RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE-I

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 NAME OF THE CANDIDATE AND MR. PRAKASH K. MERWADE

ADDRESS SJB COLLEGE OF NURSING,

BGS HEALTH AND EDUCATION CITY

UTTARHALLI, KENGERI

BANGLORE 560002

KARNATAKA
2 NAME OF THE INSTITUTE SJB COLLEGE OF NURSING, BANGLORE
560002 KARNATAKA
3 COURSE OF THE STUDY AND M.Sc. (NURSING) 1st YEAR
SUBJECT MEDICAL SURGICAL NURSING
4 DATE OF ADMISSION TO THE 15TH JULY 2009
COURSE
5 TITLE OF THE TOPIC
“ASSESS THE KNOWLEDGE
AND PRACTICES REGARDING
BODY MECHANICS AMONG THE
NURSES, WITH THE VIEW TO
DEVELOP A INFORMATION
BOOKLET”
6 BRIEF RESUME OF THE INTENDED WORK.

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6.1 NEED FOR THE STUDY
Throughout the decades the hospital and health care workers have manually
adjusted hospital equipments and have provided care to the patients. Manually adjusting
the hospital equipments and repetitive manual handling human loads is a physically
challenging job and it often causes work related musculoskeletal disorders or other
injuries.

Brown. D. reports that repetitive nursing care that involves high-risk manual tasks
such as lifting, transferring, and repositioning patients puts nurses and other health care
workers at an increased risk for developing sprains and strains to the lower back, neck,
shoulders, wrists, and knees.1 According to Nelson, nurses are frequently required to
assume awkward positions when they lean over beds, when they reach above shoulder
height, when they kneel or squat, and when they twist their torso while lifting.2

During the stressful situations, even the most experienced staff member can forget
the importance of ergonomics. So nurses are at an increased risk for work-related
musculoskeletal injuries as a result of the cumulative effects of manual patient-handling
tasks. According to statistical records, The Occupational Safety and Health
Administration (OSHA) have calculated that nearly half of all health care workers suffer
at least one work-related musculoskeletal injury during their career . More than half of all
nurses (52%) complain of chronic pain and 38% of registered nurses (RNs) have suffered
occupation related back injuries severe enough to require time away from work. Twelve
percent of RNs consider leaving the profession because of lower back pain and in an
American Nurses Association (ANA) survey, almost 60% of nurses list disabling back
injuries as one of the top three health safety issues. In 2000, health care injuries caused
time away from work for nearly 11,000 RNs and nearly 45,000 nursing assistants,
orderlies, and attendants who said that ‘‘re-exertion and overexertion in lifting’’ were the
cause of the events. According to the U.S. Department of Labor Bureau of Labor Statistics
(2005), nursing ranks sixth in a list of at-risk occupations, with 24,610 reported injuries
(strains and sprains) out of 503,530 in 2005.3

Nelson, Fragala, and Menzel (2003) identified 10 stressful patient-handling tasks

often performed by nurses as well as nursing students that place them at risk for
musculoskeletal injuries. These include bathing a patient in bed; making an occupied bed;
dressing a patient in bed; transferring a patient from bed to stretcher, wheelchair, or

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geriatrics chair; repositioning a patient in a chair; pulling a patient up to the head of the
bed; and putting antiembolism stockings on a patient. According to Menzel et. al.,
musculoskeletal injuries can begin in nursing schools, with clinical activities that require
lifting heavy patients, sustained awkward positions, and repeated stressful movements.2

The National Institute for Occupational Safety and Health (NIOSH) recommended a
weight-lifting limit of less than 51 lb. But the De Castro reports that the safe lifting limit
has limited applicability to true nursing practice because most nurses and health care
workers are female. And Nelson, Owen, et al., say’s that patients can often be heavy,
asymmetric, have a multitude of attachments, and do not have handles. They can also be
totally dependent, contracted, and uncooperative, which adds to the burden of safely
handling and moving them.2

