John D. Lloyd

Preventing nursing back injuries: Redesigning patient handling tasks

The researchers identified nine patient handling tasks that place nursing staff at high risk for musculoskeletal injuries. An expert panel redesigned these tasks using new patient handling technologies and work practice controls. The key objective was to evaluate the biomechanical benefit of the redesigned tasks. Back and shoulder muscle activity, forces on the lumbar spine, shoulder joint moments, and perceived comfort were evaluated in a laboratory setting. Using objective and subjective data, 63 participants who performed the redesigned tasks were compared with 71 participants who used standard procedures. Objective data revealed significant improvement in five of the redesigned tasks, while staff subjectively rated four of the redesigned tasks as significantly improved. Nursing tasks can be redesigned to improve caregiver and patient safety using new patient handling technologies and work practice controls. Further study is needed to redesign other high risk tasks to promote safer work environments.

Preliminary evaluation of reliability and criterion validity of Actiwatch- Score

The restoration of normal physical activity is a primary objective of most chronic pain rehabilitative interventions, yet few clinically practical objective measures of activation exist. Actigraphy is one technology that promises to fill this void in the field of pain outcomes assessment. This study evaluates the measurement properties of one of several commercially available actigraphs: the Actiwatch-Score (AW-S). We conducted separate trials to examine concordance between units when worn concurrently at the same and different body sites and to compare the AW-S to a validated optical three-dimensional motion-tracking system. The data indicate that the AW-S has excellent interunit reliability and good criterion validity, but its intersite reliability varies with activity type. These results suggest that this device, and those like it, warrants further investigation and is likely to yield valuable data regarding the optimal application of this technology.

Biomechanical Evaluation of Injury Severity Associated with Patient Falls from Bed

&NA; This study investigated the severity of injuries associated with falling from bed and the effectiveness of injury‐prevention strategies. Injury criteria were calculated for head‐ and feet‐first falls from six bed heights onto a tiled surface and floor mat. These values indicated a 25% chance of experiencing a serious head injury as a result of falling feet‐first from a bed height of 97.5 cm onto a tiled surface. Risk of injury increased to 40% when extrapolated for the height added by bedrails. Using a floor mat decreased this risk to less than 1% for bedrail height for feet‐first falls. Calculated impact forces indicated a risk of skull fracture when hitting the tiled surface. Floor mats and height‐adjustable beds positioned to the lowest height should be used to decrease the risk of injury associated with falling from bed.

Friction-Reducing Devices for Lateral Patient Transfers A Clinical Evaluation

The purpose of this study was to assess the performance of lateral transfer devices compared with the traditional draw sheet method in acute care settings through subjective feedback of caregivers actually using the devices. Every 2 weeks, the eight participating acute care units each received one of the devices, which had been randomly selected. Data were collected through caregiver surveys, which rated comfort, ease of use, perceived injury risk, time efficiency, and patient safety. An overall performance rating was calculated as the sum of these five categories. Caregivers rated air-assisted devices significantly higher (p < .05) than other devices. Lateral transfer devices are recommended over the traditional draw sheet method for performing lateral patient transfers. These friction-reducing devices are a cost-effective solution to the load of lateral patient transfers and should be favorably considered when purchasing patient-handling technologies.

Safe Patient Handling and Movement: Preventing back injury among nurses requires careful selection of the safest equipment and techniques. The second of two articles.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording , or otherwise, without the prior permission of Springer Publishing Company, Inc. Safe patient handling and movement : a guide for nurses and other health care providers / edited by Audrey L. Nelson. p. ; cm. Includes bibliographical references and index.

The effects of everyday concurrent tasks on overground minimum toe clearance and gait parameters.

Deaths and injuries resulting from falls are a significant problem for older adults. Over half of falls during walking result from a trip, and these are likely to begin when the foot contacts the ground at the point of minimum toe clearance (MTC) during the swing phase where the foot most closely approaches the ground. MTC is commonly investigated using a limited number of points and on a treadmill, which cannot account for flooring irregularities, speed changes, and direction changes of overground gait. This paper presents a new method of calculating 3D overground MTC that accounts for flooring variations and utilizes hundreds of points on each shoe. These methods are applied to 10 unimpaired adults during habitual gait: (1) without a concurrent task, (2) while carrying a 9-kg laundry basket, (3) while carrying a tray with a full glass of water on it, and (4) while answering standardized conversational questions. Results indicated that steps were slower and shorter during concurrent tasks while MTC changes were dependent on task type (higher for basket, lower for questions, and unchanged for water). Task-related MTC changes were independent of spatiotemporal gait changes. Thus, MTC during overground gait, particularly while concurrent tasks are being performed, may be an independent fall risk factor that merits further investigation in subjects at-risk of falls. The relationships between MTC, gait parameters, and older age or fall risk should be explored further in at-risk subjects and circumstances to elucidate potential tripping mechanisms.

AORN Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings.

Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology.

AORN Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed

Positioning or repositioning a patient on the OR bed in preparation for a surgical procedure presents a high risk for musculoskeletal disorders, such as low-back and shoulder injuries, for perioperative personnel. Safe patient handling requires knowledge of current ergonomic safety concepts, scientific evidence, and equipment and devices to ensure that neither the patient nor the caregiver is at risk for injury. AORN Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed provides guidelines that enable perioperative personnel to determine safe methods for positioning and repositioning a patient in the semi-Fowler, lateral, or lithotomy position in preparation for surgery.

Estimation, simulation, and experimentation of a fall from bed

Computer simulations using multibody models have been extensively applied to vehicular crash testing but have rarely been used to investigate falls. This article investigated planar and three-dimensional simulations of a single physical test of a Hybrid III anthropomorphic test dummy falling from a bed and compared them with a common estimation method. The effects of initial model position and velocity on simulated peak resultant head deceleration and head impact criterion (HIC) were determined while all contact and model parameters were held constant. Improving body position at impact and impact velocity direction both improved results. Simulating the entire fall instead of only the impact further improved simulation output, but HIC was consistently overestimated because of inaccurate contact parameters. These results show that accurate kinematics are crucial to accurate simulation output but improved contact parameters and thorough validation of experimental data are required before any fall simulation should be used to extrapolate findings beyond what is experimentally practical or possible.

Biomechanical Evaluation of Head Kinematics During Infant Shaking Versus Pediatric Activities of Daily Living

Abusive shaking of infants has been asserted as a primary cause of subdural bleeding, cerebral edema/brain swelling, and retinal hemorrhages. Manual shaking of biofidelic mannequins, however, has failed to generate the rotational accelerations believed necessary to cause these intracranial symptoms in the human infant. This study examines the apparent contradiction between the accepted model and reported biomechanical results. Researchers collected linear and angular motion data from an infant anthropomorphic test device during shaking and during various activities of daily life, as well as from a 7-monthold boy at play in a commercial jumping toy. Results were compared among the experimental conditions and against accepted injury thresholds. Rotational accelerations during shaking of a biofidelic mannequin were consistent with previous published studies and also statistically indistinguishable from the accelerations endured by a normal 7-month-old boy at play. The rotational accelerations during non-contact shaking appear to be tolerated by normal infants, even when repetitive.