Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 4  |  Issue : 2  |  Page : 184-187
Who is willing to risk his life for a patient with a potentially fatal, communicable disease during the peak of A/H1N1 pandemic in Israel?


1 Department of Management, Faculty of Social Sciences, Bar Ilan University, Givat Shmuel; Department of Emergency Medicine, Faculty of Health sciences, Ben Gurion University, Israel
2 Department of Management, Faculty of Social Sciences, Bar Ilan University, Givat Shmuel, Israel
3 Faculty of Medicine, Tel-Aviv University, Israel

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Date of Submission13-Jun-2010
Date of Acceptance12-Oct-2010
Date of Web Publication18-Jun-2011
 

   Abstract 

Background : The willingness of healthcare workers to risk their lives for a patient with a potentially fatal, communicable disease is a major concern, especially during a pandemic where the need for adequate staffing is crucial and where the public atmosphere might enhance anxiety and fear of exposure. Objective : To examine the relationships between the willingness of healthcare workers to risk their lives for a patient with a potentially fatal A/H1N1 flu, and knowledge of personal protection against infection, and trust in colleagues, workplace preparedness and the effectiveness of safety measures, during the winter A/H1N1 pandemic in Israel. Materials and Methods : A questionnaire was distributed to healthcare workers in 21 hospitals in Israel between 26 November 2009 and 10 December 2009 (the peak of the winter A/H1N1 flu outbreak). The questionnaire was completed by 1147 healthcare workers. Results : Willingness to risk one's life for a patient was significantly lower in females, respondents of younger age (18-24 years), administrative staff, and those with a non-academic education, as well as among those with a less knowledge about safety measures and among those with less trust in colleagues, in work place preparedness, and in the effectiveness of safety measures. Conclusions : Willingness to risk one's life for a patient is related to knowledge of safety measures, and trust in colleagues and work place preparedness. Education programs to enhance trust in colleagues, improve work place preparedness, and safety measures are recommended, especially for healthcare workers who are young, inexperienced, female, or administrative staff.

Keywords: Health workers, pandemic flu, willingness

How to cite this article:
Bar-Dayan Y, Boldor N, Kremer I, London M, Levy R, Barak MI, Bar-Dayan Y. Who is willing to risk his life for a patient with a potentially fatal, communicable disease during the peak of A/H1N1 pandemic in Israel?. J Emerg Trauma Shock 2011;4:184-7

How to cite this URL:
Bar-Dayan Y, Boldor N, Kremer I, London M, Levy R, Barak MI, Bar-Dayan Y. Who is willing to risk his life for a patient with a potentially fatal, communicable disease during the peak of A/H1N1 pandemic in Israel?. J Emerg Trauma Shock [serial online] 2011 [cited 2019 Nov 20];4:184-7. Available from: http://www.onlinejets.org/text.asp?2011/4/2/184/82203



   Introduction Top


In March 2009, the World Health Organization (WHO) declared A/H1N1 influenza pandemic. On 11 June 2009, the WHO declared a Level 6 (highest level) global pandemic and by12 November 2009, 7,487 people had died from the disease. [1] In Israel, between April and October 2009, 4,607 patients were diagnosed and verified as having A/H1N1 influenza, 85 of whom were hospitalized in intensive care units. The first verified A/H1N1 flu death was reported on 25 July 2009 and by 5 November 2009, 40 deaths were reported, most in patients with a chronic disease. [2]

Although a high percentage of healthcare workers feel an obligation to work during an influenza pandemic, barriers to working that may significantly reduce the health service workforce during a pandemic exist. These barriers lie along an ability/willingness continuum and absenteeism may be reduced by taking steps to prevent "barriers to willingness" from becoming perceived "barriers to ability." [3]

To prepare for a pandemic response, the issues that may affect the decision not to attend work must be identified. Ensuring worker confidence in adequate personal protection may be more important than financial incentives. [4] In one report, up to 16% of healthcare workers stated that they would not attend work during a pandemic flu regardless of its severity. [5] A study in Germany reported that 28% of a sample of healthcare workers said that it would be professionally acceptable for healthcare workers to abandon their workplace during a pandemic to protect themselves and their families. [6]

Barriers to attending work during a disaster include transportation problems and care responsibilities for children, elders, and pets. Barriers to willingness include fear and concern for family and self, and personal health problems, many of which are amenable to intervention. [7]

Other parameters related to willingness to attend work during a pandemic flu are sense of security, professional commitment, perceived professional competence, and trust in employers. [8] Another study found that willingness was related to provision of accommodations, information and guidance by employers, [3] as well as the availability of appropriate personal protection equipment, and a comprehensive education and training plan. [5],[9],[10]

The willingness of healthcare workers to risk their lives for a patient with a potentially fatal, communicable disease is a major concern, especially during a pandemic where the need for adequate staff is crucial and the public atmosphere might increase anxiety, fear, and unwillingness to work among healthcare workers. We are not aware of any report that evaluated the willingness of healthcare personnel to risk their lives for a patient during the peak of an A/H1N1 pandemic.