A study conducted by the University of Ohio measured the spinal load pressures
incurred while performing routine nursing tasks, such as transferring and repositioning
patients. Although the participant in this study was a 110-lb, alert, oriented, and
cooperative patient (not typical of a real patient), results showed that all standard methods
of transferring and repositioning that nurses are taught in schools place them in a high-risk
group for back injury.2

The Occupational Safety and Health Administration (OSHA) recommended

ergonomic safety guidelines to assist in reducing the number of work-related
musculoskeletal injuries in health care facilities. These guidelines recommend that manual
lifting of patients should be minimized in all cases and eliminated when feasible. In an
effort to support these guidelines and to establish a safer environment of care for both
nurses and patients, the ANA developed the “Handle With Care” campaign, which
promotes the elimination of manual patient handling. This evidence based information
was based on research conducted by the Veteran's Administration (VA) Patient Safety
Research Center in Tampa, FL, which examined nurses as they performed specific patient
care activities. From the research conducted, the center developed the Patient Care
Ergonomics Resource Guide: Safe Patient Handling and Movement, which provides
comprehensive evidence-based information to reduce work-related musculoskeletal
injuries in health care workers.2

According to ANA, patient-handling tasks such as lifting, repositioning, and

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transferring patients expose nurses to an increased risk for musculoskeletal injuries.
Mechanical assistive equipment such as lift and transfer devices can significantly reduce
this work-related risk and ensures a safer and more dignified approach to handling and
moving patients. The ANA, in its Position Statement, believes that the benefit of using
such equipment is a reduction of work related musculoskeletal injuries for nursing staff
and improved patient care. Six states that support this mission, Texas, Washington,
Hawaii, Rhode Island, Ohio, and New York, have recently passed legislation related to
safe patient handling.

According to the ANA, manual handling of patients is unsafe and is responsible for
most musculoskeletal injuries sustained by nurses. The ANA believes that patient
transfers can be performed more safely by using mechanical assistive devices. There is
significant evidence that supports the use of mechanical assistive devices to reduce
musculoskeletal injuries and for job injury prevention to be successful. The use of
mechanical devices allows nurses to meet a dependent patient's need for mobility and
normalcy while preventing hazards to human life and function.2

Although nurses historically have been educated and trained to use ‘‘proper’’ body
mechanics and manual techniques to prevent injury from lifting and transferring patients,
questions arise regarding the value of these methods and applicability to the practice of
nursing.4

So there is a need to conduct a study to assess the knowledge & practice of body
mechanics and create awareness regarding work related musculoskeletal injuries, among
nurses.
6.2 REVIEW OF LITERATURE
An explorative study was designed to identify the usage of body mechanics in
clinical settings and the occurrence of low back pain among 56 nurses working in the
medical, surgical, emergency and intensive care units of a state hospital in Bolu, Turkey.
Data collected through observation and interviews. Results of the study showed that the
majority of the nurses (87.5%) experienced low back pain at some time in their lives.
Among the contributing factors for back pain, the relationship between wearing high
heels, heavy lifting and back pain was significant statistically. According to the
observations, the majority of the nurses used body mechanics correctly while sitting
(53.6%), standing (58.7%), carrying (64.3%), pulling or pushing (79.4%), moving the

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patient to the side of the bed without an assistant (53.4%), moving the patient to a sitting
position in bed (71.4%) and assisting the patient to a standing position (66.6%). However
57.1% of the nurses lifted and 82% extended incorrectly. The study concludes that some
of the nurses do not use body mechanics correctly and the majorities have low back pain.5

A study was conducted to examine the staff injuries associated with the patient
handling of the obese, and to describe a process for identifying injuries associated with
their mobilization, and to report on the need for safer bariatric patient handling in a 761-
bed, level 1 trauma center affiliated with a U.S. medical school. The study results revealed
that during 2007, although patients with a body mass index of > or =35 kg/m (2)
constituted <10% of our patient population, 29.8% of staff injuries related to patient
handling were linked to working with a bariatric patient. Bariatric patient handling
accounted for 27.9% of all lost workdays and 37.2% of all restricted workdays associated
with patient handling. Registered nurses and nursing assistants accounted for 80% of the
injuries related to bariatric patient handling. Turning and repositioning the patient in bed
accounted for 31% of the injuries incurred. The study concluded that the manual
mobilization of morbidly obese patients increases the risk of caregiver injury.6

