Abstract
Social Media in Graduate Education: Beyond Our Borders
Debra Anderson, PhD, RN, PHCNS-BC
Online communication technology has removed many of the borders and boundaries constraining traditional educational settings, an evolution that has enabled the promotion of “learning” in diverse online communities. Such learning environments allow education to occur synchronously or asynchronously through creatively structured facilitation that leverages the proliferation of social media in the lives of today’s students. The purpose of this project was to describe the use of one such social media modality in graduate nursing education. Use of the social network, Facebook (FB), was effectively integrated into the course syllabus to promote the creation of a challenging learning community wherein both students and instructor engaged in critical thinking and in-depth scholarly debates.
Project objectives included the following: develop meaningful online assignments that promote in-depth discussions in classes with diverse student populations; explore effective ways to improve distance course delivery in a variety of programs, both graduate and undergraduate; and identify confidentiality issues related to the use of social media. Nursing theory, graduate level, was the platform for this project. Forty-three students were divided into groups of 10 to 11 and assigned to a private FB page. Although all students could read the posts, only those assigned to specific groups could post within their group. Each student selected a theory for discussion to fulfill the role of weekly discussion leader. The leaders were extremely well prepared, with references, examples, and questions. The students in each of these groups were engaged and provided their own references, examples, and additional questions.
The following lessons were learned during this project:
The majority of students used FB on a regular basis;
“Private” FB group differs from a “secret” FB group;
Instructors must take into account student privacy issues and patient confidentiality; and
Educational outcomes may be impacted.
Social media/networking is an effective educational method for graduate education. It promotes engagement and critical thinking while also helping students develop collegial relationships. Research to measure learning outcomes related to use of social media/networking in graduate education is needed.
Practical Tips for Travel to a Third World Country*
Jacqueline Baker, MS, RN, FNP-BC, CCM, COHN-S
This poster reflects the policies and procedures for a global petroleum company’s travel nurses who provide travel-related services to employees for global travel. The goal of the program is to educate well-informed employees about the countries to which they are traveling and specific risks and precautions specific to these countries. In addition, these nurses ensure that employees are fit to travel based on their health histories. The authors hoped that the audience could discuss at least two travel health best practices after viewing the poster.
The authors used a case study method based on best practices of one company, including the latest information from reliable sources on global travel (e.g., Centers for Disease Control and Prevention [CDC], World Health Organization [WHO], and Travax). Travel consults include pre-trip counseling, review of health history, country review including specific risks, and immunizations, travel kits, and prescriptions for malaria and other travel needs. Employees return to the United States without injury or illness, and have a productive trip due to awareness of specific areas to which they traveled (e.g., Zika, malaria, food and water precautions, deep vein thrombosis [DVT]) and resources available if they should encounter health issues. Occupational health nurses can offer a quality travel program by becoming current on health issues worldwide, and conveying information to employees so they can avoid situations that could put them at risk of illness or injury in a foreign country.
The Aging Workforce and Impact on Recruitment, Retention and Management: Implications for Occupational Health Nursing Practice
Candace M. Burns, PhD, ARNP
The purpose of this study was to (a) describe common characteristics of the aging workforce, (b) describe the impact of the aging workforce on the workplace, and (c) describe recruitment, retention, and management strategies for occupational health nurses. Review of research, other literature, and best practices was translated to occupational health nursing practice and research. By 2020, approximately 41.4 million workers (25.2%) will be age 55 years or more; by 2050, 19.6 million workers will be age 65 years or older (Bureau of Labor Statistics, 2011). The demographics and physiological, psychological, and sociological characteristics of this aging workforce were assessed, as well as the impact of this significant portion of the workforce on the workplace.
Ample evidence suggests that the majority of older workers plan to work past “traditional” retirement age. The reasons for continuing to work vary from financial need, improved health, and increased life expectancy and because these employees are highly engaged in their work, satisfied with their jobs, and committed to their organizations. Evidence also suggests that this cohort of workers is highly productive and resourceful and thus an asset to the workplace. Loss of this segment of the workforce could create a “brain drain” of skilled workers. Strategies to recruit, retain, and effectively manage this portion of the workforce were also undertaken.
Implications for occupational health nursing practice include (a) assessment of the number of workers approaching retirement age and the potential impact of the loss of their knowledge, expertise, and productivity; (b) discussions with each worker to determine their specific plans for retirement and employment (part-time or full-time) post-retirement; and (c) conduct of cohort focus groups to explore desired workplace modifications or strategies to enhance retention. Strategies for ongoing education of all workers in the organization could enhance the effectiveness of a multi-generational workforce, including discussing and dispelling common myths about aging.
Occupational health nurses may need to conduct and update detailed job analyses for all jobs to determine the knowledge and skill set needed as well as ergonomic and other infrastructure requirements to identify specific activities that may be modified to accommodate physical or cognitive demands. Occupational health nurses can engage in ongoing quality improvement projects in the workplace to determine best practices and outcomes within the organization.
Blood Pressure Education and Self-Monitoring at the Worksite
Pamela E. Carver, CRNP
Hypertension (HTN) is the most common diagnosis in the United States and one of the 10 most expensive health conditions for employers. Poorly managed and undiagnosed HTN increases health care costs and contributes to lost employee productivity. The literature strongly supports self-monitoring as key to blood pressure (BP) control, especially when paired with additional interventions such as education. Although much has been done to review various worksite health promotion programs over the last 20 years to 30 years, specific evidence regarding the potential impact of providing BP self-monitoring equipment at the worksite is lacking. The purpose of this study was to examine if improvement in knowledge, BP self-monitoring, and program satisfaction were realized by providing BP equipment and educational materials at the worksite.
This DNP scholarly project was implemented at a steel manufacturing company in Birmingham, Alabama. A BP station was established at the worksite and BP educational materials from the American Heart Association (AHA) were offered. Employees were recruited and informed consent was obtained from 32 volunteer participants. Participants completed a preprogram survey to gather demographic and health history information as well as assess BP knowledge using questions from the AHA. For a period of 6 weeks, study participants were asked to record in a log book every time they used the provided equipment. Access to the BP educational material was provided in three forms: hard copy of AHA handout, weekly emails sent with sections of AHA material provided, and web address to access interactive AHA website. At the conclusion of the 6 weeks, participants were asked to complete a postprogram survey; the same AHA BP quiz was re-administered, and questions were asked to ascertain satisfaction with the program as well as any potential change workers had made in lifestyle behaviors. Descriptive statistics were examined to determine equipment usage, changes in BP knowledge, and overall program satisfaction.
Implications for practice include the potential impact of providing BP stations at worksites so employees can self-monitor their BPs. Worksite BP stations are a small investment with potential for substantial return in terms of promoting worker health, lowering health care costs, and improving worker productivity and satisfaction.
The Impact of Shift Length on Mood and Fatigue
Linda S. Davis, PhD
The aim of this study was to establish a baseline measurement of sleep, physical activity, social-support, work immersion, and shift length, and relate these variables to fatigue and mood states of registered nurses (RNs). Shift work, long work hours, and insufficient sleep are associated with RN errors. Registered nurses working 12-hour shifts are 3 times more likely to make a patient care error than RNs working 8-hour shifts. Evidence suggests that physical, emotional, and mental work demands, short breaks, and inability to disengage from work (work immersion) may contribute to disturbed sleep patterns in RNs. The resulting fatigue may contribute to mood changes, loss in critical thinking, and disruption of family/personal/co-worker interactions and ultimately patient care errors.
