Table 1 gives the physical characteristics like average age, height and weight of the subjects who participated in the study (n=627). Out of this population, the percentage of married, single, widow and divorcee were computed as 62.6%, 35.6%, 0.8% and 1.0, respectively. There were only 11 out of total 627 volunteers who were either widow or divorcee. So their physical characteristics were not represented separately but included within the information on total number of volunteers.
are inflammatory and degenerative conditions that affect muscles, tendons, ligaments, joints or peripheral nerves, usually leading to ache, pain or discomfort [2
]. A number of studies around the world [5
] have shown that nurses suffer from different degrees of MSDs in different regions of the body due to the nature of their profession.
Table 2 presents the population of nurses, out of the total volunteers participating in the study, who were affected with MSD of different body regions. The occurrences of MSD in nine body regions of single and married nurses are also given in this table. Married nurses, as seen in this study, characteristically suffered more from upper body and upper limb MSD whereas, single nurses were found to be more prone to LB, HTB and knee injuries. Though aetiology of these observations is unknown, the role of body weight and redistribution of fat may be taken into consideration.
Table 3 gives the distribution of volunteers (n=627) in different age groups (as given in parenthesis), the percentages of nurses affected with MSD (A, %) and the population in which normal activities were prevented (B, %) in each age group. The age wise distributions of subjects indicate a gradual attrition of nurses beyond the age of 40 years. Distribution of MSD in nine regions of the body in different age groups of our nurses indicated that middle aged nurses, i.e., between 36-40 years suffer maximally from MSD in all the regions of body followed by 31-35 years and 21-25 years age group. Musculoskeletal symptoms beyond the age of 45 years were found to be quite less amongst the subjects studied. This may be due to the fact that higher age group of nurses mostly engages in administrative, housekeeping and logistic activities, rather than strenuous patient care activities. Nurses from age group 21-40 years are engaged in active patient care services and suffer maximally from MSD. These observations of the present study corroborate with the study by [7
]. They compared the MSDs in nurses working in two different hospitals and showed that 48% of the nurses in an urban general hospital suffered from LB pain whereas only 33% of nurses suffered from LB pain in a small Oncology department in another hospital. They concluded that LB pain in the nurses varied depending upon the hospital and department where the nurses work [7
]. The pain reported in some regions of the body are more (e.g., AF, WH, etc.) but the normal activities prevented are less reported. It is seen that though the pain in LB (18.8%) reported was less than AF (22.6%), but normal activities prevented due to pains in these areas were 8.6% and 6.2%, respectively. This may be due to the fact that work pressure and service rules prevented these nurses to avail.
Prevalence of MSD in different body regions among affected nurses (%) in different periods of the year is given in table 4. It includes one year period prevalence of MSD in nurses apart from MSD occurring in affected nurses between last 6 to 12 months, 7 days to 6 months and within last 7 days. It shows that LB pain was highest followed by neck and A/F. Highest musculoskeletal pain was reported in the LB (67.0%) region followed by neck (47.4%), AF (36.0 %), shoulders (34.4%), knees (33.0%), UB (28.1%), HTB (22.6%), WH (18.8%) and elbows (10.5%) for one year prevalence of MSD. The distribution of MSD of nurses as it occurred between last 6-12 months, 7 days - 6 months and within last 7 days also reported that LB pain was highest followed by pain in neck and AF. The reported incidences of pain in all the regions of the body in the two groups, 6 – 12 months and 7 days to 6 months were quite closer but less than the prevalence rate of one year. Similar results were observed by researchers in other parts of the globe [1
]. An epidemiological study in Taiwan showed that 77.9% of nurses suffered from LB pain [10
]. Niedhammer et al. [6
] observed that 57.9% of French nurses suffered from LB pain.
