Midwives' thoughts about musculoskeletal disorders with an evaluation of working tasks

The prevalence of musculoskeletal disorders is very high amongmidwives resulting in sickness absenteeism, functional limitation and staff shortages. There are several contributory risk factors having impact on the development of MSDs. This study aimed to (1) explore midwives' experiences and views about work-related MSDs and contributing risk factors, and (2) analyse working postures for musculoskeletal injury risks. A mixed method approach was used with interviews/focus group (n = 15/7) and observations (n = 22) of specific tasks (during birth and after birth) using the posture analysis observational method (Rapid Entire Body Assessment, REBA). The participants were midwives who had an active role in the United Kingdom (UK) National Health Services (NHS). It was found that MSDs were often attributed to the physical (working in awkward positions), organisational (longer shift hours, fewer staff, increased work load), psychosocial (defensive practice, higher demand) challenges of midwifery. All postures had very high to medium REBA risk levels with action categories indicating that action or further assessment is definitely necessary to reduce MSDs. This research provides a holistic approach by analysing risk factors and interactions in the work context to inform the development of risk management strategies. Midwifery working conditions have a big impact on developing musculoskeletal symptoms. Management of such symptoms will improve staff wellbeing, mother and baby safety, individuals' life trajectories and staff shortages.

Work-related musculoskeletal injuries amongst obstetrics and gynaecology trainees in East Midland region of the UK

Purpose

Work-related musculoskeletal injuries (WRMSI) have been well known amongst obstetrics and gynaecology (O&G) practitioners, but limited data have been reported. Our aim is to determine the prevalence, severity and characteristics of WRMSI amongst O&G trainees.

Methods

A musculoskeletal ergonomic survey was conducted amongst the O&G trainees in the East-Midlands region of United Kingdom (UK). The survey comprised of demographic details, year of training, previous manual handling training, any work-related orthopaedic injury, the type of injury, any treatment received in addition to any sick leave incurred after the injury were also documented.

Results

The response rate for the survey was 76% (59/78). The majority (22%) were senior specialist trainee, seventh year (ST7) and between 30 and 34 age groups. Approximately 90% of the trainees reported to have experienced pain in the last year. The most common site was the back, which was followed by the shoulders and the upper limbs. 63% of trainees reported injuries that were attributed to WRMSI. One in ten of the trainees needed time off work due to injury. A total of 20 days were lost in the last 12 months as a result of pain or discomfort attributed to obstetric work.

Conclusions

Our results demonstrate the prevalence of work-related injuries and its detrimental effects. Such injuries are underreported on incident reporting system. Ergonomics and WRMSI prevention in obstetrics and gynaecology is an area seldom discussed. Obstetric training sessions should incorporate ergonomic interventions. Further research is required to establish relevant aetiological factors related to WRMSI in this specialty.

Midwives’ Experiences of Work-Related Shoulder Musculoskeletal Problems

INTRODUCTION: Little is known about musculoskeletal disorders in midwives as distinct from nurses. The study objective was to gain an understanding of midwives’ experiences with work-related shoulder problems.

METHODS: We carried out semistructured interviews with 11 qualified Australian midwives with a history of shoulder problems, recruited through purposive sampling. Interviews were recorded, transcribed verbatim, and manually coded. An inductive approach was used to generate themes.

RESULTS: Five major themes emerged in the analysis: attribution, universality of the experience, short-term coping, long-term coping, and support. Most participants held the view that musculoskeletal problems were normal occurrences and to be expected. Participants felt vulnerable and described the ways they protect themselves from further injury. Those who had left midwifery practice had generally done so for reasons other than the shoulder problem. Family members and coworkers were the main sources of support, whereas most supervisors were perceived as neutral at best.

CONCLUSIONS: Coping strategies that enhance well-being may be most effective. The workplace culture must encourage injury reporting to monitor safety issues and decrease costs at all levels. The study findings suggest several areas for future research in midwives to provide an evidence base for prevention/intervention strategies.

Work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians: A systematic review of risk factors and functional consequences

BACKGROUND

Given a worldwide shortage of primary health care workers predicted to worsen, it is vital to address sources of attrition among these professionals. One such source may be work-related musculoskeletal disorders. We aimed to identify risk factors for and functional consequences of work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians.

METHODS

Eighteen of 87 studies identified from an electronic database search met the inclusion and quality criteria.

RESULTS

Job demands, demanding work schedules and physical exposures have the strongest associations with work-related upper quadrant musculoskeletal disorders. Functional consequences included widespread use of prescription and over-the-counter medications and major negative impact on activities of daily living. No studies of midwives were located.

CONCLUSION

High-quality studies of midwives as well as better-designed prospective studies of nurses and physicians are needed. Results of such studies could inform preventive strategies and reduce the contribution of work-related musculoskeletal disorders to attrition.

Addressing Hand Pain in Podiatry

A qualitative study reveals a range of possible ergonomic risk factors that may lead to hand pain among an understudied group of health care practitioners.

Hospital ergonomics: a qualitative study to explore the organizational and cultural factors

The primary objective was to identify the characteristics of the health care industry with respect to organizational and cultural factors and consider how these might impact on the practice of ergonomics. Qualitative methodology was chosen as a suitable approach. This was supported by a middle ground philosophical position. Twenty-one interviews were carried out with academics and practitioners using a questionnaire proforma which developed iteratively over the 18 months of the project. A progressive four stage sampling strategy was used starting with purposive sampling to spread the net. Suggested contacts were then followed up (snowball sampling), before the third stage of intensity sampling to focus on participants with specific experience in hospital ergonomics. A final strategy of analysis sampling sought extreme and deviant cases to achieve theoretical saturation. The analysis resulted in three categories: organizational, staff and patient issues. The organizational issues included both the size and complexity of the National Health Service. For example, three hierarchical lines were identified in the management structure: an administrative line, a professional line and a patient-focused clinical management line. One of the surprising findings for the staff issues was the perceived lack of ergonomic information about female workers as a population group and traditional female employment sectors. The patient issues incorporated three dimensions associated with the caring role: the type of work; expectations; and possible outcomes. The work tends to be dirty and emotional, with a professional subculture to allow the handling of other peoples' bodies. This subculture was linked to a 'coping' attitude where staff put the patients' needs and well-being before their own. The change in patient expectations (from being apologetic through to demanding their rights) is mirrored in a changing model of care from paternalism to partnership. A lack of ergonomic research was identified for female workers in the health care industry relating to both the type of work and gender issues.

Embedding ergonomics in hospital culture: top-down and bottom-up strategies

In England there has been increasing emphasis on the use of ergonomics to tackle manual handling problems for the last seven years (MHO, 1992, 1998; HSAC, 1998). At Nottingham City Hospital NHS Trust, I have tried to incorporate an ergonomic approach throughout a wide range of activities since 1994. This paper does not seek to report a research project, simply to share the experience of trying to tackle hospital manual handling risks by taking an ergonomic approach. It will explain what this has involved, where it has been successful and where there have been difficulties. In the five years since the implementation of this strategy three measures have been used to monitor trends. These are (1) manual handling incidents: showing a 33% reduction; (2) days lost from musculoskeletal-related sickness absence: 36% reduction; and (3) completed risk actions: rising from 33% completion to over 75% completion.