EffectsofLowBackPainonFunctionalDisability

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2131

www.internationaljournalofcaringsciences.org

Original Article

Effects of Low Back Pain on Functional Disability Level and Quality of Life in Nurses Working in a University Hospital

Ipek Kose Tosunoz, MSc Lecturer, Hatay Mustafa Kemal University, Hatay School of Health, Nursing Department, Hatay, Turkey

Gursel Oztunc, PhD Professor, University of Kyrenia, Faculty of Health Sciences, Nursing Department, Kyrenia, Cyprus

Correspondence: Ipek Kose Tosunoz, MSc, Lecturer, Hatay Mustafa Kemal University, Hatay School of Health, Nursing Department, Hatay, Turkey E-mail address: kosepek@hotmail.com

Abstract

Background: The nurses are under a greater risk in terms of Low Back Pain (LBP) and LBP can affect the nurses’ quality of life adversely and result in disability. This study aims at analysing the effects of LBP on functional disability level and quality of life in nurses. Methods: This is a descriptive study. The population consisted of all the nurses working at a university hospital. The whole population was included in the sampling. 514 nurses participated in the study. The confirmation of the ethics committee and permission of the institution were obtained prior to the study. The data were collected via Personal Information Form, Quality of Life Scale Short Form 36 (SF-36) and Oswestry Disability Index (ODI). Objectives: This study aims at exploring the effects of Low Back Pain (LBP) on functional disability level and quality of life in nurses. Material and Methods: This is a descriptive study. The population consisted of all the nurses working at a university hospital. The whole population was included in the sampling. 514 nurses participated in the study. The confirmation of the ethics committee and permission of the institution were obtained prior to the study. The data were collected via Personal Information Form, Quality of Life Scale Short Form 36 (SF-36) and Oswestry Disability Index (ODI). Results: It was found that 85.4% of the nurses had low back pain at any stage of their life and 57.8% had continuing back pain. Nurses’ average scores are lower for each subscale of the SF-36 except for Emotional Role when compared with other nurses who do not suffer from LBP. The mean score that the nurses with low back pain obtained from the ODI was 11.09 ± 6.18 and majority of the nurses experiences mild disability. It was indicated that there is a negative correlation between nurses’ average scores for all subscales of SF-36 and ODI (p<.05). Conclusion: The results of this study revealed that LBP is a common health problem among working nurse. LBP affects the nurses’ quality of life adversely and results in disability. Taking necessary precautions for the prevention of LBP in nurses would provide positive effects on nurses’ quality of life and functional levels.

Keywords: Low back pain, Functional disability, Nurse, Quality of life.

Introduction

Low back pain (LBP) is defined as a symptom complex consisting of pain and muscle tension or stiffness in the lumbar region localized below the costal margin and above the inferior gluteal folds, with or without pain radiating into the legs (Harrianto, 2010).The nurses are under a greater risk in terms of LBP when compared with other

health professionals as they directly carry out all the care practices for the patients. The literature points out that frequency of LBP in nurses changes between 37.5% and 97.9%.

Physical and psychosocial risk factors are effective for the occurrence of LBPs (Jafari et al., 2019; Ibrahim et al., 2019). The nurses may be exposed to various physical risk factors that threat their low

