Articles by Safe Lifting Science

Biomechanical Analysis

• Buckle, P."Epidemiological aspects of back injuries within the nursing profession." International Journal of Nursing Studies, 24(4), 319-324 (1987).
• Daynard, D., Yassi, A., Cooper, J.E., Tate, R., Norman, R., & Wells, R. " Biomechanical analysis of peak and cumulative spinal loads during patient handling activities: a sub-study of a randomized controlled trial to prevent lift and transfer injury health care workers." Applied Ergonomics, 32, 199-214 (2001).
• Engkvist, I-L., Kjellberg, A., Wigaeus, H.E., Hagberg, M., Menckel, E., & Ekenvall, L. " Back injuries among nursing personnel – identification of work conditions with cluster analysis." Safety Science, 37, 1-18 (2001).
• Gagnon, M., Roy, D., Lortie, M., & Roy, R "Evolution of the execution parameters on a patient handling task. La Travail Humain, 51, 193-210 . (1988).
• Garg, A., Owen, B., Beller, D., & Banaag, J. " A biomechanical and ergonomic evaluation of patient transferring tasks: Bed to wheelchair and wheelchair to bed." Ergonomics, 34, 289-312 (1991a).
• Garg, A., Owen, B., Beller, D., & Banaag, J. " A biomechanical and ergonomic evaluation of patient transferring tasks: wheelchair to shower chair and shower chair to wheelchair." Ergonomics, 34, 407-419 (1991b) .
• Lavender,Steven A.,Thomas, James S. Chang, Dennis and Andersson, Gunnar B.J. "Effect of Lifting Belts, Foot Movement, and Lift Asymmetry on Trunk Motions.". Human Factors. December 1995, 37(4), 844-853. Lloyd, J., & Baptiste, A. " Biomechanical evaluation of friction-reducing devices for lateral patient transfers." Research Rehabilitation & Development Journal. (2004, In Press).
• Ropicky,James Allen. "Chiropractic Rehabilitation: Appropriate Treatment of an Acute Intervertebral Disc Syndrome." ChiroMed Rehabilitation Center. Pewaukee, Wisconsin.
• Laflin, K., & Aja, D " Healthcare concerns related to lifting: an inside look at intervention strategies." The American Journal of Occupational Therapy, 1, 63-72 . (1994).
• Garg, Arun " Long Term Effectiveness of "Zero Lift" Program for Preventing Injuries to Nursing Personnel.", University of Wisconsin-Milwaukee, School of Industrial and Manufacturing Engineering
• Retsas, A., & Pinikahana, J " Manual handling activities and injuries among nurses: An Australian hospital study." Journal of Advanced Nursing, 31, 875-883 (2000)..
• S.M., & Norman, R.W " Partitioning of the L4/L5 dynamic moment into disc, ligamentous and muscular components during lifting." Spine, 11(7), 666-678 McGill, . (1986).
• Bohannon, R., & Grevelding, P " Reduced push forces accompany device use during transfers of seated subjects." Journal of Rehabilitation Research and Development, 38, 135-139 . (2001).
• Evanoff, B., Wolf, L., Aton, E., Canos, J., & Collins, J ." Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace." American Journal of Industrial Medicine, 44, 451-457 (2003)
• Steven A. Lavender, Gary A. Mirka, Richard W. Schoenmarklin, Carolyn M. Sommerich, L.R. Sudhakar, and William S. Marras "The Effects of Preview and Task Symmetry on Trunk Muscle Response to Sudden Loading." Ohio State University, Columbus, Ohio. February 1989. Human Factors. 31(1), 101-115. ("…these large muscle forces are responsible for most of the compressive and shear loadings placed on the spine and hence, responsible for the resulting back injuries when these loadings become extreme." Pg 101. "Sudden loading under asymmetric conditions can be anticipated to produce even more extreme loadings on the spine than comparable sagittally symmetric conditions, thus increasing the likelihood of low back injury." Pg 102.)

