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© 2006 Applied Ergo Conference 10 - Dallas
Consumer's Digest: Using Human-Interface Design to Select Human-Moving Equipment
Miriam Joffe, PT, CPESenior Consulting Ergonomist
mjoffe@auburnengineers.com
QuickTime™ and aMPEG-4 Video decompressor
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© 2006 Applied Ergo Conference 10 - Dallas
Objectives
ð Understand principles of human-interface priorities when selecting people-handling equipment. Benefits are for both the provider and receiver.
ð Review selection criteria.
ð Review the need for a paradigm shift when choosing between manual handling devices and man-handling people/using body mechanics alone.
© 2006 Applied Ergo Conference 10 - Dallas
It is well established that…
• people are not necessarily reliable to identify their own safe load weight limits. (Jorgensen, et. al., 1999)
• over time, most manual assistance activities put the caregiver at risk for injury.
• pain can begin before structural damage is evident (Marras, 2006) but we often ignore pain when our patients need us.
• spinal loading and spinal tolerance limits change with time/continued exposure (Marras, 2006).
© 2006 Applied Ergo Conference 10 - Dallas
Apply ergo concepts from industry to patient handling because…
• How many private homes are equipped with “transfer teams”?
• Even with “transfer teams” excessive and repeated reaching, pulling and lifting may occur that exceed our capacity over time.
• How many private homes have “handicap” bathrooms?
• How many ceilings (both home and institutional) are rated for ceiling lifts?
Photos deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Learn from MMH guidelines in industry
https://www.ohiobwc.com/downloads/blankpdf/LiftGuideBackStudy.pdf
70 lb. in the primary
reach zone
35 lb. in the secondary reach zone
How many patients weigh only 70 lbs?
How many patient handling tasks are performed with the caregiver upright and patient in the primary reach zone?
© 2006 Applied Ergo Conference 10 - Dallas
Learn from MMH Tasks
If we put limits on lifting loads for boxes to protect our backs, why do we “handle” people differently?
And if muscle strength is a limiting factor, why
not rely on mechanical equipment to help us?
http://www.jhu.edu/news_info/news/home02/m
ay02/grasp.html
Voice-activated gripping device
Photograph Courtesy of Lynda Enos, 2006
© 2006 Applied Ergo Conference 10 - Dallas
So…we turn to assistive devices
Ah, the “Good Ole Days”
Photos deleted due to file size limitation. Gait belt, old wheelchair with no adjustable parts, old style bed and sliding board.
© 2006 Applied Ergo Conference 10 - Dallas
But today we have many choices…
…so how do we know which ones to choose?
Photos deleted due to file size limitation. Various transfer and assistive devices shown in presentation.
© 2006 Applied Ergo Conference 10 - Dallas
Making Good Choices
1. Determine level of patient’s needs/dependency
(physical and cognitive abilities)
2. Determine the activity needed
(bed mobility or positioning, transfer, gait, etc.)
3. Determine who will be around to help
(trained medical staff, family member, friend)
4. Determine environment in which device will be used
(hospital, independent living center, home)
© 2006 Applied Ergo Conference 10 - Dallas
Level of Need/Dependency(or “Who’s Steering This Ship?”)
Dependent and/or combative
Independent and/or
cooperative
Other photos deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Level of Need/Dependency
Dependent and/or not
cognitively intact
Independent and/or
cooperative
Other photos of tub transfer devices deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Level of Need/Dependency
Dependent and/or not
cognitively intact
Independent and/or
cooperative Photos of sling transfer from bed and gait belt transfer from chair deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Making Good Choices
1. Determine level of patient’s needs/dependency
(physical and cognitive abilities)
2. Determine the activity needed
(bed mobility or positioning, transfer, gait, etc.)
3. Determine who will be around to help
(trained medical staff, family member, friend)
4. Determine environment in which device will be used
(hospital, independent living center, home)
© 2006 Applied Ergo Conference 10 - Dallas
Identify the Activity
Some devices are multi-functional• But may not work as well as uni-functional devices
– 3 in 1 commode (raised toilet, bedside commode and safety frame)
Some devices are applicable to many situations• Sling lifts may be used for bed to chair, commode or tub
depending on sling choice
- Solid sling for bed to chair transfer
- Slotted sling for chair to commode
- Webbed sling for chair to tub
Photo of 3 in 1 commode deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Making Good Choices
1. Determine level of patient’s needs/dependency
(physical and cognitive abilities)
2. Determine the activity needed
(bed mobility or positioning, transfer, gait, etc.)
3. Determine who will be around to help
(trained medical staff, family member, friend)
4. Determine environment in which device will be used
(hospital, independent living center, home)
© 2006 Applied Ergo Conference 10 - Dallas
Who’s Minding the Store?• Spouse with (un)licensed care giver?
• Registered nurse / hospice
• Certified nurse’s assistant (CNA)
• Unlicensed sitter/caregiver
• Friends and family
• Facility with variety of licenses professionals• Experienced teams
• Supplement by OJT aides
Photos deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Making Good Choices
1. Determine level of patient’s needs/dependency
(physical and cognitive abilities)
2. Determine the activity needed
(bed mobility or positioning, transfer, gait, etc.)
3. Determine who will be around to help
(trained medical staff, family member, friend)
4. Determine environment in which device will be used
(hospital, independent living center, home)
© 2006 Applied Ergo Conference 10 - Dallas
Where ‘Yat?
