echnology today Health Tips for Computer Users MARILYN SMITH-STONER.PHD.RN Computers bave cbanged everytbing about our world.Any Indiviuals also have a re cbange of this magnituce brings new cballenges and new sponsibility to implement self- care activities.Begin with get- c2n'for tbe lom四-term cffects时epooure to the pr2- ting a physical assessment, udl.Computera epecially pose opecific riaks to bome care espocially an cye esamination. workers.Tbis article review bealtb and onfely practiced Many employees who experi- ence eye strain,find that they related to desktop and band-beld computers. have vision changes that were preexisting.When was the last Computers greatly extend the ca apply them in a wide variety of time you bad an eye examina- pacity od the human brain,ovd situations.It is equally impor tion?H it has been longer than I stress the musdes,tendons,and tant to remember that comput- yoar ago,go get onel ligaments that hold us together. ers.although they are every A8 home health and hospice where,are a new technolgy Consideration in Using agencies throughout the country Much remains to be investi- Computers computerise,new efforts must gated and understood about There are three broad cate- be developed to prevent and their long-term benefits to gories of ergonomic concerns minimlze injuries related to the home care. regarding computer use physl- use of technology in the office cal emotional,and environmen- and hame.Nurses w细find th OSHA's Attempt to tal conditions visin,wrists,necks.backs.and Provide Ergonomic other joint&overstressed by Regulation Physical Considerations repetitive use of desktop and President Bush made headlines portable computers. early in the year when he Computer Types This article describes health signed an Executive Order re- The two primary types of com- issues related to the use of com- pealing the new ergonomic puters used In healthcare are puters.Like all other workplace standards developed by the Oc- desktop and hand-held units. bealth and salety Essues,most cupational Health and Safety The general guidelines for in- guldelines do not consider the Administration (OSHA)over fury prevention are the same tor complex and unpredictable the last 10 years.These regula both.There are four main types worsd of home care therelore. tions were to be the most ex ol mnjuries asociated with com- you will need to adapt the tensive guidelines to promote puter use guidelines to the unique home the ergonomic health of all 1.Eye strain,headaches environment found on each workers.In the absence of a 2 Musculoskeletal disorders visit.Learn the basic safety federal mandate,home health (eg.,neck shoulder.and principles of computer use to and hospice agencies should joint pain) voluntarily enact many of these 3.Kepetitive motion/stress in- minimiam standards.While:tail juries. Mmrlyn Smith-Sleweer.Phl).RN.is c 口to do s0 y save the cos球 4 Carpal Tunnel syndrome Dissance Fdcatioe Specialist Can 包mio Sote Lioloers,F2onCA of educational programs and and u Fer Diem Hospice Narse.Ad. annlysis of ergonomically high Eye Straln and Headaches deg包rcomrespondence:Mar risk lobs,the cost of repetitive Your eyes require proper light, Smirk-Stoner.447 Sherle Court. motion,eye strain,and muscu- adequate moisture,and perlods Beu￥2wCA9222子5mu loskeletal disorders will soon of rest in order to work at opti- neammrnini mt dwarf those expenses. mal level throughout the day. coL 9.no.12.December 20001 http://www.nurslngcenter.com Home Healthcare Nurse 787
vol. 19 • no. 12 • December 2001 http://www.nursingcenter.com Home Healthcare Nurse 787 Computers greatly extend the capacity of the human brain, and stress the muscles, tendons, and ligaments that hold us together. As home health and hospice agencies throughout the country computerize, new efforts must be developed to prevent and minimize injuries related to the use of technology in the office and home. Nurses will find their vision, wrists, necks, backs, and other joints overstressed by repetitive use of desktop and portable computers. This article describes health issues related to the use of computers. Like all other workplace health and safety issues, most guidelines do not consider the complex and unpredictable world of home care; therefore, you will need to adapt the guidelines to the unique home environment found on each visit. Learn the basic safety principles of computer use to Individuals also have a responsibility to implement selfcare activities. Begin with getting a physical assessment, especially an eye examination. Many employees who experience eye strain, find that they have vision changes that were preexisting. When was the last time you had an eye examination? If it has been longer than 1 year ago, go get one! Consideration in Using Computers There are three broad categories of ergonomic concerns regarding computer use: physical, emotional, and environmental conditions. Physical Considerations Computer Types The two primary types of computers used in healthcare are desktop and hand-held units. The general guidelines for injury prevention are the same for both. There are four main types of injuries associated with computer use: 1. Eye strain, headaches. 2. Musculoskeletal disorders (e.g., neck, shoulder, and joint pain). 3. Repetitive motion/stress injuries. 