16 minute read
Low back pain rises with nurse workload
Back pain in nursing
Back Pain in Nursing is the focus of this year’s BackCare Awareness Week, taking place 5-9 October.
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BACKCARE is issuing new flyers, A5 booklets, A3 posters and balloons for display, while this Special Awareness edition of TalkBack will cover initiatives from professional partner associations.
BackCare’s campaign will, with the assistance of its flagship publication The Guide to the Handling
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of People (HOP6), prevent significant back injuries in the Nursing profession. Many nurses will benefit from training which is provided by our sister organisation, the National Back Exchange. It will be advertised widely throughout the NHS and caring facilities and also through social media.
HOP6 is the leading and internationally recognised training text for the handling of people. Extensively updated, the 6th edition of this gold standard guide includes four new major sections: ● Legal framework, risk assessment, ergonomics and biomechanics methods and requirements for patient/ person safety and injury prevention ● Key strategies for organisation, training, equipment, work, health and wellbeing essential to safer handling practice ● Practical chapters setting out evidence-based best practice in core manual and
equipment skills ● Special circumstances, including key pathways and case studies.
HOP6 is widely endorsed by organisations including the Royal College of Nursing, the Chartered Society of Physiotherapy, the College of Occupational Therapists and the Health and Safety Executive.
The mission of HOP6 is to set out a person-centred systems approach, which balances the twin aims of (patient/person) safety, dignity and enablement with the prevention and management of work relevant MSDs in
health and social care workers.
The Guide to the Handling of People – 6th Edition (HOP6) is available for £49.95. For bulk order discounts and postage queries please contact orders@ backcaretrading.org.uk or call 020 8977 5474 (Mon-Thu 9am-4pm). www.backcare.org.uk
Better planning can reduce injury in the workplace
We know from bitter experience that poor moving and handling practice can cause back pain or make existing pain worse, and nurses can be as vulnerable as any worker.
Many of the potentially injurious tasks will feature in a nurse’s typical working day: lifting heavy or bulky loads; carrying loads awkwardly, possibly one-handed; pushing, pulling or dragging heavy loads; repetitive tasks; bending, crouching or stooping; stretching, twisting and reaching; being in one position for a long time. What’s more, high workloads, tight deadlines, inadequate staffing levels and lack of control of the work can often exacerbate matters.
The HSE has identified measures that can reduce the risk of back pain in your workplace 1 :
● Identify what activities can cause back pain and decide whether they can be avoided or changed ● Ask your workers for input – they have first-hand knowledge of the work and can suggest changes ● Think about how you can make jobs physically easier, for example, by moving loads on wheels ● Make sure controls, for example lifting aids, are available, used and maintained ● Look for signs of back pain among your workers, such as a reluctance to do a particular task, which may suggest your controls are not working ● Encourage them to report problems early to you or their worker representative so they get the right help.
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Back pain and MSDs are part of a wider organisational picture
EQUIPMENT such as hoists and slide sheets, better training for moving and handling, and a greater understanding of biomechanical principles have assisted in prevention and management of back pain and MSDs to nurses and healthcare employers. However, there are still problem areas that can present a risk to staff, warns the Royal College of Nursing (RCN), which represents more than 450,000 registered nurses midwives, healthcare assistants and nursing students.
Examples include having to provide care and treatment in environments that are unsuitable, such as beds in corridors and storerooms when ED overflows; static and awkward postures are also an issue, including doing dressings in home environments, operating theatres and clinics; while, for community staff, even using portable electronic equipment such as laptops in the car presents a risk.
A Healthy Workplace toolkit is available from the RCN website to help implement safe
Key factors include working patterns and shifts working environments with high quality employment practices and reduce sickness absence. Employers can health check their organisation against key indicators to achieve essential goals, including job design, health and safety, work-life balance, dignity at work, and learning and development. The toolkit challenges employers to consider important factors such as working patterns and shifts, monitoring sickness absence for hot spots and trends, and having policies in place on stress and/or mental wellbeing. www.rcn.org.uk
Intensive care nurses more likely to suffer MSD problems
INTENSIVE care unit nurses are widely believed to have more ergonomic risks than nurses working in other units in hospital, though studies on the prevalence of symptoms, as well as associated factors, are relatively scarce.
A study 1 of more than 1500 nurses working in the intensive care units of public, private and university hospitals in Turkey, found the highest prevalence for the musculoskeletal symptoms of the nurses was in the legs, lower back and back. Most of the nurses taking part in the study had encountered musculoskeletal pain or discomfort related to the previous month. The risky body movements that were frequently performed by the nurses during a shift were “turning the patient” and “bending down”.
Data were obtained by a tailored data collection form, a workplace observation form and a Rapid Upper Limb Assessment tool to delineate ergonomic risks. The final Rapid Upper Limb Assessment score for the patient turning movement was found to be higher than for the bending down movement.
Musculoskeletal symptoms were mainly associated with organisational factors, such as type of hospital, type of shift work and frequency of changes in work schedule, rather than with personal factors.
