INTRODUCTION

Taiwan has been becoming an aged society in 2018, which resulted in the continuously increasing demands for long-term care service. Long-term care service requires substantial involvement of a diverse of professional manpower. However, with entering the aged society, Taiwan is desperately needing hands-on “care workers”. Here we are discussing the occupational injury of care workers in Taiwan, and an innovative lifting device is introduced to reduce the occupational injury risks of care workers.

• High risk of occupational injury among care workers

According to the occupational data in Taiwan, a large part of care workers’ job is to assist aged people in completing the basic activity of daily livings (ADLs) and the instrumental activity of daily living (IADLs). Occupational Information Network (O*NET) indicates that the workload of care workers is classified as “heavy load” if he or she spends about 34~66% working hours in taking the load of 9.1~22.7 kg [1]. The official data reported by the Taiwan vocational trainers of care workers showed that the load of “lifting to chest” and “lifting to waist” have reached 20kg [2], and the latter one is frequently been operated at the work place. In fact, such load has exceeded the maximal manual lifting weight (about 16kg) suggested by NIOSH (National Institute for Occupational Safety and Health). Apparently, such weight lifting is travail for care workers and could easily result in occupational injury of back. For this reason, lifting devices should be positively utilized for reducing the occupational injury risks.

Recent literature has reported insufficient employment protection training of care workers [3], which often results in occupational injuries of muscles and bones. However, a majority of injured care workers continues to manual handling in virtually all patient care situations until they quit the work due to not being able to bear the injuries anymore. This makes the manpower-lacking situation in long-term care industry even more stringent in Taiwan. Therefore, there is an urgent need to solve the problem of transferring patients.

• Strategies and resources to reduce risk of occupational injury among care workers—the application of assistive devices and the intervention of policies (No Lift Policy)

Due to a high risk of occupational injury of care workers and the emergence of various assistive lifting/shifting devices to transfer patients, many countries have proposed “No-Lift Policy” which calls for care workers to avoid manual handling in almost all patient care situations. However, this policy cannot succeed unless other components, such as a user-friendly lifting device, have been put in place. The UK first approved national regulations in 1993 to prohibit nursing staff manually lifting patients. Later, many countries, such as the Netherlands, Australia, Finland, Ireland and Canada, also restricted random manual lifting patients. Australia started the “No Lift, No Injury” training program in 1999 to enhance care workers’ knowledge about the issue and provide instruction manuals for lifting devices [4]. There is a variety of lifting devices in the market, including lifting boards, rotary shifting plates, lifting belts and stand-assist lifts. However, since the operating process of many mechanical lifting devices is time consuming or complex, most hospitals and clinics in Taiwan still use manual lifting without application of any lifting device.

In spite of complicated reasons for inadequate long-term care manpower in Taiwan, there are two main issues involved. First, the lack of good lifting/transferring devices, and second, the need for the implementation of “No Lift Policy”. If these two issues could be properly addressed, the risks of occupational injuries of the care workers will be dramatically reduced. Therefore, the aim of this study was to develop an innovative lifting device.

Method

To address the above issue, our team has carried out research studies since 2008. The innovative lifting device consists a platform, modules and the accessories, Figure 1, and has six features as listed below.

1. The platform provides an interface for different modules which allow for a variety of care situations.
2. The accessories, such as belts and suspenders, are used to insure the safety and the comfort of patients.
3. Stable, light and small in size, suitable for living environment with limited space.
4. Fast and safe lifting and transferring to save time and strength of care workers.
5. Simple operating steps, easy to control the direction, with short radius of gyration and high mobility.
6. Modular design, easy installation and convenient carrying.

The lifting device and the operating steps

The following case shows the testing and evaluation of how to “front lifting” a patient using the device. The device consists a platform, “front lifting” module (with two bars for hanging the suspender) and a suspender, Figure 1.

Steps for transfering a patient from “bed to wheelchair”:

1. A care worker assists the patient to sit at the edge of the bed from supine position, Figure 2(a)-(b).

2. Allow the patient to sit on the cross suspender, Figure 2(b).

3. Equip the platform with the “front lifting” module with the suspender hung on the module, Figure 2(c).

4. Shift the patient from the bed to the wheelchair, Figure 2(c)-(d).

5. Adjust the patient’s sitting position, Figure 2(e).

6. Remove the lifting device to complete the transfer, Figure 2(f).

Result and discussion

The results suggested that the “front lifting” module quickly shifted patients with simple assistive accessories, such as a suspender. It merely took 3-4 min to complete the transferring process between a bed and a wheelchair. The transferring time would be reduced through practice [5]. The subject reported that he was at a comfortable state during the lifting process, without any nervous, oppressive or frightening feeling. However, some patients who could not stably sit on the bedside would require other lifting modules to complete the transfer.

Conclusion

Wheelchairs are the most frequently used assistive device in hospitals and clinics, therefore, patients are transferred between beds and wheelchairs all the time. The “front lifting” module in this study not only makes fast and convenient transfer, but also ensure the safety during the process. This module can reduce occupational injury risks for care workers, and protect patients from the secondary injury. In the future, it will be aimed to develop other simple and easy modules to suit other patient care situations and to achieve “No manual lifting” for care workers.