A STUDY TO ASSESS THE KNOWLEDGE AND PREVENTIVE MEASURE REGARDING HEALTH

PROBLEMS AMONG NEURONURSES, SCTIMST.

PROJECT REPORT

Submitted in partial fulfillment of the requirements

for the

DIPLOMA IN NEURONURSING

Submitted By

HARISH T. K

CODE NO: 5892

SREE CHITRA TIRUNAL INSTITUTE OF MEDICAL SCIENCES AND TECHNOLOGY

MEDICAL COLLEGE, TRIVANDRUM.

NOVEMBER 2009

CERTIFICATE FROM SUPERVISORY GUIDE

This is to certify that Mr. HARISH T. K has completed the project work on "A

STUDY TO ASSESS THE KNOWLEDGE AND PREVENTIVE MEASURE

REGARDING HEALTH PROBLEMS AMONG NEURONURSES, SCTIMST"

under my direct supervision and guidance for the partial fulfillment for the

"Diploma in NEURONURSING" in the University of Sree Chitra Tirunal

Institute for Medical Sciences and Technology, Trivandrum. It is also certified

that no part of this work report has been included in any other thesis for

procuring any other degree by the candidate.

Trivandrum

November 2009

Mrs. Dr. SARAMMA P.P,

Senior Lecturer in Nursing,

SCTIMST,

Trivandrum.

CERTIFICATE FROM CANDIDATE

This is to certify that the project report on "A STUDY TO ASSESS THE

KNOWLEDGE AND PREVENTIVE MEASURE REGARDING HEALTH

PROBLEMS AMONG NEURONURSES, SCTIMST" is a genuine work done

by me at the Sree Chitra Tirunal Institute for Medical Sciences and

Technology, Trivandrum under the guidance of Dr Saramma P.P. It is also

certified that this work has not been presented previously to any university for

award of degree, diploma, fellowship or other recognition.

Trivandrum

November 2009 Harish T.K.

Roll No: 5896,

SCTIMST,

Trivandrum.

APPROVAL SHEET

This is to certify that Mr. Harish T. K bearing Roll no. 5892 has been admitted

to the Diploma in Neuronursing in January 2009 and he has undertaken the

project entitled "A STUDY TO ASSESS THE KNOWLEDGE AND

PREVENTIVE MEASURE REGARDING HEALTH PROBLEMS AMONG

NEURONURSES, SCTIMST" which is approved for the Diploma in Neuro

Nursing awarded by Sree Chitra Tirunal Institute for Medical Sciences and

Technology, Trivandrum, as it is found satisfactory.

Examiners

1 ) ................. .

2) ................. .

Guide(s)

1 ) ..................... .

2) ..................... .

Date :

Place : Trivandrum

ACKNOWLEDGEMENT

First of all let me thank God of almighty for unending love, care and blessing

especially during the tenure of this study.

I take this opportunity to express my sincere thanks to Mrs. Saramma P.P,

Lecturer in nursing, Sree Chitra Tirunal Institute for Medical Sciences and

Technology, Trivandrum. For the guidance, she provided for executing this

study. Her advices regarding the concept, basic guidelines and analysis of

data were very much encouraging. Her contributions and suggestions have

been of great help for which I am extremely grateful. With profound

sentiments and gratitude the investigator acknowledge the encouragement

and help received from the following persons for the completion of this study.

I am thankful to Dr. Suresh Nair, HOD, Neurosurgery and Dr. M. D. Nair,

HOD, Neurology for this constant support and encouragement. All the staffs

and departmental head of neurosurgery and Neurology unit, helped for

completion of this study at some time I am indebted to them.

Harish T.K

ABSTRACT

Topic: -A study to assess the knowledge and preventive measure regarding

health problems among neuronurses.

Background: - Nurses are the principal group of health care personnel

providing primary health care at all levels and maintaining links between

individuals, families, communities and the rest of the health care system,

nurses are exposed each day to a variety of health and safety hazards.

Nurses are among those professionals with the highest incidence rates of low

back pain, bending, twisting, lifting heavy weights and making forceful

movements were related to low back pain. The International Labour

Organization acknowledged the need for safe and healthy workplaces for

nurses. Aim: - The objectives of the study were to assess the knowledge

regarding health problems among neuronurses, to assess the preventive

measures regarding health problems among neuronurses and to identify the

relationship of health problems with selected variables. Method: -This study

was conducted in NMICU, NSICU, NMW and NSW of Sree Chitra Tirunal

Institute of Medical Sciences and Technology; Trivandrum. A fifty neuronurses

were randomly selected for this study. The total period of the study was from

September 2009 to October2009. The data collection tool used for the study

was a validated self-prepared questionnaire to assess the knowledge and

preventive measure regarding health problem among neuronurses. Results: -

The data was analyzed by using Epi Info 3.2 version. In general neuro nurses

knowledge with regard to low back pain is above average. This study revealed

that there was no significant difference between the knowledge of

neuronurses about back pain with regard to their age and experience in

neuronursing. The preventive measures followed by the majority of nurses

were regular exercise (74%) and proper body mechanism (68%).

Conclusion: - Knowledge of neuronurses working in ICU and wards with

regard to low back pain are above average. Studies using more sample size

may be useful to validate findings.

CONTENTS

Chapter Titles Page No.

1. INTRODUCTION. 1- 11

2. REVIEW OF LITERATURE. 12-19

3. METHODOLOGY. 20-24

4. ANALYSIS AND 25-33

INTERPRETATION.

5. SUMMARY, CONCLUSION 34-38

DISCUSSION, LIMITATION

AND RECOMMENDATIONS.

REFERENCES. 39-44

APPENDIX.

CHAPTER -1

Introduction

51 .No. Contents Page No.

1.1 Introduction. 1

1.2 Back ground of the study. 3

1.3 Need and significance of the study. 7

1.4 Statement of the problem. 9

1.5 Objectives. 9

1.6 Operational definitions. 10

1.7 Methodology. 10

1.8 Tool. 10

1.9 Delimitations. 11

1.10 Organization of the report. 11

CHAPTER- 2

Review of literature

Sl. No. Contents Page No.

2.1 Introduction. 12

2.2 Studies related to low back 13

pain in nurses.

2.3 Studies related to low back 16

pain in hospital staff.

2.4 Key words. 19

51. No.

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

3.9

3.10

3.11

3.12

3.13

CHAPTER- 3

Methodology

Contents

Introduction.

Research approach.

Research design.

Setting of the study.

Study population.

Sample and sampling technique.

Criteria for sample.

Development of tool.

Description of tool.

Pilot study.

Data collection.

Plan of analysis.

Summary.

Page No.

20

20

21

21

21

22

22

23

23

23

24

24

24

CHAPTER-4

Analysis and Interpretation of data

51. No. Contents Page No.

4.1 Introduction. 25

4.2 Distribution of sample. 25

4.3 Neuronurses knowledge_regarding back pain. 30

4.4 Preventive measures followed by neuronurses for back 32

pain.

