PERFORMA FOR REGISTRATION OF SUBJECT FOR DESERTATION

  1. Name of the candidate and address:

Mr. RAKESH SHARMA

JSS COLLEGE OF NURSING,

MYSORE

  1. Name of the institution:J.S.S. COLLEGE OF NURSING
  1. Course of study and subject: M.Sc.Nursing, Medical Surgical Nursing
  1. Date of admission to the course: 11-05-2007
  1. Title of the topic:

“An exploratory and evaluative study of the incidence and intensity of Back Pain, related absenteeism and effectiveness of planned teaching and selected exercises programme regarding prevention and management of Back Pain among nurses, at selected hospitals of Mysore.”

  1. Brief resume of the intended work

Introduction

Traditionally health has been defined in terms of absence or presence of disease. Nightiangle defined health as a state of being well and using power the individual possesses to the fullest extent. Health, wellness, and well-being have many definitions and interpretations.1

The World health organization (WHO) takes a more holistic view of health. Its constitution defines health as “a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity”.2

Illness is state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired, compared with previous experience.3Disease can be described as an alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span.1

The ability to perform complex and precise movements permits human beings to interact and adapt to the environment. Proper functioning of the musculoskeletal system makes such movements possible. The musculoskeletal system is the largest organ system of the human body consisting of bones, muscles, joints, cartilage, ligaments, tendons, fascia, and bursae.4

Human’s back has 30 bones called vertebrae stacked on top of each other like a pack of cards except that between each two cards lies a flexible pad-like disc. These discs are like shock absorbers with a soft gel-like substance in their center to help cushion the jolts and jerks caused by simple movements like running and jumping. The whole structure extending from the base of the skull to buttocks is called vertebrae/ spinal column or, in lay man’s language, the backbone. 5

Body mechanics is the application of physical laws to the human body. The bones of body act as levers or simple machines, with the muscles supplying the force to move them. The discipline of biomechanics applies mechanical laws and principles to study how the body can perform more and better work with less energy.6

Pain is experienced by every person to some degree. It is, however, a very individualized experience and is difficult to define or understand. It is an unpleasant feeling, entirely subjective, that only the person experiencing it can describe or evaluate. Pain is learned experience that is influenced by the entire life situation of each person. 7

Pain in the back is a complex multifaceted health problem that represents excitatory challenges to health care provider. Back pain affects the physical, psychological, emotional, financial, and social aspects of a person’s life. 8

Chronic low back pain (CLBP) remains one of the most difficult and costly medical problems in the industrialized world. A review of nineteenth and early twentieth century spine rehabilitation shows that back disorders were commonly treated with aggressive and specific progressive resistance exercise (PRE). 9

If you have ever groaned, "Oh, my aching back!” you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months. 10

A back pain results from damage to one of the joints, ligaments, discs of the spine or may simply arise because of over-stretching or twisting the back to an awkward potion. With repeated stress,vertebral joints get misaligned, irritating nerves or bony spurs sprout, muscles and soft tissue stretch unevenly and nerves become irritated. Pain is the obvious outcome of these anatomical aberrations. Even though a sudden back pain may occur after a sneeze or while doing a twist or lifting heavy weights, most back pain are said to be cumulative in their cause and not the result of a single cause. 5

Adequate flexibility may help prevent muscle strain and such orthopedic problems as backache. Properly conducted stretching does not cause a person to be muscle-bound. 6

Occupational back pain in nurses (OBPN) constitutes a major source of morbidity in the health care environment. According to the National Institute for Occupational Safety and Health (NIOSH), occupational back injury is the second leading occupational injury in the United States. Among health care personnel, nurses have the highest prevalence rate of back pain, with an annual prevalence of 40% to 50% and a lifetime prevalence of 35% to 80%.Maintenance of an awkward posture places abnormal strain on a normal back. Unfortunately, nursing personnel frequently work in awkward positions or spend much of their time in a standing position with arms fully extended. This awkward positioning of the body is not initially fatiguing because of maintenance of structural integrity by the ligaments and muscles of the back. However, spending prolonged time in awkward positions or prolonged standing result in excessive stress to the ligaments with accompanying muscular contraction, leading to fatigue, strain, and discomfort. An erect posture places the heavy parts of the trunk atop a small base. Prolonged standing places strain on the ligaments and musculature of the back, which may cause cumulative trauma. In addition, fatigued muscles no longer serve their protective function and may add to the risk of acute trauma.6