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2132

www.internationaljournalofcaringsciences.org

back health due to their working places and occupational responsibilities. Long working hours, excessive work-load, insufficient breaks, shift related disruptions that affect sleeping cycle, eating habits and social life, duties that require assistance to patients in their daily lives, positioning them on the bed, carrying, lifting and transferring them or carrying medical devices of various weights and sizes, tidying beds of various heights increase the risk of a low back trauma for nurses (Abou El- Soud et al., 2014; Ibrahim et al., 2019). American Nurses Association (ANA) stated that the duties of nurses that require carrying patients are related with LBP (ANA, 2016).Psychosocial risk factors that result in stress and anxiety such as dissatisfaction about the job, lack of opportunities for relaxation and lack of a supportive and encouraging culture, and passive coping skills and may also cause LBP in nurses (Shieh et al., 2016; Abou El-Soud et al., 2014).LBP may affect the level of daily life activities and quality of life adversely and cause physical and psychological problems (Gurleyik et al., 2013; Shieh et al., 2016; Kalyani, 2019). Majority of health professionals experience disability related with LBP and their daily life activities are restraint (Al-Samawi & Awad, 2015; Kalyani, 2019). Numerous studies found that individuals who suffer from LBP have lower quality of life when compared with individuals without pain (Dundar et al., 2009; Hasanefendioglu et al., 2012). LBP affects the nurses by disability, efficiency restriction, burnout and low quality of life, also affects the organizations by absence from work, reduction in productivity and loss of labour force (Jafari et al., 2019; Ibrahim et al., 2019; Hasanefendioglu et al., 2012). These conditions cause an enormous medical and economic burden on individuals, families, employers, and the healthcare system (Pakbaz, 2019; Ibrahim et al., 2019; Van Hoof et al., 2018).A major characteristic of LBP, one of the occupational diseases, is that it is not related to what duty is done but how it is done and it can be prevented completely if the necessary precautions are taken (KoseTosunoz&Oztunc, 2017; Shieh et al., 2016).Precautions for prevention of LBPs in nurses is important in order for nurses to exercise their fundamental right to work under healthy and safe conditions, to maintain their professions and to provide beter support for their patients (Kabatas, Kocuk&Kuçukler, 2012; Ovayolu et al., 2014;

Pakbaz et al., 2019). Overall, the nurses who have important duty and responsibilities for improvement and protection of health need to protect and improve their health first in order to be able to provide effective care and be more beneficial for the patients (Pakbaz et al., 2019).

This study aims at analysing the effects of LBP on functional disability level and quality of life in nurses.

Methods

This is a descriptive study and the population of the study consisted of all the nurses working at a university hospital (N:874). No sampling criteria was applied and the whole population was included in the study. In total 514 nurses (participation rate of 58.8%) participated as somewhere on vacation (maternity leave, yearly vacation) and somewhere not willing to participate in the study.

Data collection: “Personal Information Form”, “Short form (SF)-36 Quality of Life Scale” and “Oswestry Disability Index (ODI)” were used in data collection. Personal Information Form: The form created by the researcher making use of literature review consisted of 26 items that question nurses’ socio- demographic features, working and life style, LBP characteristics, frequency of carrying out some patient care practices and getting help during these practices. Short Form (SF)-36 Quality of Life Scale: SF-36 was developed in 1992 by Rand Corporation (Ware & Sherbourne, 1992).Validity and reliability tests of the form were conducted by Kocyigit et al. (1999) in Turkey. SF-36 is the most commonly used quality of life scale in medical field and consists of 36 items and 8 subscales. These eight scales are physical functioning (PF), bodily pain (BP), role limitations due to physical health problems (RP), role limitations due to personal or emotional problems (RE), general mental health (MH), social functioning (SF), energy/fatigue or vitality (VIT), and general health perceptions (GH). The scale is evaluated considering the last four weeks. Each of the 8 subscales of the scale are evaluated separately. The scores range between 0 and 100. 100 refers to the best health condition while 0 refers to the worst health condition. Oswestry Disability Index (ODI): Developed by Roland & Fairbanks (2000), ODI is a scale that is