4.5 Summary 33

CHAPTER- 5

Summary, Conclusions, Discussion and

Recommendations

---,~~~

Sl. No. Contents Page No.

5.1 Introduction. 34

5.2 Summary. 34

5.3 Objectives of the study. 35

5.4 Limitation. 35

5.5 Major findings of the study. 35

5.6 Recommendations. 36

5.7 Discussion. 37

5.8 Conclusion. 38

--"~---~--'" ""''''''»-"*'*-'&<, , ___ "

Reference 39

Appendix

LIST OF TABLES

Table Titles Page No.

4.2a Distribution of sample by age. 26

4.2b Distribution of sample by area of 27

work.

4.2c Distribution of sample by experience 28

in nursing.

4.2d Distribution of sample by experience 29

in neuronursing.

4.3a Mean, standard deviation and p value 30

of neuronurses knowledge_by age.

4.3b Mean, standard deviation and p value 31

of neuronurses knowledge by

experience in neuronursing.

4.4 Preventive measures followed by 32

neuronurses for back pain.

LIST OF FIGURES

Figure Titles Page No. '

4.2a Distribution of sample by age. 26

4.2b Distribution of sample by area of work. 27

4.2c Distribution of sample by experience 28

in nursing.

4.2d Distribution of sample by experience 29

in neuronursing.

4.4 Preventive measures followed by 33

neuronurses for back pain.

1.1 Introduction

1

CHAPTER -1

INTRODUCTION

Low back pain affects 70 to 80% of the general population of the general

population at some time in their lives and is a leading cause of disability and

activity limitation in persons between 35 and 40 years of age (Borenstein

1999). Pain in the soft tissues of the back is extremely common among adults.

In the United States, the National Arthritis Data Workgroup reviewed national

survey data showing that each year some 15% of adults report frequent back

pain or pain lasting more than two weeks [Lawrence et al., 1998]. Back pain is

widespread in many countries, and is associated with substantial financial

costs and loss of quality of life.tA number of studies have attempted to identify

the risk factors for low-back pain especially with respect to job-related tasks

(Hoogendorn et al., (1999). Sobti et al., (1997) investigated the relationship

between physical activity in the work place and subsequent musculoskeletal

pain syndromes. The study revealed .an association between occupational

activities and musculoskeletal symptoms, which were specific for activity type

and the skeletal site involved. It was also reported that the adverse effects of

these occupational activities could still be felt many years after cessation of

exposure to such activities. The physical ergonomic features of work that are

most frequently cited as MSD risk factors include rapid work pace and

repetitive motion patterns; insufficient recovery time; heavy lifting and other

2

forceful manual exertions; non-neutral body postures (either dynamic or

static); mechanical pressure concentrations; vibration (both segmental and

whole-body); and low temperature. Many reviewers from the United States,

Canada, Europe, and Asia have reached similar conclusions regarding the

etiologic importance of these exposures for low back disorders [Gordon and

Weinstein, 1998; Jin et al., 2000; Lagerstrom et al., 1998; Nachemson, 1999;

National Research Council, 2001]. Low back pain was identified by the Pan

American Health Organization as one of the top three occupational health

problems to be targeted by surveillance within the WHO Region of the

Americas [Choi et al., 2001].

Hofmann et al. (2002) conducted a large cross-sectional questionnaire study

and reported a point prevalence of WLBI of 61 for the nurses; a lifetime

incidence rate of 87; and a relative risk between 1.35 and 1.47 for nurses (n =

2207) in relation to administrative clerks (n = 1177). There is a high inciGJ,ence

of work-related low back injury in nurses ( Bejia et al. 2005). Nurses are

among those professionals with the highest incidence rates of WLBI (Kumar

2004). The annual incidence rate of WLBI among nurses working in hospitals

in France in 1990 was 57% (Niedhammer et al. 1994). The incidence of WLBI

is also high in Italy (Larese & Fiorito 1994). In China, the prevalence rate of

WLBI for nurses at a teaching hospital has been reported as approximately

57% (Smith et al. 2004). These examples show that the WLBI problem is

significant worldwide.

3

Bending, twisting, lifting heavy weights and making forceful movements were

shown to be related to WLBI (Pun nett et al. 1991 ). Combined lifting, prior

injury, and being overweight were found to be risk factors for WLBI among

nurses (Fuortes et al. 1994). Marras et al. (1999) studied manual patient

transfers and repositioning using different techniques; they reported that

manual patient handling is an extremely risky task for WLBI. The authors

stated that 'to have an impact on low back disorders, it is necessary to provide

mechanical lift assist devices'. Transfers take longer when using assistahce

devices (Garg & Owen 1994). Daynard et al. (2001) showed that, despite

reducing the peak load, the use of some devices may increase the total

cumulative load because of the longer time required to perform the transfers.

1.2 Background of the study

The International Labour Organization acknowledged the need for safe and

healthy workplaces for nurses 32 years ago (ILO Convention 149 and

accompanying Recommendation 157, 1977). World health assemblies since

1979 have stressed the value of nurses to the world community and

addressed the need to strengthen nursing and midwifery services, including

providing nurses with safe healthful work environments (WHA 36.11, 42.27,

45.5, 49.12 and 54.12). International, national and local organizations and

many government entities have implanted policies and regulations to protect

nurses. ICN is clear that a safe work environment in the health sector

significantly contributes to patient safety and supports positive patient

outcomes. To that end ICN promotes the development and application of

4

international, national and local policies or instruments that will safeguard the

nurses' right to a safe work environment, including continuing education,

immunisation and protective clothing/equipment.

ICN strongly supports the various ILO Conventions relating to occupational

health and safety and believes that national nurses' associations should:

);;> Urge their respective governments to ensure that all health agencies fall

within the provision of occupational health and safety legislation. This can

be done through lobbying, individual and/or collective political action.

);;> Initiate and/or support research in their countries into the safety and

suitability of the work environment of nurses as well as risk behaviours,

attitudes, procedures and activities.

);;> Sensitize nursing personnel, employers and the public to occupational

hazards in the health sector, including violence or abuse.

);;> Raise nurses' awareness of their rights (as workers) to a safe

environment and of their obligations to protect their safety and promote

the safety of others.

);;> Convince governments and employers to adopt and implement all

necessary measures to safeguard the health and well-being of nurses at

risk in the course of their work, including vaccination when appropriate.

);;> Urge governments/employers to ensure the access of nursing personnel

to protective measures (e.g. clothing) and equipment at no extra cost to

staff;

5

'Jr Encourage nurses to undergo vaccinations relevant to their health and

safety in the workplace.

'Jr Cooperate with the competent authorities to ensure the accuracy of the

List of Occupational Diseases and periodically evaluate its relevance to

nursing personnel.

'Jr Support nurses' claims for compensation in relation to occupational

disease and/or injury.

'Jr Obtain and disseminate information on the incidence of work-related

accidents, injuries and illnesses of nurses.

