Neck/shoulder and back pain in new graduate nurses: A growth mixture modeling analysis

Early career demanding psychosocial work environment and severe back pain and neck/shoulder pain in experienced nurses: A cohort study

AIMS

Back pain and neck/shoulder pain are common among nurses. The aim of this study was to investigate the association between nurses' exposure to a demanding psychosocial work environment during the first three years after graduation and the occurrence of severe back pain and neck/shoulder pain in the longer term, 11-15 years later.

METHODS

The Longitudinal Analysis of Nursing Education (LANE) study (nursing graduates from 26 Swedish universities in the years 2002, 2004 and 2006) was used to create two risk cohorts of nurses not reporting severe back pain (n=1764) or neck/shoulder pain (n=1707). Nurses exposed to a demanding psychosocial work environment for one, two or three of the first three years in their career were compared to nurses not having a demanding psychosocial work environment for any of these three years regarding the incidence of severe back pain or neck/shoulder pain at follow-up, 11-15 years later. Relative risks (RR) with 95% confidence intervals (CI) were calculated using binomial regression.

RESULTS

The RR (95% CI) of having severe back pain for nurses who had a demanding psychosocial work environment for one of the three years was 1.36 (0.82-2.28) and 2.08 (1.21-3.57) for two of the three years and 2.82 (1.43-5.55) for all three years. Corresponding RRs (95% CIs) for severe neck/shoulder pain were 1.35 (0.87-2.10), 1.49 (0.88-2.51) and 1.41 (0.62-3.20), respectively.

CONCLUSIONS

Nurses who were repeatedly exposed to a demanding psychosocial work environment early in their career reported severe back pain to a higher extent in the longer term.

Sleep as a prognostic factor in low back pain: a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials

Sleep problems are common in individuals with low back pain (LBP) and sleep restriction seems to be associated with impaired pain processing. Our objective was to investigate whether sleep is associated with future LBP outcomes (i.e. pain intensity, disability, and recovery) in adults. We conducted a systematic review of prospective cohort studies and secondary analyses of randomized controlled trials (registration-PROSPERO CRD42022370781). In December 2022, we searched the MEDLINE, Embase, CINAHL, and PsycINFO databases. Fourteen studies, totaling 19 170 participants were included. Thirteen studies were rated as having high risk of bias (QUIPS tool). We used vote-counting and meta-analysis approaches to synthesize the data. We found associations between baseline sleep with future pain intensity, recovery, and between changes in sleep with changes in pain intensity, changes in disability, and recovery. We further synthesized outcomes as "overall LBP improvement" outcomes. Baseline poor sleep was moderately associated with non-improvement in LBP in the long-very long term (OR 1.55, 95% CI: 1.39 to 1.73; three studies providing unadjusted effect sizes), and non-improvement in sleep was largely associated with non-improvement in LBP in the short-moderate term (OR 3.45, 95% CI: 2.54 to 4.69; four studies providing unadjusted effect sizes). We found no association between baseline sleep with future disability and overall LBP improvement in the short-moderate term. Therefore, sleep may be a prognostic factor for pain intensity and recovery from LBP. All findings were supported by low to very low-quality evidence. Better-conducted studies are needed to strengthen our certainty about the evidence.

Experiences of nurses and midwives with disabilities: A scoping review

AIM

To identify the extent and type of evidence exploring the workplace experiences of nurses and midwives with disabilities.

DESIGN

Scoping Review.

DATA SOURCES

Four electronic databases were systematically searched in February 2022 to identify studies discussing the experiences of nurses and midwives with disabilities, published between 2012 and 2022. Google Scholar and Theses Global were also searched.

REVIEW METHODS

All search results, irrespective of their format, were uploaded to Covidence to assist with the selection of evidence. Studies discussing the experiences of nurses and midwives with disabilities were included. Two reviewers conducted screening and data extraction independently, and a third reviewer resolved conflicts.

RESULTS

Searches identified 130 studies. After screening for title and abstract, full-text review identified 23 studies for data extraction and analysis. Data were summarized and presented in tabular form under two categories (1) workplace experiences and (2) impact in the workplace. Results were presented in a descriptive, narrative form with accompanying tables.

CONCLUSION

The nurse or midwife can be impacted significantly by disability. Currently, little is known about the workplace experiences of nurses and midwives with disabilities. Therefore, a better understanding of the experiences of the nurse and midwives with disabilities is important to increase diversity, equity, accessibility, and inclusion.

