In the contemporary society, nursing homes have continued to provide the best supportive and caring environment for the elderly. They have the opportunities to have enjoyable life where entertainment and healthcare services are available for them 24/7. This may not be always the case with the managers of the nursing homes as they face numerous challenges in running the facilities, especially with the physical structures within the homes. Most of the elderly people in these homes have difficulties moving about, this means that they have to be helped with walking, moved from wheelchairs, and be bathed among other things. Workers in the nursing homes face various health and safety hazards as they are constantly exposed to risks involving biological, respiratory, x-ray and ergonomics.
Ergonomic hazards are known to cause serious malfunctions to the workers who are exposed to them, musculoskeletal disorder (WMSDs) being one of them. WMSDs results from repetitive tasks such as operations at the laundry, stocking of supplies and lifting heavy materials most of the times. Bureau of labor statistics points out that nursing homes and other facilities that engage in personal care have the highest cases of illness and injuries related to ergonomic hazards. The rate of occurrences of these injuries stands at 4.9, a figure that is much higher than 1.8 reported in other facilities.
Scientists have been involved in various studies in trying to establish the ergonomic hazards that the workers in nursing homes face every day. They also try to look for ways in which these hazards could be minimized in the nursing homes and to reduce their impacts on workers’ competence. This research is aimed at investigating the ergonomic hazards in the nursing homes that results from taking care of the elderly admitted in such facilities. It would focus on the aspects of transferring and lifting the elderly, which would be evaluated and appropriate recommendations given at the end of the research.
Research shows that there is a great need for nursing facilities to invest in mechanical lifting equipment. The workers should be trained on the proper use of the equipment and zero lift policy enforced to ensure that nurses are protected from any kind of injury that might came about as a result of lifting heavy patients. When nursing homes use the lifting equipment, injury rates tend to reduced drastically, hence saving the facility from spending money on treating staff and avoiding time wasting. Facilities are also saved from having to face many cases of compensation claims from the workers.
Mechanical lifting equipment would be beneficial to all the workers and the management of the nursing homes. A study carried out by Collins et al., (2016), established that the use of mechanical lifting equipment leads to decline in the number of injuries and fatigue among the nurses leading to a more energetic and productive workforce. The equipment protects the nurses from musculoskeletal injuries. This equipment may require the facilities to make huge initial investment to acquire them, but the profits made as result of owning these equipment grows much faster. The weight of a patient when lifted from the bed to a chair, or from a chair to a bed would not be tolerated by every worker in the nursing facility hence, it is advisable to have the lifting equipment for health and safety precautions.
A study carried out by Engkvist et al., (2000); found out that when nurses are trained on the use of lifting equipment, the problem of lifting patients is solved. Female nurses have problem when it comes to lifting and moving patients around, especially the heavy ones. The heavy weights cause strain and stress on the body of nurses making them to sustain injuries in their backs. A research carried out by Personick (1990), confirmed the fact that the nursing homes are understaffed. This means that the qualified nurses have to depend on the help of nurse aides.
In most cases, the nurses’ assistance sustains more injuries due to lack of experience and training on how to lift and move patients. The nurse assistants and the nurses are better taken care of when the management of a nursing facility invests in mechanical lifting equipment.
According to MErgs (2003), there is a need to redesign the tasks in which nurses are engaged in when working in the nursing homes. These tasks need to match the capabilities of the nurses and must not be too demanding. The study called for the management to ensure that nurses are not engaged in one single task for long as it could lead to musculoskeletal injuries or illnesses in the long run. Studies support the need to have ergonomic programs put in place in every nursing home to help with the identification, evaluation and control of the musculoskeletal disorders common among nurses and their assistants in nursing home (Peterson et al., 2004).Ergonomic programs would help nursing homes ensure that the safety of all the workers in regard to musculoskeletal injuries is ensured and competence of workers is enhanced.
According to Dr. Minnick, of the safety department at Indiana University of Pennsylvania, there are various ergonomic techniques that could be applied in nursing homes to help minimize the hazards that the workers are exposed to in the facilities. He says that these hazards could have negative impact on the productivity of the workers; hence the need to solve them before it is too late. This research is inspired by the lessons learned from Dr. Minnick’s class of ergonomics. The objectives of the ergonomics were to ensure that the learners are able to apply the techniques of the ergonomics in the evaluation, assistance and correction of the nursing home workers.
The researcher used recorded videos as the main source of evaluating the tasks carried out by the workers in the facilities. Online sources and visual images were also used to provide more clarifications on the research question, the activities and the health and safety hazards faced by the nurses working in nursing homes. The paper majored on the five techniques applied in the evaluation of ergonomic in nursing, assessment of the nursing movements and at the end, provided the researcher’s recommendations for improvements. The applied evaluation tools for the study include; Rodgers muscle fatigue analysis, metabolic demands, rapid body entire assessment, nook tables and NIOSH lifting equation.