'Jr Cooperate with other organizations supporting the worker's right to a safe

work environment.

'Jr Recognize the important relationships between workers and their families

in the development of culturally appropriate occupational health and

safety policies and treatment plans.

'Jr Support nurses' freedom from being intimidated in their role of patient

advocate.

'Jr Call for adequate monitoring systems at all levels that will ensure

appropriate implementation of policies.

'Jr Disseminate information on the introduction of new hazards in the

workplace.

Disseminate

occupational

information on non-compliance

health and safety legislation,

mechanisms for such violations.

by employers of

including reporting

6

The work environment of the nurse is frequently unsafe, however, as a result

of:

>- Environmental contamination by waste products resulting from human

and industrial activity.

>- Risks (e.g. chemical, biological, physical, noise, radiation, repetitive

work).

')' Medical technology- lack of maintenance, insufficient training in the use

of technology.

'Y Inadequate access to protective clothing and safe equipment.

'Y The disturbance of everyday life patterns associated with shift work.

>- The increasing demands made upon the emotional, social, psychological

and spiritual resources of the nurse working in complex political, social,

cultural,

>- economic and clinical settings.

'Y Incidents of violence, including sexual harassment.

'Y Poor ergonomics (engineering and design of medical related equipment,

materials and facilities).

'Y Inadequate allocation of resources, e.g. human, financial.

'Y Isolation.

ICN notes that most governments fail to collect current accurate information

on the incidence of accidents, injuries and illness of nursing personnel as the

basis for sound policy formulation. The lack of relevant data is a matter of

great concern. In certain countries, there is no occupational health and safety

legislation. In others, the means to monitor its implementation and the

7

machinery to discipline the offending employers is ineffective or non-existent.

Yet other countries have adopted legislation that excludes hospitals and other

health agencies.

Convention 149 of the International Labour Organization (ILO) concerning

Employment and Conditions of Work and Life of Nursing Personnel calls on

member states to "improve existing laws and regulations on occupational

health and safety by adapting them to the special nature of nursing work and

of the environment in which it is carried out". Section IX of the accompanying

Recommendation (157) further develops the measures considered necessary

to guarantee the health and safety of nurses in the workplace. (ICN 1999)

1.3 Need and significance of the study.

Nurses are the backbone of world health. They work in diverse settings , such

as, hospitals nursing homes, doctors office, clinics, patient homes, with the

homeless and in refugee camps, day care centers, schools, nurseries and

industry. They work in rural areas and cities. Nurses are the principal group of

health care personnel providing primary health care at all levels and

maintaining links between individuals, families, communities and the rest of

the health care system. Although nurses are essential to the health of the

world's population, they, themselves, are often put in physical jeopardy.

Globally, nurses are exposed each day to a variety of health and safety

hazards, including

8

•:• Biological, e.g. diseases such as TB, HIV/AIDS,SARS;

•:• Ergonomic, e.g. heavy lifting;

•:• Psychosocial, e.g. violence and stress;

•!• Chemical, e.g. gluteraldehyde, ethylene oxide;

•:• Physical, e.g. radiation, slips, falls.

Musculoskeletal disorders related to the physical nature of nursing- lifting and

patient handling- continues to cause high rates of morbidity in nurses and

significant loss of worktime. A 1990 epidemiological analysis of compensation

claims in England, Denmark, the United States and Israel showed that nurses

were 5.1 times more likely than cashiers to have a back-related compensation

claim (Harber 1990). A study of nurses and teachers in Ghana showed that

nurses had 21.5 times the rate of lower back pain than teachers (Dovlo 2005).

Of 844 nurses completing a questionnaire in Japan, 85.5% suffered a

musculoskeletal disorder in a12-month period (Smith et.al. 2006). Nurses

must take an active role in protecting the integrity of their work environment.

All nurses have the right to work in a safe and healthy environment with

sufficient staffing, supplies, safety equipment and immunizations for carrying

out their tasks safely and have the right to timely information about potentially

hazardous exposures and the appropriate control measures, including

personal protective equipment provided by the employer. They must report

unsafe conditions-"near-misses" and unsafe or hazardous conditions and

must take reasonable care of their own health and safety at work. They must

refrain from taking unnecessary risks in a situation that is already hazardous.

9

Without the involvement of everyone in the health and safety programmes,

optimal results will never be achieved.

The Sree Chitra Tirunal Institute for Medical Sciences & Technology is an

Institute of National Importance established by an Act of the Indian

Parliament. It is an autonomous Institute under the administrative control of

the Department of Science and Technology, Government of India. It has a

239-bedded hospital for tertiary care of cardiovascular and neurological

diseases. The patients admitted here are at very critical conditions. The CT

and MRI scan are very common diagnostic procedures. The nurses are

involved in caring of these patients and transferring them for scans. So they

are at risk for developing Low Back Pain. Some the nurses and Diploma

students are suffering from back pain. So the investigator felt to conduct a

study to assess the knowledge and preventive measure regarding health

problems among neuronurses.

1.4 State of the problem.

A study to assess to the knowledge and preventive measure regarding health

problem among neuronurses.

1.5 Objectives of the study.

1. To assess the knowledge regarding health problems among

neuronurses.

10

2. To assess the preventive measures regarding health problem among

neuronurses.

3. To identify the relationship of health problems with selected variables.

1.6 Operational definitions.

Health problem - A state in which person is unable to function normally and

without pain.

Low back pain - It refers to pain in the lumbosacral area of spine

encompassing the distance from 1st lumber vertebrae to 1st sacral vertebrae.

1. 7 Methodology

The survey approach is used in this study. The data will be collected from 50

staff nurses who are working in NMICU, NSICU, NSW and NMW of

SCTIMST. A self prepared multiple choice questionnaire is given to collect

data related to low back pain. The duration of the study is August to october

2009.

1.8 Tool

The investigator assessed the neuronurses knowledge and preventive

measure regading low back pain by using a self prepared questionnaire. The

experts in neurology department validated this content.

11

1.9 Delimitations.

The study is conducted in NMICU, NSICU, NMW and NSW of SCTIMST. The

size of the sample is 50 permanent staff nurses.

1.10 Organization of the report.

This chapter deals with introduction, background of the study, need and

significance of the study, statement of the problem, objective, operational

definitions, methodology and delimitations. Chapter 2 deals with review of

literature. Chapter 3 deals the methodology. Chapter 4 presents analysis and

interpretation of the data and chapter 5 include summary, discussion,

conclusion and recommendations. Reference and appendixes are given

towards the end.

12

CHAPTER- 2

REVIEW OF LITERATURE

2.1 Introduction

Review of literature is the keep step in research process . If refers to a broad ,

comprehensiv , in depth, systematic and critical review of scholarly,

publications, unpublished scholarly, print materials and audio visual materials

(Basvanthappa 2001 ). According to Cooper (1988) ' a literature review uses

as its database reports of primary or original scholarship, and does not report

new primary scholarship itself. The primary reports used in the literature may

be verbal, but in the vast majority of cases reports are written documents. The

types of scholarship may be empirical, theoretical, critical/analytic, or

methodological in nature. Second a literature review seeks to describe,

summarise, evaluate, clarify and/or integrate the content of primary reports.'

