Analysis Factors of Nurse Behavior using Self-protective Equipment

at Sembiring Hospital

Budi Septhian Lizar

, Friska Ernita Sitorus

, Jon Piter Sinaga

Public Health department of Universitas Prima Indonesia, Medan, Indonesia

(Public health, Nursing) department of DELI HUSADA Halth Institute, Deli Tua, Indonesia

Keywords: Factors, Nurse Behavior, Personal Protective Equipment

Abstract: The hospital is one place that has a much higher level of work relationships for accidents, injuries and

occupational diseases compared to other institutions. Nurse professions have a higher risk of being involved

in work accidents because they do physical business every day, have longer working hours and operate

high-risk equipment. The results of a preliminary survey conducted at the Sembiring Hospital conducted a

survey of interviews and direct observations conducted by researchers to several health workers in the

Inpatient Room of ten nurses, six of whom did not carry out the procedures for using PPE properly such as

not wearing gloves when going to infuse patients This study was to analyze the Factors Affecting Nurses'

Behavior Not Using Personal Protective Equipment (PPE) in the Inpatient Room of Sembiring Hospital Deli

Serdang Regency in 2018. This type of research is an analytic study using a cross-sectional design

approach. The population in this study were all nurses in the inpatient ward of the Sembiring hospital. The

sample of this study where 91 inpatients. Sampling was carried out by a stratified random sampling method

in each inpatient room at Sembiring Hospital. The results of the study with multivariate analysis with

logistic regression tests showed that the factors that influence the behavior of nurses not using PPE are

knowledge (p = 0.009 <0.05) and attitude (p = 0.001 <0.05). The conclusion in this study is that there is an

influence of knowledge and attitudes towards the behavior of nurses not using Personal Protective

Equipment (PPE) in the Inpatient Room of the Sembiring Hospital Deli Serdang Regency. It is

recommended to the hospital that nurses' knowledge be further enhanced by holding socialization and

education in the form of regular and periodic training.

1 INTRODUCTION

In Indonesia, the probability of transmission of HIV

to health care workers after an HIV-infected needle

stick injection is 4: 1000. The risk of transmission of

HBV after a needle stick injection wound

contaminated with HBV is 27 -37: 100. The risk of

transmission of HCV after a needle stick wound

containing HCV is 3-10: 100. While in the central

surgical installation of the Regional General

Hospital (RSUD) Jakarta in 2008 there were 83.3%

of workers suffering from lower back pain, 63.3% of

them were aged 30-49 years (Kepmenkes RI, 2017).

Based on the results of recording from BPJS

Employment Data Center (2018) the number of

work accident cases in Indonesia from 2011 to 2017

experienced fluctuations, the highest rate in 2015

was 110,285 cases. In 2011 there were 9,891 cases,

in 2012 there were 21,735 cases, in 2013 35,917, in

2014 there were 24,910 cases. In 2016 there were

105,182 cases and in 2017 from January-August

there were 80,392 cases (OHS, 2017)

The study of Salawati et al (2017) related to

the application of K3 to nurses revealed that before a

person adopts a behavior, he must understand what

the meaning and benefits of the behavior are for

himself and others. If the nurse knows the

importance of controlling nosocomial infections,

compliance with SOPs and existing regulations will

be created. Nurses with good knowledge will have

good OSH actions because with a good level of

knowledge knowing and understanding the negative

effects of nosocomial infections so nurses will

improve their performance in controlling nosocomial

infections (Sandewa, 2017)

Lizar, B., Sitorus, F. and Sinaga, J.

Analysis Factors of Nurse Behavior using Self-protective Equipment at Sembiring Hospital.

DOI: 10.5220/0009516104030410

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 403-410

ISBN: 978-989-758-460-2

403

Personal protective equipment is tools that

are able to provide protection against the dangers of

accidents. Personal protective equipment (PPE) is a

tool that must be used when working in accordance

with the danger and work risk to maintain the safety

of the worker himself and those around him. The

types of PPE needed include eye protection, ear

protection devices, head protection, breathing, body,

hands and arms and legs (OSHA,2017).

