Abstract
Factors Influencing Health Promotion Behaviors of Workers Who Are at High Risk of Metabolic Syndrome
Sungwon Park, Min Kyeong Jang, and Chang Gi Park
Background: Previous workplace intervention studies for metabolic syndrome were shown to improve health promotion behavior (HPB), including exercise and diet, but there has been limited literature investigating factors related to HPBs. To fill the current research gap, this study aimed to determine the factors for assessing and improving HPB using a Theory of Planned Behaviors (TPB) model for South Korean hotel employees.
Methods: Based on medical record screening guidelines from the modified National Cholesterol Educational Program Adult Treatment Panel, 167 hotel employees considered high risk for metabolic syndrome were selected. Participants completed 40 structured questions intended to explore key constructs of the TPB, including their attitudes toward HPB, perceptions of whether HPB were a norm in the workplace, perceived behavioral control (PBC) over HPB, and intention to engage in HPB. Factor analysis and structural equation modeling were applied using Stata/IC 16 to analyze participant data.
Findings: The factor analysis showed five HPB subdomains: exercise, healthy eating habits, choosing healthier foods, avoiding fatty foods, and eating regularly. Regarding predictors of HPB, structural equation modeling revealed that only PBC was significantly related to intention to engage in HPB (p < .001) and actual engagement in HPB (p < .001). Although PBC directly influenced intention to eat regularly (p < .001), eating regularity was the only behavior not directly influenced by PBC (p = .83). PBC indirectly influenced eating regularity (p = .03) via intention to eat regularly. Thus, a total 85.7% of PBC had an indirect effect on health behavior.
Conclusions/Implications for Practice: The study findings suggest that occupational health nurses should focus on strengthening employees’ PBC over mealtimes by providing employees with access to balanced food at consistent mealtimes.
Interventions to Promote Hotel Workers’ Health: A Scoping Review
Mackenzie Adams, Wei V. Li, Kate Saylor, and Marie-Anne Rosemberg
Background: The hospitality industry employs millions of workers and is a key contributor to the U.S. economy. Despite being essential drivers in the industry’s success, hotel workers, particularly hotel housekeepers, are exposed to occupational hazards and experience disproportionate rates of injuries and chronic health conditions. Thus, there is a significant need for health promotion efforts directed toward these workers. However, little is known about existing interventions targeting their health.
Methods: We conducted a scoping review to identify and appraise workplace health promotion interventions targeting hotel employees. We performed a scoping review following the framework outlined by Arksey and O’Malley (2005). Our literature search process was recorded using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Basic study information was compiled into a matrix table. Study quality was assessed using the Template for Intervention Description and Replication (TIDieR) and the Delphi List.
Findings: Eight unique interventions were identified, occurring at over 30 hotels with participation ranging between 16 and 1,207 employees. The majority of these interventions used a multilevel approach. The range of activities included educational sessions and materials, health screenings, training or directive feedback, and changes to the work environment. Although many of the reported health outcomes were not statistically significant, studies reported results with clinical implications, including decreased injury claims, reduced anxiety, improvements in cardiovascular disease risk indicators such as body mass index (BMI), and increased knowledge among participants.
Conclusions/Implications for Practice: This is the first review to interrogate the literature on existing workplace interventions targeting the health of hotel workers. While some studies found significant improvements in health outcomes, few conducted rigorous program evaluation. The results highlight the need for more and effective interventions targeting these at-risk workers.
Flipping the Nurse–Patient Relationship: An Innovation for Smoking Cessation
Amy Thornberry, Theresa Garcia, Elizabeth Sefcik, and Jessica Peck
Background: Effective smoking cessation interventions (SCI) are indicated among the working population where a concerning prevalence of smoking continues. Occupational health nurses could be effective for delivering SCI but their own self-efficacy was found to be a significant barrier. The purpose of this study was to improve the delivery of SCI to smokers at work and to explore nurse self-efficacy.
