Researchers tested four different nursing safe patient handling (SPH) training scenarios to see which one created the greatest level of compliance. Not surprisingly, they found that contextual training, meaning hands-on situational training, was more effective than classroom training, whether it be in an emergency or non-emergency patient handling situation.
In summary, they used behavioral and torso postural metrics before and after the training to measure how well the nurses retained the desired behaviors and torso postures. While there are limitations to this study, discussed below, the authors found 100% retention after one week for three key SPH behavioral goals:
- Preparing the environment
- Identifying a leader
- Communicating the process
They also found significant increases in retention for classroom trained nurses, but not the 100% seen with contextual training. There was no significant difference between behaviors and postures exhibited in emergency and non-emergency situations, thought the authors speculate that a larger sample size might have identified some difference between the two.
The nurses also showed significant postural improvements after either type of training, and the contextual training showed significant improvements over the classroom training.
The Bottom Line – How This Applies To Ergonomists
Ergonomists are often proponents of instituting safe patient handling methods and procedures at health care facilities. Our goal is to truly influence the way patient handling is performed, and we seek improvements in both provider and patient experience. As safe patient handling awareness grows, including by the force of law in some areas, more and more care facilities are attempting to tackle the issue, and training is an important component of any SPH initiative.
If SPH is viewed more as a compliance issue ("we have to do it to satisfy someone else," like the government), rather than an internally driven organizational improvement initiative, it’s easy to focus less on effective outcomes and more on compliance. Ergonomists should be prepared to advocate and explain the benefits of effective outcomes in terms that will influence decision makers. It could make the difference between going through the motions for compliance (e.g., class room training only) vs. truly improving methods and behaviors (e.g., delivering contextual, hands-on training customized to the organization).
The authors note limitations to this study, including a limited number of subjects (16), and the possibility that other types of interventions and equipment than used in this study could produce different outcomes.
In addition to these limitations, I would add that the post-training measurements were collected only one week after the training, a relatively short time period. Would the behaviors and postural changes persist over longer periods of time?
I also note that the post-training emergency and non-emergency tests were under simulated conditions, not actual patient handling conditions. Would these findings hold in real-world situations?
The researchers used a 2 x 2 factorial combination using classroom and contextual training methods in emergency and non-emergency situations. 16 subjects (10 female, six male; mean age of 33 yrs; average of 5 yrs nursing experience) were divided into groups of four, and each group was assigned to one of the four training protocols.
The performance indicator measurements consisted of postural metrics and behavioral metrics. A modified version of the Standard Posture Classification System, which uses a 0 (neutral) to 3 (severe) scale was used as the postural metric for torso flexion and torso rotation.
A pre-training test was applied to establish baseline measurements for the performance measures. A post-training test was applied 1 week after the training.
This study can be acquired from the copyright holder at: www.jenonline.org/article/S0099-1767%2808%2900588-6/abstract
Article Title: Reducing Patient Handling Injuries Through Contextual Training
Publication: Journal of Emergency Nursing, Volume 35, Issue 6, Pages 504-508 (November 2009)
Authors: ML Resnic, R Sanchez
This article originally appeared in The Ergonomics Report™ on 2010-09-08.