Two groups (RNs working 8-hour shifts and RNs working 12-hour shifts) were established with each group further divided into day shift or night shift (12-hour shift), and day shift or evening shift (8-hour shift). Mood states were measured daily using the Profile of Mood States (POMS) questionnaire and scores were averaged. Activity and sleep data were collected 24 hours each day for 7 days. Sleep and activity data were collected using a Fitbit Flex, a wireless, water resistant activity and sleep monitor (actigraph) worn on the wrist. A microelectromechanical systems-3 axis accelerometer measured motion in three dimensions. Sleep quality was measured by tracking periods of sleep restlessness, sleep latency, and sleep time. Fatigue and work immersion were measured once. The 15-item Occupational Fatigue Exhaustion Recovery (OFER) scale was used to measure chronic and acute fatigue, and effective fatigue recovery between shifts. The three-item Persistent Thoughts of Work scale was used to measure work immersion (over commitment).
Ninety-seven percent of RNs reported their work was heavy or extremely heavy. Neither body mass index (BMI) (M = 27) nor activity (8,000 steps/day) differed by shift. Shorter shift length, higher work immersion scores, and lower sleep quality predicted chronic fatigue, R2 = .26, F(4, 72) = 6.33, p < .001. Higher work immersion scores predicted acute fatigue, R2 = .158, F(4, 72) = 3.37, p = .014. Registered nurses working the 8-hour day shift were older and had higher levels of chronic fatigue (p = .001). Work immersion or the inability to disconnect from work was a major predictor of acute and chronic fatigue for long and short shifts. Although RNs working longer shifts did not experience more acute or chronic fatigue than their short shift counterparts, they were less able to recover between shifts. These RNs were younger and had higher sleep quality scores which likely allowed them to avoid fatigue. Body mass index was similar for all shifts, overweight. Older nurses are more likely to experience chronic fatigue.
Occupational health nurses designing health promotion programs should focus on ways to decrease work immersion (e.g., limit off-time texting and email, improve teamwork and social support). Self-care strategies such as breaks, healthy food selections, mindfulness activities, and attention to sleep/wake routines may be more appropriate than exercise initiatives. Further research should be conducted to identify factors that affect work immersion as well as potential strategies to mitigate the impact of work immersion on workers.
Management of Blood Borne Pathogen Exposures in Health Care Workers
Florence Dyer, ANP-C, MSN, RN
The aim of this study was to identify current and emerging blood borne pathogens (BBP) posing a threat to health care workers and define current established standards and policies to prevent exposure to BBPs as well as best practices to manage exposures. Blood borne pathogens are microorganisms that enter the human blood and cause serious diseases. Occupational health professionals should be familiar with the latest scientific information regarding agents, causes (blood/other potentially infectious materials [OPIM]), risks, prevention, and management of BBP. In addition, occupational health professionals should accurately evaluate a potential BBP exposure incident at the workplace, identifying the body fluid involved; the health status of the source and the victim; and the circumstances of the incident.
The author reviewed CDC, National Institutes of Health (NIH), Occupational Safety and Health Administration (OSHA), American Academy of Family Practice (AAFP), and U.S. Department of Health and Human Services (USHHS) current published standards and guidelines to prevent, evaluate, and effectively manage workers’ BBP exposures. The review brought to light best practices for the prevention of BBP exposure in the work place, crystallized the definitions of BBP exposure and risks, clarified best practices in the management of actual exposures, and consolidated guidelines for the documentation of exposures, counseling and treatment after BBP incidents, and ethical issues surrounding the privacy of workers involved in BBP incidents.
Occupational health professionals can improve their awareness and understanding of the latest recommendations and guidelines for the recognition, management, and documentation of workers’ BBP exposures to engage workers in caring for their health through recommended immunizations and the immediate reporting of BBP exposure incidents.
Blood borne pathogen exposure remains a threat to workers’ health and well-being. Occupational health professionals must remain up-to-date regarding the evaluation, counseling, and management of workers exposed to BBPs and the privacy issues specific to those events. As occupational health practice incorporates Total Worker Health, any effort to improve health promotion and disease prevention services to workers will have an impact on the health of workers, their families, and their communities.
Preventing Chemotherapy Exposure During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Susan Flores, BS, RN, COHN-S, CIC
Surgical technicians began to complain of burning eyes, noses, and throats during the infusion of heated chemotherapy during HIPEC surgery to the surgery director and occupational health nurse. Because the possibility of chemotherapeutic drug exposure could be occurring, all aspects of the procedure were evaluated. The aim of this program was for affected staff to state the correct personal protective equipment (PPE) needed for chemotherapy instillation during a HIPEC procedure and to discuss the general technique of HIPEC surgery for treatment of advanced abdominal cancers. Data were collected via interviews of seven surgical technicians complaining of symptoms, a full surgery department focus group, and review of the Oncology Nurse Society (ONS) PPE guidelines.
Review of necessary PPE for this procedure was reviewed with surgery staff. Despite using N95 masks, the surgical technicians were still experiencing respiratory symptoms. Various ways of covering the surgical site and tube delivering the chemotherapeutic agent to the abdominal cavity were tried to eliminate the drug smell and possible aerosolization to no avail. A surgical technician suggested trying the orthopedic hood as a means of respiratory protection; eight hoods were ordered. The eighth hood was for the surgeon who refused to wear it during HIPEC surgical procedures.
Chemotherapy PPE was reviewed and mandated for all staff participating in HIPEC cases. Seven orthopedic hoods were purchased and staff members were required to wear them during the chemotherapy instillation part of the procedure. Annual OSHA–mandated laboratory work (complete blood count, reticulocyte count, chemical panel, and urine for dipstick blood) for staff involved in chemotherapy induction was completed in October of the same year. The results were reviewed by the occupational health staff and those technicians with abnormal results were sent a copy with a letter instructing them to see their personal physicians. Ten employees of 35 employees tested (28.5%), had abnormal tests. All staff with abnormal laboratory test results reported to Employee Health that their physicians reviewed the laboratory data and had no issues with the results. Laminated signs now notify staff that HIPEC is in process and are placed on the outside surgical suite door.
Surgical cases involving hazardous drugs/chemicals will be reviewed for possible exposures to staff in close proximity to surgical/chemotherapy fields. Personal protective equipment will be reviewed for proper use during chemotherapy procedures. The hospital will continue to follow OSHA laboratory guidelines for any possible exposure to chemotherapy and review ONS guidelines periodically to assure that all chemotherapy PPE is correct.
The Effects of Mindfulness and Therapeutic Suggestion on Acute Pain Management—A New Non-Opioid Approach for Occupational Health Nursing?
Eric Garland, PhD, LCSW
This poster reported on one of the first randomized comparisons of mindfulness with hypnotic suggestion in the management of acute pain. Although hypnosis and mindfulness have been shown to be viable mind–body interventions for pain control, few (if any) comparisons of these techniques have been reported in the literature. The goal of this study was to define the efficacy of mind–body interventions for acute pain. Given the recent opioid epidemic, non-pharmacological interventions for pain are needed.
The researchers conducted a randomized controlled trial comparing the relative efficacy of hypnotic suggestion and brief mindfulness training in comparison with an educational control. Patients with unmanageable pain during a hospital stay (N = 244) were randomized to receive (a) scripted 15-minute education session (control; n = 86), (b) brief mindfulness training (n = 85), or (c) hypnotic suggestion (n = 73) interventions delivered by hospital social workers. The 15-minute mindfulness intervention was a scripted exercise that incorporated mindfulness principles of intentionally paying attention to present-moment experience in a non-judgmental fashion, with focused attention on breath sensations and an emphasis on pain acceptance. The 15-minute suggestion intervention was a scripted suggestion exercise that incorporated imagery and suggestions for changes in cognition, emotion, and body sensations (e.g., imagine changing pain sensations to a comfortable warmth or coolness). The 15-minute supportive psycho-education session focused on behavioral coping strategies for pain management. Primary outcomes were assessed before and after the 15-minute interventions, using validated outcome measures for pain intensity and pain unpleasantness. Secondary outcomes included “desire for opioids” and other psychosocial variables (relaxation, anxiety).
