Nancy N. Menzel

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.

Underreporting of Musculoskeletal Disorders among Health Care Workers Research Needs

Extensive evidence suggests that the numbers of workplace injuries and illnesses reported annually by the U.S. Department of Labor, Bureau of Labor Statistics, are underestimated for all private employers. Several states have passed safe patient handling legislation to reduce work-related musculoskeletal disorders (WMSDs) among health care workers. Research is needed to improve accurate reporting of these types of injuries to allow assessment of the effectiveness of this legislation and to enable hospitals and nursing homes to better target interventions to areas at high risk for WMSDs. In the interim, occupational health nurses and the American Association of Occupational Health Nurses, Inc., can assist in improving the accuracy of occupational surveillance for these work-related injuries.

Preventing Musculoskeletal Disorders in Nurses: A Safe Patient Handling Curriculum Module for Nursing Schools

Nursing educators who teach outmoded manual patient handling techniques contribute to the widespread problem of musculoskeletal disorders in student and practicing nurses. The authors discuss the development and implementation of a new safe patient handling curriculum module, which was pilot tested in 26 nursing programs. The module changes the focus of patient handling education from body mechanics to equipment-assisted safe patient lifting programs that have been shown to protect nurses from injury and improve care.

Patient Satisfaction With Nurse Practitioner and Physician Services in the Occupational Health Setting

The purpose of this research was to determine if patient satisfaction differed when clinical services were provided by nurse practitioners versus physicians in the occupational health setting. This convenience sample included 129 patients visiting community-based occupational medicine clinics for evaluation of a new work-related injury. There was high satisfaction with both nurse practitioner and physician providers. There was no significant difference in overall patient satisfaction between provider types. Results of this study support a practice model using nurse practitioners as primary providers in the occupational health setting.

Effectiveness of a poverty simulation in Second Life®: changing nursing student attitudes toward poor people.

Abstract Social justice is a fundamental value of the nursing profession, challenging educators to instill this professional value when caring for the poor. This randomized controlled trial examined whether an interactive virtual poverty simulation created in Second Life® would improve nursing students’ empathy with and attributions for people living in poverty, compared to a self-study module. We created a multi-user virtual environment populated with families and individual avatars that represented the demographics contributing to poverty and vulnerability. Participants (N = 51 baccalaureate nursing students) were randomly assigned to either Intervention or Control groups and completed the modified Attitudes toward Poverty Scale pre- and post-intervention. The 2.5-hour simulation was delivered three times over a 1-year period to students in successive community health nursing classes. The investigators conducted post-simulation debriefings following a script. While participants in the virtual poverty simulation developed significantly more favorable attitudes on five questions than the Control group, the total scores did not differ significantly. Whereas students readily learned how to navigate inside Second Life®, faculty facilitators required periodic coaching and guidance to be competent. While poverty simulations, whether virtual or face-to-face, have some ability to transform nursing student attitudes, faculty must incorporate social justice concepts throughout the curriculum to produce lasting change.

Hispanic construction workers and assertiveness training

BACKGROUND Hispanic (Latino) construction workers experience disparities in occupational death and injury rates in the United States. The cultural value of respect for those in authority may hinder these workers from requesting safe working conditions from supervisors. OBJECTIVE To evaluate whether Hispanic construction workers in Las Vegas, Nevada found assertiveness training more useful than non-Hispanic trainees and whether or not they practiced this behavior at work after the training. METHODS An assertiveness training simulation was part of fall prevention classes offered to area construction workers. Eight weeks after the training, participants were interviewed by telephone about class topics they found most useful and whether or not they had made any subsequent behavior changes at work. RESULTS More than half of the 760 fall prevention trainees completed telephone interviews. A smaller proportion of Hispanic trainees found assertiveness training to be useful (11%) than non-Hispanics (28%) (p⩽ 0.001). Only 2% of both groups identified practicing assertiveness at work. CONCLUSIONS A large proportion of Hispanic trainees valued other knowledge more highly. They may weigh job security as more important than speaking up about safety issues, which might threaten their employment. Interventions to improve safety should focus instead on improving work safety climate and engineering controls.

Low Back Pain in Student Nurses: Literature Review and Prospective Cohort Study.