Following the hierarchy of controls outlined

by the National Institute of Occupational Safety and

Health (NIOSH) can reduce the risk of developing

an occupational illness within this industry [11]. The

hierarchy of controls are listed from most effective

to least effective in the following order: elimination,

substitution, engineering controls, administrative

controls, and PPE. PPE is required by employers

when elimination, substitution, and engineering

controls do not work and when administrative

controls are not feasible or do not provide adequate

protection (Tamara, 2017)

According to Fuller &Vassie in Zanko (2017)

states 80-90% of work accidents when traced to

human factors.The wrong attitude or position in

conducting nursing care to patients, the lack and

attitude of careless nurses with their own safety by

not using personal protective equipment (PPE) in

carrying out their activities. Unsafe conditions

(unsafe condition) is one of the causes of workplace

accidents. Unsafe actions (unsafe actions) are

actions that can endanger workers themselves and

others that can cause accidents that can be caused by

various things such as not using PPE, not following

work procedures, not following work safety rules

and not careful work , where out of every 300 unsafe

actions, 1 (one) accident will occur resulting in loss

of workdays (Maria, 2015).

Many workers do not feel wearing PPE is

essential to their health, so PPE is often overlooked

and not considered a main factor when the overall

site safety is assessed (Efstathiou, G, 2017). In the

wastewater industry, most companies mandate that

employees wear safety glasses, steel toe boots, and

nitrile gloves as their standard PPE while they are at

work. The Occupational Safety and Health

Administration (OSHA) does not mandate specific

regulations for this industry, but the wastewater

industry is expected to follow the regulations for

“General Industry” (29 Code of Federal Regulations

1910) as they pertain to safety in the workplace (Mc

Gaw, 2017)

Based on this background, the writer is

interested in writing research entitled Analysis of

Factors Affecting Nurses' Behavior Not Using

Personal Protective Equipment (PPE) in the

Inpatient Room of Sembiring Hospital, Deli Serdang

Regency in 2018.

2 METHODS

This type of research is an analytical study

using a cross-sectional design approach, which is a

study by measuring independent variables and

dependent variables at the same time, which aims to

explain the influence, education, gender, knowledge,

attitude, availability of PPE and supervision with

behavior nurses do not use PPE in the Inpatient

Room of the Sembiring Hospital in Deli Serdang

Regency in 2018. This study was conducted in the

Inpatient Room of the Sembiring Hospital in Deli

Serdang Regency in 2018 with the entire research

process carried out in November 2018-April 2019.

The population in this study were all nurse

nurses with a minimum education level of D-III

Nursing inpatient rooms in Sembiring General

Hospital totaling 118 people and a sample of 91

nurses. Sampling was done by stratified random

sampling method in each inpatient room at

Sembiring General Hospital.

The research instrument was a questionnaire.

Data analysis was performed using the chi-square

statistical test as a bivariate data analysis and using

the Logistic regression test as multivariate analysis.

3 RESULTS AND DISCUSSION

3.1 Univariate Analysis

The univariate analysis aims to find out the

value of each independent and dependent variable.

The univariate analysis is as follows:

The Table 1 shows the distribution of

respondents based on the characteristics of age, sex,

education and length of work.Based on research that

has been done shows that for the age category, the

proportion of respondents aged the most was aged

24-45 years by 95.5%, the most gender was 71.4%

for women and 28.6% for men, the highest level of

education was at DIII education level namely 50.5%

and the most work mass in the group> 5 years is

79.1%.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

404

Table 1: Nurse characteristics

characteristics

Frequaency

Age

24-45 years (adult)

95,5

46-55 tahun (elderly man)

4,5

Gender

Male

29,7

Female

70,3

Education

DIII

50,5

49,5

working eye

>5 years

20,9

79,1

Total

100,0

Based on the Table 1 the results of the study

found that the majority of knowledge levels were 58

people (63.7%).The Table 2 shows the distribution

of respondents based on the nurse’s knowledge:

