Research On Prevalence Status Of Work-related Musculoskeletal Disorders And Intervention Among Nursing Staff In Xinjiang

Objectives:To investigate the epidemiological status of work-related musculoskeletal disorders(WMSDs)among nursing staff in Xinjiang,analysis the prevalence of WMSDs and influential factors,analysis pain intensity or discomfort and absenteeism situation related with WMSDs,so that provide the basis data for the occupation health administrative departments and medical administers.To intervene nursing skills and KAP for WMSDs of nursing staff by using the method of ergonomics so that to improve the protection consciousness and ability to prevent WMSDs.And to develop a set of rational references for occupational health management strategies for preventing and controlling of WMSDs in different nursing departments.Methods:1)6000 nurses from15 different hospitals of Xinjiang were selected by cluster random sampling method participated in the research.The standardized version of the Nordic Musculoskeletal Questionnaire(NMQ)was filled in to describe the prevalence rate of WMSDs in nursing staff,analysis the personnel characteristics of WMSDs,the status of pain intensity and absenteeism.2)By using a standard questionnaire for WMSDs,PES,SSRS,job control questionnaire and SF-36,to investigate the work-related influential factors,and the role of social psychological factors on WMSDs.Logistic regression model was used to explore the influential factors of WMSDs among nursing staff.3)The quick exposure check system(QEC)was used to evaluate ergonomic load and exposure risk levels of 15 commonly used nursing skills.KAP questionnaire for preventing WMSDs was used to evaluate nurses’awareness of preventing WMSDs.A set of interventional program was designed based on ergonomic principles and implemented on ICU nurses.Results:1)There were 5438 nurses whose questionnaires were effective.The prevalence of WMSDs in nursing staff were high,prevalence of WMSDs since work was 81.15%,prevalence of WMSDs in the past year was 76.94%,prevalence of WMSDs in the past week was 23.19%.Low back(61.36%),neck(58.94%),shoulder(48.71%),back(38.36%)and knee(32.88%)were identified as 5 most affected body parts.The status of multi-regions WMSDs were serious,15.85%of nurses were affected by two body regions,71.96%were affected by three or more body regions.2)The prevalence of female was higher than male,the prevalence of nurses in age36~40 years old and 16~20 work years(81.42%,81.60%)were the highest.The prevalence of WMSDs in married nueses and nurses who had given birth were higher(71.04%,70.74%).The prevalence of WMSDs in nurses who were in emergency departments ICUs was higher(71.14%)than other departments.The prevalence of WMSDs in nurses with≥28.0kg/m~2 BMI(73.89%)was higher.3)The abnormal sensation of soreness,numbness and other discomfort on different body parts related with WMSDs presented higher proportion.Mild and moderate pain intensity were the main symptoms,while severe and extreme sever pain on low back were severe.The absenteeism of WMSDs was 8.53%in the past year,absenteeism due to low back WMSDs was the highest(5.32%).4)The work status analysis demonstrated that,in dynamic loads analysis,actions of often bend excessively,turn around slightly and excessively,bend and turn around simultaneously,often walk,often take objects with hands or arms,often use a great deal of effort with arms or hands,often pinch the object by hands presented higher prevalence of WMSDs.In static loads analysis,actions of prolonged standing,neck in a bent forward posture for long periods,holding the hands at or under shoulder level presented higher prevalence of WMSDs.In physical loads analysis,actions of lifting,pushing and pulling,lifting heavy loads(>5kg,>20kg),with the uncomfortable position of heavy lifting,lifting with single hand,lifting heavy loads over shoulders presents lower percentage but higher prevalence of WMSDs.More frequency of heavy lifting,and to work with the upper limbs or hands hardly represented higher prevalence of WMSDs.In ergonomic environment analysis,slipping or falling during work and have nothing to lean on caused higher prevalence of WMSDs.In labor organization evaluation,That"rest time sufficient"nurses accounted for only 14.18%;"often overtime"accounted for 68.87%,without sufficient rest time,began to work just after rest,have no rights to decide breaks,always replaced colleagues for works,work overtime frequently