Research consultancy
This chapter presents the literature review of the study extracted from various sources that include health journals, reports, dissertations, internet and books among others. The literature is presented under subheadings derived from the objectives of the study that include; health and safety hazards being experienced by healthcare workers, individual and institutional related factors contributing to health and safety hazards among health workers. A healthcare worker is an individual who provides preventive, curative, promotional, or rehabilitative health care services in a systematic way to people, families, or communities.
Health-care workers (HCWs) require a shield from workplace hazards just as much as do other workers in factories. Yet, because their work is to care for the ill ones, HCWs are usually seen as “immune” to injury or illness.
Relevant literature about:
- The problem of focus
- The relevant study designs under consideration and their benefits, risks
- The data collection options, their strengths and weaknesses as relevant to this study
2.1. Theoretical framework
The study is underpinned to Side-Bet theory which holds that practices of occupational safety and health can use hazard controls and interventions to mitigate workplace hazards, which pose a threat to the safety and quality of life of workers. Demographic transition theory has been used as a framework through which the drastic changes in family and family related behaviors, age, household size, and marital status can cause Non-compliance to use of personal protective equipment.
In logistics firms there is a collective set of rules or norms that tell people how they ought to conduct various aspects of their lives. Recent data reveals fundamental shifts in values, attitudes and norms which also can cause non-compliance to use of personal protective equipment.
The changing economic status of the employers reflected in rising labor force participation rates and earnings, is most likely to be responsible for causing non-compliance to use of personal protective equipment.
The theory of reason action also will guide the study, Ajzen and Fisbein formulated this theory in 1980 based on the fact that a person’s behavior is determined by their intention to perform the behavior in question of which the intention is determined by their attitude towards the behavior, the intention is looked at as the persons readiness to perform which is determined by attitude, subjective norms and perceived behavioral control.
2.2 Health and safety hazards being experienced by healthcare workers
Exposure to waste anesthetic gases may occur in operating rooms, labour and delivery, and recovery rooms. Long-term exposure to these agents have been associated with an increased risk of renal (methoxyflurane) and hepatic (halothane) disorders and have also been correlated with an increased risk of spontaneous abortions and congenital abnormalities (nitrous oxide) in exposed workers. Adverse health effects which have been attributed to occupational exposure to anesthetic agents include unfavorable reproductive outcome, liver diseases, kidney ailments, and interference with vitamin B12 metabolism. It is reassuring to note that the evidence for other suspected hazards like malignancy, teratogenic effects, low birth weight, and infertility was deemed unconvincing (Vessey and Nunn, 2010). Efforts must be made to ensure that the levels of anesthetic gases in the work environment of nurses are kept below recommended limits. Towards this end, it may be necessary to install effective scavenging systems (Lunn, 2017).
In Japan, the Health and Safety Association Report published the results of medical examinations of the county’s salaried employees. This report includes the results from 600,000 employees in the health and hygiene sector. Nurses who work rotating shifts had complaints concerning fatigue; this was highest in the night shift, followed by evening then morning shift (Makino, Shimizu and Takata, 2015). The symptoms reported by night shift nurses included sleepiness, sadness and difficulty concentrating, with numerous complaints about cumulated fatigue and disturbed social life (Behar, 2009). Behar (2009) theorizes that shift work exerts adverse pressure by disturbing circadian rhythms, sleep and family social life. Disturbances in circadian rhythms may lead to reduction in the length and quality of sleep and may increase fatigue and sleepiness, as well as gastrointestinal, psychological and cardiovascular symptoms. Koller (2016) states that shiftwork, especially the night shift, has implications for the entire living sphere of mankind, leading to health hazards and stress. Shift workers are a population at risk since they are exposed to psychological stress, desynchronization and reduced coping mechanisms.
