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Manual patient handling (MPH) is a major occupational risk in healthcare settings. The aim of this study was to propose an MPH training model involving interdisciplinary aspects. A scheduled training program was performed with 60 healthcare workers (HCWs) from a hospital in Naples, Italy, providing training divided into three sections (occupational health—section one; physical therapy—section two; psychosocial section—section three) and lasting six hours. Fifty-two HCWs performed the training session. In section one, a questionnaire about risk perception related to specific working tasks was administered. Section two provided specific exercises for the postural discharge of the anatomical areas most involved in MPH. The last section provided teamwork consolidation through a role-playing exercise. The training program could also be useful for risk assessment itself, as they can examine the perceptions of the specific risk of the various workers and incorrect attitudes and therefore correct any incorrect procedures, reducing exposure to specific risks in the field. This pilot study proposes a training model that explores all aspects related to MPH risk exposure and also underlines the need for standardization of this formative model, which could represent a useful tool for studying the real effectiveness of training in workplaces.
Keywords: healthcare workers, manual patient handling, occupational risk trainingManual patient handling (MPH) is one of the major occupational risks for healthcare workers (HCWs). According to the 6th European Working Condition Survey (EWCS), several working tasks are performed in lifting or moving people. One explanation could be the recent expansion of the care sector in Europe, where a number of occupations require these types of tasks. According to the European survey, an increase in the percentage of workers involved in MPH (up to 10%) could be observed, and this is the only posture-related risk among those included in the EWCS that is shown to be on the increase. In particular, the percentage of female workers involved in MPH tasks for one-fourth to three-fourths of their working time is 9%, double that of men [1].
These exposure data account for the high percentage of musculoskeletal disorders (MSDs) in some categories of workers. The work-related musculoskeletal disorders (WRMSDs) in nursing workers are well reported in the scientific literature; the mean annual prevalence rates are 55% for low back pain (LBP), 44% for shoulder pain, 42% for neck pain, 26% for upper extremity pain, and 36% for lower extremity pain [2]. The year prevalence of low back pain in nurses has a mean of 70%, and the lifetime prevalence ranges from 35 to 80%. Recurrence rates of low back pain in nurses exceed 70% [3]. This prevalence rate has been found in countries all over the world; moreover, LBP might result in activity limitation for over 50% of HCWs [4,5]. HCWs are committed to several workplace activities (i.e., patient hygiene, the pronation/supination of patients in intensive care units (ICUs), moving patients from beds to stretchers or wheelchairs, etc.) that expose them to a variety of factors and moving geometries associated to LBP development.
This care setting variability and the related range of involved handling tasks are challenges in assessing the safety of MPH conditions and in developing improvement programs, including specific training to all personnel [6].
MPH and the required non-ergonomic postures involve cumulative spinal loads, often associated with lumbar disc structural degeneration and other disorders [7].
According to the WHO biopsychosocial model, health status is granted by the integration of medical and social aspects. As found in the International Classification of Functioning, overall health can be illustrated by the following diagram ( Figure 1 ) [8].
International Classification of Functioning—Paradigm of Overall Health.
The absence or reduction of physical hazards in the workplace, e.g., when moving patients, is a goal of job quality. All HCWs (i.e., nurses, sanitary aides, helpers and technicians) develop personal characteristics through their experiences, values, attitudes, and biases that have significant effects on their communication with patients. Some HCWs’ beliefs and attitudes are related to a complex relationship between feelings and emotional responses in patient care, work organization, and risk exposure. These aspects need to be deepened in the risk assessment because they could inspire interest in challenging clinical situations and physician self-care, which can improve specific training.
The American Physical Therapy Association (APTA) introduced in 2014 the standards recommendation for the development of safe patient handling (SPH) training programs and issued a position statement on the role of a physical therapist in these programs. Olkowski et al. [9] stated that physical therapists determine the most appropriate handling method for both patients and HCWs and they train HCWs in the use of SPH equipment and practices, participate in SPH programs, and could be involved in SPH policy. Moreover, several studies have investigated the effectiveness of physical training in improving the capabilities for manual handling, often highlighting beneficial effects resulting from customized exercises, in terms of improved physical capacity for manual handling tasks [10,11].
According to Clemes et al., high priority should be given to developing and evaluating multidimensional interventions, incorporating exercise training, conducted in a multidisciplinary way, to promote strength and flexibility, involving a physical therapist during the course and exploring practical exercises that could be performed at home or while working [12].
The culture of safety in the workplace undoubtedly influences the shared perceptions of workers within a specific healthcare setting. Consequently, hospitals must increase their focus on environmental and organizational aspects by incorporating a specific training program, which needs to be administered continuously, and taking care of aspects aimed at creating a safety culture that involves safe patient handling and mobility tasks [13].
