About me Started as housekeeper in a nursing home Progressed
from CNA, LPN, RN, BSN, MSN, CNE Restorative Nurse, Staff
Development, ADON Graduate work in nursing education with focused
projects and thesis on back injuries in healthcare workers
Currently direct a Nurse Aide Program, teach in a BSN program,
staff education consultant, small business owner 2
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My Interest Specifically interested in back injuries because of
family history Responsible for staff and student training in body
mechanics Professional curiosity about nurse aide back injuries as
an understudied population sparked graduate school research 3
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Purpose Discuss current research into occupational injuries in
nursing and graduate research Strategies for injury prevention
including staff and student education 4
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Statistics Nurse aides, orderlies and attendants are the 2nd
highest occupation for MSDs and RNs are 5 th (Dept of Labor 2006)
Rising rates of overweight and obese pts. are compounding problem.
In 20072008, about one-third of adults were obese and about
two-thirds were overweight or obese (CDC 2010) CNAs may be at
greater risk for injury than RNs (Li, Wolf, & Evanoff, 2004)
Nature of their work Lack of empowerment 5
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American Nurse Association Statistics ANA estimates 12% of
nurses leave annually r/t back injuries Nurses use 30% more sick
leave annually due to back pain when compared to the general
workforce Over 52% of nurses complain of chronic back pain and 38%
of the nursing workforce has been affected by back injuries 6
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My Research Survey sent out to nurse aides in Colorado Gathered
information on -Demographics -Employment -Dichotomous and Likert
style questions about injuries, training, equipment and facilities
-Open ended question asking what CNA perceived as the hardest part
of their job 7
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Findings 46% reported having hurt selves while lifting, moving,
or helping a patient 40% reported having hurt back while lifting,
moving, or helping a patient 78% of those reporting back injuries
were working in nursing home at time of injury CNA workplace
training: M=3.23 CNA school training: M=3.69 8
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Findings (cont.) Training on back injury prevention received at
work and school but not applied Meaningful proportion (43%) noted
that hardest aspect of their jobs were. Having too many patients
and/or not enough help Poor communication Being looked down on by
nurses, having poor relationships with nurses with whom they worked
9
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Implications Work-related injury, especially back injury, is an
important issue in work life of CNAs Culture change needed; easier
to put up than get help or complete necessary paper work 10
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Implications (cont.) Staffing implications Owning own role in
less than ideal CNA-Nurse working relationships On-going prevention
education needed 11
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Contributing factors to MSD Quick movements, repetitive
movements Combative patients Long work hours and overtime Work
schedules Staffing shortages Heavy lifting, bending and twisting
12
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Evidence-Based Interventions and Challenges Patient handling
equipment No-lift Policies Training on proper use of equipment and
devices Lift teams Ongoing education 13
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Patient Handling Equipment Hi/Low beds, mobile lifts, ceiling
mounted lifts, lateral transfer aides Challenges Cost Staff
training Time Equipment selection for each patient 14
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No-Lift Policies Use of equipment to move patients to reduce
manual lifting Challenges Putting equipment in place before policy
is implemented Time Staff buy in (Nonpunitive approach) 15
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Training with Equipment Ongoing training in the use of
equipment and devices Challenges Training staff across shifts,
staff turnover Reinforce training Training on equipment only used
sporadically 16
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Lift Teams Two physically fit people, competent in safe lifting
techniques, working together to accomplish high-risk patient
transfers. Challenges Logistics of providing a team 24/7 Cost
Managing workload 17
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Ongoing Education Annual body mechanics reviews Challenges
Education alone has proven ineffective for MSD safety Qualified
instruction and return demonstration is key (ideal to spot check
workers on the job) Consistent training for new employees and f/u
within first 90 days Training to specific patient needs is
difficult Modeling behavior by peers Cost 18
After-Action Reviews Ways for health care providers to learn
from their own mistakes as well as mistakes of others Challenges
Support and timely response by management Time constraints Staff
fear and embarrassment 20
