Abstract
Voluntary Smoke-Free Policies in Manufacturing Facilities and Smoke-Free Laws
Kacy Allen-Bryant, MSN, MPH, RN
About one in 10 workers is exposed to secondhand smoke (SHS) on the job. Smoke-free manufacturing facilities, either mandated by local or state law or voluntarily adopted by the company, are associated with decreased exposure to SHS and employee smoking rates. Approximately 50% of the population is covered by 100% comprehensive smoke-free laws. The study aim was to examine the associations between the presence of voluntary smoke-free policies in manufacturing facilities and the presence of local smoke-free public policies, controlling for county-level sociodemographics and facility-level characteristics. A secondary analysis of data from the 2010 Kentucky Workplace Tobacco Survey, 2003 Census Urban and Rural Classification database, Kentucky Behavioral Risk Factor Surveillance System, U.S. Department of Agriculture, and the Kentucky Center for Smoke-Free Policy database using multi-level regression analysis was conducted. Ninety-three counties (78% of all counties) and 560 facilities (69.1% participation rate) were included in the analysis. Counties with manufacturing facilities that had voluntary smoke-free policies and larger numbers of employees were more likely to have a comprehensive smoke-free law. Urban status was a significant indicator of comprehensive smoke-free laws. County-level median household income, tobacco production, and facility-level smoking cessation resources for employees were not predictors of county-level smoke-free laws. As consultants, advisors, and advocates for worker health, occupational health nurses are in a unique position to influence the adoption of voluntary smoke-free policies and indirectly drive the passage of comprehensive smoke-free laws across the country. Such policies and laws will protect workers from tobacco smoke–related morbidities and premature death.
Respiratory Protection Toolkit: Providing Guidance Without Changing Requirements. Can We Make an Impact?
Elizabeth Bien, BSN, RN, CNOR, MSN Student
Come and see what life is like for an occupational health nurse in a Middle Eastern country. Learn about employee health and well-being in Doha, Qatar, and see a variety of work challenges and opportunities. Qatar has been under the microscope due to its 2022 World Cup bid. Come and increase your understanding of the complexities of occupational health nursing practice in a Middle Eastern county. The poster will present data on work conditions in Doha as well as several pictures from a variety of workplaces, and occupational health nurses engaged in their work activities. With the widespread accessibility of international travel and the rise of respiratory infectious illness outbreaks both worldwide and nationally, U.S. health care workers are facing increasingly more respiratory exposures than in previous years. To ensure the highest quality safety initiatives are being met, one urban health care system used the recent written guidance from the Occupational Safety and Health Administration’s (OSHA) May 2015 Hospital Respiratory Protection Program Toolkit. Using a quality improvement model of Plan–Do–Study Act, the toolkit was used to identify potential opportunities for improvement within the current respiratory protection plan along with an observation tool and a short survey to identify gaps in practice placing employees at risk of exposures. The toolkit comparison showed strengths of a well-designed Respiratory Protection Program with one identified gap related to not using a respirator during an aerosol-generating procedure on a patient suspected or known to have seasonal influenza. Data were collected and assessed for opportunities to mitigate identified controllable risk, which included incorrect strap placement, failure to perform a user seal check, and reuse of disposable N95 filtering facepiece respirators. Subsequent interdisciplinary collaboration provided ideas for practice changes to decrease these risks and better prepare health care workers to be protected from potentially infectious respiratory illnesses. The use of the toolkit provided a detailed and concise document to evaluate the respiratory protection program showing that although the requirements to meet OSHA guidelines have not changed, the addition of the toolkit can effect a positive change that protects health care workers.
Workplace Sexual Violence in Female Truck Drivers: A Conceptual Framework to Look at the Problem
Kimberly Bourne, MSN, RN, SANE, CEN; Debra Anderson, PhD, PHCNS-BC
Worldwide, workplace sexual violence affects more than 50% of women; 33% are harassed, 8% are raped, and approximately 40% of workplace deaths are the result of homicide. In the United States, the majority of these deaths are related to intimate partner violence. Due to the characteristics female truck drivers share with victims of workplace sexual violence and the nature of their jobs, they are at risk for this problem. Little is known about workplace sexual violence in this population. The purposes of this presentation are to discuss what is known about three types of workplace sexual violence (i.e., harassment, sexual assault, and intimate partner violence) and present a new conceptual framework that will be used to study workplace sexual violence in female truck drivers. Articles in English between 1980 and 2015 were searched in PubMed, CINAHL, PsycInfo, and MedLine using the keywords female truck drivers, rape, harassment, and intimate partner violence. Workplace sexual violence victim characteristics included Black and White race, middle-aged or younger, lower incomes, and lower education levels. Workplace risks include working late hours at night or early in the morning, working alone, working in isolated areas, working with the public, and working in a mobile workplace. Female truck drivers are White (75%) and aged 30 to 50 years (60%), have low to middle incomes (62%), and have high school to some college education (90%). They have irregular schedules, drive and park in high-crime areas, and work daily with the public. This conceptual framework provides information about the trucking industry, including female driver characteristics, and presents a framework outlining how variables (background, psychosocial, and social/work environment) can increase the risk for workplace sexual violence in this vulnerable population.
Diabetes at Work: Facing the Unknown
Dominique Bulgin, BSN, RN
The experience of older working adults managing Type II diabetes in the workplace is affected by many factors. Diabetes at Work, a grounded theory pilot study, explores how these factors affect older adults as they balance managing diabetes with maintaining gainful employment. In-depth qualitative interviews were conducted with six working older adults using grounded theory methodology. This secondary analysis of the study explores how the unpredictable nature of diabetes influences participants’ attitudes toward changing lifestyles and work life to better manage their disease. Open coding and line by line coding were performed initially, focusing on action and process. Memos were kept throughout the process both to track conceptual ideas and for researcher reflexivity. Constant comparison methods were conducted across and between interviews. A common category emerged from the participants’ experiences: acknowledging, fearing, accepting, and ultimately facing the unknown. The unpredictable nature of diabetes was found to be a mental burden to the participants; however, they were able to relieve some of the burden using proactive methods to manage diabetes in and outside the workplace. This pilot study illuminates the lived experience of older working adults with Type II diabetes. By understanding this phenomena, future interventions can be developed that will allow these individuals better control of their diabetes, which can lead to the preservation of their productivity in the workplace.
