Chapter as health care professionals is FIRST DO

Chapter II


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chapter presents some related readings and studies on the topics associated
with the research problem. The topics contained herein discuss how the working
environment can affect the health status of the staff nurses in both government
and non government hospitals.


Working environment

environment is an important factor that can determine the safety and well-being
of both staff nurses and patients in the hospitals. it guides the clients
impression of the quality of medical care and nursing services that it caters
to the patients. Further readings of related literature show a wider horizon of
the impact of the work place on the nursing service, but not only in the
nursing service it has a large impact in the well-being of the staff nurses in
all hospitals.

            First in the guidelines of the staff
nurses as health care professionals is FIRST DO NO HARM. As such they focus
first on the safety and security of the patients most important to the staff
nurses. They keep tract of the important of their health status and that of
their patients from time to time. In case some adversities are noted and
recorded its time to thresh out the source of the problem.

            In Philippine Nurses Association
conducted a survey in 2007 that desearch the work – related problems of the
Filipino nurses. Measures included four categories: work – related
demographics, occupational injuries/ illness, reporting behaviour and safety
concerns. It showed that the top ranking concerns of the Filipino staff nurses
were stress, overwork and heavy lifting that they experience pain. Injury and
illness is quite rare, In 2015 however, a researcher said that the Filipino
nurse’s working condition is worsening because of the overload of patients, placing
them in more risk of nasocomial infection. Moreover they have prolonged working
hours and understaffing. In additional staff nurses working environment, make
it interaction difficult with the family and social contacts can’t be
maintained. As well as, with a long duty hours reduced the sleep availability
to the staff nurses. That leads to sleep deprivation, incomplete recovery of
staff nurses from work and disturbed sleep. Because of workers shift, workers
sacrificing participation in family activities and social activities. For
families, staff nurses shift works has a conflict with arranging and setting
social activities like in the times of formal. So that it affecting both staff
nurses and family’s social adjustments. This extend to disruption depend on the
staff nurses.

hours duty can also increasing exposure to working environment hazards such as
infectious agents, physical well- being, psychological well-being, emotional
demands, and chemicals. Also long term hours of duty may also reduced the
availability of time for exercise or nutritious meals and in additional
stressor job can increases the caffeine, alcohol consumption and smoking use.


Safety working environment

2012 the American Nurses Association wrote on the safety of the working
environment describe as a highest rank to the health status, in which all
leaders, managers, health care workers, and ancillary staff have a
responsibility as part of the patient- centered team to perform with a sense of
professionalism, accountability, transparency, involvement, efficiency, and
effectiveness of techniques and intervention to the patients and staff nurses’
safety. All must the mindful of the health and safety for the patient and the
health care workers in any setting providing health care, sense of safety,
respect, and empowerment to and for all persons. The chemical hazards in the
workplace must be identified and removed. Moreover the hazards offered by the
physical environment must likewise us taken cared of such as crowdedness,
ventilation, lifting, and arrangements of hospital setting and aesthetic
appearance which may affect the health status of the staff nurses.

            Alison m. Tuinkoff et al, in 2007
said that focus working environment on negative potential aspect, benefits of
worker experienced from work shift (e.g. incentive pay, personnel compared with
day shifts and volume reduced of activities)


Work Environment

            According to the
public Services Health And Safety Association (2011) said that it is tangible
workplace of the staff nurses it includes the components that compromises the
environment working condition such people used (1) creating patient attitude
favourable (2) commutation and interaction to the doctors, staff members and
patients (3) targeting, positions and market segmentation (4) quality service
perception by means of developing it positively


Psychosocial Work Environment

psychosocial work environment is important for the well-being of the staff
nurses especially in dealing with the psychiatric care. in this situation the
complex relationship with the staff nurses has been a source of stress.
Perceived stress, stress of conscience, moral sensitivity, mastery and other
individual characteristic are factors that have been associated with
psychological according to Lindstorm et al.,. they also include moral
sensitivity including the staff nurses’ attention to and awareness of moral
conflicts, values and implication, insights into the patients situation are
guides for ethical decisions making and grounds for the ability to understand a

            According to Mona Eklund and BMC
Nursing 2013, the psychosocial work environment has to do with the staff nurses
working conditions, including organizational and work characteristics, while
the care takes place and patient-staff relationship are developed. And
understanding of the nursing-staff perceptions of the work atmosphere are
related to the psychosocial work environment may contribute to new ways of
improving their work conditions.


