PENGANTAR

ERGONOMI UNTUK
PERAWAT

Disampaikan Oleh :
DR. Iwan M. Ramdan, Skp.,M.Kes.
Introduction :

• Dalam sektor kesehatan, lingkungan kerja

perawat merupakan tempat kerja yang
berbahaya
• Dalam melakukan pekerjaannya, perawat
merupakan merupakan profesi yang
berisiko mengalami kecelakaan kerja
 Manual Tasks
A manual task refers to any activity
requiring a person to use any part of their
muscular or skeletal system in their
interactions with their work environment.
It includes the following activities:

Lifting
Pulling

Pushing Holding
Carrying

Striking Throwing
 Manual Tasks
It also describes activities
involving:

Repetitive actions Sustained postures Exposure

to
Vibration
Beberapa contoh risiko kecelakaan kerja :

Terpapar cairan tubuh pasien

Muscular-Skeletal Disorders (MSD)
Kekerasan/pelecehan oleh petugas lain,
pasien atau orang lain
Tertusuk atau tergores jarum suntik
Low Back Pain
Hernia Nucleous Pulposus
Musculoskeletal disorders :

• Mengangkat dan memindahkan pasien

dengan posisi tubuh yang salah
• Mengangkat pasien dan memindahkan
pasien dengan berat melebihi kemampuan
tubuhnya
Violence / Kekerasan dalam bekerja :

• Merawat pasien dengan kondisi agresif

atau gaduh gelisah di ruang perawatan
penyakit jiwa
• Perawat wanita giliran kerja malam
berisiko mengalami kekerasan sexual

Dibutuhkan pendekatan ergonomik

What is ergonomics ....?

• Berasal dari bahasa Yunani : ergon (kerja)

dan nomos (aturan atau hukum) : aturan
atau norma dalam sistem kerja
• Bioteknologi/human engineering/human
factors engineering : membahas
optimalisasi fungsi manusia terhadap
aktivitas yang dilakukan
What is ergonomic..............?

• Ergonomics is the science of designing

the job, equipment, and workplace to fit
the worker.
• Proper ergonomic design is necessary to
prevent repetitive strain injuries, which can
develop over time and can lead to long-
term disability
In other words....
Ergonomics is concerned with the ‘fit’
between people and their work. It takes
account of the worker's capabilities and
limitations in seeking to ensure that tasks,
equipment, information and the environment
suit each worker.
Why is ergonomics...?

• Setiap pekerjaan yang dilakukan, apabila

tidak dilakukan secara ergonomik akan
mengakibatkan ketidaknyamanan, biaya
tinggi, kecelakaan kerja, PAK, penurunan
daya kerja
Where is ergonomics applied...?

• dapat dilakukan dimana saja, baik

dilingkungan rumah, perjalanan,
lingkungan sosial maupun lingkungan
kerja
• lebih dominan diterapkan di
industri/Rumah Sakit
Stressor ergonomik pada perawat

Beban / tekanan pada aktivitas :

• mengangkat atau memindahkan pasien
• melakukan perawatan, memindahkan
posisi instrumen perawatan pasien
Repetition / aktivitas kerja berulang
• membersihkan lantai
• masage pasien
Fostur tubuh yang salah pada saat :
• memindahkan pasien
• mengangkat/memindahkan peralatan
medis
• melakukan tindakan perawatan
Terpapar getaran atau kebisingan pada saat
:
• mengoperasikan peralatan medis
• melakukan tindakan perawatan
Musculosceletal Disorders :

• Keluhan muskuloskeletal disorder adalah

keluhan pada bagian-bagian otot rangka
yang dirasakan oleh seseorang mulai dari
keluhan sangat ringan sampai sangat sakit
• apabila otot menerima beban statis secara
berulang dalam waktu lama, akan dapat
menyebabkan keluhan berupa kerusakan
pada sendi, ligamen dan tendon
• keluhan hingga kerusakan dinamakan MSDs
(musculoskeletal disorders) atau cedera
muskuloskeletal
The Spine
Secara garis besar dibagi dua :
• Sementara (reversibel)
• Keluhan menetap (persistent)
Faktor penyebab

1. peregangan otot yang berlebihan

2. aktivitas berulang
3. sikap kerja tidak alamiah
4. faktor penyebab sekunder :
- tekanan
- getaran
- mikroklimat
5. penyebab kombinasi
Faktor yang berpengaruh :

1. Umur
2. Jenis kelamin
3. Kebiasaan merokok
4. Kesegaran jasmani
5. Kekuatan fisik
6. Ukuran tubuh
Studi MSDs :

• keluhan tersering : otot rangka yang

meliputi otot leher, bahu, lengan, jari,
punggung, pinggang dan otot bagian
bawah
• terjadi karena kontraksi otot yang
berlebihan akibat pemberian beban kerja
yang terlalu berat dengan durasi
pembebanan yang panjang
Terms for Disorders
• Work-related Musculoskeletal Disorder
(WRMSD)
• Cumulative Trauma Disorder
• Repetitive Strain Injury
• Overexertion or Overuse Injury
• Types of disorders
– Strains and sprains
– Rotator cuff injuries
– Disc herniations
– Carpal Tunnel Syndrome
– Bursitis, tendonitis
– Sciatica
Why is Manual Resident Handling so
Hazardous?

