Risk perception of musculoskeletal injury among critical care nurses.

BACKGROUND: Nursing is known as an occupation with high risk of musculoskeletal injury. Nurses' perceptions about the risk of injury may have a role in preventing such injury. OBJECTIVES: The aim of this study was to investigate how nurses perceived the risk of musculoskeletal injury from work and identify factors associated with their risk perception. METHODS: In a cross-sectional study using a postal survey, 361 critical care nurses reported on risk perception, physical workload, psychosocial job factors, safety climate, musculoskeletal symptoms, and safe work behavior. RESULTS: Of all critical care nurse respondents, 83% perceived that they were more likely than not to have a musculoskeletal injury within 1 year. On average, nurses perceived the risk of musculoskeletal injury as lower to themselves than to coworkers. This more positive perception of risk to self had stronger correlations with symptom experiences. Multiple linear regression analysis revealed that higher risk perception of injury was associated with greater job strain, greater physical workload, lack of availability of lifting devices or lifting teams, and more symptoms. DISCUSSION: Study findings indicated that most critical care nurses were concerned about their ergonomic job risks. Their risk perceptions about musculoskeletal injury risk were affected by physical work exposures, psychosocial job stressors, and experience with musculoskeletal symptoms, but not by perceived workplace safety climate. The findings underscore the need for management efforts to improve physical and psychosocial working conditions and create a safe work environment.

Personal service assistance: musculoskeletal disorders and injuries in consumer-directed home care.

BACKGROUND: Like other types of care for disabled or elderly adults, consumer-directed personal assistance services may present multi-factorial risks for work-related musculoskeletal disorders (WRMSDs). METHODS: Using survey data, we compared providers experiencing WRMSDs in the previous year to those who did not, seeking to identify functional, temporal, physical, and relationship risk factors for transient and chronic conditions. RESULTS: Longer work experience with the recipient and more frequent bending increased the risk of being in the most chronic group (≥12 painful episodes), whereas predictable work hours with rest breaks and greater social support from the recipient appeared protective. For transient conditions (one to two episodes), longer work experience with the recipient and predictable hours with rest breaks appeared protective. CONCLUSIONS: We offer recommendations to improve hazard assessment as well as training and information distribution related to home care programs. With the population aging, home care jobs require increasing oversight to prevent WRMSDs.

Consumer-directed personal care: comparing aged and non-aged adult recipient health-related outcomes among those with paid family versus non-relative providers.

Risk factors associated with the incidence of recipient injuries, bedsores and contractures, and health care use (i.e., emergency department and hospital use) among aged and non-aged adult personal care recipients are investigated. Data are from a statewide survey of aged and non-aged adult personal assistance service (PAS) recipients (n = 913) in California's In-Home Supportive Services (IHSS) program. This is a consumer-directed PAS program. Outcomes among recipients using relatives (other than spouses or parents) as paid providers are compared with those of recipients having non-relatives as providers. No differences were found by provider-recipient relationships. Non-aged recipients, those in poorer health, those with more than three activities of daily living (ADL) limitations, and those changing providers during the year were all at greater risk for adverse health outcomes. African American, Hispanic, and Asian recipients were at lower risk for injuries and hospital stays than were White recipients.

Factors associated with safe patient handling behaviors among critical care nurses.

BACKGROUND: Patient handling is a major risk factor for musculoskeletal (MS) injury among nurses. The aims of the study were to describe nurses' work behaviors related to safe patient handling and identify factors influencing their safe work behaviors, including the use of lifting equipment. METHODS: A cross-sectional study using a mailed questionnaire with a nationwide random sample of 361 critical care nurses. Nurses reported on the physical, psychosocial, and organizational characteristics of their jobs and on their MS symptoms, risk perception, work behaviors, and demographics. Hierarchical multiple linear regression analyses were used to identify significant factors. RESULTS: More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort-reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior. CONCLUSIONS: Safe work behaviors are best understood as socio-cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury.

Organizational climate and nurse health outcomes in the United States: a systematic review.

