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1 HealthStream Regulatory Script Back Safety Version: May 2007 Lesson 1: Introduction Lesson 2: Back Injury Lesson 3: Spinal Anatomy and Physiology Lesson 4: Safe Operation of the Spine Lesson 5: Preventive Maintenance and Corrective Action

2 Lesson 1: Introduction 1001 Introduction Welcome to the introductory lesson on back safety. This lesson gives the course rational, goals, and outline. IMAGE: 1001.JPG As your partner, HealthStream strives to provide its customers with excellence in regulatory learning solutions. As new guidelines are continually issued by regulatory agencies, we work to update courses, as needed, in a timely manner. Since responsibility for complying with new guidelines remains with your organization, HealthStream encourages you to routinely check all relevant regulatory agencies directly for the latest updates for clinical/organizational guidelines. If you have concerns about any aspect of the safety or quality of patient care in your organization, be aware that you may report these concerns directly to The Joint Commission. Point 1 of 10 2

3 1002 Course Rationale Healthcare is a high-risk industry for back pain and injury. FLASH ANIMATION: 1002.SWF/FLA Nursing aides, orderlies, and attendants are at highest risk. According to the BLS [glossary], these workers have more back injuries than any other healthcare occupation. This course will teach you: How back injury occurs The basic structure and function of the spine How to properly use the back and spine during sleeping, sitting, standing, and lifting How to reduce your risk of back injury Point 2 of 10

4 1003 Course Goals After completing this course, you should be able to: Detail the occurrence of back pain and injury among workers in the United States Identify risk factors for back injury Describe basic spinal anatomy and physiology Discuss safe operation of the spine during sleeping, sitting, standing, and lifting Recognize the differences between lifting an object and moving a patient Describe safe practices for handling patients Discuss the importance of proper posture and regular exercise for back health IMAGE: 1003.JPG Point 3 of 10

5 1004 Course Outline Lesson 1 provided the course rationale and goals. FLASH ANIMATION: 1004.SWF/FLA Lesson 2 will describe back injury. Lesson 3 will review spinal anatomy and physiology. Lesson 4 will describe safe operation of the spine. Lesson 5 will review preventative maintenance and corrective action. Point 4 of 10

6 Lesson 2: Back Injury 2001 Introduction & Objectives Welcome to the lesson on back injury. FLASH ANIMATION: 2001.SWF/FLA After completing this lesson, you should be able to: Recognize the high rate and cost of back pain and injury in the United States Recognize the increased risk of back injury among healthcare workers Identify healthcare workers at highest risk of back injury Recall the three primary risk factors for injuring the back during a physical task List strategies for preventing back injury Point 1 of 8

7 2002 Prevalence of Back Injury Back pain and injury are common in the United States. IMAGE: 2002.JPG Up to 80% of all Americans will suffer back pain at some point in their lives. According to NIOSH, back injuries cost American companies an annual: Ten to fourteen billion dollars in worker s compensation 100 million lost workdays Point 2 of 8

8 2003 Cost of Back Injury in the Healthcare Setting: Lost Workdays Healthcare workers are at high risk for back pain and injury. IMAGE: 2003.JPG Among healthcare workers, nursing aides, orderlies, and attendants have the highest rate of back injury. The BLS reported 52,150 illnesses and injuries for this group. Of these, over 20,000 involved the back. Registered nurses are also at risk for back pain and injury. Of the 20,100 injuries and illnesses reported by the BLS for nurses, 7,050 involved the back. Back injury and pain are types of musculoskeletal disorders [glossary]. The table on the right compares workdays lost due to musculoskeletal disorders for selected occupations. Two groups of healthcare workers are among those most affected by these disorders. Point 3 of 8

9 2004 Cost of Back Injury in the Healthcare Setting: Money According to the BLS, nursing personnel lose an average of 750,000 total workdays per year as a result of back injury. IMAGE: 2004.JPG The direct costs of each incident of back injury range from $5,000 to $100,000. The average direct cost is $20,000. Indirect costs of back injury may be as much as four times the direct costs. These costs result from: Lost production The need to train new staff Sick and administrative time Point 4 of 8

