An Occupational Health and Safety Interactive Systems Model Explicating Accident/Injury Causation

University of Wollongong Thesis Collections University of Wollongong Thesis Collection University of Wollongong Year 1990 An occupational health and safety interactive systems model explicating accident/injury causation Jan Pincombe University of Wollongong Pincombe, Jan, An occupational health and safety interactive systems model explicating accident/injury causation, Doctor of Philosophy thesis, Department of Nursing, University of Wollongong, 1990. http://ro.uow.edu.au/theses/1612 This paper is posted at Research Online. AN OCCUPATIONAL HEALTH AND SAFETY JNTERACTIVE SYSTEMS MODEL EXPLICATING ACCIDENT/INJURY CAUSATION A thesis submitted in fulfdment of the requirements for the award of the degree of DOCTOR OF PHILOSOPHY from THE UNIVERSITY OF WOLLONGONG by Jan Pincombe RN, RM, RIN, BA (University of Western Australia), Post Grad Dip. (UWA), M. Appl. Sci. (WAIT). DEPARTMENT OF NURSING 1990 I certify that the work contained in this thesis has not been submitted for a degree to any other university or institution. The thesis contains my work entirely. Signed 1 ACKNOWLEDGEMENTS My grateful thanks to Professor David Griffiths, Professor of Statistics, (Head of School), The University of Wollongong for his guidance and statistical advice to enable the completion of this thesis. I am deeply apprecitative of his understanding of the topic and his willingness to impart his knowledge and support. I am very grateful for his consistently positive and supportive approach which has allowed me to complete this thesis. My deep appreciation and acknowledgement to Professor Wai-On Phoon, Professor of Occupational Health, The University of Sydney and Director of Worksafe. Professor Phoon has provided meticulous criticism for the theoretical underpinnings of the study and the literature review for which I am deeply grateful. He has also understood the value of the study and has provided me with an appreciation of scholarship. I particularly thank him for his sympathetic view and his understanding for the difficulties nurse academics encounter in a sometimes hostile environment. I acknowledge the contribution of the registered nurses from the nursing staff of the hospitals involved in the study. I thank the nursing students for their co-operation and willingness to participate. I gratefully acknowledge the help and support of the lUawarra Area Health Service for their permission to carry out the study and their cooperation in accessing the injured nurses in this study. The latter I could not have achieved without their help and my thanks go to Ms. Sue Chapman and staff in the personnel department. Thankyou to my colleagues within the University for their help and encouragement through a particularly difficult period of my life. I would like to express my thanks to Dr. John Patterson, Alison Elliott, Neil Hall and Dr. Peter Milbum. My grateful thanks to Dr. Arthur Smith for providing constructive criticism and, enabling me to make changes to strengthen the arguments contained in this work. u My thanks are extended to Professor Sandra Speedy, The Nursing Department, The University of Wollongong and Doctor Graham Speedy for their faith and support and to my friends Kerry Duggan, Mary Martin and Margaret Wallace. Appreciation goes to my nursing colleagues, in particular Professor Allan Pearson, Professor of Nursing, Deakin University, Sister Pamela Joyce and Lesley Wilkes, The Catholic College and Professor Betty Anderson, The Western Sydney University, for their warmth and encouragement. I would like to acknowledge the help and advice of Dr. Ken Russell, consultant statistician to the Mathematics Department, The University of Wollongong for his reading of the thesis, particularly the methodology and results chapters. I am grateful for his wry sense of humour as well as his statistical knowledge. I am indebted to my husband, Adrian for helping me to survive. My deepest thanks to my two children, Brandon and Shauna. m ABSTRACT This study is concerned with the development of an occupational health and safety model, which provides an explanation for accident/injury causation in nurses. A multiple causation theoretical approach was adopted. The model shows that there are four input determinants, (namely, educational, environmental, management and social) that contribute towards accident/injury causation. Three main processes also contribute, specifically client/patient cenh-ed, organisational and nurse centred processes. The model was developed using both qualitative and quantitative methods. The first stage of the study consisted of collecting data from nurses using an open-ended interview (technique). Content analysis was applied to the resultant responses from which a data gathering instrument