Patients receiving the hypnotic suggestion and mindfulness interventions reported statistically significant greater reductions in pain intensity (28% and 22%, respectively) than patients receiving the education intervention (p < .001). In addition, hypnotic suggestion was associated with significantly greater decreases in desire for opioids than mindfulness or education.
Results indicated that a single brief, scripted training session either focusing on mindfulness or hypnotic suggestion may produce clinically significant benefits to patients with acute pain. These approaches provide a viable, non-opioid alternative to pain management that may benefit patients when they return to work with unmanageable pain under the care of an occupational health nurse.
These low-cost interventions were feasibly and effectively delivered in a context where numerous distractions are present. As such, it is likely that brief mind–body interventions can be delivered by occupational health nurses to improve pain management in the work setting, minimizing the need for opioid analgesics.
Reliability and Validity of Home Health Care Nurse Survey Tool
Geunjae Lee, MSN, RN
Beverly Hittle, MSN, RN
Home health care (HHC) is one of the most rapidly growing industries in the United States. More than 60% of nurses and other caregivers working for private home care companies either resigned or were terminated from their jobs in 2014 (Private Duty Benchmarking Study, 2015). Although some studies of individual factors associated with injuries and health outcomes for HHC nurses have been reported, few studies about occupational stressors affecting this group have been published. The primary objective of the current pilot study was to assess the reliability and validity of a modified version of a previously published HHC nurse stressor survey. The modified survey was designed to expand the scope of stressor-related items beyond those collected in the original instrument (i.e., Community Health Nurses’ Perceptions of Work-Related Stressors Questionnaire [CHNPWRSQ]).
The modified HHC nurse stressor survey was developed and refined by this study’s co-authors based on a review of the literature and HHC nursing subject matter expert input. A cross-sectional survey sample was drawn from a State Board of Nursing licensee database. Potential respondents were emailed a link to complete the consent and survey using the secured web-based survey collector Research Electronic Data Capture (REDCap). Data were extracted from the REDCap database and imported into IBM SPSS for statistical analysis. Reliability was assessed using Cronbach’s alpha for internal consistency and correlations for alternate (equivalent) forms for stability. Validity was assessed by the content validity index score and correlations to measure concurrent validity, a form of criterion validity. Scores on the modified HHC nurse stress survey were compared with participants’ scores on other instruments including Cohen’s 10-item Perceived Stress Scale (Cohen et al., 1983; Taylor, 2015), the 49-item version of Karasek’s Job Content Questionnaire (Karasek et Al., 1998), and the 22-item Impact of Event Scale–Revised (IES-R; Horowitz, Wilner, & Alvarez, 1979) to establish criterion validity.
This modified HHC nurse survey tool was designed to measure and expand the scope of stressors captured. Evaluation of the tool’s reliability and validity will inform the use of the modified survey instrument by other investigators in future studies. Reliable and valid stressor data will equip researchers and research consumers (e.g., HHC nurses and administrators) to potentially inform stress prevention and management strategies.
Zika Virus: Protecting Workers
Stephanie Hammond, DNP, CRNP
Kelli Borland, BSN, RN
Michelle M. Weigand, BSN, RN
Zika virus spreads mostly from the bite of an infected Aedes species mosquito. Outdoor workers are at increased risk of exposure and should be knowledgeable about potential exposures and how to protect themselves. Health care and laboratory workers are also at risk because they handle blood and body fluids that may contain the Zika virus. Many individuals infected with the virus will not have any symptoms. Some individuals may have mild symptoms including rash, joint pain, fever, muscle pain, or headaches. Symptoms can last for several days to a week and most individuals are unaware they are infected. Outside workers should protect themselves using insect repellant that contains DEET (N, N-Diethyl-meta-toluamide), pircaridin, or another Environmental Protection Agency-registered active ingredient on skin that is not covered by clothing. Laboratory and health care workers should follow universal precautions. There is no cure for Zika virus. Treatment includes rest, fluids, no non-steroidal anti-inflammatory medications, and prevention of transmission to sexual partners.
This poster displayed current information about the Zika virus including transmission, signs and symptoms, and current treatment. Occupational health nurses must learn about the Zika virus, its signs and symptoms, workers at risk, and exposure prevention. Information about the Zika virus should be provided to workers so they can protect themselves from a potential exposure.
Health and Safety Decision-Making Among Truck Drivers
Karen Heaton, PhD, FNP-BC, FAAN
Rachael Mumbower, Doctoral Candidate, RN
Long-haul truck drivers are a vulnerable population of workers who are remote, highly mobile, have difficulty accessing health care, and often do not have health insurance. They are at risk for sleep-related motor vehicle crashes as well as other injuries such as falls, strains, and sprains. Truck drivers are also known to experience a number of health-related conditions, particularly those related to cardiometabolic disease. Hypertension, coronary artery disease, and type 2 diabetes mellitus are among the most common of the chronic illnesses experienced by these workers. In spite of their significant injury risks, prevalence of chronic health conditions, and limited access to health care, little is known about how truck drivers make health and safety decisions. The purpose of this study was to describe influences on health and safety decision making among a group of long-haul truck drivers.
The study employed a qualitative descriptive design. The purposive sample (n = 10) was recruited from truck stops, by word of mouth, and by posted flyers at locations commonly visited by long-haul truck drivers such as truck stops and diesel engine maintenance shops. After informed consent was given in writing, semistructured interviews were conducted with participants. All interviews were audio-recorded and transcribed verbatim prior to analysis. A cyclic approach to coding of the data was used to develop and revise the code book. The process was repeated until a thematic structure was generated. Trustworthiness and credibility were enhanced by using reflexivity, an audit trail, and interpretive convergence.
Four general themes emerged from driver descriptions of health-related decision making: (a) individual driver characteristics, (b) key events, (c) relationships with others, and (d) company-level factors, all of which influenced health and safety decision-making among this sample of long-haul truck drivers. Factors influencing health and safety decision-making must be considered when providing care and education to truck drivers. Involving family members and significant others to assist in motivating truck drivers may be an effective strategy to positively influence health and safety decision-making. Company-level education about truck driver health and safety is needed. Finally, the dispatcher role seems to be key in the decision-making of truck drivers. Not only should this group be educated about the health and safety of truck drivers, but future studies should explore the dispatcher’s perspective and their relationships with drivers. In addition, findings from this study may be used to inform the development of educational materials and other interventions to positively influence truck driver health and safety decision-making, which could lead to a healthier transportation workforce and safer highways for the public.
Pilot Study of Stress Management Interventions for Law Enforcement Officers
Julie Hinkle, PhD, MSN, RN
Carrine Shelley, DNP, CNP
Poorly managed stress in adults can lead to worker absenteeism and impact productivity. Stress can increase blood pressure (BP), heart attack risk, obesity, depression, and other physical and psychological problems. Recent studies support the relationship of stress to disease. Law enforcement officers (LEOs), in particular, have been shown to have more negative health outcomes (higher risk of cardiovascular disease, hypertension [HTN], obesity, depression) related to stress than other workers and the general public. In addition, poorly managed stress may lead to a higher risk of posttraumatic stress disorder (PTSD) and poor conflict management both at work and at home. For instance, an increased risk of marital difficulties and domestic violence has been reported in the law enforcement community. The use of smartphones and wearable devices has the potential to help individuals manage stress. In particular, cognitive behavioral therapy (CBT) has been shown to be efficacious when delivered via computers and the Internet (mCBT). Stigma associated with mental illness may prevent individuals from seeking treatment, but the ability to anonymously access and use a mental health intervention via a smartphone may mitigate this problem. Stress Gym is an online Cognitive Behavioral Therapy intervention (iCBT) for mobile use. Two of eight modules from the Stress Gym intervention were piloted with a local police department in Central Florida during summer 2016; a pilot of all eight modules is anticipated during winter 2016-2017.
