Showing papers in "AAOHN Journal in 2004"

Nurses' perception of their work environment, health, and well-being: a qualitative perspective.

Abstract: The purpose of this analysis was to identify themes nurses expressed in open-ended comments at the end of a working conditions survey related to their work environment, health, and well-being. The nursing shortage, downsizing, and long working hours create challenges for nurses trying to deliver quality client care. In addition, nurses are experiencing high levels of physical injury in their work environments. Injuries on the job have led nurses to leave the workplace. Free form comments offered at the completion of a mailed survey of RNs were analyzed for content. Randomly selected nurses from two U.S. states were surveyed in 1999 and 2000 about their jobs with special reference to neck, shoulder, and back pain and disorders. Of the 1,428 respondents, 309 produced usable comments for this content analysis. Constant comparative analysis was used to identify themes present in themes addressed in the nurses' comments included excessive work demands, injustice or unfairness, and nurses' personal solutions to their work environments. Based on the issues raised in the themes, recommendations are provided for improving retention while promoting nurses' health and well-being.

The return to work experiences of colorectal cancer survivors.

Abstract: During the past 15 years, the number of colorectal cancer survivors has risen dramatically. While it is unclear how many colorectal cancer survivors were employed at the time of diagnosis, it is reasonable to expect a significant proportion of these survivors were temporarily displaced from the work force. This article describes the return to work experiences of 250 colorectal cancer survivors. The majority (80%) of the survivors were employed at diagnosis and 89% returned to work. Of those who returned to work, 81% sustained employment 5 years postdiagnosis. Results indicate survivors were successful in their attempt to return to work and sustain employment. However, 34% of survivors delayed their return beyond 2 months postdiagnosis. After controlling for ethnicity, education, and disease severity, the reason for delay was related to chemotherapy treatment. Prospective studies of colorectal cancer survivors to document barriers to work return can guide interventions and occupational services to keep survivors healthy and in the workplace.

Back Pain Prevalence in Nursing Personnel: Measurement Issues:

Abstract: 1. The problem of work related musculoskeletal disorders of the low back in nursing personnel has been well documented in the literature by cross sectional studies showing high prevalence rates in licensed nurses and nursing aides. However, it is difficult to compare findings among these studies because of the use of nonstandardized symptom surveys, variations in case definitions, and other methodological inconsistencies. 2. Measuring the change in current back pain prevalence yields more timely information about the effectiveness of an ergonomic intervention than assessing injury incidence rates, because of the high percent of nursing staff members who work in pain but delay filing workers' compensation claims. 3. As employers attempt to reduce manual handling injuries, occupational health nurses may be called upon to survey workers for musculoskeletal symptom prevalence and document the effectiveness of ergonomic interventions. Before using or developing any musculoskeletal disorder symptom survey for workplace surveillance or research, occupational health nurses should determine whether the survey has adequate reliability, validity, responsiveness, and practicality.

Emotional labor: relevant theory for occupational health practice in post-industrial America.

Abstract: The occupational experience of workers in service-oriented jobs can have profound effects on their health and well being, such as burnout, inauthenticity, and job dissatisfaction. The growing service economy and resultant proliferation of service-oriented jobs in current times and in the future must be acknowledged and investigated. The move from an economy driven by manufacturing industries to one dominated by service industries has taken place and currently prevails in the United States. In recognizing this shift in the "work" experience of the American work force, the changing nature of work related hazards must also be considered. Emotional labor has come to be known as an appreciable aspect of work involving direct interactions with clients and customers that can lead to adverse psychosocial outcomes. These relationships reveal the potential unpleasantness of service employment in which the performance of emotional labor is unavoidable. Although worker attributes can influence the emotional experience on the job, emotional labor is also likely to threaten the well being of workers through significantly high demands to express organizationally desired emotions and low control over what emotions can be felt and displayed. Recognition and investigation of emotional labor is necessary to understand its effects on worker populations. Conceptual models featuring emotional labor are available to guide research. However, discrimination among them based on utility and application in relation to identified study objectives and needs is essential.

