Professional risks in the activities of nurses. on the example of 3rd clinics Tashkent medical academy

Nursing is an independent profession that is on a par with medical practice, and the functions of a nurse are much broader than simply performing doctor's appointments. To meet modern requirements, a nurse should know, in addition to health standards and the basics of nursing care, the characteristics of the patient, organize social and psychological assistance. Neglect nursing at the moment leads to a significant gap in this area of healthcare from the development of modern science and medical technology and is the cause of the elimination from the profession of a qualified nursing staff, increasing imbalance in the ratio between doctors and nurses, and as a result, deterioration of the quality of medical care provided. The problem of studying the work of medical personnel is relevant in modern conditions. The labor activity of nurses is associated with conditions in which there is a huge number of negative impacts, such as interaction with drugs, high physical activity, psychoemotional loads, and others. Constant interaction with risk factors in the workplace leads to an increase in occupational morbidity, premature mortality and a decrease in working capacity.

Key words: nursing staff, risk management, workplace, composite parametric index, clinic nurses

Relevance of study: Nursing staff is the most numerous category in the structure of medical personnel, which accounts for about 59 % of all health personnel. Nursing staff are critical to achieving the «no one left behind» challenge and the success of global efforts to achieve the sustainable development goals [8]. Constant interaction with risk factors in the workplace leads to an increase in occupational morbidity, premature mortality and a decrease in working capacity [1,2,9]. These include: biological risks, such as infections caused by cuts or injections, or other contact with pathogens; chemical risks, disinfectants, or certain types of medications; physical risks, such as ionizing radiation; ergonomic risks created by the need for physical manipulation of patients or prolonged standing and walking; psychosocial risks, such as stress and shift work [3,5,6]. In this regard, the definition of risk, the study of their safe and dangerous levels of exposure to workers, monitoring of health and safety in the workplace, the organization of work on the study of accidents and occupational diseases and a number of other issues are included in the scope of risk management tasks [4,7].

Purpose of the study : To analyze the probability of risks in the activities of the nurses of the 3rd clinic of the Tashkent medical academy, to develop management solutions for risk management.

Objectives of the study:

1. To determine by the method of qualitative and quantitative SWOT analysis the possibility of risks in the clinic's activities.
2. Identify and assess risks in the activities of the clinic's nursing staff.
3. Develop measures for managers to manage risks in the activities of nurses

Materials and methods: In accordance with the purpose, the object of the study was nurses (44 people). The source of information was: questionnaire for professional risk assessment. Research methods: SWOT analysis method, Fine-Kinney method (based on a combination of the degree of exposure of an employee to a harmful factor in the workplace, the probability of a threat in the workplace and the consequences for the health and/or safety of employees if the threat occurs), mathematical calculation method, percentage method and etc.

Results: To determine the possibility of risks in the 3 ^rd clinic of the Tashkent medical academy, the method of SWOT analysis was used. Analysis of the internal environment of the clinic revealed weaknesses and threats (table 1).

Table 1

Analysis of the internal environment of the clinic

Weaknesses : low staffing of nurses, high ratio of part-time work, low wages, low motivation for their work, low computerization of workplaces, lack of a rest room.

We will use our strengths and opportunities in the future when developing risk management measures in the activities of mid-level medical personnel. To identify the significance of various factors of the internal environment of the clinic, to assess their contribution to the overall level of risks, a quantitative SWOT analysis was conducted. In the clinic's activities, strengths exceed weaknesses by 18.4 %, and opportunities prevail over threats — by 34.6 %. In order to identify risks in the activities of nurses, a survey of 44 nurses of the clinic was conducted. More than half of the respondents had extensive work experience in their specialty (16–20 years-28.9 %, 21–25 years-19.1 %, 26–30 years-12.4 %). The identification of risks in the activities of nurses caused by environmental factors affecting them directly at the workplace was carried out. The identification of risks in the activities of nurses caused by environmental factors affecting them directly at the workplace was carried out. The identification of risks in the activities of nurses caused by environmental factors affecting them directly at the workplace was carried out. The largest share of injuries is accounted for those that were received by glass fragments at the time of opening the ampoules — 61.1 %. The next most frequently is damage to the skin by the needles of syringes — 20.3 per cent. 11.4 % of the total amount is accounted for injuries associated with the installation of infusion systems (puncture needles of peripheral venous catheters) and injuries caused by other cutting objects. At the time of performing the procedures, 11.4 % of all injuries were received. After the end of the manipulations, 20.3 % of injuries were caused during the disassembly of the syringe and 5.2 % during the disposal of waste. Injuries were mostly accidental, as evidenced by their uniqueness, and were received mainly by glass fragments at the time of opening the ampoules and, less often, by needles of syringes. Compounding the situation in the clinic, the high amount of stress placed on nurses, in terms of volume of work performed during the shift and number of shifts. We obtained generalized indicators of the risk of developing diseases in the activities of the nurses of the clinic using the Fine-Kinney method. The highest risk is acute respiratory diseases, acute respiratory viral diseases and allergic rhinitis (228 points), it is classified as a high-risk category and requires immediate improvements. The risk of developing chronic bronchitis and viral hepatitis was estimated at 92 points and is classified as a serious risk that requires improvements. Bronchial asthma (55 points), diseases of the musculoskeletal system (53 points) and dermatitis (38 points) belong to the group of possible risks and their prevention should be paid attentionThe risk of developing varicose veins of the lower extremities (14 points) is small, possibly acceptable. The obtained generalized indicators of the risk of developing diseases allowed us to conclude that the highest risk in the activities of the clinic's nursing staff is acute respiratory diseases, acute respiratory viral diseases and allergic rhinitis, it belongs to the category of high risk and requires immediate improvements. The risk of developing chronic bronchitis and viral hepatitis is classified as a serious risk that requires improvements. Bronchial asthma, diseases of the musculoskeletal system and dermatitis belong to the group of possible risks and their prevention should be paid attention. The risk of developing varicose veins of the lower extremities is small, possibly acceptable.

Conclusion: Thus, on the basis of the study, measures were developed to manage the risks of the activities of the clinic's nursing staff. The chief physician is recommended to: develop an action plan to improve and improve working conditions, appoint an expert on the health and safety of employees, involve representatives of the trade Union organization in monitoring, equip the working rooms and wards with air conditioners, put into operation a new ventilation system, equip the premises with closed-type irradiators-recirculators. The chief nurse must: provide units with less aggressive means of disinfection, ensure the uninterrupted supply of specialists with special clothing, personal protective equipment, monitor the regular conduct of preliminary and planned medical examinations, introduce modern safe technologies for the destruction and disposal of medical waste, monitor the serviceability of technological and medical equipment, monitor compliance with the microclimate and hygienic standards of the production environment, ensure the regularity of personnel training in the cycles of specialization and retraining. Senior nurses are instructed to monitor the use of barrier prevention measures with the mandatory use of respirators, gloves by personnel, compliance with the current sanitary and epidemiological regime and manipulation standards.

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