Examples of ergonomic
challenges and
solutions in the
operating room
Identify the risks.
Make positive
changes to what
can be changed.
Examples of ergonomic
challenges in the O.R.
Repetitive movements carried out in a stressful environment more than
double the risk of musculoskeletal disorders.
1. Static work
When working for long periods with one’s arms in the same
position, the weight of the limb itself is often enough to cause
overload. Blood circulation worsens, you become tired and
your muscles start to ache. The brain receives reduced quality
information about what is happening in the muscles, making
working with precision more difficult as coordination worsens
and reactions slow.
2. Repetitive movements, twisting and bending
Passing and receiving instruments to and from the surgical field
means a combination of twisting and bending. Not standing close
enough to the operating table with your body bent forward and
your arms stretched, will place a very large load on your neck and/
or back. Any twisting on top of this will place increased load on
your discs. During procedures, the O.R. nurse may sometimes
end up in an extreme position; for example with all weight placed
on one leg and with the opposite arm extended, turning out
towards the mayo stand.
3. Working heights are not necessarily suitable for
everyone
During the surgical procedure, it is the surgeon’s preference
that determines the working height, regardless of whether the
work is done standing or sitting. Height variation in the team will
determine the load placed on each person. When standing, the
O.R. nurse may end up on tiptoe in order to reach.
4. The neck, your sore point
There is a well-established link between neck problems,
unhealthy working postures, poor visual ergonomics and stress.
The head is heavy, about 7–9 kilos, which increases the negative
effects of bending and twisting. If you have a poor view, you will
automatically adjust your neck in order to get a better view.
A stressful environment, or any kind of draughts, especially if
cold, will tighten the muscles. In these situations your shoulders
are often hunched and your head will be moving forwards.
5. Stress due to demanding situations
High job demands, lack of control and/or low ability to influence
decision making will increase the tension in the muscles, which
often causes pain. Sounds from the room ventilation or noise
from monitors and other technical equipment have a tiring effect.
Stress, with chronic pain as a result, may alter the way the
nervous system works, with symptoms remaining even after the
strain that caused the original muscle tension is gone. When in
pain and stressed, breathing often becomes rapid and shallow.
Stress is contagious.
6. Lack of interaction and communication
Different factors affect interaction in the O.R. Non-verbal
communication does not flow as it usually would, which may
lead to uncertainty, added tension and extra pressure. We emit
a lot of signals with our body language, often without realising it.
Incidents occur and have to be dealt with quickly.
? ?
Ergonomic deficiencies combined with time pressure, high quality
requirements, poor self regulation and low job satisfaction will increase
the risk of musculoskeletal disorders.
!
How to make positive changes
1. Vary your movements
Support your arms when possible
Take short breaks, i.e. move your head/shoulders/chest for a
few seconds. When possible, try to find support for your arms
during or in between tasks. If becoming tired or if experiencing
pain in your neck/shoulders, the most important thing is to vary
your movements, especially if you are under pressure. Rest your
hips against the operating table, when your back gets tired while
standing. Listen to what your body is telling you! Remember not to
rest on the patient.
2. Reduce the amount of repetitive twisting
Which working task is it possible to affect and perform in
a different way? Think about the position of the mayo stand
and where you chose to put your surgical equipment. To avoid
extreme positions when standing, especially repetitive twisting
and bending, try to get closer and use your legs to transfer
your weight from one leg to the other. The tasks that involve the
greatest load and which you cannot influence are best handled by
taking short breaks. Variety and recovery are the key words.
3. Adjust your working height
How can you adjust your working height? If you are working alone,
you may choose in what way you are going to carry out your
working tasks. For example, think about whether you can adjust
the height of the operating table when preparing the patient’s skin.
During the surgical procedure, the team will adjust to the working
height chosen by the surgeon. What can you do to improve the
working postures?
4. Body awareness affects your neck
Pelvis stability affects your neck. You must start from the base and ground
up to create a good position for your back and neck. Place your feet firmly
on the floor. To relax your shoulders and jaws you need pelvis stability to
support the spine and the neck. Then choose in what way to perform your
tasks. While having a short break, be aware of your feet (the floor), pelvis
(stability), shoulders and jaws (relaxed). Check lighting conditions in the
O.R. Shadows may occur due to standing positions and movements. They
often become a hindrance when trying to get a good view during surgery.
Custom-made glasses can make a big difference, with magnification for
example.
5. Interpreting the body’s signals – be aware
Be aware when the strain placed on you is both physical and
psychological. Notice your body, and if possible, adjust your working
position. Stand firmly by placing your feet on the floor properly, notice
your body’s carrying capacity, “let go“ with the downward force of
gravity. Breathe out. Connect with your body, notice the physical
sensations, take control and preserve your own ‘personal space’
regardless of whether your colleagues indicate stress through their
bodies. Think about interaction during surgery. How can you help to
create a calm and focused environment?
