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Published by cikgu online, 2020-01-22 02:48:45


Malaysian Journal of Human Factors and Ergonomics 2016, Vol. 1 (1): 40 – 44



Ezrin Hani SUKADARIN , Norraphat Uttraphan PIM , Junaidah ZAKARIA , Baba Md DEROS , Nur Syazwani Md

Occupational Safety and Health Program, Faculty of Engineering Technology, Universiti Malaysia Pahang,

26300 Gambang, Pahang, Malaysia.
Department of Mechanical and Materials Engineering, Faculty of Engineering and Built Environment,
Universiti Kebangsaan Malaysia, Bandar Baru Bangi, Selangor, Malaysia


Hospital nurses receive enormous amounts of physical and mental workload which causes them to develop work-
related musculoskeletal disorders (WRMSDs) and occupational stress. In this research, a cross-sectional study was
carried out to identify the prevalence of WRMSDs, to evaluate the level of stress, and also to investigate the
relationship between musculoskeletal complaints (MSCs) and stress level among one hundred and eight hospital nurses
(n=108) in a government hospital. Data collection was done using three instruments, namely Nordic Musculoskeletal
Questionnaire (NMQ), Workplace Ergonomic Risk Assessment Tool (WERA), and Stress Overload Scale Instrument (SOS).
Based on the results obtained, a majority of the nurses suffer lower back pain whereas in terms of stress level, the
nurses face relatively high stress level from their work. The relationship between MSCs and stress level was found to
be absent. WRMSDs and stress are both multifactorial thus making it hard to conclude that the WRMSDs experienced
by the nurses are caused by stress. Because of that, further study in relation to WRMSDs and stress is required to
explore this issue.

Keywords: WRMSDs, NMQ, WERA, SOS

INTRODUCTION Occupational stress is a psychosocial risk factor
in occupational field and it is present when
Nursing is a profession within the health care occupational demands overcome the ability to
sector that focuses on the care of individuals, address or control the situation (Eleni et al.,
families, and communities so they may attain, 2008). Reports from nurses, who feel stressed in
maintain, or recover optimal health and quality a teaching hospital in Porto Alegre has confirmed
of life. On average, hospital nurses work an nursing as the fourth most stressful of
average of 8 hours every day, 5 days a week. occupations (Negeliskii & Lautert, 2011). Nursing
Nurses always involve with heavy physical work is linked with a range of different demands;
activities such as lifting heavy loads, working in these include physical, emotional, and social
awkward postures, transferring patients and demands (McCarthy et al., 2010). Nurses are also
operating hazardous equipment. They work at risk for violence and abuse in the workplace,
under mental overload, engaging in multitasking either from the co-workers, their superiors or
and coming across frequent interruptions. from the patients themselves. This contributes to
Working under physical overload due to long the stress level of the nurses, besides the long
work hours and patient handling demands, leads and stressful working hours.
to a high risk of developing WRMSDs (Sukadarin, 2016). Recent evidence also showed that In terms of the correlation between MSCs and
nurses are exposed to the risk of WRMSDs on stress level among hospital nurses, past
several parts of body such as neck, shoulders and researches had managed to prove the existence
back, upper back, hips or and ankles (Daraiseh et of relationship between these two elements.
al., 2003). According to Warming et al., (2009), Warming et al. (2009) conducted a research to
nurses also have both a high prevalence of low examine whether patient handling tasks and
back pain and neck pain and a considerable high psychosocial factors were associated with MSCs
prevalence of knee pain. Many researchers also and they concluded that there are a significant
found that the most prevalence issue among relationship between work factors and MSCs from
hospital nurses is low back pain (Smith et al., data collected using logbook registries. Another
2004; Tinubu et al., 2010; Anap et al., 2013). study by Munabi et al. (2014) using NMQ also
Other studies showed that WRMSDs are also found that mental exhaustion is associated with
prevalent in the neck region (Barkhordari et al., WRMSDs with an almost 2 fold increase.
2013) and also the shoulders region (Smith et al., Therefore, the objectives of this study are (1) to
2006; Kee & Seo, 2007). identify the prevalence of WRMSDs among
hospital nurses, (2) to evaluate the level of


Malaysian Journal of Human Factors and Ergonomics 2016, Vol. 1 (1): 40 – 44

stress among hospital nurses throughout their
routine work and (3) to investigate the The demographic information includes age,
relationship between MSCs and stress level. gender, race, education level and household
income are presented in Table 1.
Table 1 Demographic information (n=108)

