Article Prevention DisablingBackInjuries

7/28/2019 Article Prevention DisablingBackInjuries

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Journal of Long-Term Effects of Medical Implants, 14(6)521533 (2004)

10506934/04 $20.00 2004 by Begell House Inc. 521

Received 1 April 2004; Revised 1 August 2004; Accepted 1 October 2004

Prevention of Disabling Back Injuries

in Nurses by the Use of MechanicalPatient Lift Systems

Richard F. Edlich, MD, PhD,* Kathryne L. Winters,Mary Anne Hudson, RN, BSN, L.D. Britt, MD, MPH,

& William B. Long, MD

Disinguishe Pofesso Emeius of Plasic Sugey an Biomeical EngineeingUnivesiy of Viginia Healh Sysem Dieco of auma Pevenion Reseach an

Eucaion auma Specialiss LLP Legacy Emanuel Hospial Polan Oegon; WebsieManage an Ceaive Makeing Vancouve Washingon; Coos Couny Public HealhDepamen Noh Ben Oegon; Depamen of Geneal Sugey Easen

Viginia Meical School Nofolk Viginia; Meical Dieco of aumaSpecialiss LLP Legacy Emanuel Hospial Polan Oegon

* Aess all coesponence o Richa F. Elich 16155 Jenne Lake C. Beaveon OR 97006;[email protected]

ABSTRACT: Occupaional back pain in nuses (OBPN) consiues a majo souce of mobiiy in he healh cae envionmen. Accoing o he Naional Insiue fo Occupaional

Safey an Healh (NIOSH) occupaional back injuy is he secon leaing occupaional injuyin he Unie Saes. Among healh cae pesonnel nuses have he highes ae of back painwih an annual pevalence of 4050% an a lifeime pevalence of 3580%. Te AmeicanNusing Associaion believes ha manual paien hanling is unsafe an is iecly esponsiblefo musculoskeleal isoes encounee in nuses. I has been well ocumene ha paienhanling can be one safely wih he use of assisive equipmen an evices ha eliminaehese hazas o nuses ha invie seious back injuies. Te benefi of assisive paien hanlingequipmen is chaaceize by he simulaneous eucion of he isk of musculoskeleal injuyo he nusing saff an impovemen in he qualiy of cae fo paien populaions.

o unesan he cause of isabling injuies in healh cae wokes seveal facos musbe consiee incluing he following: (1) anaomy/physiology of he back (2) isk facos(3) meical legal implicaions an (4) pevenion. Among nuses back neck an shouleinjuies ae commonly noe as he mos pevalen an ebiliaing. While mosly associae

wih epenan paien cae he isk fo musculoskeleal injuy seconay o manual paienhanling cosses all specialy aeas of nusing. Te skeleal efecs of an abnomal back makehe back moe suscepible o occupaional injuy even une nomal sess coniions. Wokescompensaion guielines fo occupaional back injuy iffe in public an pivae healh cae


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Journal of Long-Term Effects of Medical Implants

R. F. EDLICH ET AL.522

I. INTRODUCTION

Occupaional back pain in nuses (OBPN) consiuesa majo souce of mobiiy in he healh cae envionmen. Accoing o he Naional Insiue fo Occupaional Safey an Healh (NIOSH) occupaionalback injuy is he secon leaing occupaional injuyin he Unie Saes. Among healh cae pesonnelnuses have he highes ae of back pain wih an annual pevalence of 4050% an a lifeime pevalence

of 3580%. Nuses also have he highes incience aeof wokes compensaion claims fo back injuies.-OBPN is an even geae poblem han publishesaisics inicae because nuses peceive back painas an ineviable pa of nusing pacice. Te financialimplicaions of his cosly injuy have been esimae

o be as high as $16 billion annually in he UnieSaes. Te aiional cos o employes of slowepoucion employee unove an meical coseimbusemen is esimae a $10 billion annually.In ecogniion of he enomous anges o nusing ofoccupaional back pain he Ameican Nusing Associaion has publishe a lanmak posiion saemen:Eliminaion of Manual Paien Hanling o Peven

WokRelaion Musculoskeleal Disoes.

II. ETIOLOGY

o unesan he cause of isabling injuies in healhcae wokes seveal facos mus be consiee incluing he following: (1) anaomy/physiology of he

secos fom sae o sae. Nusing pesonnel shoul be emine ha he evelopmen of backpain following occupaional aciviies in he hospial shoul be epoe immeiaely o heOccupaional Healh Depamen. A nuses failue o epo OBPN immeiaely has esulein numeous enials of claims fo ehabiliaion an compensaion ha nuses eseve. Expesbelieve ha aining in pope boy mechanics oes no peven back injuy. Consequenly focus

has been place on ohe innovaive injuy pevenion pogams incluing he use of engineeing conols as well as he lif eam meho. Egonomics involves he use of mechanical evices(e.g. walking bel an mechanical hois) o ai in paien lifing an ansfeing asks.