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2133

www.internationaljournalofcaringsciences.org

sensitive for measuring functional disabilities of individuals with LBP. Validity and reliability tests were conducted by Yakut et al. (2004) in Turkey. ODI measures the intensity of LBP, how much it affects the life and the disability it causes. The scale consists of 10 questions that measure the intensity of the pain, personal care, lifting, walking, sitting, standing up, social life, sleeping, travelling and level of pain. Each question has 6 options and each can be scored between 0 and 5. Maximum score is 50 and as the score increases, so does the level of disability. Ethical Considerations: The confirmation of the ethics committee, permission of the institution and verbal consent of the nurses were obtained prior to the study. Data Analysis: SPSS 16.0 package program was used in data analysis. Descriptive statistics were reported as frequencies, means and standard deviations, medians, minimum and maximum. Chi- square was used to determine the relationship between characteristics of nurses that may influence having LBP. Mann-Whitney U test (Z value) was used in comparing two independent groups for non-parametric methods; Kruskal- Wallis H test (χ2 value) was used in comparing three or more independent groups. Bonferroni corrected paired comparison was used in spotting the groups that make the difference in group comparisons. The significance level was considered p<.05 for all statistical analyses.

Results

Out of the 514 respondents, 88.7% of the nurses were female and the average age was 32.36±9.54. It was found that 56.2% of the nurses hold a bachelor’s and above degree, 58% have normal weights according to BMI, 76.6% have medium economic level, 56.2% are married, 50.6% have no child and 27.4% of the nurses who have children have two children (Table 1).

The relationship between socio-demographic characteristics of nurses and their status of experiencing LBP is shown in Table 1. It was indicated that there was relationship between nurses’ status of experiencing LBP and gender (p<.05) (Table 1).

In the present study, 57.8% of nurses suffer from LBP (n=297). 87.5% of the nurses who suffer from LBP had family members that suffer from LBP,

%66.0 of them had education about body mechanics and 93.7% experienced LBP before in their lifetime (Table 3). It was also determined that 47.5% of the nurses with LBP performed nursing intervention of “Making bed” sometimes and with help (88.6%); 5.1% of performed intervention of “Giving bedpan” sometimes and with help (68.2%) (Table 4).

ODI percentile score average of nurses with LBP were 22.81±12.59 (2.0-77.7) and their raw score average was 11.09±6.18. According to ODI, 15.2% of nurses did not have disability, 61.3% had mild, 20.5% had moderate and 3% had high/full disability (Table 2). When the relationships between some of the characteristics of nurses and their mean ODI scores were evaluated, no significant relationship was found between ODI mean scores and gender, marital status, educational status, presence of children as socio-demographic characteristics; years of working, position, working style and number of patients given care (daily) as working characteristics; smoking, using alcohol and exercise as lifestyle characteristics; LBP in family and body mechanics education as (p>0.05). There was a significant relationship between the nursess’ ODI mean scores and age, BMI, economic level, working units, unit satisfaction, daily activity time, wearing high heels and experience of LBP in any period of life. It was found that ODI mean scores were significantly higher in the nurses between the ages of 31-35 and 41 and older compared with nurses who are 25 and younger; I. degree obesity or over has when compared with thin nurses; nurses with bad economic condition when compared with nurses with medium or good economic condition; work at policlinics and intensive care units (ICU) when compared with nurses that work at internal disease clinics and surgical clinics; the nurses that are not satisfied about their unit when compared with those who are satisfied with their unit; in the nurses who exercise for 30 minutes or less daily when compared with nurses who exercise for 31 minutes or more; nurses who wear high hills when compared with nurses who do not wear high hills; in the nurses who experienced LBP at a certain point in their life course when compared with nurses who did not experience LBP (p<.05) (Table 4). The nurses who perform the practices of “Changing the diaper”, “Making bed”, “Providing body care”,

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2134

www.internationaljournalofcaringsciences.org

“Transferring the patient to wheelchair/stretcher” and “Lifting/transporting heavy medical equipment” “often” had significantly higher ODI score averages (p=.014; p=.025; p=.020; p=.013; p=.021) (Table 5).

