Manual patient handling in the healthcare setting: a scoping review.

BACKGROUND: Manual patient handling is the most frequently reported risk factor for work related musculoskeletal disorders in healthcare. Patient handling tasks are routinely performed manually without assistive devices and can create awkward postures and high loads for nurses and allied health professionals (AHPs). However, AHPs, notably physiotherapists, also utilize therapeutic handling to facilitate patient movement during rehabilitation. OBJECTIVES: To comprehensively map the literature surrounding manual patient handling (without assistive devices) by healthcare practitioners. METHODS: AMED, CINAHL, MEDLINE, SPORTDiscus, and EMBASE databases were searched. Grey literature was sourced from Google Scholar, EThOS, Open Grey, Health and Safety Executive, National Institute for Occupational Safety and Health and Work Safe Australia. Literature published in English between 2002 and 2021 was included. RESULTS: Forty-nine records were included: 36 primary research studies, 1 systematic review and 12 'other' including narrative and government reports. Primary research was predominantly observational cross-sectional (n = 21). The most common settings included laboratories (n = 13) and hospitals (n = 13). Seven research questions were identified, with patient handling practices (n = 13) the most common. Nurses formed the largest practitioner population (n = 13) and patients were often simulated (n = 12). Common outcomes included tasks performed (n = 13) and physical demands during patient handling (n = 13). CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: This comprehensive scoping review identified that most research was observational, investigating nurses in hospitals or laboratories. More research on manual patient handling by AHPs and investigation of the biomechanics involved in therapeutic handling is needed. Further qualitative research would allow for greater understanding of manual patient handling practices within healthcare. CONTRIBUTION OF THE PAPER.

Proof of Concept Testing of Safe Patient Handling Intervention Using Wearable Sensor Technology.

BACKGROUND: Healthcare workers make up one of the occupations in the United States that experience the most musculoskeletal injuries. These injuries are often related to the movement and repositioning of patients. Despite previous injury prevention attempts, injury rates remain at an unsustainable level. The purpose of this proof-of-concept study is to provide preliminary testing of the impact of a lifting intervention on common biomechanical risk factors for injury during high-risk patient movements.; Methods: A before-and-after (quasi-experimental) design was utilized to compare biomechanical risk factors before and after a lifting intervention. Kinematic data were collected using the Xsens motion capture system, while muscle activations were collected with the Delsys Trigno EMG system. RESULTS: Improvements were noted in the lever arm distance, trunk velocity, and muscle activations during the movements following the intervention; Conclusions: The contextual lifting intervention shows a positive impact on the biomechanical risk factors for musculoskeletal injury among healthcare workers without increasing the biomechanical risk. A larger, prospective study is needed to determine the intervention's ability to reduce injuries among healthcare workers.

Identifying the critical physically demanding tasks performed by personal support workers in Canada.

Due to increased work demands, personal support workers (PSWs) are experiencing more work-related injuries. However, little is known about PSW work tasks and their corresponding physical demand. The purpose of this study was to identify critical tasks that are physically demanding and completed frequently as identified by PSWs. Additionally, we identified contextual factors (i.e., environmental-, situational-, patient-related) that influenced physical demands. We surveyed 443 community-based PSWs working in Canada who rated the physical demand associated with client care tasks and identified contextual factors that can increase task specific physical demands. Transferring/repositioning patients, dressing, and bathing were perceived as most demanding. Patient weight and mobility influenced the level of physical demand required for most tasks. These data provide a foundation to develop physical employment standards and task specific education and training to prevent PSW injuries.

Norma técnica de salud para el cuidado integral de la persona afectada por tuberculosis, familia y comunidad (NTS N° 200-MINSA/DGIESP-2023) / Technical health standard for the comprehensive care of the person affected by tuberculosis, family and community (NTS N° 200-MINSA/DGIESP-2023)

La presente publicación describe los criterios clínicos y programáticos, así como los procedimientos técnicos de las intervenciones sanitarias en el cuidado integral por curso de vida de la prevención y control de la tuberculosis en la población afectada o con factores de riesgo. Asimismo, incorpora importantes avances e innovaciones para la prevención y control de la tuberculosis, basadas en las recomendaciones brindadas por los organismos internacionales de salud y evidencias científicas, aplicadas a la realidad nacional. Así, incluye la introducción de metodología molecular en el diagnóstico de esta enfermedad, el uso de nuevos medicamentos para la terapia preventiva, esquemas totalmente orales y acortados para el tratamiento de la tuberculosis resistente, un mayor involucramiento de los actores comunitarios en la prevención y la detección de la tuberculosis, así como su participación activa en las diversas intervenciones estratégicas

The differences between normal and obese patient handling: re- structural analysis of two questionnaires.

