Abstract
Predictors of Employment in Middle-Aged and Older Adults With HIV: Implications for Occupational Health Nursing
Kristin D. Ashley, David E. Vance, and Pariya Wheeler
Background: Individuals with HIV are at risk for being unemployed. In the United States, approximately 40% to 50% of adults living with HIV are employed. There are many benefits to maintaining active employment for HIV persons. Successful work engagement can enhance long-term health, quality of life, and self-esteem. Across the life span, employment among individuals with HIV is associated with better disease-specific health factors (e.g., shorter disease duration and higher CD4 cell counts) and higher global neurocognitive functioning. Therefore, it is important to identify predictors for employment among individuals with HIV. The purpose of this study was to explore predictors of employment of HIV-positive adults in the Deep South.
Methods: This cross-sectional study consisted of HIV+ participants aged 40 years and older, who completed a comprehensive assessment that included measures of demographic variables (including employment status), mood, and neurocognitive functioning. Univariate and multivariate analyses were conducted between self-reported employment and neurocognitive function, demographics, depression, and HIV characteristics.
Findings: The sample consisted of 209 HIV participants in which 65% were male and 80% were African American, with a mean age of 51 years. Seventy-five percent of individuals were unemployed, while 25% were employed either full- or part-time. Correlates of being unemployed (ps < .05) included older age, Black race, greater depressive symptoms, lower education, positive for illicit drugs, and having a detectable viral load. While neurocognitive impairment was not associated with unemployment, poorer performance in the individual domains of executive function and working memory were associated with being unemployed (ps < .05). Multivariate analyses indicated that age, depressive symptoms, education, and viral load were all significant predictors of unemployment (ps < .05).
Conclusion/Implications for Practice: Findings suggest that older age, higher levels of depression, lower educational attainment, and disease severity may have adverse effects on employment status. Such factors may underlie associations between other factors such as race, substance use, and cognitive function and employment. Some relationships may be bidirectional, such that those with poorer mood and cognitive functioning, for example, are less likely to work, which in turn may worsen these important functional outcomes. Interventions to ameliorate depression or cognitive functioning along with occupational counseling may be examined as a way to promote employment, which may have reciprocal benefits to quality of life. Research is needed to understand reasons for unemployment in people living with HIV as well as employment trajectories over time.
FluFIT: Saving Lives Two Ways
Dina Martinez Tyson, Debra Cheek, Deborah Daniel, Clement Gwede, Marie Massaro, Cathy Mead, Linda Munoz, and Talia Schneider
Background: FluFIT is a nationally recognized evidence-based program that combines efforts to include flu vaccine and colorectal cancer (CRC) screening. This program aims to reach average risk individuals, who are 50 years of age and older who have not had a routine CRC screening. This involves providing people with a take-home fecal immunochemical test (FIT) when they receive their annual flu vaccine. According to the CDC, the 2017-2018 influenza season generated approximately 80,000 deaths. Due to the severity of the disease, H. Lee Moffitt Cancer Center and Research Institute (Moffitt) implements a mandatory Team Member (TM) influenza program annually. CRC is the second leading cause of cancer deaths in the United States. In 2018, the American Cancer Society published a national public health initiative hoping to increase CRC screenings by 80%. The mission statement at Moffitt is to “contribute to the prevention and cure of cancer.” A committee at Moffitt decided to utilize FluFIT, combining efforts of flu vaccination and CRC screenings.
Methods: FluFIT planning involved regular meetings of a multidisciplinary committee. To spread the word to Moffitt TMs, information regarding FluFIT was available on the Occupational Health website where routine flu vaccine information is provided. Other communications included Moffitt IT notifications, Wellness Fair, and electronic board notifications. At Moffitt, flu vaccines are distributed to TMs during months of September and October. Information provided by human resources stated approximately 1,780 TMs were over the age of 50. When receiving their flu vaccine, the TM reviewed the eligibility questionnaire. TMs aged 50 to 75 years who had not had a colonoscopy within 10 years and had not been diagnosed with certain gastrointestinal disorders were eligible for routine FIT screening. If eligible, TM names were listed on a distribution log and received a free FIT kit along with their vaccine. “Patty the potty,” a small toilet used as a prop displayed how to collect the FIT sample, which would test for hidden blood in stool. The kits were analyzed by the Moffitt’s microbiology lab and results were sent to the Team Member Medical Clinic (TMMC). If the result was negative, the TM received an email along with a reminder to repeat the FIT next year and annually. If the result was positive, the TM followed up at TMMC or their primary care provider.