For the pilot study, participants (n = 50) completed a demographic survey pre-intervention to include age, race, rank, marital status, military experience, years of law enforcement experience, health problems, and alcohol use. Participants completed the validated Perceived Stress Scale before (n = 50) and immediately after (n = 26) the intervention. The intervention consisted of access to the “reaction to stress” and “sleep habits” modules from the adapted Stress Gym program.
Common stress-related illnesses included hypercholesterolemia (36.73%), HTN (34.69%), difficulty sleeping (26.53%), and obesity (22.45%). Overall, sergeants held the highest mean stress level (10.2), and LEOs with 6 years to 10 years of law enforcement experience had the highest stress level at 10. Detectives had the lowest mean stress scores (7.86) and, surprisingly, those with less than 1 year of experience reported mean stress scores at 9. When looking at overall education, LEOs with only a high school education presented the highest mean stress score of 14.67; individuals with “some college” had the lowest average stress score at 7.82. No significant change in PSS was found after the intervention; the mean stress score for individuals who participated in both the pre- and postintervention surveys was 8.57 before the intervention and 11 following the intervention (n = 19; p = .14). Stress Gym shows promise as an intervention to help LEOs manage occupational stress.
Obesity and Nonfatal Work-Related Injuries in Farmers
Sharon Hunsucker, MSN, NP
Deborah B. Reed, PhD, MSPH, RN
Work-related injuries contribute substantially to the increased burden of injury in the United States. Obesity has been identified as a contributor to work-related injuries. Research on the impact of work-related injuries in farmers and other physically-demanding occupations is limited. A cross-sectional pilot study was conducted to evaluate and compare the impact of general and central obesity on work-related injuries in farmers. Specifically, the researchers aimed to identify the impact of obesity as a risk factor for non-fatal work-related injuries in farmers and describe the role of occupational health nurses in addressing obesity and work-related injuries in farmers. Data collection including completion of a survey and measured heights, weights, and waist circumferences was completed at farm shows and agricultural association meetings. The participant obesity rate exceeded the U.S. national rate. Over one fourth of the participants (n = 100) reported a minimum of one injury in the last year, with 18% reporting an OSHA-recordable injury. Findings included an increased risk for OSHA-recordable injuries and recurrent injuries associated with general obesity. The researchers identified no increased risk for injury related to central obesity. However, findings of the research support obesity as a significant risk factor for non-fatal work-related injuries in farmers. The results of this pilot study support the need for more research on the impact of obesity on farm work–related injuries as well as education and interventions to address obesity and safety in the U.S. farming sector.
Mindfulness Practices Used With Nurses in Work Settings: Integrative Review
Jin Jun, CCRN
Stress and burnout are common among nurses. Managing nurses’ occupational stress is important because stress can adversely affect staff attitudes, morale, job satisfaction, turnover, communication, emotional and physical health, quality of life, and quality of care provided to patients. Mindfulness is defined as non-judgmental present-moment awareness and has become a core construct in some stress-reduction programs.
The purpose of this integrative review was to critically appraise the current literature on mindfulness practices used by nurses at work. The specific aims of this study were to (a) explore types of mindfulness practices, (b) evaluate the effectiveness of mindfulness practices, and (c) examine the feasibility of mindfulness practices. Integrative review according to Whittemore and Knafl was used. PubMed, PyschInfo, ProQuest, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were used for this comprehensive search. The inclusion criteria were primary intervention studies examining mindfulness practice used by nurses at work. Review papers, white papers, and opinion articles were excluded.
Twelve articles were included in the review. Mindfulness practices included guided meditation in group settings or at home (n = 10), an online program (n = 1), and the use of a combination of interventions (n = 1). The duration of interventions ranged from 4 weeks to 8 weeks. Regardless of the intervention type or duration, or the study sample, mindfulness practices all resulted in improvement in participants’ well-being (n = 4), stress level (n = 8), burnout (n = 3), anxiety level (n = 4), cognition (n = 2), empathy (n = 1), resilience (n = 2), and general health (n = 4). The mindfulness interventions also did not require extensive training or time for nurses to reap benefits. Nurses report substantial stress in their lives and at work. An integrative review of mindfulness practice holds promise for improving individual well-being, workplace resilience, and empathy by managing stress. The practice implication from this integrative review is that administrators and/or nurse managers can incorporate mindfulness practices into the workday schedule. However, more research is needed regarding the best method of incorporating mindfulness practices into the workplace.
Racial and Ethnic Differences in Perceived Health, Work Environment, and Work-Related Symptoms Among Cleaning Workers*
Soo-Jeong Lee, PhD, RN, ANP
OiSaeng Hong, PhD, RN, FAAN, FAAOHN
Predominantly, immigrant and minority workers are employed in cleaning. This study explored racial and ethnic differences in perceptions about health, work environment, and work-related symptoms among cleaning workers.
This cross-sectional study gathered data from 183 cleaning workers employed in a university hospital and health sciences campus in northern California. Data such as demographic characteristics, general health, work-related symptoms, and perceptions about work environment (i.e., demand, job control, support, effort, reward, safety climate, and risk perception about chemical exposure) were collected via personal interviews and self-administered questionnaires.
The sample included 119 Asians (65.0%), 37 Hispanics (20.2%), and 27 other races (14.8%); 156 (85.7%) were foreign-born. The proportion of workers perceiving general health as excellent or very good were significantly lower among Asians (44.9%) than Hispanics (70.3%) or other groups (74.1%; p = .0022). Although symptoms due to chemical exposure did not differ by racial/ethnic groups, Asian workers were significantly less likely to seek health care (p = .046) or report the symptom to a supervisor (p = .0006). Regarding work environment, significant differences by race/ethnicity were found in perceptions about job control (p = .0002), supervisor support (p = .011), and health risk from chemical exposures (p < .0001). Compared with other racial/ethnic groups, Asians perceived lower job control and supervisor support and higher health risk from chemical exposure.
Occupational health intervention programs should incorporate these differences to provide culturally sensitive programs and optimize the intervention effectiveness. This study found racial/ethnic differences in perceptions about work, symptom experiences, and health care seeking and reporting behaviors among cleaning workers.
Sexually Transmitted Diseases: A Health Concern for Occupational Health Nurses
Lisa Lesneski, PhD, MSN, RN
Sexually transmitted diseases (STDs) are a concern for the community. Individuals with undiagnosed STDs can spread these infections to others without awareness. In the United States, the rates of chlamydia, gonorrhea, and syphilis have all increased, affecting every community. Prevention and early detection are essential in controlling the spread of STDs and limiting disease complications. Because individuals may have no STD symptoms, they do not seek health care. Undiagnosed cases affect disease reporting. In the United States, reporting is mandatory for chlamydia, gonorrhea, and syphilis. In 2015, chlamydia was the most commonly reported bacterial disease in the United States, caused by Chlamydia trachomatis. Chlamydia increased 5.9% from 2014 to 2015 compared with the previous year. Adolescents and young adults are the largest groups diagnosed with chlamydia. Researchers found that almost half the cases of tubal factor infertility were caused by chlamydia (Price et al., 2012). Many women and men infected with chlamydia are asymptomatic which may lead to the spread of the infection.
