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Occupational health and safety management system and work-related accidents among hospital nurses
Ayu Indra Dewia, Elly Wardanib,
Corresponding author
ellywardani@unsyiah.ac.id

Corresponding author.
a Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
b Department of Nursing Leadership & Management, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Nurses&#44; as the pivotal care provider for patients&#44; have greater risk of hazards or work accidents in hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> Globally&#44; there are various work accidents that occur among nurses&#44; such as needle punctures&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;3</span></a> low back pain&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#44;5</span></a> and hepatitis-C virus infection&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> In Indonesia&#44; nurses&#8217; work fatigue reached 81&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> Low back pain as much as 70&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> followed by 70&#37; of needles and other sharp objects injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The government&#39;s effort to reduce workplace accidents are to issue health regulation that health workers are entitled to health protection and safety in carrying out their duties&#46; Hospital leadership boards play an important role in managing health care workers to run their health and safety&#46; Therefore&#44; hospital&#39;s leadership boards will have to implement actions to increase productivity and reduce workplace accidents&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> Such effort could refer to Regulation of the Minister of Health of Indonesia about Hospital Occupational Health and Safety &#40;HOHS&#41;&#44; which stated that every hospital is required to hold HOHS by establishing and developing an Occupational Health and Safety Management System &#40;OHSMS&#41; and applying HOHS standards &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In a previous study at Aceh hospital conducted by Nazirah and Yuswardi<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> found that eighteen cases of work accidents reported in 2015&#44; thirteen nurses were pricked&#44; two were exposed to body fluids&#44; one was exposed to chemotherapy drugs&#44; and two cases were fall&#46; The results of initial data collection conducted by the researcher in 2018 found nineteen cases of sharp objects injury occurred in nurses&#46; This illustrates that the incidence of workplace accidents in nurses at Aceh hospital increased from 2015&#44; and has not yet approached the zero accident line&#46; Nazirah and Yuswardi research also showed that the internal and external factors of nurses&#8217; behavior in the application of occupational health and safety management were 48&#37; and 41&#37;&#46; The results of the study explained that there was still an almost equal incidence between nurses who applied health and safety management standards to those who did not&#46; This findings may imply that further attention is required to assess to what extent the hospital&#39;s health and safety management system plays a role in safe-guarding the nurses in handling a healthy and safe patient care duties&#46; Based on the description above&#44; the researcher is interested in conducting research on the relationship between OHSMS and work-related accidents among nurses at a hospital in Aceh&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study used a descriptive correlative method with a cross-sectional study design&#46; It was conducted from 12 to 18 June 2019 in the entire inpatient wards of a large urban hospital in Indonesia&#46; The sampling technique used was the simple random sampling technique&#46; The sample size in this study was 152 implementing nurses&#46; Data collection was carried out by filling out a questionnaire consisting of two parts&#58; the work accident questionnaire and OHSMS&#46; Questionnaires have done test of validity and reliability&#46; The validity content is done by consulting expert suited to the health and safety of hospital work and the construction validity of 20 nurses&#46; The reliability test result shows crombach alpha 0&#46;959&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Researcher is working with the head of room in data collection&#46; The head of room took over the role of researcher making sure nurses filled out each questionnaire after shift ended&#46; Each questionnaire has a inform consent sheet that include data confidentiality and anonymity&#44; no effect on nurses&#39;s salary&#44; answers that were given into secrecy&#44; no rights of nurses reduced and no compulsions&#46; Nurses who agreed could proceed to be signed the informed consent&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Data collection was carried out after obtaining a letter from the hospital ethics committee with number <span class="elsevierStyleItalic">97&#47;EA&#47;FK-RSUDZA&#47;2019</span>&#46; Data analysis consisted of univariate and bivariate analyzes&#46; Univariate analysis is used to see the frequency distribution and percentage of each variable&#44; while bivariate analysis is done to see the correlation between variables using the Chi-Square test&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Result</span><p id="par0035" class="elsevierStylePara elsevierViewall">Based on this research it is known that the majority of the age of respondents were in early adulthood&#44; as many as 112 &#40;73&#46;7&#37;&#41; nurses&#46; The majority of female respondents were 129 &#40;84&#46;9&#37;&#41; nurses&#46; Respondents length of service was &#60;6 years&#44; totaling 99 &#40;65&#46;1&#37;&#41;&#46; The majority of respondents&#8217; latest education was DIII nursing&#44; which was 114 &#40;75&#37;&#41; nurses&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Based on this research it is mean that 149 respondents who OHSMS in the acceptable category&#44; there were 128 &#40;84&#46;2&#37;&#41; nurse who did not experience work accidents and statistical tests with chi square at <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;06&#46; 151 respondents who HOHS&#39;s policy&#47;regulation was in the acceptable category&#44; there were 129 &#40;84&#46;9&#37;&#41; nurses