Table 2: Knowledge of nurses

Knowledge

Total

Eligible

63,7

Not Eligible

36,3

Total

100,0

Based on the results of the study found the

majority of nurses with a positive attitude of 66

people (72.5%).The Table 3 shows the distribution

of respondents based on Nurse’s Attitude :

Table 3: The Attitude of nurses

Attitude

Total

Positive

72,5

Negative

27,5

Total

100,0

Based on the Table 3 the results of the study

found that the majority of nurses stated that

supervision in the good category was 53 people

(58.2%). The Table 4 shows the distribution of

respondents based on supervision:

Table 4: Supervision of hospital nurses

Utilizing

Total

Eligible

58,2

Not Eligible

41,8

Total

100,0

Based on the Table 4 the results of the study

obtained the majority of nurses stated that there are

78 people with PPE. The Table 5 shows the

distribution of respondents based on nurse’s

availability:

Table 5: Availability of PPE

Availibility

Respondents

Available

85,7

Not available

14,3

Total

100,0

Based on the research results obtained, the

majority of nurses both in the behavior of PPE usage

that is as many as 56 people (61.5%). The Table 6

shows the distribution of respondents based on

nurse’s behavior:

Table 6: Behavior of using PPE

PPEusage behavior

Total

Good

61,5

Not good

38,5

Total

100,0

3.2 Bivariate Analysis

The Table 6 shows that the results of the

analysis test found that the value of p = 0.169> 0.05

which means that there is no significant effect

between the level of education with the behavior of

nurses not using PPE in Sembiring General Hospital.

The bivariate analysis shows in Table 7.

Table 7: Influence of education level with PPE usage

behaviour

Level off

education

Utilizing PPE

good

Not good

DIII

69,6

30,4

0,169

53,3

46,7

Total

61,5

38,5

The Table 7 shows that the results of the

analysis test found that the value of p = 0.474> 0.05,

which means that there is no significant effect

Analysis Factors of Nurse Behavior using Self-protective Equipment at Sembiring Hospital

405

between sex with the behavior of nurses not using

PPE in Sembiring General Hospital (Table 8).

Table 8: The effect of gender on PPE usage

behaviour.

Level of

education

Behavior PPE

Good

Not good

Male

53,8

46,2

0,474

Female

64,6

35,4

Total

61,5

38,5

The Table 8 shows that the results of the

analysis test found that the value of p = 0.009 <0.05

which means that there is a significant influence

between knowledge and behavior of nurses not using

PPE at the Sembiring General Hospital (Table 9).

Table 9: Effect of knowledge on PPE usage behaviour.

Knowledge

Behavior PPE

Good

Not good

Good

12,4

27,6

0,009

Not good

42,4

57,6

total

61,5

38,5

The Table 9 shows that the results of the

analysis test found that the value of p = 0.001 <0.05

which means that there is a significant influence

between attitude and behavior of nurses not using

PPE in Sembiring General Hospital (Table 10).

Table 10: Effect of attitude on PPE usage behaviour

Attitute

Behavior PPE

Good

Not good

Positive

72,7

27,3

0,001

Negative

32,0

68,0

Total

61,5

38,5

The Table 10 shows that the results of the

analysis test showed that the value of p = 0.072>

0.05, which means that there is no significant effect

between supervision with the behavior of nurses not

using PPE at the Sembiring General Hospital (Table

11).

Table 11: Effects of oversight with PPE usage behaviour.

Oversight

Use off PPE

𝜌

Good

Not good

good

72,7

27,3

0,072

Not good

32,0

68,0

total

61,5

38,5

The Table 11 shows that the analysis test

results show that the value of p = 0.124> 0.05 which

means that there is no significant effect between the

availability of PPE and the behavior of nurses not

using PPE in Sembiring General Hospital (Table

12).

Table 12: The influence of PPE availability with PPE

usage behaviour.

