医療現場に勤務する看護師を対象としたボディメカニクス学習教材の活用と評価(第2報)

Abstract

背景 看護師の職業性腰痛は深刻であり, 腰部負担の少ない動作を行うためにボディメカニクスを適切に活用することが求められる。前報では, 我々が開発したボディメカニクス学習教材の有効性について看護動作時の姿勢および意識調査から検証した。しかし, ボディメカニクスは, その活用技術を習熟し日常業務の中で実践しなければ活かされない。本学習教材の継続活用によって, 看護動作時の姿勢改善およびボディメカニクス活用への意識を強化し定着させることが可能かどうか検証する必要がある。 目的 本研究では, 本学習教材の継続活用の有効性について, 医療現場に勤務する看護師を対象として検証することを目的とした。 方法 2009年8月, 2010年3月, 同9月の計3回, 本学習教材における継続活用の有効性を, 看護動作時の姿勢と意識から検証した。対象は, 研究の趣旨に賛同が得られた看護師計32名とした。そのうちの看護師16名 (継続活用者とする) は全回の調査にっいて対象としたが, 2010年9月は本学習教材をはじあて活用した看護師16名 (初活用者とする) を比較対象者として加えた。 評価方法は, 前報と同様とした。設定1:普段通りの動作, 設定2:適切なベッド高での動作, 設定3:本学習教材を活用して客観的評価した後の動作である。分析は, SPSS16.0 for Windowsを用いてWilcoxonの符号付き順位検定を行い, 本学習教材の継続活用の有効性を角度変化から検証した。 また, ボディメカニクス活用への意識調査を実施し (5件法) , 本学習教材の継続活用の有効性を検証した。 結果 看護動作時の前傾姿勢角度を比較した結果, 設定1では, 初回57.8±17.7°, 2回目44.4±15.6° と腰部負担のかかる危険角度域となっていたが, 3回目には33.2±13.4° と有意に改善が認められた。設定2でも, 初回43.5±12.3°, 2回目35.4±11.7° と徐々に改善を認あ, 3回目には27.6±10.6° と腰部負担の少ない角度まで改善した。設定3でも, 3回目には17.6±6.4° まで改善し, 本学習教材の継続活用の有効性が認められた。 また, 「看護援助の中でボディメカニクスを活用しているか」の調査では, 本学習教材の継続活用者が3.1±0.9点であり, 初活用者の2.9±0.9点より高値であった。 結論 本研究では, ボディメカニクス学習教材の継続活用が, 看護動作時の姿勢改善およびボディメカニクス活用への意識向上を強化し, 定着に有効であることが示唆された。

Background Occupational low back pain is a serious problem among nurses, and appropriate application of body mechanics is important for enabling actions with minimal burden on the lower back. In a previous report, we verified the effectiveness of an originally developed learning material for body mechanics by investigating posture during nursing actions and by conducting an awareness survey. However, body mechanics will not be effective unless each user is familiar with application techniques and uses it in routine work. It is necessary to verify whether the continued application of this learning material enables improvement of posture during nursing actions, as well as strengthening and maintaining awareness regarding body mechanics application. Objective The objective of the present study was to verify the effectiveness of the continued application of the present learning material to nurses working in medical settings. Methods The effectiveness of the continued application of this learning material was examined based on posture during nursing actions as well as awareness of its application in a total of three times of examination. Subjects were a total of 32 nurses who consented to participate in the study. A total of 16 nurses were continuously investigated at all three time points (continuous users), and an additional 16 nurses using the material for the first time in the last examination (first time users) were investigated for comparison. The same evaluation method as in the previous study was used. Setting 1 : Normally performed action, Setting 2 : Action performed at a suitable bed height (45% of body height), Setting 3 : Action performed after using and objectively evaluating the present learning material. For analysis, the Wilcoxon signed rank test was performed using SPSS16. 0 for Windows, and the effectiveness of the continued application of the present learning material was examined in terms of changes in the angle of forward leaning. In addition, an awareness of body mechanics application was surveyed (five-point scale) to verify the effectiveness of the continued application of the material. Results Comparison of angles of forward leaning during nursing actions in Setting 1 showed that, although dangerous angles causing burden on the lower back occurred at the first (57. 8 ± 17. 7°) and second (44. 4 ± 15. 6°) measurements, a significant improvement was seen at the third measurement (33. 2 ± 13. 4°). Similarly, in Setting 2, the angle gradually improved from the first (43. 5 ± 12 . 3°) to second (35. 4 ± 11. 7°) measurement, and improved to an angle with a low burden on the lower back at the third measurement(27. 6 ± 10. 6°). The angle also improved in Setting 3 to 17. 6 ± 6. 4° at the third measurement, indicating the effectiveness of the continued application of the present learning material. Furthermore, in the survey on "application of body mechanics in routine nursing care", continuous users had a higher score (3. 1 ± 0. 9 points) compared to first-time users (2. 9±0. 9). Conclusion The present findings suggest that continued application of the body mechanics learning material enables improvement of posture during nursing actions, as well as strengthening and maintenance of awareness of the usefulness of body mechanics application.