INTRODUCTION:

Woman, Female, Lady are nouns referring to adult human beings who are biologically female; that is, capable of bearing offspring. Woman is the general term. It is neutral, lacking either favorable or unfavorable implication, and is the most commonly used of the three a wealthy woman, a woman of strong character, of unbridled appetites.

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well in all settings. Nurses are a person trained to care for sick or injured people. Critical care nurses give care to the patients with the most secure and life threatening illnesses and injuries that require constant, close monitoring and support from specialist equipment and medication in order to maintain normal bodily functions. The musculoskeletal injuries are an act that damages or hurts relating to or involving both musculature and skeleton. There are a number of ways where a critical care nurses suffers from musculoskeletal injuries. In, hospital the application of ergonomics to nurses has the potential to help them avoid musculoskeletal disorders. The advantages of ergonomic application in hospitals can be seen in significant drop of musculoskeletal injuries and bade injuries among nurses, increased productivity and financial savings for the employers (LINAK homepage 2009) According to the U.s Bureau of labor statistics in 2007, the decrease in the number of musculoskeletal disorders was the largest factor contributing to the overall decline in days away from work in general work industries. Nursing aids and attendant alone reported a 12% decline in missed work days. Ergonomics, better known as human engineering has played a significant role in decreasing the rate of injuries and illnesses among employee. The term ergonomic can be defined as the study of the design of work in relation to psychological and physiological capabilities of people (Changalur and Bernard and Rodgers, 2004). Due to sub standards practices and conditions in the work environment, musculoskeletal injuries and cumulative trauma disorders have increased among employees. Some of the risk factors associated with these disorders are as follows: awkward postures, forceful exertion extreme temperatures, repetitive motion and Duration. These factors are evaluated in most cases of musculoskeletal injuries (university of Arizona risk management and safety work page 2009). These risk factors are recognized by ergonomists. Therefore this seems to be an opportunity to enhance employee and patient safety through the increased use of approved procedures for a patient lifting system. Handling patients is a highly demanding job. It requires lifting and moving patients which can lead to serious work related injuries such as musculoskeletal disorders and cumulative trauma disorders. The Bureau of labor statistics (2004) reported that musculoskeletal disorders represent 54% of workplace injuries and illnesses among nurses, psychiatric and home health aides. More ever musculoskeletal disorders are major problems in the health carry industry. These problems can be minimized by the correct use of ergonomics solution and tools. Musculoskeletal disorders can be controlled by health care professionals, who have a full understanding of the risk factors and control strategies (Barbara and June, 2003).

STATEMENT OF THE PROBLEM:

Risk Perception of Musculoskeletal Injury among Critical Care Nurses at Sri Ramakrishna Hospital, Coimbatore.

OBJECTIVES:

· Assessment of risk perception of musculoskeletal injuries among critical care nurses.

· Education on lifting practices and prevention of musculoskeletal injury.

OPERATIONAL DEFINITION:

RISK PERCEPTION:

It is the subjective judgment that nurses make and security of risk.

MUSCULOSKELETAL INJURIES:

It refers to damage of musculoskeletal system, it is usually due to strands activity such as lifting the patient, handling the machines, prolong standing etc.

CRITICAL CARE NURSES:

The nurses who are talking care of critically patients or unstable patients. The critical care nurses should be well qualified and should posses’ adequate knowledge in comprehensive nursing care.

PROJECTED OUTCOME:

Education will improve the knowledge of the critical care nurses on prevention of musculoskeletal injuries.

Assessment of Risk perception of lifting practices and education:

The challenge of lifting and repositioning patients is considered one of the major issues in hospitals and nursing homes. Nurses can face several type of injures from lifting and helping patients. The difficulty of lifting patients can be result of the size and the weight of the patient. In addition, the use of good body mechanics from nurses can be affected by the small areas that nurses have to walk within. One example is transferring patients in small bathrooms. The conditions and practices of nurses can lead to a higher rate of injuries. These conditions contributed to the 211,000 occupational injuries suffered by nurses in 2003 (Bureau of Labor Statistics, 2003). Musculoskeletal disorders such as back injuries and tend in it is are significant problems in the workplace today. Health care professionals understand the risk factors and the control strategies to prevent musculoskeletal disorders among all caregivers. According to sattler and lipscomb, the authors of “Environmental Health and Nursing Practice” there are opportunities to provide very effective controls for a small proactive investment in the job design. Reactive changes are include the following: the change of employees work patterns and the modifications to the equipment that has been installed (Sattler and Lipscomb, 2003, p.44). Risk factors can be controlled in the design of the job or after the work has started.

