Superman need not apply: 5 myths of patient handling
Exercise, training, back belts won’t prevent injury
Hospitals rate among the top injury sources for work-related musculoskeletal disorders. Despite efforts to improve patient handling, in the past two decades, back injuries among nurses have risen substantially.
"It’s not that we haven’t tried anything [to prevent the injuries]," says Peggy Swirczek, CHSP, director of loss prevention services at the Michigan Health and Hospital Association in Lansing. "We’ve tried lots of things."
Unfortunately, some approaches to resolving patient handling hazards simply don’t work. Here are a few of the misguided notions about preventing musculoskeletal hazards:
1. Men can lift substantially more weight than women. When a patient seems too heavy and too dependent for a female nurse (or even two nurses) to lift, they often take the Superman approach. They call in a male colleague.
But lifting guidelines drafted by the National Institute for Occupational Safety and Health (NIOSH) make it clear that the lifting capacity for men is not substantially higher than for women. (NIOSH sets a limit of 46 pounds in ideal circumstances for women, and 51 pounds for men. The guidelines involved lifting a box with handles, not human beings.)
"Very few of our patients weigh under 51 pounds, and none of [the lifting is] under ideal conditions," remarks Bernice Owen, RN, PhD, professor and researcher at the University of Wisconsin-Madison. Part of the problem is the mindset in health care. "[Nurses think], This patient weighs 100 pounds; this person is light. I don’t need any help,’" she says. "But if you were in industry and told you have to lift a 100-pound box, think of the reaction you’d have."
A survey of health care workers at long-term care facilities in Michigan revealed that the average aide feels capable of lifting a totally dependent patient who weighs 150 pounds or less without assistance, Swirczek says. A similar survey is under way at the state’s hospitals.
2. Training in proper lift techniques can prevent injuries from patient handling. A nurse may have lifted patients day after day, with only occasional back strain and no serious ramifications. Then, one day, the nurse transfers a patient and suffers a back injury. The first reaction may be to ask, What did she do wrong?’
But ergonomics experts say even the best posture can’t make it safe to lift a load that is too heavy. "You can’t train [workers] to lift in an environment that’s hazardous," says Swirczek.
"We have to change the job in order to fit the worker — that’s what ergonomics is — instead of putting the whole onus on the worker and expecting them to change," says Owen. In some patient handling tasks, the "ideal" position to lift simply isn’t possible.
"One of the basics of body mechanics is straight back and bent knees," she says. "If the patient is in the middle of the bed and you’re going to lift them up in bed, how are you going to do that? The patient’s not real close to you."
3. Two-person lift teams can be used instead of lift equipment. Lift teams can be effective, depending on the weight of the patient and the number of people who are assisting. But the NIOSH guidelines still apply, notes Swirczek. If the amount lifted by each person exceeds 51 pounds, the team is lifting too much. "The considerations have to be made based on the equipment available, the weight of the patient, and the number of caregivers involved in the transfer."
"You’ve got to use engineering controls," adds Owen. "With a lot of engineering controls we need two people."
That doesn’t mean the lift team will necessarily need expensive mechanical lifts. Beds that fold into chairs and chairs that flatten and become horizontal allow for easier transfers. In a horizontal transfer, friction reducers can help as health care workers slide the patient.
4. Patients feel uncomfortable in mechanical lifts and would rather be lifted manually. "That is such a fallacy," scoffs Owen. "Why do we even think that? Sure, there are patients who are uncomfortable in a mechanical lift — probably because they sense the nurses don’t know what they’re doing. When people are skilled, when you have
a full ergonomics program implemented, our research has shown that patients are comfortable."
After all, how comfortable is it to be grasped under the arms and yanked out of a chair, notes Swirczek.
5. Back belts and regular exercise programs can reduce back injuries. Exercise is valuable to good back health, but it can’t combat a work hazard, says Owen. "I don’t think there’s evidence that it prevents back injuries," she says. "There is some evidence that people who have been back injured who have regular exercise, they are rehabilitated faster." Fatigue and the repetitive nature of the patient handling tasks can play a role in injury, says Owen.
Some nurses may say that "a little" back pain is just a part of the job. "I think we have to begin to melt that down a bit by saying we have a right to a healthy and safe workplace that includes [being free of] back ache, or neck or shoulder pain," she says.
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