Abstract
BACKGROUND: A safe healthcare work environment is essential to promote patient safety and healthcare workers' (HCWs) well-being. Nevertheless, musculoskeletal disorders (MSDs) remain highly prevalent, particularly in relation to patient handling and movement (PHM). This study aims to describe and compare HCWs health, MSDs, working conditions, and safety climate in relation to PHM in hospital care units and nursing homes, as well as to identify desired workplace improvements. METHODS: This multicentre cross-sectional study was based on data collected in 2023 as part of a prospective cluster-randomized trial conducted in Sweden. In total, 1,214 HCWs in 17 hospital care units and 27 nursing homes completed a questionnaire assessing health, PHM routines, organizational conditions, and safety climate using the NOSACQ-50 instrument. Factor analyses of PHM and work environment variables informed mixed linear regression models, evaluating associations with perceived safety climate. Qualitative content analysis was performed on open-ended responses regarding desired workplace improvements. RESULTS: MSDs were highly prevalent, with 79% of HCWs reporting symptoms in the past week. Nursing home HCWs experienced more pain sites, particularly in extremities. Compared to nursing home HCWs, hospital care HCWs more frequently disagreed that PHM activities were guided by clear policies, written guidelines, established routines, or regular training (p < 0.001). Hospital HCWs demonstrated lower adherence to safety policies and less systematic risk assessment. Despite these challenges, the overall perceived safety climate was moderately positive, with NOSACQ-50 mean scores ranging from 3.1 to 3.6. Over 40% of HCWs reported significant physical work environment issues, including heavy lifting, repetitive movements, uncomfortable positions, and high work pace. Regression analyses revealed that organizational support, clear guidelines, ergonomic and psychosocial work factors, and especially managerial support (p < 0.001), were strongly associated with higher perceived safety climate. Qualitative data mostly underscored needs for improved staffing, education, structured routines, and better access to assistive equipment, particularly ceiling lifts. CONCLUSIONS: Substantial physical and organizational challenges related to PHM were reported by HCWs across both care contexts. The findings suggest that interventions emphasizing leadership engagement, a systematic approach to training, and tailored solutions are essential to strengthen the safety climate and reduce HCWs' health risks. TRIAL REGISTRATION: NCT05276180 Registration date 02112022.