The 3 rd Joint International Conferences | http://proceeding.tenjic.

org/jic3 | ISBN: 978-602-99020-8-2

Impact Of Work Posture On Musculoskeletal Disorder In

Nurses
Kushariyadia,1,*, Mulia Hakamb,2, Norma Nabilahc,3
a
Faculty of Nursing Universitas Jember, Kalimantan St. 37, Jember 68121, Indonesia
b
Faculty of Nursing Universitas Jember, Kalimantan St. 37, Jember 68121, Indonesia
c
Faculty of Nursing Universitas Jember, Kalimantan St. 37, Jember 68121, Indonesia)
1
kushariyadi@unej.ac.id*; 2 muliahakam81@gmail.com;
* Corresponding Author

ABSTRACT
Keywords:
The problem of nurses in hospitalization is complaining of back pain, and stiff
Musculoske neck. Often nurses experience pain so that work productivity is not optimal.
letal
Ergonomics or posture errors at work cause health problems such as low back
disorders
Work pain. During the process of providing nursing care, nurses often use non-
posture ergonomic and constant body postures such as bending, lifting patients, moving
patients, installing catheters, installing infusions and other independent actions
and collaboration for a long time so that there is a risk of low back pain or back
pain. The purpose of the study was to determine the impact of work posture on
musculoskeletal disorders in nurses. The research design used in this study is
an association research using a cross sectional approach. The research sample
was 30 nurses at Jember Lung Hospital. The sampling technique uses total
sampling. Using the Nordic Body Map questionnaire and the RULA (rapid
upper limb assessment) method. The analysis test used Spearmen rank
correlation with p <0.000. The results showed that the work posture for
musculoskeletal disorders showed r value of 1.000 and p value of 0.000. That
there is a very strong relationship between work posture and musculoskeletal
disorders. Imperfect posture in nurses causes musculoskeletal complaints in the
mild category. At work postures with medium and high categories,
improvements are needed so as not to cause bigger complaints.

Copyright © 2021 Joint International Conference

All rights reserved.

I. INTRODUCTION
The problem of nurses in hospitalization is complaining of back pain, and stiff neck. Often nurses
experience pain so that work productivity is not optimal [1]. Ergonomics or posture errors at work
cause health problems such as low back pain. During the process of providing nursing care, nurses
often use non-ergonomic and constant body postures such as bending, lifting patients, moving
patients, installing catheters, installing infusions and other independent actions and collaboration
for a long time so that there is a risk of low back pain or back pain [2].

II. METHOD
The purpose of the study was to determine the impact of work posture on musculoskeletal
disorders in nurses. The research design used in this study is an association research using a cross
sectional approach. The research sample was 30 nurses at Jember Lung Hospital. The sampling

Vol. 3, No. 1, November 2021 278

 The 3 rd Joint International Conferences | http://proceeding.tenjic.org/jic3 | ISBN: 978-602-99020-8-2

technique uses total sampling. Using the Nordic Body Map questionnaire and the RULA (rapid
upper limb assessment) method. The analysis test used Spearmen rank correlation with p <0.000.

III. RESULTS AND DISCUSSION

RESULTS
Characteristics
Table 1. Characteristics of Respondents
Characteristics f %
Gender
a. Male 12 40
b. Female 18 60
Workspace
a. Dahlia 8 26.7
b. Mawar 8 26.7
c. Melati 9 30
d. Tulip 5 16.7
Work Position
a. PPL 26 86.7
b. KR 4 13.3
Health Condition
a. Healthy 30 100
b. Sick 0 0
Trauma history
a. None 30 100
b. Yes 0 0
Table 1 shows that the majority of nurses are 18 women (60%). Most of the nurse's workspace is in
the jasmine room (non-infectious) as many as 9 people (30%). Most of the nurses' work positions
(PPL) were 26 people (86.7%). The health conditions and history of trauma to the nurses were all
healthy and there was no history of trauma, each of which was 30 people (100%).

Musculoskeletal Disorders (MSDs)

Table 2. Musculoskeletal Disorders (MSDs)
Musculoskeletal Disorders (MSDs) f %
Complaint rate:
None 0 0
Low 30 100
Medium 0 0
High 0 0
Interpretation of complaint level:
No improvement 0 0
Not yet need improvement 30 100
Maybe need improvement 0 0
Needed immediate improvement 0 0

Table 2 shows that all nurses have complaints of low category MSDs as many as 30 people
(100%). The interpretation of the MSDs complaint level for all nurses is that 30 people (100%) do
not need improvement.