It was found that the nurses who do not suffer from LBP have significantly higher average scores on each subscale of the SF-36 except for Role- Emotional difficulty subscale when compared with nurses who suffer from LBP (p<.05). The median scores of SF-36 subscales in nurses with LBP were 85.0(20.0-100.0) for physical functioning (PF), 77.5 (0.0-100.0) for bodily pain (BP), 50.0 (0.0- 50.0) for role limitations due to physical health problems (RP); 33.3 (0.0-50.0) for role limitations due to personal or emotional problems (RE); 64.0 (12.0-100.0) for general mental health (MH), 62.5 (0.0-100.0) for social functioning (SF), 55.0 (0.0- 100.0) for energy/fatigue or vitality (VIT) and 60.0 (10.0-100.0) for general health perceptions (GH). The nurses who suffer from LBP obtained the highest scores in the “Physical Function” subscale of the quality of life scale, and the lowest scores in the “Emotional Role” subscale (Table 3). A significant correlation was identified between

nurses’ gender and PF ve RF subscales; age groups and PF, SF subscales; BMI groups and PF subscales; educational status and PF subscale; presence of children and PF subscale; economic level and all subscales except for PF subscale; years of working and PF subscale; working units and PF, VIT, MH, SF, BP, GH subscales; position and PF, RP, VIT, MH, SF subscales; working style and MH, SF subscales; patients given care and GH subscale; unit satisfaction and PF, VIT, MIH, SF, BP, GH subscales; Alcohol and PF subscale; exercise and PF, VIT subscales; wearing high heels and PF, VIT, BP, GH subscales; LBP in any period of life and BP (p<.05) (Table 4).

Averages of nurses’ ODI score had a medium level, statistically significant negative correlation with Physical Functioning, Role-Physical and Bodily Pain subscale score averages; low level statistically significant negative correlation with Role-Emotional, Vitality, Mental Health, Social Functioning and General Health Perception. It was found that as the SF-36 subscale score averages of the nurses increase, their ODI score averages decrease (Table 6).

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2135

www.internationaljournalofcaringsciences.org

Table 1. Distribution of socio-demographic characteristics of all nurses and The relationship between socio-demographic characteristics of nurses and their status of experiencing LBP (N=514)

Socio-demographic Characteristics All nurses (n= 514)

LBP sufferers (n=217) No LBP (n=297)

Tests P values

n % n % n % Gender Male Female

58 456

11.3 88.7

36

181

16.6

83.4

22 275

7.4 92.6

χ2= 10.561

p= .001

Age Groups (X ± SD=32.36 ± 9.54) 25 Age and ↓ 26-30 Age 31-35 Age 36-40 Age 41 Age and ↑

164 90 67 65 128

31.9 17.5 13.1 12.6 24.9

76 39 35 21 46

35.0 18.0 16.1 9.7 21.2

88 51 32 44 82

29.6 17.2 10.8 14.8 27.6

χ2=8.634 p= .071

BMI Groups Underweight Normal Overweight Obese

31 298 144 41

6.0 58.0 28.0 7.0

10 134 59 14

4.6 61.8 27.2 6.5

21 164 85 27

7.1 55.2 28.6 9.1

χ2=3.370 p= .338

Marital Status Married Unmarried/Single

289 225

56.2 43.8

116 101

53.5 46.5

173 124

58.2 41.8

χ2=1.170 p=.279

Educational Status Health High School Associate’s degree Bachelor’s and Master’s degree

137 88 289

26.7 17.1 56.2

61 33 123

28.1 15.2 56.7

76 55 166

25.6 18.5 55.9

χ2=1.116 p=.572

Having Children Yes No

254 260

49.4 50.6

119 98

54.8 45.2

141 156

47.5 52.5

χ2=2.720

p=.99 Number of Children No Child Onechild TwoChildren Three Children

260 78 141 35

50.6 15.2 27.4 6.8

119 35 55 8

54.8 16.1 25.3 3.7

141 43 86 27

47.5 14.5 29.0 9.1

χ2=7.543 p=.56

Economic Level High

79

15.4

37

17.1

42

14.1

χ2=2.552

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2136

www.internationaljournalofcaringsciences.org

Medium Low

394 41

76.6 8.0

167 13

77.0 6.0

227 28

76.4 9.4

p=.279

Table 2. Distribution of functional disability levels of nur ses with LBP according to ODI