A study conducted by Amal and Sahar (2016) on health and safety hazards as perceived by workers in the operating theatres in Cairo, Egypt revealed that most of the workers in the theatres identified the main accidental hazards as follows: cuts from sharp objects, especially needle-sticks bad blades, followed by falls on wet floors considered high incidence. This was congruent with a study conducted by Almurr (2013) on knowledge and practice of standard precaution and sharp injures among nurses in the Northern West Bank Hospitals in Palestine that found the prevalence of sharp injuries was high. Moreover, in India study by Arazoo, Bhatt, Butola and Painuly et al., (2015) on occurrence and knowledge about needle stick injuries among theatre workers reported that most of workers had high incidence of needle stick injuries.
A study conducted by Bolanie, Tinubu, Mbada, Oyeyemi and Fabumni (2010) in South West Nigeria shows that work-related musculoskeletal disorders can result from work-related events and are common among health care workers. The nursing population, which constitutes about 33% of the hospital workforce, is at particularly high risk and accounts for 60% of the reported occupational injuries. Bolanie et al., (2010) further state that musculoskeletal disorders impact more significantly on the quality of life, absenteeism, work restrictions, likelihood of transferring to another job or developing a disability than any other group of diseases, with a considerable economic toll on the individual, the organization and the society as a whole.
Back injuries rank second among all causes of occupational injuries across professions (Garrett, Singiser and Banks 2012). Health care work is highly physically demanding, and the tasks that require heavy lifting, bending, twisting and other manual handling have been implicated in health care workers’ back injuries. The frequent lifting of patients who are weak, debilitated and elderly increases the risk of back injuries in those who provide their care.
Medical science and technology development, rapid patient turnover and rising dependency of professionalism in nursing have increased the complexity and volume of the tasks demanded from nurses, and for this reason the nursing profession is increasingly characterized by occupational stress, frequent job turnover and job dissatisfaction (Hawley, 1992). Psychological hazards such as high workload, highly demanding work, fatigue (both mental and physical), and burn-out are common in hospital environments that create stress, depression and mental fatigue in their staff (Sadlier, 2010). Managerial atmospheres also affect psychological and physiological hazards (Sadlier, 2010).
Research by the National Institute for Occupational Safety and Health (NIOSH) (2008) has identified stress as one of the key occupational health challenges for nurses at the workplace. For example, nurses who work with terminally and chronically ill patients, and those who work in intensive care units, emergency rooms, operating rooms are particularly at risk for stress related symptoms (NIOSH, 2008). The early signs of stress include irritability, loss of appetite, ulcers, migraine headaches, emotional instability and sleep disturbance (NIOSH, 2008).
2.3 Individual factors contributing to health and safety hazards among health workers
According to the United States Centers for Disease Control and prevention (CDC-P), the prevalence of obesity has dramatically increased over the last 20 years. Over a third of adults are overweight and there is a significant increase in obesity as we age (CDC-P, 2014). The growing prevalence of obesity is prohibitive of manual lifting as the National Institute of Occupational Safety and Health (NIOSH, 2015) guidelines recommend that the maximum recommended weight to be lifted by women in the 90th percentile of strength is 46 lbs. The cumulative weight lifted by a nurse in one typical 8-hour shift is equivalent to 1.8 tons and this statistic represents repetitive work which surely exceeds NIOSH guidelines.
An additional risk factor for back injury is gender: females are more likely to suffer from this complaint. Nursing activities such as lifting patients into bed, helping patients out of bed, transferring patients from the bed and carrying equipment are the most frequent causes of back pains. Shires (2003) claims that the most common occupational health hazard is lower back pain in nurses, and that physicians and nurses do not receive any training on health and safety hazards. This lack of training contributes to the nurses’ inability to protect themselves from such hazards.
In a study conducted by Ghosh (2013) on occupational health and hazards among healthcare workers revealed that worker’s low working experience was among factors that contributed to occupational hazards among health workers who were working in the theatre. This is in line with a study conducted by Faber, Giver, Stroyer and Hannerz (2010) on low back pain and low physical capacity risk indicators for dropout among recently qualified eldercare workers that revealed that, low working experience was one of the individual factors that contributed to the health and safety hazards.