A study was conducted to identify high risk for musculoskeletal disorders on five
critical care units (two surgical ICUs, two medical ICUs, and one cardiac ICU) at two
large medical centers in VAMC Tampa, to identify tasks with high risk for
musculoskeletal disorders. The criteria used to identify potential high risk for WMSDs for
critical care tasks included (1) high force, (2) awkward postures, or (3) repetitive loading.
Data were collected through direct observation of physical work environment, technology,
and work practices; digital photography; interviews with ICU nurses and nurse managers;
and a 2-year review of WMSDs reported in ICUs. The study concludes that seven high-
risk patient handling tasks in critical care were identified as having high risk for
musculoskeletal disorders. These include; pushing occupied beds or stretchers, lateral
patient transfers (e.g., bed to stretcher), moving patients to the head of a bed, repositioning
patients in bed (e.g., side to side), making occupied beds, applying ant embolism
stockings, lifting or moving heavy equipment.4

A study was conducted to evaluate the effectiveness of an intensive educational and

low-tech ergonomic intervention programme aimed at reducing low back pain (LBP)
among the 345 home care nurses and nurses’ aides in four Danish municipalities.

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Participants in two municipalities constituted the intervention group and participants in
the other two served as the control group. In the intervention group, participants were
divided into small groups, each of which was assigned one specially trained instructor.
During weekly meetings participants were educated in body mechanics, patient transfer,
and lifting techniques, and use of low-tech ergonomic aids. In the control group,
participants attended a onetime only three hour instructional meeting. Information on LBP
was collected using the Standardized Nordic Questionnaire supplemented with
information on number of episodes of LBP and care seeking due to LBP during the past
year. A total of 309 nurses and nurses' aides returned the questionnaire at baseline and 255
at follow up in August 2001. At follow up, significant differences were found between the
two groups for the LBP variables, and both groups thought that education in patient
transfer techniques had been helpful.7

A study was conducted to illuminate nursing staff's perception of changes after a

course in patient transfer in karolinska Institute, Sweden. The learning process took the
form of self-experience focusing on the manner of supporting the patient to move
independently. A total of 20 participants, who had answered a previously administered
questionnaire, were chosen for interviews. The themes concerned the meaning of
changing transfer habits. A phenomenological-hermeneutic analysis method showed that
changes focused on the patient's body, the staff member's own body or cooperation with
the patient. Awareness of one's own body and confidence in one's own ability seem to
indicate differences in the manner of supporting the patient to move. The changes in
transfer habits varied in content and meaning from person to person, depending on the
focus during the transfer. These findings can contribute to an understanding of how
change takes place after an educational intervention.8

A study was conducted to assess the manual handling practices and injuries among
Intensive Care Units (ICU) nurses working in a Austin & Repatriation medical centre in
Australia. The objectives of this study were to identify patterns of manual handling
activities; the incidence, types of injury and body site injured; and establish the
consequences of injuries. The study revealed that the rate of manual handling injuries
among ICU nurses was unacceptably high (52.2%), as was back injury (71.4% of all
injuries). In order to reduce manual handling injuries the study recommended employers
to provide lifting assistance devices; design workplaces so as to minimize the need for
ICU nurses to twist, bend and/or lift items from the floor; introduce regular equipment

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maintenance procedures; provide adequate staffing to assist with lifting patients; and
implement processes that facilitate more detailed statistics on manual handling activities
and outcomes.11

A study was conducted to evaluate three brands of commercially available nursing

footwear and identify the important shoe features for adequate shoe support during
nursing activities, and to assess the effect of wearing compression hosiery by measuring
the biomechanical, physiological, and psychophysical responses of test participants at Hua
University, Taiwan. Firstly, field observations were conducted to collect job demand data,
including walking speed, and the ratios of walking, standing, and sitting. Secondly, an
experiment was conducted to evaluate the functions of professional nursing footwear and
examine the influence of compression hosiery on lower extremity discomfort relief. The
findings of this study reveals that, comfortable footwear for nursing professionals should
emphasize a foot bed with arch support outside with 1.5 cm thickness of EVA materials in
the metatarsal zone and heel height between 1.8 and 3.6 cm; this can minimize foot
pressure distribution, impact force, and increase shin and ankle comfort. In addition,
wearing compression hosiery is recommended to alleviate lower body and foot discomfort
for clinical nurses.9