 

Postural/Spinal Loading

• Buckle, P " Epidemiological aspects of back injuries within the nursing profession." International Journal of Nursing Studies, 24(4), 319-324 . (1987).
• Fragala, Guy; "Ergonomic Solutions for Preventing Patient Care Worker Back Injury." Ergomics: Wy'East Medical. Clackamas, OR. ("If the loads being lifted are excessive and beyond what is safe for a healthcare worker to lift - no matter how the lift is conducted - it will be intrinsically unsafe." Pg 8.)
• Garg. Arun " Long Term Effectiveness of "Zero Lift" Program for Preventing Injuries to Nursing Personnel.", University of Wisconsin-Milwaukee, School of Industrial and Manufacturing Engineering
• Gilbertons, L.G., Krag M.H., & Pope, M.H. " Investigation of the effect of intra-abdominal pressure on the load bearing of the spine." Transactions of the Orthopedic Research Society, 8, 177 (1983).
• Knibbe, Nico and Knibbe, Hanneke " Postural Load of Nurses during Bathing and Showering of Patients: Results of Laboratory Study: " Professional Safety, November, 1996, 37-39.
• Lavender, Steven A.;Shakeel, Kharwar; Andersson, Gunnar B.J. and Thomas, James S. "Effects of a Lifting Belt on Spine Moments and Muscle Recruitments after Unexpected Sudden Loading." . June 15, 2000. Dept. of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; and the Dept. of Kinesiology, University of Illinois at Chicago, Chicago, Illinois. Supported by NIOSH grant K01-OH03339-02. Spine. 25(12).
• Lavender, Steven A.; Mirka, Gary A.; Schoenmarklin,Richard W.; Sommerich, Carolyn M.; Sudhakar,L.R. and Marras, William S. "The Effects of Preview and Task Symmetry on Trunk Muscle Response to Sudden Loading." Ohio State University, Columbus, Ohio. February 1989. Human Factors. 31(1), 101-115. ("…these large muscle forces are responsible for most of the compressive and shear loadings placed on the spine and hence, responsible for the resulting back injuries when these loadings become extreme." Pg 101. "Sudden loading under asymmetric conditions can be anticipated to produce even more extreme loadings on the spine than comparable sagittally symmetric conditions, thus increasing the likelihood of low back injury." Pg 102.)
• Marras,W.S; Davis, K.G; Kirking,B.C and Bertsche, P.K "A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques." . 1999. Ergonomics. 42(7), 904-926. ("Overall, patient handling was found to be an extremely hazardous job that had substantial risk of causing a low-back injury whether with one or two patient handlers." Pg 904.)
• Marras, W.S., Davis, K.G., Kirking, B.C., & Bertsche, P.K. " A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques." Ergonomics, 42(7), 904-926 (1999).
• Marras, W.S., King, A.I., & Joynt, R.L " Measurements of loads on the lumbar spine under isometric and isokinetic conditions." Spine, 9(2), 176-187 . (1984).
• Marras, W.S., King, A.I., & Joynt, R.L. " Measurements of loads on the lumbar spine under isometric and isokinetic conditions." Spine, 9(2), 176-187 (1984.
• Marras, William; Davis, Kermit G. Heaney, Catherine A.; Maronitis, Anthony B., and Allread, Gary W. "The Influence of Psychosocial Stress, Gender, and Personality on Mechanical Loading of the Lumbar Spine." December 1, 2000. Spine. 25(23), 3045-3054. Reprint requests: marras.1@osu.edu. ("This study provides an indication, for the first time, that there is a biomechanical pathway to spine loading associated with psychosocial stress.")
• Marras, W.S., Lavender, S.A., Leurgans, S.E., Rajulu, S.L., Allread, W.G., Fathallah, F.A. et al " The role of the dynamic three-dimensional trunk motion in occupationally-related low back disorders." Spine, 18(5), 617-628. (1993).
• McGill, S.M., & Norman, R.W. " Partitioning of the L4/L5 dynamic moment into disc, ligamentous and muscular components during lifting." Spine, 11(7), 666-678 (1986).
• Meyer, E. " Patient lifter in a practical test. a spine-saving aid or bulk in the storage room?" Pflege Aktuell, 49, 597-600 (1995).
• Ropicky, James Allen "Chiropractic Rehabilitation: Appropriate Treatment of an Acute Intervertebral Disc Syndrome." . ChiroMed Rehabilitation Center. Pewaukee, Wisconsin.
• Snook, Stover H. and Ciriello. Vincent M. "The design of manual handling tasks: Revised tables of maximum acceptable weights and forces." September 1991. Ergonomics. 34(9), 1197-1213.
• U.S. Department of Labor Ergonomics Program: Final Rule. Section E. "Disorders of the Low Back." Federal Register. November 14, 2000. Occupational Safety and Health Administration. 29 CFR. Part 1910. 65(220), 68468-68483. Online: http://www.access.gpo.gov/su_docs/fedreg/a001114c.html. Scroll down to Occupational Health and Safety Administration. Select pages 68461 - 68510. Scroll down to Section E. (Discussion includes cadaver studies helpful in determining tolerance limits of compressive forces to the lumbar spine, pathophysiology of cumulative trauma injury to spinal discs, and studies on nurses' back injuries from lifting and moving patients.)