Findings: As of January 2018, 243 kits were distributed with 161 processed, a 65% return rate. Of those, five were positive, and they were referred for follow-up testing. In a postevaluation questionnaire, the continuation of the FluFIT program in future years was found to be favorable by TMs, as many indicated they would not have completed a routine CRC screen without this program.
Conclusion/Implications for practice: FluFIT: Saving Lives Two Ways was an easily implemented, yet valuable health promotion program that raises awareness of the importance of CRC screening. With early detection and prevention, mortality of this disease can be greatly reduced, possibly saving the lives of our most valued resource, our TMs.
Impact of California Safe Patient Handling Legislation: Health Care Workers’ Experiences
Victoria Michalchuk, Laura Stock, Kelsie Scruggs, and Soo-Jeong Lee
Background: Musculoskeletal injuries are prevalent in health care workers performing patient handling tasks. In 2011, the State of California enacted legislation on safe patient handling (SPH) to protect health care workers in hospitals. Its enforceable regulation became effective in 2014. Under the SPH law and regulation, general acute care hospitals in California are mandated to establish a SPH policy and plan to protect workers from musculoskeletal injuries including employee training, use of powered patient handling equipment to replace manual handling, and provision of lift teams or trained staff to assist. Hospital plans must also include procedures for identification and evaluation of patient handling hazards, investigation of patient handling injuries, correction of patient handling hazards, communication with employees, and evaluation of the effectiveness of the plan.
Methods: Three focus groups were conducted with 21 participants (19 nurses and two patient handling specialists) from 12 hospitals located in eight counties in the San Francisco Bay Area and San Joaquin Valley. The participants were recruited using on-site flyers, email advertisements, and word-of-mouth via various networks of unions, professional associations, nursing schools, and training events. The participants represented various units, including intensive care, medical-surgical, neurology, emergency department, operating room, postpartum, outpatient oncology, lift team, and hospital-based home care. Focus group questions addressed knowledge of the SPH law and policy, changes in SPH programs and practices, worker involvement in the SPH policy and program implementation, and perception about the policy impact on patient handling practices. All focus groups were led by an expert facilitator and digitally recorded. Thematic analysis was used for data analysis.
Findings: Since the passage of California’s SPH law, health care workers have had diverse and mixed experiences and multiple themes emerged from the focus groups. Most participants had some awareness of the SPH law and there was more provision of training on SPH and increased provision and variety of lift equipment. However, lift equipment alone was only a partial solution, and insufficient staffing continued to place a challenge on getting assistance when needed. Participants expressed increased use of lift equipment but continued to face barriers such as lack of immediate availability of equipment and patient situations where equipment use is inappropriate. Participants noted positive changes in safety culture and feeling more empowered to advocate for staff safety but also expressed that management became more punitive for injuries.
Conclusions/Implications for Practice: This study identified positive changes in the hospital programs and practices related to California’s SPH law and continuing challenges and barriers for safe practices and injury prevention. The findings provide useful information to various stakeholders including policy makers, hospital leadership and safety management, and unions to understand positive impacts of the law and the areas to address for improvement.
The Relationship Between Work Environment, Burnout, and Medication Administration Errors Among Nursing Staff in Alabama Acute Care Hospitals
Aoyjai Prapanjaroensin, PhD, BSN, and Patricia A. Patrician, PhD, RN, FAAN
Background: Approximately 30% to 60% of nurses report high levels of burnout worldwide. The major causes of nurse burnout may be related to personal and work environment characteristics such as nursing inexperience, heavy workload, and poor teamwork. Nurse burnout could impact vigilance and job performance. Nursing job performance may decrease due to decreased alertness if nurses have high levels of burnout, and this issue may be related to the act of committing a medication error. Of the very few studies exploring the relationship between nurse burnout and medication errors, the findings are conflicting. The purpose of this study was to examine the relationship between nurses’ personal characteristics, work environment characteristics, burnout levels, and self-reported medication administration errors among nursing staff in Alabama acute care hospitals.
Methods: A cross-sectional population-based study using an electronic survey ascertained demographic characteristics, the Practice Environment Scale of the Nursing Work Index (PES-NWI) (five components include: Nurse Participation in Hospital Affairs; Nursing Foundations for Quality of Care; Nurse Manager Ability, Leadership, and Support of Nurses; Staffing and Resource Adequacy; and Collegial Nurse–Physician Relationship), the Copenhagen Burnout Inventory (CBI) (three components including Personal Burnout, Work-related Burnout, and Client-related Burnout), and medication error items from The Patient Safety Culture: Hospital Survey. Nurses received a postcard with a weblink to access and complete the survey. A mailing list was obtained from the Alabama Board of Nursing for all RNs licensed in Alabama. A total of 58,997 postcards were disseminated to the nurses’ permanent addresses in Alabama. Descriptive statistics were employed to analyze these data, as well as correlational analysis to examine whether personal characteristics, PES-NWI, and medication administration errors were related to nurse burnout (CBI).
