Ergonomic factors and their relationship with musculoskeletal disorders
in nursing personnel in Latin America
Factores
ergonómicos y su relación con trastornos musculoesqueléticos en el personal de
enfermería en América Latina
Ninfa Geovanna Yanez Barragan*
Cynthia Elizabeth Pilco Toscano*
Tania Elizabeth Arguello Quintana*
Silvana Estefania Wilcaso Cando*
Introduction
Musculoskeletal disorders (MSDs) represent
one of the main causes of incapacity and absenteeism in many professions, with
nursing personnel being one of the most affected groups. This problem not only
compromises the health of workers, but also has a negative impact on the
quality of health services. The physically demanding nature of nursing exposes
professionals to various ergonomic risk factors, such as mobilizing and
transferring patients, lifting heavy loads, and adopting awkward postures for
prolonged periods of time (Ballena-Ramos et al., 2021). These conditions,
recurrent in the hospital environment, predispose to the development of MSDs,
especially affecting areas such as the lower back, neck and shoulders. Several
studies have linked these working conditions with a high prevalence of
musculoskeletal complaints in these areas of the body (Fajardo-Bautista et al.,
2024).
MSDs comprise a variety of conditions that
can develop gradually or arise as a result of acute incidents. These conditions
affect muscles, tendons, ligaments, joints and nerves, which can generate
chronic disabilities. According to the World Health Organization (2021), about
1.71 billion people worldwide suffer from MSDs, with low back pain being the
most common. This ailment limits mobility, affects functional abilities and
ultimately compromises both work productivity and the quality of life of those who
suffer from it.
In addition, the European Agency for
Safety and Health at Work (2022) warns that MSDs are one of the most common
conditions among workers worldwide, triggered by factors such as load handling,
repetitive movements, improper posture, cold working environments, long working
hours and unhealthy behavioral habits.
In the specific case of nursing, ergonomic risks are closely linked to the high
prevalence of MSDs. A recent study in a sample of 60 nurses revealed that the
most common discomforts are found in the neck (28.33%), shoulders (25%), upper
back (25%), wrist (13.33%) and lower back (1.67%). These data reflect the
impact of the physical tasks involved in nursing, particularly the manual
mobilization of patients, which forces professionals to adopt unergonomic
postures and to make intense physical efforts. According to the OWAS method,
these postures are a major cause of musculoskeletal injuries in this
professional group (Pinta et al., 2024a).
The impact of MSDs on nursing staff is not
only limited to physical health. These conditions also negatively influence the
quality of patient care and the overall efficiency of the healthcare system. In
many instances, nurses must continue to work despite pain, which increases the
risk of developing more serious injuries and even permanent disabilities. This
not only generates an increase in costs for healthcare institutions, due to the
use of medications and workers' compensation, but also affects staff morale and
job satisfaction, contributing to absenteeism and job turnover (Elizalde
Ordoñez et al., 2024).
The prevalence of MSDs in nursing staff is
alarming. A study conducted in a hospital in Cuenca, Ecuador, found that 77% of
nurses experienced low back pain, 69% experienced ankle and foot pain, and 46%
experienced neck discomfort. These findings underscore the urgency of
implementing preventive measures to address this issue (Gualán and Reinoso,
2023). Similarly, a study in Argentina highlighted that unfavorable working
conditions, such as lack of ergonomic equipment and incorrect postures, are
significant risk factors for the development of musculoskeletal injuries. This
study also linked these conditions to high rates of absenteeism due to medical
leave for occupational health problems (Acosta et al., 2022).