Ergonomic Evaluation

• Bell, F. " Ergonomic aspects of equipment." International Journal of Nursing Studies, 24, 331-337 (1987).
• Bell, F., Dalgity, M., Fennell, M., & Aitken, R " Hospital ward patient-lifting tasks." Ergonomics, 22(11), 1257-1273 . (1979)
• Bewick, N., & Gardner, D "Manual handling injuries in health care workers. International Journal of Occupational Safety and Ergonomics, 6, 209-221. (2000).
• Blosser, Fred Media Relations " No evidence that back belts reduce injury seen in landmark study of retail users," ( 202) 401-3749 Center for Disease Control and Prevention( CDC)National Institute for Occupational Safety and Health ( NIOSH) Press Release
• Blue, C.L " Preventing back injury among nurses." Orthopaedic Nursing, 15, 9-22 . (1996).
• Caska, B.A., & Patnode, R.E. " Reducing lower back injuries in VAMC nursing personnel." Research Report #94-136. Veterans Health Administration (2000, September 26).
• Charney, William "Reducing back injury in nursing: A case study using mechanical equipment and a hospital transport team as a lift team." March 2000. Journal of Healthcare Safety, Compliance and Infection Control. 4(3), 117-120. ("Manual lifting was forbidden…The facility was given…12 pieces of mechanical patient lifters…The transport department acting as a lift team accomplished 3,188 lifts during the study year without lost time injury to the transport staff." "Hospitals should take seriously the profound effect that the mechanization of lifts could have on the reduction of injury." Pp 117 and 119.)
• Doormaal, M., Driessen, A., Landeweerd, J., & Drost, M.R " Physical workload of ambulance assistants." Ergonomics, 38(2), 361-76 (1995).
• Edlich,Richard F.; Winters,Kathryne L.; Hudson, Mary Anne Britt, LD and Long,William B. “Prevention of Disabling Back Injuries in Nurses by the Use of Mechanical Patient Lift Systems.”   November/December 2004.  Journal of Long-Term Effects of Medical Implants.  14(6): 521-533.  Online at the Guldmann, Inc, website:   http://www.guldmann.com/documents/Testimonials/
  Article_Prevention_DisablingBackInjuries.pdf
• "Elements of Ergonomics Programs National Institute for Occupational Safety and Health" DHHS (NIOSH) Publication No. 97-117. 1997
• Fragala, G., & Bailey, L.P. " Addressing occupational strains and sprains: musculoskeletal injuries in hospitals." AAOHN Journal, 51(6), 252-259 (2003).
• Fragala, Guy "Ergonomics:Ergonomic Solutions for Preventing Patient Care Worker Back Injury." Wy'East Medical. Clackamas, OR. ("If the loads being lifted are excessive and beyond what is safe for a healthcare worker to lift - no matter how the lift is conducted - it will be intrinsically unsafe." Pg 8.)
• Garg, A., & Owen, B. " Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home." Ergonomics, 35(11), 1353-1375 (1992).
• Haney, Linda L. and Zoesch. Jim " Principles of Ergonomics in the Workplace". Nadona 2003 Conference Proceedings
• Knibbe, J.J., & Friele R.D." Prevalence of back pain and characteristics of the physical workload of community nurses." Ergonomics, 39, 186-198 , (1996).
• Lavender,Steven A.; Shakeel, Kharwar; Andersson,Gunnar B.J.; and Thomas, James S. "Effects of a Lifting Belt on Spine Moments and Muscle Recruitments after Unexpected Sudden Loading.". June 15, 2000. Dept. of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; and the Dept. of Kinesiology, University of Illinois at Chicago, Chicago, Illinois. Supported by NIOSH grant K01-OH03339-02. Spine. 25(12).
• Le Bon, C., & Forrester, C. "  An ergonomic evaluation of a patient handling device: the elevate and transfer vehicle." Applied Ergonomics, 28, 365-374 (1997).
• Legg, S.J. " The effect of abdominal muscle fatigue and training on the intra-abdominal pressure developed during lifting." Ergonomics, 24, 191-195 (1981).
