PATIENT HANDLING ERGONOMICS IN FINLAND
Finnish Institute of Occupational Health
Musculoskeletal disorders are common among Finnish health care workers. Neck and shoulder disorders are more common than low back symptoms. Nurses’ physical working environment and practices have improved during the last ten years, but there are still many problems. The new evidence-based methods to assist disabled patients to move are not yet in common use and the best possible advantage is not taken of the new technical aids for patient transfer.
Finland has been an independent republic since 1917. The population is 5.2 million and the area 338 000 km2 (population density 15 per km2). Two thirds of the population live in urban areas. The labour force is 2.4 million; 18 % of the population is under 15 years old and 16 % over 65 years (Statistics in Finland, 2004). The relative share of the elderly will increase in the coming decades and the care of the elderly will be under great pressure.
The majority of the population (92 %) speaks Finnish, while the minority (6 %) speaks Swedish. There are 107, 000 foreigners (2 %) (Statistics in Finland, 2004).
Finland has a public health care system, which covers nearly 90 % of all services. The municipal health care centres provide primary health care, which includes maternity and child care, school and student health care, occupational health care, home nursing and dental care.
The social and health care services employ 346,000 peoples, which is 15 % of the employed population (Statistics in Finland, 2004).
The health care expenditure per capita was 1963 € in 2002, constituting 7.3 % of GDP. The social expenditure per capita in Finland was 7089 €, which is 26.4 % of GDP (National Research and Development Centre for Welfare and Health, 2004).
Alltogether 72 % of the population reported musculoskeletal disorders during the previous month. The self-reported rate of musculoskeletal disorders among health and social workers was 75 %; for the neck-shoulder area 57 %, and for the low back 34 % (Piirainen et al, 2003). These figures are somewhat higher than in the general population. In the NEXT study (nurses early exit study) (Estryn-Behar et al, 2003) the working situation of the nursing profession in ten European countries was explored with the aim of identifying why nurses are leaving their profession early. In this study the point prevalence of musculoskeletal disorders (MSD) was high; more than a quarter of the nursing staff at any occupational level and in any country had a diagnosis of MSD made by a physician (Fig 1). Dutch, British, Norwegian and Finnish nurses reported MSDs less frequently than those from other countries. (Estryn-Behar et al, 2003.)
Figure 1. The point prevalence of musculoskeletal disorders among nurses in ten European countries in the NEXT study (Estryn-Behar et al, 2003).
The Finnish Ministry of Social Affairs and Health, the Department for Occupational Safety and Health, has published guidelines for application of the legislation on "Manual handling of loads", based on the European Directive 90/269 EEC. It came into force on 1 January 1993.
The Finnish Occupational Safety and Health Act (738/2002) has several sections which relate to patient handling ergonomics: analysis and assessment of the risks at work, design of the working environment, providing auxiliary and other technical devices , as well as a special section on ergonomics of the workstation, work postures and work motions.
The Finnish Institute of Occupational Health first published a patient-handling guide book, translated from the English book "The handling of patients. A guide for Nursing Managers” in 1984. In 1998, the institute published a new book about patient handling ergonomics, where the newer methods were introduced (Tamminen-Peter and Wickström, 1998). The most commonly taught transfer methods in Finland are the Durewall and the Kinaesthetics methods. In the Durewall method, the main principle is to create the greatest effect with the smallest power. The nurse is gliding, pulling or pushing instead of lifting. She works in a walking position and keeps moving with the patient, using kinetics energy. She avoids gripping and uses soft whole palm holds. (Durewall, 1992.) Kinaesthetics is both an approach and a tool that systematically describes and analyses the fundamental nature of human movement and its meaning for self-control, learning, performing daily activities and improving health. The resources of the patient are used to promote the development of her/his health. Through skilled touching a nurse is able to both guide and adapt to a patient's motion, thereby minimizing the risk of injury to both. Spiral patterns of movement are promoted because they require less effort, space and time than parallel motion patterns. (Hatch et al, 1994). Both methods have proved to be less strenuous than traditional assisting techniques (Tamminen-Peter, 2004).
