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Noei M, Shafi Mojadadi M, Mirhamidi S M, Fallahi M. Survey the relationship between working hours with workload and incidence of musculoskeletal disorders among the personnel of a Hospital in 2023. ioh 2025; 22 (1) : 8
URL: http://ioh.iums.ac.ir/article-1-3612-en.html
URL: http://ioh.iums.ac.ir/article-1-3612-en.html
Sabzevar university of medical sciences , mjfllh@yahoo.com
Abstract: (1460 Views)
Abstract
Background and aims: Musculoskeletal disorders are often deteriorated by factors such as prolonged working hours, excessive physical workload, mental workload and poor ergonomic designs. The aim of the study was to Survey the relationship between working hours with workload and musculoskeletal disorders among the personnel of a Hospital in 2023.
Methods
The current study is a descriptive-analytical cross-sectional study. The sample size under investigation was 90 health care workers working in a Hospital. Cornell questionnaire was used to determine the prevalence of musculoskeletal disorders, mental workload was determined by NASA-TLX and Borg scale was used to determine physical workload. The gathered data were analyzed using SPSS.22 software.
Results: In this study, average working hours per week was related to services with 54.14 working hours, followed by nurses with 49.09 working hours. The highest prevalence of musculoskeletal disorders was reported in the low back (66.7%), neck (55.6%), back (52.2%), right knee (35.6%) and right ankle (33.3%), respectively. A significant relationship was observed between physical demand dimension and Borg scale with working hours (P=0.000). There was a significant relationship between the dimension of physical demand and musculoskeletal disorders of the lower limbs (legs and feet). There was a significant relationship between working hours and musculoskeletal disorders (hip, thigh, knee, leg, and foot.
Conclusion: There exists a notable correlation between the duration of employment and the physical exertion required, as well as the incidence of MSDS affecting the lower extremities. Given that the mean tenure of the employees is 8.5 years, it is advisable for hospital administrators to contemplate the implementation of ergonomic training initiatives, the alteration of workstations, the introduction of job rotation, and the modification of work shift arrangements to mitigate the prevalence of these disorders.
Keywords: Incidence; Work load; Musculoskeletal Disorders
EXTENDED ABSTRACT
INTRODUCTION: Engaging in health care activities is among the most demanding professions, necessitating the execution of intricate and meticulous tasks often under suboptimal working conditions and prolonged periods of standing. The personnel involved in hospital health care encompasses a diverse range of roles, including general practitioners, nurses, technicians, pharmacists, security personnel, transport operatives, custodial staff, administrative clerks, laundry attendants, and nutrition department employees, each performing distinct duties and responsibilities at varying intervals. Furthermore, medical professionals and nursing staff across various departments encounter significant time constraints, urgency, and rigid working conditions. They are also vulnerable to the potential risks of violence from patients, thereby compounding their levels of stress. The duration of working hours has been recognized as a contributing factor to the incidence of musculoskeletal disorders (MSDs) within the nursing workforce. A particular study identified a correlation between extended working hours and an increase in reported cases of MSDs, thereby substantiating the assertion that working hours serve as an independent risk factor for the onset of MSDs among nursing professionals. In a broader context, a notable correlation exists between working hours and the emergence of MSDs, particularly concerning back pain, although the correlation between working hours and neck and shoulder pain appears to be less extensively documented. The pathways that connect prolonged working hours to MSDs include sustained exposure to elevated physical and psychosocial workloads, which in turn engender greater physical and psychosocial demands, alongside limited opportunities for sleep and recuperation, resulting in an escalation of fatigue and the necessity for rest. Irregular shift patterns combined with extended working hours may exacerbate the likelihood of MSDs by amplifying the workload experienced by health care professionals. This research was undertaken with the objective of surveying the relationship between working hours, workload, and musculoskeletal disorders among hospital personnel in the year 2023.
