SJB College of Nursing, Bangalore.

Dissertation Presentation
Presented By:
Mrs. Soumya B
2nd Year MSc Nursing
Medical Surgical Nursing Dept.

Guide Name:
Mrs. Diana Hephzibah
Asst. Prof.
Medical Surgical Nursing Dept.
 OBJECTIVES OF THE
STUDY:
 To assess the pre-test level of knowledge and practice
regarding comprehensive body mechanics on low back
pain among staff nurses working in ICU
 To assess the post-test level of knowledge and practice
regarding comprehensive body mechanics on low back
pain among staff nurses working in ICU
 To compare pre-test and post-test level of knowledge and
practice regarding comprehensive body mechanics on low
back pain among staff nurses working in ICU
 To correlate level of knowledge with practice regarding
comprehensive body mechanics on low back pain among
staff nurses working in ICU
 To associate the pre-test level of knowledge and practice
regarding comprehensive body mechanics on low back pain
among staff nurses working in ICU with their demographic
variables.
H1 - There is a significant difference in the pre-test and post-test level
of knowledge and practice regarding comprehensive body mechanics
among staff nurses working in ICU
H2 - There is a significant co-relation between the level of knowledge
and practice regarding comprehensive body mechanics among staff
nurses working in ICU
H3 - There is a significant association between the level of pre-test
knowledge and practice regarding comprehensive body mechanics
among staff nurses working in ICU with their demographic
variables.
 Introduction
Nurses are often the unsung hero of the health care profession. They are
arguably the most important frontline healthcare workers available in most
healthcare facilities, performing a broad range of tasks. These tireless women
and men work long hours, offering compassionate care to those in need.
Because of the nature of the job, back pain and nursing often go hand-in-hand.

Low back pain (LBP) is one of the most common causes of

musculoskeletal disorders. It is a neglected health problem responsible for
serious suffering and disability among nurse professionals. LBP accounted for
an average number of disability-adjusted life years (DALYs) higher than
different infectious diseases, non-communicable diseases, and road traffic
injuries.
 For nurses, back-related injuries usually don’t crop up all at once. It often starts
as a little spasm that slowly grows until lower back pain becomes part of life as a nurse.
Thousands of nurses struggle with low back pain due to cumulative trauma disorders
(CTDs). These are musculoskeletal and nervous system issues caused by the poor body
mechanics, strenuous routine tasks nurses perform every day. Repetitive motions,
overuse and strain, cause these painful and sometimes disabling conditions that
gradually develop over weeks, months or even years.

In India, a study conducted on occupational musculoskeletal injuries among

ICU nurses (n=103) stated that 62% had back injury both lower back and upper back.
Improper work habits were found to be the reason for their back pain.

A cross sectional survey was carried out among the nurses working in Christian
Medical College, Vellore, a tertiary hospital with multispecialty units. LBP is a constant
complaint of nurses working in the institution. On an average, in a week around 15–20
nurses report to the staff health clinic with low back pain who require leave.
Some of the duties nurses take for granted in the ICU that can eventually lead to
a back injury include:
 Heavy manual lifting associated with transferring and repositioning patients or
moving equipment and supplies without waiting for help.
 Working in awkward positions such as holding objects during a procedure or
consistently bending over.
 Pushing and pulling patients in stretchers and wheelchairs.
 The use of vibrating or impact tools or equipment for hours at a time.
 Habitual poor standing and sitting postures, exaggerating the curvature of the
lumbar spine

Body mechanic is a word which describes how we use our body in daily routine.
It 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. It includes the ways how we maintain the body when we sit, stand,
bend, and lift something. By using body mechanics, we can use our body in a safe manner
and we can prevent from many musculoskeletal injuries including low back pain.
Adequate teaching about maintaining the proper body position can minimize the
 Need For the study

LBP is thus one important health concern in nursing practice.

This is especially true in many developed countries where high workloads in the
delivery of healthcare services have drastically impacted the nursing practice.

According to Department of Labor of Bureau of labor statistics,

Registered nurses ranked fifth who are used for manual lifting and transferring
the patient with musculoskeletal injuries. Most common work related
musculoskeletal disorder was lower back pain which is affecting 79.4% of nurses.

