Professional Documents
Culture Documents
ScholarWorks@GVSU
Masters Theses
1994
Jill Slagal
Grand Valley State University
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c_
CHAIR;/ JANE TOOT, Ph.D., P.T.
J> -
'
.<
MEMBER:!
MEMBER:
The
ACKNOWLEDGEMENTS
We would like to thank Dr. William Bell for all his help in
designing and formatting the questionnaire.
We also thank
Dr. Jane Toot and Dr. Lucille Grimm for their input and
suggestions regarding this thesis.
Finally, we thank
11
TABLE OF CONTENTS
Page
ABSTRACT .............................................
ACKNOWLEDGEMENTS
. . . . .
ii
LIST OF T A B L E S ...........................
CHAPTER
1.
2.
INTRODUCTION
..............................
1
2
2
.............
...........
4
4
5
7
9
.........
M E T H O D O L O G Y .........................
12
13
19
12
R E S U L T S ................................. ...
Knowledge of Universal Precautions. . . .
Benefits of Universal Precautions . . . .
S u s c e p t i b i l i t y ..........
S e v e r i t y ........................
30
19
20
22
23
26
26
27
28
CHAPTER
Page
B a r r i e r s ................................
Hepatitis BVaccination ..................
M o t i v a t o r s ..............................
31
32
35
D I S C U S S I O N ................................
37
D i s c u s s i o n ..............................
Conclusions of the Health Belief Model
.
Limitations andStrengths ................
Implications..............................
Recommendations .........................
C o n c l u s i o n ..............................
37
40
42
44
45
46
R E F E R E N C E S ...........................................
48
APPENDIX A
53
APPENDIX B
56
APPENDIX C
60
APPENDIX D
63
APPENDIX E
5.
............
65
LIST OF TABLES
Table
Page
1.
23
2.
24
25
27
27
3.
4.
5.
6.
Response
28
7.
Response
to Perceived Susceptibility . . . .
29
8.
Response
to Perceived Severity
...........
31
9.
Response
32
10.
11.
12.
33
34
35
Chapter I
INTRODUCTION
In 1992, the Michigan Department of Public Health
Division of Disease Control reported 14,957 cases of
hepatitis B virus (HBV) infection in the United States
(MDPH, 1992).
(Fleming, 1991).
(Fleming, 1991).
The
Five to six
The
Analyzing
Chapter II
Review of Literature
Documentation regarding the hepatitis B virus (HBV) has
dated back to the 1800's .
It has
Age
The HBV-DNA
The most
This is a
This
The
This antibody is
1989).
Additional routes of
Viral
interpersonal contact,
1992).
birthing process.
literature.
Several events must occur once a person has come in
contact with the HBV for he or she to become infected.
First, the virus must enter the blood stream in order to get
to the liver.
However,
it is felt that
This
decreases with age until the age of five when the risk is at
30%.
There is a wide
The
This phase is
Twenty to
completely resolved their HBV infection, anti-HBs and antiHBc persists as evidence of previous infection (Hoilinger &
Lienstag, 1985).
1989).
These
It is estimated that
10
These
It was
The
Though an
Education
11
12
shown that only 52% of the health care workers knew that the
vaccine was available (McKenzie, 1992).
It is clear that
Hospitals need
1992).
Several
Health
13
(2) Perceived seriousness (severity) describes the
amount of threat associated with the disease or
condition.
(3) Perceived benefits refers to the effectiveness of
a specific behavior in reducing the threat of the
condition.
(4) Perceived barriers are the negative components of
the anticipated behavior.
Kasl and Cobb (19 66) viewed the HBM from a
sociopsychological perspective. They began their study with
the following three definitions:
(1) Health behavior - any activity undertaken by an
individual believing himself to be healthy for the
purpose of preventing disease or detecting it in an
asymptomatic stage.
(2) Illness behavior - any activity undertaken by an
individual who feels ill to define the state of his
health and to discover a suitable remedy.
This
14
Kasl and
The
15
in free health examinations. The results indicated that high
participation rates were more likely to occur in noncaucasians, young, or middle-aged individuals with
residential stability and a history of utilization of
medical services.
16
employees.
Conclusions
The
The more
17
In contrast, Kasl and Cobb (1966) concluded that
acceptance of free influenza immunizations among an
industrial population was not linked to differences in age,
sex, job classification, or union status.
Among this
population, results showed that overall one-half to twothirds of the individuals received the immunization.
Upon
Health motivation
In general, behavior is
The
18
Chapter III
Methodology
This research design was a descriptive study utilizing
the survey method.
