Occupational safety and health objectives of Healthy People 2010: a systematic approach for occupational health nurses--Part II.

Occupational safety and health objectives 20.6 through 20.11 focus on reducing work-related assaults, lead exposure, skin diseases and disorders, needlestick injuries, and work-related, noise-induced hearing loss and promoting worksite stress reduction programs. Using the intervention strategies provided, occupational health nurses can play a key role in reducing workplace-related injury, disease, disability, and death. variety of resources pertaining to occupational health and safety from the federal, national, health care, nursing, and environmental realms can assist occupational health nurses in developing and implementing programs appropriate for their workplaces. Through the Healthy People 2010 occupational health and safety objectives, occupational health nurses have the opportunity to develop and implement workplace policies and programs promoting not only a safe and healthy work environment but also improved health and disease prevention. Occupational health nurses can implement strategies to increase quality and years of life and eliminate health disparities in the American work force.     

Smoking cessation programs in the workplace. Review and recommendations for occupational health nurses

The worksite offers occupational health nurses unique opportunities to assist workers in their smoking cessation efforts. For nurses to be effective in this endeavor, they must be knowledgeable about the various quit smoking strategies that have met with some success. Based on the review of the research, there is no "magic bullet" to offer smokers who want to quit. Occupational health nurses have an opportunity, therefore, to use multiple approaches and design programs to fit the specific needs of the smokers in their practice. Published reports of nurses' involvement in workplace smoking cessation programs are sparse. It is crucial that occupational health nurses spearhead smoking cessation efforts at the workplace and communicate the results of these enterprises.     

Creating a successful occupational health and safety program. Using workers' perceptions.

Workers' perceptions of risk directly influence the behavioral choices they make. This directly impacts the type of safety precautions taken on the job. It is imperative that perceptions be considered when planning and implementing a worksite health and safety program. Occupational and environmental health nurses are in the perfect position to ensure workers' perceptions are considered, thus reducing worksite injury and illness and increasing company profits.     

A model for cholesterol reduction in a corporate research setting

Cardiovascular risk reduction programs at the worksite may be effective in reducing the incidence of coronary heart disease due to elevated blood cholesterol levels in the employee population. Employers have a vested interest to provide a work environment conductive to lowering an individual's risk of coronary heart disease. CHD translates into a multitude of costs for both employers and employees. The worksite can provide an excellent opportunity for a corporation to improve and maintain the health of human resources, their most valuable asset. Occupational health nurses are in a key position to identify employees at risk, provide education, make appropriate referrals, and facilitate long term lifestyle changes through tracking and follow up.     

Nurses' intervention in specific risk factors in high risk employees. An economic appraisal

1. Occupational health nurses can lower employees' health risks through appropriate screening, education, and monitoring efforts at the worksite. 2. In addition to health promotion as well as benefits education, influencing the demand for health care, creating cost efficient services, and informing employees on how, when, and why to use cost efficient health care services, are the foundations for successful health care cost management. 3. To respond to growing accountability issues, nurses need to quantitatively evaluate the overall impact of their efforts on employees' health status and corporate health care costs. 4. The occupational health nurse can be an effective health care cost manager by using appropriate strategies and resources consistently.     

Literacy and hazard communication: ensuring workers understand the information they receive.

More than 30 million American workers are exposed to hazardous chemicals in the workplace. The Occupational Safety and Health Administration first promulgated the Hazard Communication Standard in 1983 to ensure that workers were informed of the hazardous chemicals with which they work. Nine research studies published from 1983 to 2005 evaluating the relationship between literacy and hazard communication were reviewed. Three main gaps were identified: lack of learner involvement to improve hazard communication, lack of employer assessment of employee understanding of training provided, and lack of studies assessing retention of the material taught and its application at the worksite. Studies need to involve learners, assist employers in assessing employees' understanding of the material taught, and assess retention and application of the material at a later date. Nurses are often the only health care providers at worksites.Thus, they may be responsible for teaching hazard communication content, or possibly reinforcing material covered during training. Some workers may have low health literacy levels. Occupational health nurses must provide workers with hazard communication training they understand, retain, and can apply at the worksite.     

Managing asthma in the workplace: an overview for occupational health nurses.

Occupational health nurses are the ideal members of the workplace team to initiate disease management programs for chronic illnesses; asthma is just one disease for which occupational health nurses can make a difference. Employees win by improving their health and quality of life, having better control of a chronic health condition, simply feeling better, and using time off for vacation rather than sick days. Employers win by having healthier employees who are absent less often and more productive at work, and who cost the company less for their health care. Occupational health nurses are the key link in this cost saving, productivity enhancing chain. Being proactive in this disease management role clearly establishes occupational health nurses' value in their organization.     

