Oh, Their Aching Backs! Occupational Injuries in Health Care Professionals Patricia Graham, RN, MS, CNE - PowerPoint PPT Presentation

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Oh, Their Aching Backs! Occupational Injuries in Health Care Professionals Patricia Graham, RN, MS, CNE

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My Interest. Specifically interested in back injuries because of family history. Responsible for staff and student training in body mechanics. Professional curiosity ... – PowerPoint PPT presentation

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Title: Oh, Their Aching Backs! Occupational Injuries in Health Care Professionals Patricia Graham, RN, MS, CNE


1
Oh, Their Aching Backs! Occupational Injuries
in Health Care ProfessionalsPatricia Graham,
RN, MS, CNE
2
About me
  • Started as housekeeper in a nursing home
  • Progressed from CNA, LPN, RN, BSN, MSN, CNE
  • Restorative Nurse, Staff Development, ADON
  • Graduate work in nursing education with focused
    projects and thesis on back injuries in
    healthcare workers
  • Currently direct a Nurse Aide Program, teach in a
    BSN program, staff education consultant, small
    business owner

3
My Interest
  • Specifically interested in back injuries because
    of family history
  • Responsible for staff and student training in
    body mechanics
  • Professional curiosity about nurse aide back
    injuries as an understudied population sparked
    graduate school research

4
Purpose
  • Discuss current research into occupational
    injuries in nursing and graduate research
  • Strategies for injury prevention including staff
    and student education

5
Statistics
  • Nurse aides, orderlies and attendants are the 2nd
    highest occupation for MSDs and RNs are 5th
    (Dept of Labor 2006)
  • Rising rates of overweight and obese pts. are
    compounding problem.
  • In 20072008, about one-third of adults
    were obese and about two-thirds were overweight
    or obese (CDC 2010)
  • CNAs may be at greater risk for injury than RNs
    (Li, Wolf, Evanoff, 2004)
  • Nature of their work
  • Lack of empowerment

6
American Nurse Association Statistics
  • ANA estimates 12 of nurses leave annually r/t
    back injuries
  • Nurses use 30 more sick leave annually due to
    back pain when compared to the general workforce
  • Over 52 of nurses complain of chronic back pain
    and 38 of the nursing workforce has been
    affected by back injuries

7
My Research
  • Survey sent out to nurse aides in Colorado
  • Gathered information on
  • -Demographics
  • -Employment
  • -Dichotomous and Likert style questions about
    injuries, training, equipment and facilities
  • -Open ended question asking what CNA perceived
    as the hardest part of their job

8
Findings
  • 46 reported having hurt selves while lifting,
    moving, or helping a patient
  • 40 reported having hurt back while lifting,
    moving, or helping a patient
  • 78 of those reporting back injuries were
    working in nursing home at time of injury
  • CNA workplace training M3.23
  • CNA school training M3.69

9
Findings (cont.)
  • Training on back injury prevention received at
    work and school but not applied
  • Meaningful proportion (43) noted that hardest
    aspect of their jobs were.
  • Having too many patients and/or not enough help
  • Poor communication
  • Being looked down on by nurses, having poor
    relationships with nurses with whom they worked

10
Implications
  • Work-related injury, especially back injury, is
    an important issue in work life of CNAs
  • Culture change needed easier to put up
  • than get help or complete necessary paper
    work

11
Implications (cont.)
  • Staffing implications
  • Owning own role in less than ideal CNA-Nurse
    working relationships
  • On-going prevention education needed

12
Contributing factors to MSD
  • Quick movements, repetitive movements
  • Combative patients
  • Long work hours and overtime
  • Work schedules
  • Staffing shortages
  • Heavy lifting, bending and twisting

13
Evidence-Based Interventions and Challenges
  • Patient handling equipment
  • No-lift Policies
  • Training on proper use of equipment and devices
  • Lift teams
  • Ongoing education

14
Patient Handling Equipment
  • Hi/Low beds, mobile lifts, ceiling mounted lifts,
    lateral transfer aides
  • Challenges
  • Cost
  • Staff training
  • Time
  • Equipment selection for each patient

15
No-Lift Policies
  • Use of equipment to move patients to reduce
    manual lifting
  • Challenges
  • Putting equipment in place before policy is
    implemented
  • Time
  • Staff buy in (Nonpunitive approach)

16
Training with Equipment
  • Ongoing training in the use of equipment and
    devices
  • Challenges
  • Training staff across shifts, staff turnover
  • Reinforce training
  • Training on equipment only used sporadically

17
Lift Teams
  • Two physically fit people, competent in safe
    lifting techniques, working together to
    accomplish high-risk patient transfers.
  • Challenges
  • Logistics of providing a team 24/7
  • Cost
  • Managing workload

18
Ongoing Education
  • Annual body mechanics reviews
  • Challenges
  • Education alone has proven ineffective for MSD
    safety
  • Qualified instruction and return demonstration is
    key (ideal to spot check workers on the job)
  • Consistent training for new employees and f/u
    within first 90 days
  • Training to specific patient needs is difficult
  • Modeling behavior by peers
  • Cost