In
that had less than 200 beds and those considered specialty
hospitals.
An
20
All hospitals
The revised
Written
21
perceived susceptibility for contracting the HBV.
Five
There
Two questions
The needed
22
One
23
second mailing as no questionnaires from those hospitals
were returned.
The majority
As the
Age Group
20 - 30 years old
52
47.7
3 1 - 4 0 years old
35
32.1
41 - 50 years old
18
16.5
51 - 60 years old
3.7
24
The results
Years Worked
2 years or less
19
17.4
3 -5 years
32
29.4
6-10 years
23
21.1
+10 years
35
32.1
25
Table 3
Respondents bv Patient Population Primarily Treated
Population
86
78.9
acute amputee
46
42.2
wound care
59
54.1
orthopedic non-surgical
59
54.1
neurological
74
67.9
pediatric
29
26.6
geriatric
74
67.9
Data Analysis:
Chapter IV
RESULTS
survey questionnaire.
26
27
Table 4
Response to Awareness of Universal Precautions
Item
% yes
% no
100
Table 5
Response to Knowledge of Universal Precautions
Item
% agree
I am very familiar
with the contents
of the UP policy
% neither agree
nor disagree
% disagree
4.2
3.3
92.5
The
Not all
28
Table 6
Response to Perceived Benefits
Item
% agree
% neither agree
nor disagree
% disagree
5.9
89.8
4.2
Following the
UP Policy would
significantly decrease
the chances of my
contracting a hospitalacquired infection
93.3
6.7
Following the UP
Policy would
significantly decrease
the chance of my
contracting hepatitis B
93.3
1.7
5.0
29
Table 7
Response to Perceived Susceptibility
Item
% agree
% neither agree
nor disagree
% disagree
I have extensive
contact with
patients who have
disease/infections
transmitted by the
blood-borne route
43.4
21.3
35.2
46.7
20.5
32.8
35.5
19.0
45.5
I am the kind of
person who gets sick
often
12.4
9.0
78.5
I am the kind of
person who is likely
to get hepatitis B
32.8
34.5
32.8
In general, I am not
as likely to get as
sick as most of my
co-workers or friends
43.1
31.0
25.9
My chances of getting
hepatitis B sometime
in my career are high
15.1
21.0
63.9
Working in a physical
therapy department
decreases my chance
getting hepatitis B
6.7
20.2
73.1
30
From this table it can be concluded that most of the
respondents (78.5%) do not feel they get sick often.
The
The
Five questions
31
Table 8
Response to Perceived Severity
Item
% agree
% neither agree
nor disagree
% disagree
If I had hepatitis
B my future would be
ruined
32.5
25.6
41.9
13.1
20.5
66.4
If I had hepatitis B
I could still live a
normal life with
proper treatment
53.7
28.9
17.4
If I got hepatitis B
my present and future
sexual relations would
be destroyed
25.6
27.3
47.1
3.3
15.6
81.1
If I had hepatitis B
I would probably die
soon
32
Table 9
ResDonse to Perceived Barriers
% agree
Item
% neither agree
nor disagree
% disagree
Sometimes I am too
busy to carry out
the UP Policy in
cases where I should
22.5
2.5
75.0
Sometimes I forget
to carry out the UP
Policy where I
should
22.5
.8
76.7
This
33
Table 10
Response for Hepatitis B Vaccination Series
Item
% yes
% no
84 .3
15.7
34
Table 11
Response to Reasons for Not Receiving Vaccination
% yes
% no
36.8
63.2
Newness of vaccine
10.5
89.5
15.8
84.2
36.8
63.2
26.3
73.7
100.0
15.8
84.2
Hepatitis B is not a
serious disease
100.0
100.0
Cost to employee
100.0
21.0
78.9
Vaccine administration
inconvenient
21.0
78.9
No one recommended it
to me
5.3
94.7
Friend recommended
against it
5.3
94.7
11.8
88.2
Item
35
This table reported that there were many reasons the
nineteen respondents chose not to be vaccinated.
The two
Avoidance of
Table 12
Statements
% occurrence
Easier access
32.9%
Posted Reminders of UP
15.4%
9.9%
Periodic review of UP
8.8%
Education/Inservice
8.8%
36
9.9%, respectively.
In the next chapter, these results will be discussed as
well as implications and recommendations for future
research.
Chapter V
DISCUSSION AND IMPLICATIONS
Discussion
This study was designed to determine whether physical
therapists' perceived risk for contracting hepatitis B had a
significant effect on the acceptance or rejection of the
hepatitis B vaccine.
