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COVER absenteeism of nurses in hospitals due





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To decrease absenteeism of nurses in hospitals due to
musculoskeletal pain  by providing new
mechanical techniques ,providing knowledge regarding prevention of
musculoskeletal disorders to nurses and nursing students.


Nurses provide care for bedridden patients like assisting
them in with their activities of daily living like bathing ,feeding and repositioning
etc.Patient handling tasks such as lifting, transferring and repositioning
aresome of the major risk factors for musculoskeletal disorders particularly
the back being the most prominent.

Approximately £14.9 billion is invested by NHS for
caregivers(nurses) and nursing student suffering from musculoskeletal
disorders. work related musculoskeletal disorders are divided into specific and
recognized body regions of back, extremities and other regions of body parts.

Musculoskeltal disorders majorly affect muscles ,joints
and tendons in all body parts.work related musculoskeltal disorders develop on
a time period.it can be acute or chronic and can also result from injury
sustained in work related accidents.it starts from mild and then goes on to
severe disorders.such disorders are mostly dangerous to life but they adhere in
daily activities of living of an individual causing other stress and
complications.such disorders can develop in any occupational setting due to strenuous
physical activities and leading to musculoskeletal disorders.



The use of mechanical equipments are mostly used in this
developing country rather than physical use.neverthe less the prevalance of musculoskeletal
disorders and most probably back problems remain in higher range(Van Dieen and
Oude Vrielink 1998).In Great Britain(1995) almost 1,55,000 people were
suffering from musculoskeletal disorders due to work pressure and approximately
5% of one individual were suffering from more than one musculoskeletal disorder
condition.        ( jones et al 1998)

Musculoskeletal disorders actually includes a wide range
of other symptoms which includes tendosn,ligaments,nerves. Some individuals
have an acute effect while some has chronic effect in their day tot day
life.the pathophysiology and the risk factors are understood from some of the
disesase condition.back pain is very common and sometimes it is
misinterpretated with musculoskeletal disorder.back pain can be caused due to
several other reasons as well.

Despite using new mechanical technique like hoist,wheelchair
etc nurses still have to face  many other
musculoskeletal disorders not only physical but also psychological stress.conducting
epidimiological studies is very much essential to know the actual
muscloskeletal problem.

The aim is to investigate and evaluate the actual cause
of musculoskeletal disorder and the analysis to be used for betterment of  future of not only health care professionals
but also other occupations which include strenuous activities ,long time
standing etc.





Questionnaire were used for this purpose of study. Questionnaire
is a type of data collection in which questions are typed or printed  in a definite order.the questionnaire
consisted of four sections and had 45 question.There was also an extra supplement
attached so that they could elaborate their experience in it.the questionnaire

Personal data(age,weight ,height)

Characteristic of their job.

Any signs and symptoms of musculoskeletal

About job satisfaction.



Totally 5029 questionnaire
were distributed to nurses from 7 different hospitals irrespective of whether
they are suffering from musculoskeletal disorder.questionnaire were distributed
to these hospitals via post and handed over to the supretendent of the
hospitals and the nurses had to submit their completed forms.submitted forms
were totally confidential so it was not possible to follow up to those


  In this study
confidentiality was maintained within the participants.ethical issue                       was considered as it deals with the disease
condition. All higher authorities were informed and thus this study was


   There was no such limitation seen in this
study.participation of nurses were less as compared to sample prepared.the
study was time consuming as it took 20 month to actually collect and analyze
the data.






No significant difference
was seen in this study as the percentage of males and females in nursing
group.no significant differences between ages of nurses.the height and weight
both differed significantly.male nurses tended to be talle and concentrated
within 55-75kg category while as female nurses were shorter and had a wide
range of body mass.

The annual prevalence of
musculoskeletal disorders of various locations for nurses combined 49%.almost
half of the sample (42.2%) who had suffered symptoms in the past year were
therefore exhibiting symptoms at the time of the questionnaire.


1.    Current findings

Increased absentism:Increased
absentism was a major findings seen due to musculoskeletal pain which was faced
by nurses.

workload:Due to staff shortage nurses are overburdened with various tasks which
also include physical task leading to musculoskeletal pain.