Healthcare settings predispose HCWs to psychological effort and stress, making nursing a high-risk occupation. This often results in a deterioration of the relational and teamwork skills that underlie the cooperation and sharing of some risk exposures, such as MPH. Very often, in fact, numerous bedside operations (i.e., therapeutic maneuvers or patient bedside hygiene) require the involvement of multiple operators, simultaneously. Coordination in these operations is necessary for the reduction of risk exposure. An impaired relationship capacity may occur in the risk perception, deteriorating the perception itself. Useful teamwork is therefore the basis for sharing the risk among the operators. Communication and cooperation within an exposed group to MPH, especially for tasks involving the simultaneous activity of two operators, is activated by the relationships that are established between the workers; it is not just simple information sharing, but it is a complex social phenomenon influenced by the emotional, cultural, and social background of the participants and by the context in which it occurs. Moreover, Lee et al. showed that the safety climate in workplaces was the most influential factor associated with safe patient handling behaviors among critical care nurses [14]; a positive organizational safety climate, a people-oriented culture, and ergonomic practices were significant factors for safe patient handling behaviors among hospital nurses [15].
The number of patient-handling activities per day was a hard measure in risk assessment; this risk exposure could be assessed by single questions directly addressed to operators. Various assessment methods have been developed over the years. These methods present several limitations; for example, some aspects of HCWs’ physical work demands, such as non-ergonomic trunk postures that may generate a relatively high mechanical load on the back, were underestimated within some evaluation assessments. HCWs often perform physical tasks that are considered complex, unplanned, and unpredictable.
Many authors recommend that specific MPH training plays a key role in prevention programs related to manual handling [16,17]; these programs might show transfer techniques practice for all staff and provide feedback on the skills of trained staff [18]. In many countries, such as the United States, there is no standardized method for training in MPH, despite the high incidence of injury. In Italy, the MPH training programs are often non-specific and take more care of the legislative and theoretical aspects than the practical ones. In addition, the applied skills are always aimed at training in the use of technical aids, with less impact on the postural gesture linked to the correct movement of the patient. Targeted exercises and physiotherapeutic techniques of postural reprogramming are undoubtedly recommended for LBP treatment, management, and chronicity prevention, more specifically in HCWs exposed to MPH. HCWs who had less education, strength training, and fitness levels had a lower adherence to exercise programs designed based on prevention risk. Motivational strategies should be targeted at these persons, even scheduling specific work training related to MPH exposure risk [19].
However, elaborating this program is complex, as it requires in-depth knowledge about the workplace and the work organization, the shifts carried out, the clinical and psychological conditions of the personnel involved, the risk assessment, and the risk perception that these workers have about their condition. On-the-job training would have a greater impact than, for example, a non-contextualized education. The nature of training, i.e., theoretical, practical, or both, must also be considered to optimize knowledge application and favorize the opportunity of applying knowledge in real settings. Resnick et al. also identified workplace constraints that can hinder the implementation of preventive practices. For instance, participants mentioned that the difficulty of accessing equipment, as well as overcrowded workspaces, particularly for in-home care, complicates the application of the preventive practices they have learned [20]. Other scientific data confirm that the work environment can influence the application of preventive measures [17].
Thus, each specific training program carried out in the workplace should be thoroughly planned and not be exclusively due to legal obligation. Training and education programs are widely adopted as key injury prevention strategies. Training aimed at refuting incorrect attitudes and reconditioning daily operational gestures could be a primary objective of training programs for HCWs exposed to MPH risk, such as the model proposed in this paper.
The aim of this pilot study was to assess the feasibility of an interdisciplinary MPH training model, in order to define a standardized model that can be generally proposed to workplaces.
The pilot study was carried out in a Southern Italian hospital (Naples, Italy) in November 2018 and enrolled 60 HCWs. Within the scope of the mandatory training for HCWs exposed to MPH, an innovative interdisciplinary program was created. This training model was proposed and approved by the Hospital Health Management. The program was divided into three sections with a total duration of 6 h, according to specific Italian regulations. Each module lasted 2 h and consisted of theoretical and practical parts, focusing on three aspects: (a) acquiring theoretical knowledge and updates on patient-centered handling according to the WHO BioPsychosocial Health Model; (b) learning manual, technical, and practical skills for the dynamic patient–environment–worker interaction and physical effort evaluation, through techniques of global postural reprogramming according to the Mézières method; (c) improving the relational and communicative skills within the working group.
A scheme of the training program is summarized in Figure 2 .
