|Hardianto Iridiastadi||Industrial Engineering, Faculty of Industrial Technology, Institut Teknologi Bandung (ITB), Indonesia, Ganesa 10, Bandung 40132, Indonesia|
|Theodora Vani||Industrial Engineering, Faculty of Industrial Technology, Institut Teknologi Bandung (ITB), Indonesia, Ganesa 10, Bandung 40132, Indonesia|
|Putra Alif Ramdhani Yamin||Industrial Engineering, Faculty of Industrial Technology, Institut Teknologi Bandung (ITB), Indonesia, Ganesa 10, Bandung 40132, Indonesia|
Nursing jobs have generally been associated with poor posture and heavy exertion, particularly during patient-handling activities. Such working conditions are known to increase the risk of musculoskeletal disorders, and the use of patient-handling aids has been proposed to alleviate the problem. This study was conducted with the purpose of evaluating a patient-handling technology (PHT) prototype that was developed by the researchers for use in Indonesia. An experiment was conducted involving 12 nurse participants, who were asked to move a patient, either manually or by using the prototype. Postural analyses were performed using 3DSSPP software, Rapid Upper Limb Assessment (RULA), and Rapid Entire Body Assessment (REBA). A Borg scale was employed to determine the participants’ perceptions of the levels of exertion required during the experiment. The findings demonstrated that using the PHT prototype resulted in a substantial reduction in the compression force at the lumbar (L5/S1) joint. However, there was a marginal increase in shear force at this joint due to the push/pull activities involved in using the technology while handling the patient. This increase, however, was still within accepted biomechanical limits. Postural analyses based on the RULA and REBA demonstrated a great reduction in ergonomic risks when using the prototype. The nurses also reported reduced physical workload when using the PHT technology. Across all measures, there were reductions in the biomechanical risks of between 30% and nearly 70%. While the PHT prototype still needs design refinements, its use in medical settings has the potential to ameliorate musculoskeletal problems among nurses and caregivers.
Caregivers; Musculoskeletal disorders; Patient handling; Patient-handling technology prototype;
The patient-handling activities performed by hospital nurses are often associated with increased risk of musculoskeletal disorders or MSDs (Waters et al., 2007; Nelson et al., 2007; Iridiastadi et al., 2019). These are a group of disorders affecting the muscles, joints, tendons, ligaments, nerves, and bones, which are caused by strenuous physical activity in combination with poor posture (Batubara and Dharmastiti, 2017; Ribeiro et al., 2017). According to the US Bureau of Labor Statistics (2008), caregivers are subject to a relatively high rate of non-fatal occupational injuries. Caregivers include nurses, health workers, and nursing assistants. Nursing has been identified as a profession carrying a high risk of lower back or spinal injury. Every year, 10,000 nurses in the United States suffer MSDs and roughly 30–65% of these injuries are caused by manual patient-handling activities. These activities include positioning a patient manually, moving a patient between a bed and a chair, helping a patient to move around, and helping a patient to rise from a sitting position (Hodder et al., 2010).
One of the methods for reducing the risk of MSDs is to use lifting or moving aids (Nelson et al., 2006). In the United States, for instance, many medical settings have introduced patient-handling technology to reduce the risk of musculoskeletal injury. Hospitals employ floor lifts and ceiling lifts with patients. The floor lift is a portable tool that can be maneuvered on the floor so that, when handling a patient, the nurse only needs to push and control the device. The ceiling lift is usually installed on the ceiling of the room, and the nurse can move the patient by using a controller or a remote control.
Although these ideas are not new in many industrialized countries, the concept and availability of patient-handling aids is generally lacking in many developing nations. In Indonesia, such apparatus is generally only available in the larger hospitals, or it is available for rent at a high price. In recent years, the researchers have developed a patient-handling technology (PHT) prototype in the expectation that this will prove to be low-cost technology that will help reduce the risk of MSDs in Indonesian nurses and caregivers. This prototype can be used to help maneuver a patient from a bed to a wheelchair and vice versa. Two types of lifting mat are available—for the sitting and supine positions. The tool is activated through a pneumatic system; and the nurse or caregiver controls the height and position of the tool through a remote control. The PHT prototype is also equipped with wheels and a braking pedal.
Despite its potential benefits, the prototype had not yet been evaluated from the biomechanical perspective. Its effectiveness had not been proven, and it was not clear if nurses would accept the technology in the hospital setting. The major research question was whether the technology would result in lower biomechanical loads and thus, potentially, reduce the risk of MSDs. Even if it did result in lower loads, there was also a need to determine whether the loads were indeed below the acceptable ergonomic limit. If the technology was accepted by the users, and shown to perform as intended, the prototype could be manufactured and made widely available in a large number of hospitals in Indonesia.
This study was conducted based on the premise that nurses and caregivers suffer musculoskeletal problems as a result of their manual patient-handling activities. A mechanical aid (i.e., the PHT) had been designed and manufactured previously by the researchers, but it had not yet been evaluated from the biomechanical perspective. This study demonstrated that the use of this technology was ergonomically better than manual handling. The PHT greatly reduced the spinal load (at the L5/S1 joint), improved work postures, and minimized the amount of physical effort during patient handling tasks. Further research is needed to refine the design. It is expected that this technology will help reduce musculoskeletal problems among hospital nurses and caregivers in general, and in particular, among those with regular duties in handling patients.
This research was made possible by a grant provided by the Indonesian Ministry of Research, Technology, and Higher Education (Grant#: 255/SP2H/LT/DRPM/II/2016).
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