William E. Wilkinson

Back injuries & registered nurses.

L ow back pain has been a major interest of occupational health specialists since the 1600s. It is a problem found in ancient Egypt over 5,000 years ago (Yu, 1984). Low back pain is the most costly health problem in the United States for clients 30 to 60 years of age (Reuler, 1985). It is the number one symptomatic cause of outpatient visits to health care providers . Time lost from work is estimated to be 93 million days per year (Reuler, 1985). Eighty percent of the general population willexperience lowback pain during their lifetimes (Cailliet, 1981; Ror, 1984). It is estimated that 28% of the United States industrial population will have low back pain as a disabling condition at some point in their lives (Morris, 1984). Back injuries account for one in five work related injuries. Two million Americans cannot work because of back problems (Sheahan, 1982). Back pain is the third leading cause of physical limitation and disability; 3.9% of the United States population is permanently disabled by back injury each year (Flor, 1984). In 1980, 25% of all compensation indemnity claims were associated with back injuries (OSHA, 1983). An estimated

Aching backs? A glimpse into the hazards of nursing.

14billion are spent annually in the United States for treatment of and compensation for low back pain (Schaepe, 1982;Tabor, 1982; White, 1982). The cost of back injury to employers from slowed production, increased turnover, and medical cost reimbursements is estimated at

An occupational injury management information system

10billion annually. One insurance company reported paying in excess of

A teaching guide for employees exposed to waste anesthetic gases.

800,000 per day for work related back injuries (Wakefield, 1985). One study indicated an average prevalence of low back pain of 30% of the general population irrespective of the occupation of the client. This same study showed a prevalence of low back pain in nurses of34.6%. Low back pain in the nursing population was more frequent due to occupational precipitating factors than was low back pain in a control group of teachers (Cust, 1972). At least one in 15nurses will experience back injury serious enough to interfere with their professional careers (Dionne, 1985). This estimate may be low when one considers that the typical hospital staff nurse lifts 20 clients in bed and assists 5 to 10clients with transfers from bed to chairs during each shift (Nichols, 1983). Another study utilizing a sample of 3,912 nurses suggested a potential of 764,000 lost working days each year for the 40,000 nurses represented by the sample. Of the 3,912 nurses surveyed one in six with back pain attributed the back pain to a patient handling incident (Stubbs, 1983). Numerous studies implicate low back pain with or without an apparent injury as a significant problem in occupational health (Andersson, 1979; Biering-Sorensen, 1983; Brown, 1975; Chaffin, 1973; Troup, 1981). Lifting has been found to be associated with low back pain. Multiple studies indicate that nurses have a relatively high incidence of back pain when compared to other working populations or the population at large. This back pain is frequently related to lifting and other occupational hazards (Cust, 1972; Magora, 1972; Nichols, 1983; Owen, 1984; Raistrick , 1981; Stubbs, 1981, 1983). The epidemiology of back pain or injury is not completely understood.

A conceptual model of occupational health nursing.

This study evaluates a combination of extant and collected data that compute frequency and exposure to back injuries reported by nursing employees at a Northwest Medical Center system. A major problem of interest, and the focus of this study is whether there is objective evidence to support the commonly held belief that lifting patients is the main cause of back injuries experienced by nurses; and whether job classification and worksite unit might be confounded with back injuries reported and what demographic characteristics of the nursing personnel, e.g., sex, age, job classification, and worksite unit, might be confounded with occupations that are high at risk for back injuries. Personnel records and injury report forms provided objective data for 659 registered nurses, licensed practical nurses, and nurse aides. Injury report forms providing data for 123 nursing personnel filed during the most recent consecutive twelve-month period between January 1, 1982 and April 30, 1985, were abstracted, summarized, and analyzed for number of back injuries reported using DataBase III and SPSSx computer programs on an IBM-AT system. In addition, on-site observations of patient lifts were made for ten eight-hour shifts on 15 different occasions and different worksites by a nurse-research analyst. These observation data were compared with self-report questionnaire responses representing over 54% of the total population of nurses within this medical center system. An inverse relationship of reported numbers of patient lift per shift was found for the observation and self-report data. Of the 2.5 females to males reporting back injuries, the average age was 43 years, with greater numbers of those injuries working on surgical and medical units versus lesser numbers injured from psychiatry and long-term care units in decreasing order. The Chi-square test was used to compute associations found not significant between reported high and low numbers of lifts and the incidence of back injuries. The t-test compared data from the observed and self-reported number of patient lifts and provided a significant (t = p <.001) difference in favor of self-report for number of lifts per eight-hour shift. Results of this study will contribute to increasing validity of lifting patients resulting in back injuries and further study of feasible and effective methods for evaluating back injuries and preventive interventions for nursing personnel who are at high risk of developing or sustaining back injury from any cause, while on the job.