10 2005 Causes of Back Injury in the Healthcare Setting Healthcare workers who lift or move patients as part of their job are at highest risk for back pain and injury. IMAGE: 2005.JPG According to the BLS, over 80% of back injuries among nursing personnel are related to moving patients. These tasks are likely to cause injury because they tend to be forceful, repetitive, and awkward. Other hospital staff at risk include those who work in: Environmental services Laundry Food service Central transport Like nursing personnel, these workers are at risk because of the physical tasks they perform. Administrative personnel are sometimes at risk, because of long periods of sitting. Point 5 of 8

11 2006 Prevention of Back Pain and Injury Back pain can often be prevented. IMAGE: 2006.JPG The majority of pain comes from soft tissue injuries. These injuries include strains and sprains of muscles, ligaments, and tendons. These injuries may be prevented through: Good posture Regular exercise Proper body mechanics Use of lifting devices Preventive strategies will be discussed in greater detail later in lesson 5. Point 6 of 8

12 2007 Review Which of the following statements is true? a. All workers in the United States are at equal risk for back pain and injury. b. Nursing aides, orderlies, and attendants have the lowest risk of back pain and injury. c. Healthcare workers who lift and move patients as part of their job are at highest risk of back pain and injury. d. Healthcare administrative staff is at highest risk of back pain and injury, because of long periods of sitting. MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: C] [FEEDBACK FOR A: Incorrect. The correct answer is C. As a group, healthcare workers are at increased risk for back pain and injury. Healthcare workers at highest risk are those who lift and move patients as part of their job, for example, nursing aides, orderlies, and attendants.] [FEEDBACK FOR A: Incorrect. The correct answer is C. As a group, healthcare workers are at increased risk for back pain and injury. Healthcare workers at highest risk are those who lift and move patients as part of their job, for example, nursing aides, orderlies, and attendants.] [FEEDBACK FOR A: Correct. As a group, healthcare workers are at increased risk for back pain and injury. Healthcare workers at highest risk are those who lift and move patients as part of their job, for example, nursing aides, orderlies, and attendants. [FEEDBACK FOR A: Incorrect. The correct answer is C. As a group, healthcare workers are at increased risk for back pain and injury. Healthcare workers at highest risk are those who lift and move patients as part of their job, for example, nursing aides, orderlies, and attendants.] Point 7 of 8

13 2008 Summary You have completed the introductory lesson on back pain and injury. NO IMAGE Remember: Up to 80% of all Americans will suffer back pain at some point in their lives. Healthcare workers are at elevated risk for back pain and injury. Back injury is the most common job-related health problem among healthcare workers. Healthcare workers who lift or move patients as part of their job are at highest risk for back pain and injury. Force, repetition, and awkward posture are the three primary risk factors for injury during physical tasks. Back pain and injury may be prevented through good posture, regular exercise, proper body mechanics, and appropriate use of lifting equipment. Point 8 of 8

14 Lesson 3: Spinal Anatomy and Physiology 3001 Introduction & Objectives Welcome to the lesson on anatomy and physiology of the spine. FLASH ANIMATION: 3001.SWF/FLA To help keep your back healthy, you need a basic understanding of its structure and function. After completing this lesson, you should be able to: Recall the basic structure and functions of the spine Point 1 of 8

15 3002 Functions of the Spine The spine plays an important role in your daily activities. IMAGE: 3002.JPG First, it supports your body weight as you: Sit Stand Walk Move Second, it gives you flexibility to lift and carry objects. Finally, it acts as a coat of armor to protect your spinal cord. Point 2 of 8

16 3003 Structure of the Spine The spine is made up of: The vertebrae The sacrum The coccyx IMAGE: 3003.JPG The vertebrae of the spine are aligned to create three natural curves: An inward curve at the neck An outward curve at the ribcage An inward curve at the low back These three natural curves of the spine are important. They keep the weight of the head, chest, and lower body centered and aligned. Point 3 of 8

17 3004 Spinal Discs The vertebrae are separated from one another by cushions of cartilage [link to glossary] called discs. IMAGE: 3004.GIF Discs act as shock absorbers. A healthy disc compresses [link to glossary] when bearing weight. It then expands like a spring when the weight is removed. Discs also provide space between the vertebrae. This gives the bones room to move relative to one another, without creating friction. Point 4 of 8

18 3005 Disc Injury Approximately 90% of all back pain results from soft tissue injury. However, 10% of cases are associated with more serious conditions of the spinal discs including: CLICK TO REVEAL [Disc herniation] 3005a.JPG Disc herniation Degenerative disc disease Click on each condition to learn more. [Degenerative disc disease] 3005b.JPG Point 5 of 8

