1) The study examined nurses' perceptions of occupational safety and health management in Sabah state hospitals. 2) Training and competence received the highest rating, while safety incidents received the lowest. 3) Overall perceptions of safety satisfaction and feedback were above average, indicating nurses were relatively satisfied with OSH management. High training scores reflected emphasis on safety training.

1. Perception On Occupational Safety And
Health Management Among Hospital Staff
Nurses In Sabah State Health Department
A Preliminary Study
by
Nelbon Giloi, Lim Jac Fang, CHEAH Whye
Lian, CHANG Ching Thon

2. Introduction
• Sabah is a Malaysian state located on the
northern portion of Borneo island
• Second largest state in Malaysia - 73,711 sq
kilometers
• Total population of 3.27 million (11.3% of total
population of Malaysia in 2010)
• Population density – 35 people per sq
kilometer

3. • The population consists of many different
ethnic groups with Kadazan-
Dusun, Rungus, Bajau, Chinese, Murut, Malay
and other indigenous groups, being the
majority

4. • There are 22 government hospitals including
one psychiatric hospital, 83 primary health
clinics, 38 dental clinics, 20 maternal and child
health clinics and 189 rural clinics. In addition
to that there are 2 Flying Doctor Service teams
and several mobile clinic teams
• Road system - 60% gravel road / unpaved road
& 30% paved.

5. Location of Government Hospitals in
Sabah
• 1. Hosp. Kudat
• 2. Hosp. Kota Marudu
• 3. Hosp. Kota Belud
• 4. Hosp. Ranau
• 5. Hosp. Queen Elizabeth
• 6. Hosp. Bukit Padang
• 7. Hosp. Papar
• 8. Hosp. Beaufort
• 9. Hosp. Tambunan
• 10. Hosp. Tenom
• 11. Hosp. Sipitang
• 12. Hosp. Keningau
• 13. Hosp. Sandakan
• 14. Hosp. Beluran
• 15. Hosp. Kinabatangan
• 16. Hosp. Lahad Datu
• 17. Hosp. Semporna
• 18. Hosp. Tawau
• 19. Hosp. Pitas
• 20. Hosp. Kuala Penyu
• 21. Hosp. Kunak
• 22. Hosp. Pakar Likas
Goverment Hospitals

7. On Occupational Safety And Health
Management Perception
• A health care facility is a workplace as well as
a place for receiving and giving care. Health
care facilities around the world employ over
59 million workers who are exposed to a
complex variety of health and safety hazards
everyday (WHO)

8. Prevention of Occupational Injuries
• Prevention of occupational injuries among the
healthcare workforce is vital to provide quality
patient service, improve morale, and enhance
productivity by reducing time-loss and other
absenteesim (Alamgir H et al., 2007)

9. • In recent years attention has been paid to the
occupational risks and injuries of nurses - injuries
and resultant compensation to workers are
expensive
• United States - nurses’ back injuries are estimated
to cost US$6 million in indemnity and medical
payment comprising 56% of all indemity costs
and 55.1% of all medical cost
• In an Australian state - nurses’ back injury claims
accounted for A$2.39 million expenditure in one
financial year (Dawson, 2007)

10. • Job satisfaction important component of
nurses' lives.
• Impacts on:
– patient safety,
– staff morale,
– productivity,
– performance,
– quality of care,
– retention and turnover,
– and commitment to the organisation
(Stone, 2004)

11. • An online health and safety survey by the
American Nurses Association showed majority of
the nurses surveyed indicated that perception on
working conditions interfered with their ability to
deliver quality care
• These respondents also reported that health and
safety concerns influenced their decisions about
the kind of nursing work performed and their
continued practice in the field of nursing. In
addition, the perception of unsafe working
conditions may hinder recruitment and retention
of qualified staff (Stone et al., 2004)

12. Perception on Safety & Health Issues
• Important to gauge how the healthcare
workers perceive the issues on safety and
health in their workplace. Evidences show that
stress related to increased workload and
staffing patterns, including shift work, can and
does contribute to illness and injury in the
nurse population (Brown, et al., 2006)

13. • The impact of these events is of concern not
only in terms of the health risk to workers, but
also the effects on quality and safety of
patient care as well as patient and family
satisfaction (Rathert, 2007)
• Increasing work pressure results in decrease
in morale and productivity of nurses was also
found (Cavanagh et al., 1992)

14. • Monitoring nurses' working conditions and
improving the organizational climate of
hospitals is likely to improve the safety of the
employee and the profitability of the hospital
through improved system outcomes (such as
lower turnover of the employees) as well as
improve the quality of patient care delivered
(Stone et al., 2006)

15. Grade U29 Staff Nurses
• Nurses is the largest group of health care
providers deliver care to individuals in a variety of
health care facility.
• The largest group (31.5%) of frontline hospital
workers
• Malaysia –
– Rural Health Nurse, U19
– Senior Rural Health Nurse, U24
– Staff Nurse, U29
– Sister, U32
– Matron, U36 / U42

16. • Like nurses in other countries, they are
exposed to many occupational-related safety
and health problems
• Sabah State Health Department in 2000 - the
highest percentage (74.5%) of needle stick
injury were among nurses (Lim, 2004)

17. • Fukuda et al. (2010) noted that incidence of
work related injury (WRI) among hospital
workers are highest among nurses.
• Risks of other injuries including back pain
(Hofmann et all., 2002) and back injury
(Department Of Statistics Malaysia, 2009) is
shown to be higher in nurses as compared to
other professions.

