Nursing Intervention Project Outline Thi Tran and Hyun Gu Kang

 What is our mission?

 Our mission is to provide a preventive approach to reduce occupational injuries
in health care in order to improving patient care and safe patient handling.
 Who is our customer?
 We are targeting nurses specifically in both hospital settings as well as
residential care or skilled nursing facilities. Because they provide care to a large
amount of patients who need assistance in mobility and are fall risks, and this
type of work makes them more vulnerable to injuries.
 What does the customer value?
 Nurses value collaboration, integration of new methods, ideas and disciplines to
improve quality care, communication and making a difference in the community.
 Teaching – assisting patients and their families with receiving the necessary
information to maintain the patient’s optimal health.
 Quality Care – Be empathy and compassionate. Understanding and be sensitive
to patients’ feelings.
 Being able to work and provide care to their patients. And not be restraint from
work due to injuries.
 Income – not be able to earn money or enjoy work when they are in pain.
 What are our results?
 Nurses will have a new behavior approach by using the new skills they learn from
the program to safely lift, transfer and reposition patients without putting their
own health and safety at risk. This will also help with the hospital or nursing
facility reduce injury cost. Nurses will be able to have what they value include the
ability to work and provide care for their patients, as well as enjoying their job
without feeling pain.
 What is our plan?
 In order to achieve this result, we hope to collaborate with colleagues,
Kinesiology & Nursing departments at CSUSM, professionals and communities
to create this program. We will conduct a needs assessment and have
Kinesiology/Nursing students utilizing their skills and knowledge they have, to
help nurses use the correct body mechanics during work so they can avoid
occupational injuries. The initial plan is to develop the program, then turn it into a
CEU course. Giving nurses corrective exercises to help with any current injuries
they are dealing with.
100 words elevator pitch:

So you know how nurses are workers at highest risk for musculoskeletal disorders.
These injuries can cause personal consequences, and they may not be able to practice
after sustaining a serious injury. We will create a prevention program available to help
reduce the risk of developing MSDs. Kinesiology/Nursing students will help nurses use
the proper body mechanics while working to avoid occupational injuries through the
skills and knowledge they’ve learned. They will demonstrate corrective exercises to
assist nurses with any injuries they are experiencing. As a result, this will minimize the
physical pain they often experience on the job, help them maintain healthy bodies. So
they will able to enjoy and appreciate their abilities to provide care without experience
injury.

What’s another way for health promotion?

 Health policy
 Health education
 Fundraising to raise awareness
 Healthy eating
 Wellness, exercise

