Quantification and Analysis of Work Ability Index of Nursing Staff

Maia, P. M. S.

Sindicato dos Enfermeiros

Rua D. João IV, 210 4000-297 Porto/ Portugal

351 225 09 40 40, pmaia@sen.pt

Paz Barroso, M.F.C.

Departamento de Produção e Sistemas/Escola de Engenharia, Universidade do Minho/ Azurém, 4800-058 Guimarães/ Portugal

351 253 510353, mbarroso@dps.uminho.pt

Silva, C.F.

Departamento de Psicologia/Instituto de Educação e Psicologia/ Universidade do Minho/Gualtar, Braga/ Portugal cfernandes@iep.uminho.pt

ABSTRACT

The project undertaken comprised the application of the Work Ability Index (WAI), developed by the Finish Institute for Occupational Health, in a sample (n=455) of nurses from a public hospital [1]. Simultaneously, and in order to objectively assess some of the working conditions associated with the nursing activity, an ergonomics workplace analysis [2] was carried out.

This was the fist study carried out in Portugal regarding the application of the WAI. Results found for the population analysed do not differ significantly from those found in other research studies for other professional activities. Despite the low significance obtained from the statistical analyses undertaken, it is our belief that the WAI constitutes a useful tool for assessment of workers well-being and general health conditions.

Keywords

Work ability index, nursing staff, ergonomic analysis of workplaces

INTRODUCTION

Preservation of health and well-being of workers constitutes the central issue of considerable amount of research, namely on the domains of Ergonomics and Occupational Health and Safety. Within this context, the development and subsequent validation of methodologies which enable assessment of workers’ well-being and satisfaction acquires prime importance.

Nowadays frequent discussions exist regarding whether professional activities incorporate specific risk characteristics or whether risk arises from the environment under which the activity is performed. This issue triggered the need for an answer in what regards the analysis risks associated with the performance of nursing activities.

Accordingly, the research carried out focused on the application of a methodology developed within the scope of Social Sciences – the Work Ability Index [1], [3]. This latter methodology has been subsequently translated and adapted into Portuguese [4].

Parallel to the application of the Work Ability Index questionnaire, an ergonomic analysis of the workplaces was undertaken in order to assess the extent to which work ability might be determined by environmental conditions and work organisation issues.

In practical terms the application of the Work Ability Index questionnaire results in a numerical score which describes the respondent’s current work ability and which is subsequently used to identify which measures to apply in order to promote work ability. Scores may vary between 7 and 49, and interpretation is done according to the following table.

Table 1 – Interpretation of the scores obtained through application of the Work Ability Index (adapted from [1]).

Professional activity selected for analysis was, as already mentioned, nurses working within hospital environment. In addition to the characterization and analysis of the work ability index for nurses, this research also aimed at spreading the practical usefulness of the WAI within the areas of Occupational Health.

Underlying the selection of the nursing activity for application and analysis of the Work Ability Index (WAI) questionnaire was not only the considerably high number of complaints presented within this professional group, but also the systematic verbalization of the need to anticipate retirement age due to the physical and psychological strain and stress to which nurses are continuously exposed.

According to the authors who put forward the WAI questionnaire, work ability might be conceptually defined as the self assessment the individual makes regarding his/her current and future well-being, and of the capacity he/she has to maintain work regarding work demands, health and available psychological resources.

This conceptualization is fundamental since data on the prevalence of limitations for work vary significantly according to the methodology applied to assess individual work ability. This is influenced, among other factors, by the activity demands, the situation regarding job stability, the working conditions and the applicable legal and administrative mechanisms to award advanced retirement for incapacity [5].

Several research studies carried out in which the WAI was applied evidenced that prevalence of incapacity to work increases over the age group 30 to 34 years, and that both self-assessed and medically assessed incapacity for work increase significantly between 50 and 54 years of age. In addition, results also show that incapacity is more frequent in men, for all age groups [4].

The previously mentioned points, together with the acceptance that it is wide the variety of factors that may interfere and negatively affect nurses health and quality of life constitute the main premises for the research project undertaken. Additionally it was also intended to emphasise the usefulness of the WAI tool as a means of classifying ability to work and as a means of identifying and defining measures to

implement in order to maintain or promote work ability.

