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Biomedical subjects

Audrey Nelson

Publications and source records attributed to Audrey Nelson.

At least 19 recordsLinked to original sources
PubMed2005

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks.

PROBLEM STATEMENT: Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful. SPECIFIC AIMS: The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment. INTERVENTION: The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy. METHODS: A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001-January 2002) and post-intervention (March 2002-November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs. RESULTS: The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of 'unsafe' patient handling practices performed daily. Nurses ranked program elements they deemed to be "extremely effective": equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation. CONCLUSIONS: This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

Absenteeism↗
PubMed2004

Evidence-based practices for safe patient handling and movement.

Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The purpose of this article is to summarize current evidence for interventions designed to reduce caregiver injuries, a significant problem for decades. Despite strong evidence, published over three decades, the most commonly used strategies have strong evidence that demonstrate they are ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. The authors have organized potential solutions into three established ergonomic solution types: engineering based, administrative, and behavioral. For each intervention, the level of evidence to support its use is provided.

Education, Nursing, Continuing↗
PubMed2004

Technology to promote safe mobility in the elderly.

New technologies designed to help prevent adverse events related to the mobility of geriatric patients (ie, patient falls, bed-rail entrapment, patient handling, and wandering) are described. Technology offers the potential to eliminate or mitigate preventable adverse events that interfere with treatment, delay rehabilitation, potentiate impairment, and compromise patient safety. Unchecked, these adverse events can have a negative impact on patient health, functional status, and quality of life. It is not surprising that the elderly constitute the population at highest risk for adverse events, based on poor health, chronic conditions, long hospitalizations, and institutional care. Patient falls are a high-risk, high-volume, and high-cost adverse event. Key technologies to prevent falls and fall-related injuries include hip protectors, wheelchair/scooter safety features, intelligent walkers, fall alarms, and environmental aids. Bed-rail entrapment is a serious adverse event, which includes patients being trapped, entangled, or strangled in beds. New technologies to prevent bed-rail entrapment include new hospital bed designs, height-adjustable low beds, devices to close gaps in legacy beds, and bedside floor mats. Patients with mobility impairments necessitate physical assistance in transfers and other patient-handling tasks, which increases risk for the caregiver and the patient. Featured technologies to prevent patient handling injuries include innovations in floor-based lifts, new ceiling-mounted patient lifts, and improvements in powered standing lifts, new friction-reducing devices, and new patient transport technology. Wandering affects 39% of cognitively impaired nursing home residents and up to 70% of community-residing elderly persons with cognitive impairments. New technologies to prevent adverse events associated with wandering include door alarms and signal-transmitting devices. Nurses in geriatric settings would benefit from exposure to technologies that could improve patient and caregiver safety. To maximize the benefits of technology, it is critical that front-line nursing staff be involved in the testing and selection of devices that will be used in their practice. Further, to reap the full benefits of technology, a careful plan for implementation needs to be developed that would include integrating the new technology with existing infrastructure. Training needs to be provided for all staff who will be using the technology, and efforts to ensure competency over time is needed. A major barrier to widespread use of new technology is cost. Further research is needed to demonstrate the cost effectiveness of these devices. Results from these studies will help to build a business case, demonstrating that initial capital investments will result in cost savings, improved quality of care, and other benefits.

Accident Prevention↗
PubMed2004

The physical workload of nursing personnel: association with musculoskeletal discomfort.

Direct care-nursing personnel around the world report high numbers of work-related musculoskeletal disorders. This cross-sectional study examined the association between the performance of high-risk patient-handling tasks and self-reported musculoskeletal discomfort in 113 nursing staff members in a veterans' hospital within the United States. Sixty-two percent of subjects reported a 7-day prevalence of moderately severe musculoskeletal discomfort. There was a significant association between wrist and knee pain and the number of highest-risk patient-handling tasks performed per hour interacting with the load lifted. On units where lifting devices are readily available, musculoskeletal risk may have shifted to the wrist and knee.

Adult↗
PubMed2004

Upper limb pain in a national sample of veterans with paraplegia.

BACKGROUND AND OBJECTIVES: The purpose of this survey study was to examine the prevalence and intensity of pain and associated patient characteristics in a national sample of veterans with paraplegia. Of particular interest were upper limb (UL) pain conditions, which pose unique challenges to individuals who use a wheelchair for mobility. Because the risk for UL pain conditions appears to increase over time, the associations among age, duration of wheelchair use, and UL pain were evaluated. METHODS: A group of 1,675 individuals between the ages of 18 and 65 with a lesion between T2 and L2 and a mailing address on file were selected randomly from the Veteran's Affairs Spinal Cord Dysfunction Registry and mailed a survey packet. Of the deliverable packets, approximately 46% were completed and returned. RESULTS: Approximately 81% of the respondents reported at least a minimal level of ongoing unspecified pain and 69% experienced current UL pain. Shoulder pain intensity was most severe during the performance of wheelchair-related mobility and transportation activities, suggesting that UL pain may have a significant impact on functional independence. Duration of wheelchair use modestly predicted shoulder pain prevalence and intensity, but age and the interaction between age and duration of wheelchair use did not. CONCLUSION: The data of the present study suggest that the development, persistence, and exacerbation of UL pain conditions in persons with paraplegia are multidimensional processes. A comprehensive theoretic model is needed to integrate the existing empiric literature in this area.