NEEDS ASSESSMENT
 SUMMARY
Nursing work is not only rewarding but also physically demanding and stressful. The
work requires heavy lifting, bending, twisting and other postures that leave nurses with
increase risks of musculoskeletal disorders or lower back pain. Nurses often don’t use
the proper body mechanics when assisting patients, and due to a large portion of
patients need mobility assistance, as they are at a risk for falling. This type of work
makes nurses more susceptible to injuries. The injury rate for healthcare workers is
higher than the rate for construction and manufacturing, based on a report from OSHA
in 2011, the highest is 157.7 cases per 10,000 full time employees compared to 147.4
cases in construction and 111.8 cases in manufacturing. In 2010, the average incidence
rate for MSDs increased 10 percent for nurses. Risk factors include emotional stress,
overexertion/repetitive stress, overweight patients, poor techniques and shortage of lift
equipment. The result of MSDs injury cause nurses to be away from work, U.S
registered nurses had 108,000 work related MSDs involves lost work time. Nursing and
residential care facilities suffered 59,390 days away from work injuries in 2011. In
California, reports show the rate of MSDs, which injury has been increasing since 2008
to 2013, from 27,950 cases to 42,840 cases. Therefore, it is necessary to start an
effective program to educate and encourage nurses on using a new behavior approach
in patient handling. To reduce employee injury in nurses and enhance the culture of
safety for nurses and other care providers in the healthcare setting.
 STATEMENT OF PURPOSE:
 Occupational injury is any personal injury, disease or death result from an
occupational accident. In this case, health care workers experience occupational
injuries from assisting patients without using the proper body mechanics. Due to
a large portion of patients are fall risk, and need assistance with mobility. Nurses
often put their own health and safety at risk in order to help a patient (Zhao et al.
2012)
 Occupational injury rate for healthcare workers is higher and doubled the rate for
construction and manufacturing. Based on a report from OSHA, it has been the
highest (157.5 cases per 10,000 full time employees) compared to construction
(147.4 cases) and manufacturing (111.8 cases) in 2011. This is an important
issue because the injury rates for nurses and aides can lead to workers missing
work, and the cost of injury can increase, which results in 10,983 registered
nurses suffer lost time work, and 12% of nurses’ report leaving the profession
because of back pain (United States Department of Labor, 2011)
 Therefore, in order to reduce the rate of occupational injury in healthcare
workers, a prevention program is necessary to educate and encourage nurses on
using a new behavior approach in patient handling. In turn, nurses will be able to
appreciate their abilities to work and provide care while experiencing less risk of
injury.
 Audience:
 Nurses
 Influential Risk Factors:
 Behavioral
 Overexertion/repetitive stress – According to OSHA, healthcare workers
are more than 7 times as likely to develop musculoskeletal disorders (MSDs)
compared to other works (Ahmed et al. 2015)
 Patient handling activities – manual lifting of patients when transferring
them to a different position or repositioning (Leigh et al., 2014)
 Emotional stress – not getting enough rest, overwhelmed by workload. Shift
schedules that involve night duties also disturb circadian rhythm and put
different workload demands and reduce adequate communication and
participation in preventive activities than the other work schedules (Camerino
et al. 2010)
 Poor techniques – Nurses often conduct patient handling by bending their
waist and maintaining an uncomfortable posture towards the opposite side of
the bed or chair, increasing the risk of back pain. The most commonly
reported biomechanical risk factors for MSD include excessive repetition,
awkward postures, and heavy lifting (Raithatha & Mishra, 2016)
 Musculoskeletal disorder (MSD) – a wide range of inflammatory and
degenerative conditions affecting the muscles, tendons, ligaments, joints,
peripheral nerves, and supporting blood vessels. It is the most common injury
among healthcare workers and can affect patient outcomes. The nursing
population, that constitutes about 33% of the hospital workforce accounts for
60% of these MSD (Raithatha & Mishra, 2016)
  From the year 1992 – 2010, MSDs accounted for 29-35% of all
occupational injuries and illnesses involving days away from work in the
United States (Bhattacharya, 2014)
 Environmental
 Violence – aggressive patients.
 Shortage of lifting equipment/staffs
 Hospital room layout can possibly make it hard to lift/reposition patients.
 Some examples of areas of a facility that may be identified as high-risk
include: bathing rooms, extended care wings, and diagnostic units (e.g.,
radiology, emergency department, spinal unit, orthopedics department).
 Demographic (socioeconomic, psychosocial, age)
 Lifting and repositioning patients
 Overweight patients
 Patients who are dependent and need mobility assistance.
 Hospital has a “zero lift policy” but nurses will try to do it themselves (cultural
attitude)
 The different types of injuries include


 
 Sprains and strains – sprains and strains are the most frequent reported injury
among healthcare workers, they mostly affect the shoulders and lower back
(OSHA, 2013)
 Because of the physical nature of many hospital jobs, private industry hospital
employees face a higher incidence of injury and illness—6.0 cases per 100 full-
time workers—than employees working in other industries traditionally
considered dangerous, such as manufacturing and construction.
 Back injuries were the most common days away injuries, while sharp injuries
from needles were the most common no days away injuries (Facts About
Hospital Worker Safety, OSHA, 2013)
 Reports stated that frequent reposition of patients and assisting patients while
walking were risk factors for back injuries (Leigh, et al. 2014)

