Everett Chiropractic Center Blog

April 6, 2013

Protecting Nurses as a Valuable Resource – A DVD Review

Proper Wheelchair Techique - Pushing is Engineered Out!

Proper Wheelchair Techique – Pushing is Engineered Out!

In a recent Post on the Disability Industrial Complex I mentioned the State’s financial incentives for doing something about health care costs, in particular job-related injury disability. Here I review a DVD for nurses that reflects one part of that attempt.

What’s in Bold is either quotes from the DVD or my notes while watching it. Between the bold statements I will just make a comment or two, in the interest of brevity (a challenge for me in general).

Dr. Denise Smart, DPH, BSN – (WSU) has had several job-related injuries with recoveries that included medications, physical therapy “and even” surgery.

She introduces the film and does a good job of setting the tone. She is clearly qualified. Note that she doesn’t claim it to be “instructional” – it isn’t.

An “Educational offering” funded by Washington State Labor & Industries Safety and Health Investment Projects (SHIP) Grant # 2009XC00119

I was curious how much money was involved so I searched the net. Here is what I found: (This represents one little tiny piece of a big pie!)

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Washington State University College of Nursing, in collaboration with Washington State Nurses Association

Project Summary
Educate nurses and student nurses about common hazards and how to address them during patient handling. Will focus on on-line continuing education, a palm card to be used as a reference tool, an awareness video, and guidelines for a safe patient handling environment.
Amount Awarded: $73,561

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This film is for all health care providers who have direct patient care contact, and claims to demonstrate “proper and improper techniques…”

Good luck figuring out which are which. There’s a good example of what they would consider proper engineering out of lifting (see earlier Post on how this is a focus of Labor & Industries). Clearly, it’s categorically a good idea to work smarter rather than harder. Unfortunately, throughout the film and during this example (a “lift team” uses a hoist to pick up a fallen patient) what you actually see is mostly poor body mechanics.

“Injuries are not inevitable and can be prevented…”

It is important that they say this because you could definitely get a different impression from the film. If you’re a nurse watching this you have a right to be in fear.

“…injuries to nurses (and others) are receiving National attention in the form of State Regulations to address “safe patient handling.”

Washington State is one of several that have legislation requiring hospitals to provide “policies or programs to decrease work-related injuries”.

So it might be useful to be reminded that this whole exercise (the DVD production), in theory, is to help reduce work-related injuries. The tone and focus of this video reminded me mostly of the effort in the 90’s to teach “Back Schools” in the hope that if everyone was better informed it would result in less injury and disability. It didn’t work, at all. A focus on the problem rarely does. Focusing on what you don’t want is why we have a health care crisis. But I don’t know who you’re going to get to hear that.

Of hospital nurses surveyed, 75% reported that they perform “risky” moves 50% of the time. Risky moves include: lifting, pushing, pulling, and twisting as well as sustained static holds. These put both nurses and patients at risk (we are assured that “no injuries were incurred while filming this video”, “as a caveat”).

Do you think Labor & Industries will get all that engineered out? If you read the earlier Post you learned that the reason they want to engineer out the need for bending and lifting is because bending and lifting involves people. This seems like an area worth exploring…(the thinking I mean).

According to the video, most back injuries occur when the nurse attempts a task without proper equipment or adequate help.

Arguable.

AWARENESS IS THE FIRST STEP.

I am trying as hard as I can to say positive things about this video. Really. Here they have done a fabulous job. It is the first step in safety to be aware. I have mentioned many times that the reason many injuries occur is that the person involved somehow didn’t realize that they were in a moment of high risk. That thought process preceeds any inclination to do something smart about it: like get the right equipment, ask for some help, or somehow do it differently.

This is a big deal. They did a great job in this video of making nurses aware that they are at very high risk for injury (and you do get the impression that it’s inevitable). I would also argue that the guys driving delivery trucks, working at Les Schwab, or crawling around in the wings of planes all day have it nearly as bad and may be (probably are) just as unaware of the details that make them at risk. The miners, loggers, construction workers and wildland firefighters that I know, on the other hand, certainly are clear that they are in a high risk job. Unfortunately they aren’t any better at bending and lifting, in general.

“… no safe way to manually maneuver a person”… “knowledge and use of proper body mechanics for manipulating inanimate objects “do not apply to the task of lifting and moving people”.

Tell that to the martial arts community… and the NFL.

Ok, even if you put safe in quotes, so what? There is still safer, by a long shot! It is all a matter of odds. Nurses have a very very difficult job. They work the same ridiculous schedules many other people do. And they have a ton of stress.

“Use of body mechanics for patient handing is an insufficient approach for preventing musculoskeletal disorders and injuries.”