Adult↗
PubMed2004

Measuring provider compliance with ischemic heart disease guidelines.

OBJECTIVES: The purpose of this study was to assess the relationships among provider beliefs, attitudes, and intention to use Veterans Health Administration guidelines for ischemic heart disease (IHD). METHODS: A self-administered written questionnaire was mailed to providers at six Veterans Administration hospitals in a Veterans Integrated Service Network. The questionnaire measured the providers' general impression of the IHD guidelines, factors that influence use of cardiac medications, and barriers to using the guidelines. RESULTS: A total of 170 of 491 eligible providers returned the questionnaire (35% response rate). The top reasons cited for following the guidelines were to decrease mortality, prevent future myocardial infarction, decrease the risk of recurrent events, and provide positive cardiac effects. The authors found that, overall, providers have a positive impression of the IHD guidelines because they provide a standard of care and result in higher quality of care. CONCLUSIONS: The authors' results indicate that providers support the guidelines, but encounter barriers in accessing them.

Adult↗
PubMed2004

Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence.

RATIONALE, AIMS AND OBJECTIVES: Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. METHOD: As part of a larger study to test the effects of an intervention on provider adherence to ischaemic heart disease (IHD) guidelines, we conducted five focus groups at three Veterans Administration Medical Centers with 32 primary care providers, cardiologists, and internists to identify key barriers and facilitators to adherence of the guidelines. Using content analysis, responses were grouped into categories. RESULTS: The main perceived advantages of using the IHD guidelines were improvements in quality and the cost of care. Perceived barriers were the lack of ability of guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients. While providers agreed on the benefits of aspirin, beta-blockers and angiotensin converting enzyme inhibitors, barriers for use of these medications were lack of consensus about contraindications, difficulty in providing follow-up during medication titration, and lack of patient adherence. Sources of influence for guideline use were: professional cardiology organizations, colleagues, mainly cardiologists, and key cardiology journals. However, most providers acknowledged that following guidelines was a personal practice decision. CONCLUSIONS: While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers.

Focus Groups↗
PubMed2004

Lessons learned in implementing SCI clinical practice guidelines.

While clinical practice guidelines (CPGs) were designed as a tool to improve patient outcomes, decrease practice variation, and optimize resource utilization, providers often encounter significant barriers to integrating these into clinical practice. A study was conducted at six spinal cord injury (SCI) centers in the Department of Veterans Affairs (VA) to improve provider adherence and patient outcomes of two CPGs: Prevention of Thromboembolism in Spinal Cord Injury and Neurogenic Bowel Management in Adults With Spinal Cord Injury. To design effective implementation strategies, focus groups were conducted to identify provider-perceived barriers and facilitators to implementing recommendations for each of the SCI guidelines. Based on this information, four guideline implementation strategies were designed: (a) use of local opinion leaders ("clinical champions"), (b) patient-mediated interventions, (c) standardized documentation template/standing orders, and (d) social marketing/outreach visits. These strategies were implemented at each site. This article identifies "lessons learned" during the process of trying to get these CPGs embedded into clinical practice.

Attitude of Health Personnel↗
PubMed2004

Provider attitudes and beliefs about clinical practice guidelines.

The goals of clinical practice guidelines (CPG) are to improve the process and outcomes of health care, decrease practice variation, and optimize resource utilization. The objectives of this study were to (a) describe overall provider attitudes and beliefs about CPG, and (b) describe provider attitudes and acceptance of two specific spinal cord injury (SCI) CPG. A total of 152 health care providers responsible for implementation of the CPG at participating Veterans Health Administration (VHA) SCI sites responded to a survey (response rate of 35%). Overall, SCI care providers expressed positive attitudes towards CPG, including the two SCI guidelines included in this study. A comparison of responses revealed relatively few areas in which differences existed among SCI facilities and provider groups. Nurses represented the largest provider group participating in this survey and consistently expressed the most positive responses. In particular, nurses were more positive about guidelines, recognized the benefits of the guidelines, and were more willing to support the development of guidelines, compared to other providers in the study. The results of this study suggest that negative attitudes and beliefs about guidelines might be less of an obstacle to guideline implementation in VHA SCI Centers. Nurses are in a position to play a key role in their implementation.

Adult↗
PubMed2003

Spinal cord injury providers' perceptions of barriers to implementing selected clinical practice guideline recommendations.

