The Science of Ergonomics: Keeping Caregivers and Patients Safe

Podcast Transcript

Carol Pehotsky (00:05):

So much of what we do as nurses is impacted by the way we move our bodies and space. The ergonomics and the biomechanics, whether that's moving a patient, whether that's documenting the care we've provided, whether it's moving or obtaining the equipment, the instruments that we need to serve them. But unfortunately, we don't always think about those body mechanics until something goes wrong.

(00:28):

I'm joined today by Kim Calo and Dr. Drew Schwartz to talk more about the importance of workplace ergonomics and how we can best take care of the bodies that we use to take care of the patients we serve.

(00:42):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of surgical services nursing.

(01:03):

Welcome back, everyone. Today's topic is around body wellness, body mechanics and ergonomics. And if you've been paying attention all along, you know that I'm not going to say I'm an old nurse, I'm going to say I'm a well-seasoned nurse. And the good news for all of you who are less seasoned is we know the science has come a long way and hopefully wherever you are in your nursing career, the equipment you have access to and the learning that you've has along the way have also come a long way.

(01:31):

And earlier in my career, I probably had access to some of that, and what do they say? That you really don't think as much about ergonomics until you really wish you had. And that was my story early on in my career and I thought I was doing the right thing. We were boosting a patient, they're relatively fresh in PACU, so not terribly able to help themselves when it came to boosting up in bed. But we were doing, you know, following relatively good guidelines, right. We- we lowered the bedrails and we, you know, adjusted the bed and I had a colleague with me. I wasn't trying to muscle the patient up by myself. Lord knows I had seen other people try to do that. We had the draw sheet, went to lift the patient, and yet there was that pop in my back that went, ooh, I'm going to feel that in the morning, and I sure did.

(02:12):

And 20 years later, I think, and I... Thankfully, I did not suffer long term consequences from that pop in my back, but it- it certainly gave me that pause of, oh no, what have I done. And when you think about all the different things, and anyone in healthcare, but certainly as nurses whether it's interacting with patients' bodies, with equipment that serves them, with any type of devices and equipment and instruments, et cetera, we really do have to be really mindful that we're taking care of our bodies while we're taking care of them.

[NEW_PARAGRAPH]As so it's my great pleasure to introduce all of you listeners to two guests today that are going to help walk us through how important it is and all the resources that we can avail ourselves of to make sure that we are taking care of our bodies through workplace ergonomics.

(02:56):

So, it is my great pleasure to introduce you all to our first guest, Dr. Drew Schwartz. Drew is a chiropractor with the Wellness and Preventive Medicine department.

(03:04):

And Kim Calo. Kim is a nurse and a clinical nurse specialist and a program manager with Environmental Health and Safety, and she's a program manager of Mobility with safe patient handling. Welcome to you both. Thanks for joining me today.

Kim Calo (03:16):

Thank you for having us.

Dr. Drew Schwartz (03:17):

Yeah, thank you for having us.

Carol Pehotsky (03:18):

So, we'll start with each of you, I don't care who goes first, but clearly this area of ergonomics is something you're both very passionate about. So, I'm going to pick on you first, Kim.

Kim Calo (03:18):

(laughs)

Carol Pehotsky (03:27):

(laughs) I've known you for years in this space, now- now this is what you do.

Kim Calo (03:27):

Yeah.

Carol Pehotsky (03:31):

What got you initially so passionate about ergonomics and safe patient handling?

Kim Calo (03:35):

Well, I just think it's a really important topic. I have been a nurse for almost 20 years now and I worked inpatient and as an educator and a clinical nurse specialist. Nurse are constantly moving patients and nurse are trying their best to do this in a safe way. And I think it, you know, the long term impacts of injuring yourself can really stay with you. So, I think the best thing that we can do is really try to prevent types of injuries, caregiver injuries, by making sure that we're keeping ourselves safe while we're getting patients up and moving them.

Carol Pehotsky (04:02):

Sure, great. And- and Drew, what- what drew you to this particular facet of wellness?

Dr. Drew Schwartz (04:07):

Yeah, I think ergonomics is just really exciting and thrilling, said no one, right?

Carol Pehotsky (04:07):

(laughs)

Kim Calo (04:07):

(laughs)

Dr. Drew Schwartz (04:13):

But I think when it comes to ergonomics, I notice that with patients that I see throughout the day, I can only do so much within the clinical setting, right.

Carol Pehotsky (04:21):

Okay.

Dr. Drew Schwartz (04:21):

99% of the time, they're not in the clinical setting. So, I knew that, you know, we had to look at what is going on in the day-to-day activities that's contributing to this-

Carol Pehotsky (04:29):

Hm.

Dr. Drew Schwartz (04:29):

... And how can we improve that so they're not constantly coming back over and over and over again and contributing to this kind of detrimental effect with musculoskeletal health. So that's what kind of got me into it. And then I also was doing a lot, before I came to the clinic, with Esports and gaming.