So let’s try to engineer it out, skip that, and move on?!

1/10th leave the profession of Nursing because of back pain… 83% of (5000) nurses surveyed in 2001 said they worked with back pain.

Gee, I wonder if there are any health care professionals around that know anything about back pain who might be able to help?

Injuries listed by frequency
Low back pain
Shoulder
Wrist/hand
Lower extremity

In fairness, my profession looses one in twelve to disability also because of high risk physical moves that involve twisting, pushing, pulling, lifting and bending. And not all chiropractors know how to move either.

Lots of terminology and anatomy: biomechanics, ergonomics, sprains, strains.

Google these if you think it will help to know the precise definitions, but it’s like getting a precise diagnosis. Knowing more and more about the problem in health care doesn’t always lead to experiencing a solution:-) And back pain is such a good example of this that it’s almost a cliche`.

“Body mechanics” is a subset of biomechanics, based on the belief that certain positions/movements will provide protection. Body mechanics doesn’t provide protection against ackward, heavy and/or repetitive motions associated with handling patients.

It’s all relative. If they knew, they could teach. Since they don’t, we get this. If you would like to know more about how to measure you or your company employee’s risk of back injury or do something (measurable) about it call (425) 348-5207.

There are also all kinds of other issues like wet floors, poor design considerations (awkwardness factor), and obstructions to deal with.

There are always all kinds of things going on and everyone is doing the best that they can to deal with issues and make the place safer. It starts with awareness. “Common sense”, which is often said to be in such short supply, isn’t common until you have enough training and experience to make it “common.” It’s a classic in my family to point out that others don’t have common sense about simple stuff. Well it isn’t simple stuff if you’ve not been exposed to it or taught about it.

Lots of grim statistics…. focus on what the risks are and what not to do…. Showed a “lifting team” using a hoist (the lift was “engineered out”)

I already mentioned this.

This video promotes the need for a “culture of safety” throughout the career field.

Research has recognized the value of fostering a “safety culture”, therefore, “Safe Patient Handling Committees” are being formed with “teams” of “interdisciplinary members” which may make recommendations, etc.

Guess what “interdisciplinary” usually means? Here is a clue. Here is what’s important: How much good does it really do to know that you have a problem if no real solution is offered.

Not one image of someone bending properly – all were poor examples of how to bend. And there were only two examples of a nurse with a normal Body Mass Index (BMI). Google that if you need to. It’s a factor. It wasn’t addressed.

Sorry. I looked hard for signs that anyone in the video knew how to bend and lift properly (there are three simple things to look for). There was one, actually – so well hidden in the mix that it would be meaningless to the average viewer. We are sometimes like fish in water; we don’t know that we don’t know we don’t know. And don’t think that I am hung up on the terminology: it doesn’t matter what words you use; the mechanics are either there or they aren’t.

It’s an informational video but not an instructional video, and it’s a very good quality production.

I told you I was trying very hard to say positive things. They did a great job filming and producing this video. Like everything else is this Post, it’s my opinion. (With $73,561 you could probably come up with a pretty good 26-minute video too. Don’t miss what actually happened here: your money got shifted from one hand of the Government over to the other hand of the Government.)

If you would like to shift the conversation over to your back: preventing injury, recovering from injury, or rehabilitating an injury, call (425) 348-5207.

Dr Smart said it best, “Your brain is the best tool of all.”

Yep. So be careful who you listen to.

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4 Comments »

  1. […] future if things continue on the path they are on. And, as you’ll see in an upcoming Post on “Protecting Nurses as a Valuable Resource”, a great deal of that money flows back and forth from one arm of the Government to […]

    Pingback by The “Disability Industrial Complex” | Everett Chiropractic Center Blog — December 11, 2013 @ 8:22 pm

  2. […] they are classics, but there are many, many others – especially if you work in construction, nursing, or some other highly physical occupation. Be […]

    Pingback by When Is It Ok To Break The Neutral Spine Rule? | Everett Chiropractic Center Blog — February 5, 2014 @ 2:40 pm

  3. […] But I am starting to rant… Don’t get me started on the State of Washington and their approach to back pain prevention and the relative value of attention to […]

    Pingback by What Do 89% of Primary Care Physicians Think Is The Most Important Short-Term Trigger For Low Back Pain? | Everett Chiropractic Center Blog — October 10, 2014 @ 10:44 am

  4. […] likely to miss work on any given day than someone who doesn’t. (Saying that reminds me of a survey of 5,000 nurses, 83% of whom said that they were working with back pain at the time of the survey. That suggests a […]

    Pingback by Absenteeism: What are the odds? | Everett Chiropractic Center Blog — December 6, 2014 @ 7:45 am


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