IMPACT

Shortage of nurses and midwives worldwide highlights the need to understand why nurses and midwives with disabilities decide to leave the profession. Further research exploring the experiences of nurses or midwives with disabilities will help identify support requirements, develop frameworks for reasonable adjustment accommodations, and assist with future workforce planning. The EQUATOR guidelines for PRISMA have been met. No Patient or Public Contribution.

Musculoskeletal pain affecting undergraduate nursing students: A cross sectional study on the prevalence and the associated factors

BACKGROUND

Musculoskeletal pain conditions (MSP) affect not only professional nurses but nursing students too. Long standing pain conditions affecting young individuals in their productive years can impact their work efficiency and can have economic impacts. Effective interventions to decrease the effect of MSP conditions are essential for a healthy professional nursing force which form the backbone of the healthcare system.

PURPOSE

We conducted this study with an aim to estimate the prevalence and patterns of MSP conditions in undergraduate nursing students. Additionally, we attempted to evaluate the associated factors and identify the predictors of MSP conditions in them.

METHODS

This cross-sectional study was conducted using a web-based electronic questionnaire on nursing students at a tertiary level teaching hospital. The questionnaire prepared on Kobo Toolbox was circulated among the students of each class by their class representative using WhatsApp and e-mail. Two reminders were sent at 24-hour intervals. The data were analysed to identify the prevalence of MSP and evaluate the probable associated factors.

RESULTS

One hundred and seventy-nine out of 255 (70.2 %) participants responded and 173 consented for participation. Around 53.2 % participants had suffered from MSP in the past year. A total of 43.9 % of the participants had previously suffered from musculoskeletal pain even earlier than the past one-year in question. Those in their 2nd academic year had higher odds of suffering from MSP. Factors related to self-study after the formal teachings at the school/ college of nursing like the place, duration, and posture, and the pattern of usage of electronic devices like smartphones and laptop computers had no significant association with the MSP conditions. Lack of physical exercise, attending clinical placements, and the factors related to such placements like duration and frequency of placements, and the duration of breaks during any placement were noted to have an influence on MSP.

CONCLUSION

More than 50 % students reported to be affected by MSP over a year. Association with factors like inadequate physical activity, and strenuous clinical placements identified in this study indicate that modifications in the nursing curriculum are required. Encouraging physical activity on one hand, while minimising exhaustive, and taxing clinical placements might be the way forward for improving the musculoskeletal health of aspiring nurses.

Early and Persistent Dysphagia Relief Predicts Tumor Response in Esophageal Squamous Cell Carcinoma Patients Treated with Immunochemotherapy

BACKGROUND

In this prospective study, we aimed to investigate the role of patient-reported dysphagia relief in predicting pathological tumor responses to neoadjuvant immunochemotherapy (NAIC) in locally advanced esophageal squamous cell carcinoma (ESCC) patients.

METHODS

This study was designed as a multi-center, prospective study including ESCC patients who received NAIC in the discovery and validation cohorts. The patients' responses to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-OES 18 and QLQ-C30 were collected at multiple time points. Subsequent time point-intensive esophageal cancer-specific dysphagia trajectories were depicted using growth mixture modeling (GMM) analysis. Furthermore, univariate and multivariate binary logistic regression was used to assess the independent predictors for pathological tumor responses.

RESULTS

A total of 120 patients from the discovery cohort and 42 patients from the validation cohort were included in the analysis. In the discovery cohort, 19 (22.9%) of the 83 patients achieved pCR status. In the independent validation cohort, 24 patients underwent surgery, and 9 (37.5%) patients achieved pCR status. Trajectory analysis showed that, in the pCR group, the beginning of rapid declines in the slope occurred on days 3, 6, and 9. Further multivariate analysis showed that the degree of dysphagia relief (△dysphagia%) was the only significant independent predictor for pCR status (OR = 3.267, 95% CI 1.66-6.428, P < 0.001). The AUC value for △dysphagia% was 0.961 (95% CI: 0.922-0.999, P < 0.001).

CONCLUSION

The current study demonstrated that a longitudinal patient-reported outcome (PRO) was an easily obtained, cost-effective, and noninvasive tool for predicting tumor responses to neoadjuvant immunochemotherapy.

Health-promoting factors among students in higher education within health care and social work: a cross-sectional analysis of baseline data in a multicentre longitudinal study

Background

Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.

Methods

This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).

Results

Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.