BACKGROUND: Precise causes of musculoskeletal complaints among nurses are not known well, but many studies have pointed to manual patient handling tasks. Subjective judgment and decision-making process for patient lifting is crucial for gathering data regards patient handling. The aim of this study was to consider reliability and validity and re-structure of two special tools for patient handling's tasks. METHODS: In this cross- sectional study 249 nurses were fully participated. As recommended by literature for cultural adaptation of instruments, forward/backward translation method was applied. Reliability of the translated version was assessed by Cronbach's alpha coefficient. Validity testing for the two scales was based on content validity index/ratio analysis and also Exploratory Factor Analysis was run to extract latent factors. RESULTS: Reliability estimated by internal consistency reached a Cronbach's Alpha of above 0.7 for all subscales of two questionnaires. After testing the validity, the final version of questionnaires was remained by 14 and 15 questions respectively. CONCLUSIONS: These instruments evaluated for manual handling of normal and obese patients had acceptable validity and reliability in Iranian Nursing context. So, these tools can be used in further studies with the same cultures.

Evaluation of the implementation and effectiveness of a multifactorial intervention strategy for safe patient handling and movement in the healthcare sector: a study protocol of a cluster randomised controlled trial.

INTRODUCTION: Healthcare workers with physically demanding work tasks, such as patient handling and movement (PHM), are at high risk of musculoskeletal disorders. To facilitate safe PHM and prevent musculoskeletal disorders, a combination of workplace interventions, including risk assessments, is needed. The aim of this study is to implement and evaluate a multifactorial intervention strategy for safe PHM and compare it with a single intervention strategy. METHODS AND ANALYSIS: This cluster randomised controlled trial will compare a multifactorial intervention strategy with a single intervention strategy for safe PHM in workplaces in the Swedish regional and municipal healthcare systems. At least twelve healthcare units will be recruited. Care units belonging to arm A will receive: (1) guidelines for PHM, (2) training modules, (3) risk assessment with TilThermometer, (4) risk assessment with Downtown Fall Risk Index and (5) work environment mapping. Care units belonging to Arm B will receive interventions (1) and (5). The two strategies will be evaluated with regards to (1) the primary outcome of the applied strategies' intervention effectiveness (safety climate in relation to aspects of PHM) and (2) the primary implementation outcome (acceptability, appropriateness and feasibility). This study will also explore the implementation process and intervention fidelity, examine the influence of contextual factors and investigate participants' experiences of working with strategies for safe PHM. A mix of quantitative and qualitative methods will be used. The data collection is based on questionnaires, interviews and field notes of contextual factors. ETHICS AND DISSEMINATION: The study is approved by the Swedish national ethical board (Dnr 2021-00578). Study results will be published in peer-reviewed journals, presented at conferences and distributed on social media. A lay summary and dissemination strategy will be codesigned with a reference group and participating healthcare units. TRIAL REGISTRATION NUMBER: NCT05276180.

The influence of bed height as a percentage of participant height on low back forces when boosting a patient up in bed.

BACKGROUND: Repositioning patients is a frequent task for healthcare workers causing substantial stress to the low back. Patient handling methodologies that reduce low back load should be used. Some studies have observed the effect of bed height on back forces using a limited range of heights. This study details a wider range. OBJECTIVE: The aim of this study was to discover an optimal bed height for reducing low back force when boosting a patient. METHODS: 11 university students and local residents participated by completing a series of boosts with a 91.6 kg research assistant acting as dependent. The bed was adjusted 3% of participant height and 3 boosts were completed at each height which resulted in 8-10 different bed heights depending on the height of the participant. Motion and force data were collected to estimate low back forces via 3DSSPP. Pearson's R was performed to observe the correlation between caregiver height and low back forces. RESULTS: There were significant negative correlations between bed height and low back compression force at L4-L5 (r = -0.676, p = <0.001) and L5-S1 (r = -0.704, p = <0.001). There were no significant correlations with any shear forces. CONCLUSION: The highest bed height led to decreased low back compression forces regardless of participant height, but there was not a significant difference in shear forces. Thus, healthcare workers may experience less low back stress with the bed at a higher height. There may be a force tradeoff between the low back and other parts of the body that needs further exploration. Healthcare workers need to be made aware of the implications of adjusting the environment when performing patient handling tasks.

