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The Impact of Stressful Postures on the Physical Workload in Nursing
KTH, School of Technology and Health (STH), Centres, Centre for Health and Building, CHB.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Nursing staff have an elevated risk of developing musculoskeletal disorders, in particular in the lower back area. Statistics produced by leading industrial nations show that back problems are the world’s number one work-related health problem, and that healthcare workers suffer from a greater occurrence of such problems than workers in other professions. In this context, many studies have examined manual patient handling activities, which was thought to be the main cause of musculoskeletal disorders of the lower back. But nurses have many other types of work to perform and several reviews have concluded that approaches which only focus on manual patient handling activities do not sufficiently reduce back problems in nursing professions.

Other risk factors for musculoskeletal disorders of the lower back discussed in the literature included repeated bending and the high proportion of static trunk postures. The main aim of this doctoral thesis was therefore to examine the influence of stressful trunk postures on the physical workload of nursing staff in hospitals and nursing homes. It focuses on the type, number and extent of stressful postures and on identifying activities that encourage their occurrence. We used our findings to derive strategies for reducing stressful postures in nursing, and examined whether nursing staff regard such a reduction as actually relieving their physical workload.

A secondary aim was to consider the older people potentially in need of care. The background to this is that, due to steadily rising costs, many older people are unable to afford care in a nursing home, and additionally that the forecast severe shortage of nursing staff in future gives reason to look for solutions that can reduce the demand for nursing staff. Among older people who still look after themselves, we therefore examined which stressful postures they adopt when carrying out domestic tasks such as cooking and washing laundry. From the results, we provided some examples of a better design of the domestic environment, which reduces stressful postures, when performing these tasks and helps older people to be able to look after themselves in their own homes for longer.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2014. , 49 p.
Series
TRITA-STH : report, ISSN 1653-3836 ; 2014.3
Keyword [en]
nurses, musculoskeletal disorders, trunk posture, perceived exertion, ergonomics
National Category
Environmental Health and Occupational Health
Identifiers
URN: urn:nbn:se:kth:diva-143534ISBN: 978-91-7595-049-5 (print)OAI: oai:DiVA.org:kth-143534DiVA: diva2:707019
Public defence
2014-04-11, 3072, Marinens väg 30, Haninge, 13:00 (English)
Opponent
Supervisors
Note

QC 20140324

Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2014-03-25Bibliographically approved
List of papers
1. Quantitative Measurement of Stressful Trunk Postures in Nursing Professions
Open this publication in new window or tab >>Quantitative Measurement of Stressful Trunk Postures in Nursing Professions
2007 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 51, no 4, 385-395 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

The evaluation of stress to the spinal column in the provision of care has mostly concentrated on the handling of loads. However, awkward body postures alone, without load transfer, can also be stressful for the spinal column. Therefore in this study all the body postures and movements of nurses were quantitatively measured within a working shift.

METHODS:

The body postures were recorded with the CUELA measurement system (computer-assisted recording and long-term analysis of musculoskeletal loads), coupled to the individual, and this detected all movements of the trunk and the legs. These measurements were supported by video recordings, so that exact allocation of the measured data to the tasks performed was possible. In all, 24 shift measurements were carried out in 8 wards. Extent, frequency and duration of trunk postures were measured in three planes and assessed on the basis of several standards (DIN EN 1005-1, DIN EN 1005-4, ISO 11226).

RESULTS:

A mean of 1131 (+/-377) trunk inclinations of >20 degrees were performed in each shift. This corresponds to a frequency of 3.5 min(-1). A total of 237 of these inclinations lasted for >4 s. A total of 72 (+/-35) min was spent bending forward with an inclination of >20 degrees . However, the mean time spent in transferring patients (counting only the lifting process) and heavy materials was only 2 min per shift. Postures with trunk inclination of >60 degrees were adopted for a mean of 175 (+/-133) times. The main tasks responsible for this were 'bed making' (21%), 'basic care' (16%) and 'clearing up/cleaning' (16%).

CONCLUSIONS:

It could be shown that many stressful trunk postures are assumed in nursing work during a shift. Future preventive measures should therefore consider not only load handling but also tasks with awkward postures.

National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:kth:diva-143531 (URN)10.1093/annhyg/mem018 (DOI)000249763100005 ()17715425 (PubMedID)2-s2.0-34548269579 (Scopus ID)
Note

QC 20140324

Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2017-12-05Bibliographically approved
2. Messtechnische Analyse von belastenden Körperhaltungen bei Pflegekräften: eine geriatrische Station im Vergleich mit anderen Krankenhausstationen
Open this publication in new window or tab >>Messtechnische Analyse von belastenden Körperhaltungen bei Pflegekräften: eine geriatrische Station im Vergleich mit anderen Krankenhausstationen
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2007 (German)In: ErgoMed, ISSN 0170-2327, Vol. 31, 130-140 p.Article in journal (Refereed) Published
Abstract [en]

Employees in nursing professions are at increased risk of developing musculoskeletal symptoms of the back. The level of physical stress for the nurse may depend on the type of patient. Nurses who mostly care for older people of restricted mobility are exposed to particularly high physical stress, one reason being that they must transport heavy loads when transferring patients. In addition, static physical postures and frequent bending and rotation of the upper body have been discussed in the literature as possible risk factors. In the present study, the personal CUELA measurement system was used to measure all adopted trunk postures and the movements of a qualified geriatric nurse on a geriatric ward over the course of three successive early shifts, in order to quantify the occurrence of awkward postures. The measurement results from this ward were compared with those from other hospital wards (for surgery and internal medicine). The nurse on the geriatric ward adopted an inclination of the upper body of greater than 20 degrees for an average of 1,390 times per shift. This was 25% greater than the value found for the volunteers in the wards for surgery and internal medicine (1,116 times). In the geriatric ward, almost 70% of the major inclinations of the trunk (above 60 degrees) were linked to work at the patient's bed, in comparison to 42% in the other wards. The results of these measurements suggest, for example, that consistent adjustment of the height of the bed could reduce the frequency and extent of major inclination of the trunk. Reduction in the physical stress from awkward postures can help to protect the health of employees in nursing professions.