MATERIALS AND METHODS:

RESEARCH APPROACH:

The research approach adopted for this study was evaluative research approach.

RESEARCH DESIGN:

The research design adopted was one group pretest quasi experimental design.

SETTING:

The study was conducted in the critical care unit at Sri. Ramakrishna Hospital, Coimbatore.

POPULATION:

The population included was the staff nurses work in Critical Care Area at Sri Ramakrishna Hospital.

SAMPLE AND SAMPLE SIZE:

Sampling:

The technique adopted for my study was convenience sampling. There were 30 staff nurses who satisfied and they were included for the study.

Sample Size:

The total sample size consist of 38 staff nurses in Critical Care Unit,30 staff nurses were included for the study in Sri Ramakrishna Hospital.

TIME AND DURATION OF STUDY:

The duration of the data collection was 2 week from 10.03.2014 to 22.03.2014.

INSTRUMENTS AND TOOLS FOR DATA COLLECTION:

The questionnaire used for collecting data from the critical care nurses. The survey questions aimed to identify discomfort on pain on the body parts. Some of the body parts that were covered include the following shoulder, neck and back. A structured lesson plan was formulated. The education was give with the help of Laptop.

TOOLS AND EVALUATION QUESTIONNAIRE:

Tool: No:1: It is the Demographic data, which consist of Name, Age, Sex, Year of experience whether any History of musculoskeletal problem, Body Mass, Index.

Part II

It consists of 8 questions regarding identifying discomfort or pain on the body parts. The questions were of objective.

Part III

The Ergonomic assessment tools include the Rapid entire body assessment (REBA) and Rapid upper limb assessment (RULA). It consists of 8 steps the scoring was given as 1, 2-3, 4-5, 6-7.

TEACHING AID:

Laptop –power point presentation was used for teaching.

PROCEDURE OF DATA COLLECTION:

The data was collected for a period of 12 days. The Critical Care Nurses was explained about the purpose of the study. They were given 15 minutes to answer the question. Education was given to them on lifting practices and prevention of musculoskeletal injury with the help of Laptop.

TECHNIQUES OF DATA ANALYSIS AND INTERPRETATION:

Scoring was given and the Demographic Data and the Ergonomic assessment tools are co-related to find for the Positive or Negative correlation collected data was completed with the help of Master Code Sheet. As per code sheet the data was analyzed, categorized and interpreted. The “r” test was performed to find out the significance by depending on following formula.

r =

Where,

N = Sample size

T = Standard Deviation

X = Age

Year of experience

Musculoskeletal Problem

Body Mass Index

Y = REBA and RULA score of the above component.

PLAN OF DATA ANALYSIS

After collection of data, master coding sheet was prepared from the data. Data tabulation were done. The data were analyzed using descriptive and inferential statistics. Mean and Standard Deviation were used to assess percentage distribution of demographic variables and knowledge on Risk perception of musculoskeletal injuries among Critical Care Nurses.

DATA ANALYSIS AND INTERPRETATION:

The Chapter deals with the analysis and interpretation of data. With the help of collected data an attempt is made to assess the “Risk Perception of Musculoskeletal injury among Critical Care Nurses”. The study was conducted in Sri Ramakrishna Hospital, Sidhapudur, Coimbatore. 30samples were selected for this study. A structured Questionnaire consisting of 8 questions was used to identify the nurses lifting practices in critical care unit. Education was given regarding the lifting practices and prevention of musculoskeletal injury with the help of Laptop.