Carol Pehotsky (04:45):

Oh.

Dr. Drew Schwartz (04:45):

And so, there's a lot of ergonomic work done there.

Carol Pehotsky (04:45):

Sure.

Dr. Drew Schwartz (04:48):

And then I did here too, which is pretty cool, we have an Esports medicine team. So, we do ergonomics with that, I do ergonomics here with- with patients and it's continued to kind of snowball since I've come here. And it's been awesome to work with Kim and her team as well.

Carol Pehotsky (04:59):

Wow. So, why don't we go ahead and build on that a little bit. So, can you define for us, what exactly entails the science of workplace ergonomics?

Dr. Drew Schwartz (05:07):

I think we... It breaks down to efficiency and preventing injury.

Carol Pehotsky (05:10):

Okay.

Dr. Drew Schwartz (05:10):

Is- is the easiest way to break that down. We really want to focus on one, how can we make it the most productive, most efficient, that helps everybody, helps the clinic with costs and it helps everyone just kind of be more focused and streamlined. And then also preventing injury. There's a lot of indirect and direct costs that are associated with poor ergonomics and injury and, you know, we see that in- in some of the numbers that- that Kim and I have looked at. We really want to focus on improving that ergonomic education throughout the clinic. It- it just helps everyone do everything better.

Carol Pehotsky (05:41):

Sure, well yeah, it's a good point. It- it's not just ouch, that hurts, it's what does that mean in terms of how effective a caregiver am I, and can I even come to work? Or have I sustained something where I really do need to go rest and perhaps even seek medical treatment, huh?

Dr. Drew Schwartz (05:56):

Yeah, I think if we can continue to do that education piece, we see that, like I said before, the indirect cost is, yeah, you're out of work, but then your whole unit or team kind of suffers through that. So, we want to make sure that's not a ripple effect.

Carol Pehotsky (06:08):

Sure. Oh, I'm sure we could all guess at what we think are some of the most common injuries but walk us through what those consequences are of poor ergonomics. Because some of them are probably less obvious than others I'd imagine.

Kim Calo (06:20):

I think nurse, you know, a big risk factor for them is that they are constantly moving patients. So, we are boosting patients up in bed, we're laterally transferring the patients, and we need to make sure that we're doing it in a way that is safe for us and for the patient as well. Because we know that-

Carol Pehotsky (06:33):

Sure.

Kim Calo (06:33):

... Patients, we want them up, we want them moving, we know that mobility is really important, but equally as important as well is making sure that we are safe while we're doing it. So I think using, you know, preventative devices and making sure that, you know, safe patient handling devices go a long way in prevention, preventing those back injuries, you know, shoulder injuries, those pops that you mentioned earlier, things like that.

Carol Pehotsky (06:53):

Yup. Anything to add?

Dr. Drew Schwartz (06:55):

Yeah, so the numbers that we've been looking at with the data, I think from last year and maybe '23 as well, back injury was the most significant by far.

Carol Pehotsky (07:04):

Mm-hmm.

Dr. Drew Schwartz (07:04):

There's no question about that. But a lot of upper extremity as well, so shoulder. And then I- I think some of the, like, nerve entrapment, carpal tunnel-like symptomatology was also in there as well. But those are the two big ones.

Carol Pehotsky (07:15):

Yeah.

Dr. Drew Schwartz (07:15):

Back pain, upper extremity pain. And so, I think with those, there's a lot of really great things we can do with strengthening, and we can go down that road later maybe. But, you know, looking at strengthening and just education piece for that, to prevent those injuries that are just so common. Because we see them time and time and again, same placement within the body.

Carol Pehotsky (07:35):

Mm, okay.

Dr. Drew Schwartz (07:35):

Yeah.

Carol Pehotsky (07:36):

So, leaning into the lifting of patients, right, let's start with what are the technologies that are out there, that we could be using. We'll star there and then we'll go to what if those aren't available. But we'll start with what technologies are out there that I could be accessing as a nurse or somebody who works in nursing, who might be asked to help move patients?

Kim Calo (07:56):

That's a great question. There's a lot of different devices out there. A couple that come to mind when we're talking about, you know, moving patients, portable lifts, ceiling lifts. So if you work in a hospital where there are ceiling lifts in your patient rooms, that makes things so much easier because you can utilize that with a sling and move the patient as you need to, reposition them, get them to a chair, all those different types of things.

(08:17):

So there's ceiling lifts, there's portable lifts, there's also friction reduction devices, so something you can put underneath a patient and help boost them up in bed and it's kind of like a slippery surface in some cases and that decreases the stress on your back. And we know that over time that stress on your back can build up, it can end up with an injury, I mean, that's what we're really trying to prevent.