Responses to the
In
A possible
37
38
in a physical therapy department as compared with other
areas of the hospital decreases my chances of getting
hepatitis B."
A possible reason why the respondents did not consider
themselves a high risk group may be related to the
demographic data.
Acute
noted when compared with Merck, Sharp, and Dohme who found
39
in 1990 that only 30-40% of high risk health care workers
received the hepatitis B vaccine (Christian, 1990).
Similarly, Christian's study (1990) discovered that 46.6% of
all hospital employees received the vaccine.
This study explored the primary reasons for not
accepting the hepatitis B vaccine.
Concerns of pregnancy or
breast feeding and concern of side effects were the two most
commonly cited reasons.
In comparison, Christian's
It would
40
In
This may be
This
The decreasing
41
An increasing
Again, a
(1990).
Education and
42
Motivation;
It
43
transmission and contractility of the virus may lead to
insight regarding reasons for acceptance or rejection of the
vaccine.
It is impossible to
By utilizing
44
perceptions was facilitated.
further clarification.
45
The Health Belief Model asserts that if the benefits of a
health care behavior, such as receiving the vaccine,
outweigh the perceived risk of the behavior, such as side
effects and pain and discomfort, than the person is more
likely to exhibit that behavior.
Therefore, education
Health care
Therefore, stricter
Since this
46
spectrum of health professionals be surveyed.
Sampling in
Surveying of various
is also indicated.
appendix E) is warranted.
Conclusions
The results of this investigation reported that 100% of
the respondents were aware of the hospital's Universal
Precautions policies, with 92.5% agreeing that they were
very familiar with the contents.
47
knowledge of the Universal Precautions policy was discovered
when compared with previous research by Ham (1992).
However, 22.5% of the respondents agreed that they do not
always carry out the Universal Precautions policy in cases
where they should.
Again, an
Actions to increase
References
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W. T., Watson, W. T., Tauticharoenyos, P., Karwacki, J.
J . , & Srimarut, S. (1977). Transmission of hepatitis B
virus to gibbons by exposure to human salvia containing
hepatitis B surface antigen. Journal of Infectious
Disease. 135. 78-85.
Baraff, L. J . , & Talan, D. A. (1989). Compliance with
universal precautions in a university hospital
emergency department. Annals of Emeraencv Medicine. 1 8 .
654657.
Becker, M. H . , Drachman, R. H . , & Kirscht, J. P. (1972).
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Becker, M. H . , Janz, N. K . , Band, J., Bartly, J., Snyder, M.
B . , & Gaynes, R. P. (1990). Noncompliance with
universal precautions policy:
Why do physicians and
nurses recap needles? American Journal of Infection
Control. 1 8 . 232-239.
Beasley, R. P., Trepo, C . , Stevens, C. E . , & Szmuness, W.
(1977). The e antigen in vertical transmission of
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Epidemiology. 1 05. 94-98.
Centers for Disease Control (1987a). Recommendations for
prevention of HIV transmission in health-care settings
(Supplement no. 2s). Morbiditv and Mortalitv Weeklv
Report. 3 6 . ls-18s.
Centers for Disease Control (1985). Recommendations for the
prevention of viral hepatitis. Morbiditv and Mortalitv
Weeklv Report. 3 6 . 313-324, 329-335.
Centers for Disease Control (1988). Update:
Universal
precautions for prevention of transmission of human
immunodeficiency virus, hepatitis b virus, and other
blood-borne pathogens in health-care settings.
Morbiditv and Mortalitv Weeklv Report. 37, 377-387.
Centers for Disease Control (1989). Guidelines for
prevention of transmission of human immunodeficiency
virus and hepatitis b virus to health-care and public
safety workers (Supplement no. S-6). Morbidity and
Mortalitv Weeklv Report. 38, 423-434.
Champion, V. L. (1984), Instrument development for health
belief model constructs. Advances in Nursing Science.
73-85.
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49
Christian, M. A. (1991). Influenza and hepatitis b vaccine
acceptance: A survey of health care workers. American
Journal of Infection Control. 19(4), 177-184.
Coastal Healthcare (1992) . Bloodborne pathogens. Virginia
Beach, VA: Coastal Video Communications Corp.
Damrosch, S., Abbey, S., Warner, A., & Guy, S. (1990).
Critical care nurses' attitudes toward, concerns about,
and knowledge of the acquired immunodeficiency
syndrome. Heart and Luna. 19, 395-400.
