Occupational Health Hazards Among Nurses in Private Hospitals in Kuala Lumpur

This research proposal aims to investigate about the occupational health hazards among nurses in private hospital in Kuala Lumpur, Malaysia and use the findings to recommended appropriate safety guidelines in such hospital to identify and prevent such occupational injury rates for nurses.

Running head: OCCUPATIONAL HEALTH
Occupational health
Name of the student:
Name of the University:
Author’s note

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Introduction
Occupational health is defined as the process used to identify and control any form of
injures, physical, chemical and other hazards in workplace and taking appropriate steps to reduce
occupational hazards for employees. In the context of health care setting, nurses are one health
professional group who are at high risk of occupational hazard because of needle stick injuries
(NSI), blood-borne infection, contact with blood and body fluids (Khatib & El Ansari, 2015).
The occurrence and burden of this type of injury is understood by the fact that about 50% of
needle stick injuries occurs in nurses making them the most vulnerable health care workers
(HCW) exposed to occupational hazards. The main reason behind this includes their nature of
work which involves frequent performance of activities like giving injections, venipuncture and
coming in contact with patients with infectious disease like hepatitis and HIV (Balouchi et al.,
2015). Hence, considering the nature of work environment and vulnerability to occupational
hazards for nurses, conducting research to explore occupational health hazards among nurse and
evaluating their experience is important. This research proposal aims to investigate about the
occupational health hazards among nurses in private hospital in Kuala Lumpur, Malaysia and use
the findings to recommended appropriate safety guidelines in such hospital to identify and
prevent such occupational injury rates for nurses.
Specific objectives of the project
The main aim of the research proposal is to investigate about the occupational health
hazards among nurses in private hospital in Kuala Lumpur, Malaysia. By the use of primary
research method, the purpose of this proposal is to achieve the following research objectives:

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 To explore the prevalence and incidence of different types of occupational injury among
nurses.
 To investigate about the experiences of nurse related to occupational injury and the cause
behind it.
 To analyze the preventive measures implemented in hospital setting to prevent the burden
of occupational injury
Research hypothesis:
Hypothesis testing is an important part of research investigations that gives an assertion
regarding one or more population of interest. In relation to the research topic, the null hypothesis
for the research is as follows:
H0: Occupation health hazards among nurse occurs because of nurse related factors such as
negligence and poor safety skills
H1: Occupational health hazards among nurse occur because of poor implementation of
occupational safety principles in hospital setting.
Research question:
The research question for the research proposal is as follows:
What are the causes behind occupational health hazards among nurses working in private
hospitals in Kuala Lumpur?

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Literature review:
The rational for the research is understood from the review of research literatures and
identification of gaps in research papers. The literature review gave an insight into the burden of
NSI and other types of workplace hazards among nurses and some of the cause behind
occupational health injury in clinical setting. This section will summarize the keys findings of
the literature review:
Burden of occupational health injury:
Nurses are those groups of HCWs whose occupation involves regular contact with sick
patients and their body fluids, resulting in transmission of infection and subsequent risk of
injuries, disease, disability and even deaths. According the research study by Subramanian, Arip
and Subramaniam (2017), occupational infection among nurse are transmitted by different means
such as through contact with contaminated body fluids, accidental inoculation during NSI and
inhalation route. Handling of sharp objects like scalpels, inject and other blood collection device
also increases the risk of exposure to blood-borne pathogens. A review of research related to risk
perception and practices regarding occupational exposure to infected body fluids in Malaysian
health care setting revealed that sharps injuries are most prevalent in Malaysian health care
environment. The main justification given for increases number of occupation injury cases was
the improvement in the efforts related to improving the systems for training of physicians. The
study gave the reason that standards precautions for infection control are not adequately
implemented in Malaysian hospitals. The main gap in this research paper is that it was a review
of research literature. However, as there is lack of studies regarding the experiences of
occupational safety hazards from the point of view of nurses, this justified the need to conduct

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research in this area. The exploration of the perspective of nurse regarding workplace hazards
and occupational injuries can give better insight into personal and organizational barriers that
lead to such injuries and disability for nurses.
Occupational health injuries in clinical settings occur in different forms such as NSIs,
hospital acquired infections and diagnosis of other infectious disease because of exposure to
infected body fluid. There are various evidence regarding the prevalence of NSIs among health
care workers. Ishak, Haque & Sadhra (2018) used the data from the MOH national sharps injury
surveillance programme to get insight about national self-reported incidence and risk factors for
NSI among Malaysians HCWs. The study findings revealed reporting of 1234 NSI cases in the
year 2016 and the incidence or prevalence rate was 6 injuries per 1000 HCWs. The main strength
of this paper was that it just not only highlighted about the prevalence of NSIs among patient, but
also about the unsafe practices linked to such events. Hence, such data can develop
understanding regarding the areas were change is needed. However, the gaps found in this
research were that the date was linked to self-reported cases only suggesting the possibility of
under-reporting bias. The study lacked data related to attitude of employers, policies related to
NSI notification and workplace practices. Therefore, these gaps can be utilized to improve and
enhance the data related to occupational health injury among nurses in Malaysia.
Causes of occupational health injury:
Job related illness or injury is a common issue for nurses because their work
responsibilities, working environment and duties expose them to numerous occupational hazards.
For this reason, this research proposal is particularly focusing on investigating about the topic in
the nursing population. Apart from muscoskeletal pain, other occupational hazards experiences