A comparison of the occurrences of MSD of different body regions in single (A, n=223) and married (B, n=393) nurses, in different age groups are given in table 5. It shows that married nurses had higher incidences of MSD than those of the single nurses within the age range of 31-40 years. Single nurses’ responses for MSD in all of the nine body regions in the age group 21-25 years are much higher than their married counterparts. The reason for this anomaly is difficult to explain as the age range and duration of occupational exposure is same in both the groups. It may be attributed to the fact that married nurses are psychologically more tolerant and their threshold of discomfort and pain tolerance may be higher than single nurses of the same age group. This is clearly evident in the responses of single nurses reporting pain in WH and elbows as high as 60% and 54.5%, respectively, as against 0% reported in both cases by married nurses. However, the responses get reversed in the respondents between the age ranges of 31-40 years. In the age group of 31-35 years, the married nurses report pain in LB, UB and neck as 31.7%, 30.6% and 29.2%, respectively as against the responses of their single counterparts as 4.8%, 5.8% and 4.9%, respectively, for pain in same body parts. This may be attributed to the increase in cumulative stresses in the married nurses due to simultaneous handling of professional issues as well as the increased family responsibilities.
The Table 6 gives frequency of pain occurrences, type of activity reduced, duration of normal activities prevented, doctor visited and duty changed in affected nurses population (%) due to neck, shoulders and LB pain. Pain reported were maximum during 1-7 days (40.7%, 37.5%, 33.3%) as compared to that during 8-30 days (11.8%, 17.1%, 16.4%) or >30 days (29.6%, 31.9%, 32.1%) in neck, shoulders and LB, respectively. The nurses reported that reduction in their work and leisure activities together due to pain in these regions were more than reduction in work and leisure activities taken separately. The nurses affected with MSD needed to change their duties to other wards due to LB, shoulder and neck pains were 11.9%, 9.2 % and 7.1%, respectively. As a result of pain in these body regions, about 28% of affected nurses regularly visited doctors. This observation is very important for maintaining their health status and should be applied while designing the work rotation of the nurses.
Workload of different shifts as perceived and rated by the subjects’ (n=627) using Borg Scale [4
] is presented in table 7. Mean value of subjective responses in RPE scale for each shift was expressed.
From the data reported in the present study, it was found that neck; shoulders and LB pains in the nurses were more acute in nature and mostly subsided within 7 days. At the same time, about 17.8%, 13.4% and 18.1% of the affected population suffered everyday from neck, shoulder and LB pain respectively. These personnel could be identified as very chronic group suffering from MSD, whose activity (work, leisure or both) were mostly reduced. Though the number of nurses suffering from neck, shoulders and LB pain for more than 30 days was quite large, the normal activity was prevented for only 9.7 to 13.8% (Table 6) of above population. This indicated that the nurses may have learnt to work with the pain, cope with the pain, accommodate or accept the pain as part of the work component [11
]. While the nurses suffered acutely from neck, shoulder and LB pain, as seen in this study, only 27.0-29.0% visited doctor due to MSD and only 7.0-12.0% suffering from LB Pain had changed their duties to other wards (Table 6). This observation is very critical as more visits to doctor indicated unhealthy and uncomfortable work environment. This may lead to withdrawal of the nurses from active participation in nursing care, resulting in poor health care services.
While analysing the occurrences of MSD in nursing population in our study as per their age groups, it was observed that about 33% of participating nurses were between 21-30years age (younger group) and 45% between 31-40 years (middle aged), that is, the age range of 21-40 years is represented by 79% of the studied population. The age range of 41-60 years is represented by about 21% only (Table 3). This may be due to attrition of aged nurses, their withdrawal from active nursing duties, change of duties, permanent administration work sitting in the office or premature retirement due to health reasons. In a review paper, Long et al. [12
] state that incidences or prevalence of MSD is a possible source of attrition from the work force causing global shortage of health care workers. In the present study, the active young people (21-30 years) were about 33% who carried out the most physically and mentally strenuous jobs like night shift, transferring patient, administering injections, starting intravenous fluids, etc. However, it was the middle aged nurses between 31-40 years age who suffered maximum from MSDs and associated incidences (Tables 3 and 5), followed by the youngest group (21-25 years).