METHODOLOGY: The current study is a descriptive-analytical cross-sectional study. The sample size was 90 health care workers working in a Hospital. According to the ratio of the personnel of each job to the total working population (535 people), the number of nurses 45, service 23, operating room 3, intelligence 3, administrative 7, specialist 7 and general practitioner 2 were randomly selected. Based on their job, each person was assigned a natural number and selected by simple random selection. The calculation of the sample size was conducted utilizing the following formula:
In this regard, nsrs is the number of sample sizes calculated from simple random sampling
Z: Normal distribution value associated with 95% confidence interval=1.96
λ: is the relative difference in the proportion of musculoskeletal disorders, which was considered to be 20%.
d= λ*p=0.2*0.507=0.1014
P: 0.0507, 7.50% of healthcare personnel who reported pain in at least one body part in the past 12 months.
N=535 Total hospital personnel
According to the relationship, the sample size in this study was calculated:
and nf is the number of sample size after adjustment with the study population
Upon conducting a sample size calculation, a total of 80 participants was initially determined; however, this figure was augmented by 10% to account for potential attrition, culminating in a final sample size of 90 participants. The eligibility criteria for participation in the study encompassed: individuals employed within the hospital setting who deliver direct services to patients. Additionally, participants were required to possess a minimum of one year of professional experience within hospital departments and to voluntarily and knowingly consent to partake in the research study. The Cornell questionnaire was employed to ascertain the prevalence of musculoskeletal disorders, while the NASA-TLX was utilized to evaluate mental workload and the Borg scale was implemented to measure physical workload. This questionnaire serves as a tool for the subjective evaluation of physical workload or perceived exertion, which is extensively recognized for assessing physical activity levels. The Borg CR10 scale is a numerical rating scale that ranges from 0 (not at all) to 10 (extremely), incorporating several verbal anchors to enhance its usability for participants. Following prior coordination, on the designated date, time, and location, the questionnaires were distributed to staff across various departments, and after a duration of 48 hours, the completed questionnaires were retrieved from each department, with the amassed data subsequently analyzed using SPSS version 22 software.
RESULTS: In this study, the average age and body mass index of the employees were 33.30 years and 24.21 kg/m2, respectively. 70% of the employees were women. 36.6% of the employees were doing sports and 90% were shift workers.70% of the employees were sitting-standing. The highest prevalence of musculoskeletal disorders was reported in the low back (66.7%), neck (55.6%), back (52.2%), right knee (35.6%) and right ankle (33.3%), respectively. The most working hours were in the cardiac and neonatal departments, respectively. The highest average working hours per week was related to services with 54.14 working hours, followed by nurses with 49.09 working hours. The relationship between six dimensions of NASA-TLX was investigated using Pearson's correlation test. The results showed that there is a significant inverse relationship between mental and physical demands (P=0.02). Also, there was an inverse significant relationship between total weighted workload and mental demand (p=0.008). A significant positive relationship was also observed between the total weighted workload and the performance and the effort dimensions (P=0.001). There was a significant relationship between physical demand with Borg scale and working hours (P=0.001). A significant relationship was observed between physical demand and Borg scale with working hours (P=0.000). Also, there was a significant relationship between the dimension of physical demand and musculoskeletal disorders of the lower limbs such as legs and feet (P<0.05). There was a significant relationship between working hours and musculoskeletal disorders of hip, thigh, knee, leg, and foot (P<0.05).
DISCUSSION: It appears that irregular shift work patterns and prolonged working hours may elevate the susceptibility to MSDs by exacerbating the workload experienced by healthcare professionals. This research was undertaken with the objective of surveying the relationship between working hours, workload, and the incidence of MSDs. The most significant prevalence of MSDs was observed in the lumbar region, cervical area, and dorsal region, respectively. The mean weekly working hours were reported for service staff at 54.14 hours, followed by nurses at 49.09 hours. The results of a comprehensive review indicated that MSDs constitute the principal causes of absenteeism and protracted disability, with nurses being among the most susceptible cohorts. Although extended workweek hours may augment the likelihood of such disorders, the influence of particular shift scheduling characteristics within the healthcare environment appears to be minimal. Beyond prolonged working hours, nocturnal shift work was identified as an additional risk factor for MSDs. Several studies have indicated that workload and personal variables serve as moderating factors in this context. A noteworthy association was established between extended weekly work hours and shift work, correlating with an elevated risk of MSDs within the healthcare industry. Furthermore, sleep disturbances and individual characteristics such as elevated Body Mass Index (BMI) were linked to work schedules, thereby increasing the likelihood of disorder development. Given the high prevalence of MSDs within the nursing profession and the anticipated rise in demand for nurses and healthcare practitioners due to demographic changes in various nations, the prevention of MSDs is deemed crucial. Preventive strategies should focus on mitigating both the physical and psychosocial demands of work while enhancing work scheduling. Reducing the total working hours, minimizing night shifts, or decreasing shift work may effectively lower the risk of these disorders. A statistically significant positive correlation was identified between working hours and MSDs affecting the hip, thigh, knee, leg, right leg, and left leg, underscoring that the nature of shift work, adverse working conditions, and extensive weekly working hours are risk factors for MSDs. A considerable prevalence of MSDs was noted among individuals tasked with patient transportation.
