Document Type

Capstone Experience

Graduation Date

12-2025

Degree Name

Master of Public Health

Department

Environmental, Agricultural & Occupational Health

First Committee Member

Terry Stentz

Second Committee Member

Elizabeth Beam

Third Committee Member

Kelli Kopocis

Abstract

Certified nursing assistants (CNAs) are at a higher risk of back injuries in healthcare, particularly in long-term care settings. This literature review assessed the primary causes of these injuries and the efficacy of current interventions, particularly Safe Patient Handling and Mobility (SPHM) programs. A total of 26 peer-reviewed articles were published between 2014 and 2025, including experimental simulations, cross-sectional and longitudinal studies, quasi-experimental training interventions, and evaluations of SPHM programs. Across the literature, the primary contributors to back injuries included high physical workload, inadequate ergonomic design, limited access to assistive devices, and staff shortage.

Experimental and biomechanical studies have demonstrated that assistive device technologies, such as slide sheets, air-assisted devices, and motorless mechanical aids, reduce spinal load and ground reaction forces during patient transfers. Cross-sectional research identified a relationship between low back pain prevalence and limited access to equipment and poor work organization. At the same time, quasi-experimental studies showed that ergonomics training and follow-up reinforcement can reduce the risk of musculoskeletal injuries. Longitudinal evaluations of SPHM programs reported reductions in injuries and disability duration; however, effectiveness declined without ongoing training, leadership engagement, and consistent equipment availability.

Significant obstacles to safe patient handling included time pressures, inconsistent access to devices, patient resistance, and inadequate organizational support. The evidence suggests that the success of an injury prevention intervention depends not only on equipment, but also on ergonomic training, a supportive safety culture, adequate staffing, and consistent reinforcement. Strengthening these factors is essential to reducing back injuries among CNAs and improving long-term workforce safety in nursing facilities.

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