What affects musculoskeletal risk in nursing assistants and orderlies?

BACKGROUND: There are many musculoskeletal disorders in staff members at health centres, given the specific characteristics of their work. OBJECTIVE: The objective was to analyse the postural risk of patient handling tasks performed by nursing assistants and orderlies, as well as task factors, individual or organisational, that may be associated with increased postural risk. METHOD: This is a cross-sectional observational study. Analysis was done on 170 postures in five different tasks performed by 39 participants at three hospitals in Andalusia (Spain). The questionnaires collected sociodemographic variables, the task done, and REBA were used for assessment of postural risk. RESULTS: Overall the average REBA score was 9.0±2.4. Moving the patient to the head of the bed was the task with the highest risk (9.8). Handling involving more than two participants at once increased postural risk. Using mechanical aids were associated with high risk in the legs. Logistic regression analyses showed that age, stature, and not having adjustable beds available were associated with postural risk (p < 0.05). CONCLUSION: Health centre staff perform many tasks with high musculoskeletal disorder risk. Age, stature of the participants, and adjustment of bed height were associated with postural risk.

Nurses sustain manual handling risk assessment behaviours six-months after a training program to move patients safely: a pre-post study.

PURPOSE: To determine if a patient manual handling training program focused on dynamic manual handling risk assessment for staff and patient safety, together with the patient's need for physical rehabilitation, can be transferred and sustained in clinical practice. MATERIALS AND METHODS: Using a pre-post design, nurses (n = 72) from acute and rehabilitation wards participated in a 4-hour training session teaching dynamic manual handling risk assessment to safely move patients. Clinical observations audits of patient transfers were conducted prior to, and at 1-month and 6-months post training. Surveys determined experiences of training. Nurse musculoskeletal injuries and patient falls were measured 6-months after training. RESULTS: Program patient handling skills were competently implemented 89% of the time 1-month following training and were sustained 6-months following training. There was no change in falls rates and staff injury rates were very low pre- and post-training. Training was well received and all nurses passed the competency assessment. CONCLUSION: The patient handling training program taught nurses to better identify factors associated with risk to themselves and their patients and gave them improved skills to help patients move. Skills were incorporated safely into clinical practice and sustained at 6-months. It is uncertain whether training impacted musculoskeletal injuries.Implications for rehabilitationA dynamic manual handling risk assessment program for safely transferring and moving patients balances staff safety with the patient's need for physical rehabilitation.Nurses can be taught risk assessment skills to better identify factors associated with risk to themselves and their patients that can be translated to clinical practice.Thorough risk assessment at the point of the nurse-patient interaction can enable a patient to move at their highest level of function thus providing patients with opportunities to progress their rehabilitation at every interaction.

Patient handling and transportation from site of injury to tertiary trauma centres in Nepal following acute traumatic spinal cord injury: a descriptive study.

STUDY DESIGN: Descriptive study. OBJECTIVES: To describe patient handling at injury site, number of healthcare centre transfers to reach tertiary trauma centre, modes of transportation, and time from injury to reaching tertiary trauma centres among individuals with acute traumatic spinal cord injury (tSCI). SETTING: Acute SCI rehabilitation centre, Nepal. METHODS: All individuals with new tSCI admitted for rehabilitation over period of 1 year were eligible for enrolment. Following written, informed consent, enroled individuals participated in structured one-on-one interview. Data collected included demographics, injury details, pre-hospital handling techniques, and transportation specifics to tertiary trauma centre. RESULTS: In total, 211 individuals were enroled in the study. Eight (4%) individuals were assisted by first responders or traffic police, with majority (n = 203, 96%) assisted by untrained individuals. One was transferred from injury site using spinal motion restriction measures. Half were transported exclusively by ambulance while others used combinations of transportation. Six (3.4%) individuals were cared for by trained medical person during transport. Half required two or more hospital transfers prior to reaching a tertiary trauma centre. In total, 98 individuals required >24 h to reach the tertiary trauma centre. CONCLUSIONS: Individuals sustaining a tSCI in Nepal often experience improper handling, multiple hospital transfers, and prolonged time to reach tertiary trauma centres following acute tSCI. Further expanding emergency medical response systems throughout the country, training and equipping first responders in spinal motion restriction techniques, and establishing clear referral pathways for individuals with suspected tSCI are warranted. Development in these specific areas may reduce morbidity and mortality following acute tSCI.