The skeletal defects of an abnormal back make the back more susceptible to occupational injury, even under normal stress conditions. Although the proper body mechanics may be used, the stress on these abnormal structures is still excessive. Back pain from overstretching of muscles and ligaments results. Development of this type of back injury remains chronic as the restrictions of back movement prevent normal functioning.12

A normal stress on a normal back structure imposed by unexpected circumstances is the most common type of back injury among nursing personnel. For example, patients may not help pull or push with the nurse when the nurse expects them to, or a patient may fall, pulling and twisting on the nurse’s back. Because this movement is sudden, the nurse does not have adequate preparation time needed to protect the back structures from injury. Any diminished muscle strength, power, and/or joint flexibility place the nurse at a great disadvantage during these sudden movements. Excessive movements that exceed the physiologic range of motion may result in contraction of the back, causing the microscopic or macroscopic tissue damage that ultimately results in back injury. 6

Construction workers, warehouse personnel, delivery goods drivers, nurses, shopkeepers and farm workers. If you had to choose, which of these occupations suffers the highest incidence of back injury? You might think that construction workers or delivery goods drivers might be the riskiest occupations for back injuries, because the work involves a lot of bending and lifting, but you would be wrong! Many people are surprised to learn that the nursing is the riskiest occupation for back injuries! In fact, nursing has the second highest incidence of all types of non-fatal work-related injuries in the U.S.A. 12

Back pain is most often has a multifactorial origin. Therefore, strategies to reduce musculoskeletal disorders have included an ergonomic approach, which attempts to integrate equipment, tasks, personnel, and the work environment. The most common strategies include education, training in patient transfer and handling techniques, use of mechanical devices, stretching and exercise programs, learning relaxation techniques, better work conditions, and changes in work organization and life style.13

6.1 Need for the study:

Each year 15% to 20% of Americans have acute pain caused by injury or surgery. Frequent back pain is experienced by over 26 million Americans between ages 20 and 64 years and is the leading cause of disability in America under 45 year of age. 6

Back pain is common and has probably affected about 80% of adult in UnitedState at least once during lifetime. Backache is second only to headache as the most common pain complaint. Back pain in person under age 45 is responsible for more loss of working hours then any other medical condition and represents one of the nation’s most costly health problems. 6

Back pain is one health complaint today which is almost universal. Nearly every one will have back pain at sometime or the other, making it second only to common cold as a cause of lost workdays. At any given time, around one percent of work force is chronically disabled because of back pain. Its incidence is the same both in clerical white color jobs and in blue color manual worker who lift heavy weight and manually operate complicated heavy machines.5

Certain jobs are tied to stress injuries such as back pain, stiff neck, and tendonitis and wrist disorders. Better workstations and laborsaving devices, which put the least physical pressure on musculoskeletal system, adherence to some moderate exercise, schedule to maintain a healthy back, abstaining from smocking and moderating the consumption of alcohol and saturated fats (dairy and meet production) and healthy relaxation of mind and body do help to ward off back pain.5

Chronic back pain in women often results from having poor posture or from wearing high-heeled shoes. Excessive high heels cause the body to compensate to maintain balance. The lower back become lordotic (anterior curved), which strains the back muscles. 5

The treatment and prevention of back pain have increased the attention in the community because of high cost of health care and also diminished ability to perform the day-to-day activities. Persons who sit for prolonged periods causes more stress on their back. 1

In addition, obesity, stress, and occasionally depression may contribute to low back pain. Back pain is aggravated by activity, whereas pain due to other conditions is not. Patients with chronic low back pain may develop a dependence on alcohol or analgesics in an attempt to cope with and self treat the pain.7

"Nurses suffer from work-related low back pain more often than workers in other professions," Most often, nurses hurt their backs while turning bed-ridden patients or transferring them among stretchers, beds and chairs, adding that orthopedic and intensive care unit (ICU) nurses have the highest rates of low back pain among all nurses. According to a study, 65 per cent of orthopedic nurses and 58 per cent of ICU nurses develop debilitating low back pain at some point in their careers.2

If a patient is unconscious, nurses will try to turn him every two hours or so to prevent him from getting bedsores. If you consider that nurses often work 12 hours shifts, the amount of lifting in one shift adds up a lot, and you can see how the job could be very hard to manage physically. Preventing work related low back pain is a humanitarian issue, and efforts to address the controllable risk factors are essential.2