CONCLUSION: In the present investigation, a noteworthy correlation was identified between the duration of working hours and the aspect of physical demand, as well as between working hours and the Borg scale. However, no discernible correlation was established between the dimension of mental demand and working hours. Furthermore, a significant association was noted between working hours and the physical demand dimension concerning work-related musculoskeletal disorders (WRMSDs) affecting the lower extremities. Conversely, no significant relationship was found between working hours and workload with respect to WRMSDs in the lumbar region, cervical region, and thoracic area, suggesting that risk factors such as high physical exertion and repetitive motions, which were not addressed in this investigation, may play a role in the prevalence of disorders in these three anatomical regions. Ultimately, based on the outcomes of this study, it is recommended that ergonomic interventions, including the establishment of training programs focused on safe patient handling, identification of risk factors for musculoskeletal disorders, redesign of workstations, provision of lifting apparatus, optimization of job organization, implementation of work-rest cycles, and facilitation of job rotation, be undertaken to enhance the working conditions of service staff and nursing personnel within this healthcare institution. Additionally, it is proposed that if feasible, an increase in the number of service staff and nurses in departments characterized by elevated workloads should be prioritized by management.
ACKNOWLEDMENT
CONFLICT OF INTEREST
"The authors declare that there are no conflicts of interest regarding the publication of this manuscript"
Background and aims: Musculoskeletal disorders are often deteriorated by factors such as prolonged working hours, excessive physical workload, mental workload and poor ergonomic designs. The aim of the study was to Survey the relationship between working hours with workload and musculoskeletal disorders among the personnel of a Hospital in 2023.
Methods
The current study is a descriptive-analytical cross-sectional study. The sample size under investigation was 90 health care workers working in a Hospital. Cornell questionnaire was used to determine the prevalence of musculoskeletal disorders, mental workload was determined by NASA-TLX and Borg scale was used to determine physical workload. The gathered data were analyzed using SPSS.22 software.
Results: In this study, average working hours per week was related to services with 54.14 working hours, followed by nurses with 49.09 working hours. The highest prevalence of musculoskeletal disorders was reported in the low back (66.7%), neck (55.6%), back (52.2%), right knee (35.6%) and right ankle (33.3%), respectively. A significant relationship was observed between physical demand dimension and Borg scale with working hours (P=0.000). There was a significant relationship between the dimension of physical demand and musculoskeletal disorders of the lower limbs (legs and feet). There was a significant relationship between working hours and musculoskeletal disorders (hip, thigh, knee, leg, and foot.
Conclusion: There exists a notable correlation between the duration of employment and the physical exertion required, as well as the incidence of MSDS affecting the lower extremities. Given that the mean tenure of the employees is 8.5 years, it is advisable for hospital administrators to contemplate the implementation of ergonomic training initiatives, the alteration of workstations, the introduction of job rotation, and the modification of work shift arrangements to mitigate the prevalence of these disorders.
