Four Chapter Thesis

CHAPTER I THE PROBLEM AND ITS BACKGROUND

Introduction

One of the most basic human needs is safety. “All human being needs to be and feel safe, both physically and psychologically.” Most of us protect ourselves within the changing environment by functioning as healthy individuals who make decisions in a reasonable manner (Arthur Amor Pimpas, 1998). A disease is any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown (Medical Dictionary).

According to Kozier (2004), once an individual is sick and experiences the signs and symptoms of a disease, he will then adopt the second stage of illness which is the assumption of the sick role wherein he excuses himself from normal duties and role expectations. If this happens, one won’t be able to learn and perform clinical duties, which he must do as a preparation for being a fully competitive nurse.

“Minute, living organisms, called microorganisms, exist everywhere in the environment, on the human body and within the human body.” Others, called pathogens, have the ability to cause diseases. Pathogens are microorganisms that cause diseases, especially living microorganisms such as a bacterium, virus, or fungus. When the body is unable to defend itself against these pathogens, they will multiply within the body which would cause infection and would lead to the formation or start of a disease process. (Arthur Amor Pimpas, 1998)

-1-

People who have acquired a disease, especially a life-threatening disease, are rushed to the hospital for treatment. “They seek help from professional health care workers (HCWs) to alleviate the pain, signs, and symptoms, and eventually the disease itself. Health care workers are those clinical and other staff, including those in primary care, who have regular, clinical contact with patients. This includes staff such as doctors, dentists and nurses, paramedical professionals such as occupational therapists, physiotherapists, radiographers, ambulance workers and porters, and students in these disciplines (The Association of National Health Occupational Physicians or ANHOPS).”

These health care workers are the front liners in giving medical treatment and care to the patients (A person under health care. The person may be waiting for this care, may be receiving it, or may have already received it). Because of this, “the health of the HCWs is compromised or at risk all the time for a vast array of infections that cause substantial illness and occasional deaths.” Despite this, few studies have examined the incidence, prevalence, or exposure-associated rates of infection or have considered infection-specific interventions recommended in maintaining work safety. (Sepkowitz,1996).

“More than 10 years have elapsed since the last major consideration of occupationally acquired infections in health care workers. Since then, much has changed—new infections have been identified, diagnostic tests for previously recognized diseases have been improved, the use of molecular epidemiologic techniques in outbreak investigations has increasingly become routine, and outpatient and home care have become more common.” (Sepkowitz, 1996)

-2-

“Health workers are exposed to blood and other body fluids in the course of their work. Consequently, they are at risk of infection with blood-borne viruses including human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV). The risk of infection for health workers depends on the prevalence of disease in the patient population and the nature and frequency of exposures. Occupational exposure to blood can result from percutaneous injury (needlestick or other sharps injury), mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth) or blood contact with non-intact skin. The most common form of occupational exposure to blood and the most likely to result in infection, is needle-stick injury. The most common causes of needlestick injury are two-handed recapping and the unsafe collection and disposal of sharps waste. Health workers in areas such as operating, delivery and emergency rooms and laboratories have an enhanced risk of exposure. Cleaners, waste collectors and others whose duties involve handling blood-contaminated items are also at risk.

Among the 35 million health workers worldwide, about 3 million receive percutaneous exposures to bloodborne pathogens each year; two million of those to HBV, 0.9 million to HCV and 170 000 to HIV. These injuries may result in 15 000 HCV, 70 000 HBV and 500 HIV infections. More than 90% of these infections occur in developing countries. Most blood exposures in health settings are preventable. Strategies to protect health workers include implementation of Universal Precautions, immunization against hepatitis B, provision of personal, protective equipment and the management of exposures. Successful implementation of these strategies requires an effective infection control committee with support from the health setting management team(World Health Organization).”

-3-

Safety in the delivery of care in the nursing profession is a growing concern among health care workers especially staff nurses not only in the country but globally. Across the US, it was identified by the Occupational Safety and Health Administration that nursing personnel have the highest percentage of job-related health risk rates of any occupation (Foley M., 2004). “Nurses give the majority of direct care to patients. Nursing accounts for about 80% of the direct care, that patient receives and this often involves personal and intimate care activities where health care-associated diseases are potentially available outcomes (Jocel A. Frias, 2007).” “HCWs especially nursing staff have a longer exposure to their clients compared to other members of the health care team. Because of this, they are susceptible to harbor different microorganisms that are present in the workplace (Jacobson, 1990).”

