Running Head: CLINICAL REFLECTION

Clinical Reflection
Emma Cumming
Trent University

CLINICAL REFLECTION

Clinical Reflection
Look Back and Elaborate
The incident that I chose to look back and elaborate upon for this clinical reflection,
involved myself, along with two other nurses, working together to transfer a bariatric patient who
was just over 450 pounds. We were attempting to move the patient up the bed, as the patient had
breathing difficulties, and was feeling short of breath in the position that they were lying in. The
room that the patient was in did not have an overhead lift, so the three of us were forced to move
the patient using only the bed pad, up the bed. Two of us nurses were shorter (about 53), while
the third one who helped us was taller (about 510). The bed was set up to our (53) comfortable
level, and the third nurse leaned down to help us. As we were lifting the patient up the bed, the
taller nurse felt something tug in her lower back, and it turns out that she tore some muscles in
the lumbar region of her back. I felt horrible when I saw the look of pain in her eyes, and hearing
her describe the pain and the physiological and psychological impact of being off of work is
heartbreaking. She has been unable to work since this incident, and this incident occurred in the
middle of June. This nurse also happens to be a single mother, and being off of work means that
she is currently stressed about providing for her family, as well as providing educational and fun
opportunities for her small children for the summer while she is unable to lift or play with them.
Throughout our nursing education, the importance of proper lifting body mechanics was
emphasized, and this experience truly hit home the importance of using the proper techniques,
and devices when available, to ensure safety. This reflection will examine this experience,
highlighting strengths and weaknesses, and relating it to nursing research previously conducted

CLINICAL REFLECTION

on musculoskeletal injuries in nurses, and will end with recommendations surrounding learning
needs, and linking those to competencies outlined by the College of Nurses of Ontario (2014).
Strengths and Weaknesses
In this situation, I believe my strengths involved physical strength of moving the patient
who was severely obese, along with the strength of maintaining professionalism in the situation.
I did not jump to conclusions when the other nurse immediately threw her hands to her back, and
instead focused on maintaining patient dignity, centralizing my focus on the care of the patient at
hand (raising the head of the bed, talking to the patient, moving pillows and IV/central line
tubing). This allowed the injured nurse to quietly exit the room, without making a scene,
potentially embarrassing the patient. I think a weakness in this situation would be to make an
adjustment to the height of the bed that wouldve been better for all of the parties involved. Also,
I fear that I came across as not empathetic to the injured nurse involved, by focusing on patient
care. I think an area of improvement would be to time manage the situation, finding an excuse to
leave the room to check in on my colleague before continuing advanced and extended care on the
patient at hand.
Literature Evidence
Nursing is ranked as one of the professions with the most incidences of workplace
injuries (King, 2011). The term musculoskeletal disorders refers to the health problems of
body parts used for locomotion (muscles, tendons, cartilage), and musculoskeletal disorders are
common amongst registered nurses (Lovgren, Gustavsson, Melin & Rudman, 2014). Improper
lifting technique, fatigue related to short staffing, stress, and the absence of regular physical
exercise are all risk factors for developing a musculoskeletal disorder as a nurse (Sezgin & Esin,

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2014). In this situation, we were indeed short staffed, and it was near the end of a long shift, so I
believe that this correlation with the evidence is indeed valid, as the risk factors of fatigue and
improper lifting technique clearly played a role in this musculoskeletal injury. Similar risk
factors to developing a musculoskeletal disorder are also identified in the article by DArcy,
Sasai, and Stearns (2011), who identified four factors affecting injury rates to be: initial nursing
training, training at the current facility, lifting devices, and time to execute daily duties (p. 836).
As noted in the initial section of this paper, there was no overhead lift available, which resulted
in the nurses having to do the lift manually. DArcy, Sasai, and Stearns (2011) note that the odds
of having a musculoskeletal injury were 41% lower in when a lift was available, and were 35%
lower when sufficient time was available to complete the given workload. Furthermore, King
(2011) identified that changing behaviour to reduce the risk of injury is key in preventing
workplace injuries, such as using overhead lifts, transfer boards, and reporting hazards through
appropriate channels, in order to ensure personal and patient safety. These journals argue that
being accountable for your actions, and finding resources available to ensure personal and patient
safety, are key in decreasing the incident of workplace injuries. Using techniques such as transfer
devices, increased man power, and proper biomechanical movements can aid nurses in
preventing musculoskeletal injuries. Furthermore, at a systemic level, decreasing the workload of
nursing staff by providing funding for more floor nurses would help to alleviate the fatigue, and
stress risk factors identified by Sezgin and Esin, 2014, providing a safer work environment for
nurses to practice in.
At the beginning of every shift, I ask my patients to report to me if they ever feel unsafe
when ambulating, or when being transferred, as a self-check on my care being provided, and the
safe lifting techniques being used. I ask my instructor for help when needed, for transferring