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by nurse includes shoulder and neck injuries, excessive fatigue, NSIs, exposure to chemical
materials and experiences of on-the job violence (Alavi, 2014). The classification regarding
different types of occupational injuries can give idea regarding the types of injuries that need to
be explored. The literature review regarding causes and perceptions related to cause of injuries
revealed different perspectives which are discussed in more details in this paragraph. Many
research evidences were found regarding prevalence and cause of NSIs in nurses. The study by
Galougahi (2010) used descriptive analytical cross sectional study design to investigate about the
risk of occupational exposure to blood-borne pathogens among nurse. The study indicated that
the rate of NSIs were highest in females compared to males. The key activities that resulted in
NSIs included injections followed by recapping of needles. In addition, the common cause
behind this injury included crowdedness and hospital chaos. Hence, this study gave the idea that
organization related factors are the main cause behind risk of occupational hazards for nurses.
However, this study was done for nurses working in Tehran. So, exploring the perceptions of
nurses working in Malaysia regarding occupational hazards is important as the organizational
context for hospitals in Malaysia may be different from that of Tehran.
A systematic review regarding factors associated with NSIs in health care professionals
revealed that the incidence of NSIs are particularly prevalent in nurses and there are many other
factors that result in such incidences such as age, educational level, experience and number of
shifts per month. The study emphasized training as the most significant factor for the prevalence
of NSIs among nurses thus giving the implication that instead of supplying expensive equipment,
giving appropriate training related to preventive measures to nurses (Motaarefi et al., 2016).
Similar outcome was given by Subramanian, Arip and Subramaniam (2017), who supports that
the main cause behind needle stick injuries in Malaysian health care setting includes lack of

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experience, performance of minor injuries and injections, blood withdrawal and recapping
needles. However, the study outcome cannot be generalizable for different clinical setting
because the study explore diverse participants in different countries and the overall mixed result
cannot be applied for any specific local setting.
Another research paper by Laishram et al. (2013) explored about the prevalence of NSIs
in a tertiary care hospitals. By the use of cross-sectional study design and self-administered
questionnaire, the study gave the insight that the rate of NSIs was about 28.1% every year.
Similar to other research papers, this research also revealed that recapping of the needles and
intramuscular injections are two nursing activities that increase the likelihood of such injuries for
patient. This study suggested that recapping is not practiced by majority of nurses. In addition,
not wearing gloves was identified as a factor contributing to such injuries. The findings were
supported with other research evidence giving similar results. However, one limitation in the
research paper was that the study cannot be generalized for nurses working in other hospitals.
However, as the research proposal is focusing on the workplace injuries in Malaysia, conducting
research with nurses in hospitals of Malaysia is necessary.
Review of research paper also gave idea the attitude towards occupational hazards and
safety practices among health care workers. Majority of the participants in the study included
nurses and the survey regarding perceptions related to workplace injuries revealed that most of
the respondents were at risk of occupational hazards and perception related to high hazard risk
was seen in two-third of the respondents. Another alarming finding was that the rate of
compliance to standard procedure was low among participants. The study by Senthil et al. (2015)
gave the insight that participants regarding biological hazards to be occurring because of contact
with infectious materials and for those who reported being injured by NSIs, 70.5% suffered the

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injuries at least one time in previous months. It implies that implementing urgent training related
intervention is also important. The training can also be a motivator for nurses to sustain safety
work practices during routine nursing care. These findings suggest the significance of conducting
more research in the area of occupational health injury and finding out ways to involve
stakeholders to upgrade work related to hospital infection control. In the context of Malaysia too,
this research will help to identify strategic policy measures to prevent occupational hazards for
nurses.
Type of research:
From the review of research literature, it has been found that there are many studies done
for prevalence of occupational hazards in different settings. However, there is lack of studies
regarding investigation of occupational health hazards for nurses working in Malaysia. There are
many types of research methodologies and research methodology is selected by researchers
based on nature of research problems and research objectives. In case of this research proposal,
the main research problem is the burden of occupational hazards like NSIs and infectious disease
among nurses. As the study aims to investigate about the cause and preventive measures related
to occupational injury among nurse, the use of quantitative research method is considered most
appropriate for this research. Quantitative research is a process to explore and understand the
data by emphasizing on the statistical data as well as the objective measurements. By use of
emerging questions and collection of data in typical setting, quantitative research design favors
using the data collected to engage in inductive data analysis and interpret the meaning of
participant’s response (Watson, 2015). For this research proposal, quantitative data collection
method will include survey that will help in getting empirical data for the unbiased analysis of
the research issue.

