Work-related musculoskeletal disorders (WMSD) in hospital nurses: Prevalence and coping strategies

Transcription

1 Work-related musculoskeletal disorders (WMSD) in hospital nurses: Prevalence and coping strategies Kumaraguruparan Gopal 1*, Merlin Thomas 2, Jayadevan Sreedharan 3 1 College of Allied Health Sciences, 3 Research Division, Gulf Medical University, Ajman, UAE 2 Nursing department, Gulf Medical College Hospital and Research Centre, Ajman, UAE *Presenting Author ABSTRACT Objectives: This study aims to determine the prevalence of WMSDs and coping strategies towards reducing the risk for development of WMSDs. It attempts to identify the magnitude and characteristics of WMSDs and the perceived work-related ergonomic risk factors associated with nursing job responsibilities among hospital nurses. Materials and Methods: A pre-approved self-administered questionnaire was distributed to 200 nurses in the GMC hospital, Ajman. 147 completed and returned, with 74% response rate. 12 questionnaires were excluded because of incomplete data. Results: Approximately 39% of the nurses have had WMSDs at least once during the working period. The 12-month period and point prevalence rate of WMSDs in any part of body was 38%. WMSDs occurred mostly in low back (29.0%), ankle (20.0%), shoulder (14.8%) and knees (13.3%). 35.5% treated themselves or had visited other health practitioners for care. Working in awkward and cramped positions (54.1%), working in the same positions for long periods (51.1%), and lifting or transferring dependent patients (41.4%) were the job-related factors most perceived as risks for WMSDs. The top three coping strategies suggested were modifying patient s /nurses position (58.5%), modifying nursing procedures to avoid re-injury (45.9%), and adjusting plinth/bed height to change the posture (45.1%). Conclusion: The prevalence of WMSDs among hospital nurses was nearly 40%, and over 50% were at risk of developing WMSDs. The low back and the ankle joint were the most common sites of the disorder. Education programs on the prevention and coping strategies for WMSDs are recommended for the nurses in order to promote efficiency in patient care. Key words: work-related musculoskeletal disorders (WMSDs) INTRODUCTION In recent decades, studies with different methodological approaches have given evidence of the relation between work and stress and their repercussions on workers health. These have addressed issues like productivity, occupational accidents, absenteeism and increasing physical and mental symptom levels among workers in certain professional categories. Among professional categories, health workers stand out, particularly those working in the hospital environment, in view of the countless exhausting circumstances in their daily work environment 1,2. Among occupational illnesses, musculoskeletal disorders (MSD) form an important public health problem and one of the most severe conditions in occupational health. The main risk factors include work organization, environmental factors and possible overload on body segments when making certain movements like using excessive force to perform some tasks, repetitiveness and inadequate postures 3. It is considered that exhaustion at work is produced by the interaction between high psychological demands and the workers low control over their job activities. Control over work covers issues related to skill use (learning new things, repetitiveness and creativity) and psychological demand refers to the psychological requirements workers face while performing their tasks (time pressure, concentration level demanded while performing activities, task interruption and the need to await activities performed by other workers) 2,4. 159

2 The unhealthiness or burden of hospital work results from permanent exposure to one or more factors that produce diseases or suffering, deriving from the nature of work itself and its organization, as evidenced by non-specific and psychic signs and symptoms. Among health workers, research suggests nursing as one of the occupations with high risks for exhaustion and illness 1. The work activities and tasks of nursing include those associated with a high risk of work-related musculoskeletal disorders such as bed making, patient hygiene and transferring patients Several studies have indicated that many nurses report musculoskeletal symptoms resulting from tasks that involve loading the musculature and skeleton 6-7. Nurses are trained in their technical skills of handling the patients, but their knowledge about ergonomic principles in patient handling is poor due this topic not being included in the nursing curriculum. The prevalence of work-related musculoskeletal disorders among health care providers, especially nurses, has been extensively reviewed, and the evidence of prevalence is available in different parts of the world. But the prevalence of musculoskeletal disorders among the nurses in the Gulf region is not known. Further, the effectiveness of ergonomic Intervention on the prevention of musculoskeletal disorders in nurses is identified as a research gap 11. Therefore, the present study attempted to identify the magnitude and characteristics of work-related musculoskeletal disorders among the nurses, and identify the perceived work-related ergonomic risk factors associated with nursing job responsibilities. MATERIALS AND METHODS A cross sectional survey was conducted from February 2011 to December 2011 among the nurses in active service at the Gulf Medical College Hospital and Research Center (GMCHRC), Ajman, UAE. This study was approved by the Ethics Committee of Gulf Medical University. All the participants were informed about the objectives of the study, and informed consent taken from them before their participation. A standardized four-section questionnaire was employed as the survey instrument. Section A mentioned the demographic data such as age, height, weight and gender. Section B sought information on the occupational health in nursing practice and general information about the experience, work status, work setting, and nursing activities. The symptom survey questionnaire dealt with nine body areas, three upper body segments, three lower body segments and three trunk segments. Sections C and D consisted of data related to job risk factors and coping strategies. A total of 200 questionnaires were distributed and 147 were completed and returned, giving a 74% response rate. Twelve questionnaires were excluded because of incomplete data. The data collected was transferred into Microsoft Excel spreadsheet, and data entry, cleaning, coding and analysis was carried out under the direct supervision of the Research Division of Gulf Medical University. SPSS 19.0 version software was used to analyze the data. The descriptive statistics of mean, standard deviation and percentage were used to summarize the data. RESULTS This study included 135 participants comprising 113 female and 12 male nurses (91% and 9% respectively). The mean age, height and weight of the respondents were 27.4±5.26 years, ±20.65cm, 58.14±11.76 kg respectively, and work experience was 6±3.9 years. Details are given in table 1.39% of the respondents reported that they had work-related musculoskeletal pain or discomfort once or more during the period of work. Table 2 shows that the 12-month period and point prevalence rate of WMSDs in any part of body was 38%. WMSDs occurred mostly in low back (29.0%), ankle (20.0%), shoulder (14.8%), 160 GMJ, 4 th Annual Scientific Meeting of Gulf Medical University Oral Proceedings 2012