Gulmann Inc. has evise ceiling lif sysems an slings uing he pas 20 yeas. Tey havesuccessfully complee housans of insallaions wolwie coveing a wie ange of challenging coniions an complex envionmens. Te Gulmann ceilingmoune hois sysemconsiss of a wie ange of lifing unis ail componens an a complee assomen of lifingslings an accessoies. Is sling is mae of polyese which is chaaceize by is sengh anelasiciy. I eains is shape an is i epellen an easy o mainain. Te Gulmann newokhas one of he lages an inispuably mos expeience goup of ceifie insalles in heUnie Saes.

Te lif eam meho was evise o emove nusing pesonnel fom he eveyay askof moving paiens. Tis ype of inevenion assumes ha lifing is a specialize skill o bepefome only by expe pofessional paien moves who have been hooughly aine in helaes lifing evice echniques.

KEY WORDS: occupaional back injuies in nuses Ameican Nuses Associaion manualpaien hanling musculoskeleal isoes assisive paien hanling equipmen egonomicsisk facos meical legal wokes compensaion guielines Gulmann Inc. ceiling lif sysemsslings ceifie insalles lifing


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PREVENTING BACK INJURIES IN NURSES

Volume 14, Number 6, 2004

523

back (2) isk facos (3) meical legal implicaionsan (4) pevenion.

II.A. Anatomy/Physiology of the Back

Among nuses back neck an shoule injuies aecommonly noe as he mos pevalen an ebiliaing. Te spine is a complex sucue consising of24 mobile an five immobile veebae. Pas of sofissueveebal iscsseve as a sepaaion of hese

veebae. Tese iscs ae mae of a colloial gel anallow movemen while absobing mechanical shock.Ligamens un beween he veebae an along heenie spine mainaining sucual inegiy. Ane

io an poseio ligamens esis sess o he spinalcolumn hough he pevenion of sheaing acion as

well as excessive movemen. An inheen sucualweakness of he spine exiss in he lumba aea wheehe longiuinal ligamen begins o naow. Unfounaely he lumba aea is also whee he geaessess is place on he spine.

Simulaneous ineacion of he spine an back povies sucual suppo fo he boy poecs he spinal co an povies flexibiliy of moion senghan balance. Abominal an hoacic musculaue

conibue o his suppo by poviing sengh ohe spine an back. A healhy posue esuls whenhe hee cuves lumba hoacic an cevical meein a miline cene of gaviy o balance he weighisibuion. Tis balance hen poecs he iniviualfom susaining a back injuy.

Te exensibiliy of he ligamens elasiciy of heaicula capsule fluiiy of he isc an elasiciy ofhe muscles eemine he ange of moion pemieby he nomal spine. When lifing an objec he pelvisan ligamens of he spine susain he sess unil

45 of flexion is eache. Any fuhe flexion esulsin he use of back muscles. Gag e al. eemineha uing one of hei busies hous nuses flexefowa moe han 72 evey 53 secons. I was alsofoun ha hese same nuses spen moe han 13minues of his hou in a benfowa posiion of

36 o moe placing hem a high isk fo evelopmen of OBPN.

II.B. Risk Factors

While mosly associae wih epenan paiencae he isk fo musculoskeleal injuy seconay omanual paien hanling cosses all specialy aeasof nusing. Consequenly no nuse is effecively feefom he isk of injuy. Te impac on he nusing

wokfoce may esul in avese consequences a heoganizaional level as well as hough inceaseabseneeism los wok ime bunou eceasing eenion high unove an heaene ecuimen. In

aiion he occuence of musculoskeleal injuiesmay have a iscouaging effec wihin he conexof nusing shoage aging wokfoce an waningnumbe of pofessional enans.

Tee ae hee possible oigins of back injuy: abnomal sain on a nomal back nomal sess on anabnomal back an nomal sess on a nomal backha is unpepae fo he sess. In 1991 he Occupaional Safey an Healh Aminisaion issueguielines o ienify he following six isk facosin he evelopmen of a back injuy: (1) poo boy

mechanics incluing coninue bening ove a hewais lifing fom below he knuckles o above heshoules an wising a he wais especially whilelifing; (2) lifing o moving objecs of excessive

weigh o asymmeic size; (3) polonge siing wihpoo posue; (4) lack of ajusable chais foo essboy suppos an wok sufaces a wok saions; (5)poo gips on hanles; an (6) slippey fooing.

Mainenance of an awkwa posue places abnomal sain on a nomal back. Unfounaely nusingpesonnel fequenly wok in awkwa posiions o

spen much of hei ime in a saning posiion wihams fully exene. Tis awkwa posiioning of heboy is no iniially faiguing because of mainenanceof sucual inegiy by he ligamens an musclesof he back. Howeve spening polonge ime inawkwa posiions o polonge saning esul in


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excessive sess o he ligamens wih accompanyingmuscula conacion leaing o faigue sain aniscomfo. An eec posue places he heavy pa ofhe unk on op of a small base. Polonge saning

can pu sain on he ligamens an musculaue of heback which may cause cumulaive auma. In aiion faigue muscles no longe seve hei poecivefuncion an may a o he isk of acue auma.

Te skeleal efecs of an abnomal back makehe back moe suscepible o occupaional injuyeven une nomal sess coniions. Alhoughhe pope boy mechanics may be use; he sesson hese abnomal sucues is sill excessive. Backpain fom oveseching of muscles an ligamensesuls. Developmen of his ype of back injuy e

mains chonic as he esicions of ba movemenpeven nomal funcioning.

