From the Massachusetts Nurse Newsletter
November/December 2006 Edition
By Jan DuBose, RN
Recent legislative initiatives in states across the country, including a bill in the Massachusetts legislature (H.2662), provide a strong indication that the time has come to get serious about preventing nursing injuries that occur when lifting or repositioning patients.
When hospitals or nursing homes are considering the adoption of new safe patient handling programs, it’s important to remind decision-makers that they can expect to achieve a number of benefits, both to patients and caregiver staff. These include improved clinical outcomes for patients; greater patient protection, safety and comfort; caregiver injury prevention; and improved caregiver performance and morale.
Can safe patient handling programs really help to improve clinical outcomes?
While limited evidence-based research exists on this topic, most of us would agree that patients can experience significant clinical benefits as a result of being lifted periodically to a standing position and/or being repositioned on a regular basis. Typical clinical benefits might include a combination of improvements such as better overall hygiene, improved bowel/bladder functioning, a greater sense of personal dignity, improved balance, strengthened pelvic musculature, decreased UTIs and calculi formation, maintenance of bone density, and overall acceleration of rehabilitation.
When assistive devices and equipment such as patient lifts are added to the equation, you can open up a whole new world of clinical and rehabilitative benefits. While patient lifting equipment was originally designed to assist caregivers with these straightforward lifting and repositioning tasks, we now recognize that they can be used as well to assist with basic rehabilitation and performance of clinical procedures. Not only do they ensure increased comfort for the patient, but they also help ensure greater safety through avoidance of falls and reduction in bruises and skin shearing.
Rehabilitative benefits include quicker establishment of static weight-bearing, ambulation and gait training. Avoidance of contractures or venous stasis is potential benefit as well. Additionally, by facilitating the lifting process for the caregiver, the overall quality of patient care can be enhanced and the patient’s clinical outcome will often improve accordingly.
These latter improvements are largely due to nurses and caregivers being able to more easily perform toileting, skin treatment and rehabilitation tasks. For example, convenient lift straps are now available to enable nurses to hold the patient, or a limb, in a fixed position while treatments are being performed. This can be an important injury prevention aid because it avoids having an assistant bear weight while in an awkward position.
Negative effects of manual lifting
Manual lifting can have negative effects on both the patient and the caregiver, and these are sometimes underestimated or completely overlooked by caregivers and nursing managers. For example, significant injuries to the patient can result from unintended caregiver actions such as over-stressing the patient’s arms or shoulders. Also, if the patient has limited range of motion due to old humeral head fractures, shoulder subluxation or arthritis, this can predispose him to pain and further injury. Skin tears or bruising can result from excessive grasping of the patient. While infrequent, even dropping of the patient can occur, with resulting head injuries, hip fractures or other traumatic injuries. Even the fear of falling by itself is an unnecessary stressor that can adversely affect patient and caregiver alike.
Other adverse effects that can result from lack of adequate mechanical lifting assistance include pressure sores caused from too infrequent repositioning, or skin shear as a result of linen friction while being dragged rather than lifted up in bed. Loss of patient dignity can also result from awkward manual lifts. In brief, injuries or significant clinical regression can result from not using available lift and transfer equipment, sometimes even causing re-injury and/or requiring costly extension of the patient’s hospitalization.
Caregiver injury prevention
As we know, injury to a registered nurse or trained caregiver can be disastrous, causing significant pain, suffering and even loss of the one’s professional career. Such injuries are particularly prone to occur during transfer tasks such as during toileting, bathing or moving the patient between bed and wheelchair, and often they involve unanticipated movements caused by events such as when the patient begins to slip or fall.
Fortunately, many states and health care organizations are now encouraging use of these mechanical assistive devices as part of a conscious effort to improve patient care and avoid staff injuries.
How serious should we be about this issue? In national studies, the following statistics are frequently used to justify institution of safe lifting programs:
- 52 percent of nurses and caregivers complain of chronic back pain
- 12 percent of nurses are contemplating "leaving for good" because of back pain
- 20 percent of nurses have transferred to a different unit, position or employment opportunity because of lower back pain
- 38 percent have suffered occupational-related back pain severe enough to require leave from work
- 6 percent, 8 percent and 11 percent of RNs reported changing jobs for neck, shoulder and back problems, respectively.
It’s vitally important to point out one additional fact. Historically, nurses have passively resisted use of mechanical devices for patient lifting and repositioning. Yet, recent exhaustive studies have now proven, without a shadow of doubt, that lifting our patients is extremely dangerous, and further, consistent use of assistive devices can virtually eliminate musculoskeletal injuries to caregivers.
What can we do to encourage safe lifting practices? First we need to convert our passive resistance into proactive acceptance, and there are many ways to accomplish this. Step one is to encourage establishment of a safe lifting program in your individual facility.
Step two is to develop a means of ensuring that all nurses and caregivers participate in or “buy into” the program. And finally, step three is to monitor your results and compare them to previous years’ injury rates and workers’ compensation costs. Not only will you be gratified by the results, you’ll be helping to improve patient safety as well as the lives of your peers and successors.
States that have enacted legislation are Texas and Washington. Other states considering legislation are Rhode Island, Florida, New Jersey, Ohio, New York, Connecticut, Minnesota and Hawaii.