BACKGROUND/OBJECTIVE: Twelve focus groups were conducted at 6 Department of Veterans Affairs (DVA) Spinal Cord Injury (SCI) Centers. The purpose of these focus groups was to identify provider-perceived barriers to implementing selected recommendations of two clinical practice guidelines (CPGs)--Prevention of Thromboembolism in Spinal Cord Injury and Management of Neurogenic Bowel in Adults With Spinal Cord Injury--at their sites. METHODS: A total of 75 SCI direct-care staff (including physicians, nurses, dieticians, rehabilitation therapists, psychologists, and social workers) participated in the focus groups, which were conducted by trained focus group facilitators. Woolfs framework was used to classify perceived barriers into 1 of 4 categories: (a) lack of knowledge, (b) lack of agreement, (c) lack of ability, or (d) lack of systematic reminders for implementation. The "lack of ability" category was further expanded to reflect which specific aspect of the environment was seen as the obstacle: (a) patient, (b) provider, (c) SCI unit, (d) hospital or medical center, or (e) non-Veterans Affairs (VA) hospital setting. RESULTS: Providers disagreed with the recommendation to reinstitute prophylaxis in patients with nonacute SCI to prevent deep vein thrombosis and identified a number of system-level problems with providing appropriate prophylaxis. Providers identified patient reluctance to changing their bowel programs and difficulties in documenting changes in the patients' bowel program as obstacles to implementing the neurogenic bowel CPG. CONCLUSION: Based on this feedback, interventions were developed to address provider-perceived barriers. These interventions were implemented at 6 Veterans Affairs SCI Centers.

Adult↗
PubMed2003

Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: a pilot study.

OBJECTIVE: The purpose of this pilot study was to determine the effect of a 1.5-day multidisciplinary fibromyalgia treatment program on impact of illness, depression, and life fulfillment. DESIGN: A sample of 100 consecutive enrollees in a 1.5-day multidisciplinary group outpatient fibromyalgia treatment program between February 14, 2000, and May 9, 2000, in a tertiary medical center was used for this study. The Fibromyalgia Impact Questionnaire, the Life Fulfillment and Satisfaction Scales, and the Center for Epidemiologic Studies Depression Scale were administered to subjects immediately preceding the treatment program and by mail 1 mo after completing the program. RESULTS: The 78 subjects who returned their surveys 1 mo after treatment demonstrated significant improvement in the area of the impact of illness as measured by the Fibromyalgia Impact Questionnaire total score (51.3-44.7, P < 0.002). There was no significant improvement in depressive symptoms (P < 0.056) or the level of life fulfillment (P < 0.53). Subjects with depression improved on the Fibromyalgia Impact Questionnaire to the same degree as those without depression. The 22 nonresponders did not differ significantly from the responders in the variables of sex, age, pretreatment Fibromyalgia Impact Questionnaire score, marital status, educational level, family income, duration of symptoms, or history of depression. CONCLUSIONS: These results suggest that a 1.5-day multidisciplinary fibromyalgia treatment program does have a significant positive effect on the impact of illness among patients with fibromyalgia with or without concomitant depression and may be a cost-effective model for the treatment of these patients.

Adolescent↗
PubMed2003

Preventing nursing back injuries: redesigning patient handling tasks.

The researchers identified nine patient handling tasks that place nursing staff at high risk for musculoskeletal injuries. An expert panel redesigned these tasks using new patient handling technologies and work practice controls. The key objective was to evaluate the biomechanical benefit of the redesigned tasks. Back and shoulder muscle activity, forces on the lumbar spine, shoulder joint moments, and perceived comfort were evaluated in a laboratory setting. Using objective and subjective data, 63 participants who performed the redesigned tasks were compared with 71 participants who used standard procedures. Objective data revealed significant improvement in five of the redesigned tasks, while staff subjectively rated four of the redesigned tasks as significantly improved. Nursing tasks can be redesigned to improve caregiver and patient safety using new patient handling technologies and work practice controls. Further study is needed to redesign other high risk tasks to promote safer work environments.

Back Injuries↗
PubMed2003

Fall-related fractures in persons with spinal cord impairment: a descriptive analysis.

Falls are a significant cause of injury, disability, and death in the elderly, but little is known about the risk of wheelchair-related falls. The purpose of this study is to describe the incidence, etiology, location of fracture, treatment, and health care utilization of fall-related fractures in persons with spinal cord impairment (SCI). A retrospective review of 45 medical records of patients with SCI who sustained fractures, nonconcomitant with the onset of their initial injury, was completed at a Veterans Health Administration (VHA) SCI service over a 10-year period. Of the 24 veterans who sustained fall-related fractures, three (12%) were found to have repeated falls with fractures. Falls were sustained during activities (more than one wheelchair activity contributed to a fall; e.g., transfer activity with brake failure in a van) including transfer (44%), reaching (11%), propelling (15%), moving in bed (22%), transferring or riding in a vehicle (30%), and showering (7%). Factors contributing to falls included loss of balance, equipment failure, muscle spasms, excessive speed, not wearing protective straps, and narcolepsy. Among the 31 fractures sustained in 27 fall episodes in 24 subjects, lower extremity fractures accounted for 97% of the injuries and a fractured 7th rib accounted for one injury (3%). Tibial fractures occurred more frequently than femoral or ankle fractures. Four (15%) fall episodes resulted in bilateral fractures. The treatment of choice was to immobilize the fractured extremity with a soft, well-padded splint. Surgical fixation was performed in only two cases. Over 80% of the patients with fall-related fractures were admitted for inpatient stays with a mean of 66 inpatient days per patient. Hospital days were most often the result of home inaccessibility, inadequate support at home, or surgical intervention.

Accidental Falls↗