Conclusions

Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

What sociodemographic and work characteristics are associated with musculoskeletal complaints in nursing students? A cross-sectional analysis of repeated measurements

Musculoskeletal complaints (MSCs) arise during nursing education. We examined cross-sectional associations between self-reported MSCs and both sociodemographic and workplace characteristics in different clinical placement settings. We included two observations among three cohorts of third-year Dutch nursing students (total N = 711) of the undergraduate nursing program of Rotterdam University of Applied Sciences. Questionnaire data on sociodemographic, physical and psychosocial work characteristics, and MSCs were used. Generalized estimating equation analysis for repeated measurements with backward elimination was used to examine associations with MSCs. In total, 79% of students experienced MSCs. Female sex (OR 0.37, 95% CI 0.22-0.62), lifting and bending (OR 1.01, 95% CI 1.00-1.03), physical job demands (OR 2.33, 95% CI 1.68-3.22) and need for recovery (OR 1.02, 95% CI 1.01-1.03), were statistically significantly associated with overall MSCs. Models for regional complaints are also presented in this article. Nursing school and clinical placement staff should consider these factors when dealing with nursing students with MSCs.

The Ergonomic Association between Shoulder, Neck/Head Disorders and Sedentary Activity: A Systematic Review

Background

Work-associated upper limb and neck disorders are common occupational disorders throughout the world. These disorders are usually observed more in workers who spend a long time sitting, referred to as sedentary activity (SA). The immediate and distorted risk of sedentary-related problems was considered high in Europe, Australia, and the United States. Even though mediation is convenient, it is likely to reduce office workers' risks of developing cervical and upper body pain due to sedentary work. This systematic review addresses risk factors and evaluates the relationship between SA and upper body disorders in office workers (i.e., shoulder and neck/head).

Methods

PubMed, Scopus, and Web of Science were searched for articles published between January 2010 and August 2021 in the English language. The three keywords “sedentary,” “upper body elements,” and “work” (and their derivatives) were searched to identify studies and carry out this systematic review. The articles were searched so that all three keywords or at least a derivation of each keyword should appear. Findings. Of the 40 articles that met the enclosure criteria, 32 studies examined the association of SA and upper body elements during both office and computer work. However, three articles were evaluated in the sit-stand work environment, and in the remaining five studies, one was evaluated during teaching, two during hospital work, and two during mixed working conditions.

Conclusions

Research related to SA focuses mainly on extended risk factors, but there was no focus on other aspects, such as muscle and tendon contractions. As there is a convincing connection between SA and the upper body, our close examination identifies the need to institutionalize a system for collecting, analyzing, and describing the impact and short-term effects of SA on the upper body. Additionally, some suggestions were made to minimize the risk in a sedentary working environment.

Randomised control trial of a proactive intervention supporting recovery in relation to stress and irregular work hours: effects on sleep, burn-out, fatigue and somatic symptoms

Objectives

To examine if a proactive recovery intervention for newly graduated registered nurses (RNs) could prevent the development of sleep problems, burn-out, fatigue or somatic symptoms.

Methods

The study was a randomised control trial with parallel design. Newly graduated RNs with less than 12 months’ work experience were eligible to participate. 461 RNs from 8 hospitals in Sweden were invited, of which 207 signed up. These were randomised to either intervention or control groups. After adjustments, 99 RNs were included in the intervention group (mean age 27.5 years, 84.7% women) and 108 in the control group (mean age 27.0 years, 90.7% women). 82 RNs in the intervention group attended a group-administered recovery programme, involving three group sessions with 2 weeks between each session, focusing on proactive strategies for sleep and recovery in relation to work stress and shift work. Effects on sleep, burn-out, fatigue and somatic symptoms were measured by questionnaires at baseline, postintervention and at 6 months follow-up.

Results

Preventive effect was seen on somatic symptoms for the intervention group. Also, the intervention group showed less burn-out and fatigue symptoms at postintervention. However, these latter effects did not persist at follow-up. Participants used many of the strategies from the programme.

Conclusions

A proactive, group-administered recovery programme could be helpful in strengthening recovery and preventing negative health consequences for newly graduated RNs.

Trial registration number

NCT04246736.

What Do We Know About Interventions to Prevent Low Back Injury and Pain Among Nurses and Nursing Students? A Scoping Review

STUDY BACKGROUND

Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries.

PURPOSE

This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students.

METHODS

Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals.

RESULTS

Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies.

CONCLUSIONS

Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

Investigation of psychosocial factors on upper limb musculoskeletal disorders and the prevalence of its musculoskeletal disorders among nurses: a systematic review and meta-analysis

OBJECTIVE

Musculoskeletal disorders are one of the most important occupational problems especially among nurses. The aim of this study was to investigate the prevalence of musculoskeletal disorders in upper limbs and its associated psychosocial factors in the workplace.

METHODS

A systematic review was conducted by searching the Medline/PubMed, EMBASE, Scopus, ISI/web of knowledge and Google Scholar databases. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. The statistical analysis was performed using Stata software.

