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STANDARD PRECAUTIONS: KNOWLEDGE AND PRACTICE AMONG NURSES IN SELECTED PRIMARY HEALTH CENTERS IN LAGOS STATE


Content

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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