Methods: A quasi-experimental pretest, posttest was conducted on two groups, occupational health nurses (n = 5) and smokers (n = 11) working at U.S. manufacturing facilities. Occupational health nurses were educated on motivational interviewing (MI) techniques who then recruited smokers through clinic encounters. Occupational health nurses asked smokers if they would help them practice their skills by attending MI counseling sessions while at work and then incentivized with a US$50 gift card if they completed all three sessions. The two groups were measured by Likert-type scale for occupational health nurse self-efficacy and behavior change and smokers for level of change toward quitting. A paired t-test determined pretest and posttest differences; Pearson’s correlation determined relationships between occupational health nurse and smokers change scores.
Findings: Paired t-tests detected statistically significant difference in occupational health nurses’ self-efficacy scores, t(4) = −4.46, p < .001, d = 2.92, and smokers’ stage of change toward quitting scores, t(10) = −9.07, p < .001, d = 2.09, suggesting the education and practice intervention were extremely effective in increasing occupational health nurse self-efficacy and smokers’ level of change toward quitting.
Conclusions/Implications for Practice: Results indicate smokers who previously declined counseling can be successfully recruited and counseled, while simultaneously improving occupational health nurse self-efficacy toward helping these patients. Secondary findings revealed an innovation for smoking cessation through success in a recruitment method of flipping the nurse–patient relationship from nurses helping patients to patients helping nurses.
Innovations in Occupational and Environmental Health Nursing Education: An Intraprofessional and Interprofessional Approach
Victoria Vaughan Dickson, Amy Witkoski Stimpfel, Laura Ridge, and Lauren Ghazal
Background: Occupational and environmental health nurses (OEHNs) play a critical role in maintaining a healthy workforce in a rapidly changing work environment. However, there is a critical shortage of nursing professionals who are prepared to meet the occupational and environmental health needs of a global workforce. The purpose of this work was to describe the development, implementation, and evaluation of an interdisciplinary OEHN doctoral (PhD/DNP) training program that has been successfully integrated into an existing NIOSH-funded Education and Research Center.
Methods: Each phase of program development and implementation was guided by a comprehensive logic model; short-, medium-, and long-term outcomes were developed to measure success and sustainability. A strategically focused curriculum integrates research, practice, and education and emphasizes interdisciplinary collaboration, to achieve three program objectives: (a) equip nurses with the knowledge and skills to conduct interdisciplinary occupational and environmental health research (PhD) and translate research to practice (DNP) that improves health and reduces health disparities in working populations; (b) train nurses to become leaders in the field; and (c) prepare them to educate future OEHNs. A variety of intradisciplinary course curricula and training opportunities support the program outcomes. An external advisory board of regional and national experts provide guidance to the program directors.
Findings: The program has successfully enrolled a diverse cohort of PhD and DNP students (40% African American, 20% Asian). To date, doctoral dissertation research has focused on international workforce occupational health, vulnerable working populations, and total worker health. Our DNP students have focused quality improvement capstone projects working with leaders in occupational health and safety including the 9/11 WTC Centers of Excellence.
Conclusions/Implications for Practice: Providing training to OEHN doctoral students is essential to the OEHN profession and to maintaining a healthy workforce.
Building a Bridge for Occupational Health and Safety Research Through an Academic–Practice Partnership
Stephanie Hammond, Karen Heaton, and Shea Polancich
Background: Academic–practice partnerships are formalized agreements between academic nursing schools and a health care system. These partnerships are an integral piece in nursing to promote education, guide change, and improve health. One benefit of these partnerships is the improved health of the public, including workforces. Nursing schools can bring knowledge and expertise particularly about research design, data collection, quality improvement, and evidence-based practice to meet the goals for a healthy and safe work environment to a health system. The purpose of the presentation is to demonstrate how an academic–practice partnership is capable of generating research and quality improvement projects to improve the health and safety of workers.
Methods: A formalized partnership between the school of nursing and academic health system led to a discussion with the employee health manager and the Chief Nursing Officer (CNO) within the health system to identify areas of research (evidence generation) and improvement (evidence-based practice). The areas of need identified were reducing sharps injuries, drug diversion, workplace violence, RN wellness, and sleep in shift workers. These areas are currently the focus of research and improvement by PhD and DNP students from the school of nursing.