A nomal sess on a nomal back sucue impose by unexpece cicumsances is he mos common ype of back injuy among nusing pesonnel.Fo example paiens may no help pull o push wihhe nuse when he nuse expecs hem o o a paienmay fall pulling an wising on he nuses back.Because his movemen is suen he nuse oesno have aequae pepaaion ime o poec heback sucues f om injuy. Any iminishe muscle

sengh powe an/o join flexibiliy places henuse a a gea isavanage uing hese suenmovemens. Excessive movemens ha excee hephysiologic ange of moion may esul in conacionof he back causing he micoscopic o macoscopicissue amage ha ulimaely esuls in back injuy.

Accoing o NIOSH lifing guielines he maximum ecommene weigh o be life by womenin he 90t pecenile of sengh is 46 lbs. Fuhemoe his weigh figue assumes smooh lifingmoeae wih objecs unesice saning posue

favoable envionmens goo fooing consisen loaloweing asks an lifs one alone wih no ohe

wok involve. None of hese specificaions may holue all he ime fo he lifing asks pefome bynusing pesonnel. Nuses mus wok wih paiens ofiffeen sizes shapes an weigh an mus eal wih

he suen an unpeicable changes in he weigh(falls) in awkwa posiions. Alhough his guieline

was no evelope wih human paamees in mini seves as efeence o unesan he poenial fo

injuy among nusing pesonnel. Fo example whenwo nuses lif a paien weighing 140 lbs each islifing appoximaely 70 lbs which is 24 lbs ove helimi se by NIOSH fo women in he 90t pecenileof finess.

In he new lanmak epo fom he AmeicanNusing Associaion i poins ou ha manualpaien hanling specifically efes o asks such aslifing ansfeing an eposiioning of paiens

wihou he use of assisive evices. Pefominghese manual paien hanling effos places nuses

a incease isk fo musculoskeleal isoes. Teypoin ou again ha he isk can be aibue oseveal facos incluing weigh of loa paienchaaceisics awkwa posue posiioning anenvionmenal facos. Tey emphasize ha heseeffos o quanify scienifically allowable levels of

weigh fo lifing canno be genealize o he nusingwokfoce because paiens boies have asymmeicisibuion of weigh an o no posses availablesable aeas o gip heeby making i iffi cul o holhe paiens weigh close o he nuses boy. I mus

also be poine ou ha hee may be occasions whenpaiens ae agiae combaive o nonesponsive ocan offe limie levels of assisance enhancing heisk fo nusing injuy.

II.C. Medical Legal Implications

Wokes compensaion guielines fo occupaionalback injuy iffe in public an pivae healh caesecos fom sae o sae. Fo example fo sae

hospial employees in he Commonwealh ofViginia he Occupaional Healh Depamen(OHD) immeiaely assigns he nuse o a physician fo evaluaion of he injuy. If a isc is founo be pouing he nuse is place on auomaicisabiliy. If he nuse susains a back sain o any


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ohe nonisabling back injuy a ehabiliaion pogam is begun an he nuse is place on an ajuseligh uy scheule o peven fuhe aggavaion ofhe injuy. Afe 12 weeks he nuse is efee o

a specialis fo evaluaion of pogess. If he nusecanno eun o wok afe his peio hen hesae oganizaion will eminae he employ ee ani is he employees esponsibiliy o follow up wihhe sae oganizaions insuance caie o collec

wokes compensaion. If compensaion is ganehen he nuse will eceive full pay fo he fis 90ays fom he ae of he injuy an 66% pay axfeefo up o 5 yeas following he injuy. In he pivaeseco of healh cae he policy is manae by eachiniviual oganizaion which ses is own poocol

fo hanling occupaional injuies.Nusing pesonnel shoul be emine ha he

evelopmen of back pain following occupaionalaciviies in he hospial shoul be epoe immeiaely o he OHD. If he back injuy occus whenhe OHD is close he nuse shoul make aangemens so ha he o she can be seen as soon as possiblein he Emegency Depamen. A nuses failue oepo OBPN immeiaely has esule in numeousenials of claims fo ehabiliaion an compensaionha nuses eseve.

II.D. Prevention

In he pas mos pogams fo back injuy pevenion among nusing pesonnel focus on pope lifingechniques boy mechanics an back cae. Nuses

wee commonly le o believe ha he pimay wayo peven back injuies was o always use popeboy mechanics. Howeve he fac emains hasome asks wee so sessful o he boy ha even

when pope boy mechanics wee use a backinjuy esule. Fuhe some isageemen exissamong healh cae pesonnel concening whichechniques wee bes fo paien ansfes. Ofenmehos ha ae accepable in one healh cae insiuion wee consiee inappopiae in anohe.

Alhough insucion on pope boy mechanics inlifing an ansfeing paiens was believe o havea pophylacic value no scienific evience exiseha i euce he fequency of OBPN. Expes

believe ha aining in pope boy mechanics oesno peven back injuy. Consequenly focus hasbeen place on ohe innovaive injuy pevenionpogams incluing he use of engineeing conolsas well as he lif eam meho.

