RESUMEN
OBJECTIVE: To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. METHODS: This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. RESULTS: There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). CONCLUSIONS: The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.
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Movimiento y Levantamiento de Pacientes/normas , Úlcera por Presión/diagnóstico , Factores de Tiempo , Anciano , Ropa de Cama y Ropa Blanca/normas , Ropa de Cama y Ropa Blanca/estadística & datos numéricos , Lechos/normas , Lechos/estadística & datos numéricos , Distribución de Chi-Cuadrado , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Movimiento y Levantamiento de Pacientes/métodos , Movimiento y Levantamiento de Pacientes/estadística & datos numéricos , Úlcera por Presión/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To quantify differences in physical workload afforded by turn-assist surfaces relative to manual patient turns, and between nursing caregivers (turn-away vs. turn-toward) while performing partnered patient turning. BACKGROUND: Nurse caregivers experience an increased risk of musculoskeletal injuries at the back or shoulders when performing patient-handling activities. Use of turn-assist surfaces can reduce the physical burden and risk on caregivers. METHOD: Whole-body motion capture and hand force measures were collected from 25 caregivers (17 female) while performing partnered manual and technology-facilitated turns. Shoulder and low back angles and L4/L5 joint contact forces were calculated at the instant of peak hand force application for both caregivers. RESULTS: Hand force requirements for the turn-away caregiver were 93% of the estimated maximum acceptable force when performing a manual turn. Use of a turn-assist surface eliminated hand forces required to initiate the patient turn for the turn-away caregiver, where their role was reduced to inserting appropriate wedging behind the patient once the facilitated turn was complete. This reduced shoulder moments by 21.3 Nm for the turn-away caregiver, a reduction in exposure from 70% of maximum shoulder strength capacity to 15%. Spine compression exposures were reduced by 302.1 N for the turn-toward caregiver when using a turn-assist surface. CONCLUSION: Use of a turn-assist surface reduced peak hand force and shoulder-related exposures for turning away and reduced spine-related exposures for turning toward. APPLICATION: Turn-assist devices should be recommended to decrease the risk of musculoskeletal disorder hazards for both caregivers when performing a partnered patient turn.
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Lechos , Fenómenos Biomecánicos/fisiología , Cuidadores , Ergonomía , Movimiento y Levantamiento de Pacientes , Traumatismos Ocupacionales/prevención & control , Adulto , Técnicos Medios en Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento y Levantamiento de Pacientes/efectos adversos , Movimiento y Levantamiento de Pacientes/instrumentación , Movimiento y Levantamiento de Pacientes/normas , Personal de Enfermería en HospitalRESUMEN
AIM: To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact. BACKGROUND: Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking. DESIGN: Multicentre, cluster, three-arm, randomized, controlled pragmatic trial. METHODS: Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group. RESULTS: Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group. CONCLUSION: This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education. TRIAL REGISTRATION: This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.
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Adhesión a Directriz/estadística & datos numéricos , Movimiento y Levantamiento de Pacientes/instrumentación , Movimiento y Levantamiento de Pacientes/normas , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Úlcera por Presión/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento y Levantamiento de Pacientes/estadística & datos numéricosRESUMEN
The efficiency of training programmes in handling designed to prevent injuries has rarely been demonstrated by studies in the workplace. This study aimed to identify factors that may favour or inhibit the application of safe handling principles by paramedics performing full-body transfers of patients from a stair chair to a stretcher. In an observational field study, handling methods used in 45 patient transfers from a stair chair to stretcher were characterised. Principles concerning the physical environment seem to be applied frequently, but those applicable during the transfer are neglected. Principles taught during training may not be applied due to the physical constraints of the workplace and the underestimation of risk exposure. The results suggest that training should be enhanced, not by focussing on handling techniques but by focussing on compromise and the capacity to adapt work techniques based on the working context and the team-mate.
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Técnicos Medios en Salud/educación , Educación/métodos , Movimiento y Levantamiento de Pacientes/normas , Enfermedades Musculoesqueléticas/prevención & control , Traumatismos Ocupacionales/prevención & control , Adulto , Humanos , Persona de Mediana Edad , Camillas , Adulto JovenRESUMEN
Currently, due to shortages in the nursing faculty and low access to actual patients, it is difficult for students to receive feedback from teachers and practice with actual patients to obtain clinic experience. Thus, both evaluation systems and simulated patients have become urgent requirements. Accordingly, this study proposes a method to evaluate the nurse's transfer skill through observation from the patient. After verifying the proposed method, it will be integrated with a robotic patient as a future work. To verify if such an evaluation is practical, a checklist comprising 16 steps with correct and incorrect methods was proposed by the nursing teachers. Further, the evaluation parameters were determined as translational acceleration, rotational speed, and joint angle of patient. Inertial sensors and motion capture were employed to measure the translational acceleration, rotational speed, and joint angle. An experiment was conducted with two nursing teachers, who were asked to carry out both correct and incorrect methods. According to the results, three parameters reveal the difference for a patient under correct/incorrect methods and can further be used to evaluate the nurse's skill once the thresholds are determined. In addition, the applicability of inertial sensors is confirmed for the use of robot development.