• Physical demands of the

work
– Job exceeds physical
demands of individuals
• Poor equipment and facility
design
• Poor work practices
• Individual characteristics
– Age, past injuries, physical
condition, leisurely activities
What are the Risk Factors for
Musculoskeletal Disorders?

• Excessive force
• Awkward postures
• Prolonged postures
• Repetition
Excessive Forces/beban yg berlebihan

Common activities contributing

to excessive force:

• Lifting and carrying

• Pushing and pulling
• Reaching to pick up loads
• Prolonged holding
• Pinching or squeezing
 Awkward Postures

Common risky postures:

• Working overhead

• Kneeling all day

• Reaching to pick up loads
• Twisting while lifting
• Bending over to floor/ground
• Working with wrist bent
Prolonged Postures

•Standing or sitting for long

periods of time

•Holding arms in fixed

positions for extended
periods
 Repetitive Motions

Common problem to look for:

• Same posture or motions again and again
• can be very frequent over short period of time

time injury

• can be less frequent but repeated over time

time injury
 Common Problems Leading
to MSDS
Poorly Designed Equipment
• Does not have a good grip
• Too heavy
• Hard to use
• Uncomfortable
• Bad condition
• Wrong tool/equipment for the job
 Common Problems Leading
to MSDs
• Poor work organization
• In adequate scheduling
• Lack of planning
• Poor communication among staff and other
resident stakeholders
• Poor work practices
When is an Activity Likely to Become an Injury?

• Activity performed frequently

• You do the activity a long time
• Work intensity is high
• There are a combination of risk factors
 How do you find solutions?
Job
Tasks Solution
Hazards

• Form SRH team

Solution
• Ergonomic Risk Analysis Solution
• Needs Assessment
• Formulate solutions
Solution
 Proper
Fitness & body
wellness mechanics

Work practice
Engineering controls/
controls
Equipment Risk of
improvement
musculoskeletal injury

Administrative
Personal
controls
protective
equipment
Choose Effective Solutions
Engineering Most
Effective
•Tools/equipment
•Workplace design
Administrative
•Job rotation
•Number of workers

Work practices
•Changing bed height

Behavioral
•Body mechanics
•Stretching/Fitness Least
•PPE Effective
Preventing MSDS
First Choice: Engineering Controls
• Eliminate or reduce primary risk factors
• Use resident handling equipment, such as,
ceiling and portable floor lifts, air assist transfer
devices, and mechanical sit to stand lifts

• Must match equipment use with

• Resident dependency (physical and cognitive abilities)
• Type of lift, transfer or movement
• Number of staff available
Preventing MSDS

Second Choice: Administrative Controls

• Reduce employee exposure to primary risk
factors
• Ergonomics training
• Policy & procedures that define good work
practices
• Staffing and overtime practices
• Job rotation
 Preventing MSDS

Second Choice: Work Practice Controls

• Reduce employee exposure to primary risk
factors by using best work methods:
• Plan work organization
• Use good housekeeping practices
• Use adjustments on equipment
• Get help when needed
• Eliminate unnecessary movements
• Don’t use broken equipment

Remember – it’s the employee’s responsibility to use

good work practices and follow the organizations’ safe
resident handling policy and procedures
 Preventing MSDs
Second Choice: Work Practice Controls
• Neutral spine posture - 3 Curves
make your spine strong and minimize
physical stress Cervical

• It is important to KEEP THESE

CURVES when moving, bending and Thoracic
lifting

• Neutral spine is the reason body Lumbar

builders can lift so much weight without
injury

Using good body mechanics is important, even when using

equipment, but alone body mechanics will NOT prevent
MSDs
 Conduct Ergonomic Risk
Assessment
• Recognizing hazards is the first
step toward injury prevention