A literature review was conducted using CINAHL as the search engine database. A Boolean combination of nursing and STDs were used as keywords. The time frame for the search was set at the past 5 years. The search results were read for pertinent articles to include in the review. In 2015, a total of 359,216 gonorrhea cases were reported, and the U.S. gonorrhea rate increased 12.8% from 2014 to 2015. Gonorrhea diagnosis is made when an individual is infected with Neisseria gonorrhoeae bacterium. Chlamydia and gonorrhea can be cured with antibiotic treatment. Treatment costs and complications are a concern of the community and the public at large. If an STD goes undetected, a woman can experience an ectopic pregnancy or develop pelvic inflammatory disease (PID) leading to infertility.
Syphilis is caused by bacterium Treponema pallidum. From 2000 to 2015, syphilis rates increased mainly among gay and bisexual men. However, during 2014 and 2015, the syphilis rate increased in both genders: men (18.1%) and women (27.3%). In 2015, men accounted for over 90% of all cases of syphilis. Men who have sex with men (MSM) were the majority of cases, consistent with prior years. If syphilis goes untreated, it can have significant complications and even death.
The CDC estimated almost US$16 billion are spent on health care for STDs annually. It is recommended that all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners or a sex partner who has a sexually transmitted infection, have annual chlamydia and gonorrhea screenings. All sexually active gay, bisexual, and MSM populations should be screened at least once a year for syphilis, chlamydia, and gonorrhea per CDC recommendations. When an individual is diagnosed with an STD, not only should the individual be treated, but all sexual partners should be treated as well. Communication about STD before beginning sexual activity should be encouraged for all partners.
Occupational health care providers should educate workers on how STDs spread, signs and symptoms of STDs, and testing procedures; STD education benefits both workers and employers. Prevention and early detection are key.
The following are ways to prevent STDs:
Abstain from vaginal, anal, or oral sex
Vaccinate for human papillomavirus (HPV) and hepatitis B
Reduce the number of sex partners
Engage in sexual activity with one uninfected partner
Use latex condoms consistently and correctly
Move-A-Thon
Renee Lewis, CVRN-BC, CMSRN
One of the more difficult health promotion challenges that occupational health nurses address is motivating sedentary employees to become more active throughout the day. Therefore, a novel Move-A-Thon (MAT) physical activity incentive project was introduced as a new tool to motivate workers to optimize their physical activity in a well-being affirming, non-regressive context. Ten volunteers were asked to participant in a MAT wellness event demonstration project in which their steps were monetized for donation to charity. The focus of the demonstration project was to motivate sedentary participants to achieve a minimum of 3,000 steps per day. In honor of their contributions, participants’ steps were tracked and full donation credit was given for each day more than 3,000 tracked steps were recorded. Participants received a loaned Fitbit and were permitted to invite as many as five sponsors to take part. Sponsorship entailed walking with the participant on at least one occasion within the 2-week period. Full participants received a small additional activity donation credit for each sponsor who “stepped” with them on at least on occasion during the MAT.
Of the 10 office workers invited, nine volunteered to participate. Seven of the nine office workers characterized their jobs as sedentary. Eight of the nine participants reported daily steps. The ninth participant provided approximately weekly step totals and not daily information. The average number of steps per day was based on data from eight participants for whom daily steps were reported. Across an average of 13.75 full participation days, participants averaged 9,585.7 steps per day. Of eight participants queried, seven participants suggested future MAT events of longer duration and repeat MAT events would be well received by future volunteers. Findings in conjunction with this MAT pilot demonstration project indicated that participants were willing to “donate” their physical activity to charity. Their enthusiasm for the MAT event was demonstrated by consistent participation, steps achieved, and comments regarding receptivity to future MAT events. Future research to engage more sedentary workers is needed.
Environmental Noise: Public Health and Policy Implications
Marjorie C. McCullagh, PhD, RN, FAAOHN, FAAN
The negative health effects of environmental noise are far-reaching but often unnoticed, as effects accumulate over time and may not be recognized as noise-related. The purposes of this project were to describe the harmful effects of environmental noise on human health, and generate related policy recommendations for the United States. A literature review regarding the health effects of environmental noise, including historical review of national and international noise abatement initiatives and state specific regulations was conducted.
The negative health effects of noise include a higher risk of cardiovascular diseases, stress, sleep disturbances, diminished cognitive abilities and personal injury among adults, and prematurity, low birthweight, and hyperactivity among children. A minimal reduction in environmental noise levels significantly reduces these health risks. Based on WHO recommendations, European initiatives to reduce environmental noise have included community and legislative changes. Historically, in the United States, 1970’s noise abatement legislation, including federal noise reduction programs and noise education and research, was defunded in 1980, and efforts in noise abatement and control stalled. Currently, state noise regulations vary widely.
Harmful effects of noise are ubiquitous in society. As current federal policy is not enforced, and states are uneven in their enforcement of noise policy, consistency in health policy to address environmental noise is needed. In light of the urgent need to address the harmful effects of environmental noise, health policy should include the use of quieter equipment and appliances, implementation of measures to reduce transportation noise, and action in state and local governments to reduce environmental noise, including noise at public events. This policy would facilitate consistent regulation across populations and protect them from the harmful health effects of environmental noise.
Establishing Intervention Fidelity of a Hearing Health Intervention for Farm and Rural Youth
Marjorie C. McCullagh, PhD, RN, FAAOHN, FAAN
Noise-induced hearing loss (NIHL) is common among farm and rural youth in part due to a lack of programs to prepare this high-risk population to use hearing conservation strategies. Safety Days are 1-day, hands-on workshops that teach rural youth safe farm practices. This program reaches more than 100,000 children and adults in over 400 sites across the United States and Canada each year. As part of a larger study testing the effectiveness of a hearing conservation program for fourth graders attending Safety Day, a lesson (“Hearing Heroes”) was delivered to 24 local participating Safety Day programs nationwide. However, the fidelity of the actual lesson delivery to the study-designed curriculum and quality of instruction were unknown. This poster examines whether community volunteers are capable of delivering, with adequate fidelity and quality, a planned intervention designed to increase use of hearing conservation strategies among farm and rural youth.
The researchers invited 24 community volunteers to deliver a planned lesson to small groups of fourth graders and provide video recordings of the actual lesson delivery. The researchers developed instruments to rate the (a) fidelity of the hearing conservation teaching to the curriculum, and (b) quality of instruction. After reviewing the instrument for clarity, relevance, and conceptual fit, the researchers tested the instruments for interrater reliability and then used the instruments to rate video recordings. Ratings were summarized using descriptive statistics (i.e., means and frequencies).
Five of the 24 instructors responded by providing video recordings of lesson delivery. The initial instruments were modified based on review; interrater reliability in a subsample of recordings was .90 (content fidelity) and 1.0 (quality of instruction). Of the five recordings measured, the mean fidelity to the planned curriculum was .79, with nearly four fifths of lesson items fully addressed. One instructor fully addressed all key instructional points (n = 10). Both fidelity to content and quality of instruction were high. Results support the use of the study-designed curriculum as an effective way to educate farm and rural youth about hearing health.
Provisional Universal Occupational Health Model
Elizabeth Metz, MSN, RN
Total Worker Health is a broad concept created by the National Institute of Occupational Safety and Health to comprehensively examine the impact of work organizations on worker health. Although situation-specific frameworks have emerged, no broad framework connecting work organization impact on specific health outcomes of workers has been published. The purpose of this investigation was to create a universal model to guide research in occupational health fields. Punnett et al.’s (2009) situation-specific framework was adapted to broaden its scope, and a literature review was completed to ground this framework in evidence. Through these methods, the Universal Occupational Health Model was developed including concepts such as Socioeconomic Position, Work Organization, Personal Characteristics, and Physical, Mental, and Social Health. Both documented and hypothesized relationships between these concepts were explored. Due to its broad nature, the Universal Occupational Health Model can be used to study occupational health in any field. Recommendations for model advancement include further conceptual analysis of Social Health (a health outcome in this model), additional research on modifying variables, and use of the framework to validate its content validity.
