modify the rate of spatial distribution of the hazard
Change how the hazard is delivered
• Optimal floors - minimise resistance to
wheels (pre - passive)
• Large wheels (pre - passive)
• Share the load – work as a team (event -
active)
• Substantial evidence
20. #5 separate in time and space, the hazard from
that to be protected
Separation prevents transfer of energy
• Dedicated lift teams – remove 95% of
routine MH from nurses (event - passive)
- Are a team, use equipment with MH
their priority
-↓ MH injuries to nurses + v few injuries
to lift teams personal
• Substantial evidence (from USA)
21. #6 separate the hazard (by a material barrier) from
that which is to be protected
Form a barrier between hazardous equipment
and the nurse (pre – passive)
• Remove faulty or inappropriate MH
equipment and replace with appropriate
equipment
• Automatic process to maintain equipment
Provision/maintenance required by MH codes
22. #7 modify relevant basic qualities of the hazard
Amend unsafe aspects of hazards
(equip + environ)
• Equipment: “state-of-the-art” (pre-event,
passive)
• Work areas: de-clutter bed space, > space
for bariatric pt and their equipment - modify
existing or design new facilities, flooring.
(pre-event, active and passive)
23. #7 modify relevant basic qualities … cont
• Social environment: work expectations,
safety climate of organisation and the
influence of manager/supervisor (event –
active)
• Policy implemented at ward level,
overseen by managers group to target
with education
• Substantial evidence re influence of Mx
24. #8 make what is to be protected more resistant
to damage from the hazard
Make nurses more resilient and better able
to withstand MH (pre-event, active)
• Exercise - strengthens muscles and ↑
flexibility of trunk
• Short-term benefits (voluntary/mandatory,
40-60 mins, x2/week for 3-12 months
• Substantial evidence
25. #9 begin to counter the damage done by the hazard
Managing the injury in a way that prevents
further damage (post-event, active)
• Best Practice - early aggressive managed
care, by a team led by occupational physician
Includes: assessment, assurance, education,
involves manager
• Substantial evidence, international best
practice, legal requirement
26. #10 stabilise, repair and rehabilitate the object of
the damage
Aims to return injured persons to work ASAP and
undertake rehabilitation in the workplace if possible
• Psychosocial issues related to the injury (yellow
flags) may obstruct return. Must be identified and
resolved in conjunction with the manager
• Physical demands assessed modified duties
• Successful programs for general MSD and LBP
include exercise programs
27. Passive Countermeasures
Countermeasures Event Phase Approach
1.Optimal floor surface Pre-event
2. Optimal wheel size Pre-event
3. Re-design physical environment Pre-event
4. Update to ergonomically improved Pre-event
“state-of -the-art-equipment”
5. Removal of faulty, inappropriate Pre-event
equipment
6. Maintenance of MH equipment Pre-event
7. Close bed when staffing is unsafe Pre-event
8. Dedicated lift-teams Event
9. Dedicated ward for specific patients Pre-event
28. Active Countermeasures
Countermeasures Event Phase Approach
1. Exercise Pre-event
Post-event
2. Practice aligns to NLP Event
3. Equipment to move, position and Event
transfer patients
4. Assessment and decision making Event
tools
5. Teams of nurses (and aides) to Event
MH
6. Safety climate for MH practice Event
7. Assessment following injury and Post-event
address relevant workplace
issues
29. Planning injury prevention
• Injuries are predictable
• Occur as the result of a chain of events
• Intervention are planned to interrupt the
chain and address identified risk factors
• Principles are used to maximise prevention
30. Injury epidemiology principles
1. Active or passive interventions: prefers passive
- will always be effective
2. Single or mixed interventions: prefer mixed -
injuries have multiple causes with multiple
prevention opportunities. Must address host-
agent-environment in pre/event/post phases
3. Prioritise the most effective intervention rather
than relying on education to change behaviour
31. Injury epidemiology principles
4. Education efficacy increased if supported by:
-legislation /policy (enforcement)
-passive interventions in environment
-modification of psychosocial environment
32. Results of this study
• Host - did not perceive manual handling as
a heath threat. Problem - active
interventions may not be employed
• 10 agent - patients with obvious
constraints. Problem - cannot change pt
have to change approach
• 10 environment – social expectation to take
risks to complete work. Problem -
training and policy ignored
33. Implications for Practice:
• Multifaceted interventions are more effective
• Training/education are part of multifaceted
interventions (need infrastructure and
social support to use skills/knowledge)
• Develop + implement a safety climate
