# Differences in Nurses' Upper-Body Posture in Manual Patient Handling--A Qualitative Case Study
## 4 Discussion and Conclusions  
This case study aimed to assess the impact of nurses' upper body posture during manual patient handling techniques, particularly while executing a standardized 30\({}^{\circ}\) repositioning maneuver. The study sought to uncover potential variations in posture between the two participating nurses while conducting the positioning maneuvers and correlate these findings with the acceleration experienced by the repositioned patient participants. In the context of patient participant repositioning, differences in the duration of positioning emerged, notably during left-sided repositioning. This variability indicated nuanced differences in the techniques employed by the nurses, despite both being instructed to adhere to ergonomic principles aimed at minimizing physical strain [37; 39]. Typically, patient repositioning techniques are tailored to individual patient needs, often within the constraints of nurses' time availability [12]. It was noteworthy that nurse 1 exhibited shorter positioning times compared to nurse 2, potentially leading to reduced stress on body regions due to shorter exposure to challenging postures [5]. However, the study highlighted the fine balance required to avoid rapid movements during repositioning, which can contribute to musculoskeletal discomfort [48]. The subsequent analysis of upper body posture revealed that both nurses' upper-body flexion, lateral flexion, and rotation fell within ergonomic limits if these postures were sustained for short durations. Prolonged maintenance of extreme postures, as highlighted by ergonomic standards [16; 17], can result in musculoskeletal overload. It became evident that nurse 2 adopted more pronounced and potentially discomforting postures in all dimensions, implying an increased risk of overloading. Variations in maximum flexion, lateral flexion, and rotation between the two nurses underscored the divergent techniques they employed. The examination of sequence effects and acceleration further illuminated the intricacies of the repositioning process. Sequence 2 emerged as more physically demanding, attributed to the extended duration of sustained extreme upper body postures. Acceleration analysis demonstrated that nurse 2 initiated higher accelerations in both shoulder and hip regions, aligning with her more pronounced upper body postures. This finding was consistent with nurse 1 showcasing a more economical and less physically demanding technique. Interestingly, nurse 2, despite demonstrating more extreme angular positions, reported lower subjective perceived exertion across various body regions. This seemingly contradictory finding could be attributed to differences in perceived exertion between novice and experienced individuals although both participants were trained nurses, but with different years of experience, as suggested by existing literature [49]. Addressing these challenges in patient repositioning, the study highlighted the limitations of existing assistive aids, such as pillows and blankets, which offer only partial relief to nurses' discomfort and may not consistently improve patient comfort. Specialized systems catering to patient support are often one-sided in their functionality, underscoring the need for comprehensive, innovative solutions that prioritize ergonomic care for both nurses and patients [50; 51]. Considering these findings, recommendations for future studies include a more extensive investigation into the physical burdens that nurses face while handling bed-bound patients, especially in cases of higher patient weights. Adhering to upper-body posture guidelines outlined by ISO and DIN EN standards could potentially alleviate the risk of musculoskeletal strain [16; 17]. Moreover, technical training and ergonomic supervision have shown promising results in reducing work-related injuries and discomfort among nurses [32; 33; 37; 39].