Posttraumatic Stress Disorder: Implication for Veterans in the Workplace
Candace Burns, PhD, ARNP
Posttraumatic stress disorder (PTSD) is a chronic mental health disorder that follows exposure to a traumatic event. PTSD is a serious mental health concern for U.S. military personnel who have a higher prevalence of the disorder than the general population—as high as 31% compared with 6% to 8%. The purpose of this review of the literature is to provide occupational health nurses with general knowledge regarding PTSD with a focus on cognitive, physiological, and social factors that may affect the reintegration of veterans into the workplace and discuss guidelines, practices, and resources relevant to occupational health nursing practice. A review of the literature was conducted using databases such a PUBMED and CINAHL to identify relevant research and other literature for the past 10 years, 2005-2015. Common traumatic combat experiences that may result in PTSD include improvised explosive device (IED) blasts, killing enemy combatants, being fired upon, witnessing death or serious injury, fearing loss of life, and being unable to prevent or stop tragic situations. Physical stressors may include harsh living conditions, fatigue, sleep deprivation, hunger, harsh climates, high-impact noise, and other hazardous environmental exposures. Psychosocial stressors may include separation from family and friends, interruption of career or employment (especially for military reserve personnel), feelings of inadequate experience or training, and daily life concerns. Upon leaving military employment, the individual may experience limited social and other supports in the civilian sector, an additional risk factor. Occupational health nurses can identify employees’ current and former military status through a health and occupational history as well as physical examination. Screening tools can be used including the PTSD Brief Screen, the Short Screening Scale—Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5)–Defined PTSD, and the PTSD Checklist (Veterans Administration/Department of Defense). PTSD is also commonly associated with coexisting mental health conditions including depression, sleep disturbances, anxiety disorders, and substance abuse. If screening results are positive, a referral to specialized PTSD treatment can be made, providing collaborative mental health support and educating employees about PTSD and the positive impact a supportive environment can provide.
Occupational Factors Associated With Obesity and Leisure-Time Physical Activity Among Nurses: A Cross-Sectional Study
Dal Lae Chin, RN, PhD
Adverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity in a sample of nurses. This study used cross-sectional data of 394 nurses (M age 48 years, 91% females, 61% White) randomly selected from the California Board of Registered Nursing. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013. Of the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥150 minutes/week) and 57% performed regular muscle-strengthening activity (≥2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m2) was significantly more common among manager/supervisor-level nurses (odds ratio [OR] = 2.54, 95% confidence interval [CI] = [1.16, 5.59]) and nurses who worked full-time (OR = 2.18, 95% CI = [1.29, 3.70]) or worked 40 hours or more per week (OR = 2.53, 95% CI = [1.58, 4.05]). Regular aerobic physical activity was significantly associated with high job demands (OR = 1.63, 95% CI = [1.06, 2.51]). Nurses with passive jobs (e.g., low job demand combined with low job control) were significantly less likely to engage in aerobic physical activity (OR = 0.49, 95% CI = [0.26, 0.93]). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR = 0.55, 95% CI = [0.34, 0.89]). Physical workload was not associated with obesity and physical activity. Study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health-promotion programs targeting physical activity and obesity among nurses.
Factors Affecting Back Pain in Firefighters
Mantana Damrongsak, PhD, RN
Occupational back pain is a significant health and safety problem in many industrialized countries for individuals required to perform work-related forceful movement and lifting. Firefighters, an occupational group at high risk for back injury, perform many job tasks under hazardous work conditions. Almost one third (30.20%) of firefighters report current back pain. Occupational stress, age, history of back pain, and body mass index (BMI) predict the variability in current back pain among firefighters. This study aimed to (a) identify the best subset of predictors of back pain in firefighters from a set of occupational stress and demographic factors (i.e., age, history of back pain, BMI, and waist circumference), (b) test whether the addition of job satisfaction and perceived supervisor social support to the best predictive model increased predictive ability, and (c) test whether the addition of physical fitness to the model increased predictive ability. A non-experimental, correlational design was used in this study. A convenience sample of 298 male firefighters completed the Job Stress Survey, Job Satisfaction Survey, and the Content of Communication Scale instruments. The findings showed almost one third (30.20%) of the study firefighters reported current back pain. Occupational stress, age, history of back pain, and BMI predicted the variability in current back pain among firefighters (pseudo R2 = .351). Age and history of back pain were significant independent predictors of back pain. Statistically significant independent relationships between occupational stress and job satisfaction and between perceived supervisor support and job satisfaction were found. Further studies should validate the model and explore relationships among perceived supervisor support, occupational stress, and job satisfaction in other occupational groups including nurses.
Building the Future: Hospital Campus Reconstruction Project and Medical Management of Construction Workers in an Onsite Field Office
Carol Gavwiner, RN
As part of an owner-controlled insurance plan (OCIP), a multidisciplinary team of construction project managers, safety managers, hospital owners represented by the legal/risk departments, occupational health nurse managers, and internal workers’ compensation managers met to establish a worksite occupational health clinic during the demolition, expansion, and new construction of a pediatric hospital and adult hospital on a busy urban academic medical campus over a 10-year period. This poster outlines the steps taken to establish the internal occupational health field office clinic and injury/illness treatment protocols as well as the responsibilities of the onsite occupational health nurses. The screening and safety training required for all construction workers prior to entering the site are discussed. The importance of partnering with safety leaders and construction contractor management and understanding the nuances of the construction industry are highlighted.
