The Impact of Wrong Body Mechanics and Musculoskeletal Disorder among Nursing Staff of Hafr Albatin Hospital on the Quality of Patient Care

Background: Back pain is an international economic and social issue within healthcare. It is the main reason stated for sickness and absence and is a significant occupational health problem that has an influence in all areas of health care provision. Ergonomic and musculoskeletal problems are regarded as the leading occupational issue affecting the global healthcare workforce. Healthcare workers constantly rank amongst the main occupations with permanent back injuries which occur mainly from the handling of patients. Back pain studies in healthcare workers have shown a correlation between the symptoms of back pain and being in a poor posture Aim: This study aimed to assess the Wrong Body Mechanics and Musculoskeletal Disorder among Nursing Staff and relationship between back pain with nursing activities and the use of body mechanics among nurses working in hospitals. Design: a cross-sectional research design was utilized. Setting : Study was carried out in Hafr Albatin Saudi Arabia Hospitals. Subjects: A convenience sample of nurses (158) was recruited from above mentioned setting. Tools: Tool I: Demographic questionnaire and lifestyles patterns, Tool II : Back pain scale, body mechanics observation and Common nursing care activities questionnaire. Results: This study showed that 72.3 % of the studied nurses had back pain in intensive care unit ,emergency ,acute kidney unit and operation room , 100% of them had daily work hours 8and 9 and 66.7%


Introduction
Musculoskeletal disorders (MSDs) are common health problems among healthcare providers, particularly among nurses.Nursing staff recognized developing Musculoskeletal Disorder, and low back pain (LBP).Nursing daily care of patients especially with bedridden patients or non-autonomous cause a lot of Musculoskeletal Disorder or low back pain.The variation of the studies in Musculoskeletal disorders pain among nurses.Whereas, pain related to musculoskeletal disorders has been reported in different locations in female nurses more than in male nurses.The pain is not related to the number of years of experience, age, or body mass index.(Latina et al.2020).In Saudi Arabia according to the Ministry of Health in Saudi Arabia, the total number of Total Nurses and Midwives was 89,415 in 2021 who worked in different areas such as MOH, other governmental hospitals, and the private sector that serve 497 hospitals including 77,224 beds Ministry of Health, (2022).By 2030 the need for nurses will be more than doubled as predictable as the continuous population growth rate to cover the shortage of nurses in Saudi Arabia to recover from the coronavirus and to increase the quality of patient care (Alsufyani et al., 2020).The role of Musculoskeletal disorders among nurses leads to the onset of absenteeism and reduction in productivity decreasing the quality of care which has a bad influence on the business level of the hospitals (Sousa et al., 2023).Furthermore, (Lin et al.2020) found out that the nurse's years' experiences and experiences in the current unit were correlated with different Musculoskeletal pain.Spending time sitting using a computer among nurses can lead to prolonged improper work posture.(Attar S. M. ,2014) found that about 85% of nurses have musculoskeletal symptoms regarding extended working hours, especially when working in the surgical department increases low back pain.the study was also conducted on general ward nurses and intensive care units according to (Senthilkumar & Gokul, 2019) the musculoskeletal symptoms among nurses correlated with the sort of hospital and shift time.The patient-turning movement was a risky body movement among nurses who worked in the intensive care unit and general ward.According to (Du et al., 2021) many studies have a prevalence rate for musculoskeletal diseases among nurses and it was the main cause of sickness absenteeism which caused economic losses.Nurses' duty and overload in daily nursing performance lead to a significant correlation in musculoskeletal diseases among nurses.In other words, nurses reported that they have a higher rate in experiences of MSD symptoms in the upper body than lower back.The quality of care of patients can be affected by nurses' mental and physical health problems.Most countries have a great demand for nurses jobs regard of the population increase.Safety and a healthy environment are the main concern in Developed countries because it contributes to human resources productivity.The risk factor from an unsafety environment in nurses' work like long working hours and nursing shortage contributes to the increased development of musculoskeletal disorders.Female nurses have more development to musculoskeletal disorders than male nurses because they have family responsibilities and other housework.Similarly, all nurses' job demands impact patient safety in clinical practice (Krishnan et al., 2021) Research Aim: this study aims to assess the wrong body mechanics and musculoskeletal disorder among nursing staff and find out the relationship between back pain with nursing activities and the use of body

Research Design
The study used a cross-sectional questionnaire design to evaluate the effect of wrong body mechanics and musculoskeletal disorders among nursing staff.