3 Table 1. Demographic data and work experience Variable Minimum Maximum Mean S.D Age (Yrs.) Height(cm) Weight (Kg) Years of experience knees (11.8%), and neck (7.0%). 35.5% treated themselves or had visited other health practitioners for care. Table 2. Prevalence of work related musculoskeletal disorders Body region Frequency % Low back (lumbar/ sacral) Ankle Shoulder Knees Neck Upper back (thoracic) The self-reported 12-month prevalence of WMSDs was 20% for those between 25 to 30 years of age, 14.8% between 20 to 25 years of age and 5.1% between the ages of 30 to 35 years. The lowest percentage of prevalence was reported by those over the age of 35 years. 17.7% of the respondents experienced their first incidence of WMSDs within the first five years after graduation, 9.6% of respondents experienced as student nurse, and 5.9% during 5-15 years after graduation. Almost 37.7% of the respondents reported gradual onset of pain and discomfort due to their work, and 8.8% of the respondent reported WMSDs of sudden onset. 57% of the nurses who participated in this study reported that they never had training in ergonomics or how to prevent the occupational hazards during their nursing practice. Details are given in Table 3. Table 3. Relationship between the 12-month prevalence of work-related musculoskeletal disorders and the age Age (Yrs.) Frequency % The most perceived job risk factors that contributed to WMSDs during patient care were working in awkward and cramped positions (85.1%), working in the same positions for long periods Table 4. Job risk factors that may develop WMSD s among all participants Job risk factors Percentage (>7 on 0-10 scale) (<7 &>2 on 0-10 scale) Performing the same task over and over Treating an excessive number of patients in one day Performing manual orthopedic techniques (Joint mobilizations, soft tissue mobilization) Not enough rest breaks or pauses during the workday Working in awkward and cramped positions Working in the same positions for long periods (Standing, bend over, sitting, kneeling) Bending or twisting your back in an awkward way Working near or at your physical limits Reaching or working away from your body Lifting or transferring dependent patients

