DESIGNING STANDARDS IN NURSING CARE BY CONSIDERING ERGONOMIC PRINCIPLES FOR REDUCING BIOMECHANICAL PRESSURES ON THE SPINE

Zdravstvena nega je fizično naporna dejavnost in negovalno osebje ima več mišično-skeletnih obolenj kot številne druge poklicne skupine. Ravnanje s pacienti in pridružene aktivnosti se danes ocenjujejo kot primarni faktor vpliva na pojav bolečine v hrbtenici pri negovalnem osebju. Namen raziskave v doktorski disertaciji je bil, da v bolnišničnem okolju med zaposlenimi v negovalnem timu celovito analiziramo pogoje dela in njihov vpliv na bolniško odsotnost zaradi zdravstvenih težav s hrbtenico. Preučevali smo, kateri dejavniki vplivajo na obolevnost hrbtenice pri zaposlenih in koliko lahko ergonomsko tehnični pripomočki zmanjšajo nevarne telesne položaje pri delu in olajšajo premagovanje bremen. Na podlagi rezultatov analize smo oblikovali tri procesne standarde negovalnih intervencij v zdravstveni negi z uporabo ergonomsko tehničnih pripomočkov. K preučevanju problema in pridobivanju podatkov o bolečinah ledvenega in vratnega dela hrbtenice pri delu negovalnega osebja, smo v prvih dveh fazah raziskave pristopili na podlagi kvantitativne analize. Podatke smo zbirali s pomočjo dveh strukturiranih vprašalnikov. Tretja faza raziskave je predstavljala vizualno spremljanje negovalnega osebja pri rednem delu s pomočjo metode OWAS. V četrti fazi raziskave smo se osredotočili na bistvene ergonomske pomanjkljivosti pri izvajanju zdravstvene nege pacienta in oblikovali tri procesne standarde negovalnih intervencij v zdravstveni negi z uporabo ergonomsko tehničnih pripomočkov, ki se ne uporabljajo pogosto oz. se sploh ne uporabljajo. Rezultati raziskave so pokazali, da so delovna doba 19 let in več, večkratno dnevno dvigovanje bremena nad 10 kg mase in neizvajanje preventivnih vaj za krepitev hrbtenice, statistično pomembni pokazatelji težav s hrbtenico. Z metodo OWAS smo pri 15 kritičnih telesnih legah, z uporabo ergonomsko tehničnih pripomočkov, zabeležili skupno znižanje v višini 12.9 odstotnih točk, iz 20.6 na 7.7 odstotka. Naslednja pomembna ugotovitev je bila, da so zaposleni na oddelkih v bolnišnici, kjer se pogosteje uporabljajo ergonomsko tehnični pripomočki, poročali statistično pomembno manj težav s hrbtenico. V raziskavi smo pokazali, da uporaba ergonomsko tehničnih pripomočkov bistveno zmanjša kritične telesne lege in biomehanične obremenitve hrbtenice negovalnega osebja v zdravstveni negi. Ugotovili smo, da se ergonomsko tehnični pripomočki, če so na razpolago, tudi uporabljajo. Percepcija, da se osebje v negovalnem timu pripomočkov pri delu izogiba ne drži in ne more veljati kot izgovor, da organizacija ergonomskega programa ne izpelje. Če merimo učinek izvedbe ergonomskega programa le s finančnega stališča, potem morajo biti naša pričakovanja usmerjena dolgoročno.Nursing care provision encompasses physically strenuous activities which is why musculoskeletal disorders are more common in nursing staff then in most other occupational groups. Patient handling and associated activities are now considered as a major risk factor for back pain among nursing staff. The purpose of this doctoral thesis was to analyse hospital work environment and its impact on absence from work due to back pain. It included an analysis which factors contribute to back pain and of the extent ergonomic assistive devices reduce awkward working body postures at work and help to overcome physical burden. According to research results we have designed three standards for nursing interventions which make use of ergonomic assistive devices. The study was conducted in four phases. In the first and second phase, structured questionnaires were used to collect data on low back and neck pain and on the availability of ergonomic assistive devices in hospital departments. The third phase, involved visual observation body posture during work by using OWAS method. In phase four, we evaluated physical barriers in hospital which impede nursing care provision, and developed three standards for nursing interventions by using ergonomic assistive devices which have been in use rarely or not at all. Results have shown that 19 years of work and more, frequent manual lifting above 10 kg of weight and avoidance of preventive exercises to strengthen back represent significant factors for back pain. According to observations (by OWAS method) of 15 awkward body postures, use of ergonomic assistive devices contributed to overall average decrease by 12.9 percentage points, from 20.6 to 7.7 %. It was also found that nursing staff in hospital departments with more frequent use of ergonomic assistive devices reported significantly less back problems. Our research indicated that use of ergonomic assistive devices significantly reduces awkward working body postures and biomechanical strain on nurses’ spine in nursing care provision. We also found that ergonomic assistive devices, if available, are frequently used. A common assumption that nurses avoid use of ergonomic assistive devices was not confirmed and may only serve as a shallow argument to postpone the realisation of ergonomic program. If efficiency of an ergonomic program realisation is measured from a financial perspective only, then our expectations must be set for long-term