Why it's not enough to train on lift equipment
Employees move through stages of change
"Lift equipment isn't necessary unless the patient is obese. It takes too long to use the equipment. The patients won't like it."
Those are some commonly held beliefs among nurses that create a barrier for safe patient handling even if you've purchased the equipment and established a low-lift policy. Education is crucial to build buy-in from nurses for new, safer techniques for lifting, says Linda Wheadon, RN, MN, nurse health educator with the Occupational Health Department of Group Health Cooperative in Tukwilla,WA, a suburb of Seattle.
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Stages of change for preventive behavior The "Precaution Adoption Process Model" was created by psychologists Neil Weinstein and Peter Sandman to describe the stages of preventive behavior.1,2 The stages are:
References 1. Weinstein ND, Sandman PM. "The Precaution Adoption Process Model." In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education. 3rd ed. San Francisco: Jossey-Bass; 2002, pp. 121-143. 2. Whysall Z, Haslam C, Haslam R. A stage of change approach to reducing occupational ill health. Prev Med 2006; 43(5):422-428. |
"Obviously if they don't use it, it's not going to reduce injuries," says Wheadon, who was scheduled to speak at the annual conference of the American Association of Occupational Health Nurses (AAOHN) in May.
Becoming a proponent of safe lifting doesn't happen overnight. She notes that there are six stages nurses and others must go through, from a lack of awareness to an "action" stage. Education needs to address each stage.
For example, employees who are unaware need basic facts about the cause of patient handling injuries, such as the effects of cumulative stress on the spine. Those in the "deciding" phase are weighing the benefits of changing their methods with the perceived burden of using the lift equipment. They benefit from data and case studies involving back injuries as well as testimonials from others who are using the equipment.
While it may seem that nurses would embrace tools meant to protect them, safe patient handling requires nurses to change long-standing practices. "It is a tough sell," says Wheadon. "The equipment is awkward at first. It's very important for people to feel confident in using the equipment."
One-time training from the vendor isn't enough to change attitudes and habits. In fact, most nurses were taught the importance of body mechanics in nursing school. Even though research shows that body mechanics alone cannot markedly prevent injuries involved in patient handling, many nurses still believe all they need is the right posture and another nurse to help them, says Wheadon.
She conducted focus groups of nurses in the wake of the state of Washington's new safe patient handling law, which went into effect in 2007. "None of them were using the equipment to their fullest advantage," she says. "Most felt it was easier to recruit someone to pull a patient up in bed. Overall, they believed that the emphasis should be on body mechanics training."
When she evaluated the nurses' responses based on a "readiness-to-change" model, she found many of them were in the earliest stages. "They weren't aware of the cumulative dangers of lifting frequently and how the equipment could help them," she says. "Some of them weren't aware of the equipment at all. The message wasn't getting out."
It wouldn't be enough, therefore, to simply explain how to use the new equipment. "Training alone isn't going to be enough," she says. "But as a part of a comprehensive program, I think it's very important."
Based on her work, Wheadon has the following advice for implementing safe patient handling:
1. Begin by assessing the awareness of employees about safe patient handling. "Do a survey, informal or formal, to find out how informed nurses are about the problem and how engaged they are," she says.
2. Share information about injury rates, including personal stories of injured nurses." Before you start teaching people about equipment, you need to let them know the consequences. Make it personally relevant so they'll be interested," Wheadon suggests.
3. Involve nurses in the selection of the equipment. They are more likely to support the program if they helped shape it, she says. The Washington law requires frontline employees to be a part of the safe patient handling committee.
4. Explain why mechanical lifting is better for patients. Vendors will lend equipment on a trial basis, so nurses can actually feel what it's like to be lifted by a device. Also, they can gain feedback from their patients.
5. Make sure you have the support of managers. You may need to carry out these same steps with them.
6. Introduce your program with a marketing blitz. A catchy slogan, posters, e-mail messages, FAQs in the employee newsletter all those techniques will help promote the program and give it a sense of momentum.
7. Recruit role models or peer leaders. Nurses who are more knowledgeable about the equipment can encourage and train their co-workers and also will help maintain the program, Wheadon says.
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