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A test re-test reliability study of the Hands-Free Technique and Safety Climate Questionnaire in B.C. operating room nurses
November 2005
| Principal Investigators: |
Bernadette Stringer (University of Western Ontario); Elizabeth Bryce (Vancouver General Hospital) |
| Co-investigators: | Ted Haines (McMaster University), Ken Harris (University of Western Ontario) |
For more information about this development grant project, please contact Dr. Bernadette Stringer.
Issue
The Hands-Free Technique (HFT) is a work practice that has been shown to prevent injury and contamination from sharp surgical instruments, and to reduce the occupational risk of contracting HIV and hepatitis B and C. Research has shown that using HFT 75% or more of the time during bloodier surgeries, reduces injury, contamination and glove tears, and OSHA has recommended its use by operating room (OR) staff in the United States.
One factor that may affect how widely HFT is used by OR staff is the safety climate of hospitals. To prepare for future research examining that relationship, this project tested a new questionnaire that asks OR nurses and technicians about their use of HFT and their hospitals' workplace safety climate.
Key findings
- The questionnaire generates reliable answers from OR nurses on questions about HFT use and hospital safety climate.
- Participants' responses provide preliminary support for the hypothesis that HFT use may be linked to the broader safety culture of hospitals.
- OR nurses' and technicians' knowledge and use of HFT varied significantly between BC and Ontario , the two provinces where the questionnaire was tested.
Objective
To assess the test re-test reliability of a newly developed questionnaire on aspects of HFT use and hospitals' workplace safety climate in BC and Ontario, and secondarily, to assess ‘incivility' or ‘rudeness' related to doctors, managers and co-workers, during the administration of the first questionnaire.
Method
The HFT and Safety Climate Questionnaire was distributed to randomly selected OR nurses and technicians in Ontario and BC, using the hospitals' internal mail systems. Ten days after completed questionnaires were received, shortened versions were sent to participants to complete.
Statistical analyses compared responses to the full and shortened questionnaires to assess the test re-test reliability of the HFT and safety climate questions.
Results
A total of 45 BC and 39 Ontario nurses and technicians completed the full and shortened questionnaires and were able to reliably respond to all questions on the HFT and workplace safety climate. Statistical analysis indicated good test re-test reliability for both the HFT questions and the safety climate questions.
Knowledge and use of HFT varied between BC and Ontario . 100% of the BC participants knew of HFT, compared with only 62% of Ontario participants. 32% of BC participants indicated they used HFT 75% or more of the time, while only 5% of Ontario participants indicated they used HFT 75% or more of the time.
A better safety climate was found to be linked to greater use of HFT (using HFT 75% or more of the time), after controlling for age.
Results related to safety climate included the following:
- Over 50% of participants worked in cluttered areas
- 37% didn't have safety conscious managers
- 26% didn't feel ‘supported'
- 19% experienced conflict
- 11% couldn't easily communicate with supervisors
- Incivility from doctors (67%), co-workers (64%) and supervisors (49%) was very prevalent
- Supervisor incivility was mildly correlated with safety climate
Conclusions
The Hands-Free Technique and Safety Climate Questionnaire is ready for application in further, larger scale research and should elicit reliable answers.
Although additional research is required, the findings support the hypothesis that HFT use may be linked to the broader hospital safety culture.
Future directions
The questionnaire is being prepared for use in a national scale study to examine the relationship between HFT use and hospital safety climate, in a representative sample of Canadian OR nurses and technicians.
Publications and conference presentations
Two articles are undergoing peer review and the following posters have
been presented:
May 2005 : Poster: “Test re-test reliability studies of the new hands-free technique and safety climate questionnaire in BC and Ontario OR nurses”. Canadian Association for Research on Work and Health (CARWH) Conference, Vancouver.
June 2005: Presentation: “Workplace safety climate and incivility among BC and Ontario OR Nurses”. CIHR's First Canadian Conference on Mental Health in the Workplace, Workplace Mental Health Research, Montreal .
September 2005: Poster: “The influence of safety climate on nurses' use of the hands-free technique, an OR safety practice”. International Conference on the Scientific Basis of Health Services, Montreal .