RESULTS

We found 1742 articles in our initial search. After reviewing the titles, abstracts and full texts, 66 articles were finally analyzed. Psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses were identified which included boring work, inadequate staffing, job demands, insufficient support, time pressure, decision latitude, job dissatisfaction, and job stress. There was a significant relationship between these factors and prevalence of musculoskeletal disorders in the wrists, shoulders, neck and shoulders, and wrists and hands.

CONCLUSION

Collectively, the results of this study provide strong evidence of some psychosocial factors affecting the prevalence of upper limb musculoskeletal disorders among nurses. Thus, organizational interventions to minimize these stressors may be promising in reducing one risk factor for the development of nurses' musculoskeletal disorders. These interventions should not only consider the factors of physical ergonomics but also seek to improve the organizational aspects of the workplace.

Short sleep and chronic neck and shoulder discomfort in nurses

OBJECTIVE

Short sleep duration is common among nurses. Sleep restriction has been associated with musculoskeletal discomfort. However, studies on the effect of short sleep duration on chronic neck and shoulder discomfort in nurses have been lacking. The aim of this study was to determine whether short sleep duration is related to chronic neck and shoulder discomfort.

METHODS

We conducted a cross-sectional survey of female nurses in secondary referral health centers in Taiwan. We applied stratified sampling based on region (north, central, south, and east) to select representative centers for this study. A self-administered structured questionnaire, including demographic data, the psychological working environment, and musculoskeletal symptoms, was administered to nurses. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of average sleeping hours per working day on chronic neck and shoulder discomfort.

RESULTS

A total of 1602 (78.9%) questionnaires were eligible for final analysis. The prevalence rates of chronic neck and shoulder discomfort were 33.9% and 34.7%, respectively. Population attributable risk estimation revealed that a sleep duration of <7 hours per working day was the most crucial factor for chronic neck and shoulder discomfort in the nurses, accounting for 8.8% of chronic neck discomfort and 8.6% of chronic shoulder discomfort respectively.

CONCLUSION

Our study found that sleep duration on working days was associated with chronic neck and shoulder discomfort in female nurses. Further interventions are warranted for maintaining nurses' sleep hygiene.

Creating safety in care: Student nurses' perspectives

Nursing is often hazardous work. Promoting safety and care requires nurses to apply knowledge, skill and creativity in patient encounters. Nurses' risk exposures are well documented, with research on student nurses' safety more limited. We studied final-year nursing students' risk perceptions using questionnaire-based vignettes involving four patient presentations on patient aggression, manipulating patient and resource risk factors. We found student nurses were most likely to ask for help and wait when managing high-risk patient aggression scenarios. Student nurses placed most importance on their own safety and patient condition in making decisions. Resource risk significantly interacted with gender, with male nurses more likely to seek help when risks were high. There is need to improve student nurse training on managing patient aggression by promoting creative approaches to problem solving and critical thinking using simulation techniques to enhance situation awareness and translate knowledge to practice.

Improving mental health of student and novice nurses to prevent dropout: A systematic review

Aims

To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout‐related outcomes.

Design

Systematic review.

Data sources

Research papers published between January 1971–February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar.

Review methods

We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer‐reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout‐related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta‐analysis of studies was performed.

Results

We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout‐related outcomes. The overall risk of bias was high.

Conclusion

A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high‐quality studies in this field, preferably with a randomized controlled design.

Effective interventions for preventing work related physical health complaints in nursing students and novice nurses: A systematic review

From the start of their career, nursing students and novice nurses are at risk of developing physical health problems due to high physical workload, which may lead to early exit from nursing. To provide an overview of interventions preventing physical health problems in early career, a systematic review was performed. A comprehensive search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were musculoskeletal symptoms. Independent authors selected studies, appraised quality and extracted data. After screening 7111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. None focused on our primary outcome education/work dropout. All studies reported on physical complaints among student nurses only. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects were small and inconsistent. In conclusion, evidence for the effectiveness of interventions in the nursing curricula for the prevention/treatment of physical complaints is scarce and where available conflicting. We recommend high quality research on dropout due to physical health problems, as well as on the prevention/treatment of physical complaints.

Health-promoting factors in higher education for a sustainable working life - protocol for a multicenter longitudinal study

BACKGROUND

The World Health Organization has highlighted the importance of health promotion for health service providers in order to ensure sustainable working life for individuals involved in providing health services. Such sustainability begins when students are preparing to manage their own future health and welfare in working life. It has been suggested that universities, employees and trainee health professionals should adopt or follow a salutogenic approach that not only complements the providing of information on known health risks but also favors health promotion strategies. This paper describes the study design and data collection methods in a planned study aiming to explore health-promoting factors for a sustainable working life among students in higher education within healthcare and social work.