 Economic Impact
 The “days away from work” data show that hospitals suffer a particularly large
number of musculoskeletal disorders (MSDs), largely categorized as sprains and
strains. The most common cause of injury is “overexertion or bodily reaction.”
(Bureau of Labor Statistics, 2016)
 For private industry and local government hospitals, which are mainly medical
and surgical hospitals, the most common event leading to injuries in 2015 was
overexertion and bodily reaction, which includes injuries from lifting or moving
patients (Dressner, 2017)
 This event accounted for 45% of cases (24,040) in private hospitals and 44% of
cases (3,090) in local government hospitals. The second most common event
leading to workplace injuries and illnesses in private industry and local
government hospitals was falls, slips, and trips. This event represented 25% of
cases (13,230) in private hospitals and 24% of cases (1,690) in local government
hospitals (Dressner, 2017)
 National
 In 2008, 64,300 occupational MSD cases were reported nationally in the health
care industry resulting in at least one day lost from work (Stichler, Feiler &
Chase, 2012)
 The data reveals that nursing and residential care facilities suffered a reported
59,390 days away from work injuries in 2011 (Harris, 2013)
 In 2001, U.S. registered nurses (RNs) had 108,000 work-related MSDs involving
lost work time, a rate similar to construction workers (Harris, 2013)
 In 2010, the average incidence rate for musculoskeletal disorder (MSD) cases
with days away from work increased 4 percent, while the MSD incidence rate for
nursing aides, orderlies, and attendants increased 10 percent (United States
Department of Labor, 2011)

 State – California
 They use the difference-in-differences approach to see whether state-mandated
minimum nurse to patient ratio California hospital had an effect on occupational
injury rates that were reported (Leigh et al. 2014)
 The most probable difference-in-differences estimate indicated that the California
law was associated with 55.57 fewer occupational injuries and illnesses per
10,000 RNs per year, a value 31.6 % lower than the expected rate without the
law. The most probable reduction for LPNs was 38.2 % (Leigh et al. 2014)
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 Local
 Between January 2008 and June 2010, there were a total of 74 injuries in the
Labor and Delivery Unit at Sharp Mary Birch Hospital for Women and Newborns
in San Diego (Stichler, Feiler & Chase, 2012)
 85% of these injuries happened in the actual labor and delivery room with lumbar
spine injuries most often reported followed by shoulder injuries and wrist/hand
injuries (Stichler, Feiler & Chase, 2012)
 Holding patient’s legs upon the request of physicians is a high risk task with
potential for serious injury to the nurse (Stichler, Feiler & Chase, 2012)

 Population Most Affected

 According to Dr. Harris in 2013, nursing and residential care facilities recorded
injury and illness case rates of up to more than triple the U.S average for all
industries for the fiscal year of 2011, with state facilities being the highest rates.
 Goals of Communication?
 What new skills behaviors or actions are you trying to elicit the audience?
 Behavior change, using the right techniques when performing lift/reposition.
  Making sure they’re physically ready for their shift.
 How can theses changes be measure?
 Reports and incident tracking systems
 The Results?
 What do we expect to see?
 A new behavior approach in patient handling
 Using the proper techniques and body mechanics
 Avoid over extending the body
 What do we need to find out for a survey?
 Has your sprains/injury ever prevent you from work?
 Would you be interested in this class?
 How long would you want the class to be?
 What kind of content/skills/techniques you would like to see during this class?
 Have your injuries been seen by a doctor?
 Nancy:
 neck, shoulder blades and lower back aches occasionally
 prevented her from bending down too low, she couldn’t bend down to pick
up her pen one time.
 Yeah she went to see a chiropractor, and it was only one time. They just
gave her massage, but it did not go away
 Yes, she would be interested in this class. But prefer to have the class be
at the hospital for convenience.
 She said 2 hours probably.
 She hopes to see more exercises that can help her ease the pain a little,
and other exercises to prevent future injuries, or possible she can
demonstrate to the educators how she normally repositions patients and
get feedback on her techniques.
 Jen:
 Lower back pain, and arms
 The pain in her arms prevent her from giving out too much strength
sometimes, so she needed assistance when repositioning a patient who
was only “1 assist”.
 No she has not gone to see a doctor, but uses the rolly massage at home
to help with the tension in her arms
 Yes, she would be interested in the class, but prefer for it to be at the
hospital or near by.
 2 hours’ max
 hopes to learn exercises to help with the pain on her own.
 Jiji:
 Would be interested in the program, but not sure if she has time because
she has a toddler to take care of and is currently part time
 See more exercises that can help with her lower back pain, this pain only
happens occasionally
 An hour or 2

