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Questionnaire on low back pain among nurses and its impact on their job

Form no:

Date of interview:

Part I: Socio-demographic Information

1. 2. 3. 4. 5. 6. 7. Age of the respondent (in years): Height: cm Weight: . in kg BMI: weight/(ht)2 = kg/m2 Current department of work: .. Year of experience: in years Marital status: a) Unmarried b) Married c) Divorced/ separated/widow 8. Do you smoke? a) Never b) Sometime c) Often d) Always 9. Do you involve yourself in regular exercise? a) Yes b) No 9.1. How often do you engage yourself in exercise?......min..times/week 9.2. What type of exercise do you perform? a) Jogging b) Yoga c) Range of motion exercise d) Others

Part II: Information regarding Work History

10. How many hours do you work in a shift normally? a) 6 hrs b) 8hrs c) 12 hrs d) More than 12 hrs e) Others (specify). 11. How many patient do you normally care in one shift? a) 1-10 b) 11-20 c) 21-30 d) More than 30 12. How often do you perform the following task in a shift? Task Never Sometimes Moving and lifting of heavy equipments Moving patients to different position Assisting in ambulation Receiving emergency patients Doing CPR Bed making Lifting and transferring patients Medication Dressing 12.1. Indicate the level of exertion for the task above Task Moving and lifting of heavy equipments Moving patient to different positions Assisting in ambulation Receiving emergency patients Doing CPR Bed making Lifting and transferring patient Medication Dressing Light Normal Heavy



13. Does your task require following activities: Activities Standing for longer period Sitting for longer period Squatting/kneeling for longer period Pushing and pulling heavy loads Working in awkward posture Working in same position for longer period Lifting with twisted and bent trunk Making sudden movements Never Sometime Often Always

14. In a shift how much times do you spent for following activities:Activities Prolonged standing Prolonged sitting Squatting/kneeling Pushing pulling heavy load Working in awkward posture Working in same position Lifting with twisted and bend trunk Making sudden movements Time spend

15. Do you ask for help when attempting to lift, transfer or reposition patient? a) Yes b) No

15.1 Who does usually help you? a) b) c) d) Colleagues Seniors Patient party Others (specify)

16. Are mechanical lifts available and easy to find for moving patient in your hospital? a) Yes b) No

17. Have you been trained on how and when to use a mechanical lift by your supervisor? a) Yes b) No 18. Have you been trained in safe lifting techniques or good body mechanics in the past?

19. Are you satisfied with colleagues supervisor your work place your work 1 2 3 4

1=always satisfied 2=frequently satisfied 3=occasionally satisfied 4=never satisfied

Part III: Information regarding Low Back Pain

20. Have you at any time during the last 6 month had pain at your lower back? a) Yes b) No

20.1How often have you had separate spells of low back pain in last 6 months? a) b) c) d) e) 20.2 Always Once a week Once a month More than once a month Others (specify) For how long did you suffered from low back pain? days

21. Is your low back pain associated with your nursing job? a) Yes b) No 22. When did you last suffered from low back pain?...............days ago 23. Is your back pain associated with any injury or medical/surgical problems? a) Yes b) No

23.1. If yes what was it? Specify the type of injury or medical condition ..

23.2. Is your injury occurred during your shift duty? If yes, please specify 24. What factors are responsible for increasing your low back pain? a) Prolonged standing b) Lifting patient c) Awkward posture d) Frequent bending and twisting e) Others (specify)

25. What factors are responsible for relieving your low back pain? a) Taking rest b) Doing exercise c) Taking medicines d) Others (specify).. 26. In your opinion, what are the main causes of low back pain among nurses? a) Heavy physical workload b) Awkward posture c) Frequent bending and twisting d) Prolonged standing lifting heavy load e) Others (specify).

Part IV: Information regarding Effects of Low Back Pain

27. During the past 6 months have your back pain interfered your work? a) Always interfere my work b) Frequently interfere my work c) Occasionally interfere my work d) Never interfere my work 27.1 How the low back pain has interfered your work? 28. Have you been absent from your work because of low back pain During the past 6 months? a) Yes b) No 28.1 How many days of work have you missed because of pain during the past 6 months? .

29. In what way your low back pain has affected your work? a) I could not perform my job properly b) It has decreased my organizational commitment c) Ive become less productive and creative d) Has decrease the quality of care to patients e) Increased work restriction f) Poor interpersonal relation with patient g) Others (specify)..

30. Would you like to suggest some measures to reduce low back pain among nurses? Suggestions.