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A DESCRIPTIVE STUDY TO ASSESS THE
OCCURRENCE AND PREDISPOSING FACTORS OF
MUSCULOSKELETAL PAIN AMONG FEMALE STAFF
NURSES WORKING IN A SELECTED HOSPITAL,
BANGALORE.
by
SHEELA RAMAKRISHNAN
Dissertation submitted to the
Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.
In partial fulfillmentof the requirement for the degree of
Master of Science in Nursing
in
Medical surgical Nursing
Under the guidance of
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Rajiv Gandhi University Of Health Sciences
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation/ thesis entitled A descriptive study to assess
the occurrence and predisposing factors of musculoskeletal pain among female
staff nurses working in a selected Hospital, Bangalore. is a bonafide and genuine
research work carried out by me under the guidance of Prof. Chandra Devadoss,
(Dept. of Medical Surgical Nursing)
Date:
Place:
Signature of the Candidate
Sheela Ramakrishnan
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CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled A descriptive study to assess the
occurrence and predisposing factors of musculoskeletal pain among female staff
nurses working in a selected Hospital, Bangalore. is a bonafide research work
done by Sheela Ramakrishnan in partial fulfillment of the requirement for the
degree of Master of Science in Medical Surgical Nursing.
Date:
Place: Bangalore
Signature of the Guide
Prof. Chandra Devadoss,
Dept. of Medical Surgical Nursing,
The Oxford college of Nursing
Bangalore.
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ENDORSEMENT BY THE HOD, PRINCIPAL/ HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled A descriptive study to assess the
occurrence and predisposing factors of musculoskeletal pain among female staff
nurses working in a selected Hospital, Bangalore. is a bonafide research work
done by Sheela Ramakrishnanunder the guidance of Prof. Chandra Devadoss.
(Dept. of Medical Surgical Nursing)
Seal and Signature of the HOD Seal and Signature of the Principal
Prof. Chandra Devadoss Dr. Kasthuri
Date: Date:
Place: Bangalore Place: Bangalore
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COPYRIGHT
Declaration by the Candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation thesis in print or
electronic format for academic / research purpose.
Date: Signature of the Candidate
Place: Bangalore. Sheela Ramakrishnan
Rajiv Gandhi University of Health Sciences, Karnataka
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ACKNOWLEDGEMENT
No duty is more urgent than that of returning THANKS St. Ambrose.
At the outset I express my thanks to the Almighty for the blessings, unseen
presence, courage and strength throughout this study.
I take this opportunity to put down on paper my gratitude, to the numerous
people who have stood by my side, helping, guiding and encouraging me in this
accomplishment.
It is my proud privilege to express the deepest sense of gratitude to my
esteemed teacher Prof. Chandra Devadoss, HOD of Medical Surgical Nursing, my
Guide, for her expert guidance, valuable suggestions, unconditional support and
cooperation which has continually motivated me for the successful completion of this
study.
I express my sincere thanks to my co-guide Dr. Deepak Sharan, HOD,
Department of Pediatric Orthopedic and Rehabilitation, Bangalore Childrens
Hospital and Research Center, Bangalore, for his intelligent, steady guidance and
cooperation through out this study.
It is my pleasure to indebt my sincere gratefulness and genuine thanks to Prof.
Belliappa, Principal, and The Oxford College of Nursing for having provided
necessary facilities and extending support to conduct this study.
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I wish to express my sincere thanks to Dr. B.A. Pataliah, and Prof.
Thilagavathy for their timely help, support and suggestions during the study. I also
extend my sincere thanks to Mrs. Mamtha, for guiding me during the initial stages of
the study.
I also thank my class co-coordinators Mrs.Vaheeda and Mrs. Radha for their
constant encouragement and support.
I thank Dr. Ramesh, Ph. D, Statistician, Dept. of statistics, KIDWAI, for
guiding me in the statistical analysis and interpretation of the data.
My heartfelt thanks go to all the experts for having spared their valuable time
in computing the content validation of the tool and information booklet.
I extend my sincere thanks to the entire Master of Nursing faculty, the Oxford
College of Nursing for their constant guidance and timely support during the study.
I thank the Medical Superintendent and the Nursing Superintendent of
Kempegowda Institute of Medical Sciences and Research Center Hospital for their
cooperation and granting permission for conducting my pilot study in their institution.
My sincere thanks to Prof. Madhumathi, Principal, Vaidehi College of
Nursing, the Medical Superintendent and Nursing superintendent of Vaidehi Institute
of Medical Sciences and Research Center Hospital, Bangalore for extending their
cooperation and granting me permission to conduct my study in their esteemed
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I pay my grateful salutations to my parents, my husband, my daughter, all
other family members, classmates and friends for their valuable prayers, support,
blessings and best wishes that helped me to carryout this study successfully.
I extend my sincere thanks to all the participants in the study for their
wholehearted cooperation, without whom this study would have been impossible.
There are many more people who have worked behind the screen in their own
loving ways to help me accomplish this task. I would like to thank each and every
one who has helped me to complete this study.
Sheela Ramakrishnan
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RESEARCH ABSTRACT
Name: Mrs. Sheela Ramakrishnan
Guide: Prof. Chandra Devadoss
Statement of the Problem
A descriptive study to assess the occurrence and predisposing factors of
musculoskeletal pain among female staff nurses working in a selected Hospital,
Bangalore.
Objectives:
To asses the occurrence of musculoskeletal pain among nurses.
To identify the predisposing factors of musculoskeletal pain among nurses.
To determine the association between the occurrence of musculoskeletal pain
with selected demographic variables like age, marital status, years of
experience, educational background, number of hours of duty, the area of
work and practice of ergonomics.
To prepare an information booklet on Ergonomics to prevent musculoskeletal
disorders.
Hypothesis
H1: There is a significant association between the occurrence of
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Research approach
A descriptive survey approach was used.
Research Design
Survey design was selected for the present study.
Research setting
The study was conducted in Vaidehi Institute of Medical Sciences and
Research Center Hospital, Bangalore.
Sample & Sample size
The sample of the present study comprised of 100 staff nurses working in
Vaidehi Institute of Medical Sciences and Research Center hospital, Bangalore.
Data Collection Tool
Self-administered questionnaire on assessment of musculoskeletal pain and
predisposing factors was used to collect the data from the study subjects.
Pilot study
The pilot study was conducted from 26th
May 2005, at the Kempegowda
Institute of Medical Sciences Hospital, Bangalore. The tool was found feasible,
practicable and acceptable, and therefore the investigator proceeded for the main
study.
Procedure of data collection
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Major findings of the study
Findings related to the distribution of demographic characteristics:
In the present study, 61%of the subjects were in the age group of 20 29
years.
Most of the respondents (93%) had GNM qualification.
100% of the nurses worked 8-hours/ day.
Distribution of subjects according to the work experience shows, that 26% of
them had less than 2 years of experience, 25% had more than 8 years of
experience, 25% had 6 to 8 years of experience, 17% had 3 to 5 years of
experience and 7% did not have any experience at all.
With regard to the area of work of the subjects, operation theater, surgical
ward, OBG/Labor room, emergency, ICU and OPD had 11% of the subjects
each, medical ward had 10% of the subjects, Ortho ward had 9% of the
subjects, special ward had 8% of the subjects and pediatric ward had 7% of the
subjects.
In the distribution of the subjects, according to the mode of commuting to
work place, 57% of them commuted by bus.
The travel time taken for one-way travel to work by the subjects was noted as
72% of the subjects took less than hour for travel.
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Looking at the severity of pain reported, 45.5% of subjects said the pain is
same as before.
Distribution of subjects according to the self-medication for the pain shows
that 50.6% of the subjects took self-medication once in a while.
It is also evident that 42.9% of the subjects consulted a physician for the pain
and 57.1% did not consult a physician.
Findings related to the scores of actual tasks performed by nurses and ergonomic
scores:
In this study the results show that the actual tasks performed by nurses have the mean
score of 64.36. Area wise analysis of the ergonomics score shows that the work
posture with the highest mean score of 18.78 followed by the work organization with
a mean score of 14.76, patient condition with a mean score of 5.55 and domestic work
with the lowest mean score of 3.92. The ergonomics total mean score is 43.01.
