ABSTRACT
Health-care
providers are at major high-risk for contracting blood-borne infections during
the discharge of their duties. Universal
precautions framed into daily operation procedures at health-care facilities
will probably increase percentage of compliance, which will transit to minimal
occurrence of infection(s). This study aimed at assessing information,
motivation and behavioural skills of nurses as predictors of utilization of
universal precautions among nurses in health facilities in Sagamu, Ogun state,
Nigeria.
A cross sectional design was adopted for this study
all inclusive sampling technique was used to enrol two hundred and nine
qualified nurses from the total population of nurses from health facilities in
the study location. Data was collected using a self-administered questionnaire
consisting of 41-items on demographic characteristics, information on universal
precautions, motivation towards utilization of universal precautions,
behavioural-skills to utilize universal precautions and adherence practice of
universal precautions. Frequency, correlation and regression analysis were
conducted to give statistical responses to the research question and hypothesis
using the SPSS v21.
The mean age of participants
was 38.09 ± 10.47years. The
females (93.3%) were more than males (6.7%). Majority (80.4%) of the
participants were Yorubas while 14.4%, 0.5% were Igbos and Hausas respectively
and 4.8% belonged to the other ethnic groups.
Although 66.0% of the participants were married, 26.6%, 2.4%, 4.8% and
0.5% were single, separated, widowed and divorced respectively. The least
qualification of participants was Registered Nurses (23.4%) and the highest
qualification was Masters Degree in nursing (1.9%). The highest occupational level of
participants was Director of Nursing Services (0.5%) while the least was
Nursing Officers I (27.8%). Among participants, 24.9% had worked less than
5years and 13.9% had practiced nursing more than 25years.Participants had a
mean score of 10.31± 2.09 in level
of information on utilization of universal precautions measured on a 13-point
rating scale, 31.93±5.12 in level of motivation to utilize universal precautions measured on
a 45-point rating scale, 12.44±2.06 in level of behavioural-skills to utilize universal precautions
measured on a 15-point rating scale and 9.86±2.62 in level of adherence practice of universal
precautions measured on a 15-point rating scale. The relationship between
information and adherence was insignificant (R=0.068; R2=0.005;
P>0.05). There was a relationship between motivation and adherence practice
of universal precautions (R=0.274; R2=0.075; P˂0.05), and
behavioural-skills predicted the adherence practice of universal precautions
(R=0.563; R2=0.317; P˂0.000). Adherence practice of universal precaution was common among nurses with
more years (20-25years) of working experience (11.83; 95% CI:
10.66-12.99).
In
conclusion the study addressed various issues on non-compliance to universal
precautions among nurses. It is recommended that activities should be geared
towards improving the behavioural-skills of the nurses. Training and retraining
will improve the nurses’ knowledge through adequate information on safe
handling of all equipment, and necessary provision of kits to utilize universal
precautions.
CHAPTER
ONE
INTRODUCTION
1.1
Background
to the Study
Health-care providers are at major high-risk
for contracting blood-borne infections during the discharge of their duties in
health-care facilities now than ever before. Despite the introduction of these preventive
procedures in the training of healthcare workers such as nurses, doctors,
medical laboratory scientist among others, the possibility of an occupational
injury is high due to risk practices among these individuals. Various
studies have revealed that blood-borne
infections constitute a sizeable number of serious risk exposures for
health-care providers from patients diagnosed with Hepatitis virus (HBV) and
Human immunodeficiency virus (HIV) in the course of providing care for these
patients (Anozie, Anozie, Lawani, Mamah, Ajah & Nwali, 2016; Sheth, Leuva & Mannari,
2016) .
Health-care
providers carry out a number of tasks which are not limited to administration
of drugs by injection procedures, taking birth deliveries, wound dressing,
handling blood samples and other body fluids which may result in exposure
through percutaneous and needle-stick or other sharps injuries including
accidental splashes (Elseviers, Arias-Guillén, Gorke & Arens, 2014).Evidence
from a number of studies have reported risk exposures that have resulted to
about two to four needle-stick injuries annually among o health-care providers during
the process of discharging their duties particularly in Africa (Mbaisi,
Ng’ang’a, Wanzala & Omolo, 2013).
Among health-care providers in Nigeria who are exposed to these risks, the
nurses are most affected and do not give incident report at each occurrence (Diwe
& Chineke, 2013).
