Low Back Pain in Nurses BY: Shannon Grabe

Rational for chosen Topic My experience with low back pain associated with working in the home health environment.

Introduction Purpose Statement To see the effectiveness of stretching and exercise on the relief of lower back pain. What will be covered Evidence for Care Evaluation of evidence Patient care design Advocate role

Evidence for Care Nursing care problem Lower back pain and the prevalence in Nurses Stretching exercises Exercises to decrease back pain Research article was a clinical trail done on nurses in Tiawan with lower back pain

Theory Related to Article

Evaluation of Evidence Study Methods: Randomized clinical trail conducted at two regional hospitals. 127 nurses 63 in the control group, 64 in the experimental group. The experimental group agreed to 50 min 3 times a week of stretching exercise program. Results: 81% in the experimental group reported high level of low back pain relief 78% in the experimental group reported moderate low back pain relief

Evaluation of Evidence Credibility :Limitation: AuthorsApplicability JournalParticipants Peer reviewed level

TRUEPIC 1.IDENTIFY… the variables in this situation 45 y.o. Female Lack of exercise Stress Overweight High pain scale Lasted 2 weeks 2. RELATE… Or put the variables together to form propositions. Primary Proposition: Pt is c/o pain associated to strain muscles in lower back Possible Assumptions: Pt’s lack of exercise and poor back muscles, aware of importance of exercise Possible Confounding Variables: Overweight and stress and strain on back at work along with poor posture. 3. UNDERSTAND… the importance of the propositions, assumptions, and confounding variables. Proposition: If pain is not lowered pt will experience decreased mobility Significance of Assumptions: If pt is unaware of importance of exercise back pain could worsen Possible Confounding Variables: If pt does not lose weight and lower stress low back problems could worsen Situation: Mrs. Jones a 45 y.o female nurse comes in complaining of pain at a 6 out of 10 on the pain scale in her back. She is 50 lbs overweight, works 12 hours shifts in the ICU where she is on her feet for extended periods of time. Her gait is uneven and slow. She states “she has a lot of stress at work and rarely finds the time to exercise”. A back x-ray and MRI are done with negative results. No c/o radiating pain, negative straight leg test. The nurse is a 23 yo BSN prepared RN with two years ortho experience. Situation: Mrs. Jones a 45 y.o. female nurse comes in complaining of pain at a 6 out of 10 on the pain scale in her back. She is 50 lbs overweight, works 12 hours shifts in the ICU where she is on her feet for extended periods of time. Her gait is uneven and slow. She states “she has a lot of stress at work and rarely finds the time to exercise”. A back x-ray and MRI are done with negative results. No complaints of radiating pain, negative straight leg test. The nurse is a 23 y.o. BSN prepared RN with two years ortho experience.

4. EXPLAIN… the significance of the situation to those involved based on their individual KSVME Proposition: Explain options such as medication, heat, exercise and rest to decrease back pain Assumptions: Confounding Explain benefits of weight bearing exercises and stretching to lower back pain Variables: Explain how weight loss, good posture when standing and stress management will improve lower back pain 5. PREDICT… what will happen in this situation if one or more variables are not changed. Proposition: Pt’s back will back will increase and possibly cause more permanent damage Assumptions: Pt will continue to experience lower back pain that could become chronic if exercise is not increased Confounding Variables: Other illnesses or injuries could occur related to weight and stess 6. INFLUENCE… someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one. Proposition: Be sure pt understands management of lower back pain and ways to decrease pain Assumptions: Pt will understand the importance of exercise and stretching to improve lower back pain Confounding Variables: Influence pt by providing weight loss support and education along with stress management techniques 7. CONTROL… one or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isn’t an issue of wanting to dominate or do what is unreasonable or unwanted, but simply a matter of changing one or more variables in order to bring about a desired outcome when influence is not possible, realistic, or advisable. Pt will perform stretching and weight bearing exercises Pt will rest when necessary Pt will take anti-inflammatory medication Pt will illustrate proper posture

Collaboration Doctors Dietician Physical Therapy Mental health professional

ADVOCATE ROLE Nurses Advocating for Nurses

Patient Support Health promotion Self care Stress management Weight loss

References Huei-Mein, C., Hsiu-Hung, W., Chung-Hey, C., & Hsou-Mei, H.(2014). Effectiveness of a stretching exercise program on low back pain and exercise self-efficiency among nurses in Taiwan: A randomized clinical trial. Pain Management Nursing, 15, Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H.,(2010) Medical Surgical Nursing (12 th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamental’s of nursing: the art and science of nursing care (7th ed.). 19. Philadelphia, PA: Lippincott Williams & Wilkins. Yoder-Wise, P. S. (2014). Leading and management in nursing (5th ed.). St. Louis, MO: Elsevier Mosby.