2.1.2 INSTITUTION-SPECIFIC RISKS
In addition to the general and most significant risks in the home, we can find a list of risks that are more oriented to institutions:
• Falls due to tripping and slipping caused by the presence of electrical cables or beds and stretchers in areas of transit, as well as by damp or slippery floors caused by spills of liquids.
• Knocks against drawers or open cabinets, resident transfer equipment (wheelchairs, cranes, beds...) or with stacked materials, both in corridors and around work stations.
• Falling objects during handling.
2.2 PROFESSIONALS
In general terms, the tasks carried out by the assistants working in the nursing homes are mainly related to accompanying the elderly and supporting them in all their basic tasks (postural changes, administering medicines, maintaining their personal hygiene), as well as cleaning and maintaining the rooms and common areas (making the bed, setting up dining rooms, collecting the laundry, etc).
Most of the occupational hazards in institutions of this type are of an ergonomic and/or psychosocial nature. It is important to carry out an occupational risk assessment specific to each centre as working conditions may vary. However, below we point out some of the most common ones that can be found in practically all geriatric centres:
• Tasks with a significant physical burden: most assistants suffer from discomfort especially in the back, shoulders, neck and hands. The work is mainly carried out standing up.
• Forced postures: For example, when there is little space in the rooms and professionals are forced to use inappropriate postures.
• Risk of musculoskeletal disorders due to repeated movements.
• Falls and stumbles: Either due to lack of space or the presence of objects that interrupt the passage.
• Manual movement of residents: Either because the appropriate support elements are not available or because they are stored far from the patient's rooms. In an additional factor, the patient does not cooperate or offers resistance to mobilisation.
• Inadequate temperature and lighting: These are often adapted to residents rather than workers.
• Shifts: Work is done in morning, afternoon and night shifts which can cause a disruption or lack of adaptation for some professionals.
• The existence of many unforeseen events during the working day, which can generate stress.
• Difficulties in reorganising in certain situations: In cases where a worker is on sick leave.
• Numerous interruptions that affect the ability to concentrate.
• Relationship with residents and their families: Emotional burden or pressure to manage and/or hide their emotions, leading to emotional burnout.
• External pressure: need to justify their work, situations of verbal or physical violence, etc.
Most of these risks can be prevented by an adequate preventive organisation that establishes certain protocols and guidelines for action and is always accompanied by training for workers. We can distinguish four general lines of action for which all centres should develop specific actions:
• Training: Development of guidelines for action in the event of unforeseen circumstances, such as action protocols for dealing with residents and family members.
• Adaptation: Review of the work area to ensure that there is no avoidable risk.
• Tools: Providing assistants with everything necessary to facilitate their work as well as adequate training on how to use it.
• Support: Monitoring the physical and emotional health of the professionals.
Emotional burden and the burnout syndrome
Nursing home professionals face a significant emotional burden at work. During their work activity they are in contact with people who depend on them to a greater or lesser extent, which can generate a significant feeling of stress. Similarly, it is inevitable that emotional ties are established with certain patients.
On the other hand, other aspects such as working on shifts or the social perception of the assistant's work can also have a negative impact on the worker. When the emotional burden becomes excessive, something known as burnout syndrome is triggered. The professional does not feel fulfilled with his work and is passive and unmotivated, reducing his performance and affecting the entire work environment
To prevent these situations, it is important to provide psychological support to workers and to establish different measures to help them feel valued and fulfilled professionally.
2.2.1 STAFF
The staff of the care center is the link between the center and the outside. The administration, maintenance, reception staff, etc. spend a large part of their day in front of the public, dealing with family visits, solving bureaucratic and administrative issues of various kinds... that is why, in addition to risks that may arise, common to the rest of the workers (see 2.1.2.), we can highlight the following aspects:
Tension generated by "overflows" due to rush, strict deadlines, emotional involvement with patients, isolated work, night work, etc.
Also, due to lack of clarity in the requests made, objectives, work priorities, autonomy in decision making, etc. This can lead to uncertainty about the results or consequences of the decisions taken, especially at customer satisfaction level or achievement of objectives.
Overloads or mental saturation can also occur, caused by simultaneous tasks like paying attention and communicating with several systems at the same time, such as computer-phone- person- systems.
In addition to the above, it is important to highlight the ergonomic risks derived from holding the same position during the entire day of work. To correct this point, it is advisable to adopt an adequate posture and to try to change it every reasonable time.
2.2.2 ORGANIZATION
At an organisational level, each institution must have both an intervention plan to deal with occupational risks and an action protocol to deal with possible risks presented by patients.
The prevention and action plans for risks must be known by the members/workers of the institution and the patients.
In order to control incidents, each individual intervention plan includes a section dedicated to understanding possible personal risks (possibility of falling, etc.).