http://doi.org/10.33698/NRF0135 – Amarjit Kaur,Tashi Lamo, Bindu Mol Jacob, Jasbir Kaur
Abstract : The danger posed by emerging infectious diseases has resulted in significant stress and concerns amongst nursing personnel. There is scant data on concerns regarding swine flu outbreak among nurses working in a tertiary care hospital. Therefore, a descriptive study was undertaken on work related and non-work related concerns associated with swine flu outbreak amongst nursing personnel in selected wards of Nehru Hospital, PGIMER, Chandigarh. The sample size comprised of 100 nursing personnel. A questionnaire was administered to assess concerns. Results revealed that the nursing personnel perceived a great risk of personal exposure to the swine flu virus from their job (76%) and feared falling ill with the disease (66%). Majority of subjects (95%) were confident that their employer would look after their needs if they develop swine flu. A greater proportion (79%) of nurses accepted that the risk is part of their job. Health care institutions need to put these psychological concerns on the agenda and provide effective interventions and greater support for nursing personnel and their families in such future crisis.
Key words :
Concerns, Swine Flu, Nursing Personnel
Correspondence at :
Bindu Mol Jacob
Sistergrade – II
Nehru Hospital, PGIMER, Chandigarh.
Introduction
The novel influenza A (H1N1) virus was first identified in Mexico in April, 20091. On 11 June 2009, the World Health Organization (WHO) declared the occurrence of an influenza pandemic2. Since the emergence of the novel influenza A (H1N1) virus in April 2009, the virus has affected more than 213 countries, with at least 17,700 deaths3. Soon after the outbreak of H1N1 virus in the United States and Mexico in April 2009, the Government of India star ted screening people from the affected countries at airpor ts for swine flu symptoms. The first case of flu in India was found on the Hyderabad airport on 13 May 2009, when a man traveling from U.S. to India was found H1N1 positive. As of 24 May, 2010, 10193 cases of swine flu have been confirmed with 1035 deaths4.
The first case of Swine Flu (positive) was reported in the Emergency OPD of Nehru Hospital, PGIMER, Chandigarh, on 17th July, 2009. Nehru Hospital is a referral hospital with the sanctioned bed capacity of 1740 besides 171 under observation beds. Patients are received at the Emergency OPD/New OPD. After screening, swine flue patients were isolated and kept in a separate area. Waiting room in the Emergency OPD was converted to special ward temporarily to accommodate concerned patients. Later as per availability of the beds patients was transferred to various wards like Communicable Disease Ward, Respiratory Intensive Care Unit, Medical Wards and Children Ward. During the period of July, 2009 to September, 2010, we received 142 positive patients of Swine Flu. Out of these 67 (47%) expired.
Emerging infectious diseases have been described as a “clear and present danger to humanity5.” In an infectious outbreak, health care workers are more likely to be on physical and emotional over drive because of an overstretched health care system. It has been well documented that health care workers (HCW) suffered from significant stress during the SARS outbreak2.
There is scant data on concerns regarding swine flu outbreak amongst nursing personnel working in a tertiary care hospital. Since nurses are at the forefront to provide health care services, they are at risk during infectious disease outbreaks. With the occurrence of swine flu pandemic, we decided to study the work related and non-work related concerns amongst nursing personnel working in a 1600 bedded ter tiary care hospital of North India.
Materials and Methods
A descriptive research approach has been adopted in this study to assess concerns amongst nursing personnel during swine flu outbreak. This study was conducted in selected wards of Nehru Hospital. To assess their concerns, a questionnaire was administered to the subjects. Content validity of the tool was established by obtaining valuable opinion and suggestions from experts in the field of tropical medicine, internal medicine and department of nursing. Participation of the subjects was voluntary. Sample size was 100.