“Based on the prospective reports, the rate of injuries to staff nurses was 0.8 per nurse – year. Factors associated with increased injuries included recapping needles and temporary work assignments. (Klocinski, USA). In the Philippine settings, the incidence of harboring a disease is escalating among HCWs. Safety becomes even more a primary health issue for hospital HCWS in relation to the outbreak of highly and deadly disease such as HIV/AIDS, Hepa, SARS, Meninggo, Flu and PTB (Pulmonary Tuberculosis) in Asia in recent years (Gamage, 2003).”

As a nursing student, part of the Bachelor of Science in Nursing Curriculum includes Related Leaning Experience (RLE) or the student’s hands-on experience in different medical cases. “RLE’s contributory objectives include: to serve competency in the promotion of health, prevention of illness, carry out the therapeutic programs of the patients, give health guidance to patients in the hospital, in the home, and in the community.” (Donna Lynn Samaniego, et. al., 2005)

-4-

Majority of Our Lady of Fatima University (OUR LADY OF FATIMA UNIVERSITY) Lagro Branch affiliations are public hospitals. One does not need to be a keen observer in assessing the conditions of these hospitals. Most of the time, wards are too crowded with patients. “Equipments and facilities are inadequate of the patient’s needs. Even the hospital personnel, nurses, and doctors are not sufficient in number to meet every patient’s immediate demands.” (Donna Lynn Samaniego, et. al., 2005)

The aim of this research is to identify the most common diseases that Our Lady of Fatima University nursing students acquired and the preventive strategies they used during their internship or duty. Through this study, we are able to cite the most common diseases acquired by the Our Lady of Fatima University Nursing Students and the effective preventive strategies that can help other HCWs, especially Our Lady of Fatima University Nursing Students who are doing hospital duties, from acquiring diseases.

This study is significant not only to Our Lady of Fatima University nursing students, but to other nursing and medical students as well, who will undergo clinical duties as they go on with their studies as this study attempts to increase their level of awareness and education about the diseases they may acquire during their internship. It is also significant to hospital management, doctors, nurses and other medical health workers, especially those in government hospitals, because they are more at risk of acquiring life-threatening disease most present in depressed areas. The result of this study may provide some insights of the realities on the prevalence of health careassociated diseases so that effective, positive actions may be done to address the problem.

-5-

Identification and Prevention of the Most Common Diseases acquired by Selected Nursing Students of Our Lady of Fatima University during their Hospital Duties

Identification of the Most Common Diseases Etiology of the Diseases Respondents Profile • Name • Gender

Prevention of the Diseases

Number of cases with Nursing Students Having the disease

Sources of Information about the disease

Preventive Strategies taken by the Selected Nursing Students of Our Lady of Fatima University from acquiring the most common diseases

Consequences Capacity of the effectiveness of performance during hospital rotation • Severity of the Disease acquired • Effect on selfesteem of students • Capacity to carry out duties in the hospital •

Strategies used by the Selected Nursing Students of Our Lady of Fatima University to avoid nosocomial infection

Figure 1. Conceptual Framework

-6-

INPUT Common diseases acquired by the Selected Nursing Students of Our Lady of Fatima University during their hospital duties Preventive strategies used by the Selected Nursing Students of Our Lady of Fatima University during their hospital duties

PROCESS

Conducted a survey from selected Nursing Students of Our Lady of Fatima University using questionnaires. Used the percentage formula in determining the percentage of the frequency of the disease and the frequency of the effectiveness of the preventive strategies used. Used the weighted mean formula in determining the three most effective preventive strategies done by the selected Nursing Students Our Lady of Fatima University. Used the chi-squared formula in determining the significant difference between the common diseases acquired by the male and female Our Lady of Fatima University nursing students and the significant difference between the effectiveness of the preventive strategies done by the male and female Our Lady of Fatima University nursing students.