Protótipo de colchão pneumático ergonômico para o manejo de paciente com mobilidade física prejudicada / Ergonomic pneumatic mattress prototype for the management of patients with impaired physical mobility

Resumo: Trata-se do desenvolvimento de tecnologia para assistência na saúde, com depósito de Patente ­ Modelo de Utilidade, denominado de Colchão Pneumático Ergonômico com Bolsões Insufláveis Individualmente. A finalidade dessa inovação tecnológica é auxiliar na mobilização e reposicionamento de pacientes com mobilidade física prejudicada, restritos ao leito, com alto risco de lesões cutâneas, complicações pulmonares e outros agravos à saúde. A mudança de decúbito, um dos principais cuidado de enfermagem, exige técnica adequada, disponibilidade de mais de um profissional qualificado e uso de dispositivos, como coxins de posicionamento convencionais ou improvisados. Tem como objetivo reduzir riscos de agravos à saúde do paciente e doenças ocupacionais, como lombalgia e doenças osteoarticulares nos profissionais de saúde ou cuidadores em domicílio. A tecnologia foi projetada com bolsões de diferentes dimensões, de acordo com cada região corporal, os quais possuem válvulas pneumáticas internas, que permitem insuflar individualmente as câmaras de ar presentes na estrutura. Um teclado matricial recebe comandos para insuflar e desinflar os bolsões de ar pela mangueira pneumática, de modo a permitir o reposicionamento do paciente sem necessidade de força própria. Baseado em conhecimento inédito, introduziu novidade, resultando em nova tecnologia para o ambiente social e produtivo. É uma inovação radical, disrruptiva com impacto significativo no ambiente de cuidado, a qual apresenta blocos em diferentes dimensões, insufláveis individualmente, com uma camada de espuma entre a câmara de ar e a cobertura externa, cintas de fixação para estabilidade do colchão, confeccionado com tecido macio, impermeável e de boa elasticidade. Caracteriza-se como tecnologia de alta complexidade, pois associa diferentes tipos de conhecimento e interage com múltiplos saberes, na solução do problema identificado na prática clínica. O impacto social e econômico ocorre pela melhoria da qualidade da assistência, redução de agravos e, consequentemente, redução de custos ao sistema de saúde. Aplicável em diversos cenários de cuidado, como hospitais, casas de longa permanência e domicílio, tem potencial para abrangência nacional e internacional. Atende uma demanda profissional, pois oferece condição ergonômica adequada para o manejo de pacientes restritos ao leito. Com depósito de Patente no Instituto de Propriedade Industrial (INPI), sob o Protocolo de Número BR202022008156-0, está disponível para transferência da tecnologia entre a organização pública (Universidade ­ Pós-Graduação) e a Indústria, resultando em inovação que necessariamente aperfeiçoa o processo de cuidar e o serviço de saúde.

Abstract: This is the development of technology for health care, with the filing of a Patent ­ Utility Model, called Ergonomic Pneumatic Mattress with Individually Inflatable Pockets. The purpose of this technological innovation is to assist in the movement and repositioning of patients with impaired physical mobility, restricted to bed, with a high risk of skin lesions, pulmonary complications and other health problems. Changing positions, one of the main nursing care procedures, requires adequate technique, the availability of more than one qualified professional and the use of devices, such as theoretical or improvised positioning pads. It aims to reduce risks of harm to the patient's health and occupational diseases, such as low back pain and osteoarticular diseases in health professionals or caregivers at home. The technology was designed with pockets of different dimensions, according to each body region, which have internal pneumatic valves, which allow individually inflating the air chambers present in the structure. A matrix keyboard receives commands to inflate and deflate the air pockets through the pneumatic hose, in order to allow the patient to be repositioned without the need for its own strength. Based on innovative knowledge, innovation, generated in new technology for the social and productive environment. It is a radical, disruptive innovation with a significant impact on the care environment, which features blocks in different dimensions, individually inflatable, with a layer of foam between the air chamber and the outer cover, fastening straps for the mattress pad, made with soft fabric, waterproof and good elasticity. It is characterized as a highly complex technology, as it associates different types of knowledge and interacts with multiple types of knowledge in order to solve the problem identified in clinical practice. The social and economic impact occurs by improving the quality of care, reducing injuries and, consequently, reducing costs to the health system. Applicable in different care settings, such as hospitals, long-term care facilities and at home, it has the potential for national and international coverage. It meets a professional demand, as it offers adequate ergonomic conditions for the management of bedridden patients. With a patent filed at the Industrial Property Institute (INPI), under Protocol Number BR202022008156-0, the technology is available for download between the public organization (University - Graduate) and the Industry, generated in innovation that necessarily improved the care process and the health service.