Scale X̄+SD Min-Max

ODI (Percent) 22.81 ±12.59 2.0-77.7

ODI (Raw score) 11.09±6.18 1.0-35.0

Functional disability levels n %

No disability (0-4) 45 15.2

Mild Disability (5-14) 182 61.3

Moderate Disability (15-24) 61 20.5

Complete / Advanced Disability (25-34) 9 3.0

Total 297 100.0

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2137

www.internationaljournalofcaringsciences.org

Table 3. SF-36 scores according to having LBP (N=514)

SF-36 Subscales PF RP RE VIT MH SF BP GH N (%) Median (Min-Max)

Nurses with LBP

217(42.2) 85.0 (20-100)

50.0 (0-50)

33.3 (0-50)

55.0 (0-100)

64.0 (12-100)

62.5 (0-100)

77.5 (0-100)

60.0 (10-100)

Nurses

without LBP 297(57.8) 60.0

(0-100) 25.0

(0-50) 33.3

(0-50) 45.0

(0-90) 52.0

(0-100) 50.0

(0-100) 47.5

(0-100) 45.0

(5-85)

Tests P value

Z=-9.722 p=.000

Z=-6.482 p=.000

Z=-1.407 p=.159

Z=-6.302 p=.000

Z=4.690 p=.000

Z=-6.661 p=.000

Z=10.279 p=.000

Z=-8.365 p=.000

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2138

www.internationaljournalofcaringsciences.org

Table 4. The relationship between socio-demographic. work. lifestyle and LBP related characteristics of nurses and ODI and SF-36 subscales scores (n=297)

Characteristics N (%)

ODI Scores PF RP RE VIT MH SF BP GH

Median (Min-Max)

Gender Male Female

22(7.4)

275(92.6)

16(6-54)

22(2-77.8)

75 (35-100) 60 (0-100)

25 (0-50) 25 (0-50)

33.3 (0-33) 33.3 (0-50)

45 (15-80) 45 (0-90)

54 (16-100) 52 (0-92)

62.5 (25-100)

50 (0-100)

67.5 (22.5-90)

45 (0-100)

45 (5-70) 45 (5-85)

Tests P value

Z=-1.552 p=.121

Z=-2.552 p=.012

Z=-.221 p=.825

Z=-.465 p=.642

Z=-1.112 p=.266

Z=-.546 p=.585

Z=-1.480 p=.139

Z=-3.189 p=.001

Z=-.111 p=.911

Age Groups 25 Age and ↓ 26-30 Age 31-35 Age 36-40 Age 41 Age and ↑

88(29.6) 51(17.2) 32(10.8) 44(14.8) 82(27.6)

16.9 (2-55.5)

22 (2-58) 26 (4-50) 21 (2-40)

24.2 (2-77.8)

75 (0-100) 60 (0-100) 50 (5-90) 65 (10-90) 50 (0-100)

25 (0-50) 25 (0-50) 0 (0-50) 25 (0-50) 25 (0-50)

33.3 (0-50) 33.3 (0-50) 16.7 (0-50) 33.3 (0-50) 33.3 (0-50)

42.5 (0-80) 45 (0-90)

37.5 (0-80) 40 (5-80) 45 (0-85)

54 (8-92) 52 (12-84) 48 (0-88)

56 (16-100) 56 (16-88)

50 (25-100) 50 (0-87.5) 37.5 (0-100) 50 (12.5-100)

50 (0-100)

57.5 (10-100) 57.5 (0-100)

45 (0-80) 45 (20-90) 45 (10-100)

45 (5-85) 45 (10-75) 40 (5-85) 45 (5-80) 40 (15-85)

Tests P value

χ2=12.392 p=.015 (1-3,5)

χ 2=25.377 p=.000

(1-3,5)(4-5)