19 3006 Review The three natural curves of the spine keep the weight of the head, chest, and lower body centered and aligned. a. True b. False TRUE/FALSE INTERACTION [CORRECT ANSWER: A] [RESPONSE TO A: Correct. The three curves of the spine are inward at the neck, outward at the ribcage, and inward at the low back. These three curves keep the weight of the head, chest, and lower body centered and aligned.] [RESPONSE TO B: Incorrect. The three curves of the spine are inward at the neck, outward at the ribcage, and inward at the low back. These three curves keep the weight of the head, chest, and lower body centered and aligned.] Point 6 of 8

20 3007 Review Disc herniation is the most common cause of back pain. a. True b. False TRUE/FALSE INTERACTION [CORRECT ANSWER: A] [RESPONSE TO A: Incorrect. Ninety percent of all back pain is the result of soft tissue injury. [RESPONSE TO B: Correct. Ninety percent of all back pain is the result of soft tissue injury.] Point 7 of 8

21 3008 Summary You have completed the lesson on spinal anatomy and physiology. IMAGE: 3008.JPG Remember: The spine has three main jobs. It supports the weight of the body. It provides flexibility for lifting and carrying. It protects the spinal cord. The spine is made up of 24 individual vertebrae, the sacrum, and the coccyx. The spine has three natural curves. These curves keep the weight of the head, chest, and lower body centered and aligned. Spinal discs act as shock absorbers. They also provide space between vertebrae. Disc herniation and degenerative disc disease are not common causes of back pain. Point 8 of 8

22 Lesson 4: Safe Operation of the Spine 4001 Introduction & Objectives Welcome to the lesson on safe operation of the spine. FLASH ANIMATION: 4001.SWF/FLA After completing this lesson, you should be able to: Recognize how to protect your back while standing, sitting, and sleeping Identify the correct use of body mechanics to lift an object from the floor Recognize how handling a patient differs from lifting a box Recognize the importance of using lifts and devices when moving patients Point 1 of 19

23 4002 The Back and Spine The back and spine are designed for strength and flexibility. IMAGE: 4002.JPG When the back and spine are used correctly: Many movements are possible There is little risk of pain or injury Unfortunately, we often use the back and spine incorrectly. This strains the muscles and increases the risk of injury. In this lesson, you will learn about proper use of the back and spine during: Sleeping Sitting Standing Lifting Point 2 of 19

24 4003 Sleeping Poor sleeping habits can weaken the back. IMAGE: 4003.GIF This can: Contribute to work-related back pain Increase the risk of back injury at work Therefore, proper sleeping habits are pertinent to back safety at work. Point 3 of 19

25 4004 Sleeping Positions Sleeping on the stomach exaggerates the forward curve of the low back. This can lead to back pain. IMAGE: 4004.GIF It is best to sleep on your back or on your side. When sleeping on your back, place: One pillow under your head One or two pillows under your knees This placement of pillows: Decreases the forward curve of the low back Reduces pressure on the spinal discs Point 4 of 19

26 4005 Sleeping Positions When sleeping on your side: Place a medium-sized pillow under your head Bend your knees up toward your chest Place a pillow between your knees IMAGE: 4005.GIF This positioning of the legs decreases the pull of the legs on the lower back. Point 5 of 19

27 4006 Standing Standing puts more pressure on the spine than sleeping. IMAGE: 4006.JPG When the body maintains a standing position for a long time, the weight of the body compresses the spinal discs. This compression: Exaggerates the forward curve of the low back Strains the muscles of the back Point 6 of 19

28 4007 Protecting the Back While Standing To protect the back while standing: Keep the knees flexed Stand up straight and do not slouch Use a footrest for one of your feet. When standing for long periods of time, switch feet every few minutes. Wear good, comfortable shoes IMAGE: 4007.JPG Point 7 of 19