GENERAL OBJECTIVES

• Assess   work   ability   within   a   population   of   nurses   working   on   hospital environment,
• Test the usefulness  of the tool as a predictive indicator  in order to identify beforehand the need for  advanced retirement,
• Check whether results obtained for nurses vary significantly when compared to those already obtained for other Professional activities,
• Test the application of the tool in Portugal and divulge it among Occupational Health Professionals.

METHODOLOGY

The sample used for this research study comprised a total of 455 nurses from the Hospital de São João in Oporto (368 women and 87 men). Average age among the individuals is 33.03 years (SD=9.59 years).

When asked about the nature of the demands associated with the activities performed, 96.7% of the respondents describe these as both physical and intellectual.

Main function performed by the respondents is direct health care (corresponding to a total of 90.6% of answers). Average week working hours varies between 42 and 53 hours for the majority of respondents (52.4%).

The majority of the nurses enquired perform this activity for over ten years (average=10.21 years and SD=9.16 years). Also the vast majority of respondents works on shift regime (89.5%) and does such on average for 8.36 years (SD=7,66 years).

In order to distinguish between the conditions under which the tasks are performed, these were grouped into several categories defined according to the structural and functional division used across the hospital (emergency rooms, intensive care, neonatology, orthopaedics, etc.). Additionally, for each task type considered, a distinction was made between the workplace in which the task is performed. This consisted in two alternative categories – health care rooms and work rooms.

Each task type identified was defined and analysed considering which subtasks are performed in which workplaces, which equipments are required, and which postures are adopted – the latter being time-weighted.

In order to objectively assess the conditions under which the different task- types are performed the methodology suggested by the Ergonomics Section of the Finish Institute for Occupational Health was applied [2]. This required measurement and quantification of a series of parameters, namely levels of daytime and night illumination, equivalent sound pressure levels, thermal conditions (and the computation of thermal index PPD/PMV [6]).

In order to obtain a more detailed analysis of the risk associated to the postures adopted while performing some health care activities, REBA was used for risk assessment [7] [8] [9].

Ability to work was assessed through distribution and subsequent analysis of the answers given to the WAI questionnaire.

Data collection took place at the different workplaces identified and was carried out from February to September 2001.

The data collected through the application of the above mentioned methodologies was subsequently analysed and compared in order to identify whether there is a relation between some of the parameters quantified and the WAI score obtained. Statistical analysis was carried out using SPSS, version 9.0 [10].

RESULTS OBTAINED

With regard to the results obtained form the application of the WAI questionnaire, these indicate an average value of 41.44, with standard variation of4.24. Figure 1 illustrates graphically the distribution of the WAI scores obtained for the sample analysed according to the categories defined on table 1.

250

238 200

150

159

100

55

50

3

0

Low Moderate Good Excellent

WAI Categories

Table 1 – Distribution of absolute frequency according to WAI categories.

Data from figure 1 illustrates suggests that the majority of the individuals questioned assesses his/her work ability as Good (n=238; 52.3%), this category is followed by the category “excellent”, for which 159 answers (34.9%) were recorded.

Category “moderate WAI” was recorded for 55 individuals (12.1%) and only 3 have described his/her work ability as being “low” (0.7%).

In order to identify possible relations between the WAI scores registered and the values obtained for the other relevant variables quantified, a Pearson correlation analysis was carried out. This procedure was applied to investigate whether there is a relation between: WAI score and age, WAI score and gender, WAI score and number of years in the activity, WAI score and number of years working on shift regime, WAI score and number of nurses allocated to that unit, and WAI score and the number of weekly working hours.

The only variable which has shown significant (p=0.01) correlation with the values of WAI was age, this being described according to the following mathematical

expression: WAI = 43.733 – 0.0698 * age 0.704. This correlation is described on figure 2.

45

4035

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 ( )60 42,28 41,86 40,76 41,58 40,92 41,3 39,93 41,9 36,67

30

Age Groups (yrs)

Gráfico 2 – Valores de média do ICL, em função das classes etárias

Having in mind that one of the goals defined was the analysis of the influence, on the WAI score, of the different factors assessed through application of the Ergonomic Work Analysis tool, possible correlations between values were investigated. Results indicated that none of the above correlations was statistically significant.

