Occupational exposure to chemical substances and health outcomes among hospital environmental services workers: A scoping review of international studies.

Environmental services (EVS) workers are essential to preventing the spread of disease in hospitals. However, their exposure to hazardous chemicals and drugs is understudied. This scoping review will synthesize literature on hazardous chemical exposures and adverse health outcomes among EVS workers to identify research gaps and trends for further investigation. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure complete and accurate reporting. The scoping review included 25 studies on occupational exposure to chemicals among EVS workers in hospitals. Most studies focused on exposure to cleaning products, which led to dermal, respiratory, and ocular symptoms, oxidative stress, and inflammation. While personal protective equipment (PPE), training, education, and policies have the potential to enhance safety, further research is required to examine the long-term impacts of exposure and the cost-effectiveness of interventions. Future studies should utilize longitudinal approaches and self-reported data collection methods, such as diaries and interviews, to comprehensively assess exposure risks and develop effective interventions and policies. Future research is needed to understand the potential health risks faced by EVS workers from exposure to chemicals in hospitals. Longitudinal studies with objective exposure assessments and larger sample sizes should be conducted. Policies and interventions must be developed and implemented to improve safe work practices and reduce negative health outcomes.

An exploration of language: How nurses describe social factors that contribute to health.

BACKGROUND: Over the last two centuries nurses have been practicing, teaching, and conducting research on social factors that contribute to health and the language has evolved over this time. PURPOSE: To explore how social factors that contribute to health are described by nurse authors and how that use has changed over time. METHODS: A scoping review using the JBI Manual for Evidence Synthesis, Cochrane Handbook, and PRISMA guidelines was completed. FINDINGS: From 1967 to 2021, nurses used the term "social factors" most commonly and there was a shift from demographic to social factors. DISCUSSION: As the language that nurses use has shifted from demographic descriptions to the social factors that may be associated with those descriptions, nurses have an opportunity to promote the use of non-deterministic language for health promotion and research.

Population health in a global society: Preparing nurses for the future.

BACKGROUND: The COVID-19 pandemic has reinforced awareness that the health of populations is inextricably linked around the globe. Nurses require increased knowledge and preparation in global health. Nursing educators need examples of how to improve content in the curriculum. AIMS: The purpose of this paper is to describe reconceptualization of a master's level nursing course entitled "Population Health in a Global Society" to include global health competencies. METHODS: We identified four global health competencies within the following three domains: globalization of health and healthcare; collaboration, partnering, and communication; and sociocultural and political awareness. IMPLEMENTATION: We utilized guest lectures, a panel discussion, discussion forums and an independent research assignment. The methods used were well received by students, and the content delivered improved their perceived knowledge in global population health. DISCUSSION: The global health domains and competencies provided a roadmap for improving our course to focus on population health from a global perspective. CONCLUSION: In order to prepare nurses to contribute to global population health, population health courses should integrate global health competencies. The content of the revised course will better prepare nurses who will practice in a wide variety of settings and is designed for interdisciplinary education.

Workplace health promotion and safety in state and territorial health departments in the United States: a national mixed-methods study of activity, capacity, and growth opportunities.

BACKGROUND: State and Territorial Health Departments (SHDs) have a unique role in protecting and promoting workers' health. This mixed-methods study presents the first systematic investigation of SHDs' activities and capacity in both Occupational Safety and Health (OSH) and Workplace Health Promotion (WHP) in the United States (US). METHODS: National survey of OSH and WHP practitioners from each of 56 SHDs, followed by in-depth interviews with a subset of survey respondents. We calculated descriptive statistics for survey variables and conducted conventional content analysis of interviews. RESULTS: Seventy percent (n = 39) of OSH and 71% (n = 40) of WHP contacts responded to the survey. Twenty-seven (n = 14 OSH, n = 13 WHP) participated in follow-up interviews. Despite limited funding, staffing, or organizational support, SHDs reported a wide array of activities. We assessed OSH and WHP surveillance activities, support that SHDs provided to employers to implement OSH and WHP interventions (implementation support), OSH and WHP services provided directly to workers, OSH follow-back investigations, and OSH standard and policy development. Each of the categories we asked about (excluding OSH standard and policy development) were performed by more than half of responding SHDs. Surveillance was the area of greatest OSH activity, while implementation support was the area of greatest WHP activity. Respondents characterized their overall capacity as low. Thirty percent (n = 9) of WHP and 19% (n = 6) of OSH respondents reported no funds at all for OSH/WHP work, and both groups reported a median 1.0 FTEs working on OSH/WHP at the SHD. Organizational support for OSH and WHP was characterized as "low" to "moderate". To increase SHDs' capacity for OSH and WHP, interview respondents recommended that OSH and WHP approaches be better integrated into other public health initiatives (e.g., infectious disease prevention), and that federal funding for OSH and WHP increase. They also discussed specific recommendations for improving the accessibility and utility of existing funding mechanisms, and the educational resources they desired from the CDC. CONCLUSIONS: Results revealed current activities and specific strategies for increasing capacity of SHDs to promote the safety and health of workers and workplaces - an important public health setting for reducing acute injury and chronic disease.

Engaging outreach workers in the development of a farmworker health research agenda.

Farmworker health outreach workers have not traditionally been involved in the prioritization and design of research studies. This report from the field shares the results of a survey administered to outreach workers providing health services to farmworkers in North Carolina. Priority areas of research and best practices for engaged research are presented from the perspective of the outreach worker community. The purposeful involvement of outreach workers can make farmworker health research more meaningful and solution-oriented.

Observed and self-reported pesticide protective behaviors of Latino migrant and seasonal farmworkers.

Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agency's (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, although they are not required to be taught by the WPS. Farmworkers reported more long-sleeve (p=.028) and glove use (p=.000) than what was observed. It was uncommon to observe washing behavior before eating or drinking, even when washing supplies were available. Washing behaviors were significantly overreported for hand (p=.000; p=.000) and face (p=.000; p=.058) washing before eating and drinking in the field. This study documents that protective clothing behaviors that the WPS requires be taught, plus a few others are commonly practiced by Latino migrant and seasonal farmworkers, but washing behaviors in the field are not. Targeted strategies to improve washing behaviors in the field are needed.

Enabling nurses to lead change: the orientation experiences of nurses to boards.

OBJECTIVES: Nurses need to be full partners in shaping health care and health care policy. One way to do this is to be present and active on boards at all levels. The purpose of this study is to examine the orientation experiences of nurses to boards and their preparation to influence health care and health care policy. METHODS: A Web-based survey about the efficacy of board orientation was sent to members of three local boards made up exclusively of nurses. RESULTS: Liabilities and fiduciary duties were least likely to be addressed in board orientation for nurses. Board members requested more training in finance and a more formal/structured orientation process. CONCLUSIONS: Standardizing orientation elements for nurses serving on boards would best prepare them to serve on interprofessional hospital boards and work in the health policy arena. The orientation experience on local- and state-level nursing boards is fundamental to nurses beginning board service.

The Occupational and Environmental Hazards of Uncovered Toilets.

ABSTRACT: Substantial evidence demonstrates that plumes from uncovered toilets potentially expose nurses and other health care workers to aerosols containing infectious agents and hazardous drugs, including antineoplastic drugs. Most hospitals in the United States utilize flushometer-type toilets, which operate under high pressure and do not have a permanently attached closure or lid, which is known to reduce the aerosols generated by flushing. This article aims to raise awareness among nurses of the potential exposure risks associated with toilet plume aerosols, so they can educate other health care workers and take part in initiatives to address these risks.

Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic.

PURPOSE: The purpose of this concept delineation was to differentiate similar concepts impacting nurse well-being during the COVID-19 pandemic, including: compassion fatigue, burnout, moral injury, secondary traumatic stress, and second victim. METHODS: A total of 63 articles were reviewed for concept delineation. Morse's (1995) approach to concept delineation was utilized to analyse the articles. RESULTS: Concepts were described interchangeably but were found to present themselves in a sequence. A nurse may experience moral injury, leading to a second victim experience, synonymous with secondary traumatic stress, then compassion fatigue and/or burnout that can be acute or chronic in nature. An Occupational Trauma Conceptual Model was created to depict how these concepts interact based on concept delineation findings. CONCLUSION: Nurses are experiencing long-lasting occupational trauma and future intervention research should centre on optimizing nurse well-being to ensure the sustainability of nursing profession.

The Limits of 'Social Determinants of Health' Language.

A less restrictive term allows more room for our shared humanity.

The Potential for Total Worker Health® Approaches in State and Territorial Health Departments : A National Mixed-Methods Study.

OBJECTIVE: To document the extent to which state and territorial health departments (SHDs) integrate their occupational safety and health (OSH) and workplace health promotion (WHP) activities consistent with a Total Worker Health (TWH) approach. METHODS: Nationally representative survey of OSH and WHP practitioners at 56 SHDs followed by in-depth interviews. RESULTS: Despite reporting limited awareness of the TWH initiative and TWH resources, most respondents (57% OSH, 64% WHP) reported collaboration between OSH and WHP staff in their departments. Collaborations were described in-depth. Barriers to OSH-WHP collaborations included resource insufficiencies, organizational structure in the SHD, and conflicting practices. Facilitators included knowledge of TWH approaches, proximity to TWH Centers of Excellence, proximity between OSH/WHP programs, and leadership initiative. Motivations for collaboration were enumerated. CONCLUSIONS: Strategies for building TWH capacity and activity among SHDs are discussed.

Colorectal Cancer Screening: A Quality Improvement Initiative Using a Bilingual Patient Navigator, Mobile Technology, and Fecal Immunochemical Testing to Engage Hispanic Adults.

BACKGROUND: Fecal immunochemical tests (FITs) are an effective screening method to detect and prevent colorectal cancer (CRC) when done in appropriate intervals. The use of bilingual patient navigators (PNs) and secure short message service (SMS) has been demonstrated to increase CRC screening rates among Hispanic adults. OBJECTIVES: The purpose of this quality improvement project is to increase CRC screening rates among Hispanic adults in a family clinic by 25% in the post-project implementation period using an unlicensed bilingual PN, secure SMS, and at-home FITs. METHODS: A retrospective chart review was used. Spanish-translated educational videos were delivered using SMS, and instructional screening guidance was provided via telephone in Spanish by the PN. Participants were surveyed to determine satisfaction with the support received from the PN. FINDINGS: Findings showed a 35% increase in the clinic's FIT rates. Findings also showed that having a PN's support influenced the decision to complete FIT as compared to the use of secure SMS.

A Comparison of Pesticide Risk Beliefs between Farmers and Farmworkers: Implications for Risk Communication and Education.

Understanding the multi-dimensional risk beliefs of agricultural audiences allows risk communicators and educators to target those beliefs to improve practices. This study was designed to assess pesticide risk beliefs among English-speaking farmers and Spanish-speaking farmworkers and to compare their beliefs. The Pesticide Risk Beliefs Inventory (PRiBI) is a 19-item quantitative instrument used to assess the alignment of risk beliefs with those beliefs of experts in the field. A higher score on the PRiBI relates to an agreement with expert beliefs regarding pesticide risk. Farmers' and farmworkers' scores were signficiantly different on items corresponding to the use of physical properties to determine risk and specific adverse health outcomes associated with pesticide exposure. With an understanding that farmworkers rely on the physical properties of pesticides to assess risk, educators and farmers can encourage more reliable ways to assess pesticide hazards.

Encouragement: The key to increasing the number of nurses serving on boards.

Nurses have a lot of knowledge about health and health systems but are not yet adequately represented on boards and commissions that influence health and healthcare in our country. The majority of nurses are women and the hesitancy of women to seek board and elected positions are well documented. The purpose of this statewide survey of nurses was to ascertain the political engagement of nurses and their identified barriers to service. The nurses in our sample were more politically engaged than the state as a whole and 40% reported willingness to consider or pursue a board or elected position. The primary barrier was a lack of confidence that their appointment would be supported. While there were some differences by age of the respondents, time, money, and family responsibilities were also identified as barriers to seeking board and elected positions. Our results underscore the need to socialize and encourage nurses to serve in positions that influence health and healthcare in our country.

Cultural Awareness: Ensuring High-Quality Care for Limited English Proficient Patients.

BACKGROUND: Cancer hospitals throughout the United States have seen an increase in the number of adults who are considered limited English proficient (LEP); such individuals do not speak English as their primary language and have a limited ability to read, speak, write, or understand the language. This population requires nurses who are responsive to their language and cultural needs. OBJECTIVES: The purpose of this study was to assess cultural awareness among inpatient oncology nurses and to identify areas for cross-cultural training and educational development. METHODS: 44 inpatient oncology nurses from an oncology unit that admits a large number of Spanish-speaking patients responded to an online survey containing 23 Likert-type questions and 4 open-ended questions. FINDINGS: Despite survey results indicating a moderate to high level of cultural awareness, nurses expressed a need for tools and resources to provide equitable and safe care to LEP adults diagnosed with cancer. To improve the care of LEP patients, nurses suggested the use of resources such as an assigned unit interpreter, an increase in bilingual nursing staff, dual language materials, and free language lessons.

Surface Contamination With Antineoplastic Drugs on Two Inpatient Oncology Units.

OBJECTIVES: To measure surface contamination with antineoplastic drugs on inpatient oncology units and to characterize nursing staff personal protective equipment (PPE) use and factors that predict this use. SAMPLE & SETTING: A descriptive pilot study of two inpatient oncology units at Duke University Hospital in Durham, North Carolina, administering etoposide and cyclophosphamide. METHODS & VARIABLES: Surfaces in four patient rooms and select shared areas were swabbed with methanol, acetonitrile, and water. Samples were analyzed by liquid chromatography tandem mass spectrometry. Nursing staff (N = 27) answered questions about their demographics, PPE use, and factors that influence PPE use via online survey. RESULTS: Contamination with cyclophosphamide and etoposide was detectable and quantifiable in 61% and 31% of surfaces tested, respectively. Nursing staff reported suboptimal use of PPE when administering, disposing, and handling excreta of patients. Workplace safety climate was predictive of PPE use. IMPLICATIONS FOR NURSING: The potential for contamination with antineoplastic drugs in inpatient oncology units presents exposure risks for healthcare workers, patients, family members, and visitors. Future research and interventions to limit exposure and increase routine surface sampling should focus on those areas of greatest contamination, including toilet seats, a prominent finding from the current study.

Nursing Assistants' Use of Personal Protective Equipment Regarding Contact With Excreta Contaminated With Antineoplastic Drugs.

PURPOSE: To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use. PARTICIPANTS & SETTING: 27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States. METHODOLOGIC APPROACH: This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews. Research variables included recruitment rates, acceptability of observation, and understandability of a safe-handling instrument. FINDINGS: Observed use of double gloves, chemotherapy gowns, and face shields was low; use of plastic-backed pads when flushing excreta was high. IMPLICATIONS FOR NURSING: Nursing assistants are willing to participate in research. Standardized training and education about PPE use are needed.

How to Join a Board: A Practical Guide.

In October 2010, the Institute of Medicine and the Robert Wood Johnson Foundation released The Future of Nursing report. One way that "Recommendation 7: Prepare and enable nurses to lead change and advance health" has been operationalized has been placing nurses on boards, and nursing organizations have urged their constituents to serve in this capacity. This article outlines steps for obtaining an invitation to join a board. [J Contin Educ Nurs. 2018;49(12):559-562.].

Growing Up in an Era of Storms and Stress-Promoting Hope Among Adolescents in the Face of Climate Change.

This JAMA Forum discusses climate change efforts to promote hope among adolescents.