ABSTRACT
This work is a
study of the knowledge and practice of standard precautions among nurses in
primary Health centers in the various Local Government Areas of Lagos State.
This study was conducted to find out the attitude of nurses at the Local
Government level to matters of health and safety at their workplace and to
suggest areas for possible improvement for the overall health and safety of the
nurses as care givers and the patients receiving care.
It was hypothesized that (i) knowledge of
standard precautions will have no influence on nurses’ compliance with standard
precautions (ii) Availability of equipment will have no significance on nurses’
compliance with standard precautions(iii)Gender among nurses will have no
influence on the practice of standard precautions (iv) Work experience will
have no influence on nurses’ compliance with standard precautions (v)
Professional qualification will have no significant influence on nurses’
compliance with standard precautions (vi) Personal disposition will have no
influence on nurses’ compliance with
standard precautions.
To test these hypotheses,
data was collected from a sample made up of nurses from primary health centers
in the various Local Government Areas of Lagos State. This sample was selected
using Stratified random sampling technique.
The instrument
used for data collection was a self-developed questionnaire which was
administered by the researcher
personally and retrieved immediately during Forum for Local Government Nurses
and Midwives(FOLGONM) meeting held at Eti-Osa Local Government in May,2012.
Data collected
was analysed using the SPSS version 17.0.The hypothesis were tested using
pearson correlation,chi-square,t-test,one-way analysis of variance (anova) at
0.05 level of significance. The results revealed that (1)there is significant influence of knowledge on nurses’
compliance with standard precautions (2)availability of equipment had no significant influence on nurses’
compliance with standard precautions (3)gender had significant influence on
nurses’ compliance with standard precautions(4)work experience had no significant
influence on nurses’ compliance with standard precautions (5)professional
qualification had no significant influence on nurses’ compliance with standard
precautions and (6)personal disposition had no significant influence on nurses’
compliance with standard precautions. The discussion of findings showed a
fairly good practice of standard precautions among the respondents.
On the basis of
the findings of this study, the following recommendations were made: Efforts
should be intensified to ensure regular and adequate supply of personal
protective equipments/barrier clothing, workshops and refresher courses should
be organised in-house from time to time in order to achieve optimal protection
for the health worker and patients alike.
TABLE OF CONTENT
Title Page
Approval
Dedication
Certification
Acknowledgement
Table of Contents
List of tables
List of figures
Abstract
CHAPTER ONE: INTRODUCTION
Background to the study
Statement of problem
Purpose of study
Research Question
Research hypotheses
Significance of the study
Delimitations
Limitation of study
Operational definition of terms
CHAPTER TWO
Literature Review
CHAPTER THREE: METHODOLOGY
Research Method
Population
Sample and Sampling Technique
Instrument for data collection
Validity of instrument
Method of data collection
Method of data analysis
CHAPTER FOUR
Data Analysis, Results and Discussion of findings
CHAPTER FIVE
Summary
Conclusions
Recommendations
References
Appendix
LIST OF TABLES
Table 1: Age distribution of
respondents
Table 2 Health units of
respondents
Table 3: Professional
qualification of respondents
Table 4: Primary Health centers of
respondents in the various Local Government
Areas
Table 5: Gender of
respondents
Table 6: Years of experience of
respondents
Table 7: Pearson Correlation table showing relationship
between knowledge and
compliance
with standard precautions
Table 8: Chi-square
table showing relationship between availability of equipment
and compliance with standard
precautions
Table 9: t-test table showing relationship between
gender and practice of standard
Precautions
Table 10:
One-way analysis
of variance (Anova) table showing relationship between
work
experience and nurses’ compliance with standard
precautions
Table 11: One-way analysis of variance
(Anova) table showing the relationship
between
professional qualifications of
respondents and their compliance
with
standard precautions
Table 12: Chi-Square table showing
relationship between personal dispositions to
standard precautions and nurses’ compliance with standard precautions.
CHAPTER ONE
INTRODUCTION
Healthcare
workers are at risk of occupational hazards as they perform their clinical
activities in the hospital. Nurses represent a significant percentage of the
healthcare workers in any given health institution or facility. They spend
longer working hours with the patients and in the hospital. Nurses are often
referred to as being the closet to the patients.
They are exposed to blood borne infections by pathogens, such as HIV,
hepatitis B and hepatitis C, from sharps injuries and contacts with deep body
fluids. In this era of HIV epidemic in sub-Saharan Africa, this occupational
risk is real and significant.
Developing countries that account for the highest prevalence of
HIV-infected patients in the world also record the highest needle stick
injuries. Needle stick injuries were the commonest occupational health hazard
reported from a Nigerian teaching hospital.1The World Health
Organization (WHO) estimates that about 2.5% of HIV cases among Health care
workers and 40% of hepatitis B and C cases among Health care workers worldwide
are the result of these exposures.2 There is no immunization for HIV
and hepatitis C. It becomes important to prevent infection by preventing
exposure.
Since identification of patients infected with blood borne pathogens
cannot be reliably made by medical history and physical examination, universal
precautions were recommended by the Center for Disease Control (CDC) to be used
on all patients.3
Compliance with
universal safety precautions has been shown to reduce the risk of exposure to
blood and body fluids.
The importance
of effective workplace safety health programme has many benefits and these
includes; increased quality in patient care, improved employees’ morale,
reduced absenteeism and illnesses, reduced workers compensation rate and so on.
Making the working condition safer and healthy should be the concern of
workers, employers and government, as well as the public at large.