The complex nature of patient care, extended shift schedules in a

ICUs, CCUs, and reduced staffing has increased job demands of nurses19. Long
working hours, a large number of cared patients, in addition to the frequent
manual lifting and improper postures, are all critical factors associated with LBP
in nurses, implying that LBP is an occupational disease of complex origins.
 An explorative study was conducted to assess the utilization of body mechanic
technique among nurses in turkey. Results showed that majority (87.5%) of the nurses
suffer from low back pain due to improper patient handling including shifting and
transferring the patient in sitting position on the bed, not keeping the body in aligned
position.79.4% nurses move the patient in standing position, and wearing heels,71.4%
work without assistance. Study concluded that nurses do not follow practices of body
mechanic technique which leads to back pain
A descriptive co relational survey was conducted among 50 students nurses
posted in ICU of a tertiary hospital. The results revealed that 64% of the subject had
poor knowledge of body mechanics, 74% of nurses usage of Body Mechanics during
the work was found to be poor, and a weak positive correlation was found between
knowledge and usage (r =.091) of Body Mechanics among ICU nurses30.Hence, studies
showed that mostly nurses who had back pain rarely used the body mechanic
principle. Risk of back injury can be reduced by adopting special intervention such as
body mechanics.
 OPERATIONAL DEFINITIONS
 Effectiveness: It refers to the improvement in the level of knowledge
and practice regarding comprehensive body mechanics among staff
nurses working in ICU after the planned teaching programme.

 Planned teaching programme: It refers to a systematically

organized and carefully planned teaching program prepared by the
investigator and validated by experts regarding comprehensive body
mechanics.

 Knowledge: It refers to the response of the staff nurses working in

ICU regarding comprehensive body mechanics as elicited through
structured knowledge questionnaire.
 Practice: It refers to the activities carried out in prevention of low
back pain which is measured in terms of expressed responses of staff
nurses working in ICU through structured practice checklist.

 Comprehensive body mechanics: It refers to the utilization of

correct muscles to complete a task safely and efficiently, without
undue strain on any muscle or joint.

 Low back pain: It refers to the pain, muscle tension, or stiffness

localized below the costal margin and above the inferior gluteal folds,
with or without sciatica.

 Staff nurses: It refers to nurses who have completed either their basic
nursing program or GNM and working in intensive care units of
CONCEPTUAL FRAMEWORK
Schematic Representation of the Study
 METHODOLOGY
Research Approach : Quantitative – Evaluative Approach
RESEARCH DESIGN: Pre Experimental One Group
Pretest Post design
 DATA COLLECTION METHOD

Selection of the tool:

 A structured questionnaire was felt to be appropriate method to
assess the knowledge of of staff nurses working in ICU regarding
comprehensive body mechanics on low back pain.

 A likert scale on practice to assess the practice of the staff nurses

working in ICU regarding comprehensive body mechanics on
low back pain
 Description of the tool
The structured knowledge questionnaire consist of 2 parts

Part I:
Include items related to the demographic variables of the respondents about age,
gender, religion, educational status, income, marital status, years of working
experience, number of working hours, sources of information, undergone any training
programme on comprehensive body mechanics on low back pain

Part II:
Structured knowledge questionnaire to assess the knowledge of staff nurses working in
ICU regarding comprehensive body mechanics on low back pain. The tool consisted of
28 knowledge test items of knowledge questionnaire types. The items were developed
according to the sub areas like general information, physical effects, promotion and
benefits of Comprehensive body mechanics on low back pain among staff nurses. The
right answer will be scored as ‘one’ mark and the wrong answer will be scored as ‘zero’,
SLNO No of MAX.
KNOWLEDGE ASPECTS Questions SCORE
.

