Back Injuries on Nurses

Examination of Back Injuries to Nurses Including Recommendation on Improvement

In the United States, the rate of musculoskeletal injuries from exertions in highly prevalent in healthcare occupations as compared to other industries. In 2014, the Bureau of Labor Statistics found that the rate of physical exertion injuries was at 33 per 10,000 workers (The National Institute for Occupational Safety and Health (NIOSH), 2013). In comparison, the injury rate for hospital workers was twice as high averaging at 69 per 10,000 workers. In nursing home workers the prevalence was found to be three times averaging at around 107 per 10,000 workers with the rate of ambulance workers being five times averaging at 174 of 10,000. Ideally, within healthcare settings, nurses play a critically significant role in providing and assisting in the provision of primary, secondary, and tertiary care. Their work is physically demanding, as they are required to assist in mobilizing patients, transferring them between positions among other duties of toileting and showering. Compared to other healthcare professionals and due to the nature of their job, nurses are at a higher risk of suffering back pain and a higher prevalence of back injury (Dawson, McLennan, & Schiller, 2007). Several other factors have been linked to increased risk of back pain among nurses including heavy physical workload, work posture among other psychosocial factors. In light of this, we assess some of the risk factors that contribute to the prevalence of back pain among nurses, examine the extent of back injuries to nurses, and evaluate the major impact it has on the efficiency of nursing. Lastly, we give several recommendations on the mitigation and management of lower back pain among nurses for improved healthcare outcomes.

Risk Factors Associated with back Pain among Nurses

The healthcare environment represents a high rate of work-related injuries and illnesses. Consistent with previous studies musculoskeletal injuries and especially lower back pain is one of the main health concerns affecting healthcare workers. According to Razaee and Ghasemi (2014), lower back pain is one of the major issues affecting productivity and quality of life among the nursing profession. Previous research indicates a high prevalence of back pain among healthcare workers, with pervasiveness being estimated to be between 15 to 64 percent in developed countries and above 79 percent in developing countries. Consequently, nurses are exposed to several risk factors that contribute to the high rate of back pain among them. For instance, lower back pain is attributed to prolonged standing and awkward postures during surgery (Homaid, Alghamdi, & Alhozali, 2016). As Homaid et al. elaborate; nurses working in surgical-units are at a higher risk of lower back pain. The high rates can be attributed to the working conditions present in this department, which demands long working hours while standing and awkward postures. Work overload and psychological stress is also a major contributing factor to lower back pain. Usually, nurses are expected to engage in various risky activities such as the lifting of heavy objects including beds, transferring patients, repositioning patients, pulling patients onto a bed, rotating torsos among others. Other factors associated with back pain include long working hours, which is a norm within the nursing profession. Advancing age and female gender are also some of the predisposing factors of lower back pain. A study conducted by Chang, Feng, and Lian (2016) indicates that there is a high number of nurses with advanced age who are still working. Older nurses have advanced working experience and at a higher risk of experiencing back pain. Similarly, as compared to other professions, nursing is one of the areas where there are a high number of female workers. Accordingly, this explains the high rate of lower back pain prevalence within the nursing profession. 

Extent of Back Pain among Nurses

Previous research on musculoskeletal injuries among nurses shows that at least 52 percent of nurses complain of chronic back pain (American Nurses Association, n.d). Twelve percent of nurses leave the profession because of back pain, while 20 percent of the nursing professionals’ population is transferred to a different unit or employment because of lower back pain. Along with that, at least 38 percent of nurses suffer occupational-related back pain, requiring them to leave work and 6 to 8 percent of RNs reported changing work professional due to the neck, shoulder, and back pain. Consistent with the statistics, a study carried out to establish the prevalence of lower back pain in Taiwan indicated a considerably high incidence rate of back pain among nurses (Lin, Tsai, & Chen, 2012). Majority of the nurses who participated in the survey reported having current or previous history of back pain. The results also showed a close correlation between back pain characteristics with risk factors such as age, number of working years, physical workload, and the nature of the healthcare setting.

