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Ergonomics in the Perianesthesia Setting
PRACTICE CORNER
Ergonomics in the Perianesthesia Setting Theresa Clifford, MSN, RN, CPAN, CAPA QUESTION: HOW DO ergonomic principles relate to the perianesthesia environment of care? We will be renovating our Phase I unit and want to be sure that the new space is efficient. Response: The term ergonomics refers to the practice of biotechnology or the process of creating a workspace that reduces employee exposure to the risks of workplace injuries.1 In addition to reduced injuries, good workplace designs can help minimize fatigue and general discomfort from strain and stress on health care worker’s bodies. In 2013, the US Bureau of Labor Statistics reported significantly higher rates of workplace injuries among health care workers.2 Most recently the Bureau of Labor Statistics has indicated that the overall trend has been declining although the impact of workplace injuries remains concerning.3,4 In part, the active application of ergonomics and principles of safer patient handling have increased awareness of methods to minimize injuries.
There are three primary opportunities to apply ergonomic interventions in a workplace.5 The first includes physical ergonomics, which considers the actual design of patient care and nursing work areas not limited to the design of equipment, rooms, and workstations. Physical ergonomics involve understanding the impact of the workplace setting (including chairs, computers, desks, and so forth) on the body. The second is known as cognitive ergonomics which is basically the study of how the mind processes information as translated by a worker’s interaction with cues in the environment. This type of ergonomics includes an understanding of the attitudes toward interventions to reduce workplace injuries as well as education and training provided in the health care environment. Finally, organizational ergonomics are concerned with institutional policies and practices that impact work schedules, workflow, and job descriptions, to name a few. Included in this area are factors related to teamwork, quality improvement, and clinical inquiry.
Ergonomic Principles Workplace Injuries Briefly, the main principles of ergonomics address safety, comfort, ease of use, productivity, performance, and aesthetics. The primary purpose of the application of ergonomics in the workplace is to provide a healthy environment in which to work. Most institutional safety plans aim at preventing injuries and illnesses at the workplace by eliminating or reducing exposure to hazards. Of most concern are muscular skeletal disorders associated with poorly designed equipment, workstations, and lack of employee orientation to proper workflow mechanics, to name a few. Theresa Clifford, MSN, RN, CPAN, CAPA, is the Nurse Manager for Perioperative Services at Mercy Hospital, Portland, ME and a Former President of the American Society of Perianesthesia Nurses from 2009 to 2010. Conflict of interest: None to report. Address correspondence to Theresa Clifford, 144 State Street, Portland, ME 04101; e-mail address: practicecorner@ aspan.org. Ó 2016 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2016.05.003
358
Many health care roles involve a very wide range of physical action. These range from sedentary to highly active positions and postures that may not be ideal and could place workers at risk for accidents and injuries. It is common to find jobs involving pushing, pulling, reaching, bending, stretching, lifting, lowering, sitting, standing, walking, and carrying. These activities can lead to falls, fractures, bruises, abrasions, and a wide variety of musculoskeletal disorders including sprains, strains, and other related damage to joints, ligaments, muscles, tendons, and nerves.6 Each employee injury results in huge economic losses for the workplace. These include workers’ compensation for lost wages and medical costs as well as temporary staffing, backfilling, and overtime required to maintain productivity when injured employees miss work. These costs also include turnover costs when an injured employee quits as well as decreased efficiency and morale as employees become physically and emotionally fatigued.
Journal of PeriAnesthesia Nursing, Vol 31, No 4 (August), 2016: pp 358-359
PRACTICE CORNER
359
Ergonomic Strategies
Consider reducing work periods and/or providing more timely work breaks. B Encourage an active stretch exercise routine throughout the workday. B Minimize activities that require repetitive motions resulting in stress injuries. Implement ergonomic education to train people regarding the principles of workplace ergonomics including the proper use of equipment and other means to prevent injury. B Training can include recommendations about proper postures, safe patient handling and lifting practices, healthy work habits, appropriate use of keyboards and computer stations, and so forth. B
Several common approaches to ergonomics in the health care environment are available for consideration.7 Provide appropriate adaptive equipment to allow the workplace to meet the needs of the employees rather than requiring the employees to adapt to poorly designed space and equipment. B Provide ergonomic work tools such as adjustable keyboard supports, adjustable monitor arms, and task lights that can help ensure that each individual performs work in comfort, without putting added strain and stress on bodies. B Ensure that adaptive equipment allows for appropriate user control with easily adjustable components. B Other tools include appropriate lighting, handrails, barrier-free pathways, and noise controls can help prevent injuries. B Allow for adequate workspaces with ample room for storage and supportive work surfaces. Assess current workflow and implement changes to workflow processes to decrease distraction.
