The effectiveness of job specific traini

Work 23  (2004)  105­1 J0 
lOS  Press 

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The effectiveness of job specific training on
the occupational performance of student
nurses
Robin McCannon a ,*, Marilyn K. Millerb and Abdulaziz Elfessi c 
aUniversity of Wisconsin-LaCrosse, Occupational Therapy Program, 1725 Stqte Street, 4037 HSC, LaCrosse, W1
54601, USA
Tel.: +16087855063; Fax: +16087856647; E-mail: mccannon.robi@uwlax.edu
b Bloomsburg University, Department of Exercise Science, 400 E. 2nd St., Bloomsburg, PA 17815,  USA
cUniversity of Wisconsin-La Crosse, Mathematics Department, 1725 State Street, 2031 CH, LaCrosse, WI 54601,
USA

Received  14  April  2003 
Accepted 2 July  2003 

Abstract. Body mechanic checklist scores during a one­person pivot transfer, and boosting up in bed were evaluated to determine 
the effectiveness of training on the  work performance of female student nurses from a local college.  Thirty subjects participated 

in  the  study  and  were  divided  into  a  control  group,  an  experimental  group  that  received  basic  body  mechanic  training,  and 
an  experimental  group  that received job  specific training.  A one­way  ANCOVA  was  calculated  to  examine  the  effects  of the 
experimental  procedures  on  the  subjects'  performance.  This  revealed  a  statistically significant difference  between  the  groups 
(patient transfer F = 10.11, P value  < 0.001; boosting F = 38.62, pvalue < 0.001).  A post hoc analysis (Bonferroni procedure) 
indicated that the job specific training group (mean  11.65, SD 0.66) demonstrated a statistically significant improvement in their 
performance compared to  the other two groups  (control group mean 7.5, SD 0.67; BBMT mean 9.66, SD 0.67). 

1. Introduction
Low  back pain is  one of the most frequently  occurring occupational injuries within the health care industry [3].  Rogers  and Maurizio  [13]  indicated that  53% 
of healthcare workers  would  experience a back problem significant enough to  interfere  with  work performance.  According  to  Owen  [1]  the  most  costly  injury for  health  care  facilities  are  overexertion injures 
to  workers'  backs.  In  February  1999,  one  long­term 
care facility  reported losing 725  days  of work with  a 
cost of $157,663 due to low back injuries [14].  In the 
nursing population,  improper body  mechanics  during 
patient handling was reported to be the major cause of 
injury [1]. 

•Corresponding  author.  

Due to the high prevalence and cost of injuries within 

the  health  care  profession,  an  educational  injury  prevention program may be indicated.  Many researchers 
have  documented  the  need for  injury  prevention programs.  Numerous authors [6,8,9,11,16] report that the 
current  trend  for  dealing  with  low  back  problems  is 
increased emphasis on prevention of low back pain. 
The scope and content of injury prevention programs 
has varied.  Some health care professionals recommend 
educating workers using basic body mechanics training 
(BBMT) [10,16,18], while others recommend training 
that is  specific to the expected job tasks  [1,2].  Due to 
the  high  prevalence  of injuries  within  nursing,  some 
type of injury prevention program is clearly warranted. 
At present it is  not known how effective these educational  programs  are  in  preventing back injuries  from 

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occurring, however, job specific  training (JST)  might 
be the logical choice. 
Injury prevention programs typically fall into one of 
two categories,  basic  body mechanic training  and job 
specific training.  Basic body mechanic training emphasizes instruction on functional back anatomy, causes of
back injures, and proper lifting techniques [2,15,17].
Proper lifting techniques have been identified as lifting
with the knees flexed, keeping the spine as straight as
possible, holding the weight close to the body, avoiding
twisting and bending at the trunk, and maintaining a
wide base of support [7,19]. Job specific training is an
attempt to individualize the basic body mechanic training to the task at hand. Supporters of JST have argued
that BBMT was not sufficient to change employees'
work habits because the program was not specific to
the work tasks [4,9].
It is unclear whether educational programs that are
general in content or those that contain job specific
training are the most effective delivery systems for preventing injures. An effective injury prevention program
should reduce the risk of back injury, decrease the time
employees are away from their jobs, and reduce the

amount of money employers spend on worker's compensation. In addition, prevention programs should be
cost and time effective. The purpose of this study was
to determine if student nurses receiving JST or BBMT
used better body mechanics during simulated job tasks
than those student nurses that received no training at
all.

