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for ongoing and expanding public education on the multifaceted realities of nursing.

Perioperative nursing implications. Educat- ing the public about the care perioperative nurses provide is not a new concept. The knowledge necessary to practice perioperative nursing is little understood or appreciated by our patients. This study reemphasizes the importance of educating the public. Understanding the role of stereotyping will help direct our public education efforts. This study indicates that the public has many positive feelings about nursing. Perioperative nurses need to build on these positive feelings in an effort to educate the public about our educational preparation, how we act as their advocates, and our abilities to make important independent nursing decisions that affect their care.

SUZANNE F. WARD, RN, MN, CNOR NURSING RESEARCH COMMITTEE

TRAUMA

Direct transport to the operating room for resuscitation of trauma patients M Rhodes et a1 The Journal of Trauma Vol29 (July 1989) 907-9 13

It is well documented that the time between arrival at an institution and definitive care in the operating room may mean the difference between life and death for the trauma victim. The purpose of this study was to evaluate the effect on survival of patients undergoing initial trauma resuscitation in the operating room, thereby bypassing the emergency department entirely.

The study was conducted over a three-year period and involved 240 patients. Because randomization was ethically unacceptable, all patients who met the established triage criteria were admitted directly to the operating room, and each patient served as his or her own control. Researchers computed a predicted survival score (TRISS) of I for survival or 0 for death. They used four trauma indicators: the major trauma outcome study (adjusted for age), the revised trauma score, the injury severity scale, and the

mechanism of injury to compute this score. Researchers then subtracted the TRISS score from the actual survival score, using 1 for survival or 0 for death, to come up with the adjusted score (TRAIS). These scores ranged from -1 (ie, predicted to survive but did not) to 1 (ie, predicted to die but did not).

The TRAIS score is suited for use in analysis of variance (ANOVA). Researchers analyzed TRAIS scores in a five-factor ANOVA. The factors were mechanism of injury (ie, blunt or penetrat- ing), prehospital blood pressure (ie, systolic above or below 80 mmHg), severe head injury (ie, presence or absence), witnessed arrest in the field (ie, yes or no), and operative procedure (ie, major or minor).

Few patients who arrested in the field survived. Severe head injury was not a statistically significant factor. Patients who had blunt trauma injuries, had systolic blood pressure below 80 mmHg, and/ or required major surgical procedures had significantly better than predicted survival rates when resuscitated in the operating room.

The results of this study help trauma teams define criteria to determine which patients will benefit from initial operating room resuscitation. Because resuscitation in the OR costs an average of four times more than standard emergency room resuscitation, the cost must be warranted. This study concludes that victims of hypotensive blunt trauma requiring therapeutic laparotomy will benefit from OR resuscitation. Further studies are indicated for victims of penetrating trauma.

Perioperative nursing implications. Periop- erative managers and clinicians involved in trauma care can benefit from many aspects of this study. The costs of building a separate trauma operating room may be justified by survival rates of patients cared for in this room. Specific trauma criteria should be defined and used to determine which patients are treated in this room.

The designated OR should be located near the main OR and as close to the radiology and emergency departments as possible. The room also may be justified for use in other life-threatening emergencies.

Ethical considerations often prevent researchers from using true experimental control group

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designs. This study gives an example of how to conduct a study without compromising the rights of human subjects. Various statistical techniques and established outcome criteria can be used in place of randomization. The value of validating our clinical intuitions is well worth the effort.

AILEEN R. KILLEN, RN, MS, CNOR NURSING RESEARCH COMMITTEE

BACK PROBLEMS

The magnitude of low-back problem in nursing B D Owen Western Journal of Nursing Research Vol 11 (April 1989) 234-242

Previous research documents a high prevalence of low-back problems in nursing personnel. One study revealed that 52% of hospital nurses had experienced low-back problems in one year. Most of these nurses indicated that lifting patients in bed had precipitated the problem. Another study disclosed that 40% of workers’ compensation costs in hospitals in one state were caused by overexertion, primarily from lifting and lowering patients. The back was the major body part affected, and nurses were involved most often.

The author of this article claims that low-back problems in nurses are underreported. Many of the statistics are derived from incident reports, which are not completed for every injury. Therefore, those who do not report injuries are not represented in published statistics.

Objectives of this study were to determine the prevalence of low-back problems in nurses and to ascertain differences between nurses who had occupational low-back problems and those without low-back problems in relation to age, work experience, and perceived amount of patient lifting per shift. Other objectives were to determine the amount of work time lost due to low-back problems, the amount of change in activities of daily living, perceived and precipitating factors, the setting in which the low-back problem occurred; and to find out if nurses had considered leaving the profession because of low-back problems.

Questionnaires were mailed to 1,000 nurses currently licensed in Wisconsin; 567 were returned. Of those, 503 met the criteria to participate in the study. The questionnaire elicited information on age, sex, past and present nursing positions, history of low-back problems before nursing, and history of occupational low-back problems. The nurses also were asked to record their ages at the time of the episode, type of nursing agency or unit where the episode occurred, description of perceived precipitating factors, and amount of work time lost. Nurses were asked to describe how recent back problems interfered with their activities.

Subjects were grouped according to presence or absence of a history of occupation-related low- back problems. In all, 189 (38%) reported having low-back problems, and 314 (62%) reported having none. An analysis of variance indicates that neither age nor years of nursing experience had a significant effect.

Nurses with no reported problems spent fewer years lifting patients than nurses with problems. The estimated number of lifts per shift ranged from 0 to 50; nurses who reported no back problems performed significantly fewer lifts.

Most nurses with low-back problems were employed in hospitals and worked on units that required frequent lifting. More than 65% of the nurses with low-back problems described episodes that occurred within the past year, and 64% were employed full-time at the time of injury. Of the 189 nurses who reported problems related to work, only 63 reported the incidents in writing. A total of 49% of the injured nurses reported lost work days. Ten percent of the injured nurses reported a large change in activities of daily living, and 8.9% reported no change.

Moving or lifting patients in bed was thought to have precipitated back injuries in 61% of the episodes. Other causes included moving a patient from bed to a chair and vice versa, attempting to catch a falling patient, and restraining a combative patient.

Most back injuries in hospital nurses occurred on medical (28%) and surgical (27%) units. Fewest injuries occurred in psychiatric (4%) and pediatric (3%) units, and emergency, operating, and

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