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ORIGINAL ARTICLE
Year : 2023  |  Volume : 21  |  Issue : 1  |  Page : 9-13

Low back pain among nurses as related to work environment: A cross-sectional observational study


1 Department of Nursing, School of Clinical Medicine, Oba Okunade Sijuade College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria
2 Department of Medical Surgical Nursing, Babcock University, Illishan-Remo, Nigeria
3 Department of Medical Surgical Nursing, Faculty of Basic Medical Science, Federal University, Oye-Ekiti, Ekiti State, Nigeria
4 Department of Community Health Nursing, School of Nursing, Abeokuta, Ogun State, Nigeria
5 Department of Measurement and Evaluation, University of Benin Teaching Hospital Staff School, Benin City, Nigeria

Date of Submission02-May-2022
Date of Decision20-Aug-2022
Date of Acceptance30-Aug-2022
Date of Web Publication17-Jan-2023

Correspondence Address:
Mr. Olaolorunpo Olorunfemi
Department of Medical Surgical Nursing, Faculty of Basic Medical Science, Federal University, Oye-ekiti, Ekiti
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_46_22

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  Abstract 

Background: Low back pain (LBP) is a major problem in the nursing profession and it is been reported that more nurses experience LBP during the nursing practice. Studies show that only 15.9% of nurses had LBP before coming into nursing while 84.5% complained they had LBP after working in the nursing environment. Aim: The aim of this study was to determine factors responsible for low back ache, as related to the work environment in the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: A cross-sectional descriptive study was conducted from January 2019 to February 2020, with probability sampling to select a sample size (n = 260). Data collected were analyzed using tables; percentages, bivariate analysis, and and multivariate logistic regression were used for data analysis at 0.05 level of significance, through a statistical package for the social science software. Results: Among 260 nurses with backache, 159 (61.15%) were male and most of the participants' ages were between 25 and 34 years, with a mean age of 26.5 (0.37). The multivariate logistic regression analysis showed that heavy manual lifting (odd ratio [OR] 0.21, 95% confident interval [CI] 0.54–0.73), body posture (OR 0.31, 95% CI 0.20–1.08), the length of working shift (OR 0.60, 95% CI 0.74–0.86), awkward postures (OR 0.68, 95% CI 0.65–1.10), and prolonged standing during nursing care (OR 0.73, 95% CI 0.52–1.00) were the major factors for LBP among nurses, with <0.001, 0.001, 0.002, 0.002, and 0.003, respectively. Conclusions: The finding implies that all effort should be directed toward policies which have positive effects on proper management of the work environment and other conditions, such as health and safety training. Prevention of work overloads through appropriate work shifting, and the mechanism of body posture should be improved. Furthermore, periodical flexing of feet, knees, and hip is necessary in a condition where there is a need to stand for a long period of time.

Keywords: Low back pain and its causative factors, Nigeria, nurses, remedy to low back pain, working environment


How to cite this article:
Osunde NR, Nwozichi CU, Olorunfemi O, Sodimu JO, Olorunfemi OM. Low back pain among nurses as related to work environment: A cross-sectional observational study. Curr Med Issues 2023;21:9-13

How to cite this URL:
Osunde NR, Nwozichi CU, Olorunfemi O, Sodimu JO, Olorunfemi OM. Low back pain among nurses as related to work environment: A cross-sectional observational study. Curr Med Issues [serial online] 2023 [cited 2023 Feb 4];21:9-13. Available from: https://www.cmijournal.org/text.asp?2023/21/1/9/367859


  Introduction Top


Low back pain (LBP) is one of the leading causes of soft-tissue and mechanical issues injuries all over the globe causing a massive economic problem on individuals and governments.[1] The global burden of disease study has listed LBP as a major cause of disability among musculoskeletal conditions and ranked it in the top five conditions contributing to the loss of disability-adjusted life years.[2],[3] LBP has gained increasing attention in developing countries because of its impact on productivity and activities of daily living.[4],[5] It is one of the contemporary occupational health ailments that seize attention due to the substantial loss of productivity time and employee absenteeism it often incurs.[6] According to Alam, Ephrem, and Seblemengel in 2015, nursing is an occupation most often susceptible to the risk of LBP as a result of the inherent nature of activities in nursing, such as twisting, bending, sustained posture, and repeated movements which create favorable conditions for LBP. In addition to individual and psychosocial variables such as age, gender, physical status, smoking, and workplace stress, main ergonomic factors can also endanger nurses to develop LBP. A study in Nigeria showed that 408 respondents (148 [36.27%] males and 260 [63.73%] females) participated in the study, after 12 months of the study, the prevalence of LBP was found to be 300 (73.53%).[7] Likewise, the records from the staff health clinic and the Physiotherapy Department of the University of Benin Teaching Hospital, Benin City (2016–2018) show that majority of nursing personnel presented with complaints of LBP. Therefore, there is a need to look at LBP among nurses: assessment of factors responsible for LBP as related to the working environment in the University of Benin Teaching Hospital, Benin City, Nigeria.


