SEPTEMBER 2021
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Work Health & Safety
A S A W O R K H E A LT H & S A F E T Y I S S U E
In this issue
3
UPDATE FROM THE CEO
4
KEY FINDINGS
6
WORKLOAD
8
PAIN
24
MENTAL HEALTH
30
SUPPORT
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27 October Australasian Sonographers Day
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Join us in celebrating sonographers on 27 October for Australasian Sonographers Day sonographers.org
A S A W O R K H E A LT H & S A F E T Y I S S U E
Update from the CEO
W
ork health and safety is an extremely important issue for ASA members because sonographers deal with a variety of physical and emotional pressures as a part of their everyday practice. This edition of Soundeffects news is dedicated to Work Health and Safety. The Australasian Sonographers Association (ASA) 2021 Work Health and Safety Survey was distributed to all members and completed by almost 1000 members giving an overall response rate of 15%. I would like to thank the Health and Wellbeing Special Interest Group and Project Group for helping to develop the questions, and all the sonographers who participated in the survey. The survey questionnaire included a range of questions related to sonographer workflow and volume, experiences and reporting of physical pain, experiences of aspects that impact on mental health and burnout (including discrimination and harassment), and available support systems. The results of the survey are included in this edition of Soundeffects news. The ASA has a number of work health and safety resources available on our website sonographers.org, and based on the results of this survey and your suggestions, we will look to add even more resources, so we can better support you in this very important area.
The ASA has a number of work health and safety resources available on our website sonographers.org
Jodie Long CEO Australasian Sonographers Association
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A S A W O R K H E A LT H & S A F E T Y I S S U E
Key findings W ORKLOAD WORKLOAD
PA IN PAIN
› On average, private sector sonographers
› Four in five sonographers experience pain as a
› In addition to high workloads, over half of all
› Just over one quarter of sonographers report the
perform a higher number of scans per day than those working in public hospitals. sonographers are regularly working more than their scheduled hours, and/or missing their scheduled breaks.
result of their work, with workload impacting on the frequency of their pain. pain they experience.
› Of those who don’t report their pain, nearly one in eight were concerned about the potential impact reporting would have on their job.
› Almost one in five sonographers had taken time off work due to work-related pain.
M E N T A L H E A LT H
› Most sonographers are regularly delivering
bad news to patients, many with no protocols to follow or organisational support to help them manage any related stress or anxiety.
› One in three sonographers had experienced
some form of discrimination at work in the last 12 months – largely from patients rather than internal colleagues or managers.
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SUPPORT S U P P O R T
› Many sonographers were uncomfortable
raising WHS issues for fear or repercussions or having their concerns being seen as unimportant and subsequently dismissed.
› Sonographers felt that the biggest help ASA
could provide to them would be guidelines and recommendations that could be enforced on an appropriate number of scans per day and time allocated to each scan.
A S A W O R K H E A LT H & S A F E T Y I S S U E
A S A W O R K H E A LT H & S A F E T Y I S S U E
Workload Overall, almost half of all respondents (49%) indicated that their workplace used software to measure the number of scans completed per day, with 25% indicating that their workplace did not, and a further 26% unsure.
WORK VOLUME WORK DAYS AND HOURS Average Number of Days Worked per Week
Non-cardiac sonographers (50%) were more likely to indicate that their scan numbers were measured than were cardiac sonographers (33%). Similarly, using software to measure scan numbers was more prevalent in private practice (53%) than in public hospitals (37%).
39% 30% 20% 2%
7%
1 day
2 days
3 days
4 days
5 days
2%
0%
6 days
7 days
On average, almost half of all sonographers indicated that they worked five or more per week (42%). Similar proportions worked four (30%) or three or more days per week (29%). The youngest sonographers (those aged 30 years or less) were significantly more likely than all other age groups to work five or more days per week (72%). Clinical sonographers were significantly more likely than those in other roles to work three or less days per week (33%), compared with 8% of managers and 19% of students or supervising sonographers. Most sonographers (78%) work an average of 7–8 hours per day, with 16% working 9 or more hours and 5% working 6 hours or less per day. Average Number of Hours Worked per Day
78%
0% Less than 4 hours
13%
5% 4–6 hours
7–8 hours
9 – 10 hours
REST BREAKS Rest Breaks Taken in a Typical Working Day
75%
17% 30-minute 60-minute lunch break lunch break
20%
10%
8%
10-minute morning tea
10-minute afternoon tea
Mini breaks to rest/ stretch
4%
3%
Other
No breaks
Three-quarters of sonographers indicated that they typically take a 30-minute lunch break each day. Less than one in five take other breaks, including a 10-minute morning tea (20%), 60-minute lunch (17%) or 10-minute afternoon tea (10%). Less than one in ten (8%) take mini breaks to rest or stretch throughout the day. Around two in five sonographers (38%) indicated that they often miss their scheduled break due to their workload – higher amongst those in public hospitals (47%) than in private practice (35%).
3% More than 10 hours
Frequency with which Scheduled Breaks are Missed 47%
SCAN TRACKING
38%
45%
47% 37%
35%
Workplace Measures Number of Scans Completed per Day 50%
49%
53%
17%
37%
33%
Often
Sometimes
n Overall n Private practice n Public hospital Overall
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Cardiac
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18%
NonCardiac
Private practice
Public hospital
Rarely/Never
15%
A S A W O R K H E A LT H & S A F E T Y I S S U E
ADDITIONAL HOURS WORKED Regular Additional Hours Per Day
43%
36% 17% Yes, up to 30 minutes longer than scheduled
Yes, between 30 minutes and 1 hour longer
3% Yes, 1 – 2 hours longer
0% Yes, more than 2 hours
No longer
A little over half of all respondents (57%) indicated that they regularly work more than their scheduled hours per day – most commonly up to 30 minutes longer (36%).
In addition to high workloads, over half of all sonographers are regularly working more than their scheduled hours, and over two in five often miss their scheduled breaks.
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A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain EXPERIENCES OF PAIN
18%
37%
of sonographers have not experienced pain in the last 12 months
44%
of sonographers have experienced pain in the last 12 months due to work
of sonographers are currently experiencing pain due to their work
SEVERITY OF PAIN
FREQUENCY OF PAIN
Around two-thirds of sonographers who had experienced pain in the last 12 months rated that pain as moderate (i.e. between 4 and 7), with the bulk rating it as either a 4 or 5 (37%). A little over one-quarter (27%) rated their pain as low (i.e. between 1 and 3), with 7% rating their pain as high (i.e. between 8 and 10).
Around one-third of sonographers indicated that they only experience pain occasionally, depending on their workload, with 29% indicating it occurred sometime after finishing their day, suggesting that workload management could play a large role in the experience or absence of scanning-related pain. Around one-quarter indicated that they experience pain most of the time when scanning (23%) or at night time (22%), with one in eight (12%) experiencing pain all the time. Sonographers aged 30 or less were significantly more likely than others to experience pain occasionally depending on their workload (61%) or soon after finishing a scan (37%), suggesting that they had not yet developed appropriate safe scanning techniques.