Keywords: Incidence; Work load; Musculoskeletal Disorders
EXTENDED ABSTRACT
INTRODUCTION: Engaging in health care activities is among the most demanding professions, necessitating the execution of intricate and meticulous tasks often under suboptimal working conditions and prolonged periods of standing. The personnel involved in hospital health care encompasses a diverse range of roles, including general practitioners, nurses, technicians, pharmacists, security personnel, transport operatives, custodial staff, administrative clerks, laundry attendants, and nutrition department employees, each performing distinct duties and responsibilities at varying intervals. Furthermore, medical professionals and nursing staff across various departments encounter significant time constraints, urgency, and rigid working conditions. They are also vulnerable to the potential risks of violence from patients, thereby compounding their levels of stress. The duration of working hours has been recognized as a contributing factor to the incidence of musculoskeletal disorders (MSDs) within the nursing workforce. A particular study identified a correlation between extended working hours and an increase in reported cases of MSDs, thereby substantiating the assertion that working hours serve as an independent risk factor for the onset of MSDs among nursing professionals. In a broader context, a notable correlation exists between working hours and the emergence of MSDs, particularly concerning back pain, although the correlation between working hours and neck and shoulder pain appears to be less extensively documented. The pathways that connect prolonged working hours to MSDs include sustained exposure to elevated physical and psychosocial workloads, which in turn engender greater physical and psychosocial demands, alongside limited opportunities for sleep and recuperation, resulting in an escalation of fatigue and the necessity for rest. Irregular shift patterns combined with extended working hours may exacerbate the likelihood of MSDs by amplifying the workload experienced by health care professionals. This research was undertaken with the objective of surveying the relationship between working hours, workload, and musculoskeletal disorders among hospital personnel in the year 2023.
METHODOLOGY: The current study is a descriptive-analytical cross-sectional study. The sample size was 90 health care workers working in a Hospital. According to the ratio of the personnel of each job to the total working population (535 people), the number of nurses 45, service 23, operating room 3, intelligence 3, administrative 7, specialist 7 and general practitioner 2 were randomly selected. Based on their job, each person was assigned a natural number and selected by simple random selection. The calculation of the sample size was conducted utilizing the following formula:
In this regard, nsrs is the number of sample sizes calculated from simple random sampling
Z: Normal distribution value associated with 95% confidence interval=1.96
λ: is the relative difference in the proportion of musculoskeletal disorders, which was considered to be 20%.
d= λ*p=0.2*0.507=0.1014
P: 0.0507, 7.50% of healthcare personnel who reported pain in at least one body part in the past 12 months.
N=535 Total hospital personnel
According to the relationship, the sample size in this study was calculated:
and nf is the number of sample size after adjustment with the study population
Upon conducting a sample size calculation, a total of 80 participants was initially determined; however, this figure was augmented by 10% to account for potential attrition, culminating in a final sample size of 90 participants. The eligibility criteria for participation in the study encompassed: individuals employed within the hospital setting who deliver direct services to patients. Additionally, participants were required to possess a minimum of one year of professional experience within hospital departments and to voluntarily and knowingly consent to partake in the research study. The Cornell questionnaire was employed to ascertain the prevalence of musculoskeletal disorders, while the NASA-TLX was utilized to evaluate mental workload and the Borg scale was implemented to measure physical workload. This questionnaire serves as a tool for the subjective evaluation of physical workload or perceived exertion, which is extensively recognized for assessing physical activity levels. The Borg CR10 scale is a numerical rating scale that ranges from 0 (not at all) to 10 (extremely), incorporating several verbal anchors to enhance its usability for participants. Following prior coordination, on the designated date, time, and location, the questionnaires were distributed to staff across various departments, and after a duration of 48 hours, the completed questionnaires were retrieved from each department, with the amassed data subsequently analyzed using SPSS version 22 software.