Health-care
providers can also transmit infective agents associated with blood-borne
pathogens from one person to another. Transmission occurs as a result of direct
contact with infected blood or blood products, and other body fluids between
health-care providers and infected patient. Also,infected
body fluids such as blood, sputum and urine can penetrate mucus membranes or enter
through open wounds, cuts, abrasions and damaged skin. Blood-borne pathogens
may also be transmitted through mucous membrane of the eyes, mouth and nose
occasional by splashes. The Needle-stick and sharp object injuries symbolize a
major occupational challenge to health-care workers (Memish, Assiri,
Eldatlaony, Hathouth, Alzoman & Undaya, 2013).
In 1995,
Hospital Infection Control Practices Advisory Committee (HICPAC) in the United
States introduced the concept of standard precautions which combines the major
features of universal precautions and body substance isolation into a distinct
set of precautions to be adopted by health-care workers for the care of all
patients in hospitals regardless of their presumed infection status. These
precautions are to help prevent the transmission of blood-borne infections.
Should these standard precautions be framed into daily operational procedures
at health-care facilities and enforced, probably the percentage of compliance
would have been more adequate which will transit to minimal occurrence of infection(s).
Health-care workers (especially nurses)
are at high risk of becoming exposed to blood-borne infections through needle
stick and sharp object injuries (Zehnder, 2010). Various
studies had posited a number of factors that affect the utilization of
universal precautions by nurses.Three major areas that should not be
overlooked include engineering factors such as the form of sharp devices and
unavailability of devices (Wilburn & Eijkemans, 2004), organizational
factors such as the existence of supplies and policies for reporting, and
behavioral factors which are disposal-related issues (Hossein, Hosein, Eesa
& Ali, 2016).
These three areas (engineering factors, organizational
factors and behavioral factors) are in coherence with the information,
motivation measures and behavioural skills the nurses may possess for the
application of standard equipment and object-handling precautions. The use of
available sharp devices should come with information guiding their usage for
all professions, particularly nursing because of the sensitivity of their
profession (Hughes, 2008; Rutala & Weber, 2008). Existing policies guiding
the procedures for use and monitoring would serve as factors that motivate
nurses to apply the precautionary measures (Houser & Oman, 2011). The
behavioural factors revolved around their ability to carry out what they have
received information about and their willingness to practice these precautions
(Ryan, 2009). Majority of the health-care workers are
still at high risk of contracting blood-borne infections due to the lack of
application of the universal precautions.
1.2
Statement
of the Problem
Over the years, the
effects of occupational accidents have generated a lot of concerns for health
care managers and workers. The occasional contact with blood and body fluids
from infected patients by healthcare workers during treatment without precautionary
measures has become a growing concern and as such elicit probe to stem down the
tide of occurrence. The World Health Organization (2006) in a program with the
theme “Working Together for Health” posited that unsafe working conditions has
eroded the confidence of health-care workers in many countries due to
work-related illnesses and injuries which has resulted to fear of health
workers on occupational infections.
Some
studies have linked poor information to the risk of contracting blood-borne
diseases among nurses (Abdela, Woldu, Haile, Mathewos & Daressa, 2016)
while some others have associated the risk of getting blood-borne infections to
low level of professional competence among healthcare providers (Aluko,
Adebayo, Adebisi, Ewegbemi, Abidoye & Popoola, 2016). None of these studies
have however linked the risk of contracting blood-borne infections to level of
information, motivation and behavioral skills. Regular information about the
contents of the universal precautions would improve their knowledge and enable
them apply the precautions (Quan, Wang, Wu,
Yuan, Lei, Jiang, & Li, 2015).
Motivation on the other hand is the constant supply of necessary kits and drive
that makes applications of the preventive measure optimal (Amoran, & Onwube, 2013). Behavioural
skills are the competent skills that are required to maximize the full benefit
of utilizing universal precautions (Yousafzai, Janjua,
Siddiqui & Rozi, 2015).
Based on this premise,
this study would seek to investigate how these three factors (information,
motivation and behavioral skills) can serve as predictors of usage of universal
precautions in the prevention of blood-borne infections among nurses. The
factors are developed from the IMB (Information Motivation Behavioral skill)
Model (Fisher & Fisher, 1992) and used to derive relevant information on
this salient issue of concern. The study aimed to assess information,
motivation and behavioural skills as predictors of the utilization of universal
precautions among nurses in health facilities in Sagamu, Ogun state.
1.3
Objective
of the Study
The
main objective of this study was to assess the factors associated with the
utilization of universal precautions among nurses in health facilities in
Sagamu, Ogun state, Nigeria. The specific objectives are to:
1.
determine the level of information of
respondents through assessment of their knowledge about universal precautions;
2.
determine the level of motivation to
utilize universal precautions among
the respondents;
3.
measure the level of Behavioral skills of
respondents by assessing perceived self-efficacy and perceived benefit to
utilize universal precautions;
4.
assess the level of utilization of
universal precautions among the
respondents;
5.
determine if information is associated
with the utilization of universal precautions among the respondents;
6.
determine if motivation is associated
with the utilization of universal precautions among the respondents;
7.
determine if behavioural skills is
associated with the utilization of universal precautions among the respondents and
8.
identify which of these variables information, motivation and
behavioural skills will predict the utilization of universal precautions most
significantly among the respondents.
