Applied ergonomics safe patient's handling

1. Applied Ergonomics:Safe
Patient’s Handling
Ms. Chanda Jabeen
Lecturer
RN, RM, BSN
M.Phil. Epidemiology & Public Health
PhD (Scholar) Epidemiology & Public Health
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OBJECTIVES
 Define Musculoskeletal Disorders (MSDs).
 Identify the primary risk factors that can contribute
to the development of work related MSDs.
 Identify activities at work that could put you at risk
of Musculoskeletal Disorders (MSDs).
 Define why manual patient handling tasks are
unsafe.
 Define health care ergonomics.

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OBJECTIVES
 Define engineering, work practice and
administrative controls.
 Identify examples of work practice controls that
can help reduce your risk of injury when
performing patient handling and care tasks.
 Describe the steps that can reduce your risk of
injury.

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OBJECTIVES
Explain the purposes of lifting & moving the
patients
List down the methods of lifting & moving patients
Demonstrate the correct techniques of lifting &
moving patients during practical session.

5. 2011 American Nurses Association
(ANA) Health and Safety Survey
 ANA surveyed nurses in 2011
 Respondents expressed concerns about health and
safety in their work environment
 A total of 4,614 nurses responded
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6. Top 3 Health and Safety Concerns
Identified by Nurses (ANA Survey)
 Acute/Chronic effects of stress and overwork
(74%)
 Disabling musculoskeletal nurses (62%)
 Contracting an infectious diseases (43%)
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What are Musculoskeletal Disorders
(MSDs)?
Chronic or Cumulative:
Injuries that occur over a period of time (months/years)
& are caused by a combination of risk factors
Acute:
A sudden or one-time traumatic event or incident,
e.g., slip, trip, fall or car wreck
MSDs affect ligaments, muscles, tendons, cartilage, blood
vessels & nerves & spinal discs

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Some Common MSDs
 Tendinitis &
 Epicondylitis
 Rotator Cuff Tear
(shoulder)
 Bursitis (shoulder or
knees)
 Strains and Sprains
(neck, back, shoulder)
 Low Back Pain &
Sciatica
 Bulging or Herniated
Spinal Discs
 Carpal Tunnel
Syndrome

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TIME
Awkward
& Static
Postures
Repetition
Force
Primary Risk Factors For MSDs

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1. AWKWARD POSTURE & MSDS
Position of the body when performing physical tasks
Awkward postures cause biomechanical stress to
joints and surrounding soft tissues. Strength to the
body part is decreased accelerating muscle fatigue and
increasing risk of injury.

11. Awkward Postures include:
 Bending
 Twisting
 Reaching overhead
 Kneeling
 Squatting
 Pinch grips
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Awkward Posture & MSDs
Examples:
 Providing medical care or performing personal
hygiene tasks when the patient is in a chair or bed
that is too low
 Accessing medical equipment such as in-wall
oxygen or suction equipment
 Manually repositioning or transferring patients

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2. STATIC OR FIXED POSTURES
& MSDS
Postures or work positions that are held for
a period of time
Blood supply reduced to muscles muscle
fatigue

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Examples:
 Prolonged standing or sitting
 Performing patient care tasks or making a bed
while bending forward at the waist for a few
minutes or longer
 Supporting a patients extremities or heavy
instruments during a nursing task or medical
procedure
Static or Fixed Postures & MSDs

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Amount of physical exertion or muscular effort
expended when performing a task or activity such as
lifting, pushing, pulling, carrying or gripping tools
or equipment
3. FORCE AND MSDS

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Force and MSDs
The amount of force exerted is influenced by the:
– Weight, shape and condition of the patient or
equipment
– Body posture used
– Number of repetitions performed
– Duration or length of time that task is performed
Examples:
 Load or patient shifts suddenly or unexpectedly
 Lifting bariatric or obese patients
 Pushing a stretcher with poorly maintained or
incorrect casters

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Performing the same motion over and over again.
Example:
 Repeated positioning of patients in bed or
transfers to chairs
4. Repetitions and MSDs

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THE CUMULATIVE EFFECT
When the musculoskeletal system is exposed to
a combination of these risk factors (too quickly,
too often and for too long) without sufficient
recovery or rest time, damage occurs
Duration of Exposure to Risk Factors (Time)
Affected by:
 Working through breaks
 Overtime
 Task variability

