RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE KARNATAKA BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

JOSE PHILIPCITY COLLEGE OF NURSINGSHAKTHINAGARMANGALORE-575016

2. Name of the Institution CITY COLLEGE OF NURSINGSHAKTHINAGARMANGALORE-575016

3. Course of Study and Subject M. Sc. NURSINGMEDICAL SURGICAL NURSING

4. Date of Admission to the Course 4.6.2008

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5. Title of the study

EFFECTIVENESS OF VIDEO-ASSISTED PLANNED

TEACHING PROGRAMME ON PREVENTION OF WORK

RELATED MUSCULOSKELETAL DISORDERS (WMSDs)

AMONG EMPLOYEES OF SELECTED OFFICES AT

MANGALORE.

6. Brief resume of the intended work6.1 Introduction

Musculoskeletal system gives the body free movement and independent function. Disorders of the musculoskeletal system cause considerable morbidity that leads to decreased quality of life and often results in reduced life expectancy1.

Musculoskeletal disorders (MSDs) are a group of medical conditions that consist of an injury to the muscles, tendons, ligaments, joints, nerves, spinal discs, cartilages, blood vessels or related soft tissues that are caused or aggravated by physical tasks on that particular area2. The tasks that cause MSD can be performed anywhere including the home or office. However, the physical demands of the office are usually greater than those of the home. In fact, and the most MSDs are caused by office-related tasks. Since MSDs are caused by occupational tasks, these disorders are called work-related musculoskeletal disorders (WMSD)3.

Repetitive strain injury is a cumulative trauma disorder resulting from prolonged, forceful, or awkward movements. Repeated movements strain tendons, ligaments and muscles causing tiny tares that become inflamed. If the tissues are not given time to heal properly, scarring can occur. Blood vessels of the arms and hands may become constricted, depriving tissue of vital nutrients and causing accumulation of factors such as lactic acid. Without intervention, tendons and muscles can deteriorate and nerves can become hypersensitive. At this point even slight movement can cause pain4.

When we are performing tasks, we constantly put stress on our body. Small

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tares, strains and disorders develop in our tissues all the time. Usually they heal fairly quickly; this is the natural way our body functions. However, when the biomechanical stresses of the task outpace the ability to heal and repair itself damage can build up until an MSD results. WMSDs are MSDs caused by or made worse by the work environment2.

WMSDs can cause severe and debilitating symptoms such as pain, numbness and tingling, reduced work productivity, lost time from work, temporary or permanent disability, inability to perform job tasks, and an increase in workers’ compensation costs. Excessive stretching of muscles and tendons can cause injuries. Repeated stretching causing tissue inflammation can lead to long lasting injury or WMSDs2.

6.2 The need for the studyWork-related musculoskeletal disorders are a group of disorders. Almost all

work requires the use of the arms and hands. Therefore, the most WMSDs affect the hands, neck and shoulders. Work using the legs can lead to WMSDs of the legs, hip, ankles, and feet. Some problem also results from repetitive activities3.

The computer workstation has become common both at work and at home, and is now used routinely for many purposes, including data entry word processing, telecommunications, web browsing, designing and entertainment. Seating has become critical at the workplace, because a poorly designed workstation puts the user at risk for back, neck, shoulder, elbow, forearm, wrist and hand. Many computer operators type up to 60 words per minute for more than 6 hours a day. (i.e., more than 150,000 key strokes per day)5.

The National Institute for Occupational Safety and Health estimate that 15-20% of the workforce in the USA is at risk for developing WMSDs. The number of computer keyboard workers with WMSDs is as much as 12 times the number of non-keyboard users with WMSDs. Among keyboard users, the prevalence of WMSDs is as high as 60%5. According to US departments of Labour Bureau of Labour Statistics, (2003), more than 43, 51,000 cases of nonfatal MSDs occurred in the workplace6.

Worldwide 15-25% of all computer users are estimate to have WMSDs. By this, over 5 million Indian computer users may already be having WMSDs. A survey of 500 software professionals at Hyderabad revealed that over 50% had symptoms of WMSDs. Preliminary result of an ongoing prospective study among over 35,000 Indian computer professionals (2001-2008) found that over 75% reported musculoskeletal symptoms7.

Ergonomics is the scientific study of human beings in relation to their work and effective use of human energy. Most of the employees are not using appropriate ergonomics. This will lead to the development of musculoskeletal disorders. A cross-sectional study was conducted to assess the prevalence of occupational health

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problems in information technology professionals in New Delhi. The sample was selected through random sampling method. A pre-designed pre-tested semi-structured questionnaire was given to 200 IT professionals. The study findings revealed that computer-related morbidity was present in 93% of the study subjects. The visual problems were seen in 76% and musculoskeletal in 77.5%, while 35% felt stressful symptoms. This observation was found to be statistically significant (p<0.05). Females had more problems (96.7%) as compared to males (91.3%). The musculoskeletal problems were due to the study subjects using inappropriate ergonomics8.