MUSCULOSKELETAL PROBLEM:

TABLE NO 1 DISTRIBUTION OR MUSCULOSKELETAL PROBLEM

Musculoskeletal Problem	Back pain	Calf muscle pain	Knee pain	Upper back pain	Leg pain	Nothing
Back pain	5	4	1	-	2	-
Calf muscle pain	-	1	-	-	-	-
Knee pain	-	-	1	-	-	-
Upper back pain	-	-	-	1	-	-
Leg pain	-	-	-	-	-	-
Nothing	-	-	-	-	-	15
Back pain	16.66%	13.33%	3.33%	-	6.66%	-
Calf muscle pain	-	3.33%	-	-	-	-
Knee pain	-	-	3.33%	-	-	-
Upper back pain	-	-	-	3.33%	-	-
Leg pain	-	-	-	-	-	-
Nothing	-	-	-	-	-	50%

In the view of above table , out of 30 samples, 5 had back pain,1 had calf muscle pain,1 had knee pain,1 had upper back pain,4 had back pain and calf muscle pain, 1 had back pain and kneepain,2 had back pain and leg pain,15 had no complaints The purpose of this study was to identify the health and safety of nurses and the extent that patient lifting equipment and procedures are being utilized to maximize nurses and patient safety in a critical care unit. The study focuses on the evaluation of the risk factor that contributes to musculoskeletal injury and investigates work related injuries in critical care unit.

The study Objectives are:

(i) Assessment of risk perception of musculoskeletal injuries among critical care nurses.

(ii) Education on lifting practices and prevention of musculoskeletal injury.

PRESENTATION OF DATA:

Goal 1: Thirty samples were selected for this study. The survey was distributed to employees in order to identify the current condition the nurses work in. The informative survey covered different and aspects of the job such as training, working period, and work- related injuries. The researchers used ergonomic assessment tools included RULA and RUBA. Rapid Upper Limb Assessment (RULA). The researchers used the RULA employee assessment worksheet as a survey method to assess awkward postures while lifting and transferring patients. The risk assessment demanded a direct observation that covers the neck, trunk, shoulders, and upper limbs and the angle of body parts. The final score indicates the level of intervention required to control or eliminate the risk. As shown in Table 1, RULA scores resulted from nurses lifting a patient. Moreover, the completed analysis of RULA employee assessment worksheet can be seen in CHAPTER III in this research paper.

Table.1 Scores of RULA Assessment for a Nurse Lifting Patients

RULA Assessment	Arm and Wrist Score	Neck, Trunk and Leg Score	The Final Score
Lifting Patient	5	10	7

As shown in Table 1, the final score of RULA is seven for nurses lifting patients. The score of seven indicates that further investigation has to take place in order to control the risk factors and to reduce the injury rate among nurses. The score seven is considered the highest score in RULA assessment. It requires the immediate implementation for change. Another ergonomic assessment technique was used in order to identify the risk factors associated with lifting patient. This technique was REBA, RULA helped target awkward postures performed by nurses. It estimates the risks of work-related entire body injuries. REBA provides a systematic assessment of the complete body postural risk to nurse. The researcher used REBA employee assessment worksheet to analyze the practice of nurses during patient handling. It covered all parts of the nurses body such as neck, trunk, leg, arm and wrist. As in RULA assessment, REBAs outcome is a final score that determines the need to change in the way the job was done. The final score indicates the level of change required to control or eliminate the risk. As shown in Table 2, REBA scores resulted from nurses lifting patients. Moreover, the completed analysis of REBA employee assessment worksheet can be seen in Chapter III this research paper.

Table 2: Scores of REBA Assessment for a nurse Lifting Patients

REBA

Assessment

Score A

(Neck and Trunk)

Score B

Arm and Wrist Score

Score C

Final

REBA Score

Lifting Patient

As Shown in Table 2 above, REBA assessment for nurses lifting patients resulted in a final score of 12. This final score of 12 indicates that the lifting was associated with very high risks. Furthermore, the final score required more investigation and immediate change reduce and eliminate the risk factors.

The scores in the REBA employee assessment worksheet are as follows:

· Score A: represented Neck, Trunk and Leg Analysis

· Score B : represented Arm and Wrist Analysis

· Score C: is a combination of score A, score B, and load/ force score.