Ergonomics and the Perianesthesia Nurse Armed with knowledge of ergonomic principles, the perianesthesia nurse can actively participate in the evaluation of workplace safety and engage in a multidisciplinary approach to improving the health of the perianesthesia environment. Advocating for changes in the workplace, perianesthesia nurses can create healthy environments for both patients and nurses in the perianesthesia setting.
References 1. Merriam-Webster. Full definition of ergonomics. Available at: http://www.merriam-webster.com/dictionary/ergonomics. Accessed April 25, 2016. 2. U.S. Department of Labor. Bureau of Labor Statistics. Employer-Reported Workplace Injuries and Illnesses—2014. 2014. Available at: http://www.bls.gov/news.release/pdf/osh. pdf. Accessed April 25, 2016. 3. Gomaa AE, Tapp LC, Luckhaupt SE, et al. Occupational traumatic injuries among workers in health care facilities— United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 2015;64:405-410. 4. Hallmark B, Mechan P, Shores L. Ergonomics: Safe patient handling and mobility. Nurs Clin North Am. 2015;50:153-166.
5. Mao X, Jia P, Zhang L, Zhao P, Chen Y, Zhang M. An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review. PLoS One. 2015;10:e0129948. 6. Bernal D, Campos-Serna J, Tobia A, et al. Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: A systematic review and meta-analysis. Int J Nurs Stud. 2015;52:635-648. 7. Springer T. Ergonomics for Healthcare Environments. Geneva, IL: Human Environment Research Organization, inc. (HERO); 2007. Available at: https://www.knoll.com/ media/760/617/healthcare_ergonomics.pdf. Accessed April 25, 2016.
Ergonomics in the Perianesthesia Setting Theresa Clifford, MSN, RN, CPAN, CAPA QUESTION: HOW DO ergonomic principles relate to the perianesthesia environment of care? We will be renovating our Phase I unit and want to be sure that the new space is efficient. Response: The term ergonomics refers to the practice of biotechnology or the process of creating a workspace that reduces employee exposure to the risks of workplace injuries.1 In addition to reduced injuries, good workplace designs can help minimize fatigue and general discomfort from strain and stress on health care worker’s bodies. In 2013, the US Bureau of Labor Statistics reported significantly higher rates of workplace injuries among health care workers.2 Most recently the Bureau of Labor Statistics has indicated that the overall trend has been declining although the impact of workplace injuries remains concerning.3,4 In part, the active application of ergonomics and principles of safer patient handling have increased awareness of methods to minimize injuries.
There are three primary opportunities to apply ergonomic interventions in a workplace.5 The first includes physical ergonomics, which considers the actual design of patient care and nursing work areas not limited to the design of equipment, rooms, and workstations. Physical ergonomics involve understanding the impact of the workplace setting (including chairs, computers, desks, and so forth) on the body. The second is known as cognitive ergonomics which is basically the study of how the mind processes information as translated by a worker’s interaction with cues in the environment. This type of ergonomics includes an understanding of the attitudes toward interventions to reduce workplace injuries as well as education and training provided in the health care environment. Finally, organizational ergonomics are concerned with institutional policies and practices that impact work schedules, workflow, and job descriptions, to name a few. Included in this area are factors related to teamwork, quality improvement, and clinical inquiry.
