The effect of posture regulation training on musculoskeletal disorders, fatigue level and job performance in intensive care nurses

Abstract

Background

Intensive care units (ICUs) are one of the high-risk working areas in terms of musculoskeletal disability and ergonomic risks including the environment and posture factors. Correct posture technique is often ignored by nurses working in these units. This study was conducted to determine the effect of posture regulation training on work-related musculoskeletal disorders, fatigue level and job performance in nurses working in ICUs.

Methods

This quasi-experimental study with one-group pretest-posttest design included 64 intensive care nurses. The nurses received posture regulation training in three different sessions. The post-test was administered four months after the posture regulation training.

Results

The nurses reported to frequently have aches, pains and discomfort in the neck, upper back and lumbar regions. After the posture regulation training, their level of pain, ache and discomfort in the neck, right and left shoulder, upper back, lower back and right/left foot areas decreased significantly (p < 0.05). The posture regulation training reduced the levels of behavior/severity and affect, which are sub-dimensions of fatigue, and increased the level of contribution to work, which is a sub-dimension of job performance (p < 0.05).

Conclusion

The posture regulation training decreased the level of symptoms in the neck, shoulder, upper back, lower back and foot regions of intensive care nurses and partially improved their fatigue level and job performance. Therefore, posture regulation training should be added to in-service training programs and permanent measures should be taken for ergonomic risks in ICUs.

Background

Intensive Care Units (ICUs) are critical departments where healthcare professionals, primarily nurses, actively engage in patient care. Nurses in ICUs fulfill nearly all self-care needs of patients undergoing treatment in these units. Tasks performed by nurses in ICUs involve intensive treatment and care practices for partially or fully dependent patients, including positioning and mobilization within the bed, bed-stretcher transfers, and carrying out daily life activities [1, 2]. Additionally, intensive care nurses frequently engage in activities such as lifting, pushing, pulling, and transporting various medical equipment of different weights in ICUs. Throughout these activities, they face health risks associated with prolonged standing, inability to maintain proper working postures, and insufficient rest, leading to increased loads on joints involved in posture and weight-bearing [3, 4]. As a result, healthcare professionals, particularly nurses working in ICUs, may experience work-related musculoskeletal disorders (WRMDs) [5–8]. Among these disorders, lower back pain is notably prevalent and represents one of the most common WRMDs encountered by nurses, highlighting the physical challenges and ergonomic risks associated with their responsibilities in the ICU [1, 2].

WRMDs pose a significant occupational health challenge for nurses [9], leading to physical health problems such as daily-life pain and limitations [10]. In the case of intensive care nurses, the emergence of WRMDs can result in fatigue, decreased job satisfaction, increased turnover, increased sick leave, and burnout, consequently diminishing both job performance and quality of life [11–14]. Furthermore, WRMDs among nurses may contribute to increased accidents, economic losses for the institution, and direct risks for the individuals receiving care [2, 10]. Within the scope of occupational health and safety, one of the most crucial approaches to prevent WRMDs in healthcare professionals is identifying ergonomic risks and ensuring proper ergonomic practices. Ergonomics involves the science of modifying and optimizing the environment, tasks, and equipment to be consistent with the limitations and capabilities of individuals [6, 11]. In the physical realm of ergonomics, it is associated with the anatomical, anthropometric, physiological, and biomechanical characteristics of individuals, encompassing work postures, material handling, repetitive movements, musculoskeletal disorders, workplace layout, and health and safety issues [15]. Existing literature indicates a direct relationship between poor ergonomics, inappropriate posture, and the occurrence of WRMDs [3, 16, 17]. A study found that more than half of the nurses utilized non-ergonomic postures during patient care activities, and 96.5% stood for prolonged periods during working hours. The same study identified a high prevalence of lower back pain among nurses working in ICUs who adopted non-ergonomic positions while writing and working at the computer [8].

