title: The influence of ergonomic devices on mechanical load during patient handling activities in nursing homes.
abstract: OBJECTIVE
  Mechanical load during patient handling activities is an important risk factor for low back pain among nursing personnel. The aims of this study were to describe required and actual use of ergonomic devices during patient handling activities and to assess the influence of these ergonomic devices on mechanical load during patient handling activities.
  
  
  METHODS
  For each patient, based on national guidelines, it was recorded which specific ergonomic devices were required during distinct patient handling activities, defined by transferring a patient, providing personal care, repositioning patients in the bed, and putting on and taking off anti-embolism stockings. During real-time observations over ~60 h among 186 nurses on 735 separate patient handling activities in 17 nursing homes, it was established whether ergonomic devices were actually used. Mechanical load was assessed through observations of frequency and duration of a flexed or rotated trunk >30° and frequency of pushing, pulling, lifting or carrying requiring forces <100 N, between 100 and 230 N, and >230 N from start to end of each separate patient handling activity. The number of patients and nurses per ward and the ratio of nurses per patient were used as ward characteristics with potential influence on mechanical load. A mixed-effect model for repeated measurements was used to determine the influence of ergonomic devices and ward characteristics on mechanical load.
  
  
  RESULTS
  Use of ergonomic devices was required according to national guidelines in 520 of 735 (71%) separate patient handling activities, and actual use was observed in 357 of 520 (69%) patient handling activities. A favourable ratio of nurses per patient was associated with a decreased duration of time spent in awkward back postures during handling anti-embolism stocking (43%), patient transfers (33%), and personal care of patients (24%) and also frequency of manually lifting patients (33%). Use of lifting devices was associated with a lower frequency of forces exerted (64%), adjustable bed and shower chairs with a shorter duration of awkward back postures (38%), and an anti-embolism stockings slide with a lower frequency of forces exerted (95%).
  
  
  CONCLUSIONS
  In wards in nursing homes with a higher number of staff less awkward back postures as well as forceful lifting were observed during patient handling activities. The use of ergonomic devices was high and associated with less forceful movements and awkward back postures. Both aspects will most likely contribute to the prevention of low back pain among nurses.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, 2040 CA Rotterdam, The Netherlands.
authors.forename: Elin
authors.initials: E
authors.lastname: Koppelaar
authors.forename: Hanneke J J
authors.initials: HJ
authors.lastname: Knibbe
authors.forename: Harald S
authors.initials: HS
authors.lastname: Miedema
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D004389:Durable Medical Equipment / Q000706:statistics & numerical data*; D006804:Ergonomics; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D055805:Moving and Lifting Patients / Q000295:instrumentation* / Q000451:nursing; D020380:Needs Assessment; D009732:Nursing Care / Q000379:methods*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016273:Occupational Exposure; D013314:Stress, Mechanical; D013647:Task Performance and Analysis; D016474:Weight-Bearing / Q000502:physiology; D014937:Work / Q000502:physiology; D055815:Young Adult