Keyword
Geriatric nursing, back symptoms, postures, prevention, field study
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:kth:diva-143532 (URN)
Note

QC 20140324

Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2014-03-24Bibliographically approved
3. Frequent Bending-An Underestimated Burden in Nursing Professions
Open this publication in new window or tab >>Frequent Bending-An Underestimated Burden in Nursing Professions
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2012 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 56, no 6, 697-707 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to quantify the total duration per shift in which nurses work in a forward bending position over 20 degrees. Furthermore, the influence of several factors on the occurrence of sagittal trunk inclinations in nurses was investigated. Trunk postures were recorded for nine nursing home nurses from four German nursing homes and 18 hospital nurses from seven hospitals using the CUELA measurement system. A total of 79 shifts, 27 in nursing homes and 52 in hospitals, were analysed. All measurements were supported by video recordings. Specially developed software (WIDAAN 2.75) was used to synchronize the measurement data and video footage. The total duration of inclinations per shift was significantly affected by the working area (nursing home or hospital) with an increase of 25.3 min in nursing homes (95% confidence interval 2.4-48.2; P = 0.032). Another factor was the extent of personal basic care tasks performed by the nurses (P < 0.001). Nursing home nurses worked about twice as long per shift in a forward bending position compared with hospital nurses (112 versus 63 min; P < 0.001) and they assumed almost one-third more inclinations per shift (1541 versus 1170; P = 0.005). Nursing staff perform a large number of inclinations. The amount of time spent by nurses working in a forward bending position was highly dependent on the working area and the extent to which patients were in need of help. It is very likely that future preventive measures, focussing on reducing the huge amount of inclination, would reduce the physical stress in everyday nursing work substantially.

Keyword
bending, musculoskeletal disorders, nurses, trunk posture
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:kth:diva-100611 (URN)10.1093/annhyg/mes002 (DOI)000306408800005 ()22356807 (PubMedID)2-s2.0-84866662699 (Scopus ID)
Note

QC 20120813

Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2017-12-07Bibliographically approved
4. The effect of working position on trunk posture and exertion for routine nursing tasks: An Experimental Study
Open this publication in new window or tab >>The effect of working position on trunk posture and exertion for routine nursing tasks: An Experimental Study
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2014 (English)In: Annals of Occupational Hygiene, ISSN 0003-4878, E-ISSN 1475-3162, Vol. 58, no 3, 317-325 p.Article in journal (Refereed) Published
Abstract [en]

Objectives:To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion.Methods:Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for 'computer-Assisted recording and long-Term analysis of musculoskeletal loads') measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion).Results:If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P < 0.001). Bathroom tests: compared with the standing work method, the kneeling and sitting work methods led to a significant increase in the proportion of time spent in an upright posture, by 19.4% points (P = 0.003) and 25.7% points (P < 0.001), respectively. The greater the proportion of time spent in an upright position, the lower the Borg rating (P < 0.001) awarded.Conclusions:The higher the proportion of time that nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-Adjustable beds are provided in healthcare institutions.

Keyword
bed height, bending, musculoskeletal disorders, nursing, perceived exertion, trunk posture
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:kth:diva-143533 (URN)10.1093/annhyg/met071 (DOI)000333046700005 ()24371043 (PubMedID)2-s2.0-84896335490 (Scopus ID)
Note

QC 20140324

Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2017-12-05Bibliographically approved
5. Measurement of stressful postures during daily activities: An observational study with older people
Open this publication in new window or tab >>Measurement of stressful postures during daily activities: An observational study with older people
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2011 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 34, no 3, 397-401 p.Article in journal (Refereed) Published
Abstract [en]

This study measured the postures of older people during cooking and laundry. A sample of men and women aged 75+ years (n=27) was recruited and observed in a home-like environment. Postures were recorded with a measurement system in an objective and detailed manner. The participants were videotaped to be able to see where 'critical' postures occurred, as defined by a trunk inclination of ≥60°. Analysis of data was facilitated by specially developed software. Critical postures accounted for 3% of cooking and 10% of laundry, occurring primarily during retrieving from and putting in lower cabinets, the refrigerator, laundry basket or washing machine as well as disposing into the waste bin. These tasks involve a great variation in postural changes and pose a particular risk to older people. The results suggest that the use of stressful postures may decrease efficiency and increase fatigue, eventually leading to difficulties with daily activities. The specific tasks identified during which critical postures occurred should be targeted by designers in order to improve the activities. A few examples are given of how better design can reduce or eliminate some of the postural constraints.

Place, publisher, year, edition, pages
Elsevier, 2011
Keyword
Posture, daily activities, observational study, older people
National Category
Other Engineering and Technologies
Identifiers
urn:nbn:se:kth:diva-41557 (URN)10.1016/j.gaitpost.2011.06.009 (DOI)000295771800019 ()21764584 (PubMedID)2-s2.0-80052424043 (Scopus ID)
Note

QC 20110930

Available from: 2011-09-29 Created: 2011-09-29 Last updated: 2017-12-08Bibliographically approved

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