of the respondents (n = 148, or 51 percent) treated all body fluids as potentially HIV positive. The possible attrition rate from nursing positions in the canvassed hospital was 2.8 percent, with a further 43 (15 percent) undecided about resigning from their post. This study demonstrates that further safety and education needs should be attended to or reinforced.

Baker (1993) reported survey results from studies conducted in 1986 and again in 1990 in New York on 2 separate samples of nearly 600 nurses. About half the nurses in each study stated they feared contagion. The number of nurses indicating they had the right to refuse to care for AIDS patients declined by 12 percent, even though 35 percent of the nurses maintained this position (which could have an impact on developing a therapeutic relationship). The change in attitude is attributed to education about AIDS.

Managing needlestick injuries in the health care setting is vitally important in order to reduce exposure to blood-borne pathogens such as HIV and hepatitis. As needlestick injuries occur for a variety of reasons, several approaches must be utilized to combat the problem. In addition, health care providers' attitudes and fears of contagion need to be explored further, as all of these factors impact quality of care, turnover, and outright leaving of the nursing profession. These include instituting appropriate and effective engineering controls, ensuring compliance with regulatory mandates and work practice policies and guidelines, conducting surveillance programs, and providing useful educational instruction. Adequate evaluation of injury prevention programs is essential in order to determine the effectiveness of interventions, and continued research is critical to measure outcomes in terms of increased injury rates, attitudes and behavior, and intervention effectiveness.

Violence Toward Health Care Workers

An emerging occupational health concern related to both injury and stress in the workplace is the risk of violence in general and toward health care workers. Homicides in the general workplace have gained prominence in recent years, and the Bureau of Labor Statistics counted 1,063 work-related homicides in 1993, most related to robbery (BLS, 1994a). In addition, the BLS recently began surveying the number of nonfatal assaults and acts of violence in private workplaces that required injured wage and salary workers to take off a workday or more. In 1992, about 22,400 such incidents were reported, each requiring, on average, about 5 days away from work to recuperate. A sizable proportion of the victims of nonfatal violence were care givers in nursing homes and hospitals. Ironically, some of these workers were injured by intransigent patients who resisted their assistance; others were assaulted by patients prone to violence. Most of these care givers were female nurses and their aides, and typically they required about 3 to 5 days away from work to recuperate from their injuries (BLS, 1994a).



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