Findings related to association between demographic variables and actual tasks
performed by nurses and the knowledge of ergonomics showed that there is no
significant association between the demographic variables such as age, professional
experience, commuting facility used, travel time, marital status, family size and
number of children. But there was a significant association found between the area of
work and the actual tasks performed by the nurses and the ergonomic scores. There
was also a significant association found between the education of the subjects and the
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TABLE OF CONTENTS
SL No Title Page No
1. Introduction 1 - 9
2. Objectives 10 - 18
3. Review of Literature 19 - 28
4. Methodology 29 - 42
5. Results 43 - 96
6. Discussion 97 - 106
7. Conclusion 107 - 110
8. Summary 111 - 123
9. Bibliography 124 - 129
10. Annexure 130 - 155
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LIST OF TABLES
S NOTABLES Pg No
1 Distribution of Subjects by age, professional qualification and
Total years of experience46
2 Distribution of Subjects by area of work, mode of transportation
and travel time51
3 Distribution of Subjects by marital status, number of children
and size of family55
4 Distribution of Subjects by their reproductive health 59
5 Subjects by their mean height and weight 61
6 Distribution of Subjects by history of previous surgeries and
use of vitamin /iron supplements62
7 Distribution of Subjects by experience of pain in single or
multiple sites or no pain63
8 Distribution of Subjects by interval of pain by site 66
9 Distribution of Subjects by duration of pain by site68
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13 Area wise & over all scores of actual tasks and ergonomics of
staff nurses76
14 Association between Age and actual tasks performed79
15 Association between professional experience and actual tasks
performed80
16 Association between commuting facility used and actual tasks
performed81
17 Association between level of education and actual tasks
performed82
18 Association between area of work and actual tasks performed83
19 Association between travel time spent and actual tasksperformed 84
20 Association between marital status and actual tasks performed
85
21 Association between family size and actual tasks performed86
22 Association between number of children and actual tasks
performed87
23 Association between Age and ergonomic score88
24 Association between professional experience and ergonomicscore 89
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29 Association between marital status and ergonomic scores94
30 Association between family size and ergonomic scores95
31 Association between number of children and ergonomic score96
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LIST OF FIGURES
S No FIGURES Pg No
1 Conceptual framework based on health belief model18
2 Schematic representation of research methodology32
3 Distribution of subjects by age
474 Distribution of subjects by Education
48
5 Distribution of subjects by work experience49
6 Distribution of subjects by area of work52
7 Distribution of subjects by mode of commuting to work
place53
8 Distribution of subjects by marital status56
9 Distribution of subjects by number of children57
10 Distribution of subjects by family size 58
11 Distribution of subjects by history of menstrual cycle60
12 Distribution of subjects by single or multiple sites of pain64
13 Distribution of subjects by pain, numbness or tingling
sensation in different sites 65
14 Distribution of subjects by interval of pain by site67
15 Distribution of subjects by duration of pain in different
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INTRODUCTION
Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity WHO Definition on Health.1
Musculoskeletal disorders represent one of the leading causes of occupational
injury and disability within industrialized countries. By virtue of their job requirements,
hospital and community nurses constitute a substantial occupational group regularly
affected by musculoskeletal disorders.
All over the world, women are increasingly working outside homes. In India too,
the percentage of such women has constantly increased, as can be seen from the
following data2:
1930 11%
1970 50%
1983 63%
Women constitute the majority workforce in nursing field and they are at high risk of
developing various occupational and environmental diseases. Higher mortality and lower
life expectancy have been observed among Indian women in different occupations.
A di 1991 f I di f h l l i f 838 6 illi 403 4
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Work related musculoskeletal disorders and, in particular low back pain, pose a
major health and socio-economic problem in modern society. It has been shown that 60-
80% of the general population suffers from low back pain at some time during their lives.
Among nurses the lifetime prevalence was found to be slightly higher, varying between
56% and 90%3.
The recent changes in health care industry over the past 2 decades has resulted in
shorter hospital stays and higher acuity (severity of illness) levels of hospitalised patients,
which requires more skilled and time consuming nursing care. However because nurses
represent the largest expenditure in health care facilities, one of the major cost-cutting
strategies has been to reduce the size of the nursing work force, often to inadequate
levels4.
Musculoskeletal disorder comprises significant occupational injuries and
disability within the nursing profession. Risk factors are known to include workplace
activities such as manual handling, heavy lifting, strenuous tasks, and work environment.
Personal and psychosocial factors such as frequent low mood, low work-support from
superiors and body size variability are also important predictors in the development of
this condition Various international studies have shown that hospital nurses represent a
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The prevalence of back pain increased as the number of working hours spent on
repeated strenuous physical activities and the time spent on repeated bending, twisting or
reaching increased. The estimated overall prevalence of back pain owing to repeated
activities at work was 8.9% among male workers and 5.9% among female workers6.
In hospitals, a substantial part of transportation of patients requires manual effort.
Pushing and pulling are necessary to transport patients on wheeled stretchers or chairs
and are more or less hidden activities of several other tasks, such as patient handling7.
Exposure to these stressors in the work place can result in a variety of disorders in
affected workers including muscle strains and tears, ligament sprains, joint and tendon
inflammation, pinched nerves, herniated spinal discs and other conditions. These
conditions, collectively referred to as musculoskeletal disorders,may develop gradually
over time or may result from instantaneous events such as a single heavy lift pain. Loss
of work and disability may result. Not all musculoskeletal disorders are related to work
activities. Many musculoskeletal disorders are related to non-work activities, genetic
causes, age, and other factors. Musculoskeletal disorders may also result from accidents
such as trips or falls. Finally, there is evidence that musculoskeletal disorders may result
from certain psychosocial factors such as job dissatisfaction, monotonous work, and
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hurried movements, ignoring the posture. This results in increasing number of low back
pain, neck and shoulder pain, leg, and knee and foot pain. Travelling to reach the work
place by bus or by two wheelers on the uneven roads also aggravates the problem.
Therefore, the researcher considered it necessary to specifically target musculoskeletal
pain among female staff nurses who are working in the clinical area.
NEED FOR THE STUDY
Work related musculoskeletal disorders have been described as one of the main
health problems among healthcare workers. A higher prevalence of low back pain (LBP)
has often been shown among healthcare workers, particularly compared with other
hospital and industrial workers. Handling patients may cause not only low back pain but
also neck, shoulder and arms pain as it potentially exerts an excessive burden on the
neck, shoulders, and arms.
A study (Tezel A, 2005)8
to describe the distribution of musculoskeletal
symptoms in relation to the perceived work related physical demands was conducted
among 120 nursing staff, who are practicing general nursing from four large general
hospitals in Turkey A Nordic Standardized questionnaire and a self administered
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complaints in the past 6 months. The higher prevalence was low back pain reported by
69% of nurses, neck pain was reported by 46% and 54% reported shoulder complaints.
Chronic low back, neck and shoulder complaints were experienced by 41%, 25%, and
33% of nurses respectively. Chronic complaints had a correlation with nurses working in
surgery and obstetric and gynecology departments.
A fact sheet presented at the ANAs Handle with Care Campaign, (2003)9
which
was intended to develop and implement a proactive, multi-faceted plan to promote the
issue of safe patient handling and the prevention of musculoskeletal disorders among
nurses in the U.S, reported that patient handling tasks are recognized as the primary cause
for musculoskeletal disorders among the nursing workforce. Of primary concern are back
injuries and shoulder strains, which can both be severely debilitating. Continuous,
repeated performance of the activities like lifting, transferring, and repositioning patients
throughout ones working lifetime results in the development of musculoskeletal
disorders. Physical environment of the health care setting like configurations of the area
within patient rooms and the placement of furniture and treatment equipment (e.g.,
critical care unit monitors, ventilator machines) also contributes to work-related
musculoskeletal disorders. Compared to other occupations, nursing personnel are among
the highest at risk for musculoskeletal disorders The Bureau of Labour Statistics lists
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workers in hospitals, whereas incidence rates were 98.4 for truck drivers, 70.0 for
construction workers, 56.3 for miners, and 47.1 for agriculture workers.
