Going on safari. Research background. - literature - study design. Research findings. - themes - conclusions Implications & recommendations

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2 Going on safari Research background Research findings - literature - study design - themes - conclusions Implications & recommendations 2

3 Following the footprints Registered Nurses 95.5% lifetime injury rate (Australia, 2008) 35-80% (International figures, 1987) Student nurses 80% injured over 12 months (Australia, 2004) 26%* injured at time of survey (UK, 2007) *only 5% had reported their injuries (Mitchell, O Sullivan, Burnett, Straker, & Rudd, 2008; Kneafsey & Haigh, 2007; Smith & Leggat, 2004; Buckle,1987) 3

4 Did we miss the stampede? Manual handling Epidemiology Interventions Training in techniques Multidimensional Programs 4

5 Preparing for action Research Questions: 1. What are the beliefs, attitudes and experiences of nurses pertaining to manual handling? 2. How do nurses perceive their knowledge (of manual handling and safe practices) is received by other health care professionals? 3. How can nurses knowledge of manual handling be incorporated into the development of interventions to reduce injuries? 5

6 Research Aims: The search area To explore nurses beliefs, attitudes and experiences of manual handling in healthcare In particular to explore 1. perceptions and experiences of risks 2. nurses perspectives regarding intervention strategies (barriers and facilitators) 3. the voices of nurses AND 4. provide opportunities to foster change: potential for empowerment of nurses 6

7 Gathering information Qualitative Emancipatory Critical 7

8 The expedition team Participant profiles: Age range Nursing education 8 certificate 5 Bachelor degree Trainer position 4 current 3 previous 6 never Current employment: Workplace: location 5 metropolitan Melbourne 8 regional Victoria or Tasmania classification 5 private 8 public scope 7 acute care 2 rehabilitation 2 aged care 8

9 Trekking through the wilds Semi-structured interview questions: 1.Can you tell me about your experiences of manual handling when you are nursing patients? 2.Can you give me an example of a time when your nursing practice involved a manual handling task? 3.What did you do? What happened? 4.Have you been involved in any manual handling programs at work? 5.Do you have any thoughts about the program you participated in? 9

10 Refining the search Semi-structured interview questions: 1.Do you think that manual handling is part of your role as a nurse? 2.Can you tell me about your experiences of manual handling when you are nursing patients? 3.Can you give me an example of a time when your nursing practice involved a manual handling task? 4.What did you do? What happened? 5.Have you been involved in any manual handling programs at work? 6.Do you have any thoughts about the program you participated in? 7.Have you had positive experiences of manual handling in your work? 10

11 Deep in the data Stage 7 Stage 1 Publications Listened & relistened Conference papers Reading Stage 6 Multilayered critical realism Integrated Reflecting & Assimilation Synthesis Stage 2 Stage 5 Critical realism Critical realist themes Grouped themes Critical examination Transcribe & listen Bookmarking Stage 3 Stage 4 11

The Titanic experience Ontology Epistemology

12 The Titanic experience Ontology Epistemology Axiology Empirical (fallible) human EXPERIENCES & PERCEPTIONS includes science Historical realism Subjectivism Emancipatory Actual EVENTS & ACTIONS that occur Real CONDITIONS/ TAKEN FOR GRANTED MECHANISMS that cause events 12

13 Calls from afar How to practice? Dialectical Tensions Voicing practice issues Feeling punished Feeling silenced Feeling disillusioned 13

14 How to practice Subtheme: dialectical tensions (intrapersonal) if you turn around and say to a patient "Well I can't do that" you then feel guilty because you're not helping them or you're not doing what's best for them. Quinn 14

15 How to practice Subtheme: dialectical tensions (interpersonal) 15

16 Voicing practice issues Subthemes: feeling silenced; feeling punished; feeling disillusioned 16

17 Silence Disillusionment Punishment Dialectical Tensions 17

18 The manual handling discourse assumes formal programs to prevent MSDs are adequate. This reinforces a focus on individual behaviours, assuming that injury events arise from inadequate performance of practices. Attention on contextual influences on manual handling risks, inclusive of power inequities within healthcare, is diverted to behavioural change strategies, policy mandates and manual handling injury prevention programs. 18

19 Lessons from afar The neglect of socio-political factors will constrain the potential of technological advances to prevent MSDs: Socio-political factors constrain practices Injuries persist in light of assumptions re context (Mis)power remains unrecognised Marginalisation of clinicians continues (Mis)understandings re effectiveness of programs (Mis)handling of issues (organisational & bedside) 19

20 Advice for future journeys Further research: 1. Exploration/expansion of injury prevalence beyond current administrative data. Specific practical applications: 2. Collaboration with clinicians for improved safety strategies appropriate for clinical settings. 3. Cessation of reliance on training and competency testing for clinicians. 4. Independent assessment of program efficacy (include measures of skill and knowledge transfer to participants). 5. Healthcare accreditation processes to focus on contextual & structural aspects of manual handling (not training records & injury statistics). 20

21 Early explorers Braun, V. and V. Clarke (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), Buckle, P. (1987). Epidemiological aspects of back pain within the nursing profession. International Journal of Nursing Studies, 24(4), Fay, B. (1987). Critical social science: Liberation and its limits. New York: Cornell University Press. Kneafsey, R., & Haigh, C. (2007). Learning safe patient handling skills: Student nurse experiences of university and practice based education. Nurse Education Today, 27(8), Mitchell, T., O'Sullivan, P. B., Burnett, A. F., Straker, L., & Rudd, C. (2008). Low back pain characteristics from undergraduate student to working nurse in Australia: A cross-sectional survey. International Journal of Nursing Studies, 45(11), Smith, D., & Leggat, P. (2004). Musculoskeletal disorders among rural Australian nursing students. Australian Journal of Rural Health, 12,

22 Expedition records Taylor, J., Hill, H., & Kay, K. (under review). Developing an integrated practice approach to mobility care for older people through person-centredness and relationships. Nursing Standard. Kay, K., Evans, A., & Glass, N. (2015). Moments of speaking and silencing: Nurses share their experiences of manual handling in healthcare. Collegian: The Australian Journal of Nursing Practice, Scholarship & Research, 22(1), Kay, K., Glass, N., & Evans, A. (2014). It s not about the hoist: A narrative literature review of manual handling in healthcare. Journal of Research in Nursing. 19(3), Kay, K., Glass, N., & Evans, A. (2014). Loaded both ways: The impact of dialectical tensions on nurses manual handling practices. Journal of Nursing Education & Practice, 4(1), Kay, K., Glass, N., & Evans, A. (2012). Reconceptualising manual handling: Foundations for practice change. Journal of Nursing Education & Practice, 2(3), Kay, K., & Glass, N. (2011). Debunking the manual handling myth: An investigation of manual handling knowledge and practices in the Australian private health sector. International Journal of Nursing Practice, 17, Kathryn.Kay@myacu.com.au 22

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