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Aceleración , Competencia Clínica , Articulaciones/fisiología , Monitoreo Fisiológico/métodos , Movimiento y Levantamiento de Pacientes/enfermería , Movimiento y Levantamiento de Pacientes/normas , Enfermería/normas , Rotación , Lista de Verificación , Humanos , Movimiento , RobóticaRESUMEN
Early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, and improves muscle strength and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving while keeping them and our staff safe through the use of a standardized mobility protocol that incorporates the components of safe patient handling. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The protocol incorporates safe patient handling and mobility preassessment guidelines, mobility standards, equipment guidelines, and documentation tools. The activities are grounded in the evidence and well thought out to prevent complications, promote mobilization, and prevent patient and staff injuries. This article will discuss a how a tertiary care facility incorporated a safe patient-handling initiative into an existing mobility program and operationalized it across a health care system to keep our patients and staff safe.
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Protocolos Clínicos/normas , Ambulación Precoz , Movimiento y Levantamiento de Pacientes/normas , Seguridad del Paciente/normas , Enfermedad Crítica , Hospitales , Humanos , Unidades de Cuidados Intensivos , Michigan , Movimiento y Levantamiento de Pacientes/enfermeríaRESUMEN
Historically, patients supported on extra corporeal membrane oxygenation were thought to be too unstable to engage in early mobility but are at increased risk for deconditioning from prolonged immobilization due to the nature of illness, numerous cannulas, equipment, and hemodynamic and respiratory instability along with heavy sedation/analgesia or paralysis. This article will discuss the specific considerations that should be employed to keep the patient and the staff safe while providing mobility to patients on extra corporeal membrane oxygenation.
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Protocolos Clínicos/normas , Ambulación Precoz , Oxigenación por Membrana Extracorpórea/métodos , Movimiento y Levantamiento de Pacientes/enfermería , Movimiento y Levantamiento de Pacientes/normas , Seguridad del Paciente , Cuidados Críticos , Humanos , Unidades de Cuidados Intensivos , Fenómenos Fisiológicos RespiratoriosRESUMEN
This article addresses the development, implementation, and evaluation of an education program for safe patient handling and mobility at a large academic medical center. The ultimate goal of the program was to increase safety during patient mobility/transfer and reduce nursing staff injury from lifting/pulling. This comprehensive program was designed on the basis of the principles of prework, application, and support at the point of care. A combination of online learning, demonstration, skill evaluation, and coaching at the point of care was used to achieve the goal. Specific roles and responsibilities were developed to facilitate implementation. It took 17 master trainers, 88 certified trainers, 176 unit-based trainers, and 98 coaches to put 3706 nurses and nursing assistants through the program. Evaluations indicated both an increase in knowledge about safe patient handling and an increased ability to safely mobilize patients. The challenge now is sustainability of safe patient-handling practices and the growth and development of trainers and coaches.
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Implementación de Plan de Salud/métodos , Movimiento y Levantamiento de Pacientes/normas , Personal de Enfermería en Hospital/educación , Seguridad del Paciente/normas , Desarrollo de Programa , Centros Médicos Académicos/organización & administración , Humanos , Capacitación en Servicio/métodos , Sistemas de Atención de PuntoRESUMEN
Due to improvements in biomedical sciences and clinical expertise, childhood mortality has decreased. Pediatric patients experience similar complications from inactivity as adults, such as hospital-acquired conditions and delirium. Interdisciplinary collaboration is imperative to improve functional and developmental outcomes of children who suffers from either a chronic illnesses or an acute illness that results in a prolonged hospitalization. Pediatric nursing assessments should include gross motor function related to mobility. Activities to mobilize pediatric patients should be based on age and developmental assessment. The purpose of this article is to describe the modification of an adult mobility assessment for the pediatric population.
