The labor situation of 18,639 nurses employed at national medical centers in Japan was surveyed in 2009 through questionnaires. One of the results was that 49.1% of the respondents felt “very tired”, while 45.7% felt “moderately tired.” In other words, approximately 96% of the nurses felt tired. Their symptoms or signs included dyspepsia, diarrhea, constipation, hypertension, decreased immunity, menstruation disorders, and so on. The results also revealed the problems the nurses faced in their lives, including unbalanced diets, alcohol/drug abuse, low job satisfaction, and sympathetic dominance.
As in other countries, highly advanced treatment has always been offered at medical centers. The priority of nursing effort is focused on disease control rather than on health management. Disease control is characterized by a consistent focus on the physical dimensions of health. Relatively speaking, health management, by contrast, focuses not only the physical dimensions, but also the psychological and social dimensions of health. From a nursing perspective, human beings are generally conceived of as a harmonious unity of mind and body, characterized by cognition and metabolism respectively. Health problems, in terms of both their causes and the solutions undertaken to alleviate them, must therefore also be approached in a comprehensive way. Yet while the necessity of such an approach has become clear, there had not previously been any research conducted on nurses’ own health management based on this perspective.
Lower back pain and algomenorrhea are frequent complaints among women, and female nurses are no exception. The purpose of this study is to examine the effectiveness of applying acupuncture and self-reflection on daily lifestyle as a means of treating lower back pain and algomenorrhea for nurses working at national medical centers in Japan. Information pertaining to the nurses’ lifestyles was recorded by researchers before every instance of acupuncture treatment. Whether or not their symptoms or signs changed was also evaluated based on this data.
Methods
The subjects were six female nurses from a national medical center located in the Kanto region in Japan. Subjects already receiving treatment for lower back pain and/or algomenorrhea were excluded.
Data was collected over a period of three months from October to December (a total of 12 times in all), as follows:
(i) At the start of the study and again one month after the conclusion of the study, all subjects completed a “Japan Lower Back Pain Evaluation Questionnaire” and/or a “Japan Menstrual Distress Questionnaire” as well as a State-Trait Anxiety Inventory (STAI) by themselves.
(ii) Subjects received one session of acupuncture treatment for about 50 minutes each week at their hospital clinical setting. Before and after each treatment their pain level was assessed with a Visual Analog Scale.
(iii) The health activities of the subjects’ daily lives, including such information as their waking and sleeping times, diet, exercise and concerns were collected through semi-structured individual interviews, each lasting approximately 10 minutes.
Data was analyzed by time-series on an individual basis.
Results
The subjects were all in their 20s through 40s. Here we discuss them as two age groups: those in their 20s-30s, and those in their 40s. Three had lower back pain while the others all suffered from algomenorrhea. All of the subjects were willing to participate in the study for three months continually, and expressed that acupuncture treatment was effective for controlling their pain.
The results of the Visual Analog Scale for pain showed that one month after the study began their level of pain showed signs of improvement. However, the results were different between the 20~30s group and the 40s group one month after the conclusion of the study. Subjects in the former group expressed that their pain had returned to original levels, whereas those in the latter group expressed that they had been able to maintain an improved condition through lifestyle changes. The scores from the “Japan Lower Back Pain Evaluation Questionnaires” and the “Japan Menstrual Distress Questionnaires” are given in Table 1.
The data collected during the interviews showed that the lifestyles of the subjects in their 20s to 30s had not substantially changed since their adolescent days. They were single or married without children, and desired to continue their daily lives although they felt that the acupuncture treatment had proven helpful in improving their symptoms during the study period. Within a month after the conclusion of the study their symptoms returned.
The subjects in their 40s were married and lived with their families. All of them expressed that the demands of hard work at the hospital and housework at home led to their not having enough time for their own health concerns before participating in this study. They reported acquiring a consciousness of having achieved good health through the course of the study. Therefore, even after the conclusion of the study they tried to arrange their lifestyles to prevent their symptoms from returning.
The acupuncture treatment and self-reflection proved effective in helping the nurses to alleviate their lower back pain and algomenorrhea. Long-term effectiveness depended on the motivation of the subjects. It was difficult for the nurses in their 20s and 30s to maintain a good health condition after the three-month period of interaction with the researchers ended. On the other hand, the nurses in their 40s saw continued effectiveness because, in addition to caring for themselves, they were experienced in handling the responsibility of arranging the daily lives of family members. We could say that since human beings are social creatures, their relationships with others can be a source of willpower to promote health consciousness.