χ 2=6.010 p=.198

χ 2=3.158 p=.532

χ 2=9.448 p=.051

χ 2=8.409 p=.078

χ 2=16.496 p=0.002

(1,2,4,5-3)

χ 2=9.389 p=.052

χ 2=1.887 p=.757

– BMI Groups Underweight Normal Overweight Obese

21(7.1)

164(55.2) 85(28.6) 27(9.1)

15.6 (2-54) 20 (2-57.8) 22 (2-60)

26.7 (4-77.8)

55 (15-100) 65 (0-100) 65 (0-100) 50 (5-85.0)

25(0-50) 25 (0-50)

12.5 (0-50) 12.5 (0-50)

16.7 (16.7-50)

33.3 (0-50) 33.3 (0-50) 16.7 (0-50)

50 (10-80) 45(0-90) 40 (0-85) 40 (0-75)

52 (8-76) 56 (0-92)

52 (16-100) 52 (16-80)

50 (25-87.5) 50 (0-100) 50 (0-100) 50 (0-87.5)

57.5 (22.5-90) 47.5 (0-100)

55 (0-90) 45 (0-77.5)

45 (5-70) 45 (5-85) 45 (5-85) 40 (15-60)

Tests P value

χ2=8.386 p=.039 (1-4)

χ 2=7.676 p=.053

χ 2=3.242 p=.356

χ 2=.732

p=.866 χ

2=2.231 p=.526

χ 2=1.394 p=.707

χ 2=6.338 p=.096

χ 2=2.525 p=.471

χ 2=3.404 p=.303

Marital Status Married Unmarried/Single

173(58.2) 124(41.8)

22(2-60)

20 (2-77.8)

60 (0-100) 70 (0-100)

12.5 (0-50) 25 (0-50)

33.3 (0-50) 33.3 (0-50)

45 (0-80) 45 (0-90)

52 (0-100) 52 (12-92)

50 (0-100) 50 (0-100)

47.5 (0-100) 55 (0-100)

45 (5-85) 45 (5-85)

Tests P value

Z=-110 p=.312

Z=-2.345 p=.019

Z=-.849 p=.396

Z=-.034 p=.973

Z=-.905 p=.365

Z=-.237 p=.813

Z=-.186 p=.852

Z=-.898 p=.369

Z=-.997 p=.319

Educational Status Health High School Associate’s degree Bachelor’s and ↑

76(25.6) 55(18.5) 166(55.9)

18.9 (2-77.8)

22 (2-60) 22 (2-62.2)

70 (0-100) 50 (0-100) 60 (0-100)

25 (0-50) 25 (0-50)

12.5 (0-50)

33.3 (0-50) 33.3 (0-50) 33.3 (0-50)

40 (10-80) 40 (0-85) 45 (0-90)

56 (8-88) 52 (12-92) 56 (0-100)

50 (0-100)

50 (12.5-100) 50 (0-100)

57.5 (10-100) 47.5 (20-77.5)

45 (0-100)

45 (5-85) 40 (5-80) 45 (5-85)

Tests P value

χ2=4.579 p=.101

χ 2=9.972

p=.007(1-2) χ

2=2.010 p=.366

χ 2=.566

p=.753 χ

2=.486 p=.784

χ 2=.433

p=.805 χ

2=.298 p=.861

χ 2=1.583 p=.463

χ 2=3.373 p=.185

Presence of children Yes No

141(47.5) 156(52.5)

20 (2-77.8) 22 (2-60)

70 (0-100) 55 (0-100)

25 (0-50) 25 (0-50)

33.3 (0-50) 33.3 (0-50)

45 (0-90) 45 (0-80)

52 (0-92)

56 (12-100)

50 (0-100) 50 (0-100)

55 (0-100)

46.3 (0-100)

45 (5-85) 40 (5-85)