• Job analysis performed by people

with ergonomics training
– Ergonomics team
– Safety committee members
– Line personnel
Mengangkat dan Memindahkan
pasien yang ergonomis
Cara mengangkat yang benar
• Tempatkan kaki dekat dengan beban
• Kemudian tekuk lutut dan pinggul (posisi jongkok),
• Peganglah erat beban anda
• Usahakan Beban selalu dekat dengan tubuh Anda
• Angkatlah beban gunakan otot-otot yang kuat dari kaki
anda untuk mengangkat.
• Posisi punggung harus tetap lurus hingga proses
mengangkat beban selesai (posisi berdiri)
• Usahakan semua gerakan halus (pelan), hindari gerakan
menyentak atau gerakan memutar.
Body Mechanics
Safety Precautions

 Gunakan metode yang

spesifik/benar untuk
mengangkat beban
yang cukup berat untuk
menghindari perlukaan
• Petunjuk keselamatan
 Gunakan bahu, bukan
punggung (kelompok
tulang/otot terbesar)
 Tempatkan beban
mendekati tubuh
• Pergeseran pusat
gravitasi untuk pasien
• lebih maksimal
Pertimbanaagan Body Mechanics

 Petunjuk mengangkat dan

memindahkan :
• Pertimbangkan beban yang akan
diangkat
• Kenali keterbatasan anda
• Angkat tanpa memutar
• Posisi kaki satu di depan yang lain
• Berkomunikasi dengan pasangan
• Keep back locked and don’t twist
• Jaga siku membungkuk dengan tangan
dekat dengan sisi
• Jangan hyperextend punggung
• Hindari menjangkau lebih dari 15 " -20 "
di depan tubuh Anda
• Mendorong lebih baik daripada menarik
• Jaga garis tarikan melalui garis tengah
Kekuatan cengkraman/genggaman

 “Power Grip”
• Maximizes force from
hands
• Palm and fingers are in
contact with object
• All fingers are bent at the
same angle
• Hands at least 10” apart
Power Lift
 Know/find out pt weight
 Consider pt exceeding limitations
 “Power lift”
• Keep back locked in normal
curvature
• Place your feet a comfortable
distance apart
• Tighten your abs and lock back
into a slight inward curve
• Bring center of your body over
object Vertical lift
• Distribute your weight to the
balls of your feet OR just
behind them
• Lock your back and allow
upper body to rise before the
hips as you lift
Mengangkat
Teknik satu tangan
 One-handed carrying
technique
• Multiple providers
positioned around pt
• Keep back in locked
position
• Don’t lean to either side
• Lift as normal
Melewati tangga
 Whenever possible use stair
chair
• Keep back locked
• Flex at hips (not waist)
• Bend at knees (not with
back)
• Keep your weight close to
the device
• Have stronger rescuer at
the bottom
Log Rolling
 Log rolls
 Movement of a supine/prone pt
• EMT 1: Maintain C-spine
• EMT 2 & 3: Position kneeling at pt
side
• EMT 2: Raise pt nearest arm over
pt head
• EMT 2: Place 1 hand on pt shoulder
the other on pt hip
• EMT 3: Place 1 hand on pt waist
and the other at knees
• EMT 2 & 3: On count of 3 from EMT
1, roll pt onto side
• Place pt on backboard, transport
Emergency Moves

 Fastest move
 No spinal immobilization
 Immediate danger to pt if not moved
• Fire or danger of fire
• Explosives or other hazardous materials
• Inability to protect pt from other hazards
• Inability to access other pts in a vehicle who need life saving care
• Life saving care cannot be given due to pt position
 Examples:
• Clothes drag
• Blanket drag
• Torso drag
Urgent Moves

 Fast
 Spinal immobilization
 Scene is safe, immediate threat to pt life
• Altered Mental Status (AMS)
• Inadequate breathing
• Shock/Hypoperfusion
 Example
• Rapid extrication
 Moving pt from MVA with constant spinal immobilization
Rapid Extrication
 Rapid extrication from vehicle
• 1 EMT provides manual C-Spine support
• 2nd EMT applies C-Collar
• 3rd EMT places back board near door and moves to the
passengers seat
• 2nd EMT supports thorax as 3rd EMT frees pt feet from
pedals
• At direction of 2nd EMT he and 3rd EMT rotate pt so that pt
back is not in doorway
• Tx C-Spine control
• 1st EMT exits vehicle and supports head from outside
• Back board is places against pt buttock
• 1st EMT and 2nd EMT lower pt to back board
• 2nd and 3rd EMT slide the pt onto the board
• Rapid Extrication Demo
Non-Urgent Moves

