Ethics and Total Worker Health®: Constructs for Ethical Decision-Making and Competencies for Professional Practice.

Work has become increasingly technologically driven and fast paced, with long work hours, new/emerging hazards, and rising health care costs. Threats to worker safety, health, and well-being including non-traditional work arrangements and practices, precarious work, uncertain hazardous exposures, and work organization issues, such as heavy workloads, design of work, uneven work hours, and difficult interpersonal relationships among workers and managers are apparent. Furthermore, the relationship between personal health risk factors and workplace risks and exposures has drawn increased attention and concern. As employer economic pressures continue to build, it is anticipated that ethical dilemmas for practitioners will become increasingly complex. A review of relevant Total Worker Health® (TWH) literature, related ethical constructs and competencies, an examination of codes of ethics for occupational safety and health and health promotion/education disciplines was conducted. A case study for TWH utilizing an ethical decision-making model for the analysis of key ethical issues and solutions was completed. TWH approaches to protecting safety, promoting health, and advancing well-being are increasingly being adopted. These approaches can reveal ethical dilemmas, and ethical constructs are needed to guide decision-making. A core set of proposed ethical competencies for TWH professionals are identified as a transdisciplinary framework to support workplace ethical culture.

Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field.

OBJECTIVE: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®. METHODS: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs. RESULTS: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination. CONCLUSIONS: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.

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.

Development of Competencies for Respiratory Protection for Health Care Workers.

According to the Bureau of Labor Statistics, more than 18 million health care workers in the United States are currently employed in the health care field and at risk of infectious respiratory exposure. With the emergence of global infectious diseases such as Ebola and Severe Acute Respiratory Syndrome (SARS), there is a need for increased and more clinically competent use of respiratory protection among healthcare workers. In an effort to improve knowledge about the practice of respiratory protection against respiratory infectious agents, a NIOSH-funded project that included an educational program, observations of HCWs, and focus groups was conducted. This study aimed to develop, implement, and evaluate respiratory protection educational program for HCWs and hospital management. This study identified respiratory protection practice issues among HCWs and strategies for integration of respiratory protection standards and procedures into practice. Findings from these efforts were used to develop respiratory protection competencies. Any worker who has the potential for respiratory exposure to infectious agents should be protected and should be able to demonstrate these specific competencies to achieve a standard level of respiratory protection.

Evaluation of 9 health care organizations' respiratory protection programs and respiratory protective device practices: Implications for adoption of elastomerics.

Interview, observational, and discussion group data at 9 health care organizations (HCOs) were collected to better understand elastomeric half-facepiece respirators' (EHFRs) use. We found that HCOs do not routinely use EHFRs as a respiratory protection device (RPD) for health care workers; compliance with other respirator types was less than expected. This finding has important training implications for proper use of all RPDs and EHFRs as an alternative RPD stockpiled for use during a respiratory infectious outbreak.

Growing Concerns With Workplace Incivility.

Workplace incivility (WPI) is a growing issue across all public and private sectors. Occupational and environmental health nurses can educate employees and management about WPI, its risk factors and characteristics, and ways to reduce incidents of WPI.

Workplace Hazards Faced by Nursing Assistants in the United States: A Focused Literature Review.

Nursing assistants (NAs) make up a large share of the healthcare provider workforce and their numbers are expected to grow. NAs are predominantly women who earn a low wage and report financial, work, and family demands. Working as a NA is hazardous; this manuscript specifically examines the biological/infectious, chemical, enviromechanical, physical and psychosocial hazards that appear in the literature to date. A focused search strategy was used to review literature about hazards that fell into each of the five aforementioned domains. While some hazards that were documented were clear, such as exposure to influenza because of close contact with patients (biological/infectious), or exposure to hazardous drugs (chemical), literature was limited. The majority of the literature we reviewed fell into the domain of psychosocial hazards and centered on stress from workplace organization issues (such as mandatory overtime, lack of managerial support, and feeling rushed). More research is needed to understand which hazards NAs identify as most concerning and tailored interventions are needed for risk mitigation.

An Update on Travel Vaccines and Issues in Travel and International Medicine.

The fields of travel and international medicine are rapidly changing and growing. The role of occupational and travel health nurses is expanding and should be a focus for the future. At the American Association of Occupational Health Nurses Annual meeting on March 24, 2015, in Boston, five presentations were included in the session, An Update on Travel Vaccines and Issues in Travel and International Medicine. This article summarizes three of the presentations and includes a portion of the information generated by the Centers for Disease Control and Prevention (CDC) included in the fourth presentation. The first section focuses on the Essential Elements of Travel Medicine Programs including the pre-travel care assessment, trip research and risk identification, medication intervention review, non-pharmaceutical and prevention strategies, and post-travel care. The next section is an overview of key issues for business travelers. The growth in the number of international business travelers and unique aspects of business travel are emphasized in a comprehensive travel health program. This section also includes a discussion of expatriates and their special risks identified in recent literature (e.g., an assessment of the significant costs of health events and productivity losses by both business travelers and expatriates). The final section offers a specific example of a vaccine-preventable disease, namely, Japanese encephalitis (JE) virus, and needed changes in JE vaccine recommendations.

Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection.

This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices.

International survey of occupational health nurses' roles in multidisciplinary teamwork in occupational health services.