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Outputs expected from the projects:
By the use of quantitative research design and survey method, it is expected to get the
following outputs from the research projects:
 Gain data related to types of occupational injuries and causes of such injuries among
nurses working in Malaysia
 Get an idea regarding nurse’s perception related to risk of workplace hazards and ways to
prevent it
 Get idea regarding organizational interventions to prevent the risk of occupational
hazards in clinical setting
Research methodology:
Research design:
Quantitative research design will be used with the use of set of survey questions to
explore about the research topic. Use of exploratory research design is effective for a research
problem which has not been explored completely and which needs improvement in future
research design (Fitzgerald, 2013). As similar issues were identified by conducting literature
review on the topic, survey method will be used to explore about the research topic. The key
advantage of using survey as a research design is that it helps to analyze the story behind a
participant’s experience (Ndejjo et al., 2015). The literature review revealed nurse’s negligence
as a factor behind occupational health injury. However, survey method can help to explore the
topic from different angles and identify nurse’s opinion regarding the cause of different type of
occupational injury in hospitals of Malaysia.

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Participant recruitment:
The research will be conducted in tertiary hospitals of Kuala Lumpur in Malaysia. The
hospital administrators and nursing leaders will be contacted to gain permission for research.
They will be given all details regarding the purpose of research, research design, and
confidentiality criteria, outcome of research and risk and benefits to research participants. After
gaining approval for research, the nurses working in selected hospital setting will be contacted.
They criteria for selecting research participants will be included nurses working in hospitals from
0-10 years.
Data collection:
Data related to research question was collected by use of survey method. The survey was
done with list of ten questionnaires related to the research objectives. The research questionnaire
considered topics like types of injuries, location or activities contributing to occupational
hazards, frequency of injuries, attitude and perception towards occupational injury, perception
related to preventive measures in hospital setting and future recommendation to reduce the
workplace injury rates. The survey will be done by experienced research staffs and the survey
reports will be kept for further analysis. To ensure transparency during data collection, the
research staffs will maintain complete discretion with the participants to ensure correct response
has been recorded.
Data analysis:
The survey data collected will be transcribed verbatim and the transcribed data will be
coded by two research staffs. The codes or statements of research will be recorded by two staffs
and the final theme will be recorded after consensus is achieved. In case were agreements are not

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achieved regarding any theme, third reviewer will intervene to resolve the doubt and aid in the
identification of themes. Themes will be identified and sub-themes will be created if needed.
Throughout the research process and during data analysis methods, all steps will be taken to
preserve the privacy of the research participants. The key advantage of using quantitative
research analysis involves the use of larger number of participants that helps in the generalizing
the results. Another strength of using quantitative data analysis in this research design is that it is
a flexible research method that can help to get a greater accuracy along with broader objectivity
of the research issue (Choy, 2014). It is expected to complete the research by three months after
getting approval from the Research Ethics Committee of Malaysia.

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References:
Alavi, N. M. (2014). Occupational hazards in nursing. Nursing and midwifery studies, 3(3).
Balouchi, A., Shahdadi, H., Ahmadidarrehsima, S., & Rafiemanesh, H. (2015). The frequency,
causes and prevention of needlestick injuries in nurses of Kerman: A cross-sectional
study. Journal of clinical and diagnostic research: JCDR, 9(12), DC13.
Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2018). Thematic analysis. Handbook of
research methods in health social sciences, 1-18.
Choy, L. T. (2014). The strengths and weaknesses of research methodology: Comparison and
complimentary between qualitative and quantitative approaches. IOSR Journal of
Humanities and Social Science, 19(4), 99-104.
Fitzgerald, S., Chen, X., Qu, H., & Sheff, M. G. (2013). Occupational injury among migrant
workers in China: a systematic review. Injury prevention, 19(5), 348-354.
Galougahi, M. H. K. (2010). Evaluation of needle stick injuries among nurses of Khanevadeh
Hospital in Tehran. Iranian journal of nursing and midwifery research, 15(4), 172.
Ishak, A. S., Haque, M. S., & Sadhra, S. S. (2018). Needlestick injuries among Malaysian
healthcare workers. Occupational Medicine, 69(2), 99-105.
Khatib, I., & El Ansari, W. (2015). Occupational safety precautions among nurses at four
hospitals, Nablus district, Palestine. Retrieved from:
http://www.theijoem.com/ijoem/index.php/ijoem/article/view/581/666

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Laishram, J., Keisam, A., Phesao, E., Tarao, M. S., Laloo, V. J., & Devi, H. S. (2013).
Prevalence of needle stick injuries among nurses in a tertiary care hospital and their
immediate response. International Journal of Medicine and Public Health, 3(4).
Motaarefi, H., Mahmoudi, H., Mohammadi, E., & Hasanpour-Dehkordi, A. (2016). Factors
associated with needlestick injuries in health care occupations: a systematic
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Ndejjo, R., Musinguzi, G., Yu, X., Buregyeya, E., Musoke, D., Wang, J. S., ... & Ssempebwa, J.
(2015). Occupational health hazards among healthcare workers in Kampala,
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Senthil, A., Anandh, B., Jayachandran, P., Thangavel, G., Josephin, D., Yamini, R., & Kalpana,
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Subramanian, G. C., Arip, M., & Subramaniam, T. S. (2017). Knowledge and risk perceptions of
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Watson, R. (2015). Quantitative research. Nursing Standard (2014+), 29(31), 44.

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