title: The effect of working position on trunk posture and exertion for routine nursing tasks: an experimental study.
abstract: OBJECTIVE
  To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion.
  
  
  METHODS
  Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for 'computer-assisted recording and long-term analysis of musculoskeletal loads') measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion).
  
  
  RESULTS
  If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P < 0.001). Bathroom tests: compared with the standing work method, the kneeling and sitting work methods led to a significant increase in the proportion of time spent in an upright posture, by 19.4% points (P = 0.003) and 25.7% points (P < 0.001), respectively. The greater the proportion of time spent in an upright position, the lower the Borg rating (P < 0.001) awarded.
  
  
  CONCLUSIONS
  The higher the proportion of time that nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-adjustable beds are provided in healthcare institutions.
authors.affiliation: Department for the Principle of Prevention and Rehabilitation, BGW-Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Pappelallee 33/35/37, 22089 Hamburg, Germany;
authors.forename: Sonja
authors.initials: S
authors.lastname: Freitag
authors.forename: Rachida
authors.initials: R
authors.lastname: Seddouki
authors.forename: Madeleine
authors.initials: M
authors.lastname: Dulon
authors.forename: Jan Felix
authors.initials: JF
authors.lastname: Kersten
authors.forename: Tore J
authors.initials: TJ
authors.lastname: Larsson
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
mesh_terms: D000328:Adult; D001513:Beds; D005260:Female; D005851:Geriatric Nursing; D006801:Humans; D008875:Middle Aged; D009732:Nursing Care; D009735:Nursing Homes; D009740:Nursing Staff; D016272:Occupational Health; D005082:Physical Exertion; D011187:Posture; D013131:Spine; D013647:Task Performance and Analysis; D014937:Work
keywords: bed height; bending; musculoskeletal disorders; nursing; perceived exertion; trunk posture