Guidelines for an occupational safety and health program

1. OSHA has suggested that safety and health programs contain, at a minimum, the following four components: management commitment and employee involvement; worksite analysis; hazard prevention and control; and safety and health training. 2. Goals and objectives must be communicated to all employees so that everyone understands the direction the organization wants to take. 3. Periodic comprehensive surveys of the worksite provide an opportunity to step back from the routine checks for previously recognized hazards and look for others. 4. Ultimately every employee should receive safety and health training. This is essential if everyone is going to understand and accomplish "safe production."     

Medical surveillance in work-site safety and health programs

Businesses frequently call on family physicians to provide employee health services at the work site or in the clinician's office. These services include medical screening (detection of dysfunction or disease before an employee would ordinarily seek medical care) and medical surveillance (analysis of health information to identify workplace problems that require targeted prevention). Such services can transform acute care and routine screening activities into opportunities for primary prevention when they are integrated into the broader framework of work-site safety and health programs. Components of these programs include management commitment, employee participation, hazard identification and control, employee training and program evaluation. For optimal program success, family physicians must communicate with frontline safety officers and have first-hand knowledge of the workplace and its hazards. Professional and technical resources are available to guide the family physician in the role of medical surveillance program coordinator.     

Emergency Department Security Programs,Community Crime,and Employee Assaults

Background: Violence against health care workers is a serious occupational health hazard, especially for emergency department (ED) employees. A significant degree of variability in security programs among hospital EDs is present in part due to the absence of federal legislation requiring baseline security features. Nationally, only voluntary guidelines from the Occupational Safety and Health Administration (OSHA) for the protection of health care workers exist. Objectives: The purpose of this study was to examine ED security programs and employee assault rates among EDs with different financial resources, size, and background community crime rates. Methods: This cross-sectional survey was conducted among large and small hospitals located in communities with low or high rates of community crime. Hospital financial data were collected through the state health department, and employee assault data were abstracted from hospital OSHA logs. Comparisons were made using a chi-squared or Wilcoxon test. Results: Small hospitals located in towns with low community crime rates implemented the fewest security program features despite having the second highest rate of assault-related OSHA-recordable injuries among ED employees (0.66 per 100,000 staff hours). Conclusion: Due to the highly stressful workplace characteristics of EDs, the risk of employee assault is universal among all hospital sizes in all types of communities.     

Successful return to work following a musculoskeletal injury

Successful return to work following a musculoskeletal injury is facilitated by early intervention and rehabilitation that addresses the physical, psychosocial, and environmental factors in recovery. Job simulation and work hardening programs that involve the employee, the employer, and the health care providers are an effective approach to injured worker rehabilitation. The occupational health nurse's role can include early identification of injury, treatment coordination and follow up, matching worker abilities and restrictions to the job, and implementation of an injury prevention program. An injury prevention program should be worksite specific, and can include identification of injury hazards, preplacement testing, employee training, and ergonomic job redesign.     

Occupational health surveillance, screening, and prevention activities in occupational health nursing practice.

Occupational health nursing practice is broad and encompasses surveillance, screening, and prevention activities as part of the scope of practice. While there has been some controversy about who is responsible for these activities, it is clear occupational health nurses play a pivotal role in overseeing, managing, implementing, and evaluating these programs. In fact, recent OSHA standards have included broad language that permits licensed health care professionals acting within their legal scope of practice to conduct medical and health surveillance activities. While the contributions of occupational health nurses are well documented, little is known about the degree and emphasis in practice related to surveillance, screening, and prevention programs. This study examined the scope of independent and interdependent practice by occupational health nurses related to these activities and found 71% of occupational health nurses had overall responsibility for program management, and the majority performed surveillance, screening, and prevention functions as independent practice. Physician supervision for any of these activities ranged from only 0% to 8% in reporting. The results of this study validate the independent functioning in scope of occupational health nursing practice related to surveillance, screening, and prevention activities while recognizing the contributions all providers make to a healthy work force.     

新型冠状病毒肺炎防控期间综合医院员工的健康防控管理探讨

目的探讨新型冠状病毒肺炎防控期间综合医院员工健康防控管理的措施。 方法利用质量控制管理工具中的分层法，通过涵盖全员覆盖培训，依照疫情特点精细分组，梯队式健康上报流程的“3M工作方案”，实现全院员工的整体防控和管理。 结果2020年1月29日至6月6日，全院4463名员工“零感染”。 结论作为防疫“第一哨岗”的综合医院，科学精准的管理方法、全面覆盖的教学培训，是降低院内感染、保护医患安全的关键。     

Health promotion in the office

Occupational therapists have the training and skill to modify office environments in order to promote employee health. Minor changes in the ways tasks are performed can improve work performance, decrease the incidence of minor health complaints, and help prevent repetition injury. Two employee health promotion education programs are described. They were conducted by an occupational therapist and can be replicated in other settings. One program was a seven-session series for bank employees; the other was a luncheon presentation to office workers employed by a health science university.     

