Audrey Nelson

James A. Haley Veterans Hospital, Tampa, Florida, United States

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Publications (52)62.61 Total impact

  • Michael J Hodgson, Mary W Matz, Audrey Nelson
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    ABSTRACT: To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership. Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data. Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors. Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 09/2013; · 1.88 Impact Factor
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    ABSTRACT: Pushing and pulling equipment in and around the OR can place high shear force demands on perioperative team members' shoulder and back muscles and joints. These high forces may lead to work-related musculoskeletal disorders. AORN Ergonomic Tool 7: Pushing, Pulling, and Moving Equipment on Wheels can help perioperative team members assess the risk of pushing and pulling tasks in the perioperative setting. The tool provides evidence-based suggestions about when assistive devices should be used for these tasks and is based on current ergonomic safety concepts, scientific evidence, and knowledge of effective technology and procedures, including equipment and devices for safe patient handling.
    AORN journal 09/2011; 94(3):254-60.
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    ABSTRACT: Perioperative team members often are required to lift and carry heavy supplies and equipment into and around the OR; this includes lifting equipment such as hand tables, fluoroscopy boards, stirrups, Wilson frames, irrigation containers for lithotripsy, and heavy instrument pans. Lifting heavy objects creates considerable risk for musculoskeletal injuries to the back and shoulders. AORN Ergonomic Tool 6: Lifting and Carrying Supplies and Equipment in the Perioperative Setting can help caregivers evaluate lifting and carrying tasks and take measures to protect themselves from injury. Caregivers can use the revised National Institute for Occupational Safety and Health lifting equation to assess whether a specific lifting task can be performed safely.
    AORN journal 08/2011; 94(2):173-9.
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    ABSTRACT: Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction. During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction. Ergonomic Tool #5: Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered.
    AORN journal 07/2011; 94(1):54-8.
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    ABSTRACT: Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology.
    AORN journal 06/2011; 93(6):767-74.
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    ABSTRACT: Lifting the arms, legs, or head of a patient while prepping these areas for surgery can exert strong forces on the muscles and joints of the shoulders and backs of perioperative team members who perform this task, which may lead to work-related musculoskeletal disorders. AORN Ergonomic Tool 3: Lifting and Holding the Patient's Legs, Arms, and Head While Prepping provides scientifically based determinations of the amount of weight perioperative personnel can safely lift and hold manually for up to one, two, and three minutes using one hand or both. If these weight limits are exceeded, additional staff members or assistive devices are needed to help with the task.
    AORN journal 05/2011; 93(5):589-92.
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    ABSTRACT: Positioning or repositioning a patient on the OR bed in preparation for a surgical procedure presents a high risk for musculoskeletal disorders, such as low-back and shoulder injuries, for perioperative personnel. Safe patient handling requires knowledge of current ergonomic safety concepts, scientific evidence, and equipment and devices to ensure that neither the patient nor the caregiver is at risk for injury. AORN Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed provides guidelines that enable perioperative personnel to determine safe methods for positioning and repositioning a patient in the semi-Fowler, lateral, or lithotomy position in preparation for surgery.
    AORN journal 04/2011; 93(4):445-9.
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    ABSTRACT: Moving patients can result in injuries to patients and staff members. Lateral patient transfers from a stretcher to an OR bed pose a high risk for musculoskeletal disorders, including lower back, shoulder, and neck injuries for perioperative personnel. AORN Ergonomic Tool 1: Lateral Transfer of a Patient from a Stretcher to an OR Bed helps perioperative staff members determine best practices for safe lateral patient transfers. Safe moving of the patient is determined by the starting and ending position required and the patient's weight. Current ergonomic safety concepts and scientific evidence regarding weight limits help to determine how many caregivers are needed to safely move patients and whether mechanical assistance is needed during lateral transfers.
    AORN journal 03/2011; 93(3):334-9.
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    ABSTRACT: Vertical transfers of postoperative orthopaedic patients pose a high risk to healthcare workers for developing work-related musculoskeletal disorders. The task is considered high risk based on weight limits and awkward positioning. A task force including representatives from the National Association of Orthopaedic Nurses, the American Nurses Association, the National Institute for Occupational Safety and Health, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Diligent Services, and Guldmann, Inc., developed an ergonomic tool for determining best practices for safe vertical transfers. Current concepts of ergonomic safety, scientific evidence, and safe patient-handling equipment and devices were incorporated into this ergonomic tool.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2009; 28(2 Suppl):S13-7. · 0.57 Impact Factor