who did not experience a workplace accident and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;151&#46; 150 respondents who HOHS&#39;s training was in the acceptable category&#44; there were 128 &#40;84&#46;2&#37;&#41; nurses who did not experience work accidents and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;281&#46; 132 respondents who HOHS&#39;s supervision was in the acceptable category&#44; there were 112 &#40;73&#46;7&#37;&#41; people who did not experience work accidents and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#46; All the research results show that the working hypothesis is accepted&#44; it mean there is no relationship between the OHSMS&#44; HOHS&#39;s policy&#47;regulation&#44; HOHS&#39;s training&#44; HOHS&#39;s supervision with workplace accidents among nurses&#46; Besides that the research was also found 148 respondents who HOHS&#39;s plan was in the acceptable category&#44; there were 128 &#40;84&#46;2&#37;&#41; people who did not experience work accidents and the <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#46; 148 respondents who HOHS&#39;s promotion was in the acceptable category&#44; there were 128 &#40;84&#46;2&#37;&#41; people who did not experience work accidents and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#46; The result mean the working hypothesis is rejected&#44; indicating a relationship between implementation of the HOHS&#39;s plan and promotions with workplace accidents among nurses&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The occupational health and safety management system consists of HOHS&#39;s policy&#47;regulation and the implementation of the HOHS&#39;s plan&#46; Details of the discussion for more details are discussed as follows&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">HOHS&#39;s policy&#47;regulation and work related accidents among nurses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Statistical test results using chi-square obtain <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;151<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; which means there is no relationship between HOHS&#39;s policy&#47;regulation with workplace accidents among nurses&#46; Suyono and Nawawinetu<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> also found the same result that no correlation between OHS&#39;s regulations and safety behavior among nurses at a hospital in Indonesia&#46; Theoretically&#44; work accidents are caused by two factors&#44; namely unsafe conditions and dangerous actions&#46; Human factors &#40;dangerous acts&#41; occupy the most critical position towards the occurrence of workplace accidents&#44; namely between 80 and 85&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> Pratiwi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> also state that human errors &#40;unsafe behaviors&#41; are one of factors that contributing to work accidents&#46; The results of a previous study conducted by Nazirah and Yuswardi<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> among hospital nurses in Indonesia found that internal factors of nurses&#8217; behavior in the application of OHS were 42 &#40;52&#37;&#41; people considered acceptable and 38 &#40;48&#37;&#41; people were considered still not acceptable&#46; The study results explained that there were still and almost equal between nurses who applied OHS behavior and those who did not&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on this study&#39;s results&#44; most respondents were in the category 26-35 years &#40;early adulthood&#41;&#44; amounting to 112 people &#40;73&#46;7&#37;&#41;&#46; According to Akmalia and Nawawinetu&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> young people are vulnerable to work accidents compared to older age because young people tend to be less attentive&#44; less disciplined&#44; tend to obey their conscience&#44; and be careless&#46; It was concluded that the younger respondent&#44; the more respondent did not comply with work instructions&#46; The conclusion is that even though a health policy&#47;regulation has been established that reaches out to nurses&#44; OHS behavior is dependent on the nurses&#8217; personality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The implementation of the HOHS&#39;s plan and work-related accidents among nurses</span><p id="par0060" class="elsevierStylePara elsevierViewall">The HOHS&#39;s plan was implemented through HOHS&#39;s promotion&#44; HOHS&#39;s training&#44; and HOHS&#39;s supervision&#46; Details of the discussion for more details are discussed as follows&#58;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">HOHS&#39;s promotion and work-related accidents among nurses</span><p id="par0065" class="elsevierStylePara elsevierViewall">The results of statistical tests using the chi square formula obtain <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; which means there is a relationship between HOHS&#39;s promotion with workplace accidents among nurses&#46; Putri et al&#46; &#40;2018&#41; stated that promotion is significantly correlated to workplace accidents with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001 and POR of 14&#44;359 which means that nurses getting incomplete socialization of OHS promotion is at risk of 14 times the incidence of work accidents compared to nurses receiving complete OHS&#39;s promotion socialization&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Referring to research conducted by Pratiwi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> which provided OHS&#39;s education to nurses can increase nurses&#8217; knowledge about OHS&#44; which is an effective way to prevent work accidents&#46; The results of Mapanawang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> research on nurses at Liun Kendage Tahuna Regional Hospital also showed a significant correlation between knowledge and the incidence of needle stick injuries among nurses with a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The results of the research analysis of Mapanawang et al&#46; obtained an OR of 2&#46;130&#44; suggesting that nurses&#8217; poor knowledge has 2 times chance of experiencing needle stick injuries at Liun Kendage Hospital compared to those with good knowledge&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sandewa and Andhiwijaya<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> argue