On the other hand, the study conducted in Ibadan found that 84.4% of the nurses have had work related musculoskeletal disorders (WMSDs) once or more in their occupational lives. WMSDs occurred mostly in low back (44.1%), neck (28.0%), and knees (22.4%). Nurses with more than 20 years of clinical experience are about 4 times more likely to develop WMSDs than those with 11-20 years’ experience. Working in the same positions for long periods (55.1%), lifting or transferring dependent patients (50.8%) and treating an excessive number of patients in one day (44.9%) were the most perceived job risk factors for WMSDs (Tinubu et al., 2010).
Aluko, Adebayo, Adebisi and Ewegbemi (2016) conducted a study on knowledge, attitudes and perceptions of health and safety hazards and safety practices in Nigerian healthcare workers and their findings revealed that inadequate knowledge on the dangers of health and safety hazards among workers was one of the factors contributing to health and safety hazards among health workers. Similarly, Nsubuga and Jaakkola, (2015) in their study “needle stick injuries among nurses in sub-Saharan Africa,” noted that, inadequate knowledge on the dangers associated with needle stick reuse among health workers contributed to occupational hazards such needle sticks injuries among others.
Ndejjo, Musinguzi, Yu and Buregyeya (2015) in their cross-sectional study health and safety hazards among healthcare workers in Kampala, Uganda reported that lack of educational and development programmes for service providers, inadequate knowledge on the utilization of some equipment and negative attitude among theatre workers towards some occupational safety equipment contributed to health and safety hazards. This was also observed in a quantitative study conducted by Karen (2015) an assessment of the knowledge and understanding professional nurses have of health and safety hazards they are exposed to in the operating theatre environment. The study revealed that, most of the respondents lacked knowledge on the utilization of occupational safety equipment and dangers associated with occupational hazards and this contributed to the increasing prevalence of health and safety hazards.
Tesfay ad Habtewold (2014) conducted a descriptive cross-sectional institution-based study to assess the prevalence and determinant factors of occupational exposure to human immunodeficiency virus infection among healthcare workers in selected health institution in Debre Berhan town, North Shoa zone, Amhara region, Ethiopia. The study findings revealed that improper preparations of healthcare procedures among health workers contributed to occupational hazards such as getting infected by infectious diseases such as HIV/AIDS among others. Similarly, Odongkara, Mulongo and Mwetwale, (2012) in their study “prevalence of occupational exposure to HIV among health workers in Northern Uganda,” reported that, this was attributed to improper preparation of healthcare procedures that involved how to handle patients with HIV positive status during operations in the theatre.
2.4 Institutional factors contributing to health and safety hazards among health workers
Working conditions have a strong impact on workers’ health. A non-supportive working environment can cause harm if not controlled, and can lead to health and safety hazards (WHO, 2009). Hospitals are moderate health-risk industries as they provide health services to people with diverse illnesses (Maier, 2009). Shiao, McLawsy, Huanggz and Guox, (2011) found that sharp injuries remain the commonest cause of exposure to blood-borne diseases for health care workers. This shows that health and safety hazards remain a challenge for health professionals in the workplace.
Workplace factors that may contribute to occupational health hazard such as stress include dealing with life-threatening illnesses, injuries, demanding patients, being overworked, understaffing, difficult schedules, the availability of specialized equipment, the hierarchy of authority, lack of control, participation in planning and decision making, and patient deaths. According to Lewy (2011), in many hospitals the nurse may feel isolated, fatigued, angry and powerless due to a sense of depersonalization created by large bureaucratic system. Stress-related symptoms can lead to an increase in the use of cigarettes, alcohol and drugs. The health worker’s behavior and attitude may be adversely affected, leading to decreased job performance and increased absenteeism (Lewy, 2011).
