Body Mechanics and Patient Transfer Flashcards
- What are the most commonly injured body parts in healthcare?
Back/Spine
Shoulder
What is an Industrial Athlete?
Any worker who performs physically demanding work requiring his or her body to perform precise and/or repetitive skeletal movements, body positions, and manual tasks
Lifting, carrying, pushing, pulling, twisting
What does a professional athlete and an industrial athlete have in common?
Skill Will Coaching Great Equipment Physically Demanding Work
What is the difference between an elite athlete and an industrial athlete?
An elite athlete is limited with their time in the gym/field, periodization, and shorter careers.
The industrial athlete works long shift work hours, overtime, no periodization, and have longer careers.
What are periodization principles?
Elite Athletes also adhere to periodization principles in which the amount and intensity of training/competition is adjusted throughout the year. This is done to increase performance and prevent injury. Professional athletes and their medical staff know that pushing your body constantly without periods of reduced intensity or rest will result in mechanical breakdown (INJURIES)
In contrast, our Industrial Athlete in Healthcare are potentially working 20+ years, and some closer to 30 or 40.
What are ergonomic risk factors?
Awkward/Sustained Posture Forceful Exertions Contact Stress Repetition Gripping Vibration These ergonomic risk factors are the building blocks of injury.
How does your body position affect the pressure on the spine?
- When you stand this is considered 100% pressure on the spine.
- When you are lying down this is considered the least amount of pressure on the spine.
- When you lean over the pressure on the spine & discs increases up to 275% depending on the exact position!
See slide 12.
What is the power position?
Pelvis is 1/2 flexed or tilted.
Buttocks out.
Knees and hips flexed.
Head up.
Results: Keeps the curves; keeps the work in the legs.
Provides a stable base of support, enables quick reaction with less distance to travel. Allows curve of spine to be in neutral position even when low to the ground. A young child uses this position naturally.
What is the power zone?
Between the chest and midthigh.
What are the principles of good body mechanics?
- Load/arms close to body
- Hands between hips and shoulders
- Use legs to weight shift
- Avoid twisting the back
- Slow and controlled
What is the ideal work height?
This varies with the type of work being performed, i.e. whether it is light or heavy.
Precision work - 6” above elbow height to avoid excessive upper back and neck bending.
Light work - at elbow height.
Heavy work - 6” below elbow height to utilize lower body strength.
What can you do to improve your work position in a healthcare setting?
Consider equipment placement and patient/bed placement.
Perform: Macro and micro changes – bed and patient. Raise/lower equipment to optimal working height.
Think: Easier for the patient to move than for you. Ok for them to be temporarily uncomfortable to avoid repetative strain injuries to HCW.
Use Tools such as Bolsters – for you and the patient’s comfort/access.
Note: Google says as a noun, a bolster is a long thick pillow placed under other pillows for support; as a verb it means to support, strengthen, or to prop up.
What is the effect of sustained positions? How do you counter-act effects of awkward and/or sustained positions?
At rest, the amount of blood and blood flow required is low compared to dynamic movement. But during a sustained force position our body needs lots of blood but blood flow is low as blood vessels are compressed and blood is not as effectively being pumped through the muscle. This mismatch between blood flow needed and actual blood
flow can lead to muscular fatigue and decreased efficiency much sooner than dynamic work. This increases the risk for injury.
Changing positions frequency is our best prevention.
What are some examples of sustained positioning in the healthcare setting?
During an ultrasound. Lab work: Microscopy BSC or fume hood Cell counters Microtome work Pipetting Overhead lifting Lab workbenches
What is the ergonomic issue with electronics? How can you avoid?
Tech neck - describes the injuries and pain from time spent looking down at devices. Estimated added stress on neck, ~ 60 lbs onto neck (4 bowling balls).
Avoid tech neck by keeping chin up and maintaining a neutral position. Do not change the position of your neck.
How can you reduce the forces involved in moving equipment?
Slow and controlled movements will reduce the required exertion (forces) more than faster, jerky ones.
What is contact stresses/pressures in ergonomics? What body areas are particularly vulnerable to this?
- Contract stress occurs when a force is concentrated on a small area of the body, which can pinch or compress the underlying nerves and tissues and restrict normal blood flow to that area.
- Examples:
a) hard or sharp object comes in contact with the skin such as kneeling on hard ground,
b) leaning against a bed rail or stretcher, c) resting forearms or wrists on the edge of a surface (e.g., computer work), or
d) when ridges and hard edges on equipment dig into your hands.
The sides of the fingers, palms, wrists and forearms, elbows and knees are most susceptible because the nerves, tendons and blood vessels are close to the skin and underlying bones in those areas.
What is repetition and what affect does it have on the body? How do we prevent it? What can occur if we do not?
- Repetition entails performing the same motion or series of motions over and over
again using the same muscle groups with little variation or chance of recovery time. - The muscles begin to fatigue and the amount of force a person can exert and the capacity to do work will decrease.
- The task needs to be stopped for a
period of time in order for the body to recover. Time needed for recovery depends on the task as well as the individual’s physical conditioning. If the break is too short, the body will not have recovered fully and the capacity to do work decreases more quickly.
** Variation in type of task & frequent breaks** help prevent repetition issues. - Repetition can have a cumulative effect over time and result in repetitive
strain injury (RSI), similar to a single incident of excessive force.
What is an example of a repetitive task in the healthcare setting?
CPR
Microtome work in the lab.
How does the type of grip used affect the force and risk of a musculoskeletal injury (MSI)? How is this an issue with patient handling?
Gripping
1. The type of grip used when handling patients will affect the force that can be generated and risk of MSI.
2. A power (cylindrical) grip, which uses the entire hand to produce force, provides the maximum gripping force that can be generated by the hand and requires
the least amount of effort.