Goal 2: Education on lifting practices and prevention of musculoskeletal injuries

The nurses are divided into two groups. Each group contains 15 members. Education was given in two days, with the help of Laptop consist related to lifting practices of images and exercises for Back pain, Neck Pain and Calf muscle pain.

DISCUSSION:

According to the results of the methodology used in this study, there are associated risks with the job when nurses move and transfer patients. The results show that lifting patients at the critical care unit has contributed to Musculoskeletal Injuries among nurses. As represented earlier in the informative survey, ergonomic assessment tools show that musculoskeletal injuries have developed due to the current job practices of nurses. Patient handling tasks are considered high risk because of the magnitude of weight lifted, unpredictable load lifted of the patient, and sustained awkward posture while providing care (Audery, 2007).

As the collected data showed, lifting patients is a serious subject among health care workers. The use of ergonomic assessment tools and the informative survey have been intertwined. They provided an important explanation to the musculoskeletal injuries and current practices of nurses. For examples, the final scores of RULA and REBA and the answers of nurses to the survey questions have suggested the need for further investigation of the current practices of nurses.

LIMITATIONS:

The project was conducted among critical care nurses only.

Only minimum number of samples was involved.

RECOMMENDATIONS:

· Expand the distributed survey to other departments to get a greater understanding of the Musculoskeletal Injuries.

· Expand the application of ergonomic assessment tools in other departments that involve direct contact between nurses and patients.

· Review work related injuries and illnesses data to know the extent and the severity of Musculoskeletal Injuries among nurses.

NURSING ADMINISTRATION:

· Provide nurses with the knowledge of musculoskeletal disorders and encourage them to report any kind of injuries that result from lifting patients.

· Train nurses on the proper lifting patient’s techniques and the proper use of body Mechanics.

· Train nurses on the use of patient lifting equipment.

· Encourage nurses to review the process of lifting to guarantee no flexed body parts while lifting or moving patients.

· Make new polices that reduce the number of time nurses lift patients.

REFERENCES

1. A and C Black Publisher Ltd. (2008). Benchmarking. London, United Kingdom. Advance for Nurses. (2010). California’s Safe Staffing Law Saves Lives. Retrieved April 2010,

2. AL FRANKEN.(2010),Health Care. Retrieved April 2010, from AL FRANKEN U.S. Senator, Minnesota.

3. Allen, S., and Wilder, K. (1996). Occupational Health and Safety. Safe Staffing. Retrieved February 2008,

4. American Nurses Association. Position statement on elimination of manual patient handling to prevent work-related musculoskeletal disorders.

5. Barbara, S. and Jane, L. (2003). Environmental Health and Nursing Practice. (1st edition). New York, NY: Springer Publishing Company, Inc.

6. Brauer, R. L. (1990). Safety and Health for Engineers. New York, New York, Van Nostrand Reinholdvc

7. Bureau of Labor Statistics, (2001). Number of nonfatal occupational injuries and illnesses involving days away from work in 1999. Retrieved February l5,

8. Camp C. (1989) Benchmarking. The Search for Industry Best Practices that Lead to Superior Performance. American Society for Quality Control Quality Press, Quality Resources, Milwaukee, New York, USA

9. Canadian Center for Occupational Health and Safety.(2006, April 20). Hierarchy of Control 2010 . Retrieved from

10. Carpentier, J. and Cazamian, P. (1977). Night Work. International Labour Organsation. Geneve Switzerland

11. Chengalur, S. N., Rodgers, S. H., and Bernard, T.E., (2004). Kodak‘s

12. Ergonomic Design for People at Work (2nd ed). Hoboken, New Jersey: John Wiley and Sons, Inc.

13. Ellis, J. (2006). All inclusive benchmarking. Journal of Nursing Management. 14, 377-383.

14. Ergoweb. (2009). Glossary. Retrieved June 16, 2009, From

14.http://www.ergoweb.com/resources/reference/glossary.cfm

15. Etherton, J. (2001). Machinery Risk Assessment for Risk Reduction, Human and Ecological Risk Assessment. 711787-99 Firenze, R. J. (1978) The Process of Hazard Control. Dubuque, Iowa, Kendall / Hunt Publishing Company

16. Hignett, S., and McAtarnney, L. (2000). REBA Worksheet. Cornell University Ergonomics Web. Retrieved April 21, 2010 from CUErgo website:

16.http://ergo.human.come1l.edu/ahREBA. html

17. Li., Wolf, L. and Evanofi; B. (2004) Use of Mechanical Patient Lifis Decreased Musculoskeletal Symptoms and Injuries among Health Care Workers. Injury Prevention, Retrieved from

17.http://injurypreventiombmj.comlcontentl10/4/212.fi.11l.htm#related-urlsdoi:10.1136/ip.2003.004978

17.Jeffery W. Vincoli (2000).