Rodgers muscle fatigue analysis
This tool for analysis muscle fatigue was invented by Rodgers for the purposes of assessing the fatigue level in the muscles of workers during their works patters in different weeks after working for five minutes. His hypos this was that, muscles that experience fatigue faster are more vulnerable to inflammation and injury (Rodgers et al., 1994). This means that if there is a possibility of minimizing the fatigue then the illnesses and the injuries would also be reduced among the workers.
The tool is more appropriate for the evaluation of the risks that might occur due to fatigue which results from tasks that involve more than one hour t accomplish. With emphasis on the risk of fatigue among the workers, the Rodgers gave priority to change of task to break the long spells of engaging in a single task for long.
The role of this tool is to assess work capacity and is considered one of the most important tools in evaluation of ergonomics in work station. The researcher would not be in a position to determine the heart rate of each worker if not for this tool. There paper would involve some calculations of heart rates of workers to enable the researcher come up with effective recommendations on required time for rest to avoid aerobic capacity going overboard.
Rapid Body Entire Assessment
This tool assesses the postures of workers to determine the possibility of having WMSD. It evaluates the posture of workers by assigning specific scores to each part of the body. Group A score involves areas of the trunk, legs and neck; group B involves areas around wrists, lower and upper arms and postures for right and left; The score is the calculated by dividing the load by the force applied plus the factors involved. Score C would be read form the provided Table C which is derived from Score A and B. REBA decision table gives the degree of the risk involved.
This tool looks at the various designs of how workers push, pull, lower and lift during their working hours in the facility. It was designed by liberty mutual insurance Company and has been used to help establish the number of people who are capable of pulling, lifting and carrying loads without having to sustain injuries in the process. The tool has designed tables which are based on the gender of the worker who performs only one task. This research looks at the female gender especially the nurses working in nursing homes. The tool has received criticism for its inability to provide specific biochemical measurements of the workers such as NIOSH equation and RWL. It only gives a wide general outcome.
NIOSH Lifting Equation
Occupational health and safety personnel makes use of this tool in their assessment and measurement of the material handling weight that could lead to a worker sustaining injuries as a result of lift a specific material. The tool is used to establish the safe lifting guidelines and practices within facilities. The tool has tables which clarifies the estimated levels of physical strain that may occur as a result of a given lifting task and the NIOSH equation which defines every element present in the table.
Evaluation and Results
Rodgers Muscle Fatigue Analysis
In this research paper, evaluation of two activities was carried out to establish the priority of change. These tasks included transportation and lifting activities because they are the major causes of common MSDs within the nursing homes. It was observed that when a nurse tries to lift the elderly, their neck gave low scores because only their heads leaned forward and the frequency and durations were also low. During the transportation activities, the frequency was lower than the duration leading to a low score. However, the worker’s shoulder produced a high score because of the exerted force by the nurse while holding the patient’s weight with her arm for transportation.
The exerted force caused the back of the nurse to be on a higher range while transporting and lifting, leading to a medium high score for lifting. The elbows and arms of the worker scored high during the lifting activities. On the contrary, feet, knees, legs and the wrists scored low because of the worker’s failure to exert extra force on these parts when carrying out lifting and transportation tasks.
The activities in which nurses are involved in are known to cause stress more than other careers. They are vulnerable to pressure and stress as they go about their duties. The researcher conducted a test on the heart beats of a female nurse who weighed 63.5kg with 134 heart beats. The researcher calculated the metabolic demands and allowed the nurse to continue with her duties. The calculation involved a number of steps as shown below
MET*kg*time (hour) / minutes = 12.5*63.5*0.083/5 = 13.17 Kcl/ min
- Y = 0.025 * 134 – 1.76 = 1.6 O2 (L)/min
- Kj = 20.6* 1.6 = 32.96 Kj/min
- Kcal = 32.96/ 4.18 = 7.89 Kcal/min
- ml*O2/min = 7.89 *4.18 * (1/20.6)*1000/63.5 = 25.2 ml*O2/min
- (25.2-31)/ 6 = -0.96
This calculation meant that nurses can only exert 16.85 percent of force as compared to the general population.
Rapid Body Entire Assessment, REBA
REBA assessment and evaluation showed that nurses score high regarding injuries sustained during work. The recorded video and the observations made at the facility showed that the nurse’s body was extremely high to about 20-60 degree flexion. The twisted neck she had while transporting an elderly form the bed to a chair gave her a score of two. The score of two was also attributed to the patient’s weight of 22kgs.
The right and left sides of the upper arms scored a total of three. The recordings showed that the nurse experienced a slight twist of wrist and a flexion of more than 15 degrees giving the wrist area a score of two. The final REBA score was eleven, which given the circumstance, is extremely high indicating that the management should carry a thorough evaluation of their nurses.