Air-Assisted Technology: A Quality Endeavor to Reduce Employee Injury and Hospital-Acquired Pressure Injuries.

Continuous quality improvement using Lean methodology engages and values the expertise of the staff close to the patient and the everyday work of caring for them. The patients are not safe if the staff is not safe. Finding the appropriate methodology, where the problem is deeply investigated, respect is visible in the process, and evidence-based decision-making takes place to find safe patient handling solutions for moving lifting and transferring patients was a key objective in this Lean process improvement effort. This article describes the journey taken, the collaboration of 2-unit based councils, and the successful implementation of an air-assisted moving, lifting, and transferring system at a large level 1 quaternary tertiary intercity hospital.

Safe patient handling education: analysis from European higher education institutions.

OBJECTIVES: According to current research, patient handling is not universally taught in academic nursing programs in Europe. Miscellaneous patient handling education may expose students and novice health care workers to occupational hazards, especially if the evidence-based contents of safe patient handling are not recognized. Health care workers deal with high physical workloads daily, which points out the importance of evidence-based curricula contents from the early phases of education. The aim of this study was to describe the patient handling education and to analyse the differences in curricula among higher education institutions (HEIs) in Europe. MATERIAL AND METHODS: The study used a cross-sectional design and was conducted in HEIs educating health care professionals in Europe. The data was collected through a Webropol questionnaire consisting of structured and open-ended questions. RESULTS: Only 68.4% of the respondents stated that they have a framework that guides the patient handling education. Additionally, some answers referred to guidelines that are not adequate to be referred to as evidence-based guidelines on patient handling. There is variation in emphasizing workplace safety and risk assessment issues in the curricula, and variation in teaching of assistive aids. CONCLUSIONS: Currently the patient handling education in the studied HEIs does not meet the requirements of evidence-based practice. The establishment of a European-wide framework, including both theoretical and practical training for safe patient handling is needed. The inclusion of risk assessment and workplace safety issues is essential to improve the risk management knowledge and skills and further avoid work-related musculoskeletal disorders. Int J Occup Med Environ Health. 2022;35(5):615-23.

Translation and cross-cultural adaptation of the risk assessment instrument TilThermometer for a Swedish version - patient handling in the healthcare sector.

BACKGROUND: Work-related musculoskeletal disorders are common in the healthcare sector due to exposure of physical demanding work tasks. Risk assessment is necessary to prevent injuries and promote a safety culture. The TilThermometer has proved to be useful in the Netherlands for assessing healthcare workers' physical exposure to patient handling. The aim of this study was to translate the risk assessment instrument TilThermometer from Dutch to Swedish, perform cross-cultural adaptation, and evaluate its linguistic validity to a Swedish healthcare context. METHODS: Translation and validation process was performed according to following eight steps: 1) Translation (two translators), 2) Synthesis, 3) Back-translation (two back-translators), 4) Synthesis, 5) Linguistic review (one bilingual reviewer), 6) fifteen experts in a panel review according to Delphi-method, 7) Semi-structured interviewing eleven informants, analyzed using qualitative content analysis and step 8) discussion and input from creators of the instrument. RESULTS: A new Swedish version, the TilThermometer, was provided through the translation process (steps 1-5). The linguistic validity and usefulness were confirmed thru step 6 and 7. Consensus was reached in the expert review after two rounds, comments were analyzed and grouped into five groups. The qualitative content analyses of the interviews emerged in to three categories: 1) "User-friendly and understandable instrument", 2) "Further development", and 3) "Important part of the systematic work-environment management". CONCLUSION: In this study, the cross-cultural adaption and translation performed of the Swedish version of TilThermometer assured linguistic validity. This is this first phase before further testing the psychometrics aspects, inter-rater reliability and feasibility of TilThermometer. In the second phase TilThermometer will be implemented and evaluated together with other measures in the Swedish healthcare sector.