Which Nursing Tasks Impose Great Stress on The Back

The purpose of this study was to reduce back stress for nursing personnel by changing the physical demands of the job. The goals were :

• To determine the most stressful clients handling tasks
  
• To conduct an ergonomic evaluation of these task
  
• To find less stressful methods for carrying out these tasks, and
• To apply the less stressful methods in the clinical setting.

The ergonomic process involved identifying the jobs and specific task within those jobs that impose great stress on the back; studying and pilot testing ways to change the task demand; and implementing these changes in the work setting.
The study took place in two setting: a nursing/long-term care facility in which 38 nursing assistants ( two were males) ranging in age from 19 to 61 tears participated, and a laboratory in a university school of nursing in which six senior nursing students participated. participants listed the client handling tasks they perceived as most stressful in their duties. An ergonomic evaluation was then completed on the ten tasks perceived as most stressful.
The tasks ranked as most stressful were transferring the client on and off the toilet and in and out bed, and the transfers involved in bathing and weighing clients. The participants reported that they felt the greatest amount of exertion in the lower back. Problems encountered in the transfers were the presence of railings around toilets, unequal height of toilet and wheelchair seats, and stress levels related to the use of hoists. Problem with the use hoists resulted from body postures the nurses needed to assume in order to position the slings and the effort needed to push the hoist with the client in it.
Of the manual lifting techniques used, the method of lifting client under the axilla was perceived to be the most stressful; the walking belt was rated the least stressful. the most commonly used assistive device was the walking belt.
Implication : To minimize back pain, nurse need to explore ways to change environmental impediments, such as altering railings around the toilet and raising toilet seat levels. furthermore, nurses need to learn to use transfer device effectively.

Does Slow Stroke Back Massage Relax Hospice Clients?

This study was conducted to investigate the effect of a non pharmacologic intervention, slow stroke back massage (SSBM) on systolic and diastolic blood pressure, heart rate, and skin temperature. These effects were evaluated as indicators of relaxation in 30 hospice client, all of whom where in the terminal stage of illness.

SSBM is a slow rhytmic stroking with the hands. The hands move over a 2-inch-wide area on either side of spinous proccesses and from the crown of the head to the sacral area. The entire massage lasts 3 minutes. findings revealed that after SSBM, the client's heart rates and systolic and diastolic blood pressure decreased, skin temperatures increased. The effects of the treatment persisted for 5 minutes following SSBM.

Implications : Slow stroke back massage has been used effectively to promote relaxation with hospice clients. It is easy to administer, takes only a bief time, requires minimal supplies of massage oil or lotion, and can be taught to family caregivers.

Individualizing Care for Clients with Pain

1. Establish a trusting relationship. Convey your concern, and acknowledge that you believe that the client experiencing pain. A trusting relationship promotes ekspression of the clint's thoughts and feeling and enhances effectiveness of planned pain therapies.
2. Consider the client's ability and willingness to participate actively in pain relief measures. Some client who are excessively fatigued, are sedated, or have altered levels of consciousness are less able to participate actively. For example, a client with an altered level of consciousness or altered thought processes may not be able to deal with patient-controlled analgesia (PCA). In contrast, a fatigued client may express a willingness to use pain-relief measures that require little effort, such as listening to music or performing relaxation techniques.
3. Use a variety of pain relief measures. It is thought that using more than one measure has an additive effect in relieving pain. Two measures that should always be part of any pain may vary throughout a 24-hour period, different types of pain relief are often indicated during that time.
4. Provide measures to relieve pain before it become severe. For example, providing an analgesic before the onset of pain is preferable to waiting for the client to complain of pain, when a large dose may be required.
5. Use pain-relieving measures that the client believes are effective. it has been recognezed that clients are usually the authorities about their own pain. Thus, in corporating the client's measures into a pain relief plan is sensible unless they are harmfull.
6. Base the choice of the pain relief measure on the client's report of the severity of the pain. If a client reports mild pain, an analgesic such as aspirin may be indicated, whereas a client who reports severe pain often requires a more potent relief measure.
7. If pain relief measure is ineffective, encourage the client to try it one or twice more before abandoning it. Anxiety may diminish tehe effects of a pain measure, and some approaches, such as distraction strategies, require practice before they are effective.
8. Maintain an unbiased attitude (open mind) about what may relieve the pain. New ways to relieve pain are being continually developed. It is not always possible to explain pain relief measures; however, measures should be supported unless they are harmful.
9. Keep trying. Do not ignore a clinet because pain persist in spite of measures. In these circumstances, reassess the pain, and consider other relief measures.
10. Prevent harm to the client. Pain therapy should not increase discomfort ar harm the client. Some pain relief measures may have outward effects, such as fatigue, but they should not disable the client.
11. Educate the client and support persons abaout pain. Clients and support persons need to be informed about possible causes of pain, precipitating and alleviating factors, and alternatives to drug therapy. Misconceptions also need to be corrected.