General information regarding

I 5 5
body mechanics

Causes physical effects among

II 7 7
staff nurses

Promotion of comprehensive body

III 11 11
mechanics on low back pain

benefits of Comprehensive body

IV mechanics on low back pain 5 5
Part III:

This section includes 4 point likert scale on practice to assess the practice of the
staff nurses working in ICU regarding comprehensive body mechanics on low
back pain. The items were developed according to the sub areas like

o General information of comprehensive body mechanics-6

o Principles of body mechanics-19

It consist of twenty five practice statements on 4 point likert scale never,

seldom, often and always and each positive statement was awarded a score

of 4,3,2,1 and each negative statement was awarded a score 1,2,3, and 4

respectively. There were six negative statements and nineteen positive

statements. The maximum score was 100.

 Development of Planned Teaching
Programme
 Thefollowing steps are adopted to develop
planned teaching programme.
 Development of the course out line.

 Development of evaluation criteria rating scale

for planned teaching programme.

 Preparation of structured questionnaire.

 Preparation of visual aids.

 Reliability of the tool

 Reliability of research instrument is defined as the extent to

which the instrument yields the same results on repeated
measures.
 It is then concerned with consistency, accuracy, precision,
stability, equivalence and homogeneity.
 Reliability of the structured questionnaire were established by
split half reliability technique, using these values co-efficient
correlation was done with the help of Spearman Brown Formula.
 The reliability score obtained was r = 0.81 which showed
structured questionnaire were highly reliable. Hence, the tool
Formula:
Formula for Spearman Brown Formula:

Spearman Brown prophecy formula for reliability:

r1 = reliability co-efficient of correlation of whole test.

rxy = reliability co-efficient of correlation of half test.
 PLAN OF DATA ANALYSIS

The obtained data will analyze by using descriptive

and inferential statistics. The plan of analysis Is as
follows:
 Organization of data in master sheet.
 Tabulation
of data in terms of frequency, percentage,
mean, median, mode, standard deviation and range.
 Classifying knowledge scores as shown below:
Adequate knowledge = ≥ Mean + S.D
Moderate knowledge = Mean – S.D to Mean + S.D
Inadequate knowledge = ≤ Mean – S.D
Descriptive statistics were used to draw the following
conclusions:
 Mean, median, mode, mean percentage and standard deviation is
used to assess the knowledge and practice regarding
comprehensive body mechanics on low back pain among staff
nurses working in ICU
Inferential statistics were used to draw the following
conclusions:
 Frequency and percentage distribution was used to study the
demographic variables.
 Paired‘t’ test to know the significance difference between mean
pretest and post-test knowledge and practice scores of staff nurses.
 Chi-square test to test the association between the selected
demographic variables and the pretest knowledge level of staff nurses
on comprehensive body mechanics on low back pain .
 DATA COLLECTION PROCEDURE
 Permission from the Concerned Authority.

 The investigator approached the staff nurses and self introduction was done to each
respondent.

 The written consent was obtained by the participants .

 The investigator reassured that the data collected would be kept confidential.

 Data was collected in BGS GIMS Hospital, Bangalore

 Structured teaching programme was administrated after the pre test

 On day 8 post test was administered using same structured knowledge and practice
questionnaires .

