Ergonomic Principles (Nursing)

by Jessica Reuter

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    00:02 Hi! My name is Jessica Spellman. I’m going to be reviewing the principles of ergonomics.

    00:08 In this course, you’re going to be learning about the concepts of ergonomics and how it promotes a safe and healthy work environment. You’re going to learn to implement proper body mechanics in order to prevent injuries to yourself and your patients. You’re also going to learn about some assistive equipment that you can use that could help prevent injury.

    00:31 Ergonomics is a scientific study of people at work. The goal is to help reduce stress and injuries in the workplace. This is accomplished by designing tasks and workspaces that promote comfort, safety, increased use, and efficiency while performing tasks. So, the definition of proper body mechanics is the use of muscles and body position to limit injury while performing a task. This includes using your balance, your posture, and body alignment in order to prevent injury. Nurses use a lot of different body mechanics when caring for patients, including bending, lifting, and performing ADLs. Nurses do need educated on this information and need to practice it in clinical in order to be efficient at using it. We want to correct incorrect behaviors and move to using ADL body mechanics. Risk of injury to nurses and the client is decreased when proper body mechanics is used.

    01:32 So the incidents of workplace injuries is very high. In fact, healthcare workers have a high rate of muscular skeletal injury when caring for patients more so than in construction mining and manufacturing. This is mostly due to the repetition of tasks, including the heavy manual lifting, transferring, and repositioning of clients. The problem is compounded due to the increasing weight of our patient populations, and the amount of help patients need with ADLs.

    02:08 In 2008, the Centers for Disease Control reported that the direct and indirect cause of back injuries in the healthcare industry are estimated at $20 billion annually. Nurses aides suffer the highest prevalence and report the most cases of back pain among female workers in the United States. In 2000, 11,000 registered nurses suffered lost time at work due to back pain and injury. And 12% of nurses reported that they left the nursing industry because of back pain. In 2003, the American Journal of Critical Care also reported 9,000 healthcare workers every day are injured while performing work-related tasks. Disabling back pain and injuries affect 38% of the nursing workforce. The Bureau of Labor Statistics also reported nursing assistants and registered nurses were two of the five professions that had the greatest risk of injury and it was greater than 30%. Over 50% of those injuries were back injuries, but they weren’t the most severe injury that nurses suffered or shoulder injuries.

    03:25 They also kept the amount of work the longest. So as nurses, what can we do? First of all, we need to acknowledge that there’s a high risk for injury in our profession, and not always think that it’s going to happen to somebody else because it can happen to you.

    03:39 The second thing we need to do is learn about proper body mechanics and ergonomic concepts in order to change the way we do our work and prevent injury. So in order to understand part of the ergonomic principles I’m going to review, we need to talk about a few concepts.

    03:56 First is, what is weight? Weight is the force of gravity on an object. In order to lift something, you must overcome the weight of the object and know its center of gravity.

    04:06 And what the center of gravity is? The center of the mass of an object. So in humans, the center of gravity is in the pelvis when you’re standing. When a person moves, the center of gravity shifts. To lower your center of gravity, you have to bend at the hips and the knees and not just at the back. In order to be more stable, you need to keep the center of gravity on a supported base. A supported base is when the feet or shoulder width apart, and the object is close to the body. So some of the principles I want to review with you are, in order to prevent a neck and a shoulder injury, you need to keep a neutral posture with your head and your neck so that it’s in line with the pelvis, not forward or backwards, but straight in line with the pelvis. And you want to keep the work between the waist and the shoulder height. That’s the ideal height to prevent leaning over to use your back and lifting up too high and causing shoulder injury. When you are carrying a heavy item, don’t twist. You want to move with the item this way. When you’re carrying for patients in a bed, you want to lower the side rails to prevent leaning over and hurting your back.

    05:21 And when you don’t have enough space and you’re working in a small enclosed space, you’re less likely to use proper ergonomic mechanics. So you want to make sure you have plenty of rooms so that your body can move in the position that it needs to. Outside of work, there are a couple of other things that can do to help prevent injury.

    05:41 That’s exercise. Maintaining overall muscle strength, and especially core strength will help prevent back injuries. As much as you can, rest between heavy activities to reduce fatigue. If you’re at work and your patient load is very heavy that day, try and space the heavy tasks far apart so that you can recover by doing lighter tasks. If you’re totally unable to avoid repetitive movements, make sure you’re stretching at least a couple of times every hour to make sure that you don’t sustain injury from those repeated tasks.

    06:16 When you’re standing for long periods of time like when you’re documenting, making sure that you’re putting a foot up and flexing the knee and hip helps take some of the weight and pressure off of your lower back. So specifically when lifting, these are a couple of things to keep in mind. Know and follow your institution’s policy for lifting. A lot of organizations are going to a no single lifting policy so that all lifting must occur with two or more people. You need to be aware of your institution’s policies and follow them to prevent injury to yourself and your patients. When you’re lifting, you want to bend the legs and lift instead of only leaning over at the back. You want to have a strong base of support.