The main objective of this study is to
analyze the ergonomic factors that contribute to the development of MSDs in
nursing personnel. In addition, it seeks to identify working conditions and
evaluate ergonomic practices that could reduce these risks. A key hypothesis
posits that the implementation of improved ergonomic practices, along with
awareness campaigns and training, would significantly contribute to decreasing
the prevalence of MSDs, improving the quality of life of nursing staff and the
medical care they provide.The literature reviewed
points to a direct relationship between the lack of ergonomics in the workplace
and the incidence of MSDs in nursing. Among the most recurrent factors are
manual handling of patients, lifting heavy loads, and adopting awkward postures
for prolonged periods of time. In addition, recent studies have identified that
psychosocial factors such as work stress and lack of social support also play
an important role in the occurrence of these conditions (Soledad et al., 2022;
Zare et al., 2021).
This study is based on a systematic
literature review, using recognized databases such as PubMed, Scopus and
SciELO, and considering research published between 2020 and 2024. This
methodology guarantees the timeliness and relevance of the data analyzed, allowing
a deeper understanding of the ergonomic factors that influence MSDs and
proposing practical solutions to mitigate these risks in the work environment
of nursing staff.
Materials
and methods
The methodological
approach of this study is qualitative, with
a descriptive-exploratory design based on a systematic literature
review. This type of research is used to analyze, synthesize and relate
existing information on ergonomic factors and their impact on musculoskeletal
disorders (MSDs) in nursing personnel in Latin America. The review allows the
identification of trends, gaps in the literature and intervention strategies
documented in various scientific sources.
The search process
focused on identifying relevant studies using a systematic strategy based on
keywords such as “ergonomics,” “musculoskeletal
disorders,” “nursing, ‘ and ’work-related
risk factors,”combined with Boolean operators
(AND and OR). These searches were conducted
in English and Spanish, covering both global and regional research.
Recognized academic
databases such as PubMed, Scopus, Web of Science (WoS),
Redalyc and SciELO,
selected for their high quality and peer review, were consulted. In addition,
complementary sources such as theses, institutional reports and book chapters
were included, allowing for a multidisciplinary approach. This design
ensures an exhaustive and updated coverage of the subject matter, with a focus
on research published between 2020 and 2024 to guarantee the temporal relevance
of the findings.
Inclusion and
Exclusion Criteria
Selected studies had
to meet the following inclusion criteria:
-
Publications conducted between 2020 and 2024, with the aim of
ensuring the timeliness of the data.
· Articles published in
English or Spanish, to reflect a global and regional scope in the literature.
· Research specifically
examining ergonomic factors and their impact on MSDs in nursing staff.
· Empirical studies or
systematic reviews with clearly defined methodologies, including relevant
samples of health personnel.
On the other hand, we
excluded those studies that:
· Did not specify a
direct relationship between ergonomic factors and MSDs.
· Lacked sufficient data
or transparent methodologies to assess their quality.
· Focused exclusively on
non-hospital contexts or on professions other than nursing.
· Duplicate publications
or articles with a purely theoretical approach without empirical data.
Quality Assessment of
Studies
To ensure the validity
and reliability of the selected studies, critical appraisal tools were applied,
such as the CASP (Critical Appraisal Skills Programme) checklists. These
criteria made it possible to assess key aspects such as:
· Clarity in the study
objectives.
· Rigor in the
methodological design (type of study, sample size, tools used).
· Transparency in data
collection and analysis.
· Relevance of the
results and their practical applicability.
The studies
were categorized according to their level of evidence and methodological
quality. Those with significant weaknesses in their design or analysis were
excluded from the final analysis.
Synthesis and Analysis
of Results
The extracted
information was organized in an analysis matrix that allowed us to identify
patterns, similarities and discrepancies among the selected studies. Priority
was given to investigations with clear statistical data and to those that
included ergonomic intervention proposals. In addition, existing gaps in the
literature were evaluated, proposing areas for future research to address
unresolved problems, such as the implementation of ergonomic strategies in
low-resource or rural hospitals.
This methodological approach ensures that the results of the review are not
only relevant and up-to-date, but also provide a solid basis for discussion and
practical recommendations in the context of nursing staffing in Latin America.