METHODS

This protocol describes a multicenter longitudinal study involving Swedish students on higher education programs in the healthcare and social work sectors. In 2018, the study invited students on seven education programs at six universities to participate. These programs were for qualification as: biomedical laboratory scientists (n = 121); dental hygienists (n = 87); nurses (n = 1411); occupational therapists (n = 111); physiotherapists (n = 48); radiographers (n = 60); and, social workers (n = 443). In total, 2283 students were invited to participate. Participants completed a baseline, a self-reported questionnaire including six validated instruments measuring health-promoting factors and processes. There are to be five follow-up questionnaires. Three while the students are studying, one a year after graduating, and one three years after graduating. Each questionnaire captures different health-promoting dimensions, namely: health-promoting resources (i.e. sense of coherence); occupational balance; emotional intelligence; health and welfare; social interaction; and work and workplace experiences/perceptions.

DISCUSSION

This study focuses on the vastly important aspect of promoting a sustainable working life for healthcare and social work employees. In contrast to previous studies in this area, the present study uses different, validated instruments in health promotion, taking a salutogenic approach. It is hoped that, by stimulating the implementation of new strategies, the study's findings will lead to education programs that prepare students better for a sustainable working life in healthcare and social work.

Sliding Sheet Use in Nursing Practice: An Intervention Study

Background: Previous studies have discovered that the utilization of sliding sheets in patient care is a valuable technique for repositioning bedridden patients compared with traditional cotton sheets or carriers. Our aim was to examine the effects of sliding sheet usage on work-related musculoskeletal disorders and disability, perceived workload, burnout, and job satisfaction, among nurses and nursing assistants. Method: This repeated measurement study included 41 female nurses and nursing assistants from three internal medicine departments who provided direct patient care. Participants completed an eight-part questionnaire (demographics, Neck Disability Index, Quick Disability of the Arms, Shoulder and Hand Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, BackAche Disability Index workload, burnout, and job satisfaction) 4 times during the study period: 3 months prior to the intervention, on the first day of the intervention, and 3 and 6 months after commencement of the intervention. Findings: After 3 and 6 months of sliding sheet usage, pain and disability decreased in the neck ( p < .001); arms, shoulders, hands ( p = .041); and lower back ( p < .001), with an increase in job satisfaction ( p < .001). Discussion/Application to Practice: The findings of our study indicate a clear influence of reducing work-related musculoskeletal pain and disability while increasing job satisfaction when sliding sheets are introduced into nursing practice. Occupational health nurses in health care should consider this type of low-cost intervention as a method for reducing musculoskeletal injury among direct patient care providers.

The level of sense of coherence among Swedish nursing staff

AIM

To explore the level of sense of coherence among Swedish nursing staff.

DESIGN

An explorative quantitative study design was adopted using a short form for measuring sense of coherence.

METHODS

Data were collected in January 2018 from nurses working in full-time positions at two hospitals in Western Sweden. A total of 93 nurses completed the 13 item questionnaire measuring sense of coherence. Descriptive statistics were applied to obtain means and standard deviations. Spearman's rank correlation was used to describe strength of association between sense of coherence and socio-demographic categories. Between-group differences were defined using the nonparametric tests of Mann Whitney U test and Kruskal-Wallis test.

RESULTS

The internal consistency of the SOC-13 was low. An inter-item-correlation test indicated that two items decreased the internal consistency of the scale. The level of the three dimensions of sense of coherence varied; manageability was weakest and decreased the total sense of coherence. The meaningfulness dimension was as strongest.

CONCLUSION

On a national level, nurses reported weaker sense of coherence (SOC) than the general population, but stronger in an international comparison of nurses. They found their work difficult to manage, but meaningful.

IMPACT

On a national level, the nurses reported weaker SOC than the general population, but stronger in an international comparison of nurses. Findings from this study will have an impact on how nurses can manage work related stress in terms of sense of coherence. There will also be an impact on nurses' well-being, which in a long run benefits patients.

Are trajectories of neck-shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study

OBJECTIVES

The study aimed to determine the extent to which latent trajectories of neck-shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over 1 year in an occupational population.

