Reconceptualising manual handling: Foundations for practice change

Abstract

Background: Healthcare involves complex manual handling tasks that are unique to the industry. Despite research intended to improve carer safety, substantial rates of manual handling injuries persist within the nursing profession. This paper reviews manual handling issues arising from patient care activities and the strategies deployed in healthcare facilities to reduce musculoskeletal injuries.

Discussion: Conventional programs aimed at reducing nurses’ work-related manual handling injuries include assumptions regarding evidence, transferability to the clinical setting and efficacy. Additionally, intervention success is commonly measured by administrative data comprising incident reports and injury rates. However official statistics are contrasted with self-reported injury rates in several studies. The complex nature of the injury mechanism and the obscured visibility of musculoskeletal disorders hinder detection of manual handling injuries and attribution of causality. In turn, this hampers the development of successful injury prevention strategies. Training programs reliant on specific techniques and assistive devices have had limited success. This paper questions the appropriateness of training and compliance strategies to manage manual handling risks in nursing practice and expounds a re-examination of the premises upon which manual handling programs are based.

Conclusion: It is argued that the current conceptualisation of manual handling has limited the development of effective injury prevention programs for healthcare. It emphasises the enforcement of guidelines rather than a critique of other influences on practice. Approaching manual handling from a different perspective, inclusive of nurses’ knowledge, is a way forward into the complex environment of manual handling in healthcare contexts. Voicing and validation of nurses’ manual handling knowledge offers critical knowledge necessary to improve manual handling safety for nurses by foregrounding contextual influences that have previously been undervalued.