This study examined the relationship between the willingness of healthcare workers to risk their lives for a patient with A/H1N1 flu, and knowledge of the disease, trust in colleagues, workplace preparedness, and the effectiveness of disease prevention measures.


   Materials and Methods Top


Instrument and key measures

Based on a review of the literature, we hypothesized that knowledge and trust of healthcare workers were related to their willingness to risk their lives for a patient with a potentially fatal, communicable A/H1N1 flu. We selected and validated a questionnaire based on this model and prior research, [11],[12] in order to assess the relationships between willingness, knowledge of safety measures of the disease, and trust in the healthcare system. The questionnaire was validated for content and structure. Inter-observer and intra-observer variabilities of each questionnaire item were very low and the internal consistency coefficient was 0.7-0.9. The questionnaire included open and multiple-choice questions and questions on a 5-point Likert scale where 5 was "very high" and 1 was "very low". The three knowledge questions were: What are the most important protective measures to prevent droplet infection? What are the most important protective measures to prevent contact infection? What is the first thing you should do when a patient presents with unusual symptoms that might be swine flu? A score of 0 was given for irrelevant questions, unknown answers, and missing data.

Population

The study was conducted between 26 November 2009 and 10 December 2009. Healthcare workers in every department who were older than 18 years of age were asked to complete the questionnaire.

Data collection

The survey was conducted by healthcare workers with relevant academic education in health systems management and public health. The researchers were trained in providing informed consent and questionnaire administration. The study was approved by the institutional review board of Bar Ilan University. Questionnaire data were entered into an SPSS file and triple-checked to ensure accuracy.

Statistical analysis

The relationships between the willingness of health care personnel to risk their lives for a patient with a potentially fatal infectious disease and knowledge/trust were analyzed. For data analysis, "willingness to risk life" was categorized as very high/high, moderate, and low/very low. Participants who graded their willingness to treat the patient as 'very high or high' were considered to be "willing to risk his or her life." Differences between groups were analyzed using the chi-square test for fit independence. Correlations between trust and willingness were also evaluated with the Pearson's correlation. A P <0.05 was considered significant.


   Results Top


The research took place in 21 of the 24 hospitals in Israel (3 were not included because they did not agree to participate within the required timeframe). Questionnaires took 8 to 12 min to complete. A total of 1147 questionnaires were completed by healthcare personnel including 16% physicians, 39% nurses, 25% paramedical staff, 13% administrative staff, and 8% other professions. The refusal rate was less than 5%. The mean age of the population (± standard deviation) was 41± 11 years, 68% were female, 72% married, and 69% had child care responsibilities for a mean of 1.5± 1.4 children each. Participants had an average of 17± 3 years of education and 16± 11 years of professional experience [Table 1].
Table 1: Results of 1147 questionnaires completed by healthcare personnel


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Adequate workplace preparedness, as well as trust and confidence in colleagues' competence and knowledge, was significantly related to willingness to risk one's life for a patient with A/H1N1 flu (c2 (2)=317.218; P<0.001). 92% of healthcare workers who trusted their colleagues were willing to risk their lives for a patient during A/H1N1 pandemic compared with 39% of HCW who did not [Figure 1]. Using a Pearson correlation analysis, it was demonstrated the trust was highly correlated with willingness to risk one's life for a patient (r(958)=0.695; P<0.001) [Table 2].
Table 2: Variations in willingness to risk one's life for a patient with contagious and fatal A/H1N1 flu


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Figure 1: Frequency differences according to the extent of trust in workplace preparedness, trust in safety measures, and trust in colleagues between health care workers reporting high/very high willingness to treat patients suffering from an infectious lethal disease

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Health care workers who were more knowledgeable about safety measures against A/H1N1 flu were more willing to risk their lives compared to those with less knowledge (2(6)=65.823; P<0.001). 85% of healthcare workers who answered all three knowledge questions correctly were willing to risk their lives for a patient compared to 60% of those who answered all three questions incorrectly.