METHODS

This longitudinal study included 748 Danish workers (blue-collar, n=620; white collar, n=128). A questionnaire was administered to collect data on personal and occupational factors at baseline. Text messages were used for repeated measurements of NSP intensity (scale 0-10) over 1 year (14 waves in total). Simultaneously, self-reported sick leave (days/month) due to pain was assessed at 4-week intervals, while work ability (scale 0-10) was assessed using a single item (work ability index) at 12-week intervals over the year. Trajectories of NSP, distinguished by latent class growth analysis, were used as predictors of sick leave and work ability in generalised estimation equations with multiple adjustments.

RESULTS

Sick leave increased and work ability decreased across all NSP trajectory classes (low, moderate, strong fluctuating and severe persistent pain intensity). In the adjusted model, the estimated number of days on sick leave was 1.5 days/month for severe persistent NSP compared with 0.1 days/month for low NSP (relative risk=13.8, 95% CI 6.7 to 28.5). Similarly, work ability decreased markedly for severe persistent NSP (OR=12.9, 95% CI 8.5 to 19.7; median 7.1) compared with low NSP (median 9.5).

CONCLUSION

Severe persistent NSP was associated with sick leave and poor work ability over 1 year among workers. Preventive strategies aiming at reducing severe persistent NSP among working populations are needed.

Musculoskeletal symptoms in nursing students: concept analysis

ABSTRACT Objective: to analyze the musculoskeletal symptomatology concept in undergraduate nursing students through Rodgers' evolutionary method. Method: An integrative review of the literature was performed for the identification and selection of ten articles. A concept analysis was performed according to Rodgers' evolutionary method. Article search was performed using the EBOSCO Host platform, Virtual Health Library and Google scholar for the years from 2004 to 2018. Results: Based on the 3 elements of Rodgers model we found: 1) substitute terms and related concepts, where musculoskeletal disorders and musculoskeletal symptoms were highlighted; 2) as essential attributes of the concept we highlight pain and discomfort, as well as, measurement using the Nordic Musculoskeletal Questionnaire; and 3) risk factors were identified as antecedents, and the consequences were the impact on students' lives. Conclusions: This study contributes to the knowledge and clarification of the concept of musculoskeletal symptomatology in nursing students.

The relationship between task mastery, role clarity, social acceptance, and stress: An intensive longitudinal study with a sample of newly registered nurses

BACKGROUND

Transitioning into a new professional role is challenging. Unfortunately, little is currently known about how to reduce experiences of stress among new professionals. The socialization processes role clarity, task mastery, and social acceptance are assumed to reduce experiences of stress as they mediate new professionals' acquisition of knowledge, skills, attitudes, and behaviors. However, little prospective data is available on the actual effect of the processes on stress.

OBJECTIVES

To prospectively investigate how the socialization processes relate to experiences of stress among new nurses during the first three months of professional working life. Specifically, to investigate development over time, as well as how episodes of increased or decreased levels of the socialization processes relate to concurrent levels of stress. The general purpose of this investigation was to examine the suitability of the socialization processes as targets of an intervention seeking to reduce stress among new professionals.

DESIGN

An intensive longitudinal study with weekly data collections over three months.

PARTICIPANTS

264 newly graduated Swedish nurses who started their first job during the period of the study.

METHODS

The participants were followed prospectively during 14 consecutive weeks after their professional entry. Data on stress (Stress and Energy Questionnaire), role clarity (General Questionnaire for Psychological and Social Factors at Work), task mastery, and social acceptance (Needs Satisfaction and Frustration Scale) were collected weekly using digital surveys (mean response rate 82.7%). Data was analyzed using a multilevel model for intensive longitudinal data.

RESULTS

For the typical nurse, stress decreased by 0.13 units per month, role clarity and task mastery increased by 0.08 and 0.05 units, and social acceptance decreased by 0.08 units. In addition, the slopes of 95 percent of the new nurses varied within 1.18 (stress), 0.72 (role clarity), 0.44 (task mastery), and 0.86 (social acceptance) units of the typical nurse. Most importantly, when the new nurses experienced higher levels of task mastery, role clarity, and social acceptance, they experienced lower levels of stress (within-person parameter estimates: task mastery -0.40, p = .001; role clarity -0.34, p = .001; and social acceptance -0.33, p = .001).

CONCLUSIONS

Supporting the development of the socialization processes could be one theoretically based strategy to reduce levels of stress among new nurses. As stress among new professionals is not unique to the nursing profession, and the processes are considered important mediators of new professionals' adaptation in general, the results from this study should likely be generalizable to other professions.

