Applied Ergonomics 38 (2007) 7–17 Competency-based training for patient handling Sue Hignett à , Emma Crumpton Department of Human Science, Healthcare Ergonomics and Patient Safety Research Unit (HEPSU), Loughborough University, Loughborough, Leics LE11 3TU, UK Received 4 February 2005; accepted 1 February 2006 Abstract A technique-training approach has traditionally been used to address the problem of back pain associated with patient handling. This project aimed to investigate whether different levels of safety culture, based on competency-based training, resulted in different behaviour (physical and cognitive) for patient handling tasks. Sixteen healthcare organisations in the UK participated from the acute and primary healthcare sectors. Archival data for each organisation were benchmarked against the Royal College of Nursing competencies for manual handling. Behavioural data were collected on two patient handling tasks: (1) sitting-to-standing and (2) repositioning-in-sitting using observations (postural analysis) and interviews (verbal protocol analysis). The data were analysed for each organisation and then grouped by task and method into larger data sets. These data sets were triangulated using the key decision-making points (from the interview data) as the framework. The results showed that in organisations with a more positive safety culture the nursing staff demonstrated more complex decision-making about the patient handling tasks and had lower levels of associated postural risk. r 2006 Elsevier Ltd. All rights reserved. Keywords: Training; Nursing; Safety culture 1. Introduction Studies of back pain in nurses have found associations between back symptoms and poor posture (Engels et al., 1996), lifting patients (Jensen, 1990; Pheasant and Stubbs, 1992) stress at work (Estryn-Behar et al., 1990), and organisation and working relationships factors (Dehlin and Berg, 1977; Damkot et al., 1984). Traditionally a training approach has been used to address the problem of back pain as, according to Graveling (1991), it offers an easy option for employers. However Hignett (2003a) found strong evidence from 12 studies in a systematic review on patient handling that interventions relying on technique training had no impact on working practices or injury rates. To address the many questions about the content of a training programme for patient handling the Royal College of Nursing (RCN) carried out a consultation process in 2001/02 to explore the structure of a fully integrated risk management system for manual handling. Focus groups were held with nurses, nurse managers, back care advisers, manual handling experts, safety representatives, healthcare assistants, disability support groups, training and educa- tion providers, equipment manufacturers and health and safety inspectors. This resulted in the publication of manual handling competencies (RCN, 2003) to set out a framework for a safer manual handling culture instead of a prescriptive approach concerned with content, length and duration of training. A competency approach to patient handling risk management has also been used in Australia (WorkCover NSW, 1998). Competency standards describe the knowl- edge, skills and attitudes that need to be applied to minimise risks. They include units (to define the broad area of performance), elements (specific skills) and performance criteria (demonstrated outcomes for each variable). They can include a range of variables to allow for application in difference contexts and are underpinned by evidence to support the required knowledge, skills and attitudes (WorkCover, 1998, 2001). The RCN guidance aimed to bridge the gap between theory and practice by changing attitudes and behaviours ARTICLE IN PRESS www.elsevier.com/locate/apergo 0003-6870/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.apergo.2006.02.004 à Corresponding author. Tel.: +44 1509 223003; fax: +44 1509 223940. E-mail address: S.M.Hignett@lboro.ac.uk (S. Hignett).