BACKGROUND: The prevailing focus on cognitive load reduction in healthcare environment standardization excludes a domain of healthcare delivery that could contribute significantly to safety and efficiency through standardization, but it has escaped discussion in the context of the biomechanics of care delivery. Inappropriate biomechanics not only can harm caregivers but compromise care delivery. Little, however, is known regarding the biomechanics of patient care and the way it interacts with the configurational issues typically targeted in healthcare environment standardization.
OBJECTIVES: Examine the types of potentially harmful or stressful actions exhibited by nurses during patient care delivery in an acute medical/surgical setting. Examine the sources influencing unsafe actions.
METHOD: Twenty nurses provided three types of simulated care in an experimental setting involving nine care configurations that were systematically manipulated. A kinesiology expert coded 80 simulation segments representing two types of task and two levels of environmental challenge to identify potentially stressful and harmful actions. Exploratory and regression analyses were conducted on the data.
RESULTS: Analysis suggests that a considerable proportion of potentially harmful and stressful actions are associated with the design of the physical elements as opposed to the configurational factors typically addressed in standardization. Both of these factors interact to produce work-arounds that result in unsafe actions.
CONCLUSION: The standardization of healthcare environments needs a larger framework to address both cognitive lapses and the biomechanics of care delivery.