Increasing interest has been focused on understanding the role working conditions play in terms of the serious issues facing hospitals today, including quality of patient care, nurse shortages, and financial challenges. One particular working condition that has been the subject of recent research, is the impact of organizational climate on nurses' well-being, including occupational health outcomes. To examine evidence-based research on the association between organizational climate and occupational health outcomes among acute-care registered nurses, a systematic review of published studies was conducted. Studies assessing the association between organizational climate variables and three common health outcomes in nurses (blood/body fluid exposures, musculoskeletal disorders, and burnout) were reviewed. Fourteen studies met the inclusion criteria. Although most were cross-sectional in design and variability was noted across studies with respect to operational definitions and assessment measures, all noted significant associations between specific negative aspects of hospital organizational climate and adverse health impacts in registered nurses. While evidence for an association between organizational climate constructs and nurses' health was found, data were limited and some of the relationships were weak. Additional studies are warranted to clarify the nature of these complex relationships.

Rest break interventions in stoop labor tasks.

Hand cultivation and harvest of agricultural products constitute strenuous physical tasks. Working with labor-management ergonomics committees in agricultural settings, the UC Agricultural Ergonomics Research Center (AERC) tested an experimental rest and recovery protocol for its impact on symptoms and productivity during two types of work tasks. The experimental condition consisted of adding a 5 min rest break to every working hour in which there was no other scheduled break (e.g., lunchtime). This resulted in an additional 20 min of rest per workday. We tested the intervention in two trials: Trial one compared workers (n=66) randomly assigned to an experimental or a control group during the harvest of commercial strawberries. Trial two utilized a cross-over design (n=16 pairs of workers) to compare experimental and control conditions while workers inserted bud grafts into young 18'' high citrus trees. For both trials, workers under the experimental condition reported significantly less severe symptoms than workers under control conditions. The order in which the intervention was given, however, appeared to result in variations in productivity. We conclude that the introduction of frequent, brief rest breaks may improve symptoms for workers engaged in strenuous work tasks.

Psychometric evaluation of the Nursing Stress Scale (NSS) among Chinese nurses in Taiwan.

The purpose of this study was to translate the Nursing Stress Scale (NSS) into Chinese and test its reliability and validity among Chinese nurses in Taiwan. Potential participants were asked to self-administer a Chinese version of the NSS. The agreement estimation was used to determine the equivalence of the meaning between the Chinese and original English versions and was rated by five bilingual nurses as 92% accurate for the 34 items. The test-retest reliability for the NSS at 2 weeks was .71 (p = .022, n=10). Internal consistency reliability and factor analysis were tested with 770 nurses from 65 inpatient units at a medical center in Taiwan. The internal consistency of the Chinese version of the NSS for an overall coefficient alpha is .91 for the total scale, and ranges from .67 to .79 for the subscales. The Chinese version of the NSS explains 53.77% of the variance in work stressors among Chinese nurses in Taiwan. Overall, the Chinese version of the NSS is internally consistent but may not be stable over 2 weeks. There was adequate evidence of the reliability and validity of the NSS-Chinese as an instrument appropriate to measure work stress among Chinese nurses. The translated NSS could be a useful tool for examining the frequency and major sources of stress experienced by Chinese nurses in hospital settings, and for the development of appropriate interventions for stress reduction.

The contributions of interpersonal conflict to chronic pain in the presence or absence of organic pathology.

This study investigated the influences of social support and interpersonal conflict on chronic pain in patients with arthritis or with myofascial disorders. Measures of social support, conflict, and pain were drawn from subscales of the McGill Pain Questionnaire, the Multidimensional Pain Inventory, the Family Environment Scale, and the Interpersonal Relationship Inventory. Patients with myofascial disorders reported significantly worse pain (sensory and affective), higher depression scores, more interpersonal conflict, and less support from others than patients with arthritis, but did not differ from them on personality traits. Also, the contributions of conflict to pain were found to depend on the nature of the chronic disorder and on the source of the conflict, i.e., significant other, family, or social network members. For patients with arthritis, less intense pain (sensory and affective) was associated with higher family conflict. Less intense sensory pain in arthritis was also associated with more punishing responses from the significant other to pain. For patients with myofascial disorders, more intense affective pain was associated with higher social network conflict. Social support did not significantly contribute to pain for either group. Thus, chronic painful disorders may differ on the influences that social relationships have on pain. The implications of these differences for treatment are discussed.

