Prior depression and incident back pain among military registered nurses: A retrospective cohort study.

BACKGROUND: Occupational back pain rates are substantial among registered nurses, and nurses also report high rates of depression. The role of depression as a potential predictor of back pain among nurses appears understudied. OBJECTIVES: The objective of the study was to determine whether a history of depression predicted incident back pain in a population of military registered nurses when controlling for relevant risk factors. DESIGN: We employed a retrospective cohort approach using longitudinal data in which gender-specific subject groups were followed from the beginning of duty as a registered nurse to the occurrence of an outcome, or to censoring due to completion of service or the end of available data. PARTICIPANTS: This study included all United States Army registered nurses who began work during 2011-2014 without evidence of prior back pain in clinical records. METHODS: Data from automatically-collected medical and administrative sources were combined and used to provide 2134 person-years of observation on 1248 individuals. These data were organized at the person-month level in a panel data structure to support discrete-time multivariable logistic regression models. The models examined the relationships between prior depression, Body Mass Index, the presence of prior combat duty and selected control variables and the outcome, the incident occurrence of back pain. RESULTS: The incidence rate of back pain was 18.6 per 100 person-years and the period prevalence was 31.7%. Prior depression was a statistically-significant predictor of incident back pain among female subjects (odds ratio [OR]: 1.75, 95% confidence interval [CI]: 1.08-2.83, P-value<0.05). Body Mass Index of 30kg/m2 or greater, prior combat deployments, and age 36 years or older was each associated with back pain for male and female nurses. CONCLUSIONS: The study's findings provide the first evidence of a temporal link between antecedent depression and later back pain among female military nurses. High Body Mass Index was found to be a further, modifiable risk factor for back pain in this population.

Low Back Pain in Student Nurses: Literature Review and Prospective Cohort Study.

There is consensus that registered nurses worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Patient handling activities such as lifting present the highest risk of injury, activities that begin in nursing school. A literature review identified 21 studies of back pain in nursing students, indicating a wide range of prevalence rates. A prospective cohort study of nursing students in a United States baccalaureate program followed 119 students who completed the Nordic Musculoskeletal Questionnaire upon beginning the 16 month upper division major and then a year later. There was no statistically significant change in low back pain prevalence over time. While nursing students have intermittent and brief exposure to patient handling activities, nursing schools must nevertheless protect them before they enter the high risk profession of nursing by teaching evidence-based safe patient handling techniques, empowering students to refuse unsafe manual lifts, and ensuring that the clinical settings with which they affiliate have adequate mechanical equipment available.

Implementation of Health Information Technology in Routine Care for Fibromyalgia: Pilot Study.

Fibromyalgia management remains complicated and challenging. Health information technology is an evidence-based, nonpharmacological self and symptom management strategy, but few studies have evaluated its feasibility for managing fibromyalgia patients in clinical practice. FibroGuide is an example of an evidence-based, interactive, and computer-based program comprised of 10 educational modules on fibromyalgia. Study aims were to: (1) develop a process for implementing FibroGuide into the routine care of patients with fibromyalgia, (2) evaluate the overall impact on fibromyalgia before and after a 12-week implementation, and (3) assess patient perspectives on using FibroGuide health information technology to assist in self-management. In this pilot study, 35 participants with fibromyalgia were recruited from an Advanced Practice Registered Nurse's outpatient clinic. Using a descriptive design, quantitative data analysis was employed to address study aims. Based on data collection pre- and post-intervention using paired samples testing, a statistically significant change (p = .017) was observed in overall fibromyalgia impact (improved symptom severity, activity, and function). Majority felt that FibroGuide was helpful as part of their routine care, and nearly half reported that it assisted in their self-management. Although 65% noted that technology was an effective and efficient way to receive education for fibromyalgia management, 57% preferred talking to healthcare providers. Larger longitudinal studies are needed on the use of health information technology in fibromyalgia, evaluating both statistical and clinical significance, while decreasing barriers to participant use for this promising adjunct to clinical management. Providers need to be well educated on supporting self-management strategies and health information technology.

The relationship among playground areas and physical activity levels in children.

