Lower back pain among nurses. An Occupational Study on Nurses in selected hospitals of Kathmandu, Nepal

Research Paper (postgraduate), 2015

13 Pages, Grade: MPH





Table 1. Socio demographic characteristics
Table 2. Pattern of low back pain (n=240)
Table 3. Back pain arising posture (n=300)
Table 4 Respondents’ work pattern (n=300)
Table 5. Association of factors with low back pain. (n=300)






Nursing is considered as caring as well as challenging profession as nurses have to cope with many diverse situations from simple to complex work. This increasing competition and work demand put pressure on nurses physically and psychologically along with a high risk for occupational health problem. Low back pain (LBP) is commonest one. Thus, this study aimed to find out status & factors affecting LBP among nurses. Descriptive cross sectional study with verbal informed consent among 300 registered nurses by using simple random sampling was conducted. Semi structured questionnaires with Numeric Rating Scale (NRS) to measure severity of pain and Measure of Job Satisfaction (MJS), a likert scale to measure job satisfaction for psychological factors were used. Chi square test was used to see association. Among 300 nurses, prevalence of LBP was 68%. The mean age was 30.97±10.22 years. Among 240 nurses with LBP, severity was mild (37.3%). Long service duration >16 years (82.6%), prolong standing for 5-6 hours (73.1%), activity to provide nursing care (63.3%), not maintain good posture (58.1%) and prolong working hours of 47-52 hours/week (89.6%) were factors affecting LBP. MJS scale score was 2.96±0.878 which means subjects were neither satisfied nor dissatisfied. Significant association was found between long service duration, prolong working hours, incorrect posture, performing activity of nursing care and prolong standing. It is recommended to take appropriate measures to reduce long working hours, follow correct body mechanics, promote job satisfaction and to maintain standard nurse patient ratio to reduce work load to nurses in hospital settings.

Key words: Low back pain, Nurses, Body mechanics, Co-morbidities. Back trauma.

This text was written by a non-native English speaker. Please excuse any errors or inconsistencies.


Low back pain (LBP) is the most common and the leading category of occupational injury in health care or work-related health problem. Hospital workers experience more LBP than many other groups due to nature of their job.(1) Nurses play a major role in patient care. Nursing profession is one of the challenging professions as job demands in nursing is a mixture of physically (such as manual handling of patients) and mentally demanding tasks (such as dealing with crises).(2) A nurse has to provide 24 hours service in shift that implies either long term night work or work involving rotation between day, evening, and night shifts affecting disruption of circadian rhythm resulting in sleep disturbances, fatigue, and impaired work performance and safety awareness. They are always at risk for developing many occupational health problems like low back pain.(3) The etiology behind occupational LBP among nurses is usually multi factorial, which are physical factors (e.g. working in same position for longer periods, lifting or transferring dependent patient, heavy physical work, bending, twisting and caring for high number of patients.(4) and psychosocial factors (e.g. work environment, job content, job dissatisfaction, social support, personal relation). Therefore, occupational LBP is not only an individual medical problem, but also a global problem. (5)

Studies done among nurses worldwide showed the high prevalence of the condition reported at Bangladesh 66% in 2013,(6) Egypt 79.3% in 2012,(7) Taiwan 66% in 2007,(8). Annual prevalence reported at Switzerland 73%-76% in 2003, (9) Malaysia 56.9% in 2010(10). The consequences of LBP is responsible for poor quality of life, job absenteeism, high turnover decreased productivity of individual and national health services.(1) As Nepal is resource constraint country, low back pain is more prevalent in female health professional especially nurses that is affecting overall health services of Nepal likewise there is hardly any research regarding status of LBP among nurses in Nepal. Thus researcher aimed to conduct the research to find out the status of low back pain and factors affecting pain among the nurses of Nepal. Researcher expects that the findings of this research will help nursing professional to sensitize problem and early prevention of LBP in order to improve nations' health delivery services.


