Title : Assessment of Prevalence and Risk Factors of Occupational Hazards Among Nurses..

 

Assessment of Prevalence and Risk Factors of Occupational Hazards Among Nurses Working in Medical College Hospital, Thiruvananthapuram

 

 

Nurses form an integral part of the health care delivery system. Among nurses, occupational injuries and illnesses are well documented in western, developed countries. The key safety issues imparting this work force include needle stick injuries, workplace violence and musculoskeletal injuries related to patient handling. More recently concerns about work load, work hours, job stress and fatigue have emerged.

Need and significance

Nurses have been selected to be the focus of attention in this study because they constitute the largest category of health care workers in most countries. They have a critical role in the health care delivery system. It would be fair to state that the health care delivery system would cease to function in the absence of nurses.

Verbal abuses, poor working conditions, sleep disorders, depression, back ache etc. are being silently endured by nurses and those who raise their voice are further being threatened or advised to leave the job. Thus the researcher feels that the research problem is of utmost relevance to health of nurses and this study is a small step towards raising such issues.

Objectives

  1. To estimate the prevalence of occupational health hazards among nurses.
  2. To assess the risk factors for these occupational hazards.

Assumption

The prevalence of occupational hazards among nurses in Medical College Hospital Thiruvananthapuram is high.

Conceptual Framework

WHO healthy workplace model: Avenues of influence, Process and Core Principles. A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and wellbeing of workers and the sustainability of the workplace by considering the following, based on identified needs:

  • Health and safety concerns in the physical work environment;
  • Health, safety and wellbeing concerns in the psychosocial work environment including organisation of work and workplace culture;
  • Personal health resources in the workplace; and
  • Ways of participating in the community to improve the health of workers, their families and other members of the community.

The framework and model presented here include both content and process, and may be implemented by any workplace of any size, in any country. In this study the WHO model and framework is used because it brings together the principles and common factors that appear to be universally supported (also applicable to hospital work) in the literature and in the perceptions of experts and practitioners in the fields of health, safety and organisational health.

Review of Literature

Clarke et al (2002) found that needle-stick injuries among nurses were twofold higher in hospital units reporting as understaffed or having poor organisational climates, suggesting greater hazard when nurses are not allowed adequate time for proper insertion and equipment disposal. Nursing can also be physically demanding. Yip reported that “frequent repositioning of patients” and assisting “patients, while walking” were risk factors for back injuries. Trinkoff et al found that nurses with greater perceived physical demands reported more musculoskeletal problems than nurses with lesser perceived demands. Better staffing should decrease physical demands related to epositioning and assisting patients. Nurses in acute care hospitals perform complex work; with fewer patients per nurse, more time is available for nurses to provide person-focused care, including medication administration and patient education. The second mechanism for occupational injuries described by Nahrgang et al (2011), involves job satisfaction.

About 92 percent of the 4.3 million nurses and nursing aides in the US are female. All these nurses are at an additional risk for incidents of musculoskeletal disorders, workplace violence, and exposure to hazardous substances; health care workers face other hazards including latex allergy and needle stick injuries.

A longitudinal study in nurses showed the 8 years LBP (lower back pain) prevalence was 73.76 percent and 19 percent of the total sample showed increasing backache. Another study shows that there is signifi-cant association between the occupational risk factors and radiological evidence of degenerative changes in the spine on magnetic resonance imaging (MRI). It signifies that there are some professions in which there could be high burden of this health problem.

Methodology

Research approach: The research approach is quantitative that includes descriptive aspect of occupational hazards and the risk factors associated with it.

Research design: A cross sectional survey design was used to estimate the prevalence of occupational hazards and the self-reported risk factors associated with it. The most appropriate design to assess the prevalence of occupational hazards and the self-reported risk factors is cross sectional survey design and hence it suits the study.

Setting: The setting was Govt. Medical College Hospital, Thiruvananthapuram.

Sample and sampling technique: All the staff nurses, both permanent and temporary, working in hospital for the past 6 months were included. The sample size for the present study was 323 staff nurses working in different settings of the hospital. Census type sampling was used i.e. all the staff nurses available in this hospital and who met the inclusion criteria were included.

Tools and technique: A structured interview schedule was used to assess the prevalence and self-reported risk factors for occupational hazards and ‘the workplace stress scale’ to assess the prevalence of stress.

