Chapter IIRELATED LITERATURE AND STUDIES Thischapter presents some related readings and studies on the topics associatedwith the research problem.
The topics contained herein discuss how the workingenvironment can affect the health status of the staff nurses in both governmentand non government hospitals. Working environment Workingenvironment is an important factor that can determine the safety and well-beingof both staff nurses and patients in the hospitals. it guides the clientsimpression of the quality of medical care and nursing services that it catersto the patients. Further readings of related literature show a wider horizon ofthe impact of the work place on the nursing service, but not only in thenursing service it has a large impact in the well-being of the staff nurses inall hospitals. First in the guidelines of the staffnurses as health care professionals is FIRST DO NO HARM.
As such they focusfirst on the safety and security of the patients most important to the staffnurses. They keep tract of the important of their health status and that oftheir patients from time to time. In case some adversities are noted andrecorded its time to thresh out the source of the problem.
In Philippine Nurses Associationconducted a survey in 2007 that desearch the work – related problems of theFilipino nurses. Measures included four categories: work – relateddemographics, occupational injuries/ illness, reporting behaviour and safetyconcerns. It showed that the top ranking concerns of the Filipino staff nurseswere stress, overwork and heavy lifting that they experience pain. Injury andillness is quite rare, In 2015 however, a researcher said that the Filipinonurse’s working condition is worsening because of the overload of patients, placingthem in more risk of nasocomial infection. Moreover they have prolonged workinghours and understaffing. In additional staff nurses working environment, makeit interaction difficult with the family and social contacts can’t bemaintained. As well as, with a long duty hours reduced the sleep availabilityto the staff nurses.
That leads to sleep deprivation, incomplete recovery ofstaff nurses from work and disturbed sleep. Because of workers shift, workerssacrificing participation in family activities and social activities. Forfamilies, staff nurses shift works has a conflict with arranging and settingsocial activities like in the times of formal. So that it affecting both staffnurses and family’s social adjustments. This extend to disruption depend on thestaff nurses.
Longhours duty can also increasing exposure to working environment hazards such asinfectious agents, physical well- being, psychological well-being, emotionaldemands, and chemicals. Also long term hours of duty may also reduced theavailability of time for exercise or nutritious meals and in additionalstressor job can increases the caffeine, alcohol consumption and smoking use. Safety working environment In2012 the American Nurses Association wrote on the safety of the workingenvironment describe as a highest rank to the health status, in which allleaders, managers, health care workers, and ancillary staff have aresponsibility as part of the patient- centered team to perform with a sense ofprofessionalism, accountability, transparency, involvement, efficiency, andeffectiveness of techniques and intervention to the patients and staff nurses’safety. All must the mindful of the health and safety for the patient and thehealth care workers in any setting providing health care, sense of safety,respect, and empowerment to and for all persons. The chemical hazards in theworkplace must be identified and removed.
Moreover the hazards offered by thephysical environment must likewise us taken cared of such as crowdedness,ventilation, lifting, and arrangements of hospital setting and aestheticappearance which may affect the health status of the staff nurses. Alison m. Tuinkoff et al, in 2007said that focus working environment on negative potential aspect, benefits ofworker experienced from work shift (e.g. incentive pay, personnel compared withday shifts and volume reduced of activities) PhysicalWork Environment According to thepublic Services Health And Safety Association (2011) said that it is tangibleworkplace of the staff nurses it includes the components that compromises theenvironment working condition such people used (1) creating patient attitudefavourable (2) commutation and interaction to the doctors, staff members andpatients (3) targeting, positions and market segmentation (4) quality serviceperception by means of developing it positively Psychosocial Work Environment Thepsychosocial work environment is important for the well-being of the staffnurses especially in dealing with the psychiatric care.
in this situation thecomplex relationship with the staff nurses has been a source of stress.Perceived stress, stress of conscience, moral sensitivity, mastery and otherindividual characteristic are factors that have been associated withpsychological according to Lindstorm et al.,. they also include moralsensitivity including the staff nurses’ attention to and awareness of moralconflicts, values and implication, insights into the patients situation areguides for ethical decisions making and grounds for the ability to understand apatients. According to Mona Eklund and BMCNursing 2013, the psychosocial work environment has to do with the staff nursesworking conditions, including organizational and work characteristics, whilethe care takes place and patient-staff relationship are developed.
