1.1 Introduction
Low back pain (LBP) is defined as discomfort or pain localized below the costal margin and above the inferior gluteal folds, often accompanied by functional limitations that affect daily activities and work performance (Hartvigsen et al., 2018). It is recognized globally as one of the leading causes of disability and diminished quality of life, particularly among healthcare professionals whose work demands involve prolonged physical exertion and repetitive movements.
The nursing profession is inherently physically demanding, exposing practitioners to various occupational hazards that increase the risk of musculoskeletal disorders, with low back pain being the most prevalent (Davis & Kotowski, 2015). Tasks such as transferring patients, repositioning bedridden individuals, and performing routine clinical procedures require significant physical effort and often occur in fast-paced, high-pressure environments.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Low back pain (LBP) is a major musculoskeletal disorder that affects individuals across different occupations, with healthcare professionals, particularly nurses, being highly vulnerable. According to Hartvigsen et al. (2018), low back pain is defined as pain or discomfort localized in the area between the lower rib margin and the gluteal folds, which may be accompanied by functional limitations that impact daily activities and work performance. Nurses are often exposed to repetitive physical tasks such as lifting, transferring, and repositioning patients, which place significant mechanical stress on the lumbar spine and increase the likelihood of developing low back pain.
Reported that nurses experience a higher prevalence of LBP compared to other healthcare professionals due to the physical and psychological demands of their work, Davis and Kotowski (2015) affirmed that prolonged standing, bending, and patient handling are major occupational risk factors. The high incidence of low back pain among nurses has serious implications for both the individuals affected and the healthcare system, including reduced productivity, absenteeism, emotional stress, and increased reliance on analgesic medications.
It has been asserted that work environment factors such as high patient-to-nurse ratios, extended working hours, shift rotations, and limited access to ergonomically designed equipment exacerbate the risk of LBP among nurses in tertiary hospitals (Andersen et al., 2014). In addition, inadequate knowledge or implementation of safe patient-handling techniques contributes to the persistence of musculoskeletal injuries in nursing staff. Sikiru and Hanifa (2010) contended that low back pain is often underreported among nurses due to normalization of pain as an inherent part of the profession, fear of stigmatization, or lack of institutional support for occupational health.
According to the World Health Organization (2021), musculoskeletal disorders such as low back pain represent a growing occupational health concern globally, particularly in healthcare settings where physical workload is high and preventive measures are inconsistently applied. The cumulative impact of clinical and environmental factors on nurses' musculoskeletal health not only affects their personal well-being but also has significant implications for patient care, workforce retention, and overall hospital performance (World Health Organization, 2021). Despite the global recognition of LBP as a critical occupational hazard, there is limited context-specific evidence on the clinical factors contributing to low back pain among nurses in Nigerian teaching hospitals. The University of Benin Teaching Hospital, as a major tertiary healthcare institution, has nurses who routinely perform physically demanding tasks under high-pressure conditions, yet there is insufficient data to guide targeted interventions and policy development aimed at reducing the burden of LBP. This study is set against the backdrop of addressing the critical gap in understanding the clinical determinants of low back pain among nurses at the University of Benin Teaching Hospital.
1.3 Statement of Problems
Investigation revealed that low back pain is a common occupational health problem among nurses and remains a major cause of reduced productivity, work absenteeism, and diminished quality of life within healthcare systems globally. Nurses are routinely exposed to physically demanding tasks such as prolonged standing and twisting, manual handling of patients, and sustained awkward postures during clinical procedures. In tertiary healthcare institutions such as the University of Benin Teaching Hospital, nurses often work in high-pressure clinical environments characterized by staff shortages, increased patient loads, extended working hours, and rotating shifts.
Furthermore, low back pain among nurses is often underreported or poorly managed due to fear of stigmatization, lack of occupational health support, or the perception that pain is an inevitable part of the nursing profession. Chronic low back pain is associated with reduced functional capacity, increased reliance on analgesics, emotional distress, and in severe cases, premature exit from the profession. It is against this backdrop that this study seeks to assess the clinical factors contributing to low back pain among nurses at the University of Benin Teaching Hospital.
1.4 Aim and Objectives of Study
The aim of this study is to assess the clinical factors contributing to low back pain among nurses at the University of Benin Teaching Hospital. In achieving this aim, the following specific objectives were laid out as follows:
- To evaluate the impact of work environment factors, such as staffing and shift schedules, on the occurrence of low back pain.
- To identify the prevalence of low back pain among nurses in the hospital.
- To examine the relationship between clinical duties and low back pain.
- To assess the availability and use of ergonomic equipment and safety protocols in clinical practice.
- To propose evidence-based strategies for preventing and managing low back pain among nurses.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the prevalence of low back pain among nurses at the University of Benin Teaching Hospital?
- How do specific clinical duties, such as patient lifting and prolonged standing, contribute to low back pain?
- What is the level of availability and utilization of ergonomic equipment and safety protocols among nurses?
- How do work environment factors, including staffing levels and shift patterns, influence the incidence of low back pain?
- What preventive and management strategies can be implemented to reduce low back pain among nurses?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H0: There is no significant relationship between clinical factors (such as patient lifting, prolonged standing, and shift schedules) and the prevalence of low back pain among nurses at the University of Benin Teaching Hospital.
- H1: There is a significant relationship between clinical factors (such as patient lifting, prolonged standing, and shift schedules) and the prevalence of low back pain among nurses at the University of Benin Teaching Hospital.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will serve as a guide for hospital administrators to implement effective workplace interventions, improve occupational health practices, and reduce work-related injuries. Also, the study will improve nurses' awareness of risk factors and preventive strategies, leading to better personal health and reduced incidence of low back pain.
Furthermore, the research will raise awareness among nurses regarding preventive measures and promote adherence to safe patient-handling protocols. In addition, the study will guide policy formulation and resource allocation for ergonomic equipment, staffing improvements, and occupational health programs.
Lastly, the study will provide locally relevant data for further research on occupational hazards in Nigerian hospitals.
1.8 Scope of Study
The scope of the research is focused on the assessment of clinical factors contributing to low back pain among nurses. The study is limited to nurses at the University of Benin Teaching Hospital and does not extend to other healthcare institutions in Nigeria.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this research work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Low Back Pain (LBP): Refers to discomfort or pain located below the costal margin and above the gluteal folds, often associated with impaired function and physical limitation (Hartvigsen et al., 2018).
Clinical Factors: These are aspects of nursing duties such as patient handling, prolonged standing, repetitive bending, and lifting tasks that affect musculoskeletal health.
Ergonomic Equipment: Tools and devices, including patient-lifting aids, adjustable beds, and supportive chairs, designed to minimize physical strain and prevent injuries among healthcare workers.
Occupational Health: A branch of healthcare concerned with the physical and mental well-being of employees in the workplace, including prevention and management of work-related injuries (World Health Organization, 2021).
Musculoskeletal Disorders (MSDs): Conditions that affect muscles, bones, and joints, including low back pain, often caused or aggravated by work-related activities.
Prevalence: The proportion of nurses experiencing low back pain at a given point or over a specific period within the study population.
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