Results
Identifying Ergonomic
Risk Factors in Nursing Personnel
Musculoskeletal
disorders (MSDs) represent one of the main occupational health concerns among
nursing professionals. Ergonomic risks derived from the physical nature of
nursing work are one of the main causes of these disorders, affecting the
quality of life of workers and, in many cases, the efficiency in the provision
of health services (Ruiz, 2023).
Ergonomic risks in
nursing professionals, according to several studies, indicate that
musculoskeletal disorders, especially in the neck, lower back, wrists, hands
and shoulders, are the most prevalent, attributable to poor posture and an
increasing workload due to the increase in hospital care (Changalombo
et al., 2024). These risks include mechanical, physical, biological, chemical
and psychosocial factors, derived from prolonged postures, repetitive movements
and extensive walking. Weight lifting and patient mobilization are the main
causes of these disorders, in addition to dysergonomic
risks associated with inadequate design of the work environment (Elizalde Ordoñez et al., 2024).
Several studies have
identified ergonomic risk factors, including patient mobilization, awkward and
prolonged postures, and the handling of heavy loads. This analysis aims to
compare the findings in different studies regarding ergonomic factors that contribute
to the development of MSDs in nursing staff.
One of the most
recurrent factors identified in the literature is the mobilization and manual
handling of patients, which has been pointed out as the main risk factor in
multiple studies. According to Fajardo-Bautista et al. (2024), manual
mobilization is responsible for a large part of musculoskeletal injuries in
nursing, due to the lack of adequate assistive devices and the performance of
this task without adequate training in ergonomics. This finding is consistent
with Azuero-Criollo et al., (2023), who also
identified patient mobilization as the main risk factor, mentioning that 80% of
the respondents in their study reported low back pain, attributed to the
frequent forced postures adopted during patient handling.
On the other hand, Pachucho Flores et al. (2023), highlights that not having
ergonomic devices, as well as the need for mechanical systems for weight
lifting, are the main reasons for the occurrence of MSDs. This study also found
a fairly frequent level of injuries in the waist or early region, and for the
manual mobilization of patients, it is one of the most unfavorable tasks for
the nurse. In addition, Llanas, et al (2022) points out that the mobilization
of patients, as well as the manipulation of load elements, notably increase the
probability of presenting musculoskeletal alterations in the upper extremities
and spine.
This coincidence
between studies points to the manual mobilization of patients as the ergonomic
factor of greatest risk for nursing professionals, suggesting that one of the
main interventions should be the provision of adequate equipment to assist in
this task.
Another important
ergonomic risk factor is the adoption of awkward and awkward postures for long
periods of time. Chichande and Molina, (2021)
mentions that nursing professionals often adopt awkward postures due to the
need to bend or stay in one position for long periods, especially when caring
for immobilized patients or those requiring special care. This study found that
repeated trunk flexion and prolonged static postures are one of the most common
causes of pain in the spine and upper extremities.
This finding is
similar to that presented in Elizalde Ordoñez et al.
(2024), where forced and maintained postures during prolonged medical
procedures were identified as a critical factor in the development of MSDs. It
is mentioned that 76% of the nursing professionals who participated in the
study reported pain in the dorsal spine due to the postures they adopt to
assist patients.
Likewise, Osorio-Vasco
and Rodriguez, (2021) emphasize that awkward postures during long work shifts
exacerbate musculoskeletal problems in nursing professionals, particularly in
the lumbar area and shoulders. The adoption of these postures is inevitable due
to the nature of nursing work, where tasks require repetitive movements and
constant bending to manipulate patients.
Nursing work also
involves a significant amount of repetitive movements,
especially during equipment handling, patient mobilization, and general medical
care. Cardenas, (2024) highlights that repetitive movements, especially those
performed in awkward postures, such as twisting or bending, are responsible for
much of the musculoskeletal pain experienced by nurses. The study highlights
that repetitive movements in combination with lack of adequate rest contribute
to the development of upper extremity disorders.