Results: A total of 341 nurses responded to the instruments used in the study. The majority reported experiencing medium to high burnout levels (77%, n = 249), while younger nurses (r = −.17 to −.21, p < .01), and those with fewer years’ experience in nursing reported higher burnout levels (r = −.05 to −.10, p < .05). All five components of PES-NWI were negatively and significantly correlated to all three components of CBI (p < .01), which indicated that in the better nurse work environments, nurses experienced lower burnout levels. In addition, higher work-related burnout was significantly related to higher reported numbers of medication error that occurred on the unit in the last 3 months (r = .15, p < .01). However, burnout levels are not statistically related to either marital status, education levels, race, or number of patients assigned to each nurse.
Conclusion/Implications for Practice: The majority of nurses in this study reported medium to high burnout levels. Nurse age, years of nursing experience, and nursing work environment are related to burnout levels. Also, nurse burnout predicts medication administration errors. Findings from this study can be used to inform hospital in the Alabama health care system of hospital level organizational attributes that contribute to the health and safety of nurses, and patients. It also provides baseline data for actionable interventions to improve nursing care delivery, and ultimately health care.
Teaching Navy Occupational Health Nursing to New Occupational Health Nursing Personnel
Brenda Ruhrer, and Lynn Flowers
Background: Occupational health nursing is unique among nursing specialties in its consideration of legal requirements. Proficiency in this area is not just essential to meeting Joint Commission and other standards, but essential to meeting Occupational Safety and Health Administration (OSHA) regulations. Occupational health nurses and medical providers must work closely with personnel in safety, industrial hygiene, supervisors, and employees to ensure medical surveillance is completed properly and within regulations.
Methods: We implemented a 1-week training course titled, “Occupational Health Nurse Fundamentals Course” in a Navy Clinic. This course was required for all new personnel filling occupational health nursing positions, because they typically have little formal training or experience prior to their assignment. The course included content pertaining to the history of occupational health, workplace hazards, risk communication, career development within the field, relevant occupational health instruction, guidance and resources, and how to prepare for on-the-job inspections to effectively run a Navy OH clinic. The course also included a site visit to the Norfolk Naval Shipyard, which allowed students to see firsthand the risks and workplace hazards Navy personnel are exposed to. We evaluated the course by testing participants on course content before and after the course.
Findings: A total of 30 workers participated in the course. The pretest scores were 50% while posttest scores were 63%, with an improvement of 26%. We also received positive course evaluations from the participants.
Conclusions/Implications for Practice: Incorrectly or incompletely following occupational and environmental nursing protocols/guidelines can adversely affect not only individual workers, but populations of workers, and the mission of the Navy. Course attendance will enable occupational health nurses and technicians to appropriately execute the Navy’s Occupational Health programs and run an efficient occupational health clinics.
Disclaimer
The views expressed in this abstract are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U. S. Government.
Copyright Statement
I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C., §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C., §101 defines a U.S. Government work as a work prepared by a military Service member or employee of the U.S. Government as part of that person’s official duties.
The Pretravel Health Preparation Training Program for Occupational Health Clinicians
Candace McAlester
Background: International travelers are at increased health risk related to their potential exposure to diseases, accidents, and other safety risks. Travel health providers should have the proper body of knowledge to adequately prepare this population to help mitigate travel risks.
Purpose: The purpose of this scholarly project was to implement a pretravel health training program along with the use of a pretravel health checklist to improve the quality and efficiency of the ExxonMobil Baytown occupational health clinic’s travel health services.
Methods: This evidence-based practice quality improvement project used a tiered approach which consisted of a clinician, pre- and postknowledge test following a pretravel health preparation training program and implementation of a preexisting ExxonMobil travel checklist to improve the efficiency of travel health consultations. The project used ACE Star evidence-based practice model and PDSA (Plan, Do, Study, Act) quality improvement process to develop and measure outcomes of the project.
Results: The knowledge of the clinicians (n = 11) after the training program increased by 35% from pretest (M = 71.82) to posttest (M = 96.36). They also reported increased efficiency with the use of the pretravel checklist.
Conclusion/Implications for Practice: Attending an evidence-based practice training program increased the knowledge for travel health nurses which could improve overall traveler safety. The use of a pretravel checklist can assist with increasing efficiency of the pretravel preparation process which could help reduce the chance of errors.