Tests P value

Z=-.962 p=.336

Z=-3.744 p=.000

Z=-.515 p=.606

Z=-.409 p=.683

Z=-.253 p=.800

Z=-.824 p=.410

Z=-.808 p=.419

Z=-.912 p=.362

Z=-1.145 p=.252

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2139

www.internationaljournalofcaringsciences.org

Economic Level High Medium Low

42(14.1) 227(76.4) 28(9.4)

18 (2-40)

22 (2-77.8) 26.7 (8-62.2)

70 (0-100) 60 (0-100) 57.5 (0-95)

25 (0-50) 25 (0-50) 0 (0-50)

33.3 (16.7-50) 33.3 (0-50) 16.7 (0-50)

55 (5-80) 40 (0-90) 35 (0-85)

62 (36-92) 52 (8-100) 46 (0-76)

62.5 (0-100) 50 (0-100)

37.5 (0-87.5)

56.3 (0-90) 50 (0-100)

45 (10-67.5)

52.5 (5-80) 45 (5-85)

37.5 (10-70) Tests P value

χ2=11.152 p=.004 (1.2-3)

χ 2=3.727

p=0.155 –

χ 2=7.261

p=0.027 (1,2-3)

χ 2=12.633 p=0.002 (1,2-3)

χ 2=17.596 p=0.000 (1-2,3)

χ 2=14.475 p=0.001

(1-2,3) (2-3)

χ 2=14.912 p=0.001

(1-2,3) (2-3)

χ 2=8.112

p=0.017 (1-3)

χ 2=15.397 p=0.000 (1-2,3)

Years of working 1 < 1-4 5-8 9-12 > 13

13(4.4) 87(29.3) 42(14.1) 34(11.4) 121(40.7

20 (6-33) 20 (2-58) 21 (2-48) 24 (2-50)

22 (2-77.8)

60 (5-90) 75 (0-100) 70 (0-100) 57.5 (0-90) 55 (0-100)

0 (0-50.0) 25 (0-50) 25 (0-50) 6.3 (0-50) 25 (0-50)

16.7 (0-50) 33.3 (0-50) 25 (0-50)

33.3 (0-50) 33.3 (0-50)

50 (15-70) 40 (0-80) 40 (5-90) 40 (0-80) 45 (0-85)

68 (20-84) 52 (8-92) 50 (12-84) 52 (12-100) 56 (0-88)

37.5 (37.5-100)

50 (0-100) 50 (0-87.5)

50 (12.5-100) 50 (0-100)

47.5 (22.5-80)

57.5 (0-100) 51.3 (22.5-100)

45 (0-80) 45 (10-100)

45 (35-85) 45 (5-80) 45 (10-75) 40 (5-75) 40 (5-85)

Tests P value

χ2=4.266 p=.371

χ 2=18.739 p=.001 (2-4.5)

χ 2=8.841 p=.065

χ 2=4.363 p=.359

χ 2=6.651 p=.156

χ 2=8.111 p=.088

χ 2=6.995 p=.136

χ 2=8.878 p=.064

χ 2=2.587 p=.629

– Working units Internal Clinics (1)

Surgical clinics (2) Polyclinics (3) ICU(4) Pediatric Clinics (5)

Other*

62(20.9) 83(27.9) 56(18.9) 69(23.2) 23(7.7) 4(1.3)

20 (2-54) 20 (2-58)

26 (6-77.8) 26.7 (4-57.8) 21 (2-42.2)

70 (0-100) 70 (0-100) 55 (5-100) 55 (0-100) 55 (0-95)

25 (0-50) 25 (0-50)

12.5 (0-50) 12.5 (0-50) 12.5 (0-50)

16.7 (0-50) 33.3 (0-50) 33.3 (0-50) 16.7 (0-50) 16.7 (0-33.3)

40 (0-80) 50 (10-90) 50 (0-85) 40 (0-80) 35 (10-80)

52 (12-88) 64 (24-100) 60 (16-88) 52 (0-88) 48 (16-80)

50 (0-100)

62.5 (0-100) 50 (0-100)

37.5 (0-100) 37.5 (12.5-87.5)