A cross-sectional study was done among one
hundred and eight (n=108) hospital nurses of Age (Years) n %
different age, gender, race, education level, 20-29 37 34.26
household income, and working departments. 30-39 34 31.48
The respondents were randomly selected to 40-49 18 16.67
answer the questionnaires. 50-59 19 17.59
Gender n %

Nordic Musculoskeletal Questionnaire (NMQ) Female 81 75.00
(Kuorinka et al., 1987) is used to collect data on Male 27 25.00
MSCs. The questionnaire studies the MSCs Race n %
according to body regions which are the neck, Chinese 11 10.19
shoulders, elbows, wrists/hands, upper back, Indian 7 6.48
lower back, hips/thighs, knees, and ankles/feet. Malay 84 77.78
Stress Overload Scale Instrument (SOS) is used to
Others 6 5.56
collect data on stress level among the nurses Education Level
(Amirkhan, 2012). SOS categorizes the scores SPM 11 10.19
obtained into four ascending stress-severity Matriculation 1 0.93
categories namely low stress, challenged, Diploma 71 65.74
fragile, and high stress. The scores are obtained STPM 8 7.41
through summation of likert-scale-based scoring Bachelor’s Degree 16 14.81
of 24 questions in the questionnaire where the Master’s Degree 1 0.93
odd-numbered items (scale 1) are defined under
Personal Vulnerability Scale (PVS) whereas the Household Income n %
even-numbered items (scale 2) are defined under RM1000-RM3000 38 35.19
Event Load Scale (ELS). RM3000-RM5000 57 52.78

Workplace Ergonomic Risk Assessment Tool (WERA) >RM5000 11 10.19

(Rahman et al., 2011) is used to conduct postural
analysis on the nurses during their work tasks. The WRMSDs among Hospital Nurses in a goverment
WERA tool categorizes the level of risk according to hospital
the way job tasks are carried out. The risk levels
obtained could either be low (score: 18-27), Table 2 shows the frequency of MSCs among
medium (score: 28-44), or high (score: 45-54) and nurses. From the table 2 , it can be seen that the
the classified risk levels suggest the recommended most prevalent MSCs among hospital nurses is
actions to be taken in order to decrease the risk of lower back pain, thus supporting various other
developing WRMSDs. researches done on nurses such as Smith et al.
(2004), Tinubu et. al (2010), and Anap et. al.
Data Analysis (2013). The neck is also considered to show one

All data acquired were analysed using Statistical of the highest prevalence of MSCs, supporting a
Package for Social Sciences (SPSS) software to study conducted by Barkhordari et al. (2013).
obtain frequency, value, min and percentage. Other than that, the shoulders region shows a
Normality tests were conducted for all three
instruments (NMQ, WERA and SOS) in order to high frequency of MSCs as well among the nurses,
check for normality of data distribution. supporting two other previous studies conducted
Pearson's Chi-Square Test (χ²) was then by Smith et al. (2006) and Kee & Seo (2007).
conducted between NMQ – SOS to investigate the From this study, it is also found that the upper
association between MSCs and stress level among back, knees, and ankles/feet regions are also
hospital nurses. susceptible to WRMSDs. The frequency of MSCs
arranged in ascending order is as follows: elbows
(6.48%), wrists/hands (28.70%), hips/thighs


Malaysian Journal of Human Factors and Ergonomics 2016, Vol. 1 (1): 40 – 44

(32.41%), shoulders (42.60%), neck (43.52%), Table 3 Frequency of WERA scores among
ankles/feet (43.52%), knees (45.37%), upper back nurses in a goverment hospital (n=108)
(50.93%) and lower back (62.96%).
WERA Score n %
Table 2 Frequency of MSCs among nurses Low (18-27) 60 55.56
in a goverment hospital (n=108)
Medium (28-44) 48 44.44
Body Region n (%) High (45-54) - -

Neck 47 (43.52)
Shoulders 46 (42.60)
Elbows 7 (6.48) Stress Level among Hospital Nurses in a
Wrists/Hands 31 (28.70) goverment hospital.