was developed. A pilot study was conducted to enunciate specific hypotheses, test the content validity of the instrument and to develop a nursing model. The main research instrument, designated as The Occupational Health and Safety Nursing Instrument (OH&SNI) was administered to registered nurses from four hospitals and three groups of nursing students from one tertiary institution. Two hundred and sixty seven registered nurses from a defined area health service, and from hospitals associated with the clinical teaching of the tertiary nursing programme were involved in the study. One hundred and eighty-four nursing students participated in the study. One general research question and seven hypotheses were postulated to investigate the applicability of inputs and processes articulated in the model. Chi-square results revealed attitudinal trends for the four groups of registered nurses and three groups of nursing students in the study. Registered nurses' and nursing students' responses were reduced to a two by two contingency table to check differences in acceptance ("strongly agree/agree") and rejection ("disagree/sQ-ongly disagree") levels. The factors in the IV. model were supported when each question from the respondents was tested on an acceptance or rejection level (tested in each case by the chi-squared goodness of fit statistic). Case history data collected from a small number of injured nurses also gave further support to the model. The model showed inputs and processes interacted to explain accident/injury causation and demonstrated support for a multiple causation theory explanation. The model showed that certain preventive measures can be effected to help prevent accident/injury causation. CONTENTS Pa CHAPTER ONE: INTRODUCTION 1.1 Introduction 1 1.2 Background 1 1.3 Statement of the Problem 4-6 1.4 Purpose of the Study 6 1.5 Theoretical Framework 7-10 1.5.1 SituationModelsof Accident Causation 10-16 1.5.2 Multicausality Theory 16-18 1.5.3 Summary 18 1.5.4 Nursing Models 19-26 1.5.5 Summary 27 1.6 General Aims and Directions for the Development of an Occupational Health and Safety Model 1.6.1 Introduction 28 1.6.2 Grounded Theory Approach 28 1.6.3 Main Study 29 1.6.4 General Research Statement 30 1.7 Definition of Terms 30 1.8 Outhne of the Thesis 30 CHAPTER TWO: LITERATURE REVIEW 2.1 Introduction 31 2.2 Historical Perspectives 32 2.3 The Williams'Report 34-37 2.4 Changes to Occupational Health and Safety Laws 37-39 2.5 The Workers' Compensation Act, 1987 39 2.5.1 The Woodhouse Committee 39 2.5.2 The New South Wales Law Reform Commission 40 2.5.3 The Workers' Compensation Act, 1987 40-42 2.5.4 Compensation Studies and Accident Statistics 42-48 2.6 Back Injury Studies 48-49 2.6.1 International Back Injury Studies 49-62 2.6.2 Austi-alian Studies 62-67 2.6.3 Maximum Loads in Industry 67-70 2.6.4 Methodologies used to Investigate Low Back Pain 70-77 2.6.5 Summary 77-78 Vl 2.7 Nosocomial Infections 78 2.7.1 Needleprick Injury 78 2.7.2 Hepatitis B Needleprick Injuries 79-88 2.7.3 Needleprick Injuries and Acquired Immunodeficiency Syndrome (AIDS) Studies 88-98 2.7.4 Summary 98 2.7.5 Legionnaires' Disease as an Occupational Risk 99-102 2.7.6 Summary 102 2.8 Assault as an Occupational Risk Factor 102-107 2.8.1 Summary 107 2.9 Anaesthetic Gases as an Occupational Risk Factor 108-115 2.9.1 Summary 115 2.10 Dermatitis as an Occupational Health Risk 115-116 2.10.1 Summary 116 2.11 The Risk of Ionising Radiation to Nurses 117 2.11.1 Summary 118 2.12 Repetitive Strain Injury (RSI) 118-119 2.12.1 Summary 119 2.13 Overview 119-120 2.14 Recommendations for Research Investigations 120-121 CHAPTER THREE: PILOT STUDY 3.1 Introduction 122 3.2 Development of the Pilot Suidy 122 3.2.1 Development of die Instrument 123-124 3.2.2 Pilot of die Instrument in the Chnical Area 124-125 3.3 Results fi-om die pilot Study 125 3.3.1 Demographic Data: Registered Nurses 125-127 3.3.2 Demographic Data: Nursing Students 127 3.3.3 Descriptive Data: Registered Nurses 127-129 3.3.4 Descriptive Data: Nursing Students 129-131 3.3.5 Accident and Injury Descriptive Information 131 -134 3.3.6 Attitudinal and Open-Ended Responses 135-139 3.3.7 Summary 139-140 3.3.8 Recommendations 140-141 CHAPTER FOUR: METHODOLOGY:MAIN STUDY 4.1 Introduction 142 4.2 Research Design 142-148 4.3 Selection of Subjects 143 4.3.1 Subjects 143 4.3.2 Registered Nurse Population 143-149 4.3.3 Nursing Smdent Population 149-152 vu 4.4 Research Instrument 153-154 4.5 Data Collection and Recording 155 4.5.1 Method: Registered Nurses 155 4.5.2 Method: Nursing Students 155 4.5.3 Method of Scoring 156 4.5.4 Training Sessions 156 4.5.5 Content Validity of Occupational Health & Safety Nursing Instrument 156 4.5.6 Reliability Estimates 157 4.6 Statistical Analyses 157 4.7 Statistical Significance Level and Limitations 159

Load more