Avaibility

PPE

Use of PPE

𝜌

good

Not

good

Available

65,4

34,6

0,124

Not available

38,5

61,5

total

61,5

38,5

3.3 Multivariate Analysis

Multivariate analysis is used to explain the

independent variables that most influence the

dependent variable. In this study, the multivariate

analysis used was a logistic regression test.

On the table above, the logistic regression test

shows that the knowledge and attitude variables

have a p-value of less than 0.05 (p-value <0.05).

Multivariate analysis results can be concluded that

the variables of knowledge and attitudes have a

strong influence on the behavior of nurses not using

PPE. The analysis results obtained the largest value

of Exp (B) is attitude (5,780), meaning that attitude

is the most dominant variable influencing the

behavior of nurses not using PPE.The results of this

analysis can be seen from the Table 13:

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406

Table 13: Logistic regression analysis results

S.E

Wold

Sig

Exp

(B)

Knowladge

Attitude

Contents

1.293

.469

6.805

.009

3.645

1.754

.536

10.73

.001

5.780

-4.539

1.07

17.88

.000

.001

4 DISCUSSION

The results of the bivariate analysis using the

Chi-Square statistical test showed that statistically

there was no influence of the level of education on

thebehavior of nurses not using PPE in the inpatient

room of the Sembiring General Hospital. Of the 46

nurses with DIII education, who were not good in

using PPE as much as 30.4% then out of 45 nurses

with undergraduate education who did not use PPE

as much as 46.7% so that statistically did not have

too much difference between nurses and level DIII

and S1 education because some nurses are equally

less good at using PPE.

Then from the results of multivariate analysis,

for education level variables entered into the

candidate test variable for multivariate test because

the value of p <0.25, but did not enter the final

modeling stage of multivariate test with logistic

regression because the value of p> 0.05 so that the

level variable education does not affect the behavior

of nurses not using PPE in the inpatient ward of

Sembiring General Hospital. This is because there is

no significant difference in nurses with DIII

education level and S1 education level. Both of them

showed the behavior of not using good PPE. Based

on the results in the field, the research respondents

are almost balanced between the number of DIII and

S1 educators, so this difference in education level is

less able to describe the behavior of nurses.

The findings of the aforementioned studies

were in line with results of the present study.

Behavioral changes may be influenced by various

factors such as personal awareness and beliefs. In

other words, people’s awareness and beliefs have the

main role on improving health behaviors. The

findings of the present study indicated that the

theory-based training led to increase the mean score

of awareness and constructs of TPB framework in

the intervention group. The study of Navidian et al.

in Iran (2014) aimed to assess the impact of safety

education on knowledge, attitude, and the use of

PPE among workers employed in a glass industry.

They found that safety training through motivational

interview has resulted in significant difference in the

mean score of knowledge, attitude, and behavior of

using PPE in the intervention group compared to the

control (Navidian, 2017)

From the results of the bivariate analysis using

the Chi-Square statistical test showed statistically

that there was no gender effect on the behavior of

nurses not using PPE in the inpatient ward of

Sembiring General Hospital. Of the 27 nurses with

male sex, those who are not good in using PPE as

much as 37% then of 64 nurses with female sex who

are not good at using PPE as much as 39.1% so that

statistically does not have too much difference

between male nurses men and women because some

nurses are equally unfavorable in using PPE. Then

from the results of multivariate analysis, the sex

variable did not enter the candidate test variable for

the multivariate test because of the value of p> 0.25.

The absence of influence between sex on the

behavior of nurses not using PPE in the Sembiring

General Hospital in this study was because there

were no significant differences between nurses and

male and female genital sex. Some nurses, both

male, and female showed the same behavior as not

using a good PPE. Based on the results in the field,

the number of female respondents in the study was

very high, so the difference in the number of

samples that too far could not describe the nurses'

behavior.

Boys were at a significantly higher risk of

exposure compared to girls, and boys engaged more

frequently in risky behavior. Hearing and respiratory

protection was used minimally and sporadically.