 The data collection process was terminated by after thanking each respondent for
their participation.
 RESULTS
The analysis of the data is organized and presented under following sections;
Section-1: Description of demographic variables of staff nurses working in ICU Frequency and
percentage distribution of staff nurses working in ICU in selected hospitals according to their
demographic variables such as age, gender, religion, educational status, income, marital status,
working experience in years, working hours, source of information and undergone any training
programme.
Section 2: Assessment of knowledge and practice of comprehensive body mechanics on low
back pain among staff nurses before teaching programme was made under following headings:
 Frequency and percentage distribution of staff nurses working in ICU according to the pre-test level
of knowledge regarding comprehensive body mechanics
 Mean, SD and range of pre-test knowledge regarding comprehensive body mechanics on low back
pain among staff nurses working in ICU
 Frequency and percentage distribution of staff nurses according to the pretest level of practice
regarding comprehensive body mechanics on low back pain.
 Mean, SD and range of pre-test practice regarding comprehensive body mechanics on low back pain
among staff nurses working in ICU
Section 3: Assessment of knowledge and practice regarding comprehensive body mechanics
on low back pain among staff nurses working in ICU after teaching programme was made
under following headings:
 Distribution of staff nurses according to the post test level of knowledge regarding
comprehensive body mechanics.
 Mean SD and range of post-test knowledge regarding comprehensive body
mechanics among staff nurses working in ICU in selected hospitals.
 Distribution of staff nurses according to the post test level of practice regarding
comprehensive body mechanics.
 Mean, SD and range of post-test practice regarding comprehensive body mechanics
on low back pain among staff nurses working in ICU.
Section 4: Assessment of knowledge and practice regarding comprehensive body mechanics
on low back pain among staff nurses working in ICU before and after teaching programme.
 Distribution of staff nurses according to pre and post-test level of knowledge
regarding comprehensive body mechanics before and after teaching programme.
 Mean, SD and range of pre and post-test knowledge regarding comprehensive body
mechanics among staff nurses working in ICU in selected hospitals before and after
teaching programme.
 Distribution of staff nurses according to the post test level of practice regarding
comprehensive body mechanics before and after teaching programme.
 Mean, SD and range of post-test practice regarding comprehensive body mechanics
on low back pain among staff nurses working in ICU before and after teaching
programme.
Section 5: Effectiveness of teaching programme on knowledge and practice
regarding comprehensive body mechanics on low back pain among staff nurses
working in ICU.
 Paired t-test analysis for the significance of pre and posttest knowledge
regarding comprehensive body mechanics on low back pain among staff
nurses working in ICU
 Paired t-test analysis for the significance of pre and posttest practice
regarding comprehensive body mechanics on low back pain among staff
nurses working in ICU
Section 6: Assessment of correlation between knowledge and practice regarding
comprehensive body mechanics on low back pain among staff nurses working in
ICU
Section7: Association of knowledge and practice regarding comprehensive body
mechanics on low back pain with selected demographic variables of staff nurses
working in ICU
 Association between knowledge regarding comprehensive body mechanics
on low back pain with selected demographic variables of staff nurses
working in ICU
 Association between practice regarding comprehensive body mechanics on
low back pain with selected demographic variables of staff nurses working
in ICU
Mean, SD and range of pre-test knowledge regarding comprehensive body
mechanics on low back pain among staff nurses working in ICU
 Mean score percentage distribution of pre test
knowledge
70

60

General Information Benefits of body mechanics

57.4 % 56.4 %
50

Physical Effects
47.6 %
40 Promotion of body mechanics
41.5 %

30

20

10

0
1 2 3 4
Frequency and percentage distribution of staff nurses working in ICU according
to the pre-test level of knowledge regarding comprehensive body mechanics
Mean, SD and range of pre-test practice regarding comprehensive body
mechanics on low back pain among staff nurses working in ICU
Frequency and percentage distribution of staff nurses according to the pretest level of practice regarding comprehensive body mechanics on low back pain
 Mean score percentage distribution of post test knowledge

