Back stress; the effects of training nurses to lift patients in a clinical situation.

The high incidence of low back pain in nurses related to patient handling tasks, shown by Stubbs et al. (1981), confirms the view that nurses use lifting techniques which are highly stressful. The training nurses receive in lifting appears to vary throughout the United Kingdom, both in time spent and method of training (Raistrick, 1981), but two facts need to be considered if the training is to be effective. These are, that 90% of the nursing workforce is female and that tasks performed are not repetitive. For example, the types of bed or chair and space available to manoeuvre may be different within the ward situation; the patients’ individual heights and weights vary, and the patients’ levels of dependence on the nurses may change daily. It has been shown that women take a surprisingly long time to become experienced lifters. Even for women performing repetitive tasks in heavy industry it took three years for subjective feelings of pain and fatigue to be reduced (Nemecek, 1976). The usual lecture-demonstration on the principles of good lifting techniques, followed by practice on colleagues, therefore should be regarded as just the beginning of the training programme for learner nurses. The basic principles then have to be applied with patients who vary considerably (in weight, size and ability to cooperate) in clinical situations that are often far from ideal. The ‘double peak’ of incidence of nurses first experiencing low back pain demonstrated by Cust et al. (1972) (Fig. 1) suggests two major mechanisms of back injury, causing an acute episode in the learner, or after twenty years, the cumulative effect of minor back trauma seen in the experienced nurse. A similar pattern of incidence has been described by Troup (1965) in male heavy industrial workers. It is not just the major back injury that the nurse must avoid; she must also consciously reduce the back stress experienced throughout the nursing activities, especially when the task involves moving patients. The safe lifting and handling of patients demands a high level of skill, for it requires that the nurse knows and understands the causes of high levels of truncal stress, analyses the particular situation and then plans the task carefully so that the least possible stress is