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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