A crucial element of all research degrees is the review of relevant literature.

So important is this chapter that its omission represents a void or absence of

a major element in research (Afolabi 1992).

2.2 Studies related to low back pain in nurses.

2.3 Studies related to low back pain in hospital staff.

13

2.2 Studies related to low back pain in nurses.

Hou et al; (2006) conducted a cross-section study to understand the risk

factors and prevalence of musculoskeletal discomfort in different body parts

among nurses in Taiwan using a self administered questionnaire. A total of

5,269 nurses completed the quesstionnaire survey. Researchers found that

lower back was the most commonly reported site of discomfort followed by

lower legs, shoulder and neck. According to investigators the risk fators for

pain in neck and shoulder were waist-bending and waist-twisting, for pain in

lower lower back were duration of standing, waist bending and weight lifting

and for lower legpain were duration of standing and weight lifting.

Sun et al; (2007) conducted a study to explore the prevalence of occupational

low back pain and work-related risk factors in ICU nurses. Four hundered and

fourty seven ICU nurses (study group) and nurses working in other wards

(control group) of the same hospital were investigated using Occupational

Low Back Pain Investigation Questionnaire for nurses. According to the study

prevalence of occupational low back pain in ICU nurses was higher than the

control group. High frequency of bending and twisting, transferring patients in

bed were the main cause of occupational low back pain in ICU nurses

according to the authors.

Maul et al; (2003) conducted a longitudinal study with follow up at one and

eight years among nurses employed by a large university hospital in

14

switzerland. A modified version of the Nordic Questionnaire was distributed to

obtain information about demographic data, occupational activities and

various aspects of low back pain. By this study the investigator concluded that

low back pain poses a persistent problem among nurses and over an eight

year period almost half the nurses indicated the same intensity of low back

pain, thus supporting a recurrent rather than a progressive nature of low back

pain.

Chiou et al; (1994) conducted a study to analyze the related factors of low

back pain in nurses from the view of epidemiology, so as to offer a reference

in the designing/redesigning of nurses work and training programs. In this

study 3,21 nurses were surveyed in november 1991 and only 3,159 copies of

the questionnaire were valid for investigation. According to the study those

who worked in the Taipei area and the neurological department were more

aware of low back health care, as well as those who were head nurses and

those who had graduated from university. Head nurses had better posture

than the staff nurses. Head nurses and nurses working in ICU, and those who

were married and had borne children or had a history of abortion, had a

higher incidence of low back pain. Acording to investigators the risk factors for

low back pain were age, height, weight, duration of work, working habits and

sitting posture and the causes of low back pain were lifting heavy objects and

prolonged sitting.

Mohseni (2006) conducted a study to identify the prevalence and risk factors

for low back pain in nursing personnel and to analyze how individual and

15

occupational characteristics contribute to the risk of low back pain. One

thousand two hundered and twenty six nurses were randomly recruited from

general hospital in northern Iran. Different questionnaires were desinged to

cover personal and professtional data, the prevalence, and association of risk

factors with low back pain. Result of the study indicated that the prevalence of

low back pain in nurses was over 50%, lifting was the most common

mechanism for low back pain and the prolonged standing and rest were the

significant aggravating and relieving factors. The investigators concluded that

the magnitude of low back pain among nursing personnel appears to be high

and therfore more resources should be allocated to prevent such an injury

occuring in the nursing profession.

1Sienkiewicz (2007) conducted a study to investigate correlation between

strain on the spine, work place and years spent in work among 937 nurses

working in health care units in the Warsaw district area, using diagnostic

survey and questionnaire sheet including 70 question divided into 6

categories. The author concluded that this study confirmed earlier hypotheses

that strain on skeletal and muscles, non professtional and constrained body

poisition in relation to years worked in profession had significantly satistical

correlation on a level of 0.005, chi2=16.768. Strain on the spine is also

dependent upon ward in which nurses work and upon characteristic of

executed work.

\

Smedley (1998) conducted a study to assess the natural history of low back

pain. One thousand one hundred and sixty five nurses completed a baseline

16

questionnaire and up to 8 follow up questionnaire 3 months apart. The results

confirmed the imporance of back pain duration and occurrence of associated

disability and sciatica as predictors of future symptoms and allow more

reliable quantification of the natural history of back pain in women of working

age.

Dosoglu et al; (2009) conducted a cross-sectional study to investigate the rate

of low back pain in nurses working in different departments and to evaluate

the relationship between psychologic factors and low back pain. To evaluate

general aspects of low back pain Oswestry Low Back Pain and Disability

Questionnaire and 1 Ocm visual analog scale was used by the author among

118 nurse. To evaluate psychologic state Beck Depression Inventory and

Brief Symptom Inventory was used by the author. The author says that the

mean number of pain atttacks was significantly higher among nurses working

in ICU than those in surgery department and internal medicine department,

the mean Beck Depression Inventory score of subjects with pain was

significantly higher than those without pain and the mean Brief Stmptom

Inventory Score of depression was significantly higher in subjects with pain

than in subjects without pain.

2.3 Studies related to low back pain in hospital staff

Sanya et al; (2005) conducted a study to investigate the risk factors for low

back pain among workers in hospitals in lbadan under the Oyo State Hospital

Management Board using a two-part questionnaire. Six hundred and seventy-

17

five questionnaires were circulated and self administered out of which 446

were duly completed and returned, representing a response rate of 66%.

According to the investigators the point prevalence of low back pain for the

hospital workers was 20.6% while the 12-month prevalence was 47.8% and

Job tasks which predisposed significantly to low back pain were: lifting (P <

0.01 ), bending (P < 0.01 ), and staying in the same position for over 3 hours (P

< 0.01). The investigators recommended that this group of workers should

adopt good lifting techniques associated with good postural awareness in

bending.

Karahan et al; (2009) Conducted a study to describe the prevalence and risk

factors for lower back pain amongst a variety of Turkish hospital workers

including nurses, physicians, physical therapists, technicians, secretaries and

hospital aides using a 44-item questionnaire which was completed by 1600

employees in six hospitals associated with one Turkish university using a

cross-sectional survey design. Data were collected over nine months from

December 2005 to August 2006. Acording to the authors most respondents

(65·8%) had experienced low back pain, with 61·3% reporting an occurrence

within the last 12months, the highest prevalence was reported by nurses

(77 ·1%) and the lowest amongst secretaries ( 54·1%) and hospital aides

(53·5%), in the majority of cases (78·3%), low back pain began after

respondents started working in the hospital, 33·3% of respondents seeking

medical care for 'moderate' low back pain, while 53·8% (nD=D143) had been

diagnosed. with a herniated lumbar disc. Age, female gender, smoking,

occupation, perceived work stress and heavy lifting were statistically

significant risk factors according to the authors. The investigators concluded

18

that preventive measures should be taken to reduce the risk of lower back

pain, such as arranging proper rest periods, educational programmes to teach

the proper use of body mechanics and smoking cessation programmes.