Similar statistical analysis was undertaken in order to identify possible relations between the work units defined and the final WAI score, and between the different work group categories and the final WAI score. Results allowed no conclusion as to significant differences between different work units and work group categories and the associated WAI scores.

CONCLUSIONS

On the basis of the goals set for this research Project some major conclusions may be drawn. Results indicate that Work Ability Index for the nurses populations analysed is generally classified as Good and that there is a statistically significant correlation between the WAI scores and the individual’s age.

Correlation between WAI score and age is negative, that is, na increase in age corresponds to a decrease on the WAI score, this relation being more obvious above the age of 50.

None of the other factors analysed, either those concerning the individual or those related to the working conditions associated to activity performance seem to influence the individual’s current self-assessment of work ability.

The predictive usefulness of the Work Ability Index requires subsequent assessment at future moments in time. This may be accomplished through a new application of the WAI questionnaire to a considerable group of nurses who have shown interest in further participation on this research. This follow-up study will enable more accurate conclusions regarding the need of advanced retirement or of major changes to the way in which work is reorganised – namely in what concerns physical workload and psychological strain imposed.

As far as comparing the results found through this research study with other obtained from similar studies undertaken with other professional activities is concerned it may be argued that results are very similar. It is worth stressing, nonetheless, that differences were found regarding the way in which the WAI varied according to gender and age. At this respect, Ilmarinen [5] observed that there were statistically significant

differences between genders when comparing the WAI scores for the age group 51 to 58 years old, the scores being lower for men. This behaviour was not found among the sample of nurses analysed.

Subjective complaints registered regarding musculoskeletal elements seem to be associated with task performance. This conclusion arises from the results obtained through the detailed ergonomic analysis undertaken to the physical activities performed, namely those task elements associated with materials (patient) handling. The vast majority of the results obtained emphasised the need for urgent intervention regarding assistance on materials handling.

Occupational exposure to noise seems also to be one of the factors which may be related to the subjective complaints expressed by the workers. More accurate information is required to establish such link since none of the methodologies used incorporates the required means for analysis of the impact of noise exposure on overall discomfort or stress level.

To finalise it is worth stressing that this project consisted on the first application and analysis of the Work Ability Index in Portugal.

REFERENCES

• 1. Ilmarinen, J. and Tuomi, K.; Work ability index for ageing workers. Aging and Work Proceeding. Helsink:  Institute of Occupational Health; 1993; No.4, pp.142155.
• 2. Ergonomic Workplace Analysis, Ergonomics Section,  Finish  Institute  for Occupational Health, Helsinki, 1989.
• 3. Ilmarinen, J. and Tuomi, K.; Work ability of aging workers. Scandinavian Journal Environ Health. 1992; 18 (No.2), pp. 810
• 4. Silva, C.F., Silvério, J.M., Nossa, P.S. et al. Envelhecimento, ritmos biológicos e capacidade laboral – versão portuguesa do Work Ability Index (WAI). Psicologia: Teoria, Investigação e prática. Universidade Minho, Braga, Portugal: Centros de Estudos em Educação e Psicologia, Universidade do Minho; 2000; pag. 329340.
• 5. Ilmarinen J.; Aging and workcoping with strengths and weaknesses. Scandinavian Journal Environ Health. 1997; 23, pp.35.
• 6. ISO 7730, Moderate Thermal Environments, Determination of the PMV and PPD Indexes and Specification of Thermal Comfort Conditions. ISO, 1984.
• 7. Hignett, S. and Richardson, B.; Manual handling loads in a hospital: an exploratory study to identify nurses' perceptions. Applied Ergonomics. Elsevier Science, Ltd.; 1995; 26(3), pp.221226.
• 8. Hignett, S.; Postural analysis of nursing work. Applied Ergonomics. Elsevier Science Ltd; 1996; 27(3), pp.171176.
• 9. Hignett, S. and McAtamney, L.; Rapid Entire Body Assessment (REBA) Technical notes. Applied Ergonomics. Elsevier Science, Ltd.; 1999, (31), pp.201206.
• 10. Pestana, M.H., Gageiro J.N.; Análise de dados para Ciências Sociais – A complementaridade do SPSS. Edições Sílabo. 2ª edição, Lisboa: 2000