"We just keep pushing through": a mixed-method study on musculoskeletal discomfort and mental well-being among nurses in resource-limited settings.

BACKGROUND

Nurses in under-resourced settings frequently report high levels of musculoskeletal (MSK) discomfort, which significantly affects their mental well-being. While workplace strain is well documented, the combined impact of physical burden and institutional neglect remains underexplored in these environments.

AIM: The study aims to examine the prevalence of MSK discomfort and its association with psychological well-being among nurses in under-resourced healthcare environments in Northeast India, and to explore the experiential and structural factors contributing to these occupational health risks.

METHODS

A sequential mixed-methods study design was employed, following an explanatory approach. The study commenced with a survey to gather quantitative data. Quantitative data were collected from 216 nurses using the Extended Nordic Musculoskeletal Questionnaire (Extended-NMQ) and the WHO-5 Well-Being Index, the results of which informed the development of subsequent interview questions. Semi-structured interviews were then conducted with 11 nurses to capture experiential and structural factors. This structure enabled deeper contextual understanding and facilitated triangulation across data types.

RESULTS

Among the participants, 47.2% reported experiencing lower back pain, followed by discomfort in the knees (27.3%) and upper back (25%). Higher levels of MSK discomfort were significantly associated with employment in the public sector and more than ten years of work experience. A strong negative correlation was observed between MSK discomfort and mental well-being. Thematic analysis revealed key stressors: physical depletion, emotional exhaustion, organizational apathy, and limited healthcare access. In response to these challenges, nurses often relied on self-management due to insufficient institutional support. Triangulated findings underscored how structural deficiencies intensified both physical and psychological strain among nurses.

CONCLUSIONS

There is an urgent need for evidence-based occupational health interventions to address ergonomic, psychosocial, and institutional challenges, particularly in low-resource healthcare settings, to safeguard the well-being of frontline nursing staff. This study offers novel understanding from a high-need yet under-researched geographic context, namely the northeastern states of India, bridging empirical gaps in MSK health literature through the integration of experiential and structural factors.

CLINICAL TRIAL NUMBER: Not applicable.