Subject
Structured questionnaires were administered among the Ministry of Health hospital (Government) and privet hospitals in Hafr Albatin city Saudi Arabia.The population for the study was made up of all Saudi and non-Saudi staff nurses in Saudi Arabia hospital.The sample included male and female staff nurses with different qualifications and worked in 10 areas of assignments: in Intensive care unit, Emergency department, Acute Kidney Unit, Orthopedic department, Operation department, surgical department, Medical department, Delivery Room, Rehabilitation center and Psychiatric unit.We accepted all participants who had completed the questionnaire.

Inclusion criteria:
Adult nurses of both sex Working with patients in clinical areas (ICU, CCU, ER, Orthopedic department, Surgical, medical department,) Have experience 1 year or more

Exclusion criteria
Nurses working in administrative areas and not dealing with patients Sitting: The study was conducted in MOH, a private hospital in KSA

Data Collection
The researchers started data collection from January 2023 to the end of March 2023 after obtaining permission to apply for this study.The questionnaire was the main instrument for data collection Tools: Before the questionnaires were distributed to the nurses, ethical considerations were discussed, and the concepts of anonymity and voluntary participation were emphasized.The questionnaire was divided into two Sections:' Section A' was related to demographic characteristics related to nurses: It consisted of ( The majority of participants 83 % experienced work-related pain or discomfort in any part of their body that lasted for more than 3 days in the past 12 months.Less than half of the participants in the study suffered in the lower part of the body and another third suffered in both upper and lower parts together. Half of the study sample complained of injury type Muscle Strain.More than two-thirds of the sample of participants (110) described the onset of pain as gradual.More than half of the study sample's opinion about factors that contributed to your work-related injury was Performing repetitive tasks.More than half of the participants (83) gave their opinion about factors contributing to your work-related injury as performing repetitive tasks.Two-thirds of the study sample (111) officially reported the injury

Cont. Table 2 shows that according to the prevalence and types of musculoskeletal disorders experienced in nursing)
More than half of the participants (96) were see a physician for the injury.Third of the participants applied the kind of treatment as was rest.More than half of the sample have symptoms exacerbated by clinical practice and their injury caused them to alter their work habits.Two-thirds of participants have not ever had training in ways to alter their environment to reduce strain on their body (ergonomics).The sliding board was the lowest to reduce the strain on your body when working by sample options 2.5%.More than a third sample informed about the type of patient I usually treat requires maximum assistance (2 people to assist)

Table 3 reflects the distribution of the studied nurses according to pain
Almost all of the participants in the study have pain.Distribution of the studied nurses according to pain.More than two-thirds of participants have pain.Less than a third sample describe their pain intensity as comes and going and moderate.More than a third sample informed me that pain during a job by normal job activities increases my pain, but I can still perform all that is required of me.Less than a third sample describe the pain duration as the pain lasting from >6 months.More than two-thirds of participants expect changing shifts to have a negative effect as well.Most of the participants who have pain then describe the pain intensity as mild and not very much.More than half of the participants who have pain describe the pain duration as just starting      The present study revealed that there was a statistically significant relationship between apply principles of you have pain in wrong body mechanics and their weigh.These results are consistent with Agualongo et al., (2020) who reported that there was a significant association between apply principles of you have pain in wrong body mechanics with body weigh in the intensive care unit .In addition, Kang (2017) found that the majority of the sample was with 61-70 kg ' with age less than 40 years.The current study showed that there was a statistically significant relationship between pain intensity and their job title.These findings are consistent with Rayan, Adam, Abdrabou, (2021) they found that most of the nurses worked in standing positions for long durations, performed interventions that required bending Port Said Scientific Journal of Nursing Vol.9, No. 1, April 2022 135 .Forward, lifted and repositioned patients, and these nurses had higher average back pain scores.In addition, Rustoen (2018) reported that nurses frequently performed interventions that may have back pain, such as standing for long durations, performing interventions that require bending forward and lifting and repositioning patients, and although they knew the proper application in using aiding equipment; they did not reflect this knowledge in their interventions.
The present study revealed that nurses had no obesity.Many literatures proved that back pain is associated with obesity and overweight increases back strain.As the weight increases, it becomes a burden on the musculoskeletal system, which leads to back pain so this affects the nursing work.These results are consistent with Margadant (2020) who reported that nurses who are obese sustain the severest back injuries The current study showed that more of the studied nurses had back pain; this may be due to improper use of body mechanics, long working hours These results are inconsistent with Dewasi, khan, (2020) who revealed that there were no significant associations between total principles of body mechanics with a professional qualification.This result is consistent with Deng et al., (2019) who reported that no relationship between applied principle of body mechanics and back pain.In addition, Kochitty (2015) reported that most nurses experienced back pain, and working in shifts had higher average pain scores so there was a positive significant correlation between back pain prevalence and body mechanics practice among the studied nurses.According to, Shieh, et al.
(2016) reported that there was a significant correlation between the level of physical activity and back pain.These results are inconsistent with Cici, &Yilmazel, (2020) who studied the relationship between backache and body mechanics in nurses, which showed negative correlations between backache and use of the body mechanics principle.In addition to, Jambarsang, & Anoosheh, (2020) reported that bad postural habits were the major cause of backache.Because of stress felt by nurses, clinical practice can be reduced if body mechanics are used correctly, educating nurses about the content and application of the body mechanics method before clinical practice is necessary.Also, Aruja, Poopady, (2020) reported that no statistically significant relationship between intensity, frequency and duration of pain after using body mechanic principles Finally, Back pain is a serious health problem affecting nurses and they should give importance to their well-being.This will, in turn, ensure the best quality of care is delivered to patients.The findings of the current study alarming and point to a need for solutions and certain strategies should be adopted toward reducing the burdens and challenges of back pain such as nurses must ask for assistance when performing patient handling activities, scheduling adequate rest breaks, and doing relaxing and stretching exercises during work hours.Body mechanics is a term that indicates a coordinated effort of the musculoskeletal and nervous systems to maintain balance, posture, and body alignment in daily life, which is directly related to effective bodily functioning.Improper use of body mechanics increases the risk of musculoskeletal injury and back pain.Nurses need to use body mechanic techniques during performing every procedure.They can use body mechanics more effectively if they have well knowledge about it