18. Objective
• Although emphasis on occupational safety and
health is placed in Malaysia, there has not been
substantiate evaluation on the perception of
occupational safety and health management
among the employees, including nurses, in Sabah
State Health Department.
• This study aimed to determine the OSH
management and its effects as perceived by and
level of safety satisfaction and feedback staff
nurses in public hospitals in Sabah.

19. Material and Methods
• This was a cross sectional study.
• The sampling frame was among the grade U29
hospital staff nurses in the Department of Health,
Sabah, with a minimum of six months working
experience
• The minimum sample size was determined using
the formula for single proportion (EpiInfo 3.3.2)
• Based on national prevalence of occupational
related injury 30% and sampling frame of 3,391,
the minimum sample size with a confidence level
of 95%, was estimated to be approximately 213
with a 10% of non-response rate

20. • Data collection was done using a set of self
administered questionnaires adopted with
permisson from a study by Abdullah et al.
(2009)
• The questionnaires examined the perception
of employees on the management of
Occupational Health and Safety (OHS) in
public hospitals in Malaysia.

21. Ethical Approval & Informed Consent
• Obtained from the CRC Sabah and the
National Medical Research Register (NMRR)
• Informed Consent obtained from each
respondent

22. • This questionnaires consisted of two sections:
i. Six items on socio-demographic data of
respondents;
ii. Eighty five items on perception of the
implication of OSH management
elements.

23. OSH elements grouped into ten components
representing independent variables
• Leadership style • safety
• safety involvement communication,
• management • safety objective,
commitment • safety reporting,
• role of supervisor • work pressure and
• training and • safety incidents
competence

24. Dependent variable
• Safety satisfaction
• Feedback on safety

25. • The items on OSH management were scored
on a 5-point Likert-type scale:
1 indicated strongly disagreed and 5, strongly
agreed for eight elements,
1 indicated highly dissatisfied and 5, strongly
satisfied and
1 indicated “0” and 5 indicated “10 times” for one
element.

26. Results

27. Response Rate
A total of 135 nurses randomly selected from
seven government hospitals that responded
have participated in the study with a response
rate of 63.4%.

28. Age Distribution
30
26.7
25.2
25 22.2
20
20
15
10
5.9
5
0
20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs 40 yrs &
above

29. Gender
97.8
100
90
80
70
60
50
40
30
20
2.2
10
0
Male Female

30. Race
60 56.3
50
40
30
23.7
20
10.4
10
5.2
3
0.7 0.7
0
Kadazan Murut Bajau Rungus Malay Chinese Others

31. Place Of Work
70
62.2
60
50
40
30
20 14.1
10.4 11.9
10
1.5
0
Wards/ICU/CCU OPD OT/Labour Admin office Others
room/Procedure
Room

32. Years Of Working
35 31.9
30.4
30
25 22.2
20
15
10 7.4
5.9
5 2.2
0
Below 1 yr 1-5 yrs 6-10 yrs 11-15 yrs 16-20 yrs 21 yrs &
above

33. Experience Working In The Current
Hospital
38.5
40
35
30
25
21.5
20
14.8
15 12.6
10 7.4
5.2
5
0
Below 1 yr 1-5 yrs 6-10 yrs 11-15 yrs 16-20 yrs 21 yrs & above

36. Discussion
• This study revealed that training and
competence (4.04 ± 0.65) was perceived as
the most important component of their
workplace OSH practice.
• Followed by safety rules and reporting (3.70 ±
0.63), while safety incidence was had the
lowest score (1.70 ± 0.68).

37. Training and Competence
A reflection of active OSH programme
promotion and training in Sabah
– Training is important as employees who
receive safety training suffer fewer work-
related injuries than their untrained
counterparts (Colligen et al. ,2004),
– Allows employees to acquire greater
competencies to control work, and perform
jobs more safely (Barling et al., 2009).

38. • Pearson’s correlation analysis results indicated
that all OHS elements had positive correlation
with safety satisfaction and safety feedback
except safety incidence.
• Perception on safety incidence was low which
reflects that the OHS mangement was
satisfactory.

39. Safety Satisfaction and Feedback
• Safety satisfaction mean score 3.28 ± 0.51
• Safety feedback mean score 3.57 ± 0.73

40. • Interesting to note that management
committment was found to have no significant
correlation between most of the other
elements of OHS mangement, except for:
i. Safety Satisfaction
ii. Safety Communication
iii. Work Pressure
iv. Safety Responsibility

41. • Incongruent with Nor Azimah et al.’s (2009) study.
• Possible explanation was that the respondents
did not think the role of management should be
the determining factors that influenced their
knowledge and competence in occupational
health and safety.
• The need to improve and protect themselves and
establishing safety culture could be in placed as
part of their intrinsic needs, rather than as
extrinsic needs enforced by the management.

42. • Another possibility of this finding could be
related to the role of management in
implementing the rules and regulations
pertaining to safety at work and establishment
of safety culture within the organization were
unclear, thus, respondents did not perceived
management commitment as important.

43. Conclusion
• This study revealed that the overall perception on
OSH management in Sabah was fair.
• The score of safety satisfaction and safety
feedback was above average indicating that the
respondents were relative satisfied with OHS
management in Sabah.
• The high score on training and competence was
high reflecting that Sabah Health Department
had placed emphasis on training thus resulted
the perception of competent by respondents.

44. Study Limitation
• The study used a set of self administered
questionnaires enquiring specific questions on
perceptions regarding safety and health issues
during the past one year
• Subjected to respondent’s recall and reporting
bias
• Lacks generallization
• As it was a preliminary study, further study with
bigger sample involving other categories of
hospital staff from different health care setting
are needed to give better insight into OHS
management as well as providing information for
better OHS implementation.

45. Thank You