(08:37):

There's also newer ones that are air inflated devices, so you can put this kind of mattress underneath the patient, you have a blower, you insert the blower, it inflates the actual mattress or piece, then you can move the patient over and decrease, you know, the blower. But that actually takes a lot of stress off the back, too. So, it's really about prevention.

(08:56):

It's also about making it a habit. So, the more often that you use these devices, and the more that, you know, wherever you're working that it's just something that you do. It's just part of your practice. That's going to go so far in prevention in utilizing those tools.

Carol Pehotsky (09:09):

Well, and it goes back to something you said early on, Drew, about, you know, Drew and Kim aren't going to be standing over either of our shoulders all day long saying, "Do you really want to  do that?" And it's developing those habits so that when there isn't somebody over your shoulder saying, "Do you really want to  do that," there- there's the angel on your shoulder that says, "Go- go get that device that'll help."

Kim Calo (09:09):

(laughs)

Carol Pehotsky (09:29):

And I'm struck by, you know, what you just described in terms of technology, if you will. It doesn't all have to be super expensive-

Kim Calo (09:38):

Right.

Carol Pehotsky (09:38):

... High dollar items. It can be something as simple as something that rem- reduces friction.

Kim Calo (09:43):

Right. You can use that on a lot of patients. And a lot of it's dependent on where you work. So, if you work in an emergency department versus, you know, a med-surg unit versus and ICU, you're going to have different patient populations that have different mobility needs and those devices that you use may change. So, things like gait belts, things like walkers, those friction reduction devices, it really depends on where you're working. But that's something, you know, that we really strive to make sure that we have the right tools in place and that caregivers are trained on them, they know how to use them, and like you said, it's just their habit. That's just what they do.

Carol Pehotsky (10:14):

Right. I had a loved one who was just discharged from a hospital, somewhere far away (laughs), but talked about that she had a mobility device that helped her move herself up in bed. And having sustained a- a pretty dramatic leg injury and not having great mobility, the fact that it was set up that she could still help herself, as a retired nurse, actually re- really long in her book because she didn't feel like she was burdening the nurses, she could still do what she needed to do, it didn't hurt herself. She was going to feel bad if she needed to ask somebody to help boost her.

Kim Calo (10:43):

Aww.

Carol Pehotsky (10:43):

So, it went a long way to be... That she could be able to ac- access that technology, too.

Kim Calo (10:47):

I'm sure. I'm sure that really helped her, and kind of engaging her in the care, too.

Carol Pehotsky (10:50):

Yes.

Kim Calo (10:50):

Still keeping her mobile as much as she can, that really goes a long way as well.

Carol Pehotsky (10:53):

Yup. And so, sometimes though that technology isn't available. So, you know, we're trying to avoid manual lifting and sometimes we can't. What are some other things that we should be doing to mitigate the risks that go along with manual lifting if we- if we cannot avoid it and we do need to really lift that patient?

Dr. Drew Schwartz (11:11):

Yeah, I think from the equipment standpoint, I'd definitely lean on Kim with that.

(11:15):

With patients that I see that are nurses here at the clinic, it's a lot of abdominal bracing, spine stiffening techniques.

Carol Pehotsky (11:21):

Mm, okay.

Dr. Drew Schwartz (11:21):

So, we definitely want our spine to be the stiff point and the foundational point for our movers, our shoulders and our hips to push off of that stiffness. I use an analogy of, would you rather jump off cement or would you rather jump off a beach?

Carol Pehotsky (11:36):

(laughs)

Dr. Drew Schwartz (11:36):

You'd probably rather jump off a cement- cement, right? You can jump a lot higher-

Carol Pehotsky (11:40):

Sure. (laughs)

Dr. Drew Schwartz (11:40):

... That force isn't going to get sucked in, right? But when we push and- and get that spine stiff, it's more of a barreling not of a- not of a less... I would say a suck in or something like that.

Carol Pehotsky (11:49):

Mm-hmm.

Dr. Drew Schwartz (11:50):

We get that stiffness. And with that stiffness we can generate force of that much easier. We also don't recruit accessory muscles, so we're not, you know, that grabbing sensation you might feel when you're picking something up and you say, okay, I don't think that muscle is supposed to do that. That's what you feel and- and when we have that s- stiffness in there, now that force is generated, it's a lot easier.

(12:08):

The other thing we want to look at is looking at using large force generators as well. Our glutes, lower half rather than, you know, as humans we're lazy and we are just like, ah, I'm just going to move this patient super quick. And that's typically when you most see it.

Carol Pehotsky (12:20):

That's when you get hurt. Sure.

Dr. Drew Schwartz (12:20):

Yeah.

Carol Pehotsky (12:20):

Yeah.

Dr. Drew Schwartz (12:21):

So, trying to barrel out, use those glutes, a more athletic stance. There's a reason why, you know, I use a lot of sports analogies when I'm working with patients, is because athletes are the most efficient humans, right, as far as movement, right.