Where Sonography-Related Pain was Experienced Over Last 12 Months 68%
Shoulder on scanning arm
63%
Neck
42%
Wrist of scanning arm
40%
Upper back
Shoulder on non-scanning arm
27%
Forearm of scanning arm
25%
Eyes Head
16% 15%
11% 7%
Hands/fingers of non-scanning arm
7%
Upper arm on non-scanning arm Other
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23%
22% 19%
18%
12% 9%
1%
13%
Wrist of non-scanning arm
Forearm of non-scanning arm
29%
21%
Middle back
Upper arm on scanning arm
35%
29%
Hands/fingers of scanning arm
Hips
When Pain Most Commonly Occurs
32%
Lower back
5% 3% 4%
All the time Occasionally Sometime Most of the depending after finishing time when on workload the day scanning
Night time Intermittently/ Soon after The day after sporadically finishing a scanning scan
Other
A S A W O R K H E A LT H & S A F E T Y I S S U E
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A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain PERSONAL IMPACT OF PAIN
Just over a quarter of sonographers report the pain they experience, with nearly one in eight concerned about the impact on their job.
Impact of Pain on Daily Life
48%
45%
18% Difficulty sleeping
Difficulty performing non-work activities
Working reduced hours
17%
7%
Changed Unable to the scope work at all of my work whilst in pain
19% 10% Other
No impact
WHY PAIN IS NOT REPORTED Why Pain was Not Reported
49%
A little under half of sonographers experiencing pain indicated that their pain led to them having difficulty sleeping (48%) or performing non-work related activities (45%). Other impacts nominated by respondents included having to undergo surgery, medication or physical therapy, or having persistent generalised discomfort. One in five (19%) indicated that their pain had no impact on their life.
Four in five sonographers experience pain as a result of their work, with workload impacting frequency of pain. REPORTING PAIN Who Pain is Reported To
3%
1% HR Manager
3%
1% Someone else
WHS Manager GP/Medical Specialist
17%
Direct Manager
4%
Colleagues
21% 12% Pain was I did not want I did not not severe to be seen as want to enough complaining jeopardise to warrant my job reporting
4% Because nothing would change
3%
2%
Reporting of pain is discouraged
I did’t know how to report it
10% Other
When asked why they had not reported their pain, almost half (49%) indicated that it was because they believed the pain was not sufficient enough to warrant reporting. Around one in five (21%) indicated they did not want to be seen as complaining, and one in eight (12%) did not want to jeopardise their job. Amongst those who provided another response, around 4% believed that nothing would change as a result of them reporting, with smaller portions indicating that they felt pain was not worth reporting because it was just part of the job, because they couldn’t prove that it was work-related, or because they preferred to just self-manage. Amongst those who had reported their pain, this was most commonly only after the pain had persisted for more than two days (39%), with a little under one quarter (23%) reporting their pain the day they felt it. Other common responses were reporting the pain after it had persisted for more than a few months, or that they were doing regular, ongoing reporting of both the presence and absence of pain. Timing of Reporting Pain
27%
of sonographers report pain when they feel it
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Approximately three in ten sonographers experiencing pain (27%) indicated that they report their pain when they experience it. Most commonly, pain was reported to their direct manager (17%).
39% 23%
16%
11% The day I felt it
The day after I felt it
After it had persisted for more than two days
I can’t remember how long after
11% Other
A S A W O R K H E A LT H & S A F E T Y I S S U E
SONOGRAPHER’S QUICK REFERENCE GUIDE TO STRETCHING IN THE WORK PLACE | ARMS AND SHOULDERS Theraband rows Attach theraband to door handle Pull band towards you as you bend elbow Squeeze shoulder blades back
Theraband hands up
Hold band with palm down and elbow 45 degrees away from the body
Rotate shoulder so the hand finishes with the palm facing forward (‘hands up’)
‘Wax on, wax off’ Hold band with elbow bent Move arm forward without hitching shoulder Move hand in circular motion (like waxing car), then reverse circle Repeat 10 times per side
AIM
improve rotator cuff control
strengthen posterior rotator cuff
Punch plus Hold band with elbow bent Push arm forward until elbow straight Continue to push forward as you round your shoulder without hitching shoulder Repeat 10 times per side AIM
AIM
strengthen scapular retractors
AIM
Repeat 15 times per side
Improve serratus anterior strength
External rotation
Rhomboid stretch
Attach theraband to door handle
Interlace fingers in front of body
Hold band and tuck elbow to side
Round your shoulders and push palms away from your body
AIM
Repeat 15 times each side strengthen posterior rotator cuff
Hold stretch for 20 sec Repeat 3 times AIM
Rotate shoulder out from body
stretch rhomboids
Wrist flexor stretch
Wrist extensor stretch
Straighten elbow
Straighten elbow
Extend fingers up
Pull and drop fingers down
Pull fingers back towards you
Pull fingers back towards you Hold for 20 sec
Hold for 20 sec Repeat 3 times each side
www.sonographers.org
stretch wrist extensors
AIM
AIM
Repeat 3 times per side stretch wrist flexors
© 2019 Australasian Sonographers Association Ltd. The Australasian Sonographers Association gratefully acknowledges the Sonographer Health and Wellbeing Special Interest Group committee for preparation of this poster. This poster remains the property of the Australasian Sonographers Association. No part of it may be reproduced without permission. Disclaimer The information in this publication is current when published and is general in nature; it does not constitute professional advice. Any views expressed are those of the author and may not reflect ASA’s views. ASA does not endorse any product or service identified in this publication. You use this information at your sole risk and ASA is not responsible for any errors or for any consequences arising from that use. Please visit www.sonographers.org for the full version of the Australasian Sonographers Association publication disclaimer.
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A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain ENCOURAGING PAIN REPORTING
MANAGING PAIN
With respect to reporting of pain, over two in five indicated that reporting of pain is not encouraged in their workplace (43%), with a further three in ten (28%) unsure. Only 29% indicated that reporting of sonography-related pain was actively encouraged in their workplace.
WORKPLACE MEASURES TO REDUCE PAIN Measures Taken to Avoid/Reduce Pain
60%
Those working as a clinical sonographer were significantly less likely to say that reporting of pain was encouraged in their workplace (23%), than were those in management (58%) or education roles (37%). Whether Reporting of Pain is Encouraged
Unsure 28% Yes 29%
No 43%
39% 16% Alternating between sitting
Using stretch bands
9% Using straps
5%
1%
Alternating hands
Using slings
17% Other
None of the above
Sonographers employ a number of techniques to reduce pain. Three in five (60%) sonographers indicated that they alternate between sitting and standing in order to reduce or avoid pain when scanning. Around one in six (16%) used stretch bands, and a similar proportion indicated that they did not use take any particular measures. Other commonly nominated measures included: • • • • • • •
stretching or taking mini breaks (14%) exercising outside of work (11%) getting assistance from allied health professionals (6%) adjusting their posture (5%) massage (5%) adjusting their equipment or ergonomic set up (4%) reducing the number of mix of scans they do in a day, or altering scan times (4%) • using other specific equipment; or (3%) • taking some form of pain relief (2%).