A study was conducted to describe the routine activities performed during day and
night shifts, and to compare the work activities performed in different wards during these
shifts, among 83 practical nurses working at the Orthopedics and Trauma Institute, Brazil.
Forty-three of them (52%) reported pains or musculoskeletal diseases, either based on
their own opinion or diagnosed by a physician. These nurses were invited to join the
second phase of the study and twenty-nine accepted it. All work activities performed in 29
shifts were observed and recorded. The results showed that day shifts were far more
demanding in terms of the number of activities related to patients' care than afternoon and
night shifts. Also, body postures associated with day work activities demanded important
physical efforts. The number of nurses in charge during night shifts was substantially
lower than during day shifts. This could lead to an overload and affect the health of the
nurses.10
6.3 STATEMENT OF THE PROBLEM

“A study to assess the knowledge and practices regarding

body mechanics among the nurses working in BGS global

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hospital Bangalore, with the view to develop a information
booklet”

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding body mechanics among the nurses.

2. To assess the practices regarding body mechanics among the nurses.
3. To determine the correlation between knowledge and practices regarding body
mechanics among the nurses.
4. To find out an association between the knowledge of nurses regarding body
mechanics and their selected demographic variables.
5. To find out an association between the practices of nurses regarding body
mechanics and their selected demographic variables.
6. To develop an informational booklet for nurses regarding body mechanics.
6.5 OPERATIONAL DEFINITIONS

1. Knowledge: refers to scores obtained by nurses on the knowledge items of the

structured questionnaire regarding body mechanics.
2. Practices : refers to scores obtained by nurses on practice items of structured
questionnaire regarding body mechanics.
3. Body mechanics: refers to utilization of correct muscles to complete a task safely
and efficiently, without undue strain on any muscle or joint.
4. Nurses: who has successfully completed B.Sc Nursing or GNM programme and
working as a Staff Nurse [Selected Wards] in BGS Global Hospital, Bangalore.
5. Informational booklet : set of useful information, developed by the
researcher and validated by experts regarding body mechanics and its application for
nurses.
6. Demographic Variables : Age, Gender, Professional Qualification, Area of
working, Professional Experience, In-service education.
6.6 HYPOTHESIS

H1; There will be statistical association between the knowledge scores and their selected
demographic variables at 0.05 level of significance.
H2; There will be statistical association between the practice scores and their selected

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 demographic variables at 0.05 level of significance.

6.7 ASSUMPTIONS

1. Nurses have some konoledge regarding body mechanics.

2. To some extent nurses apply body mechanics while providing patient care.

6.8 DELIMITATIONS

The study is delimited to nurses working in BGS Global Hospital, Banglore, Karnataka.

6.9 PROJECTED OUTCOME

The study will help the researcher to illuminate the statistical information regarding
knowledge & practices of body mechanics among nurses.
7 MATERIALS AND METHOD

7.1 SOURCES OF DATA

Primary source: - Nurses working in BGS Global Hospital, Bangalore.

Secondary source: - Health records of nurses maintained in hospital.
Research approach: - Descriptive.
Research design: - Descriptive survey.
Research setting: - The BGS Global Hospital, Bangalore.
Population: - Nurses of BGS global Hospital, Bangalore.
Sample size: - 100
Inclusion criteria: -
Nurses who are willing to participate in study and present during data collection.
Exclusion criteria: -
Nurses working at managerial levels like ward incharge, supervisors & floor
supervisors.

7.2 METHOD OF COLLECTION OF DATA.

Sampling technique: - Purpossive

Instrument: - Structured questionnaire.