OUTPUT Identification and Prevention of the Most Common Diseases acquired by the Selected Nursing Students of Our Lady of Fatima University

Figure 2. Research Paradigm

-7-

Statement of the Problem

This study aimed to identify the most common diseases acquired by the selected Nursing Students of Our Lady of Fatima University during their hospital duties and the preventive strategies.

Specifically, it sought to answer the following questions:

1. What are the most common diseases acquired by the selected Nursing Students Our Lady of Fatima University during their hospital duties?

2. What are the three most effective preventive strategies done by the selected Nursing Students Our Lady of Fatima University?

3. Is there a significant difference between the common diseases acquired by the male and female Our Lady of Fatima University nursing students?

4. Is there a significant difference between the effectiveness of the preventive strategies done by the male and female Our Lady of Fatima University nursing students?

-8-

Hypotheses

Null Hypotheses

Ho1. There is no significant difference between the common diseases acquired by the male and female Our Lady of Fatima University nursing students. . Ho2. There is no significant difference between the effectiveness of the preventive strategies done by the male and female Our Lady of Fatima University nursing students.

-9-

CHAPTER II METHODS OF RESEARCH AND PROCEDURES

This chapter presents the research design, population and locale of the study, data gathering tools and procedures and the statistical treatment of data used.

Research Design

This study aimed to identify the most common diseases acquired by the selected nursing students of Our Lady of Fatima University during their hospital duties and the effective preventive strategies they used.

The researchers made use of the descriptive research design which main purpose is to describe events, phenomena, situations, practices and trends developing through the use of measurement or quantification of events or variables under the study.

Population and Locale of the Study

The respondents involved included 25 male and 25 female Nursing Students currently enrolled in Our Lady of Fatima University, Quezon City and were already exposed to hospital duties, regardless of the frequency of exposure and year level of the respondents.

- 10 -

The locale of the study was at the Our Lady of Fatima University Nursing Buildings, specifically the San Rafael Building (former New Regalado Building) and the Fatima Eye Rehab Center, in Regalado, Quezon City. Data Gathering Tools

The researchers used questionnaire as the main tool for obtaining the data from the respondents. The questionnaire distributed was composed of 3 parts, namely: Respondents Profile, Most Common Diseases Acquired and Ways of Prevention.

For part 1, Respondents Profile included the name and gender of the respondents.

For Part 2, Common Diseases Acquired. Different kinds of illness and diseases were presented for the respondents to put a check mark on using a multiple response type questions.

And lastly, for Part 3, Preventive Strategies Used. Upon this part of the questionnaire was the rating scale type of close ended questions (Kotler and Armstrong, 2001), which was the basis for the rating of the effectiveness of the prevention used.

Tertiary

Descriptive Rating

4.51 – 5

Highly Effective

3.51 – 4.5

Effective

2.51 – 3.5

Neutral

1.51 – 2.5

Ineffective

- 11 -

0 – 1.5

Highly Ineffective

Data Gathering Procedure

The researchers used the non-probability sampling, specifically the convenience sampling in determining the respondents involved. The first step done by the researcher was to select the respondents. The researchers stayed near the vicinity of the Our Lady of Fatima University school buildings, specifically the San Rafael Building (former New Regalado Building) and the Fatima Eye Rehab Center, both located at Regalado Avenue where most nursing students, who experienced hospital duties, gathered up. Each researcher was assigned to a specific number and gender of respondents. The purpose of thel study was attached to the questionnaire distributed. Upon making sure that the respondents understood the purpose of the questionnaires, the researchers made its way on distributing it to the students and obtaining the needed information.

Statistical Treatment of Data

The data obtained from the respondents were tabulated systematically in order to obtain accurate information related to each element of the target population.

