# Differences in Nurses' Upper-Body Posture in Manual Patient Handling--A Qualitative Case Study
Although these studies identify effective technical training types, specific intervention content and their alignment with individual nurses' movement patterns remain unclear, necessitating further research to formulate intervention recommendations. Motivated by these considerations and prior observations in nursing homes, we identified the prevalent use of bilateral 30\({}^{\circ}\) positioning maneuvers for bed-bound elderly patients and residents, which is one of the most common positioning maneuvers, especially in nursing home settings with older adults [40] (cf. Figure 1). This repositioning procedure involves the adjustment of the patient's body position by tilting them at a 30\({}^{\circ}\) angle and slowly rolling them onto one side while maintaining the angle. It has been shown that this positioning is most effective in reducing the pressure on different body segments and is therefore mostly recommended [41]. Adequate manual patient repositioning techniques, such as supporting the patient's limbs and body weight, are conducted to ensure secure and controlled repositioning for both sides (left and right positioning maneuvers). It is important to consider that the execution and the duration of the 30\({}^{\circ}\) repositioning process may vary based on individual patient needs and healthcare facility protocols. Moreover, due to the conditions of the positioning of the bed of the immobile persons, nurses have to work from both sides (left and right) in their daily routines. This might lead to unfavorable positions for the nurses if they have a preferred side due to their handedness. According to the actual situation in healthcare (e.g., time pressure, skill shortage, etc. ; [42]) we wanted to explore this practice further with an explorative laboratory study. The specific research aims were the analysis of nurses' upper-body postures, their perceived exertion, and the bed-bound individual's turning acceleration during the implementation of this maneuver. Therefore, this exploratory case study aims to investigate differences between two nurses regarding upper body flexion, lateral flexion, and rotation angles as well as participants' turning acceleration and nurses' perceived exertion. Against this background, we derived the following questions:  
1. Do the nurses' durations of the repositioning process differ? 2. Do the nurses' body positions differ during the repositioning maneuver? 3. Does the acceleration of the participants lying in bed significantly differ between both nurses and does it change over time? 4. Does the perceived physical exertion significantly differ between nurses? We assumed differences between the nurses considering their positioning technique and accompanying positioning durations, causing differing upper body positions in flexion, lateral flexion, and rotation. Furthermore, these variances in upper body positions may change over time during the turning maneuver. Additionally, we hypothesized that the nurses' positioning technique is related to the participants' turning acceleration and that it may change over time during the different turning maneuver sequences. Considering the expected differences in the individual nurses' positioning techniques, we assumed variances in physical perceived exertion between both nurses. These results could be used afterward for conducting additional field studies with bigger cohorts of nurses.