The impact of low back pain on life and work of ICU nurses in China: a hermeneutic phenomenological study

doi:10.21203/rs.3.rs-4842637/v1

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The impact of low back pain on life and work of ICU nurses in China: a hermeneutic phenomenological study

https://doi.org/10.21203/rs.3.rs-4842637/v1

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Introduction: In China, due to the large population base, shortage of medical staff, aging population and other reasons, Intensive Care Unit (ICU) nurses are required to work high intensity and long hours, coupled with constant incorrect posture, resulting in a particularly high prevalence of low back pain (LBP).

Aim: The aim of this study was to further explore the impact of LBP on the work and life of ICU nurses through a qualitative research method.

Methods: This study uses an interpretive phenomenological approach. Fifteen ICU nurses with LBP symptoms from a tertiary hospital in Qingdao, China, were recruited as study subjects. From January to April 2024, data was collected through in-depth interviews in the form of online one-on-one audio, which was then converted into text. Colaizzi's phenomenological approach was used for data analysis.

Results: The impact of LBP on ICU nurse work includes 4 themes:1)impaired efficiency and motivation of work, 2)negative emotions: anxiety, fear, and feelings of guilt, 3)turnover intention, 4)presenteeism. The impact of LBP on ICU nurse life includes 3 themes: 1)limitations to daily life, 2)imiting exercise, social and leisure pursuits, 3)roles and problems of family caregivers.

Conclusions: The high prevalence of LBP can lead to the loss of ICU nurses, and cause great trouble to their work and life. Effective measures should be taken to improve this phenomenon in the future.

Implications for Clinical Practice: This study explored the impact of LBP on ICU nurses in China through qualitative interviews. It also pointed out the potential mechanism of the negative effects of low back pain on ICU nurses, which provided help for researchers to understand the phenomena of nurse turnover and presenteeism. Finally, this study hopes to arouse the attention of society and hospitals to the LBP of ICU nurses, so as to develop effective solutions.

intensive care

nurse

low back pain

pain management

qualitative study

Many healthcare professionals suffer from work-related musculoskeletal disorders, such as low back pain and neck pain, which can have a considerable impact on their health, such as sick leave or disability.
Intensive care unit nurses have a high prevalence of low back pain due to their frequent moving and transferring of patients, night shifts, and overtime. Furthermore, low back pain will lead to a high turnover rate and limited daily life of ICU nurses.

What this paper adds

As a developing country with the largest population base in the world, healthcare professionals in China are facing considerable work pressure and a harsh working environment. This study, from the perspective of the victim, has an in-depth understanding of the experience of Chinese ICU nurses suffering from low back pain.
Explore in depth how low back pain affects working ICU nurses in China, including the physical and psychological effects of pain, and how it further influences productivity and turnover intention.
Focus on how low back pain limits the daily and leisure life of ICU nurses in China, and how it affects their role as family caregivers.

In a systematic analysis of the Global Burden of Disease Study 2021 in The Lancet Rheumatology, it was shown that low back pain (LBP) affected 619 million people globally in 2020, and projections for the prevalence of low back pain suggest that by 2050, 843 million people worldwide will suffer from low back pain, an increase of 36.4% from 2020 ^[1]. Moreover, LBP is the second most common pain after headaches, and is the main cause of years lived with disability (YLDs) ^[2]. The definition of LBP was pain or discomfort in posterior aspect of the body from the lower margin of the twelfth ribs to the lower gluteal folds ^[3]. It can lead to individual suffering, high medical expenditures, and impaired social well-being ^[4].