PERSONAL MEASURES TO REDUCE PAIN Physical Exercise Undertaken
48% Running/ jogging/walking
25%
Weights
6%
Team sports
24% Other
47%
Strength training
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23% Cardio
16% None
A S A W O R K H E A LT H & S A F E T Y I S S U E
Improved sonographer comfort means improved quality of life
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A S A W O R K H E A LT H & S A F E T Y I S S U E
SONOGRAPHER’S QUICK REFERENCE GUIDE TO STRETCHING IN THE WORK PLACE | BACK & NECK
Lengthen back of neck Hold for 5 sec Repeat 3 times
AIM
stretch upper cervical joints
Levator scapula stretch
Lower shoulder
Tilt chin to opposite armpit Hold for 20 sec Repeat 3 times each side
AIM
stretch levator scapula
Chest drop Hang onto stable front support Lean forward and let chest drop towards ground Hold for 10 sec
AIM
Repeat 5 times
improve thoracic extension
Back extension stretch Stand and place hands in lower back Extend back over hands Hold for 10 sec
AIM
Repeat 3 times
www.sonographers.org
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improve lower back flexibility
Lower shoulder
Tilt ear to the opposite shoulder
Hold for 20 sec
Repeat 3 times each side
AIM
stretch upper trapezius
Pectoral stretch Interlace fingers at the back Pull hands down and back Hold for 20 sec Repeat 3 times
AIM
Draw chin back (make a double chin)
stretch pectoral muscles
Thoracic rotation stretch Sit on chair and cross legs Twist and look over shoulder Hold for 10 sec Repeat 3 times each side
AIM
Upper trapezius stretch
improve thoracic rotation
Shoulder shrugs Roll shoulders up to ears and forwards Repeat 5 times Roll shoulders up to ears and backwards Repeat 5 times
AIM
Chin tucks
reduce tension in neck
© 2019 Australasian Sonographers Association Ltd. The Australasian Sonographers Association gratefully acknowledges the Sonographer Health and Wellbeing Special Interest Group committee for preparation of this poster. This poster remains the property of the Australasian Sonographers Association. No part of it may be reproduced without permission. Disclaimer The information in this publication is current when published and is general in nature; it does not constitute professional advice. Any views expressed are those of the author and may not reflect ASA’s views. ASA does not endorse any product or service identified in this publication. You use this information at your sole risk and ASA is not responsible for any errors or for any consequences arising from that use. Please visit www.sonographers.org for the full version of the Australasian Sonographers Association publication disclaimer.
A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain WORKPLACE IMPACT OF PAIN
Almost one in five sonographers had taken time off work due to work related pain.
TAKING TIME OFF DUE TO PAIN Actions Taken Due to Pain
79%
Taken time off work, but did not contact or access workplace safety and accident compensation
5% Taken time off work and contacted or accessed workplace safety and accident compensation
4% Contacted or accessed workplace safety and accident compensation, but did not take any
None of the above
C_AD_2102_176x118_SoundEffects
12%
In the last 12 months, 17% of respondents who had experienced pain had taken time off from work due to pain, and 9% had accessed their local workplace safety and accident commission. One in twenty (5%) had done both. However the vast majority of those who had experienced pain (79%) had continued to work through this time.
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ADVANCE YOUR CAREER AS A CARDIAC SONOGRAPHER
15
A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain SUPPORTING SONOGRAPHERS TO RETURN TO WORK
SATISFACTION WITH RETURN-TO-WORK SUPPORT
How Returning to Work was Supported
32% 24%
23%
23%
21%
23% Resources were completely sufficient 65% Resources were somewhat sufficient 48% Resources were not at all sufficient
9% My manager My workplace My colleagues Workpace helped modify modified/ assisted with safety and my role to changed the some activities accident accommodate environment to while I recovered compensation my requirements accommodate assisted with a my requirements return-to-work program
Other
There was no support provided
A third of sonographers who take time off due to pain were not supported to return to work. Equipment, Support and Resources Provided to Support Return-to-Work
44%
Consideration of type of exams booked Extra time in the scheduling of appointments
28%
Offered to return to work part-time instead of full-time
25%
Supervision of a student instead of direct scanning
24%
Ergonomically approved sonographer seating
17%
Offered to return in mixed roles
16% 10%
Arm support bands Ergonomically approved examination couch
6%
Scanning sling Ergo sling Other No resources were provided
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4% 2% 11% 16%
Less than a quarter of sonographers who took time off from work due to pain were satisfied with the return to work support they were provided with.
Untitled-1 1
Ankles
above
Knees
above
Hips
above
Shoulders
above
Ears
• Use cable supports to minimise ‘cable drag’
• Adjust the monitor so your eyes are level with the top third of the monitor
• Schedule patients to vary examination types
• Change posture at least every 8 – 10 minutes
• Refocus your eyes every few minutes
• Stretch and relax muscles often
The Australasian Sonographers Association would like to thank Bernadette Mason, Peter Mason, Val Gregory, Jenn Reid, Carolyn Hummerston and Robyn Tantau for the preparation of this poster and Julie Wheatley for her assistance with the illustrations. Copies of this poster may be ordered through the ASA Office, Level PO Box 356 Dingley 3172Victoria Australia. • Phone +61•3P: 9552 • Fax +61 3 9558 1399 • admin@a-s-a.com.au • www.a-s-a.com.au 2, 93–95 QueenVillage Street,Victoria Melbourne 3000 Australia +610000 3 9552 0000 • E: memberservices@sonographers.org • W: www.sonographers.org This poster remains the property of the Australasian Sonographers Association. No part of it may be reproduced without permission.
• Vary posture by alternating sitting and standing; varying scanning techniques; changing transducer grip; repositioning equipment and alternating scanning arm
• Minimise twisting, bending, reaching, lifting, using excessive force and awkward postures
• Position all equipment and the patient as close as possible to you
• Support arms, trunk and back as much as possible • Have ‘mini breaks’ during examinations
• Avoid sharing the monitor with the patient
• Adjust all equipment to achieve an acceptable posture before starting to scan
Hips
above
Shoulders
above
Ears
sonographers.org www.a-s-a.com.au
REMEMBER: FATIGUED MUSCLES MUST BE GIVEN TIME TO RECOVER
• Regular physiotherapy and optical health checks are recommended
• Always take tea and meal breaks to give your body time to completely relax
• Take regular frequent breaks from scanning – at least 10 minutes every hour is recommended
Wrists and elbows in a neutral position
Rotation on the head less than 45 degrees and ideally less than 15 degrees
Flexion of the neck less than 30 degrees and ideally less than 20 degrees
Forearms almost parallel to the floor
Backward reach should be minimal
Forward reach less than 25 degrees
Abduction of the arms less than 30 degrees
Thighs slightly lower than hips
Feet supported on chair or ultrasound unit footrest
Sitting
• All equipment should be fully adjustable
Tips for Safe Scanning
Wrists and elbows in a neutral position
Rotation on the head less than 45 degrees and ideally less than 15 degrees
Flexion of the neck less than 30 degrees and ideally less than 20 degrees
Forearms almost parallel to the floor
Backward reach should be minimal
Forward reach less than 25 degrees
Abduction of the arms less than 30 degrees
Weight evenly distributed on both feet
Standing
TAKE THE TIME TO GET IT RIGHT
POSTURE IS IMPORTANT FOR SONOGRAPHERS
PREVENT INJURY
19/03/2015 12:04:11 PM
A S A W O R K H E A LT H & S A F E T Y I S S U E
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A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain Pilates for Sonographers
Can it help reduce sonographer injuries?