4. Carpal Tunnel syndrome. Eye Strain and Headaches Your eyes require proper light, adequate moisture, and periods of rest in order to work at optimal levels throughout the day. Marilyn Smith-Stoner, PhD, RN, is a Distance Education Specialist, California State University, Fullerton, CA and a Per Diem Hospice Nurse. Address for correspondence: Marilyn Smith-Stoner, 447 Sherie Court, Beaumont, CA 92223-1543; e-mail: mssrn@earthlink.net. apply them in a wide variety of situations. It is equally important to remember that computers, although they are everywhere, are a new technology. Much remains to be investigated and understood about their long-term benefits to home care. OSHA’s Attempt to Provide Ergonomic Regulation President Bush made headlines early in the year when he signed an Executive Order repealing the new ergonomic standards developed by the Occupational Health and Safety Administration (OSHA) over the last 10 years. These regulations were to be the most extensive guidelines to promote the ergonomic health of all workers. In the absence of a federal mandate, home health and hospice agencies should voluntarily enact many of these minimum standards. While failing to do so may save the cost of educational programs and analysis of ergonomically highrisk jobs, the cost of repetitive motion, eye strain, and musculoskeletal disorders will soon dwarf those expenses. Health Tips for Computer Users MARILYN SMITH-STONER, PHD, RN Computers have changed everything about our world. Any change of this magnitude brings new challenges and new concerns for the long-term effects of exposure to the product. Computers especially pose specific risks to home care workers. This article reviews health and safety practices related to desktop and hand-held computers
The use of technology can never 1.Use a light touch when typing. 2.Focus on maintaining your be the goal in and of itself:it can only wrists in a neutral position when typing. support individuals to provide care. 3.Corsider using a split key- board ar wrist support Adequate light means avoiding ward and sideeays in abnormal under-or overexposure to light. positioas. Carpal Tunnel Syndrome (herlit areas,such as thode Home care atalf are high-risk Inflammation of the median close to a window with intense candidates for MSDs.Unpre nerve as It passes through the glare,are as stressful to eyes as dsctable environments such as tunnel in the wrist occurs as a too little light.The condition as- patient homes,increases the dit- result of repetitive motlon. sociated with eyestrain is ficulty of securing a work area The result of inflammation is called "computer vision syn- that allows adequate space and pain,numbness,and tingling drome."There are several inter- seating.That &s why it is partlcu- in the wrist,hand,and fingers ventions for the prevention of larly important to take the fol (except for the small finger, eye strain and headaches: lowing preventative steps in which is not affected by the averting MSDs: median nerve).In addition to 1.Clean the computer's moni- inflammation from repetitive tor reglarty 1.Consider suhstituting a stan- motion,awkward posture,pro- 2.Occaslonally look beyand the dard mouse with a trackball. onged use of muscles,and monitor to allow your eyes 2.Keep your posture just as hormonal changes can precipi- to rest. you were taught as a child- tate Carpal Tunnel Syndrome 3.The top of the monitor sups七aight (CTS)by causing swelling of should be level with your 3.Standing may be the best po- the tendons in the hand and eyes or just below.and dl sition when using a computer. wrist.There are several inter. rectly in front of you. this is especially true in the ventions for the prevention of 4.The monitor should be free of home where may be dificult CTS Injurtes: glare.If close to a window. to find a chair that allows you the screen should be at a to sit with proper p0网ure 1.Belore.during.and alter typ- right angle to the window 4.Take regular deep breathes: ing,perlorm several wrist ex. 5.Be sure to blink oiten and this allows you to relax and ercises,such as moving the consider carrying eye drops drop your shoulders. wrst In a circular motion. that will add回osture to 5.Constder purchasing a home 2.Use a wrist support pad. your eyes. parallin wax machine that al 3.Apply ice to the palm side of 6.Take hreaks from computer lows you to treat sore mus- the wrist after long periods use every 2 to 3 hrs. cles with heated wax that of typing. penetrates deeper than hot moist towels. Additionally.a page on the Musculoskeletal Disorders WebMd Health Web site Musculoakeletal disordera http://my.wchmd.com/con- (MSDs)are a vartety of com- Repetitive Motlon Injuries tent/article/1680.50855)con- plaints including sore shoul Repetitive motion injurtes tains many activities that can ders.aching backs,and still (RMs)are closely assoclated be performed throughout the necks.MSDs derive from poor with keyboard use.These in day to prevent CTS. posture and from the way you juries can be compounded move your mouse or other with the use o laptops that tracking tool.Some experts have a greater tendency to Emotional consider the mouse the most cause the wrists to maintain an Considerations "dangerous"part of the com- upward position. Technological Hardinas8 puter as it causes the user to There are several interver Because computers are every- move his or her shoulder tor- tion for the prevention of RMlls where,their emotional use is 788 Home Healthcare Nurse ht/www.Isi实enter.com 13-w112·Decewher207
