Safe Patient Handling Program in Critical Care Using Peer Leaders: Lessons Learned in The Netherlands

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Occupational back pain remains a serious problem for nurses. In Dutch health care, ergonomic changes are stimulated through convenants. For acute and critical care, a covenant was drawn up and guidelines for nursing practice developed and implemented. Because of the diverse and rapidly changing nature of ergonomic problems, the process has to be specific. A strong emphasis thus was placed on self-management and empowerment of nurses. One or two nurses were appointed per ward as peer leaders, called ergocoaches. They received additional training and were given responsibility for safe work practices. This article reports on progress made to date, viewed as work in progress.

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An ergonomic approach in acute care

In the Netherlands, the ergonomic approach is advocated as the most effective way to prevent musculoskeletal disorders among health care workers. In the literature, this is referred to as a nonlifting or minimal lifting approach, and there is evidence of the effect of such an approach and of the lack of effect of other approaches [1], [2], [3]. The primary objective is to eliminate or substitute all potentially harmful actions. For this purpose, guidelines were developed mainly based on the

Analysis of the ergonomic situation in acute and critical care

The first step was to assess the exact nature of the ergonomic problems encountered in critical care. For this purpose, research material from different sources was collected and the conclusions were combined. Methods used were surveys, observations, and direct measurements of exposure.

Guidelines for practice

After this first research phase, a national task group was formed consisting mainly of nurses and physical therapists. It was their task to develop practical guidelines as a response to the major problems the studies (described previously) pointed out. They were supported in this by human movement scientists.

This task group developed the guidelines in several stages during nearly 7 months. At each stage, they consulted with their own hospitals and their direct colleagues there. The purpose was

Implementing change in acute and critical care

After this stage of guideline development, the implementation process started. As this was expected to be a complex process, a choice was made to train and install so-called ”ErgoCoaches.” On every ward, one or two nurses needed to be appointed and trained to become an ErgoCoach (also called peer leaders, lifting co-coordinators, back injury resource nurses [BIRNs], lifting specialists, mobility coaches, and so forth) [1], [2], [3], [8]. In short, this ErgoCoach–nurse is responsible for

Preliminary results

Nationally, the percentage of nurses on sick leave has decreased from 5.6% in 2002 to 4.7% in 2005 (2003: 5.1%; 2004: 4.8%) [9]. Monitoring of all the hospitals revealed that the implementation process demonstrated a typical implementation pattern [10]. Early innovators were in the lead, followed by a mid range of hospitals underway. These hospitals had made some changes and were planning for more but were not working according to the guidelines at this stage. The reasons often were oriented

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