The questionnaire included items about concerns regarding swine flu that were work related (8 items) and non-work related (4 items) and perceived impact of swine flu on personal life and work (7 items). These items were measured on a 6 point Likert Scale for responses (strongly disagrees, disagree, not sure but probably disagree, not sure but probably agree, agree, and strongly agree). During statistical analyses, we dichotomized this scale into positive response (strongly agree, agree, and probably agree) and negative response (strongly disagree, disagree, and probably disagree). Collected data has been analyzed by using descriptive statistics. Percentage, mean and standard deviation were used for describing the socio- demographic distribution of subjects.
Results
Socio – demographic characteristics of the subjects
The mean age of subjects was 34.4 + 9.95 years. 49% subjects were of the age group between 21-30 years followed by 24% in the age group of 31-40 years. Females formed the majority (87%). Majority of the subjects (81%) were Sister Grade-II nursing officials. Out of total subjects 72% were diploma holders while 27% were graduates in nursing and only one subject (1%) was postgraduate in nursing.
Work related concerns (Table-1) Majority (76%) of the subjects felt that their jobs put them at great risk of exposure to swine flu. A total of 66% subjects felt afraid of falling ill with swine flu. Only 6% subjects felt that they should not be looking after swine flu patients. More nursing personnel (79%) accepted that the risk is part of their job. Only 7% respondents reported that they might look for another job or consider resigning because of the risk of contracting swine flu. About 10% subjects felt that they would consider it acceptable if their colleagues resign because of their risk of contracting swine flu. Majority of subjects (95%) were confident that their employer would look after their needs if they develop swine flu.
Table-1: Work related concerns of nursing personnel regarding swine flu pandemic.
| Sr. No. | Concerns regarding swine flu pandemic | Agree | Disagree |
| % | % | ||
| 1 | My job would put me at great exposure risk | 76 | 24 |
| 2 | I am afraid of falling ill with swine flu | 66 | 34 |
| 3 | I should not be looking after swine flu patients | 06 | 94 |
| 4 | Accept that risk is part of job | 79 | 21 |
| 5 | Might look for another job because of risk | 07 | 93 |
| 6 | Risk is not acceptable | 21 | 79 |
| 7 | Acceptable if colleagues resign because of their fear. | 10 | 90 |
| 8 | Confident that the employer would look after my needs if I fall ill with swine flu | 95 | 05 |
Non-work related concerns
Almost more than half of the subjects (65%) were worried that people close to them would be at high risk due to their occupation. Majority (92%) of the subjects felt that people close to them would be worried for their health. A higher proportion of subjects (80%) felt that people close to them would be worried about getting infected by them. (Table- 2)
Perceived impact on personal life and work In the event of a widespread swine flu outbreak, a higher propor tion of nurses reported that they would not be afraid of informing their family about their exposure risk (74%) and would not avoid telling others about the nature of their work (90%). A total of 68% subjects also reported that people would not avoid them and their family members (84%) because of their occupation. (Table-3)
Table-2: Non-work related concerns of nursing personnel regarding swine flu pandemic.
| Sr. No. | Concerns regarding swine flu pandemic | Agree | Disagree |
| 1. | People close to me would be at high risk of getting swine flu because of my job. | 65 | 35 |
| 2. | I would be most concerned for my: | ||
| a. Spouse/partner. | 80 | 06 | |
| b. Parents. | 78 | 22 | |
| c. Children. | 74 | 26 | |
| d. Close friends. | 81 | 19 | |
| e. Work Colleagues. | 86 | 14 | |
| f. Others | 67 | 33 | |
| 3. | People close to me would be worried for my health. | 92 | 08 |
| 4. | People close to me would be worried as they may get infected by me. | 80 | 20 |
Table-3 : Nursing personnel perceived impact regarding swine flu pandemic on personal life and work
| S. No. | Perceived Impact Regarding Swine Flu Pandemic on Personal Life and Work | Agree | Disagree |
| % | % | ||
| 1 | I would be afraid of telling my family about the risk I am exposed to | 26 | 74 |
| 2 | People would avoid me because of my job | 32 | 68 |
| 3 | People would avoid my family members because of my job | 16 | 84 |
| 4 | I would avoid telling other people about the nature of my job | 10 | 90 |
| 5 | There would be adequate staff at my workplace to handle the increased demand | 76 | 24 |
| 6 | There would be more conflict amongst colleagues at work | 27 | 73 |
| 7 | I would have an increase in workload | 71 | 29 |
At work, 76% nursing personnel felt that there would be adequate staff to handle any increase in demand and 73% subjects reported that there would be less conflict amongst colleagues at work and 71% subjects agreed that they would have an increase in work load.