The employer should observe and
abide by all government legislation concerning the health and safety at work
and some of these include: Provision of appropriate tools for workers,
refresher courses on hazards inherent in their job and how to go about the job
e.g. carrying out nursing care following scientifically approved procedures.
Provision of enabling environment with appropriate policies on safety, health
and welfare of workers, provision of personal protective equipments and setting
up a functional health and safety management which will identify serious and
frequent health hazards and taking necessary precautions to protect the
workers.
This study is aimed at assessing the observance of universal safety
precautions among nurses in the various Primary Health Centers within Lagos State.
1.1
BACKGROUND TO THE STUDY:
An
overview of Primary Health Care
Primary health care is essential
healthcare based on practical, scientifically sound, socially acceptable
methods and technology, made universally accessible to individuals and families
in the community through their full participation. Participation should be at a
cost that is affordable to community and country at every stage of their
development in the spirit of self-reliance and self-determination.
Primary
health care forms an integral part of both the country’s health system, which
is the central function and main focus, and of the overall social and economic
development of the community. It is the first level of contact of individuals,
the family and community, with the national health system, bringing health care
as close as possible to where people live and work. It also constitutes the
first element of a continuing health care process necessary for the
acceleration of social and economic development.
The original concept of primary health care came up
because health indices which define civilization have been on the negative
side. The indices include, maternal, infant and under-five mortality rates,
prevalence of preventable communicable diseases like tuberculosis, malaria,
HIV/AIDS, cholera, onchocerciasis, leprosy, childhood vaccine-preventable
diseases, among others. There is also the worrying incidence of fake and
adulterated drugs with its dire consequences.
Primary health care:
-
requires and promotes maximum community and individual self-reliance and
participation in the planning, organization, operation and control of this
health care level, making fullest use of local, national and other available
resources; and to this end develops through appropriate education the ability
of communities to participate;
- should be sustained by integrated,
functional and mutually supportive referral systems, leading to the progressive
improvement of comprehensive health care for all, and giving priority to those
most in need;
-relies on health workers, including
physicians, nurses, midwives, auxiliaries and community workers as applicable,
as well as traditional practitioners as needed, suitably trained socially and
technically to work as a health team and to respond to the expressed health
needs of the community.
Declaration of Alma-Ata
International Conference on Primary Health Care,
Alma-Ata, USSR, 6-12 September ,1978
A case study on
the activities of nurses in the Primary Health Centers as in the case of
universal safety precautions will not be complete without making mention of the
international conference held in USSR that brought about proper structuring and
development of the primary health care level.
The outcome of the conference was a success and it charged the various
countries on the need to take quality health care delivery to the door step of
the people in every community. It also charged the government on the need to
employ qualified health personnels who are best suited for the job, thus,
promoting good health.
Components of Primary Health Care
The components of
the primary health care system include:
I) Health
education
ii) Routine
Immunization
iii) Supply of
potable water and basic sanitation
iv) Reproductive
health including HIV/AIDS
v) Provision of
proper nutrition
vi) Prevention
and control of locally endemic diseases
vii) Treatment of
common diseases and injuries
viii) Provision
of essential drugs
ix) Provision of mental, oral and eye care
1.2 Statement of problem
Improper use of
safety precautions will predispose this significant workforce to increased
morbidity and mortality with special emphasis on nurses for the purpose of this
study.
1.3 Purpose of the study
- To
find out the attitude of nurses at the Local Government level to matters of health and safety at their workplace.
- To
find out if there are policies, rules and regulations for workers’ safety
and measures put in place to enforce them.
- Also
to suggest areas for possible improvement for the overall health and
safety of the nurses as care givers and the patients receiving care.
1.4 Research Question
Do nurses always comply with standard
precaution when carrying out their nursing care?
1.5 Research hypothesis
(i)
Knowledge among nurses will not have any influence on
the level of compliance with standard precautions.
(ii)
Availability of equipment will have no influence on
nurses’ compliance with standard precautions.
(iii) ` Gender among nurses
will have no relationship with practice of standard precautions.
(iv) Work experience will
have no influence/relationship with nurses’ compliance with standard
precautions.
(v) Professional
qualification will have no significant influence on nurses’ compliance with
standard precautions.
(vi) Personal disposition
will have no influence/relationship with compliance of nurses with standard
precautions.
1.6 Significance of the study
Nurses play very
vital role in the care and management of patients in any health facility or
institution. They are always in close contact with the patients. Thus, a
justification for this study cannot be overemphasized as it will be worthy to
have a research work on a crucial aspect of Nurses safety at work as they carry
out their humane function as care givers.
1.7
Delimitation of the study
This involves
the study of standard precautions among nurses at the Primary Health Care level.
It takes a look at the level of safety precautions practiced by nurses in the
various primary health centers in Lagos State. Also to suggest areas for possible improvement
for the overall health and safety of the nurses as care givers and the patients
receiving care.
1.8 Limitation of the study
This study was
limited by the self-report method of assessment of practice of universal
precautions, because the level of compliance might have been more properly
assessed by observation.
1.9
Operational Definition of Terms
Safety: The state of being safe and protected from danger or harm
Precaution: Something that is done in
advance in order to prevent problems or avoid danger
Health: A state of complete, physical,
mental, emotional, social and spiritual well-being and not merely the absence
of disease or infirmity
Contagious: A disease that spreads
quickly to other people
Infectious: A disease that can be
passed easily from one person to another especially through the air they
breathe.
Occupational hazards: Risk or dander
especially to somebody’s health or safety which is connected to a person’s job
or profession.
Needle stick injury: Injury sustained
from the use of needle during patient care.
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