W
e all know about Pilates and its value in treating and preventing low back pain and it is a proven method to improve overall body strength and conditioning.(3,4) But how valuable is it for sonographer health and wellbeing? Do we need a specific program or are generic classes or YouTube programs sufficient? The incidence of musculoskeletal injuries in sonographers is on the increase. In a recent survey, 89% of sonographers reported experiencing pain and discomfort with scanning.(1,2) As the incidence of injury is extremely high, the need to reduce the incidence of work-related musculoskeletal injuries is a growing concern. Pilates exercises have been around since the 1920s when Joseph Pilates, a German fitness enthusiast, helped rehabilitate those injured in WWI. He experimented with springs attached to hospital beds and started applying movement and resistance to their muscles. This unique exercise regime seemed to hasten their recovery time. He used this experience to develop equipment using springs for resistance that we now use widely in the form of Pilates Reformer and Trapeze Tables. Since the early 90s, this form of exercise designed by Pilates has made a resurgence. Research coming from Australia, most notably Queensland University, has suggested a link between Pilates exercises and improved spinal stability. In particular it is thought the local stabilisers, including pelvic floor and transversus abdominis muscles, act to maintain optimal posture and enhance function and biomechanical efficiency. The goal of any strengthening program is to improve the strength and endurance of the muscles needed to perform daily tasks. Wajsweiner in 2012(5) found a Pilates program was superior to a general exercise program in providing immediate improvement in low back pain. So, what is it that makes Pilates exercises a worthwhile program to explore and why should sonographers take up this form of exercise? Pilates endeavours to create a stable, central platform from which the arms and legs function. This is achieved by training appropriate control in the local (deep musculature) and the global (superficial musculature). Developing this stable base in our pelvis and trunk, as well as a strong scapula position for the upper arm to work, is paramount in preventing overactivity injuries. Given sonographers need to produce sustained force through their scanning arm, view a monitor and input data through their non-scanning arm, muscle imbalances can often develop. For this reason, Pilates is an ideal exercise program for improving sonographers’ posture and ability to maintain force through their trunk, shoulder, elbow and wrist. Pilates instructors encourage the deep core muscles (pelvic
18
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floor, transversus abdominus, multifidus, lower trapezius and rhomboids (see Figure 1) to develop as endurance muscles without promoting overactivity of the superficial muscles such as external obliques, rectus abdominis and deltoids. While Pilates exercises emphasise deep stability, coactivation of multiple muscle groups is the goal. Activity through movement also encourages repetitive stretching under load. Focused breathing with expiration on the loaded movements helps to reduce bracing and rigidity with the exercises. The resistance and load can be varied to individualise exercise programs to rehabilitate musculoskeletal pathologies ranging from mild to severe or to proactively prevent sonographers from developing issues. Figure 1. Posterior lumbodorsal fascia
Interspinalis Multifidus
Longissimus Iliocostalis Quadratus lumborum
Intertransversarii 3rd lumbar vertebra
Psoas major
Posterior layer rectus sheath
Internal oblique Transversus External oblique Superficial fascia
Linea alba Anterior layer rectus sheath
Rectus abdominis
There is also a strong emphasis on developing good postural control and improving the endurance of holding these postures. Improving the ergonomic positioning in sonographers is important, but if they can’t maintain these postures due to inadequate core strength then Pilates exercises can assist with rectifying these deficiencies. The key muscles controlling the upper limb stability are: • rhomboids • middle and lower trapezius • infraspinatus • serratus anterior • subscapularis. In a 2008 published study(6) on the effects of Pilates exercises on shoulder range and pain, it was revealed that moderate
A S A W O R K H E A LT H & S A F E T Y I S S U E
A S A W O R K H E A LT H & S A F E T Y I S S U E
Pain
Pilates for Sonographers (continued) improvements in shoulder abduction and external rotation range of motion were observed in all subjects involved. Pilates training appears to improve the quality of movement and neuromuscular repatterning. Studies have shown that sonographers report the shoulder and arm as the most frequent sites where pain is experienced.(1-2,7,8) Hence improving scapular and glenohumeral stability with Pilates exercises can help prevent overuse injuries such as subacromial bursitis, neural tension, neck and thoracic pain and elbow and wrist pain (including lateral epicondylitis).
What type of Pilates program works best? This will depend on the individual but generally an assessment by a physiotherapist or Pilates instructor is advised to see which areas are needing better control and determine if flexibility issues need to be addressed. An exercise program can then be developed to improve dysfunctional patterns and develop efficient movement patterns. This generally involves low level strengthening exercises on spring loaded equipment such as a Pilates Reformer and Trapeze Table involving a closed chain environment. These exercises incorporate low level afferent input while gently loading and stretching muscles. Pilates reformer and trapeze exercises in sitting or kneeling can help develop scapulothoracic stability. Exercises such as rowing or chariot-type exercises work well to target a good intrascapular base of stability. Bilateral or unilateral spring or TheraBand activities help promote strength around the rotator cuff and elbow. A home and/or work-based program can be incorporated to supplement a Pilates program. Kloubec(9) conducted a study involving a 12-week mat routine which suggested that individuals can improve their muscular endurance and flexibility using relatively low intensity Pilates exercises. These do not require equipment or a high degree of skill and are easy to master. Elastic bands (e.g. TheraBand) or fit balls are basic aids which can also facilitate improved core and scapular control and provide a basis for a home or work-based strengthening program. A physiotherapist would also advise on appropriate stretching exercises which may involve static stretches to improve flexibility or the use of a foam roller to target chronic tightness in the shoulders, neck and upper back.
Can a Pilates program be detrimental? If the Pilates exercises are performed incorrectly, or the exercises are too advanced for the individual, then symptoms may worsen with these exercises. For this reason, trialling ‘YouTube’ Pilates programs or following your mate’s program is not generally advised.
Conclusion The ergonomic issues that confront a sonographer often lead to overactivity of the thorax and upper limb muscles and chronic pain conditions. Pilates exercises aim to improve the deep stabilisers of the body while promoting better posture and optimal flexibility. This form of exercise I have found to be extremely useful in overcoming and preventing work-related musculoskeletal disorders in sonographers.