This conclusion is
supported by Rodriguez, (2024) , who found that
repetitive movements are one of the main ergonomic risk factors in nursing
staff, especially during procedures that require repetitive manual dexterity,
such as applying medications, administering intravenous infusions and handling
surgical equipment. This study identified a 65% prevalence of wrist and hand
pain among respondents, suggesting that repetitive movements significantly
affect the upper extremities.
The physical burden on nursing staff is not limited to just moving patients
from one location to another, but also to standing or wandering for prolonged
periods of time. Lata Carranza et al. (2024) states that standing for long
hours is another important risk factor in the development of musculoskeletal
disorders, particularly in the lower extremities. Participants of the study,
nursing professionals, said that their working hours, more than 8 hours a day,
required for a great extension of the body in vertical position, which generates
pain and exhaustion of the legs, feet and back.
Similarly, Pesántez et al. (2021) state that long working hours, often
involving night shifts, increase the effects of ergonomic factors on nursing
staff. The physical fatigue resulting from these prolonged shifts increases the
chances of injury to the back region and upper extremities, especially in cases
where there are insufficient breaks or properly scheduled rest periods.
Several studies
highlight that the work environment, together with inadequate equipment, also
contribute to ergonomic risks in nursing personnel. Gualán and Reinoso, (2023)
stress the influence of factors such as temperature, lighting and noise on the
occurrence of musculoskeletal problems, mentioning that adverse working
conditions not only affect the physical well-being of nurses, but also their
ability to perform tasks efficiently. This study found that 60% of nursing
professionals in settings with unfavorable environmental conditions reported an
increase in musculoskeletal symptoms.
Acosta et al., (2022)
also mentions the lack of adequate equipment, especially in terms of mechanical
aids for patient mobilization, as a factor that increases ergonomic risks. The
lack of such equipment forces nursing professionals to rely on their own physical
strength to perform tasks that require lifting or moving patients, which
increases the load on their musculoskeletal system.
One of the underlying
causes of the high prevalence of MSDs in nursing staff is the length of working
hours and lack of adequate breaks. Pesántez et al, (2021) mentions that nursing
professionals often work extended shifts of more than 8 hours, which increases
the risk of musculoskeletal injuries due to accumulated fatigue. The lack of
regular breaks exacerbates this problem, as workers do not have sufficient time
to recover between physically demanding tasks (Vaca et al., 2023).
Similarly, Rodriguez (2024) found that the absence of adequate breaks during
long workdays is a factor that aggravates musculoskeletal problems, especially
in the lower extremities, as professionals spend most of their time on their
feet or on the move. The accumulation of fatigue throughout the shift increases
the vulnerability of nurses to developing MSDs.
Physical activity,
such as working in inadequate postures or performing a continuous task for
extended time, already involves risk of acquiring Musculoskeletal Disorders
(MSD). Gualán and Reinoso, (2023) pointed out that musculoskeletal disorders
are often associated with non-compliance with basic working conditions.
They frequently lack
the necessary ergonomic construction features, contributing to the increased
prevalence of musculoskeletal disorders (MSDs). This study concludes that the
lack of resources and equipment, such as adjustable chairs and patient mobilization
aids, increases the risk of developing MSDs, especially in areas such as the
lower back and shoulders.
Musculoskeletal
disorders (MSDs) among nursing staff have been well documented, as it is one of
the most recognized causes of absenteeism and even diminished quality of life
in this group of individuals. MSDs develop predominantly as a result of manual
lifting of patients, awkward body positions or repetitive body movements. In
response to the growing concern for the occupational safety and health of the
nursing professional, the literature has suggested various ergonomic
intervention strategies along the lines of prevention in order to reduce the
hazards associated with such injuries.
This analysis aims to compare the findings on the most effective preventive
strategies identified in the reviewed studies, highlighting those that have
proven useful in reducing ergonomic hazards and improving the working
conditions of nursing professionals.
Prevalence of musculoskeletal disorders in nursing professionals.
