00:02
Hi! My name is Jessica Spellman. I’m going
to be reviewing the principles of ergonomics.
00:08
In this course, you’re going to be learning
about the concepts of ergonomics and how it
promotes a safe and healthy work environment.
You’re going to learn to implement proper
body mechanics in order to prevent injuries
to yourself and your patients. You’re also
going to learn about some assistive equipment
that you can use that could help prevent injury.
00:31
Ergonomics is a scientific study of people
at work. The goal is to help reduce stress
and injuries in the workplace. This is accomplished
by designing tasks and workspaces that promote
comfort, safety, increased use, and efficiency
while performing tasks. So, the definition
of proper body mechanics is the use of muscles
and body position to limit injury while performing
a task. This includes using your balance,
your posture, and body alignment in order
to prevent injury. Nurses use a lot of different
body mechanics when caring for patients, including
bending, lifting, and performing ADLs. Nurses
do need educated on this information
and need to practice it in clinical in order to
be efficient at using it. We want to correct
incorrect behaviors and move to using ADL
body mechanics. Risk of injury to nurses
and the client is decreased when proper body
mechanics is used.
01:32
So the incidents of workplace injuries
is very high. In fact, healthcare workers
have a high rate of muscular skeletal injury when
caring for patients more so than in construction
mining and manufacturing. This is mostly due
to the repetition of tasks, including the
heavy manual lifting, transferring, and repositioning
of clients. The problem is compounded due
to the increasing weight of our patient populations,
and the amount of help patients need with ADLs.
02:08
In 2008, the Centers for Disease Control reported
that the direct and indirect cause of back
injuries in the healthcare industry are estimated
at $20 billion annually. Nurses aides suffer
the highest prevalence and report the most
cases of back pain among female workers in
the United States. In 2000, 11,000 registered
nurses suffered lost time at work due to back
pain and injury. And 12% of nurses reported
that they left the nursing industry because
of back pain. In 2003, the American Journal of
Critical Care also reported 9,000 healthcare
workers every day are injured while performing
work-related tasks. Disabling back pain and
injuries affect 38% of the nursing workforce.
The Bureau of Labor Statistics also reported
nursing assistants and registered nurses were two
of the five professions that had the greatest
risk of injury and it was greater than 30%.
Over 50% of those injuries were back injuries,
but they weren’t the most severe injury
that nurses suffered or shoulder injuries.
03:25
They also kept the amount of work the longest.
So as nurses, what can we do? First of all,
we need to acknowledge that there’s a high
risk for injury in our profession, and not
always think that it’s going to happen to
somebody else because it can happen to you.
03:39
The second thing we need to do is learn about
proper body mechanics and ergonomic concepts
in order to change the way we do our work
and prevent injury. So in order to understand
part of the ergonomic principles I’m going
to review, we need to talk about a few concepts.
03:56
First is, what is weight? Weight is the force
of gravity on an object. In order to lift
something, you must overcome the weight of
the object and know its center of gravity.
04:06
And what the center of gravity is? The center
of the mass of an object. So in humans, the
center of gravity is in the pelvis when you’re
standing. When a person moves, the center
of gravity shifts. To lower your center of
gravity, you have to bend at the hips and
the knees and not just at the back. In order
to be more stable, you need to keep the center
of gravity on a supported base. A supported
base is when the feet or shoulder width apart,
and the object is close to the body. So some
of the principles I want to review with you
are, in order to prevent a neck and a shoulder
injury, you need to keep a neutral posture
with your head and your neck so that it’s
in line with the pelvis, not forward or backwards,
but straight in line with the pelvis. And
you want to keep the work between the waist
and the shoulder height. That’s the ideal
height to prevent leaning over to use your
back and lifting up too high and causing shoulder
injury. When you are carrying a heavy item,
don’t twist. You want to move with the item
this way. When you’re carrying for patients
in a bed, you want to lower the side rails
to prevent leaning over and hurting your back.
05:21
And when you don’t have enough space and
you’re working in a small enclosed space,
you’re less likely to use proper ergonomic
mechanics. So you want to make sure you have
plenty of rooms so that your body can move
in the position that it needs to. Outside
of work, there are a couple of other things
that can do to help prevent injury.
05:41
That’s exercise. Maintaining overall muscle strength,
and especially core strength will help prevent
back injuries. As much as you can, rest between
heavy activities to reduce fatigue. If you’re
at work and your patient load is very heavy
that day, try and space the heavy tasks far
apart so that you can recover by doing lighter
tasks. If you’re totally unable to avoid
repetitive movements, make sure you’re stretching
at least a couple of times every hour to make
sure that you don’t sustain injury from
those repeated tasks.
06:16
When you’re standing for long periods of
time like when you’re documenting, making
sure that you’re putting a foot up and flexing
the knee and hip helps take some of the weight
and pressure off of your lower back. So specifically
when lifting, these are a couple of things
to keep in mind. Know and follow your institution’s
policy for lifting. A lot of organizations
are going to a no single lifting policy so
that all lifting must occur with two or more
people. You need to be aware of your institution’s
policies and follow them to prevent injury
to yourself and your patients. When you’re
lifting, you want to bend the legs and lift
instead of only leaning over at the back.