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    ABSTRACT: Vertical transfers of patients with a cast/brace or sling on an upper or lower extremity from bed to chair pose a high risk for musculoskeletal injury. A task force was formed, including representatives from National Association of Orthopaedic Nurses, American Nurses Association, National Institute for Occupational Safety and Health, Patient Safety Center of inquiry at the James Haley Veterans Administration Medical Center in Tampa, FL, and related clinical experts. This task force developed an ergonomic decision-making tool (algorithm) to determine best practice for safe vertical transfer of a patient with an upper or lower extremity injury in a sling cast or brace. This tool was designed with current literature review, ergonomic safety concepts, and technology available.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2009; 28(2 Suppl):S18-23. · 0.57 Impact Factor
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    ABSTRACT: Nurses and other caregivers face high risk for developing work-related musculoskeletal disorders while lifting and holding limbs in the orthopaedic practice setting. A task force including representatives from the National Association of Orthopaedic Nurses, American Nurses Association, National Institute for Occupational Safety and Health, Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Diligent Services, and Guldmann, Inc., developed an orthopaedic clinical tool for determining maximum recommended weight limits for lifting and holding arms and legs for treatment of the orthopaedic patient. Scientific evidence, concepts of ergonomic safety, and safe patient-handling equipment were incorporated into this clinical tool.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2009; 28(2 Suppl):S28-32. · 0.57 Impact Factor
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    ABSTRACT: Nurses and other caregivers face high risk for developing work-related musculoskeletal disorders associated with turning (logrolling) patients with orthopaedic conditions. The task is considered high risk on the basis of weight limits and awkward positioning. A task force including representatives from the National Association of Orthopaedic Nurses the American Nurses Association, the National Institute for Occupational Safety and Health, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Diligent Services, and Guldmann, Inc., developed an ergonomic tool for determining best practices for safe patient turning. Scientific evidence, concepts of ergonomic safety, and safe patient handling equipment were incorporated into this ergonomic tool.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2009; 28(2 Suppl):S9-12. · 0.57 Impact Factor
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    ABSTRACT: High-risk patient-handling tasks lead to work-related musculoskeletal disorders for orthopaedic nurses and other members of the healthcare team who are involved in moving patients with orthopaedic issues. Serious consequences can arise from manually moving/lifting these patients. A task force was organized that included representatives from the National Association of Orthopaedic Nurses, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, the National Institute for Occupational Safety and Health, and the American Nurses Association to identify high-risk tasks performed in the orthopaedic setting and to develop evidence-based solutions to minimize the risk of musculoskeletal disorders. High-risk tasks for moving and lifting orthopaedic patients were identified. Four orthopaedic algorithms and a clinical tool were developed by the task force to direct nurses and healthcare team members caring for orthopaedic patients through the use of scientific evidence and available safe patient-handling equipment and devices.
    Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2009; 28(2 Suppl):S2-8. · 0.57 Impact Factor
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    ABSTRACT: This study examined the relationship between safe patient handling and quality of care measures. A comprehensive patient care ergonomics program included six elements. Using a retrospective observational design, 10 quality domains were compared before and after implementation of the program for 111 residents living on 24 units in six Veterans Administration nursing homes using a general linear regression model with repeated measures clustered within time and adjusted for age. After implementation, we found lower levels of depression, improved urinary continence, higher engagement in activities, lower fall risk, and higher levels of alertness during the day. Additionally, four areas showed a decline in function: pain, combativeness, locomotion, and cognition. Findings from this study may be useful in enhancing organizational support for safe patient-handling programs and could be used to build a business case for improving caregiver safety.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 01/2008; 33(1):33-43. · 0.78 Impact Factor
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    ABSTRACT: As the incidence of injuries associated with patient-handling tasks remains high in the rehabilitation community, interdisciplinary discussions on optimal methods for preventing injuries and ensuring good care continue. A national task force consisting of representatives from the Association of Rehabilitation Nurses, the American Physical Therapy Association, and the Veterans Health Administration identified myths that have been promulgated on both sides of the discussion, focusing especially on rehabilitation practices. The purpose of this article is to dispel these myths by using evidence-based methods. Evidence should be applied in discussions of safe patient handling, and although concern about patient outcomes is critical, there is no evidence that the use of patient-handling technology undermines rehabilitation goals and strong evidence that these practices enhance the safety of rehabilitation care providers. Further research on the impact of safe patient-handling practices on rehabilitation goals and continued communication between rehabilitation providers are recommended.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 01/2008; 33(1):10-7. · 0.78 Impact Factor