Findings: Findings are pending as the students are currently working in these focused areas within the health system. These efforts will be applied to the students’ scholarly projects. Some “lessons learned” include collaboration yields opportunity for sustainable students projects, identify leaders at the onset of collaboration, ensure capability of measuring outcomes, and ensure flexibility with changing health system priorities.
Conclusions/Implications for Practice: Academic–practice partnerships are an opportunity to collaborate with academic health systems to assist with identification, research, and improvement in the health and safety of its workers.
Vaccine-Related Anxiety: Supporting Employees With Self-Administered Acupressure
Michelle Schaffer, Eileen Kelly, Marlene Freeley, Shanna Sullivan, and Donna Berry
Background: Employees with vaccine-related anxiety are prone to avoid vaccination or, in the case of mandatory vaccination, delay. This type of anxiety ranges from mild to substantial. The purpose of our pilot initiative was to introduce and evaluate how self-administered acupressure immediately prior to the vaccination in a health care setting may impact the employee’s experience of anxiety receiving the flu vaccine.
Methods: During the 2018 influenza vaccination campaign, self-identified anxious employees were invited via posters, emails, and by occupational health nurses to answer an anonymous, 3-item questionnaire (age, gender category, and anxiety level on a 10-cm line scale). Then, the employee volunteer was set up to view a video-recorded instructional session explaining and demonstrating a simple acupressure technique. This technique was intended to reduce anxiety. Immediately after viewing the video, the employee was asked to mark a second 10-cm anxiety scale. The marked questionnaires were sealed in an envelope by the employee, dropped in a receptacle and not seen by the project team until in aggregate. The groups before and after anxiety levels were evaluated for change.
Results: Eighteen employees (4 men and 14 women) identified as anxious about the vaccination answered the questionnaire and viewed the video. Pre and post median anxiety scores were 8.0 (range, 2.7–9.8) and 5.1 (range, 0.7–9.3), respectively.
Conclusions/Implications for Practice: Implementing easy-to-use tools to help employees manage anxiety in the workplace is possible for the Occupational Health Nurse. Our pilot findings are encouraging and suggest a benefit to teaching the simple self-administered acupressure technique. By having a technique to offer, future immunization initiatives may better service anxious employees by normalizing the conversation about anxiety.
Determinants of Global Worker Health Outcomes
Pamela Carver, Stephanie Hammond, and Jennan Phillips
Background: Where we live and work, the state of our environment, genetics, income and education level, and personal relationships affect health more than access to and use of health care services. Health care providers now recognize the importance of considering the multiple factors that influence health for diverse populations and the role occupations and the workplace have in determining health outcomes. A literature review was conducted to find health determinants and strategies that improve health outcomes among the global workforce.
Methods: Standard search methods explored national and international sources for literature published since 2000 about determinants of health and health outcomes among workers.
Findings: Health outcomes are influenced by socioeconomic, political, physical, biological, and behavioral factors that affect workers. Health determinants from the socioeconomic and political environment include educational, economic, and job opportunities; health care services; transportation options; public safety resources; social norms and attitudes; community culture and ethnic characteristics; socioeconomic conditions; and resources to meet daily needs. In the physical environment, health determinants include the natural and built environment, worksites, housing, schools, recreational settings, and exposure to physical hazards. Individual biological traits and behaviors that determine health include genetics and family history; cultural/ethnic background and beliefs; chemical, alcohol, and tobacco use/misuse; health beliefs and attitudes; healthy food choices, physical activity; and education/health literacy levels.
Conclusions/Implications for Practice: Understanding links between health determinants and health outcomes is important. Occupational health nurses can protect the health of global workers by advocating for safe housing, educational opportunities, and access to healthy food choices plus safe road designs, walkways, and bike paths; promoting transparency about workplace exposures and risks; encouraging good environmental stewardship for safe water, clean air, and recycling; and facilitating tobacco cessation options and tobacco free worksites.
Cannabis: Implications for Workplace Health and Safety
Jennan Phillips
Background: Cannabis, a cannabinoid from the hemp plant that contains tetrahydrocannabinol, is illegal under federal law, yet most states allow certain forms. Federal legislation in 2018 legalized select hemp products, and projected market growth of cannabidiol (CBD) edibles derived from hemp is US$4.9 billion; edibles from cannabis could reach US$5.4 billion. Massive growth in the edible market alone increases legal and health implications.