References 1. Murphy C, Russo A. An Update on Ergonomic Issues in Sonography. Employee Health and Safety Services: Healthcare Benefit Trust. July 2000. 2. Mason B, Robinson C, Brinsmead S, Hassall L, Chamberlin S. The 2014 ASA workplace health and safety survey results. 2014. 3. Brown G and Baker J. Work-related musculoskeletal disorders in sonographers. Journal of Diagnostic Medical Sonography 2004;20:85–93. 4. Harrison G and Harris A. Work-related musculoskeletal disorders in ultrasound: Can you reduce risk? Online 2015: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC4760593/ 5. Wajsweiner H, Metcalf B and Bennell K. Clinical Pilates versus general exercise for chronic low back pain: A randomised trial. Med Sci Sports Exerc 2012;44(7):1197–1205. 6. Keays KS, Harris SR, Lucyshyn JM, MacIntyre DL. Effects of Pilates exercises on shoulder range of motion, mood, and upper extremity function in women living with breast cancer: a pilot study. American Physical Therapy Association 2008; 88(4):494–510. 7. Evans K, Roll S, Baker J. Work-Related Musculoskeletal Disorders (WRMSD) Among Registered Diagnostic Medical Sonographers and Vascular Technologists: A Representative Sample. Journal of Diagnostic Medical Sonography. 2009. 8. Hill JJ, Slade M, Russi M. Anthropometric measurements, job strain, and prevalence of musculoskeletal symptoms in female medical sonographers. Work. 2009;33(2):181–9. 9. Kloubec J, Pilates for the improvement of muscle endurance, flexibility, balance and posture. Journal of Strength and Conditioning Research 2010;24(3):661–7.
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Pain Peter Esselbach
Chair of the Sonographer Health and Wellbeing SIG
P
eter is a specialist musculoskeletal (MSK) sonographer with Radiology SA and Fowler Simmons Radiology in Adelaide. Peter is also a qualified MSK physiotherapist and Pilates instructor. Originally trained as an exercise physiologist, Peter enjoys fusing his clinical rehabilitation skills with his passion for sonography, an area reflected by Peter’s active contributions to the ASA Health and Wellbeing Special Interest Group. He has worked as a cardiac, vascular, general and MSK sonographer in Brisbane, Sunshine Coast and Adelaide. He has also lectured at UniSA and runs teaching seminars through Ultrasound Solutions. Peter Esselbach shares his insights into what sonographers and employers can do to decrease the instance of work-related pain and physical injury.
1. How has your research, practice and experience informed the way you approach work health and safety (WHS) in your own work? Having worked as a physiotherapist for 20 years, I realise how debilitating work-related injuries can be and if they are not treated early. Early identification and treatment if therefore the key to the best outcomes.
2. Why are physical WHS issues common in the sonography profession? I feel MSK pathologies are common in sonography because sonographers are asked to deal with an increasing level of stress, perform multiple repetitive activities unilaterally, while applying often considerable force through their scanning arm. This combination of factors leads to overactivity syndromes in muscles, tendons and joints. These include tennis elbow, golfer’s elbow, De Quervain’s tenosynovitis, rotator cuff pathologies, carpal tunnel syndrome and trigger point pathologies in the neck, thoracic and lumbar regions.
3. What are some of the common mistakes sonographers make that lead to WHS issues? Common mistakes sonographers make include: • not setting up the keyboard, monitor, bed height and chair appropriately • applying excessive force through the probe with the scanning arm • not adjusting the patient’s position to allow an optimal ergonomic scanning posture • not taking regular short breaks to stretch and move around • not reading the early warning signs of fatigue and seeking the appropriate medical help (doctor, physiotherapist)
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• not informing your supervisor/management so workload can be addressed.
4. What are some easy measures that sonographers could implement to avoid some of the most common WHS pain issues? Sonographers can be proactive to avoid WHS pain by: • taking micro breaks throughout scanning • stretching the appropriate muscles • adopting a strengthening program aimed at improving core strength of the thoracic and lumbar areas, and improving muscle development around the rotator cuff, elbow and wrist • developing good ergonomic principles in scanning early in your professional life • exercising regularly to help counteract work-related stress and maintain good aerobic fitness.
5. What is something employers could do to decrease the incidence of WHS issues in their workplace? Employers can reduce WHS issues by: • endeavouring to provide a worklist for sonographers that provides a variety of scanning areas, adequate time to complete and regular break times • updating chairs, beds and workstations to provide an optimal ergonomic work environment • providing an ergonomist to assess employees at their workstations • providing regular time periods to exercise (e.g. chair yoga, Pilates or stretch classes) • openly encouraging self-reporting of any physical or mental stresses encountered in the workplace.
6. What physical exercises would you recommend for a sonographer to do to offset the physical demands of their work? I encourage a range of stretches to allow muscles and joints to maintain good range and to promote adequate blood flow. Also work-hardening strengthening exercises provide muscle development to help prevent fatigue and overload issues within sonographers. Please refer to the ASA posters for details of recommended exercises or see your physiotherapist for an individual exercise program. See pages 13 & 14 for ASA posters on stretching in the workplace
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Mental Health STRESSFUL WORK SITUATIONS DELIVERING BAD NEWS
Total
Cardiac
NonCardiac
Yes, and there are protocols to follow when I do
35%
6%
38%
Yes, but there are no protocols to follow when I do
46%
9%
51%
No
19%
Most sonographers are delivering bad news to patients, many with no protocols to follow or organisational support to help them manage any related stress or anxiety.
TEAM SUPPORT Whether Sonographers Feel Like they Work in Isolation
85%
11%
Mostly I feel like I work in isolation from others
26% 37%
Around four in five sonographers (81%) deliver bad news to patients. Most of these sonographers indicated that there are no formal protocols in place to assist (46%) when doing so. Sonographers managed by other sonographers (86%) were significantly more likely than those managed by medical practitioners (54%) and non-health professionals (70%) to deliver bad news, but were also more likely to have formal protocols in place for when they do (40%). Whilst a similar proportion of clinical sonographers (82%) and managers (85%) indicated that they provide bad news to patients, clinical sonographers (49%) were significantly more likely to indicate that they had no formal protocols to follow than were managers (29%). This suggests that if formal protocols do exist, they are not necessarily being communicated down the chain to clinical sonographers.
TRAINING IN DELIVERING BAD NEWS
26% Training provided was sufficient 8% Training provided was insufficient 66% Training was not provided
I feel like I spend equal time as part of a team and in isolation
37%
Similar proportions of sonographers feel like they work as part of a team (37%), in isolation (26%) or both equally (37%). However, this sense of working in a team was significantly lower for those performing 16 or more scans per day (28%), suggesting their higher workload makes it harder for them to build connections with the rest of their team. Sonographers with less than 10 years’ experience were least likely to feel like they were part of a team 29%, compared with 40% of those with more experience.