Cardiovascular risks in firefighters: implications for occupational health nurse practice.

Abstract: Limited cardiovascular risk data are available for firefighters. This cross sectional study of data collected during annual physical examinations described the prevalence of cardiovascular risk fac...

Sleep deprivation and injuries in part-time Kentucky farmers: impact of self reported sleep habits and sleep problems on injury risk.

Abstract: Part-time farmers who hold off-farm jobs may be at risk for injuries because of impaired performance resulting from inadequate sleep. For this study, 1004 part-time male Kentucky farmers completed a telephone interview for the 1994 to 1995 National Institute for Occupational Safety and Health-funded Farm Family Health and Hazard Surveillance Project. Questions were included about demographics, sleep habits, and injury occurrence. Twelve percent of the farmers reported an injury requiring medical intervention in the previous year. Farmers reported sleeping an average of 7.6 hours daily. Approximately 6.7% of the sample had three symptoms of sleep apnea. Although hours of sleep were not related to injury incidence, sleep medication use (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.01 to 4.40) and presence of three sleep apnea symptoms (OR = 2.48, 95% CI = 1.13 to 5.41) were related to injury incidence. These data support the need for further research to examine sleep habits and promote strategies that reduce the risk for injuries caused by lack of sleep.

Relationship among risk factors for nephrolithiasis, cardiovascular disease, and ethnicity: focus on a law enforcement cohort

Abstract: This cross-sectional study determined the prevalence of nephrolithiasis and common cardiovascular disease (CVD) risk factors in a law enforcement officer (LEO) cohort and evaluated the relationship of nephrolithiasis with several CVD risk factors, including the possible effect of ethnicity. Self reported nephrolithiasis and CVD risk factors among currently employed male LEOs from nine states (n = 2,818) were compared to other men in the same states (n = 9,650). Of the LEOs, 6.2% (n = 174) self reported at least one kidney stone (range = 1 to 12, mean 2.3 6 2.1 stones). Twenty five percent of Native American LEOs (n = 7 of 28) self reported a history of stones. In LEOs with a history of nephrolithiasis, overweight defined as body mass index . 25 kg/m2 (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.04, 3.11), hypercholesterolemia (OR = 1.53, 95% CI = 1.09, 2.15), and hypertension (OR = 1.46, 95% CI = 1.02, 2.11) were associated with the disease. These results suggest officers with common CVD risk factors are also at an increased risk for nephrolithiasis. Native American LEOs have a disproportionately higher prevalence of nephrolithiasis than do other ethnic groups.

Occupational noise and effects on blood pressure: exploring the relationship of hypertension and noise exposure in workers.

Abstract: Hearing loss is the second most self reported occupational illness or injury. According to the National Institute for Occupational Safety and Health, approximately 30 million workers are exposed to hazardous noise on the job. Often only hearing loss is thought of when one refers to occupational noise, but there may be other factors to consider when addressing occupational noise such as blood pressure. What is not clear, however, is whether noise contributes to changes in blood pressure. Occupational noise is a problem in various settings and comes with known and possible health consequences. To identify and prevent possible health related effects, workplace monitoring, audiometry, and blood pressure screenings are essential. When in work settings with elevated noise exposures, occupational and environmental health nurses should be focused on creating a program designed to prevent exposure to high levels of occupational noise.

Monkeypox in the United States: an occupational health look at the first cases.