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Fatigue
Discomfort
Pain
Injury
Disability
Continued
Exposure to
Risk Factors
Time
THE CUMULATIVE EFFECT

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Patient Handling : Higher Risk Tasks
1. Transfer from/to bed to chair or stretcher
2. Manually moving patient in bed
3. Manually lifting from floor
4. Attempting to stop falls

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The physical effort required
to repeatedly lift and move
patients manually is greater
than your musculoskeletal
system can tolerate.
Why is Manual Patient Handling
So Hazardous?
The bottom line…….
There is No Safe method to
lift and transfer patients
manually
Compression
Shearing
Rotation
Arrows show
direction of load
or force on lower
back (L5/S1) when
manually lifting
and moving
patients

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HEALTH CARE ERGONOMICS
The science of fitting the physical and cognitive
demands of the job to the worker to prevent injury,
human error and improve worker and patient
comfort
or
Capabilities of
People
Demands of
the Job
“Fitting the Job to the Worker”
NOT
“Fitting The Person To The Job”

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PREVENTING MSDS
Engineering
+
Work Practice
+
Administrative
Controls
=
Reduce the Risk of Injury for
Employees & Patients
Remember - back belts are ineffective in
preventing back injuries

25. What Can You Do to
Reduce Your Risk of MSDs?
1. Assess the Patient
2. Assess & Prepare the Environment
3. Get Necessary Equipment & Help
4. Perform the Patient Care Task, Lift or Movement
Safely
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What Else Can You Do?
 Report Ergonomic Problems to Your Supervisor
 Apply Back Injury Prevention Principles to Your
Off -The-Job Activities
 Report Any Physical Problems Early
= Quicker Recovery