Improving HIV Post-Exposure Follow-Up in Health Care Workers
Linda Gutierrez, MSN
Occupational exposure to HIV is a significant risk for all health care workers (HCWs). In the United States, every year, one of 10 U.S. HCWs suffers a blood or body fluid exposure (BBFE). Transmission of one serious blood-borne infection can cost more than US$1,000,000 for medications, follow-up laboratory testing, clinical evaluation, lost wages, and disability payments. Completion of HIV post-exposure follow-up (PEFU) in HCWs is very low nationally. It is estimated only 27% to 43% of HCWs complete PEFU, even when the source patient is known to be HIV positive. The PEFU adherence rate among HCWs for a major Southern California Veterans Administration Medical Center was poor. None of the 52 HCWs reporting BBFE in 2013 completed recommended follow-up. The purpose of this practice change was to increase the rate of adherence to evidence-based guidelines for HIV PEFU in HCWs through implementation of revised infection-control policies and a reminder system. This evidence-based practice change required development of an infection-control policy based on new evidence-based U.S. Public Health Service guidelines for occupational BBFE to HIV and creation of a reminder system for follow-up care. Preliminary data: Since initiating the nurse practitioner-led practice change in December 2014, 100% of employees (N = 37) involved in BBFE have completed recommended HIV PEFU. This PEFU program increased adherence to the new infection-control policy and improved the rate of HIV PEFU in HCWs.
Macaque Monkeys and Herpes B Exposure: A Deadly Duo for Workers
Stephanie Hammond, DNP, CRNP
Herpes B is a zoonotic agent, naturally occurring among macaque monkeys. Macaque monkeys are the most commonly used monkeys for research. Workers at greatest risk for exposure are laboratory workers, veterinarians, and others with close monkey contact. The virus is similar to herpes simplex virus in humans, but monkeys may show mild or no symptoms at all. The virus can result in encephalomyelitis, resulting in death or severe impairment in humans. Exposure can occur from bites or scratches, percutaneous inoculation with infectious materials, mucosal splash, or human-to-human transmission. The virus can only be transmitted during active viral shedding, which can occur when monkeys are stressed, immunocompromised, breeding, or ill. Symptoms of the virus include vesicular lesions at site of exposure, flu-like aches and pains, fever, chills, headaches, fatigue, shortness of breath, and muscular incoordination. Post-exposure treatment includes care of the area exposed, laboratory testing, examination, education, and treatment. The medication of choice for prophylaxis is antivirals like acyclovir. The monkey and exposed worker undergo examination for the disease, serologic and polymerase chain reaction (PCR) testing, and scheduled follow-ups. The purpose of this presentation is to educate the audience of the potential risk involved after an exposure to Herpes B. Although exposures are rare, a potential exposure can be fatal if not properly evaluated and treated. In 1997, a worker contracted the virus from a mucosal splash and exposure and died as a result. It is important to educate nurses and providers of potentially exposed workers about the possible deadly consequences of an exposure. This presentation will include background information about Herpes B, prevention of an exposure, and evaluation and treatment post exposure. Occupational health nurses will have increased knowledge of Herpes B, potential exposure risk, and the treatment and follow-up required after a Herpes B exposure. Occupational health nurses and providers can use the information provided in this presentation to address potential exposures in the future.
Internet Usage by Commercial Drivers: Implications for Practice and Research
Karen Heaton, PhD, CEN, FNP-BC; Bryan Combs, MSN, CRNP, FNP-BC, CNL, ATC
Mobile health device (mHealth) use has significantly increased and has targeted smoking cessation, dietary intake, diabetes, and prostate cancer screening. However, mHealth or Internet use by commercial truck drivers (CTD) is unknown, in spite of the availability of smart technology and WiFi. The purpose of this poster is to discuss the significance of commercial driver Internet accessibility and usage as related to health information and telemedicine. Participants (N = 106) completed a survey in a study of the feasibility and effectiveness of an Internet-delivered sleep hygiene program. To be included in the study, all participants had to have access to and use a laptop computer or smartphone. The sample consisted mostly of White, married males, aged 50 years. Drivers were experienced (m = 18 years); on the road, on average, 5 days in a row; and traveled just more than 1,500 miles during a typical trip. Most used laptop computers and smartphones for truckstop Internet access via portable WiFi devices. Many CTD reported no Internet usage during the day. Reasons for Internet use differed during personal versus work time. For personal use, the CTD accessed the Internet for news, weather, and social networking. For job use, CTDs accessed the Internet for directions or maps, to interact with dispatchers, and to transmit logs or other documents. CTDs accessed the Internet less than once a day for health information on and off the job. CTDs use the Internet differently on and off the job, and did not use the Internet for health information. Further research is needed to determine whether the Internet is the best way to deliver health information or care (telemedicine) to CTD.
Identification of Occupational Home Health Exposures Among Nurses and Aides
Beverly Hittle, BSN, RN; Noma Agbonifo, CSP, MSc, MIIRSM; Rassull Suarez, MD; Kermit G. Davis, PhD
Home health care workers face a multitude of occupational exposures; yet, there has been limited research. The purpose of this study was to identify the frequency of occupational exposures among home health nurses (HHNs) and home health aides (HHAs). Thirty-one HHNs and 23 HHAs were interviewed about the frequency of exposures and hazards over a year of employment. Means for annual frequency of potential exposures and hazards were calculated for HHNs and HHAs with statistical differences identified using independent-samples t tests. HHNs and HHAs administered oral medications to patients at comparable frequencies. HHNs reported dispensing oral medications to patients 250 times per year compared with 199 times per year for HHAs. HHNs reported administering anti-cancer drugs 19 times per year compared with 10 times per year for HHAs. Both groups reported exposures to drug residue (HHNs at 145 times per year, HHAs at 122 times per year). Aside from the legal concerns stemming from HHAs working outside their scope of practice, the findings suggest a potential increased risk for an occupational exposure associated with drug residue from oral medications, particularly oral chemotherapy agents. Due to lack of training, HHAs may not be aware of these risks.