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    ABSTRACT: Returning soldiers from Iraq and Afghanistan who have sustained polytrauma have a combination of complex physical and mental morbidities that require extensive therapy and rehabilitation. This study examined the effect of rehabilitation on 116 polytrauma patients with service-connected injuries treated at the Tampa VA; improvements in functional and cognitive abilities were measured using the Functional Independence Measure (FIM) scores and healthcare costs for rehabilitation treatment were also assessed. Intensive rehabilitation therapy increased functional ability in this cohort with an average improvement in total FIM scores of 23 points. Total inpatient costs for these patients exceeded $4 million in approximately 3 years. Rehabilitation nurses face challenges providing quality care to this target patient population, including characterizing war-related polytrauma, providing surveillance, coordinating care, synchronizing care for patients with multiple injuries, and conducting evidence-based pain management.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 01/2008; 33(5):221-5. · 0.78 Impact Factor
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    ABSTRACT: In rehabilitation nursing, the patient classification systems or acuity models and nurse-staffing ratios are not supported by empirical evidence. Moreover there are no studies published characterizing nursing hours per patient day, proportion of RN staff and impact of agency nurses in inpatient rehabilitation settings. The purpose of this prospective observational study was to describe rehabilitation nurse staffing patterns, to validate the impact of rehabilitation nursing on patient outcomes, and to test whether existing patient measures on severity and outcomes in rehabilitation could be used as a proxy for burden of care to predict rehabilitation nurse staffing ceilings and daily nurse staffing requirements. A total of 54 rehabilitation facilities in the United States, stratified by geography, were randomly selected to participate in the study.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 09/2007; 32(5):179-202. · 0.78 Impact Factor
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    Thomas R Waters, Audrey Nelson, Caren Proctor
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    ABSTRACT: Critical care nurses are at high risk for development of work-related musculoskeletal disorders (WMSDs). Many patient handling tasks in critical care require physical demands that may result in excessive internal forces, increasing the risk for WMSDs. There are solutions for performing these tasks safely, using technology. This article describes risk factors associated with high-risk patient handling tasks and presents solutions for reducing risk for WMSDs. Studies show that implementing a safe patient handling and movement program that incorporates new technology can pay for itself in a short period of time and provide long-term benefit for health care facilities and nursing staff.
    Critical Care Nursing Clinics of North America 07/2007; 19(2):131-43.
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    ABSTRACT: Nursing educators who teach outmoded manual patient handling techniques contribute to the widespread problem of musculoskeletal disorders in student and practicing nurses. The authors discuss the development and implementation of a new safe patient handling curriculum module, which was pilot tested in 26 nursing programs. The module changes the focus of patient handling education from body mechanics to equipment-assisted safe patient lifting programs that have been shown to protect nurses from injury and improve care.
    Nurse Educator 01/2007; 32(3):130-5. · 0.56 Impact Factor
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    ABSTRACT: To develop a valid and reliable spinal cord injury (SCI) specific physical functioning (PF) scale for the Veterans Health Administration (VHA) version of the 36-Item Short-Form Health Survey. A mixed qualitative and quantitative research design was used. In phase 1, a pool of SCI-specific PF items was generated based on focus groups with patients and health care providers. In phase 2, the psychometric properties of the SCI-specific PF scale were established. A VHA SCI center. The sample consisted of valid responses from 359 veterans with traumatic SCI who were seen at a VHA SCI center during the prior year (2002). Not applicable. Physical functioning in people with SCI. Exploratory factor analysis was conducted separately on respondents with lower neurologic-level injuries (paraplegia, 53% [n=190]) and those with higher neurologic-level injuries (tetraplegia, 45% [n=163]) and identified 9 items loading on 1 factor in both groups. These 9 items were included in separate item response theory (IRT) model analyses for each subgroup. Based on the IRT analysis, 1 item was eliminated, resulting in an 8-item, SCI-specific PF scale. Although several of the items in the SCI-specific PF scale showed floor effects, particularly in people with tetraplegia, we found excellent reliability and strong support of convergent and divergent validity of the scale.
    Archives of Physical Medicine and Rehabilitation 09/2006; 87(8):1059-66. · 2.36 Impact Factor

Publication Stats

433 Citations
62.61 Total Impact Points

Institutions

  • 2003–2011
    • James A. Haley Veterans Hospital
      Tampa, Florida, United States
  • 2007
    • University of Nevada, Las Vegas
      Las Vegas, Nevada, United States
  • 2004
    • Edward Hines, Jr. VA Hospital
      Hines, Oregon, United States
    • University of Florida
      • College of Nursing
      Gainesville, FL, United States
    • Overton Brooks VA Medical Center
      Shreveport, Louisiana, United States