The need for a more holistic health care system

As a result of the evolution of health problems in the United States, the current health care system must change its focus from the traditional biomedical model to a holistic health oriented model. The holistic health oriented system is based on the enhancement and maintenance of health, not on the cure of disease. Given positive research findings concerning the health and cost benefits of worksite health promotion programs, it appears that industry, along with third party payers, nurses, and other health care professionals, could alter the emphasis and direction of health care. The worksite provides an ideal setting for the development of holistic programs. The occupational health nurse, whose role involves health promotion, health protection, environmental screening, and illness intervention, is in the best position to work with management in developing health promotion programs.     

Risks of phthalate exposure among the general population: implications for occupational health nurses.

Personal care items including lotions, perfumes, deodorants, shampoos, and cosmetics are sources of phthalate exposure. Women of childbearing age, children, and beauty salon workers are at greater risk for exposure. Occupational health nurses are in an ideal position to rally support for improved regulatory laws and for funding of evidence-based research that will reduce phthalate exposures and improve client health. Occupational health nurses must support the establishment and implementation of procedures for workplace safety inspections among susceptible populations. Information regarding reduction of overall phthalate exposure must be available for clients. Resources like phthalate-free product lists can be valuable tools in helping clients make informed decisions about alternatives to phthalates.     

Demonstrating the cost effectiveness of an expert occupational and environmental health nurse: application of AAOHN's success tools. American Association of Occupational Health Nurses.

According to DiBenedetto, "Occupational health nurses enhance and maximize the health, safety, and productivity of the domestic and global work force" (1999b). This project clearly defined the multiple roles and activities provided by an occupational and environmental health nurse and assistant, supported by a part time contract occupational health nurse. A well defined estimate of the personnel costs for each of these roles is helpful both in demonstrating current value and in future strategic planning for this department. The model highlighted both successes and a business cost savings opportunity for integrated disability management. The AAOHN's Success Tools (1998) were invaluable in launching the development of this cost effectiveness model. The three methods were selected from several tools of varying complexities offered. Collecting available data to develop these metrics required internal consultation with finance, human resources, and risk management, as well as communication with external health, safety, and environmental providers in the community. Benchmarks, surveys, and performance indicators can be found readily in the literature and online. The primary motivation for occupational and environmental health nurses to develop cost effectiveness analyses is to demonstrate the value and worth of their programs and services. However, it can be equally important to identify which services are not cost effective so knowledge and skills may be used in ways that continue to provide value to employers (AAOHN, 1996). As evidence based health care challenges the occupational health community to demonstrate business rationale and financial return on investment, occupational and environmental health nurses must meet that challenge if they are to define their preferred future (DiBenedetto, 2000).     

Interdisciplinary practice, education, and research: the expanding role of the occupational health nurse.

The nurses' roles are changing and expanding along with the changing health care system. Occupational health and environmental health nurses are in key positions to coordinate and direct interdisciplinary practice, education, and research. Occupational and environmental health nurses have a broad knowledge base in which they deal with employers, employees, stakeholders in communities, different governmental organizations, and families. Interdisciplinary collaboration is a way to find possible solutions to meet the needs of the work force, their families, communities, and the global community. Nurses must educate the different disciplines about their worth in collaborative interdisciplinary practice, education, and research. No single discipline can help individuals reach their full level of well-being. Interdisciplinary practice, education, and research should be encouraged for nurses to provide the best care for individuals in need of health care.     

Employee health newsletters. Analysis of characteristics

1. Although health newsletters are a frequent component of worksite health promotion programs, they vary considerably in distribution, format, and content. Such variety highlights the many options involved with this particular medium of health promotion. 2. The newsletters analyzed ranked highly in terms of attention catching potential and usefulness to employees. In addition, content strongly reflected an emphasis on prevention and healthy lifestyle habits. 3. Occupational health nurses must carefully consider advantages and disadvantages before deciding whether to use an outside vendor or produce the newsletter in-house, considering staff and time constraints in producing an effective newsletter. 4. The occupational health nurse is in a unique position to plan content and reinforce health messages that the newsletter presents, allowing for more effective interaction with the employees for whom the newsletters are designed.     

The relationship between caregiving and employment. A study of stress in employed and unemployed caregivers of elderly persons

The need for persons to provide care on an informal basis to frail and dependent elderly persons has generated a "caregiving crisis" in this country. Middle age women, the traditional caregivers for most generations, are no longer readily available to provide informal care. Instead, they are likely to be struggling to cope with the dual demands of paid employment and family responsibilities. Significant differences exist between employed and unemployed caregivers in relation to age, marital status, gender, personal health status, and caregiver-care recipient relationships. However, no differences exist in relation to the amount of stress experienced as a consequence of caregiving responsibilities. Occupational health nurses have an ideal opportunity to help employed caregivers cope with their caregiving responsibilities both at the worksite and in their personal lives.     