INTRODUCTION: Almost 20% of American children aged 6 to 11 years are obese. A decrease in physical activity has been associated with an increase in obesity. The school environment is one place where many children can be reached. This cross-sectional study determined which types of playground areas attract children and promote moderate to vigorous physical activity (MVPA) or sedentarism. METHOD: Children on two urban elementary school playgrounds (one of which offered a jogging program called Jog and Walk Stars [JAWS]) were observed before school with use of the System for Observing Play and Leisure Activity in Youth and System for Observing Play and Recreation in Communities observational tools. Descriptive statistics, paired-samples t tests, and independent-samples t tests were used to analyze the data. RESULTS: The highest populated areas for schools K and B on non-JAWS days were the general blacktop areas; however, approximately 50% of the children in these areas were sedentary. At school B on days when the JAWS program was offered, the highest populated area was the JAWS track, and 99% of those children participated in MVPA. There was a significant difference in counts for average total sedentary children per square foot between school K (M = 216.70) and school B on JAWS days: M = 80.38, t (22.02) = 2.24, p < .5, two-tailed. DISCUSSION: A playground environment assessment to identify areas that promote MVPA, such as offering a JAWS program, may be one avenue to address the need for increasing MVPA levels in children in general, in addition to physical education class, and help them obtain the recommended 60 minutes of daily MVPA.

Effectiveness of a poverty simulation in Second Life®: changing nursing student attitudes toward poor people.

Social justice is a fundamental value of the nursing profession, challenging educators to instill this professional value when caring for the poor. This randomized controlled trial examined whether an interactive virtual poverty simulation created in Second Life® would improve nursing students' empathy with and attributions for people living in poverty, compared to a self-study module. We created a multi-user virtual environment populated with families and individual avatars that represented the demographics contributing to poverty and vulnerability. Participants (N = 51 baccalaureate nursing students) were randomly assigned to either Intervention or Control groups and completed the modified Attitudes toward Poverty Scale pre- and post-intervention. The 2.5-hour simulation was delivered three times over a 1-year period to students in successive community health nursing classes. The investigators conducted post-simulation debriefings following a script. While participants in the virtual poverty simulation developed significantly more favorable attitudes on five questions than the Control group, the total scores did not differ significantly. Whereas students readily learned how to navigate inside Second Life®, faculty facilitators required periodic coaching and guidance to be competent. While poverty simulations, whether virtual or face-to-face, have some ability to transform nursing student attitudes, faculty must incorporate social justice concepts throughout the curriculum to produce lasting change.

Hispanic construction workers and assertiveness training.

BACKGROUND: Hispanic (Latino) construction workers experience disparities in occupational death and injury rates in the United States. The cultural value of respect for those in authority may hinder these workers from requesting safe working conditions from supervisors. OBJECTIVE: To evaluate whether Hispanic construction workers in Las Vegas, Nevada found assertiveness training more useful than non-Hispanic trainees and whether or not they practiced this behavior at work after the training. METHODS: An assertiveness training simulation was part of fall prevention classes offered to area construction workers. Eight weeks after the training, participants were interviewed by telephone about class topics they found most useful and whether or not they had made any subsequent behavior changes at work. RESULTS: More than half of the 760 fall prevention trainees completed telephone interviews. A smaller proportion of Hispanic trainees found assertiveness training to be useful (11%) than non-Hispanics (28%) (p⩽ 0.001). Only 2% of both groups identified practicing assertiveness at work. CONCLUSIONS: A large proportion of Hispanic trainees valued other knowledge more highly. They may weigh job security as more important than speaking up about safety issues, which might threaten their employment. Interventions to improve safety should focus instead on improving work safety climate and engineering controls.

Social marketing to plan a fall prevention program for Latino construction workers.

BACKGROUND: Latino construction workers experience disparities in occupational death and injury rates. The Occupational Safety and Health Administration funded a fall prevention training program at the University of Nevada, Las Vegas in response to sharp increases in fall-related accidents from 2005 to 2007. The grant's purpose was to improve fall protection for construction workers, with a focus on Latinos. This study assessed the effectiveness of social marketing for increasing fall prevention behaviors. METHODS: A multi-disciplinary team used a social marketing approach to plan the program. We conducted same day class evaluations and follow-up interviews 8 weeks later. RESULTS: The classes met trainee needs as evidenced by class evaluations and increased safety behaviors. However, Spanish-speaking Latinos did not attend in the same proportion as their representation in the Las Vegas population. CONCLUSIONS: A social marketing approach to planning was helpful to customize the training to Latino worker needs. However, due to the limitations of behavior change strategies, future programs should target employers and their obligation to provide safer workplaces.

Latino worker perceptions of construction risks.

BACKGROUND: Construction is a hazardous occupation, with Latino (Hispanic) workers at a greater risk for death than other ethnicities/races. Latinos accounted for over half of construction injuries involving days away from work in Nevada in 2006. METHODS: This study recruited 30 Latino construction workers from three Southern Nevada trade unions to participate in four focus groups conducted in Spanish to determine their perceived risks for injury. Audiotapes were transcribed into English transcripts, which were analyzed for themes. RESULTS: Themes included language/communication difficulties, traditional Latino values, construction trade skill level differences, and health literacy. Participants were unfamiliar with the workers' compensation system. CONCLUSIONS: Small contractors in particular should provide more effective safety training in Spanish and appropriate safety equipment. Unions should offer English language training using simulation and more information about workers' compensation rights. Occupational health providers should consider Latino beliefs and communication needs when assessing health status or providing care.

