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Occupational Health

Objectives
1) 2) 3) 4)

Identify the nursing role in occupational health Define the term: Occupational Health Nursing. Discuss prevention strategies in occupational health care.

Identify the skills and competences useful to occupational health nursing.


Identify and give examples of the categories of work related hazards. Discus the three levels of prevention.

5)

6)

Prevention Is Better Than Cure

Definition

Occupational health nursing, a component of community health nursing

It is the specialty practice that focuses on the promotion, prevention and restoration of health within the context of a safe and healthy

environment.

It includes the prevention of adverse health effects

from occupational and environmental hazards.

It provides for and delivers occupational and environmental health and safety services to workers, populations and community groups.

It

is an autonomous specialty, and nurses make independent nursing judgment in providing health care.

Occupational health

nurses work in traditional manufacturing, industry, service, health care facilities, construction sites, consulting, and government settings.

Their scope of practice is broad and includes:


Worker / workplace assessment Surveillance Primary care

Case management
Counseling Health promotion/protection

Administration and management


Research Legal / ethical monitoring

Community orientation

The knowledge in occupational health and safety is applied to the workforce aggregate.

Work-related health problems must be investigated and control strategies implemented to reduce exposure.

The interdisciplinary occupational health team consists of:

The occupational health nurse

Occupational medicine physician


Industrial hygienist, and Safety specialist.

Occupational Hazards
Industrial worker may be exposed to five types of hazards, depending upon his occupation:
1) Physical hazards 2) Chemical hazards 3) Biological hazards 4) Psychological hazards 5) Enviromechanical hazards

1- Physical hazards
Heat and cold: The common physical hazard in most industries is heat. The direct effects of heat exposure are:

burns heat exhaustion heat stroke and heat cramps

The indirect effects of heat and cold are:

Decreased efficiency

Increased fatigue and


Enhanced accident rates.

Important hazards associated with cold work are:

Chilblains

Erythrocyanosis
Immersion foot etc.

Chilblains

Light:

The workers may be exposed to the risk of poor illumination or excessive brightness. Example of acute effect is eye strain and headache.
The chronic effect include miners nystagmus, blurring of vision which lead to accidents, etc
Noise:

Auditory effects, nervousness, fatigue, etc

Vibration:

Such as drill and hammers. It affects the hands and arms and later the fine blood vessels of fingers.
Ultraviolet

Radiation:

Occurs mainly in arc welding, it affects the


eyes causing conjunctivitis and keratitis

(welders flash)

Ionizing Radiation: such as bone- marrow are more sensitive, there are
special hazards when gonads are exposed.

e.g. x-rays and radio active isotopes. Certain tissues

The radiation hazards comprise: genetic changes malformation cancer leukemia depilation ulceration sterility and in extreme cases death.

2) Chemical hazards
The chemical agents act in three ways:
1. 2. 3.

Local action,

Inhalation,
Ingestion.

The ill-effects produced depend upon:

the duration of exposure

the quantum of exposure and


individual susceptibility.

3) Biological hazards

Workers may be exposed to infective and parasitic agents at the place. The occupational diseases in this category are brucellosis, anthrax, tetanus, encephalitis etc.

Persons working among animal products e.g. hair, wool, hides and agricultural workers are specially exposed to biological hazards.

4) Psychological hazards

The psychological hazards arise from the workers failure to adapt to an alien psychological environment e.g. Frustration, Some of the psychological factors which may undermine both physical and mental health of the workers. Lack of job satisfaction, Insecurity, Poor human relationships, Emotional tension

1) 2) 3) 4)

5) Enviromechanical hazards:

Factors encountered in work environments that cause accidents, injuries, strain or discomfort (e.g., poor equipment or lifting devices and slippery floors)

Prevention of Occupational Diseases


Medical measures:
1) 2) 3) 4) 5) 6) 7)

Pre-placement examination

Periodic examination
Medical and health care services Notification Supervision of working environment Maintenance and analysis of records Health education and counseling

Engineering Measures
1) Design of

8. Isolation 9. Local exhaust ventilation 10. Protective devices 11. Environmental monitoring 12. Statistical monitoring 13. Research

building
2) Good

housekeeping
3) General

ventilation
4) Mechanization

5) Substitution
6) Dusts 7) Enclosure

Legislation
Society

has an obligation to protect the health

of the worker engaged in diverse occupations.


It

has grown out of the realization that the

worker is more important than the machine which he operates.

Legislation

The worker cannot be permitted to endanger his life


and limb in an occupation, while the employer makes fortune.

Factory laws, therefore, have been framed in every country to govern the condition in industry and to safeguard the health and welfare of the worker.

Levels of Prevention and Occupational Health Nursing


1) Primary Prevention

In the area of primary prevention, the occupational health nurse is involved in both health promotion and disease prevention.

ODonnell and Harris (1994) describe health promotion as the following:

The science and art of helping people change their

lifestyle to move toward a state of optimal health.

