Nursing Practice – The Prevalence of Occupation Hazard Associated with Nursing Practice

Nursing Practice – The Prevalence of Occupation Hazard Associated with Nursing Practice

Nursing Practice – In recent years, it has become apparent that health care workers are exposed to a variety of occupational insults that can result in serious acute and long- term adverse health outcomes. In nursing, the situation is complicated because of high demand on quality nursing care, most nurses do not have adequate knowledge on the assessment of hazards when they occur, others may not apply protective measures properly even if they know (Monica, 2007).

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However, many hospitals are built and managed without due concern for the health of the workers, often because of lack of experience in the area of occupational health.

Occupational Health (OH) was defined by the joint committee of international labour Office and World Health Organization in 1980 as the promotion and maintenance of the highest physical and social well being of workers in all occupations and places of employment, occupational health could also be defined as the health promotion and protection for the gainfully employed and the adaptation of work to man and each man to his job (Offili, 2000). The National Institute for Occupational Safety and Health (NIOSH) estimates that each year about 100, 000 people die of occupational illnesses. Nearly, 400.000 new cases of occupational diseases are recognized annually which was said to be one of the major cause of low productivity among the workers. (A.D Ajayi, 2006), similarly, Bureau of labour statistics (BLs), 2003) stated that more than 4, 351, 000 cases of nonfatal musculoskeletal injuries and illnesses occurred in workplace of these, I, 315, 000 injuries resulted in lost work days (Brunner and suddarths, 2007)

Hazards are risks or dangers that are inherent in ones occupation. The employee for a more fact that they were ignorant of the hazards overlooked available protective measures (Ajayi, 2006). People who have the greatest risk of occupation related injuries and lost work days are farmers, general contractors, steel workers, autoworker truck drivers, and nursing personnel (BLS, 2003). In nursing practice, most of the injuries have occurred during patient handling and movement activities (Nelson and Baptists, 2004). The common sources of hazards in nursing practice include minor injuries, infections such as HIV/AIDS and tuberculosis as well as physical assault on the nurse on duty and permanent damage on the individual nurses and health care workers. The outcome of these were local system or psychological.

However, the healthy people project (2000) recognizes the increase of injuries among nursing personal and the importance of preventing occupational health hazards with respect to reducing short – term and long – term illness and injuries, the various strategies identified in preventing and identifying hazards include regular cleaning, maintenance and repair of equipment, use of personal protective clothing, pre-employment periodic and exist medical examinations of workers.

Occupation, whatever the nature has a major influence on the physical, mental, social and spiritual well being of individuals, the family and society at large. Conversely, the health of an individual has a great influence on his occupation, health workers are faced with a monumental problem of hazards that if not abated is likely to increase, Hazards among nurses are alarming, and these include physical, chemical. biological and stress- related hazards.

My observation of some of these hazards among nurses in Federal Medical Centre, Abakaliki was traumatic, thus motivated this study for a better understanding of the common occupational hazards that is associated with nursing practice and the likely measures of preventing them.

Research Objectives

  1. To determine the common types of occupational hazards among nurses in Federal Medical Centre, Abakaliki.
  2. To determine the social aspect of hazards associated with nursing  practice
  3. To assess the availability of protective devices in the hospital.

Significance of the Study

This study will help to create awareness on the types, causes and preventive measure of common hazards among nurses and thereby reduce the prevalence of such hazards, the result of the study will draw the attention of hospital management on the need to provide protective devices to nurses in order to reduce occupational hazards and in turn increase productivity.

This study will provide information to the government on the prevalence of occupational hazards and the need for adequate funding of health institutions.

Research Questions

  1. What are the common hazards of nursing practice?
  2. Are there social aspect of the hazard in nursing

practice ?

3. Are there available protective devices or equipment in

the hospital?         

This study only involves nurses in Federal Medical Center Abakaliki, irrespective of their Cadre. The nurses are scattered in different wards of the hospital.

Limitation of the Study

The major challenges encountered during this study was retrieval of the distributed questionnaire, out of the 110 questionnaire distributed only 105 were retrieved, this because the nurses perform shift duty.

Operational Definition of Terms

Protective Devices: These are materials like apron, mask, hand-gloves, boots etc that protects nurses from injury while working.

Protective Measures: These are set of activities geared towards safeguarding nurses from contacting work related illness.

 Occupational Hazards: These are injuries, accidents and illnesses that nurses could contact on the course of rendering nursing care.

Review of Literature

        Occupational health hazards associated with nursing practice are widely spread and the degree is determined by the hospital setting and its available care facilities. The common occupational health hazards in nursing are:

* Biological example tuberculosis; Viruses example, Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other infectious conditions.