As noe in he lanmak epo fom he Ameican Nuses Associaion engineeing conols ae hebes efense fo woke poecion an can be effecively applie o paien hanling. echnology hasbeen evelope o euce he isk of exposue ooccupaional back injuies. Te healhcae inusy

mus embace he evoluion of hese evoluionayechnological evelopmens in ems of hei valueo he elivey of qualiy paien cae. Specializeequipmen exiss o assis in paien hanling asksan he selecion of poucs coninues o enlage.Examples of paien hanling equipmen incluefullboy sling lifs sanassiss lifs laeal ansfeevices an ficion eucing evices. Tese innovaive assisive echnologies emove he manual imension of paien hanling wih he use of assisive lifechnology. Te use of assisive equipmen elieves

he caegive of he oal effo an isk associaewih paien hanling uies., Te availabiliy anuiliy of assisive equipmen eliminae he nee oengage in oal manual paien hanling. Alhoughsome fom of paien hanling mus be uneakenby some nuses i shoul be limie o assising paiens while using assisive equipmen. Tee may besiuaions whee manual paien hanling canno beavoie; nuses may be pesene wih excepionalo life heaening siuaions pohibiing he use ofassisive paien hanling equipmen. Ohe excep

ions inclue he cae of he peiaic (infan o smallchil) o small paiens. Te Ameican Nuses Associaion sesses ha in any an all cases effos o

wa paien hanling shoul be minimize wihoucompomising paien cae o exceeing he abiliiesan skills of he nuse.


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II.E. Ergonomics

Egonomics involves he use of mechanical evices(e.g. walking bel an mechanical hois) o ai in

paien lifing an ansfeing asks. I has beensuggese ha egonomic applicaion o paien caemay lea o less OBPN. In one egonomic suyconuce by Gag an Owen in which a combinaion of he walking bel an mechanical hois wasuse he back injuy pio o inevenion was 83pe 200000 wok hous. Afe he inevenion heincience of injuy was cu almos in half o 47 pe200000 wok hous. Moe impoanly ha samesuy showe a ecease in he numbe of los anesice wok ays among nusing pesonnel u

ing he ime of inevenion. Te ecease in seveiyae was aibue o less seious OBPN. Tis ype ofinevenion also allows fo he use of only one nuseo pefom he ansfe because he mechanical evicepefoms all of he wok. Te only isavanage ousing hese mechanical paienhanling evices ishe longe ansfe ime.

1. Mechanical Patient Lift System

Gulmann Inc. ampa Floia has evise ceilinglif sysems an slings fo he pas 20 yeas. Teyhave successfully complee housans of insallaions wolwie coveing a wie ange of challenging coniions an complex envionmens. Ceilinglifs avel smoohly an quiely houghou he ailsysem a cusomize sysem buil of moula componens ha fi ogehe seamlessly. Tese componenscan be combine o fom any size ceiling ack sysemoom coveing sysem o combinaion of boh. Teails can be moune on he ceiling o wall.

Te moula componens ae easy o hanle uing anspo an insallaion. A wie selecion ofmouning backes fo wall o ceiling ensues a soliinsallaion in all siuaions.

Gulmann elives boh poucs an sysems plusconsulaion an aining o obain he bes possibleuse an opeaion of is sysems. Tei expeience

consulans an insalles will plan an insall hesysem wih opimum use of space.

2. Ceiling Hoist Systems

Te Gulmann ceilingmoune hois sysem consissof a wie ange of lifing unis ail componens ana complee assomen of lifing slings an accessoies. Using hei componens an pas i is possible o esign a ceiling moune sysem ha coulbe aape o boh iniviual equiemens an heexising envionmen. Te sysem is available as smallfeesaning selfsusaining an emovable unis oas wall o ceilingmoune sysems.

A ceilingmoune hois fom Gulmann Inc. ensues ha he use will expeience incease comfosafey an mobiliy. Fewe injuies less aiion anincease effi ciency povies healhcae wokes wihmoe ime o cae an incease saisfacion.

A ceilingmoune sysem oes no occupy anyfloo space. I equies less space fo opeaion is nevein he way an is always available. A cusomize ceiling lif sysem will impove he effi ciencies of lifingan ansfeing aciviies esuling in moe fee imeuing he wokay allowing he healhcae woke

o cae fo paiens. Te ceilingmoune sysem canbe insalle in pivae homes in hospials in caeinsiuions in mobile homes an in connecion wihequesians swimming pools heapies ec.

Te GH2 ceilingmoune lif is a new geneaionof he singlehois sysem. Te hois hangs ieclyune he ails an lifs he use wih he help ofa lifing hange o which he sling is aache (Fg1). We have been favoably impesse by eihe heGH2 ceiling hois o he GH2+2 ceiling hois wihive moo.

GH2 ceiling hoist. Te GH2 hois combines highcapaciy lifing an funcions wih an aacive iscee esign (Fg. 1). Alhough i weighs less han20 lbs he GH2 can lif up o 440 lbs. Fo geaelifing capaciy he DH2000 H (max 520 lbs) ohe DH4000 (max 660 lbs) hois can be use. Te


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GH2 has poweful baeies ha can auomaicallybe echage on an ongoing basis o when he hois islocae in specific aeas in he ail sysem epeningon he choice of echaging sysem an ail pofile.

