https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article Assessment of Occupational Health and Safety Measures’ Knowledge and Experienced Types of Hazards among Nursing Staff in Rania Hospital ABSTRACT INTRODUCTION Numerous changes in the nature of work and workplace risks have occurred. Those changes have many impacts on the work environment, demographics of the work force composition, and health care delivery mechanisms. The analysis of these trends suggests that work-health interaction con- tinues to grow in advance including the quality of performance, reducing hazards in workplace and health delivery strategies [1,2]. Workers represent half of the global population and contribute greatly to the economic and social value of Background and Objectives: In recent years, significant developments have occurred in occupational health and safety programs designed to prevent and control work–related illness and injury. The aims of the study were to assess knowledge of nurses on occupa- tional health and safety measures in hospital and their experienced type of occupational hazards’. Methods: A quantitative descriptive study of non-probability sample was conducted on 50 nurses in Rania general hospital. Data was collected from 10th August 2017 to 25th De- cember 2017. A questionnaire was developed for the purpose of data collection which in- cluded socio-demographic attributes of the study sample and questions on occupational hazards and occupational health and safety measures. Frequency, percentage and chi- square tests were used for data analysis. Results: Proper disposal of waste (90%), Acquainting rights and obligations / career and your job Descriptions (88%), Using protective clothing (86%), Having vaccination against infectious diseases within the health facility (76%), Providing a clinic for employees at work place (74%), Prompt reporting of accidents/injuries (72%) were the most items which nurses implied to them according their knowledge. Nurses mentioned that they experi- enced following occupational hazards in the hospital: physical 48%, psychological 28%, me- chanical/electrical 12%, chemical 22% and biological 10%. There was a significant and high- ly significant association between years of experience and level of education of nurses with their overall knowledge on occupational health and safety measures, respectively but not with their age. Conclusions: Nurses did not have complete knowledge regarding occupational health and safety measures and they experienced different types of hazards during their working years. Keywords: Occupational Health, Occupational Hazards, Work-related Injuries, Work- related Illness, Work Safety, Health and Safety. Shakhawan Azad Ahmed; Department of Community Health Nursing, College of Nursing, University of Raparin, Rania, Sulaymaniyah, Iraq. (Correspondence: shaxawanazad641@gmail.com ) Omar Hussein Shareef; Department of Community Health Nursing, College of Nursing, University of Sulaymaniyah, Sulaymaniyah, Iraq. 85 Erbil Journal of Nursing & Midwifery Received: 15/10/2018 Accepted: 18/4/2019 Published: 30/11/2019 mailto:shaxawanazad641@gmail.com https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article contemporary society. A substantial part of the general morbidity of the working popu- lation is related to work [3-4]. Additionally, too many workers are still exposed to un- acceptable levels of occupational risks. They remain victims of occupational diseas- es and work accidents, lose their working capacity and income potential with limited access to occupational health services [5, 6]. Occupational injuries and illness arise from unsafe conditions or activities in the work environment and are usually preventable. Occupational injuries include but are not limited to exposure to chemicals, injuries from sharp objects or machinery, injuries from unsafe working environments such as slippery or uneven floors, poor ventilation, and improper functioning of electricity. The occupational health care provider has a crucial role in addressing work place risks. Indeed the roles of occupational haz- ards in the work place are to prevent injury and illness, as well as the treatment of in- jured or ill workers [7, 8]. This is especially true for health care pro- viders and, in particular, nurses. Nurses face occupational risks every single day as they work to provide critical health care to their patients. Those risks include, but are not limited to, exposure to infectious dis- eases, exposure to chemicals, heavy lifting and physical stress, and needle sticks. Occupational health nurses have per- formed critical roles in the planning and delivery of worksite health and safety ser- vices. These are comprehensive and cost- effective services which must continue to grow. The requirements in health care costs and the concern about health care quality have increased significantly. For that reason, safety measures have been established in different settings around the world, including primary care and manage- ment of non-work-related health problems in the health services programs [9-10]. We must be aware of our ultimate goal of ensuring that all workers in the world ben- efit from full physical and mental health. It is still far from being achieved despite