Abstract: Between May 15 and June 20, 2003, 71 suspected cases of monkeypox were investigated and 37 individuals in the United States developed laboratory confirmed monkeypox. These were the first cases of human monkeypox ever documented in the United States or in the Western Hemisphere. The disease was transmitted from small animals imported from Africa to other animals, including prairie dogs sold as pets throughout the U.S. Midwest. Direct contact with the infected animals was the method of infection, and although human to human transmission was thought to have occurred, this was not confirmed by follow up testing. Because of the link with contact with a prairie dog, initial evaluation of the disease was focused toward diseases commonly associated with this animal (e.g., tularemia, plague). Laboratory findings at the Marshfield Clinic in Marshfield, Wisconsin pointed to the presence of an orthopox. The CDC confirmed monkeypox was the infecting orthopox agent. Occupational health nurses from the Marshfield Clinic had direct involvement in the identification and follow up of employees who had direct contact with the diagnosed patients. Programs, such as a respiratory protection program initiated and carried out by Clinic occupational health nurses, were used to prevent employee exposure for Clinic staff. One Clinic employee was thought to potentially have monkeypox because of her direct contact with one of the patients. Four Clinic employees were vaccinated with vaccinia vaccine as a result of their contact with patients or lab specimens. Quarantine of the potentially infected employee and her boyfriend uncovered issues that must be addressed if other infectious diseases requiring quarantine or isolation of individuals emerge or re-emerge. These include a system to compensate individuals in quarantine or isolation who do not have any other source of income. The issue of whether workers' compensation should cover an employee who is quarantined or isolated for a potential work related exposure to an infectious disease if no disease is actually diagnosed also needs to be explored. A better system of getting state or CDC laboratory results back to the local level, including the occupational health area of the generating facility, must be developed. This will be very important if diseases such as severe acute respiratory syndrome (SARS) or smallpox should re-emerge in the United States. Occupational health nurses are an integral part of any infectious disease process occurring in the United States. The identification of monkeypox in the United States shows that any planning to detect, prevent, and treat diseases with the potential to affect the employee population must include occupational health nurse involvement.

Sharps injuries in the home health care setting: risks for home health care workers

Abstract: Home health care nurses are at risk of needlesticks and blood exposures, yet few studies have been conducted related to such exposures in the home health care setting This article describes a cross sectional prevalence pilot study of needlesticks and blood exposures conducted among three home health care agencies in the San Francisco Bay area Needlestick and blood exposure reports from 1993 to 1996 were submitted from three home health care agencies The exposures were categorized using an existing categorization system and compiled into a composite report A total of 52 exposures occurred; nurses sustained 92% of exposures Twenty-three percent occurred before, during, or after needle disposal; 17% from manipulating intravenous/access ports; 15% from improper disposal; and 135% during or after blood draw Needle safety devices need to be specifically designed for the unique home health care setting and for a standardized rate of calculating needlestick injuries in this setting

Garment workers in California: health outcomes of the Asian Immigrant Women Workers Clinic.

Abstract: In this cross sectional descriptive study, the demographics, risk factors, and health outcomes of a volunteer, symptomatic sample of monolingual Cantonese garment workers in the Oakland, California Chinatown area are documented. Methods included a questionnaire and clinical examination and treatment at the Asian Immigrant Women Workers Clinic, a free clinic providing culturally focused occupational health consultation and treatment for painful musculoskeletal disorders. Because garment work involves highly repetitious, sustained awkward postures, focused education on stretching and ergonomics also was provided. Results from the first 100 clients revealed a highly symptomatic sample, with an average age of 48.7 years. Sixty-six percent rated their health status as fair or poor. Sixteen percent of the sample had nerve entrapments, and 99% had a diagnosed strain or sprain of the spine or upper extremities. This population did not file workers' compensation claims because of a lack of knowledge and a fear of reprisal. This study documented the barriers to seeking care for this low wage, immigrant population.

Managing workplace depression: an untapped opportunity for occupational health professionals.