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 Section I: - Demographic variables.
Section II: - Knowledge items regarding body mechanics.
Section III: - Practice items on body mechanics.

METHOD OF DATA COLLECTION

STEP I: -The investigator obtains permission from respective authority to conduct the
study.
STEP II: - Selection of subjects.[Nurses]
STEP III: - Investigator introduces himself to subject and notifies about his aims,
objectives, and steps of study and takes written consent.
STEP IV: - Assess the knowledge & practices of nurses by using structured
questionnaire.
STEP V: - Analysis of data is done by using descriptive and inferential statistics.
STEP VI: - Distribution of Information Booklet.
7.3 Does the study require any interventions or investigations to be conducted on
patients or other humans or animals? If so please describe briefly.

NO

7.4 Will permission obtained from your institution?

YES
7.6 Has ethical clearance been obtained from your institution?
YES
8 LIST OF REFERENCES

1. Brown, D. Nurses and preventable back injuries. American Journal of Critical

Care [online]; 2003 [cited 2009 Nov 03]; 12(5): 400-01. Available from:
http://ajcc.aacnjournals.org/cgi/content/full/12/5/400

2. Galatia Tina Iakovou. Implementation of an evidence-based safe patient handling

and movement mobility curriculum in an associate degree nursing program. Teaching
and Learning in Nursing; 2008; 3: 48-52.

3. Karen Stanger, Lou Ann Montgomerry, Eric Briesemeister. Creating a Culture of

Change Through Implementation of Safe Patient Handling Program. Critical Care
Nursing Clinics of North America; 2007; 19: 213-22.

4. Thomas R. Waters, Audrey Nelson, Caren Proctor. Patient handling Tasks with

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High Risk for Musculoskeletal Disorders in Critical Care. Critical care Nursing clinics
of North America; 2007; 19: 131-32.

5. Karahan A, bayraktar N. determination of the Usage of the Body mechanics in

clinical settings and the occurrence of low back pain in nurses. International Journal
of Nursing Studies [Online]; Jan 2004 [Cited 2009 Nov 06]; 41(1): 67-75. Available
from:
http://www.journals.elsevierhealth.com/periodicals/ns/article/PIIS002074890300083X
/abstract

6. Randall SB, Pories WJ, Pearson A, Drake DJ. Expanded Occupational Safety and
Health Administration 300 log as metric for bariatric patient-handling staff injuries.
Surgery for obesity and related diseases; 2009 Jul-Aug[cited 2009 Nov 06]; 5(4): 463-
8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19359222

7. Hartvigsen J, Lauritzen S, Lings S, Lauritzen T. Intensive Education Combined

with low tech ergonomic intervention does not prevent low back pain in nurses.
Occupation and environmental medicine [Online]; 2005 Jan [Cited 2009 Nov 06];
62(1): 13-7. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740861/

8. Kindblom K, wahlstrom R, Ekman SL. Nursing Staffs Perception of changes

inpatient transfer habits after a course- a phenomenological hermeneutic study.
Ergonomic; 2007 Jul [Cited 2009 Nov 06]; 50(7): 1017-25. Available from:
http://www.ncbi.nlm.nih.gov/sites/entrez

9. Chiu MC, Wang MJ. Professional footwear evaluation for clinical nurses. Applied
ergonomics; 2007 Mar [Cited 2009 Nov 06]; 38(2): 133-41. Available from:
http://www.ncbi.nlm.nih.gov/sites/entrez

10. Goncalves MB, Fisher FM, Lombardi JM, Ferreira Rm. Work Activities of
practical nurse and risk factors for development of musculoskeletal disorders. Journal
of Human ergology; 2001 Dec [Cited 2009 Nov 12]; 30(1-2): 369-74. Available from:
http://www.ncbi.nlm.nih.gov/sites/entrez

11. Retsas A, Pinikahana J. Manual Handling practices and injuries among ICU
Nurses. Australian Journal of Advance Nursing; 1999 Sep-Nov [Cited 2009 Nov 12];
17(1): 37-42. Available from: http://www.ncbi.nlm.nih.gov/sites/entrez

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