Vol. 3, No. 1, November 2021 279

 The 3 rd Joint International Conferences | http://proceeding.tenjic.org/jic3 | ISBN: 978-602-99020-8-2

Work Posture
Table 3. Work Posture Working
Posture f %
Observation level of work posture:
Low 1 3.3
Medium 25 83.3
High 4 13.3
Very high 0 0
Interpretation of work posture level:
No need for change 1 3.3
May need change 25 83.3
Needs change Immediate 4 13.3
Implementation of change 0 0

Table 3 shows that most nurses have a moderate level of observation of working posture as many
as 25 people (83.3%). The interpretation of the level of observation of nurses' work postures is that
most of them may need to change as many as 25 people (83.3%).

Test Spearman with Musculoskeletal Disorder Working Posture

Table 4. Test Spearman Working Posture with Musculoskeletal Disorder
Spearman's rho Working Posture Musculoskeletal
Disorder
Posture Working
a. Correlation coefficient 1.000 0.000

b. Sig. (2-tailed) 0.000 0.000

c. N 30 30

Musculoskeletal Disorder
a. Correlation coefficient 0.000 0.000

b. Sig. (2-tailed) 0.000 0.000

c. N 30 30

Table 4 shows that the results of the test have Spearmen a correlation coefficient of 1.000 and
value of p 0.000. The conclusion is that there is a very strong relationship between work posture
and musculoskeletal disorders.

DISCUSSION
Musculoskeletal Disorders (MSDs)
The results of the study stated that respondents had MSDs complaints of (100%) in the low
category. The low category means that the respondent states that he feels MSDs at work but does
not interfere with his activities and when he rests, it will disappear. The results of the study found
that many nurses felt complaints in the neck and right shoulder. Complaints are caused by posture
errors, tool errors, and other ergonomic errors. Many nurses work with the back and neck bent for a
long time, causing discomfort such as tension in the lower and upper neck muscles due to
continuous static movements for a long time and frequent intensity [1].
Complaints on the right shoulder arise because the right hand is more dominant in carrying out
work such as carrying loads, performing nursing care, documenting nursing care, and other
activities. Muscle fatigue while working causes MSDs complaints [2].
The results of the study on MSDs complaints often occur in the waist area (62.71%), neck
(59.77%), arms (49.66%), back (39.50%) [3]. The results of research in Africa show that the
Vol. 3, No. 1, November 2021 280
 The 3 rd Joint International Conferences | http://proceeding.tenjic.org/jic3 | ISBN: 978-602-99020-8-2

average nurse experiences MSDs complaints of 71.85% [4]. The results of research on nurses in
Vietnam, the level of MSDs complaints increased in the last 12 months by 74.7% and in the last 7
days by 41.1% [5].
Musculoskeletal complaints are complaints in the skeletal muscles ranging from mild to
severe complaints. Muscle complaints include temporary complaints that occur when the muscles
receive a static load and disappear by themselves when resting. Persistent complaints occur when
the load has stopped and the muscles have rested [5].

Work Posture
Results showed that the error rate that often occurs is on the back, upper and lower arms and
legs. This study focuses on working postures on body parts while working such as neck, upper arm
position, forearm, wrist, wrist rotation, back, foot position and loading. Jember Lung Hospital
nurses have a posture error rate when working with a low category of 1 person (3.3%), moderate as
many as 25 people (83.3%), and high as many as 4 people (13.3%). This means that there is an
error in body posture while working and is in the medium and high categories so that it requires
changes to the medium category and immediate changes to the high category.
Measurement of posture errors when sitting is 3.33%, while standing is 3.32% and when
lifting weights is 0%, because the load is less than 2 kg, it gets a score of 0. sitting and standing,
such as bending over when sitting and standing. This position occurs when nurses carry out nursing
care writing activities and provide nursing interventions to patients. Nurses in carrying out
activities with a bent back position and an unergonomic forearm position can cause complaints of
pain in the back, neck, and wrists. Errors in the standing position occur because the body position is
standing and bending, making one leg as a support for body weight (slanted standing position)
causing complaints of back, neck, and leg pain.
The results of this study indicate body posture, namely upper arms, forearms, wrists, neck,
back, legs and daily loading by measuring the level of RULA which aims to analyze body posture
while working as a whole. Based on the results of research in Africa that the focus in body posture
while working is the back, neck, and arms because the body parts that are mostly used when
working or doing activities are the back, neck, and arms [4]. The results of a study in Haiphong
Vietnam showed that the focus in body posture while working was the back and neck. The body
postures studied have the same focus on posture [5].
Posture is a component in the work system that is included in the design area subsystem,
namely the physical characteristics of fatigue whose components come from the operator. The
position of the body at work is largely determined by the type of work performed such as sitting,
standing, or bending. Each body posture has advantages and disadvantages, so to minimize the risk
to workers, it is necessary to focus on the use of tools by workers for comfort while working. One
that can be applied is user centered product design, namely workers. So it does not cause position
errors when working. At a high level of complaints, the wrong body posture is the body that is too
bent when sitting or standing. There are 4 assessment indicators for the slouching position in the
standing position, namely 0°, 0-20°, 20-60° and more than 60°. In the high category, it was found
that there were nurses who scored more than 20° but less than 60°. In addition, the position of the
neck also affects because when writing nursing care, the position of the head is lowered 20°. In
addition, elderly nurses can also be included in the high category because in the elderly the habit of
wrong posture has been carried out for years with frequent repetitions [5].