Carol Pehotsky (12:21):

Yeah.

Dr. Drew Schwartz (12:34):

So, if we can base that off of there even remotely, I'm not asking everyone to, you know, be amazing and be Lebron when they're moving someone, right. I get that.

Carol Pehotsky (12:35):

(laughs)

Kim Calo (12:35):

(laughs)

Dr. Drew Schwartz (12:42):

But we- we want to-

Carol Pehotsky (12:45):

But channel your inner Lebron. (laughs)

Kim Calo (12:45):

(laughs)

Dr. Drew Schwartz (12:47):

Yeah, like channel your inner Lebron and- and really focus on doing a more athletic stance because that's usually the more correct stance as far as efficiency and safety.

Carol Pehotsky (12:53):

Okay. Anything to add from a-

Kim Calo (12:55):

Right.

Carol Pehotsky (12:55):

... Do the best you can standpoint? (laughs)

Kim Calo (12:57):

Right. I mean, I think that, you know, safe patient handling equipment is really the best thing that you could do. I think also, you know, assessing the patient, looking at their mobility needs, what they're capable of, working with colleagues such as, you know, physical therapists, looking at those recommendations and involving them in the care. They're already involved in the care, but really kind of collaborating with them to find out what's the best way to move this patient and then kind of working together like that.

Carol Pehotsky (13:21):

Well, and it's a good point is that it's easy to assume the patient can't help, but have you asked the patient? Or have you involved the patient to say even something as simple as, can you bend your leg? Can you-

Kim Calo (13:33):

Mm-hmm.

Carol Pehotsky (13:33):

... Help? Asking the physical therapist, what have you been working with then on? Because it will do everybody a world of good-

Kim Calo (13:39):

Right.

Carol Pehotsky (13:39):

... If they can participate.

Kim Calo (13:40):

Right. And involving them in the goals, too.

Carol Pehotsky (13:40):

Yeah.

Kim Calo (13:42):

If the goal is to get to the patient, you know, get the patient to the chair three times a day, review that with them. Let them know, let the family know. I mean, kind of engage them in that part of the care as well.

Carol Pehotsky (13:50):

So in the up and down and around and up and down the hallway of a nurse's life, we know that also we're spending time at- at a work station on wheels, at some sort of computer station, so that's- that's also part of a nurse's daily life. Anything a nurse should be looking out for in terms of that work station, you know, you- you mentioned those carpal tunnel injuries, something I need to be on the lookout for in terms of also making that ergonomically safe for me and my charting discipline as well.

Dr. Drew Schwartz (14:18):

Yeah, I think setting it up for you is the biggest point that I always tell patients is, you're not hurting anyone's feelings if you're moving a chair up and down and you're moving the mouse a little bit.

Carol Pehotsky (14:18):

(laughs)

Kim Calo (14:18):

(laughs)

Dr. Drew Schwartz (14:27):

And you're moving the monitor. Someone that's 5'2" and someone that's 5'10" are going to have completely different, you know, biomechanics-

Carol Pehotsky (14:33):

Yeah.

Dr. Drew Schwartz (14:34):

... And levers, right. So, we have to look at setting up for you what works for you if you're sharing a space. If it's your own space, then you definitely should be-

Carol Pehotsky (14:40):

Yeah.

Dr. Drew Schwartz (14:40):

... Getting that locked in, and day one usually.

Carol Pehotsky (14:43):

Mm-hmm.

Dr. Drew Schwartz (14:43):

I've been doing some onboarding work with... As part of onboarding piece for ergonomics for new hires. Doing that now just sets them up, you know, it's kind of like the, what is it? The set it and forget it kind of-

Carol Pehotsky (14:55):

Yeah.

Dr. Drew Schwartz (14:55):

... Infomercial back in the day.

Kim Calo (14:55):

(laughs)

Dr. Drew Schwartz (14:57):

You kind of set it up and you're good to go.

Carol Pehotsky (14:57):

Mm-hmm.

Dr. Drew Schwartz (14:59):

But we have to get that set in and- and locked in. And then if you are sharing a space, really tailoring it for you. So, like I said, most of the monitors, we want to raise those up a little bit. The mouse, we want to bring that closer to our body.

Carol Pehotsky (14:59):

Okay.

Dr. Drew Schwartz (15:10):

So, taking a look at versatility and variability as well. And for the computer on wheels, that we see a- a lot of issues with because a lot of people with height discrepancies, they're just going to... They just, "Oh, I've just got to... This is what I'm using for today. Someone that was 6'2" was using it before and I'm 5'5"."

