The Prevalence of Musculoskeletal Disorders’ Symptoms and Work Posture Improvement Efforts Using Participatory Ergonomics Approach on Health Care
Silvi Rushanti Widodo ; Hardianto Iridiastadi
Nurses often get musculoskeletal disorders when do the patient handling. Some research shows that often get musculoskeletal disorders from everyday activities (Hofmann et al., 2002; Kim and Koo, 2002; Menzel et al., 2004). Nurses’ jobs are complex and involve a lot of physical injury that can trigger symptoms of musculoskeletal disorders (Ando et al., 2000; Daynard et al., 2001; Nelson et al., 2003) In general, workers get musculoskeletal disorders because their jobs are not comfortable. Starting from the uncomfortable posture, the workers will get aches and pains in certain parts of the body. If left, the aches and pains get by workers could make musculoskeletal disorders, such as Tendonitis, Tenosynovitis, or serious neurological injury such as Carpal Tunnel Syndrome (Stanton et al., 2005).
Musculoskeletal disorders get by nurses caused by most major problems when do the patient handling like move the patient from a bed to wheelchair or otherwise, bathing the patient, tilting the patient when washing or spruce up his bed, and put on the clothes to the patient (Hignett et al., 1996; Ando et al., 2000; Daynard et al., 2001; Lee and Kim, 2003; Nelson et al., 2003).
Musculoskeletal disorders’ symptom also frequently said by the nurses. The body of nurses who often feel pain are areas in lower back, legs, and hands (Nelson et al., 2006; Bardak et al., 2012). The injury risk is the risk of injury to the muscles, which include injury in the low back (Karahan et al., 2009; Bardak et al., 2012), shoulder (Owen et al., 2002), as well as the other parts of the body. In fact, the prevalence of low back pain of nurses in hospital is approaching 80% (Karahan et al., 2009). The risk of musculoskeletal disorders become one of the serious issues get by nurses, medical staff who do the patient handling.
Diseases caused by work in particular musculoskeletal disorders can occur because workers who lack understanding of the principles of ergonomics (Chengalur et al., 2004). In the last few years, there are a lot of research about how to reduce musculoskeletal disorders’ risk on nurses when do the patient handling. Some research using a variety of methods and approaches but there is not research using participatory ergonomics approach for patient handling activity.
The advantage of participatory ergonomics is the workers can be in the best position to know the symptoms of the problem and identify the macro ergonomics interventions will be accepted. Workers will be more supportive of changes to the system of work with not many approaches adopted. So, this participatory ergonomics approach has been proven very effective in establishing the principle of ergonomics and/ or security culture that sustains performance and security improvements resulting from the macro ergonomics intervention (Stanton et al., 2005).
Participatory ergonomics approach shows that workers and employers directly trained to be able to understand their work. This approach encourages workers to engage directly towards improvement process through the use of a system that is organized with short-term training with a guide that is active helping to improve the way of work (Kogi, 2008).
Research using participatory ergonomics approach have different results. Research from different countries such as development of an intervention to prevent work-related musculoskeletal disorders among hospital nurses based on the participatory approach (Kim et al., 2010) and using participatory ergonomics to improve nuclear equipment design (Santos et al., 2011) have a success result. However, research in the Unites States on reducing ergonomics injuries for librarians using a participatory approach (Yuan, 2015) and research in Australia concerning participatory ergonomics case study in coal handling train crew operations (Lynas et al., 2013) does not show good results significantly. Therefore, this research using participatory ergonomics approach to resolve the problem concerning the complaints of musculoskeletal disorders in nurses. This approach is expected to lower the number of sufferers of pain resulting from musculoskeletal disorders, manage the complaints of musculoskeletal disorders and increase workers’ productivity (Hendrick, 2001; Carrivick et al., 2005; Vink et al., 2006). In addition, research by using the participatory ergonomics approach interesting to examine whether this approach can be applied in developing countries and provide good results are quite significant.
Based on the main result of this study, the highest prevalence of musculoskeletal disorders is low back (65%). The others study also show the same result that the prevalence of low back pain of nurses in a hospital is almost 80% (Karahan et al., 2009).
Based on the relation of dependence variables show that gender have not a relation with the other variables like the others study from Jellad et al, 2013. The next result is age and working time have relation with neck and low back. This is because of decreasing of body function. Overall, this is happen because accumulation from workload and bad posture (Bardak, 2012).
Last education has relation with neck and married status has relation with right hand. But, this relation still can not explain. There is not research about this relation and need continue study. Based on the results of observation and study of the assessment of the risk level in Table 3, it can be seen that the working posture the nurses does not improve after get the ergonomics workshop. There are several reasons failed to reduce musculoskeletal disorders among nurses like body mechanics training on study can not be practiced within scope of nursing, nurses have difficulty to practice materials in training when dealing directly with patients (OR-OSHA, 2005). Patient handling activities basically manually is not recommended (Cummins, 2012).
Table 1: Demographics characteristics
Table 2: Relation of variables
Table 3: Risk level
Picture 1: Prevalence all resposdent of musculoskeletal disorders
The results of focus group discussion is a nurse who will do the patient handling should really in a ready condition. This is because it concerns for comfortability and safety of the patients and nurses themselves. Next results, patient handling activities are still do manually without the tools so need more resources and also need a tool for lifting and moving patients that it can reduce the musculoskeletal disorders for the nurses (Lee et al., 2013). Manually method in patient handling can make an awkward posture of nurses. The next thing is the nurse need to transporting the patient’s body when it will lift and move patients. One of thing that can cause the musculoskeletal disorders of nurses is they must reach out and lift the weight away
from the body (Waters et al., 2009). So, the position of bed and gurney must in perpendicular distance thus reducing the displacement. Additionally, by hold gurney bedding and then the nurse would do a little body rotation (twisting body) so that it can shorten the time of adoption of the patient and the burden of being detained by the nurse’s body was also not too long. In addition, avoid affected awkward posture at the time nurses conduct patient handling can also avoid musculoskeletal disorders (Waters et al., 2009). Then, last result of focus group discussion is nurses who will do patient handling and need more than one nurses must have the same height so that the position of the patient can be aligned. Nurses who have same height also should not ask the other nurses for raise/ down the arm (awkward posture) which it can cause the musculoskeletal disorders in arm
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