Ergonomics, while enhancing productivity, aims to provide the most comfortable and suitable working conditions for individuals [18, 19]. In this respect, ergonomics both supports employee health [6] and increases job performance [15]. In the nursing profession, a discipline dedicated to healthcare, one of the fundamental prerequisites for delivering quality health care is the conformity of work style and environment to ergonomic principles [8, 18, 20]. ICUs represent high-risk working areas in terms of ergonomic factors [21], where ergonomics is often overlooked [15]. However, the implementation of ergonomic principles in ICUs, including easily adjustable beds, assistive lifting and transportation tools, and the organization of intensive care environment according to ergonomic principles, coupled with nurses’ knowledge of using correct body mechanics during treatment and care processes, can contribute to both the prevention of WRMDs and the reduction of ergonomic risks [8, 11]. The literature indicates that nurses often have a low level of knowledge regarding workplace ergonomics [19]. Ergonomic training for nurses is typically provided during their academic and early professional years [22]. The inclusion of ergonomic training in in-service training activities throughout the year may contribute to the prevention of undesirable WRMDs and, consequently, enhance job performance. This study aims to shed light on the impact of posture regulation training for intensive care nurses on musculoskeletal disorders, fatigue levels, and job performance. It is noteworthy as the first study in Turkey examining ergonomic training among nurses working in ICUs. In studies conducted with nurses working in different units in different countries, it has been determined that ergonomic training contributes to reducing musculoskeletal disorders in nurses [11, 16, 22]. However, the effects of posture regulation training on fatigue levels and job performance in nurses have not been examined. The results of this study are anticipated to contribute to nursing managers and the literature by addressing factors influencing both the physical health preservation of intensive care nurses and their job performance, suggesting potential improvements in these aspects. The hypotheses of the study are as follows:

H1

Following posture regulation training provided to intensive care nurses, their WRMDs decreases.

H2

Following posture regulation training provided to intensive care nurses, their fatigue decreases.

H3

Following posture regulation training provided to intensive care nurses, their job performance increases.

Methods

Study design

This quasi-experimental study was conducted with one-group pretest-posttest design.

Participants

The study’s population consisted of 82 nurses actively serving in the ICUs of Kocaeli University Hospital between June 15 and November 15, 2023. To minimize the level of impact on the study, all nurses in the population were included in the sample group. Additionally, a power analysis determined that 54 nurses needed to be included in the study. However, 18 nurses were excluded based on the exclusion criteria. Consequently, the study was conducted with 64 nurses who met the inclusion criteria. Since the ICUs were located close to each other and the number of nurses working in the institution was low, the study was conducted using a single training group.

The inclusion criteria were as follows: being actively working in the ICU for at least one year, completing ergonomics risk training, and agreeing to participate in the study.

The exclusion criteria were as follows: being diagnosed with non-WRMDs musculoskeletal disease by a physician (n = 1), working in the ICUs for less than one year (n = 9), not completing ergonomics training due to reasons such as annual leave, medical report (n = 4), working in another job in spare time, being pregnant (n = 1), and not wanting to participate in the study (n = 3).

Data collection tools

The data were collected using a personal information form, the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), Piper Fatigue Scale (PFS) and Job Performance Scale (JPS). Personal information form consists of 25 questions about the nurses’ socio-demographic (age, gender, marital status, educational status, etc.) and occupational (years of working as a nurse, weekly working hours, shift work status, etc.) characteristics.

Cornell Musculoskeletal Discomfort Questionnaire was developed at Cornell University Human Factors and Ergonomics Laboratory to assess musculoskeletal system symptoms. It evaluates the frequency, severity, and interference with work due to musculoskeletal discomfort (pain, ache, discomfort) in 20 body regions (neck, right-left shoulder, upper back, right-left upper arm, lower back, right-left forearm, right-left wrist, hip, right-left thigh, right-left knee, right-left lower leg, right-left foot) during the last week of work duration for individuals working in a standing position. Participants are required to mark the different pain regions or areas shown on the scale. A score between 0 and 90 is assigned to each region. A higher score indicates an increased prevalence of musculoskeletal disorders in the respective area. The Turkish validity and reliability study of the scale was conducted by Erdinç et al. [23]. The Cronbach’s alpha values for the frequency, severity, and interference of pain, ache, or discomfort were found to be 0.87, 0.89, and 0.87, respectively. In this study, the Cronbach’s alpha values for the frequency, severity, and interference regarding musculoskeletal symptoms were found to be 0.83, 0.80, and 0.88, respectively.