* Chemicals example: Use of exposure to antineoplastic and antiviral agents: sterilants e.g ethylene and formaldehydes.

* Physical: radiation, poor lightening system, and noise

* Psychological: Stress and work overload (Ofuoma et al 2008, Ajayi, et al, 2007, Rogers 2001).

Biological Health Hazards

Biological health hazards are widely spread category of hazards which easily affect health workers including nurses. Microbes are major contaminants in indoor air like hospital wards, schools, hostels and hotels. They include moulds, fungi, viruses, bacteria, pollens and spores from occupants, building systems, furnishings and food practices.

  1. b.   Common Sources Of Biological Contamination

Ghana Health Service and World Health Organization have identified the following; as sources of biologic contamination.

Ventilation: Poor ventilation can generate viable air contamination and spread airborne pathogens from occupants suffering from diseases such as tuberculosis and measles. Mechanical ventilation, example air – conditioner can become sources of viable aerosols  when air- filters are not cleared or replaced regularly, they provide nutrient for microbes to grow enclosed rooms, hospital or offices reduce indoor ventilation.

Building Microbiology: Spores seem to be everywhere, they form part of house dust on all surfaces, and in air as aerosols. They multiply on furniture or furnishing where they release endotoxins and myotoxins [ie poison produced with a bacterium) into the atmosphere, causing variety of allergic irritant reactions and infections in the occupants.

Moisture: Excessive concentration of water vapour and condensation, water leakages, stagnant water in humidifiers, leakages from ceiling, lack of cleaning and maintenance can contribute to the introduction of biological contaminants into the air by supporting the growth of fungi, bacteria, and other microorganism on building structures.

Temperature: Warm temperature favour microbial growth and may lead to skin infection or allergic skin disease such as eczema and others.

Bacteria and Viruses: Bacteria and viruses brought in through human hosts (reservoir) may be spread through person to person contact example is mycobacterium tuberculosis (Tb). Viruses e.g measles virus may be excreted and stay on fabrics or surface (formites) or suspended in air and spread from person to person.

Lucier and Schecter (2008) reported that the common sources of hazards in nursing are as follows;

* Exposure to contaminated blood and other body fluids like liquor amni, Urine, and feaces can be sources of infection like HIV, HBV, cholera and helminthiasis.

* Improper use of protective clothing like boots, aprons etc in units such as the labour wards, operating theatre and isolation wards can lead to infections by microbes.

* Improper disinfection and sterilization of contaminated instruments and equipments e.g forceps.

* Improper disposal of contaminated needles and sharp instruments.

* Congestion in the ward with too many patients may lead to cross- infection

Studies of work- related accidents and disease have resulted in a lot of information. Rogers (2001) reported that exposure to biologic agents and subsequent infections that develop are the most familiar occupational risk faced by nurses, however, Offili (2000) for blood borne infections pointed out that blood splashes make the most common biological hazards among nurses than cutaneous exposures. Another finding by Ajayi, (2006) showed that only 21% of nurses working in Ahmed Bello University teaching hospital had needle pricks while 14% had cuts, he however attributed these hazards to non- availability of protective devices for use.

In a study carried out by Massaro (2007). The result showed that nurses while giving injection through various routes and measuring of patients blood glucose using glucometer are most likely to sustain needle stick injury. While in another study, Perry (2002) identified respiratory tract infection as the highest in percentage (67%) of biological hazards among nurses in the infectious unit of the hospital. Blood borne infections are the easiest ways of contacting hepatitis B, & C viruses and the human immunodeficiency virus (HIV).

Chemical Health Hazards

Chemical exposure to health care workers can occur through inhalation, ingestion and absorption through the skin or mucous membrane (Monica 2007). Whether an individual is at risk from exposure depends on the type, dose, frequency, and duration of exposure work practices and the individual’s health and susceptibility (Rogers B, 2001). There are varieting of chemical hazards to patient treatment and maintenance of a proper environment example, disinfectants and antiseptic such as chlorine and savlon, gluteraldehyde, ethylene oxide, hazardous drugs and latex exposure among others. (U.S Department of Labour, 2004)

According to World Health Organization (WHO), chemical health hazards refer to the occurrences of events dangerous to human health and the environment. In the short or long term, such as fire explosions, or leakages which result in the release of toxic substance that can cause illness, injury, disabilities or death.

The sources of chemical hazards in nursing or health care are as follows;

  • Liquid waste e.g faecal matter
  • Solid waste such as spoiled food, or soiled dressing.

Usually the solid waste may decompose and produce toxic gases which are dangerous to health if inhaled.

* Antiseptics and disinfectants. These are also sources of hazards to nurses if not used properly or carefully.  Sterilization agents like formaldehyde which are used mostly at the operating theatre, can also cause some respiratory diseases

* Detergents used for hand washing such as carbolic soap, may also have adverse effects.

