Perception On Occupational Safety And

Health Management Among Hospital Staff

Nurses In Sabah State Health Department

A Preliminary Study

by

Nelbon Giloi, Lim Jac Fang, CHEAH Whye

Lian, CHANG Ching Thon

Introduction

• Sabah is a Malaysian state located on the

northern portion of Borneo island

• Second largest state in Malaysia - 73,711 sq

kilometerskilometers

• Total population of 3.27 million (11.3% of total

population of Malaysia in 2010)

• Population density – 35 people per sq

kilometer

• The population consists of many different

ethnic groups with Kadazan-

Dusun, Rungus, Bajau, Chinese, Murut, Malay

and other indigenous groups, being the and other indigenous groups, being the

majority

• There are 22 government hospitals including

one psychiatric hospital, 83 primary health

clinics, 38 dental clinics, 20 maternal and child

health clinics and 189 rural clinics. In addition health clinics and 189 rural clinics. In addition

to that there are 2 Flying Doctor Service teams

and several mobile clinic teams

• Road system - 60% gravel road / unpaved road

& 30% paved.

• 1. Hosp. Kudat

• 2. Hosp. Kota Marudu

• 3. Hosp. Kota Belud

• 4. Hosp. Ranau

• 5. Hosp. Queen Elizabeth

• 6. Hosp. Bukit Padang

• 7. Hosp. Papar

• 8. Hosp. Beaufort

• 9. Hosp. Tambunan

• 10. Hosp. Tenom

Location of Government Hospitals in

Sabah

• 10. Hosp. Tenom

• 11. Hosp. Sipitang

• 12. Hosp. Keningau

• 13. Hosp. Sandakan

• 14. Hosp. Beluran

• 15. Hosp. Kinabatangan

• 16. Hosp. Lahad Datu

• 17. Hosp. Semporna

• 18. Hosp. Tawau

• 19. Hosp. Pitas

• 20. Hosp. Kuala Penyu

• 21. Hosp. Kunak

• 22. Hosp. Pakar Likas

Goverment Hospitals

On Occupational Safety And Health

Management Perception

• A health care facility is a workplace as well as

a place for receiving and giving care. Health

care facilities around the world employ over

59 million workers who are exposed to a 59 million workers who are exposed to a

complex variety of health and safety hazards

everyday (WHO)

Prevention of Occupational Injuries

• Prevention of occupational injuries among the

healthcare workforce is vital to provide quality

patient service, improve morale, and enhance

productivity by reducing time-loss and other productivity by reducing time-loss and other

absenteesim (Alamgir H et al., 2007)

• In recent years attention has been paid to the occupational risks and injuries of nurses - injuries and resultant compensation to workers are expensive

• United States - nurses’ back injuries are estimated • United States - nurses’ back injuries are estimated to cost US$6 million in indemnity and medical payment comprising 56% of all indemity costs and 55.1% of all medical cost

• In an Australian state - nurses’ back injury claims accounted for A$2.39 million expenditure in one financial year (Dawson, 2007)

• Job satisfaction important component of nurses' lives.

• Impacts on:

– patient safety,

– staff morale,

– productivity, – productivity,

– performance,

– quality of care,

– retention and turnover,

– and commitment to the organisation

(Stone, 2004)

• An online health and safety survey by the American Nurses Association showed majority of the nurses surveyed indicated that perception on working conditions interfered with their ability to deliver quality care deliver quality care

• These respondents also reported that health and safety concerns influenced their decisions about the kind of nursing work performed and their continued practice in the field of nursing. In addition, the perception of unsafe working conditions may hinder recruitment and retention of qualified staff (Stone et al., 2004)

Perception on Safety & Health Issues

• Important to gauge how the healthcare

workers perceive the issues on safety and

health in their workplace. Evidences show that

stress related to increased workload and stress related to increased workload and

staffing patterns, including shift work, can and

does contribute to illness and injury in the

nurse population (Brown, et al., 2006)

• The impact of these events is of concern not

only in terms of the health risk to workers, but

also the effects on quality and safety of

patient care as well as patient and family patient care as well as patient and family

satisfaction (Rathert, 2007)

• Increasing work pressure results in decrease

in morale and productivity of nurses was also

found (Cavanagh et al., 1992)

• Monitoring nurses' working conditions and

improving the organizational climate of

hospitals is likely to improve the safety of the

employee and the profitability of the hospital employee and the profitability of the hospital

through improved system outcomes (such as

lower turnover of the employees) as well as

improve the quality of patient care delivered (Stone et al., 2006)

Grade U29 Staff Nurses • Nurses is the largest group of health care

providers deliver care to individuals in a variety of health care facility.

• The largest group (31.5%) of frontline hospital workers workers

• Malaysia –

– Rural Health Nurse, U19

– Senior Rural Health Nurse, U24

– Staff Nurse, U29

– Sister, U32

– Matron, U36 / U42

• Like nurses in other countries, they are

exposed to many occupational-related safety

and health problems

• Sabah State Health Department in 2000 - the • Sabah State Health Department in 2000 - the

highest percentage (74.5%) of needle stick

injury were among nurses (Lim, 2004)

• Fukuda et al. (2010) noted that incidence of

work related injury (WRI) among hospital

workers are highest among nurses.

• Risks of other injuries including back pain • Risks of other injuries including back pain

(Hofmann et all., 2002) and back injury

(Department Of Statistics Malaysia, 2009) is

shown to be higher in nurses as compared to

other professions.

Objective

• Although emphasis on occupational safety and health is placed in Malaysia, there has not been substantiate evaluation on the perception of occupational safety and health management among the employees, including nurses, in Sabah among the employees, including nurses, in Sabah State Health Department.