1.4
Research Questions
1.
What is the level of information of the
respondents in this study?
2.
What is the level of Motivation of the
respondents in this study?
3.
What is the level of Behavioral skills
of the respondents in this study?
4.
What is the level of utilization of
universal precautions among the respondents in this study?
5.
What is the association between
information and the utilization of universal precautions among the respondents
in this study?
6.
What is the association between
motivation and the utilization of universal precautions among the respondents
in this study?
7.
What is the association between
behavioural skill and the utilization of universal precautions among the
respondents in this study?
1.5 Justification for the Study
The
prevalence of blood-borne infections among health-care workers has become a
case of serious concern in the field of public health (WHO 2016). The Center for Disease Control
and Prevention (CDC) pointed out that the incidence of blood-borne related
infections from needle-stick injury results from improper needle-sticks disposal-related activities, activities after use and prior
to disposal such as item disassembly and recapping a used needle. The situation
of needle-stick injury poses a threat for further transmission of blood-borne
infections and this has aroused researcher interest in health-care
workers as they are the most at risk.
Studies have pointed out that
non-utilization of the universal precautions are due to poor knowledge of the
nurses about blood-borne diseases (Gupta, Bajapai, Sharma, Shah & Sarin,
2013) and lack of materials for carrying out the precautionary measures
(Frickman, Schmeja, Reisinger, Mittlmeier, Mitzner, Schwarz et al, 2016). However, of the many
studies that have been conducted on occupational-risk exposure and risk
preventive practices, only a few were theoretical and conceptually grounded
(Atulomah & Oladepo, 2002;
Efstathiou, Papastavrou, Raftopoulos, & Merkouris, 2011; Alemie, 2012). Most of the studies
were carried out on general health care workers with only a few laying emphasis
on the nursing profession (Hassanpour, Mohammadi & Nikbakht-Nasrebadi,
2015; Sin, Lin, Chan & Wong, 2016).
Therefore,this study would
fill the gap identified in these studies by assessing how a behaviour theory,
the information, motivation and behavioural skills model can effectively
predict utilization of universal precautions to prevent blood-borne infections
among nurses. The study wouldattempt to find suitable explanations for
continued exposure of occupational risk of blood-borne infections despite the
well-established introduction of the preventive measures. At the end of this
study, issues regarding information-received by nurses and their reasons for
non-utilization of universal precautions would be revealed. The findings might
provide guidance and standards for complying with these precautions. This would
improve the health care facilities and services provided. Therefore making
Sagamu nurses healthy people and by extension nurses in Nigeria.
1.5
Hypotheses
This
study hypothesized the following:
H1: There will be a significant
relationship between information and the utilization of universal precautions
among the respondents.
H2: There will be a significant
relationship between motivation and the utilization of universal precautions
among the respondents.
H3: There will be a significant
relationship between behavioural skills and the utilization of universal
precautions among the respondents.
H4:One of these variables information, motivation and behavioural
skill will predict the utilization of universal precautions most significantly
among the respondents.
1.7 Operational definition of
terms
Universal Precautions
These are set of
procedures and guidelines to prevent parenteral, mucous membrane and non-intact
skin exposures of health-care workers to blood-borne pathogens, which was
publish by centers for disease control and prevention (CDC) as recommendation
for prevention of blood-borne infections among health-care providers. Universal
precautions require the use of protective equipment such as gloves, apron,
mask, goggle and safe disposal of sharp devises to minimize percutaneous
injuries.
Information
Information in
this study connotes knowledge. Information can be converted into actionable
knowledge in support of decision making process. Effect of information is
mainly expressed as a result of the development and deployment of prevention
behavioural-skills that are directly applied to the initiation and maintenance
of preventive behaviour
Motivation
Motivation in this
study explains the reason for constant repetition of behaviour. Motivation is
internal and external factors that arouse desire and drive for a continually
role by building ones interest. The direct effect of motivation on preventive
behaviour is prominent when complicated or unusual behavioural-skills are not
required to perform a preventive behaviour.
Behavioural-skills
Behavioural-skills
in this study are supplementary requirement to perform preventive behaviour. It
also determines whether even knowledgeable individual and highly motivated
individual will be capable of practicing the necessary prevention. It composes
of a person objective ability and perceived self-efficacy concerning
performance of the sequence preventive behaviour.
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