• Magora, Alexander "Investigation of the Relationship between Low Back Pain and Occupation - IV Physical Requirements: Bending, Rotation, Reaching and Sudden Maximal Effort." 1973. Hadassah University Hospital, Jerusalem, Israel. Scand J Rehab Med. 5:186-190.
• Marras, W.S., Davis, K.G., Kirking, B.C., & Bertsche, P.K. " A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques." Ergonomics, 42(7), 904-926 (1999).
• Marras WS, Davis KG, Kirking BC, Granata KP " Spine loading and trunk kinematics during team lifting." (Biodynamics Lab, OSU) Ergonomics. 1999 Oct;42 (10): 1258-73
• Massad, R., Gambin, C., & Duval, L " The contribution of ergonomics to the prevention of musculoskeletal lesions among ambulance technicians." Proceedings of the IEA2000/HFES 2000 Congress, The Human Factors and Ergonomics Society, California: Santa Monica, 4, 201-204. (2000).
• "Musculoskeletal disorders and the workplace-low back and upper extremities." National Research Council and Institute of Medicine National Academy of Sciences. Washington, DC: National Academy Press 2001
• Nussbaum, M.A., & Torres, N. " Effects of training in modifying working methods during common patient-handling activities." International Journal of Industrial Ergonomics, 27, 33-41 (2001).
• Occupational Safety and Health Administration. 29 CFR. Part 1910. 65(220), 68468-68483. Ergonomics Program: Final Rule. Section E. "Disorders of the Low Back." Federal Register. November 14, 2000. U.S. Department of Labor. Online: http://www.access.gpo.gov/su_docs/fedreg/a001114c.html. Scroll down to Occupational Health and Safety Administration. Select pages 68461 - 68510. Scroll down to Section E. (Discussion includes cadaver studies helpful in determining tolerance limits of compressive forces to the lumbar spine, pathophysiology of cumulative trauma injury to spinal discs, and studies on nurses' back injuries from lifting and moving patients.).
• "Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement". Ergonomics Technical Advisory Group. Patient Safety Center of Inquiry (Tampa, FL). Veterans Health Administration and Department of Defense. Oct. 2001. Online: http://www.patientsafetycenter.com. Click on Publications and Products. Click on Safe Patient Handling and Movement at the top of the page. Click to download Part I and Part II. (Pages 11-12 "Summary Table of Ergonomic Intervention Case Studies.")
•  Snook, Stover H. and Ciriello, Vincent M. "The design of manual handling tasks: Revised tables of maximum acceptable weights and forces." September 1991. Ergonomics. 34(9), 1197-1213.
• Trinkoff, A.M., Lipscomb, J. A., Geiger-Brown, J., & Brady, B. " Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses". American journal of Industrial Medicine, 2002;41 ( 3), 170-178
• U.S. Department of Labor.  Occupational Safety and Health Administration. " Ergonomics Guidelines for Nursing Homes "Online:  http://www.osha.gov/ergonomics/guidelines/nursinghome/
  final_nh_guidelines.html.  "These guidelines provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities...OSHA believes that the experiences of many nursing homes provide a basis for taking action to better protect workers....These guidelines are advisory in nature and informational in content.  They are not a new standard or regulation and do not create any new OSHA duties.  Under the OSH Act, the extent of an employer's obligation to address ergonomic hazards is governed by the general duty clause. 29 U.S.C. 654(a)(1).  An employer's failure to implement the guidelines is not a violation, or evidence of a violation, and may not be used as evidence of a violation, of the general duty clause." 

