A research project is described that analyses the back pain prevalence and physical working conditions of community nurses. The purpose was to compare the position of nurses working in institutional care with the specific situation of nurses working in the private homes of their patients. The results of a questionnaire showed that the back pain prevalence was relatively high as compared to other occupations and also when compared to other health care sectors. The home care organization is influenced not only by sick leave due to back pain, but also its efficiency is hampered by nurses with back pain who continue to work. It appeared that the total sick leave incidence due to musculoskeletal disorders other than back pain exceeds that due to back pain alone. The physical exposure level not only consisted of frequent and heavy lifting and transferring of patients but also a substantial static workload was present. The onset of back pain seems to result from a gradual build up of overload reaching its maximum. A preventive approach should take these differential loading factors into account. The consequences for preventive interventions are discussed resulting in recommendations towards a (participatory) ergonomic approach. This material forms the baseline of a controlled prospective trial in home care.

Compliance with exercise regimens is difficult to obtain as is compliance with other medical regimens. In analyzing noncompliance, two problems exist: (I) current theories only partly explain patients' noncompliance; (2) health care prbviders seldom act according to the recommendations derived from research findings. These problems may be due in part to great differences in types of compliance behavior. A significant difference exists between short-term supervised compliance and long-term nonsupervised compliance. Therefore different theoretical and practical approaches may be needed depending on the specific compliance behavior in question. Analysis of compliance with exercise regimens indicates that interventions based on behavioral theory are adequate for short-term compliance, whereas a self-regulation approach can be useful in long-term compliance. As a logical consequence, the health care provider should be able to act dljjferently, according to the type of compliance needed. The practical implications for exercise regimens in physical therapy practice are discussed in detail.

Objective: This systematic review aims (1) to identify barriers and facilitators during implementation of primary preventive interventions on patient handling in healthcare, and (2) to assess their influence on the effectiveness of these interventions. Methods: PubMed and Web of Science were searched from January 1988 to July 2007. Study inclusion criteria included evaluation of a primary preventive intervention on patient handling, quantitative assessment of the effect of the intervention on physical load or musculoskeletal disorders or sick leave, and information on barriers or facilitators in the implementation of the intervention. 19 studies were included, comprising engineering (n = 10), personal (n = 6) and multiple interventions (n = 3). Barriers and facilitators were classified into individual and environmental categories of factors that hampered or enhanced the appropriate implementation of the intervention. Results: 16 individual and 45 environmental barriers and facilitators were identified. The most important environmental categories were ''convenience and easy accessibility'' (56%), ''supportive management climate'' (18%) and ''patient-related factors'' (11%). An important individual category was motivation (63%). None of the studies quantified their impact on effectiveness nor on compliance and adherence to the intervention. Conclusion: Various factors may influence the appropriate implementation of primary preventive interventions, but their impact on the effectiveness of the interventions was not evaluated. Since barriers in implementation are often acknowledged as the cause of the ineffectiveness of patient handling devices, there is a clear need to quantify the influence of these barriers on the effectiveness of primary preventive interventions in healthcare.Among healthcare staff the prevalence of musculoskeletal disorders (MSDs) is higher than in most other occupations.1 Patient handling activities are a major cause of MSDs among nursing personnel. 2The high occurrence of MSDs has important consequences due to substantial health care utilisation, sickness absence and permanent disability.3 A wide range of primary preventive interventions have been developed in the past to reduce physical load related to patient handling and therefore decrease the occurrence of MSDs. Conflicting results have been found for engineering interventions such as lifting devices.4 5 There is strong evidence that personal interventions alone, such as training on preferred patient handling techniques, are not effective.6 7 Either these techniques did not reduce the risk of back injury or the training did not lead to adequate change in lifting and handling techniques.7 Administrative interventions, targeting work practices and policies, are often an integral part of a more comprehensive intervention. There is moderate evidence for the effectiveness of multidimensional interventions, which are being applied more often recently.4 6 Nelson and Baptiste described several barriers in the implementation of patient han...

This article approaches the option of logging lifting activities by nurses in patient care. Practical problems in nursing limit the use of direct observation and measurements to assess exposure to lifting in real life settings. Indications were found that logs registering the frequency of manual handling could be an option in nursing. The development of a log is accounted for and its use during an intervention, introducing 40 patient hoists in home care, is described. The exposure to manual handling was reduced significantly in the intervention group (average number of patient transfers per nurse/week (ptn/w) 35-21). The control group remained stable (ptn/w 24-24). The reduction of exposure was only partly due to the hoists substituting manual transfers, suggesting the presence of an elimination effect. Possible explanations indicating that the hoists were partly responsible for this are: 1. The patients' relatives could now perform the transfers with the hoist; 2. Hoists combine several manual transfers into one mechanical transfer; 3. Hoists require only one operator for manual transfers that require two nurses. The log pointed to unpredicted elimination effects in addition to the substitution effects, and provided detailed information for evaluating the intervention. Relevance to industry Assessment of exposure to manual handling, using a frequency-oriented log, appears to provide relevant information for designing back pain prevention policies in nursing. Insight is given into the effects of an intervention using hoists. With some adaptations, the log could monitor ergonomic policies in nursing practice on a routine basis. This is a NIVEL certified Post Print, more info at http://www.nivel.eu Knibbe, J.J., Friele, R.D. The use of logs to assess exposure to manual handling of patients, illustrated in an intervention study in home care nursing.

ObjectiveThis study aims to identify individual and organisational determinants associated with the use of ergonomic devices during patient handling activities.MethodsThis cross-sectional study was carried out in 19 nursing homes and 19 hospitals. The use of ergonomic devices was assessed through real-time observations in the workplace. Individual barriers to ergonomic device use were identified by structured interviews with nurses and organisational barriers were identified using questionnaires completed by supervisors and managers. Multivariate logistic analysis with generalised estimating equations for repeated measurement was used to estimate determinants of ergonomic device use.Results247 nurses performed 670 patient handling activities that required the use of an ergonomic device. Ergonomic devices were used 68% of the times they were deemed necessary in nursing homes and 59% in hospitals. Determinants of lifting device use were nurses' motivation (OR 1.96), the presence of back complaints in the past 12 months (OR 1.77) and the inclusion in care protocols of strict guidance on the required use of ergonomic devices (OR 2.49). The organisational factors convenience and easily accessible, management support and supportive management climate were associated with these determinants. No associations were found with other ergonomic devices.ConclusionsThe use of lifting devices was higher in nursing homes than in hospitals. Individual and organisational factors seem to play a substantial role in the successful implementation of lifting devices in healthcare.