that formal education factors affects knowledges&#46; According to Pinggian et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> one of the most dominant factors contributing to work accidents is a low level of education &#40;<span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; Based on the results of this study it is found that the majority of nurses&#8217; education levels were 3th diploma nursing as many as 114 &#40;75&#37;&#41; people and work accidents also occurred most frequently in nurses with 3th diploma nursing degrees as many as 20 &#40;13&#46;2&#37;&#41; people&#46; Comparison of work accident rates in nursing DIII nursing nurses with nurses is 2&#58;1&#46; According to that result was mean not enough knowledge nurses 3th diploma nursing about OHS&#44; so need to improve in other option like training&#44; next education&#44; etc&#46; Kozier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> supported and stated that after the 1965 American Nurses Association &#40;ANA&#41; resolution&#44; the minimum education for those who work in nursing practice is on undergraduate nursing&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this study&#44; researcher found that of the 4 people who stated the HOHS&#39;s promotion was not acceptable&#44; three people had work accident&#44; and there was a significant correlation between gender and work accident &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The results of this study indicate many work accidents occur in females&#46; Psychologically&#44; anxiety symptoms are more common in females than males&#46; The instability of hormone estrogen-progesterone affects psychiatric stability in female&#44; so this causes female to be more sensitive in receiving stressor&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> From other research&#44; Apriady et al&#46; found that respondents who felt lacking preparation and knowledge in facing exams would experience more severe anxiety&#46; The researcher concluded that nurses may be more susceptible to work hazards if they are lacking on obtaining OHS&#39;s promotion and knowledge&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">HOHS&#39;s training and work related among nurses</span><p id="par0085" class="elsevierStylePara elsevierViewall">The results of statistical tests using the chi square formula obtain <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;281<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; which means there is no relationship between HOHS&#39;s training with workplace accidents among nurses in Indonesia&#46; This study&#39;s results contradict with results of research conducted by Aryanto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> where there is a correlation between OHS&#39;s training and workplace accidents&#46; The results of this study is supported by the results of research conducted by Putri et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> the nurses at the Depok District Hospital showed no correlation between training with nurses&#8217; occupational safety behaviors at the Depok District Hospital &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;219&#44; 95&#37;&#41;&#46; Nurses&#8217; poor work behavior can cause work accidents such as the results of Pratiwi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> the better nurse&#39;s behavior on OHS is lower work accident will be&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Researches found that most work accidents occur during the working period of respondents who were in the category &#60;6 years &#40;65&#46;1&#37;&#41;&#44; namely 99 &#40;65&#46;1&#37;&#41;&#46; Longer working period workers tend to have experience in anticipating possible hazards because they are very familiar with their work&#39;s ins and outs with various conditions&#47;conditions of the patient&#46; The majority of respondents were in the age category 26&#8722;35 years &#40;early adulthood&#41; as many as 112 &#40;73&#46;7&#37;&#41;&#46; Younger people do mobilization&#47;higher role involvement in work&#44; tend to want to finish quickly&#44; so they are less careful in working&#44; which can trigger work accidents&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The analysis results found a mismatch between the types of workplace accidents among nurses with HOHS&#39;s training obtained&#46; The results showed that most occupational accidents that occurred on nurses were exposed to the patient&#39;s body fluids as many as 12 &#40;7&#46;9&#41; people&#46; According to Ramdan and Rahman&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> the use of Personal Protective Equipment &#40;PPE&#41; is an effective way to prevent that work accidents&#46; But in the HOHS&#39;s training sub-variable section questionnaire&#44; there was no question related to the use of PPE training&#46; The researcher did not ask for training on the use of PPE in the questionnaire because according to the Republic of Indonesia Ministerial Regulation&#44; the use of PPE does not include in the form of training but in the form of promotion &#40;socialization of the use of PPE&#41; and supervision of the use of PPE&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">HOHS&#39;s supervision and work related accidents among nurses</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study&#39;s results contradict with results of research obtained by Ansari and Azkha<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> where there is a correlation between OHS&#39;s supervision and work accidents&#44; with a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014 and Azizah<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; Putri et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> findings also showed a not significant relationship between the OHS&#8217; supervision variable with the incidence of workplace accidents among nurses&#46; From the results of this study&#44; as many as 20 &#40;13&#46;2&#37;&#41; of respondents stated that HOHS&#39;s supervision was not acceptable&#44; there were 17 &#40;11&#46;2&#37;&#41; people who did not have a work accident and three &#40;2&#37;&#41; people who had a work accident&#46; This might have happened because the researchers only focused on direct supervision conducted by observe&#47;monitoring in this study&#46; However&#44; there