Cannabis: Workplace Implications of Employee Cannabis Use
Linda Gifford-Meuleveld, RN, COHN-S, CCM, CPDM, FAAOHN
Cannabis is the most frequently detected drug in workplace drug-testing programs. Occupational health nurses are becoming increasingly involved with health and safety issues related to cannabis use by working adults. The occupational health nurse must understand the workplace implications of the increasing acceptance of cannabis use including knowledge of (a) federal and state laws, (b) cannabis impairment as a growing safety issue, and (c) the accuracy of various drug testing methods. This study used a literature review and both qualitative and quantitative research strategies (i.e., correlational analysis and case study) to gather information. The researchers also had on-site laptop access to individual occupational health nurses’ state status for legal standing, medical marijuana cards, and other available published statistics. Occupational health nurses must be informed on issues related to increasing acceptance of cannabis among employed adults:
Cannabis impairment and its relationship to workplace safety
Federal laws and changing state laws related to cannibis (including medical marijuana cards and the Americans with Disabilities Act)
Testing practices for cannabis-related impairment
Knowledge of key web sites for additional information
More research is warranted regarding:
Knowledge and proficiency in the management of workplace substance abuse programs relating to cannabis impairment management
Knowledge of federal (e.g., ADA) issues related to cannabis use by employees (medical and/or recreational)
Knowledge of cannabis testing options
Methods to impact substance abuse programs and training in nurses’ workplaces.
Global Health Competencies for the Occupational and Environmental Health Nurse*
Jennan A. Phillips, PhD, MSN, RN, FAAOHN
The increase in global public health crises highlights the need for all health professionals to possess certain knowledge and skills to deliver health care to an increasingly global workforce. All nurses must understand how social determinants of health in one country can affect entire populations on the other side of the globe. The increasingly global economy further impacts the practice of occupational and environmental health nurses. Nurses competent in global health care have the expertise needed to manage health care for their workers regardless of where they work or travel.
Increasingly, medical and nursing faculty recognize the importance of identifying principles and competencies in global health needed by health care professionals. One group of nursing faculty adapted a list of global health competencies identified for medical students and evaluated the extent to which nursing faculty in several countries recognized the competencies as essential content for undergraduate nursing students. The adapted list included 30 competencies divided into six subscales: (a) Global Burden of Disease, (b) Health Implications of Travel and Displacement, (c) Social and Environmental Determinants of Health, (d) Globalization of Health and Health Care, (e) Health Care in Low Resource Settings, and (f) Health Care as a Human Right and Development Resource.
Although the competencies included in these studies have not been formally endorsed by professional nursing organizations, they are the only comprehensive list of global health competencies identified to date to guide nursing curricula at any level or in specific specialty areas such as occupational and environmental health nursing. The specific aim of this poster presentation was to describe the knowledge and skills needed by occupational and environmental health nurses in today’s global society and work environment.
The objective of this study was to describe knowledge and skills needed by occupational and environmental health nurses in today’s global society and work environment. The researchers used literature review and curricula mapping to identify the needed knowledge and skills.
A review of the literature identified a list of global health topics and skills needed by nurses. Faculty used a previously developed tool to evaluate the inclusion of global health competencies in nursing curricula and reviewed all courses across several programs at one school of nursing for inclusion of the competencies. The mapping exercise and discussion with course managers and faculty in each of the programs identified inclusion of or gaps in global health content for nursing students. The experience solidified the significance of identifying global health competencies for nurses including those specializing in occupational and environmental health. A search of electronic databases identified a variety of web-based education programs and learning resources on global health such as Healthy People 2020 and WHO resources. A toolkit of these learning resources was developed and provided for faculty to include in courses.
Educational programs for occupational and environmental health nurses, both academic and continuing, must include content to increase competency in global health. Research is needed to evaluate whether the global health competencies adapted from general nursing education are applicable to specific nursing specialty areas and if additional competencies are needed. The global society demands that occupational and environmental health nurses, regardless of their practice setting, be competent in global health.
The goal for all nurses in the 21st century is competency as global nurses and global citizens. That goal can be reached by occupational health nurses only if they know the expertise needed, where their gaps in knowledge are, and strategies that could be used to increase their knowledge and skills in global health. A comprehensive list of global health competencies was identified to guide nursing curricula for academic or continuing education courses and self-study for nurses, including those in occupational and environmental health nursing.
Conservation of Resources: A Theory to Explain Nurse Burnout
Aoyjai Prapanjaroensin, RN
Burnout, a work-related psychological stress syndrome among workers in people-oriented occupations, has been an issue of concern for decades for health care workers, especially nurses. Yet, few studies have examined a unified theory that explains the etiology, progression, and consequences of nurse burnout. The aim of this literature review was to examine how the Conservation of Resources theory explains burnout in the nursing profession. This literature review integrated current knowledge about nurse burnout using Conservation of Resources theory, which focuses on four resources (i.e., objects, conditions, personal characteristics, and energy). The databases used in this study included CINAHL, PubMed, and PsycINFO. A total of 21 articles were included in this review. The Conservation of Resources theory explained that burnout will occur as a result of perceived or actual loss of any of these four resources. Furthermore, nurse burnout could affect work performance, leading to a lack of consistency in vigilance and overall quality of care. The Conservation of Resources theory explains the etiology, progression, and consequences of nurse burnout. Further studies must explore whether nurse performance is a mediating factor between nurse burnout and patient safety. Health care organizations and nursing administration should develop strategies to protect nurses from the threat of resource loss to decrease nursing burnout, which may improve nurse and patient safety. The Conservation of Resources theory can guide interventions to decrease burnout as well as future research to examine the relationship between professional nurse burnout and patient safety.
Didactic Reader’s Theater Influences the Health and Safety of a Vulnerable Working Population
Deborah B. Reed, PhD, MSPH, RN
Production agriculture suffers the highest worker fatality rates of any industry and has the oldest workforce with an average age of 58.3 years. Previous efforts to reduce fatality rates among middle-aged and senior farmers have failed. A cutting-edge intervention, based on evidence from previous research, was found to be directly responsive to the farm community. The goal of this project was to change work behavior to improve health and prevent injury. Working with Agriculture Extension, commodity groups, and farm safety organizations, the researchers developed theater tailored to the region and delivered by farmers (“actors”) during a dinner theater event. Couples (individuals age 45 years and over) were recruited as 95% of America’s farms are family operations. Three short plays, focused on work health behaviors (e.g., stress, wearing seat belts on machinery, sunscreen, and hearing protection) and consequences, supplemented by brief discussions led by the project leader, comprised the event. Evaluation of receptivity and subsequent behavior change was tracked through telephone interviews 2 weeks and 2 months post-event.
To date, 369 individuals (M age: 63 years) have participated across five theaters. Participants rated the event as highly realistic and enjoyable; they reported that it helped them understand the interactions of aging, health, and work injury. Fifty-seven percent reported at least one substantial change in their health or work behaviors based on the information they received. Examples of changes included focusing on single tasks, fatigue prevention strategies, hydration, improved communication, and skin and hearing protection. These statistics were updated as enrollment continues into early 2017.
