Nursing profession is identified as having the highest risk in terms of ergonomic risk. Nurses stand for long hours, do pushing, pulling, elevating movements, as a result of which, musculoskeletal disorders may easily develop (Rasmussen et al. 2013, Sezgin and Esin 2015). The prevalence of the musculoskeletal symptoms (MSS) of nurses working in the clinical settings is found to be between 69.55-88.2% in the literature (Samaei et al. 2015, Barkhordari et al. 2015, Ganiyu et al 2015). Having MSS decreases work performance, and increases work absenteeism, this affects patient care negatively and increases the illness costs (Lee et al. 2013, Lu et al. 2012, Khamisa et al. 2013) Musculoskeletal disorders may be prevented by effective ergonomic risk management programs. These programs include; body mechanics training, exercise education, giving educational materials and they do not require for the nurses to leave their daily work (Lim et al. 2011, Black et al. 2011, Odeen et al. 2013, Côté et al. 2013, Stigmar et al. 2013). The aim of this study is to evaluate the effects of ergonomic risk management program with a view to reduce MSS of the ICU nurses.
Methods:
The study which is developed as “Pre-test post-test design for non-equivalent control groups” comprised in Istanbul, Turkey. The study population consists of two hospitals that are connected to Ministry of Health and have adult intensive care units. The data was collected from 8 ICUs including general, emergency, reanimation, coronary and neurology. The ICUs were evaluated and compared by their physical and ergonomic environmental characteristics. They are found to have the similar characteristics following the criterias such as architectural structural appropriateness, patient transfer equipments (lifts, stretchers) and bedside support areas.
The study sample included 116 nurses with high ergonomic risk who have been working in intensive care unit more than 6 months, and accepted to participate the study (Hospital A: 57, Hospital B: 59). The sample size was calculated by power analysis as 72 ICU nurses (36 in intervention group, 36 in control group). According to that, 35 nurses were selected for the intervention group and 37 nurses were selected for the control group by systematic sampling.
In the pre-test section of the study, the “Descriptives of Nurses and Ergonomic Risk Reporting Form” and “Rapid-Upper Limb Assessment (RULA)” tool were used to collect data about demographics of nurses and the level of ergonomic risks. An “Ergonomic Risk Management Program (ERMP)” was applied to the nurses in the intervention group. The ERMP is a health promotion program developed by using PRECEDE-PROCEED Model. The interventions included by the ERMP are (1) a video training lasts for two weeks which is related to the musculoskeletal risks and exercises to prevent them in the ICU settings without disrupting the works processes of the nurses (2) providing educational materials such as booklets and CDs including the training program (3) personal interviews about discussing the predisposing, reinforcing and enabling factors of behavior change (4) providing exercise mats for the nurses to be able to do the exercises shown during the video training. In 26 weeks following the intervention, SMS reminders were sent to the nurses every four weeks and there was a follow-up including ergonomic risk assessments in the first and third months. After this, the same data collection forms related to nurses’ levels of ergonomic risk were applied to the both groups.
The Statistical Package for Social Sciences 16.0 software was used in statistical analysis. The sociodemographic, ergonomic and working conditions of the nurses were displayed as number, percentage and mean. The paired samples t-test, Q-square test, the analysis of variance in repeated measures, and Cochran’s Q test were applied to evaluate and compare the association between the variables considering the homogenity and the type. The findings were evaluated in between the 95% confidence interval.
Results:
The mean age of the nurses was 27.71±5.21 and 73.6% were female. The Body Mass Index of the nurses was 22.6± 3.1, and 62.5% of them were not doing regular exercise. In the results of the study it is found that there was no difference between the intervention and control group for sociodemographic characteristics, general health and work conditions, MSS, level of pain and ergonomic risk scores (p>0.05). Following this information, these two groups were identified as having similar characteristics before the ERMP intervention.
The legs and lower back were the body parts that MSS are mostly seen before and after the ERMP intervention. In the following month of ERMP intervention, the RULA arm, hand, wrist (score A), trunk, leg, feet (score B) and total scores were found to be decreased as, 0.79, 0.96 and 0.82 points for the patient turning movements and 0.82, 1.85 and 1.40 points for the bending down movements, respectively.
At the end of the ERMP follow-up by the sixth month, the nurses in the intervention group were found to have a significant increase on the frequency of exercise. Moreover, there was a significant decrease on the perceived MSS related pain intensity scores as 0.77 points (p<0.05). The mean total RULA score of nurses for patient turning movement was found to be 4.39±1.49 which means “immediate further analyses and modifications recommended”. The mean total RULA score of the nurses for bending down movement was found to be 3,75±1,64 which means “further analyses and modifications recommended”. However, there was no significant change in the sick leave days in the intervention group before and after the ERMP.
Conclusion:
This study revealed that ERMP was effective not only to reduce the ergonomic risks and MSS related pain level but also to increase the exercise frequency of the ICU nurses. The ergonomic risk management interventions intended at reducing the musculoskeletal symptoms will improve the quality of life of the nurses and their work performance in the long term. The programs focused on risk management and continuous risk assessment which is applied at the workplace could be recommended for the future studies. The study designs in relation to ergonomic risk prevention should be developed in a model based framework and also include visual technologies such as video films and valid measurement risk assessment tools in order to reduce MSS of the ICU nurses.
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