DISCRIMINATION
32% of sonographers have experienced discrimination
8% Unsure/prefer not to say 60% of sonographers have not experienced discrimination
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Mostly I feel like I work as part of a team
A S A W O R K H E A LT H & S A F E T Y I S S U E
One in three sonographers had experienced some form of discrimination in the last 12 months – largely from patients.
Almost half of all respondents who had experienced discrimination, bullying or harassment in the last 12 months said that the perpetrator had been a patient (49%). Around three in ten had been bullied by management – either a direct (31%) or other manager (28%). One quarter had been discriminated against by colleagues – either direct (25%) or other (24%) colleagues. Around three-quarters of those who had been discriminated against chose to report it (74%).
MAINTAINING MENTAL HEALTH Two-thirds of respondents indicated that they maintain their mental health by exercising and debriefing with colleagues or friends (66% for each). Half (51%) follow a healthy lifestyle. Less than one in twelve (7%) indicated that they do not do anything to maintain their mental health. Measures Taken to Maintain Mental Health
MENTAL HEALTH IMPACT AT WORK Over half of all respondents indicated that in their role as a sonographer, they experience frustration, cynicism or exhaustion (56%), or feelings of stress and anxiety (55%). One-third (34%) indicated that they feel like they are not taking good care of themselves. Only one in five indicated that they had not experienced any negative feelings at work. Together, these elements suggest that there may be a high portion of the workforce who are either experiencing or potentially vulnerable to burnout.
SEEKING PROFESSIONAL ASSISTANCE In the last 12 months, around one in twelve respondents (8%) indicated that they had sought professional assistance due to a specific incident or to manage the mental load associated with work. A further 7% indicated that they had received some other form of support.
66% Exercise
15%
5%
Meditation
66% Debrief with colleagues
10% Other professional assistance
51% Follow a healthy lifestyle
Professional counselling
6% Other 7% Nothing
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A S A W O R K H E A LT H & S A F E T Y I S S U E
YOUR MENTAL HEALTH MATTERS
ASA RESOURCES COVID-19 restrictions continue to affect members in Australia and New Zealand. The ASA regularly updates the Mental Health and Resilience Resources page on our website to provide sonographers with relevant materials to equip you and your family with mental health resilience, wellbeing and support.
VIEW RESOURCES
This webinar will address the Australian mental health implications for sonographers and other frontline health professionals during the COVID-19 pandemic and strategies for preventive mental health and wellbeing.
Presented by Dr. Bec Jackson, PhD
WATCH WEBINAR 26
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A S A W O R K H E A LT H & S A F E T Y I S S U E
Mental Health Dr Bec Jackson
Consultant Psychologist | Executive Coach| Leadership and Development Coach
D
r Bec Jackson has spent 20 years building her professional expertise across psychology, academia, therapy and education in clinical, forensic and organisational psychology roles. The last 10 years have focused on the military, government leaders and private enterprise. Five years ago, she founded The Jackson Company, a bespoke para-disciplinary consulting practice which combines her unique skills, experience and expertise.
What are the most common mental health issues affecting sonographers? • Stress-related illness • Reactive anxiety • Burnout • Compassion fatigue • Vicarious trauma. One of the most overlooked areas of sonography today is the job-related stress of today’s frenetic healthcare environment. The constant pressures to perform and conform at a faster and faster pace inevitably leads to stress. Stress is a known normal part of life; however, such severe and prolonged demands can lead to sonographer disorganisation, inefficiency, and even a loss of dedication to the career. This phenomenon has been labelled compassion fatigue (CF) (When Caring Hurts, Bloom, 2002). Burnout is thought of as the cost of high achievement brought about by devotion to a career that no longer produces the expected reward. In healthcare, first responder and caregiving settings, the experience of burnout is common. Sometimes a vacation, secondment or job reassignment can alleviate such burnout. However, especially in sonographers who have personally experienced problems like those of their patients, there is great risk of countertransference – the act of taking on the emotional reactions of their patients. If prolonged and untreated, both burnout and countertransference can progress to a condition called ‘belief alteration’, in which the sonographers’ perceptions of themselves diminish while their feelings of ‘loss of control’ in behaviour and cognition (thinking) increase. This can present as compassion fatigue, mood disorder or even increased suicide risk. Burnout and compassion fatigue come from the attitudes and the perspectives that drive sonographers to overextend themselves – high standards, dedication to patient welfare, commitment to duty. Sonographers suffering burnout may share the symptoms of helplessness, loss of idealism, and the development of a cynical negativism, but the distinguishing feature of compassion fatigue
is the inability of sonographers to distance themselves from the pain of their patients. This places them at a high risk of vicarious trauma. Those who develop compassion fatigue often develop satisfaction fatigue and watch their job performance decrease as their mistakes go up. Once morale drops, personal and professional relationships will suffer. Those experiencing compassion fatigue lack the energy to relate to others and this includes patients, colleagues, friends and family. The relationships they traditionally enjoyed with co-workers, friends, or family simply evaporate. Sonographers with CF may exhibit increased levels of cynicism, anger, hostility, and irritability. They begin to label anxious patients as ‘difficult, needy, and demanding’. If left unattended, the effects can cause deterioration of the sonographer’s work life and home life, eventually leading to an overall decline in general health and/or clinical depression. Some of the symptoms to look out for include: • Physical: insomnia, stiff muscles, fatigue, diarrhoea, palpitations, and clammy hands, dry mouth • Emotional: depression, fear, frustration, anxiety, feelings of powerlessness • Behavioural: short attention span, overactivity, irritability, grinding teeth, taking risks, ‘power tripping’, crying.
What are some examples of stressful or difficult situations that sonographers face at work? There are several presentations which are stressful for sonographers. These include but are not limited to: • pregnant patients experiencing bleeding • fertility patients awaiting positive pregnancy result • absence of fetal heart tones • suspicions of fetal abnormalities • menopausal patients with bleeding and pain • patients sent to rule out malignancy • life-threatening cardiovascular conditions • transplant patients suffering possible rejection • intimate examinations and internal scans. Additionally, there are circumstantial factors which make the job more stressful. They include: • volume of work and staffing levels • supervision access • current health concerns with COVID-19 • renumeration and budget • limited access to ongoing professional development • experience with breaking bad news.
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Dr Bec Jackson (continued)
For those working in obstetric ultrasound, one frequently cited stressor is the delivery of bad or difficult news. Training in news delivery may reduce sonographer stress levels, but no studies I have found have investigated sonographer experiences of this training. You should limit your work if you believe that your physical, emotional and psychological health is such that your performance or judgement may be affected. You have a duty to look after yourself. If you believe that your health status is putting you or your patients at risk, you must take action. This also means sharing information with your manager and cooperating with them in any referral to occupational health services.