Limited English proficiency workers. Health and safety education.

1. As the population of adults with limited English proficiency plays an increasingly important role in the United States workplaces, there has been a growing recognition that literacy and limited English skills affect health and safety training programs. 2. Several important principles can be used as the underlying framework to guide teaching workers with limited English proficiency: clear and vivid way of teaching; contextual curriculum based on work; using various teaching methods; and staff development. 3. Two feasible strategies were proposed to improve current situation in teaching health and safety to workers with limited English proficiency in one company: integrating safety and health education with ongoing in-house ESL instruction and developing a multilingual video program. 4. Successful development and implementation of proposed programs requires upper management support, workers' awareness and active participation, collaborative teamwork, a well structured action plan, testing of pilot program, and evaluation.     

The basics of an exposure control plan.

Prevention and control of employee injury and exposure begins with an organizational commitment to provide a safe work environment for the employees. An Exposure Control Plan (ECP) helps to ensure this safe environment, and is developed by an organization and administered to provide for the elimination and minimization of occupational exposure to blood-borne pathogens, which is one of the greatest areas of risk for the health care provider. The Occupational Safety and Health Administration (OSHA) standard 29 CFR 1010.1030, "Occupational Exposure to Bloodborne Pathogens," outlines the requirements necessary to meet compliance as an institution. However, occupational exposure requirements have changed over the last few years and now incorporate practice advances regarding safety devices (ie, needleless and protected) and their use and implementation. Directives addressing the management of the employee who has been exposed to blood-borne pathogens have also been added. This article focuses on important elements in developing an institutional exposure control plan.     

Integrated approach for managing health risks at work--the role of occupational health nurses.

Currently, many organizations are using a department-centered approach to manage health risks at work. In such a model, segregated departments are providing employee benefits such as health insurance, workers' compensation, and short- and long-term disability or benefits addressing work-life issues. In recent years, a new model has emerged: health and productivity management (HPM). This is an employee-centered, integrated approach, designed to increase efficiency, reduce competition for scarce resources, and increase employee participation in prevention activities. Evidence suggests that corporations using integrated HPM programs achieve better health outcomes for their employees, with consequent increased productivity and decreased absenteeism. Occupational health nurses are well positioned to assume leadership roles in their organizations by coordinating efforts and programs across departments that offer health, wellness, and safety benefits. To assume their role as change agents to improve employees' health, nurses should start using the language of business more often by improving their communication skills, computer skills, and ability to quantify and articulate results of programs and services to senior management.     

OSHA 101: an introduction to OSHA for the occupational health nurse.

The OSHA standards become easy to use with experience. Occupational health nurses who are unfamiliar with the standards are better served to use them as a reference, rather than attempting to read the entire document. Many of the standards have booklets published to assist users in understanding the information. These booklets are available within the publications link of the OSHA website. Occupational health nurses who have taken the initiative to gain knowledge about OSHA and to become fluent in navigating the OSHA standards soon discover that the ability to access the information contained in the standards quickly is a marketable skill. Employers depend on occupational health nurses to develop comprehensive programs that achieve the goal of injury prevention and also meet compliance requirements. The standards contain a wealth of information to do just that.     

Absenteeism control programs. Results of a national survey of certified occupational health nurses

An absenteeism control program can reduce employee absenteeism, thereby reducing company expenses, improving productivity, and bringing workers back to work sooner. A survey of Cohn's suggests that many companies in the United States lack absenteeism control programs, and those firms that have such programs are unlikely to have all the elements of a good program in place. Placing the occupational health nurse in charge of a comprehensive program will provide needed leadership, responsibility, expertise, and control.     

Implementing a job hazard analysis program.

Analyzing the workplace for hazards and controlling the hazards identified to reduce risk is a proactive approach to workplace safety and the primary prevention of occupational illnesses and injuries. A JHA is a simple, time tested, and effective tool to assist in this analysis. Job hazard analysis methods may enhance and complement many current business initiatives. When programs can be integrated to contribute to leadership mandates, there are opportunities for increased support and resources. Involving other departments and disciplines with complementary programs also reduces duplication of effort. Prioritizing jobs to be analyzed based on risk assessment results in a manageable approach for beginning a program. A team process involving employees, supervisors, and key safety participants is most effective. Successful programs encourage each team member to observe or videotape key jobs, list the job steps, and involve the team in developing hazard reduction solutions and safe job procedures. When effectually used, JHAs have been proven to improve communication and participation, while enhancing worker safety.     