Carol Pehotsky (15:25):

(laughs)

Kim Calo (15:25):

(laughs)

Dr. Drew Schwartz (15:26):

It's like, so they're reaching their arm all the way up, holding it up, engaging all these upper extremity musculature and then wondering why they're having, you know, headaches that come... Wrap around behind their eye, shoulder clicking, popping, stiffness in their mid-back. It's because you're in that position, in that elongated lever throughout the day. So, set it up for you and just make sure it's versatile and so we can get a lot of movement throughout the day as well. And movement promotion is significant as well.

Carol Pehotsky (15:51):

I'm hearing a theme around, you know, as- as humans we fool ourselves into thinking, this will just be a moment.

Dr. Drew Schwartz (15:51):

Mm-hmm.

Carol Pehotsky (15:55):

And its moment plus moment plus moment plus moment adds up into rep- repetitive injury.

Dr. Drew Schwartz (16:03):

Yeah. Yeah, and I think the other thing, too, you kind of alluded to it, where is that we need to have that equipment part of our daily activity-

Carol Pehotsky (16:10):

Yeah.

Dr. Drew Schwartz (16:10):

... And within our field of view, right.

Carol Pehotsky (16:10):

Mm.

Dr. Drew Schwartz (16:13):

So, if it's in sight, it's in mind. So, one of the things that I like to do if you're on, like a computer on wheels, if you're on, uh, station throughout the day, get a sticker, get a figurine, put that in your field of view. Every time you see that reminds you, okay, I need-

Carol Pehotsky (16:13):

Oh.

Dr. Drew Schwartz (16:25):

... To sit back in the chair.

Carol Pehotsky (16:26):

Habitual cue, yeah.

Dr. Drew Schwartz (16:27):

Yup. Seat back just a little bit, back on that backrest, what is my posture looking like, what's my head looking like Because it's probably looking like a C shape, right. So, if we can do that mental cueing throughout the day, that helps us, prevent us into getting those poor posture. Because we're not going to do it 100% of the day, it's not feasible. I don't do it, you know, I want to be realistic. I have-

Carol Pehotsky (16:44):

He's sitting up very tall in his chair, ladies and gentlemen.

Kim Calo (16:44):

(laughs)

Dr. Drew Schwartz (16:44):

It's, yeah-

Carol Pehotsky (16:47):

I'm sitting up all straight up and down as well.

Dr. Drew Schwartz (16:47):

(laughs)

Kim Calo (16:47):

(laughs)

Dr. Drew Schwartz (16:50):

But it- but it's not realistic, right. And I- I think we all know that and so having realistic expectations to say, like you're not going to do this all the time. But we want that to be the majority of the time, not the 100% of the time.

Carol Pehotsky (17:01):

Yeah. And I - I think if you ask most nurses just man on the street, woman on the street, they would talk about back injuries, they wouldn't necessarily talk about documentation related work injuries. But when you think about the amount of documentation we do, right?

Kim Calo (17:01):

Right.

Carol Pehotsky (17:15):

It makes sense-

Dr. Drew Schwartz (17:17):

Yeah.

Carol Pehotsky (17:17):

... That that could be an injury source as well.

Dr. Drew Schwartz (17:19):

Yeah. And I think the computer is... People almost think it- it comes with the territory, right.

Carol Pehotsky (17:20):

Yeah.

Dr. Drew Schwartz (17:25):

Low back. Oh, I work at a desk, I'm supposed to have back pain. No.

Carol Pehotsky (17:25):

(laughs)

Kim Calo (17:27):

(laughs)

Dr. Drew Schwartz (17:28):

No.

Carol Pehotsky (17:28):

No.

Dr. Drew Schwartz (17:29):

We definitely don't want that.

Carol Pehotsky (17:30):

Yeah.

Dr. Drew Schwartz (17:30):

So, I- I think when we look at computer work, a lot of the patient moving and stuff might be like, oh, that's the thing. But that computer work is, you know, you're not doing anything then all of a sudden, you're going to move a patient so you're going zero to 60, that musculature is like, waking up, like what's going on?

Carol Pehotsky (17:45):

Yeah, both ends of the spectrum of-

Dr. Drew Schwartz (17:45):

Yeah.

Carol Pehotsky (17:47):

... Of you challenging completely different muscle groups-

Dr. Drew Schwartz (17:50):

Mm-hmm, yup.

Carol Pehotsky (17:50):

... But still challenging each of them.

Dr. Drew Schwartz (17:51):

Correct.

Carol Pehotsky (17:51):

Yeah. So the- the teams that I lead, still moving lots of things but in a para-adaptive space, it could be a patient, it could be a very heavy instrument tray, it could be a microscope or a laser so it's- it's often patient but sometimes it's grabbing things off of low shelves, or it's pushing and pulling heavy pieces of equipment. Any recommendations for caregivers that are moving heavy equipment and- and different things they need to do in terms of body mechanics or ergonomics with that work?