Omokhodion et al; (2000) Conducted a cross-sectional study in a rural

hospital in south-western Nigeria to determine the prevalence of low back

pain among it staff using the questionnaire which is administered to staff to

sought information on social and demographic characteristics, job history,

smoking status, frequency and severity of low back pain and factors

predisposing to low back pain. Seventy-four out of a total of eighty workers

participated in the study. According to the study the prevalence of low back

pain among staff was 46%, the highest prevalence of back pain (69%) was

recorded among nursing staff, followed by secretaries/administrative staff

(55%) and cleaners/aides (47%). Heavy physical work (45%), poor posture

(20%) and prolonged standing or sitting (20%) were the most frequent

activities reported to be associated with low back pain among these workers.

The investigators concluded that health education on posture and correct

lifting techniques can be introduced to reduce the burden of low back pain

among these workers.

19

•!• The key terms used for search

http://www.ncbi.nlm.nih.gov\pubmed

Keyword No of Articles

Low back pain in nurses 404

Low back pain among hospital staff 629

Assessment of nurses knowledge 140

regarding low back pain

20

CHAPTER- 3

RESEARCH METHODOLOGY

3.1 Introduction

Research methodology is the systemic way to solve the research problem. It

includes the step that researcher adopts to study his problem with the logic

behind (Kothari 1990). It indicates the general pattern of organizing the

procedure of gathering valid and reliable data for an investigation. This

chapter provides a brief description of the method adopted by the investigator

to conduct this study. This chapter includes the research approach, research

design, setting of the study and sampling technique .It further deals with the

development of the tool, procedure for the data collection and plan for data

analysis.

3.2 Research approach

The survey approach was selected as the objectives of the study were (1) to

assess the knowledge regarding health problems among neuro nurses. (2) to

assess the preventive measures regarding health problems among neuro

nurses.(3) to identify the relationship between health problems and with

selected variables. More over survey approach is suitable for educational fact

finding in a relatively small sample

21

3.3 Research design

To accomplish the objectives of the study a survey design is used for data

collection and analysis of the data. In order to assess the knowledge

regarding health problem particularly about low back pain data were collected

from nurses by self prepared questionnaire including 10 question based on

various aspects such as meaning of low back pain , risk factors ,treatment etc.

3.4 Setting of the study

This study was conducted in neuro medical units and neuro surgical units of

Sree Chitra Tirunal Institute for Medical sciences and technology, is an

institution of national importance where there is a separate department for

neuro medical and surgical unit, which include neurology medical and surgical

wards, comprehensive neuro medical and surgical intensive care unit.

3.5 Study population

The target population of the study was both male and female permanent staff

nurses in the neuro medical and surgical unit.

22

3.6 Sample and sampling techniques

Random sampling technique was used to select the samples for the study.

Two-stage random sampling was used for the present study .In the first stage,

10 samples were selected for the pilot study. In the second stage the 50

samples were selected for this study.

In these study approximately 60 populations is included. Out of this

investigator look 50 samples for study from four weeks duration .The duration

of study period included from 20 September 2009 to 20 October 2009.

3. 7 Criteria for sample selection

The samples selected were based on the following criteria.

Inclusion criteria

+ Nursing staff working in NMICU, NMW, NSICU and NSW

• Nurses who are willing to participate.

Exclusion criteria

• Nurses working in other departments.

• Nurses who are not willing are excluded from the study.

• Ward in charge sister and temporary staff nurse.

23

3.8 Development of Tool

Data collection tool refers to the instrument which was used by the

investigator to obtain relevant data .An extensive review and study of

literature helped in preparing items for the tool. A self-prepared questionnaire

is used as tool for the study to collect data. The tool was examined by experts

of Sree Chitra Tirunal Institute for Medical sciences And Technology. The

research tool was finalized according to expert's opinion.

3.9 Description of the tool

The structured questionnaire consist of two sections

Section-1: General information Or Demographic data.

Section-2: It consists of a total 12 questions regarding knowledge of staff

nurses about low back pain and preventive measures followed.

3.10 Pilot study

A pilot study was conducted from 15/9/2009 to 17/9/2009 after obtaining

permission from the authorities among 10 diploma in neuronursing and

diploma in cardiovascular and thoracic nursing students working in intensive

care units. The aim of the pilot study was to find out the practicability and

feasibility of the tool. The pilot study gave more information about research

study. The total time period requited was 5 to 10 minutes. The pilot study

samples were excluded from the main study. The finalized tool was used to

24

assess knowledge of staff nurses about low back pain and preventive

measures followed. The pilot study findings reveled that the study was

feasible and practicable.

3.11 Data collection procedure

For data collection formal permission was obtained from the authorities. The

investigator first introduced and explained the need and purpose of the study.

Confidentiality of their responses was assured. The nursing staffs were

interviewed with the structured tool. The time taken for the assessment was

about 5 to 10 minutes.

3.12 Plan of analysis

The investigator developed a plan for data analysis after the data collection.

The data obtained from the nursing staff using self- prepared questionnaire

would be analyzed by descriptive statistics and present in the form of bar

diagram. Percentages would be used for describing the sample.

3.13 Summary

This chapter presented the research approach used for the study, research

design of the study, setting of the study, sample and sampling techniques,

development of description of tool, pilot study, data collection procedure and

plan for analysis.

25

CHAPTER-4

ANALYSIS AND INTERPRETATION

4.1 Introduction

Analysis is the categorizing, ordering, manipulating and summarizing the data

to an intelligible and interpretable form so that the research problem can be

studied and tested including relationship between variables. (kerlinger 1986)

Interpretation refers to the process of making sense of the results and

examining the implications of the findings with in a broad context.

4.2 Distribution of sample according to demographic data.

4.3 Neuro nurses knowledge regarding back pain.

4.4 Preventive measures followed by neuro nurses for back pain.

4.2 Distribution of sample according to demographic data.

4.2a Distribution of sample by age.

The age of the nurses ranged from 24 to 52 years with a mean of 35.04,

median 35 and mode 25. The age distribution is given in Table 4.2a.

26

Table 4.2a

Distribution of sample by age.

Age Group Frequency Percentage

<30 years 17 34%

30-39 years 17 34%

40-49 years 13 26%

>50 years 3 6%

Total 50 100%

The data given in table 4.2a show that majority of nurses (68%) were below

40 years. The same data is shown as bar diagram in the figure4.2a.

18

16

~ 12 i 10 ::s e- 8

LL. 6

4 2 0

Fig4.2a Distribution of sample by age

<30 years

30-39 years

40-49 years

Age group

Fig 4.2a

>50 years

II <30years

II 30-39 years

[] 40-49 years

>50 years

27

4.2b Distribution of sample by area of work.

