Decision Factors in Patient Handling

Injuries to patient handlers are a worldwide problem and have been listed as a primary research interest by the National Institute for Occupational Safety and Health (NIOSH) since the 1980’s. However, injuries still persist. The Bureau of Labor Statistics (BLS) injury data for 2002 indicates that nurses and healthcare personnel incurred 623,600 nonfatal injuries and illnesses, a 12.6/100 incident rate. In forty percent of these cases, injury to the back was the primary cause. Research on patient handling has provided valuable insights, such as Dr. Marris’s work on maximum safe spinal load limit. However, interpretation of the needed response based on research has lead to a division of approaches when contemplating policy versus engineering solutions. An examination of the various approaches yields solutions that directly relate to desired secondary outcomes based on immediacy and/or the developer’s job interest. Consequently, these different interests have shown to both help and/or contribute to the existing people or environmental factors, which a nurse must weigh before performing a patient lift. To better understand this, a descriptive study of people and environmental factors was done, examining and mapping their influence and interaction based on data from literature, interviews, and focus groups. People factors involve staff culture, patient characteristics, and handler characteristics. Environmental factors deal with physical space, situation/event, and administration/policy. The degree to which each of these factors influence and/or determine a nurse’s decision on how to perform a particular lift can be ascertained by a series of questions. The number of questions per factor varies, but each directly relates to a primary confounding issue. During this study, a list of questions was compiled with each derived from 25 common items/variables identified to be influencers by nurses, doctors and administrators. Consequently, the future research developed and proposed here is based on this list of 25 variables and seeks to provide two things. One is to develop a hierarchy of importance for the variables that control a lift. Second is to examine existing deficits in literature beyond technique. The overall objective is to understand the effects of space restriction (one variable) on a lift and to quantify it in terms of increased risk based on the unobstructed lift.