Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s13

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address ROOPA RASHMI D’SOUZA (in block letters) I YEAR M. Sc. NURSING ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE – 575 001.

2. Name of the Institution ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE – 575 001.

3. Course of Study, M. Sc. NURSING Subject MEDICAL SURGICAL NURSING

4. Date of Admission to the course 20.05.2011

5. Title of the Topic

A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO-ASSISTED TEACHING PROGRAMME ON KNOWLEDGE REGARDING BODY MECHANICS AMONG II YEAR GNM STUDENTS IN A SELECTED SCHOOL OF NURSING AT MANGALORE

6. Brief Resume of Intended Study

1 Introduction

“Technically, the biggest ‘safety system’ in healthcare is the minds and hearts of the workers who keep intercepting the flaws in the system and prevent patients from being hurt. They are the safety net, not the cause of injury.”

– Don Berwick

Body mechanics is the coordinated efforts of the musculoskeletal and nervous systems to maintain proper balance, posture, and body alignment during lifting, bending, moving, and performing activities of daily living. Proper body mechanics reduces the risk of injury to the musculoskeletal system. Body mechanics also facilitates body movement so that a person is able to carry out a physical activity without using excessive muscle energy.1

Skills needed to care for clients often require physical strength to provide individuals with assistance required to remain mobile. Nurses/caregivers may need to carry, pull, push or lift clients and equipment to accomplish daily care. It is imperative to know and use proper lifting techniques and seek assistance as needed to avoid injury to self and others.2

It is crucial for nursing students early in their education to be aware of correct body mechanics. Clinical nursing requires a strong theoretical knowledge base, coordinated psychomotor skills, and physical endurance. Nurses assist clients to turn, walk, and increase their activity. On occasions a nurse is faced with a client who is physically unable to move and must be positioned and transferred by the nurse. The best self-protection for the nurse while administering care is to consistently and habitually incorporate the principles of sound body mechanics into practice, thus reducing the risk of musculoskeletal injury.1

Body mechanics is concerned with three areas: body alignment, body balance, and coordinated body movement.

2 6.1 Need for the Study

Body mechanics is the application of mechanical principles and knowledge of human anatomy to the action of body parts during activity. The need for study of body mechanics usually involves learning appropriate ways to move the body in order to accomplish tasks without stress or injury. Correct body mechanics helps protect joints and muscles from being pushed beyond their capacities while allowing them to be used for maximum effectiveness.3

Nurses often need to teach clients the use of proper body mechanics for safe walking and movement. First, however the nurse needs to understand and practice proper body mechanics. People (clients and nurses alike) differ in weight, size, and ability to move. The nurse’s physical strength is not as important as how efficiently he or she uses the body. Ultimately, efficient use of one’s body will determine how effectively and safely the nurse is able to move clients. Therefore, it is important to provide safety for both nurse and client.4

Good mechanics is the efficient, coordinate, and safe use of the body to produce motion and maintain balance during activity. Proper movement provides proper body functioning of musculoskeletal structures reducing the energy required to move and maintain balance and therefore reducing fatigue.5

A cross-sectional study was conducted in Turkish University on low back pain prevalence and associated risk factors among hospital staff from December 2005 to August 2006. Chi-square test and multivariate logistic regression technique were used and it was found that most respondents (65.8%) had experienced low back pain. The highest prevalence was reported by nurses (77.1%) and lowest amongst the hospital aides (53.5%). In majority of the cases (78.3%) low back pain began after respondents started working in the hospital, 33.3% of the respondents seeking medical care for moderate low back pain, while 53.8% (n=143) had been diagnosed with a herniated lumbar disc. Perceived work stress and heavy lifting were statistically significant risk factors when multivariate logistic regression techniques were conducted (P<0.05). Therefore, preventive measures should be taken to reduce the risk of lower back pain such as arranging proper rest periods, educational programmes to teach the proper use of body mechanics.6

A case referent study was conducted to identify and quantify work related and non- work related risk indicators for reported over exertion back injuries among nursing