A survey by Siukola et al. (2004) examined the nursing staff’s experiences of working conditions, practices and ergonomic arrangements during the years 1992 -2003 in Finland. The nurses’ physical working environment and work practices had improved during that period. Progress had been made in ergonomics of beds and auxiliary devices for patient handing, but there are still problems like lack of space, especially in hygiene facilities. To solve the problems, more attention should be paid by head nurses and occupational health care to promote and develop nurses’ working conditions. (Siukola et al, 2004.) The aids most used are different sliding sheets; a low-friction silk sheet is a common option for moving patients up in bed and double – thickness roller sliding sheets for moving patients to a shower trolley (Körkkö, 2004). Hoists are not yet available in all institutions where they would be needed (Siukola et al, 2004), and, on average only 35 % of the nurses use hoists, though the frequency of usage varies a lot in the different institutions (Körkkö, 2004).
The traditional assisting techniques such as drag lifts are still commonly applied. Thus, the education in patient-handling ergonomics should be developed toward evidence-based methods in the professional training of health care workers. Systematic analysis and assessment of the risks in the workplace for implementing the new occupational safety and Health Act should also be started in all health and social care institutions.
Durewall - institutet. Homepage (www-document). Up-dated 5.12.2003, (referred 19.1.2005).www.durewall.com
Estryn-Behar, M., le Nézet O., Laine, M., Pokorski, J., Caillard, J-F. and the Next-Study Group 2003, Physical load among nursing personnel. In H-M. Hasselhorn, Peter Tackenberg & Bernd Hans Müller (Ed.) Working conditions and intent to leave the profession among nursing staff in Europe. Report No 2003:7, University of Wuppertal.
Hatch, F., Maietta, L. & Schmidt, S. 1994, Kinaesthetic: Interaction durch Berührung und Bewegung in der Krankenpflege. 3. Auflage. (Deutscher Berufsband für Pflegeberufe, Deutschland)
Körkkö, S. 2004, Use of assistive devices in lifts and transfers among nursing personnel and occupational physiotherapist training impact on their use. (In Finnish, with a summary in English. Nosto- ja siirtovälineiden käyttö hoitotyössä ja työfysioterapeutin koulutuksen vaikutus niiden käyttöön.) (Turun ammattikorkeakoulu, Turku)
Manual handling of loads, guidelines for application of the legislation based on the European Directive 90/269 EEC 1993, (In Finnish Käsin tehtävät nostot ja siirrot työssä) The Finnish Ministry of Social Affairs and Health, Department for Occupational Safety and Health (Pk-paino, Tampere)
National Research and Development Centre for Welfare and Health (STAKES) 2004, Health care Expenditure and Financing in 2002. www.stakes.info/2/14/index.asp
Occupational Safety and Health Act (738/2002). Ministery of Social Affairs and Health, Finland.
Piirainen, H., Hirvonen, M., Elo, A-L., Huuhtanen, P. ym. 2003, Work and Health – interview report 2003 (In Finnish Työ ja terveys –tutkimus 2003) (Työterveyslaitos, Helsinki)
Siukola, A., Nygård, C-H., Stålhammar, H. and Perkiö-Mäkelä, M. 2004, Ergonomics and promotion of work conditions in nursing between the years 1992 and 2003, (In Finnish, with a summary in English Ergonomia ja työolojen kehittäminen hoitotyössä vuosina 1992-2003) Työ ja Ihminen 4 (accepted)
Statistics in Finland 2004, Statistical Yearbook in Finland, (Karisto, Hämeenlinna)
Tamminen-Peter, L. 2004, A psychophysical comparison of three patient handling methods, when assisting the geriatric patient to move from wheelchair to bed. In Abstract Book of Fifth International Scientific Conference on Prevention of Work-related Musculoskeletal Disorders. (Premus 2004 Jul 11-15; Zürich)
Tamminen-Peter, L. and Wickström, G. 1998, Manual patient handling. Skilled nurse activates and supports. (in Finnish Potilassiirrot. Taitava avustaja aktivoi ja auttaa.) (Työterveyslaitos, Helsinki)