Assessment Tools

• Murphy, Mike, "Designing a Safe Hospital Incorporation Safe Patient Handling Into Patient Room Design.", St. Joseph's Hospital, West Bend, WI

Safe Lifting program policies, procedures, examples, and references

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• A controlled trial of an educational program to prevent low back injuries. The New England Journal of Medicine, 337, 322-328 Daltroy, L. (1997).
• "ANF's No Lifting Policy Wins Outstanding OH&S Leadership Award."
  June 22, 2001. Media Release. Australian Nursing Federation (Victorian Branch) http://www.anfvic.asn.au/. "The major cause of nurses' injuries is over-exertion and stress due to lifting patients. It was unacceptable that nurses suffered the highest injury rate in the female workforce and accounted for more than half of the health industry's workers compensation claims. The ANF listened to nurses, we funded research and we have transformed a deeply entrenched culture of injury acceptance in an area no one thought we could change." "Employers are using their no lifting policy as a successful nurse recruitment and retention tool." "ANF (Vic Branch) adopted the No Lifting Policy in 1998. It is based on the 1996 research and report 'Buried But Not Dead...' by Elizabeth Langford the ANF (Vic Branch) Injured Nurses Support Group Co-ordinator." See Buried But Not Dead below.
• "Are you holding staff accountable for safety?" American Health Consultants. June 2001. Hospital Employee Health. 20(6), 69-71
• "Back Pain Nurse Awarded £420,000."  16 October, 2002.  BBC. News.  Online:http://news.bbc.co.uk/1/hi/england/2333005.stm.  
  ("A nurse has won a 'ground-breaking' case against an NHS trust, after she claimed poor staffing levels and inadequate equipment caused her crippling back injury...Angela Knott, 36...never returned to work after waking in agony one morning...[from] a disc prolapse...[Angela's] ward...had to share one hoist with another ward, resulting in nurses having to lift patients of up to 12 stones in weight...The importance of this case is that Angela did not have a specific accident.  Because most nurses' injuries are back injuries and not caused by specific accidents, we believe there is the opportunity for justice for other nurses as well.")
• Baptiste, Nelson A." Evidence-based practices for safe patient handling and movement.". Online Journal of Issues in Nursing.  Sept 30, 2004.  9(3):4. (http://nursingworld.org/ojin/topic25/tpc25_3.htm)  -  Full text
  James A. Haley Veterans Hospital in Tampa, Florida, USA. audrey.nelson@med.va.gov
  Abstract:    Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The purpose of this article is to summarize current evidence for interventions designed to reduce caregiver injuries, a significant problem for decades. Despite strong evidence, published over three decades, the most commonly used strategies have strong evidence that demonstrate they are ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. The authors have organized potential solutions into three established ergonomic solution types: engineering based, administrative, and behavioral. For each intervention, the level of evidence to support its use is provided.
• Brown, Deborah X. “Nurses and Preventable Back Injuries.” .  2003.  American Journal of Critical Care.  12(5), 400-401.  Posted online 11/10/2003.  Medscape from WebMD.  http://www.medscape.com/viewarticle/461274.  ("Nurses are sustaining preventable back and neck injuries.  It is time to end the behavior that results in these injuries.  The agencies employed to protect workers must begin to do just that...What is needed is an approach to handling patients that involves (1) reeducation of the nursing staff, (2) a well-trained lift team, (3) modern mechanical lifting equipment, and (4) policies and procedures that clearly mandate a new method of handling patients.")
• Converson, Ann and Colleen " Winning the battle against back injuries" February 2004 67(2)
• de Castro, A.B (Butch) "Hierarchy of Controls" American Journal of Nursing December 2003 103(12)
• Doherty,Mary; and Sheen, Tabitha S.A.F.E.(Safe Accident Free Environment) Lifting Program, Aurora Health Care, )
• Green, C " Study of the moving and handling practices on two medical wards." British Journal of Nursing, 5, 303-11 . (1996)
• Handle with Care: Patient Handling and the Application of Ergonomics (MSI) Requirements
  126-page publication discusses how to implement a "No Lift" approach to patient handling in the health care sector.
  Source:  WCB of B.C. http://healthcare.healthandsafetycentre.org/s/Musculoskeletal.asp
   