Access to occupational health services for primary prevention and control of work-related injuries and illnesses by the global workforce is limited (World Health Organization [WHO], 2013). From the WHO survey of 121 (61%) participating countries, only one-third of the responding countries provided occupational health services to more than 30% of their workers (2013). How services are provided in these countries is dependent on legal requirements and regulations, population, workforce characteristics, and culture, as well as an understanding of the impact of workplace hazards and worker health needs. Around the world, many occupational health services are provided by occupational health nurses independently or in collaboration with other disciplines' professionals. These services may be health protection, health promotion, or both, and are designed to reduce health risks, support productivity, improve workers' quality of life, and be cost-effective. Rantanen (2004) stated that basic occupational health services must increase rather than decline, especially as work becomes more complex; workforces become more dynamic and mobile, creating new models of work-places; and jobs become more precarious and temporary. To better understand occupational health services provided by occupational health nurses globally and how decisions are made to provide these services, this study examined the scope of services provided by a sample of participating occupational health nurses from various countries.

Chromosomal effects of non-alkylating drug exposure in oncology personnel.

Therapy-related leukemia has been a recognized sequela of cancer treatment for decades with "signature" abnormalities of chromosomes 5, 7, and 11 observed in treated patients. Risk to oncology personnel handling anti-cancer agents has also been documented by non-specific measures of genotoxicity in blood and urine. Using chromosomal markers applied in clinical practice, we previously demonstrated in oncology workers, a dose-related increase in abnormalities of chromosomes 5 and 7, known to be targets of alkylating agent exposure. In the analysis presented here, we extended that work to also assess damage resulting from non-alkylating drug exposure. Peripheral blood lymphocytes from oncology personnel (N = 63) and non-exposed controls (N = 46) was collected and examined using the fluorescent in situ hybridization technique with probes for targets on chromosomes 5, 7, and 11. Participants recorded drug handling events over a 6 week period. Important co-variates were considered. Examining chromosomal outcomes as a function of drug handling frequency, we employed Poisson Regression to obtain incident rate ratios (IRRs) for selected drug handling frequencies. We found a dose-related increase in the IRR for aberrations in all three chromosomes 5, 7, and 11, reaching statistical significance for chromosome 5, as a function of non-alkylating drug handling. This suggests that the targeting of chromosome 5 is not limited to alkylating agent exposure, as some recent evidence in treated patients has also shown. Thus, the pattern of insult observed in treated patients appears to extend to oncology personnel exposed in the workplace.

Energy drinks and worker health risks.

Occupational and environmental health nurses play a key role in raising awareness, advocating for public health and safety, and preventing deleterious health consequences for individuals who consume energy drinks.

Ergonomics and nursing in hospital environments.

This study describes workplace conditions, the environment, and activities that may contribute to musculoskeletal injuries among nurses, as well as identifies solutions to decrease these risks and improve work-related conditions. The study used a mixed-methods design. Participants included nurses and stakeholders from five hospitals. Several focus groups were held with nurses, walk-throughs of clinical units were conducted, and stakeholder interviews with key occupational health and safety personnel were conducted in each of the five hospitals, as well as with representatives from the American Nurses Association, Veterans Health Administration hospital, and National Institute for Occupational Safety and Health. Several key contributing factors, including the physical environment (e.g., layout and organization of work stations), work organization and culture (e.g., heavy workload, inadequate staffing, lack of education), and work activities (e.g., manual lifting of patients, lack of assistive devices), were identified. Recommendations included the need for a multifaceted and comprehensive approach to developing a sound ergonomics program.

Occupational and environmental health nursing: ethics and professionalism.

This article provides an overview of ethical issues related to the practice of occupational and environmental health nursing and possible strategies for resolution. Also, professionalism related to professional growth and advancing the specialty is discussed.

Focus on the aging worker.

This article discusses select characteristics of the aging work force, health-related issues that can impact work productivity, and strategies and resources that can foster a more productive work environment. The older work force is vital to the future of the U.S. economy. Employers should recognize the value of older workers. Occupational health nurses can assist older workers in maintaining and optimizing their health.

Evaluation of an occupational health nursing program through competency achievement: on-campus and distance education, 2005 and 2008.

This descriptive cross-sectional study was conducted in 2005 and 2008 to evaluate self-reported competency achievement by occupational health nursing program graduates. Twelve competencies were evaluated at three levels: competent, proficient, and expert. In 2005, most graduates believed they were at the proficient level in 10 of the 12 competencies, with three competencies approaching the expert level. In 2008, all graduates rated their competency achievement at the proficient level for all 12 competencies, with nine competencies approaching the expert level. Graduates entering the program with experience had higher competency scores compared to those without experience. Distance education learners had higher competency scores compared to on-campus graduates. From 2005 to 2008, reported competency achievement increased in all areas except research, which was only marginally reduced by a 0.1 score. Based on competency findings, curriculum and course assignments related to leadership role, policy development, professional development, and research were modified.

Occupational health nursing education.

Occupational health nursing academic education is generally provided at the specialty level through master's and doctoral degree preparation. This graduate education provides preparation for administrative, occupational health specialist, practitioner, academician, and researcher roles. Guided by nursing science, this specialty education encompasses a comprehensive curriculum that requires occupational health and safety coursework, practicum experience, and interdisciplinary learning.

Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs.

OBJECTIVE: To determine the frequency of "signature" chromosomal abnormalities in oncology workers handling anticancer drugs. METHODS: Peripheral blood from health care personnel (N = 109) was examined with probes for targets on chromosomes 5, 7, and 11. The effect of drug-handling frequency on chromosome abnormalities was assessed. RESULTS: An excess of structural (0.18 vs 0.02; P = 0.04) and total abnormalities (0.29 vs 0.04; P = 0.01) of chromosome 5 was observed in the high-exposure group compared with the unexposed. Increased incidence rate ratios (IRRs) for abnormalities of chromosome 5 (IRR = 1.24; P = 0.01) and for either chromosome 5 or 7 (IRR = 1.20; P = 0.01) were obtained at 100 handling events. Effect sizes were augmented 2- to 4-fold when alkylating agent handling alone was considered. CONCLUSIONS: Biologically important exposure to genotoxic drugs is apparently occurring in oncology work settings despite reported use of safety practices.