Abstract: Depression is one of the most prevalent and costly health issues affecting the American work force. Despite well established research demonstrating the association between employee depression and reduced on-the-job productivity, increased absenteeism, and higher health care use, most employers remain largely unresponsive to the need for company based depression initiatives. Organizational and individual barriers can prevent companies from effectively managing employee depression. Organizational barriers include information gaps, lack of data to justify increased investment in employee mental health programs, and employers' ambiguous roles in addressing depression. Individual barriers such as an inability to recognize signs and symptoms; stigma; confidentiality and privacy concerns; and unavailability of easily accessible, quality resources can keep employees who are depressed from seeking treatment. Many occupational health professionals may feel ill prepared or uncomfortable taking the lead in creating more aggressive worksite responses to depression, but they are, perhaps, in the best of all possible positions within an organization to succeed. Occupational health professionals have the credentials, credibility, training, and experience necessary to build a strong case for business leaders for why investing in workplace depression programs is so important. Occupational health professionals are the most qualified to design and deliver destigmatized, customer friendly programs and services for employees to access for help with depression, and to integrate their services with other departments such as benefits, health promotion, EAP, and human resources, to create an effective, organization-wide depression initiative.

The risky business of production agriculture: health and safety for farm workers.

Abstract: The lifestyles of employees affect their work and their health. Occupational health nurses need to know as much as possible about employees to render the best care possible. Production agriculture is a risky business performed by many employees. By understanding the risks involved, occupational health nurses can optimize the health of workers in the off farm and on farm contexts of their lives. Managers and supervisors need to realize that investment in farm health and safety can yield financial benefits in terms of decreasing lost workdays caused by injury and illness and increased morale through public recognition of the importance of agricultural production.

Focus on osteoporosis.

Abstract: Talk about osteoporosis risk in your male patients. Safety concerns with treatments are still being evaluated, but in most cases benefits outweigh the risk of adverse effects. Drug holidays may be appropriate for select patients, but the evidence is limited. Calcium is still required for healthy bones, but intake should be through diet rather than supplements, and more is not better. All adults should take a vitamin D supplement. Smoking cessation and avoiding excessive alcohol intake can reduce the risks of both osteoporosis as well as adverse effects of treatment.

Seasonal and migrant agricultural workers: a neglected work force.

Abstract: A desperate need exists to provide occupational health services to migrant and seasonal farm workers in the United States. There are unique challenges related to this endeavor, and the authors have attempted to explain some of the issues that have not been previously discussed in a forthright manner. In doing so, it is likely that some controversy related to the topic has been introduced.

Work related injury and illness.

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Rewarding safe behavior: strategies for change.

Abstract: Effective, sustainable safety incentives are integrated into a performance management system designed to encourage long term behavior change. Effective incentive program design integrates the fundamental considerations of compensation (i.e., valence, instrumentality, expectancy, equity) with behavior change theory in the context of a strong merit based performance management system. Clear expectations are established and communicated from the time applicants apply for the position. Feedback and social recognition are leveraged and used as rewards, in addition to financial incentives built into the compensation system and offered periodically as short term incentives. Rewards are tied to specific objectives intended to influence specific behaviors. Objectives are designed to challenge employees, providing opportunities to grow and enhance their sense of belonging. Safety contests and other awareness activities are most effective when used to focus safety improvement efforts on specific behaviors or processes, for a predetermined period of time, in the context of a comprehensive safety system. Safety incentive programs designed around injury outcomes can result in unintended, and undesirable, consequences. Safety performance can be leveraged by integrating safety into corporate cultural indicators. Symbols of safety remind employees of corporate safety goals and objectives (e.g., posted safety goals and integrating safety into corporate mission and vision). Rites and ceremonies provide opportunities for social recognition and feedback and demonstrate safety is a corporate value. Feedback opportunities, rewards, and social recognition all provide content for corporate legends, those stories embellished over time, that punctuate the overall system of organizational norms, and provide examples of the organizational safety culture in action.

Reducing overall health care costs for a city municipality: a real life community based learning model.