Higher low back and neck pain in final year Swiss health professions' students: worrying susceptibilities identified in a multi-centre comparison to the national population

BACKGROUND

Low back pain (LBP) and neck pain (NP) are of considerable socioeconomic burden. Considering the escalating demand on health services that LBP and NP have globally, they represent an arguably unsustainable drain on resources with the projected increased demand secondary to an ageing population. Identifying populations at risk for LBP and NP may inform public health prevention strategies. Health professions' (HP) students may be more susceptible due to their demographic factors and potentially risky postural demands of their education and formative clinical practice. The aim of our study was to compare self-reported LBP and NP of HP students with the general and stratified Swiss population to identify their prevalence. In addition, we compared the prevalence of LBP and NP in students studying different professions in order to identify whether susceptibilities exist.

METHODS

In this cross-sectional study, self-reported LBP and NP reported by final-year HP students (n = 1848) were compared with the Swiss national population aged ≥15 years living in private households (n = 21,597). Binary regression models estimated crude prevalence and prevalence adjusted for age, gender, and education. Design-based F-Tests assessed differences between students and the Swiss population.

RESULTS

Crude, overall four-week (4w) prevalence (mean (95% CIs)) for LBP was 61.0% (58.4-63.5) in all HP students versus 40.0% (39.2-40.9) in the Swiss population. Female HP students aged 21-30 years (63.3% (60.5-66.1)) reported higher LBP than the same-aged Swiss female population with secondary (43.7% (39.5-47.9)) or tertiary (36.6% (30.8-42.9)) education. Crude, overall 4w prevalence for NP was 59.8% (57.2-62.3) in all HP students versus 36.4% (35.6-37.3) in the Swiss population. Female health professions' students aged 21-30 years reported higher NP (63.2% (60.4-66.0)) than the same-aged Swiss female population with secondary (36.6% (32.7-40.8)) or tertiary (35.4% (29.6-41.8)) education. The inter-professional differences shown indicate midwifery to be most susceptible to reporting both conditions.

CONCLUSIONS

Considerably higher LBP and NP were reported by final year HP students when compared with the general and stratified Swiss population. Worrying inter-professional susceptibilities were shown and reveal the need for further explanatory studies. Measures to reduce complex health problems like LBP and NP should be introduced into curricula in order to optimize the longevity of clinical careers and to protect the future HP workforce.

Physical and mental determinants of dropout and retention among nursing students: protocol of the SPRiNG cohort study

Background

The shortage of nursing professionals is of growing concern. The causes of this include the demanding physical and mental workload, leading to a dropout of nurses that may start during their education. However, it is unclear to what extent nursing students already perceive a physical and mental workload leading to health problems during their nursing education and placement, and to what extent these health problems cause students to dropout from nursing education. Very few prospective cohort studies have investigated protective and risk factors in relation to dropout and retention among nursing students.

Methods

Three cohorts of third-year nursing students will be followed for 2.5 years. Students will be enrolled from the Bachelor of Nursing program of the Rotterdam University of Applied Sciences. At baseline, students will receive a self-administered questionnaire. Primary outcome is dropout from nursing education and dropout from the nursing profession. Data on dropout from nursing education will be retrieved from the student administration on a yearly basis. Dropout from the nursing profession will be measured one year after graduation, using the self-reported questionnaire. Secondary outcomes are presenteeism and sick leave (during internship/work). In addition to student characteristics, the questionnaire asks about physical and mental internship/work characteristics, personal and behavioral factors, and experienced physical and mental burden.Main aims of this study are to determine: 1) the prevalence and incidence rates of dropout, 2) the protective and risk factors, and early indicators of dropout, and 3) the interaction between these factors and the indicators.

Discussion

Data analysis of a large, prospective cohort study with regard to determinants of dropout and retention of nursing students and newly graduated nurses is in progress. Findings emerging from this study can be used to develop a predictive model to identify the first indicators of dropout from nursing education and nursing profession, for which targeted interventions can be deployed.

Structural equation model of interactions between risk factors and work-related musculoskeletal complaints among Iranian hospital nurses

BACKGROUND

Statistics indicate a high risk of developing work-related musculoskeletal disorders among hospital nurses. The challenge is to understand the associations between musculoskeletal symptoms and various individual and occupational risk factors.

OBJECTIVE

This study examined the direct and indirect interactions of various risk factors with musculoskeletal complaints in hospital nurses.

METHOD

In a cross-sectional design, Iranian hospital nurses from Semnan University of Medical Sciences participated in a questionnaire survey reporting their perceived perceptions of various work-related risk factors and musculoskeletal symptoms. We tested our proposed structural equation model to evaluate the relations between latent and observed concepts and the relative importance and strength of exogenous variables in explaining endogenous musculoskeletal complaints.