6. Good communication skills and team spirit
Before organising and meeting the surgical team you need
to become aware of your emotional condition. What emotions,
thoughts and needs affect you and how might they affect the team?
How can you connect with your body and its physical sensations,
gain awareness to focus on the surgical procedure together with
your team? In interaction with the team, communication is best
when you are alert and consciously aware of your body. Then you
will be able to interpret non-verbal communication and preserve
your own space. You can differentiate between your own stress and
your colleague’s. You help the team to deal with the intensity of the
situation and retain their focus. Look at each other with respect.
Research indicates that the communication climate in a workplace affects
the ability to manage not only psychological stresses and strains but also
physical ones.
Physical training on prescription for people who are
healthy but don´t exercise
The Borg Rating of Perceived
Exertion (RPE) scale
Purpose: Reduce the risk of illness and musculoskeletal disorders
First 4–6 weeks:
6 No exertion at all
• Endurance training, i.e. a brisk walk that gets your heart rate up
8
• Intensity: the equivalent of Borg Scale 12–14
9 Very light
• Duration: 12–15 minutes, increase gradually to 20 minutes
• Frequency: three times /week, but not three days in a row
Over the next 4–5 months, the intensity of the training gradually will
increase to Borg Scale 14–16. Exercise 30 minutes, three times/week,
but not three days in a row. The physical training will also make you
more capable of dealing with stress. Specific strength training is needed
to prevent work-related injuries. Training arm, trunk, shoulder muscles
and pelvis stability, with light weights or resistance band, increases the
endurance of the muscles. This is important when managing surgical
equipment.
7 Extremely light
10
11 Light
12
13 Somewhat hard
14
15 Hard
16
17 Very hard
18
19 Extremely hard
20 Maximal exertion
Physical activity – We need at least 30 minutes of physical activity each day.
We also need scheduled physical training in order to cope with everyday life
after the work day is over. This is increasingly important as we get older.
Balance between activity and rest
We are designed for movement, but we need the right
amount and sufficient recovery to be able to maintain
the body’s functions. In order to maintain concentration
and reduce our tiredness, it is as important for us to
rest our mind as it is to vary our movements, while
working.
The challenge is to perform the same work in a
different way and to find opportunities of taking short
breaks during the surgical procedure.
Research shows that after a long and demanding
surgical procedure, involving one-sided, repetitive
work steps, time is required for rest.
To prevent the risks of tissue damage, inflammation
and pain, the body must be given a chance to recover
and repair damaged tissues.
Physical activity and physical training prevent and cure
diseases. The key is balance between activity and rest.
Smart on-the-job exercises
with resistance band
Four exercises that will make you stronger, more flexible and fit in the operating room. Stand
firmly with slightly bent knees and pelvis stability. Avoid straining your thumbs and keep your
wrists straight when you are pulling. Do the exercises at a leisurely pace, 3–5 times per exercise.
Regular training: 10–15 times, 3 repetitions, 2–3 times a week.
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ergonomics in the O.R.
1. Central section of the deep and superficial muscles on the upper side
of the shoulder
1. Have straight arms hanging by
your sides, with your thumbs pointing
forwards.
2. Place the band over the back of your
hands. Adjust the length of the band,
note the position of the thumb.
3. Move your arms straight out to
the sides. Let your elbows guide
the movement.
2. The frontal muscles on the upper side of the shoulder and major
muscles of the back
1. Stand as if you are walking, with
your knees bent.
2. Adjust the length of the band.
Turn your thumbs inward.
3. Keep your trunk straight forwards.
4. Tighten your abdominal muscles.
5. Pull one arm straight forwards,
and the other arm straight back.
6. Reverse the sides and repeat.
3. Shoulder blade muscles; the shoulder's outward rotating muscles
1. Have your arms bent with your
elbows by your body.
2. Shorten the band and keep it on
the back of your hands. Turn your
thumbs up.
3. Turn your forearms outwards,
still keeping your elbows close to
your body.
4. Muscles between the shoulder blades
1. Extend your arms upwards with
elbow joints bent.
2. Extend the band. Place the band
over the back of your hands.
3. Pull the band down to your
shoulders behind your head.
4. Let your elbows guide the
movement. Bring your shoulder
blades together.
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to one or more of the Mölnlycke Health Care Group of Companies.
Copyright Kerstin Melander, Hälsan & Stressmedicin and Mölnlycke Health Care (2013)
#42181
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