In particular, in the industrial health department, the lifetime prevalence of low back pain in nurses is higher than in the general population, with reports as high as 50–80% ^[5]. Although Factors related to low back pain are multiple and complex ^[6]. However, there is a higher prevalence of musculoskeletal disorders such as low back pain among nursing professionals due to unnatural work postures, lifting and transporting patients or equipment, rotating night shifts, overtime, and a nursing work context with its workloads, especially in developing countries where assistive devices are not available ^[7]. In addition, the Intensive Care Unit (ICU), as a special department of the hospital, is considered to be the place with the highest incidence of work-related musculoskeletal disorders due to the nature of its inherent work. A systematic review and meta-analysis of the prevalence of LBP in ICU nurses showed the pooled prevalence of LBP in ICU nurses was estimated as 76.0%, which is higher than that of caregivers in other clinical settings ^[8].

Although LBP has a considerable negative impact on health, society, psychology and economy, due to the influence of traditional Chinese culture, Chinese ICU nurses are ashamed to express the problems caused by LBP, resulting in policymakers and concerned bodies have not paid enough attention to this issue. The aim of this study was to investigate the impact of LBP on the work and life of ICU nurses in China by using phenomenological hermeneutic study, and to lay a foundation for the subsequent development of effective prevention and mitigation measures.

Through interviews with ICU nurses with LBP and analysis of the interview data using an interpretive phenomenological approach, we gained insight into how LBP affects their work and life. In this way, we will explore the mechanism of LBP leading to turnover tendency, economic loss, poor quality of life and psychological problems.

3.1 Study design

The author of this article, an ICU nurse with 3 years of experience in LBP, found that Chinese ICU nurses are widely tortured by LBP, affecting their normal work and life, but are ashamed to express themselves under the influence of their traditional Chinese culture. Therefore, in this study, we chose the qualitative research method of hermeneutic (interpretive) phenomenology. Phenomenology can be defined as an approach to research that seeks to describe the essence of a phenomenon by exploring it from the perspective of those who have experienced it ^[9]. And the main aim of hermeneutic phenomenology is to gain an in-depth understanding of the meaning of lived experiences from an individual's perspective by investigating interactions among individuals and their inhabited historical and cultural contexts ^[10]. Thus, In the process of data collection, the author constantly reviews the interview notes and reflects on the evolution of the phenomenon in order to explore the essence hidden behind the phenomenon.

3.2 Recruitment of participants

In this study, convenience sampling was used. From January to April 2024, nurses with LBP experience in various ICUs of a tertiary hospital in Qingdao were selected. The inclusion criteria of participants: 1)Work in ICU for more than 1 year, 2) At least 3 episodes of low back pain lasting at least one day in the past 12 months, 3)Able and willing to provide informed consent, 4)Willing to describe their lived experiences and be audio-recorded, 5)Chinese speakers. Exclusion criteria: 1)LBP associated with menstrual periods, pregnancy or febrile illness, 2)History of lumbar surgery, 3)Pathological low back pain. When the theme is saturated, in other words, when no new themes are generated, the researchers stop including the sample of participants.

3.3 Data collection

Data were collected using a one-to-one semi-structured interview method. Because semi-structured interviews generally provide a degree of flexibility, it allows the interviewer to follow and explore what is elicited in the interview situation, and it also helps to discover new information that may not have been identified at the beginning of the study ^[11]. Based on a large reading of the LBP literature, the researchers developed an interview outline: 1)Can you tell us about yourself? 2)Can you describe your low back pain? 3)What impact does low back pain have on your work? 4)What impact does low back pain have on your life? 5)How do you cope with low back pain? The interviewer encourages the interviewee to express freely the content related to the study, and the interviewer gives appropriate prompts when the interviewee starts discussing issues that are not related to the study or when the expression is interrupted. End the interview when no new topics emerge.

The interviews in this study were conducted in the form of online one-on-one audio at a time convenient for the participants. All interviews were conducted in Chinese by the first author. Both the interviewer and the interviewee are native speakers of Chinese, so the content of the interview can be well understood and analyzed. After each interview, the author converts the audio recording into text within 24 hours and reads and summarizes the main points.