Andunderstanding of the nursing-staff perceptions of the work atmosphere arerelated to the psychosocial work environment may contribute to new ways ofimproving their work conditions. Mental Health Effects of Nursing Work Mentaldisorder in the workplace – depression in particular has important consequencesfor quality life, the costs and utilization of health care, safety andproductivity. Some mental health indications are extended work schedules,number of overtime having long shift when working more than 10 hours per dayconsistency.
Shift work has been associated with more mental stress and higherlevels of burnout among health care workers. Depression and anxiety have alsobeen shown to vary with the level of work place, variety, control, socialsupport and conflicting demands made on workers. Thus with both unfavourablework conditions and extended work hours, the effect of mental health may bemultiplied.
Fatigue is thought to be a central nervous system stressor. Therehave been reports that a long shift causes deterioration in mood. Nurses have to be emotionally strongas she hears witness to an ongoing patient. This emotional labor is necessaryto display socially appropriate emotins that are congruent with the jobrequirements in face to face interaction with patients.
The more intense andfrequent the interpersonal interaction with other staffs, visitors and patientswhich requires her to extend emotional effort, the more likely she willexperience symptoms including emotional exhaustion, which may suffer intensefeeling of emotional pain can result if to properly handled to affect bothphysical health and family life. Some interventions have been tiredto reduced work- related mental changes. One of which is changing theorganization of work to reduce thestress by providing cognitive- behavioural, interventions, relaxationtechniques of various types, or multi modal strategies. According to Griffithone of the reviewed studies using organizational intervention, changing toindividualized nursing care and primary care only one was deemed “potentiallyeffective”. Seven studies of strategies to helpstaff nurses manage their stress were prevented; music, relaxation, exercise,humor, role-playing, assertiveness, social support education, and cognitivetechniques were among the stress- reducing strategies studied.
There is an onerecommendation for being the most effective approach due to small number ofstudies. Problem on Mental Health NursesMidwifery Student in 2014, commented that nurses are an indispensable componentof the work force in the health status of the staff nurses, but it is stressfuljob and working environment is one of the factors that may affect nurses healthstatus in terms of psychological and physical health. They play a critical rolein improving the society ‘s health but lack of attention in their mental healthcan lead to reduction of efficiency, loss of workforce and creation of physicalas well as mental complications for both the nurses and patients well-being.
Common problems Accordingto Pascale Carayon, Ayse Pe Gurses 2012, nurses are experiencing higher loadsthat 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 injuriesand illness is important.
The presences of healthy and awake staff nurses areproviding a critical vigorous advocacy to the staff nuses, vigilant monitoringand care to the patient empathetically. Stressors in many workplace of thestaff nurses can produce injuries, illness and diseases are present in theworking environment of the staff nurses. this factors of stressors included therelated to organization characteristic, immediate context of work, and externalorganization occurring throughout the industry of the health. Staff nurses experiencepsychological demands and physical significant during of their daily life’s,also the climate work safety that contribute as a adverse to the health statusof the staff nurses. actors to determined a organizational level of the staffnurses (1) drowsize organization within the pressures, ( employment nurses useunder the alternative arrangements such as travelling staff and pool. (2)Turnaround time for the care to the patient such as higher patient loads andearly discharge. This external nurse’s practices content includes use ofincreasing complex innovations of technology, managed lean care to patients ascontrast, work force of older staff nurses and (aging population) increasingdemand of elder patients who are very sick. These are the levels of factors canproduce the threats to the safety of the staff nurses while in the duty hoursor in the job.
The nursing working hazards canimpair both health of staff nurses in government and non government hospitalseither in short term or long term. The outcomes of health include nasocomialinfections, musuloskeletal injuries/disorders, cardiovascular, mental healthchanges, and neoplastic diseases. Commonly, majority of the finding stressorson the work place and selected health hazards outcomes. Stressors has aaspect of the work way as nursingorganized (e.
g. long term, overtime and shift work) and job demands inpsychological, like work pace. Also contribute direct work care influence thesafety of the staff nurses, including the physical job demands impact such asawkward postures, patient lifting, and protective devices for needleprickprevention. Workschedule relationship between health and safety complex are influenced the workschedule characteristic (direction and speed o rotation, time of shift, shiftlength, rest breaks and patterns of days off) also the characteristic of joband the workers.