Piper Fatigue Scale was developed by Piper et al. [24] to evaluate one’s subjective perception of fatigue. It consists of a total of 22 items and four subscales: the behavior/severity subscale, assessing the impact and severity of fatigue on daily life activities; the affective subscale, covering the emotional significance attributed to fatigue; the sensory subscale, reflecting the sensory symptoms of fatigue on mental, physical, and emotional aspects; and the cognitive/mood subscale, indicating the level of fatigue’s impact on cognitive functions and mood. Subscale scores are obtained by summing the scores of all items on that subscale and dividing by the number of items. Responses for each item are scored between 0 and 10. The total fatigue score is obtained by summing the scores of all 22 items and dividing by the number of items. The total score obtained from the scale varies between 0 and 10, and as the score increases, the fatigue experienced by the person increases. The Turkish validity and reliability study of the scale was conducted by Can [25], indicating a Cronbach’s alpha coefficient of 0.94. In this study, the Cronbach’s alpha value was calculated as 0.89.

Job Performance Scale was developed by Greenslade and Jimmieson [26] and validated in Turkish by Seren et al. [27]. It consists of 32 items organized into six subscales; coordination of care, assistance and support to patients, support to colleagues, contribution to the organization, provision of information, and. The items are rated on a 5-point Likert scale, where higher scores indicate higher job performance and lower scores indicate lower job performance. In the Turkish validation study, the Cronbach’s Alpha coefficient was calculated as 0.95 [27], while in the current study, it was found to be 0.91.

Intervention

The data were collected in three stages. In the first stage, after obtaining institutional permission, observations were made by the physiotherapist in the ICUs to determine the content of posture regulation training. For this purpose, intensive care nurses were observed for three days a week for approximately two hours during working hours regarding posture risks. Observations were conducted on the postures frequently used by intensive care nurses during patient care, giving positions to patients, writing at the desk, taking medication, materials, serum, etc., from the shelf or cabinet, standing, lifting a box or a heavy object from the ground, carrying a lifted heavy object, and working at the computer. At the end of the first week, the nurses who by nurses who willed and agreed to participate in the study individually filled out the data collection forms (pre-test). Subsequently, an ergonomics training plan was prepared taking into account the working methods and rest periods of the nurses.

The second stage of the study involved the development of posture regulation training. The posture regulation training is not routinely included in the in-service training program at the institution where the study was conducted. The training was provided by a physiotherapist with clinical and academic experience in the field of physiotherapy and rehabilitation, who is a member of the research team. The training took place in the seminar room of an ICU, using computer-aided power point presentation, models, demonstrations, visual and written materials (brochures), and was conducted at hours convenient for the nurses. The instructor provided ergonomic training in three sessions, each lasting approximately 60 min, with one-week intervals between sessions at four different ICUs. To enhance the quality of the training and increase participant engagement, each training session was divided into six small groups of 10–12 participants. At the end of each training session, the nurses’ questions related to the topic were addressed. The training topics were as follows:

• First week: definition of ergonomics, types of ergonomic risks, ergonomic risks in the intensive care unit, precautions to be taken for ergonomic risk factors.

• Second week: WRMDs and the impact of WRMDs on physical health and job performance of nurses.

• Third week: Body mechanics and work posture.

The opinions of three physiotherapist academics, as experts in the field, were sought for the content of the training. The total training time for each nurse averaged 125.32 ± 12.27 min. Additionally, informative notes reflecting the content of the training were posted on the nurse bulletin board for all nurses to inform about the training. Moreover, the physiotherapist who provided the training visited the ICU daily and repeated the information given during the training to the nurses when necessary. The training sessions were also incorporated into the in-service training practices of the institution.

In addition to the verbal and visual training, correct posture techniques were applied one-on-one by the trainer to all participants in the third week of the training using the demonstration technique. In particular, training was provided on patient transfer, desk work, bending down, lifting objects on the floor and reaching for high shelves while maintaining correct posture. Strengthening and stretching exercises for the muscles required for correct posture were given as a home program.