Impact of Back Pain on Effective Nursing

Lower back pain or injuries are one of the most common complaints among nurses, demanding medical attention. It is one of the most common forms of musculoskeletal disorders, estimated to affect more than half of the nurse professionals in healthcare settings. In fact, according to a report carried out by the European Foundation for the Improvement of Living and Working Conditions, lower back pain is one of the most significant health disorders facing the healthcare workforce (Roupa, Vasssilopoulos, & Sotiropoulou, 2008). As Roupa et al. further elaborate, lower back pain significantly impair nursing efficiency at the individual level and the workplace. For instance, studies indicate that lower back pain is one of the most frequent reasons for temporary disability among individuals below the age of 45 years. It is also the third most frequent reasons for physical activities restrictions among individuals. The nursing professionals belong to the high-risk group regarding the incidence of musculoskeletal injuries, especially back pain. Consequently, according to Roupa et al., lower back pain among nursing professionals has considerable impacts on the efficiency of nursing and the individuals. Firstly, the survey found that the impact of lower back pain affected sleep systematically as compared to other activities. In a related study, it was observed that the higher the level of pain, the more the intensity of the reactions towards individual behavior. This can be interpreted with the understanding that pain acts as a repressive factor, preventing rest and sleep among nursing professionals and the capacity to socialize and form interpersonal relationships with others. Secondly, musculoskeletal pain is one of the largest contributions of absenteeism at work among the economically active group. Virtually, depending on the severity of pain, a majority of nursing staff are likely to miss work if the pain is severe, which leads in a shortage of workers and decreased positive patient outcomes and compromised patient safety.  Patient care is complex, and nurses are required to work with extended shifts, lower back pain has the ability to affect not only the quality of care but also lead to inadequate staffing and high-stress levels among nurses. Importantly noted, high-stress levels among nurses have been known to have several adverse effects on the quality life of nurses and also the quality of care delivered and patient safety. Similarly, while lower back pain is not a life-threatening disease, it demands long-term treatment, which exerts financial pressure on the nursing practice, occupational compensation and the individual.

Recommendations to Manage Back Pain among Nurses

Nursing is one of the largest occupations in the United States, also ranking as the largest among healthcare professionals. Unfortunately, due to the strenuous work environment with irregular shift schedules and strenuous physical workloads, a majority of the nurses often experience musculoskeletal injuries or pain in their lifetime as nurse professionals. Apart from the impact the disorder has on the individual nurse, it also adversely affects the whole nursing occupation threatening to compromise of the quality of care delivered and patient safety. Nonetheless, as reviewed by Pinky, Donna, & Patricia, (2016), musculoskeletal injuries and especially lower back pain can be prevented or managed to reduce the impact it has on the nursing professionals and the efficiency of nursing. For instance, mind-body exercises are used as a treatment and prevention option for lower back pain. Exercise effectively reduces pain, disability, and improves the functionality of the affected part. However, studies indicate that the impact of exercise is considerably small as long-term adherence is often poor. Evidence further points towards combining exercise with other behavioral programs and educational components, which can be effective as compared to individual exercise therapies. Additionally, recommended forms of exercise include yoga and Tai, which are some of the popular body-mind exercises that have shown progress in the management or treatment of back pain. Along with that, it is important to understand how mind-body exercise manages chronic back pain. Ideally, several modifiable risk factors can be altered with these exercises. For example, lower back pain is associated with weakness in lower extremities, reduced pelvic strength, and lack of torso flexibility. Yoga has the ability to increase muscular strength and flexibility among nurses with low back pain. Exercise also boosts body awareness and proprioception as well as kinesthetic awareness. Although there is limited literature on how exercise achieves this, tai chi has been associated with improved physical function among individuals with peripheral neuropathy. Similarly, as compared to other healthy people, persons with back pain have low postural control. Studies indicate that exercise in the form of tai chi reduces sway measures with multiple outcomes on balance.

Apart from physical exercise, the other method that can be used to mitigate or manage the risk of lower back pain is the use of cognitive behavioral training. Ideally, this strategy involves providing training programs to nurses on various issues associated with managing back pain (Rasmussen, Holtermann, & Mortensen, 2013). For example, participants are taught skills focusing on improving their understanding, experience, and anticipation of pain by going through cognitive exercises on ways physical activity may relate to pain. Another focus can be on the relationship between physically demanding work and pain. Nurses can be taught on ways to survive, function, and have a good life despite their pain. It is also suggested that the training program can also focus on addressing health-related challenges and propose a solution. Nurses who undergo the training sessions should also be encouraged to share with others who have not attended the training and help them with lower back pain prevention and management.

