Table 3.

Approaches to preventing musculoskeletal injuries among nurses worthy of further investigation

Theme	Sub‐themes	Example quotes
Culture of safety	Changes in management approaches	“There's always a lot of management systems and management telling the workers what to do rather than going to the workers and saying what do we need to do that's going to help you” (P1). “If the staff are given the control of what needs to be put in place to make them safe they're more likely to follow through instead of management saying “this is what you must do”…” (P1). “One of the main premises of occupational health and safety is consultation and communication. Consulting with staff and asking them what they want… can't get everything, we realise that, but you make concessions” (P1)
	Routine assessments of competence	“That mantra of ensuring that people are safe and competent to use the equipment and not just kind of winging it” (N2). “There could be a practical component to your annual performance review and that is about demonstrating competence in a range of different things specific to the environment that you're working in” (N3)
	Early reporting of injury	“Get on to injuries quickly or pain quickly so that you're managing it really well – they've got access to experts in the field that can help… that could be a responsibility of the employer” (P2)
	Promotion of physical activity and healthy lifestyle	“If you make, like, tai chi classes available at lunch time or Pilates or whatever the flavour of the month is and if you make it available to your staff at knocking off time, for example, so they can do a Pilates class before they go home – you know cheaper access to gyms or whatever” (P2). “An orientation to self‐care, looking after yourself, preventing injuries, making sure that you don't put yourself in a vulnerable position… trying to just mitigate the possibilities of dangers for oneself” (N3)
	Posters and print material	“I think that there's very little information around about how to prevent injury, as in, on the other end, just to give an example, preventing falls in hospital… you can't walk in the hospital and miss it. There's posters everywhere and those posters are aimed at staff and they're also aimed at the public. I don't think I've ever seen something that says “reduce risk of injury to staff by doing A, B, C” or “have you thought about doing this?” (P5)
	Pre‐employment screening	“Pre‐employment screening may be an option – there are certain pre‐employment screening tests that have been shown to be valid to identify an increased risk” (P1)
	Hazards analysis	“I injured my back, my lower back, nursing when an oxygen cylinder, a large one, fell and it was about to hit a patient and I dived and grabbed it so that was a hazard that should have been identified and made secure so it's about a hazard analysis – looking around to prevent those kinds of things” (N4)
Manual handling training	Training within clinical contexts	“On the floor, you know, I think maybe on the floor where a physio could go round and perhaps just with the more difficult perhaps scenarios have practice sessions” (P3). “On the job training, experience, is massively important… I think perhaps in the past it was like “oh well we've done the manual handling because they did that as part of their orientation, box ticked, that's it”, but I think it's more about the integration into actual workplace practices and on the job training… I would presume that would be more effective” (P2)
	Practical experience	“It's like learning to give an injection online… you can see how to do it but until you've actually got the needle… it's the same with lifting, you can see everything but until you've actually tried it out… it has to be practical” (N4)
	Refresher courses	“Those training programmes for recertification, refresher type of thing, I think that's really important” (N1). “Refresher courses maybe every year you've gotta go to your manual handling training. It needs to be practical. I don't think watching a video is of any benefit” (P1)
	Manual handling champions	“Something that may help well is if they had, cause it's hard to expect everyone to be an expert on manual handling, but if perhaps a ward having like someone who's like a champion or spokesperson for that and if they've had extra training perhaps they could be the ones who influence the culture and thinking of the ward and bring concerns around people not utilising correct technique” (P4). “You don't tend to go and read a textbook about how to move a person from A to B, it's more about what you see people doing” (P5)
	Lift teams	“If you've got lifters available, you know orderlies or whoever available to do the lifting and they get the training, they get the proper support… and whatever they need, they're well equipped to be able to do it, do it properly and safely, that might be a potentially better way to do it” (N5)
Workflow	Well‐designed workspaces	“The physical work environment of the hospital has changed dramatically over the 30 years that I've been involved… they've got rid of clear workspaces, they've got rid of the nurses station, there's all little cubby holes and rooms… there's no process for doing things and finding things” (N4)
Footwear	Podiatrist assessment	“When you see some of the staff in hospital, they're wearing crocs, which they're actually not allowed to wear, or they're wearing canvas shoes which aren't wipe able really… or something that's fashionable as opposed to practical. And if you're working an 8 or a 12 hr shift it's no wonder that some people end up with pain and back problems when they're not actually wearing appropriate footwear. It's almost like every nurse should have a podiatrist assessment and get properly assessed in terms of what footwear they should have” (N5)
Electric beds		“That would be a really easy recommendation to stop nurses injuries is to give them electric beds. For example, especially on orthopaedics because people have lower limb injuries, they often want to elevate, you know, like their legs for swelling purposes, and actually to take that tilt off the bed is the most dodgiest thing for your back, you have to come grab the bed at the end, bend your knees and take the wait of the patient as you lower it. So that would be a really simple fix” (P5)
Needs analysis	Individual tailoring	“Tailoring whatever you're doing to the particular demands of the job… workplace assessments and setting up a work station to suit” (P2)
	Frequency of lifting across different environments	“Taking an individualised approach… people are going to act differently so not one piece of equipment is going to be appropriate. Then choosing an environment where the frequency of needing to transfer is high would probably be a better place to do it… It's not just one size fits all” (P4)
	Distribution of resources	“It is difficult for an organisation because sometimes that equipment might lie unused for days and then sometimes five people might need it at once so it is very difficult for an organisation to be able to cost wise manage that… it's just frustrating at the time when you need a piece of equipment and it's not available… so whether or not, you know, a proper needs analysis has occurred… doing a stocktake on what current equipment is available and marrying that up with the profiles of the patients that are coming into the hospitals” (N5)
Stories		“The use of stories – you give the explanations, do the demonstrations, and tell the stories of the consequences of what may happen” (N1). “Stories really are powerful” (N4). “We talk about the power of stories and perhaps actually inviting people who have encountered significant musculoskeletal injuries during their profession to inspire people to think about it a little bit more because I do think we probably brush over it” (N2). “I'm really interested in the people who have got injuries, what happened to them, what were there things, where did they find themselves, was it getting someone out of a bath, was it the day to day stuff, was it about backs wearing out. That would be interesting to then put together what kinds of things, what kinds of situations, we need to think about” (N3)