GCNRN4 Research In Nursing

Introduction:

While treating critically ill or mobility restricted patients, the most important challenge that the nurses caring for this patient population face is related with manual handling and fall prevention for the mobility restricted patient. Along with that, the workplace stress of handling such patient demographics also has a considerable impact on the burnout experienced by the nurses and performance statistics of the nurses (Kay, Evans & Glass, 2015). Considering the policy oriented environment, there have been many policies identified to address the issue of manual handling of acute patients and preventing falls and fall related injuries. For instance, the Falls policy, 2004 by Health.wa.gov.au and the safe patient handling policy by the ANMF or Australian Nursing and Midwifery federation have identified plenty of the issues or challenges that are prevalent in the acute or aged care scenario (Anmf.org.au., 2018; Health.wa.gov.au, 2018). This paper will attempt to examine the challenges associated manual handling of the acute or mobility restricted patients and the risk of fall and fall associated injuries along with its associated with workplace related stress on the nurses.

Brief description:

Manual handling is a very common care need for patients with mobility restrictions or any kind of disability. On a more elaborative note, manual handling can be defined as a task which requires the person to lift, lower, push, pull, carry or otherwise move, hold or restrain any patient using repetitive or sustained force. In this case, the task of manual handling of a patient is associated with a variety of different risks, not just to the patients but also to the nurses and care staff. The heavy lifting and manoeuvring that the nurses have to carry out is often associated with extreme hazard risks (Abedini, Choobineh & Hasanzadeh, 2015). There is mounting evidence that the manual handling that the nurse have to carry out in order to be able to complete the care needs of the acute or chronically ill patients has resulted in lower back and musculoskeletal injuries. Along with that, the manual handling is also associated with a far higher risk of falls. On a more elaborative note, the heavy lifting of a critically ill and/or mobility restricted aged patient is complex and requires a systematic approach and the assistance of tools. The lack of any of the mentioned facts can lead to fall and injuries for both the patient and nursing staff as well. The manual lifting of positioning of the patients is needed to be avoided as per the Safe patient handling policy by ANMF and the risks of fall and the effect of the same on the empowerment or the dignity of the patient. Yet, the need for manual handling is still prevalent in the patient care scenario, and in most cases the nurses lack the exact training or the resources to follow the exact manual handling guideline or protocol to ensure minimal hazard risk on both patients and the nursing staff. Hence, the risk of fall and injury continues to escalate along both physical and emotional stress on the nursing professional involved with the care (Mital, 2017).

Critical analysis of manual handling, fall and impact on workplace stress:

The challenges associated with manual handling and the associated fall risk among other injurious risks have been a considerable concern of the health care industry for a considerable amount of time. Hence, many research studies have invested efforts and resources in discovering the extent of the various challenges associated with manual handling and how it links with fall risk and what impact it is capable of inflicting on the workplace stress scenario of the nurses and their performance or productivity. As mentioned by Allahyari et al. (2014), musculoskeletal injuries are the most abundantly reported risk associated with manual handling actions, although it has to be highlighted in this context that the exact aetiology of these musculoskeletal injuries are multifactorial, there is considerable evidence that indicates the presence of a causal relationship between the musculoskeletal disorders in the health acre facility and the care staff that have to carry out manual handling of patients. The most prevalent type of musculoskeletal disorder that is found in the patients is the low back pain, which has been attributed to be linked with repetitive movements, forceful exertions, non-neutral body positions and exposure to vibrations (Anap, Iyer & Rao, 2017).

As argued by Villarroya et al. (2016), on the other hand, the musculoskeletal disorders that developing the nursing or care staff results primarily from the cumulative damage rather than a single incident or accident. Hence, it can be deduced that for the manual handling, the day by day damage caused ion the musculoskeletal system of the nurses of the manual hand ling of the patents without proper training or infrastructure for a prolonged period of time causes the development of several disorders. As discussed by Piccenna (2017), there is a significant lack of rehabilitation or screening facility available for the nurses that are associated with care practices requiring regular manual handling, which adds to the burden of the diseases by not being recognized early one. On a similar note, the prevalence and persistence of the musculoskeletal diseases in the health care industry has created serious concerns all across the globe. Challenges in the musculoskeletal disorder detection and diagnosis and the limitation in the claiming of injuries and the cultural influences that discourage injury reporting contribute to the present scenario.

 Exploring the issue further, it has to be mentioned that the risk of manual handling and associated falls is the most contributed by the lack of training and education among the nursing professionals. On a more elaborative note, the safe patient handling practice education of the nurses are more focused educating good body mechanics to the nurses rather than focusing on the empirical evidence and judgment regarding the co0mpetency of the injured nurses and their integrity. Even with respect to voicing the response of the nurses that have been injured while practicing manual handling, most of the nursing professionals have found to be silenced or ignored or overlooked which further discourages them from reporting the incidences of injury while manual handling of the patients. It has to be mentioned in this context that these challenges have a profound impact in adding on to the workplace stress that these nurses are already suffering from (Kneafsey, Clifford & Greenfield, 2015).