Mental Health Effects of Nursing Work

disorder in the workplace – depression in particular has important consequences
for quality life, the costs and utilization of health care, safety and
productivity. Some mental health indications are extended work schedules,
number of overtime having long shift when working more than 10 hours per day
consistency. Shift work has been associated with more mental stress and higher
levels of burnout among health care workers. Depression and anxiety have also
been shown to vary with the level of work place, variety, control, social
support and conflicting demands made on workers. Thus with both unfavourable
work conditions and extended work hours, the effect of mental health may be
multiplied. Fatigue is thought to be a central nervous system stressor. There
have been reports that a long shift causes deterioration in mood.

            Nurses have to be emotionally strong
as she hears witness to an ongoing patient. This emotional labor is necessary
to display socially appropriate emotins that are congruent with the job
requirements in face to face interaction with patients. The more intense and
frequent the interpersonal interaction with other staffs, visitors and patients
which requires her to extend emotional effort, the more likely she will
experience symptoms including emotional exhaustion, which may suffer intense
feeling of emotional pain can result if to properly handled to affect both
physical health and family life.

            Some interventions have been tired
to reduced work- related mental changes. One of which is changing the
organization  of work to reduce the
stress by providing cognitive- behavioural, interventions, relaxation
techniques of various types, or multi modal strategies. According to Griffith
one of the reviewed studies using organizational intervention, changing to
individualized nursing care and primary care only one was deemed “potentially

            Seven studies of strategies to help
staff nurses manage their stress were prevented; music, relaxation, exercise,
humor, role-playing, assertiveness, social support education, and cognitive
techniques were among the stress- reducing strategies studied. There is an one
recommendation for being the most effective approach due to small number of


Problem on Mental Health

Midwifery Student in 2014, commented that nurses are an indispensable component
of the work force in the health status of the staff nurses, but it is stressful
job and working environment is one of the factors that may affect nurses health
status in terms of psychological and physical health. They play a critical role
in improving the society ‘s health but lack of attention in their mental health
can lead to reduction of efficiency, loss of workforce and creation of physical
as well as mental complications for both the nurses and patients well-being.


Common problems

to Pascale Carayon, Ayse Pe Gurses 2012, nurses are experiencing higher loads
that ever before due to the main reasons (1) decreasing demand of staff nurses,
(2) inadequate supply of nurses, (3) reduced staffing, (4) increasing overtime,
and (5) reduction in patient length of stay.

            Alison m. Tuinkoff et al, in 2007,
said that the safety of nurses and patients in the workplace induced injuries
and illness is important. The presences of healthy and awake staff nurses are
providing a critical vigorous advocacy to the staff nuses, vigilant monitoring
and care to the patient empathetically. Stressors in many workplace of the
staff nurses can produce injuries, illness and diseases are present in the
working environment of the staff nurses. this factors of stressors included the
related to organization characteristic, immediate context of work, and external
organization occurring throughout the industry of the health. Staff nurses experience
psychological demands and physical significant during of their daily life’s,
also the climate work safety that contribute as a adverse to the health status
of the staff nurses. actors to determined a organizational level of the staff
nurses (1) drowsize organization within the pressures, ( employment nurses use
under the alternative arrangements such as travelling staff and pool. (2)
Turnaround time for the care to the patient such as higher patient loads and
early discharge. This external nurse’s practices content includes use of
increasing complex innovations of technology, managed lean care to patients as
contrast, work force of older staff nurses and (aging population) increasing
demand of elder patients who are very sick. These are the levels of factors can
produce the threats to the safety of the staff nurses while in the duty hours
or in the job.

            The nursing working hazards can
impair both health of staff nurses in government and non government hospitals
either in short term or long term. The outcomes of health include nasocomial
infections, musuloskeletal injuries/disorders, cardiovascular, mental health
changes, and neoplastic diseases. Commonly, majority of the finding stressors
on the work place and selected health hazards outcomes. Stressors has a
aspect  of the work way as nursing
organized (e.g. long term, overtime and shift work) and job demands in
psychological, like work pace. Also contribute direct work care influence the
safety of the staff nurses, including the physical job demands impact such as
awkward postures, patient lifting, and protective devices for needleprick

schedule relationship between health and safety complex are influenced the work
schedule characteristic (direction and speed o rotation, time of shift, shift
length, rest breaks and patterns of days off) also the characteristic of job
and the workers.