The prevalence of MSD and associated problems were also found to be quite less in the more aged population (41-60 yrs) in the present study. This finding agrees with the study by Larese and Fiorito [7
] which says the intensity of MSD depends upon the type of activities undertaken. Ribeiro et al. [13
] carried out a cross-sectional study that estimated the prevalence of work related musculoskeletal disorders (WRMSD) among 308 nursing assistants in Salvador, Bahia. They stated that the prevalence of WRMSD in at least one body segment was 83.4%, followed by low back (53.9%), legs (51.9%), neck (36.4%), upper back (35.7%) and shoulders (33.8%).
The reason for low prevalence of MSD and associated problems in the age group 26-30 years is not yet understood. It may be assumed that this group was already familiar with the hazards of the job and they had not yet spent sufficient time in the service to develop the WRMSD symptoms. Development of WRMSD normally takes about 10-15 years under any work situation of occupational environment. On the other hand, higher responses of the youngest nurses group, in terms of prevalence of MSD, may be considered as their overreaction to a semi-precarious situation and/or being less capable, both physically and mentally, of tolerating the stress of their profession. It is expected that with the progress of their job, they too become acclimatized to the situation and become more tolerant and flexible.
From the available data, the occurrences of MSD in different regions of the body in the single and married nurses (Table 2) were calculated. The study on prevalence of MSD in lower body by Chiou and Wong [10
] indicated higher prevalence rate in married nurses. However, present study shows that single nurses suffered more in lower body MSD as compared to married nurses. Also, the pattern / sequence of occurrence of normal activity prevention in both groups did not conform to the incidences in the total population. Elbows pain caused more number of days’ activity prevention in the married population (63.8%) which is only 9.1% in single nurses. Maximum days’ normal activity was prevented due to LB pain (51.6%, Table 2) in single nurses. There was not much differences in the duration of pain due to neck, shoulders and LB pain in both the groups (Table 6), but activity was reduced more in both the groups due to LB pain as compared to pain in other areas. All these observations indicated that additional social and household responsibilities of raising a family in married nurses along with job stresses played synergistic role in developing the MSD symptoms.
When the distribution of MSD as per the age groups was compared in both married and single group (Table 5), it was observed that in single nurses group it was the youngest nurses (21-25 years) who suffered maximum from all the MSD in all the regions of the body with equal distribution in neck, shoulders, elbow, WH, UB, LB and AF regions. However, in the married nurses’ population, middle aged nurses between 31-35 and 36-40 years suffered maximally due to MSD. The prevalence of MSD in nine regions of the body was almost equal in these age groups of married population. It follows that responses of the youngest group (21-25 years) in the total population was actually a representation of the responses of the single/ unmarried nurses. A comparison of the activities prevented due to MSD in single and married nurses’ population indicate that maximum activity prevented due to LB pain was 32.9% in married whereas in single nurses it was 51.6% (Table 2). This indicated that younger group was more sensitive and lacked capabilities to cope with occupational stresses and constraints. On the contrary, the occurrences of MSD in the middle aged population were quite natural as it happened in all occupational work environments. Normal activities, as shown in Table 3, were prevented maximally for 31-35 years and 36-40 years age groups of nurses suffering from LB, HTB and neck pains.
Subjective perception of the nurses about workloads of short, long and night shifts, as they undertake regularly, were taken after the respective shifts (Table 7). According to individual perception of the participating nurses, the long shift (0730h-1900h) and night shift (1900h-0730h) were between ‘hard’ to ‘very hard’ category of work as per the Scale administered. This indicated that these shifts were perceived by participating nurses as physically and mentally highly demanding. A study by Herin et al. [14
] indicated that the psychosocial factors play an important role in the development of upper limb MSD and that there is association between the organizational work environment and MSD in health care workers. This may indicate that the subjects’ perception of a particular shift as ‘very heavy’ may be one of the causal factors in onset of WRMSD in our nurses.