Descriptive cross-sectional study was conducted in two hospitals, one government and another semi government hospital of Kathmandu from July to December 2014. Simple random sampling technique was used after making sampling frame of six government hospitals and three semi-governmental hospitals in Kathmandu based on document of list of hospitals published by Gelal Research Group on May 15, 2013. The study population was all nurses those who were registered nurse and registered Auxiliary nurse mid wife working in selected hospitals. Nurses who were physically and mentally unfit & have co-morbidities (arthritis, osteoporosis, ankylosing spondylitis, radicular syndrome or cauda equina syndrome, infection, inflammatory process, irritation, tumour & congenital abnormalities in the spine) or back trauma were excluded. Sample size was 345 which were determined by using the following formula.

Abbildung in dieser Leseprobe nicht enthalten

Where, n=sample size

Confidence limit (z) =1.96,

Nurses' prevalence with pain (p) =0.66, **[1]

Acceptable Standard error (d) =0.05 (5%) &

Person's proportion of free of condition (q) = 1-p = 1- 0.66= 0.34.

Self-administered semi-structured questionnaire was used for data collection. Among 345 respondents, 300 (86.9%) responded so sample size was 300. Questions were translated into Nepali. All ethical issue was addressed according to ethical guidelines of State University of Bangladesh and concerned authority of organization. Administrative approval was taken from an organization. Verbal informed consent was taken from the respondent. Anonymity and confidentiality were maintained.

Questionnaire consists of four section related to socio demographic characteristics, pattern of pain (experience, timing, severity, distribution, duration, intensity of pain), factors of pain (physical, social, psychological and organizational factors) and work pattern of nurses. The factors that contribute to LBP i.e. socio demographic characteristics (age, BMI, marital status, service duration), physical factors (Incorrect posture, prolong standing), social factors (low job satisfaction, low support from seniors, relationship with co-workers), organizational factors (duty hours, night shift rate), work pattern (type of nursing activities, administrative working time) were taken as independent variable where as low back pain as dependent variable.

LBP is defined as symptom of a pain which can be localized at the precise anatomical delineation of spinal area of low back (between coastal margins of twelfth rib and the inferior gluteal folds), with or without radiating leg pain from various causes but is not a disease. Correct body mechanics is defined as keeping straight back, lifting chin, heading up while sitting and standing, bending knees while lifting low objects, avoiding twisting, keeping wide leg base support while standing.

Instrumentations were used to identify severity of pain measured by using the valid pain measurement scale called Numeric Rating Scale (NRS). It is a single segmented 11-point numeric scale in a horizontal bar or line that measures pain severity in adults where 0 representing one pain extreme (e.g., “no pain”) and 10 representing the other pain extreme (e.g., “pain as bad as you can imagine” and “worst pain imaginable”). Job satisfaction level was measured by using valid and reliable tool named Measure of Job Satisfaction (MJS). It comprises 7 subscales; Personal satisfaction, Satisfaction with workload, Satisfaction with professional support, Satisfaction with training, Satisfaction with pay, Satisfaction with prospects, Satisfaction with standards of care which may be combined to give a measure of 'Overall Job Satisfaction'. There are 43 items and respondents were asked to rate their degree of job satisfaction on a five-point likert scale, ranging from ‘very satisfied’ to ‘very dissatisfied’. Data analysis was done by using Statistical Package for Social Sciences (SPSS) version 16.0 & mean, frequency distribution, percentage etc. were used for analysis. Interpretation was done in frequency tables, pie charts & bar diagrams. Chi square test was applied to explain the association of age, service duration, working department, job satisfaction with low back pain.


Among 300 nurses who responded those of sample size 345 the prevalence was 68%. . Out of 300, more than half 156 (52%) were unmarried, 116 (38.7%) were Diploma in Nursing, only 8 (2.7%) were having M.Sc. or Master in Nursing. Nearly three fourth 217 (72.3%) were staff nurse, 68 (22.7%) were Auxiliary Nurse Midwife and only 15 (5%) were Nurse In charge. (Table 1).