The work area distribution is given in the table 4.2b

Table No 4.2b

Distribution of sample according to area of work

Area of work No. of staff Percentage

NSICU 13 26%

NMICU 13 26%

NSW 12 24%

NMW 12 24%

Total 50 100%

The data given in table 4.2b show that nurses working in NMICU, NSICU,

NMW and NSW. The percentage is almost same in both ICU staffs and ward

staffs. The same data is shown as pie diagram in the figure 4.2b

Fig.4.2b. Distribution of sample by area of work

Fig. 4.2b

IINMICU

DNSW

DNMW

26

Table 4.2a

Distribution of sample by age.

Age Group Frequency Percentage

<30 years 17 34%

30-39 years 17 34%

40-49 years 13 26%

>50 years 3 6%

Total 50 100%

The data given in table 4.2a show that majority of nurses (68%) were below

40 years. The same data is shown as bar diagram in the figure4.2a.

Fig4.2a Distribution of sample by age

• <30 years

• 30-39 years

• 40-49 years

• >50 years

<30 30-39 40-49 >50 years years years years

Age group

Fig 4.2a

27

4.2b Distribution of sample by area of work.

The work area distribution is given in the table 4.2b

Table No 4.2b

Distribution of sample according to area of work

Area of work No. of staff Percentage

NSICU 13 26%

NMICU 13 26%

NSW 12 24%

NMW 12 24%

Total 50 100%

The data given in table 4.2b show that nurses working in NMICU, NSICU,

NMW and NSW. The percentage is almost same in both ICU staffs and ward

staffs. The same data is shown as pie diagram in the figure 4.2b

Fig.4.2b. Distribution of sample by area of work

• NSICU

• NMICU • NSW • NMW

Fig. 4.2b

4.2c Distribution of sample by experience in nursing.

The nursing experience distribution is given in the table 4.2c

Table No 4.2c

Distribution of sample by experience in nursing

Experience in nursing in years Frequency Percentage <5 9 18%

5-15 18 36%

15-25 18 36%

>25 5 10%

Total 50 100%

data given in table 4.2c show 1 hat majority of nurses (72%)

experienced between 5 to 25 years. The same data is shown as bar diagram

in the figure4.2c

Fig.4.2c Distribution of sample according experience in nursing

Frequency

Frequency Year of Experience

Fig4.2c

29

4.2d Distribution of sample by experience in neuronursing.

The neuronursing experience distribution is given in the table 4.2d

Table No 4.2d

Distribution of samples by experience in neuronursing

Experience in neuronursing in years Frequency Percentage

<5 21 42%

5-15 18 36%

>15 11 22%

Total 50 100%

The data given in table 4.2d show that majority of nurses (78%) were

experienced between 5 to 15 years. The same data is shown as cone

diagram in the figure4.2d.

Fig4.2c Distrbution of sample according to experience in neuronursing

Frequency

Year of experience

Fig4.2d

30

4.3 Neuronurses knowledge regarding back pain.

Knowledge of 50 neuronurses regarding back pain ranged from 5 to 10

(maxmimum score 10) with a mean of 7.74 ± 1.17, median 8 and mode 7.

This shows that mean knowledge of neuronurses with regard to back pain is

above average. The relationship with neuronurses knowledge and selected

variables are shown in Table 4.3a and 4.3b.

Table 4.3a

Mean, standard deviation and p value of neuronurses knowledge by

age.

Age in years Mean(S.D) p value

<3 7.58(1.25) 0.37

>35 7.89(1.11)

The Table 4.3a show the knowledge of neuronurses with age less than 35

years range from 5 to 9 with a mean of 7.58 ±1.25 and with age more than 35

years range from 6 to 10 with a mean of 7.89 ± 1.11.The neuronurses with

age more than 35years have more mean knowledge than neuronurses with

age less than 35 years. By doing student t test there is no statistical difference

in the mean knowledge (p = 0.37) of neuronurses about back pain with regard

to age.

31

Table 4.3b

Mean, standard deviation and p value of neuronurses knowledge by

experience in neuronursing

Experience in neuronursing Mean(S.D) p value

-

<5 Years 7.55(1.14) 0.3

>5 Years 7.89(1.2)

The Table 4.3b shows the knowledge of neuronurses with less than 5 years of

experience in neuronursing range from 5 to 9 with a mean of 7.55 ±1.14 and

with more than 5 years of experience in neuronursing range from 6 to 10 with

a mean of 7.89 ±1.2. The neuronurses with more than 5years of experience in

neuronursing have more mean knowledge than neuronurses with less than 5

years of experience in neuronursing. By doing student t test there is no

statistical difference in the mean knowledge (p = 0.3) of neuronurses about

back pain with regard to experience in neuronursing.

32

4.4 Preventive measures followed by neuro nurses for back

pain.

Table 4.4

The table 4.4 shows the preventive measures followed by neuro nurses

for back pain

Preventive measures Frequency Percentage

Yes No

Regular exercise 37 13 74% 26%

Proper Body Mechanism 34 16 68% 32%

Team work 27 23 54% 46%

Maintaining BMI 20 30 40% 60%

Physiotherapy 11 39 22% 78%

Medications 6 44 12% 88%

Lumbar bracing and 4 46 8% 92%

······Back belts

The table 4.4 shows that that majority (74%) of nurses follow regular exercise

to prevent back pain. The same data is shown in Fig 4.4.

33

Fig.4.4 Preventive measures followed by the neuronurses

40

35

30

» 25 o

3 20 O" * 15

10

5

0

27

20

6

• Regular exercise

• Proper Body Mechanism

• Team work

• Maintaining BMI

• Physiotherapy

• Medications

• Lumbar bracing and Back belts

Preventive measures

Fig 4.4

4.5 Summary

This chapter deals with analyses and interpretation of data collected from fifty

neuronurses of SCTIMST, Trivandrum. Descriptive statistics were used for

analysis. Bar and pie diagram were used to illustrate the findings of the study.

34

CHAPTERV

SUMMARY, CONCLUSIONS, DISCUSSION AND

RECOMMENDATIONS

5.1 Introduction

A brief account of the study is given in this chapter, which cover objectives,

findings of the study and possible application of the result. Recommendation

for future research and suggestion for improving the present study are also

presented.

5.2 Summary

This study was conducted with the objectives to assess the knowledge and

preventive measure regarding health problems among neuronurses and to

identify the relationship of health problems with selected variables. A review of

related research literature helped the investigator to get a clear concept about

the topic under taken, as well as to develop tools, methodology of the study

and decide plan of data analysis.

The study was conducted in NMICU, NSICU, NSW and NMW of SCTIMST;

the size of the sample was 50. Permanent staff nurses excluding sister in­

charge were included in this study. The duration of the study was from August

35

2009 to October 2009. A self-prepared questionnaire was used for collecting

data, it contains 12 questions regarding knowledge and preventive measures

and demographic data were also collected. The data was analyzed and

interpreted using descriptive statistics.

5.3 Objectives of the study

1. To assess the knowledge regarding health problems among

neuronurses.

