Carol F. Durham, RN, has worked in nursing since 1976-most currently as the director of a university lab where nursing students practice their clinical skills. Over the years, she believed that the way to keep herself and nursing students injury-free when transferring and lifting patients meant employing proper body mechanics.
"We thought we were progressive, because we gave all our students standard gait belts to use with their patients at clinical sites," said Durham, a North Carolina Nurses Association (NCNA) member.
Then Durham and her colleague, Lindsay Allen, MSN, RN, at the University of North Carolina at Chapel Hill (UNC-CH) School of Nursing, report having their eyes opened while attending last year's Fifth Annual Safe Patient Handling and Movement Conference. Its cosponsors included the ANA, the Veterans Health Administration (VHA), the University of South Florida (USF), and the National Institute for Occupational Safety and Health (NIOSH).
The two attended the conference with other faculty participating in a national pilot program aimed at teaching nursing students how to move patients safely by following set protocols, including the use of appropriate equipment. The ANA received a NIOSH grant to develop an educational module and pilot program with nurse ergonomics experts.
Durham and Allen, an NCNA board member, also attended a postconference session where they were taught how to use innovative patient handling equipment, reviewed pilot program educational materials, and met with vendors who would be providing equipment free of charge to their schools to use in clinical labs.
This fall, the UNC-CH educators incorporated the safe patient handling pilot program into their nursing curriculum. They also addressed this work-place issue within their greater health care community and throughout the state-efforts that earned their nursing program recognition at this year's safe patient handling conference. The Veterans Integrated Service Network 8 Patient Safety Center of Inquiry (PSCI)-a part of the Veterans Health Administration (VHA) system and the mecca of safe patient handling innovation-presented "Educator Awards" to two other nursing programs: Belmont University in Tennessee and Boise State University in Idaho.
THE SEEDS OF CHANGE
When the ANA began its work-place injury prevention program, "Handle with Care," in 2003, its leaders, along with nurse ergonomics experts and other nursing organizations, soon realized that they needed a strategy to reach nursing students and faculty about safe patient handling techniques and equipment.
Florida Nurses Association (FNA) member Nancy Menzel, PhD, RN, COHN-S, an assistant professor at the University of Florida and expert in work-related injury and pain, was instrumental in developing the pilot educational module on safe patient handling-with an eye toward ensuring the information could easily fit into nursing programs' curricula, according to Audrey Nelson, PhD, RN, FAAN, director of the VHA's Patient Safety Center. The pilot curriculum includes information on nurses' risk factors for injuries, algorithms to assist with decision making, and examples of technology in action.
Some of the educational materials, including the educational module, are available online for some period of time at NIOSH's Web site at http://www.cdc.gov/niosh/review/public/safe-patient and through a link on the ANA's Web site, http://www.nursingworld.org. Additionally, the algorithms are available at the Patient Safety Center's Web site at http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling.asp.
NIOSH is seeking comments on the draft module, but Nelson encourages nurse educators to begin using the information in their programs.
Another major part of the pilot involves hands-on skills.
"We knew that for the educational module to be successful, we needed to have the technology available to faculty and students participating in the pilot," says Nelson, an FNA member. To meet that need, Nelson matched nursing programs with vendors who would provide a specified range of assistive equipment, from high-tech strategies, such as electrically powered, sit-to-stand portable lifts to low-tech strategies, such as new gait belts with handles and friction-reducing draw sheets.
From the applications submitted to the ANA, 26 nursing programs-representing a mix of public and private and two- and four-year schools-ultimately are participating in piloting the curriculum beginning in fall 2005, with three others chosen to serve as a control group, Nelson says.
BEST EDUCATOR HONORS
As the two primary educators teaching beginning level nursing skills, Dawn M. Weiler, MS, RN, ANP, assistant professor of nursing, and Rosemary Macy, PhDc, RN, associate professor of nursing, headed the pilot program at Boise State.
The two introduced the curriculum into their nursing program in fall 2005. But they promoted the importance of safe patient handling beyond the nursing student population-making it part of an interdisciplinary patient care skills course that includes respiratory care and radiological sciences students.
"Faculty realized the importance of implementing new safe patient handling techniques," Macy says. "We want to prevent injuries in our future nurses."
On the other hand, Macy says most students initially don't seem to realize the risks of heavy lifting unless they've had previous health care experience.
"However, when they were taught with the new safe handling equipment, they felt that it made sense," she says. "And they found the hands-on piece really exciting."
So far, 130 nursing and other health sciences students and at least 30 faculty have learned the new course content.
Last fall the nursing department also hosted an informational session on the importance of safe patient handling and demonstrated the equipment for other faculty, students, and staff nurses and administrators from area hospitals to gain their support.
Current plans include continuing to teach the curriculum to beginning students and then bring it to upperclassmen and graduate students next fall.
Like the other two programs, Macy and Weiler also have promoted safe patient handling extensively through nurse-targeted publications and the general media.
Tennessee Nurses Association members Lynne Shores, PhD, RN, associate professor of nursing, and Debra Wollaber, PhD, RN, dean of the College of Health Sciences, were honored for their work garnering support for safe patient handling at Belmont University and beyond.
Shores says the curriculum is user-friendly so students feel comfortable using all the equipment within an hourlong skills lab. So far, 56 nursing students have completed the curriculum, and Belmont is using the curriculum with 39 students this spring. (Vendors working with Belmont ultimately donated the equipment to the program - an action occurring at other pilot schools.)
"Next fall we're going up to 64 students, so we'll have a bigger influence, in terms of numbers," Shores says.
But nurse educators already have had an impact on changing health care professionals' views on patient and nurse safety.
Shores says that Belmont hosted a coffee for area nurse leaders, including two who work for major health care systems-one with 42,000 beds. Shores says she showed them the equipment and why it made sense to implement a safe patient handling program.
Allen and Durham are leading the implementation of the pilot at UNC-CH, so far reaching 177 students in its BSN program and about 10 RNs in a refresher class. They furthermore are introducing a safe patient handling, hands-on component to the school's geriatric nursing continuing education workshops.
Allen also demonstrated the equipment to executives at a neighboring hospital-which since agreed to purchase lift equipment.
One of the unique aspects of UNC's program involves the development of a learning aid by faculty and a teaching associate, Jean LeCluyse, BSN, RN, who's also a medical illustrator.
"She created generic illustrations that we included in handouts to remind students how the equipment can be used and to show that devices made by other vendors can look different from what they see in our lab," Allen says.
Nancy Hughes, MS, RN, director of the ANA's Center for Occupational and Environmental Health, says that data collected from the pilot schools will be analyzed for its effectiveness.
"We then want to make the curriculum available to as many nurse educators as possible in both schools and health care settings," she says.
The ANA also recommends that new graduates ask about the availability of safe patient handling equipment when they interview for RN positions-which will help the safe patient handling movement gain steam as a crucial recruitment and retention strategy.