Increase backpain:
nurses doing strenuous activities like manual lifting, positioning,making an
occupied bed etc leads to back pain.

Lack of effective
training :improper training leads to improper use of techniques.

2.    Service improvement

In the
above mentioned issues faced by nurses which are very common can be improved if
all participants take initiative by improving their skills in body mechanics
and also hospitals providing proper guidelines and methods to improve them.The
amount and severity of injuries due to increase in physical demands of patients
and its cost can be reduced. providing an alternative to manual lifting of
patients is the primary goal of the ergonomics process in hospitals setting and
of these guidelines . OSHA recommends alternative use for manual lifting and to
eliminate it wen feasible.it also recommends to incorporate this manual in
overall process an to recognise and prevent ocuupational safety and health

this change is very much required for future nurses ther is a strong need for
change and pressure to the management in creating a positive change by
influencing the employees to accept the change and to implement them in their day
to day activities.acoording to Wittig(2012) this may require promoting it with
good communication skills ,management support and with proper leader.In simple
terms a good leader is reqired here to promote this change.Ajmal et al (2013)
has an opinion that change is aprocess which can be effectively implemented
with a good leadership qualities.in most of the cases leaders are the one who
bring the change and it is the leader who builds trust with the employee aand
such influential process leads to successfull change process.

Hence the
sevice improvement in this study implies only on to the participation of nurses
,managers and other higher subordinates who can implement these changes and make
this change permanent also for future betterment .such change can not only
benefit the nurses but also the other occupation who also deal with strenuous physical
activities and has suffered musculoskeletal disorders.this requires planning
from yhe management perspectives.


Improvent,use of
technology,changes in system are currently seen as an integral part of the NHS
and nurses play the vital role in delivery of healthcare (DOH 2004) With the implementation
of clinical governanace many NHS trust are examining and evaluating the
standard of care by implementing new initiatives and by maintaining the quality
of care.

The main goal is to discuss
and explore the initiatives by implementing the change in a clinical area of an
NHS trust..the proposed  change includes
orienting the staff with the new equipments ,training them with the use of
machineries, letting out the manuals to each ward and conducting training
sessions ,use of body mechanics and also the beneficial treatment available in
the hospitals for the staffs already suffering from musculoskeletal disorders.

Musculoskeletal networks of care is a partnership between NHS England
and the arthritis and musculoskeletal alliance (ARMA). These networks help to
foster the relationship  between care
sectors and the third paty and helps in giving the best possible care.the
medical system in UK recognises the importance of leadership in healthcare.to
understand the oragnisation as a whole there should be a strong understanding  between appropriate culture,work
conditions,organisational caharacteristic and the role of leadership and its
role in facilitating effective teamwork. 

NHS has develop a healthcare leadership model:





This model doesn’t highlight on personal qualities, but will help to
manage oneself behaviour and will help to relate to people.

The heathcare leadership model is made up of nine leaderhip dimensions
and are as follows:

a.    Inspiring shared purpose:It is valuing of
ethics and to be curious about how to improve services and patient care.in this
leaders create a shared value or opinion in an unique individual so that the
care ahs been delivered to patients,family and community.it is essential to
stay true to NHS values and principle,to take personal ris to stand up for the
right,and to be courageous to accept the challenges.

b.    Leading with care:to understand the need of a
team and provide a caring and safe environment to help to do their job
effectively.helping to understand theri emotional needs and to help them to
come over it.

c.    Evaluating information:to use available information
for make effective plan to make improvement in change.to meet the needs of all
service users and to respect the different perspectives.to keep oneself
updated  on how to develop proposals for
improvement.this helps in gathering data ,scanning it appropriately and
developing new concepts by thinking creatively.

d.    Connecting our services:to understand how
health and social care is interconnected and how different group of people
,organizations connect and interact.leaders understand how different group of people  and organization work ,they try to evaluate
and implement their goals,culture so they can make relationship and better
connections with other organisations.understandingand adapting the culture and
political requirement in other group organization.

