Back sprains and strains are the leading causes of work-related musculoskeletal disorders for nurses, who continue to have the highest job-related injury rates of any occupation, according to the Bureau of Labor Statistics. A major contributing factor? Overexertion from lifting, as you might have guessed. The best way to prevent back injuries from lifting is to avoid lifting tasks, but this is hardly practical in surgical facilities. The answer lies in ergonomics, balancing the physical capabilities of the worker to the physical demands of the job and realizing that patient handling tasks are unique and unpredictable, as the level of assistance a patient can offer may change at any point.

Unlike other industries where lifting occurs in vertical planes, patient handling tasks are accomplished in horizontal planes, as patients are supine (repositioning in bed, transferring from operating room table to stretcher, stretcher to bed or bed to chair) when needing assistance. The horizontal planes of movement apply shear stress on the spine in both the anterior-posterior and lateral planes. Here are five work-method tips to assist in patient handling tasks that should also be combined with engineering and administrative controls.

1. Assess the patient's physical and cognitive status.
Before you lift, ask yourself several questions. Are the patient's size and weight barriers to safe lifting? Is the patient able to cooperate and follow instructions? Does the patient have any sensory limitations due to medications? Is the patient able to provide assistance by bearing weight, fully or partially, or not at all? Is the patient able to assist with her upper extremities? Is the patient able to properly balance and coordinate his body to assist?

2. Prepare and plan your work organization based upon your work surroundings.
Safe housekeeping is safe working. Be sure the path for transfers or movement is clear. Check the work area for spilled fluids, cords and other equipment. Are you able to safely handle medical devices such as IV tubing, monitoring devices, catheters and oxygen tubing? Is there proper lighting? Apply brakes to beds and chairs to eliminate unnecessary movements that may cause harm. Remove arm and foot rests on wheelchairs to eliminate barriers. Does the patient have non-slip footwear?

3. Get necessary help and equipment.
Always consider using mechanical aids for assistance, such as lift aids, gait belts, slings and anti-friction devices. Rely on other staff members when you have assessed that you need lifting help.

4. Use adjustments on equipment to make your job easier.
Adjust equipment to the proper height to minimize reaching and bending and to keep tasks within your primary reach zone, which is at waist level when your elbows are bent at 90 degrees to your body's trunk.

5. Perform the patient handling safely.
Explain the task to the patient and determine how much help he can give during the task, if any. Your goal is to have the patient assist as much as possible.

Position equipment correctly. This could mean lowering bed rails, raising convertible stretcher chairs and adjusting bed and table heights to eliminate barriers.

Coordinate your task as a team with the other person who may be assisting you (the patient or other nursing personnel). Plan the direction and timing of the move.

Use your body as one unit. Keep loads close to the body. Use a wide stable base of support with your feet firmly placed at least shoulder-width apart. Lower your center of gravity and keep your head upright with your nose between your toes. Bend at the hips and not at the waist.

Maintain the normal "S" curve or neutral position for your spine. Use your large leg muscles rather than the small muscles of the trunk and upper extremities. Tighten your abdominal muscles to stabilize your spine and pelvis while also tucking in your buttocks.

Point your toes in the direction you are planning to move with one foot planted in the direction of the move. Pivot with both feet in the direction of the move. Never twist at the waist or your back. Firmly grasp the patient with your full hand. Move in stages if necessary.

Optimal solution
When you combine these five safe work methods with engineering and administrative controls, you'll be providing the most optimal injury risk reduction to employees and patients. In addition, redesigning difficult and demanding jobs by applying ergonomic principles and concepts makes patient handling a win-win for all stakeholders.