A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE
REGARDING OCCURRENCE AND PREVENTION OF LOW BACK PAIN
AMONG III YEAR AND IV YEAR B.Sc. NURSING STUDENTS IN
SELECTED COLLEGE AT BANGALORE.
M.Sc. Nursing Dissertation Protocol submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
By
Mrs. ANITHA THOMAS
M.Sc NURSING 1ST YEAR
2009-2011
Under the Guidance of
HOD, Department of Medical Surgical Nursing
Anuradha College of Nursing
Gandhadakaval,
Hegganahalli Cross
Vishwaneedam Post
Magadi Road
Bangalore –91
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
CURRICULAM DEVELOPMENT CELL
CONFORMATION FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Registration number :
Name of the candidate : Mrs. Anitha Thomas
Address : Gandhadakaval, Hegganahalli Cross,
Vishwaneedam Post, Magadi Road, B,lore-91 .
Name of the institution : Anuradha College of Nursing
Course of study and subject : M.Sc Nursing in Medical Surgical Nursing.
.
Date of admission to course : 15-05-2009
Title of the topic : A study to assess the knowledge and attitude
regarding occurrence and prevention of low back
pain among III Year and IV Year B.Sc Nursing
Students in Selected College at Bangalore
Brief resume of the intended work : Attached
Signature of the student :
Guide Name :
.
Remarks of the guide :
Signature of the guide :
Co-guide name :
Signature of co-guide :
HOD name :
Signature of HOD :
Principal Name : Mrs. Radhika K.
Principal Mobile No : 9945621112
Remarks of the Principal :
Principal signature :
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 NAME OF THE CANDIDATE MRS.ANITHA THOMAS
AND ADDRESS I YEAR M.Sc. NURSING,
ANURADHA COLLEGE OF NURING
GANDHADAKAVAL,
HEGGANAHALLI CROSS
VISHWANEEDAM POST, MAGADI ROAD
BANGALORE-91
2 NAME OF THE INSTITUTION ANURADHA COLLEGE OF NURING
GANDHADAKAVAL
HEGGANAHALLI CROSS
VISHWANEEDAM POST, MAGADI ROAD
BANGALORE-91
3 COURSE OF STUDY AND M.SC NURSING
SUBJECT MEDICAL SURGICAL NURSING
4 DATE OF ADMISSION TO
THE COURSE 15-05-2009
5 TITLE OF THE TOPIC:
“A STUDY TO ASSESS THE KNOWLEDGE AND
ATTITUDE REGARDING OCCURENCE AND
PREVENTION OF LOW BACK PAIN AMONG III YEAR
AND IV YEAR B.SC NURSING STUDENTS IN SELECTED
COLLEGE AT BANGALORE.”
6 BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
Low Back pain (LBP) is one of the most common complaint of
people in most countries. It is estimated that 8 to 10 million people in the United
States experience back pain every year. The cervical (upper back ) vertebrae and
lumbo-sacral (lower back) vertebrae are most commonly affected. A majority of adults
(80% or more) experience at least one episode of low back pain(LBP) some time in
their lives. Low back pain causes 40% to 50% of all lost work days. The cost of low
back pain is at least 16 billion yearly in the United States.1
Back strain is an acute injury leading to low back pain. Back strain
occurs when the client flexes the back without bending the knees or makes rotating
movements creating significant stress on the inter-vertebral disk and muscles of the
lower back. Several risk factors are associated with low back pain , including lack of
muscle tone and excess weight, poor posture, smoking, stress and prolonged period of
sitting are also associated with low back pain.2
Most lower back pain is caused by one of many musculo skeletal
Problems including acute lumbo-sacral strain, unstable lumbo-sacral ligaments and
weak muscles, osteoarthritis of the spine, spinal stenosis, inter-vertebral disk problems
and unequal leg length.3
There has been agreement on a number of points, in particular that
nursing is among the high risk occupations with respect to low back problems, with a
point prevalence of approximately 17%, an annual (period) prevalence of 40-50% and
a lifetime prevalence of 35-80%. When considering the contributing factors there is
some divergence, but one of the popular notion is generally proven that more frequent
patient handling appears to correlate with increased of low back pain.4
Recurring back pain resulting from improper body mechanics or other
non-traumatic causes is often preventable. A combination of exercises that don’t jolt or
strain the back, maintaining correct posture and lifting objects properly can help
prevent injuries. The use of wide elastic belts that can be tightened to pull in lumbar
and abdominal muscles to prevent low back pain is controversial. The use of back
support belt worn by persons who lift or move merchandise found no evidence that the
belts reduce back injury or back pain.5
6.1 NEED FOR STUDY
Back Pain is such a common health condition that an estimated 8 out of
10 people experience it at least once during their life time. Pain felt in the low or upper
back. There are many causes of back pain. Pain in the low back can relate to the bony
lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal
cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen
and the skin covering the lumbar area.6
According to survey conducted during the year 2005-2009, the Worldwide
incidence of LBP among nurses was reported as 1 to 10 of about 1,840 and that in
India it was 1 to 10 of about 1,390. In the case of Karnataka it was reported to be 1 to
10 of about 54, while in Bangalore it constituted 1 to 10 of about 54,900, during the
same year. Where as the incidence of low back pain among nurses in Worldwide, the
year 2009 was reported as 1 to 10 of about 273,000 and it was 1 to 10 of about 349,000
in India. In Karnataka and Bangalore, it was reported as 1 to 10 of about 5,230 and 1 to
10 of about 57,400 respectively, during the same year.7
The study was conducted on “Majority of Health workers have Chronic
backache”, two researchers has brought to light the prevalence of lower backache as a
common occupational problem among nurses. More than 50 per cent of the health
workers were selected from government and private hospitals. In this study the results
were while 50 per cent of them were found to have minimal level of disability and 35
per cent had moderate level of lower backache. And the most of the nurses working in
the wards that include heavy workload like Intensive Care Unit (ICU) or casualty units
had a high prevalence and extent of lower backache and those having high Body Mass
Index(BMI) or those who are overweight have still higher level of low backache as it
leads to compression and narrowing of the disk.8
The study was conducted on “Study of low back pain in student
nurses”,199 student nurses were taken for this study. The results of this study were
37% reported back pain which lasted for at least 3 consecutive days. A combination of
personal characteristics are also coincided with back pain reports, within this group of
nurses. Recommendations of this study were: (1) the consideration of a modified
training programme for lifting and handling; and (2) the need for a standardized system
of recording back problems as suggested by the DHSS- commissioned Robens
Institute Report.9
The study was conducted on “Functional movement training for
recurrent low back pain.” 61 participants were taken for this study. The result showed
that, of the participants 67% provided data at 2 months and 44% provided information
at 12 months.The scores were evaluated at 2,6& 12 months. In particular, at 2 months
the CS-PFP (Continuous Scale Physical Functional Performance) changes scores
revealed a trend (P=.072) toward greater improvement in groups 2 and 3 compared
with group 1.CS-PFP scores also trended toward significance for group 2 and 3 (P=.7
and .9, respectively.) 10
Low Back Pain is one of the important problem in the nursing field.
Nurses are at high risk of developing low back pain. Nursing staff has shown the
connection between lifts and transfers of patient’s on one hand and low back problem
on the other. Even though good body mechanics and exercises can be done to prevent
low back pain, the incidence rate is seen high among nurses. So the investigator is very
much interested in doing the research in this topic.11
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. The typical purpose for
analyzing a review existing literature is to generate research question to identify what is
known and what is not known about the topic. The major goals of review of literature are
to develop a strong knowledge base to carry out research and non -research scholarly
activity.12
Review of literature from the study is been divided in to:
STUDIES RELATED TO CAUSES AND RISK FACTORS OF LOW BACK PAIN
A study was conducted on “A Study of the Back Pain beliefs of Female
Undergraduate Healthcare Students”. Three hundred and 82 female undergraduate nursing
and physiotherapy students were taken for this study .The results showed that, differences
were evident in the future consequence of low back pain between countries (P<0.001),
undergraduate course (P<0.001), and low back pain status(P=0.021).Healthcare provider
beliefs were found to be (P<0.001). Fear avoidance beliefs related to physical activity
were influenced by country (P=0.002) and undergraduate course (P<0.001). Nursing
students had more negative back pain beliefs than physiotherapy students (P<0.001) and
the experience of low back pain was associated with more positive beliefs on the future
consequence of back trouble (P0.021).13
The study was conducted on “Musculoskeletal disorders self-reported by
female nursing students in Central Japan”. Sample is 222 female nursing students.The
result showed that one third of nursing students (36.9%) reported Musculo Skeletal
Disorders ( MSD). Musculoskeletal disorders of the lower back was (13.5%). However,
previous hospital work was found to increase the risk of MSD by a factor of 4.4 (OR 4.4,
95% CI 1.3-13.3, P=0.0107).14
The study was conducted on “Occupational back pain in Iranian nurses”.