This theater format promises to be an effective means for starting health behavior conversations among families, and for producing substantial behavior changes that can reduce illness and injury among a highly vulnerable work group. It is relatively inexpensive and can be tailored to specific topics and settings. The format may be applicable to other settings where role modeling and oral traditions are prominent, or among groups where low literacy is a barrier to most other interventions. Occupational health nurses often practice with limited budgets. The use of didactic readers theater may be a method that is relatively inexpensive and fun. Use of theater can be embedded in other events that workers attend.
The Value of the Workers’ Compensation Nurse Case Manager
Linda Reiher, APNC, COHNS, CCRN
Workers’ compensation costs are rising. It is the role of the Occupational Medicine Service (OMS) to reduce these costs and return employees to work in a timely manner. In review of data within the department, back and shoulder injuries were associated with the greatest loss of time and highest cost to manage. On average, workers with back and shoulder injuries were out of work for 41 days, greater than the 27.6-day benchmark of third-party administrators for the same injuries. The authors identified gaps in case management which needed to be reconciled, and instituted a workers’ compensation case manager to effectively manage back and shoulder injuries thus closing these gaps and reducing time away from work and associated costs.
In 2014, a retrospective chart review for the year 2013 was completed to establish baseline data pertaining to back and shoulder work injuries. In all, 119 charts were reviewed. The following criteria were evaluated:
Number of days from date of injury to the date initially seen in OMS.
The amount of time lost from the initial date of injury.
The total time from date of injury to return to work.
The number days to schedule an appointment with a specialist.
The number of days to schedule a procedure/diagnostic test and have it completed.
The number of days to schedule a physical/occupational therapy appointment from initial call.
In 2015, the authors implemented a concurrent review of employees with back and shoulder injuries at three OMS sites and piloted a RN Case Manager role for 4 months reviewing, implementing, and tracking data points noted above for 35 cases with back and shoulder work injuries.
The goals of the program were to reduce the turnaround time from 41 lost days to 35 lost days (Key Performace Indicator [KPI]; 15% decrease) and to reduce the days from time seen in OMS to time returned to duty from 41 days to 35 days. The Occupational Medicine Service pilot program achieved a KPI of 8.5 days. The team improved the process with an 80% reduction by hiring a Workers Compensation Case Manager; the average number of lost days for back and shoulder injuries was reduced to 8.5 days resulting in a savings of lost days from 41 days to 8.5 days. The OMS saved the company US$901,771. Initially, 119 charts of back and shoulder injuries from 2013 were reviewed retrospectively; it was determined that the cost of these injuries was US$923,127.41. Further examination of these data and surgical versus non-surgical cases were reviewed. Of the 119 cases, six were surgical cases. The cost for the six surgical cases was US$219,346.32, which was subtracted from total costs and resulted in a US$703,781.09 cost of non-surgical back and shoulder work injuries in 2013.
After piloting the RN Workers’ Compensation Case Manager role in the Occupational Medicine Service for a 4-month period and tracking a total of 35 non-surgical back and shoulder work injuries in 2015, the attributed cost was US$21,346.57. Hiring the Workers’ Compensation Case Manager for the Occupational Medicine Service promoted a significant cost saving while facilitating less lost time for employees. Internally, the department streamlined communications with specialist offices and third-party administrators. Work continues as the role of RN Workers’ Compensation Case Manager evolves and becomes embedded into the OMS structure.
The Relationship of Welding Fume Exposure, Smoking, and Pulmonary Function in Welders*
Laura L. Roach, DNP, MSN, CNS
Employees are at risk for exposure to welding-related fumes, dust, or chemicals. Continued exposure to these substances can place the employee at risk for permanent lung changes. It is the job of the occupational health nurse in collaboration with safety managers to assess the risk by evaluating employees using pulmonary function testing (PFT). The purpose of this study was to explore the relationship between occupational exposure to welding fumes and pulmonary function to add supportive evidence and clarity to the current body of research. The three objectives of the study were as follows:
Examine various ways exposures to welding fumes can be decreased.
Explore types of welding and the particulates to which welders are exposed.
Illustrate how exposures to welding fumes are harmful to employees.
The researchers conducted a retrospective chart review of PFT and pulmonary questionnaires already available in charts from preplacement physicals to the most recent tests. Multiple regression analysis was used to identify multiple predictors of PFT changes while controlling for other impacting variables (e.g., age and respirator use, in this case).
When comparing smoking welders, the researchers controlled for age and percentage of time using a respirator and found that years welding was statistically significant (p = .04). When comparing non-smoking welders, controlling for years welding, and percentage of time using a respirator, age was statistically significant (p = .03). Age was a statistically significant finding for non-smokers due to natural lung changes. Based on these findings, data supported that smoking has a synergistic effect with welding fume exposure on pulmonary changes. In nonsmoking welders, age has an impact on welding fume exposure due to the natural decrease in lung function with age. Use of a respirator was not statistically significant for either group possibly due to sample size. The population included 17 smokers and 22 nonsmokers for a total of 39 participants. Pulmonary function tests showed a decrease in smoker’s lung function compared with non-smokers. It can be concluded that smoking and age have an impact on pulmonary decline; welding fume exposure and smoking causes increased pulmonary decline in relatively young healthy workers. Smoking welders should be strongly encouraged to quit smoking due to increased risk of pulmonary decline. This finding supports the hypothesis that smoking has a synergistic affect with welding fume exposure on pulmonary decline. It could be concluded that even though respirator use was not statistically significant in this study, welders should ensure adequate ventilation and respirator use.
Advancing Best Practices in Occupational Hearing Conservation Worldwide*
Bryan J. Topp, MS, MPH, RN
Certification in occupational hearing conservation (CAOHC certification) is largely understood and respected in the field of occupational health and safety in the United States. However, many other countries do not mandate or offer training similar to CAOHC. Many multinational companies and occupational health nurses have expressed interest in introducing this type of training into their hearing conservation programs. The purpose of this poster was to introduce occupational health nurses from outside the United States to hearing conservation training and certification. Objectives for this poster were as follows:
Define occupational hearing conservation certification.
State Council for Accreditation in Occupational Hearing Conservation’s (CAOHC’s) role as the global leader in the development and delivery of high quality occupational noise exposure resources.
Identify the importance of CAOHC.
Explain the role occupational hearing conservationists can play in protecting workers and advancing the field of occupational health nursing.
The poster included qualitative data, case studies, and a literature review. Council for Accreditation in Occupational Hearing Conservation training has been piloted in Latin American, Asian, and Middle Eastern countries. Council for Accreditation in Occupational Hearing Conservation will continue to work with countries to implement best practices and training in hearing conservation. Their intent is to continue to disseminate best practices in occupational hearing conservation throughout the world.
A Systematic Review of the Work-Life Balance of Hospital Nurses*
Akiko Ui, MS
For over a decade, the shortage of hospital nurses has been a critical social issue not only in Japan but also in many other countries. Because of this, studies have been conducted with the goal of improving the retention of nurses. In particular, reports have recently been published which focus on nurses’ work–life balance. Therefore, this systematic review highlights studies relating to nurses’ work–life balance and the relationship between nurses’ work–life balance and its effects on hospital nurses.
The systematic review was conducted by searching PubMed, EBSCOhost, and ICHUSHI; 18 studies fulfilled the following criteria: (a) majority of the study sample were nurses working in hospitals, (b) focused on nurses’ work–life balance, and (c) studies published in English or Japanese. This systematic review was guided by concepts and processes from Salmond’s and Saimbert’s 2011 book, Comprehensive Systematic Review for Advanced Nursing Practice.