Abstract: City municipalities implementing health and wellness programs patterned after North Little Rock, Arkansas, can significantly reduce the cost of health care for employees, as well as reduce costs associated with workers' compensation claims and lost time caused by injury. In addition to primary care services, effective programs include health risk assessments through pre-placement physicals, employee physicals, drug screening, employee health and wellness promotion programs, and immunization and registry. In implementing the program, a team from the University of Arkansas for Medical Sciences College of Nursing worked with city officials to establish a steering committee, safety initiatives through first responders, systems for monitoring immunizations, criteria for pre-placement physicals, and an employee health and wellness program. While the benefits for the city are well documented, the contract also created opportunities for education, research, and services in a real life community based learning laboratory for students in the College of Nursing. In addition, it provided opportunities for faculty to participate in faculty practice and meet the College's service missions. The College's model program holds promise for use by other major health care centers across the region and nation.

Education of garment workers: prevention of work related musculoskeletal disorders.

Abstract: This educational intervention was designed as part of a garment worker occupational health and safety initiative, with the goal to reduce musculoskeletal symptoms in this monolingual Cantonese speaking population. Using risk communication and the Chinese concepts of yin and yang, the class curriculum was designed to be participatory. It focused on linking symptoms to high risk work activities; explaining the nature of musculoskeletal injury; and encouraging compliance with self care measures of ice, stretching, and early symptom reporting. A total of 21 women completed the Healthy Work Classes, with an increase in perceived levels of energy measured after each class. Additionally, contingency contracting for both individual and workplace change was piloted. This curriculum was revised to become a "train the trainer" program, with training of garment worker leaders and the goal to disseminate this prevention based curriculum to garment workers in the Oakland, California community.

Workplace violence against K-12 teachers: implementation of preventive programs

Abstract: Decreasing both workplace and school violence needs to be a priority of individuals, families, communities, and workplaces for the effort to be successful. Key factors associated with school and workplace violence such as parental influences, school staff and police involvement, peer pressure, student influences such as drug and alcohol abuse and a preoccupation with weapons, and the mass media have all been identified as possible factors associated with violence against teachers. In addition, individual student characteristics such as gender, socioeconomic status, and a history of prior violence may play a role. However, none of these factors can be identified or singled out as the reason for violence. Violence against teachers occurs as a result of a combination of these factors. Understanding how these factors interact should be a goal of every community and school. Occupational health nurses have the unique opportunity to partner with communities, school nurses, and the school system to develop effective violence prevention programs. Working in schools is an area of expansion for occupational health nurses. They have the expertise to perform worksite assessments and to identify key areas of weakness throughout the facility. Their expertise in reviewing and analyzing workplace injury data and developing cost effectiveness analysis for proposed interventions is unique. Occupational health nurses also have the skills to network with school officials and other key stakeholders to develop interventions to impact the substantial implications of violence in the schools. Language: en

Implementation of a scheduled toileting program in a long term care facility: evaluating the impact on injury risk to caregiving staff.

Abstract: This study evaluated the impact of a scheduled toileting program on the risk of injury to caregivers and on resident agitation or aggressive behaviors. Injury data, ergonomic assessments, staff questionnaires, and resident agitation checklists were used to evaluate the program in a 75 bed unit, with a similar unit acting as a comparison. The program resulted in an increased percentage of residents toileted regularly in the intervention unit, while aggressive incidents declined in both groups. Staff in the intervention unit reported a significantly lower perceived risk of injury to the head and neck than the comparison group. Although the program resulted in increased workload to manage multitasking, monitor an additional aspect of scheduled care, and perform more toileting transfers, overall risk of physical injury was reduced. The toileting program, a shift toward resident focused care, and enhanced agitation awareness combined to reduce resident handling injuries and resident agitation expressed as verbal behaviors or emotional upset, but not as physical behaviors. Clear communication, mentoring, and monitoring were important for successfully changing care practices.