27. LIFTING &
TRANSFERRING
PATIENTS
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28. The Purposes Of Lifting &
Transferring Patients
 To provide comfort to patient
 To maintain body alignment & position of
helpless patient.
 To encourage early ambulation- after general
anesthesia/post operation
 To encourage blood circulation
 To prevent complication eg: decubitus ulcer &
deep vein thrombosis (DVT)
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29. Methods Of Lifting &
Transferring Patients
1. Australian lift/shoulder lift.
2. 3 man’s lift
3. Lifting & Transfer Pts from bed to
chair/chair to bed
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30. AUSTRALIAN
LIFT
 To lift or move a patient to the top part of the bed.
 Requires 2 people; standing opposite each other at
the side of the bed.
 Using a ‘hand-forearm interlock’ technique to
support the buttock of patient (the heaviest part).
 Both nurses face in the direction of the movement-
to prevent spinal twisting.
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31. Australian Lift...technique
1.Technique to sit-up patient
• Stand at the side of patient
- left and right of patient
 Take out the pillow
 Help patient to sit and lower down the
head of bed
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32. Australian Lift...technique
2. Technique to move patient
• Stand next to patient’s
shoulder & facing towards the
head of the bed
• Lower down your body by flex
the knees & place your
shoulder under the patient’s
armpit
• Let patient’s arms rest on the
nurses shoulders.
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33. Australian Lift...technique
 Place the arms under the
patient’s thighs
 Hold each other arms using
a hand- forearm interlock
 The other arm holds the
side of the bed.
 On the count of 3, lift &
move the patient onto the
head of the bed.
 Comfort the patient.
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34. 3 MAN’S LIFT
Also called as the three-person carry
Requires 3 people of about equal height to
transfer a patients from his bed to stretcher or
another bed.
The strongest person supports the heaviest part of
patient’s body
The tallest person support the head & shoulder of
patient.
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35. 3 man’s lift...technique
1. Technique – placing the
trolley/stretcher/bed
 Provide privacy to
patient.
 Place the trolley at the
right angle (90°) at the
foot of the bed.
 Lock the wheels of the
bed & trolley.
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36. 3 man’s lift...technique
2. Technique - staffnurse
position
 All three nurses stand at
one side of the trolley
(preferably on right side):
Nurse 1: the strongest, tallest,
stand between head &
shoulder of patient.
Nurse 2: stand between hips &
thighs of patient.
Nurse 3: stand between upper
& lower legs.
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37. 3 man’s lift...technique
3. Technique – bring patient
towards/closer to nurses
 Cross patient’s hands and legs.
 Each nurses flexes the knees &
place the foot nearest to the bed
slightly forward.
 The arms are put under the:
Nurse 1: patient’s
head/neck &
shoulder
Nurse 2: patient’s hips &
thighs
Nurse 3: patient’s
upper/thighs
& lower legs
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38. 3 man’s lift...technique
4. Technique – lifting the
patient
 On the counts of 3, the nurses
roll the patient onto their
chests.
 Support the patient’s weight
on the elbow.
 Step back in unison. Then,
pivot around to the
trolley.
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39. 3 man’s lift...technique
Nurse 1
Pivot to the trolley/stretcher/bed
Nurse 2
Retreat with 3 times small steps
Nurse 3
Retreat with 3 times big steps
 Standing with a line leading to
trolley/stretcher/bed
 Step forward with right foot
toward trolley/stretcher/bed
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40. 3 man’s lift...technique
5. Technique – placing patient
on the trolley/strecther/
bed
 Stand close to the trolley
 Lower the patient by
flexing nurses knees &
hips until nurse elbow are
on the surface of the
trolley.
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41. 3 man’s lift...technique
5. Technique – placing patient
on the trolley / strechter
/bed...cont
 Release the patient slowly
on the trolley surface.
Then align & cover the
patient.
 Raise the trolley side rails
to ensure safety of patient.
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42. Lifting From Bed To Chair/ Chair To
Bed
1. Technique – placing
patient in sitting position
(on the side of bed)
 Bend the knees of patient
 Put one hand under the
neck and one under the
knees of patient
 Lift the patient's feet
 Give signal to move
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43. Lifting From Bed To Chair/ Chair To
Bed
2.Technique – holding the
patient
 Place both hands behind
the waist of patient
 Instruct the patient to
rest both hands on the
shoulders of nurse
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44. Lifting From Bed To Chair/ Chair To
Bed
3. Technique – moving the
patient
• Stand directly in front of
patient
• Place one foot forward (in
between patient’s legs) &
one back
• Instruct the patient put
one foot in front
• Pivoting the patient with
his/her back facing the
wheelchair
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45. Lifting From Bed To Chair/ Chair To
Bed
4. Technique – Assist patient
to sit on the edge of the
chair
 Instruct patient to step
backward until touch the
chair
 Stand directly in front the
patient with one
foot forward and one
back.
 Place both patient’s hands
on the wheelchair arms or
on your shoulder.
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46. Lifting From Bed To Chair/ Chair To
Bed
4. Technique – Assist patient
to sit on the edge of the
chair…cont
 On the count of 3, ask
the patient to sit.
 Ask the patient to push
back into the wheelchair
seat.
 Lower the footplates (of
wheelchair) & place the
patient’s feet on them.
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47. Moving Patient from Bed to wheel chair
Step # 1
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 Position and lock the
wheelchair close to the
bed. Remove the armrest
nearest to the bed, and
swing away both leg rests.
 Help the patient turn onto
his or her side, facing the
wheelchair.
 Put your arm under the
patient's neck with your
hand supporting the
shoulder blade.

48. Moving Patient from Bed to wheel chair
Step # 2
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 As the patient bends
toward you, bend your
knees and lower the
patient into the back of the
wheelchair.
 A helper may position the
patient's buttocks and
support the chair.
 Reposition the foot rests
and the patient's feet.

49. Rolling a Patient over in Bed
Step 1. Cross Arms
 Cross the patient's arms
on his or her chest; bend
the leg farther away
from you.
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50. Rolling a Patient over in Bed
Step 1. Cross Arms
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51. Rolling a Patient over in Bed
Step 2. Turn the
patient
• Put one hand behind the
patient's far shoulder.
• Put your other hand
behind the patient's hip.
• Turn the patient,
supporting the patient's
leg with your knee.
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52. Reference
American Nurses Association. (2011). ANA Health and
Safety Survey: Hazards of the RN Work
Environment. 2011. nursingworld. org.
FunctionalMenuCategories/MediaResources/Me
diaBackgrounders/The-Nurse-Work- Environment-
2011-Health-Safety-Survey. pdf.
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