2. Methods and procedures
2.1. Subject selection
Participants were recruited for this study based on
their undergraduate major. Twenty-four nursing students and six pre-physical therapy students volunteered
to participate in the study. The subjects were randomly
assigned and equally divided into one of three groups:
an experimental group which received basic body mechanic training (BBMT); an experimental group which
received BBMT and job specific training (JST) focusing on nursing tasks; and a control group which received no training. Student nurses and pre-physical
therapy students were chosen for this study as they had
some knowledge of patient handling tasks, but limited instruction of body mechanic techniques for these
tasks. This study was limited to healthy female students to control extraneous variables. Differences in the

subjects' age, height, and weight were assumed to be

equally distributed among the control and experimental
groups. Subjects with a prior history of back problems
were excluded from the study. Participants were enrolled in the study after written informed consent was
obtained according to the Institutional Review Board
for Human Research at the University of WisconsinLaCrosse. Prior to participating in the study, a flexibility test of the lower back and hamstrings as described
by Corbin and Lindsey [5] was administered to the subjects. This was completed to identify those subjects
who may not have had sufficient flexibility to safely
complete the study. All subjects fell within the good
fitness or high performance zones.

2.2. Development of instrumentation
A body mechanic evaluation checklist was designed
to evaluate the body mechanic techniques of each subject during work tasks (see Appendix A). The checklist used in this study was adapted from previous body
mechanic evaluation checklists [15,16]. The checklist
was used to evaluate a one-person pivot transfer from
an adjustable table to a chair, and boosting a patient
up in bed. Eight criterion were used to evaluate the
one-person pivot transfer with a total of 16 points possible. Boosting a patient up in bed was evaluated on
six criterion with a total of 12 points possible.
The body mechanic evaluations were completed by

three occupational therapists (the primary investigator,
and two additional occupational therapists who were
thoroughly trained in the evaluation process). There
was a maximum of 2 points possible for each criterion.
Evaluators gave the subject a score of 0 if the subject
demonstrated minimal aspects of the criterion, a score
of 1 if the subject demonstrated some aspects of the
criterion and a score of 2 if the subject demonstrated
most or all aspects of the criterion. A pilot study was
completed to determine interrater reliability. Intraclass
correlation coefficients (ICC) were calculated as this
statistical tool is used to assess reliability among more
that two raters, and reflects both the relationship and
agreement among ratings. The ICC reflected good to
excellent reliability for both tasks (one person pivot
transfer ICC = 0.969; boosting up in bed ICC = 0.875).

2.3. Data collection
Subjects were videotaped completing one trial of
the following simulated work tasks: one-person pivot

transfer and boosting a patient up in bed. Standard in-

R. McCannon et al. /  The effectiveness ofjob specific training on the occupational performance of student nurses

structions were provided to each subject.  The volunteer 
patient  who  participated in  the  simulated  work  tasks 
was a healthy male weighing 79.38 kilograms and was 
1.78 meters tall.  He was  instructed to require minimal 
assistance from the subject to complete the work tasks. 
Subjects were videotaped with two  video cameras operating at a nominal frame rate of 30 frames per second. The subjects moved at right angles to the optical axis of one camera. The cameras were positioned
as far away from the action as possible to minimize
perspective error.
After the first videotaping session, the two experimental groups received the experimental treatment
(BBMT or JST). Once the experimental treatments
were completed, all subjects in the three groups were
filmed again completing the same two simulated work
tasks (one-person pivot transfer and boosting a patient
up in bed).
2.4. Experimental treatment or procedures
The control group did not receive any training. Both

experimental groups participated in a half hour lecture
on basic body mechanic techniques. The session included a review of back anatomy, caused of back injuries, and body mechanic principles. The causes of
back injuries were identified as poor posture, lifting
weight in a stoop position (improper lifting technique),
holding an object too far away from the body, not
maintaining the natural curves of the back, and twisting. Body mechanic principles included lifting with leg
muscles while keeping the back straight, maintaining
back curves, maintaining a wide base of support, keeping the weight close to the body, and avoiding twisting. A muscle chart and a model of the spine were
utilized in teaching back anatomy. Slides were used
to show examples of proper body mechanic principles.
There was no mention of specific work tasks during
this instruction.
Following the completion of this session, the BBMT
group was asked to leave and the JST group then receivedahalfhour ofjob specific training as outlined below. This training took place in a classroom equipped
with an adjustable table. The JST included basic transfer techniques, proper body mechanic techniques for
the one-person pivot transfer, and boosting a patient up
in bed. Basic transfer techniques included reminders
on safety during transfers such as standing as close to
the patient as possible, using a transfer belt, and giving
adequate instructions to the patient. Techniques taught

for the one-person pivot transfer included using a trans-

107

fer belt, bending hips and knees simultaneously, maintaining spine alignment, proper foot and body placement, and avoiding twisting. Proper techniques for
boosting a patient up in bed included proper foot and
body placement, utilization of body momentum when
moving a patient, avoiding twisting, maintaining spine
alignment and bending hips and knees when moving a
patient.
After the instructor demonstrated each of the job
tasks, all subjects were given the opportunity to practice
the tasks. During the practice time the instructor corrected any errors the subjects made. The occupational
therapist providing the BBMT and JST was the primary
investigator. This allowed for consistency during the
training.
Following the pre- and post treatment videotaping
sessions, the body mechanic evaluation checklist was
used to evaluate the subjects' body mechanic techniques during the simulated work tasks. The three

evaluators viewed the videotapes together and independently scored each subject. Two of the three evaluators
were blind to the subjects' placement into the experimental or control groups.
The mean (group average) and standard deviation
(SD) for the results of the body mechanic evaluation
checklist were obtained for the three groups. A oneway ANCOVA was calculated to examine the effects
of the experimental procedures on the subjects' performance of a one-person pivot transfer and boosting a patient up in bed. After the null hypothesis was rejected,
a post hoc comparison was made with the Bonferronitype multiple comparison.