MSDs include a variety
of conditions that affect muscles, tendons, ligaments, joints and nerves,
causing pain, discomfort and, in severe cases, permanent disability. In nursing
professionals, the prevalence of these disorders has been well documented in multiple
studies, which point to occupational factors such as long working hours, manual
mobilization of patients, and awkward and repetitive postures as the main
causes (Armas and Chiriboga, 2020). This analysis seeks to compare data on the
prevalence of MSDs in different studies, focusing on the areas of the body most
affected and the factors that contribute to their occurrence.
Several studies have
documented the high prevalence of MSDs in nursing professionals. For example,
Osorio-Vasco and Rodriguez, (2021) reports that 66% of the body areas evaluated
in a sample of nursing professionals experience pain during working hours. The
data from this study highlight that musculoskeletal problems most frequently
affect the lower back and shoulders, these being the most vulnerable areas.
In the research by Gualán and Reinoso (2023) , an even
higher prevalence is observed, with 77% of the respondents reporting pain in
the lower back and 69% in the ankles and feet. This study, conducted in a
hospital in Cuenca, Ecuador, highlights that nursing professionals experience
significantly higher levels of muscle pain than the average working population.
The high frequency of these disorders suggests that working conditions in
nursing are a key factor contributing to the onset of MSDs.
On the other hand, Pachucho Flores et al. (2023) provides a more specific
analysis of the surgical area, finding that 75% of healthcare workers in that
area experience pain in the neck, 80% in the lower back, and 80% in the wrists
and hands. This study shows that nursing professionals working in physically
demanding areas, such as surgery, are particularly exposed to developing MSDs
due to a combination of ergonomic factors and the demands of their work
environment.
A recurrent aspect in
the literature reviewed is the identification of the areas of the body most
affected by MSDs in nursing staff. Chichande and Molina, (2021) mentions that
57% of nursing professionals report pain in the neck, 46% in the lower back, and
37% in the head. This suggests that the cervical area and the lumbar region are
the most vulnerable to the occurrence of MSDs, which is consistent with other
studies.
Similarly, Pesántez et al., (2021) reports that 94.3% of nurses surveyed
reported neck pain, making it the most affected area, followed by the low back
(87.4%) and feet (59.7%). This finding highlights the high incidence of neck
pain, which may be related to forced postures and patient handling, which
require constant bending and flexing of the neck.
In addition, Gualán and Reinoso, (2023)
highlights that 80% of the nursing staff surveyed report myalgia (muscle pain)
in the upper extremities, and 60% suffer from bursitis or disc herniation,
which indicates a significant affectation in the extremities and spine due to
the physical workload. This study also notes that the upper extremities,
including the wrists and shoulders, are frequently affected by repetitive
motions and the handling of heavy medical equipment.
The low back is
consistently the most affected region in the studies reviewed. Azuero-Criollo
et al. (2023) shows that 72% of nursing professionals report low back pain,
confirming that awkward postures, manual mobilization of patients and lack of
mechanical aids contribute to the high level of MSD prevalence in this region
of the body. This result is aligned with Fajardo-Bautista et al., (2024), who
also identified the lower back as the most frequently affected region, noting
that the physical burden of daily nursing activities increases the risk of
lower back injuries.
In the article by Naranjo et al. (2023), it is reported that musculoskeletal
disorders (MSDs) in nursing professionals are a highly prevalent occupational
health problem, affecting between 80% and 85% of workers in this area. The most
affected regions include the lower back, where approximately 66.4% of nurses
report pain, followed by the neck (56.3%) and knees (51.2%). These injuries are
strongly associated with the manual mobilization of patients and the adoption
of inadequate postures during long working days. The high incidence of MSDs
generates significant absenteeism, affecting both the health of professionals
and the efficiency of the healthcare system, which underscores the urgent need
to improve ergonomic conditions in hospital environments.