 Adrienne:
 Do experience some aches her arms but she doesn’t know if that’s from
patient care or not.
 Would be interested in the program if it’s at the hospital
 Would like to see more of the correct body mechanics for patient handling.
 Reference
- Raithatha, A. S., & Mishra, D. G. (2016). Musculoskeletal Disorders and
Perceived Work Demands among Female Nurses at a Tertiary Care Hospital in
India. International Journal of Chronic Diseases, 2016, 5038381.
http://doi.org/10.1155/2016/5038381
- Leigh, J.P., Markis, C.A., Iosif, AM. et al. Int Arch Occup Environ Health
(2015) 88: 477. https://doi-org.ezproxy.csusm.edu/10.1007/s00420-014-0977-
y
- Boden, L., Sembajwe, G., Tveito, T., Hashimoto, D., Hopcia, K., Kenwood, C., . .
. Sorensen, G. (2012). Occupational injuries among nurses and aides in a
hospital setting. American Journal of Industrial Medicine, 55(2), 117-126.
- Bhattacharya, A. (2014). Costs of occupational musculoskeletal disorders (MSDs)
in the United States. International Journal of Industrial Ergonomics, 44(3), 448-454.
doi:10.1016/j.ergon.2014.01.008
- Trinkoff, A. M., Lipscomb, J. A., Geiger-Brown, J., & Brady, B. (2002).
Musculoskeletal problems of the neck, shoulder, and back and functional
consequences in nurses. American Journal of Industrial Medicine,41(3), 170-178.
doi:10.1002/ajim.10048
- Boden, L. I., Sembajwe, G., Tveito, T. H., Hashimoto, D., Hopcia, K., Kenwood,
C., . . . Sorensen, G. (2011). Occupational injuries among nurses and aides in a
hospital setting. American Journal of Industrial Medicine, 55(2), 117-126.
doi:10.1002/ajim.21018
- Bernal, D., Campos-Serna, J., Tobias, A., Vargas-Prada, S., Benavides, F. G., &
Serra, C. (2015). Work-related psychosocial risk factors and musculoskeletal
disorders in hospital nurses and nursing aides: A systematic review and meta-
analysis. International Journal of Nursing Studies, 52(2), 635-648.
doi:10.1016/j.ijnurstu.2014.11.003
- Rahman, H. A., Abdul-Mumin, K., & Naing, L. (2017). Psychosocial factors,
musculoskeletal disorders and work-related fatigue amongst nurses in Brunei:
structural equation model approach. International Emergency Nursing, 34, 17-22.
doi:10.1016/j.ienj.2017.04.001
- Zhao, I., Bogossian, F., & Turner, C. (2012). The Effects of Shift Work and
Interaction Between Shift Work and Overweight/Obesity on Low Back Pain in
Nurses. Journal of Occupational and Environmental Medicine, 54(7), 820-825.
doi:10.1097/jom.0b013e3182572e6a
- UNITED STATES DEPARTMENT OF LABOR. (n.d.). Retrieved November 06,
2017, from
https://www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html
- Camerino, D., Sandri, M., Sartori, S., Conway, P. M., Campanini, P., & Costa, G.
(2010). Shiftwork, Work-Family Conflict Among Italian Nurses, And Prevention
Efficacy. Chronobiology International, 27(5), 1105-1123.
doi:10.3109/07420528.2010.490072
- Occupational Traumatic Injuries Among Workers in Health Care Facilities —
United States, 2012–2014. (2015, April 24). Retrieved November 06, 2017, from
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6415a2.htm
- Occupational Safety and Health Administration. (2013). Facts about Hospital
 Worker Safety [Brochure]. Author.
- Michelle Dressner, "Hospital workers: an assessment of occupational injuries and
illnesses," Monthly Labor Review, U.S. Bureau of Labor Statistics, June
2017, https://doi.org/10.21916/mlr.2017.17.
- Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work,
2015. (2016, November 10). Retrieved November 06, 2017, from
https://www.bls.gov/news.release/osh2.nr0.htm
- Understanding Risks of Workplace Injury in Labor and Delivery
Stichler, Jaynelle F. et al. Journal of Obstetric, Gynecologic & Neonatal Nursing ,
Volume 41 , Issue 1 , 71 - 81