3.4 Data analysis

Colaizzi's method of phenomenological enquiry was used for data analysis ^[12]. Colaizzi's method to data analysis consists of 7 steps: Familiarization, Identifying significant statements, Formulating meanings, Clustering themes, Developing an exhaustive description, Producing the fundamental structure and Seeking verification of the fundamental structure.In this study, the data were analysed using a combination of NVivo software and manual analysis. All the authors of this study participated in the whole process of data analysis to ensure that the key themes could fully interpret this research question.

3.5 Ethical considerations

This study was approved by the Ethics Review Committee of the Affiliated Hospital of Qingdao University (QYFY WZLL 28377). All participants understood the purpose and content of the study, and agreed to record the interview process and sign written informed consent. All participants have the right to withdraw from this study at any time.The authors keep the interview materials confidential and guarantee that they are only used for research purposes.

A total of 15 nurses were interviewed in this study, from the General ICU, the emergency ICU, the extracardiac ICU, and the neurosurgical ICU (see Table 1 for participant characteristics). Interviews range from 12 to 46 minutes. Through the 7 steps of Colaizzi's method, the data were coded 39 times, it is concluded that the impact of low back pain ICU nurses' life and work includes: 1)impaired efficiency and motivation of work, 2)negative emotions: anxiety, fear, and feelings of guilt, 3)turnover intention, 4)presenteeism, 5)limitations to daily life, 6)imiting exercise, social and leisure pursuits, 7)roles and problems of family caregivers.

Table 1

Characteristics of ICU Nurse Participants.
Participant Code	Age (years)	Gender	Education	Department	ICU work experience (years)	work experience (years)	Duration of each shift(hour)
N1	29	Female	Bachelor’s degree	General intensive care unit	4	6	12
N2	30	male	Bachelor’s degree	Cardiac intensive care unit	4	6	12
N3	30	Female	Bachelor’s degree	General intensive care unit	7.5	7.5	12
N4	34	Female	college degree	General intensive care unit	10	11	12
N5	27	male	college degree	General intensive care unit	4.5	4.5	12
N6	34	Female	Bachelor’s degree	General intensive care unit	11	11	12
N7	35	Female	college degree	General intensive care unit	11	12	12
N8	29	male	Bachelor’s degree	General intensive care unit	7	5	12
N9	29	male	college degree	emergency intensive care unit	6	1.5	12
N10	35	Female	Bachelor’s degree	General intensive care unit	12	2.5	12
N11	38	Female	Bachelor’s degree	emergency intensive care unit	15	12	12
N12	29	male	Bachelor’s degree	neurosurgical intensive care unit	3	2	12
N13	37	Female	college degree	Neurosurgical intensive care unit	16	15	12
N14	33	Female	Master’s degree	Cardiac intensive care unit	10	8	12
N15	34	Female	Postgraduate diploma	General intensive care unit	11	6	12

4.1 The impact of low back pain on work

4.1.1 Impaired efficiency and motivation of work

During the onset of low back pain, participants indicated that this pain and discomfort in the lower back affected the efficiency and quality of their work.

“Sometimes, to be honest, my backache is so bad that I say to myself, let me sit down and rest for a while! Let's put the job at hand for a while!” N2.

“Because in the ICU, you have to deal with lifting and transferring patients, moving Dialysate and replacement fluid, frequent cardiopulmonary resuscitation... After the back pain, I was forced to change the way I worked, and if I could, I was used to dividing heavy objects into two parts. Or gather more colleagues to complete the task together. But this usually takes more personnel effort and time.” N5.

“When rescuing a patient, especially when cardiopulmonary resuscitation is needed, I don't dare to rush forward first. Even if I performed CPR, it would take someone else to replace me in a few minutes.” N6.

“Sometimes you need to give oral care to patients with artificial airways, and you may be required to bend over for a long time, and then when you do it, you may feel a little coping.” N10.

The most common high risk factors for LBP were assisting the patient to turn over and lift the patients, which is one of the most common and important tasks in the ICU. Meantime, participants showed that on average, they needed to assist the patient to turn over 4–5 times per shift, so the pain seriously affected the work efficiency of the participants during the LBP attack.