Ergonomic Principles Workplace Injuries Briefly, the main principles of ergonomics address safety, comfort, ease of use, productivity, performance, and aesthetics. The primary purpose of the application of ergonomics in the workplace is to provide a healthy environment in which to work. Most institutional safety plans aim at preventing injuries and illnesses at the workplace by eliminating or reducing exposure to hazards. Of most concern are muscular skeletal disorders associated with poorly designed equipment, workstations, and lack of employee orientation to proper workflow mechanics, to name a few. Theresa Clifford, MSN, RN, CPAN, CAPA, is the Nurse Manager for Perioperative Services at Mercy Hospital, Portland, ME and a Former President of the American Society of Perianesthesia Nurses from 2009 to 2010. Conflict of interest: None to report. Address correspondence to Theresa Clifford, 144 State Street, Portland, ME 04101; e-mail address: practicecorner@ aspan.org. Ó 2016 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2016.05.003
358
Many health care roles involve a very wide range of physical action. These range from sedentary to highly active positions and postures that may not be ideal and could place workers at risk for accidents and injuries. It is common to find jobs involving pushing, pulling, reaching, bending, stretching, lifting, lowering, sitting, standing, walking, and carrying. These activities can lead to falls, fractures, bruises, abrasions, and a wide variety of musculoskeletal disorders including sprains, strains, and other related damage to joints, ligaments, muscles, tendons, and nerves.6 Each employee injury results in huge economic losses for the workplace. These include workers’ compensation for lost wages and medical costs as well as temporary staffing, backfilling, and overtime required to maintain productivity when injured employees miss work. These costs also include turnover costs when an injured employee quits as well as decreased efficiency and morale as employees become physically and emotionally fatigued.
Journal of PeriAnesthesia Nursing, Vol 31, No 4 (August), 2016: pp 358-359
PRACTICE CORNER
359
Ergonomic Strategies
Consider reducing work periods and/or providing more timely work breaks. B Encourage an active stretch exercise routine throughout the workday. B Minimize activities that require repetitive motions resulting in stress injuries. Implement ergonomic education to train people regarding the principles of workplace ergonomics including the proper use of equipment and other means to prevent injury. B Training can include recommendations about proper postures, safe patient handling and lifting practices, healthy work habits, appropriate use of keyboards and computer stations, and so forth. B
Several common approaches to ergonomics in the health care environment are available for consideration.7 Provide appropriate adaptive equipment to allow the workplace to meet the needs of the employees rather than requiring the employees to adapt to poorly designed space and equipment. B Provide ergonomic work tools such as adjustable keyboard supports, adjustable monitor arms, and task lights that can help ensure that each individual performs work in comfort, without putting added strain and stress on bodies. B Ensure that adaptive equipment allows for appropriate user control with easily adjustable components. B Other tools include appropriate lighting, handrails, barrier-free pathways, and noise controls can help prevent injuries. B Allow for adequate workspaces with ample room for storage and supportive work surfaces. Assess current workflow and implement changes to workflow processes to decrease distraction.
Ergonomics and the Perianesthesia Nurse Armed with knowledge of ergonomic principles, the perianesthesia nurse can actively participate in the evaluation of workplace safety and engage in a multidisciplinary approach to improving the health of the perianesthesia environment. Advocating for changes in the workplace, perianesthesia nurses can create healthy environments for both patients and nurses in the perianesthesia setting.
References 1. Merriam-Webster. Full definition of ergonomics. Available at: http://www.merriam-webster.com/dictionary/ergonomics. Accessed April 25, 2016. 2. U.S. Department of Labor. Bureau of Labor Statistics. Employer-Reported Workplace Injuries and Illnesses—2014. 2014. Available at: http://www.bls.gov/news.release/pdf/osh. pdf. Accessed April 25, 2016. 3. Gomaa AE, Tapp LC, Luckhaupt SE, et al. Occupational traumatic injuries among workers in health care facilities— United States, 2012-2014. MMWR Morb Mortal Wkly Rep. 2015;64:405-410. 4. Hallmark B, Mechan P, Shores L. Ergonomics: Safe patient handling and mobility. Nurs Clin North Am. 2015;50:153-166.
5. Mao X, Jia P, Zhang L, Zhao P, Chen Y, Zhang M. An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review. PLoS One. 2015;10:e0129948. 6. Bernal D, Campos-Serna J, Tobia A, et al. Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: A systematic review and meta-analysis. Int J Nurs Stud. 2015;52:635-648. 7. Springer T. Ergonomics for Healthcare Environments. Geneva, IL: Human Environment Research Organization, inc. (HERO); 2007. Available at: https://www.knoll.com/ media/760/617/healthcare_ergonomics.pdf. Accessed April 25, 2016.