Optimal health is defined as a balance of physical,


emotional, social, spiritual and intellectual health.

Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior and create environments that

support good health practices.

Of the three, supportive environments will probably have the greatest impact in producing lasting changes.

The occupation health nurse uses a variety of


primary prevention methods, with one-on-one

interaction as an important strategy for evaluating


risk reduction behavior for individuals.

The occupational health nurse has daily contact with numerous employees for many reasons (e.g., assessment and treatment of episodic illness or injury and health surveillance); therefore this is an important method of promoting health.

Similar to CHN professionals, occupational health


nurses plan, develop, implement and evaluate aggregate-focused intervention strategies. The occupational health nurse plans and implements programs such as:

1.

weight

2.
3. 4. 5. 6.

Cholesterol reduction,
AIDS awareness, Ergonomics training and Smoking cessation. Recognizing potential and existing hazards and maintaining communications with safety and industrial hygiene resources will continue to be critical work for the occupational health nurse.

For

overall health promotion, the nurse may

plan implement and evaluate a health fair,


which is a multifaceted health promotion

strategy.

As

part of an overall health and wellness

strategy, the occupational health nurse may


negotiate with the employers for an on-site

fitness center or area with fitness equipment;


if cost or space is prohibitive, the employer

may choose to partially subsidize


membership at a local fitness center.

Types of non-occupational programs included in the area of primary prevention are cardiovascular health, cancer awareness, personal safety, immunization, prenatal and postpartum health, accident prevention, retirement health, Stress management and relaxation technique.

Occupational health programs could include topics such as:


emergency response. first aid and cardiopulmonary resuscitation training. immunization programs for international business travelers. prevention of back injury through knowledge of proper lifting techniques. ergonomics and other programs targeted to the specific hazards identified in the workplace.

Womens health and safety issues such as:


maternal-child health,
reproductive health,
breast stress

cancer education and early detection,

management and work-home balance issues will achieve heightened significance as more women enter the workforce.

The

occupational health nurse can play a key role in the development and delivery or prenatal, postpartum and childhood programs in the workplace. primary importance will be the ability to serve as a change agent to initiate needed programs in the work environment.

Of

The

occupation health nurse will face challenges in developing programs that are culturally and linguistically appropriate. occupational health nurse may be in an advocacy role to negotiate with the employer for changes in the work environment to reduce or eliminate existing or potential occupational exposures to known and potential risk factors.

The

2) Secondary Prevention

Secondary prevention strategies are aimed at early diagnosis, early treatment interventions and attempts to limit disability. The focus at this level of prevention is on identification of health needs, health problems and employee at risk.

As with primary prevention, the occupational health nurse uses a number of different secondary prevention strategies.
By providing direct care for episodic illness and injury, the occupational health nurse is afforded the opportunity to conduct assessments and provide treatment and referrals for a variety of physical and psychological conditions.

The occupational health nurse can offer health screenings, which are designed for early detection of disease, at the work site with relative ease and at minimal cost. Screenings may focus on vision, cancer, cholesterol, hypertension, diabetes, TB and pulmonary function. Other types of screening may be contracted with a vendor who uses mobile equipment to provide screenings such as mammography.

The replacement evaluation is performed before the worker begins employment in a new company or is placed in a different job. The evaluation is a baseline examination that consists of: a medical history,

an occupational health history and a


physical assessment that should target the type of work that the employee will be performing.

For example, if the employee is going to be lifting materials in a warehouse, special attention should be paid to any history of musculoskeletal problems.
Strength testing and range of motion should be performed for all muscle groups.

The examination may also include medical tests to determine specific organ functions that may be affected by exposure to existing agents in the employees workplace.

For example, if the employee is working with a chemical that is a known liver toxin, baseline liver function tests may be appropriate to determine the current health status of the liver and its ability to handle this specific chemical exposure.

Periodic assessments usually occur at a regular

interval (e.g., annual and biannual) and are based on specific protocols for those exposed to substance or irritant: - such as lead, - asbestos, - noise or - various chemicals.

Examinations of individuals transferring to other

jobs are critical to document any changes in health that may have occurred while the employee was working in a specific area with a specific process.

Activities must continue to focus on prevention and early detection of other health conditions such as breast cancer and providing accessible and affordable screening programs.
The occupational health nurse is in an excellent position to play a key role in reducing morbidity and mortality associated with breast cancer.

3) Tertiary Prevention

On a tertiary level, the occupational health nurses play a key role in the rehabilitation and restoration of the worker to an optimal level of functions.

Strategies include :

case management
negotiation of workplace accommodations, and

counseling and support the workers who will continue to


be affected by chronic disease.

For workers needing special accommodations, the occupational health nurse can negotiate and facilitate

those appropriate to the employees health


limitations.

Counseling regarding adjustment to normal work life and support for behavior modification (e.g., smoking cessation) may also be provided.