Developing quality assurance programs in the occupational health setting

It is important in the delivery of quality nursing care to have a system in place to evaluate the care administered. It is the responsibility of the profession to develop such a system, which is done in nursing through quality assurance programs. Quality assurance programs are based on standards of practice and peer review systems. Occupational health nurses are somewhat unique in their work situations and often need to develop creative strategies for quality assurance programs. The criteria used to evaluate nursing care may be developed to look at the structure, process, or outcome of nursing care. The model for implementation of quality assurance programs involves seven steps.     

Environmental justice: implications for occupational health nurses.

Through the use of innovative tools, such as clinical mnemonics, exercises in risk and asset mapping, and strategic program development, occupational health nurses can incorporate dimensions of environmental justice (EJ) into the workplace. Occupational health nurses who also take on educational roles can use case studies and network with labor and EJ groups to provide clinical experiences for occupational and environmental health nursing students, thereby integrating EJ into occupational and environmental health nursing practice. Occupational health nurses are well positioned to serve as technical experts within community-based participatory research projects. Occupational health nurses must share their knowledge and experience as members of coalitions that represent workers in their fight for worker health and safety.     

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.     

Smoke-free nurses: leading by example.

Occupational health nurses' scope of practice includes health promotion and restoration of health from environmental hazards (American Association of Occupational Health Nurses, n.d.). Because the nursing profession is the largest constituent of health care providers, it is essential that occupational health nurses tackle the smoking epidemic among the nursing profession. By encouraging smoking cessation among nurses, occupational health nurses reduce the environmental hazard of second-hand smoke and improve the health of nurses who smoke. When occupational health nurses take an active role in encouraging smoking cessation among nurses, they become leaders in reducing smoking within their communities. Members of the nursing profession are also role models. Occupational health nurses must help nurses become healthy role models and credible educators in the battle against smoking.     

Child day care arrangements and employee health.

With the changing demographics of the work force and predictions that two thirds of new job entrants will be female, it is vital that occupational health nurses develop programs to meet these changes to ensure the health and safety of the work force. Workers and their families can no longer be viewed as separate from the workplace. There is an interactive relationship between workers, their families, and their work. Child day care arrangements can positively or negatively affect all three domains. Available, affordable, accessible, and dependable child day care are only part of the answer for the child care crisis facing today's workers. The perception of the quality of the day care center seems to be a major factor affecting mothers in the work force. Occupational health nurses are in a pivotal position to assist workers in meeting the unique demands and challenges of the dual career family--including child day care--thus promoting a more productive, healthier, and safer work force.     

Hepatitis B vaccine: acceptance among occupational health nurses practicing in hospital employee health settings.

Seventy-seven percent of the hospital employee nurses in this study had accepted hepatitis B vaccine, a higher rate than that reported in the literature for other health care workers. The study found a significant relationship between increased perceived susceptibility to HBV and hepatitis B vaccine acceptance. The unvaccinated nurses did not perceive the employee health setting as risky, yet their clientele (health care workers) are five to 10 times more likely than the general population to be hepatitis B carriers. The younger and less experienced nurses were significantly more likely to have been vaccinated. The hepatitis B vaccine should be offered early in the career of employed health care workers, made accessible at the worksite, and offered to student health care workers. Hepatitis B vaccine education and counseling should focus on increasing perceived susceptibility to HBV for all health care workers and stress vaccine safety and effectiveness.     

Screening for and treating intimate partner violence in the workplace.

The WHO has declared that violence is a leading worldwide public health problem with intimate partner violence one of the most common forms of violence against women (2002). Health care providers are frequently among the first to see victims of intimate partner violence and must strive to provide appropriate and effective care to abused women. Violence by intimate partners can be prevented. Occupational health nurses have a unique opportunity to intervene with abused women. Routine screening for intimate partner violence increases the likelihood of violence identification, leading to early intervention that may prevent trauma and injury. Occupational health nurses can foster a caring and confidential workplace where abused women feel safe to disclose the violence in their lives and trust that the nurse will provide treatment. A safe and healthy workplace, where abused women feel comfortable disclosing intimate partner violence and seeking treatment may also protect coworkers from the stress and violence that may potentially affect them. Occupational health nurses need to add screening for and treatment of intimate partner violence to their current health promotion and prevention activities to benefit all employees.