The third stage of the study was completed four months after the posture regulation training. Considering studies in the literature, it was decided to evaluate the effectiveness of the training at the end of the fourth month [11, 22]. In this stage, the nurses individually filled out the data collection forms, excluding the personal information form, after completing the posture regulation training (post-test). Filling in the data was done when the nurses had just started working, especially in order not to affect their fatigue and pain status. The completion of data collection forms by the nurses in both pre-test and post-test took approximately 20–25 min.

The study was completed in approximately five months. The first phase was completed in one week, the second phase in three weeks, and the third phase, which was conducted four months after the training, was also completed in one week.

Data analysis

The data were analyzed using the SPSS 23.0 program and evaluated using descriptive statistical methods (mean, standard deviation). In addition, the Paired Sample t-test was used to compare the nurses’ pre-test and post-test mean scores on the CMDQ, the PFS, and the JPS. Furthermore, the study’s effect size was determined to be 84%. The significance level for statistical evaluations was set at p < 0.05.

Results

The mean age of the nurses was 29.39 ± 5.00 years. Of them, 73.4% were female, 56.3% nurses were married, 70.3% had a bachelor’s degree, 32.8% were smokers, 9.4% were overweight and obese, and 14.1% had chronic diseases. In addition, 12.5% of the nurses had musculoskeletal disorders or diseases in themselves and 31.3% in their families, and only 32.8% practiced sports activities at least three times a week for at least 30 min.

Table 1 provides information on other occupational and ICUs working characteristics of the nurses. The average length of time that nurses participating in the study have worked in the ICUs is 6.03 ± 4.47 years. Approximately two-thirds of the nurses (70.3%) worked 40 h a week, and 67.2% stated that they took breaks during their work. All of the nurses stated that they did not receive training on ergonomic risks in the unit they worked.

Table 1.

Professional and intensive care working characteristics of nurses

Characteristics	n	%
Working time in the intensive care unit (Mean ± SD) (years)	6.03 ± 4.47
Years working as a nurse
1–5	27	42.2
6–10	26	40.6
11–15	6	9.4
16 years and above	5	7.8
Weekly working hours
Less than 40 h	3	4.7
40 h	45	70.3
More than 40 h	16	25.0
Shift working status
Yes	50	78.1
No	14	21.9
Giving rest periods during work
Yes	43	67.2
No	21	32.8
Staying in the same position while working
Yes	40	62.5
No	24	37.5
Feeling under pressure or stressed from your job
Yes	43	67.2
Partially	18	28.1
No	3	4.7
Finding the support received from auxiliary health personnel sufficient during the study
Yes	21	32.8
Partially	32	50.0
No	11	17.2
Consideration of leaving the intensive care unit
Yes	26	40.6
No	38	59.4
The state of doing one’s job fondly
Yes	16	25.0
Partially	33	51.6
No	6	9.4
Indecisive	9	14.1
Participation status in a training program on ergonomic risks at any time in the unit in which the employee works
Yes	0	0.0
No	64	100.0
General health assessment
Good	24	37.5
Middle	35	54.7
Bad	5	7.8

Table 2 shows the comparison of the mean scores of the nurses on the CMDQ before and after the posture regulation training. According to the average score of the nurses from the CMDQ before the posture regulation training, the nurses frequently experienced aches, pain, and discomfort in the neck (26.16 ± 28.85), upper back (23.21 ± 25.82), right foot (21.91 ± 30.24), left foot (21.13 ± 29.08), and lumbar (20.89 ± 22.04) regions. After the posture regulation training, the areas where the most aches, pain, and discomfort occurred were the left foot (14.79 ± 20.58) and the right foot (14.40 ± 20.61). After the posture regulation training, the nurses experienced significantly less pain, ache and discomfort in the neck, right and left shoulder, upper back, lower back, and right and left foot regions (p < 0.05).

Table 2.