Nursing's leadership in positioning human health at the core of urban sustainability.

The United Nations predicts that by 2050 nearly three fourths of the world's population will live in urban areas, including cities. People are attracted to cities because these urban areas offer diverse opportunities, including the availability of goods and services and a higher quality of life. Cities, however, may not be sustainable with this population boom. To address sustainability, urban developers and engineers are building green structures, and businesses are creating products that are safe for the environment. Additionally, efforts are needed to place human health at the core of urban sustainability. Without human health, cities will not survive for future generations. Nursing is the discipline that can place human health in this position. Nursing's initiatives throughout history are efforts of sustainability-improving human health within the physical, economic, and social environments. Therefore, nursing must take a leadership role to ensure that human health is at the core of urban sustainability.

Patient satisfaction with nurse practitioner and physician services in the occupational health setting.

The purpose of this research was to determine if patient satisfaction differed when clinical services were provided by nurse practitioners versus physicians in the occupational health setting. This convenience sample included 129 patients visiting community-based occupational medicine clinics for evaluation of a new work-related injury. There was high satisfaction with both nurse practitioner and physician providers. There was no significant difference in overall patient satisfaction between provider types. Results of this study support a practice model using nurse practitioners as primary providers in the occupational health setting.

Underreporting of musculoskeletal disorders among health care workers: research needs.

Extensive evidence suggests that the numbers of workplace injuries and illnesses reported annually by the U.S. Department of Labor, Bureau of Labor Statistics, are underestimated for all private employers. Several states have passed safe patient handling legislation to reduce work-related musculoskeletal disorders (WMSDs) among health care workers. Research is needed to improve accurate reporting of these types of injuries to allow assessment of the effectiveness of this legislation and to enable hospitals and nursing homes to better target interventions to areas at high risk for WMSDs. In the interim, occupational health nurses and the American Association of Occupational Health Nurses, Inc., can assist in improving the accuracy of occupational surveillance for these work-related injuries.

Psychosocial factors in musculoskeletal disorders.

Work-related musculoskeletal disorders (MSD) have a multifactorial etiology that includes not only physical stressors but also psychosocial risk factors, such as job strain, social support at work, and job dissatisfaction. Once an injury has occurred, psychosocial factors, such as depression and maladaptive pain responses, are pivotal in the transition from acute to chronic pain and the development of disability. Interventions to prevent MSD incidence and address psychosocial risk factors for delayed recovery are described.

Ergonomic assessment of a critical care unit.

Although direct patient care providers in all settings suffer musculoskeletal injuries at unacceptable rates, high-risk tasks in nursing homes are the most frequently researched. Less is known about the high-risk tasks performed by critical care nurses. To identify the tasks in critical care that differ from those in nursing homes, this qualitative study used the Ergonomic Workplace Assessment Protocol for Patient Care Environments to assess a medical ICU. Results and recommendations for change are presented.

Preventing musculoskeletal disorders in nurses: a safe patient handling curriculum module for nursing schools.

Nursing educators who teach outmoded manual patient handling techniques contribute to the widespread problem of musculoskeletal disorders in student and practicing nurses. The authors discuss the development and implementation of a new safe patient handling curriculum module, which was pilot tested in 26 nursing programs. The module changes the focus of patient handling education from body mechanics to equipment-assisted safe patient lifting programs that have been shown to protect nurses from injury and improve care.

Effectiveness of an evidence-based curriculum module in nursing schools targeting safe patient handling and movement.

Nursing schools in the United States have not been teaching evidence-based practices for safe patient handling, putting their graduates at risk for musculoskeletal disorders (MSDs). The specific aim of this study was to translate research related to safe patient handling into the curricula of nursing schools and evaluate the impact on nurse educators and students' intentions to use safe patient handling techniques. Nurse educators at 26 nursing schools received curricular materials and training; nursing students received the evidence-based curriculum module. There were three control sites. Questionnaires were used to collect data on knowledge, attitudes, and beliefs about safe patient handling for both nurse educators and students, pre- and post-training. In this study, we found that nurse educator and student knowledge improved significantly at intervention schools, as did intention to use mechanical lifting devices in the near future. We concluded that the curriculum module is ready for wide dissemination across nursing schools to reduce the risk of MSDs among nurses.