The musculoskeletal disorders are more seen in females and people younger than thirty years of age. A cross-sectional study was conducted in Thailand to assess the prevalence of musculoskeletal symptoms among office workers. The data was collected from 1428 subjects from 54 workplaces through descriptive questionnaire. The study finding revealed that the prevalence of MSDs was 63%. Sites of symptoms in order of prevalence were head/neck (42%), low back (34%), upper back (28%), wrists/hands (20%), shoulder (16%), ankles/feet (13%), knees (12%), and elbows (5%). Female office workers had more symptoms than males (p<0.05).Office workers younger than 30 years were more likely to have symptoms

in the upper back than those older than 49 years (p<0.05). The study finding revealed that prevalence was also depending on gender and age. So we must develop specific strategies to reduce the occurrence of such symptoms among office workers9.

A study was conducted in Salem, Tamil Nadu to assess the effectiveness of video-assisted teaching module on improving the knowledge about ECG monitoring among staff nurses. The data was collected from 100 subjects through structured knowledge questionnaire. The result of the study revealed that the overall post-test knowledge score (36.34±2.09) was higher than the pre-test knowledge score (29.22±4.39). The difference in mean percentage score between pre- and post-test was around 48.30 which indicates that the video-assisted teaching module was effective in improving the knowledge of staff nurses10.

The investigator had come across many incidents in his five years of experience in nursing profession where many white collar employees were coming to the orthopaedic outpatient department with the complaints of back pain and neck pain. Many of the studies and experts identified that it is due to lack of exercise, awkward body postures, repeated work, poor knowledge about body mechanics and lack of break time between the works. Several studies have also proved that video-assisted teaching is more effective than lecturing. From these instincts the investigator was motivated and planned for doing awareness programme with the help of a video-assisted teaching material.

6.2 Review of literatureA study was conducted in Gujarat to assess the prevalence of musculoskeletal

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disorders in computer operators. The data was collected from 440 subjects through a structured questionnaire. The sample was selected through random sampling. The study findings revealed that the prevalence of musculoskeletal disorders was 75.2 % (n=419). Three-fourths of the subjects were young and working on computers for about 21 to 40 hours a week. This study revealed that there was significantly higher association between MSD and duration of computer use11.

A longitudinal cohort study was conducted in Netherlands to assess the prevalence of arm, neck, shoulder complaints among computer-using office workers at National Social Security Institution. The data was collected from 600 office workers through structured questionnaire. Random sampling method was used for sampling. The study finding revealed that from the response rate of 44% (n=264), 54% of the respondents had at least one complaint in the arm, neck, and shoulder. The neck symptoms were 33%, shoulder 31%, hand 11%, elbow 6%, and wrist 7%. The symptoms are more in females (61%) than males (39%). The correlation of MSD and workstation was 0.59, body posture ranged from 0.38 to 0.45, job control range from 0.28 to 0.51 and break time ranged from 0.39 to 0.60. The study results showed that neck and shoulder complaints are more than that of arm hand and elbow complaints12.

A cross-sectional study was conducted in Sudan to assess the prevalence of arm, neck and shoulder complaints among computer users in a telecommunication company and three banks. The data was collected from 282 subjects through a structured questionnaire. The study findings revealed that out of the 250 respondents 64% had neck complaints and 41% had shoulder complaints. The analysis of the result revealed that office equipment, computer position, head and body posture, awkward body posture, autonomy, quality of break time, skill discretion, decision authority, time pressure, task complexity, social support, and work flow were the contributing factors of MSD13.

An evaluatory study was conducted to determine the effectiveness of video-assisted teaching on prevention and management of accidents to mothers of children below five years of age in selected day care centre at Mangalore. Data was collected by structured knowledge questionnaire from 64 mothers having children below five years of age. The study results showed that the knowledge gained through video-assisted planned teaching programme was good as evident with a highly significant difference (t63=18.31, p<0.05) between the mean post-test (14.34) knowledge score. This study recommended that video-assisted planned teaching programme was found to be an effective strategy for providing information and for improving the knowledge of mothers14.

6.3 Statement of the problemEffectiveness of video-assisted planned teaching programme on prevention of

work related musculoskeletal disorders (WMSDs) among employees of selected offices at Mangalore.

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6.4 Objectives of the study1. To determine the level of knowledge of work related musculoskeletal

disorders among office employees before the administration of planned teaching programme through structured knowledge questionnaire.

2. To find the effectiveness of video-assisted teaching programme in terms of gain in knowledge scores.

3. To find the association with the pre-test knowledge scores and the selected

demographic variables.

6.5 Operational definitions1. Effectiveness: In this study the effectiveness refers to the extent to which the

video-assisted teaching programme has attained the desired gain in knowledge scores as measured by knowledge questionnaire.

2. Knowledge: In this study, knowledge refers to the scores obtained by the employees by giving correct responses to knowledge questionnaire.

3. Employees: In this study, employees are those who are spending minimum of four hours in a day using computers in sitting position.