Te hois has a builin baey saus inicao ana chaging ligh ha inicaes when echaging isaking place. Te GH2 is conolle by a micopocessoall infomaion on aily opeaion loasan possible iegulaiies is capue o be useuing sevice inspecion. Tis feaue ensues ha

weaing pas can be ienifie an eplace befoea beakown occus. Because of is high pocessspee he ual spee funcion inceases lifingspee when he hois is unloae. Tis means hahe oveall lifing pocess can be caie ou fase

wihou compomising safey. Because of is smallinsallaion imensions lifing heigh is incease(almos 5 cm highe han ha of DH2000). Te hoisopeaes quiely an paiens ae move smoohlyon he Gulmann ail sysem.

GH2+2 ceiling hoist with drive motor. Te GH2+2is a fully auomaic ceiling hois wih a builin

moo fo opeaion on he ail sysem. Te ivemoo is pemanenly moune an canno be eofie. I has a unique consucion ha allowssof sa an sop. Te GH2+2 has he same lifing

specificaions as he GH2 (max 440 lbs) an onlyiffes by having he builin ive moo. Whenusing a GH2+2 noe ha he ive moo akesappoximaely 1 secon o eihe acceleae o sophe hois. When sopping he uni fom maximumspee he ive moo mus be cu off 45" befoehe esie posiion.

Slings. Te sling is mae of polyese chaaceizeby is sengh an elasiciy. I eains is shape anis i epellen an easy o mainain. All slings wih

ivie leg suppos have inse foam pas on he legswhich ae easy o pu on an smoohe on he skin(Fg. 2). Te suspension sap makes i easy o hanghe sling up an soe i. Insucion labels ae aacheo he sling poviing he caegive guiance in heuse of he sling. Moels wih a small back sufacehave ae paing fo aiional comfo. If neeehee ae auxiliay saps available. Te colo of heban on he sling inicaes o he caegive an use

wha ype of sling hey ae using. All basic slings aepovie wih a pocke o faciliae coec posiioning

of he sling. Te cene ban povies guiance fohe caegive in posiioning he sling when he paienis in a supine posiion. Te sling is easy o mainainbecause i can be washe a 85 C.

Te funcion of he aine acive sling poviessuppo aoun he ches an shoule aeas. Deachable leg saps give suppo aoun he hip aea(Fgs. 3 an 4) an peven he use fom sliing ouof he sling. Tis sling is mos suiable fo pesons

wih euce boy balance bu hey mus be able obea weigh on hei legs. I is gea fo walk aining

in heapy as well.

II.F. Guldmann Certification Program

Te Gulmann Inc. newok has one of he lagesan inispuably mos expeience goups of ceifie

FIGURE 1. The GH2 hoist combines high capacity lifting

with an attractive, discreet design. In spite of its size, the

GH2 hoist can lift up to 440 lbs.


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FIGURE 4. Suitable for persons with reduced body bal-

ance, but must be able to bear weight on their legs and

is great for walk training.

FIGURE 2. Specifications of Guldmann ABC slings:

1. Materialpolyester characterized by its strength

and elasticity. Retains its shape, is dirt repellent and

easy to maintain.

2. Padding on legsall slings with divided leg sup-ports have inset foam pads on legs. Easy to put on,

smoother on skin.

3. Suspension strapmakes it easy to hang the sling

up and to store it.

4. Instruction labelindicates all that the healthcare

worker needs to know.

5. Padding in back sectionfor added comfort on

models with small back surface.

6. Auxiliary strapsit is possible to use auxiliary

straps.

7. Type markingthe colour of the band identifiestype of sling.

8. Positioning pocketall basic slings are provided with

a pocket to facilitate correct positioning of sling.

FIGURE 3. Provides support around the chest and shoulder

areas. Detachable leg straps give support around the hip

area and prevent the user from sliding out of the sling.


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insalles in he Unie Saes. In 2003 alone i hasceifie moe han 25 people an aine many moefo iniial planning so hey can ean hei ceificaionin he coming yea.

Gulmann Ceificaion is no a given jus foshowing up fo aining. I equies leaning heoyan pacical insallaion of complicae ceiling lifsysems. Classes ae limie o wo o hee peopleo assue hanson aining an qualiy ime wihinsucos. Te ceificaion is vali fo 1 yea. Ahe en of 1 yea he ceificae hole will unegoa eview by he ceificaion couse insucos.

Te ceificae hole mus povie GulmannInc. wih poof of a equie minimum numbe ofGulmann Ceiling Lif Sysems insalle uing

ha peio. If he numbe of sysems o he complexiy of he sysems o no mee he Gulmannsanas aiional aining may be equie oenew ceificaion.

Te Gulmann Insucos have 3 o 12 yeasexpeience in his inusy an hey have insallemoe han 300 ceiling lif sysems. Tey ae on call foechnical an use suppo ove he phone an hey

will also avel wihin he US an Canaa fo onsieaining an suppo uing complicae insallaions.Shoul assisance be equie fo is insucos a

suppo newok is available a Gulmann R&D anhe clinical aine saff.

