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Healthcare workers are at a high risk of developing musculoskeletal disorders (MSD). The objective was to develop an innovative Reciprocal Health Care Model for MSD prevention in nursing homes.Two questionnaires measuring health complaints, safety attitudes, job satisfaction and stress, risk awareness and working conditions were administrated anonymously to employees and employers in 15 nursing homes. Altogether 233 (NOSACQ-50) and 69 (KIVA questionnaires) participants fulfilled the questionnaires. A qualitative approach includes focus group interviews with 69 employees. Electromyography (eMotion EMG) was used as the method for determination of the nursing workers’ thumb muscle’s (m. abductor pollicis brevis) fatigue.The study examines behavioural-cultural aspects of MSD (e.g. hazard recognition, risk assessment and safe performance of jobs) among healthcare workers and reveals key issues in MSD prevention programs. The results show the linear dependences between the level of fatigue of the thumb muscles at the beginning and at the end of an 8 hour workday; between the EMG signals from the muscles in the resting state and after a 5 min strained state. A statistical analysis of the questionnaires shows many organisations with positive safety attitudes. However, qualitative data indicate some important safety flaws and drawing attention to contextual variables in the development of safety management systems in order to improve the MSD prevention.The paper presents an innovative conceptual model for the improvement of safety climate with focuses on MSD prevention, which enables to integrate MSD prevention programs into safety management system in nursing homes. The essential aspects are the established MSD prevention programs have to be a fully integrated into general and safety management system in the organisation and the magnitude of complexity of MSD risk factors (including behavioural-cultural aspects of MSD), like most culturally-based things, must be recognised, acknowledged and be managed.