4. Video-assisted teaching programme: In this study, video-assisted teaching programme refers to the systematically planned audiovisual teaching method on the prevention of work-related musculoskeletal disorders among office workers highly concentrating on the correct body mechanisms in the workplace, identifying the signs and symptoms, and the preventive measures of work-related musculoskeletal disorders.

5. Work-related musculoskeletal disorders (WMSDs): In this study WMSDs are, those disorders that consist of an injury to the muscles, tendons, ligaments, joints, nerves, spinal disc, cartilages and related soft tissue caused by occupational tasks like using computers.

6.6 AssumptionsThe study assumes that:

1. Office employees will be having some knowledge on WMSDs.

2. WMSDs are common among computer workers.

3. Video-assisted teaching is an effective method to improve the knowledge.

6.7 Delimitations

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Employees working in selected offices.

Employees who are present in the office at the time of data collection.

6.8 HypothesesThe hypotheses will be tested at 0.05 level of significance.

H1: The mean post-test knowledge scores of office employees on WMSDs will be significantly higher than their pre-test knowledge scores.

H2: There will be significant association with pre-test knowledge scores on WMSDs and the selected demographic variables.

7. Material and methods7.1 Source of data

In this study the data will be collected from employees working in the office in sitting position and operating computers in selected offices at Mangalore.

7.1.1 Research designPre-experimental, one-group pre-test post-test design.

7.1.2 SettingThe study will be conducted in selected offices at Mangalore.

7.1.3 PopulationPopulation includes employees working in offices at Mangalore.

7.2 Method of data collection7.2.1 Sampling procedure

Sample for the study will be selected by disproportionate stratified random sampling technique.

7.2.2 Sample sizeIn the present study, the sample size will be 50 office employees.

7.2.3 Inclusion criteria for sampling Employees whose job requires spending minimum of four hours in a day for

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using computers in sitting position.

Employees in the age group of 20-50 years.

Employees who are willing to participate in the study.

Employees who are able to communicate in English.

7.2.4 Exclusion criteria for sampling Employees who are using computers for less than four hours in a day.

Employees who have the history of musculoskeletal disorders like spondilitis, ganglion, carpal tunnel syndrome and low back pain and are on treatment.

7.2.5 Instruments intended to be used Structured knowledge questionnaire.

7.2.6 Data collection method Permission will be obtained from selected offices at Mangalore.

By using disproportionate stratified random sampling selecting 50 office workers.

Purpose of the study will be explained and consent will be taken from the subjects.

Participant’s pre-test knowledge will be assessed by administering a structured knowledge questionnaire and on the same day video-assisted teaching will be given to them.

The post-test will be conducted using the same knowledge questionnaire on the seventh day.

7.2.7 Plan for data analysis1. The pre-test and post-test data will be analysed using mean, median and

standard deviation.

2. The effectiveness of video assisted teaching programme will be analysed using paired t-test

3. The association with pre-test knowledge scores and the selected demographic variable will be analysed using chi-square test.

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7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.

Yes, the investigator needs to evaluate the effectiveness of video-assisted teaching programme on work-related musculoskeletal disorders among the office employees.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance has been obtained from authority.

8. References1. Black JM. Medical surgical nursing. 7th ed. Philadelphia: Elsevier

Publications; 2004.

2. Foley MJ. Avoiding mouse elbow. Available from: URL:http://analytics.ncsu.edu/seesug/2004/foley.pdf.

3. OSH:answers. Work-related musculoskeletal disorders. Available from: URL: http/www.ccohs,ca/oshanswers/disease/rmrsi.htm

4. Lewis S. Medical surgical nursing. 6th ed. Philadelphia: Mosby Publications; 2006.

5. Jacobs K. Ergonomics for therapists. 2nd ed. Butterworth Heinemann Publications.

6. Brunner, Suddarth. Textbook of medical surgical nursing. 11th ed. Philadelphia: Lippincott Publishers; 2008.

7. Sharan D. Repetitive strain injuries. Available from: URL:www.deepaksharan.com/pois-media-htm.

8. Suparna K. Occupational health problems and role of ergonomics. Bioline International 2006;9(3):111-4.

9. Prawitjanwantanakul. Prevalence of self reported musculoskeletal disorders among office employees. Journals of Occupational Medicine;58(6):436-8.

10. Shanthi AY. Assess the effectiveness of video-assisted teaching module on

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knowledge of ECG monitoring among staff nurses in selected hospital at Salem. Unpublished dissertation submitted to Vinayaka Mission Deemed University.

11. Bhandari D. Occurrence of musculoskeletal discomfort in computer operators. Indian Journal of Community Medicine 2008;333(1):65-6.

12. Eltyeb SE. Prevalence of complaints of arm, neck and shoulder among computer office workers. Journal of Environmental Health 2008 Jun;8(1):33-5.

13. Stall BJ. Prevalence of complaints of arm, neck and shoulder among computer office workers. Journal of Environmental Health 2007 Jan;7(1):65-8.

14. Geetha KS. Effectiveness of video-assisted planned teaching programme on prevention and management of accidents to mothers having children below five years of age. Unpublished dissertation submitted to Rajiv Gandhi University of Health Sciences; 2007.

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