Physical symptoms influenced use of hearing and

respirator use, as did physician recommendation to

use such protection. Of students who operated farm

tractors, only half most frequently operated tractors

with safety bars and seat belts. Sixty percent of the

students reported using equipment with damaged or

missing safety shields (Efstathiou, 2017)

From the results of the bivariate analysis using

the Chi-Square statistical test showed statistically

that there is an influence of knowledge on the

behavior of nurses not using PPE in the inpatient

room at Sembiring General Hospital. From 58

nurses with good knowledge, those who are not

good in using PPE are only 27.6%, then from 33

nurses with poor knowledge, the use of PPE is not

good, only 57.6%, so statistically it can be

Analysis Factors of Nurse Behavior using Self-protective Equipment at Sembiring Hospital

407

concluded statistically that most nurses with

knowledge not good enough to have poor PPE usage

behavior. Then from the results of multivariate

analysis, the knowledge variable entered into the

candidate test variable for the multivariate test

because the p-value <0.25, then entered the final

modeling stage of the multivariate test with logistic

regression because of the p-value <0.05.

The influence of knowledge on the behavior of

nurses not using PPE in this study is that the

majority of nurses have good knowledge. Of the

majority of nurses with good knowledge, almost all

of them use PPE well. Vice versa, nurses with poor

knowledge also almost all have behaviors that do not

use PPE properly.

From the results of the bivariate analysis using

the Chi-Square statistical test showed statistically

that there was an influence of attitudes on the

behavior of nurses not using PPE in the inpatient

room at the Sembiring General Hospital. Of the 66

nurses with a positive attitude, those who are not

good in using PPE are only 27.3% then out of 25

nurses with a negative attitude almost all nurses use

PPE that is not as good as 68.0% so that statistically

it can be concluded that the majority of nurses

negative attitude has the behavior of using PPE that

is also not good. Then from the results of

multivariate analysis, the attitude variable entered

into the candidate test variable for the multivariate

test because the p-value <0.25, then entered the final

modeling stage of the multivariate test with logistic

regression because of the p-value <0.05.

The influence of attitudes on the behavior of

nurses not using PPE in this study is that the results

obtained from all nurses who have negative attitudes

are almost all do not use PPE properly. Nurse's

attitudes related to the reaction or response of nurses

to the use of PPE. Although the average nurses in

this study stated that they agreed with the attitude to

use PPE, there were still some nurses who had a

negative attitude towards using PPE.

Regarding nurses' attitudes in carrying out their

work related to occupational safety and health,

efforts made by the hospital especially for hospitals,

namely before doing their work or hours of duty or

guarding nurses, nurses receive directives from both

the head nurse or the head of the room to work

carefully and optimally. Then also carried out

related information about OSH in the hospital that

the importance of good safety and work attitude in

the inpatient room (OHSA, 2017)

A recent survey has shown that organizational

factors including improved positive workplace

safety climate, reduced patient work load (i.e., fewer

number of patients per day), and fewer barriers to

using PPE play an important role relative to the use

of precautionary measures.

(28)

Similar findings were

reported in another survey where the likelihood of

chemotherapy drug exposure decreased when nurses

reported adequate staffing, resources, and favorable

working conditions (Fiese CR, 2018)

From the results of the bivariate analysis using

the Chi-Square statistical test showed statistically

that there was no influence between supervision on

the behavior of nurses not using PPE in the inpatient

ward of Sembiring General Hospital. From 53

nurses with good supervision, those who were not

good in using PPE were 47.2%, then from 38 nurses

with poor supervision, those who were not good in

using PPE were 26.3% so it can be concluded that

both nurses who received good supervision were

also partially large still does not use PPE properly.

Then from the results of multivariate analysis, for

the surveillance variable into the candidate test

variable for multivariate test because the p-value

<0.25, but does not enter the final modeling stage of

the multivariate test with logistic regression due to

the value of p> 0.05.

The absence of influence between supervision

on the behavior of nurses not using PPE in this study

is due to the results that the majority of nurses get

good supervision. Of the majority of nurses who get

good supervision, not all of them use PPE well.