* Chemical vapors from drugs such as during administration of cytotoxic drugs when inhaled, can affect the body adversely

Effects of Chemical Hazards

Monica (2007) identified three different effects of chemical agents on nurses: they include:

* Local or Site of Contact:

This is when the drug or chemical directly affects part of the body. It causes irritation, burning sensation, or burns of the skin, mucous membrane, or in the eye.

* Systemic Effects: The harm does not occur at the site of contact. For example there may be depression of the central nervous system when there is absorption of a solvent through the skin, or necrosis of the liver from intake of an overdose of a drug.

* Psychological Effects: In severe situations the individual may develop post – traumatic stress disorders, such as chronic anxiety or depression. Acute anxiety on the other hand may mimic acute toxic reactions

In a case – control study, Selevan and colleagues (1985) reported significantly higher fetal loss among nurses occupationally exposed to antineoplastic agents during the first trimestes of pregnancy.

Christensen and colleagues (2010) Surveyed 457 female pharmacists regarding work practices related to handling antineoplastic agents. Results indicated that more than 40% of the respondents reported cytotoxic drug skin contact. Nurses most at risk for toxic effects are those with regular cumulative exposures to these agents in practice settings such as hospitals oncology floors, oncology units, private physicians offices and out patients clinics (Rogers 2001)

Latex allergy, which is associated with the use of medical gloves, is a growing problem among healthcare workers, with prevalence rates of 10% reported in frequent users, such as operating room personnel, (Charpin D, 2002). Latex is composed of prone rubber and water, with small amount of resins, proteins, sugars and minerals. During the process of making latex products, other chemical products and added, however, the proteins is the major sensitizing antigen.

Mechanical Agents

Mechanical agents are associated with injuries and accidents in the work setting poorly designed or inadequate equipment or work stations can cause discomfort and potentiate such injuries as cumulative trauma disorders. Cluttered and slippery floors from spilled fluids) contribute to falls and other accidents (Rogers (2001).

The extent of low back pain and injury among nursing personnel is thought to be underestimated. A survey by Owen (2009) of 503 nurses, found that only 34% of respondents with work related back pain filed an injury report and 12% were contemplating leaving the profession because of the problem.

In several studies, tertiary care hospitals staff have reported work- related back pain and injury and have implicated lifting techniques, poor stetting, lack of use of assistive device, inadequate communication and constitutional factors as contributory factors (Rogers, 2001, A, Ayodele et al, 2008).

Hospital and long- term care nursing staff are at high risk for sustaining back injuries because they must lift, bend, and pull while moving and transferring patient (Brunner and Suddearths, 2007).

Wilkinson and colleagues (2002) retrospectively investigated occupational injuries among 9608 university health science center and hospital employees during a 32 – month period. During this time 1513 injuries were reported, with the most frequent injuries being needle stick injuries (32. 1%), followed by sprains and strains (17.2%); of the later 55% involved back injuries that were caused by lifting and twisting motions.

Ayodele and colleagues (2008) carried out a research on the prevalence of musculoskeletal disorders among nurses in university college hospital Ibadan. During this period (79. 4%) of all nurses complained of lower back pain. This high prevalence was attributed to job inexperience, type of work and high volume of work. Meanwhile, in related study, Erickson (2003) stated that work related musculoskeletal disorders increased with increasing number of working hours per week.

Psychosocial Agents

Psychosocial agents or stressors are well known to nursing. They may result in significant  amount of stress, leading to a variety of work related problems such as absenteeism, staff conflict, staff turnover, decreased moral, and decreased practice effectiveness (Fielding, 2004). Sources of stress identified in the work environment include poor working conditions, work overload, role ambiguity, organizational, politics, physical danger, poor communications and shift work.

Shift Work: It estimated that 11.5 million Americans (27% of men and 16% of women) work some type of shift work pattern (Mott PE, 2005), The demands of shift work cause desynchronisation of the internal rhythms, which can lead to a variety of psychological and physical problems, including gastrointestinal disturbances, exhaustion, depression, anxiety, interpersonal relationship difficulties and higher rates of accidents (Moore- Ede Mc, 2005), Shift workers have reported a lower sense of well – being, with lower participation rates in social organizations, engagement in more solitary activities, higher incidence of family and sexual problems, higher rates of divorce, and  decreased work performance compared with day workers. (Ladou J. 1990).

Violence: Compared to other health care, nurses face a higher level of risk  for violence. More than 9.5% of general nurses working in general hospitals are assaulted annually (Wells and Bowers, 2002), Gerbrich et al. (2004) reported that the   rate for both physical (13. 2%) and non- physical (38.8%) violence  are on the rise in emergency department, home/ long term care, intensive care and physical/behavioural care nurses.