Methods: Standard search methods explored relevant databases published in English between 2014 and 2019 for reviews of evidence, court decisions, or legislative outcomes about marijuana, medical marijuana, cannabis, and related products.
Findings: Two evidence-based reviews reported therapeutic and adverse effects of cannabis and cannabinoids. Conclusive or substantial evidence showed effectiveness for treating chronic pain in adults, as antiemetics for chemotherapy-induced nausea and vomiting, and improving patient-reported multiple sclerosis spasticity symptoms. Substantial evidence revealed statistical associations between long-term cannabis smoking, worsened respiratory symptoms, and increased chronic bronchitis episodes. Moderate evidence showed association between cannabis use and development of substance dependence/abuse disorder for alcohol, tobacco, and other illicit drugs. Increasing evidence showed cannabis adversely affected the cardiovascular system via cannabis-induced arteritis, vasospasms, and platelet aggregation. Growing support suggested heavy cannabis users are more likely to report thoughts of suicide than nonusers; regular use may increase risk for developing social anxiety disorder, and cannabis use within 24 hours impaired performance in cognitive domains of learning, memory, and attention.
Conclusions/Implications for Practice: Health professionals must understand issues surrounding cannabis to develop evidence-based educational programs and health and safety policies for the workplace. Occupational health nursing professionals knowledgeable of evidence surrounding cannabis use can manage worksite programs to prevent injuries and illness more effectively and advocate for legislation and health policies to promote health and safety.
Measurement of Nursing Mothers’ Perceptions of Workplace Lactation Support: A Systematic Review
Robin Ray, MSN, RN
Background: Lack of workplace lactation support is one potential contributing factor to low rates of exclusive breastfeeding in the United States compared with other countries. The most frequently cited reasons that working mothers discontinue breastfeeding before 6 months include lack of managerial lactation support, an unsupportive work environment, and difficulties locating suitable milk pumping and storage locations. The purpose was to systematically review research articles reporting psychometric properties of instruments used to measure nursing mothers’ perceptions of workplace lactation support.
Methods: A search was conducted in the electronic databases PubMed, CINAHL, and PsycINFO. English-language research articles using quantitative methods to examine measures of workplace lactation support published between January 2007 and March 2019 were systematically reviewed. Of 22 full-text articles assessed for eligibility, eight articles were chosen for synthesis.
Findings: Three workplace lactation support instruments were identified. Each instrument’s purpose, reliability, and validity were summarized. Five articles used the 12-item Workplace Breastfeeding Support Scale (WBSS), two articles used the 41-item Employees Perception of Breastfeeding Support (EPBSQ), and one article used the 29-item Perceived Breastfeeding Assessment Tool (PBSAT). The WBSS was chosen as the recommended method for measuring nursing mothers’ perceptions of workplace lactation support.
Conclusions/Implications for Practice: Content, construct, and predictive validity were present for most but not all of the identified instruments. Adaptability, number of items, interpretation of score, and identified domains are all important aspects to consider when selecting a measure to assess nursing mothers’ perceptions of workplace lactation support.
Intervention Needs of Hotel Housekeepers: A Grassroots Approach
Marie-Anne Rosemberg, Li Wei, Maria Militzer, and Pratyush Mahapatra
Background: Hotel housekeepers represent the largest worker group of the 1.8 million employees in the hospitality industry. They are exposed to a plethora of biological, physical, chemical, and psychosocial hazards at work as well as other stressors outside of work that increase their risk for negative health outcomes. Other studies have generally focused on identifying these stressors and not on deliberating potential solutions. We aim to address this gap.
Methods: Four focus groups were conducted and audio-recorded. Two of the focus groups took place in hospitality establishments with English-speaking workers. The other three focus groups were conducted in Spanish in one of the participants’ home. We also conducted five individual phone interviews with managers to understand management buy-in and feasibility of a workplace-based program informed by the workers’ expressed needs. The audio-recordings were translated as needed and transcribed verbatim. The transcripts were coded following a content analysis approach.