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Clinical Tools Patient assessment tools to standardize ways to
assess patients and decide on appropriate lifting and care
techniques Challenges Staff training (turnover, reinforced over
time) Integration into routine processes (admissions, COC)
Communication between staff 21
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Peer Leaders Specially trained staff who works on-site with
staff to make practice changes and improve safety Challenges
Incentives Support and timely response by management Choosing
appropriate peer leaders 22
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Helpful Work Practices Assess patient and yourself Eliminate or
reduce manual lifting when possible Get help and ask patients to
help Mentally plan Good working height Check equipment Proper body
mechanics Use your legs, keep patient close Do not twist when
turning (pick up or pivot feet) 23
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Make Education Count! Modeling behaviors Ongoing training and
assessment Return demonstrations (with real patients) Positive
reinforcement system 24
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Help! Facebook- Injured Nurses Network of America Nurse and
Health Care Worker Protection Act of 2009 (S.1788) Full text
http://www.govtrack.us/congress/billtext.xpd?bill=s111- 1788 ANA-
http://www.anasafepatienthandling.org/http://www.anasafepatienthandling.org/
Work Injured Nurses Group (WING) 25
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S. 1788 Summary Nurse and Health Care Worker Protection Act of
2009 - Requires the Secretary of Labor to propose a standard on
safe patient handling and injury prevention to prevent
musculoskeletal disorders for direct- care registered nurses and
all other health care workers that requires the use of engineering
controls to lift patients and the elimination of manual lifting of
patients through the use of mechanical devices, except where
patient care may be compromised. Requires health care employers to:
(1) develop and implement a safe patient handling and injury
prevention plan; (2) provide their workers with training on safe
patient handling and injury prevention; and (3) post a uniform
notice that explains the standard and the procedures to report
patient handling-related injuries. Requires the Secretary to
conduct unscheduled inspections to ensure compliance with safety
standards. Allows health care workers to: (1) refuse to accept an
assignment in a health care facility that violates safety standards
or for which such worker has not received required training; and
(2) file complaints against employers who violate this Act.
Prohibits employers from taking adverse actions against any health
care worker who in good faith reports a violation, participates in
an investigation or proceeding, or discusses violations. Authorizes
health care workers who have been discharged, discriminated, or
retaliated against in violation of this Act to bring legal action
for reinstatement, reimbursement of lost compensation, attorneys'
fees, court costs, and other damages. Requires the Secretary of
Health and Human Services (HHS) to establish a grant program for
purchasing safe patient handling and injury prevention equipment
for health care facilities. 26
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Success Stories San Francisco General Hospital- Lift teams and
equip Camden Nursing Home (Maine)- Lifts Kennebec LTC (Maine)-
Lifts, assessment tools, gaitbelts, comprehensive training, safety
rewards Six LTC facility cohort study 6 facilities, 1728
participants, 6 year pre-post intervention Equipment, zero lift,
training (45 minutes-2 staff, return demo on residents) 73%
reduction in workers comp claims Equipment and training expenses
recovered in less than 3 years 27
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Personal and Professional Interventions Presentation of
research findings at nursing conferences, webinars Discussion of
findings with students, peers, colleagues, friends and family
Student training, modeling, and reinforcing behaviors Assist with
local facilities -annual training, return demos Formation of
Occupational Training Solutions (OTS) to produce a product that
could be used to prepare and retrain safe and competent caregivers
28
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Basic Nursing Training Supplements Product Development Basic
Care Skills for Nurses and Nursing Assistants More than 50 skills
are covered on 5 DVDs in this OTS Basic Nursing video series.
Demonstrating basic nursing care from real nurses on real people
Videos are divided into easy to follow modules. Additional learning
resources and assessment tools are included in our package. Each
skills video includes: Clear and concise skills demonstrations
Modeling of compassionate interactions between caregivers and
patients Bonus instructional features with tips on Things to
Remember and Things to Report when caring for patients Safe and
competent care tips throughout each video Proper lifting and back
safety techniques modeled throughout. Module of 8 different
transfer techniques included 29
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Thank you! Questions? Email me! Patricia Graham
[email protected] Product Information at
www.basicnursetraining.com 30