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Ambulación Precoz/normas , Movimiento y Levantamiento de Pacientes/normas , Evaluación en Enfermería/normas , Seguridad del Paciente , Pediatría , Desarrollo de Programa/métodos , Niño , Enfermedad Crónica , Humanos , Limitación de la MovilidadRESUMEN
BACKGROUND: Despite high quality guidelines underpinning pressure ulcer care (NPUAP/EPUAP/PPPIA, 2014), pressure ulceration still poses a significant financial impact on health care services in treatment and staff costs as well as having a profound effect on the health and quality of life of individuals experiencing them. Repositioning is a key preventative technique recommended by occupational therapists and other health care professionals. The frequency and quality of repositioning movements performed by individuals, however, can be difficult to determine. This paper explores the use of technology in monitoring repositioning movements in sitting. OBJECTIVE: To explore the outputs of technologies such as interface pressure mapping systems and accelerometers in enabling the therapist to accurately monitor seated behaviour and enhance practice through targeted interventions to prevent sitting acquired pressure ulceration. METHOD: Reviewing the findings of two recent research studies with 'at risk' cohorts (spinal cord injury; elderly orthopaedic), using accelerometry and seated interface pressures, this paper will highlight how useful this technology is in clinical practice to monitor weight shifts and repositioning behaviours. RESULT: Both studies illustrated that the majority of individuals did not adhere to the frequency or magnitude of movements currently recommended to redistribute seating interface pressures. When repositioning was performed it was ineffective in reducing seated pressures. CONCLUSION: In an era of personalised medicine, technology has an important role to play in providing the service user, caregivers and healthcare staff with important biofeedback information about seated behaviours, particularly those that minimise the risk of developing sitting acquired pressure ulcers. This information can augment occupational therapists' clinical decision-making in maximising active pressure ulcer prevention.
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Movimiento y Levantamiento de Pacientes/efectos adversos , Movimiento y Levantamiento de Pacientes/normas , Postura/fisiología , Traumatismos de la Médula Espinal/terapia , Acelerometría/métodos , Anciano de 80 o más Años , Mapeo del Potencial de Superficie Corporal , Femenino , Humanos , Masculino , Monitoreo Fisiológico/métodos , Movimiento y Levantamiento de Pacientes/instrumentación , Presión/efectos adversos , Úlcera por Presión/prevención & control , Factores de Riesgo , Traumatismos de la Médula Espinal/complicacionesRESUMEN
The aim of this study was to identify current research on turning frequencies of adult bed-bound patients and inform future turning practices for hospitals based on evidence-based practice. We undertook a scoping review framework that provided a transparent and systematic methodology using 8 electronic databases (CINAHL, PubMed, Cochrane Library, ScienceDirect, PsycINFO, Scopus, ProQuest, and Web of Science) to identify articles published from 2000 to 2016. Articles were included if they focused on the prevention of hospital-acquired pressure ulcers related to the frequency of turning or repositioning of bed-bound patients. Literature search and data extraction were performed independently by 3 authors. The study followed the PRISMA guidelines. In total, 911 articles were identified, of which 10 were eligible. Of the eligible articles, 8 studies could not reach a conclusion on the effective frequency of turning and duration for repositioning patients to prevent the development of pressure ulcers. Only 2 studies found significant differences among the intervention and control groups. Results regarding turning and repositioning schedules are inconclusive; however, the topic needs further exploration to improve the outdated guidelines surrounding pressure ulcer prevention. This may, in turn, make the work of nurses more efficient and make treatment cost-effective for both the patients and the hospitals.
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Movimiento y Levantamiento de Pacientes/métodos , Movimiento y Levantamiento de Pacientes/normas , Posicionamiento del Paciente/métodos , Posicionamiento del Paciente/normas , Úlcera por Presión/prevención & control , Cuidados de la Piel/métodos , Cuidados de la Piel/normas , Adulto , Anciano , Anciano de 80 o más Años , Personas Encamadas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Although the literature has noted the positive effects of facilitation in implementation research, little is known about what facilitators do or how they increase adoption of a program. The purpose of this study was to understand internal facilitation activities in implementing a national safe patient handling program from the perspective of facility coordinators who implemented the program. METHODS: Using a qualitative descriptive design, data were collected in five focus groups at two international Safe Patient Handling and Mobility Conferences. Participants were 38 facility coordinators implementing a safe patient handling program in the Department of Veterans Affairs medical centers throughout the United States. Data were analyzed using direct content analysis to gather descriptions of internal facilitation. RESULTS: The internal facilitation process involved engaging multiple disciplines and levels of leadership for implementation. Fifty-four facilitation activities were identified, including five activities not currently listed in an existing taxonomy. Key characteristics and skills of facilitators included persistence, credibility and clinical experience, and leadership and project management experience. Themes were mapped onto an existing framework and taxonomy of facilitation activities. LINKING EVIDENCE TO ACTION: Internal facilitation is both an implementation intervention and a process involving a wide range of activities. The findings provide an understanding of what internal facilitators are doing to support practice changes and the characteristics and skills of internal facilitators that are likely to result in long-term organizational change. Five recommendations for action address organizations, senior leaders, and internal facilitators.
