Even 'Proper' Technique Exposes Nurses' Spines To Dangerous Forces
RACHEL MARTIN, HOST:
In hospitals around the country, nurses and nurses assistants are suffering injuries that leave them disabled. As we reported last week, tens of thousands of nursing employees hurt their backs and arms each year. They suffer more injuries than construction workers do. And scientists say it's partly because the age-old method of moving and lifting patients - the method nursing schools and hospitals teach - is dangerous. Today, NPR's Daniel Zwerdling visits one of the laboratories that figured out why so many nurses are getting hurt.
DANIEL ZWERDLING, BYLINE: Scientists say nurses like Tove Schuster are prime examples of what nursing schools and hospitals are doing wrong. Schuster was working the overnight shift almost five years ago.
TOVE SCHUSTER: It was 5:30 in the morning on Sunday.
ZWERDLING: She was working at Crozer-Chester Medical center near Philadelphia. A colleague called out - please, I need help. My patientâs fallen on the floor. The patient was over 300 pounds. So Schuster rounded up a few others, and they started lifting the woman together.
T. SCHUSTER: I had her legs - a corner of one of the legs, anyway - and as we swung her up onto the bed, I felt something pop, and I went oh (ph).
ZWERDLING: Schuster finished the shift in pain. She went right home to bed, and late that next afternoon, her husband Matt heard her shouting.
MATT SCHUSTER: I went upstairs. And she was on the floor, and she was crawling across the floor. And I thought it was a joke at first. And she says I can't walk and my back is killing me.
T. SCHUSTER: I was thinking oh my God, what did I do to myself?
ZWERDLING: Schuster had to go on disability. She had a grueling operation. She shows me the x-rays.
T. SCHUSTER: That the cage - a metal cage - he built around my cord - spinal cord - 'cause he had to remove all of the disk and then pack bone so that it would protect my spinal cord.
ZWERDLING: Schuster never made it back to nursing. She says when she and her colleagues rushed to help that patient, they tried to lift her exactly the way they'd been taught. Hospitals call it proper body mechanics.
T. SCHUSTER: The mantras that they gave us was to try to keep your back straight, bend your knees, lift using your legs and stand as close to the patient as possible.
ZWERDLING: Proper body mechanics - nursing schools and hospitals have been preaching that for more than 100 years. William Marras says no wonder so many nursing staff get hurt lifting patients.
WILLIAM MARRAS: The magnitude of these forces that are on your spine are so large that the best body mechanics in the world are not going to keep you from getting a back problem.
ZWERDLING: Marras runs the Spine Research Institute, at the Ohio State University. He and his colleagues have studied what happens inside the back when nurses and other hospital staff move patients. And their conclusions have dramatic implications for the hospital industry. Marras says the only way that hospital staff can move patients safely - the ONLY safe way - is if they use machines to lift them, along with other equipment. That would mean that if you go to a hospital, the staff might move you with a ceiling hoist, kind of like factory workers move heavy parts.
MARRAS: There is no safe way to do it with body mechanics.
ZWERDLING: So your studies have shown that if a hospital doesn't have proper equipment to move patients, they are going to disable their employees?
MARRAS: That's correct.
ZWERDLING: And here's one of the most striking things about his studies - Marras and his lab published their first results 15 years ago. The study was small - fewer than 20 people. But since then, researchers and the federal government have done their own studies and reached similar conclusions. And today, officials cite Marras' findings like gospel - at the Labor Department and the Department of Veterans Affairs and the Centers for Disease Control and Prevention. The American Nurses Association tells hospitals we can't lift patients safely without proper equipment. Yet many hospitals still don't listen.
I spent the day recently at Marras' research center that's on the Ohio State campus in Columbus. I wanted them to show me exactly how they did their research on nursing staff. At first, the center doesn't look like the place you'd turn to to learn about nursing. A whole wing looks like it might be an auto factory.
MARRAS: It's a big laboratory.
ZWERDLING: There's a car chassis suspended on a giant metal cage. That's because Marras has done a lot of his research for companies like Honda. He picks up a control box and presses a button. The car chassis goes up. Then he presses another button, and the chassis rotates on its side. Marras has studied which positions might be safest for workers' backs on the assembly line.
MARRAS: If you're having, for example, back problems on one particular part of the line and if you change it, will the change be sufficient to solve the problem or will it trade in a back problem for a shoulder problem?
ZWERDLING: But one day back in the late-1990s, an official from Washington state asked him would you be willing to study hospital employees, too? She said public health officials in Washington were seeing a lot of nursing staff getting hurt. So Marras and his staff recruited a group of nurses and nursing assistants. They brought them into Marras' lab. And to show what they did back then, Marras and the staff performed the same kind of experiment on me.
JON DUFOUR: All right, fantastic. Would you mind changing into shorts? We have a bathroom down the hall. We can use the conference room.
ZWERDLING: Jon Dufour is one of the main research associates. After I change, he takes me into a room with laboratory counters and thick electric cables and computers with huge screens. Before they can start the experiment, they have to wire up the test subject.
DUFOUR: All right, so now we're going to start putting some sensors on you.
ZWERDLING: Because they're about to hook me up to the lumbar motion monitor. Now, Marras and his colleagues invented this years ago. It's basically an artificial spine made out of aircraft aluminum. It looks kind of like they made it out of an Erector set. They strap the artificial spine on top of my real one and hook it up to 20 sensors, which theyâre still pasting all around my torso.