The study, which was published by the International Council of Nurses, proposed that health policy makers should develop and support occupational health teams, and “ergonomic risk prevention programs” should be implemented throughout the units. www.icn.ch 1 Predisposing factors for musculoskeletal symptoms in intensive care unit nurses; D Sezgin, MN Esin, 2014
Nurses are among the professionals with the highest incidence rates of work-related low back problems. Every year, thousands of nurses worldwide work with less efficiency, receive medical reports and/or retire early.
This study of hospital units in Turkey highlights the key influencing factors impacting the frequency and severity of low back pain in nurses
THOSE working in intensive care units experience low back pain more frequently due to reasons such as providing patient care by bending forward for long durations, over-forcing/ overloading some body parts while repositioning patients, and sparing more time for patient care.
In addition, the workload in intensive care units, and frequent repetition of body movements and functions such as reaching up-forward, holding, claspinghugging, lifting and turning, prepare the ground for the emergence of this problem.
A 2014 study 1 of intensive care units in the province of Gaziantep, Turkey, examines the frequency and severity of low back pain and influencing factors in nurses working especially in intensive care units and considers the options for reducing the incidence of back pain in the profession.
Some 84.2% of the nurses experienced low back pain and 66.7% of the nurses evaluated this pain as “moderately severe”. More than half (53.1%) of the TALKBACK l AUTUMN 2020
nurses experienced low back pain for up to three years and almost 40% had pain attacks once a week. It was determined that 37.5% of the nurses who experienced low back pain did not make any attempts to relieve the pain, 49% experienced an increase in low back pain, 71.9% did not see a doctor, and 79.2% did not receive any treatment for their low back pain.
The study found the vast majority of nurses in the sample (97.9%) remained standing for a long time; those who performed interventions that require bending forward numbered 95.8%; who lifted patients (68.8%); who changed sheets while the patient was in the bed (65.6%); who repositioned patients (83.3%) and who did not use any aiding equipment during interventions (60.4%).
Education
Nurses, who play such an important role in protecting, maintaining and improving individuals’ health, should attach greater importance to protecting their own health, says the report. Surprisingly, a high proportion (86.5%) of the nurses sampled in this study did not receive education on low back pain.
Most of the nurses worked in standing position for long durations, performed interventions that required bending forward, lifted and repositioned patients, and these nurses had higher average low back pain scores. Moreover, it was observed that the nurses who did not use any aiding equipment during interventions yet believed in the benefit of using it constituted the majority. This result may be explained by the lack of sufficient education given to nurses about the risks that may cause low back pain and the lack of sufficient time during interventions for using aiding equipment.
Working conditions
It was reported that low back pain increased in parallel with the increase in working hours and this result was associated with sparing less time for resting. As other research 2 has observed, orthopaedic and ICU departments have heavy workloads that are likely to cause low back pain, and therefore the risks posed by these clinics should be evaluated. In this study, it was noted that nurses who worked in internal diseases and pediatric intensive care units had higher low back pain average scores. This may be due to the fact that interventions that are more likely to cause low back pain are applied more in patients hospitalised in these units since these patients need different nursing cares, and that these clinics provide service under different conditions.
In addition, it was also found that working conditions and satisfaction with the place of employment affected low back pain; nurses who worked in shifts had higher low back pain average scores; and nurses who were partially satisfied with their place of employment experienced more low back pain.
Working with fewer personnel during shifts, having to perform patient transfers on one’s own
without help, lack of sleep, and decrease in the quality of sleep may be associated with low back pain. Moreover, it is thought that the employees feel better and experience less anxiety as their satisfaction with the institution of employment increase, and that these factors have a positive effect on low back health.
Nurses who evaluated their health condition as “very good” experienced less low back pain problems and had lower low back pain average scores. This result may indicate that nurses who define their health status as “very good” feel much better, as observed in the satisfaction with the institution of employment, and this situation increases their performance and therefore decreases their low back pain related problems.
In line with its findings, the study highlights the value of regular education programmes to control risk factors that may cause low back pain. Nurses should be provided with guidance on using aiding equipment that would reduce physical load, and necessary protocols should be established to control compliance to these rules by close monitoring. In addition, it is considered vital that attention is paid to complying with body mechanics during all kinds of nursing interventions in patient care, and the differences between clinics in terms of the risk factors for low back pain are taken into consideration.
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2 Frequency and Severity of Low Back Pain in Nurses Working in Intensive Care Units and Influential Factors; Ozlem Ovayolu, Nimet Ovayolu, Mehtap Genc, Nilgun ColAraz Pak J Med Sci, 2014 Jan-Feb Vieira ER, Kumar S, Coury HJ, Narayan Y. Low back problems and possible improvements in nursing jobs. J Adv Nurs. 2006
FIVE ESSENTIALS FOR NURSES ON THE GO
● Wear comfortable and supportive shoes ● Maintain good body posture ● Lift wisely and with caution ● Eat a healthy diet and stay hydrated ● Have a positive outlook at work
The vast majority of nurses said they remained standing for a long time
Bariatric patient handling in theatre and on the ward
Image: jcomp/Freepik THE obese population in the UK continues to grow and this group is over-represented in their use of health and social care services. The manual handling of these patients presents a specific challenge partly due to individual factors but also in terms of policies, space, equipment and vehicles for safe care, treatment and transportation.