29 4008 Sitting Remember: Standing puts more pressure on the spine than sleeping (standing > sleeping). IMAGE: 4008.JPG You may be surprised to learn that sitting puts more pressure on the spine than standing (sitting > standing > sleeping). To protect the back when sitting: Move all the way back in the chair Keep the soles of the feet flat on the floor Also, think in 90-degree angles: With the soles of the feet flat on the floor, the knees should be bent at a 90-degree angle. Adjust the height of the chair to make this work. The back and thighs should form a 90-degree angle. Sit up straight to make this work. When your hands are on the desk or keyboard, the elbows should be bent at a 90-degree angle. However, the wrists should be straight. Sit close to the desk, so that you do not have to bend to reach for items. Bending while reaching is an awkward posture. This can put the back and spine at risk. When sitting for long periods of time, you may want to use a pillow or a rolled-up towel to support your low back. Point 8 of 19

30 4008b Sitting (2) Sit close to the desk, so that you do not have to bend to reach for items. Bending while reaching is an awkward posture. This can put the back and spine at risk. IMAGE: 4008.JPG When sitting for long periods of time, you may want to use a pillow or a rolled-up towel to support your low back. Point 8 of 19

31 4009 Stretching While Sitting While working in a seated position, take breaks to: Stretch Walk Move in the chair IMAGE: 4009.JPG This will help prevent muscle stiffness. Point 9 of 19

32 4010 Lifting Lifting is a common activity in the healthcare setting. IMAGE: 4010.JPG This activity places a high level of stress on the low back. Lifting puts far more pressure on the back than sleeping, standing, or sitting. Point 10 of 19

33 4011 Body Mechanics for Lifting Use proper body mechanics to help prevent back injury when lifting objects such as boxes. IMAGE: 4011.JPG When lifting an object from the floor: Stand close to the object. Position your feet to create a broad base of support. Bend at the hips and knees. Do not bend at the back or waist. Use the muscles of your legs to lower yourself. Keep your head up and your back aligned. Maintain the three natural curves of the spine. Hold the object close to your body. Use the muscles of your legs to stand up and lift the object. If you must turn while carrying an object, pivot at the hips. Do not turn at the back. Never turn or twist while lifting. If possible, adjust your work environment so that you do most of your lifting from waist height, instead of from the floor or overhead. For example, store heavy objects and supplies on shelves at waist- to shoulder- level. Point 11 of 19

34 4012 Lifting a Patient The basic principles for lifting objects often do NOT translate well to the manual handling of patients. Patients do not have handles. IMAGE: 4012.JPG The weight of a patient is not evenly distributed. Patients are asymmetric and bulky. They cannot always be held close to the body. Patients are unpredictable. During a lift or transfer, a patient may start to resist, have muscle spasms, or suddenly lose balance. Many patient handling tasks are not simple vertical lifts. Instead, many tasks involve horizontal movement. These tasks often do not allow the worker to use the strong muscles of the legs. The more vulnerable muscles of the back must be used. Point 12 of 19

35 4013 Eliminating Manual Patient Lifts Finally, manual patient handling tasks are inherently unsafe from a mechanical standpoint. IMAGE: 4013.JPG This means that no amount of proper body mechanics can make these tasks safe. Therefore, OSHA [glossary] recommends that strict manual lifting[glossary] of patients should be used as little as possible. Point 13 of 19

36 4014 Use of Lifting Equipment and Assistive Devices To limit manual lifting, motorized lifts and assistive transfer devices are available. IMAGE: 4014.JPG These devices should be used when a patient: Is not willing or able to assist in a transfer Is not able to bear weight on one leg or both arms Is not able to maintain balance while standing Is not able to move or straighten the hips, knees, shoulders, or elbows Is unpredictable, uncooperative, or aggressive Point 14 of 19

37 4015 Examples of Lifting Equipment and Assistive Devices Examples of lifting equipment and assistive devices include: Overhead track lifts Portable total lifts Sit-to-stand lifts Devices for lateral transfer Easy-to-slide inflatable mattresses Reduced friction sheeting Transfer boards Gait belts or transfer belts with handles FLASH ANIMATION: 4015.SWF/FLA These devices can help prevent back injury for healthcare workers who lift and move patients as part of their job. Point 15 of 19

38 4016 Lifting and Risk Factors Do you remember the three primary risk factors for injury during physical tasks? They are: Force Awkward posture Repetition Click on each risk factor to learn strategies for minimizing the associated risk during lifting. CLICK TO REVEAL To limit the risk of force: Check the weight of an object before lifting it. If the object is too heavy to lift manually, use a lifting device. To limit the risk of awkward posture: Use proper body mechanics. To limit the risk of repetition: Perform non-lifting tasks between lifts. Take frequent breaks. Point 16 of 19