Comparison of nurses’ pretest and posttest Cornell Musculoskeletal Discomfort Questionnaire score means

Body regions	Pretest	Posttest	Test, p	95% Confidence
	Mean ± SD	Mean ± SD		Lower	Upper
Neck	20.89 ± 22.04	10.96 ± 15.61	4.560; <0.001**	5.57	14.28
Right shoulder	17.64 ± 23.59	11.50 ± 18.34	3.185; 0.002*	2.88	9.99
Left shoulder	16.58 ± 23.06	11.85 ± 19.24	2.406; 0.019*	0.80	8.66
Upper back	23.21 ± 25.82	9.75 ± 17.17	4.857; <0.001**	7.92	18.99
Right upper arm	6.42 ± 14.05	5.54 ± 13.50	1.207; 0.232	-0.57	2.34
Left upper arm	5.51 ± 14.14	5.85 ± 14.40	0.815; 0.418	-0.96	2.29
Lower back	26.16 ± 28.85	11.15 ± 15.51	4.501; <0.001**	8.34	21.67
Right forearm	4.74 ± 9.87	3.57 ± 7.52	1.069; 0.289	-1.01	3.33
Left forearm	4.53 ± 9.41	3.44 ± 6.57	1.024; 0.310	-1.03	3.20
Right wrist	4.10 ± 9.22	3.42 ± 6.16	0.604; 0.548	-1.56	2.92
Left wrist	3.88 ± 8.88	3.58 ± 6.30	0.276; 0.783	-1.84	2.44
Hip	12.78 ± 23.05	8.04 ± 15.73	1.815; 0.074	-0.47	9.96
Right thigh	8.51 ± 17.03	7.64 ± 17.27	0.447; 0.656	-3.03	4.78
Left thigh	8.31 ± 16.89	6.53 ± 13.72	1.171; 0.246	-1.25	4.82
Right knee	10.90 ± 22.08	8.53 ± 14.59	1.003; 0.320	-2.35	7.08
Left knee	10.28 ± 20.14	7.98 ± 13.02	1.222; 0.226	-1.46	6.05
Right lower leg	14.25 ± 23.14	10.57 ± 15.77	1.519; 0.134	-1.16	8.52
Left lower leg	13.78 ± 21.82	10.56 ± 16.50	1.463; 0.148	-1.17	7.63
Right foot	21.91 ± 30.24	14.40 ± 20.61	2.293; 0.025*	0.96	14.05
Left foot	21.13 ± 29.08	14.79 ± 20.58	2.041; 0.045*	0.013	12.53

*p < 0.05; **p < 0.01

Table 3 shows the comparison of the mean scores of the PFS and JPS of the nurses before and after the posture regulation training. The general mean score of the nurses on the PFS before the posture regulation training was 5.30 ± 1.35, and 5.40 ± 1.75 after the training. When the nurses’ fatigue levels were evaluated before and after the posture regulation training, no significant difference was found in the general fatigue level (p > 0.05). However, it was determined that there was a statistical decrease in the behavior/violence and affect sub-dimensions of the nurses after the posture regulation training (p < 0.01).

Table 3.

Comparison of nurses’ pretest and posttest Piper Fatigue Scale and Job Performance Scale mean scores

Scales	Pretest	Posttest	Test, p	95% Confidence
	Mean ± SD	Mean ± SD		Lower	Upper
Piper Fatigue Scale
Behavior/severity	6.30 ± 1.88	5.15 ± 1.91	6.482; <0.001**	-0.79	1.50
Affective	3.71 ± 0.76	5.89 ± 2.12	-7.134; <0.001**	-2.78	1.56
Sensory	5.59 ± 2.14	5.37 ± 1.97	0.978; 0.332	-0.22	0.66
Cognitive/mood	5.58 ± 2.24	5.18 ± 1.76	1.759; 0.083	-0.05	0.85
General	5.30 ± 1.35	5.40 ± 1.75	-0.576; 0.567	-0.44	0.24
Job Performance Scale
Coordination of care	4.18 ± 0.82	4.29 ± 0.52	-1.233; 0.222	-0.30	0.07
Assistance and support to patients	3.78 ± 0.75	3.93 ± 0.58	-1.799; 0.077	-0.31	0.01
Support to colleagues	3.80 ± 0.89	4.11 ± 1.29	-1.689; 0.096	-0.66	0.55
Contribution to the organization	3.62 ± 0.67	3.75 ± 0.52	-1.408; 0.164	-0.32	0.05
Provision of information	3.97 ± 1.31	3.89 ± 0.69	0.481; 0.632	-0.24	0.39
Contribution to the job	3.58 ± 0.96	3.86 ± 0.82	-2.242; 0.028*	-0.53	-0.03
General	3.82 ± 0.68	3.97 ± 0.53	-1.770; 0.082	-0.32	0.01

