Manual handling in hospitals
Discuss about the Leadership in Clinical Practice for Musculoskeletal Systems.
The essay deals with the current issue noted identified in the workplace that is manual handling in hospitals. The aim of the essay is to discuss the issue succinctly and critically analyse the issue in the context of nursing practice. Further the essay intends to explore the impact of the nursing leadership on this issue from clinical practice. The essay demonstrates the synthesis of the principle of leadership that is applicable in practice by critically analysing the related literature. The thesis for the essay is that effective leadership in clinical practice can address the issue of the manual handling in hospital and related injuries. The essay discuses the barriers in the process of change required to minimise the issue. Lastly the essay discuses the leadership attitudes and skills required by the nurses to facilitate and evaluate the change process and outcomes.
Manual handling by nurses in the hospital is considered a workplace issue as it is associated with several health problems. Manual handling involves any activity needing effort to move, push, lift, carry, pull, hold, any object or person. Manual handing is inherent in nursing care delivery. It is the performance of physical activities using the musculoskeletal systems. It may be during handling toxic chemicals or handling patients. Poor manual handling is the risk factors for nurses as well as other care providers. Manual handling is the common cause of the injury in the hospital setting that may arise from specific setting. The injuries may be moderate to severe and cannot be treated completely. These injuries may lead to chronic illness. Nurses and nursing aides are highly vulnerable to the musculoskeletal injuries due to primary responsibility for heavy lifting objects and patients (Mital, 2017).
Nurses have patient handling tasks and the risk of injury has been recognised widely as per the literature due to growing number of injuries. The safety of the nurses is at stake, because of which the manual handing is the nursing issue. The potential risk factors to safety and health in nurses handling tasks manually include weight, distance, posture and other risky tasks (Bernal et al., 2015). Weight refers to moving adult patients with limited mobility and assists them that may cause injuries due to overexertion and stress. Factors like drip stands, bed rails, furniture, wheel chairs separate the worker from the patient causing injuries. Awkward position or posture may result in the musculoskeletal disorders. The highly risky tasks includes moving a hostile person, totally dependent patients, lifting patients from floor, transferring the patients from bed to chair and to other locations. Repositioning a patient in chair or bed or bathing and assisting disabled person into a vehicle. Other factors contributing to the manual handling and associated injuries slippery floor, inadequate lightening, spillage of chemicals, fatigue due to repeated manual handling (Teeple et al., 2017).
Risk factors associated with the manual handling
The contributors of injuries due to manual handling in nursing practice includes slips, trips, and falls, muscular stress as objects are not handled, annual handing of trolleys, adjustment of beds, handling of lead aprons, and linen. The main type of manual handing injury has been found to be sprains and strains. Among the registered nurses the 40% of the injuries include back, 9 per cent the lower limbs, 12 per cent the upper limbs. In the patient handling activities the injuries mainly involved beds such as repositioning and transferring patients. These injures are even common if the nurses are working in the aged care facility (Kneafsey et al., 2015). These injuries may hamper the work efficiency of the nurses and implies for change in workplace that will address the issue. Psychological risk factors were found to be associated with the manual handling injuries. Psychological changes such as immune system responses, endocrine response, and muscle tension. Psychological risks for the musculoskeletal disorder include high work pressure with little rewards, lack of autonomy over work, and tight deadlines (Bernal et al., 2015). Over the time the psychological risk factors may develop as mental health issues. Thus, change is required to prevent mental health issues among nurses due to manual handling and prevent decreases in work productivity. Change is required to improve the care quality and patient’s health outcomes.