Adequate light means avoiding under- or overexposure to light. Overlit areas, such as those close to a window with intense glare, are as stressful to eyes as too little light. The condition associated with eyestrain is called “computer vision syndrome.” There are several interventions for the prevention of eye strain and headaches: 1. Clean the computer’s monitor regularly. 2. Occasionally look beyond the monitor to allow your eyes to rest. 3. The top of the monitor should be level with your eyes or just below, and directly in front of you. 4. The monitor should be free of glare. If close to a window, the screen should be at a right angle to the window. 5. Be sure to blink often and consider carrying eye drops that will add moisture to your eyes. 6. Take breaks from computer use every 2 to 3 hrs. Musculoskeletal Disorders Musculoskeletal disorders (MSDs) are a variety of complaints including sore shoulders, aching backs, and stiff necks. MSDs derive from poor posture and from the way you move your mouse or other tracking tool. Some experts consider the mouse the most “dangerous” part of the computer as it causes the user to move his or her shoulder for- 1. Use a light touch when typing. 2. Focus on maintaining your wrists in a neutral position when typing. 3. Consider using a split keyboard or wrist support. Carpal Tunnel Syndrome Inflammation of the median nerve as it passes through the tunnel in the wrist occurs as a result of repetitive motion. The result of inflammation is pain, numbness, and tingling in the wrist, hand, and fingers (except for the small finger, which is not affected by the median nerve). In addition to inflammation from repetitive motion, awkward posture, prolonged use of muscles, and hormonal changes can precipitate Carpal Tunnel Syndrome (CTS) by causing swelling of the tendons in the hand and wrist. There are several interventions for the prevention of CTS injuries: 1. Before, during, and after typing, perform several wrist exercises, such as moving the wrist in a circular motion. 2. Use a wrist support pad. 3. Apply ice to the palm side of the wrist after long periods of typing. Additionally, a page on the WebMd Health Web site (http://my.webmd.com/content/article/1680.50855) contains many activities that can be performed throughout the day to prevent CTS. Emotional Considerations Technological Hardiness Because computers are everywhere, their emotional use is ward and sideways in abnormal positions. Home care staff are high-risk candidates for MSDs. Unpredictable environments such as patient homes, increases the difficulty of securing a work area that allows adequate space and seating. That is why it is particularly important to take the following preventative steps in averting MSDs: 1. Consider substituting a standard mouse with a trackball. 2. Keep your posture just as you were taught as a child— sit up straight. 3. Standing may be the best position when using a computer, this is especially true in the home where it may be difficult to find a chair that allows you to sit with proper posture. 4. Take regular deep breathes; this allows you to relax and drop your shoulders. 5. Consider purchasing a home paraffin wax machine that allows you to treat sore muscles with heated wax that penetrates deeper than hot moist towels. Repetitive Motion Injuries Repetitive motion injuries (RMIs) are closely associated with keyboard use. These injuries can be compounded with the use of laptops that have a greater tendency to cause the wrists to maintain an upward position. There are several interventions for the prevention of RMIs: 788 Home Healthcare Nurse http://www.nursingcenter.com vol. 19 • no. 12 • December 2001 The use of technology can never be the goal in and of itself; it can only support individuals to provide care
rarely given much thought.I master the intricacies ol a Radiation coined a term "technological Point of Care system on the Computer monitors create an hardineas"(TH)to describe the first day of use:it takes time electromagnetic field due to the tralt that retlects adaptation to Establishing a plan for yourself electrical current used to run technology in the emvironment. to lear speciic functions will them.Long term exposure to TH is the sum total of psycho- help you to overcome your this radiation has an unknown ef- logical characteristics that are fear that the technology is too doct.The same general guide related to computer use.These difficult to master. hnes for the prevention of other characteristics include a sense jures also pertain to the pre of ease while using computers. Environmental vention o radlation effects.Do the ability to stay calm when Considerations not sit closer than 40 in.from the the technology fails to respond back or sides of the computer as anticipated,and a general Temperatur8 Extreme移 sense of confidence when using xcessively cold【ons,asis Summary a computer.Individuals who often the case when atr condi Every advance in technology are technologically hardy re tioning in a building is improp has a human cost and a human member that patient care,not erly set or when it is very hot or 1o8s.Computers make much using a c0回pter,s the goa cold,can cause additional possible:however.they can The use of technology can strain on joints and muscles stretch the limit of what un Dever be the goal in and of lt- that are operating computers prepared and overworked self:it can onhy support individ for long periods od time. joints and muscles can safety uals to provide care.Comput- produce.Take care of yourself era can do many tasks better Excessive Noise and assure that your ageney and faster than humans.How- Excessive noise is another tac- cares for you,too.Use these ever,they lack common sense toe that may cause a person to simple guidelines to keep your wisdom,and the capactty to shout and can further stress neck,all the loints and mus know when rules need to be one's beck muscles. cles of your arms,and your broken for the patient's bonefit. eyes healthy.