Research on the impact of musculoskeletal injuries among nurses had reported
that 52% of nurses complain of chronic back pain; 12% of nurses leaving for good
because of back pain as the main contributory factor; 20% transferred to a different unit,
position or employment because of lower back pain, 12% considering leaving profession;
38% suffered occupational-related back pain severe enough to require leave from work
and 6%, 8% and 11% of RNs reported even changing jobs for neck, shoulder and back
problems, respectively.
Smith DR, et al (2003) 5
investigated the prevalence of musculoskeletal disorder
among a previously understudied group of Asian nursing professional in a rural setting. A
total of 305 female nurses were recruited from a university teaching hospital in
Yamanashi prefecture, central Japan. Data were gathered by means of a self-reporting
questionnaire. Lower back pain was the most commonly reported musculoskeletal
disorder (59%), the shoulder (46.6%), neck (27.9%), knees (16.4%), and upper leg
(11.8%). Working in the surgical department was shown to increase the risk of any
musculoskeletal disorder by 2 7 times 95% when compared to the nurses in other
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static loads (i.e., boxes with handles) and primarily focused on men. Further body
mechanic methods primarily concentrate on the lower back for lifting and did not account
for other vulnerable body parts involved in other types of patient handling tasks, such as
lateral transfers from bed to stretcher, requiring the nurse to use the weaker muscles of
the arms and shoulders as the primary lifting muscles, rather than the stronger muscles of
the legs (Nelson A, et al, 2003)10
.
Work related musculoskeletal disorders among nurses have been reported to have
associations with tasks involved in handling patients, in particular lifting patients, and
have been studied from both the physical and ergonomic viewpoints. It suggested that
work related low back pain is not associated only with transferring patients, and tasks
other than patient handling are also considered to be hazardous to musculoskeletal
systems, so the necessity of comprehensive task analysis has been emphasized. There are
however, few studies, which have surveyed actual workloads and reported the
associations between tasks and work related musculoskeletal disorders. (Shoko Ando, et
al, 2000)11
.
A study done by Josephson M, et al (1997)12over a period of 3 years related to
the musculoskeletal symptoms and job strain among nursing personnel 285 nursing
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of the body regions were defined as cases. The results indicated that 13% were defined as
cases at all four assessments and 46% varied between cases and not cases during the
study period. Job strain was found to be the risk factor for musculoskeletal symptoms and
that the risk is higher when it is combined with perceived high physical exertion.
A research project described by Knibbe JJ, et al (1996)13
analyses the back pain
prevalence and physical working conditions of community nurses. This is to compare the
position of nurses working in institutional care with the specific situation of nurses
working in the private homes of their patients. The results of a questionnaire showed that
the back pain prevalence was relatively high as compared to other occupations and also
when compared to other health care sectors.
Noting the higher percentage of nurses reporting musculoskeletal pain from the
literatures, the unavailability of such a study done in India, the past clinical experience of
the researcher and the expert suggestion given by the physician specializing in
musculoskeletal pains, the researcher felt the need for investigating the occurrence and
the predisposing factors contributing to the musculoskeletal pain among nurses which in
turn will help other researchers to develop a program designed to reduce job-related
musculoskeletal injuries in nurses in India
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VARIABLES
FUNCTIONAL VARIABLE
The functional variables under study are age, marital status, educational
background, number of hours on duty, years of experience in specific area, and practice
of ergonomics.
OPERATIONAL DEFINITION
Occurrence
In this study, occurrence is referred to the happening of musculoskeletal pain
among female staff nurses.
Predisposing factors
In this study, predisposing factors refers to those factors like actual tasks
performed, work posture, work organization, patient condition and domestic
tasks.
Actual tasks:
In this study, the actual tasks are referred to the routine tasks performed by
the nurses while working with the patients, e.g. making occupied bed, transfer of
patients from bed to stretcher or stretcher to bed, etc.,
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Work organization:
In this study, work organization is referred to as the planning and
organization of the tasks done by the staff nurses at the beginning of the shift of as
and when the condition of the unit or the patient changes, like planning at the
beginning of the work, having to take up extra responsibilities other than job, etc.
Patient condition:
In this study, the patient condition refers to the conditions of the patients
in their place of work like sudden change in condition of the patient, many
patients with serious disabilities in the ward, etc.
Domestic work:
In this study, domestic work refers to the tasks the female nurses have to
do at home after the working hours like mopping the floor, grinding, washing
cloths, etc.,
Musculoskeletal pain
In this study, musculoskeletal pain refers to the pain experienced in
neck/shoulders, forearm, low back, knee and legs by the staff nurses as reported
by them.
Ergonomics:
In this study ergonomics mean the equipment and practices used by the nurses for
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Nurses
In this study, nurses refer to professionally qualified female staff nurses working
in the selected hospitals of Bangalore.
Selected hospitals
In this study, the selected hospitals refers to randomly selected general hospitals
having bed strength of more than 50 beds in Bangalore, Karnataka.
ASSUMPTION:
The occurrence of musculoskeletal injuries among staff nurses is related to
the patient handling tasks like lifting, transferring, repositioning patients,
and poor usage of body mechanics.
Musculoskeletal injuries among nurses are caused by long standing hours
on the job.
LIMITATIONS:
1. This study is limited to female staff nurses who are working in the clinical area
only.
2. Assessment of pain is based on the subjective data obtained from the responses to
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CONCEPTUAL FRAMEWORK
Conceptual Framework is a theoretical approach to the study of problems that are
scientifically based and emphasizes selection, arrangement, and classification of its
concepts.
The conceptual framework for this study is based on the review of literature and
clinical experience of the investigator. The present study is particularly intended to assess
the occurrence and predisposing factors of musculoskeletal pain among nurses, in terms
of their demographic data, number of hours of duty, the area of work and practice of
ergonomics. The investigator identified Health Belief Model was suitable for this study.
Health Belief Model by Becker (1974) 14
has become popular conceptual
framework in nursing especially in studies focusing on patient compliance and preventive
health care practices. The major components of Health Belief Model include perceived
susceptibility, perceived severity, perceived benefits and costs, motivation and enabling
or modifying factors. Nurses make basic decisions about health care and health
behaviours pertaining to them. Regular practices of body mechanics or ergonomics in the
work place, periodic health appraisals, incorporating practices like yoga or exercises in
the daily life style improving fitness and early detection and treatment of any
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susceptibility of developing musculoskeletal pain and feel there is a real danger that they
will experience an adverse condition and suffer with this pain lifelong.
Perceived seriousness refers to the beliefs a person holds concerning the effects a
given disease or condition would have on ones state of affairs. In this study, these effects
can be considered from the point of view of the difficulties that the musculoskeletal pain
would create. For instance, pain and discomfort, loss of work time, financial burdens,
difficulties with family relationships, and susceptibility to future conditions.
Perceived benefits of taking action toward the prevention of disease or toward
dealing with an illness is the next step to expect after an individual has accepted the
susceptibility of a disease and recognized it is serious. The direction of action that a
person chooses will be influenced by the beliefs regarding the action.
However, action may not take place even though the nurses may believe that the
benefits of taking action are effective. This may be due to barriers. In this study the
barriers may be difficulties in lowering workload, too many different tasks, too much
responsibility, too much work, shortage of staff, time pressure, unplanned work, static
work postures, lifting and handling objects.
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or external like use of lifting and turning devises to turn or shift patients, practice of good
body mechanics or ergonomics and improving ones fitness level.
Health Belief Model is directed more towards health protecting behaviour than
health promoting behaviour. Periodic health appraisal by the nurses will help to protect
them from developing musculoskeletal pain and prevent health status that is deviating
from normal.
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REVIEW OF LITERATURE
Review of literature refers to the activities involved in identifying and
searching for information on a topic and developing an understanding of the state of
knowledge on that topic.15
This review of literature presents a review of published studies related to the
incidence and factors related to the musculoskeletal pain among nurses. The Review
of literature for the present study has been done from published articles, textbooks,
reports, and Medline search etc. the Review of literature is arranged from the year
2005 to 1995.
The review of literature is presented under the following headings:
1. Literature related to the incidence, risk factors, and the location of
musculoskeletal disorders among nurses and nurses aids.