Sample is 1226. Results were , that prevalence of low back pain in nurses was over 50%.
Lifting was the most common mechanism for low back pain (30.4%). Prolonged standing
and rest were (57.6% and 59.2%) respectively.15
The study was conducted on “New low back pain in nurses: work activities,
work stress and sedentary lifestyle”.144 nurses were selected for this study. The result of
this study were, 38% nurses reported new low back pain. Sedentary leisure time activity
was not associated with new low back pain. Being comparatively new on a ward (adjusted
relative risk 2.90), working in bending postures (adjusted relative risk 2.76) and poor work
relationship with colleagues (adjusted relative risk 2.52) were independent predictors of
new low back pain.16
The study was conducted on “Patient – handling skill, back injuries, and
back pain. An intervention study in nursing”. Sample size is 255 nurses. Result of this
intervention study showed that the major risk indicators for back injuries were poor
patient-handling skill, low numbers of repetitions in the sit-up test, and high work-load
scores.17
The study was conducted on “Biopsychosocial factors are associated with low
back pain in female nursing students”. Participants were 170 female undergraduate
nursing students. Results were, over 30% of students reported significant low back pain.
Significant low back pain were physically active (P=0.04), had higher scores (P=0.01) and
used passive coping strategies (P<0.001).18
The study was conducted on “Factors predicting dropout in student nursing
assistants”. Sample is 790 subjects. The result of this study were, about 83% of women
had low back pain were other factors( a history of previous exposure to heavy physical
workload, etc.) associated with risk of dropout, OR (95% CI)=2.5(1.2-5.3).19
STUDIES RELATED TO OCCURRENCE AND PREVENTION OF LOW BACK
PAIN
The study was conducted on “Low back problems and possible
improvements in nursing jobs.” Participants were 47 nurses (23 orthopaedic and 24
intensive care nurses. In this study the results were, the life time incidence and point
prevalence of low back pain were 65% and 30%, respectively, in orthopaedic nurses.
Scoring scale was used to assess the pain. According to the Visual Analogue Scale, and
the Borg scores and force effort on the Visual Analogue Scale were moderately correlated
(r=0.53,P<0.01 for both comparisons.20
The study was conducted on “Determination of the usage of body mechanics in
clinical setting and the occurrence of low back pain in nurses”. Sample is 56 nurses who
work on the medical, surgical emergency, and intensive care units. The results of this
study were, the majority of the nurses (87.5%) experienced low back pain at some time in
their lives. 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 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%).51.1% of the nurses
lifted and 82% extended incorrectly.21
The study was conducted on “Exercise for the primary, secondary, and
tertiary prevention of low back pain in the workplace”. 15 were selected for analysis. The
results of this study was strong evidence that exercise was effective in reducing the
severity and activity interference from low back pain. Poor methodological studies
showed that only limited evidence supporting the use of exercise to prevent low back
pain. But high methodological quality of studies showed significant reductions in low
back pain intensity with exercise.22
The study was conducted on “Graded exercise for recurrent low back pain”.
Participants were 36 men and 35 women. The results showed that, of the participants 83%
provided date at the 12-month follow-up and 79% at 36 months. At 12-months, between
group comparison showed a reduction in perceived disability in favor of the exercise
group. Ratings of physical health and self-efficacy beliefs also improved in the exercise
group over the long term.23
6.3 STATEMENT OF THE PROBLEM
“A study to assess the knowledge and attitude regarding occurence and
prevention of Low Back Pain among III year and IV year B.Sc Nursing students in
selected colleges at Bangalore”.
6.4 OBJECTIVES OF THE STUDY
The objectives of the study are:
To assess the knowledge level regarding occurrence and prevention of low back
pain among III year and IV year B.Sc Nursing students.
To assess the attitude regarding occurrence and prevention of low back pain among
III year and IV year B.Sc . Nursing students.
To compare the knowledge and attitude regarding occurrence and prevention of low
back pain among III year and IV year B.Sc Nursing students.
To find the association between the knowledge regarding occurrence and prevention
of low back pain with selected demographic variables (age, sex, education, parent’s
education, place of residence, occupation of the father).
To find the association between the attitude regarding occurrence and prevention of
low back pain with selected demographic variables ( age, sex, education, parent’s
education, place of residence, occupation of the father). .
6.5 HYPOTHESIS
The hypothesis will be tested at 0.05 level of significance.