    07:04 So the legs should be shoulder width apart. You want to tighten the core to protect the back, and keep the center of gravity of the object between the waist and the shoulders close to the body and don’t twist. Safest way to lift or move a client may be to use a piece of assistive equipment. Also, planning ahead and asking for assistance from other individuals may make it easier to lift or move patients. When you’re pulling or pushing an item, there's also a few things to keep in mind. You need to widen the base of support.

    07:42 Since you’re going to be moving, you need the wide base to help maintain your posture.

    07:48 Pull objects toward the center of gravity rather than pushing them away. When you’re pulling an object close to you, you want to have your one leg behind you to help with the transfer of weight. When you’re pushing something, you want to have a foot in front of you so you can transfer your weight forward as you’re pushing the item. And you also want to face the direction of the movement. Again, don’t twist when you’re moving a patient, but lifting them up towards the head of the bed and facing the direction that they’re moving. Sliding, rolling, and pushing patients require less energy than lifting them and moving them. So there’s some assistive equipment that we can use to help transfer patients. A transfer assist device is a non-mechanical device that helps us move or transfer a patient.

    08:40 It decreases awkward positioning for the nurse, and it can help decrease musculoskeletal injury.

    08:46 Some examples of transfer assist devices are slide sheets, lower sheets, transfer belts, gait belts, and turning discs. Education on those items is not going to be provided in this lecture. Facilities that use these items will have their own education on how to properly use this equipment. Patient lifts is another way to lift the patient out of the bed and either move them to the shower or a chair. It’s designed to lift and transfer clients from one place to the other. There’s a manual model that uses hydraulics that help decrease the workload so that you can move them easier. Then there’s also battery operated ones that require a rechargeable battery and a power source. So make sure you know which is available at your institution. Again, there are many manufacturers of lifts, different types. They generally have the same components, but specific education at your facility is going to help prevent an injury to yourself or your client. So when used correctly, it can decrease injury to clients or yourself. Just as it is important for nurses to understand ergonomics to prevent injury to themselves, it’s important for nurses to understand ergonomics to prevent client injury as well. It is the responsibility of nurses and nursing assistants to position patients correctly, knowing that if you do not position them appropriately, they could become injured or fall. Being aware of the correct positioning and how to support clients in positions is important to review. So, I am going to be going over a few of the client positions that we use most frequently in the clinical setting. First of all is the supine position. The client is lying on their back, knees straight in front of them, head on the pillow. Some areas that may need to be supported in this position are pillows behind the knees, a pillow behind the neck to prevent neck strain, and possibly under the arms to prevent any should string. Semi-Fowler's position is a supine position where the head of the bed is at 30 degrees and the knees may be slightly elevated. As long as there’s a pillow behind the neck to support the head, it may or may not require any more pillows for comfort. Fowler’s position is a supine position with the patient on their back and the head of the bed 45 degrees. The knees are also elevated to take pressure off the low back, and pillows can be used for comfort. High Fowler’s is a supine position with the head of bed 90 degrees, and the knees may or may not be elevated. It can be uncomfortable for one person to have the knees elevated, and in another, it may be better to have them elevated to prevent low back strain. Prone is when a patient is on their stomach, one head to the side. The lateral side-lying position, patient lays on the side with the weight on the dependent hip and shoulder, and arm is in front of the body and a pillow is placed under the head and possibly between the legs and the thighs to maintain proper alignment of the pelvis. Sims’ or semi-prone, the client is on the side halfway between lateral and prone. So they’re not quite lying all the way on their stomach but a little bit further over then on lateral. So the lower arm is then behind the client, which sounds like it could be caused a lot of shoulder strain that the client is not positioned correctly.

    12:29 And then the upper arm is in the front and both legs are flexed. The orthopneic position, this is for patients that are having trouble breathing and it’s when the patient sits on the edge of the bed and either has a bedside table or chair or something next to them and they rest their arms on the table and they kind of lean their face forward. It helps clients feel like they can catch their breath, a little bit better. Trendelenburg is when the bed is flat, and then the head of the bed is tilted down lower than the foot of the bed. And reverse Trendelenburg is the opposite of that when the patient is lying flat and supine and the head of the bed is higher than the foot of the bed. So in summary, nurses and nursing assistants are in a high-risk group for sustaining a work-related injury.

    13:19 Being aware of ergonomic principles and body mechanics during lifting, transferring, and positioning patients is the key to preventing injury to ourselves and our clients. Sometimes using assistive equipment like lifts and transfer devices can help protect clients and healthcare workers from injury. Make sure you know your institution’s policy on lifting and how to use assistive devices in order to prevent injury. Knowing how to use assistive equipment properly, as well as reviewing the correct positioning of clients and practicing safe ergonomic principles is the responsibility of every nurse. All right. This has been principles of ergonomics with Jessica Spellman. Thank you.

    About the Lecture

    The lecture Ergonomic Principles (Nursing) by Jessica Reuter is from the course Safe and Effective Care Environment (Nursing). It contains the following chapters:

    • Principles of Ergonomics
    • Scope of the problem
    • Center of gravity math
    • Pushing/Pulling
    • Ergonomics for clients

    Author of lecture Ergonomic Principles (Nursing)

     Jessica Reuter

    Jessica Reuter

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