Abstract There is consensus that registered nurses worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Patient handling activities such as lifting present the highest risk of injury, activities that begin in nursing school. A literature review identified 21 studies of back pain in nursing students, indicating a wide range of prevalence rates. A prospective cohort study of nursing students in a United States baccalaureate program followed 119 students who completed the Nordic Musculoskeletal Questionnaire upon beginning the 16 month upper division major and then a year later. There was no statistically significant change in low back pain prevalence over time. While nursing students have intermittent and brief exposure to patient handling activities, nursing schools must nevertheless protect them before they enter the high risk profession of nursing by teaching evidence-based safe patient handling techniques, empowering students to refuse unsafe manual lifts, and ensuring that the clinical settings with which they affiliate have adequate mechanical equipment available.

Health Effects Associated with Foreclosure: A Secondary Analysis of Hospital Discharge Data

Objectives. The purpose of this study was to assess the health effects of high home foreclosure rates in an area of the United States of America and the utility of hospital discharge data for this purpose. Methods. We analyzed hospital discharge data from three postal zip codes using the principal diagnosis for 25 Diagnostic Related Groups associated with stress. Descriptive statistics were used to characterize hospital discharge rates for each condition by year and zip code. To test for differences across time, the Cochran-Armitage trend test was performed. Results. Most conditions did not demonstrate a statistical change between 2005 and 2008. There was a marked spike in bipolar and depressive disorders in 2007 in all zip codes. Conclusions. The sharp rise for bipolar and depressive disorders in 2007 coincides with the doubling of foreclosure filings nationally. There are many confounding factors affecting hospital discharge data, which limit its specificity for assessing the health effects of foreclosure.

Nurses as scapegoats in Ebola virus disease response

At the same time that the first cases of Ebola virus ease appeared outside of West Africa in October 2014, International Journal of Nursing Studies published an torial critiquing the inconsistent international guides for respiratory protection for health care workers istering to patients infected with this lethal virus cIntyre et al., 2014). MacIntyre et al. questioned the ommendations of the World Health Organization and United States Centers for Disease Control and vention (CDC) for the use of medical/surgical face sks alone (instead of respirators) for routine hospital e. Those authorities based their recommendations on presumed mode of transmission of Ebola, direct tact with blood and body fluids, not aerosols. ever, there have been no studies of Ebola virus osol transmission during aerosol generating procees, such as intubation. In light of this evidence gap, editorial’s authors point out that respirators should recommended because they offer advantages over sks beyond superior filtration, in that they are fitted the user and the seal is tighter, offering improved tection. When two registered nurses at one hospital in the ited States, who were following the CDC’s guidelines respiratory and other personal protective equipment, ill with Ebola virus disease after caring for an cted patient, the CDC’s physician director publicly med them for lapses in following the agency’s tocol, rather than examining whether the protocol lf was sufficiently protective (Collman and Gardner, 4, October 13; Kerns, 2014; Mohan, 2014). Would the C have been so quick to blame the victims had they been nurses? Previous to this occupational disease transmission, a sician in the same hospital’s emergency department misdiagnosed the infected man and sent him home, y to have him return three days later with fulminant la virus disease from which he subsequently died. her than investigating the root cause of the initial ure to diagnose, the hospital immediately blamed a ge nurse for not communicating the patient’s West Africa travel history to the emergency room physician (Hunt and Jacobson, 2014). The hospital in later days confirmed that the nurse had documented the travel history correctly, but it then shifted the blame to lack of interoperability between the nurses’ and physicians’ versions of the electronic health record (Diana, 2014). It then retracted even this faint association with nurse involvement (Carr, 2014) and offered a list of ‘‘lessons learned,’’ none of which include remediation of nurse practices (Jacobson, 2014). But why was this healthcare facility so quick to blame a nurse instead of the physician who missed the initial diagnosis? In Spain, a nurse’s aide, widely misidentified as a nurse (Associated Press, 2014), came down with Ebola virus disease in early October 2014 after caring for a patient who had returned from West Africa with the disease. She was the first person to be diagnosed with Ebola virus disease outside of Africa, which may have contributed to a government health official accusing her of lying when she first reported symptoms to the Spanish health authority (Minder, 2014). On the other hand, had Marı́a Teresa Romero Ramos been a physician, would the official’s first response have been to question her integrity? These cases illustrate scapegoating by powerful organizations. According to Bonazzi, as quoted in Cooke (2007):

Occupational health software: Selecting the right program

1. Occupational health nurses who are selecting software should identify specific goals for computerization, such as tracking compliance activities or analyzing trends. 2. Nurses should evaluate software programs by the extent to which each achieves these goals without exceeding available resources. 3. Successful software installations require commitment from an on site project manager to ensure that the program meets specifications and that the vendor provides adequate user training and ongoing support.