Exploring the Influence of Clinical and Classroom Training on Advocacy for Safe Patient Handling Practices Among Student Physical Therapists

Abstract

BACKGROUND AND PURPOSEOver the last 20 years in the USA, concerns regarding safe patient handling (SPH) have received increased attention among health professionals performing patient handling tasks.1,2 Olkowski and Stolfi3 recently surveyed 192 acute care physical therapists (PTs) and found that 91.1% of those who responded to the survey are trained to use SPH equipment and practices and have positive perceptions regarding SPH. SPH can be defined as the judicious use of assistive technology (eg, electro-mechanical equipment and lift-assist devices), ergonomic principles, and other resources (eg, lift teams) to maximize patient and caregiver safety for patient handling tasks such as lifts, transfers, and repositioning.1 In contrast, traditional nontherapeutic patient handling tasks for lifts and transfers have been performed manually by health care providers with a foremost emphasis on use of sound body mechanics. A recent systematic review of occupational musculoskeletal injuries in the health care environment found that patient handling was the most common occupational factor in the cause of work-related injuries among PTs and nursing practitioners. Lifting and transfer of patients was the largest reported occupational cause of practitioner injuries.4 Campo and colleagues5 found a 1-year incidence rate of work-related musculoskeletal disorders (WMSDs) of 20.7% among PTs in the US and noted that many of these injuries were due to patient handling tasks. Darragh and colleagues6 surveyed 1,158 occupational therapists (OTs) and PTs in Wisconsin and found that patient transfers and lifts were associated with 58% of all injuries reported.Using a phenomenological approach to explore the meaning of work-related pain in PTs and OTs, Campo and Darragh7 noted that all therapists were concerned about their potential clinical longevity due to work-related pain. Such injuries may also occur during physical therapist education, as Nyland and Grimmer8 found that physiotherapy students' risk of low back pain increased progressively with the year of study. WMSDs have serious consequences to clinicians, employers, and the health care system as a whole. As many as 1 in 6 PTs have reportedly changed professions as a result of a WMSD injury.9 In addition, employers and insurance companies are left to deal with significant direct and indirect costs due to work-related injuries that totaled $194 billion in 2007.'° Worker's compensation covers less than 25% of these costs, leaving the burden shared through all members of society and contributing significantly to the cost of health care.10Use of assistive technology and biomechanically sound lifting and transfer techniques, principles of SPH practice, have been shown to reduce both the rate of injury and the economic burden associated with lifting injuries.11'14 Although SPH techniques are often taught in health professions classrooms, a discrepancy between education and clinical practice appears to persist.15'18 Students found clinical settings were not frequently supportive of SPH techniques.16'21 For example, Green19 asked nursing students to reflect on their performance of SPH practices throughout their clinical experiences and found that allowing students to develop a heightened sense of awareness through reflection on action enabled them to establish personal attitudes and the subsequent assertiveness to utilize SPH techniques. This type of reinforcement early in the education process is vital to protect students, as evidence shows that WMSDs are most frequent and significant within a PTs initial 4-5 years of work.22'24Perhaps a dynamic, multi-disciplinary approach to promoting a safer work environment for health care workers could be most effective in changing SPH attitudes. Geiger25 examined the combined efforts of Israeli ergonomists and direct health care providers with regard to a safe patient handling and movement program spearheaded by physical therapists. Short-term outcomes included improved hospital-wide awareness of ergonomics, patient safety equipment, and a need for additional safety equipment. …