Similarly, MC Phaul and Lipscomb (2004) state that the majority of threats and assaults to nurses  arise from patients

Physical Agent

Physical agents in the work environment such as noise or vibration can create health hazards through the transfer of physical or mechanical energy to human being in that environment, thereby producing tissue trauma.

Radiation is a common physical agent widely used in medicine for various diagnostic and therapeutic procedures. Health care workers may be at risk for radiation exposure to body fluids of patients receiving metabolized therapeutic nuclear radiation. (Godwin G.L, 2005) radiation exposure has been linked to cancer development and reproductive toxic  effects.

Another physical hazard noise, can result in hearing loss to healthcare workers if decibels are high enough. Nurses working in air rescue operations, such as Life flight, are exposed to considerable noise emitted by variety of equipment. (National safety council 2008). Exposure to noise can lead to psychological stress. The bombardment of noises from equipment, alarms, visitors, suction equipment, ventilators, patients and call bells, as well as from other health care providers can lead to sensory overload.

Empirical Studies

Universal precautions apply to blood, other body fluids containing visible blood, semen and vaginal secretions. It also applies to tissues and the following fluids: Cerebrospinal fluids, synovial pleural, peritoneal, pericardial and amniotic fluids. Universal safety precautions are with the assumption that a hazard exists.

Universal safety precautions are defined as a set of precautions designed to prevent transmission of Human Immunodeficiency virus (HIV), hepatitis B virus (HBV) and other blood borne pathogens when providing first aid or health care (centre for Disease control and prevention, 2007). Employing universal precautions means taking precautions with everybody. If precautions are taken, health care workers do not have to make assumption about peoples lifestyles and risks of infections. Health workers should have the right to be able to protect themselves against infection whether it is HIV, hepatitis or anything else (World Health Organization, 2004)

The following Universal Infection Control precautions were documented by WHO to help protect health care workers from blood borne disease including HIV:

  • Wash hands with soap before and after procedures.
  • Use of protective barriers such as gloves, gowns, aprons, foot wear for direct contact with blood and other body fluids.
  • Disinfect instruments and other contaminated equipment.
  • Proper handling of soiled line, that is in gloves should be used.
  • The use of new, single – used disposable needle for each patient.
  • Contaminated sharps should be discarded immediately without recapping and into containers that are closed, sealed and destroyed before completely full.

According to Health and safety (Health and safety, 2007), Biological – safety Universal precautions include:

– Barrier protection:- This should be worn at all times to prevent skin and mucous membrane contamination with blood and body fluids, this includes gloves, gowns masks and goggles.

– Gloves are to be worn when there is potential for hand or skin contact with blood, other potential infectious materials or items contaminated with these materials.

– Wear face protection (face shield) during procedures that are likely to generate droplets of blood or body fluid to prevent exposure to mucous membrane of the mouth, eye and nose.

-Wash hands or other skin surfaces thoroughly and immediately if contaminated with blood or body fluids or immediately after gloves are removed.

World Health Organization (WHO)  also documented that the risk of professional exposure to viruses is compounded by the restricted size of staff in many health units, the lack of basic protective equipment and cleaning materials, poor awareness of staff and alarming rise in number of people infected by either or both viruses (HIV and Hepatitis B virus) in the society.

Health workers especially the nurses have a moral and ethical duty to care for all people without discrimination. At the same time, they must be concerned about their personal health, welfare and safety. This concern is genuine, confronted with these challenges, nurses are urged to comply with the universal safety precautions in their daily professional practice, in addition to adopting a safe lifestyle and behaviour in their private life.

Conceptual Framework

Self – care deficit theory as described by Orem is used as theoretical basis for this study.

Orem’s self care theory is associated with a desire to enable and allow people to take initiative in being responsible for their own health care when it is possible. Self-care is care  that is given by oneself to oneself. It is a deliberate action, which has an overall purpose related to meeting specific, individual requirements for effective living. It is a learned behaviour and aided by intellectual curiosity, instruction and supervision from others and experience in performing self-care measures (Hanson VF, 2006). She focuses on self – care requisites which are universal, developmental and health deviation. The universal self-care requisites are often referred to as basic human needs and these include:  the maintenance of a sufficient intake of air, intake of water, intake of food, balance between activity and rest, prevention of hazards to life, human functioning and human well- being.

In this study, the healthcare workers need the basic human needs for survival and material work output. There must be prevention of hazards by them to promote human functioning and well being. When the precautions against hazards are properly implemented by health workers

through the self preventive measures there will be proper client care and increased work output.

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