“Sometimes, if a patient is particularly heavy, I will find a few more colleagues in advance to help me assist me in transferring the patient.” N7.

“When it hurts, I don't dare to lift the patient. If you're always asking for help, that's not the right thing to do. So, I try not to push too hard as much as possible, for example, when I turn a patient over, I may just want to put a pillow on one side of his body and not move him again.” N12.

Frequent low back discomfort leads to a loss of confidence in nursing work and a decrease in motivation for ICU nurses. In particular, all of the participants had to work 12 hours of continuous work per shift.

“Faced with long hours of work before going to work, it is common to lose confidence and not want to work, especially during the busy day shift.” N3.

4.1.2 Negative emotions: anxiety, fear, and feelings of guilt

Busy nursing work and LBP often lead to anxiety and fear among ICU nurses.

“I don't know how to balance work and body, I don't want to take frequent leave, I am afraid of causing trouble to my superiors and colleagues, but when I go to work, I am very painful because of low back pain.” N4.

“Sometimes, at work, even when I am walking for a simple activity, I feel uncomfortable in my lower back, and I feel that I can't even manage my own body, and what is the meaning of my work.” N8.

“My low back pain caused me to be afraid of a high workload, that it would be aggravated by an inappropriate way of working, and I was also afraid of my superiors and colleagues questioning my ability to work.” N14.

Due to the influence of traditional Chinese culture, Chinese people are ashamed to express their problematic situations, and the physical pain makes ICU nurses have to tell those around them about their situation, which leads to them often feeling guilty.

“I don't want to cause trouble for others, just don't want to make my colleagues feel useless, so I still try to complete my work.” N2.

“My colleagues have taken great care of me at work and tried not to overexert myself as much as possible, so I...”N4.

4.1.3 Turnover intention

The physical pain and the intensive nature of ICU work aggravate the turnover tendency of ICU nurses with LBP.

“I went to see a doctor for LBP, and the doctor advised me to change departments and rest, suggesting that I should not continue to work in ICU if I wanted to relieve LBP.” N4.

“When my pain was severe, the head nurse arranged for me to work in other departments for a while, but I felt anxious as a temporary worker in other departments, and I had the idea of resigning.” N9.

“When a nurse over the age of 35, like me, does not have enough energy to face the work in the ICU, I will wonder where I should go in the future.” N7.

4.1.4 Presenteeism

Presenteeism refers to the phenomenon of people, despite complaints and ill health that should prompt rest and absence from work, still turning up at their jobs, which often leads toreduced productivity^{[3, 13]}. Due to labor shortages, interpersonal relationships, and financial pressures, some participants chose to keep working even when they encountered LBP.

“Sometimes you want to take a leave of absence, but you can't let others always work overtime for you, and sometimes when the department is very busy, you are embarrassed to always be absent.” N9.

“To be honest, you must earn money when you go to work, then my back hurts, if I am always resting, then my income... Including the semi-annual bonus and the year-end bonus will definitely be affected.” N3.

“A lot of times, you can't take care of your low back pain because you have to work. Especially when rescuing patients, you endure the pain for a long time, and the pain will be worse after the work is over.” N11.

There were 7 males and 8 females among the participants. Male nurses have shown that they also contribute to LBP due to their tendency to take on more physical work. And as men, most of them choose to endure the pain and continue to work.

“I can't help it, even if I have low back pain, I have to persevere. Because men are still the main force in the physical labor of turning over and moving the patient, it is very difficult for the woman to lift the patient if you do not make an effort.” N5.

4.2 The impact of low back pain on life

4.2.1 Limitations to daily life

LBP also caused disruption to participants' daily lives, resulting in restrictions on many activities of daily living.

“No matter what I do, I always think about whether my lower back is okay or not, and there are many chores that need to be done by my waist, such as mopping the floor, and I leave it to other people in the family to do it” N1.