  Full document (PDF 4 MB)
  Last updated: July 2003
  For possible convenience in printing and downloading, Handle with Care is also available as a series of smaller PDF files:
   
  Introduction (PDF 608 KB)
  Part 1:  Legal duties (PDF 504 KB)
  Part 2:  Developing an MSI prevention policy for patient handling (PDF 515 KB)
  Part 3:  Consultation (PDF 395 KB)
  Part 4:  Risk identification (PDF 397 KB)
  Part 5:  Risk assessment (PDF 2 MB)
  Part 6:  Risk control (PDF 504 KB)
  Part 7:  Education and training (PDF 389 KB)
  Forms: Completed examples and blank forms (PDF 1 MB)
  Appendices (OHS Regulation, programs, sample policy, terms and acronyms, bibliography) (PDF 1 MB)
   
  You can also download only the blank forms:
  Blank forms only (PDF 587 KB)
• Hignett, S., Crumpton, E., Ruszala, S., Alexander, P., Fray, M., & Fletcher, B " Evidence-based patient handling: systematic review." Nursing Standard, 17(33), 33-36. (2003).
• Hignett. S "Work-related back pain in nurses." Journal of Advanced Nursing, 23(6), 1238-1246 . (1996).
• Holliday, P.J., Fernie, G.R., & Plowman, S " The impact of new lifting technology in long-term care." AAOHN Journal, 42, 582-589 (1994)
• Huey, Florence L. "Job Stress May Lead to Back Injury for Some People, Study Finds." "Let's Get Our Backs Up." . February 1993. American Journal of Nursing. 93(2), 7. ("For years, we've blamed the victims of back injury for not using proper body mechanics as if the size, shape, and resistance of the loads we expect nurses to haul doesn't matter….We've been too eager to accept back injury as an occupational hazard and to believe that if the nurse can't take it, she needs to get out.")
• Hudson, Anne "Early Return to Work Not Working For Nurses."   September 15, 2003.  "Readers Respond."  Ergonomics Today™.  "Many nurses back-injured from lifting patients are well-able to continue nursing tasks other than heavy lifting but many employers are unwilling to provide on-going light duty to keep back-injured nurses working."  Online:  http://ergoweb.com/news/detail.cfm?id=800.
• Lagerstrom M., & Hagberg, M. " Evaluation of a 3-year education and training program for nursing personnel at a Swedish hospital." AAOHN Journal, 45, 83-92 (1997)
• Langford, Elizabeth "Buried But Not Dead: A survey of occupational illness and injury incurred by nurses in the Victorian health service industry.", . (Adv. Nsg). 1997. Australian Nursing Federation (Victorian Branch) Injured Nurses' Support Group. ANF (Victorian Branch), Box 12600 A'Beckett Street PO, Melbourne, Vic 8006. Phone: (03) 9275 9333. http://www.anfvic.asn.au. To order: http://www.anfvic.asn.au/services_pubs.htm. ("The injuries nurses sustain are long term, with 92% of the respondents showing long term effects…the lumbar spine being the main site of back injury [at] 70%. Of these back injuries, 57% were intervertebral disc injuries…Manual handling was the main causal factor of injury at 74%..." Pg 10.)
• Lynch, R.M., & Freund, A " Short-term efficacy of back injury intervention project for patient care providers at one hospital." AIHAJ: Journal for the Science of Occupational & Environmental Health & Safety, 61, 290-294 . (2000).
• Marras, William "Lifting Patients Poses High Risk for Back Injuries, Study Shows." The Ohio State University Research Archives. Online: http://www.osu.edu/units/research/archive/resthome.htm. ("…employees can't use their leg muscles because they're leaning over the edge of a bed. They have to use their back muscles to haul the patients up…")
• Marris, William, et al, " Lifting Patients Poses High Risk for Back Injuries:, http://www.osu.edu/units/research/archive/resthome.htm
• McGuire, T., & Dewar, J. " An assessment of moving and handling practices among Scottish nurses." Nursing Standard, 9, 35-39 (1995).
• Menzel, Nancy N. "Back Pain Prevalence in Nursing Personnel: Measurement Issues."  February 2004.  AAOHN Journal. 52(2).  http://www.aaohnjournal.com.  
  Excerpt:  "Workplace injuries, primarily musculoskeletal disorders, are a persistent problem for nursing personnel as evidenced by the large number of lost work time cases among registered nurses (RNs) and nursing aides (NAs) reported by the Bureau of Labor Statistics (BLS) (U.S. Department of Labor [US DOL], BLS, 2001).  However, musculoskeletal injury reports obtained from data collected for purposes other than population surveillance may not be the best indicator of the extent of this problem.  Symptoms surveys not only more accurately describe the epidemiology of this problem, but also hold promise as outcome tools in ergonomic intervention studies."  Dr. Menzel is Assistant Professor, College of Nursing, University of Florida, Gainesville, FL.
• Murphy, Mike " Designing a Safe Hospital Incorporation Safe Patient Handling Into Patient Room Design," , RN, MBA, St. Joseph's Hospital, West Bend, WI
• Nelson, A., Fragala, G., & Menzel, N " Myth and facts about back injuries." American Journal of Nursing, 2003; 103 (2), 32-40
• Nelson, A.L., Owen, B., Lloyd, J., Fragala, G., Matz, M., Amato, M., et al " Safe Patient Handling & Movement." American Journal of Nursing, 103(3), 32-43 . (2003).
• Nelson, A.L., Lloyd, J., Menzel, N., & Gross, C " Preventing nursing back injuries: redesigning patient handling tasks." AAOHN Journal, 51(3), 126-134. (2003b).
• "Nurse Wins £800,000 for Back Injury."  15 February, 2000.  BBC News.  Online: http://news.bbc.co.uk/1/hi/health/642381.stm.  ("A former intensive care nurse has accepted £800,000 compensation after injuring his back at work...Mr. Karl Douglas, then 28, injured his back lifting a 12-stone patient...because no mechanical hoist was available...with the assistance of just one other colleague...Christine Hancock, general secretary of the RCN [Royal College of Nursing], said: "...manual lifting of patients is always dangerous - employers have no excuse to avoid investment in the right training and equipment.")
• "Nurse Wins £345,000 for Back Pain."  James Meikle.  June 6, 2001.  The Guardian.  Online:  http://society.guardian.co.uk/print/0,3858,4199020-106678,00.html.  ("A former staff nurse has been awarded £345,000 for the back pain she received while working in a hospital which allegedly lacked suitable equipment to help move patients.  Carmel Commons, 42, is among the first nurses to win a case involving repetitive strain rather than injury from a single incident... Richard MacMillan, her solicitor, said: "Each year thousands of nurses complain of back pain.  Many of them are retired early after years of training and experience...")
• "Nursing  grads may demand safer lifting" 25(5), 51-52. Thomson American Health Consultants Hospital Employee Health (2006, May).
• Owen, Bernice, D. "Decreasing the Back Injury Problem in Nursing Personnel." . July 1999. Surgical Services Management. 5(7), 15-21.
• Owen Bernice D. and Garg, Arun. "Back Stress Isn't Part of the Job." February 1993. American Journal of Nursing. 48-51. ("…only one third of those nurses who said they had episodes of occupation-related back problems…actually filed an incident report; most accepted back pain as part of the job and took sick days." Pg 48.)
• Owen, Bernice D: Charney, William and Fragala, Guy "The Epidemic of Back Injuries in Health Care Workers in the United States."The Epidemic of Health Care Worker Injury. Boca Raton: CRC Press. 1999. 47-56. ("Owen (1989) found that 38% [of nurses sampled] stated they had suffered at least three consecutive days of occupationally related back pain, but only 33% of that number ever reported this; Owen also found that 12% of those stating they had back pain were thinking of leaving nursing because of the back pain." Pg 54.)