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Práctica Clínica Basada en la Evidencia , Adhesión a Directriz , Hospitales de Veteranos/normas , Movimiento y Levantamiento de Pacientes/normas , Percepción , Competencia Clínica , Grupos Focales , Humanos , Investigación Cualitativa , Estados UnidosRESUMEN
OBJECTIVE: The objective of the study was to identify which components of a system-wide safe patient handling (SPH) program reduced musculoskeletal injury (MSI) due to patient handling among nurses. METHODS: The 3-year longitudinal study from 2008 to 2011 used a pretest-posttest design. The study was conducted in the Veterans Health Administration, and all medical centers participated. The outcome was 2011 MSI incidence rates due to patient-related handling for nurses, expressed as injuries per 10 000 full-time employees. RESULTS: Three organizational risk factors, bed days of care, facility complexity level, and baseline MSI incidence rate, were significantly associated with MSI incidence rate and explained 21% of its variation. Five SPH components, including deployment of ceiling lifts and other new technologies, peer leader effectiveness, competency in SPH equipment use, facility coordinator link with safety committee, and peer leader training, uniquely accounted for an additional 23% of the total variation. CONCLUSIONS: Findings provide evidence to support the effectiveness of a multicomponent approach to SPH programs given contextual considerations.
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Capacitación en Servicio/normas , Movimiento y Levantamiento de Pacientes/normas , Sistema Musculoesquelético/lesiones , Personal de Enfermería en Hospital/educación , Enfermedades Profesionales/prevención & control , Heridas y Lesiones/prevención & control , Adulto , Femenino , Hospitales de Veteranos , Humanos , Incidencia , Estudios Longitudinales , Masculino , Modelos Estadísticos , Seguridad del Paciente/normas , Evaluación de Programas y Proyectos de Salud , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Heridas y Lesiones/epidemiologíaRESUMEN
PURPOSE: This study evaluated the effectiveness of a safe patient handling program (STEPS) at an inpatient rehabilitation unit in reducing injury due to patient transfers. Our objectives were to compare number of staff injuries during the 1.5-year period post training to pre training (baseline) and to determine whether reduction in injuries was sustained long term during a 2.5-year post training period. METHODS: All nursing and therapy staff as well as new hires received STEPS training. Periodic retraining was not provided. FINDINGS: The number of injuries was significantly reduced at post training compared to baseline (p = 0.01). However, the reductions in injuries were not sustained long term. CONCLUSION: We estimated a cost benefit of $3.71 for every dollar invested in retraining based on injury reduction realized during the post training period. CLINICAL RELEVANCE: Retraining is likely to have a positive cost benefit when it results in maintaining reduction in staff injuries.
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Movimiento y Levantamiento de Pacientes/métodos , Personal de Enfermería/educación , Traumatismos Ocupacionales/prevención & control , Seguridad del Paciente/normas , Enfermería en Rehabilitación/métodos , Desarrollo de Personal/métodos , Anciano , Educación Continua en Enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento y Levantamiento de Pacientes/normas , Enfermería en Rehabilitación/educación , Enfermería en Rehabilitación/normas , TiempoRESUMEN
The perioperative environment presents unique ergonomic challenges related to lifting and moving patients. These challenges place perioperative team members and patients at an increased risk for injury. The updated AORN "Guideline for safe patient handling and movement" provides perioperative nurses with guidance on safe patient handling and movement practices to help minimize the incidence of injuries to patients and health care workers. This article provides an overview of the guideline and discusses recommendations for a safe patient handling and mobility (SPHM) program, ergonomic planning and facility design, SPHM technology, an individualized SPHM and ergonomic plan, and fall risk and mobility assessments. It also includes a scenario describing concerns related to patient and perioperative team member safety. Perioperative nurses should review the guideline in its entirety and apply the recommendations for safe patient handling and movement.