The neck and cervical region are other common areas of affectation in nursing
staff. In the research of Llanas, et al., (2022), it is reported that 60% of
nursing professionals experience neck pain, especially after long working days
where static or inclined postures are required. This finding is reinforced in
Elizalde Ordoñez et al., (2024), where it is mentioned that neck pain is
particularly frequent in nurses who spend long periods performing administrative
tasks or assisting patients in positions that require constant neck flexion.
Likewise, Acosta
(2022) highlights that the adoption of awkward postures and the handling of
patients without proper equipment contribute to the high prevalence of neck
pain, reporting that 37% of nursing professionals experience pain in this area
on a constant basis.
The upper extremities,
particularly the shoulders, wrists and hands, are also frequently affected by
MSDs. In Gualán and Reinoso, (2023) , 65% of
respondents reported pain in the wrists and hands, which can be attributed to
the repetitive movements involved in nursing tasks, such as medication
administration and general medical assistance. The study mentions that the
continuous use of heavy medical instruments, such as medication trays, is one
of the main causes of this pain.
Similarly, Lata Carranza et al.,(2024) found that the
upper extremities are one of the most affected areas, with 80% of respondents
reporting pain in the wrists and 60% experiencing shoulder problems due to
heavy lifting. This finding suggests that repetitive physical activities, such
as handling equipment and assisting in patient transfer, are key factors in the
development of upper extremity MSDs.
Ergonomic Intervention Strategies
Within the critical
analysis of studies dealing with the prevention of ergonomic disorders in the
nursing field, it is clear that, although ergonomics training is an effective
strategy, several studies appeared with varying biases in practical application
and implementation. For example, Elizalde Ordoñez et al. (2024) noted how a
well-structured training program could reduce injuries by showing staff how to
safely mobilize patients in routines. However, periodic renewal of such
programs is vitally important, a recommendation that not all healthcare
institutions are able or willing to implement consistently. Rodriguez (2024),
however, notes that such training should be done as part of the organizational
structure, and while he advocates such changes, he does not explain how
physical practice or allocation of time resources would impact the actual
implementation of such changes.
Similarly, with regard
to the use of assistive equipment and devices, there are equally logistical and
economic despite agreement on their benefits. Azuero-Criollo et al. (2023) and
Pachucho Flores et al. (2023) note that lifting devices and adjustable beds
significantly reduce physical strains on staff, however, Pesántez et al. (2021)
warns of over-reliance on these devices due to unavailability and neglect, a
scenario often found in underdeveloped hospitals. These above scenarios only
compound the burden, as it only affects the ease of work for hospitals with 100
percent investment in devices without help to benefit the rest, increasing the
imbalance in reported benefits.
It is widely known and practiced that the introduction of regular breaks and
task rotation helps alleviate residual stress for workers, however, this is
more of an administrative than a practical strategy and, as a result, some
hospitals are unwilling or lack the means to implement. Osorio-Vasco and
Rodriguez (2021) and Hernandez Nava et al. (2022) are of the opinion that
breaks and several rotations can help alleviate muscle fatigue, while Llanas et
al. (2022) show that, depending on the situation, workload and understaffed
conditions restrict the effective implementation of this strategy and raise
doubts about the universal applicability of certain measures.
Another important
aspect to be taken into consideration is the ergonomic design of the work
environment; however, in Latin America there is a negative correlation between
theory and practice. Carrasco et al. (2023) and Gualán and Reinoso (2023)
postulate adjustments in the conditions and furniture elements of workstations
with the intention of avoiding MSDs, but Aceves-González et al. (2021)
highlight that this is an important limitation in the region. This limitation
implies that, even if the ergonomics of the design is correct, in practice the
situation is very different, since the availability of resources and the degree
of institutional commitment would have to be high.
Finally, the very
involvement of personnel is essential for minimal risk in active MSDs;
scientific assessments are regularly carried out as part of the ergonomic
program to quantify risks. Lata Carranza et al. (2024) show results of their
research where they compared the actions carried out by experts and which have
allowed that in hospitals in Ecuador the identification of risks has increased.