• This study aimed to determine the OSH management and its effects as perceived by and level of safety satisfaction and feedback staff nurses in public hospitals in Sabah.

Material and Methods• This was a cross sectional study.

• The sampling frame was among the grade U29 hospital staff nurses in the Department of Health, Sabah, with a minimum of six months working experience

• The minimum sample size was determined using • The minimum sample size was determined using the formula for single proportion (EpiInfo 3.3.2)

• Based on national prevalence of occupational related injury 30% and sampling frame of 3,391, the minimum sample size with a confidence level of 95%, was estimated to be approximately 213 with a 10% of non-response rate

• Data collection was done using a set of self

administered questionnaires adopted with

permisson from a study by Abdullah et al.

(2009) (2009)

• The questionnaires examined the perception

of employees on the management of

Occupational Health and Safety (OHS) in

public hospitals in Malaysia.

Ethical Approval & Informed Consent

• Obtained from the CRC Sabah and the

National Medical Research Register (NMRR)

• Informed Consent obtained from each • Informed Consent obtained from each

respondent

• This questionnaires consisted of two sections:

i. Six items on socio-demographic data of

respondents;

ii. Eighty five items on perception of the ii. Eighty five items on perception of the

implication of OSH management

elements.

OSH elements grouped into ten components

representing independent variables

• Leadership style

• safety involvement

• management

• safety

communication,

• safety objective, • management

commitment

• role of supervisor

• training and

competence

• safety objective,

• safety reporting,

• work pressure and

• safety incidents

Dependent variable

• Safety satisfaction

• Feedback on safety

• The items on OSH management were scored

on a 5-point Likert-type scale:

1 indicated strongly disagreed and 5, strongly

agreed for eight elements, agreed for eight elements,

1 indicated highly dissatisfied and 5, strongly

satisfied and

1 indicated “0” and 5 indicated “10 times” for one

element.

Results

A total of 135 nurses randomly selected from

seven government hospitals that responded

have participated in the study with a response

Response Rate

have participated in the study with a response

rate of 63.4%.

Age Distribution

20

25

30

20

25.2

22.2

26.7

0

5

10

15

20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs 40 yrs &

above

5.9

Gender

60

70

80

90

100

97.8

0

10

20

30

40

50

Male Female

2.2

Race

30

40

50

60 56.3

23.7

0

10

20

30

Kadazan Murut Bajau Rungus Malay Chinese Others

0.7

5.23

10.4

0.7

23.7

Place Of Work

40

50

60

7062.2

0

10

20

30

40

Wards/ICU/CCU OPD OT/Labour

room/Procedure

Room

Admin office Others

14.110.4

1.5

11.9

Years Of Working

20

25

30

35

30.431.9

22.2

0

5

10

15

20

Below 1 yr 1-5 yrs 6-10 yrs 11-15 yrs 16-20 yrs 21 yrs &

above

2.2

5.97.4

Experience Working In The Current

Hospital

25

30

35

4038.5

21.5

0

5

10

15

20

25

Below 1 yr 1-5 yrs 6-10 yrs 11-15 yrs 16-20 yrs 21 yrs & above

12.6

21.5

14.8

5.2

7.4

Discussion

• This study revealed that training andcompetence (4.04 ± 0.65) was perceived asthe most important component of theirworkplace OSH practice.

• Followed by safety rules and reporting (3.70 ±0.63), while safety incidence was had thelowest score (1.70 ± 0.68).

Training and Competence

A reflection of active OSH programmepromotion and training in Sabah

– Training is important as employees who receive safety training suffer fewer work-receive safety training suffer fewer work-related injuries than their untrained counterparts (Colligen et al. ,2004),

–Allows employees to acquire greater competencies to control work, and perform jobs more safely (Barling et al., 2009).

• Pearson’s correlation analysis results indicated

that all OHS elements had positive correlation

with safety satisfaction and safety feedback

except safety incidence. except safety incidence.

• Perception on safety incidence was low which

reflects that the OHS mangement was

satisfactory.

• Safety satisfaction mean score 3.28 ± 0.51

• Safety feedback mean score 3.57 ± 0.73

Safety Satisfaction and Feedback

• Interesting to note that management

committment was found to have no significant

correlation between most of the other

elements of OHS mangement, except for:

i. Safety Satisfactioni. Safety Satisfaction

ii. Safety Communication

iii. Work Pressure

iv. Safety Responsibility

• Incongruent with Nor Azimah et al.’s (2009) study.

• Possible explanation was that the respondents

did not think the role of management should be

the determining factors that influenced their

knowledge and competence in occupational

health and safety. health and safety.

• The need to improve and protect themselves and

establishing safety culture could be in placed as

part of their intrinsic needs, rather than as

extrinsic needs enforced by the management.

• Another possibility of this finding could be

related to the role of management in

implementing the rules and regulations

pertaining to safety at work and establishment pertaining to safety at work and establishment

of safety culture within the organization were

unclear, thus, respondents did not perceived

management commitment as important.

Conclusion

• This study revealed that the overall perception on OSH management in Sabah was fair.

• The score of safety satisfaction and safety feedback was above average indicating that the respondents were relative satisfied with OHS respondents were relative satisfied with OHS management in Sabah.

• The high score on training and competence was high reflecting that Sabah Health Department had placed emphasis on training thus resulted the perception of competent by respondents.

Study Limitation

• The study used a set of self administered questionnaires enquiring specific questions on perceptions regarding safety and health issues during the past one year

• Subjected to respondent’s recall and reporting bias bias

• Lacks generallization

• As it was a preliminary study, further study with bigger sample involving other categories of hospital staff from different health care setting are needed to give better insight into OHS management as well as providing information for better OHS implementation.

Thank You