Lived Experience of Musculoskeletal Wellbeing

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Despite many NHS organisations' providing formal workplace wellbeing ... Graham Boniface (Physiotherapist @ Leicestershire Partnership NHS Trust) E-mail: ...
District Nurses: Lived Experience of Musculoskeletal Wellbeing Graham Boniface (Physiotherapist @ Leicestershire Partnership NHS Trust) E-mail: [email protected]

Background § 

NHS staff sickness in 2012/13 contributed to the loss of 13.7 million working days. This resulted in a cost of £1.55 billion[1].

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Each day 6000 staff take time off work with a musculoskeletal disorder

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Despite many NHS organisations’ providing formal workplace wellbeing initiatives[3), MSD accounts for 40% of sickness absence[3].

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Nurses, the largest clinical professional group in the NHS, are known to be at high risk of developing MSD because of patient handling[4,5].

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Findings

Methodology (MSD) [2].

District nursing poses unique risks due to working environment (patient home)[6].

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Qualitative approach using Interpretative Phenomenological Analysis (IPA)[11].

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IPA allows the ‘lived experience’ of individuals to be understood but also allows comparison (See Figure. 1).

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1.  The Stoical Self 2.  The Selfless Self

 

3.  The Future Self 4.  The Burdensome Patient Leg 5.  Workforce Wellbeing – Please Engage Me

Idiographic Accounts (Unique Descriptions) §  The Stoical Self: “I just don’t have a lot of sick time off to be honest if I can help it, so I thought if I’m going to be off in pain, it doesn’t make that much difference if I am at work or at home, so I just about did it and came to work” (Sally)

Wellbeing Services § 

Five core themes were identified from the interview transcripts:

Current landscape for workplace prevention of MSD[7]: Proactive:

§  The Future Self: “Most of us will say we can’t be doing this job in our 60’s but yet retirement is 67 now”. (Kath)

Nomothetic Account (Overall Picture)

Moving & Handling Training Display Screen Examination

§  The Burdensome Patient Leg: “It is putting a lot of strain on both your back and your knees”. (Anna)

Reactive:

Examples of Participant Quotes

Phased/therapeutic return to work Occupational health/staff physiotherapy

Figure 1. Using IPA to compare similarities

Method

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Both approaches rely on staff engagement for success[8].

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Despite the preventative strategies above, staff sickness absence remains a concern for the NHS[9].

- 7 district nurses.

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NHS England recently recognised the need to better support staff with their health and wellbeing in the 5yr Forward View[10].

- ≥ 40 yrs. Old.

 

- Job band 6 – 7.

Secondary Aim   §  To establish what is the best way to engage district nurses in musculoskeletal health and wellbeing initiatives at work.

References

  1.  HSCIC. (2014). NHS Sickness Absence Rates - January 2014 to March 2014 and Annual Summary 2009-10 to 2013-14. Health and Social Care Information Centre. 2.  THE CHARTERED SOCIETY OF PHYSIOTHERAPY. 2015. Research shows 6,000 NHS staff in England off sick daily with MSK problems [Online]. The Chartered Society of Physiotherapy. Available: http://www.csp.org.uk/news/2015/03/05/research-shows-6000-nhs-staffengland-sick-daily-msk-problems [Accessed 13/07/2014 2015].

Purposeful Sampling

- Audio taped. - Semi structured. - 45 – 90mins long. - Transcribed verbatim. - Participants to confirm accuracy. - Analysis based on Braun & Clarke, 2006.[12]

Interviews

March 2015

Timescale

Primary Aim   §  To examine the lived experience of musculoskeletal wellbeing in NHS district nurses working in a community healthcare trust.

Jan 2015

- Female.

- ≥ 5 yrs. nurse experience.

Study Aims

Implications for Wellbeing Delivery

Thematic Analysis August 2015

3.  The health foundation & the nuffield trust. 2015. Nhs staff sickness absence [Online]. The Health Foundation. Available: http:// www.qualitywatch.org.uk/indicator/nhs-staff-sickness-absence [Accessed 13/07/2015 2015]. 4.  NHS CHOICES. (2014). Did you know? [Online]. Available: http://www.nhs.uk/Livewell/nhs.../Didyouknow.aspx [Accessed 01/10/2014 2014]. 5.  MICHIE, S. & WILLIAMS, S. (2003). Reducing work related psychological ill health and sickness absence: a systematic literature review. Occupational and Environmental Medicine, 60, 3-9. 6.  KNIBBE, J. & FRIELE, R. 1996. Prevalence of back pain and characteristics of the physical workload of community nurses. Ergonomics, 39, 186-198.

§  Educating district nurses about MSD warning signs may help them to seek help sooner, reducing the risk for taking time off. §  District nurses are concerned about being physically able to work into 50’s & 60’s. This could have implications for workforce recruitment and retention. §  District nurses showed preference for face-to-face employer wellbeing initiatives opposed to being delivered on-line. Face-to-face wellbeing reviews may help address individual barriers to issues like exercise avoidance. §  Patient handling activities in the patient home, specifically leg dressings was felt to cause musculoskeletal pain. Equipment was often difficult to access and not fit for purpose. Research is needed to identify best practice.

Conclusion §  This small exploratory study provides a valuable insight into district nurses perceptions of musculoskeletal wellbeing. §  It identifies potential strategies for promoting staff engagement with workplace wellbeing initiatives. §  Patient handling in the homecare environment may be placing district nurses at increased risk of MSD, therefore needs further attention.

7.  HAYNE, C. R. 1988. The Preventive Role of Physiotherapy in the National Health Service and Industry. Physiotherapy, 74, 2-3. 8.  DANNA, K. & GRIFFIN, R. W. (1999). Health and Well-Being in the Workplace: A Review and Synthesis of the Literature. Journal of Management, 25, 357-384. 9.  BOORMAN, S. 2009. NHS Health and Well-being. London: Department of Health. 10. NHS ENGLAND (2014). Five Year Forward View. NHS England. 11. SMITH, J. A., FLOWERS, P., & LARKIN, M. (2009). Interpretative phenomenological analysis: Theory, method and research. Sage. 12. BRAUN, V., & CLARKE, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.