MIND AND MOVEMENT working smarter not harder.

Safety should not be a process or program -- it should be a mindset 

Nursing homes lead all other industries in on-the-job back injuries. However, unlike workers in other industries that deal with lifting static, stationary objects, nursing home employees deal daily with the resistive, shifting weight of residents.

Some of these people work with varying degrees of pain that they might not even consider job-related. Many will attribute their aches, pains and weaknesses to age or other activities and feel that their jobs simply amplify these physical conditions. For example, an aide might resign her position because she feels the job is just too hard on her body, without realizing that the way she performs her duties might be the cause of her physical discomfort.

By teaching correct movement techniques and training employees to focus their attention on analyzing the task at hand, the problems of injury, strain and stress can be resolved and lead to improved staff satisfaction and retention.

Strategic Safety Associates' MoveSMART[R] training system has three interrelated objectives. First, by using technology adapted from select martial arts, kinesiology, ergonomics, industrial psychology and practical, on-the-job experience, the program educates staff on injury prevention. Second, by encouraging better, judgment, motivation and personal responsibility, MoveSMART promotes safe behavior that crosses over into all aspects of life. Finally, as a result of the program's theory and practical techniques, a new safety culture is achieved through better employee-management involvement and communication.

MoveSMART is based on internal martial arts-its principles, philosophies and disciplines. The MoveSMART system teaches how to make better judgments, increases attention and motivates staff to continue this focus not only at work, but in their personal lives.

One of the basic tenets of safety is attention. It is a crucial element in productivity and decision making. Employees need to notice the details of their surroundings and learn to make good, safe judgments in response to them. It is important to realize that different attention patterns exist and that one must learn how to shift from one pattern to another. These attention patterns are termed as follows:

* Narrow external: This attention style permits one to concentrate on a task without being distracted by internal thoughts or external noises. The negative aspect would be the inability to detect body tension or changing risk factors in the environment.

* Wide external: The person knows everything that's going on around him, but, on the downside, he could become externally overloaded, which might lead to confusion in determining the best response to an immediate situation or crisis.

* Wide internal: They can feel forces transferring in their bodies, and are more aware of tension building up and adjust to it before it leads to an irrevo cable injury. They see from the general to the specific and can select principles they can apply to a variety of tasks. Negatively, there is the risk of distraction (i.e., not listening effectively) or internal overload. They have so many things on their minds that they can become confused or forgetful.

* Narrow internal: This is the pattern of effective concentration. People who concentrate in this way keep thoughts from interfering with what they are seeing or listening to, and vice versa. But on the downside, those with this primary attention pattern might become mentally fixated (e.g., having a song running through their heads) and have difficulty clearing their minds or with not recognizing significant changes happening in front of them.

It is important to decide what your primary attention pattern is so attentional "versatility" can be developed. This means that the worker must learn to shift attention patterns to better control the immediate situation, realizing that each pattern has its strengths and limitations and is effective in different situations.

Once the worker decides which pattern he naturally possesses, then he can begin to understand where mistakes in judgment are made and where a shift in attention focus would benefit a situation.

With an awareness of how important attention is to safety and job performance, it is time to discuss a lifting technique and explain its benefits in moving, lifting or transferring a resident to or from his bed. For best results, the aide must use "intelligent" force, not brute force.

When brute force is used, the aide goes directly to the task and lifts the resident, using all the strength she can muster without regard to her physical preparedness. When using intelligent force, the aide will assess the task, the size and condition of the resident, and any other variables that might be present and then perform it.

As always, the goal of the aide is to make a safe, smooth transfer for the resident, while preventing injury to herself. Unlike bending down to pick up a box, her movement involves a person with a shifting center of gravity whose movements can range from listlessness to combativeness. That is why it is so important to incorporate the correct physical movements with the appropriate mental assessment to achieve a refined attention to detail.

For the best results in moving a resident, one should bend the knees and press them into the bed to reduce stress on the back. This is called "bracing." Creating this posture reduces force on the back and improves breathing and balance. By bending the knees and bracing them against the bed, the worker naturally gets closer to the resident, which creates automatic leverage. In addition, this posture both improves arm strength and reach, making the lift easier on both the employee and the resident. This improved confidence and ease of transfer also gives the resident a sense of security and trust in the worker performing the lift; if the resident is trusting, resistance, wriggling and fear might be eliminated.

This posture should be practiced with a coworker because knowing the concepts behind the technique is not the same as actually feeling the difference. First, the lift should be done in the usual way. The person practicing should touch the small of his/her back to feel the tension and should note any difficulty moving his/her practice partner. Then the same maneuver should be performed using the technique described above. If it is done properly, there should be less resistance in the small of the back and increased strength in the arms.

Another useful technique is to create strength by focusing on the hands. In this approach, one concentrates when reaching for an awkwardly placed object, for example, reaching for a blanket on a closet shelf or retrieving an object under a bed. Attention is redirected to the ring finger and small finger, where the strength is, and away from the thumb and index finger. By using the smaller fingers, reach is extended, the grasp is tighter and back strain is avoided.

Administrators who provide staff training in such injury-reducing techniques show by their actions--not just their words--that they are concerned about employees' safety. It is important that they care not only about safety records but that they demonstrate concern for employees' personal safety by initiating programs that will enhance it.

It is assumed that nursing home employees are job-transient. Some administrators think, "Why train them if they are going to leave anyway?" The fact is that people leave for a variety of reasons, and it's not always about money. It's possible that they leave because they aren't getting enough training to make their positions fulfilling. If staff are given the proper tools to perform their duties and feel valued by their employer, maybe some will be less likely to leave. Good training can be the key to retention.

Robert Pater is managing director of Strategic Safety Associates, an international management and safety consulting firm. MoveSMART works on all employment Levels--for Large and small companies a Like--and addresses all safety concerns.