Fleming, S. H. (1991). Occupational safety and health
administration newsletter. News United States Department
of Labor.
Francis, D. P., Haider, S. C . , Prendergast, T. J . , Peterson,
E . , Ginsberg, M. M . , Lookabaugh, C., Holmes, J. R., &
Maynard, J. E. (1984). Occurence of hepatitis A, B, and
non-A, non-B in the United States: CDC sentinel county
study I. American Journal of Medicine. 7 6 . 69-74.
Gerberding, J. L . , Bryant-Leblanc, C. E . , Nelson, K . , Moss,
A. R . , Osmond, D . , Chambers, H. F . , Carlson, J. R . ,
Drew, W. L . , Levy, J. A., & Sande, M. A. (1987). Risk
of transmitting the immunodeficiency virus,
cytomegalovirus, and hepatitis b virus to health care
workers exposed to patients with AIDS and AIDS related
conditions. The Journal Of Infectious Diseases. 1 5 6 (1),
1-8.
Gerber, M. A., & Thung, S. N. (1981). Pathology of hepatitis
B virus. Pathobioloav Annual. 11, 197-288.
Hadler, S. C . ,
A. S. Evans
Epidemiology
York: Plenum
In
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Hoilinger, F. B . , & Dienstag, J. L. (1985). Hepatitis virus.
In E. H. Lenette, A. Balows, W. H. Hausler, Jr., & H. J.
Shadomy (Eds.), Manual of Clinical Microbiology (4th ed.)
(pp. 813-835). Washington D. C . : American Society of
Microbiology.
Hospitals, U.S./Michigan (1992). AHA Guide to Hospitals.
Jenison, S. A., Lemon, S. M . , Baker, L. N . , & Newbold, J. E.
(1987) Quanlitative analysis of hepatitis B virus DNA in
saliva and semen of chronically infected homosexual men.
Journal of Infectious Disease. 156. 299-307.
Kasl, S. V., & Cobb, S. (1966). Health behavior, illness
behavior and sick role behavior. Archives of
Environmental Health. 12, 246-262.
Kegeles, S. (1963). Why people seek dental care; A test of a
conceptual formulation. Journal of Health and Human
Behavior.
166-173.
Krauss, J. (1992). Public Policy:
Testing of health care
workers. Journal of Professional Nursing. 18(2), 70.
McKenzie, C. (1992). Hepatitis b vaccination. AAOHN Journal.
40, 517-520.
McManhon, B. L . , Alward, W. L. M . , Hall, D. B . , Heyward, W.
L. , Bender, T. R . , Krantz, T. P., & Maynard, J. E.
(1985). Acute hepatitis B infection: Relation of age to
the clinical expression of disease and subsequent
development of the carrier state. Journal of Infectious
Disease. 151. 599-603.
Michigan Department of Public Health, Division of Disease
Control (MDPH) (1993). Reported Cases of All Reportable
Diseases. Lansing, MI: Division of Disease Control.
Michigan Department of Public Health (MDPH) (1992). Summary
of Selected Diseases U.S. Morbiditv. Lansing, MI:
Division of Disease Control.
Moore, R. M . , Kaczmarek, R. G. (1990). Occupational hazards
to health care workers: Ill-defined, and not fully
appreciated, American Journal of Infection Control.
18(5), 316-327.
Mullan, E. L . , Baker, C. H . , & Brennan, J. M. (1984).
Special report:
Keeping health-care workers healthy,
legal aspects of hepatitis b immunization programs.
The New England Journal of Medicine. 311. 684-688.
51
APPENDIX A
UNIVERSAL PRECAUTIONS
53
54
Universal Precautions
Universal Precautions should be used in the care of all
patients in which the risk of blood exposure is increased
and the infection status of the patient is unknown.
All
Hands
Hand
fluids is likely.
5.
55
7.
APPENDIX B
PERMISSION TO USE QUESTIONAIRRE
56
x^^GRAND
'^SWE
UNIVERSITY
April 22,
1993
To:
Whom It May Concern
From:
Jane Toot, PhD., FT
Director, Department of Physical Therapy
Grand Valley State University
Re:
Research Study
Two students, Jill Richards and Patricia Rohrs, in our
entry-level masters program plan to conduct a study
investigating the perceptions and knowledge which physical
therapists demonstrate regarding issues surrounding hepatitis
B.
It is their plan to utilize a questionnaire originally
developed by Dr. Marshall Becker, PhD and later revised by
Rosemary Ham M.S.N.
