Patient Handling: Applying the DINO Method among Portuguese Nurses Cotrim, Teresa ab ; Canuto, Daniel a ; Gomes, Silvia a ; Francisco, Cláudia c ; Correia, Lidia c a Secção Autónoma de Ergonomia, Faculdade de Motricidade Humana, Estrada da Costa, Cruz Quebrada, tcotrim@fmh.utl.pt; dcanuto@fmh.utl.pt; sdgomes@fmh.utl.pt b CIPER, Centro Interdisciplinar de Estudos da Performance Humana / FMH / UTL, c Hospital Garcia de Orta, EPE, Av. Torrado da Silva, 2800 Almada, csfrancisco@hgo.min-saude.pt; lcorreia@hgo.min-saude.pt ABSTRACT In the literature a patient transfer has been defined as a work task where nurses assist or lift a patient from one location to another or from one position to another. Using a safe work technique during patient handling is considered as one prevention strategy when integrated in multidimensional interventions. This study aimed to characterize nurses performance when accomplishing patient transfers applying DINO (Direct Observation Instrument for Assessment of Nurses’ Patient Transfer Technique). It was also intended to identify critical factors that influence nurses’ performance by using opinion questionnaires for professionals and patients. After the participants informed consent we carried out 40 observations in eight adult wards. Immediately after the observation of each transfer and the filling out of the DINO checklist, we applied the questionnaires to gather information about the nurse’s and the patient’s opinion of the carried out transfer. The DINO results can be observed in the final scoring between a minimum of 8 and a maximum of 15. The average result was 11,28 points (sd=4,99), which can suggest that the way in which the technical transfer was carried out might not have been the safest. The main results showed that in 35 observations there were enough space to the transfer performance (87,5%); in 9 of the transfers we noticed that the equipment to which the patients were transferred were not correctly positioned and blocked (22,5%); and in none of the observations the height of the bed was considered as being correct, as none of the beds height could be regulated. These last two factors contributed to a lower final DINO score. 63,6% of the patients considered that the transfer was carried out very safely, 81,8% considered that the transfer was very comfortable and 90,9% considered that during the transfer their dignity and privacy were maintained. Keywords: Hospital Ergonomics; DINO; Intervention Evaluation Tool; Patient Handling; Work Technique; Nurses. 1. INTRODUCTION Working within the health care sector is generally considered physically demanding (Dawson et al, 2008; Johnsson et al, 2002). For nurses patient handling tasks are performed daily and repeatedly during a work shift, which makes it strenuous and a major cause of musculoskeletal disorders (Kjellberg et al, 2000; Johnsson et al, 2002). In the literature a patient transfer has been defined as a work task where nurses assist or lift a patient from one location to another or from one position to another (Kjellberg et al., 2000). It can then be concluded that patient handling is a complex task and that it is an interaction between two or more individuals. In this interaction the nurse who will perform the transfer and the individual who will be transferred are present (Hignett et al, 2003; Johnsson et al, 2002). Different aspects of work technique and its importance in its relation with musculoskeletal disorders have been widely discussed (Hignett et al, 2003; Schibye et al, 2003), but it was Kjellberg et al (1998) who defined work technique as composed by two elements: the method chosen to carry out the task and the individual performance of the task. Using a safe work technique during patient handling is considered as one prevention strategy when integrated in multidimensional interventions (Bos et al, 2006; Dawson et al, 2008; Hignett et al, 2003). Although interventions can vary greatly in design and in content, when considered together there is moderate evidence supporting their efficacy in preventing back pain in nurses and musculoskeletal symptoms (Bos et al, 2006; Dawson et al, 2008). Nevertheless, comparing the effectiveness of these interventions has been difficult due to the different outcome measures used to evaluate success (Fray & Hignett, 2009). So, to study work techniques Johnsson et al (2004) developed an instrument called DINO (DIrect Nurse Observation instrument) where nurses’ work technique during patient transfers is assessed based on observation and Fray and Hignett (2009) developed an evaluation tool that allows comparison across all healthcare areas for future patient handling interventions called IET (Intervention Evaluation Tool) that includes 12 parts corresponding to previous evaluation tools. One of its parts is DINO. This study aimed to characterize nurses performance when accomplishing patient transfers applying DINO (Direct Observation Instrument for Assessment of Nurses’ Patient Transfer Technique) (Johnsson et al, 2004). It was also intended to identify critical factors that influence nurses’ performance by using opinion questionnaires for professionals and patients. This study is part of a wider project to adapt and evaluate the applicability of IET to Portugal (Fray e Hignett, 2009; Cotrim et al, 2011). Integrated in this project the first application of DINO was carried out in Portugal, as well as its translation and cultural adaptation (Cotrim et al, 2011). 2. MATERIALS AND METHOD In this study was used the observational method by means of DINO (Johnsson et al, 2004) for characterizing the nurses performance during the transfer of patients and two questionnaires were applied with the objective of characterizing the 194