2. Literature related to the interventional don for musculoskeletal disorders
among nurses.
LITERATURE RELATED TO THE INCIDENCE, RISK FACTORS, AND
THE LOCATION OF MUSCULOSKELETAL DISORDERS AMONG
NURSES AND NURSES AIDS
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revealed that Greek nurses reported significantly more back complaints in the past 12
months (75 vs 62%) than the Dutch workers, but chronicity (11 vs 12%) and sickness
absence (17 vs 15%) of these complaints did not differ. Similar differences were
observed for neck complaints but not for shoulder complaints. About 40% of Greek
nurses visited a medical specialist for back complaints while 33% of Dutch nurses
sought care through a general practitioner. The significant risk factors for back pain
was found to be postures (Ors 1.9 and 1.9) and moderate general health (ORs 4.3 and
2.9) in both countries. This study revealed that the cross-national differences were less
important for the risk factors and musculoskeletal complaints.
In an Australian self-reporting questionnaire survey of musculoskeletal
disorders among rural Australian nursing students in North Queensland, Australia,
260 students from all three grades were involved. (Smith DR, et al, 2004)17
The
results revealed that musculoskeletal disorder at some body site (80%), with low back
pain being the common condition (59.2%) followed by neck (34.6%), knee (25%),
shoulder (23.8%), feet (16.5%), wrist (12.7%) and legs (11.9%). A musculoskeletal
disorder of shoulder was slightly more common among males when compared to
females (39.3% vs 22.0%). Overall investigation revealed that musculoskeletal
disorders is more frequent among rural Australian students when compared to their
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through a cross-sectional study, reported musculoskeletal disorders associated with
these changes. The results revealed that with the adjusted odds ratios for
musculoskeletal disorders for more than 6 versus 0 to 1 changes were (1) neck: 4.45
(95% confidence interval = 1.97, 10.08), (2) shoulder: 2.63 (95% CI = 1.17, 5.91),
and (3) back: 3.42 (95% CI = 1.61, 7.27). This emphasized the adverse impact on
health caused by the changing health care system and this must be addressed to
prevent further injuries among nurses.
An epidemiological study done by Smith DR, et al (2004)18
, investigated the
musculoskeletal complaints and psychosocial risk factors among Chinese hospital
nurses in Mainland, China. 282 female registered nurses were surveyed using a
modified Chinese language version of Standardized Nordic Questionnaire. The
results revealed that the 12-month period- prevalence of musculoskeletal complaints
at any of the four regions (neck, shoulder, upper back, lower back) was 70%. The
lower back being the commonest (56%) followed by neck (45%), shoulder (40%) and
upper back (37%). The significant risk factors identified were high mental pressure,
boring and tedious tasks and limited work support. This study did not find a
correlation between manual handling or perceived physical exertion and increased
reporting of musculoskeletal complaints.
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general health, occurrence of musculoskeletal complaints in the past 12 months,
chronic complaints during at least 3 months, and complaints which led to sickness
absence. All the risk factors were analyzed through odds ratios in a logistic regression
analysis. The results reveled that the physical load were associated with the
occurrence of back pain (OR = 1.85), neck pain (OR = 1.88), and shoulder pain (OR =
1.87). But these factors were not associated with chronic complaints and
musculoskeletal sickness absence. This concluded that the handling of physical loads
among nurses seems to put them at risk for the occurrence of musculoskeletal
disorders.
A Norwegian questionnaire survey (Eriksen W, 2003) 20
from 6,485
vocationally active nurses aids was done to determine the prevalence of
musculoskeletal pain among them. Results showed that the prevalence of
musculoskeletal pain was 88.8% (95% CI = 88.0 89.6) and intense musculoskeletal
pain was 51.1%. The prevalence of widespread pain was 26.6%. This concluded that
the prevalence of musculoskeletal pain among the Norwegian nurses aids were high
and all the regions of the body were affected. The prevalence rates varied with age,
gender, working hours per week and the service sector in which they worked.
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covariates. Adjusted odds ratios for highly demanding work (vs low) ranged from
4.98 to 6.13 depending on body site and for the staff nurses the odds ranged from 9.05
to 11.99. (Trinkoff AM, et al (2003)21
.
A Japanese epidemiological investigation of musculoskeletal disorders
included a complete cohort of 222 female nursing students (Smith DR, et al, 2003)22
.
This involved a retrospective analysis of data gathered by means of a self-reported,
anonymous questionnaire. It revealed that more than one-third of all nursing students
(39.6%) reported a current musculoskeletal disorder at some body site. By location
shoulder was 14.9%, lower back was 13.5%, neck 9.5%, knee 5.0%, forearm 2.7%,
legs 2.3% and feet 1.8%. 4.5% of the students reported headache. This study
concluded that the musculoskeletal disorders were common among Japanese nursing
students.
A longitudinal study performed with a follow up at 1 and 8 years among
nurses employed by a large university hospital in Switzerland (Maul I, et al, 2003)23
.
A modified version of the Nordic Questionnaire, a clinical examination and several
functional tests were used. 269 nurses answered the questionnaire on all three
occasions. For each subgroup the course of low back pain was recorded. The results
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LITERATURE RELATED TO THE INTERVENTIONS DONE FOR
MUSCULOSKELETAL DISORDERS AMONG NURSES:
A study done on workplace prevention and musculoskeletal injuries in nurses
by Trinkoff AM, et al (2003) 27
described the availability of preventive devices and
training in relation to neck, shoulder, and back musculoskeletal disorders in registered
nurses. Data from 1163 randomly selected currently working nurses were collected
through anonymous mailed surveys. The results showed the nurses with mechanical
lifting devices and lifting teams available were significantly less likely to have neck
or back musculoskeletal disorders. Training in workstation adjustment was also
associated with significantly lower musculoskeletal prevalence, through postural
training was not.
Hignett S, et al (2003)28
did a systematic review on intervention strategies to
reduce musculoskeletal injuries associated with handling patients. Research between
1960 and 2001 were sought out through a search strategy. A checklist was selected
and modified to include a wide range of study designs. Inter-rater reliability was
established between six reviewers before the main review process commenced. The
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preventive therapies like coordination training in space curl, kinaesthetics, and back
protective patient transfer with regard to coordination, back pain and quality of life.
The results revealed that trained individuals showed a significant reduction of back
pain frequency before and after training and showed an increase in quality of life
(5.4%). In comparison there was no difference in untrained individuals. The used
coordination-training program is enhancing coordination and reducing back pain
whilst having a positive effect upon quality of life of an individual.
Burton AK (1997)30
, retrospectively surveyed 1216 nurses at hospitals in
Belgium and Netherlands. Data was collected through a questionnaire concerning
workloads, musculoskeletal symptoms, work loss and psychosocial factors. The
musculoskeletal problems and low back troubles were less in Dutch hospitals than the
Belgium hospitals with a significantly heavy workload in Dutch nurses. The striking
difference was found in psychosocial variables, as the Dutch nurses were less
depressed and more positive about pain, work and activity as compared to Belgium
nurses. It was concluded that the ergonomic intervention alone may not control the
musculoskeletal problems in nurses and it was proposed to have additional
psychosocial information to challenge misconceptions and encourage self-
management.
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The literature provided the support for the researcher to put forward the need for
study. The knowledge gained will help the researcher to strengthen the study design;
development of tool and the analysis plan for the study and recommendations.
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RESEARCH METHODOLOGY
Research methodology is a way to systematically solve the problem. In this
we study the various steps that are generally adopted by the researcher in studying the
research problem along with the logic behind them.
The purpose of this section is to communicate to the readers what the
investigator did to solve the research problem or to answer the research questions.
This section in the research report often tells the readers about the major
methodological decision.
Research approach
The selection of research approach is the basic procedure for the conduct of
research enquiry. A research approach tells the researcher as to what data to collect
and how to analyze it. It also suggests possible conclusions to be drawn from the data.
In view of the nature of problem selected for the study and the objectives to be
accomplished, a descriptive survey was considered for the present study. The present
study aimed to assess the occurrence and predisposing factors of musculoskeletal pain
among female staff nurses by using the descriptive survey approach.