3. A pinch (precision) grip, which only involves the fingertips (i.e., between thumb and finger(s)), can produce ~25% of the force of a power grip.
4. Because the human body does not possess any handles, it is difficult to find areas that would enable the use of a good grip, at least not without potentially injuring the patient.
How does vibration in the workplace affect the body? Where may it be experienced in the workplace setting?
Vibration results in more intense upper body but affects the whole body. Vibration can increase the chances and/or impact of injury by about 25%
Example: Riding in an ambulance.
What is the Hierarchy of Controls?
In order from most effective to least, they are:
- Elimination
- Engineering Controls
- Administrative Controls
- PPE
What are some examples of administrative controls?
Job Rotation
Rest Breaks
Work Practice Changes
What are some examples of PPE in the hospital?
Gloves, respirators, lead protection etc.
Proper footwear
Bolsters
SPH equipment
How do I become an industrial athlete?
Two main goals: prevent injury and increase performance.
Aerobic Conditioning
Flexibility & ROM
Muscular Strength
Muscular Endurance
What are the benefits of aerobic conditioning?
- Increased heart/lung capacity & efficiency
- Increased blood and oxygen flow to muscles during sustained exercise
- Increased circulation in the body which promotes healing of muscles
- Increased endurance/decreased fatigue
Why is it important to have and maintain flexibility?
- Range of motion possible around a specific joint(s)
- The ability to make longer or wider without tearing or breaking
- Short muscles = decreased ROM
Mores susceptible to strain (exceed extensibility limits)
This is particularly important in awkward postures that cannot be altered.
What is the best way to increase flexibility? What are the two different types of stretching?
- Dynamic stretching is more effective prior to activity. Static Stretching is better suited to improving overall flexibility
- Dynamic stretching. Slow, controlled body movements with gradual increase through full ROM, speed, or both
- Static stretching: No movement; maintaining or holding a position
What is the problem with static stretching?
Research has shown that static stretching prior to activity can be detrimental to performance. 5-30% reduction in strength & power production.
Does not necessarily lead to decreases in injury.
Although it does improve overall flexibility.
When do most injuries occur in the work place?
Most injuries occur in the first 2 hours of work. This emphasizes the importance of proper warm up and stretching.
What is the reason dynamic stretching is so important? What is the impact of age?
- When a person is not active the synovial fluid resembles a thick gel or paste. When the body begins moving, say to warm-up before exercise, then as the body temperature rises, the fluid begins to become less viscous.
- Increased risk of joint injury if synovial fluid has not take on the properties to better protect the joint.
- Best thing to do - make sure that warm-up begins gently and gradually heart rate and body temperature increase which, in turn, allows the muscles to receive greater blood flow which delivers oxygen to all parts of the body. This heightened state of activity will also affect the joints by warming and thinning the synovial fluid and allowing it to better protect the joints. 4. This is more important as we age. The body requires longer and longer time to warm-up.
What is a neutral posture?
- The neutral posture or zone is a region of little or no resistance to movement in the middle of a joint’s range of motion. The joints or body segments are not bent or twisted significantly in any direction and the natural curves of the spine are maintained so that the least amount of energy is required to maintain it.
- This position places the least amount of stress/strain on soft tissues and the muscles are in their strongest position to
develop the maximum amount of force most efficiently.
What is an awkward posture?
An awkward posture is one that deviates significantly from the neutral position or zone (i.e., extreme joint ranges). The muscles, tendons, nerves and bones are stretched, shortened, and/or compressed and are not in an optimal position for force
development.
What can you do instead of pulling a load with the arms/shoulders/back?
Stabilize the arms and shoulders with elbows tucked in to the sides
Bend the knees and hips
Place weight onto foot closed to patient/item to be moved
Shift the weight onto the foot closest to the destination.
What are the difference between NIOSH guidelines for manual material handling and safe patient handling?
NIOSH Guidelines:
Manual Material Handling – 51 lbs
Safe Patient Handling – 35 lbs
Why are safe patient handling weights lower than manual weights?
Humans do not have handles (love handles don’t count)
Weight is not distributed evenly
Can move unpredictably
What percentage does a leg or an arm weight approximately with respect to total body weight?
- A leg weighs about 16% of total body weight. When a patient weighs 18-41 kgs (40-90 lbs), some restrictions begin
Patient >95 kg (209 lbs) has legs weighing over recommended limit of 16 kgs (35 lbs) - An arm weighs about 5% of total body weight. When a patient weighs >64 kgs (140 lbs) some restrictions begin
A patient >199kgs (438 lbs) has arms weighing over the recommended limit.
What are the three elements of safe patient handling?
The triangle theory supports equal importance placed upon:
- Safety for the worker
- Safety for the patient
- Continuing to foster independence for the patient
Where should patient handling tasks be done (in terms of HCW body level)?
Patient handling tasks should take place between hip and chest height
Heavy tasks at hip level
Closer tasks at chest
Adjust the bed accordingly
Bariatric patients may require that the bed be lowered to reduce reaching over the chest wall.
What are some improper patient handling practices?
- Handling patients without proper assessment
- Not using appropriate equipment
- Awkward positions:
- Twisting
- Bending/Stooping
What are the goals of a patient mobility assessment?
Determine patient capability and consider safety. The three elements are: 1. Transfer technique required. 2. Number of HCWs required. 3. Equipment required.
When is a patient mobility assessment performed and by whom?
- On admission, including baseline and current status (Nurse)
- Whenever a team member recognizes a change in status (Nurse) Improve or worsen
- Screen before every transfer (Everyone)
ACES
What do you do if you are not sure of patient’s capabilities or doubt them?
HCWs can always choose a more conservative method of transfer.