the availability of effective interventions for occupational health. Occupational health hazards consist of the biological, physical, mechanical, ergonomic, chemical, psycho- social hazards [1]. The aims of this study were to assess 1) occupational and safety measures orienta- tion, 2) knowledge on occupational health and safety in hospital and its association with their age, level of education and year of experience, 3) type of occupational haz- ards’ experienced among nurses in Rania general hospital. A quantitative descriptive study of non- probability purposive sample was conduct- ed on 50 Nurses from 120 nurses who work in Rania General Hospital who were available during data collection. Data was collected in the period from August 2017 to December 2017. The sample of hospital nurses were selected from different hospi- tal departments including emergency, pharmacy, radiology, surgical and opera- tional room and coronary care unit. A questionnaire was developed for the pur- pose of data collection in the study. The first part included socio-demographic attributes of the participants. Occupational Health and Safety Measures, Occupational health Hazards and supportive activities were the main domains in the second part of the questionnaire. Six experts in the field reviewed the question are and check- list who suggested some modification in order to improve internal validity of the tool while the reliable of the questionnaire result of correlation was (r=0.78) for the entire questionnaire by test and retest. The study was approved by the Scientific Committee of College of Nursing at METHODS 86 Erbil Journal of Nursing & Midwifery https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article The majority of the study sample (82%) thought that effective occupational health and safety policies have impact on job per- formance in the hospital. Sixty four per cent of nurses got training sessions regard- ing occupational health and safety measures. More than half the nurse (58%) mentioned that they had periodic educa- tional program regarding that and 52% attend symposium about it (Table 2). The majority of the study sample men- tioned that following are components of occupational health and safety measures: Proper disposal of waste (90%), Ac- quainting rights and obligations / career and your job Descriptions (88%), Using protective clothing (86%), Having vaccina- tion against infectious diseases within the health facility (76%), Providing a clinic for employees at work place (74%), Prompt reporting of accidents/injuries (72%). Only 26% of the study sample mentioned that they have a medical file within the health facility (Table 3). Nurses mentioned that they experienced following occupational hazards in the hos- pital: physical 48%, psychological 28%, me- chanical/electrical 12%, chemical 22% and biological 10% (Table 4). Table 5 shows that there was significant and highly significant association between years of experience and level of education of nurses with their overall knowledge on occupational health and safety measures, respectively but not with their age. Table 5, displays the relationship between level of nurses’ education and their knowledge. The distribution of the level of education among participants showed that 84% graduated from medical institute. This finding is significant for the Kurdistan Re- gion. For several years colleges of nursing and nursing institutions have worked to improve the level of knowledge and University of Raparin, as well as University of Sulaimanyah. The formal permission was given by administration of the hospital. Da- ta was collected through face to face inter- view technique and analysis by SPSS ver- sion 21. Variables were analyzed utilizing descriptive and inferential statistics. De- scriptive statistical analyses included fre- quency, percentage, correlation coefficient and chi-square. The highest percentage (48%) of the nurses were aged between 22-29 years. The ma- jority were male (64%). Regarding of the years of experience, half of them (44%) had 1-5 years. The majority of the nurses (84%) graduated from medical institutes while the lowest percentage of them (4%) are graduates primary nursing school and col- lege. The majority of the sample (74%) were married while the lowest percentage of them (24%) were single (Table 1). 87 Erbil Journal of Nursing & Midwifery RESULTS Items F (%) Age group 22-29 24 (48) 30-37 21 (42) 38-46 5 (10) Gender Male 32 (64) Female 18 (36) Years of experiences 1-5 22 (44) 6-10 17 (34) 11-16 11 (22) Level of Education Primary nursing school 2 (4) Secondary nursing school 4 (8) Medical institute 42 (84) College of nursing 2 (4) Marital status Single 12 )24( Married 37 )74( Divorced 1 )2( Total 05 )155( Table1: Distribution of the nurse's socio- demographic of the study sample https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article education of their graduates. This finding indicates that education is critical to nurs- ing practice in the hospitals. The findings suggest that future study of an educational intervention aimed at non graduates who are working as nurses is critical. At the same time, there appears to be a signifi- cant relationship between years of experience and knowledge as identified in Table 5. 