Musculoskeletal Disorders (MSDs) with Work Posture

Results of this study indicate that there is a very strong relationship between
musculoskeletal disorders and work postures with the results of the test r- 1.000 and p-value 0.000.
These results indicate that many Lung Hospital nurses experience posture errors while working in
the medium and high level categories and a few have working posture errors in the low level
category. There is no perfect attitude that is implemented by nurses, causing musculoskeletal
complaints even though it is in the mild category and there is no need for improvement. However,
the wrong work posture such as working posture in the medium and high categories requires
improvement so as not to cause more severe complaints.

Vol. 3, No. 1, November 2021 281

 The 3 rd Joint International Conferences | http://proceeding.tenjic.org/jic3 | ISBN: 978-602-99020-8-2

The results of this study indicate a positive correlation, namely there is a strong relationship
between work posture and MSDs complaints, meaning that if there is a high work posture error, the
higher the perceived MSDs complaints will be.
The results of a study in Iran stated that there was a significant relationship between the
angle of curvature and rotation with neck and back pain. This study aims to determine the
relationship between sitting posture and complaints of musculoskeletal pain in elementary school
children. The results of another study stated that there was a significant positive correlation on the
post-test between the physical energy demands of other musculoskeletal demands and the intensity
of pain [6].
Various complaints of MSDs themselves can come from various factors. Factors that are
closely related to this complaint are unnatural work postures, such as unnatural work attitudes
which mean wrong work attitudes and cause the body to move away from its natural position. Such
as the movement of the hands raised, the back and neck that are too bent, the head is lifted, the
farther the position of the body from the position of the body's gravity, the greater the risk of
MSDs complaints. The cause of unnatural posture comes from individuals and work tools that are
not in accordance with the ability of workers [5].

IV. CONCLUSION
The nurse experienced a moderate category of work posture error. The nurse has a low-grade
musculoskeletal disorder. There is a relationship between work posture and complaints of
musculoskeletal disorders where the p value <0.000 then H0 is accepted where the r value is 1.000
which indicates the relationship between the two variables is very strong.

V. REFERENCES

[1] M.N. Binarfika and M. Tri. Analisis tingkat risiko muskuloskeletal disorders (MSDS)
dengan the rapid upper limbs assessment (RULA) dan karakteristik individu terhadap
keluhan MSDS. Departemen Keselamatan dan Kesehatan Kerja. Fakultas Kesehatan
Masyarakat Universitas Airlangga. 2014. http://journal.unair.ac.id/download-fullpapers-
k331e290a467full.pdf.
[2] OSHA. Safe patient handling. 2013.
https://www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html.
[3] P. Yan, F. Li, L. Zhang, Y. Yang, and A. Huang. Prevalence of work-related
musculoskeletal disorders in the nurses working in hospitals of Xinjiang Uygur
Autonomous. Pain research and management. Vol 2017. Region.
https://scholar.google.co.id/scholar?q=Ping+Yan,+2017&hl=en&as_sdt=0&as_vis=1&oi=
scholart.
[4] T.J. Ellapen and S. Narsigan. Work Related Musculoskeletal Disorders among Nurses:
Systematic Review. 2014. January 2014. Journal of Ergonomics S4(01).
[5] Tarwaka, S.H.A. Bakri, and L. Sudiajeng. Ergonomi untuk keselamatan, kesehatan kerja
dan produktivitas. Uniba press, Surakarta. 2004. http://shadibakri.uniba.ac.id/wp-
content/uploads/2016/03/Buku-Ergonomi.pdf.
[6] S. lbeigi, N. Rastegar, M. Saghebjoo, A. Ebrahimi Etri, and H. Farzaneh. The relationship
between anthropometrical domain and upper extremity abnormalities in primary school
girl students. 2018. Journal of Ergonomics 6 (1), 19-29.

Vol. 3, No. 1, November 2021 282