55 (10-90)

57.5 (0-100) 45 (10-100) 45 (0-90)

45 (10-77.5)

47.5 (5-75) 45 (5-85) 40 (15-80) 40 (5-85) 40 (5-80)

Tests P value

χ2=14.566 p=.006 (1-3,4) (2-3,4)

χ 2=12.142 p=.016 (1,2-3)

χ 2=6.278 p=.179

χ 2=8.311 p=.081

χ 2=26.910 p=.000

(1-2,3) (2-4,5) (3-4)

χ 2=22.219 p=.000 (1-2,3) (2,3-4)

χ 2=13.976 p=.007

(1,3,4-2)

χ 2=11.135 p=.025 (2-4)

χ 2=6.175

p=0.186 –

Position Responsible nurse Clinic nurse Polyclinic Nurse Other**

26(8.8)

221(74.4) 46 (15.5) 4 (1.3)

19 (2-50)

22 (2-77.8) 26 (6-60)

77.5 (0-100) 60 (0-100) 55 (10-100)

50 (0-50)

25 (0-50) 12.5 (0-50)

33.3 (0-50) 33.3 (0-50) 33.3 (16.7-

50)

50 (0-80)

40 (0-90) 47.5 (10-85)

60 (36-84) 52 (0-100) 62 (16-88)

62.5 (12.5-87.5)

50 (0-100) 50 (12.5-100)

67.5 (22.5-90)

47.5 (0-100) 45 (22.5-100)

45 (20-80)

45 (5-85) 42.5 (15-80)

Tests P value

χ2=5.190 p=.075

χ 2=8.359 p=.015 (1-3)

χ 2=7.343 p=.025 (1-2,3)

χ 2=4.441 p=.109

χ 2=10.457 p=.005 (2-3)

χ 2=9.274 p=.010 (2-3)

χ 2=7.325 p=.026 (1-2)

χ 2=5.725 p=.057

χ 2=1.280 p=.527

– Working style Day shifts Night shifts Day and night shifts

116(39.1) 20(6.7)

161(54.2)

22.1 (2-77.8)

20 (2-46) 20 (2-58)

60 (0-100) 70 (30-100) 65 (0-100)

12.5 (0-50) 37.5 (0-50) 25 (0-50)

33.3 (0-50) 33.3 (16.7-

33.3) 33.3 (0-50)

45 (0-85) 50 (10-90) 40 (5-80)

60 (0-88) 58 (8-88)

52 (12-100)

62.5 (0-100) 50 (25-100) 50 (0-100)

45 (0-100)

56.3 (10-100) 47.5 (0-100)

42.5 (5-85) 45 (5-70) 45 (5-85)

Tests P value

χ2=2.961 p=.228

χ 2=4.433 p=.109

χ 2=1.079 p=.583

χ 2=2.459 p=.292

χ 2=4.861 p=.088

χ 2=6.325

p=.042(1-3) χ

2=7.323 p=.026 (1-3)

χ 2=.722

p=.697 χ

2=.046 p=.977

International Journal of Caring Sciences September-December 2020 Volume 13 | Issue 3| Page 2140

www.internationaljournalofcaringsciences.org

Patients Given Care (Daily) 10 and less 11-20 21 and over

147(49.5) 87(29.3) 63(21.2)

22 (2-60)

20 (2-77.8) 20 (2-54)

60 (0-100) 70 (0-100) 65 (0-100)

12.5 (0-50) 25 (0-50)

12.5 (0-50)

33.3 (0-50) 33.3 (0-50) 16.7 (0-50)

40 (0-90) 45 (0-80) 45 (0-85)

52 (0-92)

60 (12-100) 52 (16-84)

50 (0-100)

62.5 (0-100) 50 (12.5-87.5)

45 (0-100) 55 (0-100)

47.5 (22.5-90)

40 (5-85) 45 (5-85)

42.5 (15-80)

Tests P value

χ2=2.837 p=.242

χ 2=1.634