e.    Sharing the vision:communicating and conveying
in a clear and honest picture of the work so that they inspire work and help
others to see how they fit in that work.communication helps in credibility and
gaining trut and to make long term goals.it helps in creating clear direction
and to inspire confidence for future plans.

f.     Engaging the team:Involving the teammates and
valuing their skills and knowledge into their project will help the individual
to work in more enthusiasm and will try to put more efforts in it.this helps to
create a healthy environment within the company.involving teams helps in
cooperating to raise the standards and bar,fostering creative participants and
stretching their excellence and innovations.

g.    Holding to account:leaders should create a
clarification of what they actually want and what does success look like in
order to make them in focus on their goal with bit of freedom to self manage
their demands and thus to improve quality of care.setting a clear mindset,challenging
for continous improvement and innovating changes.

h.    Developing capability:using a range of
experiences and capability of the employee ,acting as a role model for personal
development.they need to meet the future goals,develop their own potential and
learn both from success and failure.helping to provide opportunities for better
development,building long term capabilities.

i.      Influencing for results:deciding how to
collaborate and have appositive impact on people by building healthy relationship,building
and using interpersonal skills to persuade and build collaboration.adapting
approach to connect with diverse groups.building positive commitments.

However not all skills will be considered in making preventions for
musculoskeletal disorders in  nurses but
deals with the best method that can be deployed in other managerial approach.

Change in culture and people can be effectively changed by an effective
leader(Dinwoodie et al ,2016).Organizational changd has been brought out
successfully by possessing skills in change management .

Evaluating the findings that the employees are very much keen to
introduce such change but the drawbacks seen were that there were so many
experienced senior nurses who already suffered from musculoskeletal disorders and
they were not interested in learning new technological techniques which lead
todemotivation of other new staffs and so therefore transformational models
were suggested.



The one who can impress and act upon a group of people and behave
according to his/her objectives is a leader.The application of both knowledge
and skills is enhanced by a leader.

An individual who influences a group of individuals to achieve a common
goal is a leadership process(Northouse’s,2007)the process leadership
application of a leader can be explained through  its ability and skills (Jago 1982)

Leadership qualities which are essential for effective leader(Martin Webster)

Ø  Appreciative:a leader should be appreciative
towards it subordinates which helps the subordinates to be more enthusiastic
and put on more efforts for completing the work.

Ø  Confident: confidence is the major key or a leadership.this
quality enhances the beayty of a leader and also the work is done on time if
the leader is stern on his objectives.

Ø  Compassionate:leader should be compassionate towards
their subordinates and empathize towards their emotional needs.

Ø  Courageous :being courageous is another
important quality of a leader.to take up challenges and  to fullfill its given objectives is

Ø  Diligent:a diligent leader is always a good
leader.diligent towards subordinates helps the subordinates to maintain trust
and do work efficiently.

Ø  Fair: a leader should be fair among all the
workers and should not consider to be impartial at any time.

Ø  Flexible: a leader should be flexible and approachable.he
should consider his subordinates as his priority wherever possible.

Ø  Honest:being honest as a leader helps the
subordinates to maintain a trust and create a healthy bond between them.

Ø  Responsive: a leader should be active and
should be responsive.

The leadership process
contains five essential elements(Dr.Roger K Allen)

leadership orientation and commitment:this is
a one two days orientation sessions in which high performance is met by the
leaders.in this process they will learn about the change in high performance
and gain trust within the organization.

Assessment of the business and organisation:in
this they summarize key issue to address and identify strenghth and weaknesses
and alignment issues.

Development of strategy and vision:in this
step they understand the current business environment ,foecast the future  situation and creat long term plan.

Chartering the change process:in this step
they assign the work to delegated group of people ,establish a time frame and
evaluating it.

Integrated management of business performance:In
this the organisation make a key element and evaluate the result and discuss
their pros and cons.



Change is very common and constant.it runs through all
the business regardless of size,industry and age.the change is significant and this
change can lead to many other complications.as our world is changing and
developing new technology and skills in developing country.our world is
changing and so the organization needs to change and develop into new modern
ways.organization who deal with the change well survive and other organization  who don’t accept this change have to struggle
to survive.

