Abstract
Recently medical services and nursing system are being reformed due to high medical costs and shortage of clinical nurses. The shortage of clinical nurses influences not only their working conditions but also their own health problems. In European countries and the United States, low back pain (LBP) has been reported to be one of the most common and costly health problems among clinical nurses.
To estimate the occupational risk factors of LBP among nurses, a questionnaire survey of LBP and occupational risk factors was carried out in 1987 on 947 clinical nurses and as well as on 300 female clerical workers of three local goverments. First, to examine the prevalence and the magnitude of the problem, we analyzed several kinds of prevalence rates of LBP and its characteristics among nurses and clerical workers. Second, a case-control study was conducted to investigate the relationship between LBP and occupational risk factors. In analyzing occupational risk factors of LBP, odds ratios, age adjusted odds ratios and 95% confidence intervals were computed. Finally, to estimate simultaneously the effect of multiple risk factors of LBP and to confirm univariate age adjusted odds ratio analyses, several multivariate analyses were performed.
Point, period (a month), and lifetime prevalence rates of LBP and prevalence rate of severe LBP among clinical nurses were significantly higher than those of clerical workers (p<0.05-0.001, respectively). Demographic and occupational items, such as being an assistant nurse (as opposed to a registered nurse), and working in certain departments (internal medicine, orthopedic surgery, neurosurgery, psychiatry, tuberculosis ward) showed significantly higher odds ratios for LBP (p<0.05-0.001, for all). Many items pertaining to working conditions connected with shift work, hospitalized conditions of patients, taking breaks and holidays, working postures, weight of patients and equipment lifting and moving, working environments and so on had significantly elevated age adjusted odds ratios (p<0.05-0.001, for all). Intensity of work loads estimated subjectively such as ‘caring for patients who are in bed’, ‘supporting patients when transporting and bathing them’, ‘preparing drugs and injections, and treating’, ‘observing and monitoring patients' conditions’, ‘instructing and explaining procedure to patients and their family’ and so on also had significantly elevated age adjusted odds ratios (p<0.05-0.001, for all). Moreover, many items on the problems connected with working life and interpersonal relationships showed significantly higher age adjusted odds ratios (p<0.05-0.001). In multivariate analyses, independent variables which made a significant contribution to the model were similar to the items which had significantly elevated age adjusted odds ratios. In summarizing these results, many independent variables were related to shift work, physical nursing work loads and mental stress in caring for patients. It is noteworthy that not only direct influences from occupational factors but also indirect influences from their effects on workers' lives were observed.
These results suggest a positive relationship between nursing work load and LBP. Therefore, it is recommended that working conditions and work loads of clinical nurses as mentioned above be improved in order to prevent LBP and promote the quality of nursing services.