2. To assess the preventive measures regarding health problems among

neuronurses.

3. To identify the relationship of health problems with selected variables.

5.4 Limitation.

The study is limited to staff nurses working in NMICU, NSICU, NMW and

NSW of SCTIMST.

5.5 Major findings of the study.

Knowledge of 50 neuronurses regarding back pain ranged from 5 to 10

(maxmimum score 10) with a mean of 7.74 ± 1.17, median 8 and mode 7.

This shows that mean knowledge of neuronurses with regard to back pain is

above average.

36

The knowledge of neuronurses range from 5 to 9 with a mean of 7.58 ± 1.25

(age < 35) and from 6 to 10 with a mean of 7.89 ± 1.11 (age> 35). There was

no significant difference between the mean knowledge of neuronurses about

back pain with regard to their age.

The knowledge of neuronurses range from 5 to 9 with a mean of 7.55 ± 1.14

(experience < 5) and from 6 to 1 0 with a mean of 7.89 ± 1.2

(experience>5).There was no significant difference between the mean

knowledge of neuronurses about back pain with regard to experience in

neuronursing.

The preventive measures followed by the majority of nurses were regular

exercise (74%) and proper body mechanism (68%).

5.6 Recommendations for the future study.

Keeping in mind the findings and limitations of the study, the following

recommendation were made for future research.

1. Similar study would be reported in other intensive care units and wards

of this institute.

2. Similar study can be reported by increasing the size of the sample.

37

5. 7 Discussion.

There are many studies related to the different aspects of low back pain

among nurses. This present study emphasized to assess the knowledge and

preventive measure regarding health problems among neuronurses using a

self prepared questionnaire. The aim of the study is to assess the knowledge

regarding health problems among neuronurses, to assess the preventive

measures regarding health problems among neuronurses and to identify the

relationship of health problems with selected variables. Mohseni (2006)

conducted a study to identify the prevalence and risk factors for low back pain

in nursing personnel. The study indicated that the prevalence of low back pain

in nurses was over 50%. Karahan et al; (2009) conducted a study to identify

the prevalence and risk factors for low back pain in hospital workers.

According to the authors most respondents (65·8%) had experienced low

back pain and the highest prevalence was reported by nurses (77·1%) and

the lowest amongst secretaries (54·1 %) and hospital aides (53·5%).

Omokhodion et al; (2000) conducted a study to determine the prevalence of

low back pain among it staff. According to the study the prevalence of low

back pain among staff was 46%, the highest prevalence of back pain (69%)

was recorded among nursing staff. Chiou et al; (1994) conducted a study to

analyze the related factors of low back pain in nurses from the view of

epidemiology. The study revealed that for low back pain treatment physical

therapy was the nurse's first choice and operation was the last choice.

38

In this study the questionnaire includes issues on presence of low back pain

risk factors, region of low back pain, physiotherapy, treatment of choice and

drug of choice. The results of the above studies were comparable. In the

present study 30% of the neuronurses have low back pain. The preventive

measures followed by the neuronurses are regular exercise (74%) and proper

body mechanism (68%). The more resources should be allocated to prevent

low back pain occurring in the nursing profession. To validate the findings

more sample size is needed.

5.8 Conclusion.

Based on the findings of the study, the following conclusions were drawn.

The mean knowledge of neuronurses working in ICU and wards with regard to

low back pain is above average. The study shows that there was no

significant difference between mean knowledge of nurses about low back pain

with regard to their age and experience in neuronursing.

39

REFERENCE

1) Afolabi, M. (1992), The review of related literature in research,

International journal of information and library research, 4(1), 59-66.

2) Basavanthappa, B.Y. (1999), Nursing research, second edition,

Newdelhi, jaypee brother medical publishers, 225-260.

3) Battie, M. C and Videman, K. T. (1997). Musculoskeletal Disorders in

the Workplace: Principles and Practice, St. Louis MO: Mosby-Year Book

Inc.

4) Bejia, I. et al. (2005), Prevalence and factors associated to low back

pain among hospital staff , Joint Bone Spine, 72(3), 254-259.

5) Borenstein, D. G. (1999), Epidemiology, etiology, evaluation and

treatment of low back pain, Current Opinion In Rheumatology, 11, 151-

157.

6) Chiou, W.K. et al. (1994), Epidemiology of low back pain in Chinese

nurse4s, International journal of Nursing studies, 31 (4), 361-368.

7) Choi, B. C. K. et al. (2001 ), Developing regional workplace health and

hazard surveillance in the Americas, Pan American Journal of Public

Health, 10, 376-381.

8) Cooper, H. M. (1988), The structure of knowledge synthesis, Knowledge

in Society, 1, 104-126.

40

9) Daynard, D. Yassi A. et al (2001), Biomechanical analysis of peak and

cumulative spinal loadsduring simulated patient-handling activities: a

substudy of a randomized controlled trial to prevent lift and transfer

injury of health care workers, Applied Ergonomics, 32(3), 199-214.

10) Dolvo, 0.(2005), Wastage in the health workforce: some perspectives

from African counties, Human Resource Health, 3(6) [on-line] August,

2006.Available at

http :/www. pubmedcentral.gov/articlerender. fcgi?tool=pmcentrez&artid= 1

198245.

11) Dosoglu et al. (2009), Low back pain among nurses: a review,

Neurosurgery Quarterly, 19(1 ), 29-34.

12) Fuortes, L. J. et al. (1994), Epidemiology of back injury in university

hospital nurses from review of workers compensation records and a

case-control survey, Journal of Occupational Medicine, 36, 1022-1026.

13) Garg, A. and Owen, B. (1994), Prevention of back injuries in healthcare

workers, International Journal of Industrial Ergonomics, 14(4), 315-331.

14) Gordon, S. L. and Weinstein, J. N. (1998), A review of basic science

issues in low back pain, Physical medicine and rehabilitation Clinics of

North America, 9, 323-342.

15) Harber, P. (1990), Occupational Back Pain of Nurses, The Western

Journal of Medicine, 175-176.

16) Hasselhorn, H. M. et al. (1999). Occupational Health for health Care

Workers: A Practical Guide, Elsevier Science, Amsterdam.

41

17) Hofmann, F. et al. (2002), Low back pain and lumbago-sciatica in

nurses and a reference group of clerks: results of a comparative

prevalence study in Germany, International Archives of Occupational

and Environmental Health, 75(7), 484-490.

18) Hoogendorn, W. E. et al. (1999), Physical load during work and leisure

time as risk factors for back pain, Scandinavian Journal of Work

Environment and Health 25, 387-403.

19) Hou, J. et al. (2006), Risk factors for musculoskeletal discomfort in

nurses, The Journal of Nursing Research, 14(3), 228-36.

20) International Council of Nurses, (1999). Position Statement:

Occupational Health and Safety for Nurses, [online]. Available at:

www. icn. ch/pshealthsafetyOO. htm.

