The healthcare industry is very unique in that there are so many different cogs that keep the engine running, from nurses and doctors to home-care workers. While the roles of each cog can be vastly different, the main injury risk is the same. It’s well documented that patient manual handling has one of the highest injury risks across all industries. Many different injury prevention methods have been introduced over the past decade, ranging from the standard group training to hoists and slide-mats. However, the incidence of body-stressing injuries caused by patient manual handling remains high globally.
So what can we do to protect our healthcare workers from sustaining a life-changing workplace injury?
Caring for People Comes with Risk
Let’s start by putting things in perspective and checking the research. Annually, an average of 55% of nurses experience low back pain and 44% experience shoulder pain. According to the US Bureau of Labor Statistics, they are three times more likely to sustain a back injury than construction workers.
But it’s not just the nurses that have a high injury risk. We recently completed a trial measuring the postures and movements of sonographers at a busy public hospital. For every hour of their shift, they spent over 20 minutes with their back in an awkward posture. You can imagine the cumulative load on the muscles and joints that would occur over a nine-hour shift, five days a week!
We also measured the movements of operating theater nurses who are required to assist surgeons by positioning the patients prior to surgery and holding limbs in required positions during surgery. These workers are often required to hold limbs weighing up to 40 pounds for over 30 minutes.
So why is there such a high risk of injury when manual handling patients? The main reason is pretty obvious — people are heavy! Even a light adult weighs over 100 pounds, a weight that would not be lifted by a person in any other industry without the assistance of equipment, such as a hoist or a forklift.
However, the biggest injury risk is not the weight, it’s the unpredictability. Most body stressing injuries occur when a patient is moving — when the healthcare worker, partially supporting the patient’s body weight, suddenly can no longer support the weight due to the patient shifting. The healthcare worker is required to either support the patient to protect them from injury or let them fall.
There’s a reason these workers are in healthcare: they care about people, and therefore the vast majority will not be willing to let a patient injure themselves or let them fall to the ground. They will always try to support the patient’s weight, often injuring themselves while trying to protect the patient from injury.
This story is all too common amongst healthcare workers. And I’ve seen firsthand the impact these injuries have on the lives of the injured worker. My mother was a nurse who sustained a back injury trying to help a patient who had fallen and was in pain. Her back injury resulted in seven segments of her spine being fused, early retirement from a career that she loved and ongoing pain and discomfort.
And her injury was 100% preventable. She would not have sustained her injury if:
- She had waited for another nurse to assist her. However, the nursing staff were always busy and the patient was in pain, so rather than waiting for another staff member, she tried to assist the patient by herself.
- She had developed a habit of bending and twisting rather than using her legs to squat.
So, how can we help healthcare workers to protect themselves from injury?
1. Manual Handling Training
The most common approach is extensive manual handling training with regular refresher courses. This is somewhat effective at educating the workers about how to avoid being in a position where they have to support too much weight, including the use of lifting aids and always asking for assistance from other healthcare workers.
Recent research has indicated a multidisciplinary approach is more effective at changing worker behavior than lifting training. This multidisciplinary training included an occupational medicine component, a physical therapy component and psychological training.
Problem — We know that this form of training becomes less effective at changing worker behavior the more time that passes following the training, so regular refresher courses are required.
Solution — Group-based refresher training is not time- or cost-effective. The most effective way to achieve long-term behavior change is to use “nudge theory.” This involves small pieces of engaging information being delivered to the workers on a regular basis at a time when it has the most impact. The best way to do this is through smartphone technology using an app to deliver training modules that are personalized for each worker. The same app can also be used to report any concerns or hazards, such as the need for more manual handling aids.
2. Manual Handling Aids
Manual handling aids in healthcare include mechanical hoists and slings for lifting patients and various low-friction devices (hover mats, or slide mats) for transferring patients from one bed to another. These devices usually require more than one healthcare worker to use them.
Problem — All of these devices are ineffective if the worker does not use the correct technique, so training and refreshers are required. However, more often than not, the lifting aids are too difficult to use, or there aren’t enough aids for the number of workers who need them.
Solution — An environment must be created where the use of aids is the primary focus, and workers are rewarded for using them correctly. This requires the development of a safety-first culture, which we all know is the key to injury prevention in all industries.
3. Movement Coaching
This is a relatively new approach that has been implemented successfully across a number of industries where workers are required to perform physically demanding tasks. The idea is that the best way to change worker behavior is to provide them with feedback when they are performing the task.
In sport, we all know the coach’s role is to watch the athletes in practice and competition and provide feedback on how they can improve. This feedback is the most effective when it is delivered while the athlete is practicing or competing, so they can make immediate changes and learn. The same feedback is ineffective if it is delivered hours or days later. Physical therapists and exercise physiologists also watch their patients move when they do their assessments and provide feedback on how they can improve to reduce pain. This feedback would be ineffective if it was delivered hours or days after the assessment.
Problem — Delivering movement coaching feedback for all healthcare workers throughout their shift requires a lot of time and effort from OHS professionals or their managers/supervisors. This time and effort is also very expensive.
Solution — Use wearable technology that provides the workers with alerts when they move in a way that increases their injury risk, prompting them to stop and change the way they move. This regular feedback has been effective at changing worker behavior across many industries. When coupled with regular training refreshers using smartphone technology, movement coaching is a time- and cost-effective way to reduce injury risk for healthcare workers. However, make sure that the movement analysis component of the technology is validated (by an independent research organization or university) and reliable, so you know the worker is receiving the correct feedback.
Mitigating Risk in Manual Handling
Our healthcare workers are exposed to the unique injury risks associated with patient manual handling. We all know that this risk cannot be reduced through an engineering solution, as healthcare workers will always be required to assist in moving patients. And the injury frequency numbers indicate that the risk has not been significantly reduced over the past decade.
Whilst the use of manual handling aids can reduce the injury risks, the biggest opportunity to protect healthcare workers from injury involves the use of wearable and smartphone technology. Manual handling training can be more effective through the use of nudge theory and smartphone technology, whilst movement coaching using wearable technology can help workers to avoid bad manual handling habits and move in a way that is safe. This cost-effective technology is not only enabling workers to reduce their injury risk at work, but protect their ability to earn an income and maintain their own quality of life while protecting patients.