3 personnel from Stockholm County Hospitals. Two hundred and forty cases and 614 referents completed the questionnaire about occupation, type of clinic, working hours, shift work, patient transfers, perceived exertion, back pain, prior back injury, job strain, BMI, smoking, immigrant status, physical training, and self-rated fitness. The highest relative risks (RR) were observed for work-related factors: working at an orthopaedic clinic (RR=5.2, 95% CI=2.7-10.2, ≥ 1), patient transfer/shift (RR=2.7, 95% CI=1.6-4.5); and working full time (RR=2.4, 95% CI=1.6-3.6). Training in the use of transfer devices, and regular use of transfer devices, reduced the relative risk from patient transfer.7

A study was conducted in the nursing schools of the US on the effectiveness of an evidence-based curriculum module in nursing schools targeting safe patient handling and movement. The aim of the study was to translate research related to safe patient handling into the curricula of nursing schools and evaluate the impact on nurse educators and students' intentions to use safe patient handling techniques. Nurse educators at 26 nursing schools received curricular materials and training; nursing students received the evidence- based curriculum module. There were three control sites. Questionnaires were used to collect data on knowledge, attitudes, and beliefs about safe patient handling for both nurse educators and students, pre- and post-training. In this study, researchers found that nurse educator and student knowledge improved significantly at intervention schools, as did intention to use mechanical lifting devices in the near future. The researchers concluded that the curriculum module is ready for wide dissemination across nursing schools to reduce the risk of musculoskeletal disorders (MSDs) among nurses.8

The investigator’s own experience and discussion with the colleagues and experts helped her realise that body mechanics among student nurses is an essential skill taught during their course. As student nurses are the future staff nurses, if they are educated, we could control the injuries to the patients as well as staffs. Therefore, the investigator decided to undertake the study to assess the effectiveness of a video-assisted teaching programme on body mechanics for nursing students in a selected nursing institute at Mangalore.

6.2 Review of Literature

An explorative study was conducted in Turkey to identify the usage of body mechanics in clinical settings and occurrence of low back pain among nurses. The sample

4 comprised 56 nurses. Data were evaluated using percentage, chi-square and Mann-Whitney U tests. The results showed that majority of the nurses (87.5%) experienced low back pain. 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 a sitting position in the bed (71.4%), and assisting the patient to standing position (66.6%). However, 57.1% of nurses lifted and 82% extended incorrectly. It was concluded that nurses do not use body mechanics correctly and majority have low back pain.9

A study was conducted to evaluate the effectiveness of an intensive educational and low tech ergonomic intervention programme aimed at reducing low back pain (LBP) among the 345 home care nurses and nurses’ aides in four Danish municipalities. Participants in two municipalities constituted the intervention group and those in the other two served as controls. In the intervention group, participants were divided into small groups, each of which was assigned one specially trained instructor. During weekly meetings, participants were educated in body mechanics, patient transfer and lifting techniques, and use of low tech ergonomic aids. In the control group, participants attended an overtime only three hour instructional meeting. Information on LBP was collected using the standardised Nordic questionnaire supplemented with information on number of episodes of LBP and care-seeking due to LBP during the past year. A total of 309 nurses and nurses’ aides returned the questionnaire at baseline and 255 at follow-up in August 2001. At follow-up, significant differences were found between the two groups for the LBP variables, and both groups thought that education in patient transfer techniques had been helpful.10

A quantitative study was conducted in Hamburg, Germany. The body postures were recorded with CUELA measurement systems (computer assisted recording and long-term analysis of musculoskeletal loads). All the body postures and movements of nurses were quantitatively measured within a working shift. A mean of 1131±377, trunk inclinations of < 20 degrees were performed in each shift; this corresponds to a frequency of 3.5. A total of 237 of these inclinations lasted for > 4 seconds. A total of 72±35 minutes were spent bending forward with an inclination of >20 degree. Postures with trunk inclination of > 60 degrees were adopted for a mean of 175±133 times. The main tasks responsible for this were bed making (21%), basic care (16%) and cleaning (16%). Therefore, future preventive measures should be considered not only in load handling, but also in tasks with