Bradycardia induced by hyperkalemia

Abstract: The incidence of chronic cardiac disease is increasing (Jessup, 2003). As a result, it is important for occupational health nurses to recognize adverse effects (e.g., electrolyte abnormalities, dysrhythmias) associated with current treatment guidelines (Hunt, 2001). As shown in the example in this case study, the current recommended treatment for clients who have myocardial ischemia and left ventricular dysfunction (i.e., ACE inhibitor and a potassium-sparing diuretic) puts clients at risk for hyperkalemia, especially in the presence of renal insufficiency.

Evaluation of an environmental health education program: assessing changes in knowledge of health professionals.

Abstract: Knowledge about environmental health is crucial for nurses so they can take into account both the living and occupational environments of clients during history taking and physical assessments. When focused on local environmental conditions and exposures, outreach educational programs on environmental health can result in a measurable increase of interest to learn and enhance the knowledge base of participants. Public health agencies and educational institutions should consider entering into partnerships to sponsor such professional development programs for nurses and other health professionals to promote the health of local populations.

Urban Sprawl and You: How Sprawl Adversely Affects Worker Health

Abstract: Urban sprawl, once thought of as just an environmental issue, is currently gaining momentum as an emerging public health issue worthy of research and political attention. Characteristics seen in sprawling communities include increasing traffic volumes; inadequate public transportation; pedestrian unfriendly streets; and the division of businesses, shops, and homes. These characteristics can affect health in many ways. Greater air pollution contributes to higher asthma and other lung disorder rates. An increased dependence on the automobile encourages a more sedentary lifestyle and can potentially contribute to obesity. The increased danger and stress of long commutes can lead to more accidents, anxiety, and social isolation. Occupational health nurses can become involved by promoting physical activity in the workplace, creating programs for injury prevention and stress management, becoming involved in political smart growth measures, and educating and encouraging colleagues to become active in addressing this issue.

Great Safety Performance: An Improvement Process Using Leading Indicators:

Abstract: The Great Safety Performance model uses leading indicators to drive injury prevention and provides a process to improve a company's safety outcomes by maximizing the conditions for safety within the workplace. The model asserts that leaders and workers need to jointly create conditions whereby everyone will know what to do, be able to do it, be equipped to do it, want to do it, and experience interactions that support safe performance in their job duties. These factors are referred to as the conditions for great performance. The Great Safety Performance model can serve as a vehicle to quantify, document, and demonstrate the efforts a company invests to create a safe workplace with safe work practices. By using the Great Safety Performance model, organizations can design and implement a variety of high leverage improvement initiatives specific to their business situations.

Defining the roles and functions of occupational health nurses in Japan: results of job analysis.

Abstract: The purposes of this study were to obtain descriptive information about the job duties and tasks of Japanese occupational health nurses and to compare the roles and functions of occupational health nurses in the United States and Japan. A modified version of a job analysis survey developed by the American Board for Occupational Health Nurses was used to collect data. The findings indicated 62% of Japanese occupational health nurses perform direct care roles, approximately half perform educating or advising and consulting roles, and approximately 40% perform management roles. Details related to specific tasks and differences in nurses with varying preparation also are presented. Although there were many similarities in the types of tasks performed by nurses in Japan and the United States, the proportion of time devoted to specific tasks in the two countries varied. These results support the need for developing an educational system to enhance occupational health nursing practice in Japan. The information derived from the study provides a knowledge base that can be used to provide guidance and direction to the content of occupational health nursing programs.

Diabetes update: promoting effective disease management.

Abstract: Diabetes is common, serious, costly, and controllable. Current scientific evidence indicates much of the morbidity and mortality associated with diabetes can be eliminated through prevention, early detection, improved delivery of care, and better education for diabetes self management. Unfortunately, a wide gap still exists between current and desired diabetes care and practices. Using existing tools (see Figure) (Kentucky Diabetes Network, 2004), the occupational health nurse can help bridge this gap for employees with diabetes by assuring a workplace that supports achievement of successful outcomes related to diabetes management and control.