الفهرس 
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Abstract
In recent years, it has become apparent that health care workers are exposed to a variety of occupational hazards that can results in serious acute and long term adverse health outcomes. In nursing, the situation is complicated because of high demand on quality nursing care. Interventions should be institute to mitigate the hazards, which are considered avoidable and preventable. It is the responsibility of the management to provide healthy and safe workplaces for all health care workers in line with the requirements of the relevant national and international laws and regulations, and to organize the work in such a way that the exposure of health care workers to hazardous factors and risks at work are eliminated or minimized, and their safety and health is protected.
This study showed that there was a degree of exposure to the types of occupational health hazards among the nursing staff at kidney dialysis unit and there is a lack of formal training to them.
Aim of the study:
The aim of the study was to identify the types and factors contributing to occupational hazards as perceived by nursing staff in kidney dialysis units.
Design:
A descriptive study design was utilized to conduct this study.
Setting:
The study was conducted at kidney dialysis units at four hospitals namely; Damanhur medical institute, Kafr El Dawwar general hospital, Aldalangat general hospital and Hosh Essa general hospital, all of them affiliated to the ministry of health at Al Behara governorate except Damanhur medical institute affiliated to the General authority for Educational institutes and Hospitals.
Subjects:
The study subjects of this study consisted of all staff nurses who are working in kidney dialysis units at the previously mentioned hospitals approximately (n= 150). Number of nurses at Damanhur medical institute = 37, number of nurses at at Kafr El Dawwar general hospital =36, number of nurses at Aldalangat general hospital =44 and number of nurses at Hosh Essa general hospital =33.
Tools of the study:
Two tools were used to collect data of this study:
Tool one: Questionnaire for nursing staff perception of exposure to the different types of occupational hazards and its contributing factors.
It was developed by the researcher based on the reviewing of related literature to assess the types of occupational hazards facing nursing staff working in kidney dialysis units and their contributing factors. It consisted of two parts as follows.
Part (1): Nurses demographic characteristics data sheet composed of six questions related to setting, age, gender, educational level, marital status and years of experience.
Part (2): Questionnaire for nursing staff perception of exposure to the different types of occupational hazards and its contributing factors consists of (47) items divided into two subscales as follows:
A- Perception of nursing staff to the levels of exposure to the types of occupational hazards.
It included (37 items) divided in to five types of occupational hazards namely; physical hazards (8 items) biological hazards (5 items) mechanical hazards (10 items) chemical hazards (6 items) and psychosocial hazards (8 items). Responses of this part was measured by using Five points Likert scale to assess each type of occupational hazards, it ranged from (1-5). (1=never), (2= rarely), (3= sometimes), (4= usually), and (5= always).
B- Perception of nursing to the contributing factors to occupational hazards.
Question from 38-47 are 10 items including 7 sub items, Nursing staff responded to question number 38 and 39 by using yes or no (Yes=2) and (No=1). While they responded to questions from 40-47 by using three–points Likert scale to assess their perception about the contributing factors to occupational hazards. Subjects responded on three–points scale ranged from (1-3), (1=disagree), (2= unsure) and (3= agree).
Tool Two: Contributing factors observational checklist:
It was developed by the researcher based on the reviewing of related literature to assess the contributing factors of occupational hazards facing nursing staff in kidney dialysis units by the researcher. Observation of the study units was carried out by the researcher for two successive shifts morning and evening shifts. It included 9 main items including 14 sub items (and filled on three–points scale ranged from (2=complete), (1= partially complete), (0= not complete).
Method
1. An official permission was obtained from the administration of the Faculty of Nursing and the identified study setting to collect the necessary data of the study.
2. After reviewing of related literature and studies in the field, the researcher prepared the tools by English language then translate it into Arabic language and tested for content validity by a paper to jury of seven experts in the field of the nursing administration, community health medicine and medical surgical nursing from Alexandria and Damanhur University. They suggested adding section B to tool one to assess perception of study subjects towards the contributing factors to occupational hazards based on their comments modification was done.
3. Study tools were tested of internal consistency of the items composing each dimension of the tools using Cronbach’s alpha coefficient. Both tools proved to be highly reliable. The Cronbach’s Alpha for tool 1= 0.890 and for tool 2= 0.8 for (>0.60).
4. A pilot study was conducted on 10% of the study subjects (n=15) in a kidney dialysis unit at Abo Ematamir General hospital. This to check and ensure the clarity, applicability,feasibility of the tool, Some questions were revised and rearranged to be easily understood. The pilot subjects were not included in the study subjects.
5. Data were collected by the researcher from the identified study subjects through hand delivered questionnaire while they were in their work shifts and at the break time. Instructions needed were given before the distribution of the questionnaire.
6. The questionnaire was completed in the presence of the researcher to ensure objectivity of staff nurses, non-contamination of their opinions and check that all items were answered. The amount of time needed to fill the questionnaire items was about 15 minutes for each study subject.
7. Data collection by the researcher by observational checklist to the identified study setting through observation of the study units for two successive shifts. Data collection phase consumed a period of one month started from 29 March 2018 to 29 April 2018.
8. After data was collected it was revised, coded and fed to the computer and analyzed using IBM SPSS software package version 20.0
9. Ethical consideration
Written informed consent from the selected study subject were obtained before participation in the study.
The subjects were informed about the purpose of the study and they have the right to withdraw from the study.
The confidentiality, autonomy and privacy of the study subjects were assured.
