Table 3 Studies with barriers and facilitators in the implementation of personal interventions aimed at patient handling in health care
StudyDesign (duration)Population (setting)InterventionOutcomesType of barrier (B) or facilitator (F)
Best (1997)11RCT (1 year)18 staff INT and 37 staff CON (nursing home)(1) 32 h training in techniques to decrease lifting using semi-squat posture and weight transfer techniques such as bracing, pivoting, lunging and counterbalancing the load; (2,3) in-house orientation trainingNo significant difference in back pain after 12 monthsInfluenced attitude of staff through delay in opening nursing homes (B-1B) Nurses wanting to transfer the patient “the old way” (B-2A) Variety of skill and knowledge levels due to staff turnover (B-2B)
Feldstein et al (1993)26CT (1 month)50 subjects INT and 25 subjects CON (hospital)(1) 2 h teaching session in correct body mechanics, patient transfer techniques, one-on-one assistance, reinforcement of proper use of equipment, and problem identification regarding environmental hazards, and 8 h of practical time on units over 2 weeks; (2) no interventionNo significant change in back pain and back fatigue.Nurses put patients first (B-1A) Nurses concerned over loss of continuity of care to patients during program participation (B-1A) Low moral after nursing strike ending shortly before study began (B-1A) Items taught on the course go against the work culture of the nurses (B-2E)
Johnsson et al (2002)27OBS (6 months)51 nursing assistants (hospital and primary care)Training in patient handling methods and moving skills, physical and psychosocial risk factors, balance between patient’s need for rehabilitation and use of lifting aids and workplace design, and awareness of body movements; 2 learning modelsNo decease in musculoskeletal problemsPatient handling methods seen as good (F-1A)
Lagerstrom et al (1998)28OBS (3 years)348 participants (hospital)Education and training program in patient transfer technique and how and when to use lifting devices, physical fitness exercise and stress managementNo significant reduction in musculoskeletal symptomsWorking technique was appreciated by nurses (F-1A) Need for common work technique emphasised by different actors, such as the occupational health care department, the labour unions and nursing personnel (F-2A) All nursing personnel educated and trained at the same time (F-2B) Management’s detailed knowledge of personnel working conditions and needs (F-2C) Need for common work technique according to management (F-2C) Management applied for money to carry out the program (F-2D) Hospital already well-equipped with transfer devices (F-2D) Permanent component of competence training for nursing staff by continuous follow-up (F-2F)
Lynch and Freund (2000)29CT (30–60 days)Pretest 164 nurses, post-test 59 trained nurses and 45 controls (hospital)(1) Back injury training program in back injury risk factors, risky activities, control strategies including engineering controls, administrative controls, use of proper body mechanics when handling patients; (2) staff not attending to trainingReduction in number of reported lost-time back injuries from 7 in the first three quarters of 1996 to 1 in the fourth quarter of 1996Lack of availability of mechanical devices (B-2B)
Peterson et al (2004)30CT (1 month)2 units INT and 1 unit CON (nursing home)Training in correct ergonomic work practices, administrative strategies, and use of engineering controls: (1) only NAs trained, reinforced by RA; (2) all nurses trained, training reinforced by daily supervision from the registered nurses and licensed practical nurses; (3) no trainingNo significant difference in pain/discomfort surveyNA not wanting to participate because of other priorities (B-1A) Lack of time to reinforce training on the floor (B-2B) NA not wanting to participate because of high turnover rate (B-2D)
  • CON, control group; CT, controlled trial; INT, intervention group; NA, nursing assistant; OBS, observational study; RA, research assistant; RCT, randomised controlled trial. Type of barrier: B-1B represents a barrier (B), within individual (1), category B (ability).