*p < 0.05; **p < 0.01

The general mean score of the nurses on the JPS before the posture regulation training was 3.82 ± 0.68 and 3.97 ± 0.53 after the training. When the job performance status of the nurses was evaluated, it was determined that there was a significant increase only in the contribution to work sub-dimension in the post-test (p < 0.05) (Table 3).

Discussion

Nowadays, the high prevalence of WRMDs among nurses has increased interest in occupational health practices involving ergonomics [7]. This study aimed to determine the impact of posture regulation training on WRMDs, fatigue levels, and job performance in nurses working in ICUs. The study revealed that posture regulation training reduced symptoms in the neck, shoulders, upper back, lower back, and foot areas of intensive care nurses, partially improving their fatigue levels and job performance.

Nurses are more exposed to ergonomic risk factors and, consequently, WRMDs due to prolonged standing compared to other employees. The preventability of WRMDs is crucial for improving both the health of nurses and the quality of patient care [28]. The study found that the nurses frequently experienced pain, discomfort, and soreness in the upper back, neck, and lower back areas. The study finding is parallel with the literature [1, 5, 7, 9, 13, 29, 30]. A systematic review reported that Turkish nurses experience musculoskeletal symptoms in the upper back (12.1–69.0%), neck (30.3–54.0%), shoulders (17.8–46.0%), and legs (12.2–64.4%) [10]. Nurses working in ICUs in Turkey are involved in repetitive tasks throughout the day, such as preparing and administering medications, making patient beds, frequently changing patients’ position to prevent decubitus ulcers, assisting them with dressing, blood drawing, and frequently inserting intravenous lines. During these tasks, nurses may adopt different body postures or engage in prolonged activities in the same position, leading to musculoskeletal disorders, especially in the neck, upper back, and lower back regions.

The study found that after posture regulation training, the nurses experienced a reduction in their pain, discomfort, and soreness in the neck, shoulders, upper back, lower back, and foot areas. A study conducted in Iran determined that ergonomics training reduced the frequency of upper and lower extremity complaints among nurses [31]. Another study also identified a decrease in the severity and frequency of upper back pain in nurses after ergonomics training [11]. In an evaluation of ergonomic risks during blood pressure measurement in nurses, a study revealed significant improvement in body posture after ergonomics training, emphasizing its potential to reduce WRMDs [30]. An ergonomics-training program aimed at improving nurses’ body posture resulted in a decrease in the frequency of pain associated with musculoskeletal disorders (MSD) [16]. In a study involving operating room nurses, ergonomics training led to a decrease in the prevalence of MSD in the ankle, wrist/hand, upper back, neck, hip, and shoulder regions [22]. A study with nurses working in ICUs in Egypt found an increase in their awareness of ergonomic safety after ergonomics training [6]. Our study results support Hypothesis 1 and are consistent with those in the literature. The significant reduction in physical symptoms in certain body areas through affordable and accessible posture regulation training, without the implementation of any exercise or treatment program, is an important outcome of our study. Thus, our study results and others suggest evidence that posture regulation training can reduce WRMDs in nurses.

In the study, a decrease in the levels of behavioral/violence and emotional dimensions of fatigue in nurses was observed after posture regulation training. In the literature, there are no specific studies on the relationship between ergonomics and fatigue in nurses. However, a study in a different sector found that ergonomic interventions reduced the participants’ musculoskeletal complaints and fatigue levels, had positive effects on activity-related fatigue levels, especially in the body and legs, and reduced the participants’ desire to stretch [32]. Our study results partially support Hypothesis 2. In general, it is expected that reducing WRMDs through ergonomics could also lead to a decrease in fatigue levels. In this study, a reduction in fatigue levels in certain areas was observed after posture regulation training, and this could be attributed to the timing of data collection.