§Home setting
§ Often in the living room
§ Cramped quarters / bathroom access problems
§ Limited funding
§ Institution
§ Floor plan generally better suited for equipment and storage
§ Shared resources and better funding§ Independent living center
§ Skilled nursing facility
§ Acute care or rehab facility
© 2006 Applied Ergo Conference 10 - Dallas
Fear Factor
Using equipment may be scary the caregiver and the
patient.
Photos deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Choosing Controls
• Understand system operation easily• Group similar controls together
• Operate with simple or no direction
• Control adjacent to label and/or display
Bad Good Good
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Chosing Controls• Use population stereotypes
• Left to right increases
• Counter-clockwise to open
• Red = danger or stop
• Green = safety, OK, go
• Up = on, higher, increase, raise
• Down = off, lower, decrease
On Off
Up / down Left to right
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Chosing Controls
• Should not require awkward movements
• Force requirements should match user abilities
• Resistance provided – eliminates unnecessary force and repeated action
• Device should fit hand size
• One-hand operation preferred
• Redundant/consistent coding– Color, shape and sizing
– May have auditory, tactile and/or visual alerts
• Appropriate feedback provided – did you get the response expected?
– green light on with correct action vs. alarm for incorrect action
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Chosing Displays• Labels
- adequate lighting and no glare
- legible
- consistent
- size appropriate for viewing distance
- black on white best
- locate next to control Low Light Adequate
Levels Light Levels
0.25 inches 0.15 inches
0.10 inches 0.10 inches
Critical Labels (Information, data, emergency labels)
Noncritical labels (Non-emergency labels, instructions, identification labels)
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Chosing Displays
BIGGER
BOLDER
The appropriate size and type of the
characters can affect eye fatigue and DATA
ENTRY ERRORS
Character spacing and dimensions are important
BRIGHTERBRIGHTER
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Chosing Displays
• Use icons or pictograms that are easy to understand
?What does that mean? Easily understood
© 2006 Applied Ergo Conference 10 - Dallas
Principles for Choosing DisplaysColor• Black on white for lighted conditions
• White on black for non-lighted conditions
Dear Mr. Bloggs:
Thank you for meeting with me yesterday.
I hope that we will be able to work together in the future.
Dear Mr. Bloggs:
Thank you for meeting with me yesterday. I hope that we will be able to work together in the future.
© 2006 Applied Ergo Conference 10 - Dallas
Human Interface/Design Features
• Build in adjustability where possible- Height (e.g. bed, lift, chair/toilet seat, handle length)
- Fit 90% of caregiver and patient population (reach for smallest person and clearance for largest person)
• Weight limit/capacity
• Neutral posture- Find equipment that promotes neutral posture for both
the caregiver and patient (e.g., using for controls)
- Fit hand size and finger length for hand controls
• Ease of use- Speed of response to controls
- Maneuverablity and handle design
- Number of parts to be manipulated
© 2006 Applied Ergo Conference 10 - Dallas
Human Interface/Design Features
• Minimize force
- Minimize requirement to engage and grip equipment
- Consider limitations of user (e.g., finger, hand or foot weakness due to age or disability)
- Consider force to move equipment and/or parts (e.g., bed, rails, lift device)
- Steering and braking mechanism (via hand or foot)
- Push/pull force over flooring (e.g., carpet vs. smooth flooring, ramps/slopes, thresholds)
- Manual vs. powered
© 2006 Applied Ergo Conference 10 - Dallas
Human Interface/Design Features
• Architectural limitations
- Structural integrity of floor, walls and ceiling
- Doorway clearance and room size
- Flooring and threshold
- Turning radius (e.g., room for equipment and people
• Maintenance and storage
- Easy to clean
- Easy to store
• Training
- Easy for caregiver to learn
- Easy for patient to learn
Photos deleted due to file size limitation.
© 2006 Applied Ergo Conference 10 - Dallas
Paradigm Shift
If we use assistive devices to handle “product” in industry to protect our workers for cumulative injury, then we should also use assistive devices to handle people in (home) healthcare settings to protect our caregivers.
These devices are not barriers to kindness, empathy or therapy goals. Rather, they can be integrated into how we handle people so that we can be around to do the same tomorrow.
© 2006 Applied Ergo Conference 10 - Dallas
Paradigm Shift
Photos deleted due to file size limitation. They show modern equipment used for MMH in factories compared with those used for patient handling.
© 2006 Applied Ergo Conference 10 - Dallas
Summary
Chose devices that
ü fit the needs, size and complexity of both caregiver and patient
ü are easy to use and maintain
ü require minimal training
ü require minimal maintenance
Consider
§ Environmental issues
§ Architectural limitations (space, flooring, etc.)
§ Person who uses the control (caregiver vs. patient)
§ Impact on safety
© 2006 Applied Ergo Conference 10 - Dallas
Questions?Questions?Miriam Joffe, PT, CPESenior Consulting Ergonomist
mjoffe@auburnengineers.com
© 2006 Applied Ergo Conference 10 - Dallas
Resources and References
Ergonomics Design Guidelines, Auburn Engineers (1997)
Ergonomics Guidelines for the Prevention of Musculoskeletal Disorders in Nursing Homes (2003). OSHA
Ergonomic Design for People at Work, Van Nostrand Reinhold Company, NY (1986)
L. Enos. “The Ergonomics of Patient Handling Equipment Design: Enchancing Caregiver and Patient Safety” presentation (2006)
Grandjean, E., Fitting the Task to the Man, 4th ed., Taylor and Francis
W.S. Marras. Safe Patient Handling Conference in Buena Vista, Florida (2006)
Ohio Bureau of Worker’s Compensation
www.baddesigns.com - examples of poor control designs
© 2006 Applied Ergo Conference 10 - Dallas
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