presented higher prevalence of WMSDs.The prevalence of nurses on shifts(80.52%)was higher than non-shifts.The prevalence of WMSDs of nurses whose working hours per week were more than 40h(76.94%)was higher than nurse in less than40h working hours per week,P<0.05.5)Analysis on nursing practice environment scores(PES),the lowest score items were adequate staff,nurses have the opportunity to participate in hospital management decision,the department has enough support equipment to help nurses have more time caring for patients.It was found that the prevalence of WMSDs in nurses with good PES group was lower than that in the middle and poor PES group,P<0.05.The total score of social support of nursing staff was40.69±6.71,which was in the middle level.The status of subjective supports and objective support were difference between nurses with WMSDs and non-WMSDs,P<0.01.The work control sense score was 3.14±0.65which was in the upper level.The status of work control was difference between nurses with WMSDs and non-WMSDs,P<0.05.The total score of quality of life(SF-36)was 58.43±1.49 which was lower than the Chinese norm.The 6 dimensions of physiological function,body pain,emotional function,general health,physiological field of health were differences between nurses with WMSDs and non-WMSDs,P<0.01.6)Multivariate logistic regression models showed that sufficient resting time,adequate personnel and material resources,mental health,and general health status were protective factors for WMSDs.Age,gender,working in emergency department or ICUsand BMI,always bending,work with the upper limbs or hands hardly,prolonged standing(83.43%),neck in a bent forward posture for long periods,always push or pull a heavy object,begin to work just after the break,always work overtime,working hours per week more than 40 hours,were the main risk factors of WMSDs.7)15nursing skills were evaluated by using QEC.The result showed that,cardiopulmonary resuscitation,patient repositioning were exteme-high risk skills,making an occupied bed,patient transferring,manual percussion to mobilize pulmonary secretions were high risk skills,computer operating and enema were middle risk skills,and the others were low risk skills.8)Nursing staff WMSDs protection related knowledge score was 36.35±12.88,protection attitude score was 31.04±6.44,protection behavior score was 41.26±4.83,protection related knowledge and behavior score were low,the protective attitude was a little better.9)Through the interventions based on ergonomic principles,the scores of knowledge and the behavior related with preventing WMSDs were increased after intervention,P<0.05.The ergonomic loads on back and wrist of nursing skills including patient repositioning,making an occupied bed,patient transferring,manual percussion to mobilize pulmonary secretions were decreased after intervention,P<0.05.The prevalence of WMSDs in the past year for upper and low back were decreased after intervention,P<0.05.Conclusions:1)The prevalence of WMSDs for Xinjiang nursing staff is higher.The problem multi-site WMSDs is highlighted.Administers should pay more attention on pain intensity of nurses due to WMSDs.The absenteeism rate was low than normal groups,it may be related to the lack of nursing staff,the lower consciousness of prevention on WMSDs and also the under-reporting data and so on.It is suggested that a system of WMSDs health monitoring and management regulations should be established in hospitals.2)Sufficient rest time,adequate human and material resources,mental health,general health status are protective factors for WMSDs.Age,sex,work in severe emergency departments or ICUs,BMI,always bending,work with the upper limbs or hands hardly,prolonged standing(83.43%),neck in a bent forward posture for long periods,always push or pull a heavy object,begin to work just after the break,always work overtime,working hours per week more than 40 hours,were the main risk factors of WMSDs.3)Nursing staff are seriously lacking of WMSDs related knowledge,protective behavior.Patient repositioning,making an occupied bed,patient transferring,manual percussion to mobilize pulmonary secretions are exteme-high and high risk skills.Interventions based on ergonomic principles and healthy education are useful to enhance the consciousness of preventing and controlling of WMSDS,to partly decrease the prevalence of WMSDs for different regions of body.But the effects of interventions need to be proved for long time implementing.