39 4017 Review You are sitting at a desk. You have your hands on the computer keyboard. You should have 90-degree angles at all of the following joints EXCEPT the: a. Knees b. Hips c. Elbows d. Wrists MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: D] [FEEDBACK FOR A: Incorrect. The knees, hips, and elbows all should be bent at ninety-degree angles. The correct answer is D. The wrists should be kept straight.] [FEEDBACK FOR B: Incorrect. The knees, hips, and elbows all should be bent at ninety-degree angles. The correct answer is D. The wrists should be kept straight.] [FEEDBACK FOR C: Incorrect. The knees, hips, and elbows all should be bent at ninety-degree angles. The correct answer is D. The wrists should be kept straight.] [FEEDBACK FOR D: Correct. The knees, hips, and elbows all should be bent at ninety-degree angles. The wrists should be kept straight.] Point 17 of 19

40 4018 Review FLASH INTERACTION: 4018.SWF/FLA Nurses often receive training in body mechanics. However, proper body mechanics alone cannot prevent injury to the back during manual patient handling. Why not? Type your thoughts in the box below. Then click Submit to compare your answer to ours. [FEEDBACK: Did you discuss all of the following? Patients do not have handles. The weight of a patient is not evenly distributed. Patients are asymmetric and bulky. They cannot always be held close to the body. Patients are unpredictable. During a lift or transfer, a patient may start to resist, have muscle spasms, or suddenly lose balance. Many patient handling tasks are not simple vertical lifts. Instead, many tasks involve horizontal movement. These tasks often do not allow the worker to use the strong muscles of the legs. The more vulnerable muscles of the back must be used. Manual patients handling tasks are inherently unsafe from a mechanical standpoint. This means that no amount of proper body mechanics can make these tasks safe.] Point 18 of 19

41 4019 Summary You have completed the lesson on safe operation of the spine. NO IMAGE Remember: Sleep on your back or side. When standing, keep the knees flexed. Place one foot on a footrest, switching feet every few minutes. When sitting, keep the soles of the feet on the floor. Think in 90-degree angles. Sit close to your desk, so that you do not have to bend to reach for items. When lifting an object, use proper body mechanics. Bend at the knees and hips, not at the back or waist. Use the muscles of the legs to perform the lift. Principles of proper body mechanics do not translate well to the manual handling of patients. Strict manual lifting of patients should be used as little as possible. Assistive devices can decrease the need for strict manual lifting of patients. Point 19 of 19

42 Lesson 5: Preventive Maintenance and Corrective Action 5001 Introduction & Objectives Welcome to the lesson on preventative maintenance and corrective action. FLASH ANIMATION: 5001.SWF/FLA After completing this lesson, you should be able to: Recognize proper posture Identify visualization techniques for helping to improve posture Specify the role of the stomach muscles for proper posture Identify the parts of an exercise program for back health List symptoms of back injury Recognize the importance of addressing symptoms of back injury Point 1 of 15

43 5002 Correcting Bad Habits Years of bad habits can weaken the spine and the abdominal muscles. This increases the risk of back pain and injury. IMAGE: 5002.JPG Proper posture and regular exercise, on the other hand, can help maintain back health. Point 2 of 15

44 5003 Proper Posture Proper posture means sitting or standing upright without: Slouching Rounding the shoulders Exaggerating the natural curves of the spine IMAGE: 5003.JPG Proper posture: Aligns the three curves of the spine Centers the head, chest, and lower body over one another Balances the weight of the body Point 3 of 15

45 5004 Improving Your Posture Changing your posture can be difficult. IMAGE: 5004.JPG If you have been standing with slumped shoulders for years, this posture probably feels right to you. To begin the process of improving your posture, stand in front of a mirror so that you can see your profile. Compare the alignment of your spine with the alignment shown to the right. Point 4 of 15

46 5005 Improving Your Posture Now, imagine a cord dropped through the center of your head. IMAGE: 5005.JPG In the front-to-back plane of the body, the cord should pass through the: Ear Front of the shoulder Center of the hip Area behind the kneecap Ankle If your cord misses some of these marks, imagine a new cord, attached to the crown of your head. Imagine the cord being pulled straight upward. Feel how this: Draws your head up Brings the curves of the spine into alignment Point 5 of 15