  Materials and Methods Top


This is a cross-sectional descriptive study conducted from January 2019 to February 2021. The setting was the University of Benin Teaching Hospital, a Tertiary Health Institution situated in the Ugbowo community in Egor Local Government Area, Benin City, Edo State. The target population comprised 730 male and female nurses working in the Clinical Department of the Hospital at the time of the study. The sample size is 260 participants selected through the probability sampling technique from the target population. The participants were from five units of the Nursing Department, namely surgical, medical, pediatric, perioperative, and accident and emergency units, respectively.

Sample size determination

A simple random sampling technique was employed to ensure that every nurse who met the inclusion criteria was adequately represented and had an equal chance of being selected. The sample size was determined using the Taro Yamane method of sample size calculation according to the formula, n = sample size, e = margin of error = 0.05, with a confidence level of 95%, with a sample size of 260. The inclusion criteria were nurses with LBP, and those who have put in a minimum of 12 months' work schedule before the study was conducted were included in the study. However, nurses who were on annual, sick, or maternity leave were excluded from the study.

A self-structured questionnaire was developed. The instrument comprised two sections: section A consists of demographic characteristics of respondents which were made up of four items, and section B contains 11 items to determine the causative factors of LBP as related to the work environment. The instrument was validated by experts in Neurology, Orthopedic, and Physiotherapy Departments for face and content validity. Moreover, to ensure the reliability of the instrument, a pilot study was carried out with 30 nurses at the Edo Specialist Hospital, Benin City. This was subjected to Cronbach Alpha statistics which index of 0.82 and this was considered high for the measure of internal consistency of the instrument.

Method of data analysis

The questionnaires were screened for completeness by the researcher. The data obtained were coded and analyzed using SPSS Statistical Software version 21.00 (IBM corp., released 2012 Armonk, NY, USA: IBM Corp).

Ethical approval

The study was approved by the Institutional Ethical Committee of the University of Benin Teaching Hospital on February 7, 2020, with Reference Number: ADM/E22/A/VOL. VII/148272. Having obtained the informed written consent from the eligible participants, the respondents were informed about the purpose and benefits of the study. They were also informed of their right to withdraw at any time without any consequences. Information provided by the participants during data collection was not divulged to others. Name or any form of identity was not required on the questionnaire to ensure confidentiality and anonymity, thus protecting the privacy of participants.


  Results Top


In total, 206 nurses were included in this study. [Table 1] revealed that a greater proportion of the respondents 159 (61.15%) were male while 101 (38.85) were female. About 2/3 of the respondents had more than 1-year work experience and fall between the age of 25 and 34 years, with a mean age of 26.5 (0.37). As shown in [Table 2], the bivariate analysis showed a significant association between LBP and identified factors including heavy manual lifting, working in an awkward position, wrong body posture, long working hours, bending forward for too long, and prolonged standing with P < 0.05.
Table 1: Sociodemographic characteristics among nursing workers at University of Benin Teaching Hospital

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Table 2: Bivariate analysis showing causative factors and low back pain

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The multivariate logistic regression analysis [Table 3] shows that heavy manual lifting (odd ratio [OR] 0.21, 95% confident interval [CI] 0.54–0.73; P ≤ 0.001), body posture (OR 0.31, 95% CI 0.20–1.08; P = 0.001), the length of working shift (OR 0.60, 95% [CI] 0.74–0.86; P = 0.002), awkward postures (OR 0.68, 95% [CI] 0.65–1.10; P = 0.002), and prolonged standing during nursing care (OR 0.73, 95% CI 0.52–1.00; P = 0.003) were found to be significant factors of LBP among nurses as related to work environment.
Table 3: Multivariate logistic regression analysis showing causative factors of low back pain as related to working environment/conditions

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  Discussion Top


Factors for low back pain among nurses as related to the work environment

LBP is an important public health problem affecting the nurses' population worldwide and is one of the most important causes of work-related disability. This present study identified the following working condition as a factor of LBP as, lifting of heavy materials or patients during nursing practice, awkward position by nurses during nursing practice, improper body posture when lifting the patients, long work hours by nurses, nurses involving in prolonged standing during nursing procedures, and nurses bending forward for too long duration to carry out nursing procedures.

This present study found that strain from manual lifting of heavy object and prolong standing during nursing practice, are common causes of LBP. This is in agreement with a study carried out in 2018 on critical care nurses' pain experiences and the prognostic factors and found that changing bed linens while the patient remained in bed and lifting, pulling, or pushing heavy materials caused those nurses to feel significant pain in the shoulder, neck, upper arm, wrist, and knee.[8]

Similarly, this study also identified working in wrong body posture and awkward positioning, demonstrated by nurses during nursing practice as a major cause of LBP. This is in agreement with a study carried out in 2018, on the awkward trunk postures (wrong body posture at work) and their relationship with LBP among hospital nurses and found that trunk awkward postures, as a major causative factor for the development of LBP among nurses.[9] Traditionally, back pain in the nursing profession is associated with heavy lifting and wrong posture when trying to lift patients out of bed. We, therefore, encourage the use of an electric adjustable bed and practice of proper body mechanics posture during patient lifting.

