Work-related musculoskeletal disorders: the epidemiologic evidence and the debate

The purpose of this book is to provide nurses with the best available research, thereby enabling better decisions that result in improved health care and safety practices and lead to better outcomes. Nurses often are the ones who find errors and prevent pa tient harm. In their focus on patient safety, nurses identify critical issues and research for evidence-based practice. This book is a great resource for practicing nurses, nurse educators, re searchers, leaders, and students. The Agency for Healthcare Research and Quality strongly promotes that safety and quality of health care is dependent on the availability of the best research possible and the ability to deliver results of research into the hands of practitioners, policy makers, and consumers. This text is a culmination of subject expert knowledge, practice, and research from 89 contributors who represent a broad range of nurses and senior researchers across the nation. The topics covered in this text provide excellent background for any clinician, nurse educator, or nurse leader. The topics include • evidence-based practice, • patient-centered care, • working environment for nurses, • care models, and • patient acuity. The chapters provide an easy-tounderstand guide and include a background section and analysis of the literature based on the topic presented. Practice implications are identified at the end of each chapter and guide efforts for improving quality and patient care. Research implications for each topic outline target areas for improvement and can be used by clinicians to inform and guide practice. There are also questions and issues to develop or expand thesis topics and research papers, which faculty members may find useful. A section on critical opportunities contains current topics, including wrong site surgery, communication hand offs by nurses, medication administration safety, medication reconciliation, and personal safety for nurses. These topics are very well presented with numerous research citations and examples from all areas of nursing— from patient entry to the facility to discharge and home care. The authors use exhibits, tables, guides, templates, models, and representations within each chapter and conclude with a list of references including web sites for further independent review and citation. The volumes are written in a manner that allows for quick access, and they are

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

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Religion, Spirituality, and Health: The Research and Clinical Implications

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth‐leading cause of death in the United States in 2019 and the seventh‐leading cause of death in 2020 and 2021, when COVID‐19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth‐leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes — costs that have been aggravated by COVID‐19. Members of the dementia care workforce have also been affected by COVID‐19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers’ understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI‐related clinical trials.

2022 Alzheimer's disease facts and figures

Five subscales were derived from the Nursing Work Index (NWI) to measure the hospital nursing practice environment, using 1985-1986 nurse data from 16 magnet hospitals. The NWI comprises organizational characteristics of the original magnet hospitals. The psychometric properties of the subscales and a composite measure were established. All measures were highly reliable at the nurse and hospital levels. Construct validity was supported by higher scores of nurses in magnet versus nonmagnet hospitals. Confirmatory analyses of contemporary data from 11,636 Pennsylvania nurses supported the subscales. The soundness of the new measures is supported by their theoretical and empirical foundations, conceptual integrity, psychometric strength, and generalizability. The measures could be used to study how the practice environment influences nurse and patient outcomes.

Practice Environment Scale of the Nursing Work Index

Nurses working 12-h shifts complain of fatigue and insufficient/poor-quality sleep. Objectively measured sleep times have not been often reported. This study describes sleep, sleepiness, fatigue, a...

Sleep, Sleepiness, Fatigue, and Performance of 12-Hour-Shift Nurses

Background
Nurses are at very high risk for work-related musculoskeletal injury/disorders (MSD) with low back pain/injury being the most frequently occurring MSD. Nurses are also likely to work extended schedules (long hours, on-call, mandatory overtime, working on days off). The purpose of this study was to examine the relationship of extended work schedules in nurses to MSD.

Methods
Using a longitudinal, three wave survey of 2,617 registered nurses, Wave 1 work schedule data were related to neck, shoulder, and back (MSD) cases occurring in Waves 2 or 3.

Results
Schedule characteristics increasing MSD risk included 13+ hour/days, off-shifts, weekend work, work during time off (while sick, on days off, without breaks), and overtime/on-call. These increases in risk were not explained by psychological demands, but were largely explained by physical demands.