88 Erbil Journal of Nursing & Midwifery Table 3: Knowledge regarding occupational health and safety measures in hospital Table 2: occupational and safety measures orientation among study sample No Not sure Yes Items No (%) F % F (%) F (12) 6 (6) 3 (82) 41 Do you think effective occupational health and safety policies have any impact on job performance in the hospital? 1 (34) 17 (2) 1 (64) 32 Did you get training sessions about occu- pational health and safety measures? 2 (38) 19 (4) 2 (58) 29 Did you have periodic educational pro- gram in your department regarding occu- pational health and safety measures? 2 (44) 22 (4) 2 (52) 26 Did you attend any symposia regarding occupational health and safety measures? 3 No Not sure Yes Items No (%) F (%) F (%) F (8) 4 (2) 1 (90) 45 Proper disposal of waste. 1 (26) 13 (14) 7 (60) 30 Regular monitoring on safety and health standards to en- sure if they are complied with. 2 (6) 4 (6) 3 (86) 43 Using protective clothing 3 (14) 7 (14) 7 (72) 36 Prompt reporting of accidents/injuries 4 (44) 22 (14) 7 (42) 21 Re-training on safety and health practices 0 (30) 15 (12) 6 (58) 29 Having a safety committee in the hospital 6 (26) 13 (14) 7 (60) 30 Having written copy of occupational health and safety policy of the hospital in department 7 (30) 15 (18) 9 (52) 26 Providing protective devices especially the safety of the work environment 8 (16) 8 (8) 4 (76) 38 Having vaccination against infectious diseases within the health facility 9 (8) 4 (4) 2 (88) 44 Acquainting rights and obligations / career and your job Descriptions 15 (68) 34 (6) 3 (26) 13 Having a medical file within the health facility 11 (16) 8 (10) 5 (74) 37 Providing a clinic for employees at work place 12 (36) 18 (26) 13 (38) 19 Reporting the accident to the appropriate authorities 13 https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article 89 Erbil Journal of Nursing & Midwifery No Not sure Yes Items No (%) F (%) F (%) F (44) 22 (8) 4 (48) 24 Physical: falling, sliding, back injuries, muscle, needle stick? 1 (54) 27 (18) 9 (28) 14 Psychological: work pressure, the violence of the pa- tient and his family? 2 (72) 36 (16) 8 (12) 6 Mechanical, electrical: electrical injuries when using electrical appliances? 3 (72) 36 (6) 3 (22) 11 Chemical: exposure to chemicals such as acids and tox- ins and those that lead to a fire or explosion, and clean- ing materials and dust? 4 (90) 45 (0) 0.0 (10) 5 Biological: bacteria, viruses and mildew? 0 Table 4: Type of occupational hazards’ experienced by study sample No Not sure Yes p-value F ( %) F (%) F (%) Age group years 22-29 248 (36.9) 65 (9.7) 359 (53.4) 5.948 NS 30-37 227 (38.6) 72 (12.1) 290 (49.3) 38-48 50 (35.7) 15 (10.7) 75 (53.6) Level of education primary nursing school 10 (17.9) 3 (5.4) 43 (76.9) 5.550 HS secondary nursing school 51 (45.5) 15 (13.4) 46 (41.1) medical institute 444 (37.8) 124 (10.5) 608 (51.7) nursing college 22 (29.3) 7 (2.51) 27 (58.2) Years of experiences 1-5 216 (35.1) 72 (11.7) 328 (53.2) 5.51 S 6-10 195 )41( 48 (10.1) 233 (48.9) 11-16 114 )37( 31 (10.1) 163 (52.9) Table 0: Association between age, level of education, years of experience of the study sample and their overall knowledge on occupational health and safety measures in hospital https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article Table 5, displays the relationship between level of nurses’ education and their knowledge. The distribution of the level of education among participants showed that 84% graduated from medical institute. This finding is significant for the Kurdistan Re- gion. For several years colleges of nursing and nursing institutions have worked to improve the level of knowledge and educa- tion of their graduates. This finding indi- cates that education is critical to nursing practice in the hospitals. The findings sug- gest that future study of an educational intervention aimed at non graduates who are working as nurses is critical. At the same time, there appears to be a signifi- cant relationship between years of experi- ence and knowledge as identified in Table 5. This is worth noting as “learning on the job” and by being exposed to nurses who have greater knowledge could have an effect on nursing practice. This must be studied further. Regarding educational pro- grams on occupational health and safety, the findings indicate that 82% of the nurses surveyed think that they should have train- ing on occupational health and safety. This is highly significant to the overall study and should inform future educational interven- tions. Only 52% of those surveyed indicat- ed that they had any safety training during orientation. Indeed, the results from these results are extremely significant to future studies and any interventions that are planned for occupational health and safety. The current study explored that, using all the necessary personal protective equip- ment was associated with reduced expo- sure to both biological and non-biological hazards. This finding supports evidence by Hayden et al., who reported that use per- sonal protective equipment reduced acqui- sition of illnesses in hospital settings [12]. Indeed, use and compliance with utilization of personal protective equipment has for long been recognized as important infec- tion control