“You can walk, but if you stand for a long time, I need to move to relieve my pain. Also, when I have to drive for a long time, I have to stop to rest and stretch my back.” N9.

“I often have trouble sleeping because of low back pain, I have to change positions constantly, and sometimes I wake up again at two or three o'clock in the middle of the night.” N13.

“It's very embarrassing that LBP has had an impact on my sex life as well...” N7.

4.2.2 Limiting exercise, social and leisure pursuits

LBP not only limited participants' daily lives, but also made it difficult for them to face leisure and social activities. And, while proper exercise strengthened core competence and relieved low back pain, participants also experienced inadequate exercise due to pain sensation and dysfunction.

“I want to travel when I have a break, but I don't dare to choose the attractions that need to climb the mountain.” N3.

“When my pain is severe, I just want to lie down at home when I rest, and I can't go out with friends or children.” N14.

“Sometimes I want to go to the gym, but because of the discomfort in my lower back, I don't even dare to do exercises like jumping rope and climbing, let alone sit-ups.”N6.

4.2.3 Roles and problems of family caregivers

In the interviews, some of the participants also indicated that they were an important member of the family, but because of the influence of LBP, they were unable to take care of the elderly or children, resulting in the lack of family caregiver role.

“Even though we are in the prime of our youth, many of the chores in the family cannot be done and can only be handed over to others.” N3.

“For example, my son, I don't dare to pick him up anymore since I hit the low back pain, and he knows that I am sometimes uncomfortable and will not force me...” N7.

“When I came home from 12 hours of work, not only did I not have the energy and time to deal with housework and babysitting, but I often asked my husband to give me a waist massage and a hot compress.” N10.

“When I was tutoring my children's homework, I couldn't sit all the time, I had to sit for a while and stand up and walk around...” N15.

The authors of this paper argue that people should first recognize the harm that a phenomenon poses to us before they can further think about how to use existing resources to solve the problem. In other words, if a phenomenon does not attract enough attention, then it cannot be solved.

5.1 The impact of low back pain on work

A recent systematic review and meta-analysis showed that the overall prevalence of work-related musculoskeletal disorders among clinical nurses staff in China was as high as 79%, and the top two most affected body parts are the neck (58%) and the waist (57%) ^[14]. Furthermore, ICU patients suffer from severe physical weakness, poor self-care ability, and rapid changes in their condition in China. Therefore, ICU nurses not only need to conduct multiple procedures such as airway management and pressure sore prevention per shift, but also need to master advanced life support techniques such as extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) compared to other wards. This, combined with a staff shortage and a large number of patients in China, has led to a high prevalence of work-related musculoskeletal disorders among ICU nurses. According to the report, 28.9% of Chinese ICU nurses asked for leave or transfer to another ward due to low back pain ^[15].

Although more and more researchers have paid attention to the high prevalence of LBP in nurses, most of the existing studies focus on exploring its high-risk factors and improvement measures, and pay little attention to its impact on nurses ^{[16, 17]}. Therefore, in order to further explore the impact of LBP on the work and life of ICU nurses, this study included 15 nurses with LBP experience in 4 different ICUs of a tertiary hospital in China to conduct one-on-one semi-structured interviews.This study generated 7 key themes through a phenomenological hermeneutic approach, including 4 themes on the impact of LBP on the work of ICU nurses, and 3 themes on the impac of LBP on the work of ICU nurses.

This study shows that LBP has a negative impact on ICU nurse productivity and motivation, which is also consistent with the results of a previous cross-sectional survey ^[18]. However, this study explores on a deeper level how LBP affects work content and efficiency.

