C.U. Okeafor1 and F.E. Alamina2
Background: Psychosocial hazards pose a great threat to the mental health of health care workers. There is a dearth of research on this type of hazard in hospital settings in Nigeria.
Objective: This study aimed to assess the psychosocial hazards and the corresponding risks among health care workers in a tertiary health facility in Rivers State.
Methods: A cross sectional study was carried out in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria using qualitative method. Data on the psychosocial hazards were obtained from medical and surgical clinics, medical and surgical wards, theatre, laboratory, radiology and administrative sections of the hospital via key informant interviews. The risk assessment matrix was used to ascertain the risk scores and levels of identified hazards. The scores were summarized using medians and interquartile ranges and the differences in the median scores across the sections were compared using Kruskal Wallis statistics.
Results: A total of eighteen subjects were interviewed from the sections of the hospital. Work overload had the highest proportion of all the psychosocial hazards in the theatre (83%), radiology (71%), clinic (52%), ward (42%) and laboratory (38%). Other psychosocial hazards were poor interpersonal relationship, assault from patient relatives and job dissatisfaction/boredom. The differences in the median psychosocial hazard risk scores across the sections were not statistically significant (P=0.915).
Conclusion: This study showed that health care workers are exposed to psychosocial hazards in the workplace. Work policies targeted at addressing these hazards among this group of workers need to be implemented.
Keywords: Psychosocial, Hazards, Health care, Workers, Nigeria
Hospitals are places of treatment and healing for patients, however, they may present a significant number of hazards to the health care workers, which could negatively impact on their health and safety. Health care workers are exposed to one of the most hazardous occupational settings.1,2
Occupational hazards refer to workplace factors, which have a potential to cause harm, injury or ill health.2,3 These hazards could be physical, chemical, mechanical, biological or psychosocial.2,4 In recognition of occupational hazards among health care workers, the 2006 world health report of the World Health Organization (WHO) called for the support and the protection of the health work force.5 The report stated that the working condition of health workers contributes to work attrition in many countries due to work-related illness and injury.5 Noteworthy, the influence of work on health dates back to the late 18th Century, when Bernadino Ramazzinni identified the role of occupation in the dynamics of health and disease.6
Of the various types of hazards, psychosocial hazards impacts the most on the mental wellbeing of health care workers.5,6 Psychosocial hazards refer to those aspects of work design, work organization and management, including their social context, which have potential of inflicting psychological or physical harm.7 Work-related psychosocial hazards include interpersonal relationships at work, work overload, work stress, low job control, bullying, violence and poor organizational justice.2 Prolonged exposure to these psychosocial hazards is related to increased health problems, such as cardiovascular diseases8, and could also contribute to psychiatric disorders, including depression.9,10
Psychosocial hazards are thus associated with the experience of work-related stress. Work-related stress is common and the economic burden of this problem is quite huge. It has a high cost in terms of workers’ health, absenteeism and reduced job performance.11 Leka et al.12 noted that 6.5 million working days are lost each year in the United Kingdom due to workrelated stress. Also, nearly 28% of European workers reported that their mental well-being were hampered following exposure to psychosocial hazards.13 Noteworthy, 50-60% of all lost working days can be attributed to work-related stress and psychosocial risks.13
In spite of the increasing research on psychosocial aspects of work in high-income countries, a dearth of this problem exists in Africa and specifically, Nigeria.14 Hence, there is need to explore the psychosocial hazards among health care workers in low-income countries. Furthermore, this could serve as a basis for instituting occupational health and safety policy and programs tailored to health care workers. This study aimed to identify the psychosocial hazards and ascertain the risks among health care workers in a tertiary health facility in the south-south region of Nigeria.
MATERIALS AND METHODS
This study was carried out in the University of Port Harcourt Teaching Hospital (UPTH), a tertiary health facility located in Rivers State, South-South Nigeria. Although a tertiary health facility, it provides primary, secondary and tertiary health care to people in Rivers state and the neighbouring states. A cross-sectional study design using a qualitative approach was employed in the study. The study population comprised health care workers from the medical and surgical clinics, medical and surgical wards, theatre, laboratory, radiology and administrative sections of the hospital. Health care workers who had worked in these sections for at least five years and who served as the most senior available staff at the time of study constituted key informants.
Key Informant Interviews (KII) via a structured guide were used to obtain information on the psychosocial hazards and the risk related to the identified hazards. The risk related to each of the hazards was assessed using the Risk Assessment Matrix (RAM).15 The matrix comprised likelihood of exposure to the hazard, consequence, risk ranking and risk level of the identified hazards. The likelihood (L) of exposure for each hazard was graded on a 1-5 scale representing Rare, Unlikely, Possible, Likely and Very Likely. The consequence (C) of each exposure was also graded on a scale of 1-5 representing: Insignificant, Minor, Moderate, Major and Extreme. The Risk Ranking scores (rated on scale 1-25) were obtained from the product of the likelihood of exposure and consequence of exposure (L x C). Risk levels were obtained from the risk ranking scores and classified as Low (score of 1-3), Moderate (score of 4-6), High (score of 8-12) or Extreme (score of 15-25). The matrix is represented in Figure 1.
Data obtained from interviews were analyzed via thematic analysis. The identified themes constituted the psychosocial hazards reported. The risk scores and levels for each of the identified hazards were generated based on the RAM. The risk ranking scores were summed and proportions calculated for each of the identified hazard. The distribution of the identified psychosocial hazards was presented in tabular form. The risk levels of the identified psychosocial hazards were highlighted using the colour-coded matrix.