Evaluation of the Civilian Health Promotion Services Program at Air Force Materiel Command—Are Modifiable Health Risks Reduced, and What Is the Return on Investment (ROI)?
Judith Holl, BSN, MPH, COHN
Modifiable health risk factors such as obesity and stress are associated with increased health care costs for workers and reduced productivity. Employers who implement risk-reduction programs can achieve long-lasting population health improvement at a reasonable cost. Evidence-based programs may also increase workforce performance and force readiness. Air Force Materiel Command (AFMC), in collaboration with Federal Occupational Health (FOH), implemented the Civilian Health Promotion Services (CHPS) program in FY06 to improve population health and maintain a productive workforce to support civilian employees and the mission of the Air Force. The components of the CHPS program include a wellness web portal, education classes, wellness challenges, awareness campaigns, body composition screenings, and cardiac risk profiles (CRPs). The key to the CHPS program is mobile worksite wellness and a population health management approach. AFMC, FOH, and Truven Health Analytics use information gathered from the CHPS program as well as medical cost data provided by the office of personnel management to document longitudinal changes in health risk assessment (HRA) participation, population health outcomes, and economic impact measured as a return-on-investment (ROI). The evaluation found risk reductions in obesity, hypercholesterolemia, elevated blood glucose, physical inactivity, poor nutrition, tobacco use, and excessive alcohol consumption in the aggregate sample; the aggregate sample achieved a positive ROI. The project underscored accountability for human capital investment programs from both a health and a financial perspective.
Management of Burns
Sylvia Judd, MSN, ARNP-CNP
Burn injuries can have a devastating impact on individuals’ physical being, their mental health status, and their quality of life. Because the skin is the body’s largest organ, a burn injury can disrupt thermoregulation, the ability to fight infection, and protection against the environment. This presentation is designed to familiarize the occupational health nurse on the management of burns that may present in the workplace due to exposure to heat and electrical and chemical sources. Burns that cover a certain percentage of body area may be treated in an outpatient setting; however, it is instrumental to be aware of the burns that must be referred to a hospital or burn center for specialized care. This poster will describe the initial care of burns; identify the difference between first-, second-, third-, and fourth-degree burns; describe the initial care of burns and when to refer to specialized care; and discuss follow-up care of burns. Occupational health nurses should be familiar if they are presented with a burn injury, to know how to properly manage a burn and when to refer to specialized care.
Use of Physiologic Markers to Evaluate Firefighters’ Reactions When Exposed to Stressors
Georganne Kincer, RN, MSN, COHN-S
The National Fire Protection Association (NFPA) reported that of 64 firefighter fatalities during 2014, 36 (56%) were due to heart attacks. The literature on firefighters supports that deaths from heart attacks (or sudden cardiac death) have been the number one cause of on-duty firefighter fatalities for a decade (NFPA, 2015). It is imperative to find ways to reduce risks to firefighters. The proposed study seeks to examine vital signs as early warning of cardiovascular and respiratory distress during firefighting activities. The ultimate goal is early detection of firefighter distress allowing for interventions to reduce acute exposures prior to occurrences of cardiovascular or pulmonary compromise, while still allowing firefighters not demonstrating distress to perform their essential job functions and trainings. Investigators will monitor firefighters’ blood pressure (BP), heart rate (HR), tympanic temperature (TT), oxygen saturation levels (SpO2), perceived exertion (RPE), and respiratory distress (RD) levels during routine live-burn training exercises. HR will be continuously monitored during the live-burn training scenarios using Zephyr Bioharness, and pre- and post-scenario measurements of BP, HR, TT, SpO2, RPE, and RD will be gathered. This quantitative, repeated-measures research design will be used to measure vital signs on a convenience sample of approximately 55 firefighters. A statistically significant (p = .05) increase in firefighters’ vital signs, RPE, and RD scores and a decrease in SpO2 will be demonstrated during post-live-burn training compared with baseline measures, after adjustment for potential confounders and covariates. This study will determine the feasibility of acquiring previously collected vital signs (VS) data and replicating VS collection methods in the expanded study of 55 firefighters. The researchers will monitor an estimated total of 10 additional live-burn exercises at regional sites to achieve a sufficient sample size for the VS analysis. Fire departments and firefighters who agree to be surveilled during live-burn exercises will suggest the success of this type of research in identifying at risk workers before they experience life-threatening cardiovascular events.
Revalidation (Recertification) of Nurses in U.K. Public Health Practice
Helen Kirk, MA, BSc (Hons), BA, RN, RM, Queen’s Nurse
In response to public concern about standards in health care, the United Kingdom proposed a new system for periodically assessing whether nurses and midwives were up-to-date on practice developments. This proposal was given additional impetus after a government-sponsored review showed serious failings in one hospital (e.g., Francis Report). The U.K. regulatory body for nurses and midwives (NMC) proposed a revalidation model built on existing systems of appraisal and continued professional development (CPD) portfolios. The proposed system was piloted in Public Health England (PHE) in 2015 to establish whether a proportionate system could be introduced for assessing the practice of nurses and midwives working in public health. A quarter of PHE nurses and midwives were invited to volunteer for an assessment of their records of CPD and appraisal against proposed and existing NMC criteria. Each volunteer underwent an appraisal and prepared an on-line portfolio. Forty nurses and midwives expressed interest in participating in the pilot; 26 completed the pilot (this number was significantly affected by a decision by NMC to shorten the pilot period) and provided feedback. Of these, 19 provided additional feedback in a post-pilot survey. Revalidation, as it was proposed for the pilot, is practicable for nurses and midwives working in public health.