Some of the studies showed a significant relationship between nurses’ work–life balance and job satisfaction, burnout, and stress. No clear definition of work–life balance was found in the literature reviewed; however, six studies did provide definitions. Among the six studies, work was defined in a similar way. However, components of life have a variety of elements such as social life, family life, and private life. In addition, although a variety of instruments were used to measure work–life balance, components of work–life balance were not consistent. Some of the studies indicated only the ratio of work and life (total ratio: work + life = 100%), respectively, without showing any particular components to measure the ratio of work to life. Five of the studies did not use a tool to quantify work–life balance; they used different instruments such as job satisfaction, burn out, and stress to evaluate work–life balance. These were limitations of studying the relationship between work–life balance and its effects.
It is critical to develop a valid and reliable instrument to quantify work–life balance and provide comparable results. An evaluation index could be a potential tool to understand the relationship between nurses’ work–life balance and its effect on hospital nurses. In addition, it is necessary to clarify the elements of work–life balance to further study the relationship between nurses’ work–life balance and its effects. For future work, it would be useful to develop worldwide standard definitions of elements of work–life balance. These definitions would support comparison studies from around the world, and help workers find the best ways to improve work–life balance. As a result, nurses’ retention and health could be improved.
Some studies successfully showed the relationship between work–life balance and job satisfaction, burnout, and stress. However, in each study, work–life balance was defined differently, and the elements to measure work–life balance also differed. Thus, the studies are not comparable and do not clearly direct interventions to achieve work–life balance.
Shift Work and Fatigue Among Police Officers: The BCOPS Study
John M. Violanti, PhD
Fatigue in police officers has been associated with increased risk of injury and other negative health consequences. Shift work may be considered one of the occupational factors that contribute to increased fatigue. This cross-sectional study examined the association between shift work and fatigue among urban police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (2004-2009). A 15-year work history database, containing day-by-day account of start time and hours worked, was used to define shifts as day, afternoon, or night. The shift at which an officer spent the majority of hours was considered the dominant shift. A 10-item questionnaire taken from the Standard Shiftwork Index (SSI) survey based on a 5-point Likert-type scale (5 = very much to 1 = not at all) was administered to assess chronic fatigue. ANOVA/ANCOVA were used to compare mean values of the overall fatigue score across dominant shifts. In addition, Poisson regression was used to compare prevalence of responses with individual items across shift categories. Overall and gender-stratified analyses were conducted.
Officers with complete data on shift work and fatigue (n = 308) were included in the analysis. The majority were White (77%), male (75%), married (72%), and patrol officers (75%). No significant differences were observed across shifts among officers overall. However, analyses of the responses to the individual items revealed significant association between shift work and feeling of tiredness (somewhat to very much) among male but not female officers. The prevalence of tiredness was twofold higher in officers working the afternoon shift compared with those working the day shift (Poisson Regression [PR] = 2.17, 95% confidence interval [CI]: [1.33, 3.56], p = .002). Adjustment for age, gender, race/ethnicity, education, marital status, smoking status, rank, physical activity hours, and alcohol consumption did not attenuate this association. Organizations that offer shift work should consider reducing worker fatigue with education and other strategies, especially for those workers assigned to evening shifts. Future longitudinal studies may assess the potential social and biological correlates that can better explain associations between shift work and fatigue.
Using Motivational Interviewing to Address Obesity in Commercial Motor Vehicle Drivers
Juanita L. Wilson, DNP, CRNP, MSN, MHA, COHN-S
This poster presentation introduced an evidence-based practice (EBP) project that could be used to address the global health problem of obesity within the commercial motor vehicle driver population.
The population for this project were commercial motor vehicle drivers who work for a global battery manufacturer. This population was adult, aged 18 and older, male and female, inclusive of all races and ethnicities, and with BMIs of 30 or greater. Twenty volunteer participants completed the project. All commercial motor vehicle drivers were male (n = 20), between the ages of 26 and 69, with a mean age of 43.8 years. Reported ethnicity lacked diversity, with 95% (n = 19) Caucasian and 5% (n = 1) Hispanic.
The findings from a comprehensive literature review reflected clinical evidence that promoted healthy behavioral change by using motivational interviewing (MI) to increase self-efficacy, ultimately reducing obesity. The literature review also identified a clinically valid tool to measure self-efficacy in relation to weight loss. A systematic review by VanBuskirk and Wetherell (2014) evaluated 12 randomized controlled trials (RCTs) with nine positive results when using MI for weight loss. The meta-analysis of body weight reduction from the RCTs found a mean effect size of .47 that approached significance (p = .07). Overall, the findings indicated that MI is effective at health behavior change to achieve weight loss, and the researchers suggested as few as one MI session may be effective.
Similar to MI, evidence supported self-efficacy to reduce weight. An 18-month behavioral weight loss study by Warzizski et al. (2008) examined 170 participants for their levels of self-efficacy, meaning their ability to stick to a diet and lose weight. The outcome of the study revealed that self-efficacy was associated with weight loss (p = .02), and an average weight loss of 4.64% of baseline was achieved, as well as an 11.7% increase in self-efficacy. Meybodi, Pourshrifi, Dastbaravarde, Rostami, and Saeedi (2011) investigated the effectiveness of MI to increase self-efficacy for weight loss. Thirty overweight and obese Iranian women were randomized to either a MI intervention group or a control group. The MI intervention group received four MI sessions and the control group did not receive any intervention. Self-efficacy was measured using the Weight Efficacy Lifestyle Questionnaire (WEL-tool questionnaire) and weight loss was measured in BMI reduction. After 2 months, the participants in the intervention group showed significant reduction in BMI (p = .001) and improvement in self-efficacy (p < .05). The WEL-tool is a 20-item Likert-type scale questionnaire used to measure self-efficacy for weight loss. A qualitative study by Ames, Heckman, Diehl, Grothe, and Clark (2015) demonstrated statistical and clinical validity for the WEL-tool. The WEL-tool was demonstrated to be a clinically valid tool to measure self-efficacy related to weight loss in multiple studies for over two decades. In summary, based on the findings in the literature, evidence suggested the implementation of MI to increase self-efficacy for weight loss in obese individuals.
This EBP project measured and evaluated two outcomes: an increase in weight loss measured by a reduction in BMI and an increase in self-efficacy for healthy behavior change and weight loss as a result of a MI intervention. Data revealed an increase in group self-efficacy for weight loss by 14.8%, exceeding the benchmark of 11%. An analysis of group BMI revealed commercial motor vehicle drivers lost a mean of 0.65 kg/m2, exceeding the benchmark of 0.5 kg/m2 to two pounds per week. The outcomes of this EBP project suggest that MI was successful for the experimental group, helping commercial motor vehicle drivers increase their confidence in their ability to lose weight and lower BMI. The results suggest a short-term MI intervention can be a cost-effective and easy to implement solution to mitigate obesity when implemented as a clinical standard for commercial motor vehicle drivers as well as other populations.
Motivational interviewing is a compelling intervention that can reduce obesity because it explores an individual’s motivations for healthy behavior change. Motivational interviewing supports self-efficacy, improving diet and exercise behaviors. Overall, this EBP practice project was an effectual approach to increase self-efficacy and reduce BMI, thus lessening the adverse impact of obesity.
Future practice implications from this project include introducing MI to promote a variety of healthy behavior changes in clinical settings and could be considered to address obesity in a variety of populations. The use of various forms of technology such as cell phones and apps should also be considered when addressing obesity. Using MI in combination with diet and exercise education and technology to engage participants in healthy decision making is a cost-effective and easy to implement solution to mitigate obesity, and should be considered useful not only with commercial motor vehicle drivers but for the population at large.
Footnotes
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Poster presented at both the 2017 Global Summit and 2017 AAOHN Annual Meeting.