21) International Labour Organization, (1977). Recommendation 157,

Nursing Personnel Recommendations, [online]. Available at:

www.ilo.org/ilolex/english/recdispl.htm

22) Jin, K. et al. (2000), Risk factors for work-related low back pain in the

People's Republic of China, International Journal of occupational

Environmental Health, 6, 26-33.

23) Karahan et al. (2009), Low back pain: prevalence and associated risk

factors among hospital staff, Journal of advanced nursing, 65(3), 516-

524.

24) Kumar, S. (2004), Ergonomics and biology of spinal rotation,

Ergonomics, 47(4), 370-415.

42

25) Lagerstrom, M. (1998), Work-related low-back problems in nursing,

Scandinavian Journal of Work Environment and Health, 24, 449-464.

26) Larese, F. and Fiorito, A. (1994), Musculoskeletal disorders in hospital

nurses: a comparison between two hospitals, Ergonomics, 37(7), 1205-

1211.

27) Lawrence, R. C. (1998), Estimates of the prevalence of arthritis and

selected musculoskeletal disorders in the United States, Arthritis

Rheumatoid, 41, 778-799.

28) Marras, W.S. et al. (1999), A comprehensive analysis of low-back

disorder risk and spinal loading during the transferring and repositioning

of patients using different techniques, Ergonomics, 42(7), 904-926.

29) Maul, I. et al. (2003), Course of Low Back Pain among Nurses; A

Longitudinal Study across Eight years, Occupational and Environmental

Medicine, 60, 497-503.

30) Mohseni-Bandpei, M. et al. (2006), Occupational back pain in Iranian

nurses, an epidemiological study, British Journal of Nursing, 15(17),

914"'-917.

31) Nachemson, A.L. (1999), Back pain: Delimiting the problem in the next

millennium, International Journal of Law and Psychology, 22, 473-490.

32) Niedhammer, I. Et al. (1994), Back pain and associated factors in

French nurses, International Archives of Occupational and

Environmental Health, 66(5), 349-357.

43

33) Omokhodion, F.O. et al. (2000), Prevalence of low back pain among

staff in a rural hospital in Nigeria, Journal of occupational medicine, 50,

107-110.

34) Punnett, L. et al. (1991), Back disorders and non-neutral trunk postures

of automobile assembly workers, Scandinavian Journal of Work

Environment and Health, 17: 337-346.

35) Sanya, A.O. et al. (2005), Risk factors for low back pain among hospital

workers in lbadan, Oyo state, Nigeria. Journal of the Nigeria society of

physiotherapy, 15(20, 31-34.

36) Sienkiewicz, Z. et al. (2007), Strain on Spine-Professional threat to

nurses health, Advance medical science, 52(1), 131-135.

37) Smedley, J. et al. (1998), Natural history of low back pain- a longitudinal

study in nurses, Spine, 23(22), 2436-2471.

38) Smith, D.R. et al. (2004), Musculoskeletal disorders among professional

nurses in mainland China, Journal of Professional Nursing, 20(6), 390-

395.

39) Smith, D.R. et al. (2006), A detailed analysis of musculoskeletal disorder

risk factors among Japanese nurses, Journal of Safety Research, 37(2),

195-200.

40) Sobti, A. et al. (1997), Occupational physical activity and long-term risk

of musculo skeletal symptoms: A national survey of post office

pensioners, American journal of indutrial medicine, 1997; 32(1):76-83.

44

41) Sun, J. et al. (2007), Prevalence and risk factors of occupational low

back pain in ICU nurses, Chinese journal of industrial hygiene and

occupational diseases, 25(8), 453-455.

42) World Health Organization (1983). World Health Assembly

Recommendation 36.11 The Role of Nursing and Midwifery Personnel in

the Strategy for Health of All, [online]. Available at

www.who.int/hrh/nursing_midwifery/resolutions/en/index. html

43) World Health Organization, (1989). World Health Assembly

Recommendation 42.27, Strengthening Nursing/Midwifery in Support of

the Strategy for Health for all, [online]. Available at:

www.searo.who.int/LinkFiles/HRH_Documents_WHA42.27.pdf

44) World Health Organization, (1992). World Health Assembly

Recommendation 45.5, Strengthening Nursing and Midwifery in Support

of Strategies for Health for All,[ online] Available at:

http://www.searo.who.int/LinkFiles/HRH_Documents_WHA45.5.pdf

45) World Health Organization, (1996). World Health Assembly

Recommendation 49.12, WHO Global Strategy for Occupational Health

for All, [online]. Available at:

www. who. i nt/occu pational_health/publications/wha49rep/ en/

APPENDIX

ACUTE LOW BACK PAIN QUESTIONNAIRE

SECTION A

DEMOGRAPHIC DATA

Age

Sex

Height

Weight

Unit

Year of experience in nursing

Year of experience in neuronursing

SECTION 8

Read the question carefully and tick the correct answer.

1. Work-related musculoskeletal disorders include injury to

A. Muscle.

B. Tendon.

C. Nerve.

D. All the above.,

2. Risk factors for musculoskeletal disorders are all of the following

except

A. Fixed or constrained position.

B. Improper body mechanism.

C. Smoking.

D. Drinking.

3. Which area of back is more prone to injury?

A Cervical.

B. Thoracic.

C. Lumbar.

D. Sacrum.

4. If straight leg raising test is positive it indicates

A. Space occupying lesion.

_ B. Disk herniation.

C. Canal stenosis.

D. Vertebral diskitis.

5. The first choice of treatment for acute low back pain is

A. Surgery.

B. Medication.

C. Physiotherapy.

- D. Bed rest.

6. The steps followed in the treatment of acute low back pain is

A. Cold and heat application, bed rest, physiotherapy,

medication, surgery.

B. Bed rest, cold and heat application, physiotherapy,

medication, surgery.

C. Physiotherapy, medication, surgery, Bed rest, cold and heat

application.

D. Medication, surgery, cold and heat application, bed rest,

physiotherapy.

7. In case of acute low back pain when should you go for physiotherapy?

A. When pain is present.

B. When pain is severe.

C. When pain is absent.

D. Not recommended.

8. If you have acute low back pain then

A. Heat application should be followed by cold.

, B. Cold application should be followed by heat.

C. Heat and cold application simultaneously.

D. Not recommended.

9. If you have acute low back pain then while sleeping in supine position

pillow should be placed under the

A. Shoulder.

B. Back.

~ C. Knees.

D. Head.

10. Drug of choice for acute low back pain is

_ A. Non Steroidal Anti-inflammatory Drugs.

B. Opiods.

C. Narcotics.

D. Muscle relaxant.

11. Do you have back pain?

A. Yes.

B. No.

12. What are the preventive measures followed by you to prevent acute

low back pain?

A

B.

C.

Regular exercise.

Lumbar bracing.

Back belts.

D. Medication.

E. Physiotherapy.

F. Maintaining Body Mass Index.

G. Team work.

H. Proper ~ody mechanism.

I. If any other please mention ................... .