4 Table 5. Coping strategies to avoid the occurrence of WMSDs Strategies % I modify patient s position/ my position 58.5 I modify my nursing procedure in order to avoid stressing an injury 49.9 I adjust plinth/bed height so I can stretch and change posture 45.1 I select techniques/procedures that will not aggravate or provoke my discomfort 42.2 I get someone else to help me handle a heavy patient 40.0 (87.3%), bending or twisting of back in an awkward way (84.4%) and lifting or transferring dependent patients (79.2%). Modifying patient s/nurse s position (58.5%), modifying nursing procedures to avoid re-injury (45.9%), and adjusting plinth/bed height to change posture (45.1%) were identified as the top three coping strategies. Details are given in Table 4. The preventive measures (coping strategies) for reducing the occurrence WMSDs adopted by the participants are shown in Table 5. Modifying patient s/ nurse s position (58.5%), modifying nursing procedures in order to avoid reinjury (45.9%), and adjusting plinth/ bed height to change posture (45.1%) were the top three coping strategies that were reported by the respondents in this study. DISCUSSION The results of this study show that nearly a third of the nurses had WMSDs at least once in their work period. The high prevalence of musculoskeletal disorders among nurses is thought to be due to physical work demands, as well as to work organizational factors, of which scheduling is an important component 12,13. One third of the participants experienced WMSDs in any part of the body predominantly in the low back and resorted to self-medication or were treated by health practitioners. Undesirable posture was reason reported by majority of them. The important coping strategies adopted were changing patients or nurses positions, nursing procedures, and plinth/bed height. Tinubu et al. 14 indicated the lifetime prevalence of WMSDs among the nurses as 84.4%. The prevalence rates of WMSDs in nurses varied according to studies but have been generally high In a previous study from Nigeria, Fabunmi et al. 15 reported the 12- month period prevalence of self-reported musculoskeletal disorders at anybody site to be 90.7%. Smith et al. 16 in a study from rural Japan reported a 12-month prevalence of 91.9%. Ali Sheikhzadeh et al. 18 studied WMSDs among perioperative nurses and technicians (PNT) and found lower back pain followed by ankle/foot and shoulder pain to be the main causes of absenteeism from work. Subjectivity of terms, variations in instrument, organizational differences in work settings, and cultural differences in the perception and reporting of pain and disorders are the evidence for the variation in rates of WMSDs in the different studies. CONCLUSION The prevalence of WMSDs among the hospital nurses was nearly 40% and more than half of the nurses were in the risk of developing WMSDs. The low back and the ankle joint were the most common sites of disorder. Educational programs on prevention and coping strategies for WMSDs are recommended for the nurses in order to reduce the overuse injuries and promote efficiency in patient care. REFERENCES 1. Menzel NN, Brooks SM, Bernard TE, et al, The physical workload of nursing personnel: association with musculoskeletal discomfort. Int. J. Nurs. Stud 2004;41(8): GMJ, 4 th Annual Scientific Meeting of Gulf Medical University Oral Proceedings 2012

5 2. Karasek RA, Theörell T. Healthy work-stress, productivity, and the reconstruction of working life. New York: Basic Books; Hartvigsen J, Lauritzen S, Lings S, et al, Intensive education combined with low-tec ergonomic intervention does not prevent low back pain in nurses, Occup.Environ.Med 2005;62: Guthrie P, Westphal L, Dahlman B, et al. A patient lifting intervention for preventing the work related injuries of nurses. Work 2004;22: Ando S, Ono Y, Shimaoka M, et al. Association of self-estimated workloads with musculoskeletal symptoms among hospital nurses. Occup. Environ. Med 2000; 57(3) Ando S, Ono Y, Shimaoka M, et al. Associations of self-estimated workloads with musculoskeletal symptoms among hospital nurses. Occup. Environ. Med 2000;57(3): Hofmann F, Stossel U, Michaelis M, et al. Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany. Int. Arch. Occup. Environ. Health 2002;75(7): Kim YO & Koo JW. Musculoskeletal symptoms and related factors onthe nurses in several general hospitals. Korean. J. Occup. Health 2002;41(3): Daynard D, Yassi A, Cooper JE, et al, Biomechanical analysis of peak and cumulative spinal loads during simulated patient-handling activities: a sub study of a randomized controlled trial to prevent lift and transfer injury of health care workers. Appl. Ergon 2001;32(3): Feng CK, Chen ML, Mao IF. Prevalence of risk factors for different measures of low back pain among female nursing aides in Taiwanese nursing homes Available from: URL: Bork BE, Cook TM, Rosecrance JC, et al. Work-related musculoskeletal disorders among physical therapists. Phys Ther 1996;76: Hui L, Ng G, Yeung S, et al. Evaluation of the physiological work demands and low back neuromuscular fatigue on nurses working in geriatric wards. Appl Ergon 2001;32(5): Tinubu BMS, Mbada CE, Oyeyemin AL et al, Work-Related Musculoskeletal Disorders among Nurses in Ibadan, South-west Nigeria: a cross-sectional survey,bmc Musculoskeletal Disorders 2010;11: Fabunmi AA, Oworu JO, Odunaiya NA. Prevalence of musculoskeletal disorders among nurses in University College Hospital, Ibadan. West African Journal of Nursing 2008;19(1): Smith DR, Kondo N, Tanaka E, et al. Musculoskeletal disorders among hospital nurses in rural Japan. Rural and remote health Journal 2003;241: Adegoke BOA, Akodu AK, Oyeyemi AL. Work-related musculoskeletal disorders among Nigerian Physiotherapists. BMC Musculoskeletal Disord 2008;9: Ali Sheikhzadeh, Gore C, Zuckerman JD, et al, Perioperating nurses and technicians perceptions of ergonomic risk factors in the surgical environment, Applied Ergonomics 2009;40: Denis, St-Vincent, et al Intervention practices in musculoskeletal disorder prevention: Acritical literature review. Appl. Ergon 2008;39: