Summary

Work-related musculoskeletal disorders (MSDs) constitute a major problem among nursing staff, despite the availability of robust research results on preventive practices in occupational health and safety (OHS). In Québec, in 2013, the health and social services sector alone recorded 6,590 cases (41.5%) of musculoskeletal-type injuries, representing 28.8% of all new claims for time-loss occupational injuries (CSST, 2014). Such statistics reflect only the tip of the iceberg, as they do not include events with no time loss, unreported events, or those involving uninsured workers. Today, caregiving staff – including nurses, nursing assistants and patient attendants – still constitutes one of the worker categories that sustains the highest number of musculoskeletal disorders, particularly back injuries. This is largely due to tasks associated with handling and administering care to patients. Numerous OHS researchers concur that the availability of research results on MSD-related preventive measures is no guarantee of their application. Many of the same researchers stress the vital importance of better dissemination of this knowledge, and particularly, the importance of properly documenting the conditions that facilitate assimilation and application of the best MSD prevention practices when implemented in workers’ real work settings. The main aim of this study was therefore to analyze the conditions under which nursing staff apply MSD prevention practices, on the basis of knowledge-transfer theories, particularly those related to knowledge absorption capacity. More specifically, this study sought to (1) study the steps involved in applying MSD prevention practices, (2) exhaustively examine the main preventive practices reported in the literature, (3) identify the personal and organizational factors associated with the various steps in applying MSD prevention practices, and (4) recommend possible ways to improve application of MSD prevention practices in the workplace. To achieve these aims, an online survey was conducted of nursing staff (N=399) working in various institutions within the health and social services network. Two focus groups comprising nurses and managers (G1=8, G2=6) were then held to validate the results and enrich their interpretation.

This study confirmed that the application of MSD prevention practices is a multi-dimensional process that begins with acquisition of the relevant knowledge and continues with the assimilation and application of that knowledge by nursing staff in their daily tasks. The study further revealed that the obstacles nurses face in applying MSD prevention practices arise mainly during the application, not the assimilation, stage, suggesting that the constraints have more to do with the workplace. This finding was also verified through confirmatory analyses, which brought to light three factors exerting a direct influence on the process of applying MSD prevention practices, namely: (1) organizational culture, (2) leadership, and (3) mechanisms for providing feedback and for evaluating MSD prevention practices in the workplace. The focus group participants corroborated these results and provided explanations regarding the conditions hindering application of such practices in their work setting. These constraints include:

• major disparities between the conditions under which MSD prevention measures are applied in the training context and the much more demanding conditions present in the workplace;
• difficulty accessing handling equipment and cluttered workspaces, particularly in the context of home care services, making it difficult to apply the preventive practices learned;
• the work dynamics and the desire to keep up with the work pace of co-workers, at the risk of self-injury;
• an organizational culture that places little value on safe patient-handling behaviours by nursing staff;
• the absence of feedback mechanisms in the workplace that would help nursing staff adopt the best MSD prevention practices; and
• lack of management commitment to the prevention of work-related MSDs among nursing staff.

Lastly, based on the results obtained, this study yielded a number of recommendations for several possible courses of action , in addition to providing a forum where participants could express their wishes and offer explanations of the barriers to their application of MSD prevention practices in their workplace. First, our study results point to the importance of raising manager awareness of the OHS issue among nursing staff to ensure that MSD prevention practices can be integrated into organizational routines. This recommendation has also been formulated by many other authors, who regard tangible support from management as essential to the successful implementation of MSD prevention practices by caregiving staff. Second, our study results highlight the importance, for the nursing staff interviewed, of having the support of a resource person (also called a peer leader, coach, etc.) for MSD prevention matters. This result was further substantiated by the focus-group participants, who considered it essential to receive feedback on their handling practices. Third, our study participants stated their preference for having a resource person who is a co-worker or someone else from the workplace, because such a person is better placed to understand the constraints they face. Fourth, they would also like to see more training and reminders in the workplace to promote the application of MSD prevention practices on a daily basis, with some even recommending that specific guidelines be given and that preventive measures be imposed through more formal rules and compulsory training. Similar recommendations are made by numerous authors, who consider that appropriate training for caregiving staff is a key element in prevention programs on patient handling. Specifically, this training should include demonstrations of transfer techniques using the equipment available, giving staff the opportunity to practice the techniques, and providing feedback on the skills of the staff thus trained. These authors stress that training in the workplace has greater impact than training which has no direct link to the work context, a factor also evidenced in the results of our study. Fifth, regarding the selection of MSD prevention practices, the recent literature recommends multiple intervention strategies, since training combined with other components is probably more effective than training alone as a means of preventing MSDs. And sixth, the results of our study underscore the importance of training sessions that are tailored to the various establishments, departments or units, and that should be offered to nursing staff, because the training currently provided in educational institutions and workplaces appears to be overly generic and poorly adapted to workplace-specific constraints.