Posture Coaching and Feedback during Patient Handling in a Student Nurse Population

Abstract

OCCUPATIONAL APPLICATIONS Physically demanding nurse activities, such as patient handling, are leading contributors to an occupation with a historically high prevalence of musculoskeletal injury. Numerous strategies have been investigated to reduce injury rates associated with patient handling activities, including mechanical lifts and ergonomic educational programs. Despite such interventions, injury rates remain high in the profession. We implemented a posture coaching and verbal feedback intervention to evaluate patient handling activities in a student nurse population. Our aim was to provide a feedback intervention that could be implemented in student curriculum to educate student trainees. Results indicate that feedback during patient handling tasks can have an effect on lifting behaviors. The feedback intervention session led to changes in spine postures and more efficient movement strategies. This work, if implemented correctly, could translate to improved patient handling activities. Future work, however, is needed to evaluate both the long-term retention of the training and impact on actual injury rates.

TECHNICAL ABSTRACT Background: Nurses who routinely perform patient handling and transfer activities are at a high risk for the development of musculoskeletal injury. Despite biomechanical quantification of spine loads, ergonomic education programs, and other intervention strategies, injury rates remain high for the profession, in particular to the low back. Purpose: The purpose of this work was to evaluate a combined feedback and posture coaching session to improve patient handling techniques (trunk kinematics) in a student nurse population. Methods: Ten student nurses performed three patient-handling tasks: 1) Placing a sling under the patient; 2) transferring a patient from bed-to-chair; and 3) repositioning a patient in bed. Trunk kinematics were measured throughout all tasks. Participants performed a pre-feedback session (four repetitions of each task), followed by a feedback (eight repetitions of each task) session and a final post-feedback session (four repetitions of each task). Feedback included verbal instructions on safe lifting techniques and real-time auditory feedback based on the participant's trunk flexion (using a set threshold of 45º). Results: The largest changes due to the feedback intervention were observed during the bed-to-chair task. There was a significant decrease in the mean time to complete the bed-to-chair task (∼6 sec.) following feedback, along with a mean reduction of ∼7.5º in peak trunk flexion. Peak trunk flexion and rotation, along with triaxial trunk rotational velocity and acceleration, were all reduced for the bed-to-chair task following feedback. Conclusions: Despite the use of a relatively minimalist feedback training protocol (i.e., eight repetitions of a movement), kinematic changes in patient handling tasks were demonstrated. A combination of auditory feedback and coaching appears to be a promising method to lead to beneficial changes in spine postures (closer to neutral) and more efficient movement strategies. The largest changes in trunk kinematics were found for the most complex task (bed-to-chair), and these changes could help reduce cumulative loading and injury risk during patient transfers.

KEYWORDS:

• Nursing
• Patient handling
• Posture
• Kinematics
• Occupational Biomechanics
• Feedback

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ACKNOWLEDGMENTS

Thanks to Dr. Tilak Dutta and the Toronto Rehabilitation Institute team at the University of Toronto for the PostureCoach Collaboration and thanks to all nursing student volunteers.

Additional information

Funding

This research was supported by a Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) seed grant and the Natural Science and Engineering Research Council of Canada (NSERC) Discovery Grants program.