Fewer women (74%) were willing to risk their lives for a patient compared to 82% of men (χ2 (2)=8.004; P<0.05). We found that 82% of workers ages 45-54 years willing to risk their lives compared to 64% of younger healthcare workers (ages 18-24) (χ2 (2)=8.004; P<0.05).

Willingness was also related to level of education; 88% of those with an MD or PhD degree were willing to risk their lives for a patient compared to 60% of those with a high school education (χ2 (4)=50.120; P<0.001). In parallel, 91% of physicians were willing to risk their lives compared with 57% of administrative personnel (χ2 (8)=93.032; P<0.001). There was no relationship between marital status and willingness to risk one's life for a patient.


   Discussion Top


This study demonstrated that the level of trust healthcare workers had (in colleagues, in workplace preparedness and in safety measures) was directly related to their willingness to risk their lives for a patient with a potentially fatal, communicable A/H1N1 flu during the A/H1N1 pandemic in Israel. Our results are supported by a previous study that demonstrated that investing resources in increasing the personal safety of health care workers significantly increased their willingness to attend work during pandemic avian flu. [4] The level of trust the workers felt in their employers' ability to protect them against infection had the highest correlation with willingness to attend work. [4] Another study showed that the frequency and credibility of information that employers provided healthcare workers was important during a disaster. [8]

The results of our study concerning the relationship between trust in colleagues and willingness of healthcare workers to risk their lives are supported by the basic military maxim of "one for all and all for one" which implies that soldiers are willing to risk their lives because they know that their friends will do it for them. The idea of applying this concept to healthcare workers is novel. The striking correlation between the level of trust in colleagues and the willingness of healthcare workers to risk their lives for a patient suggests that healthcare managers might apply methods from military preparedness to healthcare disaster preparedness training.

Our findings that knowledge about personal protection is related to the willingness to risk one's life is supported by previous studies that demonstrated that the willingness to treat a patient in nonconventional emergency scenarios is related to knowledge and perceived coping ability. [8],[13],[14] Similarly, implementing an educational program was found to improve the willingness of Nigerian physiotherapists to care for patients with AIDS. [15]

The process of education of the Israeli health care system included the five elements of the pyramid of preparedness including doctrine/regulations, structure/organization, personnel, infrastructure/equipment, and education and drills. A comprehensive process of educating health care workers included distribution of documents of official regulations, lectures, seminars, and conferences concerning all aspects of the pandemic.

This study also demonstrated significant relationships between demographics and the willingness to risk one's life for a patient. These results support previous studies where those of female gender and younger age were less willing to attend work in the case of pandemic avian flu. [3]

The Israeli health care system is prepared to support the families of the health care workers during emergency and disaster. In previous events such as the Second Lebanon War, kinder gardens were opened in the hospitals in order to enable health care personnel to attend work without worrying for their families. Personal protection equipment was supplied to health care workers in order to improve their perceived safety and transportation was provided to them in order to enable their attendance in their shifts in spite of the impairment in public transportation that occurred during the Second Lebanon War. This system of support might explain the high willingness found among the health care workers in Israel to risk their lives for a patient.

We found that administrative staff was less willing than direct healthcare workers to risk their lives for a patient. Another study reported that physicians were significantly more willing to attend work during an avian flu pandemic than were nursing and administrative personnel. [4] We found a greater willingness to risk one's life among all sectors than that reported by Irvin et al,. The difference might be attributed to the fact we conducted our study during the peak of the A/H1N1 outbreak, whereas the study by Irvin et al. was conducted before the avian flu pandemic occurred, suggesting that fear of the unknown may have been stronger than fear of the known. Another possible explanation for this finding is that while faced with terrorist attacks, Israeli healthcare workers have been trained to work in spite of personal risks. The fact that administrative personnel are less willing than direct care personnel to attend work provides important information for healthcare managers who will need to focus on this population in future preparedness programs.

We also found that experienced personnel are more willing to risk their lives for a patient than those with less experience, perhaps because experienced personnel are better trained and more knowledgeable in disaster response and therefore have a better understanding of the perceived risks.

This study has several limitations. We used a convenience sample that included only healthcare workers who were at work the day the questionnaire was distributed. This might bias the results because health care workers who did not attend work during the peak of the pandemic were not surveyed. However, the percentage of those not at work at this time was very low and the sample was large.

This study provides a comprehensive evaluation of the willingness of healthcare workers to risk their lives for a patient with a potentially fatal, communicable disease. These results might provide tools that will enable healthcare managers to predict the extent of willingness of personnel to attend work and to prepare backup where the probability of system failure is high. Healthcare managers must also focus their efforts on enhancing knowledge, and building trust among their staff, confidence in workplace preparedness and safety measures to increase their willingness to risk their lives, if necessary, during the next pandemic flu or other disaster. Special emphasis should be placed on younger, less experienced workers and those who are not directly involved in patient care.


