A Thesis Presented to Thesis Congress

Union Christian College

San Fernando City, La Union

Presented by: Alfredo G. Lim, RN, MAN

COMPLIANCE OF STAFF NURSES WITH STANDARD PRECAUTION IN SELECTED HOSPITALS IN LA UNION: A BASIS FOR AN ENHANCED RLE PROGRAM AMONG COLLEGES OF NURSING

Never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself. Florence Nightingale

Over 59 Million health care workers are exposed to a complex variety of health and safety hazards everyday including biological hazards, such as TB, Hepatitis, HIV/AIDS, SARS; and chemical hazards

The Background

Outbreak of SARS, Swine flu, and other infectious diseases

Observation backed- up with researches outside the Philippines pinpointing to the compliance of health care workers with Standard Precautions specifically Hand Hygiene and the use of Personal Protective Equipment

Transmission of SARS in health care facilities was frequently associated with noncompliance with standard precautions. (Minnesota DOH, 2007) According to DeLaune (2006), nurses should emphasize health promotion.

What is Standard Precaution?

It is a guideline created by various agencies including the World Health Organization and is the basic infection control precautions in health care.

It requires that HCWs assume that the blood and body substances of all patients are potential sources of infection, regardless of the diagnosis, or presumed infectious status. (WHO Regional Office for Western Pacific,2004)

COMPONENTS
hand hygiene

use of personal protective equipment, proper handling of soiled linens,

prevention of needle stick injuries,

environmental cleaning and spillsmanagement, and

appropriate handling of waste.

Merle Mishels Uncertainty in Illness Theory, the experiences of uncertainty are directly related to chronic and life threatening illness. uncertainty = inability to determine the meaning of illness-related events that occur when the decision maker is unable to assign definite value to objects or events and is unable to predict outcome accurately

RESEARCH DESIGN
Quantitative Descriptive Correlational Design - formal, objective, systematic process in which numerical data are utilised to describe the relationship among variables

PARADIGM

INPUT

PROCESS

OUTPUT

POPULATION AND LOCALE

STAFF

NURSES ASSIGNED IN THE HOSPITALS FOR 6 MONTHS

PRIVATE TERTIARY HOSPITALS 1 PUBLIC TERTIARY HOSPITALS 2 PUBLIC SECONDARY HOSPITALS

RESEARCH INSTRUMENT

questionnaire

Survey

Patterned to WHO policies Other researches included in the RRL

Part

I - demographic profile such as age, gender, and length of experience. Part II - Level of awareness of the respondents regarding Standard precaution. Part III - level of compliance.

Part

IV - extent of INFLUENCE of the different factors to the SNs level of compliance

Sampling
Convenience and Quota Sampling Slovins Formula 187 Population size

127 Sample size

Table 12 Summary of Level of Awareness regarding Standard Precautions

Hand Hygiene Use of Personal Protective Equipment Appropriate handling of patient care equipment and soiled linen Prevention of needlestick/sharp injuries Environmental cleaning and spills-management

FULLY AWARE FULLY AWARE FULLY AWARE FULLY AWARE

MUCH AWARE
FULLY AWARE FULLY AWARE

appropriate handling of waste. GENERAL AVERAGE WEIGHTED MEAN

Table 21 Summary: Level of Compliance with Standard Precautions

Hand Hygiene Use of Personal Protective Equipment Appropriate handling of patient care equipment and soiled linen Prevention of needlestick/sharp injuries Environmental cleaning and spillsmanagement appropriate handling of waste.

HC HC HC HC HC VHC HC

GENERAL AVERAGE WEIGHTED MEAN

Table 22 Extent of Influence of Institutional/ Environmental Factors

A. Institutional/ Environmental Factors

Descriptive Equivalent

the lack of time or being too busy. lack of means or supplies. distant equipment or facility for handwashing, wearing of PPEs,etc the lack of safety culture (or safety climate) in my department. AVERAGE WEIGHTED MEAN

HI HI MI

MI
MI

Table 23 Extent of Influence of Behavioural/ Personal Factors Descriptive A. Behavioural/ Personal Factors
Equivalent

my forgetfulness to utilize such precautions.

MI HI MI MI PI MI MI MI

the perceived risk of me being exposed to pathogens/ infection. its negative effects on my appearance. (eg. make- up, hair, etc.) its negative effects on my nursing skills. (eg. find difficulty in rendering care due to the use of PPE) giving me discomfort. the need to provide care IMMEDIATELY.
the type of patient. AVERAGE WEIGHTED MEAN

Table 24 Extent of Influence of Educational Factors

A. Educational Factors
Descriptive Equivalent

my academic training. (eg. school, imparted by my instructors) my clinical training in terms of using Standard precautions, especially the use of PPE, etc. (eg. OJT/RLE duties) my superiors/ doctors/etc. acting as negative role model AVERAGE WEIGHTED MEAN

HI

HI

HI HI

Table 25 Significant Difference in the Level of Awareness in terms of the profile of the respondents Components AGE SEX YEARS OF EXPERIENCE

Hand Hygiene Use of Personal Protective Equipment Appropriate handling of patient care equipment and soiled linen Prevention of needlestick/sharp injuries

.013*/+

.002* .003*

.029*/+

.004*
.011*

Environmental cleaning and spills-management Appropriate handling of waste.