According to Polit and Hungler15
the descriptive approach is one that gives
accurate portrayal of characteristics of persons, situations or group and the frequency
with which certain phenomena occur.
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manipulation of experimental variables, control of extraneous variable, procedure of
data collection and the type of statistical analysis to be used to interpret the data.
In the present study, descriptive survey design was selected and the primary
objective of the study was to assess the occurrence and predisposing factors of the
musculoskeletal pain among female staff nurses.
The design chosen for the study is presented in the figure as follows.
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Setting of the study
The setting is the location where a study is conducted.
The study was conducted in Vaidehi Institute of Medical Sciences and Research
center hospital. This is a 1000-bed general hospital with attached medical and nursing
colleges. This hospital has all the specialty areas like Internal medicine, Surgery,
Orthopedics, Eye, ENT, Cardiology, Operation Theaters, Emergency room, etc.,
The selection of hospital was done on the basis of
Availability of permission in the hospital to conduct the study
Availability of samples.
Fulfills the inclusive criteria.
Variables
Variable is an attribute of a person or object that varies and takes on different
values. 15
Functional variable
The functional variables under study are age, marital status, educational
background, number of hours on duty, years of experience in specific area, and practice
of ergonomics.
Population
P l i f h li f ll h bj bj
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Sample & Sample size
Sample consists of a sub set of a population selected to participate in a research
study. 15
The sample of the present study comprised of randomly selected 100 female staff
nurses working in Vaidehi Institute of Medical Sciences and Research Centre Hospital,
Bangalore.
Sampling technique
A simple random sampling technique is a most basic probability sampling design,
in which each element in the population has an equal, independent chance of being
selected. 15
A probability, simple random sampling technique was used to select the samples
for the study.
Sampling criteria
Inclusion criteria
i. Those who are willing to participate in the study
ii. Those who can read and write English
iii. Those who are presently working as staff nurses in Vaidehi
Institute of Medical Sciences Hospital and Research centre,
Bangalore
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Development of criteria rating scale
Criteria checklist for validation of tool was developed.
Section A comprised of demographic data.
Section B comprised of structured self-administered questionnaire on musculoskeletal
pain and actual tasks performed by nurses.
Section C consisted of structured self-administered questionnaire on the risk factors and
practice of ergonomics, which had Very Relevant, Relevant, Needs modification, Not
Relevant, and remarks by experts.
Description of the tool
The self-administered questionnaire consists of three parts:
Section Aconsisted of baseline data which include age, professional qualification, years
of experience, area of work, number of hours of duty/day, family related questions,
questions related to reproductive health and general health.
Section B consisted of questions to elicit the area of musculoskeletal pain, its interval,
duration, intensity by Visual Analogue numerical Scale, and the type of treatment taken
and the actual tasks performed by the nurses. The questionnaire included 24 items related
to the actual tasks, not all of which involved handling patients. The self estimated
severity of workloads in actual tasks was categorized into always (every day), often (2-3
times a day) sometimes (1 2 times a week and rarely (once a week)
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pushing, transporting, lifting and repetitive work with shoulders, arms, hands and fingers.
The next item was work organization, which consists 7 questions that included planning
of work, taking up responsibilities other than tasks at work, relationship with superiors
and colleagues, etc. Patient condition was the next item with 3 questions, eliciting
information on sudden change in patients condition, many admissions with emergencies
in the word, etc. Domestic work was included as the 4th
item, which consists of 2
questions, suggesting the type of work they do at home after work and any domestic help
with the household routine.
Content validity of the tool
Content validity refers to the degree to which an instrument measures what it is
supposed to measure. 15
The prepared instrument along with the objectives and criteria checklist was
submitted to five experts for establishing content validity. The five experts comprised of
nurse educators in the field of Medical Surgical Nursing for establishing the content
validity. The tool was modified as per suggestions of the experts and final tool was
constructed.
Pre testing of the tool:
Pre testing of the self-administered questionnaire was done to check the clarity of
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It was found that it took 45 minutes to complete the questionnaire and the items
were simple to comprehend and also it was found reliable.
Reliability of the tool:
Reliability of research instrument is defined as the extent to which the instrument
yields the same results on repeated measures. It is then concerned with consistency,
accuracy, precision, stability, equivalence and homogeneity.15
The final tool was tested for reliability. The self-administered questionnaire was
administered to ten staff nurses.
The reliability of the tool was established by testing the stability and
internal consistency. Stability was assessed by test and retest method. Internal
consistency was assessed by using split half technique with raw score method &
Deviation method - Spearman Brown prophecy Formula.
Spearmans Brown Prophecy Formula for reliability
2 r
r1
= -------------------
1 + r
r = The correlation coefficient computed on the split halves.
r1= The estimated reliability of the entire test.
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Deviation Method:
xyr =
X2 . Y2
The reliability of the tool was found to be 0.9 by raw score method and 1 by deviation
method, which indicated that the tool was reliable.
Pilot Study Report
A pilot study is a small-scale version or trial run, done in preparation for major
study. It is designed to acquaint the researcher with the problems to be corrected in
preparation for the larger research project. It also provides the researcher with an
opportunity to try out the procedure for collecting data.The function of the pilot study is
to obtain information for improving the project or assessing its feasibility.
The purpose of the pilot study:
To evaluate the tool constructed.
To find out the feasibility of conducting the final study
To determine the method of statistical analysis.
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The staff nurses were selected by probability simple random sampling. The
subjects for pilot study possessed the same characteristics as that of the sample for the
main study. The self-reported questionnaire was administered to 10 staff nurses working
in the Kempegowda Institute of Medical Sciences Hospital. It took 45 minutes to
complete the questionnaire by each staff nurse.
Pilot study findings:
None of the participants had any musculoskeletal injury before joining nursing course.
50% of the participants claimed to have pain in multiple sites (neck, shoulder, forearm,
lower back, knee and legs) and 50% of the participants had pain in the lower back. With
regard to the duration of pain 50% of the participants claimed that it was less than 1-
week duration. 60% of the samples that complained of musculoskeletal pain used to take
self-medications for relief of pain and 10% had seen a physician for the musculoskeletal
pain and were treated with injections and physiotherapy. While associating the
demographic variables with occurrence of musculoskeletal pain among nurses, it was
found that the area of work had a significant relationship in causing musculoskeletal pain
among nurses.
Problems faced during pilot study:
The problems faced by the investigator in the process of carrying out this study were
as given below:
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Data collection procedure
Formal administrative permission was obtained from the Medical superintendent
and nursing superintendent of the hospital prior to the data collection. The final study
data was collected from 26 09 - 2005 to 14 10 - 2004 in Vaidehi Institute of Medical
Sciences and Research center Hospital, Bangalore. Subjects were selected by simple
random sampling.
The investigator contacted all the respondents before conducting the study; the
investigator introduced her and explained the purpose of the study to the staff nurses,
then obtained the consent and administered the questionnaire. Permission obtained from
the ward-in-charges to allow the selected staff nurses to complete the questionnaire. The
staff nurses were allowed to be in the work area to complete the questionnaire.
All the respondents cooperated well with the investigator in completing the
questionnaire. Thanking the respondents for their participation, interest and cooperation,
the investigator completed the process of data collection.
Plan for data analysis
The data obtained was analyzed in terms of the objectives of the study using
descriptive and inferential statistics. A master data sheet was prepared with responses
given by the subjects. The plan of data analysis was as follows:
Section I: Description of demographic characteristics
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Practice of ergonomics.
Section IV: Association between the occurrence, predisposing factors of musculoskeletal
pain and practice of ergonomics and demographic variables.
Conclusion:
This chapter dealt with the research approach, research design,
setting of the study, variables under study, population, sample and sampling technique
selection, development of the tool, description of tool, pilot study, data collection
procedure and plan for data analysis.
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ANALYSIS AND INTERPRETATION OF DATA
This chapter deals with the analysis and interpretation of data obtained from 100
participants in Vaidehi Institute of Medical Sciences and Research center, Whitefeild.
Bangalore. The data was processed and analyzed on the basis of the objectives and
hypothesis formulated for the present study.
