Why a ‘no-lift’ policy may not be good enough
July 1, 2005 4 minutes read
Why a ‘no-lift’ policy may not be good enough
Stress, workload affect MSD injuries
Look beyond the lift to prevent ergonomic injuries. Stress, working conditions, and other psychosocial factors play a role as well, recent research shows.
That means even the best equipment and lift policies will not eliminate work-related musculoskeletal disorders (MSD). You may need to consider such issues as working hours, staffing, and stress reduction, says Nancy Menzel, PhD, RN, assistant professor at the University of Florida College of Nursing in Gainesville.
“Virtually all of the attention has been on the physical risk factors of nursing,” she says. And while lift equipment is important, “it’s not the whole story. In addition to reducing the physical risk factors in the workplace, employers are going to have to also address the psychosocial risk factors.”
The Institute of Medicine recognized this aspect of MSDs in its report, Musculoskeletal Disorders and the Workplace, when it determined that work-related MSDs are multifactorial.1 The National Institute of Occupational Safety and Health (NIOSH) also has sponsored research to shed light on working conditions and its impact on nursing injuries.
Long working hours are linked to musculoskeletal injuries, according to preliminary findings from a University of Maryland School of Nursing study of 2,600 nurses. The nurses were surveyed three times over an 18-month period about working conditions, schedules, shoulder and back pain, and needlesticks.
“We’ve seen already, with the longer work hours, that there is some impact for patients. It’s not surprising that it would be the same for nurses,” says researcher Alison Trinkoff, RN, ScD, FAAN, professor at the University of Maryland School of Nursing in Baltimore.
Scheduling can increase stress, but long hours also increase the opportunity for injury, says Trinkoff. “Your scheduling can affect how much physical demand your body is exposed to and how much chance you get to rest,” she says.
Stress adds to muscle strain
Stress itself has a physical component, as the body tenses and muscles tighten. Those changes can increase the risk of injury. “Clearly, we know that work stress also interacts with the physical factors,” says Tom Waters, PhD, CPE, team leader in the Human Factors and Ergonomics Research Section of NIOSH in Cincinnati.
A study evaluating the NIOSH lifting equation found a strong correlation between job dissatisfaction and back pain.2 “If [employees] were not satisfied at all, they were seven times more likely to have back pain in the past year,” he explains.
More research is required to explore the relationship between satisfaction and back pain. But the research findings show a link between the physical and psychosocial aspects of work and indicate that improving the psychosocial factors would bring broad benefits. Efforts to improve the work environment could include creating greater support from supervisors, building a stronger safety climate, and improving staffing, Waters adds.
Employers also could help bridge the work-home life balance with on-site day care or exercise gyms and programs. “There are interventions . . . that can alleviate the psychosocial factors,” he says.
In her studies, Menzel tried to find interventions that might reduce stress and risk of injury in nurses. In one, she recruited 32 nurses and randomly assigned them to an intervention or control group. The intervention group attended an 1½-hour class using cognitive behavioral therapy to reduce stress and pain every week for six weeks. The sample size was small because the study was designed to test the feasibility of this approach.
“To be in the study, we asked for people who had back pain in the last year of at least a week’s duration,” adds Menzel, whose study has not yet been published. “Some of them had current back pain, some had back pain in the past.”
None of the participants were on work restriction due to injury, she says. The intervention group reported less pain, while the control group reported more pain at the end of the study.
However, that finding was not statistically significant because of the small sample size, Menzel notes. Stress levels actually rose in the intervention group, although again, that was not statistically significant.
“We speculated because it was another added burden to their schedules,” she says. “They had to arrange child care and show up for the sessions. They were also made more conscious of their stress levels.”
In another small study, Menzel looked at the combination of cognitive behavior therapy and lift equipment. The study did not find a link between the cognitive therapy and fewer lost workdays, but it did show that employees who were depressed, as measured on a screening tool, were more likely to have lost work time.
Menzel also advises employee health professionals to look at pain rather than injury as the outcome variable. “If you reduce back pain and [resolve] some of the psychosocial issues, the injury rates should fall,” she says.
Of course, proper lift equipment remains most important in reducing MSDs. “This is the next frontier,” Menzel adds. “Once they get the equipment in, and nurses buy in and use it, and facilities have a no-lift policy, then facilities need to look at some of these other factors.”
References
1. Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education, National Research Council. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington, DC: National Academy Press; 2001.
2. Waters TR, Baron SL, Piacitelli LA, et al. Evaluation of the revised NIOSH lifting equation: A cross-sectional epidemiologic study. Spine 1999; 24:386-394.
Look beyond the lift to prevent ergonomic injuries. Stress, working conditions, and other psychosocial factors play a role as well, recent research shows.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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