First of all, in order to ensure the continuity of nursing work, nurses from different icus in this study worked for 12h per shift, so longer working hours increased the burden of nurses' low back muscles. Besides, whether it is general ICU or specialized ICU, most patients in ICU are unable to turn over independently due to physical weakness, poor mobility and cognitive problems, so ICU nurses need to regularly assist patients to change positions in order to prevent pressure injury, which is the main cause of lower back damage. In China, most ICUs are not equipped with nursing assistants and assistive devices, and clinical registered nurses are almost entirely responsible for assisting in patient movement and transport. However, after LBP occurs, ICU nurses are unable to work as before because of pain and suffering, which requires more staffing and takes longer to handle the same job. This is like a circle, high work intensity promotes LBP, LBP in turn reduces work efficiency.

Secondly, a previous study indicated that longer pain duration is related to depression ^[19]. This study shows that ICU nurses often experience negative emotions, not only because of LBP, but also because of the work and life distress that LBP brings to them, such as worry and anxiety about not being able to complete their jobs successfully, fear of impaired quality of patient care provided, and feeling guilty for causing distress to colleagues and superiors. Therefore, in the case of ineffective relief measures such as massage, hot compress, acupuncture, ICU nurses often need to go through both physical and mental torture. Finally, the high intensity of nursing work, the pain in the lower back that is difficult to relieve, and a variety of negative emotions prompt the ICU nurses to have the idea of quitting. However, quitting a job means losing both economic income and social ties, so even if LBP torments the participants, most of them choose to continue to work and do not even apply for additional breaks, which is what we refer to as presenteeism. There is a study suggest that presenteeism may be caused by the following factors: a median or lower income level, irreplaceability and work with dependent or vulnerable people ^[20]. Our research indirectly confirms this.

This study confirms through a qualitative approach that while there is sometimes no evidence that LBP leads to an increased dimission rate and decreased work capacity among ICU nurses, LBP does contribute to this outcome through a significant impact on ICU nurses' work ability, motivation, interpersonal relationships, and psychology. However, there is a lack of clinical guidelines for the management of LBP to solve this problem, which also poses a particular challenge for healthcare practitioners ^[11].

5.2 The impact of low back pain on life

Participants in this study were the first to point out the impact of LBP on their daily lives, such as inability to take care of household chores, sleep disturbances, limited driving, and impaired sex life. These limitations in daily activities may indirectly affect the family life and social relationships of ICU nurses. In addition, ICU nurses are often in a state of extreme exhaustion due to their shift work (especially two-shift rotation), fewer breaks per shift, and frequent heavy lifting ^[21]. The reasons described may lead to a decrease in life satisfaction among ICU nurses.

The study also showed that LBP limited the exercise, social, and leisure pursuits of ICU nurses, which was easily overlooked in previous studies. Fearing an exacerbation of LBP, ICU nurses may choose to forgo social activities, family outings, and leisure pursuits. Meanwhile, although majority of ICU nurses understand the benefits of core muscle stability training, they believe that it strengthens the core muscles to maintain spinal stability, so as to relief pain ^[22]. However, many participants did not exercise regularly and scientifically due to fear of movement, lack of time and burnout. There is a study that suggests, develop an individualized, supervised exercise consensus based on the personal characteristics, goals and preference ^[23]. This approach aims to create a safe and non-threatening environment for physical activity, in order to prevent unhelpful associations of unhelpful associations between exercise and pain, and has the potential for future applications to improve the current predicament.

The last theme to be mentioned was roles and problems of family caregivers. As defined by the Caregiver Coalition (2011), a family caregiver is defined as an individual who provides free ongoing care and assistance to a family member who needs support due to a physical, cognitive, or mental health condition ^[24]. The participants in this study were between the ages of 27 and 38, and most of them had elderly people and children to care for in their families. Regardless of whether a family member has a medical condition, there are still physical, psychological, and financial costs for participants as family caregivers. Traditional Chinese culture holds that people have an obligation to support their parents and children. As a result, participants experience a psychological burden when they are unable to perform their caregiver function because of LBP. In addition, this study found that both male and female participants experienced a series of problems caused by LBP, but it was more difficult for male participants to talk about such problems under the influence of traditional Chinese culture and gender characteristics. It is reassuring to see that when female caregivers in the family are unable to carry out their roles and responsibilities due to LBP, their partners often choose to take on more responsibilities and provide them with adequate physical and psychological support.