Interview: interview was conducted with the help of structured schedule to estimate the prevalence and risk factors for occupational hazards. The work place stress scale, a standardised tool was used to assess the stress level of staff nurses using interview method.

Data collection: The data collection was done over a period of 6 weeks from 19 January 2015 to 28 February 2015. Prior permission was obtained for the study from Institutional Human Ethics Committee and the Medical Superintendent of Medical College Hospital. Informed consent was obtained from the staff nurses after explaining the purpose of the study. They were assured that all the data would be kept strictly confidential and will be used for only study purpose. Face to face interview with 323 staff nurses was conducted using the structured interview schedule and the workplace stress scale round the clock. Each interview lasted for about 20 minutes except few cases which took more than 30 minutes. All the staff were very cooperative and enthusiastic during the study.

Data analysis: The collected data were coded, organised and entered in MS-Excel and analysed using Statistical package for social sciences (SPSS17). The prevalence and self-reported risk factors was estimated by percentage. Chi-square test was used to find out the association between occupational hazards and selected demographic variables. Results were discussed with experts in the field of nursing, community medicine and statistics.

Results

The results are presented in the following headings

Section I: Socio demographic data

Of the 323 staff nurses, 34.4 percent belonged to the age group of 20-25 followed by 31.3 percent in age group 26-30. The least number of nurses, 4 percent were in the age group of >40.

About 81.4 percent were female and the rest 18.6 percent were male.

62.5 percent staff nurses were GNM, 30.7 percent were having BSc nursing degree; about 6.2 percent staff nurses were Post Basic BSc nursing while only 0.6 percent staff had MSc Nursing qualification.

55.1 percent had less than 5 years of experience, 22.6 percent of staff nurses had experience between 5-10 years and about 22.3 percent had experience of more than 10 years.

76.2 percent of staff nurses were fully immunised for HepB, 13.9 percent staff partially immunised and 9.9 percent were unimmunised.

 

Majority of them, i.e. 35.9 percent were from ICUs followed by 24.1 percent from Medical ward, 15.5 percent from surgical ward, 10.2 percent from Ca-sualty, 6.5 percent from OT and about 7.7 percent from other sections.

Section 2: Prevalence of occupational hazards among staff nurses

1. Needle stick injuries

Among the 323 staff nurses, 72.9 percent had needle stick injuries while the remaining 27.6

percent never had needle stick injuries.

About 58.2 percent of them had needle stick inju-ries with frequency <5 times, 10.8 percent of them had injuries between 5-10 times, 2.2 percent staff nurses had injuries between 10-20 while 1.2 per-cent had injuries more than 20 times.

Only 28.2 percent of staff nurses had needle stick injuries during the last 6 months.

About 26 percent of staff nurses had needle stick injuries less than 5 times, 1.5 percent of them had injuries between 5-10 and 0.6 percent staff nurses had injuries between 10-20.

2. Musculoskeletal disorders

Of the 323 staff nurses, about 78.6 percent of them had musculoskeletal disorders

65.6 percent of nurses had back pain, 29.7 percent had shoulder pain.

Neck pain was reported by 31.3 percent of nurses while muscle pain was reported by 37.2 percent. The remaining 8.7 percent had other forms of mus-culoskeletal disorders like leg pain, knee pain.

3. Allergy

Among the 323 staff nurses, allergy was present among 38.4 percent of staff nurses.

Allergy to gloves dominated (17.3%) among the al-lergies followed by allergic asthma, allergy to chemi-cals, allergy to medicines and other allergies with values 10.2, 6.2 and 5.9 percent respectively.

4. Infections

About 39.3 percent of staff nurses had some sort of infections

7.1 percent had repeated respiratory tract infec-tions occurring every 2 weeks. About 7.7 percent reported to have infections once in 24 weeks while 8 percent had infections once in 48 weeks and 13.9 percent reported infections occurring once in 3 months.

Each case of infections reported were Tuberculosis, MRSA, Hepatitis B. The other infections contributed 6.8 percent that included conjunctivitis, and chickenpox.

 

Stress: Among the 323 staff nurses, 33.1 percent had fairly low stress while 29.4 percent had moderate stress. Severe stress was found in 9.3 percent of staff.