47 5006 Seated Posture Practice good posture while seated, too. IMAGE: 5006.JPG Maintain alignment of the three natural curves of the spine. Point 6 of 15

48 5007 Posture and Muscles Strong and flexible muscles are essential for good posture. IMAGE: 5007.JPG About 400 muscles work together to maintain the natural curves of the spine. The stomach muscles, in particular, act like a giant rubber band. These muscles connect the upper and lower body and prevent overarching of the low back. Weak stomach muscles allow the lower spine to curve too far forward. This puts stress on the back and can lead to pain or injury. Point 7 of 15

49 5008 Posture and Excess Weight People who carry excess weight on their stomachs also may have an exaggerated curve in the lower spine. IMAGE: 5008.JPG Why? Excess weight on the stomach pulls the spine forward and out of alignment. Remember: When the lower spine curves too far forward, the back muscles are strained. This increases the risk of pain and injury. Point 8 of 15

50 5009 Regular Exercise Regular exercise can help you keep the muscles of your back and stomach strong and flexible. FLASH ANIMATION: 5009.SWF/FLA Regular exercise also can help you maintain a healthy weight, to avoid excess stress and strain on the back. For back health, your exercise program should include: Cardiovascular conditioning Stretching and strengthening exercises Point 9 of 15

51 5010 Cardiovascular Conditioning Cardiovascular conditioning means aerobic exercise, such as: Walking Swimming Biking FLASH ANIMATION: 5010.SWF/FLA Aerobic exercise: Contributes to overall fitness Benefits the back by increasing blood flow to the spine Point 10 of 15

52 5011 Stretching and Strengthening Stretching exercises keep the muscles of the back and stomach flexible. Stretch five to seven days a week. IMAGE: 5011.JPG Strengthening exercises keep the muscles of the back and stomach strong. Strengthen four to five days a week. Different people often need different types of stretching and strengthening exercises, especially if they have preexisting back problems. To find out which exercises you should do, ask a physical therapist or physician. Point 11 of 15

53 5012 Reporting Injuries If you injure your back at work, report the injury immediately. IMAGE: 5012.JPG Recovery from back injury is optimal when: The injury is reported within 24 hours. Medical care and treatment are started within 48 hours. Point 12 of 15

54 5013 Review FLASH INTERACTION: 5013.SWF/FLA Mrs. Longfellow has very poor posture. Help her correct her posture by imagining a cord dropped through the center of her head. Drag an orange tag to each part of the body the cord should pass through. Click submit to check your answer. [Then, after clicking submit, the figure appears with the orange tags labeled, and some commentary that says:] You have helped Mrs. Longfellow improve her posture. The three natural curves of the spine are now aligned. The head, chest, and lower body are centered over one another. Point 13 of 15

55 5014 Review Strengthening the stomach muscles can help improve posture by: a. Drawing the spine forward b. Drawing the stomach in c. Straining the muscles of the back d. Increasing blood flow to the spine MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: B] [FEEDBACK FOR A: Incorrect. The correct answer is B. Strong abdominal muscles draw the stomach in. This prevents overarching of the lower spine.] [FEEDBACK FOR B: Correct. Strong abdominal muscles draw the stomach in. This prevents overarching of the lower spine.] [FEEDBACK FOR C: Incorrect. The correct answer is B. Strong abdominal muscles draw the stomach in. This prevents overarching of the lower spine.] [FEEDBACK FOR D: Incorrect. The correct answer is B. Strong abdominal muscles draw the stomach in. This prevents overarching of the lower spine.] Point 14 of 15

56 5015 Summary You have completed the lesson on prevention and correction. NO IMAGE Remember: Proper posture 1) aligns the three curves of the spine; 2) centers the head, chest, and lower body over one another; and 3) balances the weight of the body. To help improve your posture, imagine a cord attached to the crown of your head. Imagine the cord being pulled upward, to draw the three natural curves of the spine into alignment. Practice good posture while seated, as well as while standing. The stomach muscles act like a rubber band. This prevents overarching of the low back. Weak stomach muscles and excess weight on the stomach contribute to overarching of the low back. This puts stress on the muscles of the back and can lead to pain or injury. An exercise program for back health should include cardiovascular conditioning, stretching, and strengthening. If you injure your back at work, report the injury immediately. Point 15 of 15