Change management concept is very much common and
familiar in most of the businesses today but this change has  been managed by various organizations nd from
which they are surviving and those who arenot able to accept this change has to
suffer alott with various differences.the change process management has to
familiar so that the people involved in it should understand and implement it .

One of the models for understanding the organizational change
was evaluated by Kurt Lewin back in the 1940s and still holds at a very first
position.the name .the name of his  model
is known as Unfreeze-change-refreeze,which refers to change process which he
decribed in easy terms.this change management model remains widely used today
by all the major sector as it is the most easiest change management tool that
can be used.to

To start any succesfull changing methodology the
organization should understand why the change has to be done . before change
can occur motivation for change should be initiated,many cherished assumptions
should be re-examined about oneself and ones relation to other.this is the
unfreezing stage where change begins.

Understanding Lewin’s change
management model:



This is the first step in the Lewin’s change management
model .it involves to make the organization understand about the need of change
and why we need this change.for this we have to breakup the old protocol or the
ancient protocol to put up a new protocol and make sure that the organization
accepts it.

The major key to this is to make subordinates understand
why we have to accept the change and why we should change the oldest protocol
and modernize it.we can do this by conducting a meeting and showing a
presentation on how our standards are lowering down due to increase absentism
in nursing,increase workload due to staff shortage and increase of back pain in

To actually start with this we have to actually change
the belief ,attitude and pressurise the management in an accepted way so that
they can accept this change as this change can not only benefit the nurses but
also other occupations who deal with manual patient handling like
physiotherapist,health care assistants ,doctors etc.

Always the first part of change model is always risky and
stressfull as we have to handle the higher authority that is chief executive
officer,chief finanace officer,head of finance and contracting,head of communicationand
engagement department,head of quality and safety,governance and corporate
affairssenior manager etc.

A crisis is been created if we effectively force the
organization to re eexamine its core.a new equilibrium can be motivated tto
build a strong goal.without this type of motivation we cannot get in the
participation to bring out the change.


This is the second step in
the Lewin’s change management model.it involves to remove the insecurity from
the unfreeze stage and to develop new techniques which should be included to
remove the old protocol.new directions has to be made to make the people
believe in this change and to actually work on it.

the modification or the
changeover does not happen overnight.people take time to incorporate such
change and participate by taking initiative or by being proactive.this change
model actually initiates in making changes by actually making use of new
mechanical techniques and showing them the pros and cons of using this
machinery instead of mnual handling.manual handling not only causes musculoskeletal
disorders but also is time consuming,dangerous to patients as it will be the
reason for patients fall.

In order to get a positive
response andto contribute to accomplishment people has to understand how it
will promote well being of the health care professionals.

To make sure that the
participation for this revolutionization is perfect make sure that the given reasons
and the benefits is actually understood by the higher authorities.for this
communication and time management is the only key.communicating through out the
process and gaining their trust,describe them the benefits of using high-tech machineries
like hoists,remote control beds,wheelchairs,etc rather than making humans to
slog and create differences.answer them correctly,openly and honestly.make sure
that the employees participation is active.to generate short term wins to
generate reinforcement.negotiating with the external stakeholders  and making sure that the change has been


Refreeze is the third and the final step of Lewin’s change
management model.organization gets ready to refreeze when the changes done are
taking shape and people have started accepting it.for this we have to identify
what are the beneficiaries who are supporting the change and also need to
identify the barriers who are not able to sutain the change.all the staff should
be given training regarding the use of machineries and when using it
supervision should be done.communicate with the staffs and ask for their
feedbacks.The training of staffs should be done every week till they are well
versed with their use and continous supervision.

Lewins change management model is a very straight
forward  and simple to use framework in
any management.These three distinct stages of change management will help to recognize
the reason of creating the major change.the motivation of change should be
created first  that is unfrreze.by
promoting effective communication and empowering people will help to promote the
change by implementing it that is change.aand when the stability is maintained
the process ends in here that is refreeze.





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