Nursing Report: Exploring LBP and Ethical Dilemmas in Nursing Practice

This report delves into two critical issues in nursing practice: low back pain (LBP) and ethical dilemmas. The first section analyzes LBP as a significant safety concern, particularly in medical-surgical wards, highlighting the vulnerability of nurses due to the nature of their duties, manual lifting, and environmental factors like staffing and night shifts. It discusses intrinsic factors like beliefs about LBP, psychological distress, and the absence of ergonomic knowledge, which can lead to early retirement. The second section focuses on ethical dilemmas, specifically the challenge of providing patient information to carers while maintaining patient confidentiality. It explores the conflict between nurses' obligations to protect patient privacy and the need to share information for optimal patient outcomes, considering the rights of both patients and carers. The report emphasizes the importance of patient preferences, communication strategies, and an ethic of care that promotes and protects relationships, offering insights into resolving these complex issues.

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Name of student:
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Module 1
Nursing literature on case study analysis indicates lower back pain to be a significant
safety concern pertaining to the speciality area of the medical-surgical ward. Nurses working
at this speciality area are vulnerable to this complication owing to their nature of
responsibilities and duties (Cilliers & Maart, 2013). According to Adhikari and Dhakal
(2015), pain is an undesirable emotional experience that is felt in mind due to identifiable
changes in the body. Low back pain is the form of pain suffered as a defence mechanism of
the body designed to protect the body from injury or further damage from external agents.
Lower back pain (LBP), commonly known as lumbago or lumbosacral pain, is felt bellow the
12th rib and above the gluteal folds. LBP is a recognised cause of morbidity in the healthcare
sector. Several studies report the high prevalence of LBP among nurses in healthcare settings.
This group of care professionals are particularly subjected to LBP. The pain is a notable
cause of morbidity among nurses working in the medical-surgical unit (Chen et al., 2014).
As highlighted by Arsalani et al., (2014) mechanical hazards in healthcare settings,
including the medical-surgical ward, encompass LBP that occur from manual lifting. Nurses
are required to lift patients admitted to the surgical unit for shifting patient places. Nurses are
also required to lift and transport equipment that is commonly used in surgical settings. Such
situations are highly disadvantageous as lifting aids are not always available. Poor lifting
postures and working conditions are implicated to be the causative factors for LBP.
Mechanical factors such as transferring of patients or frequent lifting are recurring procedure
in surgical wards, increasing the chances of LBP. Environmental risk factors for LBP include
the organisational climate and staffing. There exists a relationship between night shifts and
LBP, wherein lack of rest and poor sleeping patterns lead to increased muscle strain. As
nurses are responsible for responding immediately to emergency situations in a medical-
surgical ward, there get insufficient time to rest. Intrinsic factors pertaining to lower back

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pain are beliefs about LBP, psychological distress and coping behaviours. Poor health status
has also been linked with LBP, mainly focusing on excess weight (Lövgren et al., 2014).
Research also indicates a significant association between work-related factors and
musculoskeletal disorders and work pressure. What makes the situation more complicated for
nurses is the absence of knowledge on back acre ergonomics. LBP leads to the early
retirement of nurses working in the medical-surgical unit. These retirement requests are put
forward on the ground of sickness absence, ill health, changes in job and reduction in work
productivity (Cilliers & Maart, 2013).
Module 2
Ethical dilemmas are integrated into nursing practice when it comes to delivering
optimal quality care to patients. One of the significant dilemmas faced by nurses is regarding
providing patient information to carers sincethey need to consider the confidentiality
concerns of the patient. A nurse is usually torn between the ethics of maintaining patient
confidentiality and the obligation provide adequate patient information to carers for achieving
desirable patient outcomes.
According to Gold et al. (2008), a patient’s right to privacy is to be considered
fundamental to nursing practice and medical care. A nurse in such as a case acts as the
guardian of the clinical information collected about the patient. Nevertheless, a health decline
might complete the nurse to safeguard patient privacy while combating the concerns and
expectations of the carers. A carer under such conditions looks for adequate medical
information related to the patient for providing appropriate care at different settings. It is
natural to have differences between the expectations and care approaches of nurses and

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carers. Carers might believe that information is to be passed on without restrictions, as
opposed to the opinion of nurses. Nurses might not support the automatic offering of patient
information in order to protect the confidentiality and privacy of the patients. Further, carers
might develop the need of information updates to be undertaken regularly and routinely. On
the other hand, nurses might indicate updates to be done based on responses to concerns
(Ellis, 2017).
As highlighted by Herring (2007) the dilemma of sharing patient information emerges
from the fact that the work of carers is often unrecognised and unvalued. It is noteworthy that
law and traditional medical ethics often ignore and fail to acknowledge the interests of carers.
The significance of their care delivery is often undermined. This is, in part, because of the
individualistic ethic that has come to dominate the legal and ethical discourse. The resolution
to the arising concern would be difficult to achieve. It is required on the nurse’s part to be
aware of the expectations of patients and carers in relation to communication of patient
information (Potter et al., 2016). Meanwhile, carers and patients must be aware of the
constraints imposed on nurses. Patients are to be motivated to communicate their preferences
regarding information sharing. This can be simplified through the utilisation of a prompt
sheet that assists the clinical encounter. An approach is recommended on the basis on an ethic
of care promoting and protecting relationships of care, instead of an model of rights that is
individualised (Grace, 2017).

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References
Adhikari, S., & Dhakal, G. (2015). Prevalent Causes of Low Back Pain and its Impact among
Nurses Working in Sahid Gangalal National Heart Centre. Journal of Nepal Health
Research Council.
Arsalani, N., Fallahi-Khoshknab, M., Josephson, M., & Lagerström, M. (2014).
Musculoskeletal disorders and working conditions among Iranian nursing
personnel. International Journal of Occupational Safety and Ergonomics, 20(4), 671-
680.
Chen, H. M., Wang, H. H., Chen, C. H., & Hu, H. M. (2014). Effectiveness of a stretching
exercise program on low back pain and exercise self-efficacy among nurses in
Taiwan: a randomized clinical trial. Pain Management Nursing, 15(1), 283-291.
Cilliers, L., & Maart, S. (2013). Attitudes, knowledge and treatment of low back pain
amongst nurses in the Eastern Cape, South Africa. African journal of primary health
care & family medicine, 5(1).
Ellis, P. (2017). Understanding ethics for nursing students. Learning Matters.
Gold, M., Philip, J., McIver, S., & Komesaroff, P. A. (2009). Between a rock and a hard
place: exploring the conflict between respecting the privacy of patients and informing
their carers. Internal medicine journal, 39(9), 582-587.
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice.
Jones & Bartlett Learning.
Herring, J. (2007). Where are the carers in healthcare law and ethics?. Legal Studies, 27(1),
51-73.

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Lövgren, M., Gustavsson, P., Melin, B., & Rudman, A. (2014). Neck/shoulder and back pain
in new graduate nurses: A growth mixture modeling analysis. International journal of
nursing studies, 51(4), 625-639.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-Book.
Elsevier Health Sciences.