On analysing the issue, manual handling comes with risk of chemical, biological, and physical hazards. Change is required as the increases in rate of injuries will leads to the nurse turn over. If a hospital already has a shortage of nurses then nurse absenteeism and turnover may cause fall in the care quality. Workplace change is required to prevent the workplace injury due to heavy lifting and other risky manual activities. Change is required to modify the nursing activities and restructure the working environment in a manner that will reduce the occupational injury. Educational based approach will help the nurses develop the injury prevention strategies. Other strategies of change include regular risk assessment, feedback from nurses and implementation of evidence based strategies. With such change the nurse can not only protect themselves but also protect the patients from trips and falls. Change is thus required to improve the patient’s satisfaction and ensure patient safety care (Kay, Evans & Glass, 2015).
There are several barriers to change and reduction of injuries associated with the manual handling. It includes lack of adequate training program on safe work skills, inappropriate work design, as well as incorrect beliefs and attitude towards the safe work performance. Tainting is important to help employees recognise the risks and hazards associated with the manual handlings and ways to deal with it. Training helps build relevant knowledge, attitudes and skills and translate the same into workplace. Lack of nurses’ training on manual handling leads to poor awareness on safety, use of mechanical aids, and negative attitude towards change (Akbari et al., 2017). Lack of the ergonomic approaches in the workplace such as “no lift policy” is additional barriers. Implementing such policies will lead to change in the issue. Hospitals lacking mechanical aids require the nurses to use the human strength. Change implementation requires supply of adequate assistive equipments. Further barriers include poor hospital layout, lack of flexible hours, poor physical work environment, high complexity in work, increase in physical demand of the work, lack of necessary equipments such as walkers, wheelchairs increases the frequency of manual handing and consequently injuries. Other factor that acts as barriers in the implementation of change is the lack of leadership role among nurses (Kneafsey et al., 2015).
Barriers to change and reduction of injuries associated with the manual handling
Effective leadership in clinical practice helps nurses deliver high quality care and implement practice change. It is critical for the nurses to ensure the patient safety, and facilitate positive staff development. Registered nurses and senior nurse manager must have the skills to offer their leadership to their juniors. Since experienced nurses have influence on all aspects of healthcare delivery, they should be able to exert this influence confidently to recognise and address any manual handling issues. It is necessary for the nurse managers to have the ability to stand their ground amidst tough competition. Nurse leaders must be able to motivate others in achieving shared goals while having clear vision. Simultaneously, the nurses must be able to maintain the professional standards to set an example for future nurse leaders while implementing change (Denker et al., 2015).
Nurses should have the skill to actively participate in the leadership activities and policy making. They must have centre stage in problem solving with conflict resolution skills (Chan, Sit & Lau, 2014). The skills required to implement change in the practice is to solve the problems of manual handling while maintaining the group effectiveness. In addition to be solution focused the nurse must be able to motivate others while retaining compassion. By applying these skills the nurses may earn respect from others and be able to lead the change needed in practice. In addition the nurse leaders must have the skills to effective decision making, appropriate delegation, and acting with integrity. These effective leadership skills are required for development of team members (Powell-Cope et al., 2014). Nurse leaders must engage in regular risk assessment in the hospital to assist the fellow nurses and the junior nurses to cope up with stress due to manual handling of patients and objects. Based on the risk assessment data financial supports may be taken from higher authority by discussing the evidence based strategies for implementation. Nurse leaders must demonstrate resilience in responding to change and also support other nurses to see achievable changes in public health setting. The nurse leader may implement new mobility assessment tools to guide decisions relate to patient lifts or prevent patient migration in bed. Further workplace safety guidines by WHO and OSHA must be stringently followed (Colvin et al., 2016).