Kim Calo (18:22):

I think you bring up a great point because there's lots of people that work in a hospital that aren't necessarily moving patients but they're moving, like you said, they're picking up large boxes or they're pushing carts or they're doing things in their day-to-day work that really can put them at a risk for developing some sort of injury in their back. And so, I think, you know, as you mentioned, good body mechanics. I believe they always say, you know, pushing instead of pulling, you know, if you can do that. I'm sure Drew has more- has more tips on that. But I, you know, I think being aware of it and kind of... I think that a lot of places will also, you know, do some training when you're hired to kind of make sure that you understand, you know, your role in this and how you can keep yourself safe.

Dr. Drew Schwartz (18:58):

Yeah. I think going back to, you know, stiffening spine, using big muscle groups, you really can't go wrong with that typically. Now, yes, easier said than done, Because-

Kim Calo (18:58):

Sure.

Dr. Drew Schwartz (19:07):

... You know, we're not going to be, like you said, we're not going to be on your shoulder like, "Eh, I wouldn't do it that way," right?

Carol Pehotsky (19:11):

(laughs)

Dr. Drew Schwartz (19:11):

So, I... we- we know that it can't be perfect all the time but stiffening the spine, moving big muscle groups. Trying to keep that spine long is another good recommendation, almost as if someone's pulling a string up above your head. Just to keep that spine from doing that- that C shape-

Carol Pehotsky (19:26):

Mm. Mm-hmm.

Dr. Drew Schwartz (19:26):

... Um, I think is good. And then, once again a mental cue, right. If you're not at a computer station, what can you do? Well, patients that I see that have that, we- we look at, you know, maybe I wear a ring or I wear a bracelet, or I put something on my hand, reminds me every time I see that, ah, I should, you know, use those big muscle groups again.

Carol Pehotsky (19:43):

Oh, so I am- I'm reaching to go push that thing-

Dr. Drew Schwartz (19:44):

You'll see it-

Carol Pehotsky (19:44):

... And I've got something on my hand-

Dr. Drew Schwartz (19:45):

... Mental cue, yeah.

Carol Pehotsky (19:46):

Okay.

Dr. Drew Schwartz (19:47):

So, I, you know, I- I like that, and you really can't go wrong with that. The other thing is to take a look at, as weird as it sounds, take a look at how a toddler moves. They don't have the bad habits, they don't have-

Carol Pehotsky (19:47):

(laughs)

Kim Calo (19:56):

(laughs)

Dr. Drew Schwartz (19:56):

... You know, the- the weird-

Carol Pehotsky (19:58):

Yeah.

Dr. Drew Schwartz (19:58):

... An injury here, a knee injury here. You don't see many toddlers with like an ACL tear, right. So-

Kim Calo (19:59):

(laughs)

Dr. Drew Schwartz (20:03):

... What we want to look at is how does a toddler pick something up, right. Spine. Long, moving through the hips, picking it up. And we look at that, we're like, wow, that's- that's interesting. I- I wouldn't do that, I would just bend over and, you know, round my back. So, when all else fails-

Carol Pehotsky (20:17):

Hm.

Dr. Drew Schwartz (20:17):

... Watch a toddler.

Carol Pehotsky (20:18):

So, a lot of conversation we've had today about training. So what can we do in terms of, you know, onboarding is very important, no matter, you know, we've got listeners from all parts of the country and I think even the world, and knowing that it's different where- wherever you go. So hopefully everybody's getting some sort of training, no matter where they're working, in terms of taking good care of themselves. What are some things that we can be doing to educate ourselves, not just when we start a new job but sort of through out. Where- where should we be going for more information or reminders about how to take good care of our bodies to make sure that they keep working when it comes to body mechanics and ergonomics?

Kim Calo (21:00):

I think that you bring up some really good points. I think that training's essential and I think, you know, when we teach classes on mobility and safe patient handling, we want caregivers to be involved and actually practicing with them... With the safe patient handling device, that is, and to really feel comfortable with it. But making sure that, as Drew mentioned, that it's close by. So, a lot of it, making sure that it's easily accessible and making sure that they feel confident when they're using it. That they know how to use it, that they know where it is, and that they know which patients would benefit from it.

Carol Pehotsky (21:29):

Mm, yeah.

Kim Calo (21:29):

And I think that goes a long way I think also the unit culture. So, if you have a unit that, you know, constantly gets out their portable lift and they use it when they're moving patients. Or they use that air assisted device on patients all the time, it's really going to increase that prevention of, you know, injuries and things like that because they're used to using it. And I think that goes along with nursing leadership, too. Setting that example, making sure the equipment is there, there's, you know, a stockpile of it, it's accessible and all those good things really go hand in hand.

Carol Pehotsky (21:57):

A- a great shared governance topic-

Kim Calo (21:59):

Yes.

Carol Pehotsky (22:00):

For- for-

Kim Calo (22:00):

Oh, definitely.