18. Lewis Dictionary of Occupational Environment Safety and Health. Engineering Control. New York, NY, Lewis Publishers.

18.Kearney, D. S. (2008). Ergonomic Made Easy. Lanham, Maryland, Government Institutes, an imprint of The Scarecrow Press, Inc.

19. Library of the Congress. (2009-2010). Nurse and Health Care Worker Protection Act of 2009. Retrieved from http://thomas.loc.gov/cgi-bin/query/z?cl l1:H.R.238l .

20. LINAK. (2009). The MEDLINE and CARELINE Division. Retrieved June 29, 2009, from

20.http://www.medline-careline.linak.com/About/?id2=152

21. McAtamney,L.,and Corlett,E.N.(1993) RULA:A survey method for the investigation of work-related upper limb disorders.Applied Ergonomics,24(2), 91-99.

22. National Institute for Occupational Safety and Health. (2009). Safe Patient Handling Training for School of Nursing. Retrieved November 2009, from

22.http://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-l27.pdf

23. Nelson, A. L., Collins, J., Knibbe, H., Cookson, K., de Castro, A.B., and Wippile, K. L. (2007). Safer Patient. Nursing Management, 38 (3),26-32

24. Nelson, A.L., Motacki, K. and Menzel N. (2009). The Illustrated Guide to Safe Patient Handling and Movement. New York, NY. Spring Publishing Company, LLC.

25. Occupational Health and Safety Association. (2010). OSHA Forms for Recording Work-Related Injuries and illnesses. Retrieved October 31, 2008, From OSHA web site:

25.http://www.osha.gov/recorclkeeping/new-osha30oforml-1-04.pdf

26. Oulton, J. (2006). The Global Nursing Shortage: An Overview of Issues and Actions. Policy, Politics and Nursing Practices Journal, (7) (3), 34S-39S

27. Peate, W. and Lunda, K. (2001). Ergonomics: A Risk Manger’s Guide to Reducing Injuries, Cost and Liabilities. Houston, TX, USA. ABS Consulting Publication.

28. Retsas, A., and Pinikahana, J. (2000). Manual Handling Activities and Injuries among Nurses: An Australian Hospital Study. Journal of Advanced Nursing. 31 (4): 875-883

29. Sattler, B. and Lipscomb, J. (2003). Environmental Health and Nursing Practice. (1st edition). New York, NY: Spring Publishing Company, Inc.

30. Stammers, R. and Patrick, J. (1975). The Psychology of Training. London, Methuen and Co Ltd.

31. Stramler. J. H (1993). Dictionary for Human Factors: Ergonomics. Boca Raton, Florida, CRC Press, Inc.

32. Tayyari, F. and Smith, J. (1997). Occupational Ergonomics Principles and applications. (1st edition). London, UK: Chapman and Hall.

33. U.S. General Accounting Office. (2001). Health workforce: Ensuring adequate supply and distribution remains challenging (Rep. NO. GAO-01-l 042T). Washington, DC

34. University Of Arizona. (2009). Risk factors in Ergonomics. Retrieved June 16, 2009, from http://risk.arizona.edu/healthandsafety/ergonomics.shtml

35. Welton, J. (2007). Mandatory Hospital Nurse to Patient Staffing Ratio: Time to Take a Different Approach. The online Journal of Issues in Nursing, 12, 3 Manuscript 1.

Received on 03.06.2016 Modified on 22.07.2016

Int. J. Adv. Nur. Management. 2016; 4(4): 339-344.

DOI: 10.5958/2454-2652.2016.00076.7