CLINICAL REFLECTION

patients, and she often commends my biomechanical lifting techniques (I was in kinesiology
prior to nursing school, which I believe aided in my ability to perform lifts safely). In relation to
this event, I believe that I shouldve asked the taller nurse if she was comfortable with the height
of the bed, and should not have just assumed that since I was comfortable and prepared to lift
safely, that she was. I have been told by my clinical instructor that I need to speak up and speak
my mind more often, and I believe that with more effective communication, this injury could
have possibly been prevented, by empowering the nurse to state her opinion on comfort with the
bed level and the safety of her own lift.
Learning Needs and Competencies
Based on this reflection, along with the input received from my clinical instructor, I
believe that I need to become more confident in my communication abilities, in order to ensure
the safety of myself, the patient, and of my fellow co-workers. By using effective, open
communication, thus relating to the competency of professional responsibility (and
accountability) (College of Nurses of Ontario, 2014), I believe that this situation could have been
avoided, and knowing this, I will be sure to use open communication, such as asking fellow
colleagues about their comfort and safety, in order to ensure that further injuries do not occur
from lack of effective communication. Another learning need that I have identified is learning
about the lifts and services available for transferring bariatric patients at Southlake. Becoming
familiar with what rooms have overhead lifts in them, and if there are services such as trained
volunteers or porters to help with the transferring, would be beneficial to my practice. Knowing
that a bariatric patient was coming to the floor, I would encourage the unit clerk to put the patient
in a room with an overhead lift, in order to ensure the lift is available if needed. This ties in to the
competency of knowledge based practice, and self-regulation (College of Nurses of Ontario,

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2014). Through attempting to have bariatric patients in rooms with overhead lifts, and by
familiarizing myself with any services available to help with patient transfer of bariatric patients,
I am working on preventing injuries to myself, my colleagues, and my patient, ensuring a safer
work environment for all.
Overall, this was an exceptional learning experience that I will use to change my personal
practice in the future. I learned the value of effective communication, proper lifting technique,
and being accountable and responsible for the safety of myself, and others. Through this
experience, I believe that I will be able to move forward in nursing with a safer, more competent
approach to my practice.

CLINICAL REFLECTION

References
D Arcy, L., Sasai, Y., & Stearns, S. (2011). Do assistive devices, training, and workload affect
injury incidence? Prevention efforts by nursing homes and back injuries among nursing
assistants. Journal of Advanced Nursing 68(4), 836-845. doi: 10.1111/j.13652648.2011.05785.x
Lovgren, M., Gustavsson, P., Melin, B., & Rudman, A. (2014). Neck/shoulder and back pain in
new graduate nurses: a growth mixture modelling analysis. International Journal of
Nursing Studies 51, 625-639. doi: 10.1016/j.ijnurstu.2013.08.009
Sezgin, G., & Esin, M. (2014). Predisposing factors for musculoskeletal symptoms in intensive
care nurses. International Nursing Review 62, 92-101. doi: 10.1111/inr.12157.
King, C. (2011). Health care worker safety in surgery, AORN 94, 457-468. doi:
10.1016/j.aorn.2011.03.013
College of Nurses of Ontario (2014). Competencies for entry-level registered nurses. Retrieved
from: http://www.cno.org/Global/docs/reg/41037_EntryToPracitic_final.pdf?