Findings: Twenty-three housekeepers and five hotel managers participated in the study. The workers expressed the needs for key interventions ranging from work organization to health behavior change. Ergonomics training to prevent musculoskeletal injuries, programs on chemical and biological hazards, as well as better pay, scheduling, and increased work hours were all identified as priorities for the workers on an organizational standpoint. Several of the workers had chronic conditions such as diabetes, hypertension, asthma, and depression. They expressed the need for dietary programs, stress management, exercise, smoking cessation, as well as access to social services.
Conclusions/Implications for Practice: Hotel workers are at risk for poor health. Culturally tailored interventions that the workers have prioritized will yield positive outcomes. Grassroots interventions are necessary to address the workers’ expressed needs.
Certification: Transforming the Future of Occupational Health Nursing
Pamela Swann, Lucy Carlson, Jean Drevdahl-Orchard, Denise Knoblauch, and Carole Cusack
Background: National certification examination programs must periodically survey and assess the industry to validate testing programs and keep current with industry/job changes. The American Board for Occupational Health Nurses (ABOHN) conducted a Practice Analysis in 2018 to identify job activities of occupational health nurses. ABOHN appointed an Advisory Committee (AC) to identify job responsibilities of occupational health nurses and develop the examination specifications for the three examinations: Certified Occupational Health Nurse (COHN), Certified Occupational Health Nurse–Specialist (COHN-S), and Case Management (CM).
Methods: The ABOHN Board of Directors, Staff and Exam Development Advisory Committee worked with our testing vendor and defined the target population as occupational health nurses in AAOHN, AOHP, and ABOHN. The team developed survey sampling plan, identified task lists, determined survey rating scale, determined relevant demographics variable, identified content area, integrated the tasks, rating scales, and demographics in a survey instrument which was sent via email to target population. Data about demographic and work characteristics were analyzed electronically with SPSS 19 using descriptive statistics.
Findings: A total of 7,385 occupational health nurses were sent links to the web-based survey containing 136 task statements in March 2018. The number of usable responses provided were 803 COHN-S, 546 COHN, and 370 CM. The number of tasks identified for inclusion on the survey were 132 COHN-S, 99 COHN, and 84 CM.
Conclusions/Implications for Practice: The AC linked the tasks to relevant domains of knowledge. These knowledge domains form the basis of the test content outline or blueprint. The revisions to the examination content outlines were completed for COHN, COHN-S, and CM examinations and new examinations were launched in 2020.
Culture Eats Strategy: A Case Exemplar of Interprofessional System-Wide Health Promotion Success
Joyce Karl
Background: Burnout has become a widespread issue for many workers in many professions and workplaces. Clinician burnout is especially concerning due to the potentially detrimental effect on health care quality, safety, and system performance. The National Academy of Medicine (NAM) created an “Action Collaborative on Clinician Well-Being and Resilience” to address this important workplace issue. The Ohio State University (OSU) was the first university in the United States to appoint a Chief Wellness Officer as part of a campus-wide strategy to improve population health and well-being. The OSU program to address clinician, faculty, staff, and student well-being was selected as a case study by the NAM to help leaders generate actionable ideas to improve well-being in their settings. Key components were shared.
Methods: Central coordination and alignment of multiple well-being initiatives implemented in numerous departments across a large university over the past 9 years have been used to build a culture of individual and community wellness. The strategic plan includes a health and wellness scorecard that uses validated tools and measures: (a) culture and environment of health/wellness; (b) population health outcomes burden of illness, healthy lifestyle behaviors, mental health, and physical health; and (c) fiscal health and value of investment.
Findings: This initiative has led to US$3.65 return on investment for every dollar invested in wellness; cumulative productivity net savings of over US$15 million from university wellness programming across the university; decreased anxiety, depression, and stress; increased academic performance; and increased levels of healthy lifestyle behaviors.
Conclusions/Implications for Practice: This exemplar highlights the importance of addressing burnout and well-being at the systems level. Leaders need to be actively engaged in creating a wellness culture and supporting initiatives. Grassroots efforts are also essential to maximize engagement and promote/celebrate individual successes.