Developing a simulation tool to quantify biomechanical load and quality of care in nursing

Area of Science:

• Ergonomics and Biomechanics
• Healthcare Operations Research
• Nursing Systems

Background:

• Nursing is a high-risk profession for musculoskeletal disorders (MSDs) due to demanding workloads.
• Existing tools inadequately address the complex interplay between workload, physical demands, and care quality.
• Managing MSD risk requires novel approaches to quantify physical and performance impacts.

Purpose of the Study:

• To develop and apply a simulation tool combining Digital Human Modelling (DHM) and Discrete Event Simulation (DES).
• To quantify the impact of varying operational factors (geographical assignments, patient acuity, nurse-patient ratios) on biomechanical load and quality of care.
• To identify trade-offs between reducing physical workload for nurses and maintaining high-quality patient care.

Main Methods:

• Integrated DHM and DES to model care delivery in an acute care hospital unit.
• Utilized lumbar load data from 86 care tasks as inputs for the DES model.
• Simulated shift-long biomechanical loads, analyzing peak L4/L5 compression and moment.

Main Results:

• Increasing geographical patient-bed distance reduced L4/L5 compression by 8.8%.
• Increased patient acuity decreased L4/L5 moment by 4%.
• Higher nurse-patient ratios decreased L4/L5 compression (10%) and moment (17%).
• Despite reduced biomechanical load, quality of care indicators deteriorated significantly (20-29%) across all tested scenarios.

Conclusions:

• Simulation models can quantify trade-offs between nursing biomechanical load and quality of care.
• Operational adjustments that reduce physical demands on nurses may compromise patient care.
• This approach supports evidence-based decision-making for optimizing hospital policies and design.