• Educate managers/supervisors
• Substantial evidence
Hinweis der Redaktion
HBM framework/model to understand health behaviouras injuries are predictable they are also preventable … and …to a large extent society (hospitals) chose the injury rate it has”
Cases 84, controls 284
Passive built into the environment or work systemsEnforcement of legislation of policy
Almost ¾ of injuries involved patient handling therefore main area to addressBecause if the hazard doesn’t exist, energy transfer cannot occurEG ban firecrackers and ban 3 wheel all terrain vehiclesNLP is a framework and cannot function alone – required equipment, education and ongoing enforcementNLP cannot be assed alone:NLP+equip+edu sig greater reduction of MH injuries than all other injuries, sig decline in lost work days and restricted work activityNLP+ multifaced sig decrease in MSI and modified work days + equip and policytoped ranked elements of program
Works by decreasing the energy to be transferredE.Gs limit horsepower of motor vehicle engines, use small packs for toxic drugsEquipment per se doesn’t reduce injuries. Must be appropriate for the task, state-of-the-artStand up hoists – eliminate stress when standing and lowering but not during preparationFloor based – probs if wheels small, over carpet, in confined spaces, v large ptCeiling hoist eliminate these potential probs + Financial saving from equip – recouped in 2-4 years
Previous eg store firearms in a locked container, close beaches when life guards are not presentAssessment recommended within generic ed programs, algorithims EB, RDMS auditBariatric best practice – trng, equip, probs with space logistics, communication, getting equip, compliance with policy
Eg use seat belts in motor care and make shorter cleats on football bootsNon-optimal :Carpet, inclined, wood, carpet Optimal vinyl tile glued to a level concrete floor Hard floor is optimalShare load doesn’t 1/2 load but does share it. Prob with work practice primary pt care
E.G. Provide cycle ways and overpasses for pedestrian trafficEntire seperation not possibleSpecialised service, address shortage of time, shortage of staff, workload, Separate nurses from hazard for 95% of the timeUse MH equipment within NLP
Fence swimming pools , insulate electric cords
e.g. narrow spacing for cot slats, non-slip surfaces for wet areasEquipment – improve wheels/handles, motor assist, convert to ceiling hoists
This study 21% described social expectation to participate in unsafe practice (own, colleagues and senior nurse)Safety climate refers to shared views about safety and is an indication of the safety culture of an organisation.Assosc btwn safety climate, safe practice and injury rateThis study suggested safe MH was less valued than time Mx and the ability to complete workInjury stats not a PI - unitl injury start values unlikley to be bvlaued by MxNeed to modify safety climate – essential feature of this mod is the infleunce of the mx, supporting and enforcing safe MH practice.Suggest Mx would value safe MH practice if outcomes were values and given equal kudos with other healthcare indicators (falls, med errors, pressure ulcers, UTI).Poss that until social and safety climate of health facilities are modified, there will be an expectation to undertake unsafe practice.
e.g. prohibit alcohol consumption near water rec areas, musculoskeletal conditioning for athletesNurse pop x2 conflicting evidence one did (physio led) one didn’t (home ex program)But did demonstrate efficacy in 3x SR of other pops which did included nurses.The potential to increase capacity may be more valuable to some groups: older, less fit, overweight and with a previous MH injury.
Prohibit further play on the day an athlete is concussed, provide emergency care at the siteRed flags = fractures, tumours, infections, nerve root painNo x-rays unless red flag is suspectedYellow flags = work demands, Advantages of remaining at work and active, encouraged to RTW asapAdvantages of aggressive Mx – red flags identifies and treated early or eliminated. Retention or early re-enty eliminated diff associated with physical/social factors in work area
e.g. surgery, mental and physical rehabilitation, modification of injured persons settingInvolvement of the worksite is vitalExercise programs – early activity and stretching advocated, with referral to exercise management program if the injured person has not returned to work after 2 to 4 weeks
Passive Primarily in pre-event phasePrimarily engineering Some enforcementInfrastructure to automatically protect Preferred interventions – no action neededPresent regardless of beliefs, staffing, emergencies, business etc
Exercise involved with all active strategies but alone only with exercisePrimarily event phasePrimarily multiple approaches (EEE)Problem every MH activity is active and involves decisions – influenced by beliefs, time, staffing, environment etc.