A test of two training interventions to prevent work-related musculoskeletal disorders of the upper extremity.

We investigated, on behalf of a large electronics manufacturer, two types of worker training interventions for their efficacy in preventing unnecessary muscle tension and the symptoms of work-related musculoskeletal disorders. The first intervention, Muscle Learning Therapy (MLT), used electromyographic (sEMG) feedback and operant conditioning to decrease muscle tension during complex work tasks. The second intervention used adult learning and cognitive behavioral techniques in small group discussion to advance the worker's capabilities for symptom and stress management and problem-solving. Workers were randomly assigned to a control group or one of the two treatment conditions. Prior to training, baseline data were collected using symptom diaries and sEMG recordings of the trapezius and forearm muscles of the left and right arms. The training interventions were conducted for 6 weeks with reinforcement training provided at 18 and 32 weeks post-baseline. Follow-up data were collected after the initial 6-week training period and at 32 weeks, prior to the reinforcement training. Symptom outcomes demonstrated significant differences at 6 weeks, increasing in severity for the control group and declining modestly for the educational group, with little change for the MLT group. These differences were not maintained at further follow-up. The MLT group was consistently effective in reducing muscle tension in the trapezius areas after 6 and 32 weeks, and was partially effective for the forearms. Further testing is recommended of these training interventions, especially with the inclusion of strategic, periodic reinforcement of the worker's learning.

Chronic pain in the workplace.

Chronic pain, especially chronic back pain, is costly to workers, their families, employers, and society. Successful return to productive work life for the worker with chronic pain requires multi-disciplinary efforts, including those of the nurse case manager, occupational health nurse, and nursing specialist in pain management. Sensitivity to the dynamics of multiple stakeholders in the RTW process is essential because of their diverse perspectives. Successful RTW can be facilitated by a combination of approaches, including case management, worker capacity evaluation, ergonomic job analysis, team design of job modifications, appropriate medical treatment, and self management by the worker.

Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: an analysis of cross-sectional survey data.

BACKGROUND: Patient handling is a major risk factor for musculoskeletal injuries among nurses. Lifting equipment is a main component of safe patient handling programs that aim to prevent musculoskeletal injury. However, the actual levels of lift availability and usage are far from optimal. OBJECTIVE: To examine the effect of patient lifting equipment on musculoskeletal pain by level of lift availability and lift use among critical-care nurses. DESIGN AND PARTICIPANTS: A cross-sectional postal survey of a random sample of 361 critical-care nurses in the United States. METHODS: The survey collected data on low-back, neck, and shoulder pain, lift availability, lift use, physical and psychosocial job factors, and sociodemographics. Musculoskeletal pain was assessed by three types of measures: any pain, work-related pain, and major pain. Multivariable logistic regressions were used to examine the associations between musculoskeletal pain and lift variables, controlling for demographic and job factors. RESULTS: Less than half (46%) of respondents reported that their employer provided lifts. Of 168 nurses who had lifts in their workplace, the level of lift availability was high for 59.5%, medium for 25.0%, and low for 13.7%; the level of lift use was high for 32.1%, medium for 31.5%, and low for 31.5%. Significant associations were found between lift availability and work-related low-back and shoulder pain. Compared to nurses without lifts, nurses reporting high-level lift availability were half as likely to have work-related low-back pain (OR=0.50, 95% CI 0.26-0.96) and nurses reporting medium-level lift availability were 3.6 times less likely to have work-related shoulder pain (OR=0.28, 95% CI 0.09-0.91). With respect to lift use, work-related shoulder pain was three times less common among nurses reporting medium-level use (OR=0.33, 95% CI 0.12-0.93); any neck pain was three times more common among nurses reporting low-level use (OR=3.13, 95% CI 1.19-8.28). CONCLUSIONS: Greater availability and use of lifts were associated with less musculoskeletal pain among critical-care nurses. These findings suggest that for lift interventions to be effective, lifts must be readily available when needed and barriers against lift use must be removed.

The Thai version of Effort-Reward Imbalance Questionnaire (Thai ERIQ): a study of psychometric properties in garment workers.