This questionnaire will be used in
combination with one developed by Margaret Christian, RN,
M.A.
I am the chair of the faculty committee and will be
joined by William Bell, PhD. and Lucille Grimm, B.S.N., EdD.
The nature of this study has been reviewed by the committee.
The use of the questionnaire is believed to be appropriate
for the study.
Your permission to utilize would be deeply
appreciated.
The proposal will be reviewed by the
Institutional Review Board of Grand Valley State University.
Should have you have any questions please feel free to
call me at 615-895-3356 or to contact one of the
investigators.
j'e I
Date
Pr
'J
/^.GRAND
miLEY
SW E
UNIVERSITY.
1 CAM PUS DRIVE ALLENDALE MICHIGAN 49401-9403 616/895-6611
April 22,
1993
To:
Whom It May Concern , ____
From:
Jane Toot, PhD., FT
Director, Department of Physical Therapy
Grand Valley State University
Re:
Research Study
Two students, Jill Richards and Patricia Rohrs, in our
entry-level masters program plan to conduct a study
investigating the perceptions and knowledge which physical
therapists demonstrate regarding issues surrounding hepatitis
B.
It is their plan to utilize a questionnaire originally
developed by Dr. Marshall Becker, PhD and later revised by
Rosemary Ham M.S.N.
This questionnaire will be used in
combination with one developed by Margaret Christian, RN,
M.A.
I am the chair of the faculty committee and will be
joined by William Bell, PhD. and Lucille Grimm, B.S.N., EdD.
The nature of this study has been reviewed by the committee.
The use of the questionnaire is believed to be appropriate
for the study.
Your permission to utilize would be deeply
appreciated.
The proposal will be reviewed by the
Institutional Review Board of Grand Valley State University.
Should have you have any questions please feel free to
call me at 516-895-3356 or to contact one of the
investigators.
Date
S j!!!
VALLEY
STATE
1 CAM PUS DRIVE ALLENDALE MICHIGAN 49401-9403 616/895-6611
April 22,
1993
To:
Whom It May Concern
From:
Jane Toot, PhD., FT
Director, Department of Physical Therapy
Grand Valley State University
Re;
Research Study
Two students, Jill Richards and Patricia Rohrs, in our
entry-level masters program plan to conduct a study
investigating the perceptions and knowledge which physical
therapists demonstrate regarding issues surrounding hepatitis
B.
It is their plan to utilize a questionnaire originally
developed by Dr. Marshall Becker, PhD and later revised by
Rosemary Ham M.S.N.
This questionnaire will be used in
combination with one developed by Margaret Christian, RN,
M.A.
I am the chair of the faculty committee and will be
joined by William Bell, PhD. and Lucille Grimm, B.S.N., EdD.
The nature of this study has been reviewed by the committee.
The use of the questionnaire is believed to be appropriate
for the study.
Your permission to utilize would be deeply
appreciated.
The proposal will be reviewed by the
Institutional Review Board of Grand Valley State University.
Should have you have any questions please feel free to
call me at 616-895-3355 or to contact one of the
investigators.
yi-T/
' 9Jo
APPENDIX C
LETTERS TO PHYSICAL THERAPY
DEPARTMENT SUPERVISORS
60
Facility:
Number of inpatient physical therapists:
APPENDIX D
INFECTION CONTROL SURVEY
COVER LETTER
63
APPENDIX E
INFECTION CONTROL SURVEY
65
Hepatitis B Survey 1
P lease in d ic a te y o u r level o f agreem en t o r disagreem ent w ith th e following
s ta te m e n ts by placing a circle a ro u n d the a p p ro p ria te num ber.
Strongly
A gree
1
S trongly
D isagree
1.
2.
3.
4.
5.
6.
7.
8.
9.
Yes
6 7
No
Strongly
Agree
Strongly
Disagree
12.
13.
19.
21.
Yes
No
22.
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
Other (w rite in ):
23.
24.
What type o f patient population do you primarily w ork with (Check all that
apply)
(
(
(
(
(
(
(
25.
I am;
(
(
(
(
(
26.
)
)
)
)
)
)
)
)
)
)
)
)
20-30
31-40
41-50
51-60
61 +
years
years
years
years
years
o f age
o f age
o f age
o f age
o f age
( ) 2 years or less
( ) 3 years to 5 years
( ) 6 to 10 years
( ) M ore than 10 years
1 This form Is used with the permission of Marshall Becker, Ph. D.,
Rosemary Ham, RN. M.S.N., and Margaret Christian, RN, M.A.