Means it can be concluded that both nurses who get

good supervision also mostly still do not use their

PPE properly (Blais, 2016)

The purpose of the supervision for these

nurses, according to them, is to find out the extent of

the work done by the nurse, whether it is by

standards or work plans, whether resources have

been used by those set. If the supervision

management system in a hospital is optimal, this is

what makes them use PPE better.

From the results of the bivariate analysis using

the Chi-Square statistical test showed that there was

no statistically significant influence between the

availability of PPE on the behavior of nurses not

using PPE in the inpatient room at the Sembiring

General Hospital. Of the 78 nurses who stated that

PPE in Sembiring General Hospital was available,

only 13 nurses stated that PPE in Sembiring General

Hospital was available but even though the nurses

stated that PPE was available but most nurses still

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

408

did not use PPE well. Then from the results of

multivariate analysis, for the PPE availability

variable entered into the candidate test variable for

the multivariate test because the p-value <0.25, but

did not enter the final modeling stage of the

multivariate test with logistic regression because of

the value of p> 0.05. the influence between the

availability of PPE on the behavior of nurses not

using PPE in this study was due to the result that the

majority of nurses stated that PPE was available. Of

the majority of nurses who stated that PPE was

available, not all of them used PPE well. Means it

can be concluded that both the availability of PPE in

Sembiring General Hospital is complete even though

most still do not use PPE properly.

The inconvenience is due to the use of PPE

which is felt hot when using a mask because it is

seen as a hot workplace condition and is found in the

work area, especially in the production section.

Because of the inconvenience sometimes workers

choose to take it off not to wear it. Personal

protective equipment should be used in certain

circumstances in this case for workers because it is

indeed the use of PPE as a last resort to prevent

workplace accidents. Based on Green's theory that

something inherent in someone as a predisposing

factor in this case is the convenience of using PPE

can affect a person's behaviour ( JhonyKalasuat,

2019).

ICU HCWs report suboptimal levels of

influenza PPE adherence. This finding in a high-risk

setting is particularly concerning, given that it likely

overestimates actual behavior. Both suboptimal

adherence levels and significant PPE knowledge

gaps indicate that ICU HCWs may be at a

substantial risk of developing and/or transmitting

nosocomial respiratory viral infection. Improving

respiratory virus infection control will likely require

closing knowledge gaps and changing organizational

factors that influence behaviour (Daugherty, 2017).

Greater levels of management commitment to

safety and perceived risk were also related to lower

odds of adverse events. These results point to the

value of implementing a comprehensive health and

safety program that utilizes available hazard controls

and effectively communicates and demonstrates the

importance of safe handling practices. Such actions

also contribute to creating a positive safety climate

(DeJoy, 2017).

Findings from the present research regarding

management commitment towards PPE enforcement

is consistent with other research. Studies also

encourage supervision to ensure that PPE is

comfortable, and to always check, maintain, and

replace PPE to improve the practice of wearing PPE

[Tanko, 2017]. Research has also emphasized the

importance of enforcing employees to comply with

the use of PPE through disciplinary action,

incentives, and education [Stephenson, 2018].

5 CONCLUSIONS

Based on the results of the discussion in this

study that there is an influence between attitude and

knowledge on the behavior of not using PPE on

nurses because knowledge will provide

reinforcement to a nurse in every decision and

behavior. Nurses who have high knowledge will

generally be able to work according to standards.

Conversely, implementing officers who have low

knowledge will tend to work in a hurry. A good

attitude can be realized if it is based on

responsibility for everything that has been chosen by

the nurse with all the risks that exist when going to

do the work. Occupational accidents caused by

umans are greatly influenced by individual behavior

or attitudes at work.

ACKNOWLEDGEMETS

My deep thanks to DELI HUSADA Deli Tua Health

Institute for providing the opportunity for all

lecturers on this beloved campus to gain Knowledge

in Writing the Scientific Journal and provide new

Experiences in holding the International

Conferences. Hopefully with the implementation of

this activity in the future I can contribute to the

progress of DELI HUSADA Deli Tua Health

Institute.

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