What is something simple sonographers could implement to maintain their mental health and wellbeing at work? If we acknowledge the significant and varied stressors and hassles involved in a sonographer’s daily work setting, managing their own stress response is one of the toughest aspects of practising as a sonographer. Considerations for sonographers to maintain their mental health and wellbeing include: • self-compassion breaks • macro self-care skills • micro self-care skills • peer support and supervision • reflection (journaling).
Self-care All people need self-care. To promote self-care, we also need to raise awareness of emotional labour. Part of the role of a sonographer involves bearing witness to the suffering of others. The helpers and healers in our community are at the frontline of humanity, which means they see behind the facade of society and bear witness to the pain and suffering of others on a daily basis. The pain and trauma of patients who attend an ultrasound examination and receive upsetting news or diagnosis can affect the health of sonography professionals over time. This, in turn, also impacts on the sonographer’s own significant others, friends, family, and colleagues. In addition to increasing awareness of the support that we need to offer to staff, it’s also significant that there is a link promoted between staff experience and patient satisfaction. When staff are cared for their ability to care for patients increases. By speaking about the emotional impacts of the job, it makes a space to question how to support each other, including patients. It also highlights that the job of a sonographer can be stressful.
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It is important to note that although it may be an individual staff member who feels the effects of the job personally, there is a collective responsibility to restore that person’s wellbeing, not least including having supportive colleagues, managers and employing organisations. Factors to provide support include ensuring that there is time available in the working day for debriefing, having regular clinical supervision sessions and, where appropriate, referral or selfreferral to counselling services for staff. Methods of self-care can be a means of restorative practice for sonographers to temper the effects of emotional labour. Macro self-care includes taking regular holidays or breaks from work, enjoying hobbies, social activities with friends, taking regular exercise, healthy eating and getting plenty of sleep. Micro self-care skills include striving to achieve a sense of calm, rejuvenation, gratitude, self-compassion, meditation, awareness and balance. Knowing when to pause for a few seconds, to breathe, and to remember during the roller coaster emotions of your day that you and your health are also important for the care of your patients. Ethically, health providers have a duty of care to not just our patients, but also our colleagues and a responsibility to look after ourselves. That is the essence of restorative practice for sonographers.
What are some important policies employers can implement in their workplace to protect the mental health and wellbeing of sonographers? • Stress policy contained within Occupational Health and Safety (OH&S) and reviewed annually • Structured reflective practice should be encouraged at all levels • Supervision – both peer and managerial • Ongoing CPD to cover strategies for mental health and wellbeing • Climate/Wellbeing surveys.
Other considerations for employers • Buddy systems can be implemented for members of staff affected by stress (in fact, buddy systems are also preventative). • Adjustments made to the employees’ work practices (hours of work reduced, phased return to work after incidents), staffing levels of the department and work areas affected. • Changes to the employees’ workload (although consideration must be taken for the stress levels of the staff who may be affected by the changes within the department). • Become an ‘RUOK’ workplace. • Access to employee assistance programs (EAP), which include offering counselling to employees affected by stress
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and burnout. • Changes to rosters or overtime bans implemented for affected employees. • Allowing the employee to be transferred to a less stressful department. • Involvement of the occupational health advisor in developing solutions. • Updating of the sickness policy to include stress. • News delivery training is perceived to be effective by sonographers and may help to reduce sonographer burnout levels.
If a sonographer is experiencing mental health decline from an issue at work, what should they do? • Take immediate steps • In accordance with the stress policy, contact their supervisor and discuss options • Use EAP service provided • Use Beyond Blue or Lifeline resources • Seek professional referral to a psychologist.
Other suggestions • Organise a group within their hospital, town, or city and to meet regularly once a month. • Organise weekly professional development lunches within their department to share difficult experiences. • Select mentors and supervisors to listen, share, give advice, comfort, and encouragement. • Select peer mentors by changing the roles of giver and receiver each week. • Use the internet to access sonography support groups, forums and masterminds and write about their experiences and ask questions of other sonographers.
Concluding remarks • Supervisors can protect their staff by providing a nonthreatening, flexible and professionally supportive work atmosphere. In return, sonographers can repay their managers by using creative problem-solving behaviours, offering peer support, and practising self-care. • Sonographers carry emotionally heavy daily loads and looking after mental health and wellbeing is significant if patient care is to be maintained and sonographers are going to avoid burnout, compassion fatigue, chronic stress, vicarious trauma.
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Support LEGISLATION AND GUIDELINES AWARENESS OF LEGISLATION Nine in ten respondents (90%) indicated that they were aware of legislation covering safe work practices. However, most did not know what the legislation covered (54%). Two-thirds of respondents (68%) indicated that they followed their workplace’s safe scanning processes at least some of the time, with one-quarter (25%) following these processes all the time. One in three (28%) indicated that there were no safe scanning processes in their workplace.
REPORTING WORKPLACE ISSUES Four in five respondents (79%) indicated that they know who in their workplace they should report workplace issues to.
COMFORT RAISING WHS ISSUES Only one-third of sonographers (32%) indicated that they felt comfortable raising WHS issues to their employer, with one in five (22%) stating they felt uncomfortable. Respondents who indicated that they felt uncomfortable bringing WHS issues to the attention of their employer were asked to provide further information on why. The main reasons given by respondents related to: • fears they would not be taken seriously or that WHS issues are seen as unimportant • fears of repercussions and not wanting to jeopardise their job • concerns that nothing would change.
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A S A W O R K H E A LT H & S A F E T Y I S S U E
A S A W O R K H E A LT H & S A F E T Y I S S U E
Support Lynden Albiston
Senior Associate Workplace Relations & Safety
Lynden is a workplace relations specialist with expertise in a broad range of advisory and litigious matters. He advises clients in both the public and private sectors on matters including unfair dismissal, general protections, enterprise bargaining, workplace investigations, modern award, contract and policy interpretation and discrimination law.
S
easoned workplace relations lawyer, Lynden Albiston, discusses his experience with workplace health and safety issues and how the law supports sonographers.
1. We know that being in minor pain, fear of an issue not being deemed worthy of consideration, or fear of repercussions are major barriers to reporting work health and safety (WHS) issues. What do you believe individuals and employers can do to help combat this? From an employer’s perspective, creating a proactive culture of issue identification and reporting is very important. This should include the implementation of a robust workplace health and safety policy with a clear procedure for reporting incidents backed by a meaningful commitment from management to the health and wellbeing of staff. An employer should actively seek to identify those tasks which are most likely to cause sonographers pain, discomfort or other more serious conditions over an extended time frame while seeking to formulate, as far as reasonably practicable, strategies for reducing those risks. In a legal sense, these steps are consistent with employer obligations under occupational health and safety legislation to provide a workplace that is without risks to the (physical and mental) health and safety of its employees. In a practical sense, it is well understood that a workplace which promotes high standards of health, welfare and safety is conducive to increased employee morale and productivity, together with reduced levels of absenteeism and greater employee retention. These are important considerations given the time and cost investment associated with training a skilled sonographer. From an employee’s perspective, it is important to understand that they have the benefit of broad legal protections under the Fair Work Act 2009 (Cth) should they choose to raise a complaint or inquiry in relation to their employment. This necessarily
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includes a complaint or inquiry in relation to an injury or illness which is impacting on the employee’s ability to perform their role, regardless of whether that illness or injury was suffered within the workplace or outside of it. Separately, employees are also protected from ‘victimisation’ under federal and state antidiscrimination law, which makes it unlawful to treat an employee unfairly because they have made a complaint about a ‘disability’ (which is very broadly defined and includes a temporary affliction or more permanent impairment). Employees can raise such concerns with confidence knowing they are legally protected where they do.