Upper Back 55 (50.93) Table 4 shows the frequency of SOS scores among
Lower Back 68 (62.96) nurses in a goverment hospital. From the table 4,
Hips/Thighs 35 (32.41) 39 nurses (36.11%) obtained scores under the low
stress category, which is the lowest risk of stress
Knees 49 (45.37)
Ankles/Feet 47 (43.52) signifying very little to no stress. Other than
that, 11 nurses (10.19%) scored under challenged
category whereas 20 of them (18.52%) scored
Postural Analysis of Hospital Nurses in a under the fragile category. The challenged and
goverment hospital fragile categories are categories signifying
presence of low risk of stress. A total of 38
Table 3 shows the frequency of WERA scores
among nurses in a goverment hospital. Out of the nurses (35.19%) scored under the high stress
108 nurses, 60 nurses (55.6%) obtained a low category, which signifies presence of high risk of
WERA risk level. These scores obtained are from stress.
analysis of job tasks such as observation of vital Table 4 Frequency of SOS scores among nurses
signs, documentation, answering phone, bed- in a government hospital (n=108)
making, assisting the doctor, pushing wheelchair,
and administering medicine. These job tasks are
considered to be low risk as not much force is SOS Score n %
extended on the body when they are carried out
by the nurses. However, they do involve some Low Stress (Lowest Risk) 39 36.11
occasional bending and and awkward postures
but only in a short time. The remaining 48 nurses Challenged (Low Risk) 11 10.19
(44.4%) obtained a medium WERA risk level. The
scores obtained are from job tasks such as Fragile (Low Risk) 20 18.52
sponging, dressing, pushing bed, patient bed-
transfer, and helping patient walk. These job High Stress (High Risk) 38 35.19
tasks require a bit of force to carry out, such as
patient bed-transfer where the nurses are
required to manually lift the patients up from Relationship Between MSCs and Stress Level
the bed to transfer them to different beds. Some among Hospital Nurses in a government hospital
tasks such as sponging and dressing, require
some repetitive movements and bending of the Results of SOS survey showed that, 35.19% of
body to carry out, thus making them a bit total respondents fall under high stress category.
hazardous to be carried out. None of the nurses MSCs among them also found that, back area
observed obtained a high WERA risk level, (lower and upper) shows significant highest
meaning that none of the job tasks are numbers among other area. Because of that,
unacceptable in terms of their handling risk. relationship between MSCs and stress level were
further explored. Pearson’s chi-square analysis is
used to find the relationship between MSCs and
stress among hospital nurses by comparing NMQ
index (MSCs) with SOS scores (stress level). From
the analysis, result found that p-values = 0.329,
χ² = 36.012 , df = 33 which the p value


Malaysian Journal of Human Factors and Ergonomics 2016, Vol. 1 (1): 40 – 44

significant stress level faced by the nurses in
higher than 0.05 (p > α). The incidence of p- terms of frequency, is low stress level, followed
value being higher than the alpha level proves very closely behind by high stress level. This high
that there is no relationship between MSCs and frequency of these two opposite stress levels
stress level among hospital nurses. signifies that there are a lot of factors that play
roles in causing occupational stress. For example,
different nurses have different stress-handling
According to Reporting of Injuries, Diseases and capabilities eventhough they carry out the same
Dangerous Occurrences Regulations 2013 job tasks or are given the same work pressure.
(RIDDOR), 50% of the serious accidents occurring Stress-handling capabilities can be influenced by
in nursing homes are results of manual handling. a lot of factors such as age, gender, education
Although after conducting postural analysis level, and household income. Work load may also
among hospital nurses using WERA indicated that be a risk factor in giving such result as nurses in
the respondents exposed to the low and medium different departments may face different amount
ergonomics risk level, the result found is still in of work loads which signifies occupational stress.
Furthermore, the data analysis also showed that
doubt. Not only manual handling task, hospital there is no correlation between MSCs and stress
nurses also involve with awkward posture, level among hospital nurses. This may be due to
working in the same position for a long period of WRMSDs and stress are both multifactorial thus
time, and repetition of movements. Nurses making it hard to conclude that the WRMSDs
sometimes have to do a lot of awkward bending experienced by the nurses are caused by stress at
while standing in order to carry out job tasks work or that the stress faced by the nurses are
such as administering medicines on the patients caused by the WMSDs they are having instead of
other factors.
and taking and checking blood of patients lying
on the bed. In addition, nurses also do a lot of ACKNOWLEDGEMENTS
repetitive movements for a long period of time
too such as during sponging and dressing whereby This study was supported by Universiti Malaysia
repetitive movements of the hand is needed. Pahang (UMP). We would like to express our
These activities, if done in moderation, would gratitude to the Faculty of Engineering
not be harmful on the nurses, but in this case, Technology (FTek), UMP Malaysia for the support
in this study. Not to forget, our sincerest
the nurses have to do the same job tasks on gratitude to all respondents who took part in this
many patients repeatedly. Due to that, there is research.
no surprise, the study respondents, complaint
alot at several parts of their body. COMPETING INTERESTS

There is no conflict of interest.
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