Rodriguez and Acosta (2023) emphasize the evaluation focusing on the process
and add that the risk assessment process requires the inclusion of nursing
staff in the assessments to obtain more realistic and applicable information.
However, the use or application of these assessments in a systematic way
remains a challenge in resource-limited institutions.
Situation in Latin
America on ergonomics and musculoskeletal disorders in nursing professionals
Nursing professionals
in the Latin American region find themselves in a work environment that
presents other dimensions of commitment, in this case of ergo-psychosocial
character, which corresponds to the high rate of MSDs, being one of the
pathologies with the highest degree of prevalence worldwide and which limits or
even invalidates the work performed, generating an impact both on the quality
of life of the workers and on the functionality of the health systems.
Ergonomics, which involves designing the work in such a way that it adjusts to
the physical and mental capacities of the worker, is capable of raising the
level of health in the sector and preventing these injuries, although its
application faces great challenges in the region.
Manual mobilization of
patients without an appropriate mechanical device is one of the ergonomic risk
factors that stand out in Latin America. In a hospital in Cuenca, Ecuador, the
majority of nurses, specifically 77% of all nurses, presented low back pain
when performing this activity, Gualan and Reinoso (2023). To this same opinion,
Azuero-Criollo et al. (2023) add that the absence of cranes and ergonomic
lifting systems exacerbates this problem, forcing workers to perform physically
hard work manually, which, in turn, causes an increase in the number of
musculoskeletal injuries. Practically in this situation the mobilization of
patients is more difficult in a rural hospital where resources are scarce and
only physical strength is used to move the patient.
Another of the
diagnoses in patient care are postures that are uncomfortable and awkward to
perform, and which are frequent during care and during surgical procedures. For
example, Chichande and Molina, 2021, have reported that the assumption of
active postures is related to the development of muscle and skeletal pain.
Osorio-Vasco and Rodriguez 2021 especially highlight abnormal postures adopted
in the course of assisting patients and performing patient care or treatment
procedures, which cause low back and neck pain. The shortage of ergonomic
workstations and adjustable chairs multiplies these risks, i.e., both the
physical health of nurses and their ability to perform nursing activities
without interruptions and other detrimental factors.
Repetitive movements,
another relevant ergonomic factor, also cause the occurrence of MSDs in nursing
staff. As Tenorio reported in July 2024, sixty-five percent of nurse
practitioners felt wrist and hand pain because they perform activities with
equipment to pierce medical instruments and even medication tubs. Although
these activities may seem benign in the short term, they begin to cause
microtraumas that will develop into chronic injuries over time. These injuries
affect the functionality of the upper extremities and compromise your nurse's
range of action and, therefore, action in optimal performance of their duties.
In addition, prolonged
hours of work without sufficient recovery time result in the accumulation of
fatigue, reducing the body's recovery intervention and, thus, increasing the
risk of injury. Hernandez Nava et al. (2022) note that prolonged and continuous
shifts of more than eight hours duration increase physical fatigue while
Pesántez et al. (2021) emphasize that in some hospitals understaffing forces
nurses to work excessive hours without reasonable breaks. Work overload is also
prevalent in rural and public hospitals where there is a shortage of resources
and manpower, thus aggravating MSDs among this population.
However, other
countries in the region such as Argentina and Chile have implemented training
programs in their hospitals for nursing staff where they are taught safe
practices for patient movement and proper postures (Chichande and Molina, 2021)
despite the high prevalence of MSDs. In some regions of Latin America,
ergonomic intervention measures have been implemented to prevent MSDs among
staff. Ergonomics training is one of the most widely used strategies to prevent
MSDs. However, Rodriguez and Acosta (2023) suggest that ergonomic evaluations
be carried out with nurses involved, being a staff that can detect problems and
is expected to comply with the advice given.
The implementation of
ergonomic devices such as cranes and adjustable beds has been shown to be
effective in reducing MSD, as it reduces the physical stress of nursing staff.