Term Effects and Vulnerable

1.      Schernhammer
and colleagues (2006) Commonly workers shift complaints Gastrointestinal (GI)
problems and could be due to cardiac rhythm changes, immune changes function or
the type food available during the shift of the staff nurses. Psychologically
complaints frequently reported, including depression and other mood
disturbance, relationship difficulties and personality changes. Work shift is
associated with an increasing model in spontaneous birth, preterm, and reducing
fertility in women. The exposure to light at night can increasing risks for
cancer and reduced relaxation levels.

2.      Shift
of work may make it possible to control symptoms and diseases progression by
interfering with treatment regimens involving regular sleep times, avoiding
sleep deprivation, controlling amounts and times  of meals and exercise, as careful timing of medications
that have variations in effectiveness.

3.      According
to Sood, he said that shift work may exacerbate unstable angina or history of
myocardial infarction, insulin-dependent diabetes, hypertension, asthma,
substance abuse, sleep disorders, GI disease, psychiatric illness and epilepsy
that requiring medications.

4.      Added
to the list by Costa that the renal impairement, suprarenal pathologies,
thyroid, pregnancy and malignant tumors also associated with less tolerance of
staff nurses shift work.

5.      Trinkoff
and colleagues found that work with long hours were related to musculoskeletal
injuries and needlesticks in staff nurses.


Coping Strategies

the behavioural and administrative strategies freely must be used before
consideration pharmacologic and since there stimulants and sedatives can be
addictive and management be safe and effective for long term use.

suggested strategies are:

1.      Taking
snap during work to improve alertness.

2.      In
lessen the musculoskletal injuries in the staff nurses there should be higher
staffing and lower patient loads. This is to reduce the task requiring heavy
lifting, bending and twisting which causes the health care workers back

3.      Some
effective approach to multiple the musculoskeletal disorders are the proper
approach toward (1) no. of lifting polices (2) patient handling
devices/equipments (3) patient lifting teams and (4) training on proper use of
patient handling devices/equipments.

4.      An
important criterion for the selection of substance or chemicals like aerosols,
gases, and skin contaminants from medications used in practice should be used
to prevent hazardous chemical exposure and to select from the safer alternative
products or processes. There should be adequate indoors air circulation to
decreases the concentration of the volatile organic compounds in formaldehyde
which give of artificial fragments that gives potentials toxic human health

5.      To
protect patients and health workers from latex allergy, hazards from aerolizing
particles of latex attached to powder in latex gloves or bursting latex
balloons must be eliminated.

Some many recommendations have been
written but the authors stated that no. of recommendations on the most
effective approach were possible ue to the small number of studies.


Government and Non Government

government and non government hospitals has a similarities. They differ in
financial and management lay out. Government hospitals are owned by the
government while the non government hospitals are owned by private individuals
or corporation who manage the financial and managerial affairs of the
hospitals. the government hospitals are affordable to the general public and
provide treatment at a very low cost. Treatment in the privately owned
hospitals is very high. People especially the low-income ones go to the
government hospitals but the affluent ones prefer the privately owned hospital.
In case of emergencies and various treatment people tend to go to the private

            Because it has less patients than in
government hospitals. Moreover  they are
more equipped to offer personalized care. Unlike in the government hospitals
where waiting time is short and the nurses are more cordial. On other hand the
private hospitals can refuse patients who they think cannot pay. In government
hospitals, patients expect personalized care from the staff nurses who are
usually overloaded because public hospitals cannot refuses admission of

            A number of studies point out that
both the government and non government hospitals have almost the same problems
on the health status of their staff nurses as well as the other health care

            Both agree on the hypothesis that
the work environment and work place can determine the health status of their
staff nurses. The only difference lies the manner and intensity by which the
different factors, physical and psychological well-being tangible or
intangible, found in the work environment affect their health status of the
staff nurses. These differences may be due to the different style and means of
funding organizations and management in the government and non government

            At any rate choosing the right
hospitals and right physicians are among the important factors to consider
which has significant effect on the treatment and healing. As for the staff
nurses and other health care givers, they have all the freedom to choose the
hospitals that they think could give them the outermost care, safety and
protection from the hazards that goes with their profession.


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