Factors related to turnover intentions and work-related injuries and accidents among professional caregivers: a cross-sectional questionnaire study

BACKGROUND@#The Japanese health and welfare industry has a shortage of professional caregivers, and work-related accidents and injuries among this group are therefore especially critical issues. This study aimed to examine the factors associated with turnover intentions and work-related injuries and accidents among professional caregivers in Japan.@*METHODS@#Self-report questionnaires were distributed to care workers (N = 1396) at 26 geriatric-care facilities. The questionnaire addressed basic attributes, work and organizational characteristics, wage adequacy, and intrinsic motivations for work (e.g., "being suited to caring work"). Social-relational aspects of the work environment were assessed via three subscales of the Social Capital and Ethical Climate in the Workplace instrument (i.e., "Social Capital in the Workplace," "Exclusive Workplace Climate," and "Ethical Leadership"). Dependent variables were the experience of work-related accidents or injuries in the prior year and organizational and occupational turnover intentions. We used datasets of professional caregivers for analyses.@*RESULTS@#The response rate was 68% (N = 949). Among the 667 professional caregivers, 63% were female. On multivariable logistic regression analysis for work-related accidents and injuries for each sex, those with higher scores for "being suited to caring work" were found to experience significantly fewer work-related accidents and injuries (odds ratio [OR] = 0.78, p < 0.01) among female caregivers. Male caregivers who perceived an exclusive workplace climate experienced more work-related accidents and injuries (OR = 1.61, p < 0.01). However, experience of work-related accidents and injuries did not show significant relationships with organizational and occupational turnover intentions. Additionally, "being suited to caring work" (OR = 0.73, p < 0.01) and ethical leadership (OR = 0.76, p < 0.05) were found to be negatively associated with organizational turnover intentions. "Being suited to caring work" (OR = 0.61, p < 0.01), inadequacy of wage (OR = 2.22, p < 0.05), and marital status (OR = 2.69, p < 0.01) were also associated with occupational turnover intentions of professional caregivers.@*CONCLUSIONS@#These findings highlight the need to foster intrinsic motivations for work as well as providing a supportive and ethical work environment to reduce high turnover rates and work-related injuries and accidents among professional caregivers.

Análisis de las fracturas mandibulares causadas por accidentes laborales: estudio descriptivo retrospectivo / Analysis of mandibular fractures caused by work related accidents: retrospective descriptive study

El objetivo de este estudio fue evaluar la tendencia de los pacientes con fracturas mandibulares asociados a accidentes laborales. Se realizó un estudio descriptivo retrospectivo en todos los casos de fracturas mandibulares que asistieron al servicio de cirugía maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago de Chile en un periodo de 4 años (enero 2009 - diciembre 2012). Todas las fracturas mandibulares fueron consignadas. La información fue recopilada a través de revisión de fichas clínicas electrónicas. Entre los años 2009 al 2012 se presentaron un total de 74 pacientes incluidos en el estudio con 102 rasgos de fracturas mandibulares. La fractura más común fue la de cóndilo mandibular (35 pacientes). Se observó una tasa de complicaciones del 8%. Los resultados mostrados en este estudio están en línea con la literatura y el análisis de este reporte provee información para el diseño de planes de prevención de riesgos, especialmente para desarrollar medidas de protección facial. Nivel de Evidencia: Tipo II. Estudio descriptivo.

The objective of this study was to evaluate the tendency of patients with mandibular fractures associated with working accidents. A retrospective descriptive study was performed in all cases of mandibular fractures who attended the maxillofacial surgery service at the Clinical Hospital Mutual Seguridad C.CH.C. Santiago de Chile, in a 4-year period (January 2009 - December 2012). All mandibular fractures were recorded. The information was collected through review of electronic medical records. Between 2009 and 2012, 74 patients were included in the study with 102 lines of mandibular fractures. The most common fracture was the mandibular condyle (35 patients). The complication rate was 8%. The results shown in this study are in line with the literature and the analysis of this report provides information for the design of risk prevention plans, especially in developing measures of facial protection.

