Dissertations & Theses (Open Access)

Date of Award


Degree Name

Doctor of Philosophy in Nursing (PhD)


Nancy Bergstrom

Second Advisor

Duck-Hee Kang

Third Advisor

Edyth Kirk

Fourth Advisor

Ming-Lun (Jack) Lu


Background: Physical risk factors for work-related musculoskeletal disorders (WMSD) among licensed nurses have been well established. Rehabilitation following WMSD traditionally focuses on physical dimensions, but both physical and psychological factors may be useful during rehabilitation, as suggested by the Fear Avoidance Model of Chronic Pain (FAMCP) and the Pain Experience Psychological View model (PE).

Purpose: The purpose was to describe demographic characteristics of nurses with and without WMSD and relationships among related psychological factors of pain (intensity, severity, and interference), personality traits (extraversion and neuroticism), and coping strategies (catastrophizing, diversion, reinterpreting, cognitive coping, fear avoidance, and depression) as postulated in accordance with the FAMCP and PE models.

Methods: An online survey was posted on the websites of three nursing organizations. Nurses with a WMSD (n=124 of 243 participants) completed demographics, WMSD History, Numeric Pain Rating Scale (NPRS), Coping Strategies Questionnaire- 24 (CSQ- 24), Fear Avoidance Belief Questionnaire (FABQ), Eysenck Personality Questionnaire- Brief Version (EPQ-BV), and Centers for Epidemiological Studies Depression Scale (CES-D). Nurses without a WMSD (n=119 of 243 participants) completed three sections, demographics, EPQ-BV, and CES-D.

Results: Overall, nurses (n= 243) were predominately Caucasians (82%), females (94%), and married/partnered (68%). In age, 40% were 50 to 59 years old and 44% were employed as a staff nurse in a hospital. Nurses with WMSD reported higher educational level, with 43% having a MSN degree. The highest level for nurses without WMSD was a BSN degree (44%). Nurses with WMSD also reported higher depressive symptoms in relation to the pain experience. Findings were in accordance with the conceptual model in that the relationships of negative coping strategies directed an avoidance pathway. Castastrophizing showed a positive relationship to all psychological factors except cognitive coping and extraversion. Nurses with WMSD showed strong position correlations between catastrophizing and pain severity, r (124) = 0.622, p = .01, catastrophizing and fear avoidance related to work activity, r (124) = 0.549, p = .01, and catastrophizing and depression, r (124) = 0.502, p = .01. Overall, the strongest correlation was between neuroticism and depression, r (124) = 0.733, p = .01.

Conclusions: Relationships between concepts (catastrophizing, fear avoidance, depression) in the FAMCP and psychological risk factors are supported. Catastrophizing is associated with pain severity, fear avoidance, and depression, and fear avoidance is associated with neuroticism, elevated pain levels, and depression. Extroversion is inversely associated with depression. Further work is needed prior to the development of interventions for rehabilitation of nurses with WMSD.

Included in

Nursing Commons



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