Table 1. Socio demographic characteristics

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Nearly one tenth (9.3%) were from cardiac ICU unit, 24 (8%) were from cardiac surgical and Female medical ward, 20 (6.7%) each were from ICU, Male medical ward I and II, Neurology, Male surgical and Female surgical wards. Orthopedic ward, Oncology ward Urology ward, Coronary Care Unit (CCU), Cardiac Medical ward and Cardiac emergency ward had 16 (5.3%) respondents each. Few 8 (2.7%) were from ENT ward.

Researcher tried to explore the severity of low back pain using Numeric Rating Scale (NRS). Among 300 respondents, severity of pain was mild in 112 (37.3%), 76 (25.3%) had pain moderate pain, 16 (5.3%) & 96 (32.1%) had severe pain & no pain respectively.

Table 2. Pattern of low back pain (n=240)

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Among pain positive respondents, pattern of low back pain showed nearly three fourth 148 (72.5%) had localized pain, 32 (15.7%) had pain radiated to buttock & 24 (11.8%) had pain radiated to leg. Most respondents 96 (47.1%) felt pain during activity, 76 (37.2%) felt after activity & 32 (15.7%) felt all the times. Nearly two third 132 (64.7%) were suffering from pain less than 6 weeks whereas 28 (13.7%) had pain between 6-12 weeks and 44 (21.6%) had pain more than 12 weeks. 140 (68.6%) had intensified pain that doesn’t required analgesics only rest is sufficient, 32 (15.7%) required both analgesics and rest. Both requiring analgesics and whom pain is not even relieved by analgesics were same i.e 16 (7.8%). Almost two third, respondents 132 (64.7%) answered pain intensified most in morning shift, 60 (29.4%) in night shift and 12 (5.9%) in evening shift (Table 2).

Posture that aroused back pain was multiple responses. Nearly two third of the respondents 124 (63.3%) answered while performing nursing care procedure. 104 (53.1%) replied prolong standing, 80 (40.8%) answered bending, 40 (20.4%) while lifting patients and equipment & only 16 (8.2%) while pulling and pushing objects. (Table 3)

Table 3. Back pain arising posture (n=300)

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Table 4 Respondents’ work pattern (n=300)

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The results regarding work pattern of respondents includes type of nursing activity that is done in a shift duty. Among 300 respondents, nearly one third 98 (32.7%) did basic care, 87 (29%) did complex care and least 22 (7.3%) did housekeeping work.

Result time spent for administrative working depicted two third 199 (66.3%) of respondents spent 1-2 hours of administrative work whereas 93 (31.0%) spent 3-4 hours of administrative work. Minor 8 (2.7%) respondents spent 5-6 hours for administrative work. (Table 4)

Association of factors of pain with low back pain was done which were socio demographic factors (age, BMI & service duration), physical factors (frequency of maintenance of good posture, duration of standing), organizational factor (duty hours per week) & psychological factor (job satisfaction). Result showed there was statistically significant association (p<0.05) of factors of back pain (service duration, duty hours per week, maintenance of good posture, standing duration per shift and overall job satisfaction) with presence of low back pain. Likewise, results showed there is no statistically significant association (P>0.05) of age and BMI with the presence of low back pain. As the age and BMI of the respondent increases there is presence of respondents’ back pain. (Table 5)


[1] ** Prevalence (66%) was taken from a cross-sectional study among 100 nurses from three selected hospitals in Savar, Bangladesh in 2013 (6)

Excerpt out of 13 pages


Lower back pain among nurses. An Occupational Study on Nurses in selected hospitals of Kathmandu, Nepal
State University of Bangladesh  (State University of Bangladesh)
Public Health
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This text was written by a non-native English speaker. Please excuse any errors or inconsistencies.
LBP, Lower Back Pain, nurses, Kathmandu, Nepal, hospital, work
Quote paper
Lok Raj Joshi (Author)Sajana Shrestha (Author), 2015, Lower back pain among nurses. An Occupational Study on Nurses in selected hospitals of Kathmandu, Nepal, Munich, GRIN Verlag, https://www.grin.com/document/337855


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