Browsing by Author "Engkvist, I-L"

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Accidents leading to over-exertion back injuries among nursing personnel
(Arbetslivsinstitutet, 1999) Engkvist, I-L
The overall aim of the present thesis was to contribute to the knowledge of occupational accidents leading to over-exertion back injuries among nursing personnel, which can be used for developing effective preventive strategies. Different combinations of factors and events were assumed to determine the type of accident process leading to an over-exertion injury. The first study used the Swedish Occupational Injury Register (ISA) to investigate the occurrence of reported accidents leading to back injuries among female assistant nurses in the working population during a two years period. In Study II standardised instruments for the systematic investigation of accidents were developed with the aim to collect the information necessary for effective accident prevention. The third study investigated factors involved in the accident process leading to back injury by using these instruments. Study IV identified and quantified work-related and non-work-related risk indicators for reported back injuries. Study V identified different patterns of risk indicators in the nurses work situation and factors modifying the risk for back injuries in these situations. The source population was all nurses employed in the Stockholm County hospitals (totally 24,500 persons) and the observed periods were 12 months (Study III) and 36 months (Study IV-V), respectively. Assistant nurses had a high relative risk of accidents leading to over-exertion back injuries compared to other Swedish women, and also compared to registered general nurses. Most accidents occurred during patient transfer. Several factors contributing to the accident process were identified by the instruments. One important factor was deficiencies in the work environment, e.g. lack of space or lack of transfer devices, which entailed the nurse to perform patient transfers in a non-optimal way. Six types of accidents were defined by their pattern of factors contributing to the risk associated with the accident process. The strongest risk indicators for reporting a back injury were working in an orthopaedic ward, performing regular patient transfers and working full-time. The relative risk of patient transfer was lower among nurses who had received training in how to use the devices on their own ward, and who frequently used transfer devices. Further, six homogeneous groups of work conditions and their modifiers were identified, two of which were associated with an increased risk. These groups consisted of a high proportion of assistant nurses working full-time, on a rolling schedule and regularly performing patient transfers. A large proportion of the groups had had a prior injury. The three low-risk clusters were primarily characterised by part-time work. According to the results in this thesis, the most important measures for prevention of accidents leading to over-exertion back injuries are related to the work organisation and measures directed towards the environment.
Events and Factors Involved in Accidents Leading to Over-exertion Back Injuries among Nursing Personnel
(Arbetslivsinstitutet, 1997) Engkvist, I-L
The overall aim of the present thesis was to identify factors and events involved in over-exertion accidents leading to back injuries among nursing personnel. The hypothesis was that patterns of different combinations of factors and events involved determine the type of accident process leading to an over-exertion injury. The aim of the first study (Study I) was to investigate the occurrence of reported over-exertion accidents leading to back injuries among female nurses' aides in the working population of Sweden during a two year period. The study was based on the Swedish Occupational Injury Register (ISA). The criterion for inclusion was that the injured person had reported an injury due to over-exertion of the back connected to a certain time and place. The subject's age, number of years in present occupation, experience of present work, area where the accident occurred, main event, time, and days of sick leave were studied. The nurses' aides had a relative risk of 6.0 for occupational back accidents compared to other employed Swedish women. The major risk factor was lifting, which led to 84% of the accidents. The mean duration of sick leave was 59 days for the whole group. The length of the sick leave increased with age. To find preventive strategies, a new method for accident process investigation, was developed in co-operation between practitioners and researchers (Study II). Standardised instruments for the systematic investigation were developed, consisting of two structured interview protocols, one for the injured person and one for the supervisor. Also an ergonomic checklist was designed for the three areas where the preceding study showed most of the accidents occurred; patient's room, corridor, toilet and further one for "other space", e g. X-ray department, treatment room. The instruments were developed through frequent discussions and adjustments in a task force of 24 researchers and occupational health personnel. Inter-observer reliability was 90% or more in 19 of 26 items in the checklist. Inter-method reliability also showed the same agreement for all items in the checklist (90% or more). The purpose of the third study (Study III) was to investigate factors involved in the accident process leading to back injury by using the interview protocols and the ergonomic checklist. The prospective, open cohort study included state registered nurses, auxiliary nurses and general registered nurses and covered all reported occupational over-exertion back accidents among nurses in the Stockholm County hospitals during one year and was. Detailed information on the accident process was obtained in interviews. The same inclusion criteria as for Study I were used in Study III, except that the case was included whether the injury led to a sick leave or not. During the study period 130 accident processes were investigated. Sixty per cent of the injuries were reported by state registered nurses, 20% by registered nurses and 20% by auxiliary nurses. In 73 %, the injured persons had more than three years' experience of the specific working tasks they were doing when the accidents occurred. In 59 % the accident occurred in the patient's room, 12 % in the toilet and 11 % in the corridor. Cluster analysis identified six clusters and their pattern of contributing factors for the accident process. Most over-exertion back accidents occurred during patient transfer in the bed or to/from the bed. During the transfers, which most often were performed without using transfer devices, the nurse had to make a sudden intervention, e.g. to prevent the patient from falling after suddenly losing balance or resistance during transfer. However, there were physical conditions, such as shortcomings rendered in the working environment or lack of transfer devices that entailed performance in an unsafe way. The differences in the clusters showed the complexity of these kinds of accident and that the measures for prevention, or for blocking an accident process once started, have to be of different kinds and at several different levels in the organisation. One example is improved working environment with more space, especially around beds and in toilet. Another example is more and easy-to-use transfer devices, more training in transfer techniques and clear instructions to the nurses. Further to avoid under staffing and time pressure on the ward. Increased safety awareness, both from the employers and among the employees is vital.