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 kilometers 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 KadazanDusun, Rungus, Bajau, Chinese, Murut, Malay 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 to that there are 2 Flying Doctor Service teams and several mobile clinic teams Road system - 60% gravel road / unpaved road & 30% paved.

Location of Government Hospitals in Sabah

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 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 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 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 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, 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 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 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 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 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 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 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 (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 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 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) 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 respondent

 This questionnaires consisted of two sections: i. Six items on socio-demographic data of respondents; 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 commitment role of supervisor training and competence safety communication, 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, 1 indicated highly dissatisfied and 5, strongly satisfied and 1 indicated 0 and 5 indicated 10 times for one element.

Results

Response Rate
A total of 135 nurses randomly selected from seven government hospitals that responded have participated in the study with a response rate of 63.4%.

Age Distribution
30

25.2
25

26.7 22.2

20
20

15

10

5.9
5

20-24 yrs

25-29 yrs

30-34 yrs

35-39 yrs

40 yrs & above

Gender
97.8
100 90 80 70 60 50 40 30 20 10 0

2.2

Male

Female

Race
60

56.3

50

40

30

23.7
20

10.4
10

5.2 0.7

0.7

Kadazan Murut

Bajau

Rungus

Malay

Chinese Others

Place Of Work
70

62.2

60

50

40

30

20

14.1

10.4 1.5

11.9

10

Wards/ICU/CCU

OPD

OT/Labour room/Procedure Room

Admin office

Others

Years Of Working
35

30.4
30

31.9

25

22.2

20

15

10

5.9
5

7.4

2.2

Below 1 yr

1-5 yrs

6-10 yrs

11-15 yrs

16-20 yrs

21 yrs & above

Experience Working In The Current Hospital

40

38.5

35

30

25

21.5

20

14.8
15

12.6 7.4 5.2

10

Below 1 yr

1-5 yrs

6-10 yrs

11-15 yrs

16-20 yrs

21 yrs & above

Discussion
This study revealed that training and competence (4.04 0.65) was perceived as the most important component of their workplace OSH practice. Followed by safety rules and reporting (3.70 0.63), while safety incidence was had the lowest score (1.70 0.68).

Training and Competence

A reflection of active OSH programme promotion and training in Sabah Training is important as employees who receive safety training suffer fewer workrelated 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).

 Pearsons correlation analysis results indicated that all OHS elements had positive correlation with safety satisfaction and safety feedback except safety incidence. Perception on safety incidence was low which reflects that the OHS mangement was satisfactory.

Safety Satisfaction and Feedback

Safety satisfaction mean score 3.28 0.51 Safety feedback mean score 3.57 0.73

 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 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. 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 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 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 respondents recall and reporting 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