Injury Contributors in Clinical Practice

“Human Factors” are commonly referenced when describing safety hazards found within organizations. In healthcare, “human factors” are more commonly considered when explaining safety incidents such as needle sticks, slips-trips-and-falls, and exposure to infections which focus minimally on the patient’s involvement, while readily questioning the competence of the caregiver.

However, the more hazardous safety risks are those which rely upon the physical abilities of both the patient and the caregiver. Because we rarely consider patients themselves as environmental risks other than patho-physiologically, our traditional thinking preclude us from acknowledging that the greatest potential for injuries in point-of-care environments is directly related to two essential “human factors:” patient and caregiver.

Do Safe Lifting Methods Exist?
Injuries to caregivers are common given that it is impossible to predetermine exactly what will happen during any given patient lifting event. Recent studies have implied that the type of lifting required in patient care offers no safe methods to manually lift patients1. Traditional approaches to nursing care suggest proper “body mechanics” as the acceptable standard of practice for averting these physical injury risks. However, it could be argued that conventional logic for applying body mechanics to lifting patients is rather illogical given that body-mechanic techniques assume that proper body alignment for the lifter is always achievable.

Whereas proper “body mechanics” may very well be effective in settings where objects are fixed and the object’s weight is evenly distributed, lifters in controlled environments are more likely to encounter lifting scenarios which allows the lifter to ensure proper body alignment before performing the lifting exercise. Consider the type of lifting that takes place within the often space-constrained patient environments. The uncontrolled environments require caregivers to work from awkward postures and positions. Unfortunately, this has commonly led to back injuries and muscle strains that have very little to do with “proper” body alignment and/or lifting techniques.two nurses lift patient

In reflecting upon our formal training in safe lifting techniques, many of us can recall instructions that included keeping our backs straight while bending at the knees all while attempting to hold objects close to our bodies prior to lifting. What many of us would not remember are the rationales explaining why our safety depended primarily upon our ability to execute these steps, all while undervaluing the patient’s involvement other than considering the patient’s weight. We have been trained to believe that the primary factor for the lifter to consider in safeguarding their health is dependent upon the caregiver’s ability to properly align their body before performing the lifting exercise. Hence the term “Human Factors,” which in this instance speaks to one human, predetermining the lifting event with limited insight on how the patient will actually respond when executing the lifting process.

Comparatively speaking, this process is ideal for lifting in non-clinical work environments where the lifter has the benefit of predetermining his body posture while also assessing the object to be lifted. To the lifter’s advantage, the object to be lifted is more likely to be fixed, meaning the object’s weight is evenly distributed. It is even possible for the lifter in this setting to benefit from leveraging points such as side-grips or handles or possibly using a forklift to perform the lift all together. Again, the only human factor here is the lifter which in this example results in a significantly reduced risk for acquiring a lifting injury.

Complications in Hospital Environment
As it pertains to lifting in clinical environments, scenarios are often quite the opposite. The lifting event is more commonly unpredictable as one can rarely predetermine the actions of the other person being lifted. This increases the injury risk because now there are two variables or “Human Factors” to consider. Appropriate body posturing as described in “proper body mechanics” is unlikely. The patient to be lifted is not a fixed object, so the lifter is left to lift human weight which is both uneven and disproportional.

Additionally, the lifter in a clinical environment is less likely to achieve “proper” body alignment especially given that most clinical lifting events include scenarios requiring awkward posturing such as: bending over hospital beds to turn-and-reposition immobile patients; standing in front of wheelchairs and commodes in effort to lift another human into a standing position; or having to lift a patient lying flat from the floor to either the height of a hospital bed or bedside chair. Even when there is more than one lifter involved in lifting patients from the floor, “proper body mechanics” are not likely to minimize injury risks when that human body weight is unevenly distributed.

Whereas these physical risks are both easily recognizable and well-known, it is reasonable to conclude that current risk management strategies are not consistent with the nuances prevalent at the point-of care. All the while, caregivers remain fixated on perfecting traditional lifting techniques that are unfounded as effective injury prevention methodologies. The solutions to decreasing injury risks related to lifting patients are dependent upon accepting and implementing more modernized safety prevention models which concentrates to minimize the human factor element.

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Implications for Nursing
To argue the aforementioned perspectives as justifications for why traditional injury prevention strategies are ineffective, the discussion points at minimum are aimed at prompting caregivers to reflect on past lifting practices and related difficulties. Through recalling those difficulties and lifting experiences, it is within reason to attribute most lifting injuries to the two human factor components found in every patient lift conundrum. When considering more innovative patient lift practices, the gradual implementation of strategies to include awareness are essential to assisting caregivers in overcoming the comforts of familiar nursing practices. By concentrating on minimizing the “Human Factors” found in patient lift scenarios, it becomes more likely to conclude patient-lift technology is the more probable means for allowing caregivers the necessary control needed to guide patient-lift events. Furthermore, strategies which include patient lift technology are the most consistent solution for reducing staffing injuries related to manual patient lifting2.

Built into these concepts describes an ever increasing need for patient care organizations to re-strategize commonly applied practices for averting injury risks associated with patient handling. Industry standards for workers who lift and move freight designates a maximum allowable weight for lifting at 50 pounds. In moving forward, if we want to improve clinical workplace safety, our safety philosophies must emphasize the direct correlation between clinical hazards and “Human Factors” as primary causative factors for injuries. Patient lift technology provides the most likely potential for success given its ability to effectively minimize the Human Factor’s element thereby decreasing the overall injury risk.

References
1Elnitsky CA, Powell-Cope G, Besterman-Dahan KL, Rugs D, Ullrich PM. Implementation of Safe Patient Handling in the U.S. Veterans Health System: A Qualitative Study of Internal Facilitators’ Perceptions. Worldviews on Evidence-Based Nursing 2015.

2. Kay K, Glass N, Evans A. Reconceptualising manual handling: Foundations for. Journal of Nursing Education and Practice 2012;2(3):203-22.

Roric P. Hawkins is safe patient handling coordinator at Michael E. DeBakey VA Medical Center in Houston.

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