In this essay, I will discuss about the occupational health management plan for nurses to avoid the musculoskeletal injuries that occur during manual handling of the patients in a nursing home. Patient handling has long been considered as the major contributor of musculoskeletal injuries in the health care staff and especially among the nurses. Among all the musculoskeletal injuries, low back pain was acknowledged more common among the nursing professionals (Long, Johnston & Bogossian, 2012). The etiology of musculoskeletal disorders among nurses depends on a number of factors relating to work postures, work tasks, work organization, work control and other personal factors. The most important high-risk issue regarding the development of musculoskeletal disorders among nurses is the manual handling of patients. During the patient handling, nurses usually are unable to position themselves in an appropriate lifting position and, therefore, must reach far across the patient in order to obtain a firm grasp. The most high-risk tasks are specifically to move the patients around the bed, manually transferring them between bed and chair, lifting patients from the floor and manually lifting them before or after a bath. The management of the musculoskeletal disorders among the nurses is a contentious issue.. In recent years, workplace restructuring has completely changed the work environment of hospital nurses, minimizing the staff number and reducing the daily tasks of those remaining into shorter and more intense periods.
Details of the workplace:
The workplace that I have chosen is The Bottlebrush House, which is a unit of Casuarina Nursing Home. This unit provides care for the residents suffering from dementia. It comprises four main houses (wings) set out butterfly shaped from the centre of the building on two levels. A separate dining area and lounge is present on each level. The total number of individual suites are 31 and 4 of them have been specially designed for people with disabilities. Among them, five suites have interconnecting doors for couples. Each house has shared facilities such as drying lines and laundry, car spaces and courtyard. The working staffs include physiotherapists, occupational therapists, rehabilitation consultants, podiatrists, audiologists, dentists and nurses. The total number of staff workers is around 65 among which approximately 30 include the nursing staff. As our identified population is the nursing staff, so we will discuss more details about their working profiles. Majority of the nursing staff are young and middle-aged females having a middle-class socio-economic status. Majority of the nurses are young while only a small proportion of nurses are middle-aged working for more than 10 years, making this age group more vulnerable to musculoskeletal disorders. The young nurses are also prone to musculoskeletal disorders but to a lesser extent.
Identification of the occupational hazard and risk assessment:
The majority of the residents in the nursing home are elderly and require frequent clothing changes especially in relation to toileting. A risk assessment of dressing/undressing the residents identified the following manual task related risks to nurses, enrolled nurses and others responsible for doing this task:
- Abnormal postures, which include sustained side bend and twist movement along with weight bearing while dressing – especially while putting resident’s pants on.
- Frequent occurrence and shifts for all nurses/enrolled nurses.
- Bruising and tearing of residents’ skin.
- Injury to both residents and staff can be caused due to agitation and aggression of some patients (Zeller & Levin, 2013).
For the identification of the hazard, a number of sources of information can be utilized. For example in developing a plan, people who will be the prime source of information are professional ergonomists, safety engineering and workplace health and hazard management experts. Secondly, important evidence can be found in an incident or injury register having records of incidents involving manual handling. Crucial information can be obtained from some internal sources (minutes of meetings, reports, audits, questionnaires and surveys) as well as external sources (relevant state or territory WHS codes of practice and guideline). The final important source of information that can assist in the risk identification process is the informed direct observation of the workplace and the tasks being performed (Zabielska et al., 2014).