5 awkward postures.11

A comparative study was conducted in Australia regarding musculoskeletal disorders (MSDs) among rural Australian nursing students. A self-reporting questionnaire was administered to 260 students. A high proportion of students reported an MSD at some body site (80.0%), with low back pain being the most common condition (59.2%). This was followed by MSD of the neck (34.6%), knee (25.0%), shoulder (23.8%), feet (16.5%), wrist (12.7%), and legs (11.9%). MSD of the shoulder was slightly more common among males when compared to females (39.3% v/s 22.0%, P=0.0424). Previous paid employment as a nurse or nursing assistant was found to increase the risk of upper arm MSD by a factor of 10.8 (OR=10.8, 95% CI=1.9-205.8, P=0.0276). Therefore, it suggests that MSD is more frequent among rural Australian nursing students, when compared to their counterparts around the world.12

A cross-sectional study was conducted in Hong Kong, China, on work stress, patient handling activities, and the risk of low back pain among nurses. Three hundred and seventy-seven (377) nurses were recruited from six district hospitals. One hundred and seventy-eight (47.2%) study subjects were randomly selected from two district hospitals and 199 (52.8%) study nurses made up the convenience sample. Data were collected by face-to-face interviews on work factors (both psychological stress and patient handling activities related to work), demographics, psychological distress and lifestyle factors and the occurrence of low back pain (LBP). Out of the 377 nurses interviewed, 153 (40.6%) reported having LBP within the last 12 months. With symptoms of LBP as the outcome, risks were increased where nurses self-reported that they only occasionally or never enjoyed their work [adjusted odds ratio (OR) 2.07], where frequent manual repositioning of patients on the bed was required (adjusted OR 1.84) and where they were required to assist patients while walking (adjusted OR 2.11) after adjustment for other potential confounders. The main route to prevention of LBP among nurses is likely to lie in improved ergonomics and psychological health in their work place. Good posture and correct transferring techniques in ward situations should be reinforced with hands-on practice performed on nurses' common types of clients.13

6.3 Problem Statement

6 A study to assess the effectiveness of video-assisted teaching programme on knowledge regarding body mechanics among II year GNM students in a selected school of nursing at Mangalore.

6.4 Objectives of the Study

1. To determine the knowledge level regarding body mechanics among II year GNM students by using a structured knowledge questionnaire.

2. To evaluate the effectiveness of video-assisted teaching programme (VATP) on knowledge regarding body mechanics in terms of gain in the mean post-test knowledge scores.

6.5 Operational Definitions

Knowledge

In this study knowledge refers to the correct responses obtained from the II year GNM students regarding their knowledge on body mechanics as measured by a structured knowledge questionnaire.

Video-assisted teaching

In this study video assisted teaching programme (VATP) refers to the computerized disc on body mechanics prepared by the investigator, which is used to impart knowledge to the students.

Effectiveness

In this study effectiveness refers to the desired change brought about by the video- assisted teaching programme on knowledge regarding body mechanics as measured in terms of significant gain in the mean post-test knowledge score.

Body mechanics

In this study body mechanics refers to the coordinated efforts of the musculoskeletal and nervous system to maintain balance, posture, and body alignment during shifting, lifting, handling, bending, moving, and performing activities of daily living/nursing care.

7 6.6 Assumptions

 II year GNM students will have some knowledge regarding body mechanics.

 Good knowledge will help in practising proper body mechanics.

6.7 Delimitations

 This study will be delimited to II year GNM students of selected nursing school at Mangalore.

6.8 Projected outcome (Hypothesis)

H1: The mean post-test knowledge score of II year GNM students regarding body mechanics will be significantly higher than their mean pre-test knowledge score at 0.05 level of significance.

Variables under study

 Dependent variable: In this study, the dependent variable is the knowledge of II year GNM students regarding body mechanics.

 Independent variable: In this study, the independent variable is the video-assisted teaching programme on body mechanics. 7. MATERIAL AND METHODS

7.1 SOURCE OF DATA

Data will be collected from students of the selected nursing school at Mangalore.

7.1.1 Research Design

One group pre-test post-test design will be used for the study.

O1 X O2

O1 – Pre-test

X – Video-assisted teaching

O2 – Post-test

8 7.1.2 Setting

The study will be conducted in one of the nursing institute which offers GNM, B. Sc., P. C. B. Sc. and M. Sc. nursing courses.

7.1.3 Population

Population of the study would consist of II year GNM students at a selected school of nursing at Mangalore.

7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling Procedure

Purposive sampling technique.

7.2.2 Sample Size

Sample size will consist of 50 II year GNM students from the selected nursing school at Mangalore.