 Scene Safe
 Stable pt
 Suspect spinal injury
 Examples:
 Direct Ground Lift
 Extremity Lift
 Direct Carry
 Draw Shift
Direct Ground Lift
 Direct Ground Lift (No spine injury)
 Two or more rescuers lifting a patient from the side -Cradle
• 2-3 rescuers line up on one side of pt
• Rescuers kneel on one knee
• Pt arms placed on pt chest
• Rescuer @ head places one arm under pt neck and cradles head.
He places other hand under pt lower back
• Second rescuer places one under the pt knees and the other
under the pt buttock
• On signal the rescuers lift pt to their knees and roll pt towards their
chest
• On signal the rescuers stand and tx pt to stretcher
• Steps are reversed to lower pt
Extremity Lift
 Extremity Lift (No extremity injuries)
 Two rescuers lifting the patient by the extremities
 One rescuer in the armpit-forearm drag position and the other
holding the patient behind the knees.
• 1 EMT kneels at the pt head, another kneels at pt side by the knees
• EMT at the head places 1 hand under each of the pt shoulders
• EMT at the knees grasps the wrists
• EMT at head slips his hands under the pt arms and grasps pt wrists
• EMT at feet slips his hands under the pt knees
• Both EMT’s move to a crouching position
• EMTs stand simultaneously and move pt to stretcher
Direct Carry
 Similar to direct ground lift except the pt is carried
 Tx of supine pt from bed to stretcher
• Place cot perpendicular to bed with head of cot at foot of bed
• Both EMTs stand between stretcher and bed facing pt
• 1st EMT slips arm under pt neck and cups pt shoulders
• 2nd EMT slips hand under hips and lifts slightly
• 1st EMT slips other arm under pt back
• 2nd EMT places arms under pt hips/calves
• EMTS slide pt to edge of bed
• Pt is lifted/curled towards EMTs chest
• EMTs rotate and place pt on stretcher
Draw Sheet
• Loosen sheets from bed
• Place stretcher next to
bed
• Reach across and firmly
grasp sheet
 Head
 Chest
 Hips
 Knees
• Slide pt gently onto
stretcher
Stretchers

 Most commonly used

 Easy to tip over
• High center of gravity
Stretchers
 Rolling
• Restricted to smooth terrain
• Pulled by foot end
• One person guides the head
 Carrying
• Two EMTs
 EMTs face each other from opposite ends of stretcher
 Ideal for small spaces
 Requires more strength
• Four EMTs
 One EMT on each corner
 Requires less strength
 Safer of rough terrain
 Loading into ambulance
• Use sufficient lifting power
• Follow manufacturers directions
• Ensure all pt and stretchers are secure
before moving
Portable Stretchers

 Lightweight, foldable
 Permits tx of pt
• Down stairs
• Over rough terrain
 Carried end to end
Scoop/Orthopedic Stretcher
 Function
• Splits apart to scoop up the
patient on the ground from
either side
• Facilitates easy lifting of
supine pt
 Form
• Aluminum frame
• Splits lengthwise in half
• Allows pt to be “scooped”
off ground
 For spinal injury pt,
• Cervical immobilization is
maintained
Scoop/Orthopedic Stretcher

 How to use it…

• Measure and adjust the length of the device to be just
longer than the pt
• Slide the stretcher under both sides of the pt
• Lock the head first
• Lock the feet
• Strap the pt in place
• Place pt on a secondary device and secure
 Ex. LBB
Stair Chair
 Designed to move pt who
are able to assume sitting
position
 Not used for
• Pt with spinal injuries
• Unconscious
 Extremity lift is preferred to
load pts
 Best to have a spotter
behind EMT at feet while
descending stairs
Backboards
 Long Spine Boards
 Function:
• Rigid support for spinal column
to prevent further injury
 Types:
• Wooden
• Plastic
 Uses:
• Primary device for
supine/recumbent pt
• Rapid extrications
• Secondary support in assoc
with short spine board
Short Spine Boards
 Function
• Extends from base of the buttock to
just above pt head
• Attached by straps or cravats Support
of spinal column to prevent further
injury
 Types
• Wooden
• Vest type
 Kendrick Extrication Device (KED)
 Uses
• Extricate pt in MVA who are in sitting
position
Stokes Basket
 Function
• Movement of pt over rough
terrain
 Form
• Large basket
• Flat bottom
• LBB can fit
• Pt can be immobilized as
normal
Patient Positioning
 Unresponsive pt (non traumatic)
• Rolled into recovery position (Left side)
 Pt with dyspnea or chest pain
• Position of comfort
• As long as hypotension doesn’t occur
 Suspected spine injury
• Immobilized to long backboard
 Pregnant Pt
• Left lateral recumbent
• Supine= Fetus on vena cava
 Shock
• Elevated legs 8”-12”
 Nausea/Vomiting
• Position of comfort
• EMT in position to control airway