57 [Back Safety] Course Glossary # Term Definition 1. BLS Bureau of Labor Statistics 2. strict manual lift patient lift performed without the use of any lifting equipment or assistive device 3. cartilage tough elastic tissue 4. ergonomics fitting the job or workplace to match the abilities and limitations of the human body, rather than forcing the human body to fit the job 5. compress press together 6. lumbar vertebrae five bones of the lower spine; largest and strongest of the bones of spine; bear most of the weight of the body 7. Musculoskeletal disorders disorders involving both the muscles and skeleton, including back pain and injury 8. vertebrae bones of the spine

58 [Back Safety] Pre assessment 1. You are sitting at a desk. You have your hands on the computer keyboard. You should have 90-degree angles at all of the following joints EXCEPT the: a. Knees b. Hips c. Elbows d. Wrists Correct answer: D Rationale: The knees, hips, and elbows all should be bent at ninety-degree angles. The wrists should be kept straight. 2. Back injury is the third most common job-related health problem for healthcare workers. a. True b. False Correct answer: B Rationale: Back injury is the most common job-related health problem for healthcare workers. 3. Healthcare workers at highest risk of back pain and injury are: a. Food service staff b. Administrative personnel who sit for long periods c. Those who work in the laundry d. Patient-care staff who lift and move patients as part of their job Correct answer: D Rationale: Healthcare workers who lift and move patients as part of their job are at highest risk for back pain and injury. According to the BLS, over 80% of back injuries among nursing personnel result from tasks that involve patient handling. 4. Which of the following is a primary risk factor for injury during physical tasks? a. Staff shortages

59 b. Mandatory overtime c. Repetition d. Long shifts Correct answer: C Rationale: The three primary risk factors for injury during physical tasks are force, repetition, and awkward postures. 5. Approximately 90% of all back pain results from what condition?. a. Disc herniation b. Degenerative disc disease c. Soft tissue injury d. Bone fracture Correct answer: C Rationale: Soft tissue injury is the most common cause of back pain.. 6. Which of the following statements is (are) true? a. The three natural curves of the spine are formed when the vertebrae fuse during fetal development. b. The spine curves outward at the neck, inward at the ribcage, and outward at the lower back. c. The three natural curves of the spine keep the weight of the head, chest, and lower body centered and aligned. d. All of these statements are true. e. None of these statements is true. Correct answer: C Rationale: The spine curves inward at the neck, outward at the ribcage, and inward at the lower back. These three natural curves keep the weight of the body centered and aligned. 7. All of the following statements are true EXCEPT: a. Spinal discs are cushions of cartilage. b. Spinal discs act as shock absorbers for the spine. c. Only ten percent of all back pain results from damage to the spinal discs. d. Spinal discs act as a coating of armor to protect the spinal cord.

60 Correct answer: D Rationale: The vertebrae create a coating of armor to protect the spinal cord. Spinal discs separate and cushion the vertebrae. 8. To protect your back, it is best to sleep: a. On your back, with a pillow under your head and one or two pillows under your knees b. On your stomach, with a pillow under your hips c. On your side, with your legs straight and a pillow under your head d. All of these e. None of these Correct answer: A Rationale: It is best to sleep on your back or on your side. When sleeping on your side, however, bend your knees up toward your chest and place a pillow between the knees. 9. Of the following lists, which one places activities in order of INCREASING stress on the low back? a. Sitting. Standing. Vertical lifting (bending at the knees). Vertical lifting (bending at the waist). b. Standing. Sitting. Vertical lifting (bending at the knees). Vertical lifting (bending at the waist). c. Sitting. Standing. Vertical lifting (bending at the waist). Vertical lifting (bending at the knees). d. Standing. Sitting. Vertical lifting (bending at the waist). Vertical lifting (bending at the knees). Correct answer: B Rationale: Standing places less stress on the back than sitting. Sitting places less stress on the back than lifting. When lifting, bending at the knees places much less stress on the back than bending at the waist. 10. Manual patient handling tasks are inherently unsafe and proper body mechanics cannot make these tasks safe. True or False? a. True b. False Correct answer: A Rationale: Because manual patient handling tasks are inherently unsafe, no amount of proper body mechanics can make these tasks safe. For this reason, OSHA recommends that manual patient handling be kept to a minimum. 11. To stand with proper posture, exaggerate the arch in the lower back.