II.G. Hospitals Using Guldmann Lift Equipment

Hospials ha have selece he Gulmann lifequipmen inclue he following: Caig HospialEnglewoo Coloao; Elange Chaanooga ennessee; Legacy Emmanuel Hospial Polan Oegon; Magee Rehabiliaion Hospial Philaelphia

Pennsylvania; Shephe Cene Alana Geogia;Spauling Rehabiliaion Cene Boson Massachuses; an Te Insiue fo Rehabiliaion anReseach (IRR) Houson exas. Tese hospialshave aken his leaeship appoach in healhcae oensue ha hei paiens ae life safely wihou anyinjuy o he healhcae pesonnel.

III. LIFT TEAM METHOD

Te l if eam meho was evise o emovenusing pesonnel fom he eveyay ask of mov

ing paiens. Tis ype of inevenion assumes halifing is a specialize skill o be pefome onlyby expe pofessional paien moves who havebeen hooughly aine in he laes lifing eviceechniques. Tese pofessional paien moves usemechanical lifing evices fo evey oalboy ansfe. Tis philosophy is base on he belief ha hepecenage of nusing pesonnel emove f om lifing esponsibiliies is iecly elae o a ecease ininjuy an compensaion ollas spen among hesesame pesonnel.

en hospials paicipae in he lif eam suy.In each of he hospials a eucion in majo caegoies of back injuy as a esul of moving paiens

was epoe. Lif eams wee able o eliably meehe nees of he paien while emoving a lagenumbe of nusing pesonnel fom hei obligaionof paien lif ing an ansfe. Tis change allowehe nuses o spen moe ime poviing paiencae. All 10 hospials epoe excellen nusingsaisfacion wih he lif eam via qualiy assuancequesionnaies. No ownime was epoe when

a eques was mae fo he eam o make a ansfe.Because of a ecease in he numbe of injuies as

well as wokes compensaion o nusing pesonneluing he ime of inevenion a small amoun ofhe exa monies wee use o compensae membes of he lif eam. Teefoe he pogam wasselfconaine an succeee in eucing OBPN.Coninue evaluaion of he pogam on a lagescale is neee.

IV. EMPLOYER/MANAGEMENT COMMITMENT

Te Ameican Nuses Associaion inicaes haemployes an manages shoul aop a policy hacommis he insiuion o he safes appoach ofhanling an moving paiens. Te safes appoachpioiizes he use of assisive equipmen an iscou


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ages he pefomance of manual paien hanling. Oganizaional acions mus suppo he use of assisiveequipmen fo paien hanling asks by invesing inan aequae supply of appopiae assisive equipmen

ensuing ha he equipmen is eaily available anesignaing esouce specialiss skille in he assessmen an evaluaion of paien hanling. In aiion any policy elae o he eliminaion of manualpaien hanling mus no be puniive. Nusing saffshoul be encouage o paicipae an effecivelyimplemen equiemens fo safe paien hanling anno be mae feaful of epoing inciens of wokelae injuy. Tese elemens ae essenial o ensueha a policy successfully esicing manual paienhanling seves o euce he isk of musculoskeleal

isoes.

V. DISCUSSION

Seveal suies have eemine ha fequen manuallifing an/o ansfeing of paiens is he pimaycausal faco of low back pain in nusing pesonnel.- Many nuses believe ha of all jobelae askspaienhanling aciviies ae he mos likely o esulin low back pain. Quanificaion suies have con

fime his peceive exeion fining high levels ofbiomechanical sess inuce by hese paienlifingan ansfeing asks.- aining in pope boymechanics has faile o have a longem effec on henumbe of back injuies susaine by nusing pesonnel. When elying on aining alone many healhcaeinsiuions neglec o ienify an conol isks.

Te poblem of lifing a paien is no simply oneof ovecoming a heavy weigh. Te nuse mus alsoake ino accoun he size shape an efomiiesof he paien along wih any physical impaimens

of lowe limb funcion as well as balance an cooinaion. Some paiens also may be combaiveconace o uncoopeaive. Any unpeicablemovemen o esisance fom he paien may howhe nusing pesonnel off balance uing he ansfeesuling in back injuy. Space limiaions equipmeninefeence an unajusable bes chais an com

moes may also conibue o an incease in he iskof an occupaional back injuy. Tese facos pevennusing pesonnel fom pacicing pope boy mechanics allowing fo he coninue high pevalence

of OBPN.Te Ameican Nusing Associaion has campaigne an coninues he call fo a feeal Occupaional Safey an Healh Aminisaion sanao conol hazas in he wok place in an effo opeven wokelae musculoskeleal isoes.A egulaion ha inclues sipulaions equiinghealhcae seings o use engineeing conols (i.e.assisive lif an ansfe equipmen) fo paienhanling asks woul lea o he eliminaion ofoal manual paien hanling. In he absence of a

naional sana he Ameican Nusing Associaionalso suppos effos o uneake hese egulaionsa a sae level. I is impoan o emphasize haegulaion an enfocemen ae necessay componens of he oveall effo o peven wokelaemusculoskeleal isoes.