3. Results
The three evaluators viewed the videotapes and rated
each subject's pre- and post treatment performance on
the two simulated work tasks. The mean of each subject's score was calculated for each job task before and
after the experimental treatment. Again, intraclass correlation coefficients were calculated and excellent interrater reliability was noted for both tasks (pre test one
person pivot transfer ICC = 0.95, post test one person
pivot transfer ICC = 0.923; pretest boosting up in bed
ICC = 0.917, posttestboosting up in bed ICC = 0.911).
3.1. One person pivot transfer
The mean score for the control group was 7.5 (SD
0.67), BBMT mean was 9.66 (SD 0.67) and the JST

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R. McCannon et al. /  The effectiveness ofjob specific training oll,the occupational performance ofstudent nurses

mean was  11.65 (SD 0.66).  ANCOVA results revealed 
there was a statistically  significant difference between 
the  three  groups  (F = 10.11,  p value  < 0.001).  A 
post­hoc  comparison  was  therefore  completed  which 
revealed that the control and JST groups were statistically different from each other. In comparing the means
from these two groups the JST score was higher indicating an improved score. There was no statistically
significant difference between the control and BBMT
groups or the BBMT group and the JST group.
3.2. Boosting a patient up in bed

The mean score for the control group was 5.51 (SD
0.43), BBMT mean was 5.57 (SD 0.43) and the JST
mean was 10.12 (SD 0.43). ANCOVA results revealed
there was a statistically significant difference between
the three groups (F = 38.62, p value < 0.000). A
post-hoc comparison was therefore completed which
revealed that the JST group was statistically different
from the BBMT group and the control group. In comparing the means from the three groups, the means
were approximately the same for the control and BBMT
group, while the JST score was higher indicating an
improved score.

4. Discussion
4.1. One person pivot transfer

ANCOVA results revealed there was a statistical significant difference between the three groups and the
post-hoc comparison indicated that this difference occurred between the control group and the JST group.
The higher mean of the JST group indicated that the
JST group preformed better on the simulated work task
than the group that received no training. It therefore
appears that the job specific training was affective in
changing the subjects' performance of the one-person
pivot transfer. There was a difference in the means between the BBMT group and the JST group with again
the JST group being higher, however there was no statistically significant difference.
4.2. Boosting a patient up in bed

ANCOVA results also revealed there was a statistically significant difference between the three groups
during boosting a patient up in bed. The post-hoc
comparison indicated that this difference occurred be-

tween the JST group and both the BBMT and the control group. In comparing the means from the three
groups, the means were approximately the same for the
control and BBMT group, indicating that although the
BBMT group received basic body mechanic education
they preformed approximately the same as the group
that received no training at all. It would appear that
the basic body mechanic education was ineffective in
changing the occupational performance of the subjects
during this task. Again the JST score was significantly
higher than the BBMT and control group indicating an
improved score. Therefore it appears that only the job
specific training was effective in changing the occupational performance of the subjects during this task.
4.3. Clinical implications

Injury prevention consultants need to closely evaluate the contents of the injury prevention programs they
are providing to industry. The results of this study support the idea that body mechanic training should be specific to the worker's job tasks. From the results of this
study, it appeared that subjects who received BBMT
could not apply the general principles they learned to
their work performance. The cost of injury prevention
programs is of concern to many companies. Although
JST may take longer to complete and therefore could be
more costly, it appears to be more effective in changing
the work behaviors of the participants. In a cost saving
effort it may be tempting to only provide a short, basic
body mechanic training session that does not focus on
specific job tasks, however, the findings of this study
indicate that the results of this type of training would
be similar to providing no training at all.
The findings of this study are similar to the findings
of McCauley [15] and Dortch and Trombly [12] as
these authors also support the effectiveness of JST over
no training at all. Carlton [16] found that there was
no significant difference in work performance during
lifting tasks between the subjects that received basic
body mechanic training and the subjects that did not.
This is similar to the findings of this study as well.

5. Conclusion
Student nurses who participated in the JST demonstrated an improvement in their body mechanic techniques during simulated work tasks, compared to the
BBMT group and the control group. It appeared that
the JST was the most effective in improving body mechanic techniques for boosting a patient up in bed, and
a one-person pivot transfer.

R. McCannon et al. /  The effectiveness ofjob specific training on the occupational performance of student nurses

Acknowledgements

I  would like to  thank Dr.  Miller,  Dr.  Pretasky,  Dr. 
Wilder, Dr.  Brenda Rooney, Richard McCannon, Dale 
Wirth  and the  students  and faculty  at Viterbo College 
and  UW­La  Crosse  for  assisting  and  participating  in 
this study. 

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