   Conclusions Top


We conclude that the willingness of healthcare workers to risk their lives for a patient is higher among those who trust their colleagues and have confidence in workplace preparedness and the effectiveness of safety measures. Willingness to risk one's life is also higher in healthcare workers who were more knowledgeable concerning personal protection, who were relatively older and more experienced. This method of assessment is recommended worldwide, in order to improve evidence-based decision making of health policy makers and disaster preparedness.

 
   References Top

1.World Health Organization. Available from: http://www.who.int/csr/disease/swineflu/en/index.html , A/H1N1 pandemic flu, [Last accessed on 2010 Feb 24].  Back to cited text no. 1
    
2.Israel Ministry of Health, the division of disaster and emergency preparedness and response. Available from: http://www.health.gov.il/h1n1/world.asp , [Last accessed on 2010 Feb 24].  Back to cited text no. 2
    
3.Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts J, et al. Healthcare workers attitudes to working during pandemic influenza: A qualitative study. BMC Public Health 2009;9:56.  Back to cited text no. 3
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4.Irvin CB, Cindrich L, Patterson W, Southall A. Survey of hospital healthcare personnel response during a potential avian influenza pandemic: Will they come to work? Prehosp Disaster Med 2008;23:328-35.  Back to cited text no. 4
[PUBMED]    
5.Barnett DJ, Balicer RD, Thompson CB, Storey JD, Omer SB, Semon NL, et al. Assessment of local public health workers′ willingness to respond to pandemic influenza through application of the extended parallel process model. PloS one 2009;4:e6365.  Back to cited text no. 5
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6.Ehrenstein B, Hanses F, Salzberger B, Influenza pandemic and professional duty family or patients first? A survey of hospital employees. BMC Public Health 2006;6:311.  Back to cited text no. 6
    
7.Qureshi K, Gershon RR, Sherman MF, Straub T, Gebbie E, Mc Collum M, et al. Health care workers ability and willingness to report to duty during catastrophic disasters. J Urban Health 2005;82:378-88.  Back to cited text no. 7
    
8.Smith E. Paramedics Perception of Risk and Willingness to Work During Conventional and Non- Conventional Disasters. Adelaide, Australia: Presented at the Australian College of Ambulance Professionals (ACAP) National Conference; 2006.  Back to cited text no. 8
    
9.Shapira Y, Marganitt B, Roziner I, Shochat T, Bar Y, Shemer J, Willingness of staff to report to their hospital duties following an unconventional missile attack: A state wide survey. Isr J Med Sci 1991;27:704-11.  Back to cited text no. 9
    
10.Koh, D, Lim MK, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of SARS on work and personal lives of healthcare workers in Singapore - what can we learn? Med Care 2005;43:676-82.  Back to cited text no. 10
    
11.Peltz R, Avisar SG, Bar-Dayan Y. Differences in public emotions, interest, sense of knowledge and compliance between the affected area and the nationwide general population during the first phase of a bird flu outbreak in Israel. J Infect 2007;55:545-50.  Back to cited text no. 11
    
12.Peltz R, Avisar SG, Ventura-Gabay M, Bar-Dayan Y. Differences in the sources of information used by the population between the affected area and the nationwide general population during the first phase of a bird flu outbreak in Israel. Prehosp Disaster Med 2008;23:57-9.  Back to cited text no. 12
    
13.Lanzilotti S, Galanis D, Leoni N, Craig B. Hawaii Medical Professionals Assessment. Hawaii Med J 2002;61:162-73.  Back to cited text no. 13
    
14.Rokach A, Cohen R, Shapira N, Einav S, Mandibura A, Bar-Dayan Y. Preparedness for anthrax attack: The effect of knowledge on the willingness to treat patients. Disasters 2010;34:637-43.  Back to cited text no. 14
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15.Oyeyemi A, Oyeyemi A, Abegunde A. Knowledge, attitude and willingness of Nigerian physiotherapists to provide care for patients living with Acquired Immunodeficiency Syndrome. Physiother Res Int 2008;13:176-88.  Back to cited text no. 15
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Yaron Bar-Dayan
Department of Management, Faculty of Social Sciences, Bar Ilan University, Givat Shmuel; Department of Emergency Medicine, Faculty of Health sciences, Ben Gurion University
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.82203

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