The study determined an increase in the level of contribution to work in intensive care nurses after posture regulation training. A study conducted in Egypt reported that the quality of work life of nurses improved after ergonomics training [11]. Another study found a significant decrease in physical workload and improvement in work style after ergonomics training for nurses [28]. Another study on the effectiveness of ergonomic interventions found that ergonomic interventions aimed at improving the process of patient transport in nurses resulted in a decrease in job satisfaction from 35 to 26% [33]. Abd Rabou and Akel [34] also found that ergonomics training had a positive impact on the work quality of nursing interns. A descriptive study determined that ergonomic competence in nurses was a negative predictor of work-related stress [35]. Our study result is consistent with those in the literature, and partially supports Hypothesis 3. This result highlights the importance of posture regulation training in areas where the quality of patient care needs to be maintained at the highest level, such as intensive care units. However, in this study, it is intriguing that posture regulation training only resulted in improvement in the level of contribution to work in nurses. This situation may be attributed to the individual characteristics of the sampled nurses and the evaluation period of the training intervention.

This study has some limitations. Since it was conducted in a single university hospital during a specific time period, the results may not be generalizable to the entire population. Additionally, the study relied on the nurses’ self-reported information for WRMDs, fatigue levels, and job performance, constituting another limitation. The lack of a control group, failure to exclude risk factors for WRMDs, and the absence of a comparison for the effectiveness of the training are significant limitations for the study. In addition, posture regulation training is limited to only regulating the posture of the employee. Furthermore, monitoring posture risks only during regular working hours (08 am – 05 pm) is also among the important limitations of the study. Long-term randomized controlled trials could provide more information about the impact of ergonomic training that includes environmental and posture regulation on WRMDs, fatigue levels, and job performance in intensive care nurses.

Conclusion

The study revealed that after ergonomic training, the nurses experienced a decrease in their symptoms, especially in the neck, shoulders, upper back, lower back, and feet areas. There was also a reduction in the fatigue dimensions of behavior/violence and emotion. Furthermore, an increase was observed in the contribution to work dimension of job performance. This study provided the first data in Turkey on the prevention/reduction of WRMDs and the enhancement of job performance through ergonomic training for intensive care nurses, emphasizing the necessity of ergonomic training for health professionals. In this context, it is recommended to incorporate ergonomic training into in-service training programs in health care institutions. It is also suggested to use reminder education techniques such as posters and brochures to highlight the importance of the subject, establish an ergonomic team in occupational health and safety units, including nurses and physiotherapists, and raise awareness among nurses about ergonomic risks in ICUs. Additionally, it is recommended to conduct further randomized controlled trials on the impact of ergonomic training on WRMDs, fatigue levels, and job performance in nurses working in ICUs.

Abbreviations

ICUs

Intensive care units

WRMDs

Work-related musculoskeletal disorders

CMDQ

Cornell Musculoskeletal Discomfort Questionnaire

PFS

Piper Fatigue Scale

JPS

Job Performance Scale

MSD

Musculoskeletal disorders

Author contributions

O.B.D. and F.T.Y. contributed to the conception of the study. O.B.D. and F.T.Y. contributed to the data interpretation, data analysis and manuscript writing. O.B.D. and F.T.Y contributed to interpretation, discussion, reviewed/edited the manuscript. O.B.D. contributed to the data collection. F.T.Y. contributed to the grammar of the manuscript. All authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Before collecting the data, a written permission was obtained from the ethics committee of Sakarya University of Applied Sciences Ethics Committee (Decision No: 86528/06-2023) and the institution where the study was conducted. Nurses participating in the study were informed about the purpose, methodology, and benefits of the study, and their willingness to participate was sought and obtained. Since individual rights should be protected in the use of human phenomenon in research, the condition of “Informed Consent” was fulfilled in the light of the principle of “Willingness, Voluntariness”. Written consent was obtained from nurses who agreed to participate in the research.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.