Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: An analysis of cross-sectional survey data

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Abstract

Background

Patient handling is a major risk factor for musculoskeletal injuries among nurses. Lifting equipment is a main component of safe patient handling programs that aim to prevent musculoskeletal injury. However, the actual levels of lift availability and usage are far from optimal.

Objective

To examine the effect of patient lifting equipment on musculoskeletal pain by level of lift availability and lift use among critical-care nurses.

Design and participants

A cross-sectional postal survey of a random sample of 361 critical-care nurses in the United States.

Methods

The survey collected data on low-back, neck, and shoulder pain, lift availability, lift use, physical and psychosocial job factors, and sociodemographics. Musculoskeletal pain was assessed by three types of measures: any pain, work-related pain, and major pain. Multivariable logistic regressions were used to examine the associations between musculoskeletal pain and lift variables, controlling for demographic and job factors.

Results

Less than half (46%) of respondents reported that their employer provided lifts. Of 168 nurses who had lifts in their workplace, the level of lift availability was high for 59.5%, medium for 25.0%, and low for 13.7%; the level of lift use was high for 32.1%, medium for 31.5%, and low for 31.5%. Significant associations were found between lift availability and work-related low-back and shoulder pain. Compared to nurses without lifts, nurses reporting high-level lift availability were half as likely to have work-related low-back pain (OR = 0.50, 95% CI 0.26–0.96) and nurses reporting medium-level lift availability were 3.6 times less likely to have work-related shoulder pain (OR = 0.28, 95% CI 0.09–0.91). With respect to lift use, work-related shoulder pain was three times less common among nurses reporting medium-level use (OR = 0.33, 95% CI 0.12–0.93); any neck pain was three times more common among nurses reporting low-level use (OR = 3.13, 95% CI 1.19–8.28).

Conclusions

Greater availability and use of lifts were associated with less musculoskeletal pain among critical-care nurses. These findings suggest that for lift interventions to be effective, lifts must be readily available when needed and barriers against lift use must be removed.

Introduction

Unsafe patient handling is a major risk factor for musculoskeletal injuries among nurses (Waters et al., 2006). Each year, more than 10,000 nurses in the United States experience work-related musculoskeletal disorders resulting in lost work days and nurses rank among the top five occupations for musculoskeletal disorders (Bureau of Labor Statistics, 2010). Injuries from patient handling tasks account for 31–66% of all musculoskeletal injuries among healthcare workers (D’Arcy et al., 2012, Kim et al., 2012, Pompeii et al., 2009).

Use of mechanical patient lifting equipment can reduce the risk of musculoskeletal injury from patient handling. Biomechanical and lift intervention studies have shown significant reductions in biomechanical stress, musculoskeletal discomfort, injury rates, and workers compensation costs (Engst et al., 2005, Evanoff et al., 2003, Li et al., 2004, Yassi et al., 2001, Zhuang et al., 2000). Eliminating risky manual lifting and promoting the use of adequate lifting equipment have become a key component of safe patient handling policies internationally (American Nurses Association, 2012b, Australian Nursing Federation, 2012, Workers Compensation Board of British Columbia, 2006). Since 2005, 10 states in the United States have enacted safe patient handling legislation that requires provision of patient lifting equipment to prevent musculoskeletal injury among healthcare workers (American Nurses Association, 2012b).

Providing lifts to nurses is the first step in ensuring safe patient handling, and having a lift readily available and having nurses actually use the lift are key to the success of lift interventions. However, lifts are not available in many healthcare settings. Even in settings where lifts are provided, actual lift availability and usage is far from optimal (Lee et al., 2010, Trinkoff et al., 2003). A 2011 survey by the American Nurses Association (2012a) showed that while two thirds of respondents had patient lift and transfer devices available, less than one third reported using the devices frequently.

The purpose of this study was to investigate the effect of lifts on musculoskeletal pain by level of lift availability and lift use. As there are discrepancies between lift provision and actual lift availability and use, the intervention effect may differ by the actual levels of lift availability and lift use. However, this difference has not yet been explored in intervention or observational studies. Three lift variables examined in this study have different characteristics. Lift provision is a purely organizational level variable, determined by whether or not it is provided by the employer. The level of lift availability is primarily an organizational level variable determined by the number and proper maintenance of lifts in the workplace, but may also be affected in part by individual factors such as age, gender, or work status of the nurse. For example, when there is a conflicting demand for these devices, male nurses may give priority of use to their female nurse colleagues. The level of lift use measures actual utilization for patient handling when needed; both organizational and individual factors play roles in the level of actual use (Koppelaar et al., 2011, Rickett et al., 2006).

Section snippets

Study design and population

This study analyzed data from a cross-sectional survey conducted in 2006 among critical-care nurses in the United States (Lee et al., 2010). The original study mailed the survey to 1000 nurses randomly selected from the American Association of Critical-Care Nurses (AACN) membership list; the response rate was 42%. Among initial respondents, the study identified 361 nurses who met the eligibility criteria. Inclusion criteria were critical-care nurses currently employed as staff or charge nurses

Study sample

The study sample (n = 361) characteristics are presented in Table 1. The typical respondent was female, White, married, working in a non-profit community hospital and ICU, at a full-time job on the day shift. Of the sample, 168 (46.5%) reported that their employer provided lifts; among these nurses, lifts were available always to 33 (19.6%), most of the time to 67 (39.9%), often to 19 (11.3%), occasionally to 23 (13.7%), rarely to 21 (12.5%), and never to 2 (1.2%) [missing n = 3]. The 168 nurses

Discussion

This study investigated the effect of patient lifting equipment on musculoskeletal pain by level of lift availability and lift use among U.S. critical-care nurses, using three types of pain outcome measures. The information on the type of lift equipment was not available in this study, but most lifts available to the study participants are likely to be floor-based lifts, given the fact that the survey data were collected in 2006. The study sample presented high prevalence of musculoskeletal

Conclusions

This study investigated the effects of patient lifting equipment on musculoskeletal pain for multiple levels of lift availability and actual use. Overall findings point to the following conclusions: (a) lifts appear to have the strongest potential for reducing work-related pain in the shoulders, and (b) consistent actual availability of lifts and removal of barriers against lift use among nurses may be important co-determinants for the prevention potential of lift interventions. The findings of

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