.018*/ +

.026*

Significant Difference in the Level of Compliance in terms of the profile of the respondents
AGE SEX YEARS OF EXPERIENCE

Hand Hygiene Use of Personal Protective Equipment

Appropriate handling of patient care equipment and soiled linen Prevention of needlestick/sharp injuries Environmental cleaning and spills-management Appropriate handling of waste.

.015*/ +

.009*/vw .000*/ vw .000*/ vw -

.007*/ +

.000*/ nsr
.000*/ vw .038*/ vw -

Significant Relationship and Difference Between the Level of Awareness and Level of Compliance
COMPONENTS RELATIONSHIP DIFFERENCE

Hand Hygiene Use of Personal Protective Equipment Appropriate handling of patient care equipment and soiled linen Prevention of needlestick/sharp injuries Environmental cleaning and spillsmanagement Appropriate handling of waste.

r= .288** r= .347**

p= 7.24x10^-12* p= 1.58375x 10^-21*

r=.447**

p= 7.62406x10^-08*

r=.584**

p= 0.036633311*

r=.508**
r=.403**

p= 0.648272968
p= 0.009583972*

RATIONALE: This program is being proposed in response to the findings that there is an inadequate compliance of nurses with standard precautions. Many factors arose that led to this inadequacy, and it was found out that the academic training of these nurses highly influences their compliance. Hence, it is imperative that our nursing curriculum must evolve to develop a competent professional in the future- a nurse having a sense of responsibility and conscious awareness. Thus, this program proposes an strict integration of the standard precautions in the related learning experiences of the students.

GOAL: The programs goal is to increase the adherence of the future nurses to standard precautions. OBJECTIVES: After the duration of the RLE program, the student will be able to: Explain the chain of infection, its nature, and how to break the chain. Discuss and explain the importance, components, and indication of standard precautions. Demonstrate proper use hand hygiene, use of PPE, and the like. Demonstrate strict adherence to standard precautions.

PERSONS RESPONSIBLE: Dean of the different schools and colleges of nursing for proper dissemination and compliance Clinical Coordinator Clinical instructor and class lecturers Faculty Development Committee ACTIVITIES: Discussion in classrooms, pre-conference, postconferences. Reporting and journal sharing in updates regarding infection control. Demonstrations and Return Demonstrations. Role playing Critical Thinking- activities.

CONCLUSIONS
Based on the findings of the study, the following conclusions are derived:

1. Majority of the staff nurses are young adults, female, and with 1-2 years of experience. Hence, they can be easily be trained and re- oriented to the guidelines set by their respective institutions.
2. Staff nurses generally are knowledgeable on the guidelines of standard precautions which indicate that they have a better grasp of concepts to deliver quality patient care.

3. Staff nurses highly comply with standard precaution and follow the guidelines set by the World Health Organization. All of the components were often being followed by staff nurses, hence, is sustained by them. This indicates that staff nurses deliver an acceptable nursing care to their patients. 4. Staff nurses behaviour, education, training, environment and their workplace influence in the development of their compliance with standard precautions. (education highly influences compliance)

5. Sex and the length of experience can affect the level of awareness and compliance of staff nurses with standard precautions. Female staff nurses and nurses with longer hospital experience tend to be more aware and compliant; hence, can render nursing care with regards to infection control.

6. Staff nurses who are aware of standard precautions are compliant, as well. This indicates that nurses who are knowledgeable and conscious in minimizing infection tend to practice infection control more often in taking care of their patients.

RECOMMENDATIONS
Based on the conclusions derived in the study, the following recommendations are made: 1. Although the respondents have adequate awareness and knowledge regarding standard precautions, it is imperative that symposiums, and trainings must be held, emphasizing its importance, the indications of hand hygiene, the recommended guidelines on prevention of needle stick injuries, the proper use of PPE, proper waste disposal, and disinfecting patient care equipment.

2. In order to increase the compliance of staff nurses, other research- based strategies can be done. These may involve posters that encourage and reminds personnel to hand wash; seminars; provision of alcohol-based dispensers in strategic areas of each department; and availability of supplies.

3. Standard precautions must be fully integrated in the nursing curriculum. It must emphasize its importance, indications, and proper use. This must be integrated in courses such as Health Care 1, Health Care 2, Microbiology, Nursing Care Management subjects. It must be also emphasized, used (together with the clinical instructor) and properly complied with during Related Learning Experiences.

4. Clinical instructors, Staff nurses, Head nurses, physicians and other health care providers must be a good role model for the students to follow.

5. The researcher recommend that another research study should be done to compare the level of awareness and compliance of staff nurses to the type of hospital they are working at (eg. Private vs. Public, Secondary vs. Tertiary). Also, it is recommended to increase the population from province- wide to regionwide to have more accurate result. The researcher also recommends that other health care providers can be assessed to find out their level of compliance, and compare the findings among them.

END

Thank

you for listening!