Aching HCWs: Do you feel their pain?
January 1, 2006 3 minutes read
Aching HCWs: Do you feel their pain?
Pain proves hard to eradicate
Every day, nurses are going home with back pain. Some of them may even have back injuries they never tell you about.
Ideally, ergonomic intervention would eliminate both back pain and injury. But using pain as a way to predict future injury, or reducing pain as a goal of an ergonomic program, has proved problematic.
In fact, back pain is pervasive among nurses, says Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Research Center at the James A. Haley Veterans Hospital in Tampa, FL. "In the first studies [on back pain], we found almost every nurse reports very high levels of pain on an ongoing basis," says Nelson.
Nelson and colleagues compared back pain in units that required heavy lifting, such as the intensive care unit, and those with minimal patient handling, such as psychiatry. "There were no significant differences," she says. "They all reported high levels of pain."
Pain may be a long-term marker that reflects a career-long experience rather than a short-term effect, she says.
Nurses also may be suffering in silence. Preliminary results from a study of 2,065 nurses in 13 hospitals indicate that many nurses have had a recent injury.
When asked whether they had had an injury in the past four months, 14% said they had suffered a back injury. More than one in five (22%) reported having strained their shoulder or neck and 11% had strained their hip or leg.
The research, which has not yet been published, indicates that reports on the U.S. Occupational Safety and Health Administration's 300 log underestimate the true burden of injury, says lead author Patricia W. Stone, PhD, MPH, RN, assistant professor at the Columbia University School of Nursing.
Some health care facilities have begun to address pain, as well as injury, and to encourage reporting of pain as a "near miss" event.
At Aurora-Bay Care Medical Center in Green Bay, WI, occupational health physician Pierce Sherrill, DO, FAOASM, asks managers to respond to complaints of pain.
"I think we need to emphasize that it's OK to tell your manager when you're hurt," he says. "We need to make sure the managers understand that by the time the employee comes to them and says, I'm hurting and it's probably due to work,' this employee probably has been hurting for about a month and needs to be taken seriously right off the bat."
Sonography, in which technicians must hold a steady, awkward position, is a common area of concern. At Marshfield (WI) Clinic, Bruce E. Cunha, RN, MS, COHN-S, manager of employee health and safety, sent a symptom survey to about 40 sonographers after one developed disabling myofascitis, or muscle pain. He asked if they had any current problems, or if they had any problems with pain in the past six months. If they answered yes, they circled the body part on a figure.
"A majority said they were having problems with the neck and shoulder," says Cunha.
With help from an ergonomics consultant from the workers' compensation insurer, Cunha modified the work space. For example, monitors were moved so that the sonographers wouldn't have to twist their necks while scanning.
Sherrill and his colleagues at Aurora-Bay Care also analyzed the sonography work environment in which hand and arm injuries were prevalent. When sonographers hold an awkward, static position for five to 20 minutes, they risk muscle fatigue, he says.
Sherrill changed some equipment, adjusted the height of chairs, and modified keyboards to improve the positions. The hospital also mounted a pulley system to assist in the lifting of heavy sonography equipment. But Sherrill also told employees that it may take time for the muscle pain to go away.
In fact, studies have shown that while ergonomic interventions reduce injuries, they do not necessarily impact pain. "It may take so long for that chronic pain to go away that we're not measuring the outcomes long term enough to see differences," says Nelson.
In one study, "we collected musculoskeletal pain before and after a very large intervention," says Nelson. "We provided huge amounts of equipment, better staffing, and training. There were huge differences in other variables, but the pain remained high no matter what we did."
Injuries lead to direct costs from medical claims, workers' compensation, and lost time. But pain also takes its toll in other ways.
"The pain affects [employees'] non-work life, too. They actually cut back on recreational activities and rest up before the next shift," she says. "It affects their quality of life."
Every day, nurses are going home with back pain. Some of them may even have back injuries they never tell you about.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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