measure in the healthcare in- dustry [13,14] which should be empha- sized to minimize exposure to occupational hazards. These findings are largely comparable to previous studies conducted in low and middle income countries. Ziraba in Ugan- da, Nsubuga in Uganda, Orij in Nigeria, De Castro in Philippines, and Adib-Hajbaghery in Iran reported that sharp related injuries and stress were the major health related hazards experienced by healthcare work- ers in their studies [15-16]. Although many health facilities provided special waste disposal containers for medi- cal wastes and safety tools and equipment as control measures for occupational health hazards, simple measures like hand washing were not fully embraced. The pro- portion of health workers who reported washing hands after recommended proce- dures was lower than has been reported by previous studies [17,18]. The study also found that, respondents who experienced work related pressures were more likely to report occupational hazards. Work related pressures have been reported to have negative impacts includ- ing the compromise of patient care thus resulting to a diminished quality of life for both healthcare workers and patients [19]. The findings with regard to training of staff are also comparable with those of a study that was carried out on the relationship between employees' perceptions of safety and organizational culture where insuffi- cient safety training was the root cause of major accidents at the work place since employees did not have the knowledge and skills to identify potential hazards [20,21]. In a similar study, organizations which em- phasized on safety through training and other managerial practices observed an 90 Erbil Journal of Nursing & Midwifery DISCUSSION https://doi.org/10.15218/ejnm.2019.11 Erbil j. nurs. midwifery, Vol. 2, No. (2), Nov, 2019 Original Article [3] Gitlin DF, Schindler BA, Stern TA, Epstein SA, Lamdan RM, McCarty TA, et al: Worley LL. Recommended guidelines for consultation- liaison psychiatric training in psychiatry resi- dency programs: A report from the Academy of Psychosomatic Medicine Task Force on psychiatric resident training in consultation- liaison psychiatry. Psychosomatics: Journal of Consultation and Liaison Psychiatry. 1996 Jan. [4] Hayden MK, Blom DW, Lyle EA, Moore CG, Weinstein RA. Risk of hand or glove contami- nation after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients' environment. Infec- tion Control & Hospital Epidemiology. 2008 Feb;29(2):149-54. [5] Singer AJ, Clark RA. Cutaneous wound heal- ing. New England journal of medicine. 1999 Sep 2;341(10):738-46. [6] Marais BJ, Raviglione MC, Donald PR, Harries AD, Kritski AL, Graham SM,et al: Scale-up of services and research priorities for diagnosis, management,2010 Jun 19;375(9732):2179- 91.. [7] Rafael E, Parker JE. Occupational and envi- ronmental medicine in the United States. International archives of occupational and environmental health. 1998 Apr 1;71(3):155- 61. [8] Nicholson PJ. Occupational health in the European Union. Occupational medicine. 2002 Mar 1;52(2):80-4. [9] Conway PM, Campanini P, Sartori S, Dotti R, Costa G. Main and interactive effects of shiftwork, age and work stress on health in an Italian sample of healthcare workers. Ap- plied ergonomics. 2008 Sep 1;39(5):630-9. [10] De Castro AB, Cabrera SL, Gee GC, Fujishiro K, Tagalog EA. Occupational health and safe- ty issues among nurses in the Philippines. Aaohn Journal. 2009 Apr;57(4):149-57. [11] Yassi A. Utilizing data systems to develop and monitor occupational health programs in a large Canadian hospital. Methods of information in medicine. 1998;37(02):125-9. [12] Brott T, Adams Jr HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al: Measurements of acute cerebral infarction: a clinical examina- tion scale. Stroke. 1989 Jul;20(7):864-70. increase in safety compliance among their employees [23]. Other similar study further reported that employees who have re- ceived safety training will likely report less work-related injuries than their untrained counterparts [22]. The study showed that the most significant factor in relation to occupational health and safety practice was related to nurses’ knowledge. It is important to continue to train nurses in university and institution educational settings on the importance of occupational health and safety. It is also recommended that all hospitals should es- tablish an orientation unit related to occu- pational health and safety not only for their new nursing employees, but also for all employees. Third, it is important to have and evaluate continuing educational pro- grams on occupational health and safety. Overall, this study is important in informing future interventions and practice for nurs- es on occupational health and safety. The authors reported no conflict of inter- ests. [1] Bolyard EA, Tablan OC, Williams WW, Pear- son ML, Shapiro CN, Deitchman SD, Hospital Infection Control Practices Advisory Com- mittee. Guideline for infection control in healthcare personnel, 1998. Infection Con- trol & Hospital Epidemiology. 1998 Jun;19 (6):407-63. [2] Burgel BJ, Childre F. The occupational health nurse as the trusted clinician in the 21st cen- tury. 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