2. Most of the sonographers surveyed weren’t confident that workplace accident and safety compensation staff had understood the nature of the role of their work. What can sonographers do when speaking to external WHS staff to make them feel confident that they are understood? In terms of communicating with any person from the relevant state or territory-based workplace health and safety agency in relation to an actual or pending workers’ compensation claim, the most practical way to describe the nature of the work performed by the sonographer is to supply the relevant person or agency with a copy of the sonographer’s position description (if the employer has not already done so). Prior to the lodgement of a worker’s compensation claim (and ideally with a view to avoiding that outcome), from an evidentiary perspective, it may also be beneficial for a sonographer to maintain a log over a designated time period which records the daily tasks the sonographer was required to perform, the duration of each task, the associated physical movements and any other relevant considerations that might have caused pain or discomfort (for example, it is accepted that an increase in patient body mass index can make certain forms of imaging more challenging). This could be accompanied by the sonographer’s own subjective assessment of any pain or discomfort that they experienced. Feedback of this nature will offer a useful insight to any person or agency that is not familiar with the duties and responsibilities undertaken by the sonographer. Where provided to an employer, it may also assist them to more accurately identify those tasks which represent a health and safety risk and to shape any risk mitigation strategy accordingly.
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Safe Work Australia website provides a useful centralised repository of information on safe work across Australia and can be accessed at www.safeworkaustralia.gov.au
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Support Lynden Albiston (continued)
3. What rights do sonographers have when they feel they are being bullied or harassed by a patient? Verbal and physical threats, bullying and/or harassment of a medical professional by a patient is a subcategory of a broader phenomenon commonly referred to as ‘patient-initiated violence’. This is an acknowledged issue for many practitioners in a range of medical fields. Where a sonographer feels bullied, harassed or threatened by a patient in their care, the sonographer is entitled to clarify with the patient that they are uncomfortable with the patient’s behaviour and to reiterate their expectations in this respect. If the patient becomes further aggravated, and the sonographer determines the patient to pose a risk to health and safety, the sonographer is entitled to cease providing treatment and to ask the patient to leave. Having a clear mechanism for managing patients who are an identified risk (such as the presence of an additional staff member during consultation and treatment) and implementing other mechanisms such as a duress alarm or a telephone number for distress calls may also assist. These actions may be supported by a Patient Code of Conduct, which includes continuing obligations on the patient to act in a respectful and courteous manner towards medical staff as a precondition to receiving treatment, and the continuing provision of that treatment, which can be revoked where a breach occurs. We also recommend that an employer implement a risk and incident management system designed to enable a transparent, coordinated and consistent approach to undesirable patient behaviour, including patient-initiated violence. This necessarily contemplates education and training in relation to the identification of risk factors for undesirable patient behaviour and the proactive implementation of appropriate de-escalation strategies where possible.
4. One in three sonographers surveyed felt unsupported when returning to work after a WHS injury. What can employers and the individuals do to assist in this process? This feedback is representative of a broader issue across Australian workplaces where employees returning to the workforce following an extended absence report feeling unsupported or ‘left behind’ (be that after an illness or injury, due to parental leave, or for another reason). In all cases, the primary objective for both parties should be to ensure a clear, open and judgement-free dialogue which
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appropriately addresses the employee’s capabilities and expectations and involves an active undertaking by the employer to consider and act on those, at all times cognisant of its legal obligations which normally involve facilitating the employee’s return to their previous role. In the specific context of a workplace injury, employers are bound by specific ‘return to work’ arrangements which generally contain common requirements in each state and territory. Typically, this includes a requirement for the employer to meet with the employee together with other individuals such as an appointed return to work coordinator and the employee’s treating practitioners. In part, the process is directed at identifying the basis on which the employee can return to work, including on pre-injury duties or modified/alternative duties in accordance with an applicable ‘Return to Work’ plan. As part of this process, we recommend that an employee identify their skillset, their views as to how those skills and capabilities can be effectively deployed (where not returning to full pre-injury duties) and their return to work goals, potentially in conjunction with their treating practitioner. It will also be important for the parties to reach an understanding regarding communication strategies where an employee feels as if they have exceeded their physical or mental limitations within that return to work framework. There are clear health benefits to employees associated with structure, financial security and social inclusion regarding a return to work. Employers should similarly be aware that by actively engaging with employees in a positive and constructive way with a clear commitment to doing all things reasonably necessary to facilitate the employee’s return to the workplace and support them in this capacity, it will typically reduce the cost of the illness or injury to the employer by assisting the employee to return to their pre-injury role sooner where this is possible.
5. What are the main points of legislation covering safe work practices, and where can sonographers go to access these? The first step for an employee is to consult their employer’s work health and safety policy, which should ideally provide information with respect to the employee’s rights and obligations in the workplace under both the terms of the policy and at law. Workplace health and safety is regulated at the state and territory level such that there is a minor variation between the law in each jurisdiction. However, the Safe Work Australia website provides a useful centralised repository of information on safe work across Australia and can be accessed at https://www.safeworkaustralia.gov.au
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STRETCHING FOR SONOGRAPHERS
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EDUCATIONAL VIDEOS
REDUCING INJURY TO SONOGRAPHERS
ULTRASOUND ERGONOMICS
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A S A W O R K H E A LT H & S A F E T Y I S S U E
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This educational video demonstrates ergonomics and workplace safety for the optimising scanning setup for the sonographer, machine and patient.
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Special ASA Work Health and Safety Issue 2021 ONLINE SEPTEMBER ISSUE Soundeffects news is the biannual magazine of the Australasian Sonographers Association (ASA) Ltd. The information in this publication is current when published and is general in nature; it does not constitute professional advice. Any views expressed are those of the author and may not reflect ASA’s views. ASA does not endorse any product or service identified in this publication. You use this information at your sole risk and ASA is not responsible for any errors or for any consequences arising from that use. Please visit www.sonographers.org for the full version of the ASA’s publication disclaimer. Copyright Soundeffects news is a registered publication of the ASA Ltd. Acceptance of a manuscript enables the ASA to publish the material in any medium in association with Soundeffects news for non‑profit purposes. The author/s will be advised of any proposed uses. The author retains ownership of the manuscript. The author is thus able to use the material elsewhere provided Soundeffects news is cited. Requests for reprints by other sources will be referred to the author.
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