Musculoskeletal disorders and working conditions among Iranian nursing personnel.

This study investigated the prevalence of musculoskeletal disorders (MSDs) and associations with organizational, physical and psychosocial working conditions among 520 nursing personnel in Tehran, Iran. The results of the cross-sectional study on aids and different educational levels of nurses showed that the participants experienced 88% of MSDs in at least one body region during the past 12 months. The 3 most prevalent body regions were the low back (65.3%), knee (56.2%) and neck (49.8%). The participants reported inflexible work schedule, poor quality of devices for transferring patients, overexertion and job dissatisfaction. Physical and psychosocial exposure revealed an elevated odds ratio (95% confidence interval) of MSDs. The results showed a combination of high physical and psychosocial work demands along with low control over the work which increased work-related stress and enhanced the risk of MSDs. This study findings could help to understand work-related MSDs among nursing personnel in a developing country where the work situation and sociocultural context differ from other countries.

The school nursing profession in relation to Bourdieu's concepts of capital, habitus and field.

AIM: The aim was to define the work and professional role of school nurses, in terms of Bourdieu's key concepts of capital and habitus. METHOD: A qualitative study with a deductive approach, based on data from six focus-group interviews with 24 school nurses and 15 individual interviews with school nurses. Thus, a total of 39 school nurses participated in the study. The data were analysed using content analysis. RESULTS: The results explain, in terms of Bourdieu's key concepts of capital and habitus, how school nurses experience their work in the educational setting. A model including different aspects of school nurses' work is shown. CONCLUSION: The new Swedish Education Act focuses on promoting students' general health, so that they are able to reach their academic potential. In this task, the school nurse is to be one of a group of several professionals working together. The present study shows how school nurses experience their professional role and their work in relation to Bourdieu's concepts of capital, habitus and field. To strengthen the school nursing profession, school nurses need to show their competence in promoting students' health.

Adaptation of questionnaire measuring working conditions and health problems among Iranian nursing personnel.

PURPOSE: To adapt a questionnaire in the Persian language measuring working conditions and health problems among nursing personnel. A further aim was to test the validity and reliability of the questionnaire. METHODS: The adapted questionnaire was based on three well-established questionnaires. Physical working conditions items were from Nurse Early Exit Study. Psychosocial working conditions scales were included from Copenhagen Psychosocial Questionnaire which contains two scales on general and mental health as well. The Nordic Musculoskeletal Questionnaire was the origin of the musculoskeletal disorders questions. During the culture adaptation process, an expert panel method was used. To achieve equivalence between the sources and target version, some changes were made by the expert panel. Then the questionnaire was examined in the field for face validity and construct validity (n = 92) among Iranian nursing personnel from two hospitals. Construct validity was assessed using a priori hypothesized correlations of the outcomes with exposures. Finally the adaptation process was completed by reliability assessment using Cronbach's alpha and Intra-class Correlation Coefficient (ICC). RESULTS: The construct validity result was the correlation of the health outcome with the work-related exposure (physical rs = .71 and psychosocial rs = .66). In the reliability assessment, Cronbach's alpha and ICC were .60 and .70 respectively. CONCLUSION: The findings show that the adapted questionnaire has an acceptable conceptual structure and provides reliable information from the nursing profession. Consequently, the questionnaire is applicable to work situation studies among nurses and other health care workers.

Striving for balance between family and work demands among Iranian nurses.

The study reported here explored Iranian nurses' experience of managing work and family roles. Grounded theory method guided the data collection and data analysis from both individual and focus group interviews. Five categories emerged: family role, working conditions, seeking support, perceiving dissatisfaction, and perceiving threats to health. The core concept that emerged was striving for balance between family and work demands. In the work-family role the Iranian nurses faced significant pressures, and they mostly relied on their own capabilities to create balance, often neglecting their own needs. This resulted in perceived dissatisfaction and health threats.

The aspects school health nurses find important for successful health promotion.