Occupational injury and illness for health science center employees: presenting data in a clear manner to management.

FIGURE I: Diagram showing placement c!occupational injury Management Information Subsystem in the total system. Presented at the Occupational Health Section of the 111th American Public Health Association Annual Meeting, Dallas, Texas; the 11th Annual Nursing Research Conference at the University of Arizona, Tucson; and the 9th National Primary Care Nurse Practitioner Symposium at the University of Colorado, Keystone. The assistance of Marcus M. Key, MD, MIH,D. Jack Kilian, MD; and Michael Decker, PhD, with the University of Texas at Houston; and Robert J. Long, DrPH, with Data Management Services of Boise, Idaho, in the conduction of this project is greatly appreciated and gratefully acknowledged. This research was supported in part by a National Institute for Occupational Safety and Health Traineeship Grant.

Information Systems for Worksite Health Promotion Programs

tice and pregnancy controlled survey of women anesthetists in the United Kingdom. Lancet, 1, 1326-1328. Lee, J.A. (1978), Thenew nurse in industry. A guide for the newly employed occupational health nurse (DHEW Pub. No. 78-143). Cincinnati, OH: National Institute for Occupational Safety and Health. McKay, R., & Segal, M. (1983). Methods and models for the aggregate. Nursing Outlook, 31(6),328-334. National Institute for Occupational Safety and Health (NIOSH). (1977). Criteria for a recommended standard . . . occupational exposure to waste anesthetic gases and vapors. (DHEW Pub. No. 77-140). Washington, D.C.: Government Printing Office. Parker, J.E. (1982). Basic components of a hospital employee health program. Occupational Health Nursing, 30,(5), 21-27. Smith, CA, &Piper, D.A. (1982). Hazards of a hospital complex: An occupational health screening program. Occupational Health Nursing, 30(3), 37-40. Spence, AA, Cohen, E.N., Brown, BW., Knill-Jones, R.P., & Himmelberger, D.U. (1977). Occupational hazard for operating room-based physicians. Journal of the American Medical Association, 238(9), 955-959. Vaisman, A.I. (1967). Working conditions in surgery and their effects on the health of anesthesiologists. EKSP Khir Anesthetic, 3,44-49.

A theoretical framework for occupational health program evaluation.

Occupational health nurses can practice and research in their profession better if they approach occupational health nursing with a well developed conceptual model. The Wilkinson Windmill Model is one conceptualization of occupational health nursing an occupational health nurse may use for guidance in practice, research, and education. The model consists of five primary components. This conceptual model may be a useful framework for understanding the role of the occupational health nurse in many different environments and may prove valuable as a tool for conducting research.

Rehabilitation assessment: a practical guide for the occupational health nurse.

Occupational hazards to U.S. health sciences employees are outlined and discussed. Methods for analyses and presentations of when, where, and what groups of employees at a Southwestern state university health science center reporting job-related injuries during part of fiscal 1982 are set forth. The four tables and three figures included are examples of how to use data routinely kept, though often ignored, for creating information and displaying it to communicate quickly and effectively with management.

Worker's compensation and the occupational health nurse.

HYPERTE SIVE PROFIL E REPORT FIG RE I William E. Wilkinson. RNC. DrPH . COHN. Director, Occ upatio nal Health Nursing . North west Center tor Occupationa l Hea lth and Safety, Department of Co mmunity Health Ca re Sys tems . Department of Envi ronmental Health . University of Washington. Seattle . Connie S. Wilkinson. RN. MPH. Nursing Home Care Unit Supe rvisor. Veteran s Administration Medic al Cen ter. Seattle. Washington.