RESULTS: In this study, the average age and body mass index of the employees were 33.30 years and 24.21 kg/m2, respectively. 70% of the employees were women. 36.6% of the employees were doing sports and 90% were shift workers.70% of the employees were sitting-standing. The highest prevalence of musculoskeletal disorders was reported in the low back (66.7%), neck (55.6%), back (52.2%), right knee (35.6%) and right ankle (33.3%), respectively. The most working hours were in the cardiac and neonatal departments, respectively. The highest average working hours per week was related to services with 54.14 working hours, followed by nurses with 49.09 working hours. The relationship between six dimensions of NASA-TLX was investigated using Pearson's correlation test. The results showed that there is a significant inverse relationship between mental and physical demands (P=0.02). Also, there was an inverse significant relationship between total weighted workload and mental demand (p=0.008). A significant positive relationship was also observed between the total weighted workload and the performance and the effort dimensions (P=0.001). There was a significant relationship between physical demand with Borg scale and working hours (P=0.001). A significant relationship was observed between physical demand and Borg scale with working hours (P=0.000). Also, there was a significant relationship between the dimension of physical demand and musculoskeletal disorders of the lower limbs such as legs and feet (P<0.05). There was a significant relationship between working hours and musculoskeletal disorders of hip, thigh, knee, leg, and foot (P<0.05).
DISCUSSION: It appears that irregular shift work patterns and prolonged working hours may elevate the susceptibility to MSDs by exacerbating the workload experienced by healthcare professionals. This research was undertaken with the objective of surveying the relationship between working hours, workload, and the incidence of MSDs. The most significant prevalence of MSDs was observed in the lumbar region, cervical area, and dorsal region, respectively. The mean weekly working hours were reported for service staff at 54.14 hours, followed by nurses at 49.09 hours. The results of a comprehensive review indicated that MSDs constitute the principal causes of absenteeism and protracted disability, with nurses being among the most susceptible cohorts. Although extended workweek hours may augment the likelihood of such disorders, the influence of particular shift scheduling characteristics within the healthcare environment appears to be minimal. Beyond prolonged working hours, nocturnal shift work was identified as an additional risk factor for MSDs. Several studies have indicated that workload and personal variables serve as moderating factors in this context. A noteworthy association was established between extended weekly work hours and shift work, correlating with an elevated risk of MSDs within the healthcare industry. Furthermore, sleep disturbances and individual characteristics such as elevated Body Mass Index (BMI) were linked to work schedules, thereby increasing the likelihood of disorder development. Given the high prevalence of MSDs within the nursing profession and the anticipated rise in demand for nurses and healthcare practitioners due to demographic changes in various nations, the prevention of MSDs is deemed crucial. Preventive strategies should focus on mitigating both the physical and psychosocial demands of work while enhancing work scheduling. Reducing the total working hours, minimizing night shifts, or decreasing shift work may effectively lower the risk of these disorders. A statistically significant positive correlation was identified between working hours and MSDs affecting the hip, thigh, knee, leg, right leg, and left leg, underscoring that the nature of shift work, adverse working conditions, and extensive weekly working hours are risk factors for MSDs. A considerable prevalence of MSDs was noted among individuals tasked with patient transportation.
CONCLUSION: In the present investigation, a noteworthy correlation was identified between the duration of working hours and the aspect of physical demand, as well as between working hours and the Borg scale. However, no discernible correlation was established between the dimension of mental demand and working hours. Furthermore, a significant association was noted between working hours and the physical demand dimension concerning work-related musculoskeletal disorders (WRMSDs) affecting the lower extremities. Conversely, no significant relationship was found between working hours and workload with respect to WRMSDs in the lumbar region, cervical region, and thoracic area, suggesting that risk factors such as high physical exertion and repetitive motions, which were not addressed in this investigation, may play a role in the prevalence of disorders in these three anatomical regions. Ultimately, based on the outcomes of this study, it is recommended that ergonomic interventions, including the establishment of training programs focused on safe patient handling, identification of risk factors for musculoskeletal disorders, redesign of workstations, provision of lifting apparatus, optimization of job organization, implementation of work-rest cycles, and facilitation of job rotation, be undertaken to enhance the working conditions of service staff and nursing personnel within this healthcare institution. Additionally, it is proposed that if feasible, an increase in the number of service staff and nurses in departments characterized by elevated workloads should be prioritized by management.
ACKNOWLEDMENT
CONFLICT OF INTEREST
"The authors declare that there are no conflicts of interest regarding the publication of this manuscript"
Article number: 8
Type of Study: Research |
Subject:
Ergonomics
Received: 2024/04/29 | Accepted: 2025/04/17 | Published: 2025/03/30
Received: 2024/04/29 | Accepted: 2025/04/17 | Published: 2025/03/30
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