19
Emerging Interventions and Challenges
  • After-action reviews
  • Clinical tools
  • Peer leaders

20
After-Action Reviews
  • Ways for health care providers to learn from
    their own mistakes as well as mistakes of others
  • Challenges
  • Support and timely response by management
  • Time constraints
  • Staff fear and embarrassment

21
Clinical Tools
  • Patient assessment tools to standardize ways to
    assess patients and decide on appropriate lifting
    and care techniques
  • Challenges
  • Staff training (turnover, reinforced over time)
  • Integration into routine processes (admissions,
    COC)
  • Communication between staff

22
Peer Leaders
  • Specially trained staff who works on-site with
    staff to make practice changes and improve safety
  • Challenges
  • Incentives
  • Support and timely response by management
  • Choosing appropriate peer leaders

23
Helpful Work Practices
  • Assess patient and yourself
  • Eliminate or reduce manual lifting when possible
  • Get help and ask patients to help
  • Mentally plan
  • Good working height
  • Check equipment
  • Proper body mechanics
  • Use your legs, keep patient close
  • Do not twist when turning (pick up or pivot feet)

24
Make Education Count!
  • Modeling behaviors
  • Ongoing training and assessment
  • Return demonstrations (with real patients)
  • Positive reinforcement system

25
Help!
  • Facebook- Injured Nurses Network of America
  • Nurse and Health Care Worker Protection Act of
    2009 (S.1788)
  • Full text http//www.govtrack.us/congress/billtext
    .xpd?bills111-1788
  • ANA- http//www.anasafepatienthandling.org/
  • Work Injured Nurses Group (WING)

26
S. 1788 Summary
  • Nurse and Health Care Worker Protection Act of
    2009 - Requires the Secretary of Labor to propose
    a standard on safe patient handling and injury
    prevention to prevent musculoskeletal disorders
    for direct-care registered nurses and all other
    health care workers that requires the use of
    engineering controls to lift patients and the
    elimination of manual lifting of patients through
    the use of mechanical devices, except where
    patient care may be compromised. Requires health
    care employers to (1) develop and implement a
    safe patient handling and injury prevention plan
    (2) provide their workers with training on safe
    patient handling and injury prevention and (3)
    post a uniform notice that explains the standard
    and the procedures to report patient
    handling-related injuries. Requires the Secretary
    to conduct unscheduled inspections to ensure
    compliance with safety standards. Allows health
    care workers to (1) refuse to accept an
    assignment in a health care facility that
    violates safety standards or for which such
    worker has not received required training and
    (2) file complaints against employers who violate
    this Act. Prohibits employers from taking adverse
    actions against any health care worker who in
    good faith reports a violation, participates in
    an investigation or proceeding, or discusses
    violations. Authorizes health care workers who
    have been discharged, discriminated, or
    retaliated against in violation of this Act to
    bring legal action for reinstatement,
    reimbursement of lost compensation, attorneys'
    fees, court costs, and other damages. Requires
    the Secretary of Health and Human Services (HHS)
    to establish a grant program for purchasing safe
    patient handling and injury prevention equipment
    for health care facilities.

27
Success Stories
  • San Francisco General Hospital- Lift teams and
    equip
  • Camden Nursing Home (Maine)- Lifts
  • Kennebec LTC (Maine)- Lifts, assessment tools,
    gaitbelts, comprehensive training, safety rewards
  • Six LTC facility cohort study
  • 6 facilities, 1728 participants, 6 year pre-post
    intervention
  • Equipment, zero lift, training (45 minutes-2
    staff, return demo on residents)
  • 73 reduction in workers comp claims
  • Equipment and training expenses recovered in less
    than 3 years

28
Personal and Professional Interventions
  • Presentation of research findings at nursing
    conferences, webinars
  • Discussion of findings with students, peers,
    colleagues, friends and family
  • Student training, modeling, and reinforcing
    behaviors
  • Assist with local facilities -annual training,
    return demos
  • Formation of Occupational Training Solutions
    (OTS) to produce a product that could be used to
    prepare and retrain safe and competent caregivers

29
Basic Nursing TrainingSupplements
  • Product Development
  • Basic Care Skills for Nurses and Nursing
    Assistants
  • More than 50 skills are covered on 5 DVDs in
    this OTS Basic Nursing video series.
    Demonstrating basic nursing care from real nurses
    on real people
  • Videos are divided into easy to follow modules.
    Additional learning resources and assessment
    tools are included in our package.
  • Each skills video includes
  • Clear and concise skills demonstrations
  • Modeling of compassionate interactions between
    caregivers and patients
  • Bonus instructional features with tips on Things
    to Remember and Things to Report when caring
    for patients
  • Safe and competent care tips throughout each
    video
  • Proper lifting and back safety techniques modeled
    throughout. Module of 8 different transfer
    techniques included

30
  • Thank you!
  • Questions? Email me!
  • Patricia Graham
  • patricia_at_otsinfo.com
  • Product Information at
  • www.basicnursetraining.com
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