Dr F C Trevelyan Health and Rehabilitation Research Centre, Auckland University of Technology (P39, Wednesday, NZI 5 Room, 3.30-4)

1. Implementing change in the NHS
Factors to consider when implementing a ergonomics intervention
aimed at reducing back pain among nurses
Dr. Fiona Trevelyan¹ & Prof. Peter Buckle²
¹ Health and Rehabilitation Research Centre
Auckland University of Technology, NZ
² Robens Centre for Health Ergonomics
University of Surrey, UK

2. Extent of the problem
 Bureau of Labour Statistics (2002)
1st = Truck drivers
2nd = Nursing aides, orderlies and attendants
3rd = Labourers
6th = Registered nurses
7th = Construction workers
 Low back pain has been identified as a major reason why nurses leave their
profession (Nelson et al, 2003)
 Smedley et al (1995) found a 1-year prevalence of 45% with 10% having an
absence from work for a cumulative period of greater than 4 weeks

3. Aim of our study
 To implement and evaluate an ergonomics
intervention in an health care setting
Smedley J., Trevelyan F., Inskip H., Buckle P., Cooper C., and Coggon D.,
(2003) Impact of an ergonomics intervention on back pain among nurses.
Scand J Work Environ Health. 29 (2), 117 – 123.

4. Intervention process
3 main stages
 Definition
 Implementation
 Evaluation

5. Content of intervention
 Policy and risk assessment
 Work organisation
 Senior managers
 Change agents
 Manual handling link nurses
 Equipment
 Training

6. Patient handling equipment

7. Evaluation
Intervention site Comparison site
Baseline measurement Baseline measurement
INTERVENTION No intervention
Re-assessment Re-assessment

8. Measurement strategy
1. Reported back pain
Self report questionnaire: low back and neck pain
2. Exposure to risk factors associated with back pain
a) Task analysis
Identify proportion of nursing shift accounted for by nursing tasks
b) Exposure to physical risk factors
Describe each nursing task with respect to time spent exposed to awkward posture
(trunk flexion>20 degrees) and load

9. Data collection: PEO
Observed pre/post intervention at
both sites:
• 16 nurses each for a full shift
• Medical and orthopaedic
wards
• Staff nurses and health care
assistants
• Early and late shifts

10. Time spent on ‘intervention’ tasks
Proportion of shift Min. – Max.
 Administration 14% 3 - 26%
 Attend patient 12% 5 - 16%
 Clean/tidy 7% 1 - 14%
 Wash/dress 6% 0 - 15%
 Make bed 3% 0 - 7%
 Patient transfers 3% -
TOTAL 45%

11. Examples of task identification
attend patient administration

12. Time spent on ‘non-intervention’ tasks
Proportion of shift Min. – max.
 Communication 23% 10 - 25%
 Fetch/carry 7% 3 - 9%
 Other general 11% 6 - 31%
 Other misc. 1% 0 - 12%
 Rest break 8% 2 - 11%
TOTAL 50%

13. Time spent on ‘other’ tasks
Proportion of shift Min. – max.
 Assist to eat 0% 0 - 5%
 Drugs 1% 0 - 9%
 IV/injection 0% 0 - 5%
 Mealtime 1% 0 - 5%
 Move object 3% 1 - 6%
 Other basic 0% 0 - 4%
 Other technical 1% 0 - 3%
 TPR 0% 0 - 2%
 Wound 0% 0 - 0.3%
TOTAL 6%

14. Duration of ‘intervention’ tasks
Median duration (seconds)
Comparison Intervention
Pre (post) Pre (post)
Administration 52 (55) 58 (36)
Attend patient 38 (45) 47 (46)
Clean/tidy 68 (60) 74 (78)
Make bed 157 (260) 161 (209)
Wash/dress 415 (342) 534 (298)

15. Results: task analysis
 administration’ and ‘clean/tidy’ tasks were associated
with the least amount of trunk flexion > 20 degrees
 ‘wash/dress’ task was associated with the greatest
amount of trunk flexion > 20 degrees
 ‘make bed’ task changed by the greatest amount at
both sites

16. Results: patient transfers
Patient transfers were characterised by
 short duration
 high percentage time in trunk flexion > 20 degrees
Large variability due in part to:-
 level of patient dependency
 handling technique and equipment used
 work environment

17. Conclusions: exposure data
 Changes in exposure were less than expected
 Variability in nursing tasks made true estimates of
change in exposure very difficult to interpret
 Changes at comparison site were not anticipated

18. Conclusions
 Methods must be sensitive to anticipated change
 Tasks where interventions are targeted may form a small
part of a shift
 Organisational factors can influence the intensity and
uptake of an intervention
 The impact of an ergonomic intervention may vary in
different parts of an organisation

19. Factors that influenced the intervention
 Intervention took place in a ‘real life’ setting
 Large scale of intervention (24 wards and 1600
nurses)
 Problems with staff attendance to manual handling
training
 Work load of Health & Safety Advisers
 Profile of health and safety in the hospital

20. Recommendations
If planning a similar intervention
 Recommend a top-down/bottom-up approach
 Adopt a participatory approach
 Agree a strategy that ‘fits’ the organisation and is supported by key
stakeholders
 Target high risk work areas – depending on size of organisation
 Target high risk ‘intervention’ tasks
 Ensure change agent that leads the intervention is respected within
the organisation
 Empower local experts e.g. manual handling link nurses
 Create a sustainable structure that will survive staff turnover