Work-related back pain among nurses is a problem of significant proportion. Nurses have a high rate of back pain compared to the general population and other occupational groups. There has been little reduction in the rate of nurses' back pain and solutions to this complex problem continue to be elusive. Many quantitative studies have been undertaken examining and identifying the risk factors contributing to a high risk of back pain among nurses. Few of these studies focus on the complexities and context of the nurses' physical and social environment. An exploration of these factors will assist to explain why interventions have not been successful and why the risk of back pain among nurses remains high. 17

Nurses have high rates of low back pain (LBP) and injury. Research has shown that individuals with LBP have poor trunk muscle control and that when these muscles are trained, their back pain improves. However, we do not yet know whether poor muscle, control is the reason for LBP.18

About 5,000 nurses are currently being treated for back pain following a surge in patients' weights and the number of patients a nurse has to care for, according to the British Chiropractic Association. There are thousands of nurses with work-related back pain and this could increase in the future. A lot do not turn up in official statistics because it affects employment status. The weight of patients is a contributory factor to back pain. It is not just a weight issue - it is a fitness issue with people, that they are unable to turn themselves over easily.19

A systematic literature review was undertaken to assess the effectiveness of interventions that aim to prevent back pain and back injury in nurses. There was no strong evidence regarding the efficacy of any interventions aiming to prevent back pain and injury in nurses. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses.20

LBP is acknowledged as a common cause of disability and related sickness absenteeism is commonly used as a disability indicator. It is estimated that in 1994–95, 116 million production days were lost in the United Kingdom due to LBP-related work incapacity. Equivalent figures are not available for Ireland, which has very limited sickness absenteeism data. The Health and Safety Authority (Ireland) does record all work injury-related sickness absences of 3 days duration. However, no national record of non-work injury-related back absenteeism exists in Ireland. 21

Training seems to play an important role in reducing the incidence of injury, as shown by the fact that about 80% of injuries occur among nursing aides, orderlies, and attendants compared with 20% occurring among registered nurses. Research has shown that training programs can be effective. In response to concerns over high incidence and severity of back injuries among nursing staff and others at a 440-bed acute care Australian hospital, the impact of a one-year Back Injury Prevention Program was evaluated. At the end of the program, trainees showed increased knowledge of injury risk factors, a marginal increase in the use of mechanical patient transfer devices, and a decrease in repositioning of patients in bed, compared with control subjects. Furthermore, compared with the average injury rates for the prior 3 years, trainees showed a 30% decrease in injuries.Workplace intervention programs can be effective in reducing back injuries. A 2-years inception cohort study investigated risk factors for 320 nurses, who incurred 416 back injuries, at a large teaching hospital in Winnipeg, Canada. Results showed that back injuries that occurred while lifting patients resulted in greater time loss, the degree of pain was strongly related to the duration of time loss, and that participation in the return-to-work program focusing on back injury prevention reduced the duration of time loss. 12

Nurses as a group are frequently injured on the job due to the immobility of large patients and the relative mechanical disadvantage that stretchers, wheelchairs and hospital beds present. It is suggested that if your back is prone to problem you can be benefited by use of teams of people to assist in transfers, use of good body mechanics when lifting, wearing good shoes and having a back support at work. Be as careful with your own body as you are with the patient's. 12

Prospective cohort study was conducted with follow up by repeated self-administered questionnaires every three months over two years on 961 female nurses who had been free from low back pain for at least one month at the time of completing a baseline questionnaire. Of 838 women who provided data suitable for analysis, 322 (38%) developed low back pain during follow up (mean 18.6 months), including 93 (11%) whose pain led to absence from work. The strongest predictor of new low back pain was earlier history of the symptom, and risk was particularly high if previous pain had lasted for over a month in total and had occurred within the 12 months before entry to the study (incidence during follow up 66%). Frequent low mood at baseline was strongly associated with subsequent absence from work for back pain (odds ratio 3.4; 95% confidence interval 1.4 to 8.2). After adjustment for earlier history of back pain and other potential confounders, risk was higher in nurses who reported frequent manual transfer of patients between bed and chair, manual repositioning of patients on the bed, and lifting patients in or out of the bath with a hoist. 7