Accidents leading to over-exertion back injuries among nursing personnel

Sammanfattning: The overall aim of the present thesis was to contribute to the knowledge of occupational accidents leading to over-exertion back injuries among nursing personnel, which can be used for developing effective preventive strategies. Different combinations of factors and events were assumed to determine the type of accident process leading to an over-exertion injury. The first study used the Swedish Occupational Injury Register (ISA) to investigate the occurrence of reported accidents leading to back injuries among female assistant nurses in the working population during a two years period. In Study II standardised instruments for the systematic investigation of accidents were developed with the aim to collect the information necessary for effective accident prevention. The third study investigated factors involved in the accident process leading to back injury by using these instruments. Study IV identified and quantified work-related and non-work-related risk indicators for reported back injuries. Study V identified different patterns of risk indicators in the nurses' work situation and factors modifying the risk for back injuries in these situations. The source population was all nurses employed in the Stockholm County hospitals (totally 24,500 persons) and the observed periods were 12 months (Study III) and 36 months (Study IV-V), respectively. Assistant nurses had a high relative risk of accidents leading to over-exertion back injuries compared to other Swedish women, and also compared to registered general nurses. Most accidents occurred during patient transfer. Several factors contributing to the accident process were identified by the instruments. One important factor was deficiencies in the work environment, e.g. lack of space or lack of transfer devices, which entailed the nurse to perform patient transfers in a non-optimal way. Six types of accidents were defined by their pattern of factors contributing to the risk associated with the accident process. The strongest risk indicators for reporting a back injury were working in an orthopaedic ward, performing regular patient transfers and working full-time. The relative risk of patient transfer was lower among nurses who had received training in how to use the devices on their own ward, and who frequently used transfer devices. Further, six homogeneous groups of work conditions and their modifiers were identified, two of which were associated with an increased risk. These groups consisted of a high proportion of assistant nurses working full-time, on a rolling schedule and regularly performing patient transfers. A large proportion of the groups had had a prior injury. The three low-risk clusters were primarily characterised by part-time work. According to the results in this thesis, the most important measures for prevention of accidents leading to over-exertion back injuries are related to the work organisation and measures directed towards the environment.