BACKGROUND: The work of school health nurses has changed over time; today they focus on health promotion, i.e. encouraging and protecting pupils' health. AIM: The aim of this study was to explore school health nurses' conditions for health promotion work with pupils aged 13-15 years. METHODS: Eight school health nurses from eight different municipalities in Sweden were interviewed. Since the focus was on describing school health nurses' own experiences of their conditions for health promotion work, the research method used was based on Graneheim and Lundman's qualitative content analysis. RESULTS: The results showed that conditions for school health nurses' work with health promotion varied between the different municipalities. This had an influence on what they did and the extent to which they worked in this way. The school health nurses described three important aspects that were essential in order to enable successful health promotion work in schools: organisation, support and knowledge. Organisation: It was important to understand the role of school health nurses and the conditions for health promotion work. Without this, they could only work on an individual level. Support: A network of other professions, working in close collaboration for the health of the pupils, created an understanding of ill health and what could be done to promote health. Knowledge: Most school health nurses recognized a lack of general theories and methods, leading to different empirical working methods in the municipalities. CONCLUSION: In an organisation where the need for health promotion work was understood, and school health nurses had support and knowledge, health promotion could be performed not only on an individual- but also on a general level.

The perceived perceptions of head school nurses in developing school nursing roles within schools.

AIM: To gain a deeper understanding of how Swedish head school nurses perceive their leadership in developing school health care. BACKGROUND: A well-functioning school health care is important for promoting the health of children and young people. METHOD: Constructivist-grounded theory was used to analyse 11 individual interviews with nine head school nurses. RESULTS: Head school nurses strive to find a balance between what they experience as vague formal goals and strong informal goals which leads to creating local goals in order to develop school health care. CONCLUSION: The head school nurse's job is experienced as a divided and pioneering job in which there is uncertainty about the leadership role. They provide individual support to school nurses, are the link between school nurses and decision makers and highlight the importance of school nurses' work to organizational leaders. IMPLICATIONS FOR NURSING MANAGEMENT: This study shows that school health care needs to be founded on evidence-based methods. Therefore, a structured plan for education and training in school health care management, based on research and in cooperation with the academic world, would develop the head school nurses' profession, strengthen the position of school health care and advance the school nurses' work.

Health behaviour and sense of coherence among pupils aged 14-15.

AIM: The overall aim of the study was to investigate if there was a relationship between health behaviour and sense of coherence (SOC) in pupils aged 14-15. A specific aim was to investigate if socioeconomic areas and sex could be related to health behaviour and SOC of these pupils. METHOD: A cross-sectional study was conducted in a sample of pupils in grade eight selected from primary schools in Stockholm city with regard to socioeconomic area. The final sample of the study was 383: 196 girls and 187 boys. Two questionnaires, the Health Profile Scale measuring health behaviour and the Sense of Coherence Scale were used to collect data. RESULTS: Of the total group, girls had a significantly lower SOC mean score compared to boys. There were differences in health behaviour related to both SOC and sex. In comparison with boys, the girls showed a lower SOC in several health behaviours, e.g. breakfast, dinner, alcohol and bed-going habits. The pupils in the high socioeconomic area showed a low SOC score in several health behaviours. CONCLUSION: The findings in this study were that girls aged 14-15 had a lower SOC mean score compared to boys. The girls showed a lower SOC score related to several health behaviours. There were no significant differences in the SOC mean scores between the two socioeconomic areas.

Evaluation of nursing students' work technique after proficiency training in patient transfer methods during undergraduate education.

UNLABELLED: The aim of this study was to investigate if nursing students improved their work technique when assisting a simulated patient from bed to wheelchair after proficiency training, and to investigate whether there was a correlation between the nursing students' work technique and the simulated patients' perceptions of the transfer. METHOD: 71 students participated in the study, 35 in the intervention group and 36 in the comparison group. The students assisted a simulated patient to move from a bed to a wheelchair. In the intervention group the students made one transfer before and one after training, and in the comparison group they made two transfers before training. Six variables were evaluated: work technique score; nursing students' ratings of comfort, work technique and exertion, and the simulated patients' perceptions of comfort and safety during the transfer. The result showed that nursing students improved their work technique, and that there was a correlation between the work technique and the simulated patients' subjective ratings of the transfer. In conclusion, nursing students improved their work technique after training in patient transfer methods, and the work technique affected the simulated patients' perceptions of the transfer.

Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel.

Based on two research projects in Sweden during the 1990s, the aim of this study was to identify former nursing personnel's main reasons for leaving nursing care, and to find out under what circumstances they would consider returning. Two open-ended questions in a questionnaire were analysed. The results showed that different aspects of working conditions, mainly working schedule, management and status of profession were the dominating reasons both for leaving and considering a return. The findings indicate that interventions required for retaining personnel in nursing care need to be addressed both at the political and at the local level.