Enhancing Professionalism for Army National Guard Occupational Health Nurses
Angelique Lawyer, RN, MSN, MPH, APHN-BC
The Patient CaringTouch System (PCTS) was developed to reduce clinical quality variance by adopting a set of internally and externally validated best practices to improve the care provided to patients and their families. In line with the PCTS framework for nursing, the Army National Guard (ARNG) occupational health nurses participated in activities to increase occupational health-service quality and practice standardization. The PCTS is comprised of five core elements that, when combined synergistically, improve workforce outcomes and nursing staff effectiveness by ensuring the right person is doing the right job, the right way, at the right time. The PCTS 5 core pillars are Enhanced Communication, Capability Building, Evidence-Based Practices, Healthy Work Environments, and Patient Advocacy. After months of independent study in their home states, attending a 3-day review course, and joining together in after-hours study groups, 14 nurses sat for the 3-hour COHN-S onsite examination. The ARNG nurses exceeded the national pass rate of 74%; 11 of the 14 (78%) nurses passed the examination and became certified COHN-S. This educational training contributed to capability-building efforts and nearly tripled the number of ARNG-certified occupational health nurses.
Develop Home Health Care Workers Stress Scale
Geunjae Lee, RN, COHN-S, MSN Graduate Assistant
Home health care is one of the most rapidly growing industries in the United States. Turnover is very high among home health care workers (HHCWs). More than 60% of caregivers working for private duty home care companies quit or were fired in 2014. Attracting and retaining HHCWs is a high priority for many home health care agencies. Although multiple studies have been conducted relating to occupational stress/job satisfaction for HHCWs, no psychometric tool has been designed specifically for HHCWs. Properly measured stressors will help administrators and the home health care industry create efficient interventions and stress-management programs. The purpose of this proposed study is to develop a psychometrically sound instrument that measures stressors in HHCWs. A quantitative, cross-sectional survey research design will be used to measure the component of the HHCW’s occupational stress. The sample will be drawn from the state board of nursing public database. Respondents will be emailed a link to complete the consent and survey using a secured web-based survey collector known as Research Electronic Data Capture (REDCap). Data will be extracted from the REDCap database and imported into IBM SPSS for statistical analysis. Study data should provide a test–retest reliability coefficient of .7 or greater, Cronbach’s alpha for the HHCW questionnaire of .70 or greater, Content Validity Index (CVI) score for the HHCW questionnaire 0.80 and above, and factor analysis that will establish construct validity of the instrument. The developed questionnaire will specifically measure HHCW stressors. Data gathered through the developed questionnaire will be used in future studies to collect larger, validated, reliable data sets to understand and measure accurate components of stressors. With accurate and adequate stress data, administrators and the home health care industry can implement effective stress-prevention programs or manage strategies to address current issues.
Interdepartmental Collaboration to Reduce Conjunctiva Exposure Risk: Process Improvement to Increase Awareness and Enhance Compliance
Victor R. Lange, BS, BA, MS, MSPH, *JD, ICP, CRC, CRA
Although most clinicians make an effort to avoid needlestick injuries and hand contamination, less attention is given to preventing infection risk from body fluids and/or contaminant splashes to the eye. Infectious pathogens, such as HIV and hepatitis, can transfer through eye mucous membranes. An estimated 62% of all reported non-sharp blood and body fluid exposure incidents occur to the conjunctiva, and more than 90% of these exposures occur without proper eye protection. The purpose of this presentation is to demonstrably improve employee safety. This study focused on an interdepartmental, collaborative, process-improvement program to reduce and prevent eye-splash exposures through increased risk awareness and enhanced protective eyewear compliance. Detailed education on risk, including discussion about exposure incidences and best-practice prevention, was attended by all clinical staff. Easy-to-access protective eyewear dispensers were installed in surgery, medical and surgical units, intensive care, cardio-pulmonary lab, engineering, and environmental services. Staff were reminded to review risk prior to initiating an action where a splash could occur. Mask- and glove-level eye protection was implemented. A splash-reporting tool was placed near eyewear dispensers. Splash exposures and “splash saves” were tracked. Compared with the prior 12 months of baseline data, program implementation resulted in 100% reduction in eye splashes and, in 90 days, 15 splash saves. Collaboration among infection prevention, occupational health, nursing education, and executive management as well as use and availability of appropriate protective equipment provided an opportunity to virtually eliminate eye exposures and significantly improve health care worker safety.
Effects of a Workplace Environmental Intervention on Improving Physical Activity, Prolonged Sitting, Cardiometabolic Health, and Productivity in Sedentary Workers: A Pilot Study
Yun-Ping Lin, PhD
There is little research on effective programs for increasing physical activity and reducing sitting aimed at improving worker health and productivity, so this study was designed to test the feasibility and efficacy of a 3-month workplace environmental intervention. A pilot study using a quasi-experimental design included a total of 99 office workers (52.5% women; M age = 49.8 ± 8.6 years), from two workplaces. The intervention included five components: monthly newsletters, motivational tools, pedometer challenge, environmental prompts, and walking paths. The comparison group received monthly newsletters only. Measures were collected at baseline and 3 months and included blood glucose, insulin, cholesterol (total, high density lipids [HDL], low density lipids [LDL]), triglycerides, blood pressure, waist circumference, BMI, physical activity, occupational sitting, physical activity, and productivity loss outcomes. Generalized estimating equations were used to examine changes over time for the outcome variables. The intervention group showed significant improvements in BMI (p < .001), diastolic blood pressure (p < .001), total cholesterol/HDL ratio (p = .021), and physical activity (p = .018). Although no treatment effects were seen for waist circumference, week-day sitting time, workplace sitting and walking time, and productivity loss, significant improvements were observed in both groups (ps < .05-.001). Preliminary evidence suggests that the workplace environmental intervention is feasible, and it can improve worker health and productivity. Even with only monthly newsletters, the authors observed some positive effects on the comparison group. Employers should consider implementing interventions, not just to increase physical activity but also to reduce sitting. These findings can be used by occupational health professionals to guide the implementation of environmental interventions.