Statistical analysis is a method of rendering quantitative information meaningful
and intelligible. Statistical procedures enable the research to reduce, summarize,
organize, evaluate, interpret and communicate numeric information.
Analysis is the categorizing, ordering, manipulating, and summarizing of data to
obtain answers to research questions. The purpose of analysis is to reduce date to
intelligible and interpretable form so that the relations of research problem can be studied
and tested.
The data collected was tabulated, organized and analyzed using descriptive and
inferential statistics and was based on the objectives of the study.
The objectives of the study:
To asses the occurrence of musculoskeletal pain among nurses.
To identify the predisposing factors of musculoskeletal pain among nurses.
To determine the association between the occurrence of musculoskeletal pain with
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Hypothesis
H1: There is a significant association between the occurrence of
musculoskeletal pain and the following:
1) The selected demographic variables like age, marital status, years of
experience and educational background.
2) The area of work and the actual tasks performed.
3) The practice of ergonomics in the work place
Organization and presentation of data:
The obtained data was entered into the master sheet for tabulation and statistical
processing. The analysis of data was organized and presented under the following
sections.
Section I:
Findings related to the distribution of demographic characteristics.
Section II:
Findings related to the self-reported musculoskeletal pain.
Section III:
Findings related to
The actual tasks performed
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SUBJECTS BY AGE
61
31
8
0
10
20
30
40
50
60
70
20 - 29 30 - 39 >39
AGE GROUP
NO.OF
SUBJECT
S
Fig: 3 Distribution of subjects by age
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SUBJECTS BY EDUCATION
6%
93%
1%
GNM
B.Sc. (N)
PC B.Sc(N)
Fig. 4 Distribution of subjects by Education
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From the above table-1 it is observed that 61% of the subjects were in the age
group of 20 - 29 years, followed by 31% belonged to 30 39 years, and 8% belonged to
the age group of above 39 years.
Most of the respondents 93%% had GNM qualification, 6% had BSc(N)
qualification and 1% had PC BSc(N).
Distribution of subjects according to the work experience shows, that 26% of
them had less than 2 years of experience, 25% had more than 8 years of experience, 25%
had 6 to 8 years of experience, 17% had 3 to 5 years of experience and 7% did not have
any experience at all.
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Table 2
Distribution of Subjects by area of work, mode of transportation and
travel timeN = 100
SUBJECTSS. No VARIABLE CATEGORY
FREQUENCY PERCENTAGE
1. AREA OF WORK Operation Theater
Ortho ward
Medical ward
Surgical ward
OBG/Labor room
Special ward
Emergency
ICU
Pediatric ward
OPD
11
9
10
11
11
8
11
11
7
11
11
9
10
11
11
8
11
11
7
11
2 MODE OF
COMMUTING TO
WORK PLACE
Bus
Walk
Two wheeler
57
39
4
57
39
4
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SUBJECTS BY AREA OF WORK
0%
11%
9%
10%
11%
11%8%
11%
11%
7%
11%
Operation Theatre
Ortho Ward
Medical Ward
Surgical Ward
OBG/Labor room
Special Ward
Emergency
ICU
Paediatric Ward
OPD
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57
39
4
0
10
20
30
40
50
60
NO
.OF
SUBJECTS
Bus Walk Two wheeler
MODE
SUBJECTS BY MODE OF COMMUTING
TO WORK PLACE
i h d h f k f h bj i h i l d
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With regard to the area of work of the subjects, operation theater, surgical ward,
OBG/Labor room, emergency, ICU and OPD had 11% of the subjects each, medical ward
had 10% of the subjects, Ortho ward had 9% of the subjects, special ward had 8% of the
subjects and pediatric ward had 7% of the subjects.
Distribution of the subjects according to the mode of commuting to work place,
57% of them commuted by bus, 39% of them walked to work and 4% of them used two
wheelers.
The travel time taken for one-way travel to work by the subjects was noted as
72% of the subjects took less than hour for travel and the rest of 28% traveled hour
or more.
T bl 3
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Table 3
Distribution of Subjects by marital status, number of children and size
of familyN = 100
SUBJECTSS. No VARIABLE CATEGORY
FREQUENCY PERCENTAGE
1 MARITAL
STATUS
Single
Married
49
51
49
51
2 NUMBER OF
CHILDREN
No children
One child
Two children
Three children
54
19
25
2
54
19
25
2
3 SIZE OF FAMILY 2 or less people
3 4 people
5-6 people
> 6 people
2
42
47
9
2
42
47
9
The above table 3 shows that 51% of the subjects are married and 49% of them
are single. Looking at the number of children the subjects had, 54% of them did not have
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SUBJECTS BY MARITAL STATUS
Single
49%
Married
51%
Single Married
Fig 8 Distribution of subjects by marital status
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54
19
25
2
0
10
20
30
40
50
60
NO.O
FS
UBJECTS
No Children One Two Three
NO.OF CHILDREN
SUBJECTS BY NO.OF CHILDREN
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SUBJECTS BY FAMILY SIZE
2
42
47
9
0 20 40 60 80
2 or less
3 - 4
5 - 6
>6
FAMILYSIZE
NO.OF SUBJECTS
Table 4
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Table 4
Distribution of Subjects by their reproductive health
N = 100
SUBJECTSS. No VARIABLE CATEGORY
FREQUENCY PERCENTAGE
1 HISTORY OF
MENSTURAL
CYCLE
Regular
Irregular
Menopause
87
7
6
87
7
6
2 BLEEDING
DURING
MENSUS
Scanty
Moderate
Heavy
Menopause
7
82
5
6
7
82
5
6
3 YEARS SINCE
ATTAINING
MEOPAUSE
1 year
2 years
3 years
7 years
2
1
1
2
33.3
16.7
16.7
33.3
Looking at the reproductive health of the samples, 6% of them had attained
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SUBJECTS BY HISTORY OF
MENSTURAL CYCLE
87%
7% 6%
Regular
Irregular
Menopause
Table 5
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Subjects by their mean height and weight
N= 100
S
No
VARIABLES MIN MAX MEAN MEDIAN SD
1 Height 140 174 158.26 158 6.95
2 Weight 33 72 53.35 52 8.14
The above table 5 explains the height and weight of the subjects. The minimum
height is 140 cms and the maximum height is 174 cms, with a mean height of 158.26
cms.
Looking at the weight of the subjects the minimum weight is 33 Kgs and the
maximum being 72 Kgs, with the mean weight of 53.35 Kgs.
The mean BMI calculated with the obtained mean height and weight is 21.30,
which is with in the normal limits of 18.5 24.9.
Table 6
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Distribution of Subjects by history of previous surgeries and use of
vitamin /iron supplements
N = 100
SUBJECTSS. No VARIABLE CATEGORY
FREQUENCY PERCENTAGE
1 PREVIOUS
SURGERY
Yes
No
28
72
28
72
2 USE OF
VITAMIN/ IRON
SUPPLEMENTS
Yes
No
18
82
18
82
The above table 6 shows that 28% of subjects reported of having surgeries in the
past. 18% of the subjects reported of taking vitamin and iron supplements and 82% of
them did not use regularly.
None of the subjects reported postural deformities.
Table 7
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Distribution of Subjects by experience of pain in single or multiple sites
or no pain
N = 100
SUBJECTSS. No VARIABLE AREA OF PAIN
FREQUENCY PERCENTAGE
1 SITES OF PAIN Single site
Multiple site
No pain
35
42
23
35
42
23
2 PAIN,
NUMBNESS, &
TINGLING
SENSATION
Neck
Shoulder
Forearm
Lower back
Knee
Legs
No pain
14
23
1
56
22
45
23
18.2
29.9
1.3
72.7
28.6
58.4
23
Distribution of subjects by sites of pain shows that 42% of the subjects reported
reported by 22 and 23 subjects each and the least reported area of pain was the forearm
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with one subject.