Conclusion
Based on the findings of the current study, most of the studied nurses had back pain and the majority had reported lack of lifting equipment and insufficient training in the use of lifting equipment as the barriers to perform body mechanics.This study revealed that was a statistically significant correlation between methods to perform body mechanics, degree of back pain, and nursing activities of the studied nurses.

Recommendations
In the light of the results of the present study, the following recommendations are suggested: 1.A health training program about proper body mechanics is important to a healthy nursing career.
2. Developing a simplified and comprehensive booklet including guidelines about the use of body mechanics.3. Develop policies for safe patient's transfer and handling (no lift policy), and ensure the availability of ergonomic chairs and automatically adjustable patient beds to control occupational health hazards.

Table 5
shows the relation between Pain intensity if the pain and Demographic characteristics have 20.8% of participants aged 25 and under described the severity of pain as comes and goes and is very mild.33.30% of participants aged 26-30 and under described the severity of pain as Moderate and not very much.33.30% of participants aged 31-35 and under described the severity of pain as Comes and goes and is very severe.46.70 % of participants aged 36-40 and under described the severity of pain as Moderate and not very much.87.70 % of participants aged more than 40 and under described the severity of pain as Very severe and not very much.Most of the married participants described the intensity of pain as coming and going and being very mild.Two-thirds of the participants whose weight ranged from 61 g to 70 g described the intensity of the pain as Very severe and did not vary much.Most of the participants were female and then described the intensity of the pain as very intense and not much different and very severe and does not vary much.Two-thirds of technicians who participated in the study describe the pain intensity as very severe and does not vary much.All MOHs participating in the study describe the pain intensity as Moderate and does not vary much and Very severe and does not vary much.There was no particular difference between the departments associated with pain intensity.All participants who associated the intensity of pain with working 8 to 9 hours a day described it as Mild and does not vary much, Comes and goes, and moderate and Moderate and does not vary much.There was no clear distinction between the departments within the study for Pain Duration and Demographic

