Computers greatly extend the capacity of the human brain, and stress the muscles, tendons, and ligaments that hold us together. As home health and hospice agencies throughout the country computerize, new efforts must be developed to prevent and minimize injuries related to the use of technology in the office and home. Nurses will find their vision, wrists, necks, backs, and other joints overstressed by repetitive use of desktop and portable computers.
This article describes health issues related to the use of computers. Like all other workplace health and safety issues, most guidelines do not consider the complex and unpredictable world of home care; therefore, you will need to adapt the guidelines to the unique home environment found on each visit. Learn the basic safety principles of computer use to apply them in a wide variety of situations. It is equally important to remember that computers, although they are everywhere, are a new technology. Much remains to be investigated and understood about their long-term benefits to home care.
OSHA’s Attempt to Provide Ergonomic Regulation
President Bush made headlines early in the year when he signed an Executive Order repealing the new ergonomic standards developed by the Occupational Health and Safety Administration (OSHA) over the last 10 years. These regulations were to be the most extensive guidelines to promote the ergonomic health of all workers. In the absence of a federal mandate, home health and hospice agencies should voluntarily enact many of these minimum standards. While failing to do so may save the cost of educational programs and analysis of ergonomically high-risk jobs, the cost of repetitive motion, eye strain, and musculoskeletal disorders will soon dwarf those expenses.
Individuals also have a responsibility to implement self-care activities. Begin with getting a physical assessment, especially an eye examination. Many employees who experience eye strain, find that they have vision changes that were preexisting. When was the last time you had an eye examination? If it has been longer than 1 year ago, go get one!
Consideration in Using Computers
There are three broad categories of ergonomic concerns regarding computer use: physical, emotional, and environmental conditions.
The two primary types of computers used in healthcare are desktop and hand-held units. The general guidelines for injury prevention are the same for both. There are four main types of injuries associated with computer use:
Eye strain, headaches.
Musculoskeletal disorders (e.g., neck, shoulder, and joint pain).
Repetitive motion/stress injuries.
Carpal Tunnel syndrome.
Eye Strain and Headaches
Your eyes require proper light, adequate moisture, and periods of rest in order to work at optimal levels throughout the day. Adequate light means avoiding under-or overexposure to light. Overlit areas, such as those close to a window with intense glare, are as stressful to eyes as too little light. The condition associated with eyestrain is called “computer vision syndrome.” There are several interventions for the prevention of eye strain and headaches:
Clean the computer’s monitor regularly.
Occasionally look beyond the monitor to allow your eyes to rest.
The top of the monitor should be level with your eyes or just below, and directly in front of you.
The monitor should be free of glare. If close to a window, the screen should be at a right angle to the window.
Be sure to blink often and consider carrying eye drops that will add moisture to your eyes.
Take breaks from computer use every 2 to 3 hrs.
Musculoskeletal disorders (MSDs) are a variety of complaints including sore shoulders, aching backs, and stiff necks. MSDs derive from poor posture and from the way you move your mouse or other tracking tool. Some experts consider the mouse the most “dangerous” part of the computer as it causes the user to move his or her shoulder forward and sideways in abnormal positions.
Home care staff are high-risk candidates for MSDs. Unpredictable environments such as patient homes, increases the difficulty of securing a work area that allows adequate space and seating. That is why it is particularly important to take the following preventative steps in averting MSDs:
Consider substituting a standard mouse with a trackball.
Keep your posture just as you were taught as a child—sit up straight.
Standing may be the best position when using a computer, this is especially true in the home where it may be difficult to find a chair that allows you to sit with proper posture.
Take regular deep breathes; this allows you to relax and drop your shoulders.
Consider purchasing a home paraffin wax machine that allows you to treat sore muscles with heated wax that penetrates deeper than hot moist towels.
Repetitive Motion Injuries
Repetitive motion injuries (RMIs) are closely associated with keyboard use. These injuries can be compounded with the use of laptops that have a greater tendency to cause the wrists to maintain an upward position.
There are several interventions for the prevention of RMIs:
Use a light touch when typing.
Focus on maintaining your wrists in a neutral position when typing.
Consider using a split keyboard or wrist support.
Carpal Tunnel Syndrome
Inflammation of the median nerve as it passes through the tunnel in the wrist occurs as a result of repetitive motion. The result of inflammation is pain, numbness, and tingling in the wrist, hand, and fingers (except for the small finger, which is not affected by the median nerve). In addition to inflammation from repetitive motion, awkward posture, prolonged use of muscles, and hormonal changes can precipitate Carpal Tunnel Syndrome (CTS) by causing swelling of the tendons in the hand and wrist. There are several interventions for the prevention of CTS injuries:
Before, during, and after typing, perform several wrist exercises, such as moving the wrist in a circular motion.
Use a wrist support pad.
Apply ice to the palm side of the wrist after long periods of typing.
Additionally, a page on the WebMd Health Web site (http://my.webmd.com/content/article/1680.50855) contains many activities that can be performed throughout the day to prevent CTS.
Because computers are everywhere, their emotional use is rarely given much thought. I coined a term “technological hardiness” (TH) to describe the trait that reflects adaptation to technology in the environment. TH is the sum total of psychological characteristics that are related to computer use. These characteristics include a sense of ease while using computers, the ability to stay calm when the technology fails to respond as anticipated, and a general sense of confidence when using a computer. Individuals who are technologically hardy remember that patient care, not using a computer, is the goal. The use of technology can never be the goal in and of itself; it can only support individuals to provide care. Computers can do many tasks better and faster than humans. However, they lack common sense, wisdom, and the capacity to know when rules need to be broken for the patient’s benefit. Nurses will always be needed for those functions.
Computer Anxiety is the term used when discussing a reluctance to use computers. It includes: fear that using a computer will do harm, lowered self-image when using computers, worry, and distractibility. Studies show it may affect 30% to 40% of the population (Tseng, Tiplady, Macleod, & Wright, 1997). The best “cure” for computer anxiety is to use computers. Recognizing how much you already use computers may be the best way to overcome at least some computer anxiety.
Challenging yourself to learn one new skill at a time is another way of addressing anxiety. No one is expected to master the intricacies of a Point of Care system on the first day of use; it takes time. Establishing a plan for yourself to learn specific functions will help you to overcome your fear that the technology is too difficult to master.
Excessively cold rooms, as is often the case when air conditioning in a building is improperly set or when it is very hot or cold, can cause additional strain on joints and muscles that are operating computers for long periods of time.
Excessive noise is another factor that may cause a person to shout and can further stress one’s neck muscles.
Adequate Work Space
Having adequate work space is important. Home environments are less predictable—negotiate with the family to have one space cleared for you and your portable laptop.
Computer monitors create an electromagnetic field due to the electrical current used to run them. Long-term exposure to this radiation has an unknown effect. The same general guidelines for the prevention of other injuries also pertain to the prevention of radiation effects. Do not sit closer than 40 in. from the back or sides of the computer.
Every advance in technology has a human cost and a human loss. Computers make much possible; however, they can stretch the limit of what unprepared and overworked joints and muscles can safety produce. Take care of yourself and assure that your agency cares for you, too. Use these simple guidelines to keep your neck, all the joints and muscles of your arms, and your eyes healthy.
Key Points of OSHA Guidelines
Agencies would need a reporting procedure and method of responding to RSIs.
Employees must receive information on RSIs.
Agencies must identify, in advance, problem jobs.
Agencies need to design and implement measures to control RSIs.
Employees must receive additional training when working in jobs with a high risk for RSIs.
Employees with injuries would receive specific medical management.
© 2001 Lippincott Williams & Wilkins, Inc.