The patient transfer task : methods for assessing work technique

Sammanfattning: The ability to move is an important part of everyday life. Assisted transfers, at hospitals or at home, can lead to high physical load on the nurse's musculoskeletal system, which in turn could cause musculoskeletal problems. The overall aim of this thesis, comprising five studies, was to develop methods for assessing the nurse's work technique in patient transfers tasks, with the focus on the load on the musculoskeletal system, and to evaluate work technique after participation in training programmes. Further aims were to evaluate the patient's safety and comfort in transfer situations, and to describe older people's experiences of transfer situations. In Studies I-II, two observation instruments for assessment of nurses' work technique were developed (Pate and DINO). The tests of validity and reliability for both instruments were acceptable to satisfactory, and the evaluations of work technique showed that they functioned as intended. In Study III, the video observation instrument (Pate) was used. The training programme consisted of two models of learning, traditional groups and quality circles, and was evaluated by using the video observation instrument. The patient rated perceived safety and comfort, while the participants rated their own work technique, comfort and perceived exertion during the transfer, using rating scales. The result showed that immediately after training the participants in both models of learning had improved their work technique, and that both the patient and the nurse perceived the transfer to be more comfortable. There was no difference in the effect of the two models of learning. No reduction of musculoskeletal problems was reported by the participants six months after training. In Study IV, the work technique of nursing students after proficiency training in patient transfer methods was evaluated by using the direct observation instrument (DINO). The results showed that the students improved their work technique after training. Both the patient and the students perceived the transfer to be more comfortable. There was also a positive correlation between the student's work technique and the patient's perceptions of safety and comfort during transfer. Study V focused on the older people's experiences of being assisted in transfers, using a qualitative method with semi-structured interviews. The results showed that older people experienced fear of falling and fear of pain, and thus of endangering the healing process in assisted transfers. The participants considered that this fear depended both on their own inability and on the nurse's lack of knowledge in performing safe patient transfers. This thesis indicates that the instruments showed acceptable to satisfactory reliability and validity; and that the work technique of the participants improved directly after training. Furthermore, patient ratings of perceived safety and comfort increased. Using training programmes in recommended patient transfer methods can be seen as primary prevention, since these programmes make it possible for the nurse to learn work technique that could lead to a decreased load on the musculoskeletal system. For the patient, the nurse's acquired skills could lead to a safer and more comfortable transfer, and to improved quality of care.