Carol Pehotsky (22:01):

... You know, we've- we've got some nursing students who are listeners and- and as you're entering the nursing workforce, it's a great question to ask on interviews or as you're coming into the workforce is-,  what does your team do around safe patient handling? Or how do you involve your caregivers in decisions around device purchases around safe patient handling? How are you encouraging your caregivers to take care of themselves?

Kim Calo (22:25):

Right. And as nurse are training new nurses on the nursing unit. So, if you have a new grad that's coming in, hey, this is the air assisted device that we use, and these are the patients that we use it on, and all the things that go along with caring for those patients. So, making sure as you're onboarding, you know, those new nurses, that they feel comfortable, they feel empowered, and they know how to use that certain safe patient handling device.

Carol Pehotsky (22:44):

And if you're walking into a unit where- where someone says, eh, we don't use that-

Kim Calo (22:49):

Right.

Carol Pehotsky (22:49):

... Then what?

Kim Calo (22:49):

Right, I mean-

Carol Pehotsky (22:50):

Yeah.

Kim Calo (22:50):

I- I think, speak up. You know-

Carol Pehotsky (22:52):

Yes.

Kim Calo (22:52):

... Where are these devices? Let me show you this.

Carol Pehotsky (22:54):

Yeah.

Kim Calo (22:54):

Did you know that these, you know, these products ex- exist. Or to your point, shared governance projects, you know, looking at things like that. Looking at different data points and things like that of, you know, we instituted using these safe patient handling devices and then look at this data point now.

Carol Pehotsky (23:07):

Mm-hmm.

Kim Calo (23:07):

So, I think there's a lot that you can do with it. And really just looking at the assessment of the patient. What are they capable of doing, and what's the best piece of equipment to use for this? But it's got to be that culture of mobility and safe patient handling that kind of go together.

Carol Pehotsky (23:20):

And to wrap it all together for our nursing leaders in the audience, we made a couple references along the way, but a nurse leader or really any... A- a nurse who's really looking to enact change, you know, we're very fortunate that we have these resources at Cleveland Clinic. Someone, perhaps another organization doesn't necessarily have these resources wants- wants to be able to put together and ask for more or different devices. What advice would you give somebody? To... How- how to tackle some of this?

Kim Calo (23:48):

Yeah. I think that's a great question. I think that listening to your caregivers. I think doing, you know, a routine risk assessment on your nursing unit, trying to look at your patient population, what are the best devices, consulting, you know, area experts that might be able to come in and help you with these kinds of questions. And then leading by example as well. So, kind of, you know, showing the devices to your caregivers, kind of showing data. Data always speaks volumes so if you can show, you know, different studies that this was used on this and then they had better outcomes. Honestly, when we show caregivers safe patient handling devices, they're excited about them. They like to use them. I don't think that, you know, you'll have issues in that. It's making sure that it's the culture of the unit, that's it's just something that they do. It's kind of muscle memory. Okay, we're going to boost this patient, we're going to grab this device to help us make it easier. I think that goes a long way.

Dr. Drew Schwartz (24:34):

Yeah, I think that the education piece is the vast majority of the problem, right. If we can't have that education piece within an organization or a culture, you're not going to have a lot of ergonomic awareness, right. You just don't know what you don't know. So, I think if we can continue, especially here at the clinic, you know, people can reach out to our team, and we have the services here. This is what we do. Whether it's nursing, whether it's someone within-

Carol Pehotsky (24:34):

Yeah.

Dr. Drew Schwartz (24:34):

... You know, pathology-

Carol Pehotsky (24:58):

Yeah.

Dr. Drew Schwartz (24:58):

... Or oncology, whatever. We do this for a living and as you can tell, we're super excited about ergonomics.

Carol Pehotsky (24:58):

(laughs)

Kim Calo (24:58):

(laughs)

Dr. Drew Schwartz (25:04):

But that education piece is the biggest thing that. And if you're not, you know, within the clinic or anything like that, take a look at, I don't know, you're probably looking at reaching out to your P/T department. They probably have a great resource for biomechanics to give chiros. Same thing, we- we want to take a look at who has biomechanics nailed down.

Carol Pehotsky (25:22):

Mm-hmm.

Dr. Drew Schwartz (25:23):

They probably are doing some ergonomic training within that. Take a look and reach out to them. I think that would be a good resource. The problem with, you know, as everything with stuff on the internet, there's a lot of stuff. There's a lot of voices-

Carol Pehotsky (25:34):

Ah, sure.

Dr. Drew Schwartz (25:34):

... And some of the wild stuff is the stuff, especially on YouTube that gets the most clicks that you'll see that, oh, we need to do this, this, this. So really take that with a grain of salt. There's a lot of really good resources from different institutions. We've done a couple of wonderful articles and different content surrounding ergonomics. So, take a look at that. Don't always click on the first YouTube video.

