Position Statement on Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders

Alabama Nurse,  Dec 2003-Feb 2004  

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Suummaryy: In order to establish a safe environment of care for nurses and patients, the American Nurses Association (ANA) supports actions and policies that result in the elimination of manual patient handling. Patient handling, such as lifting, repositioning, and transferring, has conventionally been performed by nurses. The performance of these tasks exposes nurses to increased risk for work-related musculoskeletal disorders. With the development of assistive equipment, such as lift and transferdevices, the risk of musculoskeletal injury can be significantly reduced. Effective use of assistive equipment and devices for patient handling creates a safe healthcare environment by separating the physical burden from the nurse and ensuring the safety, comfort, and dignity of the patient.

Background:

?The term musculoskeletal disorder describes a collection of conditions affecting, but not limited to muscles, nerves, tendons, ligaments, joints, catilage, or spinal discs. Common manifestations of musculoskeletal disorders include low back pain, scitica, rotator cuff injury, and carpal tunnel syndrome. Job tasks, such as patient handling can lead to the development of these conditions or exacerbate existing ones.

Nurses suffer a disproportionate amount of musculoskeletal disorders consequent to the cumulative effect of repeated manual patient handling events, often involving unsafe loads. Among nurses, back, neck, and shoulder injuries are commonly noted as the motl prevalent and debilitating. Though nurses have been historically trained to use "propel" body mechanics to prevent injury from lifting and transferring patients, questions arise as to their true value and applicability to the practice of nursing.

While mostly associated with dependent patient care, the risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. As such, no nurse is effectively clear from the risk of injury. The impact on the nursing workforce may lead to adverse consequences at the organizational level, as well, through increased absenteeism, lost work time, burnout, decreasing retention, high turnover, and threatened recruitment. Moreover, the occurrence of musculoskeletal injuries may have a profoundly discouraging effect within the contexts of nursing shortage; aging nursing workforce, and waning numbers of professional entrants.

Manual Patient Handling

The distinction of manual patient handling specifically refers to tasks such as lifting, transferring, and repositioning of patients without the use of assistive devices. Performing manual patient handling places nurses at increased risk for musculoskeletal disorders. This risk can be attributed to several factors, including weight of load, patient characteristics, awkward posture and positioning, and environmental factors. While attempts to scientifically quantify allowable levels of weight for lifting have been made, designations based on static loads or developed using non-representative study populations cannot be generalized to the nursing workforce. Patients' bodies have an asymmetric distribution of weight and do not possess available, stable areas to grip thereby making difficult the attempt to hold a patient's weight close to the nurse's own body. Also, there may be occasions when patients are agitated, combative, non-responsive, or can offer limited levels of assistance, potentiating the risk for injury. In addition, the structural physical environment of care may necessitate awkward positions and postures further increasing the susceptibility of developing a musculoskeletal disorder. Altogether, these factors merge to create an unsafe load for nurses to manage capably. Even with assistance from additional staff members, it is critical to note, that the exposure to the hazard persists.

Engineering Controls

Engineering controls are the best line of defense for worker protection and can be effectively applied to patient handling. Technology has been successfully applied to significantly reduce the risk of exposure to occupational hazards in the healthcare setting, such as for needlestick injuries and communicable airborne diseases. The health-care industry must embrace the evolution of technological development in terms of its value to the delivery of quality patient care by a safe and healthy workforce.

Specialized equipment exists to assist in patient handling tasks and the selection of products continues to grow. Examples of patient handling equipment include full-body sling lifts, stand-assist lifts, lateral transfer devices, and friction reducing devices. Assistive equipment removes the manual dimension of patient handling and assumes a large proportion of the patient's weight. The use of assistive equipment relieves the caregiver of the total effort and risk associated with patient handling duties. The availability and utility of assistive equipment eliminates the need to engage in total manual patient handling. Though some form of patient handling must be undertaken by nurses, it should be limited to assisting patients While using assistive equipment (e.g., repositioning a patient in a chair after using a lifting device)