2 :
Chi square test MC: Monte Carlo *: Statistically significant at p ≤ 0.05 Discussion Nursing has one of the highest incidences of work-related back problems.The nurses performed many physical tasks in the job exposed them to back pain and complications.The incidence rates continue to climb and the direct and indirect costs associated with back injuries for nurses are estimated to be 20 billion annually (Ross, 2021).Over three-quarters of a million workdays are lost annually as a result of back injuries and related complications in nursing; with an estimated 40,000 nurses reporting illnesses from back pain each year (Alziyadi & Elgezery, 2021).Nursing activities require bending, standing for long hours, and care of dependent patients when activities associated with improper use of body mechanics were the main cause of back injury.The use of proper body mechanics is important to reduce the risk of injury to the musculoskeletal system and also to facilitate body movement allowing physical mobility without muscle strain and excessive use of muscles energy, In addition, proper body alignment enhances lung expansion and promotes efficient circulatory renal and gastrointestinal function (Soylar & Ozer, 2018).The present study illustrated that more than one-third of studied nurses were in age 36-40 years old, these results are consistent with Kang (2017) who reported that most of the nurses ranged from 30 to 40 years, it might be related to being still in the fitness and have tolerated physical job demand.In addition, Kochitty (2015) reported that back pain prevalence was reported between the ages of 35-45.In addition to, Shieh, et al. (2016) reported that back pain is increasing in nurses who are 40 years old or more related to hormonal change may be altered bone density.The present study revealed that there was statistically significant relation between apply principles of you have pain in wrong body mechanics and their age.These results are consistent with Iawim, & Dutta (2020) who reported that there were significant associations between apply principles of you have pain in wrong body mechanics and age.These results are consistent with Ibrahim & Elsaay (2015) who revealed that poor use of body mechanics are associated with the incidence of back pain among healthy ageing.Many studies pointed to the correlation between ageing and back pain (Ross, 2021).
. The study conducted by Fakhradin, Parnia & Fatemeh (2019) recommended that back pain at the time of the survey ranged from moderate to severe with symptoms of weakness, numbness, discomfort and having interrupted sleep.Nursing activities as lifting and transferring patients need physical efforts that cause injuries (Rawat et al., (2017).The current study showed that there was a statistically significant relation between body mechanics and their intensity of back pain.The study conducted by Olalla, Naranjo, López, Muñoz, & Bayas, (2020) found that most nurses have severe back pain which leads to disability.In addition to Sharma, Shrestha, Jensen, (2017) found that nurses who had not received any workshop about body mechanics remained standing for long periods, performed interventions that required bending forward, lifted and repositioned patients, and did not use any aiding equipment during interventions, experienced more pain and had higher average pain scores.The current study showed that there was no statistically significant relation between applied principles of body mechanics, pain duration and their department of current practice.These results are consistent with samawi & Awad, (2015) they found that nurses participated continuing training program on the proper use of body mechanics could help them to improve their safe practice skills and prevent back strain.According to, Sharma, Shrestha, & Jensen (2017) revealed that the importance of training and education level to prevent back pain so training about body mechanics and patient lifting must increase skills to prevent back pain.

Result Table 1 shows that According to Demographic characteristics of nursing working
11) items, which include gender, age, academic qualification, years of work experience, area of assignment, martial state, nationality, height, weight, type of hospital (government or privet), and daily work hours.(Choi et al 2020) Section B' Prevalence and type of musculoskeletal disorders experienced in nursing: a 21-item instrument was designed to measure the Prevalence of musculoskeletal disorders (13 items) and type

Table 4 shows the relation between you have pain and Demographic characteristics
One-third of the participants suffering from pain were aged 36 to 40 years, on the other hand, 15 of the 44 participants did not suffer from pain, and the participants were aged 36 to 40 years.Third of the participants who had pain (114) the age were (36-40) years old (29.8%).More than two-thirds of participants who have pain (114) were married (71.1%).Less than a third of participants who have pain (114) weight 51 kg -60 kg (25.4%).More than two-thirds of participants who had pain (114) were female gender (95.6%).Most of the participants who have pain (114) had a job title as a nursing technician or nursing specialist 40.4% for each title equal percentage.Most of the participants who have pain (114) worked at a Government hospital (MOH) (95.6%).Less than a third of participants who have pain (114) were a department of current practice in the surgical department (18.4%).Most of the participants (89.5%) who have pain (114) worked 8 hours & 9 hours

Table 6 Show the Relation between Pain Duration and Demographic characteristic
Nearly half of the sample of 21 participants chose Lasting from >1-3 months for Pain Duration and Demographic were age 31 -35 years old.The third sample of (40) participants who have pain Lasting from >6 months them age > 40 years old.Two-thirds of a sample of (44) participants who have pain Lasting from >6 months were Married.A third of the sample of (44) participants who have pain Lasting from >6 months weigh 51kg -60 kg.Most of the sample of (44) participants who had pain Lasting from >6 months were female gender.Less than half of the sample (19) of (44) participants have pain Lasting from >6 months of their job title, Nursing technician and Nursing specialist.Most of the sample (44) participants who had pain Lasting for>6 months were working in a government hospital (MOH).Less than a third of the sample (9) of (44) participants who have pain Lasting from >6 months were working in Emergency departments.Most of the sample of (44) participants have pain Lasting from >6 months of work duties 8 hours & 9 hour

Table ( 4): Relation between demographic characteristics and observation checklist about pain among studied nurses (n = 158)
2 : Chi-square test MC: Monte Carlo FE: Fisher Exact *: Statistically significant at p ≤ 0.05