Kim Calo (25:54):

(laughs)

Carol Pehotsky (25:55):

Always good advice-

Dr. Drew Schwartz (25:56):

Yeah.

Carol Pehotsky (25:56):

... No matter what the topic.

Dr. Drew Schwartz (25:57):

(laughs)

Kim Calo (25:58):

(laughs)

Carol Pehotsky (25:58):

Boy, it's hard to beat that, right? And- and I- and I guess I also offer that, you know, sometimes expense gets in the way but when you think about the cost of, you know, and caregiver downtime and- and all of that's wrapped into there, it- it, you know, a nurse leader really looking at the data around that, some of these technologies can kind of pay for themselves, probably, right?

Kim Calo (26:19):

Oh, right, yeah. I think, you know, when you look at that type of data and you look at the cost and... Or if you have somebody, a caregiver that gets injured-

Carol Pehotsky (26:25):

Yeah.

Kim Calo (26:25):

... And then has to leave that unit or place that they're working-

Carol Pehotsky (26:25):

It's awful.

Kim Calo (26:28):

... Because they can't do that kind of work anymore.

Carol Pehotsky (26:30):

Yeah.

Kim Calo (26:30):

It's horrible, you know, for that caregiver and that's what we don't want to happen.

Carol Pehotsky (26:34):

Right.

Kim Calo (26:34):

But there is, you know, then you're hiring a new employee, you're training a new employee, there's the, you know, the morale of the nursing unit knowing that somebody was injured, things like that.

Carol Pehotsky (26:35):

Right.

Kim Calo (26:43):

So, I think that that all can kind of go together with that. The safe patient handling devices, there's a lot of them out there and you can figure out what suits your unit and what works best for your caregivers. Get their feedback, too. What did they find... did they like this one versus another one. You know, there's different ones out there and they can kind of see what- what would they use. Because you... They... You want them to use it. You don't want it to-

Carol Pehotsky (26:43):

Right.

Kim Calo (27:02):

... To sit in a closet and not be used. You want it to be out there and making sure they're protecting themselves.

Carol Pehotsky (27:07):

All right. Well, so we're going to go watch toddlers pick up things.

Kim Calo (27:07):

(laughs)

Dr. Drew Schwartz (27:07):

Yup.

Carol Pehotsky (27:10):

We're not going to click on the first YouTube video.

Dr. Drew Schwartz (27:12):

Yup.

Carol Pehotsky (27:12):

We're going to work on our core strength.

Dr. Drew Schwartz (27:14):

(laughs)

Carol Pehotsky (27:14):

And channel our inner angel on our shoulder to make sure we're, uh, using good posture. (laughs)

Kim Calo (27:19):

All good life lessons.

Carol Pehotsky (27:20):

All good... Right? Very applicable. So- so you guys have been fantastic guests. I can't thank you enough for joining us. Before we call it a day, we like to flip to our speed round where we get to let our audience in to get to know a little bit more about you as amazing human beings and not only as content experts in ergonomics. So, we'll end with just one fun question for each of you. Would you please share with our audience what's the best advice you've ever received. Who wants to go first?

Kim Calo (27:47):

I can go first.

Carol Pehotsky (27:48):

Okay.

Kim Calo (27:48):

My best advice I ever received was from my mom.

Carol Pehotsky (27:51):

Okay.

Kim Calo (27:51):

And her advice was you'll never regret being kind, which it has really helped me and in a lot of situations I think it's just a great life lesson. And I try to, you know, just remember that and it's... I just think it's nice.

Carol Pehotsky (28:04):

It's fantastic. Top that.

Dr. Drew Schwartz (28:06):

Yeah.

Carol Pehotsky (28:06):

(laughs)

Kim Calo (28:07):

(laughs)

Dr. Drew Schwartz (28:08):

You can't top, you know, mom quotes. That's good. No, I don't know who said it, I... But one of the things that I like to live by is do something hard every day. Do something that challenges you every day. Whether that's working out in the morning, whether that's, you know, doing ice baths or sauna, whatever you want to do. You know, reading a book that you been... Uh, I don't... I should read this, but I don't really enjoy reading this, but I should do it. Doing something that challenges you every day just makes you a better person and the rest of your day is going to be a little easier knowing that you did the toughest thing already.

Kim Calo (28:39):

Oh, I like that.

Carol Pehotsky (28:39):

All right. I like that, too.

Kim Calo (28:39):

Yeah.

Carol Pehotsky (28:39):

All right. Thank you so much for joining me today.

Kim Calo (28:41):

Thank you for having us.

Dr. Drew Schwartz (28:42):

Thank you for having us.

Carol Pehotsky (28:46):

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@CCF.org.

(29:07):

To learn more about nursing at Cleveland Clinic, please check us out at ClevelandClinic.org/nursing.

(29:13):

Until next time, take care of yourselves and take care of each other.

(29:21):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.