鱼 Nurses will always be needed Adequate Work Space for thoe functions Having adequate work space is REFERENCE tmportant.Hame environments Tseng H M.Maclood,H.A. Computer Anxiety are less predictable-pegotiate r小t.P.l93).Caimputer anx- Computer Anxiety is the term with the family to have one space lety and measurement ol mood used when discussing a reluc cleared for you and your change.Copafers in Hwiun B. hacor 13,J0G-316. ance to use computers.It in- portable laptop. cludes:fear that using a com- puter will do ha▣.wered self-image when using comput- Key Points of OSHA Guidelines ers,worry.and distractibility. Studies show it may alfect 30 1.Agencies would need a reporting procedure and method to40 of the population o responding to RSls. (Tseng.Tlplady,Macleod. 2.Emplovees must receive information on RSl8. Wright.1997).The best cure" 3.Agencies must identify.in sdvance,problem jobs for computer anxiety s to use 4.Agencies need to desig and implement measures to computers.Recognizing how control Rsls. much you already use comput- ers may be the best way to 5.Employees must receive additional training when working overcome at least some com- In johs with a high risk for RSts. puter anxi线y 6.Employees with injuries would receive specific medical Challenging yourself to management learn one new akill at a time another way of addressing anx- 2at:h饰/em.Gt/在线/e1.m tety.No one is expected to aL19·a2.embr200! http://www.nursingcenter.com Home Healthcare Nurse 789
rarely given much thought. I coined a term “technological hardiness” (TH) to describe the trait that reflects adaptation to technology in the environment. TH is the sum total of psychological characteristics that are related to computer use. These characteristics include a sense of ease while using computers, the ability to stay calm when the technology fails to respond as anticipated, and a general sense of confidence when using a computer. Individuals who are technologically hardy remember that patient care, not using a computer, is the goal. The use of technology can never be the goal in and of itself; it can only support individuals to provide care. Computers can do many tasks better and faster than humans. However, they lack common sense, wisdom, and the capacity to know when rules need to be broken for the patient’s benefit. Nurses will always be needed for those functions. Computer Anxiety Computer Anxiety is the term used when discussing a reluctance to use computers. It includes: fear that using a computer will do harm, lowered self-image when using computers, worry, and distractibility. Studies show it may affect 30% to 40% of the population (Tseng, Tiplady, Macleod, & Wright, 1997). The best “cure” for computer anxiety is to use computers. Recognizing how much you already use computers may be the best way to overcome at least some computer anxiety. Challenging yourself to learn one new skill at a time is another way of addressing anxiety. No one is expected to master the intricacies of a Point of Care system on the first day of use; it takes time. Establishing a plan for yourself to learn specific functions will help you to overcome your fear that the technology is too difficult to master. Environmental Considerations Temperature Extremes Excessively cold rooms, as is often the case when air conditioning in a building is improperly set or when it is very hot or cold, can cause additional strain on joints and muscles that are operating computers for long periods of time. Excessive Noise Excessive noise is another factor that may cause a person to shout and can further stress one’s neck muscles. Adequate Work Space Having adequate work space is important. Home environments are less predictable—negotiate with the family to have one space cleared for you and your portable laptop. Radiation Computer monitors create an electromagnetic field due to the electrical current used to run them. Long-term exposure to this radiation has an unknown effect. The same general guidelines for the prevention of other injuries also pertain to the prevention of radiation effects. Do not sit closer than 40 in. from the back or sides of the computer. Summary Every advance in technology has a human cost and a human loss. Computers make much possible; however, they can stretch the limit of what unprepared and overworked joints and muscles can safety produce. Take care of yourself and assure that your agency cares for you, too. Use these simple guidelines to keep your neck, all the joints and muscles of your arms, and your eyes healthy. REFERENCE Tseng, H. M., Macleod, H. A., & Wright, P. (1997). Computer anxiety and measurement of mood change. Computers in Human Behavior 13, 305–316. vol. 19 • no. 12 • December 2001 http://www.nursingcenter.com Home Healthcare Nurse 789 Key Points of OSHA Guidelines 1. Agencies would need a reporting procedure and method of responding to RSIs. 2. Employees must receive information on RSIs. 3. Agencies must identify, in advance, problem jobs. 4. Agencies need to design and implement measures to control RSIs. 5. Employees must receive additional training when working in jobs with a high risk for RSIs. 6. Employees with injuries would receive specific medical management. Source: http://www.mmm.com/cws/issue1.html