Consequently, nursing is a highly physically demanding job with most of the musculoskeletal injuries resulting from patient handling and lifting of heavy items. Hughes, Robert Wood Johnson Foundation., and United States (2008) propose three common interventions that can be used to prevent work-related musculoskeletal injuries. The first measure involves patient handling equipment and devices. The intervention includes using height-adjustable electric beds that do not require the nurses to adjust them manually. Similarly, the intervention also encompasses the use of mobile mechanical or ceiling mounted lifts to be used in bed repositioning. The second proposed intervention is the no-lift policy, which focuses on reducing the manual patient handling measures. The intervention is intended to reduce the need for nurses to manually lift patients, who may be heavy and cause musculoskeletal injuries. The third intervention involves training nurses on the proper use of equipment. Ideally, most nurses do not understand how some devices within the healthcare settings function. Training nurses on body mechanics and lifting techniques are not enough, evidence-support should also be incorporated to ensure they understand how the equipment operates and to minimize the risk of causing musculoskeletal injuries. Additionally, hospitals can also consider hiring patient lift teams. While a nurse has to lift patients, in most cases, the nurse staff are not strong enough to carry out this responsibility. Healthcare facilities should consider hiring a lifting team who will work together with the nurses to ensure high-risk patient transfers are successful and without exposing nurses to the risk of musculoskeletal injuries.

Over the years, lower back pain prevalence has persisted among nurses despite primary prevention initiatives. Causes of high incidence rates and recurrence of lower back pain are dependent on several factors, with the physical workload and patient handling activities been reported as the major contributors. Similarly, the hazard of nursing work such as the prevalence of musculoskeletal injuries can impair the health of the nursing staff and compromise on the delivery of care and patient safety. Interventions to mitigate the impact of musculoskeletal injuries are necessary also to improve efficiency in nursing. Most interventions have been single-faceted focusing on only one aspect of low back pain and with low success rate. Physical training and cognitive behavioral training have been promising on the prevention and management of lower back pain. However, the increased risk and persistent nature of lower back pain among nurses calls for secondary intervention measures focusing a modifying functional workplace environment, especially because the work is physically demanding. Some of these interventions involve modifying the workplace environment to reduce the necessity to handle the physical workload on the part of the nurses. Apart from helping nurses with coping strategies, interventions, which involve modification of the workplace environment to reduce physical workload should also be implemented. Healthcare facilities should be willing and ready to commit financial investment to improve patient and more importantly leverage their commitment to improving worker safety. 

References

American Nurses Association. (n.d). Handle with Care Fact Sheet. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/Factsheets-and-Toolkits/FactSheet.html

Chang, C. T., Feng, P. K. J., & Lian, C. W. (2016). Risk factors of Low Back Pain among Nurses Working in  Sarawak General Hospital. Health and the Environment Journal, 7(1), 13-24.

Dawson, A. P., McLennan, S. N., Schiller, S. D., Jull, G. A., Hodges, P. W., & Stewart, S. (2007). Interventions to Prevent Back Pain and Back Injury in Nurses: A Systematic Review. Occupational and Environmental Medicine, 64(10), 642-650.

Homaid, M. B., Alghamdi, A., Alhozali, F., Alfahmi, N., Hafiz, W., Alzahrani, A., Abdelmoety, D., … Elmorsy, S. (2016). Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: A cross-sectional study. Annals of Occupational and Environmental Medicine, 28(1), 1-8.

Lin, P. H., Tsai, Y. A., Chen, W. C., & Huang, S. F. (2012). Prevalence, characteristics, and work-related risk factors of low back pain among hospital nurses in Taiwan: A cross-sectional survey. International Journal of Occupational Medicine and Environmental Health, 25(1), 41-50.

Pinky, B.-S., Donna, L. B., Patricia, A., Helene, L., & Peter, M. W. (2016). Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review. Nursing Research and Practice, http://dx.doi.org/10.1155/2016/9018036.

Rasmussen, C. D. N., Holtermann, A., Mortensen, O. S., Søgaard, K., & Jørgensen, M. B. (2013). Prevention of low back pain and its consequences among nurses’ aides in elderly care: a stepped-wedge multi-faceted cluster-randomized controlled trial. Bmc Public Health, 13(1), 1-13.

Razaee, M., & Ghasemi, M. (2016). Prevalence of low back pain among nurses: predisposing factors and role of workplace violence. Trauma Mon., 19(4), 9-14.

Roupa, Z., Vasssilopoulos, A., Sotiropoulou, P., Makrinika, Noula, M., Faros, E., & Marvaki, C. (2008). The problem of lower back pain in nursing staff and its effect on human activity. Health Science Journal, 2(4), 219-225.

The National Institute for Occupational Safety and Health (NIOSH). (2013). Safe Patient Handling and Mobility (SPHM). Centers for disease Control and Prevention. Retrieved from: https://www.cdc.gov/niosh/topics/safepatient/default.html