Inadequate staffing is another risk factor that increases the potential for health and safety hazards amongst health workers. Often stressful tasks such as transferring patients from a bed to a chair or vice versa may be done alone and manually due to lack of staff and equipment. Several studies have examined the association between nursing staff levels and workplace injuries and illness (Lipscomb et al., 2014; Kingma, 2016). These studies analyzed the staffing variables which included the ratio of service provider to patients, the availability of nursing aides to assist in patient transfers, and the reported worker injuries. High injury rates were reported in areas with low staffing levels. Working for more hours is also a result of inadequate staffing. This causes increased exposure to physical demands and reduced recovery time between work shifts, resulting in increased health and safety hazards (Lipscomb et al., 2012). In addition, Engkvist et al (2008) found out that Swedish nurses working over 35 hours were at increased risk of back injuries. Similar findings were documented by (Engels et al., 2016) in a study carried out in Netherlands. At Kenyatta National Hospital, all nurses work for at least 40 hours per week, exposing most of them to health and safety hazards (Akello, 2013).
In a study conducted by Volquind, Bagatini, Monteiro and Londero (2012) on health and safety hazards and diseases related to the practice of anesthesiology the findings showed that, lack of equipments and tools for protection among workers while executing their duties were among the institutional factors that contributed to health and safety hazards. This is also mentioned in the study conducted by (Nicholau and Arnold, 2010) on environmental safety including chemical dependency in the United States that revealed that lack of adequate equipments and tools for protection in the health facilities contributed to health and safety hazards among health workers.
Studies have identified three sources of stress among health workers. These are the physical, psychological and social environments. The working conditions such as the poor ventilation in the unit, lighting and the inadequate temperature levels are among the potential work-related stresses (WHO, 2014). Difficulties in coping with stress combined with psychological or emotional instability could lead to violence and there are several studies supporting that the healthcare workers specifically health workers are especially affected by the risk of physical violence-particularly in the operating rooms which is a source of stress (Moustaka and Constantinids, 2010).
Work relationships are potential stressors among health workers. Two sources of stress in this field are the conflicts with co-workers and the lack of staff support (WHO, 2015). Another assessment showed that lack of social support from colleagues and superiors and less satisfaction with the head nurses contributed significantly to the appearance of stress, while the Health and Safety Executive identify the negative effect of lack of understanding and support from their managers, on workers’ stress (Moustaka and Constantinids, 2010).
Studies indicate that, in addition to nursing itself, organizational and management characteristics influence the occurrence of health and safety hazards among health workers (WHO, 2015; Moustaka and Constantinids, 2010). With regard to previous research, a large part of potential sources of stress for health workers appear to be organizational in nature including stress-generating nursing work situations, which can be of physical, psychological or social nature. Besides responses to patients’ physical and psychological status, increased job demands, because of the use of sophisticated technologies, competition among hospitals, shortage of workers, work overload, and lack of task autonomy and feedback, as well as reduced advancement opportunities, appear to be major determinants of emotional exhaustion among health workers (Moustaka and Constantinids, 2010).
2.5. Identified Research Gap
Ndejjo, Musinguzi, Yu and Buregyeya (2015) in their cross-sectional study health and safety hazards among healthcare workers in Kampala looked at Mulago and Butabika National Referral Hospitals, Mengo Hospital, Kibuli Muslim Hospital, Nsambya hospital, Kadic Hospital, International Hospital Kampala and Case Medical Centre. They didn’t involve healthcare workers in specialized Uganda Cancer Institute that is focused on research, training, consultation, prevention and treatment of cancer in areas of pediatrics, oncology, gynecology, radiotherapy, surgery, pharmacy and recently venturing in to bone marrow transplant.
There are some services like radiotherapy and chemotherapy that are not in the eight sampled hospitals but are in Uganda Cancer Institute, if they are there in the eight hospitals then fewer patients utilize them than Uganda Cancer Institute. Therefore, Uganda Cancer Institute’s healthcare workers are exposed to some occupational health and safety hazards that are not in the eight sampled hospitals. This research will unearth the hazards that were not reported in the previous research
2.6. Conceptual Framework
The conceptual frame work has been development based on the studies done by various scholars; it explains how the independent variables influence the dependent variable at different levels