Occupational health program:
To curb the musco-skeletal and other health problems that affect the nursing workforce, a comprehensive health program must be established. The goal of this program should be to encourage the healthcare organization to support the nursing industry and reduce the number of musco-skeletal injuries. The employer is solely responsible for the working conditions in his organization. He should prevent and protect the workers in case of hazards (Boden et al., 2012). He should have a complete knowledge on the machines and materials used in the nursing home and that all policies should be followed. The outcome of this program is to introduce measures on both design and administrative levels so that nurses are given better working conditions. On the design level, innovative and ergonomically efficient devices should be introduced. Sometimes, it may happen that the work area is situated at a height that is difficult for the nurses to reach. Adjustable and proper workstations should be the first step in design control. Poorly designed tools give wrist and joint pain to the nurses. The tools should be lightweight and if powered then the magnitude of the vibration should be within the permissible limit. The labour inspector should formulate the ideas for the creation of these ergonomically efficient devices in consultation with the nurses so that he will know the exact changes that need to be done (De Jonge & Dollard, 2002). The equipments that can be used by the nursing workforce are inflatable mattress, adjustable stretchers and belts. An inflatable mattress with cushion can be used for shifting the patients, adjustable stretchers with height adjustable facility can also be used for movement of the patients and flexible chairs that could be converted into stretchers is a good option when the patients are transferred from a bed to a chair. Improvisations can be done on the belts too. They can have handles that will be attached around the patient’s waist for better clutch. Boards that are used for transferring the patients can be used with low friction material. Equipments to life patients can be either free standing or attached to bed. The nurses for their own protection can use other shielding gear such as aprons, gloves and kneepads. These safety devices or equipments should not be viewed as the only solution for the prevention of musco skeletal diseases in nurses. Rather they should be a part of a holistic approach towards the patient care program. On the administrative level, the higher management should look into the ways by which the risks can be controlled (De Castro, 2004). The managerial measures should be implemented properly. There should be shift rotation where the work hours of the nurses should be rotated periodically so that their stress is reduced. Constant high workload can hamper their health. During extreme work pressure periods, adequate rest and break time should be allotted to the employees. Task variety is another option where the nurses are given multiple kinds of tasks so that their body parts are not constantly exposed to a repetitive kind of movement and it will stimulate their interest. Training is one of the most critical tasks that must be arranged by the employer. The trainer or the labour inspector should have a complete knowledge of the various hazards that can occur in that industry. He must be closely coordinated with the manager and the union to identify the risk areas and provide remedial measures for them. Nurses should be given appropriate trainings and mock situations to test whether they have truly understood or not. The language in the training should be clear and concise so that there is no problem in understanding the instructions. If possible, local dialect can be used in these training for ease of understanding. There can be audiovisual presentations, demonstrations, mock situations, role-playing and training materials that should be included in the trainings.
The management and supervisors should be well trained and informed about the safety practices executed in the workplace (Boucaut & Cusack, 2015). There should be proper record keeping so that it will help in tracking the number of incidents and taking precautionary measures to prevent them. There should be managerial discussions with nurses so that they are encouraged to give their inputs on new nursing methodologies. They should be encouraged to share their daily challenges on patient care, hectic work schedules and nursing home environment via polls, surveys and one-to-one meetings. The supervisors should promote teamwork and cooperation among the nurse workforce. They should be encouraged to give presentations in the meetings, participate in educations sessions and mentoring sessions with older nurses with new comers. They should be made aware that these trainings are for their own benefit and they should willingly participate. HR personnel and management should work towards creating a career plan for the nurses that will offer them informal and formal education to align with their goals. A reward system should be present to motivate the employees who use the correct protective gear and measures in their daily work life (Lerman et al., 2012).
From the above discussion, it can be concluded that working environment with both ergonomically designed equipments and relaxed schedules should be provided to the nurses. Occupational health and safety is a critical aspect for the success of the business. The healthcare industry especially the nurses have to face musco-skeletal disorders and high work stress in their daily lives. It is usually during shifting of the patients that they have to endure awkward positions and neck injuries. In addition, job stress and agitation of the patients are other difficulties faced by them (Letvak, Ruhm & Gupta, 2012). The same scenario is present in The Bottlebrush House where approximately 30 nurses are present. Inadequate work shifts decrease their efficiency and hamper their health. In their everyday work life, they have to lift or reposition their patient, which causes extreme pain in the neck and wrists. The supervisors and management should take action against the workplace hazards and construct a comprehensive health care program. Data collected from records and surveys and consultation with professionally trained ergonomists help to establish such healthcare programs. A judicious combination of design and administrative controls is required to curb this problem (Nelson & Baptiste, 2006). In 2003, the International Labour Organization (ILO) created a global strategy to maintain a healthy work culture and the development of suitable techniques and trainings for the employees. A favourable working environment can lead to an increase in workers’ productivity, less injury and accidents and hence less costs related to these injuries. This will in turn help to retain staff. Ergonomically efficient devices such an inflatable mattress, belts with handles and flexible chairs should be used in the hospitals and nursing homes. The nurses should be given adequate time to rest and periodic shift rotations. Training is an integral part of this program since it educates the nurses on the precautionary and preventive measures that they should take. Nurses themselves should be motivated to take up these educational programs. They should be asked for regular feedback on the daily challenges they face. It can be done via surveys and suggestion boxes. Managerial leadership discussions should involve the nurses so they can give their inputs on current nursing techniques and experiences. This will encourage the nurses to share their problems and take up precautionary measures. Engineering, administrative and behavioural control types provide solution to the workplace hazards faced by nurses. The trainer or counsellor should listen or ask for feedback from nurses on their career and work targets. They should give support in case of problems. A positive environment of work culture should be present in the hospital where the mode of communication between the nurses and the managers should be easy.
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