84

82

80

78

General Information Benefits of body mechanics

76
82.6 % 83 %

74

Physical Effects
72
74.7 % Promotion of body mechanics
73.2%

70

68
1 2 3 4
Distribution of staff nurses according to the post test level of knowledge regarding
comprehensive body mechanics
Mean, SD and range of posttest practice regarding comprehensive body
mechanics on low back pain among staff nurses
Distribution of staff nurses according to the post test level of practice
regarding comprehensive body mechanics on low back pain
 Mean, SD and range of pre and posttest knowledge regarding comprehensive body
mechanics on low back pain among staff nurses before and after training programme
 Distribution of staff nurses according to pre and posttest level of
knowledge regarding comprehensive body mechanics on low back pain
among staff nurses before and after training programme
Mean, SD and range of posttest practice regarding comprehensive body
mechanics on low back pain before and after training programme
Distribution of staff nurses according to the pre and posttest level of practice regarding
comprehensive body mechanics on low back pain before and after training programme
 Paired t-test analysis for the significance of pre and posttest knowledge regarding
comprehensive body mechanics on low back pain before and after training programme
Paired t-test analysis for the significance of pre and posttest practice regarding
comprehensive body mechanics on low back pain
Research hypothesis-1
• H0: There is no significant difference in the pre-test and post-test level of
knowledge and practice regarding comprehensive body mechanics on low back
pain among staff nurses
• H1: There is a significant difference in the pre-test and post-test level of
knowledge and practice regarding comprehensive body mechanics on low back
pain among staff nurses
The mean pre-test and post-test level of knowledge and practice regarding
comprehensive body mechanics on low back pain among staff nurses.
The paired t-test was carried out and it was found to be invariably
significant at P<0.05 level, hence the results shows that the null hypothesis was
rejected and research hypothesis was accepted. It evidenced that the training
programme was significantly effective in improving the knowledge and practice
regarding comprehensive body mechanics on low back pain among staff nurses.
Correlation between knowledge and practice regarding comprehensive body
mechanics on low back pain among staff nurses in selected hospital
 The correlation coefficient between the level of knowledge and practice
regarding comprehensive body mechanics on low back pain among staff nurses.
The rank correlation r = 0.347 which is significant at p< 0.05. Indicates that there
is positive linear correlation between the level of knowledge and practice
regarding comprehensive body mechanics on low back pain among staff nurses.
Research hypothesis-2:
• H0: There is no significant co-relation between the level of knowledge and
practice regarding comprehensive body mechanics on low back pain among
staff nurses.
• H2: There is a significant co-relation between the level of knowledge and
practice regarding comprehensive body mechanics on low back pain among
staff nurses.
There is a positive correlation between knowledge practice regarding
comprehensive body mechanics on low back pain among staff nurses hence null
hypothesis was rejected and research hypothesis was accepted.
Association between knowledge regarding comprehensive body mechanics on low back pain among staff nurses and selected
demographic variables
 The association between levels of knowledge regarding
comprehensive body mechanics on low back pain among with their
selected demographic variables. In relation to demographic
variables, the chi square value for variables such as age, gender,
professional qualification, area of working ,In-service education,
working experience, and source of information were in the order of
5.48, 0.231, 7.28, 3.281, 1.24, 2, and 2.746 respectively. Out of which,
professional qualification (chi square=7.28*) shows significance
with the level of knowledge of staff nurses regarding comprehensive
body mechanics.
Association between practice regarding comprehensive body mechanics on low back pain among staff nurses and selected
demographic variables
 The association between levels of practice regarding
comprehensive body mechanics on low back pain among staff nurses
with their selected demographic variables. In relation to demographic
variables, the chi square value for variables such as age, gender,
religion, educational status, monthly income, and marital status,
working experience, number of working hours and source of
information were in the order of 2.479, 2.336, 2.35, 0.898, 3.971, 245,
2.83, 1.906 and 1.673 respectively respectively and shows no significant
association with the level of knowledge of staff nurses regarding
comprehensive body mechanics.
Research hypotheses-3:
• H0: There is no significant association between the level of pre-test
knowledge and practice regarding comprehensive body mechanics on
low back pain among staff nurses with their demographic variables.
• H3: There is a significant association between the level of pre-test
knowledge and practice regarding comprehensive body mechanics on
low back pain among staff nurses with their demographic variables.
The chi-square value at the level of p<0.05 for
knowledge and practice respectively and prove that there was
association between the level of pre-test knowledge and practice
regarding comprehensive body mechanics on low back pain among staff
nurses with their demographic variables such as professional
qualification hence null hypothesis was rejected and research hypothesis
 Limitations of the Study

 Difficulty was faced to get co-operation from the staff

nurses as they had busy working hours.

 As the setting is far from the institution, it was inconvenient

for the investigator to travel a long distance to collect data.

 The investigator faced very much difficulty in collecting

related reviews as there were very limited studies of the

same kind.
 Recommendations

 A similar study can be done on larger sample to validate and

generalize the findings.

 A similar study can be conducted and evaluated using alternative

teaching strategies like interactive learning sessions, self-

instructional module, etc.

 A similar study can be done to assess the effectiveness of training

programme on other related physical illness among the staff nurse