10. Statistical analysis:
E- Data Coding
• After data collected, it was revised, coded and fed to the computer and analyzed using IBM SPSS software package version 20.0. Qualitative data were described using number and percent Quantitative data were described using range (minimum and maximum), mean, standard deviation. Significance of the obtained results was judged at the 5% level.
• All statistical analysis was done using two tailed tests and alpha error of 0.05. P value less than or equal to 0.05.was considered to be statistically significant.
F- Descriptive statistics
• Frequency and percentages:
They are used for describing and summarizing qualitative and categorical data.
• Arithmetic Mean (X), and Standard Deviation (SD):
They were used to measure central tendency and dispersion respectively for quantitative data. Significance of the obtained result was judged at the 5% level.
G- Analytical statistics:
The used tests were:
Chi-square test
It tests the association between qualitative nominal variables, it is performed mainly on frequencies. It determines whether the observed frequencies differ significantly from expected frequencies.
Fisher’s Exact or Monte Carlo correction
It is used whenever the expected frequency in any of the cells of 22 table falls below 5. This test involves the calculation of the P value directly, without the use of particular test statistic.
F-test (ANOVA)
One way analysis of variance (ANOVA) was performed for comparison between more than two groups
Pearson coefficient
To correlate between two normally distributed quantitative variables.
Student t-test
It is used during comparison between the means of different sample groups. The “t” is calculated as follows:
H- Graphic presentation:
Graphic were used for data visualization by using Microsoft office excel.
The main results of the present study were as follows:
Mechanical hazards ranked the first and psychological hazards ranked the least as perceived by the studied hemodialysis nursing staff.
More than three-quarter of nursing staff perceived level of exposure to physical hazards as low. Around two- thirds of nursing staff perceived level of exposure to noise as moderate.
More than three-quarter of nursing staff perceived level of exposure to biological hazards as low. Nearly one-half of nursing staff perceived level of exposure to contaminated blood as moderate.
One-third of study subjects perceived level of exposure to mechanical hazards as moderate. Two- thirds of study nurses perceived level of exposure to carrying heavy objects as moderate, around two- thirds of study nurses perceived level of exposure to back pain as moderate, more than three fifth of study nurses perceived level of exposure to feet pain as moderate and more than two fifth of study nurses perceived level of exposure to slippery floor as moderate.
Three-quarters of nursing staff perceived level of exposure to chemical hazards as low, two fifth of study nurses perceived level of exposure to powder of latex gloves as moderate.
Three-fifth of nursing staff perceived level of exposure to psychological hazards as low, about two- thirds of study nurses perceived level of exposure to stress due to work load as moderate and three fifth of study nurses perceived level of exposure to stress due to shift work as moderate.
There was statistically significant relation between biological hazards and educational level and orientation to the work in the unit when receiving it.
There was statistically significant relation between psychological hazards and marital status.
There was a statistically significant relation between biological and mechanical hazards with attended training workshops.
The vast majority of nurses illustrate the presence of occupational safety policies and procedures in the unit.
The highest contributing factors as perceived by nursing staff were improper hand washing with any nursing procedure with the patient, lack of training programs, irregular maintenance of machines, lack of regular medical investigation and lack of immunization against hepatitis B. While the lowest contributing factors as perceived by nursing staff are lack of security in the unit and absence of air purifier in it.
Based on the findings of the present study, the following recommendation can be made:
A- Recommendation for hospital administrators:
• They should develop and disseminate policies and guidelines of safety practices at kidney dialysis units.
• Provide healthy and safe workplaces for all nurses in line with the requirements of the relevant national and international laws and regulations.
• Provide organizational guidelines and rules about hazards assessment and identification.
• Conduct educational programs for nursing staff about ways to minimize exposure to hazards.
• Ensure the availability of the experienced and well trained nurses on occupational hazards 24 hours to decrease exposure to hazards all times.
• Increase nurses awareness regarding biological hazards at kidney dialysis units.
• Personal Protective Equipment (PPE) should be made accessible to nurses with a written plan on how and when to use it. Posters should also be posted on healthcare facilities to remind workers of universal safety precautions.
• Give Hepatitis B vaccine obligatory to all nurses.
• Develop appropriate strategies to reduce the impact of occupational hazards.
• Provide education to increase nurse’s awareness regarding correct body positioning during the course of their activities and provide ergonomic control measures (e.g., mechanical lifting equipment availability of ergonomic chairs and automatic adjustable patient beds).
• Psychological counseling and therapy should be easily accessible and available for staff members.
B- Recommendations for first line nurse managers:
• Implementing fitness training program includes (pre service, orientation and in service training programs) about the types of hazards in work place, their influence on nurses and how to avoid exposure to them.
• Training nurses to use consistently, protective equipment that prevents blood contact, and eye protection, such as face shields and goggles, that prevent blood dripping into the eyes.
• Providing nurses knowledge about blood borne pathogens and universal precautions as a prerequisite for change in behavior that could be beneficial for protect them.
• Provide clear specific job description, flexible work schedules, fair distribution of weekend and holiday work, rest time between shifts, adequate meal times and regular meeting with their nurses to discuss any occupational hazards and solve their problems.
C- Recommendations for nurses:
• Comply with safety policies and health procedures instructions given for their own safety.
• Attend training program about the types of occupational hazards and how to avoid the exposure to them.
• Report any incidents of exposure to any types of occupational hazards immediately to supervisor.
• Use safety devices and protective equipment correctly.
D- Recommendations for further studies:
• Examine the relation between potentiality of hazards among nursing staff and productivity.
• Investigate the impact of training program and nurse’s safety practices.
• Study the relation between application of safety practice in kidney dialysis units and incidence of occupational hazards.