Elaborating further, the injuries and the emotion al burnout of such menial and hard work is attributed to cause immense physical and emotional burnout in the patients. The inability of properly handling the patient, causing any sort of discomfort to them, and any injury to the patient causes extreme dissatisfaction in the patients which in turn leads to immense sense of incompetence and lack of self-worth. Along with that, it has to be mentioned that the newly graduating nurses that are transitioning into practice face the most intensity of the challenges with the manual handling and have been reported to be associated with the most of the falls and fall related injuries. Along with that, it has to be mentioned that the lack of emotional support for the newly graduating nurses often causes withdrawal and dropping out of practice as well which in turn leads to low employee turnover rates of the health care facilities (Hogan, Greiner & O’Sullivan, 2014).

With respect to falls when manually handling the patients, lifting and positioning the patients for the activities of daily living. On a more elaborative note, the most of the fall risk with manual handling of the patients have been reported to be associated with patients with disability or paralytic patients. However, there are considerable arguments that states the risk of falls when manual handling is associated with acutely ill patients or patients with critical illnesses. Along with that, another school of thought states that the lack of co-operation from the patient while manual handling is taking place has also been reported to be one of the most important contributing reasons to the unrest, fall and associated injuries. In support the Elnitsky et al. (2014), have mentioned that the lack of the competence and capabilities in the nurses to actively engage in the therapeutic engagement or patient centred enabling or empowering care approach rather than just providing assistance leads to a sense of dependence and incapability in the patients, for culturally diverse patients, the lack of proper consent and therapeutic engagement, manual handling also can be interpreted as offending to patients which in turn leads to challenges of successful manual handling and falls. Hence, it has to be accounted for in here that there are a myriad of different concepts associated with these practice oriented issues concerning patient handling ranging from use of proper technique and tools to lack of proper training and skills and to lack of proper patient carer interaction which facilitates this issue. Hence, undoubtedly the intervention strategies must also focus on all these different issues equally, the policies existing have undoubtedly attempted to emphasize on certain aspects such as fall risk assessment and safe patient handling guidelines there still are many areas of concern which has not been addressed by the existing policies (Hignett, Otter & Keen,  2016).

Recommendation strategies:

In terms of strategies that can be recommended with aim to address the concerns of the nurses that are required to carry out manual handling, the most of the focus should be in proper education and training of the nurses based on empirical evidence and the lived experience of the nurses rather than just emphasizing on teaching them good body mechanics. As argued by Wanless (2016) the nurses have very minimal input in the safe patient manual handling and fall or injury prevention planning and implementation even though the nurses are the biggest and the most influential stakeholder of the entire scenario. The nurses who have had lived experience of the manual handling can provide the exact issues and challenges that the nurses and the patients face while carrying out the manual handling for activities of daily living or any other activity. The marginalization or silencing of these nurses are a massive hindrance to policies and protocols being designed that can actually benefit the patients and the nurses and can reduced the rate of falls. Another very important strategy is skill enhancement, focused entirely on the patient demographics that the nurses are going to attend to and their particular patient handling needs. This strategy will ensure that nurses are trained according to the exact care needs of their patient populations and they understand all the skills and tricks to employ while handling them safely and effectively (Fragala & Fragala, 2014).

On another note, Olinski & Norton (2017) have also discussed that only safe manual handling training or good body mechanics training is not nearly enough for addressing the musculoskeletal injuries suffered by the nurses when carrying out these job roles for prolonged period of times. There is need for multidimensional interventions incorporated in the training involving exercise training to promote strength and flexibility of the nurses. Another article by authors state that the implementation of a curated program taking the aid of patient-handling devices such as Medi-chair, stand up or floor lifts, sliding bench and wheelchairs can improve reduce the rates of manual handling accidents and falls and will be of lesser risk to musculoskeletal injuries in the nursing care staff as well. Lastly, the need for a more compassionate and co-operative approach for the nurses committing manual handling errors and suffering from any related injuries is also a grave requirement for the present day scenario. Especially for the transitioning nurses the burden of these new responsibilities are already exhausting the marginalization or maltreatment from the patient, patient families or the organization is also extremely needed to encourage them and safeguard their confidence. The integration of family members or engaging the patient in easy conversation can also help the nursing care staff to build a rapport with the patient encouraging mere co-operation from them and it will also help evade the risk of manual handling accidents and falls (Healey, 2016).

Conclusion:

On a concluding note, a nurse often has to complete a varied range of activities in order to be able to provide safe and effective care activities to the patients. However, while completing these activities the nurses are also required to complete the myriad of activities, the nurses also experience a variety of challenges and issues. On a more elaborative note, in the specialized clinical settings addressing the acute or aged patients, the care needs develop manual handling care needs and as a result the nurses addressing these complications also have to build on their skillset and competence in order to be able to provide adequate care to the patients as well. It has to be mentioned in this context that for the acute care nurses, the impact of the workplace stress also has a severe impact on the performance of the nurse in consideration along with affecting the quality of care provided to the patients by the nurses. This essay has successfully explored the varied range of issues and challenges prevailing in the care scenario involving manual handling of patients, risk of fall and the impact on the stress or burnout. The recommended strategies can hope to address a few of the issues identified although there is need for further research to enhance the effectiveness of the policies and protocols associated with manual handling of patients and the risks.

References:

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Piccenna, L., Lannin, N. A., Scott, K., Bragge, P., & Gruen, R. (2017). Guidance for community?based caregivers in assisting people with moderate to severe traumatic brain injury with transfers and manual handling: evidence and key stakeholder perspectives. Health & social care in the community, 25(2), 458-465.

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