The hidden time-bomb causing injuries to nurses & carers

March 1, 2023 Phil Strong

Statistics show that 80-90% of us will have a sore back at some time(s) in our lives to the point where we consider it an issue. For the majority of people, this is because our bodies can’t keep up with the demands we place on them and there are many contributing factors.

Nurses and care-givers who care for patients ‘inbed’ are at particular risk due to the repetitive nature of their work, process design which doesn’t take this into account and compromising body mechanics (ie poor posture when doing their job). It’s a hidden time-bomb as it can take years or even decades before (accumulative) visible damage or disease symptoms appear.

For nurses and care-givers, their compromised posture when manually moving or repositioning patients can cause additional forces on their bodies, leading to fascia damage. Studies have shown that fibromyalgia often occurs when the fascia adheres and creates restrictions throughout the body.

As fascia is a protective mechanism it can usually heal itself without any problems. However, damage depends on the tissues involved and how much force it can withstand, i.e. the tissue threshold. The tissue threshold is defined by the amount of force, chemical events (including redox) and/ or radiation (including temperature) any given tissue can handle. Generally, it makes sense to discern “normal force” – in other words, events surpassing the tissue threshold of healthy tissue causing trauma, but within the limits of normal homeostasis.

If these tissue thresholds are exceeded, they sometimes do not heal correctly causing it to harden. This develops restrictions and hypersensitivity and as a result can cause tension throughout the rest of the body and pain (often in the back, neck and shoulders).

What’s becoming clear from pioneering research is the role of biotensegrity ie a person’s fascia, and the body’s natural way (homeostasis) of working within gravity and using tensegrity to avoid tissue damage.

Caring for a patient inbed can be physically demanding, not least because of there is a lot of standing, bending and reaching involved. Jerry Sitek gives a good explanation of why: “We live in gravity and the weight and force our body produces on our feet, ankles, legs and spine while standing is extensive. As a result our body works overtime to hold balance on two feet. Everyone has internal body sway that constantly corrects for balance and gravity. This is done through the body’s collagen lining called the fascia which attaches, stabilises, encloses, and separates muscles. Those of us who have experienced a therapeutic massage know the relaxation it provides but perhaps are not aware that the relaxation is a direct result of massaging the fascia. When the body lacks balance, body sway becomes extensive, the fascia becomes tense and loses its elasticity and the muscles become tense and fatigued, expending substantial energy to balance. Looking at it from that perspective, you can see just how hard our body works to balance and remain upright.”

However, many of the present accepted and recommended products used, methods and practices for inbed care continue to expose the nurse/ carer’s tissues to unnecessary stresses and forces. This is mainly due to the present practice of working against gravity during the caring acts of supporting, moving and stabilising the patient.

For example, nurses and carers do a lot of standing. The real reason standing becomes painful is because, “When standing in one spot, the body works so hard to balance (consciously and subconsciously) that body sway becomes detrimental if not controlled and causes excess tension and strain in muscles we use to balance. Extended duration standing then results in body and muscle fatigue which allows for development of more critical health issues and can even play a role in the safety while performing a task.”

Sitek continues, “Because we are uncomfortable standing, we begin cognitively thinking (perhaps mostly subconsciously) about how to find relief. That is depleting the available thought capacity we are using to do our work. This leads to inefficiency, chronic body pain and in some cases, injury.”

For nurses and carers, this indicates that standing and working against gravity will have an effect on their concentration as well as their physical health. This is certainly supported by research into the link between the cerebellum, midbrain, and cerebral function.

Eliminating the physical impact by using an ergonomic and biotensegrital approach

Whilst Phil-e-Slide has long-been calling for change (and explaining why there is resistance to it), organisations such as the Chartered Institute of Ergonomics and Human Factors are starting to listen and in 2017 launched their white paper to encourage design to help people “do the right thing” and “make it impossible or hard to do the wrong thing”.

However, using the present thinking and practices trajectory, a focus on the Healthcare Vision for 2037 mean until then, many more healthcare professionals will be injured “whilst doing their jobs” with many of them caring for patients inbed.

A change in focus is needed from that of managing the forces that are at work to one that is predicting and preventing them instead. Only then will the physical and concentration effects these have on care-givers be eliminated.

De-fusing the “time bomb” today

The good news is that this can be achieved today – with products currently available – and by using a philesynergetic approach. This works with (rather than against) gravity, removing the need for care-givers to physically move patients when being cared for inbed. Nurses/ carers will not need to manually handle a patient as they can be supported, repositioned and stabilised in a controlled manner using an intuitive inbed care system. It also removes some of the time they spend standing whilst undertaking these tasks. Our “Safety Dance” video explains in more detail how this approach works and the types of beds, their features and bedding layers already available, can work together (but need to be used synergetically) to achieve this.

This approach meets the Chartered Institute of Ergonomics and Human Factors aim to help people do the right thing – and avoid behavioural drift – through intuitive design, and as such eliminates the injury risk to both care-giver and their patients.