医院管理中的工作压力管理

目的探讨将工作压力管理理论引入医院管理的方法和措施。方法通过查阅文献并结合现代医院的工作特点对将工作压力管理理论引入医院管理的方法和措施进行分析。结果探讨了医院进行工作压力管理的必要性,总结出在医院中进行压力管理的五项措施,即改善工作环境,进行工作再设计;建立压力应对培训体系,进行各种培训;建立有效的横向和纵向沟通链,增强相互信任;实施员工帮助计划,帮助员工缓解压力;创建合作上进的医院文化,营造和谐氛围。结论现代医院管理应紧紧抓住“以人为本”的原则,更加关注员工的心理健康,实施有效的压力管理,使医护人员的工作压力保持在一个适度的水平上,达到员工和医院效率的最优化。     

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

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.     

Training programs for children: literature review.

INTRODUCTION: Training programs are increasingly being prescribed for occupational therapy for adults affected by chronic illness and/or handicap, but their use is more recent for children and teenagers. OBJECTIVE: A review of the literature to synthesize information concerning training programs for children, whether healthy or with disease or handicap, considering the target population, methodology, the results and limitations. METHODS: We searched the Medline database with use of the key words retraining, training, training programs, physical activity, physical training, fitness program, sport, children, disability, and handicap. We also searched references of the selected articles for appropriate studies. DISCUSSION/CONCLUSION: Physical activity seems to be a good means of primary preventing adverse health in the healthy child and secondary prevention in children with chronic disease or handicap. Thus, training programs could be adapted and integrated into the global treatment of sick or handicapped children in the health care situation or in the home. These programs are feasible and do not undermine children's health, but few studies have shown clear data on the methods of the programs. The suggested training programs, not always validated, included two to five sessions from 30 to 60 min/week, for 6-16 weeks, of variable activity and intensity, adapted to the condition and the objectives of therapy. Training programs adapted to children should be validated to allow their accessibility by health care professionals dealing with children with chronic disease and/or handicap.     

Nurses under threat: a comparison of content of 28 aggression management programs

Staff who work in the health service are now recognized as a high-risk group for assault in the workplace. Recently, professional and industrial organizations have begun to suggest appropriate curricula for training staff in aggression management. However, there is currently a plethora of aggression management training programs (AMP) available, varying both in content and in duration. In this paper, 28 programs were evaluated against 13 major content areas derived from the recommendations made from key professional and industrial organizations, and what may be today considered appropriate/ideal content areas for AMP. Information on programs available in English was sought via standard databases, the Internet, program providers, and through networking with colleagues and professional organizations. The majority of the programs reviewed covered personal safety issues for staff and patients, together with legal issues. The use of restraint, pharmacological management of aggression and seclusion were features of programs specifically addressing the needs of health care staff in mental health settings. Most programs appeared not to address the psychological and organizational costs associated with aggression in the workplace. This is surprising since the literature suggests that the effects of violence are wide and varied, including increased absenteeism and sick leave, property damage, decreased productivity, security costs, litigation, workers' compensation, reduced job satisfaction together with recruitment and retention issues. Also, few programs were based on a systematic evaluation of their outcomes. Suggestions for program development and their teaching are discussed.     

The final word. OSHA's final ruling offers firm deadlines for infection control

Departments that have put off program development while waiting for the final ruling to be published have a lot of work to do. Many departments have been cited and fined by OSHA in the past year for failure to begin infection-control programs or provide hepatitis-B vaccines to personnel. Under the new budget, OSHA was granted permission to up its fine structure sevenfold--thus, a small fine is $7,000, and the highest fine for a single violation is $70,000. Fines can have a greater impact on a department's budget than implementation of the program over time. A key point to remember is that a strong infection-control program will reduce exposure follow-up costs and worker-compensation claims. Infection control is a win-win situation.     

Initiation of a school employee wellness program: applying the Comprehensive Health Education Model.

Employee wellness is an important component of a coordinated school health program and one that often lacks formalization. With many things competing for the school nurse's attention, health promotion for staff most often consists of helping to arrange flu vaccination and blood pressure screenings. The Comprehensive Health Model assists school personnel desiring to formalize an employee wellness program. An earlier nursing practice management article (Galemore, 2000) explored the history and components of work-site wellness programs. The purpose of this article is to review the process as outlined by the Comprehensive Health Education Model used by one school district to initiate an employee wellness program.     

品管圈活动在呼吸重症监护病房的应用与效果

目的在呼吸重症监护病房应用品管圈实施持续的护理质量改进,以提高护理工作质量。方法组建了压疮管理、静脉治疗、气道管理、药品安全及低年资护士技能培训5个品管圈,各品管圈组织专项学习与督导,对存在的问题进行原因分析,制订并落实质量改进措施。结果提高了护理工作质量及患者对护士服务的综合满意度。结论开展品管圈活动,可以增进护士的团队精神,充分发挥其工作积极性,提高护理质量。