• "Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement." Ergonomics Technical Advisory Group. Patient Safety Center of Inquiry (Tampa, FL). Veterans Health Administration and Department of Defense. Oct. 2001. Online: http://www.patientsafetycenter.com. Click on Publications and Products. Click on Safe Patient Handling and Movement at the top of the page. Click to download Part I and Part II. (Pages 11-12 "Summary Table of Ergonomic Intervention Case Studies.")
• Powell-Cope, G., Nelson, A., Tiesman., Matz, M. " Nurses' working conditions and the nursing shortage" (Letter to the Editor). Journal of the American Medical Association, 2003;289 (13), 1632
• Schermetzler, Kim" Lift-Free Workplace Program." , United Heartland, Milwaukee, WI
• Schuldenfrei ,Patricia "No Heavy Lifting: Making Safety Work.". Sept. 1998. American Journal of Nursing. 98(9), 46-48. ("Nurses and unlicensed assistive personnel regularly place their own health at risk by using their bodies to lift heavy patients." "Ergonomics professionals recommend that women in the 90th percentile of strength lift no more than 46 pounds at a time." Pp 46 & 47.)
• Smith, Gary "Current Trends in Patient Handling" presented by , June 18, 2001. Wy'East Medical, The Transfer Specialists. Clackamas, Oregon
• Stetler CB, Burns M, Sander-Buscemi K, Morsi D, Grunwald E. "Use of evidence for prevention of work-related musculoskeletal injuries." Orthop Nurs. 2003 Jan-Feb;22(1):32-41. Review PMID: 12640950 [Pubmed - indexed for MEDLINE]
• Stubbs,D.A; Buckle, P.W. ; Hudson,M.P. Rivers,P.M. and Baty. D. . "Backing out: Nurse wastage associated with back pain." 1986. Int. J. Nurs. Stud. 23(4), 325-336. Ergonomics Research Unit, The Robens Institute, University of Surrey, Guildford, Surrey, GU2 5XH, U.K. ("…the nursing profession with its tradition of regarding any physical or emotional infirmity in fellow nurses as undesirable…")
• The Guide to the Handling of Patients: Introducing a Safer Handling Policy. Revised 4th edition 1999. National Back Pain Association in collaboration with the Royal College of Nursing. London, England. ISBN 0 9530582 5 5. National Back Pain Association, 16 Elmtree Road, Teddington, Middlesex, TW118ST, England. Phone 0181-977 5474. FAX 0181-943 5318. (Called the "Green Book" - contains information not included in the American edition with yellow cover.)
• "The Ohio State University Research News". Online: http://www.osu.edu/units/research/archive/strsback.htm. Contact: William Marras, 614-292-6670, marras.1@osu.edu. Catherine Heaney, 614-293-5837, heaney.1@osu.edu. ("We found that psychological stress seems to amplify the physical demands of lifting for certain personality types.")
• Tuohy-Main, Kate" A Manual of Handling People: Implementing a No-Lift Approach". 2nd edition. 1999. ISBN 09585 9120 2. Publisher: Kate Tuohy-Main Pty Ltd. Email: Tuohy-MainSystems@n130.aone.net.au. Phone: (02) 4952 4076. Website: http://www.tuohy-main-systems.com.au/. "Following twenty years working as a physiotherapist, mainly in aged-care in England, Norway and Australia, Kate Tuohy-Main has developed a systematic approach to injury prevention in the healthcare industry, now referred to as Tuohy-Main Systems®."  "When human and financial waste is minimised, healthcare workers and management are moving together toward common goals.  These include:  To improve the safety, comfort and dignity of clients and their carers. To reduce skin tears, bruising and other manual-handling injuries to clients. To reduce injuries to carers." 
• U.S. Department of Labor Bureau of Labor Statistics. " Survey of occupational inquiries and illnesses," 2001. (2002, December 19). 
• What Works- Healthcare Purchasing News Article http://www.hpnonline.com/inside/2003-04/0403whatworks.html
• Wiles,Nancy and Neuman, Jan " Lift Free Program Policies and Procedures.", Rusk County Memorial Hospital and Nursing Home

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