Factors contributing to the decision to leave nursing care: a study among Swedish nursing personnel.

BACKGROUND: An ageing nursing workforce raises questions of recruitment strategies and how to prevent nursing personnel from leaving their jobs. AIM: The aim of this study was to examine factors contributing to the decision to leave nursing care with special reference to work conditions related to nursing care. METHODS: This paper is based on data from a survey of nursing personnel who were employed at various county hospitals in Sweden from 1992 to 1995 (n = 1507). A self-administered questionnaire was used to identify those who had left nursing care voluntarily (n = 158) and to examine factors contributing to their decision to leave. RESULTS: Results showed that unsatisfactory salary contributed most to the nursing personnel's decision to leave, followed by lack of professional opportunities and restricted professional autonomy. CONCLUSION: The fact that nursing personnel leave because of unsatisfactory salary and lack of professional opportunities underpins the importance of making nursing more attractive in terms of financial and professional development. However, the sample size of this study was relatively small and larger studies are thus required to further investigate the importance of these factors in the decision to leave nursing care.

A direct observation instrument for assessment of nurses' patient transfer technique (DINO).

The aim of this project was to develop a direct observation instrument to assess the work technique of nursing personnel during patient transfers and to test the validity and reliability of the instrument. An expert group developed this instrument, called DINO (DIrect Nurse Observation instrument for assessment of work technique during patient transfers), which contains 16 items divided into three phases of a transfer: the preparation, performance and result phases. To quantify the assessments a scoring system was constructed, giving an overall score for each transfer, depending on the level of musculoskeletal health and safety. Four observers assessed 45 patient transfers at hospital wards and showed in an evaluation that the inter-observer reliability and criterion-related validity of DINO was satisfactory. The assessments with the DINO instrument are done directly when the transfer occurs, without costly equipment. Therefore, it has a wide range of applications. For example, when evaluating training in work technique or when identifying an unsafe work technique as a risk factor for musculoskeletal problems in epidemiological studies.

Patient safety and comfort during transfers in relation to nurses' work technique.

BACKGROUND: The work technique used by health care professionals in patient transfer tasks affects the musculoskeletal load on the professionals, but probably also the safety and well-being of patients being transferred; it is thus a matter of quality of care. AIMS: The aim of this paper is to report a study exploring the relations between the work technique of nurses in patient transfer tasks, and patients' perceptions of safety and comfort during the transfers. METHODS: The work technique used by 102 nurses at orthopaedic wards to perform two common patient transfers: one transfer higher up in bed and one from bed to wheelchair, were examined using video recordings and an observation instrument. A work technique score for each performed transfer was calculated, indicating the level of musculoskeletal safety for the nurse. Nurses assessed their own work technique and patients rated the perceived safety and comfort on bipolar scales directly after each transfer. RESULTS: Patients' perceptions of safety and comfort were positively correlated to the work technique score in both transfers. Patients felt safer and more comfortable during transfers performed with a safe technique, according to the work technique score, than during those performed with a poor technique. Patients' ratings of safety in the transfer from bed to wheelchair, and their ratings of comfort in both transfers, were positively correlated to nurses' assessments of their own work technique. However, the correlation coefficients were rather low. CONCLUSIONS: The results support the existence of a relationship between nurses' skills in patient transfers and quality of patient care.

Work-system risk factors for permanent work disability among home-care workers: a case-control study.