SUBJECTS BY SINGLE OR MULTIPLE
SITE OF PAIN
35%
42%
23%
35%
42%
23%
single site
multiple site
no pain
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18.2
29.9
1.3
72.7
58.4
56
0.0 20.0 40.0 60.0 80.0
No.of subjects
Neck
Shoulder
Forearm
Lower Back
Knee
Legs
Experience of Pain, Numbness or
Tingling sensation
Table 8
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Distribution of Subjects by interval of pain by site
N = 77
LAST 3 MONTHS > 3 MONTHS
S. No SITE OF PAIN
FREQUENCY % FREQUENCY %
1 Neck
Shoulder
Forearm
Lower back
Knee
Legs
10
16
0
6
10
16
71.4
69.6
0
10.7
45.5
35.6
4
7
1
50
12
29
28.6
30.4
100.0
89.3
54.5
64.4
From the above table it is evident that chronic lower back pain was reported by
maximum number of subjects (50 subjects, 89.3%), followed by the pain in the legs
reported by 29 subjects (64.4%) and knee pain reported by 12 subjects (54.5%). The site
reported maximum by subjects with in the last 3 months duration of pain was shoulder by
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INTERVAL OF PAIN BY SITE
10
16
6
10
16
4
7
1
50
12
29
0 10 20 30 40 50 60
Neck
Shoulder
Forearm
Lower Back
Knee
Legs
Table 9
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Distribution of Subjects by duration of pain by site
S.NO SITE OF
PAIN
< 1
WEEK
1-4
WEEKS
4-8
WEEKS
8-12
WEEKS
12 16
WEEKS
Total
1 Neck 9 5 14
2 Shoulder 15 6 2 23
3 Forearm 1 1
4 Lower back 7 34 13 2 56
5 Knee 8 11 2 1 22
6 Legs 14 22 8 1 45
Total 54 78 25 3 1
The above table indicates that the maximum number of subjects reported pain
between 0 to 4 weeks in multiple sites, in which the lower back and the legs being the
highest. One subject reported pain of 12 to 16 weeks duration in the legs. 2 subjects
reported lower back pain of 8 to 12 weeks.
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0
5
10
15
20
25
30
35
PERCE
NTAGE
Neck
Shoulder
Forearm
LowerBack
Knee
Legs
SITE OF PAIN
SUBJECTS BY DURATION OF PAIN
< 1 wk.
1 - 4 wks.4 - 8 wks.
8 - 12 wks.
12 - 16 wks.
Fig. 15 Distribution of subjects by duration of pain in different sites
Table 10
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Distribution of Subjects by intensity and severity of pain
N= 77
SUBJECTS
S. No VARIABLE CATAGORY
FREQUENCY PERCENTAGE
1 INTENSITY
OF PAIN
Mild (0 3)
Moderate (4 6)
Severe (7 10)
19
57
1
24.7
74.0
1.3
2 SEVERITY OF
PAIN
More than before
Same as before
Less than before
17
35
25
22.1
45.5
32.4
The above table 10 explains the intensity and severity of pain. 74% of the
subjects reported moderate intensity of pain using the visual analogue numerical pain
scale. 24.7% reported mild pain and only 1.3% reported severe intensity of pain.
Looking at the severity of pain reported, 45.5% of subjects said the pain is same
as before and 32.4% of them said that the pain is less than before and 22.1% of subjects
reported the pain is more than before when ever it occurs.
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SUBJECTS BY INTENSITY OF PAIN
Mild
25%
Moderate
74%
Severe
1%
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17
35
25
0 20 40 60 80
NO.OF SUBJECTS
More severe
than Before
Same as before
Less than
before
SUBJECTS BY SEVERITY OF PAIN
Fig. 17 Distribution of subjects by severity of pain
Table 11
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Distribution of Subjects by self-medication & consultation with
PhysicianN= 77
SUBJECTS
S. No VARIABLE CATAGORY
FREQUENCY PERCENTAGE
1 SELF
MEDICATION
Regularly
Very often
Once in a while
No
8
26
39
4
10.4
33.8
50.6
5.2
2 CONSULTATI
ON WITH A
PHYSICIAN
Yes
No
33
44
42.9
57.1
Distribution of subjects according to the self-medication for the pain shows that
50.6% of the subjects took self-medication once in a while, 33.8% of subjects took self-
medications very often and 10.4% of them took regularly and 5.2% of them did not take
self-medications. This table also indicates that the majority of subjects (94.8%) are used
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8
26
39
4
0 10 20 30 40
NO.OF SUBJECTS
Regularly
Very Often
Once in a while
No
SUBJECTS BY PRACTICE OF SELF
MEDICATION
Table 12
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Distribution of Subjects by the type of treatment received for the pain
N= 33
SUBJECTSS. No VARIABLE CATAGORY
FREQUENCY %
1 TREATMENT
RECEIVED
Tablets
Tablets, injection & physiotherapy
Tablets & physiotherapy
Physiotherapy
19
1
11
2
57.6
3.0
33.3
6.1
From the above table it is evident that out of the 33 subjects who received
treatment, 57.6% of them received only tablets for the pain, 33.3 % of them had received
tablets and physiotherapy, 6.1% of them received physiotherapy alone and 3% had
received tablets, injection and physiotherapy in combination.
SECTION - III
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This section deals with analysis and interpretation of the data collected to find
out the actual repeated tasks performed by the nurses in the daily work, and the practice
of ergonomics. The ergonomic scores are analysed under the headings like work posture,
work organization, patient condition, and domestic work.
TABLE - 13
Area wise & over all scores of actual tasks and ergonomics of staff
nursesN=100
S
No
VARIABLESQUES
TIONS
MIN MAX MEAN MEDIAN SD
1 Actual tasks performed
by nurses (total)
24 44 83 64.36 65 9.49
2 Ergonomics
Work posture
Work organization
Patient condition
8
7
3
14
11
3
22
20
9
18.78
14.76
5 55
19
15
5 5
1.9
1.78
1 92
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18.8
14.8
5.6
3.9
43.0
0 10 20 30 40 50
MEAN SCORES
Work Posture
Work
Oganisation
Patient
Condition
Domestic Work
Ergonomics
Total
MEAN SCORES BY PRACTICE OF
ERGONOMICS
Fig 19 Mean scores by practice of ergonomics by nurses
The above table reveals that the actual tasks performed by nurses have the mean
score of 64.36.
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Area wise analysis of the ergonomics score shows that the work posture with the
highest mean score of 18.78 followed by the work organization with a mean score of
14.76, patient condition with a mean score of 5.55 and domestic work with the lowest
mean score of 3.92. The ergonomics total mean score is 43.01.
SECTION - IV
This section deals with analysis and interpretation of the data collected to find
out the association between demographic variables and actual tasks scores and
ergonomics scores of respondents. A nonparametric chi square test (
2
) was used to
describe the association between the actual tasks scores, ergonomics scores and selected
demographic variables.
Objective:
To determine the association between the occurrence of musculoskeletal pain with
Section- IV
Association between demographic variables and actual tasks performed
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Association between demographic variables and actual tasks performed
by nurses
TABLE: 14
Association between Age and actual tasks performed
N=100
Actual tasks score
S No AGEMedian
&Below
Median
Above
MedianTotal 2
Level
of
Signifi
cance
1.20 29
30 39
>39
35
13
6
26
18
2
61
31
8
3.52NS
Total 54 46 100
2(2,0.05)= 5.99 ** Not Significant at 0.05 and 0.01 level2(2,0.01) = 9.21 NS = Not Significant
The above table 14 represents that there was no association found between the
age of the subjects and the actual tasks performed by the nurses Chi square shows
TABLE: 15
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Association between professional experience and actual tasks performed
N=100
Actual tasks score
S
No EXPERIENCE
Median
&BelowMedian
Above
Median Total 2
Level of
Significance
1.No experience
1 2 years
3 5 years
6 8 years
> 8 years
4
13
10
14
13
3
13
7
11
12
7
26
17
25
25
0.44 NS**
Total 54 46100
24,0.05)= 9.49 ** Not Significant at 0.05 and 0.01 level2(4,0.01) = 13.28 NS = Not Significant
The above table 15 represents that there was no association found between the
Table 16
Association between education and actual tasks performed
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N=100
Actual tasks score
S No EDUCATIONMedian
&Below
Median
Above
MedianTotal 2
Level
of
Signifi
cance
1.GNM
B Sc N
PC B Sc N
52
1
1
41
6
0
93
6
1
4.4NS
Total 54 46 100
2(2,0.05)= 5.99 ** Not Significant at 0.05 and 0.01 level2(2,0.01) = 9.21 NS = Not Significant
The above table 16 represents that there was no association found between the
education of the subjects and the actual tasks performed by the nurses. Chi-square shows
statistically non-significant (2 = 4.4, not significant at 0.05 and 0.01 levels of
significance)
TABLE: 17
A i ti b t ti f ilit d d t l t k
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Association between commuting facility used and actual tasks
performed
N=100
Actual tasks score
S
No
COMMUTING
FACILITY USEDMedian
&Below
Median
Above
MedianTotal 2
Leve
l of
Sign
ifica
nce
1.
