To lift or not to lift: An institutional ethnography of patient handling practices
View File(s)
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for de Ruiter, Hans-Peter by View
Title | Page Views |
---|
Popular Works for de Ruiter, Hans-Peter by Download
Title | Downloads |
---|
View Citations
Citations
The handling (lifting, mobilizing, moving etc) of patients is an integral part of the carework in health-care institutions. For obvious reasons, this puts healthcare providers at risk for musculoskeletal injuries (MSIs); furthermore the risk of such injuries has been considered an inherent risk of care work. In the last decade a concerted effort has been made to decrease (with the goal of eliminating) caregiver injuries by implementing safe patient handling programs (SPHP). These programs are presented as evidence-based algorithms that require the use of mechanical lifting devices. Institutions implement SPHPs as policies and procedural guidelines to which caregivers must conform. SPHPs represent a change in institutional thinking from the earlier belief that MSIs were inherent to care work, to the contemporary idea that injuries are preventable. Despite these efforts, healthcare providers continue to be exposed to the risk of injury.
The assumptions underlying the SPHP are open to questions, none of which are addressed in the literature. Most importantly the literature does not take into consideration that healthcare providers are handling individual patients with subjective and unique needs. For the purpose of understanding why healthcare providers continue to be exposed to the risk of MSIs, the purpose of this study is to explore how the generic policies and guidelines meant to apply to all patient-caregiver interactions impact patients and caregivers in everyday care work. In particular, this study examines the complexity of care delivery on inpatient care units that have implemented the latest research recommendations regarding safe patient handling. This study starts with the assumptionthat care workers are positioned at the intersection between the patient and the hospital policies and guidelines that govern their care. In order to understand the caregivers’ continued exposure to injury, this study examines the work of caregivers during their shift and the policies and guidelines they encounter that impact their decisions.
This study is an Institutional Ethnography (IE), a unique research approach that makes visible how complex actions in everyday care work are coordinated by institutional texts such as policies and guidelines. This research approach permits the researcher to make visible the connection between the actual day-to-day experiences of people and the organizational priorities as reflected in institutional texts.
This study was conducted in two healthcare facilities on neurology and rehabilitation units which had instituted SPHPs and had state-of-the-art lifting equipment. Two sources of data were collected for this study, the first were observations of every day lifting. It describes caregiver practice beginning with 1. A description of how caregivers obtain the knowledge they need to handle the patients encountered during their shift. 2. What occurs once the caregiver encounters the patient. 3. Their decision-making process used to determine how to transfer a patient. 4. How the transfers are brought into action, and 5. How this care is then documented and reflected in the patient's record. The second source of data were the institutional texts that impacted the handling of patients. These were identified by interviewing caregivers and managers and performing searches in institutional data bases.
Key findings of this study are that 1. Caregivers are subjected to multiple policies simultaneously that require conflicting actions, 2. The knowledge needed to handle patients safely is primary contextual knowledge of the individual patient, 3. The conflict between institutional texts is an important reason why caregivers continue to be exposed to risk of injury, 4. Practice that does not lead to adverse outcomes is invisible, only when problems occur does the practice become visible for the institution because of documentation requirements 5. Documentation is the primary tool for reflecting patient handling practices, yet the patient health record does not reflect actual practice but rather is a reflection of the institutional priorities. These finding have implication on actual documentation practices, health-care policy making and the moral impact on caregivers.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3339000; ProQuest document ID: 275982965. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Ethnography |
Research Approach | Qualitative Research |
Keywords | Patient Handling; Workplace Injuries; Nurse Safety; Healthcare Policy; Nurse Musculoskeletal Injuries (MSIs) |
Grantor | University of Minnesota |
Advisor | Liaschenko, Joan; DeBruin, Debra |
Level | PhD |
Year | 2008 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Related items
Showing items related by title, author, creator and subjects.
-
When the injured nurse returns to work: An institutional ethnography
Clune, LaurieNursing is a high risk profession for injury. A Canadian survey reports many nurses are in poor physical and emotional health; they sustain more musculoskeletal and violence related injuries than other occupational groups. ... -
Job satisfaction in relation to communication in healthcare among nurses: Practical recommendations
Vermeir, Peter; Degroote, Sophie; Vandijck, Dominique; Verhaeghe, Rik; Vogelaers, Dirk; Mariman, AnEffective communication and teamwork are essential to provide high-quality care and patient safety. Poor communication can lead to various negative outcomes, such as discontinuity of care and compromise of patient safety. ... -
Lean Healthcare from the institutional, professional, and patient perspectives
Fernandes, Hellen Maria de Lima Graf; de Jesus, Mariana Véo Nery; da Silva, Dirceu; Guirardello, Edineis de BritoLean is a management philosophy derived from the Toyota System, widely applied in the industry and adapted to the health area in order to reduce costs and optimize resources by reviewing processes to generate value for the ... -
Keeping nurses safe: Creation of a safe patient handling and mobility program
Powers, Rebekah; Ramdeo, Christina (2017-03-03)Session presented on Saturday, March 18, 2017: Work related musculoskeletal injuries among nurses are costly. As many as 20% of nurses who leave direct patient care do so because of risks associated with their work (OSHA, ... -
Exploring patient assessment practices in the acute hospital environment: An ethnography
Osborne, Sonya R. (2014-11-17)Session presented on Friday, July 25, 2014: Purpose: In Australia, as in other countries, recognising and responding to clinical deterioration in hospitalised patients has become a national priority. Ward nurses play an ...