Once he employees leave he conolle seing ofa aining pogam he heoeic aining pinciplesmay no have applicaion. oo many obsacles mayeffecively peven goo boy mechanics incluinghe size of he oom he poximiy of he be an

wheelchai an he paiens coniion. Moe impoanly eaching pope boy mechanics oes no focuson paiens who ae jus oo heavy o ansfe even

wih assisance.Removing he haza of back injuies involves

implemenaion of innovaive lifing pogamsincluing egonomics an he lif eam meho.Cos savings fom use of he mechanical lifingequipmen o lif eam in highisk epamensshoul be use o puchase lifing equipmen foohe aeas wihin he healh cae insiuion unil

all isks fo back injuy have been eliminae. Tesoluion involves a paaigm shif fom focusing onpope boy mechanics o compleely eliminainghe isk associae wih paien hanling. ainingalone may pepae nusing pesonnel fo lifing asksha ae jus oo angeous even when ieal boymechanics ae use.


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VI. CONCLUSION

Occupaional back pain in nuses (OBPN) consiues a majo souce of mobiiy in he healh

cae envionmen. Accoing o he Naional Insiue fo Occupaional Safey an Healh (NIOSH)occupaional back injuy is he secon leaingoccupaional injuy in he Unie Saes. Amonghealhcae pesonnel nuses have he highes aeof back pain wih an annual pevalence of 4050%an a lifeime pevalence of 3580%. Te AmeicanNusing Associaion believes ha manual paienhanling is unsafe an is iecly esponsible fomusculoskeleal isoes encounee in nuses. Ihas been well ocumene ha paien hanling can

be one safely wih he use of assisive equipmen anevices ha eliminae hese hazas o nuses hainvie seious back injuies. Te benefi of assisivepaien hanling equipmen is chaaceize by hesimulaneous eucion of he isk of musculoskelealinjuy o he nusing saff an impovemen in hequaliy of cae fo paien populaions.

o unesan he cause of isabling injuies inhealhcae wokes seveal facos mus be consieeincluing he anaomy/physiology of he back iskfacos meical legal implicaions an pevenion.

Among nuses back neck an shoule injuies aecommonly noe as he mos pevalen an ebiliaing. While mosly associae wih epenen paiencae he isk fo musculoskeleal injuy seconay omanual paien hanling cosses all specialy aeasof nusing. Te skeleal efecs of an abnomal backmake he back moe suscepible o occupaional in

juy even une nomal sess coniions. Wokescompensaion guielines fo occupaional back injuyiffe in public an pivae healh cae secos fomsae o sae. Nusing pesonnel shoul be emine

ha he evelopmen of back pain following occupaional aciviies in he hospial shoul be epoeimmeiaely o he Occupaional Healh Depamen.A nuses failue o epo OBPN immeiaely hasesule in numeous enials of claims fo ehabiliaion an compensaion ha nuses eseve. Expesbelieve ha aining in pope boy mechanics oes

no peven back injuy. Consequenly focus hasbeen place on ohe innovaive injuy pevenionpogams incluing he use of engineeing conolsas well as he lif eam meho. Egonomics involves

he use of mechanical evices (e.g. walking bel anmechanical hois) o ai in paien lifing an ansfeing asks.

Gulmann Inc. has evise ceiling lif sysems anslings fo he pas 20 yeas. Tey have successfullycomplee housans of insallaions wolwie coveing a wie ange of challenging coniions an complex envionmens. Te Gulmann ceilingmounehois sysem consiss of a wie ange of lifing unisail componens an a complee assomen of lifingslings an accessoies. Is sling is mae of polyese

chaaceize by is sengh an elasiciy. I eainsis shape an is i epellen an easy o mainain.

Te Gulmann Inc. newok has one of he lagesan inispuably mos expeience goup of ceifieinsalles in he Unie Saes.

Te lif eam meho was evise o emovenusing pesonnel fom he eveyay ask of moving paiens. Tis ype of inevenion assumes halifing is a specialize skill o be pefome onlyby expe pofessional paien moves who havebeen hooughly aine in he laes lifing evice

echniques.

ACKNOWLEDGMENT

Tis aicle highlighing evoluionay avancesin back injuy pevenion in healhcae wokes iseicae o he Honoable Unie Saes Repesenaive Pee A. DeFazio Oegon fo his insumenalleaeship in eveloping naional legislaion ha willpeven isabling back injuies in ou naions healh

cae wokes.

REFERENCES

1. Naional Insiue fo Occupaional Safey anHealh. Pogam of he Naional Insiue fo Oc


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cupaional Safey an Healh FY 1985 pogamplan. Alana (GA): Cenes fo Disease Conolan Pevenion; 1985. DHHS (NIOSH) publicaion No. 85109.