H1: There will be significant association between the knowledge and attitude
regarding occurrence and prevention of low back pain among III year and IV year
B.Sc. Nursing students.
H2: There will be significant association between the knowledge regarding
occurrence and prevention of low back pain with selected demographic variables
(age, sex, education, parent’s education, place of residence, occupation of the father).
H3: There will be significant association between attitude regarding occurrence and
prevention of low back pain with selected demographic variables (age, sex,
education, parent’s education, place of residence, occupation of father).
OPERATIONAL DEFINITIONS
6.6
KNOWLEDGE
“Knowledge is the information or the awareness gained through the experience or
education”
ATTITUDE
“An attitude is any belief or opinion that includes an evaluation of some object,
person or event along a continuum from negative to positive”.
BACK PAIN
“Backache is any pain in the back, usually in the lower part. Causes are often
physical, including mechanical issues (usually related to disc problems), injuries
(from a fall, heavy lifting or accident), certain medical conditions or diseases (such
as scoliosis), infections and tumors.”
OCCURENCE
“In this study, it refers to the incident or happening of Low Back Pain.”
PREVENTION
“In this study, it refers to stop or reduce low back pain and good body mechanics
should be maintained to prevent low back pain.”
B.Sc NURSING STUDENTS
“In this study, it refers to the students who are studying III year and IV year Nursing
programme in selected college, Bangalore”.
ASSUMPTIONS
Student nurses will have knowledge regarding occurrence and prevention of low
6.7
back pain.
Student nurses will have positive attitude regarding occurrence and prevention of
low back pain.
Student nurses will take the preventive measures (good body mechanics and
exercises) in the aspect of low back pain prevention.
DELIMITATIONS
The study is delimited to:
6.8
Study is limited to 100 samples.
Study is limited to only III year and IV year B.Sc Nursing students who are
studying in K.T.G College of Nursing, Bangalore.
Study is limited to only student nurses who are willing to participate in this
study.
The study is limited for 4 weeks.
PROJECTED OUTCOME
The present study will help the B.Sc Nursing students who understand about low
6.9
back pain and hence to decrease the occurrence of low back pain.
MATERIALS AND METHODS
7.0 SOURCE OF DATA
7.1 RESEARCH DESIGN
Descriptive design will be used for this study.
7.1.1
RESEARCH APPROACH
Survey approach will be used for this study.
SETTING
The selected setting is K.T.G College of Nursing, Bangalore. It is 2km away
7.1.2
from the college.
POPULATION
Comprises of students who are studying III year and IV year B.Sc Nursing.
7.1.3
METHOD OF COLLECTION OF DATA
Interview will be conducted between 9am to 2pm. Data will be collected
7.2
from 5 samples per day. The duration of the study will be 4 weeks. The
duration of 30 minute will be spent per each subject.
SAMPLING PROCEDURE
Convenient sampling will be used for this study.
7.2.1
SAMPLE SIZE:
The sample size is 100.
7.2.2
INCLUSION CRITERIA FOR SAMPLING
The criteria for the sample selections are:
7.2.3 Third year and fourth year B.Sc Nursing students who are willing to
participate in this study.
Third year and fourth year B.Sc Nursing students who are available during
data collection.
EXCLUSION CRITERIA FOR SAMPLING
Those who are sick.
7.2.4 Nursing students who are studying I year and II year.
INSTRUMENT INTENDED TO BE USED
SELECTION OF TOOL
7.2.5 This consists of 3 parts,
PART-I :- Consists of demographic variables such as age, sex, education, parent’s
education, place of residence, occupation of the father.
PART-II:- Questionnaire will be used to assess the knowledge. 25 questions will be
used.
PART-III:- Questionnaire will be used to assess the attitude. 20 questions will be
used.
SCORING PROCEDURE
For Answers, If answer is YES - 1
If answer is NO - 0
DATA COLLECTION METHOD:
Prior permission will be obtained by the significant authorities and from
7.2.6 the subjects. The investigator will use questionnaires to assess the knowledge and attitude
regarding LBP among III year and IV year B.Sc Nursing students. Interview will be
conducted between 9am to 2pm. Data will be collected from 5 samples per day. The
duration of the study will be 4 weeks. /the duration of 30 minutes will be spent per each
subject.
PILOT STUDY
Six samples will be selected and study will be conducted to find out the
7.2.7 feasibility.
DATA ANALYSIS PLAN
Descriptive statistics such as mean deviation will be used for assessing the
7.2.8 knowledge and attitude. Inferential statistics such as chi-square and t test will be used to
compare within demographical variables.
DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO
BE CONDUCTED ON PATIENT’S OR OTHER HUMANS OR ANIMALS?
7.3 --YES--
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN
CASE OF 7.3?
YES, ethical clearance will be obtained from the Research Committee of
7.4
ANURADHA College of Nursing and Permission was obtained from Principal of K.T.G
College of nursing, Bangalore, to conduct the study.
Consent will be taken from III year and IV year B.Sc Nursing students who
are willing to participate in this study.
LIST OF REFERENCES:
1.Brunner and Suddarth’s. “Text Book of Medical-Surgical Nursing”. 11th ed. NewYork:
8.0 Lippincott; 2008. P no. 2392.
2. Black Joyce M. “Medical-Surgical Nursing”. 7th ed. St.Louis: Saunders Elsevier
Publications; 2005. P no. 2140.
3. Donna D Ignatavicius. “Medical-Surgical Nursing”. 2nd ed. Philadelphia: Saunders
Company; 1995. P no. 1170
4. Hignett S. “Work-related back pain in Nurses”. 1996 Jun; 23(6): 1238-46.
5. Kondo A, Misawa T. “Low back pain: Tips on pain relief and prevention”. 1979 Mar;
23(2): 164-70.
6. Van Nieuwenhuyse, et al. “A prospective study about Back Pain”. 2009 Nov.
7. Sharma SC, Mittal R. “Incidence of low back pain among Nurses”. 2009 Nov.
8. Sameer Kumar Sharma. “Majority of health workers have chronic backache”. 2009 Feb.
9. Klaber Moffett JA, Hughes, et al. “A longitudinal study of low back pain in student
Nurses”. 1993 Jun; 30(3): 197-212.
10. Schenkman ML, Roman M, et al. “Functional movement training for recurrent low back
pain”. 2009 Feb; 1(2): 137-46.
11. Lagerstrom M, Hansson T. “Work related low back problems in Nursing”. 1998 Dec;
24(6): 449-64.
12. Basavanthappa BT. “Nursing Research”. 2nd ed. New Delhi: Jaypee Brothers. P no.
155,177.
13. Burnett A, Tam SM, et al. “A study of the Back Pain Beliefs of Female Undergraduate
Healthcare Students”. 2009 Jan; 25(1): 20-8.
14. Smith DR, Mizutani T. “Musculoskeletal disorders self-reported by female nursing
students in Central Japan”. 2003 Sep; 40(7): 725-9.
15. Mohseni-Bandepel MA, Fakhri M, et al. “Occupational back pain in Iranian Nurses”.
2006 Sep 28-Oct 11; 15(17): 914-7.
16. Yip VY. “New low back pain in nurses: work activities, work stress and sedentary
lifestyle”. 2004 May; 46(4): 430-40.
17. Videman T, Rauhala H, et al. “Patient – handling skill, back injuries, and back pain. An
intervention study in nursing”. 1989 Feb; 14(2): 148-56.
18. Mitchell T, Smith A, et al. “Biopsychosocial factors are associated with low back pain in
female nursing students”. 2009 May; 46(5): 678-88.
19. Svensson AL, Mortensen OS. “Factors predicting dropout in student nursing assistants”.
2008 Dec; 58(8): 527-33.
20. Vieira ER, Kumar S, Narayan Y. “Low back problems and possible improvements in
nursing jobs”. 2006 Jul; 55(1): 79-89.
21. Karahan A, Bayraktar N. “Determination of the usage of body mechanics in clinical
setting and the occurrence of low back pain in nurses”. 2004 Jan; 41(1): 67-75.
22. Bell JA, Burnett A. “Exercise for the primary, secondary and tertiary prevention of low
back pain in the workplace”. 2009 Mar; 19(1): 8-24.
23.Aust J Physiother. “Graded exercise for recurrent low back pain”. 2009 Feb; 34(3):221-8.
9. NAME & SIGNATURE OF THE Anitha Thomas
CANDIDATE
10. REMARKS OF THE GUIDE The study is suitable & feasible
11. NAME AND DESIGNATION OF
11.1 GUIDE R. Prasanna Kumari
11.2 SIGNATURE
11.3CO-GUIDE
11.4SIGNATURE
11.5 HEAD OF DEPARTMENT R. Prasanna Kumari
11.6 SIGNATURE
12 12.1 REMARKS OF THE PRINCIPAL The study is suitable & feasible
12.2 NAME & SIGNATURE OF THE Radhika .K
PRINCIPAL
