ramakrishnan sheela

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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



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



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



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


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


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


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


99/183

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


100/183

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


Table 16

Association between education and actual tasks performed


101/183

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



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


102/183

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



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


103/183

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


104/183

TABLE: 20

Association between marital status and actual tasks performed


105/183

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


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


significance).

TABLE: 21

Association between family size and actual tasks performed


106/183

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



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


107/183

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



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


108/183

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



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


109/183

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


Th b t bl 24 t th t th i ti f d b t th

Table 25



110/183


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


111/183

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


commuting facility used by the subjects and the ergonomic scores. Chi-square shows


TABLE: 27


112/183

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


113/183

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



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 )


114/183

TABLE: 30


115/183

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



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


116/183

Association between number of children and ergonomic score

N=100

Ergonomic score

S

No

NUMBER OF

CHILDRENMedian

&Below

ramakrishnan sheela

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