Prevention of Pressure Ulcers: Exploring the Influence of Nurses, Equipment and Working Techniques

Abstract: Patient immobility remains to be one of the primary causes of pressure ulcers. In spite of the evidence supporting this, it still is a daily challenge to increase or at least stabilize patient mobility. In the process of activating and mobilizing patients the type of equipment and the working technique of nurses is crucial for success. At the same time these aspects are also crucial for the protection of nurses’ backs. Repositioning in bed is rated as one of the most physically demanding transfers for nurses. From an occupational health perspective these techniques have been designed in order to protect nurses backs, shoulders and arms. The bed itself, the type of mattress, but also transfer aids like lifters and sliding sheets influence the risk profile for both the patient (pressure ulcers and others) and the nurses (occupational health problems). Force- and pressure-measurements indicate that, in order to get the maximum primary or secondary preventive effect out of the equipment, the working technique of nurses plays an important part. An analysis was made of the three most common repositioning techniques. Measurements (MecMesin and X-Sensor) and calculations (3D SSPP 6.0) demonstrate that small differences in technique result in large differences in pressure distribution, contact-area, the risk of shear forces under the patient’s skin and the biomechanical load for the nurses. The conclusions drawn from these findings are partly contradictory when it comes to practical recommendations for the nurses. Even during the process of frequent repositioning, a procedure intended to reduce the risk of developing pressure ulcers, some of techniques currently taught in regular nursing training may be safe for the nurses to perform from an occupational health perspective, but in fact also result in an increase in risk for the patient instead of the intended decrease. In this study a cross-over is made between the field of biomechanics and ergonomics and the clinical research on the prevention and treatment of pressure ulcers. Such a cross-over, so far, although still in a developmental stage, seems to be relevant for daily practice and has led to a currently on-going process of re-design of transfer techniques.

Keywords: Ergonomics, transfer techniques, pressure ulcer, back pain, occupational health, nurses

DOI: 10.54941/ahfe100474

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