RESULTS

Measurement model fits the data relatively acceptable. Our findings showed direct effects of psychological, role-related and work posture stressors on musculoskeletal complaints. Fatigue mediated the adverse indirect relations of psychological, role-related, work posture and individual factors with musculoskeletal complaints.

CONCLUSIONS

Structural equation modeling may provide methodological opportunities in occupational health research with a potential to explain the complexity of interactions among risk factors. Prevention of work-related musculoskeletal disorders among nurses must account for physical and psychosocial conditions.

Human Factors Evaluation of Surgeons' Working Positions for Gynecologic Minimal Access Surgery

STUDY OBJECTIVE

To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients DESIGN: Mixed methods (Canadian Task Force classification III).

SETTING

Teaching hospital in the United Kingdom.

MEASUREMENTS

Survey, observations (anthropometry, postural analysis), and interviews.

RESULTS

Work-related musculoskeletal disorders (WRMSDs) were present in 63% of the survey respondents (n = 67). The pilot study (n = 11) identified contributory factors, including workplace layout, equipment design, and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average-size mannequin and plus-size mannequin) but not between patient size groups, suggesting that port preference may be driven by surgeon preference (and experience) rather than by patient size.

CONCLUSION

Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a workplace that supports adaptation to the task, the surgeon, and the patient.

Caring for the Caregivers: Results of an Extended, Five-component Stress-reduction Intervention for Hospital Staff

The health-related consequences of stress in hospital workers and associated costs of absenteeism and high turnover have increased the need for programs targeting stress in this population. "Caring for the Caregivers," a multimodal approach to stress-reduction designed to address the multidimensional nature of stress in hospital staff, integrates five components: cognitive, somatic, dynamic, emotive and hands-on, in a flexible eight-month format. Significant improvements were demonstrated for 97 participants compared to 67 controls in pre-post scores for the Maslach Burnout Inventory, Job-Related Tension Index, Perceived Stress Scale, Productivity Scale, General Health Questionnaire, Positive and Negative Affect Schedule, and Visual Analogue Scales of 12 stress-associated symptoms. Together with significant reduction in upper respiratory infections and family doctor visits, these results suggest that providing hospital staff with multiple techniques addressing commonly encountered work stressors impacts positively on health and well-being and significantly reduces stress and burnout in this population.

Musculoskeletal Injury Prevention for New Nurses

Nurses continue to sustain musculoskeletal injuries even with increased emphasis on safe patient handling and mobility (SPHM) and organizational cultures of safety to protect health care workers. Analysis of data from 2011-2014 registered nurse graduates explored hospital safety culture, SPHM education/training, and incidence of new-nurse musculoskeletal injury. Results indicated hospitals provided some type of SPHM education and training, but 46% of study participants were not informed or aware of national SPHM standards or guidelines. Merely 13.9% of participants stated a written “no manual lifting policy” had been implemented; only 32.9% indicated staffing was adequate for SPHM tasks; and only 39.4% stated the hospital had all of the equipment needed to perform SPHM safely. Thirty-nine percent of participants had already sustained a musculoskeletal injury with an additional 35% sustaining but not reporting an injury. More actions are needed to ensure a decrease in musculoskeletal injuries for new nurses.

Is that really my movement? - Students' experiences of a video-supported interactive learning model for movement awareness

Healthcare staff and students have a great risk of developing musculoskeletal symptoms. One cause of this is heavy load related work activities such as manual handling, in which the quality of individual work technique may play a major role. Preventive interventions and well-defined educational strategies to support movement awareness and long-lasting movement changes need to be developed. The aim of the present study was to explore nursing students’ experiences of a newly developed interactive learning model for movement awareness. The learning model, which is based on a life-world perspective with focus on interpersonal interaction, has been used with 11 undergraduate students from the second and final year. Each student participated in three individual video sessions with a facilitator. Two individual interviews were carried out with each student during the learning process and one interview 12–18 months after the last session. The interviews were audio-recorded and transcribed verbatim, and a phenomenological hermeneutic method inspired by Paul Ricoeur and described by Lindseth and Norberg was used to interpret the interviews and diary notes. The interpretation resulted in three key themes and nine subthemes. The key themes were; “Obtaining better preconditions for bodily awareness,” “Experiencing changes in one's own movement,” and “Experiencing challenges in the learning process.” The interactive learning model entails a powerful and challenging experience that develops movement awareness. The experience of meaningfulness and usefulness emerges increasingly and alternates with a feeling of discomfort. The learning model may contribute to the body of knowledge of well-defined educational strategies in movement awareness and learning in, for example, preventive interventions and ergonomic education. It may also be valuable in other practical learning situations where movement awareness is required.