You want to have a strong base of support.
07:04
So the legs should be shoulder width apart.
You want to tighten the core to protect the
back, and keep the center of gravity of the
object between the waist and the shoulders
close to the body and don’t twist. Safest
way to lift or move a client may be to use
a piece of assistive equipment. Also, planning
ahead and asking for assistance from other
individuals may make it easier to lift or
move patients. When you’re pulling or pushing
an item, there's also a few things to keep
in mind. You need to widen the base of support.
07:42
Since you’re going to be moving, you need
the wide base to help maintain your posture.
07:48
Pull objects toward the center of gravity
rather than pushing them away. When you’re
pulling an object close to you, you want to
have your one leg behind you to help with
the transfer of weight. When you’re pushing
something, you want to have a foot in front
of you so you can transfer your weight forward
as you’re pushing the item. And you also
want to face the direction of the movement.
Again, don’t twist when you’re moving
a patient, but lifting them up towards the
head of the bed and facing the direction that
they’re moving. Sliding, rolling, and pushing
patients require less energy than lifting
them and moving them. So there’s some assistive
equipment that we can use to help transfer
patients. A transfer assist device is a non-mechanical
device that helps us move or transfer a patient.
08:40
It decreases awkward positioning for the nurse,
and it can help decrease musculoskeletal injury.
08:46
Some examples of transfer assist devices are
slide sheets, lower sheets, transfer belts,
gait belts, and turning discs. Education on
those items is not going to be provided in
this lecture. Facilities that use these items
will have their own education on how to properly
use this equipment. Patient lifts is another
way to lift the patient out of the bed and
either move them to the shower or a chair.
It’s designed to lift and transfer clients
from one place to the other. There’s a manual
model that uses hydraulics that help decrease
the workload so that you can move them easier.
Then there’s also battery operated ones
that require a rechargeable battery and a
power source. So make sure you know which
is available at your institution. Again,
there are many manufacturers of lifts,
different types. They generally have the same
components, but specific education at your
facility is going to help prevent an injury to
yourself or your client. So when used correctly,
it can decrease injury to clients or yourself.
Just as it is important for nurses to understand
ergonomics to prevent injury to themselves,
it’s important for nurses to understand
ergonomics to prevent client injury as well.
It is the responsibility of nurses and nursing
assistants to position patients correctly, knowing
that if you do not position them appropriately,
they could become injured or fall. Being aware
of the correct positioning and how to support
clients in positions is important to review.
So, I am going to be going over a few of the
client positions that we use most frequently
in the clinical setting. First of all is the
supine position. The client is lying on their
back, knees straight in front of them, head
on the pillow. Some areas that may need to
be supported in this position are pillows
behind the knees, a pillow behind the neck
to prevent neck strain, and possibly under
the arms to prevent any should string. Semi-Fowler's
position is a supine position where the head
of the bed is at 30 degrees and the knees
may be slightly elevated. As long as there’s
a pillow behind the neck to support the head,
it may or may not require any more pillows
for comfort. Fowler’s position is a supine
position with the patient on their back and
the head of the bed 45 degrees. The knees
are also elevated to take pressure off the
low back, and pillows can be used for comfort.
High Fowler’s is a supine position with
the head of bed 90 degrees, and the knees may or
may not be elevated. It can be uncomfortable
for one person to have the knees elevated,
and in another, it may be better to have them
elevated to prevent low back strain. Prone
is when a patient is on their stomach, one
head to the side. The lateral side-lying position,
patient lays on the side with the weight
on the dependent hip and shoulder, and arm is
in front of the body and a pillow is placed
under the head and possibly between the legs
and the thighs to maintain proper alignment
of the pelvis. Sims’ or semi-prone, the
client is on the side halfway between lateral
and prone. So they’re not quite lying all
the way on their stomach but a little bit
further over then on lateral. So the lower
arm is then behind the client, which sounds
like it could be caused a lot of shoulder strain
that the client is not positioned correctly.
12:29
And then the upper arm is in the front and
both legs are flexed. The orthopneic position,
this is for patients that are having trouble
breathing and it’s when the patient sits
on the edge of the bed and either has a bedside
table or chair or something next to them and
they rest their arms on the table and they
kind of lean their face forward. It helps
clients feel like they can catch their breath,
a little bit better. Trendelenburg is when
the bed is flat, and then the head of the
bed is tilted down lower than the foot of
the bed. And reverse Trendelenburg is the
opposite of that when the patient is lying
flat and supine and the head of the bed is
higher than the foot of the bed. So in summary,
nurses and nursing assistants are in a high-risk
group for sustaining a work-related injury.
13:19
Being aware of ergonomic principles and body
mechanics during lifting, transferring, and
positioning patients is the key to preventing
injury to ourselves and our clients. Sometimes
using assistive equipment like lifts and transfer
devices can help protect clients and healthcare
workers from injury. Make sure you know your
institution’s policy on lifting and how
to use assistive devices in order to prevent
injury. Knowing how to use assistive equipment
properly, as well as reviewing the correct
positioning of clients and practicing safe
ergonomic principles is the responsibility
of every nurse. All right. This has been principles
of ergonomics with Jessica Spellman.
Thank you.