This study aimed to test the psychometric properties of the Thai version of the Effort-Reward Imbalance Questionnaire (T-ERIQ). The English version of the 23-item ERIQ was translated and back-translated. Content validity was examined by five experts and face validity was examined by twelve key informants before being tested for construct validity with 828 workers from six garment factories. Predictive validity was assessed through the relationship between the ERI constructs and psychological health outcomes including psychosomatic symptoms, state of anxiety, depression, and job satisfaction. The internal consistency of the Thai ERIQ was tested using the first survey (n=828), and test-retest stability was examined 2 to 4 wk later with a subsample (n=408). The results show that 2% of workers reported effort-reward imbalance (ERI ratio>/=1). The Thai ERIQ has good content validity with a Content Validity Index of 0.95. Cronbach's alpha coefficients for the effort, reward, and overcommitment scales were 0.77, 0.81, and 0.66, respectively. The 2-4 wk stability of these three constructs was moderate (r=0.496-0.576, p<0.001). Overall, the factorial validity was demonstrated as the best model fit, with high values of the goodness-of-fit indices, using confirmatory factor analysis, indicating accordance with the theoretical constructs of the ERI model. Logistic regression analyses supported significant associations of reward with all psychological health outcomes (p<0.05). The findings suggest that the Thai ERIQ has adequate reliability and validity to investigate the psychosocial work environment. The Thai ERIQ can be applied to the Thai working population, particularly industrial manufacturing workers.

The prevalence of and risk factors for back pain among home care nursing personnel in Hong Kong.

BACKGROUND: There is a large gap in research with regard to back pain (BP) among home care nursing personnel (HCNP); only seven studies have been conducted worldwide. There is a need to identify the magnitude of and risk factors for BP that are unique to Hong Kong (HK) HCNP. METHODS: A total population sampling technique was employed in this cross-sectional questionnaire-based study. Hierarchical multiple logistic regression analyses were used to control for potentially confounding variables. RESULTS: The 12-month prevalence of upper and lower BP was 71.2% (n=265). Three predictors were identified: physical risk factors in the office (OR=3.57, 95% CI=1.55-8.24), static postures (OR=1.41, 95% CI=1.04-1.90), and psychological job demands (OR=1.11, 95% CI=1.01-1.22). CONCLUSION: HCNP in HK have a high prevalence of BP. BP in HK HCNP is independently attributable to physical work factors in the office, static postures, and psychological job demands, and is not primarily associated with patient lifting and transferring which are traditionally identified as risk factors for BP in hospital nursing personnel. Am. J. Ind. Med. 49:14-22, 2006. (c) 2005 Wiley-Liss, Inc.

Functional limitations and well-being in injured municipal workers: a longitudinal study.

Two instruments, the Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36), were used to document both the immediate and short-term effects of workplace injuries in municipal workers. Telephone interviews were conducted up to 3 months following the injury. One hundred fourteen subjects agreed to participate in the study; 90 workers completed at least one useable interview. The relationship between functional limitation and lost days was evaluated using Cox proportional hazards models. At 3 months following the onset of injury, SF-36 scores for physical function, role-physical, and bodily pain differed significantly from population norms. Using one standard deviation of change, statistically significant hazard ratios were seen in subjects with lower SF-36 physical component summary, physical function, and bodily pain scores, and higher HAQ disability and fatigue scores. Functional limitations persisted in workers after relatively minor workplace injuries despite a 91% return to work rate.

Priority risk factors for back injury in agricultural field work: vineyard ergonomics.

With support of a NIOSH Community Partners grant, the authors reviewed data from three cooperating vineyard companies in Napa and Sonoma Counties, finding both high rates of evidence of musculoskeletal disorders (MSDs) and identifying priority MSD hazards for intervention. Data from OSHA 200 injury report logs identified 29 reported MSDs and 435 lost workdays in a working population of 194 in a 30-month period. The majority of these (20) involved backstrain. High risk job tasks were identified, including: employer-identified tasks, analysis of injury reports, and ergonomics risk factor checklist survey of task work. Triangulating across these three data groups resulted in identification of high priority tasks, including: hand harvest work, hand pruning, and weeding using shovels. Priority risk factors for back injury in these jobs were: repetitive lifting of heavy loads, repetitive exertion of force by the trunk and upper extremities, and repetitive or sustained awkward postures of the trunk (including full stoop and twisting with loads).