OBJECTIVE: There is a growing need for home-care services in western societies. As home-care workers show high levels of absence related to poor health it is important that we broaden our knowledge about what factors in the work system contribute to this. The aim of this study was to explore and estimate the impact of the work system on permanent work disability and its relative importance compared with home-life risks among home-care workers. METHODS: The cases (617 subjects) were all home-care workers in Sweden, whose disability pension was approved in 1997 or 1998. The controls (771 subjects) were home-care workers still working. We used a questionnaire to gain situation-specific information on working life and home life 5 and 15 years before disability pension entitlement. RESULTS: The most important risk factors in the work system were poor ergonomic/lifting conditions, time pressure and lack of professional caring technique. Fifteen years prior to disability pension entitlement, insufficient management (odds ratio (OR) 95%, CI 2.6[1.6;4.2]) and relational problems at work were also risk factors. Five years before disability pension entitlement, poor organisational support (4.1 [2.5;6.7]), opportunities for co-working and working climate (3.5 [2.4;5.2]) were also strongly related to a persisting work ability. The magnitude of exposure to a number of risk factors had an increased effect (highest 13.8 [5.6-33.8]). The strongest risk factor in home life was little opportunity to rest from work (4.9 [3.0;8.0]). The risk factors in working life were robust to the inclusion of the grouped risk factors of home life. CONCLUSIONS: The conclusion was that risk factors related to the work system are, alone, strongly related to permanent work disability among home-care workers. Also, exposure to several of the risk factors constitutes a notably strong risk for permanent work disability.

Work technique of nurses in patient transfer tasks and associations with personal factors.

OBJECTIVES: Back disorders among nursing personnel are associated with the worktask of assisting patients during transfers. The objectives of the study were to explore the work technique applied by nursing personnel in patient transfer tasks and to determine whether different personal factors were associated with work technique safety. METHODS: The work technique used by 102 nurses to perform two common patient transfer tasks in orthopedic wards, transfer higher up in bed and transfer from bed to wheelchair, was examined with the use of video recordings and an observation instrument. A work technique score was calculated for each performed transfer. It indicated the level of musculoskeletal safety and hazard for the nurse. The participants also filled out a questionnaire concerning different personal factors. RESULTS: A variety of strategies was used by the nurses to perform the transfer tasks. Being older and suffering from low-back symptoms were factors associated with the use of poor work technique in both tasks. There was also an association between male gender and poor technique in transferring patients from bed to wheelchair. CONCLUSIONS: The results indicate an association between poor work techniques and low-back symptoms. Special attention should be paid to older nurses, nurses with low-back problems, and possibly also to male nurses when training programs on patient transfer technique are designed, as these groups seem to apply comparatively poor work techniques in patient transfer tasks.

Evaluation of training in patient handling and moving skills among hospital and home care personnel.

The aim of the study was to evaluate the training programme in patient handling and moving skills according to the Stockholm Training Concept. The evaluation focused on work technique, musculoskeletal problems, job strain and the experience of the person being transferred. The training programme consisted of two models of learning: traditional groups and quality circles. Fifty-one people employed at geriatric hospitals and in primary care, participated in the training programme. For the evaluation, the participants were video-recorded in one standardized transfer situation: moving the patient from bed to wheelchair, before and after the training. The participants' work technique during the patient transfer was assessed using seven items. A questionnaire covering individual factors, physical exertion, job strain, and musculoskeletal problems, was filled in by the participants before training and also six months after. The results showed improvements in six of the seven work technique items, directly after training. A decrease in the participants' physical exertion during transfers of patients from 'bed to chair' was shown six months after completion of the training programme. There was no significant decrease in the participants' musculoskeletal problems and job strain after training. Ninety-eight per cent of the participants were positive about having participated in the training. Training in patient handling and moving skills led to improved work technique. The participants improved their transfer technique and experienced less discomfort during the transfer, and patients experienced greater comfort and safety when being transferred.

Rehabilitation of home care workers: supportive factors and obstacles prior to disability pension due to musculoskeletal disorders.

The aim of this study was to retrospectively explore the prevalence of rehabilitation actions, supportive factors, and obstacles for rehabilitation among home care workers with musculoskeletal disorders, especially focusing on aspects related to occupational rehabilitation. All home care workers in Sweden whose disability pension was approved in 1997 and 1998 because of a musculoskeletal disorder, were selected (n = 373). Data, covering aspects of the rehabilitation process and conditions in working life 5 and 15 years prior to their disability pension, were collected from a questionnaire. The majority considered that the disorder leading to a disability pension was caused by their work, but only one-third of them had their occupational disorder formally approved. Only one-third of the study group received occupational rehabilitation. However, an approved occupational disorder was related to higher prevalence of occupational rehabilitation. In the age group 60-65, few home care workers received rehabilitation. The majority perceived good support from their supervisor and working team, but no support with regard to lowering physical demands. Modification and reduction of physical demands might improve both sustained work ability in home care work and the outcome of the rehabilitation.