An Integrative Review of Text Message Reminders for Health Surveillance Examinations
Tammy Lockhart, RN
Text messaging has become a preferred method of communication with 81% of adults sending or receiving texts. Since 2005, increased use of text messaging has improved attendance rates for outpatient clinic appointments. Health surveillance examinations are essential to early identification of occupational diseases. The ability to notify employees of their scheduled appointments poses a challenge in the health surveillance examination process. The use of text messaging can be expanded to occupational health settings to improve health surveillance examination compliance by sending reminders to employees when these examinations are due. The purpose of this presentation is to evaluate the literature in relation to the use of text message reminders for promoting timely attendance at health surveillance examinations. The peer-reviewed literature database, SCOPUS, was searched for relevant studies between 2005 and 2015 using the keywords text message and appointment reminders. Nine articles met inclusion criteria. Authors for seven of the nine articles reported significant improvement in attendance. In one study, no significant improvement was found. In the final study, participants’ response showed no show rates could be reduced by 50% if text message reminders were used. This integrative review established that text message reminders for health surveillance may be an effective method to improve attendance for appointments. Future studies are needed to expand the use of text message reminders in occupational settings.
Diagnosing Latent Tuberculosis Infection in Immunocompetent Adults With a History of Bacille Calmette–Guerin Vaccination
Amy Melvin, DNP, NP-C
Accurate diagnosis and treatment of latent tuberculosis infection (LTBI) is essential to disease eradication in low-incidence countries. However, lack of a gold standard for LTBI testing leads to variable clinical practice and increased health care costs. In addition, vaccination with bacille Calmette–Guerin (BCG) complicates LTBI diagnosis when the tuberculin skin test (TST) is used. This project presents an evidence-based algorithm for diagnosing LTBI in immunocompetent adults with a history of BCG vaccination to a group of 24 pulmonary clinicians working in a large, urban, public hospital system. The purpose of this project was to (a) determine best practice for diagnosing LTBI, (b) develop and disseminate an educational intervention and clinical algorithm, and (c) determine the effectiveness of the intervention. The authors conducted a narrative literature review to guide the development of the algorithm. They included 10 primary research studies analyzing the results of QuantiFERON®-TB Gold (QFT) compared with TST in 22,984 subjects, along with three systematic reviews comparing sensitivity and specificity between QFT and TST across 167 studies. Comparison of pre and post data showed QFT was the preferred test for LTBI (43%-100%) and acknowledged the treatment of LTBI as an essential component to TB control (67%-100%). An evidenced-based algorithm and educational intervention to guide clinicians in the most appropriate use of QFT have the potential to improve the accuracy of LTBI diagnosis. Future research should include evaluation of additional education methods and random chart reviews to assess recidivism rates.
Predictors of U.S. Health Care Utilization by Agricultural Workers
Abby Mutic, CNM, MSN
Agricultural workers have a disproportionately high risk of occupational injury and disease, yet have insufficient access to health care. Despite expansion of clinical networks, utilization remains inadequate. This poster examines the characteristics of farmworkers who accessed health care services and evaluates the influence of English literacy on the likelihood of seeking health care. Data from the 2011 to 2012 U.S. National Agricultural Workers Survey were examined from 12 regions. Workers, surveyed at their workplaces, reported on work, family, and health conditions. Survey methods were used to account for complex survey design when estimating parameters and computing variance estimates. Bivariate analyses were performed on a subset of characteristics to test for significance regarding accessing health services in the last 2 years. A logistic regression determined characteristics likely influencing workers’ tendencies to access care. Workers (N = 3,025) were comprised mostly of Spanish-speaking (70%) males (72%). Sixty-three percent had a 10th-grade education or less, 32% were uninsured, and 61% accessed care. Migrant farmworkers were 60% (odds ratio [OR] = 0.4, confidence interval [CI] = [0.3, 0.5]) less likely to access care than non-migrants. Female workers were 3 times (CI = [2.3, 4.0]) more likely to access health care than men. Those with chronic health conditions were significantly more likely to access care. Workers who engaged in adult education (English as a second language [ESL], migrant education, job training, Even Start, or college) or who read English were almost 2 (CI = [1.5, 2.2]) and 3 times (CI = [1.9, 3.7]) more likely to access care, respectively. Aside from chronic conditions and insurance, gender and English literacy were most predictive of health care utilization.
Burnout in the Nursing Profession: Concept Analysis
Aoyjai Prapanjaroensin, RN
Nursing is key to improving the quality of patient care by reducing adverse outcomes. However, poor working conditions may lead to mental and physical health problems in the nursing workforce. Poor physical and mental health in nurses could decrease nurse performance and quality of care; nurse burnout has been shown to affect patient safety. Reducing burnout among nurses and improving patient safety are priorities for the American Nurses Association and the Joint Commission. To identify the first steps toward reducing professional burnout, the concept within nursing practice must be identified, defined, and analyzed. Walker and Avant’s method provided the framework for this concept analysis. A review of nursing literature from 2005 to 2015 was conducted using the journal databases CINAHL and PubMed, from which 22 articles defining or describing burnout were selected. Emotional exhaustion, negative feelings and attitudes toward the recipients of the service, and a feeling of low accomplishment and professional failure characterized burnout. Factors preceding burnout among nurses included work overload, time pressure, and ethical conflicts, as well as personal characteristics. Consequences observed among nurses were diminished organizational commitment, turnover, absenteeism, and physical and mental illness. Three empirical indicators of burnout included the Maslach Burnout Inventory, the Copenhagen Burnout Inventory, and the Professional Quality of Life Scale. Organizational and nursing administration leaders should develop strategies to create positive work environments to reduce professional nursing burnout, which in turn could reduce the cost of burnout through employee turnover and replacement, and will ultimately improve the quality of care.