Modelo de Análise e Prevenção de Acidentes - MAPA: ferramenta para a vigilância em Saúde do trabalhador / Model of Analysis and Prevention of Accidents - MAPA: tool for operational health surveillance

A análise de acidentes de trabalho é importante para a vigilância e a prevenção desses eventos. Métodos atuais de análise buscam superar visões reducionistas que enxergam essas ocorrências como eventos simples explicados por erros dos operadores. O objetivo do artigo é analisar o modelo de análise e prevenção de acidentes (MAPA) e seu uso em intervenções de vigilância, destacando aspectos vivenciados na apropriação da ferramenta. Optou-se por método descritivo analítico apresentando as etapas do modelo. Para ilustrar contribuições e ou dificuldades foram selecionados casos nos quais foi usada a ferramenta em contexto de serviço. O MAPA integra abordagens teóricas já experimentadas em estudos de acidentes fornecendo apoio conceitual útil desde a etapa de coleta de dados à conclusão e intervenção. Além de revelar fragilidades da abordagem tradicional, ajuda a identificar determinantes organizacionais como falhas gerenciais, de concepção de sistemas e da gestão de segurança envolvidas na acidentalidade. Os principais desafios encontram-se no domínio dos conceitos pelos usuários, na exploração de aspectos organizacionais mais à montante na cadeia de decisões ou em níveis superiores da hierarquia, bem como na intervenção para mudanças nos determinantes destes eventos.

The analysis of work-related accidents is important for accident surveillance and prevention. Current methods of analysis seek to overcome reductionist views that see these occurrences as simple events explained by operator error. The objective of this paper is to analyze the Model of Analysis and Prevention of Accidents (MAPA) and its use in monitoring interventions, duly highlighting aspects experienced in the use of the tool. The descriptive analytical method was used, introducing the steps of the model. To illustrate contributions and or difficulties, cases where the tool was used in the context of service were selected. MAPA integrates theoretical approaches that have already been tried in studies of accidents by providing useful conceptual support from the data collection stage until conclusion and intervention stages. Besides revealing weaknesses of the traditional approach, it helps identify organizational determinants, such as management failings, system design and safety management involved in the accident. The main challenges lie in the grasp of concepts by users, in exploring organizational aspects upstream in the chain of decisions or at higher levels of the hierarchy, as well as the intervention to change the determinants of these events.

Da vigilância para prevenção de acidentes de trabalho: contribuição da ergonomia da atividade / From surveillance to work-related accident prevention: the contribution of the ergonomics of the activity

Os acidentes são fenômenos complexos, cuja determinação situa-se na organização do trabalho, dimensão invisível aos agentes de vigilância. O objetivo deste artigo é analisar e comparar o alcance das intervenções realizadas em uma empresa frigorífica, em 1997, baseada na checagem de normas de saúde e segurança, e em 2008, quando se incorpora a ergonomia da atividade. Foi realizado estudo de caso com análise documental referente à intervenção de 1997 e análise ergonômica do trabalho adotada em 2008. Em 1997 as ações de vigilância incidiram principalmente sobre os fatores de risco visíveis. Mesmo cumprindo as exigências, a empresa continuava, em 2008, com proporção de incidência anual de 26% de acidentes, o que motivou a busca da nova abordagem. Verificou-se, em 2008, que a gênese dos acidentes era provocada por um circulo vicioso: trabalho intenso; inadequação de meios técnicos; absenteísmo e rotatividade (84% ao ano) com recrutamento de inexperientes. Esse quadro é agravado por práticas autoritárias. A ergonomia da atividade contribuiu para compreender as causas organizacionais ultrapassando os aspectos normativos da vigilância tradicional, o que indica sua importância para tornar mais efetivas as ações de vigilância para a prevenção.