7.2.3 Inclusion criteria for sampling

1. Students who are willing to participate in the study.

2. Students who are available at the time of data collection.

7.2.4 Exclusion Criteria for sampling

1. Students who are not willing to participate in the study.

7.2.5 Instrument intended to be used

The tool would consist of three sections:

1. Demographic proforma

2. Structured knowledge questionnaire for assessing knowledge regarding body mechanics.

3. Video-assisted teaching programme regarding body mechanics.

7.2.6 Data collection method

Permission will be obtained from the concerned authority. The purpose of the study

9 will be explained to the subjects and informed consent will be taken. Pre-test will be conducted with a structured knowledge questionnaire to assess the knowledge level. This will be followed by giving a video-assisted teaching on body mechanics. On the seventh day, post-test will be conducted with same structured knowledge questionnaire.

7.2.7 Data Analysis Plan

Descriptive and inferential statistics will be used to analyse the data. Findings will be presented in the form of tables and figures. Demographic data will be presented in terms of frequency, percentage, mean and standard deviation. Effectiveness of video-assisted teaching will be analysed by using paired ‘t’ test.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

No. The study does not involve any investigation or intervention, however a video- assisted teaching will be given to the sample on body mechanics.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance will be obtained from the ethical committee of the college of nursing prior to the conduction of the study. Permission to conduct the study will be obtained from the concerned authorities of the selected school prior to conducting the study. Informed consent will be taken from the respondents and confidentiality will be assured.

List of References

1. Potter PA, Perry AG. Fundamentals of nursing: concepts, process, and practice. Philadelphia: Mosby Publications; 2003. p. 697-730.

2. White L. Foundation of basic nursing. 2nd ed. Australia: Thomson Publications; p. 553-64.

3. Nowlis E. Nursing: a human needs approach. 3rd ed. USA: Houghton Mifflin Company; 1985. p. 442-60.

10 4. Bunker-Rosdahl C, Kowalski MT. Textbook of basic nursing. 2008. p. 565.

5. Kozier B, Erb G. Fundamentals of nursing: concepts and procedures. 3rd ed. California. p. 1053-67.

6. Karahan A, Kav S., Abbasoglu A, Dougan N. Low back pain: prevalence and associated risk factors among hospital staff. The Journal of Advanced Nursing 2009;65(3):516-24.

7. Engkvist IL, Hjelm EW, Hagberg M, Menckel E, Ekenvall L. Risk indicators for reported over-exertion back injuries among female nursing personnel. Epidemiology 2000 Sep;11(5):519-22.

8. Nelson AL, Waters TR, Menzel NN, Hughes N, Hagan PC, Powell-Cope G, et al. Effectiveness of an evidence-based curriculum module in nursing schools targeting safe patient handling and movement. International Journal of Nursing Education Scholarship 2007;4(1).

9. Karahan A, Bayraktar N. Determination of the usage of body mechanics in clinical settings and the occurrence of low back pain in nurses. Int J Stud 2004 Jan;41(1):67-75.

10. Hartingsen J, Lauritzen S, Lings S, Lauritzen T. Intensive educational combined with low tech ergonomic intervention does not prevent low back pain in nurses. Occupational and Environmental Medicine 2005 Jan;62(1):13-7.

11. Freitag S, Ellegast R, Dulon M, Nienhaus A. Quantitative measurement of stressful trunk postures in nursing professions. Ann Occup Hyg 2007 Jun;51(4):385-95.

12. Smith DR, Leggat PA. Musculoskeletal disorders among rural Australian nursing students. Aust J Rural Health 2004 Dec;12(6):241-5.

13. Yip Y. A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. J Adv Nurs 2001 Dec;36(6):794-804.

11 8. Signature of the Candidate

9. Remarks of the Guide

Name and Designation of (in block letters)

10.1 Guide MRS. SUCY GEORGE

12 ASSISTANT PROFESSOR ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE.

10.2 Signature

10.3 Co-guide (if any)

10.4 Signature

11. 11.1 Head of the Department REV. SR. ANN ROSE D’ALMEIDA PRINCIPAL ATHENA COLLEGE OF NURSING FALNIR ROAD MANGALORE.

11.2 Signature

12. 12.1 Remarks of the Chairman and Principal

12.2 Signature