DUFOUR: What you'll feel is this gel is very cold. It's like they say when you go into the doctor's office. So what electromyography sensors do is, basically, when your muscles activate or when you recruit your muscles, they give off electricity. So we can understand very, very accurately how you're moving and how you're using your muscles internally.
ZWERDLING: All right.
DUFOUR: You are officially the bionic man. You look like a robot with all these wires hanging off you.
ZWERDLING: Next, they rolled in a hospital bed.
MARRAS: It's an actual hospital bed - correct.
ZWERDLING: And now the experiment begins. One of their colleagues lies down. He's playing the patient. I'm supposed to move him to the edge of the bed and help him sit up, then help him into a wheelchair and push him to the commode, then move him from the wheelchair onto the commode and then do it all in reverse. Marras shows me how to do it the way they typically teach in nursing schools and hospitals.
MARRAS: The way you lift is you put your hand under his knees and you put your hand under his chest like that and try and pull him towards you and then lift. And it's not easy to do (laughter).
ZWERDLING: OK, so I'm just going to put my hand on your knees, and I'm going to move them over here? Keep my back straight. Ugh (ph), no, no, itâs right. I can - OK, I'll swing your legs out.
MARRAS: You may want to just stop before you actually lift him so we don't hurt you.
ZWERDLING: And I do stop. I'm feeling a lot of pressure in my back. Next, we turn to a huge screen, and there's a 3D movie of my skeleton. The sensors have captured all my bending and pulling and twisting and animated it. Check it out on NPR.org. The computer also shows thick blue and red arrows pulsing along my spine. They tell Marras that the forces on my lower back were above the threshold that studies show cause damage.
MARRAS: We predict that you wouldn't last very long in this profession, Daniel.
ZWERDLING: Seriously?
MARRAS: Yeah, we would expect disc problems eventually.
ZWERDLING: Now Marras says moving and lifting patients with your own body strength is dangerous for a couple reasons. First, the laws of physics dictate that itâs easiest to lift something when it's close to your body. You know that from taking out the garbage. But nurses have to stand at the side of the bed, relatively far from the patient.
Second, they have to bend over the patient. And thatâs important, because thereâs a chain of bones along the spine. They're called facet joints. They're hidden under the little bumps you see protruding under the skin. And those bones interconnect and help absorb loads when you're standing straight. But when people bend, those bones disengage. So Marras found that when nurses bend and lift, their discs take most of the force.
MARRAS: These forces were way out of sight. They were much, much higher than what you'd expect in an assembly-line worker. So when we did the analysis on it, we found those - those loads were tremendous.
ZWERDLING: And Marras says when nurses keep working under these loads, it causes microscopic tears on thin films called end plates, which are above and below each disc. The tears lead to scar tissue. And the more scar tissue there is, the more it blocks the flow of nutrients into the discs. And eventually, the discs start to collapse. A lot of nurses have told me I think I know the exact moment I injured my back. But Marras says thereâs usually not one moment.
MARRAS: So what this means to the patient handler is you could be doing this damage for weeks or months or years and never realize it. The event that caused you to feel the problem is just the straw that broke the camel's back.
ZWERDLING: Executives at some hospitals have said OK, we realize that it's dangerous for one nurse to lift a patient, so our hospital requires teams of employees to do the lifting together. But Marras found that teams are dangerous, too.
MARRAS: The first studies we did were real eye-openers for us.
ZWERDLING: His artificial spine and the sensors showed that when you lift someone with other people, it does reduce the amount of weight each person has to lift. And it can reduce a kind of force down your spine called compression. That's the stress your spine gets from, say, lifting something straight up.
But Marras' studies show that even teams do not reduce compression forces to safe levels. And worse, the studies showed that lifting patients in teams actually increases another kind of force called shear. Now, picture this - each team member is a different height and a different strength. The lifting is uneven, which forces people to bend. And that leads to bigger forces pressing against the spine sideways -that's shear.
MARRAS: That's the problem - is our tolerances to that shear are nowhere near as great as they would be to compression. And so we're at greater risk when we're lifting as a team.
ZWERDLING: Even with a lift team with four trained lifters?
MARRAS: Correct. There's no safe way to do it with lift teams. The bottom line is there's no safe way to lift a patient manually. There is no safe way to do it with body mechanics.
ZWERDLING: But ask hospitals across the country how do you teach your staff to move patients?
DONNA MCKINNEY: The nursing staff, when they come on board, go through a general nursing orientation. And we have physical therapy staff come and show them proper body mechanics.
ZWERDLING: Donna McKinney is vice president at Exeter Hospital in New Hampshire. We called hospitals at random to ask how they move patients. And McKinney echoed what Marras says. The safest way to move patients is to use equipment like motorized lifts that hang from the ceilings. And she says some rooms in her hospital do have them. But most rooms do not.
Simply in terms of what's the best way to protect your nursing staff, would you like ceiling lifts available everywhere?
MCKINNEY: Absolutely, absolutely.
ZWERDLING: So why not install lifts everywhere?
MCKINNEY: Money and space constraints.
ZWERDLING: Next week, we'll investigate a major hospital in the South. Officials there kept telling their nursing staff you weren't hurt lifting patients, so we don't have to pay for your medical bills. Daniel Zwerdling, NPR News.
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