A cost effectiveness evaluation of an instructional program for back injury prevention among nursing personnel

Date of Award


Degree Type


Degree Name

Doctor of Education (EdD)


Instructional Design, Development and Evaluation


P. Doughty


Nursing, Health care, Adult education, Continuing education, Back injuries, Prevention programs

Subject Categories



Nursing personnel, including both registered professional nurses and ancillary personnel (licensed practical nurses, aides, and attendants), has been identified as an occupational grouping at high risk to incur work-related back injuries. Back injury prevention programs for nursing personnel often include training in safe lifting procedures and proper body mechanics. However, there is little evidence to demonstrate program effectiveness to support rationale for current practice.

The major purpose of this study was to assess the cost-effectiveness of an instructional program addressing the problem of work-related back injuries among nursing personnel. The study was conducted as an ex-post facto evaluation of an instructional program piloted at a teaching hospital in central New York State. Seven nursing units, including 201 nursing personnel, were eligible for participation in the study. Effectiveness was measured using four criteria: (a) efficiency, (b) worth, (c) reduction in prevalence of back complaint and (d) changes in behavior.

The results of the evaluation include the following. The projected 5-year life cycle cost of the instruction is approximately 15% of the predicted injury costs for the same population. Program worth to the participant audience and supervisory staff was established. No significant changes in prevalence rates (point or two-week) were observed. Behavioral change was observed by supervisors and self-reported by participants. Two trends have been revealed. Nursing personnel perceive the occupational problem of back injury related to organizational factors rather than skills deficit. Increased injury reporting following program activities indicates a potential intermediate negative impact.

In summary, the cost-effectiveness evaluation found the instructional program to be of high quality and well-received by the participant audience and supervisory staff. However, there was no strong evidence to suggest that this pilot instructional program reduced either the short-term or intermediate burden of illness attributed to occupational back injury among nursing personnel. Recommendations for improving instructional effectiveness include identification of the occupational hazard of back injuries among nursing personnel as a safety issue where ownership of the problems lies with both the institution and the individual. The institution can support back injury prevention instruction with policy including provision and maintenance of equipment, adequate staffing, and explicit procedures on lifting techniques to ensure a safe work environment. The individual has the responsibility to maintain recommended or required procedures. Further research is required to identify superior lifting techniques and to assess long-term impact of the instruction and the supportive role of instructional training in conjunction with other interventions.


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