Transport
Walk
34
20
27
19
61
39
0.19 NS**
Total 54 46 100
2
1,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level2(1,0.01) = 6.63 NS = Not Significant
The above table 17 represents that there was no association found between the
commuting facility used by the subjects and the actual tasks performed by the nurses.
Chi-square shows statistically non-significant (2 = 0.19, not significant at 0.05 and 0.01
TABLE: 18
Association between area of work and actual tasks performed
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N=100
Actual tasks score
S
NoArea of work
Median
&Below
Median
Above
MedianTotal 2
Leve
l of
Sign
ificance
1.
Operation theater
Orthopedic ward
Medical ward
Surgical ward
OBG/Labor room
Special ward
Emergency
ICU
Pediatric ward
OPD
10
3
6
4
6
6
3
3
3
10
1
6
4
7
5
2
8
8
4
1
11
9
10
11
11
8
11
11
7
11
24.33 S
Total 54 46 100
29,0.05)= 16.92 Significant at 0.05 and 0.01 level2(90.01) = 21.67 S = Significant
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TABLE: 20
Association between marital status and actual tasks performed
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N=100
Actual tasks score
S
No
MARITAL STATUSMedian
&BelowMedian
Above
Median
Total 2
Level
of
Significance
1.
Single
Married
25
29
24
22
49
51
0.34 NS**
Total 54 46 100
21,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level2(1,0.01) = 6.63 NS = Not Significant
The above table 20 represents that there is no association found between the
marital status of the subjects and the actual tasks performed by them. Chi-square shows
statistically non-significant (2 = 0.34, not significant at 0.05 and 0.01 levels of
significance).
TABLE: 21
Association between family size and actual tasks performed
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Association between family size and actual tasks performed
N=100
Actual tasks score
S
No FAMILY SIZE
Median
&BelowMedian
Above
Median Total
2
Level
of
Significance
1.
2 4 people
> 4 people
27
27
17
29
44
56
1.72 NS**
Total 54 46 100
21,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level2(1,0.01) = 6.63 NS = Not Significant
The above table 21 represents that there is no association found between the
family size of the subjects and the actual tasks performed by the nurses. Chi-square
shows statistically non-significant (2 = 1.72, not significant at 0.05 and 0.01 levels of
significance)
TABLE: 22
Association between number of children and actual tasks performed
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Association between number of children and actual tasks performed
N=100
Actual tasks score
S
No
NUMBER OF
CHILDREN
Median
&BelowMedian
Above
Median Total
2
Level
of
Significance
1.
No children
One
2 or more
28
10
16
26
9
11
54
19
27
0.42 NS**
Total 54 46 100
21,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level2(1,0.01) = 6.63 NS = Not Significant
The above table 22 represents that there is no association found between the
number of children of the subjects and the actual tasks performed by the nurses. Chi-
h t ti ti ll i ifi t (2 0 42 t i ifi t t 0 05 d 0 01
Association between demographic variables and ergonomics score
TABLE: 23
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TABLE: 23
Association between Age and ergonomics score
N=100
Ergonomic score
S No AGEMedian
&Below
Median
Above
MedianTotal 2
Levelof
Signifi
cance
1.20 29
30 39
>39
33
17
5
28
14
3
61
31
8
0.20 NS**
Total 55 45 100
2(2,0.05)= 5.99 ** Not Significant at 0.05 and 0.01 level2(2,0.01) = 9.21 NS = Not Significant
The above table 23 represents that there was no association found between the
age of the subjects and the ergonomic scores. Chi-square shows statistically non
significant (2 = 0.20, not significant at 0.05 and 0.01 levels of significance)
TABLE: 24
Association between prof essional experience and ergonomic
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p p g
score
N=100
Ergonomic score
S
NoEXPERIENCE
Median
&Below
Median
Above
MedianTotal 2
Level ofSignific
ance
1.No experience
1 2 years
3 5 years
6 8 years
> 8 years
4
12
11
15
13
3
14
6
10
12
7
26
17
25
25
1.83 NS**
Total 55 45 100
24,0.05)= 9.49 ** Not Significant at 0.05 and 0.01 level2(4,0.01) = 13.28 NS = Not Significant
Th b t bl 24 t th t th i ti f d b t th
Table 25
Association between education and actual tasks performed
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Association between education and actual tasks performed
N=100
Actual tasks score
S No EDUCATION Median&Below
Median
AboveMedian Total 2
Level
of
Signifi
cance
1.GNM
B Sc N
PC B Sc N
55
0
0
38
6
1
93
6
1
9.14S
Total 54 46 100
2(2,0.05)= 5.99 ** Significant at 0.05 level2(2,0.01) = 9.21 S = Significant
The above table 25 represents that there was association found between the
education of the subjects and the ergonomic scores.. Chi-square shows statistically non-
significant at 0 05 levels (2 = 9.14, significant at 0.05 levels of significance)
TABLE: 26
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Association between commuting facility used and ergonomic scores
N=100
Ergonomic score
S
No
COMMUTING
FACILITY USEDMedian
&Below
Median
Above
MedianTotal 2
Level
of
Signifi
cance
1.
Transport
Walk
35
20
26
19
61
39
0.36 NS**
Total 55 45 100
21,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level
2(1,0.01) = 6.63 NS = Not Significant
The above table 26 represents that there was no association found between the
commuting facility used by the subjects and the ergonomic scores. Chi-square shows
statistically non-significant (2 = 0.36, not significant at 0.05 and 0.01 levels of
TABLE: 27
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Association between area of work and ergonomic scores
N=100
Ergonomic score
S
NoArea of work
Median
&Below
Median
Above
MedianTotal 2
Leve
l of
Sign
ifica
nce
1.
Operation theater
Orthopedic ward
Medical ward
Surgical ward
OBG/Labor room
Special ward
Emergency
ICU
Pediatric ward
OPD
6
5
5
9
5
73
1
5
9
5
4
5
2
6
18
10
2
2
11
9
10
11
11
811
11
7
11
23.70 S
Total 54 46 100
TABLE: 28
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Association between travel time spent and ergonomic scores
N=100
Ergonomic score
S
No
TRAVEL TIME
SPENTMedian
&Below
Median
Above
MedianTotal 2
Levelof
Signifi
cance
1.
< HOUR
HOUR OR
MORE
39
16
33
12
72
28
1.66 NS**
Total 55 45 100
21,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level2(1,0.01) = 6.63 NS = Not Significant
The above table 28 represents that there is no association found between the
travel time spent by the subjects and the ergonomic scores. Chi-square shows statistically
i ifi t (2 1 66 t i ifi t t 0 05 d 0 01 l l f i ifi )
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TABLE: 30
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Association between family size and ergonomic scores
N=100
Ergonomic score
S
NoFAMILY SIZE
Median
&Below
Median
Above
MedianTotal 2
Levelof
Signifi
cance
1.
2 4 people
> 4 people
29
26
15
30
44
56
3.78 NS**
Total 55 45 100
2
1,0.05)= 3.84 ** Not Significant at 0.05 and 0.01 level2(1,0.01) = 6.63 NS = Not Significant
The above table 30 represents that there is no association found between the
family size of the subjects and the ergonomic scores. Chi-square shows statistically non-
significant (2 = 3.78, not significant at 0.05 and 0.01 levels of significance).
TABLE: 31
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Association between number of children and ergonomic score
N=100
Ergonomic score
S
No
NUMBER OF
CHILDRENMedian
&Below