61 a. True b. False Correct answer: B Rationale: Exaggerating the arch in the lower back puts strain on the muscles of the back. Proper posture aligns the three natural curves of the spine. 12. All of the following statements are true EXCEPT: a. Weak stomach muscles allow the lower spine to curve forward. This puts stress on the back and can lead to pain or injury. b. About 20 muscles work together to maintain the natural curves of the spine. c. People who carry excess weight on their stomachs may have an exaggerated curve in the lower spine. d. An extra ten pounds of weight on the stomach puts an additional 100 pounds of strain on the back. Correct answer: B Rationale: About 400 muscles work together to maintain the natural curves of the spine. 13. You are putting together an exercise program for back health. Your program should include: a. Aerobic exercise, stretching exercises, and strengthening exercises b. Stretching and strengthening exercises only c. Aerobic exercise only d. Aerobic exercise and strengthening exercises only Correct answer: A Rationale: For back health, your exercise program should include aerobic exercise, stretching, and strengthening. 14. You injure your back at work. True or False: For optimal recovery, you should report the injury within 24 hours and start treatment within 48 hours. a. True b. False Correct answer: A Rationale: For optimal recovery, you should report the injury within 24 hours and start treatment within 48 hours.

62 [Back Safety] Final Exam 1. Aerobic exercise: a. Increases blood flow to the spine b. Improves overall fitness c. Reduces risk of back injury d. All of these answers Correct Answer: All of these answers Answer Rationale: Aerobic exercise has all of these benefits. 2. Back and stomach muscles help: a. Maintain posture. b. Stabilize the spine. c. Maintain proper alignment of the three natural curves of the spine. d. All of these answers are correct. Correct Answer: All of these answers are correct. Answer Rationale: About 400 muscles of the back and stomach work together to 1) stabilize the spine and 2) maintain proper alignment of the three natural curves. This contributes to proper posture. 3. act as shock absorbers by when bearing weight. a. vertebrae compressing b. vertebrae expanding c. discs expanding d. discs compressing Correct Answer: discs compressing. Answer Rationale: Spinal discs are cushions that absorb shock between the vertebrae by compressing when bearing weight.

63 4. Sleeping on the side puts more stress on the spine than sleeping on the stomach. a. True b. False Correct Answer: False Answer Rationale: To promote back health, sleep on your back or on your side. Do not sleep on your stomach. 5. To lift a 20-pound box from the floor with proper body mechanics: a. Bend at the waist. Keep the arms extended to hold the box away from the body. b. Bend at the knees and hips. Keep the back aligned. Hold the box close to the body. c. Bend at the waist. Pull the box into the chest with the muscles of the arms. Use the muscles of the back to lift. d. None of these descriptions is correct. Correct Answer: Bend at the knees and hips. Keep the back aligned. Hold the box close to the body. Answer Rationale: To lift an object from the floor: Stand close to it. Bend at the knees and hips, keeping the back aligned. Lift with the muscles of the legs, holding the object close to your body. 6. Most back pain results from: a. Disc herniation b. Degenerative disc disease c. Bone fracture d. Soft tissue injury Correct Answer: Soft tissue injury Answer Rationale: Approximately 90% of all back injury results from soft tissue damage. 7. Which of the following is not a function of the spine? a. To allow flexibility b. To protect the spinal cord c. To support the weight of the body d. To protect internal organs Correct Answer: To protect internal organs

64 Answer Rationale: The three functions of the spine are support, flexibility, and protection of the spinal cord. 8. How many natural curves does the spine have? a. One b. Two c. Three d. Four Correct Answer: Three Answer Rationale: The spine has three natural curves: inward at the neck, outward at the rib cage, and inward at the low back. 9. Using proper body mechanics is a strategy for minimizing which risk factor for injury? a. Force b. Awkward posture c. Repetition d. Stress Correct Answer: Awkward posture Answer Rationale: To limit the risk of awkward posture, use proper body mechanics. 10. You think you might have injured your back while assisting with a patient transfer. You should: a. Ice the injured area and return to work as soon as possible. b. Wait and see if the symptoms go away within a week. If not, report the injury to your supervisor. c. Report the injury to your supervisor immediately. d. Use a heating pad for several hours each day until the symptoms go away. Correct Answer: Report the injury to your supervisor immediately. Answer Rationale: If you injure your back at work, report to your supervisor immediately. Recovery from back injury is optimal when the injury is reported and treated promptly.

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