5.3 Implications for future research

Healthcare professionals (HCP) in large hospitals in China may be likely to suffer from LBP, considering the facts of shortages in medical staff, the large Chinese population base, the aging of the population and patients’ inclination to go to large hospitals ^[25]. In this study, a qualitative research method was used to investigate the impact of LBP on the work and life of ICU nurses in a tertiary hospital in China, inspired administrators to pay attention to the problems caused by LBP, and suggested that they can formulate corresponding preventive measures according to Chinese culture and social norms to prevent the occurrence of LBP or reduce the impact of LBP on ICU nurses.

To prevent low back pain, administrators should raise awareness among health care professionals about physical fitness, correct posturing, ergonomic adjustments in equipment and environment. It is suggested to strengthen the training of nurses on the prevention of low back pain and improve the self-management ability of nurses with occupational low back pain. At the same time, hospitals should increase the organizational, family and financial support of nurses, so that they can feel social support from different sources, so that nurses can better balance their roles and tasks in work and family, and reduce the negative impact of occupational low back pain on nurses, so as to effectively reduce their turnover behavior.

5.4 Methodological considerations and limitations

As a limitation, this study only included ICU nurses from one of three hospitals in China, thus ignoring the differences between different regions in China. At the same time, in the process of data collection, we found that most of the ICU nurses were under the age of 40, and the proportion of ICU nurses over the age of 40 was relatively small, and it was unclear whether they left the ICU because of LBP. Furthermore, the level of pain in the samples was not graded, and therefore the relationship between pain level and severity of effects was not studied.

ICU nurses bear the important responsibility of treating and nursing critically ill patients, which requires them to have strong professional ability and physical strength. The high prevalence of LBP can lead to the loss of ICU nurses, which can take a huge toll on hospitals and critically ill patients. Therefore, it is necessary to fully understand the impact of LBP on ICU nurses. This study explores the significant impact of LBP on the work and life of ICU nurses through a phenomenological hermeneutic approach, with the aim of drawing public attention and expecting policy, institutional, and behavioral changes to improve this phenomenon.

ICU intensive care unit

LBP low back pain

YLDs years lived with disability

ECMO extracorporeal membrane oxygenation

CRRT continuous renal replacement therapy

HCP healthcare professionals

Ethics approval and consent to participate

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Competing Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

This work was supported by Health Commission of Shandong Province (Grant number: 202314050911). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors' contributions

C.X. and YB.G. design of the work; C.X. and XJ.G. the acquisition, analysis, C.X. interpretation of data; C.X., LL.W. and BR.H. have drafted the work or substantively revised it. All authors reviewed the manuscript.

Acknowledgements

Not applicable.

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The impact of low back pain on life and work of ICU nurses in China: a hermeneutic phenomenological study

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Abstract

What is already known

1 Introduction

2 Aim

3 Methods

3.1 Study design

3.2 Recruitment of participants

3.3 Data collection

3.4 Data analysis

3.5 Ethical considerations

4 Results

4.1 The impact of low back pain on work

4.1.1 Impaired efficiency and motivation of work

4.1.2 Negative emotions: anxiety, fear, and feelings of guilt

4.1.3 Turnover intention

4.1.4 Presenteeism

4.2 The impact of low back pain on life

4.2.1 Limitations to daily life

4.2.2 Limiting exercise, social and leisure pursuits

4.2.3 Roles and problems of family caregivers

5 Discussion

5.1 The impact of low back pain on work

5.2 The impact of low back pain on life

5.3 Implications for future research

5.4 Methodological considerations and limitations

6 Conclusions

Abbreviations

Declarations

Ethics approval and consent to participate

Consent for publication

Availability of data and materials

Competing Interests

Funding

Authors' contributions

Acknowledgements

References

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