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Engkvist I-L, Hagberg M, Wigaeus Hjelm E, Menckel E, Ekenvall L, PROSA study group. The accident process preceding overexertion back injuries in nursing personnel. Scand J Work Envi ron Health 1998;24(5):367-375. Objectives This prospective dynamic-population-based study investigated factors involved in the accident process preceding overexertion back injuries among nursing personnel. MethodsThe study covered all reported occupational overexertion back injuries due to accidents among of the approximately 24 500 nurses in the Stockholm County hospitals during 1 year. It was assumed that several factors interact in the accident process. Detailed information was obtained for each injury by interviews with the injured nurse and head nurse. Risks in the physical environment were identified using an ergonomic checklist.Results During the study 136 overexertion back injuries were reported. Of the 130 nurses participating in the study, 125 had been injured in connection with patient work. Cluster analysis yielded 6 clusters and their pattern of contributing factors. The most frequent injury occurred during patient transfer in the bed or to or from the bed, without the use of transfer devices, when the patient suddenly lost his or her balance or resisted during the transfer and the nurse had to make a sudden movement. However, there were physical conditions, such as shortcomings in the physical work environment or a lack of a transfer device, that compelled the nurses to perform the tasks under unsafe conditions. C O~C~U S~O~SThe clusters showed a complexity of different kinds of accidents and indicated that the measures for preventing accidents, or for blocking an accident process once started, have to be of different kinds and placed at several different levels in the organization of a workplace.Key terms back, cluster analysis, lifting, nurse, patient transfer.Nurses have a documented high risk of work-related back injuries ( 1 -4 ) . Nursing aides in Sweden have a relative risk of 6.0 for reported occupational accidents leading to an overexertion back injury when compared with all other employed Swedish women (5). Most injuries occur during patient transfer and lead to a long sick leave, an average of 59 days, the indication being that they cause both personal suffering and a high social cost. According to Troup, most published reports dealing with the causes of back injuries consider a single causative factor and tllus ignore other contributory factors (6). Before preventive measures can be suggested, it is important to investigate carefully the circumstances involved in the accident process. Studies using interview methods to obtain qualitative data may identify factors contributing to the onset of occupational back pain (7).The purpose of this study was to investigate factors involved in the accident process preceding overexertion back injuries among nursing personnel. Subjects and methods DefinitionsThe use and definitions of the concepts accident and injury vary from researcher to researcher (8-1 1). In the p...

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