As per Frankel & PGCMS (2018) there are various leadership style that a nurse may undertake such as democratic, autocratic, transformational, transactional, coaching and authoritative, depending on the situation. It is also known as situational leadership model, where nurses adopt the leadership style based on the response and attitude of the subordinates. It will help implement change with the most appropriate leadership style. Thus, the nurses must have the skill to choose the appropriate leadership style depending on the health care related challenge. The literature related to leadership greatly emphasise on the transformational leadership skills for nurses. These skills include clinical supervision, mentoring, intentional success planning, promotion of centres for excellence and giving value to clinical competence. In addition two more key skills are required to lead a change in the practice setting. It includes professional socialization and communication skills (Ha & Jeon, 2016). Nurse leaders must be able to clearly communicate their change strategies say, tactics to minimise the musculoskeletal disorders or may communicate any ergonomic changes. Having effective communication skills will help nurse leaders to provide effective education and training to juniors on safe patient handling and mobility. Nurse may discuss with panel of experts to develop new standards to prevent manual handling injuries. The nurse leader may be empowered to implement evidence-based changes to ensure nurses safety, decreases injuries and hazards in workplace. For instance the, leaders may implement specialised technology to handle bariatric patients, or develop sling management system. These skills and attributes will help nurses to positively influence organisational outcomes and improve safety (Vaccaro et al., 2012).
Effective leadership in clinical practice
There are several evaluation and measurement strategies for evaluating the implemented change process which will help the hospital facilities to improve. The change process can be evaluated using both quantitative and qualitative methods. The role of the nurse as leader includes taking feedback from the nurses through survey questionnaire and face-to-face interview. It will help the nurses to collect both subjective and objective data. Based on the feedback the nurses may modify the action plan and eliminate the drawbacks for positive outcomes (Mertens, 2014). It will help in proper utilization of the intervention by the health care professionals to minimise the injuries related to manual handling of patients. The positive outcomes of the intervention or change can be determined through adequate number of bed rails, assistive devices, hoists, and wheel chairs in hospitals to avoid manual handling hazards. Other indicators may include formulation of new policy such as no lift policy for ensuring safe workplace environment for nurses. Equipment advancements and establishment of safety regulation with stringent penalty system for non-compliance also indicates a positive change towards manual handling issue. An implementation of safe manual handling process may be indicated by increases in nurse awareness of the use of the assistive devices and knowledge related to manual handling related injuries. Decrease in rate of injuries is also an important indicator. The nurse may make a “business case for safe patient handling and mobility program” for presenting decision analysis (Posavac, 2015).
In conclusion manual handling is the significant hospital based issues. It demands implementation of change at the policy level, individual level as well as institutional level. To implement such changes effective leadership in clinical practice is required. In the course, the assignment discussed the aspects where the healthcare facilities can implement change with rationale and also discussed the possible barriers that can stop the facility from achieving those changes. Further, the assignment brings importance of leadership in maintaining these situation and the required attributes were mentioned with evaluation strategy for the possible outcomes.
References
Akbari, H., Akbari, H., Abadi, M. B. H., Fesharaki, M. G., & Ghasemi, M. (2017). Assessing the risk of manual handling of patients and its relationship with the prevalence of musculoskeletal disorders among nursing staff: Performance evaluation of the MAPO and PTAI methods. Iranian Red Crescent Medical Journal, 19(2).
Bernal, D., Campos-Serna, J., Tobias, A., Vargas-Prada, S., Benavides, F. G., & Serra, C. (2015). Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis. International journal of nursing studies, 52(2), 635-648.
Bernal, D., Campos-Serna, J., Tobias, A., Vargas-Prada, S., Benavides, F. G., & Serra, C. (2015). Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis. International journal of nursing studies, 52(2), 635-648.
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Colvin, C. M., Karius, D., & Albert, N. M. (2016). Nurse Adherence to Safe-Handling Practices: Observation Versus Self-Assessment. Clinical journal of oncology nursing, 20(6).
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Kneafsey, R., Clifford, C., & Greenfield, S. (2015). Perceptions of hospital manual handling policy and impact on nursing team involvement in promoting patients’ mobility. Journal of clinical nursing, 24(1-2), 289-299.
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Vaccaro, I. G., Jansen, J. J., Van Den Bosch, F. A., & Volberda, H. W. (2012). Management innovation and leadership: The moderating role of organizational size. Journal of Management Studies, 49(1), 28-51. https://doi.org/10.1111/j.1467-6486.2010.00976.x
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