2. BieingSoenson F. Risk of back ouble in iniviual occupaions in Denmak. Egonomics 1985;28:5154.

3. Gus G Peason JG Mai A. Te pevalence oflow back pain in nuses. In Nus Rev 1972; 19:169178.

4. Dehlin 0 Heenu B Hoal J. Back sympoms innusing aies in a geiaic hospial. Scan J RehabilMe 1976; 8:4753.

5. Habe P Bille E Guowski M Soohoo K Lew MRoman A. Occupaional lowback pain in hospialnuses. J Occup Me 1985; 27:518524.

6. Jensen R. Disabling back injuies among nusingpesonnel: eseach nees an jusificaions. ResNus Healh 1987; 10:2938.

7. Gag A Owen BD Calson B. An egonomic evaluaion of nusing assisans job in a nusing home.Egonomics 1992; 35:979996.

8. Weeks JL Levy BS Wagne GR. Pevening occupaional isease an injuy. Washingon DC:Ameican Public Healh Associaion; 1991.

9. McAbee RR Wilkinson WE. Back injuies anegisee nuses. AAOHN J 1988; 36:106112.

10. Ameican Nuses Associaion Posiion Saemen:

Eliminaion of Manual Paien Hanling o PevenWokRelae Musculoskeleal Disoes: EffeciveDae: June 21 2003 Washingon D.C.

11. inkoff AM Lipscomb JA GeigeBown J BayB. Musculoskeleal poblems of he neck shoulean back an funcional consequences in nuses.Am J In Me 2002; 41(3):170178.

12. Callie R. Low Back Pain Synome. 3rd e. Philaelphia: FA Davis 1981.

13. Blue CL. Pevening back injuy among nuses.Ohop Nus 1996; 15(6):920; quiz 2122.

14. Gag A Owen BD Belle D Banaag J. A biome

chanical an egonomic evaluaion of paien ansfeing asks: be o wheelchai an wheelchai obe. Egonomics 1991; 34:289312.

15. PowellCope G Nelson A iesman H Maz M.Nuses woking coniions an he nusing shoage. JAMA 2003; (13):1632 auho eply 1633.

16. Anesson GBJ Pope MH. Te paien. In: Pope

MH Anesson GBJ Fymoye JW Chaffi n DBeios. Occupaional Low Back Pain: Assessmen

eamen an Pevenion. S Louis MO: Mosby;1991; 132147.

17. Naional Insiue fo Occupaional Safey anHealh. Wok pacices on manual lifing. Cincinnai OH: Cene fo Disease Pevenion. USDHHS(NISHA) 1991; 81122.

18. Nelson A Lloy JD Menzel N Goss C. Peveningnusing back injuies: eesigning paien hanlingasks. AAOHN J 2003; 51(3):126134.

19. Owen B Gag A. Back sess isn pa of he job.Am J Nus 1993; 93(2):4851.

20. Fleche JA. o lif o no o lif. Raiogaphy 1981;47(559):162164.

21. Venning PJ. Back injuy pevenion among nusing

pesonnel. Te ole of eucaion. AAOHN J 1988;36(8):327333.22. Subbs DA Buckle PW Huson MP Rives PM

Woingham CJ. Back pain in he nusing pofession. I. Epiemiology an pilo mehoology. Egonomics 1983; 26(8):755765.

23. Owen BD. Pevening injuies using an egonomicappoach. AORN J 2000; 72(6):10311036.

24. Gag A Owen B. Reucing back sess o nusingpesonnel: an egonomic inevenion in a nusinghome. Egonomics 1992; 35(11):13531375.

25. Chaney W. Te lif eam meho fo eucing back

injuies. A 10 hospial suy. AAOHN J 1997; 45(6):300304.

26. Nelson A Owen B Lloy JD Fagala G Maz MWAmao M Bowes J MossCueon S Ramsey GLenz K. Safe paien hanling an movemen.Am J Nus 2003; 103(3):3243; quiz 44.

27. Bell F Dalgiy ME Fennell MJ Aiken RC. Hospial wa paienlifing asks. Egonomics 1979;22(11):12571273.

28. Feguson D. Sain injuies in hospial employees.Me J Aus 1970; 1(8):376379.

29. Geenwoo JG. Back injuies can be euce wih

woke aining einfocemen. Occup Healh Saf1986; 55(5):2629.

30. Jensen R. Evens ha igge isabling back painamong nuses. Poceeings of he Human Facosan Egonomics Sociey 29t Annual Meeing. 1985Sep 29; Sana Monica CA; 799801.

31. Habe P Bille E Vojecky M Rosenhal E Shi


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533

mozaki S Hoan M. Nuses beliefs abou cause anpevenion of occupaional back pain. J Occup Me1988; 30(10):797800.

32. Calson BL. Egonomic job evaluaion of nusing

assisans a Rock Couny healh cae nusing homefaciliy (MS heses). Milwaukee WI: Depamenof Inusial an Sysems Engineeing Univesiyof Wisconsin; 1989.

33. Gagnon M Sica C Siois JP. Evaluaion of foces

on he lumbosacal join an assessmen of wokan enegy ansfes in nusing aies lifing paiens.Egonomics 1986; 29(3):407421.

34. Bell F. Paien lifing evices in hospials. Lonon:

Coom Helm; 1984.35. Ameican Nuses Associaion Commen o 29 CFR1910 Egonomics Popose Rule submie by MayFoley Mach 1 2000 o U.S. Depamen of LaboOccupaional Safey an Healh Aminisaion.

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