Comparison of Vigilance Between Night- and Day-Shift Nurses
Ojai Prapanjaroensin, RN
Twelve-hour shifts among nurses have been extensively studied because of concerns for both patient and nurse safety. Sleepiness is significantly associated with the risk of occupational injuries (e.g., needlestick injuries) and patient care errors or near errors. Also, performance on tasks requiring vigilance is enhanced during the circadian day and impaired during the circadian night. Therefore, the aim of this study was to determine whether night-shift nurses have impaired vigilance at the end of a 12-hour shift compared with day-shift nurses. In this nested, longitudinal study, the researchers enrolled 15 day and 15 night-shift nurses who worked at an acute-care facility in the southeastern United States. The Psychomotor Vigilance Test was used to measure sustained attention and reaction time at 3 days before the next work shift as a baseline, at the end of each 12-hour shift for 3 consecutive work days, and at the end of 3 days off. Overall, significant changes in the median reaction time (MRT) were observed across 5 time periods, F(4, 25) = 3.77, p value = .016. Day-shift nurses had faster MRT than night-shift nurses, F(1, 28) = 0.295, p value = .592. Following days off, MRT improved in night-shift nurses, but not in day-shift nurses. Longer consecutive working days can affect vigilance among nurses, especially night-shift nurses. Organizational and nursing administration should develop strategies to create better work environments for nurses to improve patient and nurse safety.
Three Masked Men
Nancy Pritchard, RN, BSN
Pediatric hospitals care for little patients with either a potential or definitive diagnosis of “whooping cough” or pertussis. A study was conducted to determine exposures and risks to employees. Staff who would clinically benefit from vaccination were identified. Vaccinations were encouraged, convenient, and free. One department addressed staff concerns regarding exposures. In addition to education, that department identified patients at risk, the location of personal protective equipment (PPE), and signage. It was found that more PPE was needed and should be located in each room convenient to the staff when they needed it. The use of signage was increased. Using a suction cup method on the door allowed staff to identify the risk rapidly because the sign was turned and all staff entering the room were made aware. The staff were educated on the procedure, the disease process, and the treatment algorithm if exposed. A fun team of Three Masked Men were selected to audit the risk reduction and protective process monthly. When noncompliance was found, that staff were invited to join the masked team. This approach created a fun way for the staff to be engaged and empowered, creating positive results. This program has drastically reduced exposures to staff although patient characteristics have not changed. The staff report this approach is a way to live their values and stay healthy.
Domestic Violence in the Occupational Health Setting: How to Screen and When to Intervene
Candace Sandal, DNP, MBA, APRN, COHN-S, FAAOHN
Many standard occupational health questionnaires do not ask about domestic violence. This issue is pervasive in U.S. society and frequently left unaddressed, leaving workers (and often children) in unsafe and potentially fatal situations. This poster was designed as an educational module to heighten awareness among occupational health nurses about the issue of domestic violence within the scope of work-related health. In the poster presentation, domestic violence is defined and the incidence of cases is acknowledged in the United States. The cycle of violence is explained with the identification of the issues surrounding the abuse including “Why doesn’t she just leave?” Crucial nursing assessment instructions for the victim are given, with detailed instructions on documentation of the findings. Literature review of the issue and direct education from recognized providers in the field are also discussed. How to screen for domestic violence is presented in a simple two-question process to enable the occupational health nurse to identify a problem in a brief period of time within a worker encounter. Upon confirmation from the client that abuse has occurred, the poster indicates evidence-based practice to assist the victim in obtaining help, understanding the resources available, and becoming empowered. The occupational health nurse is provided responses that are supportive and promote safety for the victim and the family. Occupational health nurses should be aware that screening for domestic violence is an opportunity to recognize this vulnerable population and offer support and resources. Through the poster presentation, nurses can learn the skills to screen for domestic violence and offer support to the victim of abuse using best-practice guidelines.
Nurse in Washington Internship (NIWI)
Letha Smith, RN, MS, COHNS
The Nurse in Washington Internship (NIWI) program provides nurses and nursing students the opportunity to learn the legislative and regulatory process and how to influence health care policy. The content of this poster included a description of NIWI, who is eligible to apply, the deadline, length of the program, location, and how to make application. The poster also described participants’ responsibilities, program objectives, activities held during NIWI, and the author’s experiences and credits.