Conclusions
Adverse schedules are significantly related to nurse MSD. Healthier schedules, less overtime, and reducing work on days off would minimize risk and recovery time. Am. J. Ind. Med. 2006. © 2006 Wiley-Liss, Inc.

Longitudinal relationship of work hours, mandatory overtime, and on‐call to musculoskeletal problems in nurses

Perceived physical demands and reported musculoskeletal problems in registered nurses

Background
Though musculoskeletal disorders (MSDs) are highly prevalent among registered nurses (RNs), little is known about functional consequences of MSDs in nurses.

Methods
Data on neck, shoulder, and back MSD problems were analyzed in 1,163 working nurses (response rate = 74%). Cases had relevant symptoms lasting at least 1 week or occurring at least monthly in the past year, with at least moderate pain intensity, on average. MSD problems with a frequency, duration, or pain intensity below the level needed to meet the case definition were defined as MSD symptoms. Those who did not meet symptom or case criteria at any body site were defined as asymptomatic. Odds of consequences (e.g., saw a doctor/provider, missed work, reduced/modified work, non-work activities, or recreation, medication use, inadequate sleep) were estimated for cases versus those with symptoms.

Results
We found 45.8, 35.1, and 47.0% of nurses had neck, shoulder, or back MSD problems (either at the case or symptom level), respectively, within the past year. Cases were far more likely to have seen a provider versus those with symptoms (adjusted odds ratio, aOR Neck: 4.33, 95% CI: 2.85–6.56; aOR Shoulder: 4.83, 95% CI: 3.00–7.77; aOR Back: 3.69, 95% CI: 2.47–5.49). Cases also were more likely to experience all other functional consequences.

Conclusions
MSD consequences are substantial and suggest opportunities for intervention. Future research will examine the impact of work organization and physical demands on MSDs. Am. J. Ind. Med. 41:170–178, 2002. © 2002 Wiley-Liss, Inc.

Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses.

BACKGROUND Although nurse staffing has been found to be related to patient mortality, there has been limited study of the independent effect of work schedules on patient care outcomes. OBJECTIVE To determine if, in hospitals where nurses report more adverse work schedules, there would be increased patient mortality, controlling for staffing. METHODS A cross-sectional design was used, with multilevel data from a 2004 survey of 633 nurses working in 71 acute nonfederal hospitals in North Carolina and Illinois. Mortality measures were the risk-adjusted Agency for Healthcare Research and Quality Inpatient Quality Indicators, and staffing data were from the American Hospital Association Annual Survey of hospitals. Principal components analysis was conducted on the 12 work schedule items to create eight independent components. Generalized estimating equations were used to examine the study hypothesis. RESULTS Work schedule was related significantly to mortality when staffing levels and hospital characteristics were controlled. Pneumonia deaths were significantly more likely in hospitals where nurses reported schedules with long work hours (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.17-1.73, p < .01) and lack of time away from work (OR = 1.24, 95% CI = 1.03-1.50, p < .05). Abdominal aortic aneurysm was also associated significantly with the lack of time away (OR = 1.39, 95% CI = 1.11-1.73, p < .01). For patients with congestive heart failure, mortality was associated with working while sick (OR = 1.39, 95% CI = 1.13-1.72, p < .01), whereas acute myocardial infarction was associated significantly with weekly burden (hours per week; days in a row) for nurses (OR = 1.33, 95% CI = 1.09-1.63, p < .01). DISCUSSION In addition to staffing, nurses' work schedules are associated with patient mortality. This suggests that work schedule has an independent effect on patient outcomes.

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Alison M. Trinkoff

Papers

Sleep, Sleepiness, Fatigue, and Performance of 12-Hour-Shift Nurses

Longitudinal relationship of work hours, mandatory overtime, and on‐call to musculoskeletal problems in nurses

Perceived physical demands and reported musculoskeletal problems in registered nurses

Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses.

Nurses' work schedule characteristics, nurse staffing, and patient mortality.