The statistical treatment of data used to determine the percentage of acquiring the most common diseases was the percentage formula, as shown below:

- 12 -

P=

F x 100 N

where: P = percentage F = frequency N =number of respondents

The statistical treatment of data used to determine the percentage of acquiring the most common diseases was the weighted mean formula, as shown below:

WM =

Σfx N

where: WM f x N

= weighted mean = frequency of score = raw score = total number of respondents

The statistical treatment of data used in determining the significant difference between the common diseases acquired by the male and female Our Lady of Fatima University nursing students and the significant difference between the effectiveness of the preventive strategies done by the male and female Our Lady of Fatima University nursing students, using 0.05 as its level of significance, is the chi-squared formula, as shown below:

X² =

Σ(o-e)²

where: X² = chi-squared o = observed frequency

e = expected frequency

e Degree of Freedom (Common Diseases Acquired) df = (c – 1) (r – 1) = (2 – 1) (12-1) = (1)(11) df = 11 α = 0.05 Critical Value = 19. 675

Degree of Freedom (Preventive Strategies Used) df = (c – 1) (r – 1) = (2 – 1) (11-1) = (1)(10) df = 10 α = 0.05 Critical Value = 18. 307

- 13 -

CHAPTER III RESULTS AND DISCUSSIONS

This chapter deals with the analysis and interpretation of the data gathered from the questionnaire. It presents the graphical and textual explanations of data to answer the specific questions based on the statement of the problem.

1. On the Common Diseases Acquired by the Respondents during Hospital Duties 40

35.48

35

30.11

Percentage

30 25 20 15 10

10.75 5.38

5.38

3.23

5

2.15

1.08

2.15

2.15

1.08

1.08

es M ea sl

Di ar rh ea

Ra sh es

Fe ve r

on ia

ps

Pn eu m

um M

ck en

Po x

TB Ch i

UT I

ds Co l

Co ug h

So re

Ey es

0

Common Diseases Acquired

Figure 3. Percentage of the Common Diseases Acquired.

The most common disease acquired by the selected Nursing Students of Our Lady of Fatima University is cold, which has a frequency of 28 or 30.11%, where 14 or 35.90% is on males and 14 or 25.93% is on females. Second is cough, which has a frequency of 33 or 35.48%, where 16 or 41.03% is on males and 17 or 31.48% is on

- 14 -

females. And third is TB (tuberculosis), which has a frequency of 10 or 10.75%, where 3 or 7.69% is on males and 7 or 12.96% is on females.

The frequency of acquiring sore eyes is 5 or 5.38%, where 1 or 2.56% is on males and 4 or 7.41% is on females. The frequency of acquiring UTI is 5 or 5.38%, where 2 or 5.13% is on males and 3 or 5.56% is on females. The The frequency of acquiring chicken pox is 3 or 3.23%, where 1 or 2.56% is on males and 2 or 3.70% is on females. The frequency of acquiring mumps is 2 or 2.15%, where 0 or 0% is on males and 2 or 3.70% is on females. The frequency of acquiring fever is 2 or 2.15%, where 1 or 2.56% is on males and 1 or 1.85% is on females. The frequency of acquiring rashes is 2 or 2.15%, where 0 or 0 is on males and 2 or 3.70% is on females. The frequency of acquiring pneumonia is 1 or 1.08%, where 0 or 0% is on males and 1 or 1.85% is on females. The frequency of acquiring diarrhea is 1 or 1.08%, where 1 or 2.56% is on males and 0 or 0% is on females. The frequency of acquiring measles is 1 or 1.08%, where 0 or 0% is on males and 1 or 1.85% is on females.

2. On the Preventive Strategies Used by the Respondents during Hospital Duties

The most effective preventive strategy used by the selected nursing students is handwashing. Its effectiveness in the prevention of a disease to males is 4.92, which is highly effective and 4.52 to females, which is also highly effective. As a whole, it had an average of 4.72, which is highly effective. Second is vaccination. Its effectiveness to males is 4.52, which is highly effective and 4.44 to females, which is effective. As a whole, it had an average of 4.48, which is effective. Third is proper disposal of sharps/ used needles. Its effectiveness to males is 4.56, which is highly effective and 4.16 to females, which is effective. As a whole, it had an average of 4.36, which is effective.