Understanding the Interactions Between Young Adult Cancer Survivors and Occupational Safety and Health Professionals
Dawn Stone, PhD(c), RN, ANP-BC, COHN-S; Wendie A. Robbins, PhD, RN
The objectives of this study included the following: to understand the interactions of employed young adult cancer survivors with occupational and environmental health professionals at the workplace and generate theory grounded in the words of young adult cancer survivors and occupational and environmental health professionals that explain their interactions in the workplace. Approximately 70,000 young adults (age 15-39) are diagnosed with cancer annually in the United States (NCI, 2015). Despite this high number, young adult survivors have received little attention from researchers compared with children and older adults diagnosed with cancer. Recent studies support the view that individuals between the ages of 18 and 40 are the most underserved age group in cancer research (NCI, 2011). The National Institute of Occupational Health and Safety also recognizes the need to research and eliminate health discrepancies in cancer survivors as indicated in their Occupational Health Disparities Program (2012). Constructivist grounded theory was the qualitative design used for this study. Semi-structured individual interviews generated data from young adult cancer survivors 5 years post treatment. The survivor sample was obtained through a data set from the California Surveillance Program in Los Angeles. During the interviews, survivors identified the professionals who were most helpful to them in the workplace. Based on this feedback, occupational health professionals were recruited from their respective professional organizations and also interviewed individually. Data analysis used constant comparative analysis of verbatim transcription of interviews and memos that constructed categories and themes. This study was approved by institutional review boards (IRBs) at University of California, Los Angeles (UCLA) and the State of California. Many young adult cancer survivors are working; however, some experience lingering pain or fatigue influencing functionality in the workplace. Cancer survivors often expressed fear about limited employment opportunities as a consequence of the late effects of cancer or its treatments, as well as stigma or discrimination from others. The impact of cancer on people’s working lives is an increasingly important concern, but knowledge about this issue by occupational and environmental health professionals is variable. Major themes grounded in the words of the participants included identity, disclosure, support, and uncertainty. Understanding the interactions between young adult cancer survivors and occupational health professionals within the context of the workplace has potential to improve quality of life for survivors while promoting awareness of the challenges confronted and the services needed for support. Ultimately, assessments and interventions can be developed to manage symptoms associated with the consequences of cancer while promoting adaptation to the workplace. Exploring strategies to keep survivors working will reduce fiscal burdens of using public support for those workers who are disabled. The National Cancer Institute can use this theory to develop evidence-based guidelines for occupational health and oncology nursing practice.
Impact of Vaccine Preventable Disease Policy on Increasing Influenza Vaccination Rates in Health Care Workers
Linh Tran, MS, RN, OCN
MD Anderson Cancer Center (MDACC) is a comprehensive cancer care and research institution in Houston, Texas, with more than 20,000 employees. This poster will describe the impact of an institutional policy and mandatory participation program on increasing influenza vaccination rates in health care workers (HCWs). MDACC designed and implemented the Vaccine Preventable Diseases Policy (VPD), which mandated participation in the annual influenza campaign for all clinical operations (12,000 +) employees in 2012. The institutional policy required all employees to either receive a flu shot or wear a surgical mask when caring for patients for the duration of the respiratory virus season. Program compliance consisted of receiving a flu shot or signing a waiver/declination. Compliance stickers on identification badges were issued to serve as a visual confirmation to those who had been vaccinated. The overall employee vaccination rate for the 2011-2012 flu season was 75%, 86% in high-risk areas and 83% in nursing. Following policy implementation in 2012, vaccination rates rose 10% to 18% in all targeted groups in 1 year. For the 2012-2013 season, Employee Health provided 17,883 flu shots, the overall vaccination rates increased to 93%, high-risk areas achieved 96%, and nursing reached 95%. Since 2012, vaccination rates have steadily risen to greater than 95% in all groups. The VPD policy has had a major impact on increasing HCW vaccination rates at MDACC. Institutional policies, supported by mandatory participation programs, are an effective mechanism to increase and maintain HCW immunization rates.
Implementation of Guided Actions to Reduce Recurrence of Sharps-Related Injuries
Laura Walker, MSN, RN, CNE, CCRN
Each year, nearly 400,000 needlestick and sharps-related injuries are reported by health care workers in hospitals throughout the United States. Because exposures bring the risk of transmission of deadly blood-borne diseases, health care organizations are mandated by the U.S. Occupational Safety and Health Administration to investigate every needlestick and sharps-related injury. In an acute-care academic hospital organization, an educational task force was formed through the network-wide sharps-safety committee to standardize the existing electronic post-exposure investigation process in an effort to better identify behavioral actions and/or system failures that allowed the error to happen. The task force also focused on standardizing the managerial-led educative coaching process to ensure objective sharps-safety best-practice remediation methods were being presented to the injured employee by management. Just culture concepts were integrated into the electronic post-exposure investigation as well as managerial-led educative coaching processes. Just culture concepts transformed the existing post-exposure investigation process. A fair and safety-supportive systematic approach was created to better assist managers in identifying, addressing, and advising educative actions to reduce the opportunity for future injury recurrences. Understanding that many needlestick and sharps-related injuries can be prevented, the incorporation of just culture concepts provided a homogeneous process in which managers are better able to identify behaviors and/or systems that encourage errors and proposed corresponding meaningful, objective educational resources for employees in an effort to ensure sharp-safety best practices are cultivated.
An Analysis of Workplace Violence Training Programs Used in Health Care Settings
Donna Zankowski, MPH, RN, COHN
Workplace violence is a serious work-related hazard for all health care workers, and an important concern for Occupational Safety and Health Administration (OSHA). In the summer of 2014, the Graduate Nurse Internship Program of the Office of Occupational Health Nursing at OSHA was given the opportunity to analyze the content of commercially available training programs used to prevent workplace violence (WPV) in health care settings. The objective of this project was to develop a set of relevant criteria for evaluating WPV-prevention training programs, create and populate a usable database, and analyze and present the findings. Through a search of available information (including research papers, legal statutes, on-line resources, previous OSHA citations, and the WPV-prevention training recommendations of professional organizations), a set of 42 qualitative data elements were identified. After receiving samples of 12 different WPV-prevention programs’ training materials, a thorough review of all program content was conducted using the 42 data elements. The relevant coded data were then compared with OSHA’s recommended training criteria for health care settings. The results demonstrated consistent gaps in training content. The information from this project will assist OSHA to better understand the content health care workers are being taught as part of their on-the-job WPV-prevention training. It can also alert occupational health nurses, administrators, and managers that WPV-prevention training, conducted at their health care facility, may be missing critical information necessary to the prevention of WPV.