Author: Carol F. Durham, Ed.D.(c.), RN
Title: Director Clinical Education & Resource Center and Clinical Associate Professor
Institution: UNC-Chapel Hill School of Nursing
Coauthors: Audrey Nelson, PhD, RN, FAAN, Director, VA Patient Safety Research Center, Tampa, FL, USA Nancy N. Menzel, PhD, RN, Associate Professor, School of Nursing University of Nevada Las Vegas, La
Evidence-Based Practice, Safety
Skills or Simulation Laboratories
The teaching strategy is designed to evaluate the following Evidence-based Practice KSAs: Knowledge: Discriminate between valid and invalid reasons for modifying clinical practice based on clinical expertise or patient/family preferences. Attitude: Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from best clinical practices. Skill: Consult with clinical experts to decide when to deviate from best clinical practices.
The teaching strategy is designed to evaluate the following Safety KSAs: Knowledge: Discuss potential and actual impact of national patient safety resources, initiatives and regulations. Attitude: Value relationship between national safety campaigns and implementation in local practices and practice settings. Skill: Use available resources such as VISN 8 Patient Safety Center for professional development and to focus attention on assuring safe practice.
As part of ANA’s Handle with Care campaign, the School of Nursing at The University of North Carolina at Chapel Hill was chosen as one of 26 schools in the United States to participate in a pilot project titled “Effectiveness of an Evidence-Based Curriculum Module in Nursing Schools Targeting Safe Patient Handling And Movement.” The project was developed by principal investigator Audrey Nelson, RN, PhD, FAAN, Director of the Patient Safety Research Center in Tampa, Florida, in collaboration with the American Nurses Association (ANA) and the National Institute for Occupational Safety and Health (NIOSH). UNC-Chapel Hill was the only school in North Carolina to be chosen for the project.
The SPHM curriculum is designed to teach nursing students about the risks involved in manually lifting patients and to educate students on safe patient handling and movement. The new curriculum moves away from the traditional curriculum of body mechanics and manual lifting to an evidence-based curriculum that focuses on specific patient assessment and the use of algorithms to determine the safest way to lift and move each individual patient.
Prior to lab, students had to do readings and watch a video on the CD-ROM, as prepared by Dr. Nancy N Menzel, RN, PhD, the University of Nevada Las Vegas School of Nursing (insert SPHM packet here). When students arrive at lab they were given a packet containing four assessment forms and the algorithms. To prepare for clinical rotations, each student practiced selecting and using each device in simulated patient care scenarios following a two-step process. First, the students assess the patient and the environment using key assessment criteria. Second, using the algorithms, the students select the appropriate equipment or assistive device to use and the number of caregivers needed to complete the task safely. Under the supervision of faculty or teaching assistants, students practice with the different types of mechanic lifting equipment.
The students rotate through three rooms in groups of 8-10 students. Each have different simulated patient scenarios and types of equipment, requiring students to use critical thinking to perform their patient and environment assessment and to determine the correct algorithm to follow (insert SPHM scenarios here). The emphasis is on patient safety as well as nurse safety.
Ergonomic hazards exist for nurses when handling patients and equipment. Ergonomic hazards refer to a combination of stressors or workplace conditions that may cause harm to a worker. Patient handling and movement have been recognized as the primary cause for musculoskeletal disorders among nurses. Nursing often requires lifting, transferring, and repositioning patients, and these activities have traditionally been performed manually. Other activities that can put nurses at risk include feeding, bathing, dressing and weighing patients. Long-term, continuous manual performance of these nursing tasks causes undue strain and leads to injury. The physical environment in health care, such as room design and size and the placement of furniture and equipment, also contributes to musculoskeletal injuries (ANA, 2003).
The development of patient handling equipment has made manual lifting essentially unnecessary in nursing. Safe patient handling equipment ranges from high dependency devices such as floor and ceiling mounted sling lifts, stand-assist lifts, transfer chairs, and lateral transfer devices, to lower-tech equipment such as friction reducing devices (ie. sliding sheets and transfer boards) and gait belts.
A growing number of health care facilities have made SPHM programs a priority in their organization and have seen positive results in the reduction of injuries among nurses. The use of this equipment also has a positive impact on patient outcomes. Patient safety is improved because falls and skin tears are reduced, as these devices provide a more secure means of lifting, transferring, and repositioning patients. Activities such as toileting and skin care are also made easier with the use of these devices. The comfort and dignity of patients are drastically improved when using safe patient handling devices as opposed to manual lifting (ANA, 2003)
The Safe Patient Handling and Movement training presentation can be downloaded at the NIOSH Web site:
The Safe Patient Handling and Movement algorithms, didactic materials, and quiz can be downloaded at the Veterans Affairs Patient Safety Center of Inquiry Web site:
The NIOSH Contact Person: Dr. Thomas R. Waters, DART, Cincinnati, OH, firstname.lastname@example.org
Bringing about culture change is energizing as well as challenging. It is important for us who are the “walking wounded” to protect our beginning nurses from injuries. To ignore the strong evidence is negligent.
If you have questions about implementing this curricular change please contact Carol Durham, Director, Clinical Education & Resource Center at Carol_Durham@unc.edu and be CERTAIN to list in the subject line QSEN teaching otherwise the request may not be received.
The pilot program was carried out fall semester 2005 with 177 undergraduate students. We continue to teach the evidenced-based curriculum. Quantitative evaluation of the curriculum implementation is forth coming.