In addition to that, this present study identified bending forward for too long or prolonged standing as another major causative factor of LBP. This is in agreement with different studies which identified prolonged standing at work and bending forward for too long when carrying out nursing responsibilities or duties both of which were found to be associated with a number of potentially serious health outcomes, such as lower back and leg pain. This research then suggested the use of floor mats, sit–stand workstations/chairs, shoes, shoe inserts, and hosiery or stockings.[10],[11]

Moreover, this study also found too long working hours as a factor for LBP. This is supported by a study carried out in Denizli State Hospital on the prevalence of and risk factors for LBP among health-care workers in 2017 which also agreed with this present study. In their study, they found that working for more than 4 h while standing (P = 0.012) or sitting at the desk (P = 0.021), using the computer for more than 4 h (P = 0.0001), and a greater number of years of service (P = 0.001) were found to be factors increasing LBP risk.[12] We can, therefore, conclude that looking at the long working hours demand by the nature of nursing care and practice, nurses among other health-care workers are at higher risk of LBP.


  Conclusions Top


We found that LBP is a common disease affecting nurses in Nigeria and the flaws identified by this study as related to working conditions shown to have a major effect on the life of nurses and the quality of nursing care rendered. We, therefore, suggested that all efforts should be directed toward policies aimed at the proper management of the working environment and other conditions such as health and safety training. Prevention of work overload through appropriate work shifting and the mechanism of body posture should be improved, periodical flexing of feet, knees, and hip is necessary in a condition where there is a need to standing for long periods of time. Moreover, strengthening the pelvic, abdominal, and lumbar muscles can be achieved through regular exercise, standing and sitting up straight, and sleeping on a firm mattress. Likewise, the awkward manual lifting of patients should be avoided and the practice of back-strengthening and stretching exercises should be encouraged.

Acknowledgments

The authors sincerely appreciate all the nurses that participated in the study.

Ethical statement

Ethics approval and consent to participate in the study were obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Ünal M, Evcik E, Kocatürk M, Algun ZC. Investigating the effects of myofascial induction therapy techniques on pain, function and quality of life in patients with chronic low back pain. J Bodyw Mov Ther 2020;24:188-95.  Back to cited text no. 1
    
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Shahrezaee M, Keshtkari S, Moradi-Lakeh M, Abbasifard M, Alipour V, Amini S, et al. Burden of musculoskeletal disorders in Iran during 1990-2017: Estimates from the Global Burden of Disease Study 2017. Arch Osteoporos 2020;15:103.  Back to cited text no. 3
    
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Manyozo SD, Nesto T, Bonongwe P, Muula AS. Low back pain during pregnancy: Prevalence, risk factors and association with daily activities among pregnant women in urban Blantyre, Malawi. Malawi Med J 2019;31:71-6.  Back to cited text no. 4
    
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Alsufiany MB, Lohman EB, Daher NS, Gang GR, Shallan AI, Jaber HM. Non-specific chronic low back pain and physical activity: A comparison of postural control and hip muscle isometric strength: A cross-sectional study. Medicine (Baltimore) 2020;99:e18544.  Back to cited text no. 5
    
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Mekonnen TH. Work-related factors associated with low back pain among nurse Professionals in East and West Wollega Zones, Western Ethiopia, 2017: A cross-sectional study. Pain Ther 2019;8:239-47.  Back to cited text no. 6
    
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Awosan KJ, Yikawe SS, Oche OM, Oboirien M. Prevalence, perception and correlates of low back pain among healthcare workers in tertiary health institutions in Sokoto, Nigeria. Ghana Med J 2017;51:164-74.  Back to cited text no. 7
    
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Çelik S, Taşdemir N, Öksüzoğlu A, Dirimeşe E, Koçaşli S. Critical-care nurses' pain experiences and the prognostic factors. Dimens Crit Care Nurs 2018;37:3-11.  Back to cited text no. 8
    
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Nourollahi M, Afshari D, Dianat I. Awkward trunk postures and their relationship with low back pain in hospital nurses. Work 2018;59:317-23.  Back to cited text no. 9
    
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Waters TR, Dick RB. Evidence of health risks associated with prolonged standing at work and intervention effectiveness. Rehabil Nurs 2015;40:148-65.  Back to cited text no. 10
    
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Zayed HA, Saied SM, El-Sallamy RM, Shehata WM. Work-related musculoskeletal disorders among nursing staff of Tanta University Hospitals: Pattern, risk factors, and coping strategies. Egypt J Community Med 2019;37:51-61.  Back to cited text no. 11
    
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Şimşek Ş, Yağcı N, Şenol H. Prevalence of and risk factors for low back pain among healthcare workers in Denizli. Agri 2017;29:71-8.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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