Work-Related Low Back Disorders in Nurses: Frequency of Occurrence, Causes and Preven

  1. work-related low back disorders in nurses: frequency of occurrence, causes and prevention

    written by: [color=#003f5e]edgar ramos vieira / ergonomics research lab, faculty of rehabilitation medicine, university of alberta, canada.
    work-related low back disorders (wlbd) are frequent in nurses [1-3]. this is the most prevalent and most costly musculoskeletal disorder [4]. in 2000, based on the national health interview survey, from 11 to 13 million people developed low back pain, and about $100 billion were spent on this problem in the u.s. considering the people who had worked in the previous year, 22.4 million had back pain in 2000, and nurses were among the workers with the highest risk (prevalence ratio > 2) [5].
    wlbd in nurses is significant problem worldwide. for example, the annual incidence rate of wlbd in french nurses in 1990 was 57% [6]. the same figure was found for chinese nurses [7]. the incidence of wlbd is also high in italy [8], and in the u.s. nurses have the highest incidence of disabling wlbd among all professionals [9].
    bending, twisting, lifting heavy weights and making forceful movements, as during patient handling and transfers, are risk factors for wlbd [10,11]. in my study i found that approximately 70% of the wlbd in nurses resulting in time off work happened while transferring or moving patients; orthopedics and icu were the departments where wlbd happed most often [3]. nurses with high frequency of patient lifting are up to 7.54 times more likely to have wlbd than nurses with low frequency of lifting [12].
    practical suggestions to reduce the risk of wlbd in nurses
    • adjust bed height: avoid too much bending and facilitate the task by, for example, reducing the amount of force required to get a patient from sitting to standing.
    • stay active and in good shape: exercise increases the functional capacity of the musculoskeletal system reducing the risk of injury. a lighter upper body imposes lower load on the spine throughout the time.
    • minimize the time in awkward postures: don't rush because it may lead to accidents and/or overexertion injuries, but try to spend the least time in extreme postures [i.e. too much flexion, extension, rotation, lateral flexion (bending sideways)]. wlbd are caused not only by overexertion (too much) but also by the cumulative effects of prolonged activities (too long).
    • support your weight: use your arms to support part of your weight when bent forward; for example, while waiting for others to get ready for a patient transfer. support your thighs against the bedside and use your lower limbs force to help moving patients in bed. this will reduce the amount of back force needed.
    • ask for help: many wlbd in nurses happen while trying to move a heavy or confused patient by themselves. share the load and work together with other colleagues and with the patient if possible. you never know when the patient will resist or make a sudden movement.
    • plan before execution: think about what you want to do before you start it. make sure that all equipment you need is available (belts, chairs, sliding sheets, etc) and that you have enough space to complete the task safely. talk with your coworkers and agree on what you will do when working together (lifting or transferring a patient), use vocal clues to synchronize your movements.
    • use mechanical lifts and other assistive devices: lifts and other devices (belts, sliding sheets and boards, etc) can significantly reduce the amount of effort required to move a patient.
    • set up the patient rooms ergonomically: the location and position of the furniture and equipment (beds, chairs, over bed tables, bedside cabinets, iv poles, ventilators, etc) have a direct effect on how well and safely you can perform your job. having to reach over or move furniture around all the time may increases the low back load significantly.
    • organizational issues: try to distribute heavier patients among different staff to distribute the load evenly; make sure the transfers and x-rays are not all schedule close to the end of the shift. by this time you are tired and more susceptible to injuries.
    • stretch and relax your muscles: take breaks as possible and stretch your muscles and move your back from side to side, forward and back ward. massage your low back. these simple measures help to reset the tonus (stiffness) of your muscles and may reduce the discomfort by the end of the shift and the risk of injuries.
    1. buckle, p. (1987) epidemiological aspects of back pain within the nursing profession. international journal of nursing studies 24 (4):319-324.
    2. bejia, i., younes, m., jamila, h.b., khalfallah, t., ben salem, k., touzi, m., akrout, m. and bergaoui, n. (2005) prevalence and factors associated to low back pain among hospital staff. joint bone spine 72 (3):254-259.
    3. vieira, e.r., kumar, s., coury, h.j.c.g. (2006) narayan y. low back problems and possible improvements in nursing jobs. journal of advanced nursing; 55 (1):79-89.
    4. woolf, a. d., pfleger, b. (2003) burden of major musculoskeletal conditions. bull world health organ. 81 (9):646-656.
    5. national academy of sciences (2001) musculoskeletal disorders and the workplace. washington-dc: national academy press.
    6. niedhammer, i., lert, f. and marne, m.j. (1994) back pain and associated factors in french nurses. international archives of occupational and environmental health 66 (5):349-357.
    7. smith, d.r., wei, n., kang, l. and wang, r.-s. (2004) musculoskeletal disorders among professional nurses in mainland china. journal of professional nursing 20 (6):390-395.
    8. larese, f. and fiorito, a. (1994) musculoskeletal disorders in hospital nurses: a comparison between two hospitals. ergonomics 37 (7):1205-1211.
    9. jensen, r. (1987) disabling back injuries among nursing personnel: research needs and justification, research in nursing and health 10, 29-38.
    10. bernard b. p., (ed.) (1997) musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. publication no. 97-141, cincinnati, oh: u.s. department of health and human services,
    11. punnett, l., fine, l.j., keyserling, w.m., herrin, g.d. and chaffin, d.b. (1991) back disorders and nonneutral trunk postures of automobile assembly workers. scandinavian journal of work, environment & health 17 (5):337-346.
    12. stobbe, t.j., plummer, r.w., jensen, r.c. and attfield, m.d. (1988) incidence of low back injuries among nursing personnel as a function of patient lifting frequency. journal of safety research 19 (1):21-28.
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  3. by   Brian
    also see this discussion on this topic:
  4. by   glasgow3
    With all due respect to the author of this article, I feel that a laundry list of risk reduction strategies obscures a clear, evidence based reality: manual patient handling results in preventable, career ending injuries for health care workers.

    Manual lifting is unsafe for patients and health care providers alike; the practice should be eliminated in my view.
  5. by   evieira
    Quote from glasgow3
    with all due respect to the author of this article, i feel that a laundry list of risk reduction strategies obscures a clear, evidence based reality: manual patient handling results in preventable, career ending injuries for health care workers.

    manual lifting is unsafe for patients and health care providers alike; the practice should be eliminated in my view.
    i (author) completely agree with you. yes, manual patient lifting should be eliminated, but that is not simple as you know. there are technical limitations yet. until manual lifting can be eliminated, i believe that some care could be taken in order to reduce the risks... hopefully manual patient lifting will be eliminated soon and nursing will become a less physically taxing profession. most of the suggestions in the article are known, but are frequently overlooked.
    take care and keep healthy...
  6. by   RNKITTY04
    Research needs to be done on the effects that the "COWS" are having on the profession. My co-workers and I are constanly sustaining lower back injurys d/t the awkwardness and heavyness of the "computers on wheels" that are more or less our attatched to our body's for a entire shift.