- 15 -

The effectiveness of use of mask to males is 4.36, which is effective and 4.04 to females, which is effective. As a whole, it had an average of 4.20, which is effective. The effectiveness of use of gloves to males is 4, which is effective and 4.16 to females, which is effective. As a whole, it had an average of 4.08, which is effective. The effectiveness of proper disposal of linens to males is 4, which is effective and 4.14 to females, which is effective. As a whole, it had an average of 4.06, which is effective. The effectiveness of taking vitamins/ supplements to males is 4.2, which is effective and 3.88 to females, which is effective. As a whole, it had an average of 4.04, which is effective. The effectiveness of use of gowns to males is 4.12, which is effective and 3.92 to females, which is effective. As a whole, it had an average of 4.02, which is effective. The effectiveness of enough rest to males is 3.96, which is effective and 3.64 to females, which is effective. As a whole, it had an average of 3.80, which is effective. The effectiveness of regular check-up to males is 3.8, which is effective and 3.68 to females, which is effective. As a whole, it had an average of 3.74, which is effective. The effectiveness of exercise to males is 3.96, which is effective and 3.28 to females, which is neutral. As a whole, it had an average of 3.62, which is effective.

3. On the Significant difference between Common Diseases Acquired by Male Nursing Students and Common Diseases Acquired by Female Nursing Students

Since the computed value of X² = 45.93, which is greater than the critical value of X² = 19.675 at α = 0.05 with the df = 11, the null hypothesis is rejected. Therefore, there is a significant difference between common diseases acquired by Male Nursing Students and common diseases acquired by Female Nursing Students.

- 16 -

4. On Significant difference between the effectiveness of the preventive strategies done by the male and the effectiveness of the preventive strategies done by the female Our Lady of Fatima University Nursing Students from acquiring these diseases during their hospital duties

Since the computed value of X² = 1923.15, which is greater than the critical value of X² = 18.307 at α = 0.05 with the df = 10, the null hypothesis is rejected. Therefore, there is a significant difference between the effectiveness of the preventive strategies done by the male and the effectiveness of the preventive strategies done by the female Our Lady of Fatima University Nursing Students from acquiring these diseases during their hospital duties.

- 17 -

CHAPTER IV CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the conclusions and recommendations made by the researchers about this study.

Conclusions

From the data collected in the questionnaire, the researcher had summed up the following findings:

1. The most common diseases acquired by the Our Lady of Fatima University Nursing Students is cough which had 33 or 35.48%, where 16 or 41.03% is on males and 17 or 31.48% is on females. Followed by colds which had 28 or 30.11%, where 14 or 35.90% is on males and 14 or 25.93% is on females. And third is Tuberculosis (TB) which had 10 or 10.75%, where 3 or 7.69% is on males and 7 or 12.96% is on females.

2. The most effective prevention used by the Our Lady of Fatima University nursing students from acquiring such disease is handwashing which is highly effective to all, regardless of gender.

3. There was a significant difference between the common disease acquired by male and the common disease acquired by female Our Lady of Fatima University Nursing Students.

- 18 -

4. There was a significant difference between the effectiveness of the preventive strategies done by the male and the effectiveness of the preventive strategies done by the female Nursing Students of Our Lady of Fatima University during their hospital duties.

Recommendations

Considering the results and conclusions made, the researchers offer the following recommendations:

1. Those nursing students who are and who will undergo hospital duties or internship must equip themselves with the necessary preventive measures to prevent from acquiring the most common diseases such as coughs, colds, TB and others. Since the most common disease acquired in the hospital setting is about respiratory problem, which is a contagious disease, we recommend that the nurses must at all times, if possible, keep a 3 feet distance among patients and should always wear masks in interacting with the patients.

2. Students must always perform handwashing before, during, after or as long as necessary to prevent from acquiring and transmitting diseases, since handwashing has been a highly effective prevention for nursing students based on our study. It is also the oldest, simplest, and cheapest way to control the spread of infectious organisms.

- 19 -

3. Based on the study, which showed that the female nursing students are more susceptible in acquiring diseases than the male nursing students, we recommended that female nursing students must be more careful in doing hospital duties.

4. Since the preventive strategies is highly effective on the male respondents than of the females, females should look for other ways of prevention and or combine one or more preventive strategies to give them enough prevention so as not to acquire diseases during their hospital duties and boost their immune system. They should also see to it that they follow standard precautions and proper ways of using the preventive measures since it may affect the effectiveness of the preventive measures done.

- 20 -