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Implementing change in the NHS: Factors to consider
1. Implementing change in the NHS
Factors to consider when implementing a ergonomics intervention
aimed at reducing back pain among nurses
Dr. Fiona Trevelyan¹ & Prof. Peter Buckle²
¹ Health and Rehabilitation Research Centre
Auckland University of Technology, NZ
² Robens Centre for Health Ergonomics
University of Surrey, UK
2. Extent of the problem
Bureau of Labour Statistics (2002)
1st = Truck drivers
2nd = Nursing aides, orderlies and attendants
3rd = Labourers
6th = Registered nurses
7th = Construction workers
Low back pain has been identified as a major reason why nurses leave their
profession (Nelson et al, 2003)
Smedley et al (1995) found a 1-year prevalence of 45% with 10% having an
absence from work for a cumulative period of greater than 4 weeks
3. Aim of our study
To implement and evaluate an ergonomics
intervention in an health care setting
Smedley J., Trevelyan F., Inskip H., Buckle P., Cooper C., and Coggon D.,
(2003) Impact of an ergonomics intervention on back pain among nurses.
Scand J Work Environ Health. 29 (2), 117 – 123.
7. Evaluation
Intervention site Comparison site
Baseline measurement Baseline measurement
INTERVENTION No intervention
Re-assessment Re-assessment
8. Measurement strategy
1. Reported back pain
Self report questionnaire: low back and neck pain
2. Exposure to risk factors associated with back pain
a) Task analysis
Identify proportion of nursing shift accounted for by nursing tasks
b) Exposure to physical risk factors
Describe each nursing task with respect to time spent exposed to awkward posture
(trunk flexion>20 degrees) and load
9. Data collection: PEO
Observed pre/post intervention at
both sites:
• 16 nurses each for a full shift
• Medical and orthopaedic
wards
• Staff nurses and health care
assistants
• Early and late shifts
10. Time spent on ‘intervention’ tasks
Proportion of shift Min. – Max.
Administration 14% 3 - 26%
Attend patient 12% 5 - 16%
Clean/tidy 7% 1 - 14%
Wash/dress 6% 0 - 15%
Make bed 3% 0 - 7%
Patient transfers 3% -
TOTAL 45%
12. Time spent on ‘non-intervention’ tasks
Proportion of shift Min. – max.
Communication 23% 10 - 25%
Fetch/carry 7% 3 - 9%
Other general 11% 6 - 31%
Other misc. 1% 0 - 12%
Rest break 8% 2 - 11%
TOTAL 50%
13. Time spent on ‘other’ tasks
Proportion of shift Min. – max.
Assist to eat 0% 0 - 5%
Drugs 1% 0 - 9%
IV/injection 0% 0 - 5%
Mealtime 1% 0 - 5%
Move object 3% 1 - 6%
Other basic 0% 0 - 4%
Other technical 1% 0 - 3%
TPR 0% 0 - 2%
Wound 0% 0 - 0.3%
TOTAL 6%
14. Duration of ‘intervention’ tasks
Median duration (seconds)
Comparison Intervention
Pre (post) Pre (post)
Administration 52 (55) 58 (36)
Attend patient 38 (45) 47 (46)
Clean/tidy 68 (60) 74 (78)
Make bed 157 (260) 161 (209)
Wash/dress 415 (342) 534 (298)
15. Results: task analysis
administration’ and ‘clean/tidy’ tasks were associated
with the least amount of trunk flexion > 20 degrees
‘wash/dress’ task was associated with the greatest
amount of trunk flexion > 20 degrees
‘make bed’ task changed by the greatest amount at
both sites
16. Results: patient transfers
Patient transfers were characterised by
short duration
high percentage time in trunk flexion > 20 degrees
Large variability due in part to:-
level of patient dependency
handling technique and equipment used
work environment
17. Conclusions: exposure data
Changes in exposure were less than expected
Variability in nursing tasks made true estimates of
change in exposure very difficult to interpret
Changes at comparison site were not anticipated
18. Conclusions
Methods must be sensitive to anticipated change
Tasks where interventions are targeted may form a small
part of a shift
Organisational factors can influence the intensity and
uptake of an intervention
The impact of an ergonomic intervention may vary in
different parts of an organisation
19. Factors that influenced the intervention
Intervention took place in a ‘real life’ setting
Large scale of intervention (24 wards and 1600
nurses)
Problems with staff attendance to manual handling
training
Work load of Health & Safety Advisers
Profile of health and safety in the hospital
20. Recommendations
If planning a similar intervention
Recommend a top-down/bottom-up approach
Adopt a participatory approach
Agree a strategy that ‘fits’ the organisation and is supported by key
stakeholders
Target high risk work areas – depending on size of organisation
Target high risk ‘intervention’ tasks
Ensure change agent that leads the intervention is respected within
the organisation
Empower local experts e.g. manual handling link nurses
Create a sustainable structure that will survive staff turnover