LongTerm Effects and Vulnerable1. Schernhammerand colleagues (2006) Commonly workers shift complaints Gastrointestinal (GI)problems and could be due to cardiac rhythm changes, immune changes function orthe type food available during the shift of the staff nurses. Psychologicallycomplaints frequently reported, including depression and other mooddisturbance, relationship difficulties and personality changes. Work shift isassociated with an increasing model in spontaneous birth, preterm, and reducingfertility in women. The exposure to light at night can increasing risks forcancer and reduced relaxation levels.2.
Shiftof work may make it possible to control symptoms and diseases progression byinterfering with treatment regimens involving regular sleep times, avoidingsleep deprivation, controlling amounts and times of meals and exercise, as careful timing of medicationsthat have variations in effectiveness.3. Accordingto Sood, he said that shift work may exacerbate unstable angina or history ofmyocardial infarction, insulin-dependent diabetes, hypertension, asthma,substance abuse, sleep disorders, GI disease, psychiatric illness and epilepsythat requiring medications.4. Addedto the list by Costa that the renal impairement, suprarenal pathologies,thyroid, pregnancy and malignant tumors also associated with less tolerance ofstaff nurses shift work.
5. Trinkoffand colleagues found that work with long hours were related to musculoskeletalinjuries and needlesticks in staff nurses. Coping StrategiesUsingthe behavioural and administrative strategies freely must be used beforeconsideration pharmacologic and since there stimulants and sedatives can beaddictive and management be safe and effective for long term use.Somesuggested strategies are:1. Takingsnap during work to improve alertness.2. Inlessen the musculoskletal injuries in the staff nurses there should be higherstaffing and lower patient loads.
This is to reduce the task requiring heavylifting, bending and twisting which causes the health care workers backinjuries.3. Someeffective approach to multiple the musculoskeletal disorders are the properapproach toward (1) no. of lifting polices (2) patient handlingdevices/equipments (3) patient lifting teams and (4) training on proper use ofpatient handling devices/equipments.4.
Animportant criterion for the selection of substance or chemicals like aerosols,gases, and skin contaminants from medications used in practice should be usedto prevent hazardous chemical exposure and to select from the safer alternativeproducts or processes. There should be adequate indoors air circulation todecreases the concentration of the volatile organic compounds in formaldehydewhich give of artificial fragments that gives potentials toxic human healtheffects.5.
Toprotect patients and health workers from latex allergy, hazards from aerolizingparticles of latex attached to powder in latex gloves or bursting latexballoons must be eliminated.Some many recommendations have beenwritten but the authors stated that no. of recommendations on the mosteffective approach were possible ue to the small number of studies. Government and Non GovernmentHospitals Thegovernment and non government hospitals has a similarities.
They differ infinancial and management lay out. Government hospitals are owned by thegovernment while the non government hospitals are owned by private individualsor corporation who manage the financial and managerial affairs of thehospitals. the government hospitals are affordable to the general public andprovide treatment at a very low cost. Treatment in the privately ownedhospitals is very high. People especially the low-income ones go to thegovernment hospitals but the affluent ones prefer the privately owned hospital.In case of emergencies and various treatment people tend to go to the privatehospitals. Because it has less patients than ingovernment hospitals. Moreover they aremore equipped to offer personalized care.
Unlike in the government hospitalswhere waiting time is short and the nurses are more cordial. On other hand theprivate hospitals can refuse patients who they think cannot pay. In governmenthospitals, patients expect personalized care from the staff nurses who areusually overloaded because public hospitals cannot refuses admission ofpatients. A number of studies point out thatboth the government and non government hospitals have almost the same problemson the health status of their staff nurses as well as the other health caregivers. Both agree on the hypothesis thatthe work environment and work place can determine the health status of theirstaff nurses. The only difference lies the manner and intensity by which thedifferent factors, physical and psychological well-being tangible orintangible, found in the work environment affect their health status of thestaff nurses.
These differences may be due to the different style and means offunding organizations and management in the government and non governmenthospitals. At any rate choosing the righthospitals and right physicians are among the important factors to considerwhich has significant effect on the treatment and healing. As for the staffnurses and other health care givers, they have all the freedom to choose thehospitals that they think could give them the outermost care, safety andprotection from the hazards that goes with their profession.