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Movimiento y Levantamiento de Pacientes , Humanos , Movimiento y Levantamiento de Pacientes/normas , Movimiento y Levantamiento de Pacientes/métodos , Movimiento y Levantamiento de Pacientes/enfermería , Ergonomía/métodos , Ergonomía/normas , Seguridad del Paciente/normas , Guías de Práctica Clínica como Asunto , Enfermería Perioperatoria/normas , Enfermería Perioperatoria/métodosAsunto(s)
Movimiento y Levantamiento de Pacientes/métodos , Movimiento y Levantamiento de Pacientes/normas , Personal de Enfermería en Hospital/educación , Seguridad del Paciente , Pediatría , Accidentes por Caídas/prevención & control , Niño , Humanos , Personal de Enfermería en Hospital/normas , Administración de la Seguridad/métodosRESUMEN
This article is written predominantly for healthcare assistants. It may also be useful for anyone less familiar with transferring patients or who delegates to HCAs. It offers a definition of patient transfer and addresses considerations for patient safety and the role of HCAs throughout the three distinct phases of transfer, which are: preparation to transfer (before); considerations of transfer (during); and at the point of final handover (actual transfer) in a hospital. It also addresses the role of escorting patients, and highlights the difference between transferring and escorting. Finally, a framework for best practice is suggested, which could be applied in clinical areas where high proportions of patients are transferred, such as emergency departments, discharge lounges and admissions or assessment units. This framework is adaptable and can help in the development of local hospital policies for the safe transfer of patients. The key message of this article is that patient transfer is a process that requires adequate preparation and occurs in distinct phases, each of which must be carried out with proper care and attention if patients are to be transferred safely.
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Movimiento y Levantamiento de Pacientes/normas , Asistentes de Enfermería/normas , Pase de Guardia/normas , Transporte de Pacientes/normas , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
The prehospital management of serious injury is a key skill required of pitch-side medical staff. Previously, specific training in sports prehospital-immediate care was lacking or not of a comparable standard to other aspects of emergency care. Many principles have been drawn from general prehospital care or in-hospital training courses. This article discusses sports prehospital-immediate care as a niche of general prehospital care, using spinal injury management as an illustration of the major differences. It highlights the need to develop the sport-specific prehospital evidence base, rather than relying exclusively on considerations relevant to prolonged immobilisation of multiply injured casualties from motor vehicle accidents, falls from height or burns.
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Servicios Médicos de Urgencia/normas , Medicina de Emergencia/educación , Traumatismos Vertebrales/terapia , Medicina Deportiva/educación , Técnicos Medios en Salud/educación , Traumatismos en Atletas/terapia , Curriculum , Medicina de Emergencia/instrumentación , Medicina de Emergencia/normas , Diseño de Equipo , Práctica Clínica Basada en la Evidencia , Humanos , Movimiento y Levantamiento de Pacientes/métodos , Movimiento y Levantamiento de Pacientes/normas , Oxígeno/uso terapéutico , Planificación de Atención al Paciente/organización & administración , Planificación de Atención al Paciente/normas , Medicina Deportiva/instrumentación , Medicina Deportiva/normas , Camillas/normas , Tiempo de Tratamiento , Triaje/métodos , VacioRESUMEN
BACKGROUND: Musculoskeletal injuries from patient handling are significant problems among health care workers. In California, legislation requiring hospitals to implement safe patient handling (SPH) programs was enacted in 2011. This qualitative study explored workers' experiences and perceptions about the law, their hospital's SPH policies and programs, patient handling practices, and work environment. METHODS: Three focus groups were conducted with 21 participants (19 nurses and 2 patient handling specialists) recruited from 12 hospitals located in the San Francisco Bay Area and San Joaquin Valley. Qualitative content analysis was used for data analysis. RESULTS: Multiple themes emerged from diverse experiences and perceptions. Positive perceptions included empowerment to advocate for safety, increased awareness of SPH policies and programs, increased provision of patient handling equipment and training, increased lift use, and improvement in safety culture. Perceived concerns included continuing barriers to safe practices and lift use such as difficulty securing assistance, limited availability of lift teams, understaffing, limited nursing employee input in the safety committee, blaming of individuals for injury, increased workload, and continuing injury concerns. Participants indicated the need for effective training, sufficient staffing, and management support for injured workers. CONCLUSIONS/APPLICATION TO PRACTICE: This study identified improvements in hospitals' SPH programs and practices since the passage of California's SPH law, as well as continuing challenges and barriers to safe practices and injury prevention. The findings provide useful information to understanding the positive impacts of the SPH law but also notes the potential limitations of this legislation in the view of health care workers.