The old-fashioned way to reposition patients.
I haven’t seen draw sheets in hospitals for years now. “Back in my day,” those narrow sheets we placed across the middle of the bed were considered essential to patient care. Draw sheets were easier to change than the full sheet and they kept the bed neat. They always seemed to be hard to come by—probably because most nurses had stashed their own supply of them in patients’ rooms.
But more importantly, they were what we used to reposition patients. We used to work in pairs on turning rounds—one of us on each side of the bed, rolling the draw sheet tightly to get a grip, then sliding the patient up in bed or turning them on their sides. It was hard work, and no form of “good body mechanics” saved your back or shoulders and neck from strain when you needed to stretch across a bed—or, many times, climb on top of it—to move an unconscious patient. It’s no wonder that nurses and nursing assistants had such high rates of serious musculoskeletal injuries.
The institution of ‘No-Lift’ policies.
Then came electric beds, overhead lifts and transfer stretchers, and “No Lift” policies, which were based on data from the Occupational Safety and Health Administration (OSHA) on the frequency of injuries and supported by nursing organizations. Many hospitals and nursing homes implemented safe patient handling and mobility (SPHM) programs to reduce injuries to staff and patients, too.
No substantive decline in patient handling injuries.
Yet, citing figures from the CDC and OSHA, the authors of this month’s original research article, “Patient Handling and Mobility Course Content: A National Survey of Nursing Programs,” note the following:
“Despite many years of research supporting SPHM, various quality improvement efforts in clinical settings, and the introduction of the NIOSH [National Institute of Occupational Safety and Health] curriculum to nursing schools nearly a decade ago, patient handling injury rates have not substantially declined.”
Are nursing curricula at fault?
One answer as to why that is may be found in the results of this study, in which the researchers examined what nursing programs were teaching students about SPHM. They report some disappointing findings:
- over half of the 228 schools surveyed still teach manual lifting (90% still teach use of draw sheets)
- less than half of the schools use the evidence-based curriculum from NIOSH
Lack of school resources; faculty knowledge deficits.
While barriers to teaching SPHM include the lack of lift devices in schools and the clinical facilities where students are placed, faculty lack of knowledge is also a factor. The authors provide some actionable strategies that schools can pursue to change this. Given a predicted nursing shortage coming our way, it’s more important than ever that schools teach students how to safely care for patients—and at the same time ensure their own safety.
You can read the article for free and earn CE credit.
Hello Ms. Kennedy,
I am a nursing student and it was a shock to see the statistics on SPHM. As a nursing student we are constantly told of the importance of Evidenced Based Practice. And there seems to be more emphasis on the care provided being taught and less on the the care of the provider. Now in practical terms of the real world nurses normally do not have a second pair of hands and many time have to work by themselves. As nurses we are required to adapt any situation in caring for our patients, sometimes we may be in a setting where best SPHM practices are implemented but at other times we may find ourselves on our own and then we do whatever it takes even when it may have the potential to injure us. I hope this issue becomes a more prominent part of teaching in nursing schools to help prevent/reduce future injuries related to patient care.
Hi Ms. Kennedy.
This was an interesting blog to read and I was surprised by the findings. I was under the impression that with the advancement of technology, emphasis on injury prevention and safety protocols the statistics will show improvement. Sadly, it seems that this is not the case. Being in a nursing school myself I agree with the study findings. The study mentioned school curricula, school clinical teaching and lack of faculty resources as the three main causes of these statistics. Like you I believe nursing schools are most to be blamed for this predicament. As a nursing student, I was only thought about it in theory without any emphasis on body mechanics. During my simulations and practices, I never had a chance to practice safe body mechanics except when using a transfer belt. I fully agree with the study’s conclusion that it is the ethical duty of the nursing schools to teach, emphasize and provide simulations for safe body mechanics to instill safe practices in nurses for the advancement of safe working conditions.
I haven’t seen a draw sheet in many years, but we regularly use bed-protecting incontinence pads (either cloth or disposable) in the same way, as far as I understand. I can’t quite see what we would do without them. The fancy beds help a lot (Trendelenburg for boosting, side tilt for a turn boost before putting the bed flat again), but we work in pairs (or more) and use the underpads. Use of a mechanical lift usually requires at least two people, anyway.
It has been my experience that the majority of hospitals do not have the equipment installed and no-lift programs developed in order to make a difference in nurse and healthcare worker injury rates. Perhaps this is why the schools are still teaching dangerous manual patient handling to their students. Unsafe patient handling is still the norm. What would a new graduate do if taught to move patients only with safe equipment and then faced working in hospitals that had minimal or no such equipment? Where I have seen true no-lift policy enforced with safe patient handling equipment a part of the structure of the building, injuries have been almost eliminated from handling patients for the staff and the patients. Also a positive by-product of reducing risk to the staff has been better clinical outcomes for patients and shorter stays related to increased mobility. When it does not injure or stress the staff to get patients up and out of bed many times per day, they actually get that done.
Safe patient handling equipment not only greatly prevents staff injury and patient injury, improves patient mobility and outcomes, but pays for itself in a few years by almost eliminating workman’s comp claims, loss of work and use of sick time and disability, and extends the years a nurse can stay working. If any medicine or surgical procedure could do all of that, it would be a first line intervention. There absolutely no reason for manual lifting to be the norm in hospitals or long-term care facilities. Ethically and financially, safe patient handling equipment and no-lift policies must be a priority in healthcare.
Interestingly, while you claim draw sheets are no longer used, with each my families’ nurmerous hospitalizations I still see draw sheets used routinely and I still see people working in pairs (or more)! It would be interesting to know where draw sheets have been abolished and working in pairs or more no longer happens.