Loaded both ways: The impact of dialectical tensions on nurses’ manual handling practices

摘要

Background: Manual handling is an integral part of the work of nursing however high injury rates persist. A clarification of the clinical practice issues related to manual handling is the first step towards reducing manual handling injuries. As historical, cultural and socio-political factors combine to shape nurses’ manual handling practices, it is vital that the dominant paradigms guiding manual handling interventions are critically analysed. If the complexities of the clinical environment are not considered during the development of manual handling safety programs, then injuries and deviations from recommended practices may continue. Methods: This paper discusses the findings from a qualitative research study conducted in 2012 on the manual handling experiences of thirteen nurses from two Australian states. The study explored nurses’ perceptions and experiences relating to manual handling in the healthcare context and their participation in injury prevention programs. The research was framed in a critical emancipatory methodology incorporating an intent to provide opportunities for reflective practice, enhanced awareness and the potential for empowerment. The two methods used in this study were semi-structured interviews and researcher reflective journaling. Findings: Thematic analysis produced an overarching theme of 'power relations' that revealed a subcategory of ‘(mis)power’ and further subthemes of 'how to practice' and 'voicing practice issues'. Specifically this paper discusses a dataset on the first subtheme, 'how to practice’ and the dialectical tensions experienced by nurses when undertaking manual handling activities. The findings suggest that the socio-political context of healthcare impacts upon nurses’ professional lives and produces discordance between manual handling policy and practice. The authors argue that manual handling issues may not be resolved without due consideration of these contextual influences on practice. Conclusion: Critical reflection and recognition of nurses' manual handling concerns can validate nurses’ experiences and make explicit previously taken-for-granted assumptions about manual handling. A clear understanding of the conditions that constrain nursing practice is a prerequisite for manual handling improvements in healthcare. The inclusion of nurses’ perspectives and experiences enables the generation of new insights to aid the development of interventions that are more readily embraced by clinicians. Furthermore, the reconceptualisation and identification of ways to restructure manual handling can empower nurses to act on the basis of this knowledge. The paper concludes with a discussion on the overall significance of conducting this study in relation to the development of sustainable manual handling practice changes within the existing healthcare context.