Discussion
The present study revealed that the mean age of subjects was 34.43 + 9.95 year. Cheong et al also reported similar findings in their study in which mean age of the subjects was 31.3 year + 10.7 year and female formed the majority2. The nursing personnel perceived a great risk of personal exposure to the swine flu virus from their job (76%) and feared falling ill with the disease (66%). This is consistent with a study on public health workers, where Balicer et al found that 66% of the respondents perceived themselves to be at personal risk when per forming their duties during an influenza pandemic6. The vast majority (93%) of the respondents would not think about leaving their job because of the risk involved. This is similar to a study which found that majority of health care workers would not consider leaving their job and would continue to look after patients during an Avian Influenza outbreak2.
A greater propor tion (93%) of respondents felt that they might not look for another job because of the risk involved. This finding is in agreement with Wong TY et al, who repor ted that majority felt that they should continue their job despite the risk involved during an Avian Influenza pandemic2. The current study revealed that only 10% of our respondents felt it acceptable if their colleagues resigned out of fear of contracting swine flu. This finding is inconsistent with a study, which repor ted that half of their respondents felt it acceptable if their colleagues resigned out of fear2.
Most of the nursing personnel (95%) were confident that their employer will look after their needs if they fall sick with swine flu. This is consistent with a study which found that most HCWs (88.5%) were confident that their employer will look after their needs if they fell ill with Avian Influenza2. In the current study 74% respondents agreed that they would not be afraid of telling their family about the risk of exposure. This is in disagreement with findings of Chery etal, who reported that health workers were more likely to fear telling their family about the risk of exposure. 68% respondents felt that people would not avoid them or their family members due to their job whereas the other study revealed inconsistent findings in which majority (75%) felt afraid of telling their family about the risk of exposure. 90% subjects agreed that they would not avoid telling other people about the nature of their job which is in disagreement with other studies.
A higher percentage (76%) nurses felt that there would be adequate staff at the workplace to handle the increased demand. This finding is in agreement with Cheong et al. 27% subjects felt that there would be more conflict among colleagues at work which is in disagreement with other studies which reported that there would be more conflict amongst colleagues at work 71% respondents felt that there would be an increase in workload which is in agreement with other studies.
This study shows that the majority of nursing personnel have significant concerns such as great personal risk of exposure to the swine flu virus from their job and falling ill with the disease. Health care institutions need to put these psychological concerns on the agenda and provide effective interventions and greater support for nursing personnel and their families in such future crises.
References
- Torres JP, Ryan OM, Herve B et Impact of the Novel Influenza A (H1N1) during the 2009 Autumn-winter season in a Large Hospital setting in Santiago, Chile. Clinical infectious diseases 2010; 50: 860-867.
- heong KS, Wong YT, Lee YH et al. Concerns and preparedness for an Avian Influenza pandemic: A comparison between community Hospital and Tertiary Hospital Health Care Workers. Industrial Health 2007; 45: 653-
- Hung IFN, Kelvin KW et Effect of clinical and virological parameters on the level of Neutralizing Antibody against Pandemic Influenza A Virus H1N1 2009; CID 2010; 51: 274- 279.
- 2009 Flu Pandemic in India http:// wikipedia. Org1wiki1 2009_ Flu_ pandemic_in_India.
- Beigel JH. Toward Better Clinical data in emerging infectious diseases CID 2009; 48: 1647-
- Balicer R, Omer S et al. Local Public Health Worker’s perceptions toward responding to an influenza pandemic. BMC Public Health 6,
- 99. http://www.biomedcentral.com/1471 -2458/ 6/99. Accessed September 24, 2010.