Work-related accidents are complex phenomena determined by the work organization process, the dimensions of which are usually invisible to surveillance agents. The scope of this paper was a case study based on documentary evidence to analyze and compare the success of an intervention conducted at a meat processing and packaging factory, by focusing on checking health and safety norms in 1997, and incorporating ergonomic concepts in 2008. In 1997, surveillance actions focused primarily on visible risk factors. Despite fulfilling sanitation requirements, the company still had an annual accident rate of 26% in 2008, which motivated the search for a new approach. In 2008, it was seen that accidents were caused by a vicious cycle involving intense work, technical inadequacy, absenteeism and high turnover (84%) that led the company to recruit inexperienced workers. This scenario was aggravated by authoritarian management practices. The ergonomics of the activity contributed to the understanding of organizational causes -thus superseding the normative aspects of traditional surveillance - which revealed the importance of ensuring that surveillance actions for prevention are more effective.

Análisis de los accidentes de trabajo y de trayecto de los trabajadores de un hospital de especialidades, en Jalisco México / Analysis of work-related accidents and commuting accidents among workers of a speciality hospital in Jalisco, México

Se presenta un análisis sobre accidentes de trabajo y de trayecto, de los años 2006 al 2010 de un hospital de especialidades, en el estado de Jalisco, México. En los años antes mencionados se dieron 102, 117, 122, 106 y 135 accidentes, respectivamente. Con el objetivo de evaluar el comportamiento en los años mencionados sobre accidentabilidad y establecer comparaciones entre ellos, se revisaron los formatos existentes en lo referente accidentes de trabajo y de trayecto, dándose una accidentabilidad de 582 riesgos de trabajo de los cuales 345 fueron accidentes de trabajo y 237 accidentes de trayecto, en los periodos antes mencionados. En el año 2010 se dio el mayor número de riesgos de trabajo (accidentes de trabajo y de trayecto), con el 23,197 por ciento. En la categoría de enfermera general, los accidentados de trabajo como de trayecto, en los cinco años de la investigación, fue la de mayor accidentabilidad. En lo referente al turno de trabajo, el matutino fue el de mayor accidentabilidad, tanto para accidentes de trabajo como de trayecto, en cada uno de los años. En el año 2008, el mes de noviembre fue donde ocurrió el mayor número de accidentes, con el 13,90 por ciento del total de los años estudiados. En la actividad que realizaban al accidentarse, los trabajadores con mayor siniestralidad fue caminando en los años estudiados. En el tipo de accidente con mayor accidentabilidad fue movimientos bruscos. En la región anatómica afectada, en el año 2006 fue manos y sus partes de la misma; en el 2007, el cuello fue el de mayor accidentabilidad; en el año 2008 fueron las manos y sus partes de la mismas como también el cuello; en el 2009, cuello y tobillos; y, en el 2010 fue el cuello. Las causas de los accidentes para los años 2006, 2007 y 2009 fue falta de atención; para el 2008 y 2010 fue acto inseguro de terceros. El agente de la lesión fue la reacción corporal en los cinco años estudiados.

This paper presents an analysis of commuting accidents and work related accidents occurred between 2006 and 2010 to workers of a specialty hospital in the state of Jalisco, México. The total number of both types of accidents in these years were 102, 117, 122, 106 and 135 respectively. The purpose of this analysis is to evaluate and compare occurrence patterns. Commuting and work related accident reports from these years were reviewed resulting in a total of 582 events (345 industrial accidents and 237 commuting accidents). 2010 presented the highest rate of work-related events (work-related and commuting accidents) with 23.197percent. “Registered Nurse” was the category with the highest accident rate (work-related as well as commuting accidents) during the five-year period reviewed. As to the working shift with the highest rate, the morning shift showed the most accidents (work-related and commuting) in every year reviewed. November 2008 was the month with the highest accident rate (13.9percent). The activity performed by workers with the highest accident rate was walking. Sudden movements was the type of accident with the highest rate. In 2006 the hands were the most affected body part; in 2007 the neck; in 2008 hands and neck; in 2009 neck and ankles, and in 2010 the neck. The main causes of accidents were: in 2006, 2007, and 2009 lack of attention; in 2008, and 2010 unsafe actions by third parties. The agent of injury in the reviewed five-year period was body reaction.