A 2007 HSE report RR573 1 explored the risk factors associated with the bariatric patient pathway through the health and social care systems – which up until that time had not been investigated systematically – and it was estimated that 40%-70% of Trusts did not have a bariatric policy. Education and training in this specialised area have steadily improved as has the design of appropriate equipment and accessible environments, though efficient management processes and communication remain critical in order to ensure the safety, dignity and comfort of the patient and the health and safety of staff.
In the theatre
The RR573 report explores risks within the patient journey across health, social care and domestic settings. The pathway through theatres identified concerns associated with the equipment, furniture and management. For example, due to the other ceiling mounted equipment in an operating theatre it was not always possible to have a ceiling mounted hoist/track so sliding boards were used for lateral horizontal transfers. On the table, there were difficulties in positioning the patient due to unpredictable movements of the excess flesh changing the weight distribution on the table. Supporting limbs in limb holders was the preferred option but where patients did not fit then staff might have to stretch across the patient and/ or hold the flesh/limb. Slide sheets were not left in situ due to pressure concerns adding to the difficulty of repositioning during the operation.
On the ward
When it came to care on the ward, factors again included the equipment (design, width, safe working load) and spatial constraints. It was identified that equipment could be used to stand (using the electric bed), turn (using a hoist) and reposition (by leaving the sliding sheets in situ) the patient to reduce the risks. An overhead track or monkey pole could help to increase the patient’s independence.
Clinical issues associated with treatment and care included stretching to treat and holding the weight of limbs (internal examination and blood pressure observations). Tissue viability was a concern, with specialist mattresses, leg dressings and the problem with the limbs being too heavy for the leg cradle. Respiratory treatment needed specialist equipment, and chest physiotherapy was difficult to deliver due to problems with positioning the patient for access to different areas of the chest, and the physical effort involved.
1 Risk assessment and process planning for bariatric patient handling pathways www.hse.gov.uk
Assessing the key reasons for chronic back pain
NURSES have long been seen as vulnerable to developing back pain. In fact, in 1995 the prevalence in nurses of back pain was 14.7% compared with 11.5% in age-matched controls, according to the study Epidemiological aspects of back pain 1 . An obvious cause for this difference would be due to the demands of lifting and handling, as was felt by the participants.
The study also shows that back pain is common even if you are not a nurse. University of Oxford research has shown that in some people with early onset chronic back pain, especially those younger than 50, there are links with earlier than average disc degeneration in the lower lumbar spine that are more prevalent than asymptomatic age matched controls. In others there are no identifiable pathological changes on MRI scans. Most of these degenerative changes occur at the lower two mobile levels of the lumbar spine. This study, submitted for publication, was confined to female subjects, though there is no reason to believe that males are more or less afflicted than females. So what are the factors that contribute to this common complaint? We know
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Anxiety and depression exacerbate chronic pain
that overweight and poor physical fitness are important contributors to back pain. Anxiety and depression have long been recognized as conditions that exacerbate chronic pain. There is increasing evidence to suggest that inflammation is an important process underlying chronic pain. We need large scale studies to explore these relationships which have so far not been funded.
Over the last 25 years, there have been many improvements in lifting and handling techniques and practices. BackCare publishes a regularly updated evidence-based training guide to lifting and handling, currently the edition is HOP6, with a new HOP7 on the way, which has specific advice for nurses and their training. There are many aids for lifting and handling patients. They range from simple devices to facilitating sliding patients during transfers, to sophisticated devices for recovering fallen patients, such as the HoverJack Device (https://hovermatt. com/products/evacuation-ems-hoverjackdevice/). These have transformed nursing practice. Fortunately, most people, including nurses, have back pain that can be controlled with simple measures available in primary care, including basic analgesics, fitness, weight control and manual therapy. We still have more work to do to develop effective and evidence-based therapies for chronic back pain.
Jeremy Fairbank MD FRCS, Emeritus
Professor of Spine Surgery, University of Oxford
1 Leighton D, Reilly T. Epidemiological aspects of back pain: the incidence and prevalence of back pain in nurses compared to the general population. Occupational Medicine,1995;45(5):263–7.
Choose an exercise you enjoy to manage your back pain
EXERCISE is commonly advised as one of the best ways to help prevent and manage most back pain. The type of exercise you do does not matter as long as you do something and remain active.
The choice of exercise is yours because if you enjoy what you are doing, you will be more likely to continue and see the benefits. Walking and running have remained popular during lockdown despite the disappointment of many cancelled events this year.
Other people find that swimming helps their back pain, the water environment taking the strain off joints and muscles while engaging the major muscle groups. Yoga is also great for strengthening core and back muscles and increasing flexibility. Similarly, Pilates strengthens muscles and the spinal column and promotes good posture.
Now that gyms are reopening (cautiously), a wide variety of structured exercise programmes can provide cardiovascular workouts and all over body conditioning which includes the back and core muscles.
There are also some exercises you can do on your own at home without specialist equipment that can help to strengthen your back and prevent and ease back pain. These can be found in information sheets on the BackCare website.
https://backcare.org.uk/ get-involved/