is an involvement of the head room&#39;s function in the indirect supervision&#44; such as directing during shift changes&#44; namely providing advice&#44; guidance&#44; motivation&#44; communicating safety at work&#44; and facilitating collaboration which is also supervision and can affect to work accidents&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> The results of qualitative research Wardani and Ryan<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> found that nurses in Indonesian hospitals perceive that leadership is supervising&#44; guiding and educating staff&#46; These comments mean that nurses are very dependent on their leader&#44; specifically the head nurse&#47;head of the room&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is known from the results of a study conducted by Tarigan and Putra<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> that the frequency distribution of the head nurse&#39;s directing management function at the inpatient room in Indonesia was mostly in the acceptable category&#44; namely 34 &#40;56&#46;7&#37;&#41; respondents&#46; From the results of research conducted by Anwar et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> it is known that the frequency distribution of head room&#39;s directional functions in the inpatients room in Indonesia hospital was also in the acceptable category&#44; 70 &#40;93&#46;3&#37;&#41; respondents&#46; The researcher concluded that nurses who were poorly supervised were likely prone to work accidents&#46; Therefore&#44; direct supervision and continue monitoring efforts should be in place to avoid unnecessary work harms&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Based on the results of this study&#44; The conclusions is that a good policies&#47;regulations is not enough to prevent a work accident among nurses but it also requires the attention of the nurses itself to observe the policies&#47;regulations&#46; It is recommended for nurses to pay attention to the HOHS policies&#47;regulations&#46; The implementation of the HOHS&#39;s plan &#40;training&#44; supervision and promotion&#41; has relationship to prevent accidents among nurses&#44; this is also mean that the HOHS committee requires conducting regular OHS training and promoting to nurses and maintaining on-going supervision to reduce workplace accidents&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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              "titulo" => "HOHS&#39;s policy&#47;regulation and work related accidents among nurses"
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              "titulo" => "The implementation of the HOHS&#39;s plan and work-related accidents among nurses"
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              "titulo" => "HOHS&#39;s promotion and work-related accidents among nurses"
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          "titulo" => "HOHS&#39;s training and work related among nurses"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The prevalence of hospital work-related accidents is increasing each year in Indonesia&#46; To tackle the issue&#44; the ministry of health requires each hospital organizes Occupational Health and Safety Management System &#40;OHSMS&#41;&#46; Occupational Health and Safety &#40;OHS&#41; management is an effort to prevent accidents and illnesses due to work among hospital nurses&#46; This study aims to determine the relationship between OHSMS and work related accidents among nurses&#46; This study used <span class="elsevierStyleItalic">cross sectional study</span> design with <span class="elsevierStyleItalic">simple random sampling</span> technique towards 244 nurses and got 152 samples with <span class="elsevierStyleItalic">solving formula</span>&#46; The study was carried out on June 2019 with questionnaires that had done test of validity and reliability&#46; The validity content is done by consulting expert and the construction validity of 20 nurses &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;444&#41;&#46; The reliability test result show <span class="elsevierStyleItalic">crombach alpha</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;959&#46; The inform consent sheet is given at the front of questionnaire for approval by signing&#46; Data analysis consisted of univariate and bivariate analyzes&#46; Univariate analysis is used to see the frequency distribution and percentage of each variable&#44; while bivariate analysis is done to see the correlation between variables using the <span class="elsevierStyleItalic">Chi-Square test</span>&#46; There was no relationship between Hospital Occupational Health and Safety&#39;s &#40;HOHS&#41; policy&#47;regulation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;151&#41;&#44; training &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;281&#41;&#44; and supervision &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#41; with workplace accidents among nurses&#46; However&#44; there were a relationship between the implementation of the HOHS&#39;s plan &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41; and promotion &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41; with workplace accidents among nurses at the hospital&#46; The conclusions is that a good policies&#47;regulations is not enough to prevent a work accident among nurses but it also requires the attention of the nurses itself to observe the policies&#47;regulations&#46; Implementing of the HOHS&#39;s plan &#40;training&#44; supervision and promotion&#41; has relationship to prevent accidents among nurses&#46;</p></span>"
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                  \t\t\t\t" scope="col">No&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">OHSMS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">152&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HOHS&#8217; promotion</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acceptable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Not acceptable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="10" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HOHS&#39;s training</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acceptable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Not acceptable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos