Psychosocial work factors in new or recurrent injuries among hospital workers: a prospective study.

PURPOSE: Accumulating evidence suggests an important role for psychosocial work factors in injury, but little is known about the interaction between psychosocial factors and previous injury experience on subsequent injury risk. We examined the relationships between psychosocial work factors and new or recurrent injury among hospital workers. METHODS: We studied 492 hospital workers including 116 cases with baseline injury and 376 injury-free referents at baseline over follow-up. Job strain, total support, effort-reward imbalance, overcommitment, and musculoskeletal injury at baseline were examined in logistic regression models as predictors of new or recurrent injury experienced during a 2-year follow-up period. RESULTS: The overall cumulative incidence of injury over follow-up was 35.6 % (51.7 % for re-injury among baseline injury cases; 30.6 % for new injury among referents). Significantly increased risks with baseline job strain (OR 1.26; 95 % CI 1.02-1.55) and effort-reward imbalance (OR 1.42; 95 % CI 1.12-1.81) were observed for injury only among the referents. Overcommitment was associated with increased risk of injury only among the cases (OR 1.58; 95 % CI 1.05-2.39). CONCLUSIONS: The effects of psychosocial work factors on new or recurrent injury risk appear to differ by previous injury experience, suggesting the need for differing preventive strategies in hospital workers.

Hospital nurses working wounded: motivations and obstacles to return to work as experienced by nurses with injuries.

BACKGROUND: Despite the high rate of work-related injuries among hospital nurses, there is limited understanding of factors that serve to motivate or hinder nurses return to work following injury. OBJECTIVES: Perspectives of nurses with work related injuries, as they relate to obstacles and motivations to return to work, consequences of injury, and influences of work climate were documented. METHODS: This was a sub-study of nurses taken from a larger investigation of hospital workers. A purposive sample of 16 nurses was interviewed. Analysis was carried out using grounded theory as the research method. RESULTS: Nurses' responses fell into four concepts: organizational influences, personal conditions, costs and losses, and employee health as influenced by workers' compensation systems. Conceptualization of these concepts resulted in key categories: injury as an expected consequence of hospital work; nursing alone versus nursing together; the impact of injury on professional, family, and social roles; and nurses' understanding of and involvement with the workers' compensation system. DISCUSSION: The findings provide new perspective into features that support or hinder nurses' with injuries return to work and corroborate existing occupational health research. Consideration of these findings by hospital and employee health managers may help promote more effective return to work programs within the hospital setting.

Work-related violence experienced by urban taxi drivers.

OBJECTIVES: This study measured violence (physical assault, robbery, or weapon confrontation) in taxi drivers, and determined socio-demographic/work factors associated with violence. METHODS: In 2010, 130 taxi drivers, working in a large city in the Western US, were administered a survey evaluating workplace violence events. RESULTS: The study population was male (94%), mean age 45, married (54%), foreign-born (55%), with 24% speaking Arabic at home. Drivers drove at night (51%), for an average of 9.7 years and 41 hr/week. Almost half reported a history of violence during their driving careers: physical assault, weapon confrontation, or robbery. In the prior 12 months, 12% were physically assaulted, 8% robbed, and 6% confronted with a weapon. Night drivers reported more assaults over their lifetime compared to day drivers (mean = 1.64 [sd 4.29] vs. mean = 0.53 [sd 1.05], P = 0.047). CONCLUSIONS: Taxi drivers experience violence at work. Strategies are needed to prevent violence especially in night drivers.

Job stress and work-related musculoskeletal symptoms among intensive care unit nurses: a comparison between job demand-control and effort-reward imbalance models.

BACKGROUND: The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model. METHODS: This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression. RESULTS: Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with musculoskeletal symptoms compared to combined variables of the JDC and ERI models. CONCLUSIONS: The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only.

Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: an analysis of cross-sectional survey data.

BACKGROUND: Patient handling is a major risk factor for musculoskeletal injuries among nurses. Lifting equipment is a main component of safe patient handling programs that aim to prevent musculoskeletal injury. However, the actual levels of lift availability and usage are far from optimal. OBJECTIVE: To examine the effect of patient lifting equipment on musculoskeletal pain by level of lift availability and lift use among critical-care nurses. DESIGN AND PARTICIPANTS: A cross-sectional postal survey of a random sample of 361 critical-care nurses in the United States. METHODS: The survey collected data on low-back, neck, and shoulder pain, lift availability, lift use, physical and psychosocial job factors, and sociodemographics. Musculoskeletal pain was assessed by three types of measures: any pain, work-related pain, and major pain. Multivariable logistic regressions were used to examine the associations between musculoskeletal pain and lift variables, controlling for demographic and job factors. RESULTS: Less than half (46%) of respondents reported that their employer provided lifts. Of 168 nurses who had lifts in their workplace, the level of lift availability was high for 59.5%, medium for 25.0%, and low for 13.7%; the level of lift use was high for 32.1%, medium for 31.5%, and low for 31.5%. Significant associations were found between lift availability and work-related low-back and shoulder pain. Compared to nurses without lifts, nurses reporting high-level lift availability were half as likely to have work-related low-back pain (OR=0.50, 95% CI 0.26-0.96) and nurses reporting medium-level lift availability were 3.6 times less likely to have work-related shoulder pain (OR=0.28, 95% CI 0.09-0.91). With respect to lift use, work-related shoulder pain was three times less common among nurses reporting medium-level use (OR=0.33, 95% CI 0.12-0.93); any neck pain was three times more common among nurses reporting low-level use (OR=3.13, 95% CI 1.19-8.28). CONCLUSIONS: Greater availability and use of lifts were associated with less musculoskeletal pain among critical-care nurses. These findings suggest that for lift interventions to be effective, lifts must be readily available when needed and barriers against lift use must be removed.

Heavy and light/moderate smoking among building trades construction workers.

OBJECTIVE: The purpose of the study was to identify the correlates of heavy smoking (defined as more than one pack of cigarettes per day) in building trades construction workers. DESIGN AND SAMPLE: This study used cross-sectional data from the MassBUILT smoking cessation intervention study at Massachusetts building trades unions with the sample of 763 smokers. MEASURES: Data collected included information about smoking behavior, individual, psychological, interpersonal, and occupational factors obtained through self-reported questionnaires. RESULTS: Approximately 21% of smokers were heavy smokers. Significant factors related to heavy smoking were: older age (OR = 1.10; 95% CI: 1.06-1.14), male gender (OR = 4.55; 95% CI: 1.62-12.79), smoking the first cigarette of the day within 30 min of waking (OR = 4.62; 95% CI: 2.81-7.59), smoking initiation at earlier age (OR = 0.93; 95% CI: 0.87-1.00), higher temptation to smoke (OR = 1.55; 95% CI: 1.17-2.05), household smoking (OR = 1.90; 95% CI: 1.18-3.06) or living alone (OR = 4.11; 95% CI: 1.70-9.92), and exposure to chemicals at work (OR = 1.61; 95% CI: 1.06-2.53). CONCLUSION: Addressing the influence of these factors on heavy smoking could lead to the development of targeted, multiple components in comprehensive cessation strategies for blue-collar smokers.

Risk perception of musculoskeletal injury among critical care nurses.

BACKGROUND: Nursing is known as an occupation with high risk of musculoskeletal injury. Nurses' perceptions about the risk of injury may have a role in preventing such injury. OBJECTIVES: The aim of this study was to investigate how nurses perceived the risk of musculoskeletal injury from work and identify factors associated with their risk perception. METHODS: In a cross-sectional study using a postal survey, 361 critical care nurses reported on risk perception, physical workload, psychosocial job factors, safety climate, musculoskeletal symptoms, and safe work behavior. RESULTS: Of all critical care nurse respondents, 83% perceived that they were more likely than not to have a musculoskeletal injury within 1 year. On average, nurses perceived the risk of musculoskeletal injury as lower to themselves than to coworkers. This more positive perception of risk to self had stronger correlations with symptom experiences. Multiple linear regression analysis revealed that higher risk perception of injury was associated with greater job strain, greater physical workload, lack of availability of lifting devices or lifting teams, and more symptoms. DISCUSSION: Study findings indicated that most critical care nurses were concerned about their ergonomic job risks. Their risk perceptions about musculoskeletal injury risk were affected by physical work exposures, psychosocial job stressors, and experience with musculoskeletal symptoms, but not by perceived workplace safety climate. The findings underscore the need for management efforts to improve physical and psychosocial working conditions and create a safe work environment.

Occupational factors and smoking cessation among unionized building trades workers.

The purpose of this study was to estimate the contribution of occupational factors to smoking cessation among building trades workers. Longitudinal data came from the MassBUILT smoking cessation intervention study for unionized building trades workers. Multivariable logistic regression analyses were applied to identify the significant predictors of smoking cessation, which was defined as abstinence from smoking during the previous 7 days at the 1-month monitoring and prolonged abstinence for at least 6 months at the 6-month monitoring. Greater concern about exposure to occupational hazards was significantly associated with increased likelihood of smoking cessation at 1 month (odds ratio = 1.06; 95% confidence interval = 1.01-1.11). Additionally, smokers who had a more positive view of their unions had at least marginally increased likelihood of smoking cessation at 1 month. Furthermore, older age, higher levels of educational attainment and household income, and fewer cigarettes smoked per day were important covariates that predicted smoking cessation. Concerns about exposures to work hazards should be incorporated into comprehensive intervention approaches for building trades workers. Additionally, the findings emphasize that blue-collar workers with lower income and education levels and heavy smokers should be considered target groups for implementing cessation interventions.

Health and safety strategies of urban taxi drivers.

This study describes health and safety concerns and self-care strategies of San Francisco taxi drivers. Focus groups and a written cross-sectional survey were done in a convenience sample of taxi drivers working in San Francisco. Sessions were audiotaped, transcribed in English, and independently coded to identify major health and safety themes, using thematic content analysis. Strategies to manage health and safety issues are the focus of this analysis. Five focus groups were held in 2009 with 36 participants. Major health and safety themes included stress, body pain, danger, vulnerable employment status, and concerns related to unhealthy working conditions. Self-care strategies included diffusion/decompression to manage stress, maintaining a positive attitude, maintaining power and control, and practicing proactive self-care. Creative self-care strategies were described by taxi drivers to keep healthy and safe at work. These data will inform future self-care interventions to reduce health and safety risks of taxi driving.

Cigarette smoking in building trades workers: the impact of work environment.

BACKGROUND: Blue-collar workers smoke at higher rates than white-collar workers and the general population. Occupational factors may contribute to smoking behavior in this group. However, little is known about the role of occupational factors in explaining cigarette-smoking patterns. METHODS: This study used cross-sectional data from the MassBUILT smoking cessation intervention study. Multivariable logistic regression analysis was conducted to investigate the association of occupational factors with current cigarette smoking among 1,817 building trades workers. RESULTS: Current cigarette smoking was significantly associated with the following occupational factors: union commitment (OR = 1.06; 95% CI: 1.00-1.12); exposure to dust (OR = 1.50; 95% CI: 1.15-1.95), exposure to chemicals (OR = 1.41; 95% CI: 1.11-1.79); and concern about exposure to occupational hazards (OR = 0.93; 95% CI: 0.91-0.95). CONCLUSION: The findings highlight the need to explicate the pathways by which occupational factors may contribute to current smoking behavior among building trades workers. Smoking cessation programs for this population should consider work-related occupational factors along with individual approaches.

Factors associated with safe patient handling behaviors among critical care nurses.

BACKGROUND: Patient handling is a major risk factor for musculoskeletal (MS) injury among nurses. The aims of the study were to describe nurses' work behaviors related to safe patient handling and identify factors influencing their safe work behaviors, including the use of lifting equipment. METHODS: A cross-sectional study using a mailed questionnaire with a nationwide random sample of 361 critical care nurses. Nurses reported on the physical, psychosocial, and organizational characteristics of their jobs and on their MS symptoms, risk perception, work behaviors, and demographics. Hierarchical multiple linear regression analyses were used to identify significant factors. RESULTS: More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort-reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior. CONCLUSIONS: Safe work behaviors are best understood as socio-cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury.

Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees.

Workplace discrimination reports have recently increased in the U.S. Few studies have examined racial/ethnic differences and the mental health consequences of this exposure. We examined the association between self-reported workplace discrimination and depressive symptoms among a multi-ethnic sample of hospital employees. Data came from the prospective case-control Gradients of Occupational Health in Hospital Workers (GROW) study (N = 664). We used the Center for Epidemiological Studies Depression Scale (CES-D) to assess depressive symptoms and measured the occurrence, types, and frequency of workplace discrimination. African Americans were more likely than other racial/ethnic employees to report frequent and multiple types of discrimination exposure. Multivariate relationships were examined while controlling for socio-demographic factors, job strain, and general social stressors. After adjustment, workplace discrimination occurrence and frequency were positively associated with depressive symptoms. The positive association between workplace discrimination and depressive symptoms was similar across racial and ethnic groups. Reducing workplace discrimination may improve psychosocial functioning among racial/ethnic minority hospital employees at greatest risk of exposure.

Psychosocial work factors and shoulder pain in hotel room cleaners.

BACKGROUND: Hotel room cleaners have physically demanding jobs that place them at high risk for shoulder pain. Psychosocial work factors may also play a role in shoulder pain, but their independent role has not been studied in this group. METHODS: Seventy-four percent (941 of 1,276) of hotel room cleaners from five Las Vegas hotels completed a 29-page survey assessing health status, working conditions, and psychosocial work factors. For this study, 493 of the 941 (52%) with complete data for 21 variables were included in multivariate logistic regression analyses. RESULTS: Fifty-six percent reported shoulder pain in the prior four weeks. Room cleaners with effort-reward imbalance (ERI) were three times as likely to report shoulder pain (OR 2.99, 95% CI 1.95-4.59, P = 0.000) even after adjustment for physical workload and other factors. After adjustment for physical workload, job strain and iso-strain were not significantly associated with shoulder pain. CONCLUSIONS: ERI is independently associated with shoulder pain in hotel room cleaners even after adjustment for physical workload and other risk factors.

Workplace violence prevention programs in psychiatric units and facilities.

Psychiatric health care providers have high rates of workplace violence victimization, yet little is known about the strategies used by facilities to reduce violence. This study compared workplace violence prevention (WVP) programs in psychiatric units and facilities in California and New Jersey. Information was collected through interviews, a facility walk-through, and a review of written policies and training material. A similar proportion of hospitals in both states had WVP training programs. A higher proportion of hospitals in California had written WVP policies, and a higher proportion of New Jersey hospitals had implemented environmental and security modifications to reduce violence. Legislation is one of many potential approaches to increase workplace violence prevention programs in health care settings.

Body fluid exposure in nurses of Fars province, Southern Iran.

BACKGROUND: Blood and body fluid exposures place healthcare workers at risk for blood-borne infections. To determine the extent of the problem in Iran, we assessed blood and body fluid exposure in healthcare workers in Fars Province hospitals. METHODS: We distributed 2,118 questionnaires using a stratified random sampling method among nurses of these hospitals. We used Chi-square test, Student's t-test, and multiple logistic regression analysis for determining risk factors for exposure. RESULTS: The overall prevalence of blood and body fluid exposures was 79% with a rate of exposure to sharps devices of 50%. Hypodermic needles were involved in most exposures (73%) with the most common source of injury being needle recapping (35%). Blood was the most frequent contaminant (87%) in mucocutaneous exposures, most commonly associated with inserting and removing intravenous lines (50%). Sharps injuries were independently associated with gender, professional level, and hospital location; mucocutaneous exposures were related to professional level and hospital location. Only 28% of nurses reported their exposures. CONCLUSION: The high level of risk found among nurses in Fars Province highlights the urgent need for interventions to enhance their occupational safety and to prevent unnecessary transmission of blood-borne viruses.

Characteristics of persons and jobs with needlestick injuries in a national data set.

BACKGROUND: Physicians, nurses, and others are at risk of needlesticks, yet little national information is available regarding incidence across demographic and occupational categories. METHODS: Analysis was conducted on national data on occupational injuries for 1992-2003 from the Bureau of Labor Statistics (BLS). Because BLS data were limited to cases with 1 or more days of work loss, and reasons related to reporting of incidents, the data only reflected a subset of all needlesticks. Nevertheless, the data were internally consistent across categories so that relative magnitudes were reliable. Statistical tests for differences in proportions were conducted that compared needlesticks with all other occupational injuries and employment. RESULTS: Cases with 1 or more days of work loss numbered 903 per year, on average, from 1992 through 2003. Women comprised 73.3% (95% CI: 72.5%-74.2%) of persons injured. For those reporting race, white, non-Hispanic comprised 69.3% of the total (95% CI: 68.1%-70.4%); black, non-Hispanic, 14.8% (95% CI: 13.9%-15.6%); and Hispanic, 13.8% (95% CI: 12.9%-14.6%). The age bracket 35 to 44 years had the highest percentage of injuries at 34.0% (95% CI: 33.1%-34.9%). Ages over 54 years reported smaller percentages of needlestick injuries than either all other injuries or employment. Occupations with greatest frequencies included registered nurses, nursing aides and orderlies, janitors and cleaners, licensed practical nurses, and maids and housemen. Occupations with greatest risks included biologic technicians, janitors and cleaners, and maids and housemen. Almost 20% (95% CI: 18.88%-20.49%) of needlesticks occurred outside the services industry. Seven percent (95% CI: 6.56%-7.53%) of needlesticks resulted in 31 or more days of work loss in contrast to 20.46% (95% CI: 20.44%-20.48%) of all other injuries. CONCLUSION: In this nationally representative sample, the most frequent demographic and occupational categories were women; white, non-Hispanic; ages 35 to 44 years; and registered nurses.

Workplace violence prevention programs in hospital emergency departments.

OBJECTIVE: Hospital violence is a growing concern, yet little is known about existing programs. This study compared workplace violence programs in high-risk emergency departments among a representative sample of 116 hospitals in California and 50 hospitals in New Jersey. METHODS: Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. RESULTS: California had significantly higher scores for training and policies and procedures, but there was no difference for security and environmental approaches. Program component scores were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. CONCLUSIONS: Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found.

Costs of needlestick injuries and subsequent hepatitis and HIV infection.

BACKGROUND: Physicians, nurses and other healthcare workers (HCWs) are at risk of bloodborne pathogens infection from needlestick injuries, but costs of needlesticks are little studied. METHODS: We used the cost-of-illness and incidence approaches. We used the perspective of the medical provider (medical costs) and the individual (lost productivity). Data on needlesticks, infections from hepatitis B and C (HBV, HCV) and human immune-deficiency (HIV) among HCWs, as well as data on per-unit costs were culled from research literature, Centers for Disease Control and Prevention reports, and Bureau of Labor Statistics reports. We also generated estimates based upon industry employment and scenarios for source-patients. These data and estimates were combined with assumptions to produce a model that generated base-case estimates as well as one-way and multi-way probabilistic sensitivity analyses. Future costs were discounted by 3%. RESULTS: We estimated 644,963 needlesticks in the healthcare industry for 2004 of which 49% generated costs. Medical costs were $107.3 million of which 96% resulted from testing and prophylaxis and 4% from treating long-term infections (34 persons with chronic HBV, 143 with chronic HCV, and 1 with HIV). Lost-work productivity generated $81.2 million, for which 59% involved testing and prophylaxis and 41% involved long-term infections. Combined medical and work productivity costs summed to $188.5 million. Multi-way sensitivity analysis suggested a range on combined costs from $100.7 million to $405.9 million. CONCLUSION: Detailed methodology was developed to estimate costs of needlesticks and subsequent infections for hospital-based and non-hospital-based health care workers. The combined medical and lost productivity costs comprised roughly 0.1% of all occupational injury and illness costs for all jobs in the economy. We did not account for lost home production or pain and suffering costs, however, nor did we estimate benefit/cost ratios of specific interventions to reduce needlesticks.

The association of socioeconomic status and psychosocial and physical workplace factors with musculoskeletal injury in hospital workers.

BACKGROUND: The combined effect of socioeconomic, organizational, psychosocial, and physical factors on work-related musculoskeletal disorders (WRMSDs) were studied in a heterogeneous, socioeconomically diverse sample (cases and their matched referents) of hospital workers. METHODS: Cases were defined by a new acute or cumulative work-related musculoskeletal injury; referents were matched by job group, shift length, or at random. Information was obtained through telephone interviews and on-site ergonomics observation. Questionnaire items included sociodemographic variables, lost work time, work effectiveness, health status, pain/disability, and psychosocial working conditions using Effort Reward Imbalance (ERI) and Demand-Control (DC) models. Two multivariate models were tested: Model 1 included occupation as a predictor; Model 2 included education-income as a predictor. RESULTS: Cases reported greater pain, disability, lost time, and decreased work effectiveness than the referents. Model 1 was statistically significant for neck/upper extremity injury (Chi-square = 19.3, P = 0.01), back/lower extremity injury (Chi-square = 14.0, P = 0.05), and all injuries combined (Chi-square = 25.4, P = 0.001). "Other Clinical" occupations (34% mental health workers) had the highest risk of injury (OR 4.5: 95%CI, 1.7-12.1) for all injuries. The ERI ratio was a significant predictor for neck and upper extremity (OR 1.5: 95%CI, 1.1-1.9) and all injuries (OR 1.3; 95%CI, 1.04-1.5), per SD change in score. CONCLUSIONS: In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income.

Measuring the physical demands of work in hospital settings: design and implementation of an ergonomics assessment.

BACKGROUND: Assessing the physical demands of the heterogeneous jobs in hospitals requires appropriate and validated assessment methodologies. METHODS: As part of an integrated assessment, we adapted Rapid Entire Body Assessment (REBA), using it in a work sampling mode facilitated by a hand-held personal digital assistant, expanding it with selected items from the UC Computer Use Checklist, and developed a scoring algorithm for ergonomics risk factors for the upper (UB) and lower body (LB). RESULTS: The inter-rater reliability kappa was 0.54 for UB and 0.66 for LB. The scoring algorithm demonstrated significant variation (ANOVA p<0.05) by occupation in anticipated directions (administrators ranked lowest; support staff ranked highest on both scores). A supplemental self-assessment measure of spinal loading correlated with high strain LB scores (r=0.30; p<0.001). CONCLUSION: We developed and validated a scoring algorithm incorporating a revised REBA schema adding computer use items, appropriate for ergonomics assessment across a range of hospital jobs.