As Azuero-Criollo et al. (2023) point out, the sustained application of such devices
decreases the risk of back and shoulder injuries. In the opinion of Pachucho
Flores et al. (2023), other devices such as adjustable beds and ergonomically
designed carts ensure easier and more efficient performance of daily routines,
as staff can position patients without undue tilting or awkward postures.
However, Pesántez et al. (2021) argue that the lack of maintenance and training
in the use of these devices affects their effectiveness. In many Latin American
hospitals, ergonomic devices are used inappropriately due to damage or lack of
knowledge on how to use them.
Another significant
intervention is the rotation of tasks and the application of short breaks
during working time, which have shown positive consequences in the reduction of
fatigue and MSD. Osorio-Vasco and Rodriguez (2021) recommend work breaks and
shift rotation as appropriate ways to combat muscle fatigue. For their part,
Llanas et al. (2022) indicate that this strategy has led to a 40% reduction in
muscular pain in nursing personnel in some hospitals that have applied these
systems.
Although there have
been these achievements, there are difficulties that negatively affect the
effectiveness of ergonomic interventions in the Latin American context. One of
the main limiting factors is the lack of economic resources for the purchase of
ergonomic equipment and the development of training activities. Many hospitals
do not have the necessary aids paid in advance by many hospitals, even more so
if one considers that nursing personnel are still exposed to avoidable risks.
On the other hand, Acosta (2022) points out that the absence of awareness of
occupational ergonomics is another unfavorable factor, which in rural areas is
even more pronounced.
Finally, although
there are different ergonomic proposals and strategies that have proven to be
effective in the prevention of MSDs in nurses, important challenges must be
faced when implementing them in Latin America. Lack of resources, awareness and
qualified personnel restrict the implementation of these interventions and
leave nursing workers in work situations that are detrimental to their health
and the quality of care they can provide to patients. For truly effective
change to occur, it is critical that health systems in the region understand
the need to apply ergonomics to the workplace and make appropriate investments
to establish safe and healthy workplaces. Such training, along with ongoing
training of health care workers and their managers, is equally fundamental to
establishing improvements in the culture of occupational safety accessible to
workers and the patients who need them.
Conclusions
Musculoskeletal
disorders (MSDs) are one of the most prevalent conditions among nursing
professionals in Latin America, with the most affected areas being the lumbar
region, cervical and upper extremities. The main causes of these disorders are
found in the physical demands inherent to nursing work, such as manual
mobilization of patients, prolonged and repetitive postures, and the handling
of medical equipment in suboptimal conditions. These factors not only affect
the physical health and well-being of professionals, but also the quality of
patient care and the efficiency of the healthcare system.
The study highlights
that, although there are effective ergonomic strategies to mitigate these
risks, such as training in proper mobilization techniques, the provision of
ergonomic equipment and the organization of regular breaks during working
hours, their implementation is limited in many hospitals in the region. This
problem is particularly acute in rural areas, where the lack of economic and
technological resources aggravates the working conditions of nursing personnel.
Comparison of the
findings reveals that Latin American countries face structural and financial
challenges that hinder the widespread application of ergonomic measures. In
contrast, countries with more advanced ergonomics and occupational health
policies show a lower incidence of MSDs in their nursing staff, underscoring
the need to strengthen public policies and prevention programs in the region.
It is concluded that
addressing MSDs in nursing professionals requires a comprehensive approach that
combines continuous ergonomic training, investment in assistive equipment, and
the design of healthy work environments. These actions would not only reduce
the incidence of MSDs, but also improve the quality of life of workers and the
operational efficiency of health systems, promoting safer and more effective
patient care.
For future studies, it
is recommended to expand research in specific areas, such as the long-term
effectiveness of ergonomic interventions in different hospital settings, and to
explore how psychosocial factors interact with physical risks in the development
of MSDs. It would also be beneficial to analyze the economic impact of MSDs on
health systems in the region to justify investment in sustainable ergonomic
programs.
..........................................................................................................
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