Section 3: Self-reported risk factor assessment for occupational hazards.

Majority of staff nurses (53.3%) reported recapping the needle and work load (48.6%) as the known risk factors of needle stick injuries.

Lack of adequate staff contributed to 73.1 percent of musculoskeletal disorders, improper technique of lifting/moving the patient contributed 57.3 percent while lack of good assistive devices was reported by 50.8 percent of staff nurses.

Majority of them (42.4%) responded glove powder as the major risk factor for allergy

Working continuously with infected patients (70.9%) and unknown needle stick injuries (50.8%) were two major risk factors for infections among nurses.

Major cause of stress was frequent night shifts (76.8%) followed by work load (62.5%).

Conclusion

Half the staff nurses had less than 5 years of experi-ence and about three-fourth were fully immunised for Hepatitis B. Most of the staff nurses were from the ICUs.

Needle stick injuries was reported by more than 70 percent of the staff nurses and most of them reported recapping the needle and work load as the major risk factors for the same. More than three-fourth of the staff nurses had musculoskeletal disorders, mostly with back pain. Majority of them found ‘lack of adequate staff’ and ‘improper technique of lifting/moving the patient’ as the risk factor. Staff nurses with longer years of experience had high prevalence of musculoskeletal disorders.

Allergy was reported among more than one-third of the staff nurses. Majority of them responded glove powder as a major risk factor. The incidence of allergy was more among female nurses. Nearly 40 percent of staff nurses had some sort of infections; most of them reported ‘working continuously with infected patients’ and ‘unknown needle stick injuries’ as two important risk factors.

 

Moderate stress was found among 29.4 percent of staff nurses and severe stress in 9.3 percent of staff. Majority of staff nurses reported ‘frequent night shifts’ as major risk factor followed by ‘work load’. Further, staff nurses in the younger age group had comparatively higher stress than elders.

Implications

Nursing service

The study findings can be used by the nurses to reduce the risk factors of occupational hazards at their work place.

 

The community health nurse can take the role  a facilitator and educator and can educate the nurses regarding occupational health hazards.

Nursing education: Prevention of occupational hazards among nurses can be included in the syllabus of nursing education.

Nursing administration: Nurse administrators can be involved in formulating the health education policy in various setting regarding prevention of risk factors of occupational hazards. 

Recommendations

  1. A similar study can be replicated on a large scale in different government and private hospitals generalisability of the present study.
  2. A longitudinal study can be conducted to ascertain the actual risk factors of individual occupational health hazards.
  3. In addition to interview technique of data collection other methods like observation, questionnaire can be employed to ensure validity.
  4. Qualitative method can be employed for in-depth study of risk factors and preventive measures of occupational hazards.
  5. There is need to create a position of OccupationalHealth Nurse in every hospital whose main aim should be to identify nurses’ problems and to solve them.

References

  1. Nakata A, Swanson NG, Caruso CC. Nurses, smoking, and immunity: Areview. Rehabil Nurs 2010; Sep/Oct; 35(5): 198-205. Available at http://dx.doi.org/10.1002/j.20487940. 2010.tb00048.x. accessed on April 2014
  2. Mariconda M, Galasso O, Imbimbo L, Lotti G, Milano C. Relationship between alterations of the lumbar spine, visualized with magnetic resonance imaging, and occupational variables. Eur Spine J 2007; 16: 255-66
  3. Maul I, Läubli T, Klipstein A, Krueger H. Course of low back pain among nurses: A longitudinal study across eight years. Occup Environ Med 2003; 60: 497-503
  4. Nahrgang JD, Morgeson FP, Hofmann DA. Safety at work: A meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes. J Appl Psychol 2011; 96(1): 71-94
  5. Yip YB. A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. J Adv Nurs 2001, 36(6): 794-804
  6. Clarke SP, Rockett JL, Sloane DM, Aiken LH. Organizational climate, staffing, and safety equipment as predictors of needle stick injuries and near misses in hospital nurses. Am J Infect Control 2002; Jun; 30(4): 207-16
  7. World Health Organisation. WHO Healthy Workplace Framework and Model: Background and Supporting Literature and Practices. WHO Publications 2010; 82-99

 

Author: Rathish Rajan

 Staff Nurse, Neuro ICU, SCTIMST, Thiruvananthapuram

Sources: TNAI Journal