This tool was applied in investigating the nurses who were involved in pushing the patients on wheelchairs on distances about 30 meters. The researcher estimated the height between the chair holders and the floor to be 70.1 centimeters. It was also established that a single nurse would push up a patient after every 30 minutes. It was observed that the total weight heavy and exceeded the weight recommended.
The outcomes showed that acceptable force required for female nurses to push patients on a wheelchair rules out 90 percent of the nurses, meaning only 10 percent have the capacity to push patients without causing injuries to themselves. The results also showed that it is extremely dangerous to have nurses pushing patients on wheelchairs in the nursing homes.
NIOSH Lifting Equation
This tool was used to determine the acceptable weight limits when lifting patients in a nursing home. The result of the NIOSH showed that it is difficult to apply the tool in the nursing home because of the inconsistent and unstable load weights. The tool could only be used when determining if the weight of a single patient lifted by a specific nurse could lead to the nurse sustaining injury. The researcher determined that the RWL for the lifting should not have exceeded 7.4 pounds, but it was unthinkable to have such a low load even in a nursing home.
The RWL remains a useful tool that enables managers and their employees determine how a load could be hazardous even without lifting. The equation below shows the values attained when a nurse lifts a patient or a device. This tool was also difficult to apply in a nursing home setting because it requires that the load be constant and stable. The researcher used estimated measures to determine the risks that might be involved in lifting patients by the nurses.
RWL = 51(pound)*0.36*0.78*0.85*0.85*0.75*0.95
RWL = 7.4 pound
LI = 200 pound/ 7.4 pound
LI = 27 (This is a higher lift index- extremely harmful – because it exceeded the limit 1.0 by 26)
It is important to identify hazardous activities and problems which might interfere with the productivity of workers in a nursing home. These hazards should be controlled to an acceptable limit that would not have a negative impact on the performance of the nurses. The back and the shoulders have been identified as the most vulnerable regions to injuries and are also the most painful places when injured. Management of any nursing home must evaluate and correct any task that might cause injuries to these regions when the nurses lift or transport their patients. The measurements achieve from the assessment tools must be re-designed to meet the required standards for the safety of the nurses.
The most important thing to do would be to find ways in which the demands and damages caused by various tasks within the nursing homes could be minimized or stopped. The nurses should be trained on how to carryout out of the tasks they are involved in their line of work. The guidelines provided by the OSHA in 2003 for the nursing homes could be applied to reduce risks in the facility. The nursing home needs to
- Increase the number of staffs
- Adjust peak periods
- Order lift assistance devices
- Ensure that ergonomic programs are implemented
- Carry out staff training
- Involve employees
- Encourage management support and participation
The researcher’s recommendation to HCFA to direct that the federal register leave out reporting of SLCs was accepted. HCFA would continue to cover set lift devices that do not need complete chairs. The researcher also raised a concern with the Secretary’s office that the HCFA did not consider all the available options before it decided to continue with seat lift. This should not have happened as there are many kinds of chairs that could enable the nurses to lift the patients more easily that HCFA’s preference. The pneumatic seats, for example, could be bought for between 129 US dollars to 250 US dollars. Some companies even rent out theses seats at a cost of between 71 to 157 US dollars per month.
Ergonomic programs are important in ensuring the safety of nurses in a nursing home. It is important that every nursing home observes all the guidelines of the OSHA regarding safety of workers in those facilities. Health and safety of nursing home workers must be given priority by management if they want to have productive workforce with increased profit margins. All workers should be trained on how to handle mechanical lifting equipment for their safety and the safety of patients within their care.
Collins, J. W., Wolf, L., Bell, J., & Evanoff, B. (2004). An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Injury Prevention, 10(4), 206-211.
Engkvist, I. L., Hjelm, E. W., Hagberg, M., Menckel, E., & Ekenvall, L. (2000). Risk indicators for reported over-exertion back injuries among female nursing personnel. Epidemiology, 11(5), 519-522.
MErgS, C. P. E. (2003). Preventing nursing back injuries: redesigning patient handling tasks. Workplace Health & Safety, 51(3), 126.
Personick, M. E. (1990). Nursing Home Aides Experience Increases in Serious Injuries. Monthly Lab. Rev., 113, 30.
Peterson, E. L., McGlothlin, J. D., Blue, C. L., Peterson, E. L., McGlothlin, J. D., & Blue, C. L. (2004). Ergonomics-The development of an ergonomics training program to identify, evaluate, and control musculoskeletal disoders among nursing assistants at a state-run veterans’ home. Journal of occupational and environmental hygiene, 1, D10-D16.
Rodgers, M. M., Gayle, G. W., Figoni, S. F., Kobayashi, M., Lieh, J., & Glaser, R. M. (1994). Biomechanics of wheelchair propulsion during fatigue. Archives of physical medicine and rehabilitation, 75(1), 85-93.