Workers' compensation experience in some Indigenous Northern Ontario communities.

BACKGROUND: There is a dearth of research about occupational health and safety experience in Indigenous communities and compensation applications from Indigenous workers appear limited. OBJECTIVE: This qualitative descriptive study was designed to explore workers' compensation experiences in some Canadian Indigenous communities. METHODS: A community-based participatory research approach was used to conduct focus groups (n = 25 participants) in three Northeastern Ontario (NEO) Indigenous communities and at one NEO Indigenous employment centre. Semi-structured focus group questions addressed community experience with workers' compensation, the compensation process, and discussion of a training session about the process. Reflexive thematic analysis followed Braun and Clarke procedures. RESULTS: Discussion with study participants resulted in these themes: 1) both lack of knowledge, and knowledge, about compensation demonstrated, 2) impact of lack of compensation coverage and need for universal coverage on reserve, 3) need for community training sessions about workers' compensation, 4) workload and financial impact of workers' compensation on reserve, and 5) requirement for cultural competence training in the compensation board. CONCLUSIONS: This qualitative descriptive study revealed the: need for more information about applying for workers' compensation and navigating the process, need for universal workplace insurance coverage in Indigenous communities, demand for community-based compensation process training, community costs of compensation, and the requirement for cultural safety and competence training for compensation organization employees. More education about the workers' compensation process would be of benefit to leadership, health care providers, administrative personnel, employers, and employees on reserves. Nurses in community health centres are well situated to provide further guidance.

The provision of workplace accommodations following cancer: survivor, provider, and employer perspectives.

PURPOSE: With improvements in screening, diagnosis, and treatment, the number of persons surviving cancer and staying at or returning to work is increasing. While workplace accommodations optimize workers' abilities to participate in the workforce, there has been little in-depth investigation of the types of accommodations reported to have been provided to cancer survivors and the processes relevant to ensuring their successful implementation. METHODS: We employed an exploratory qualitative method and conducted 40 semi-structured interviews with three groups: (i) cancers survivors (n = 16), (ii) health/vocational service providers (n = 16), and (iii) employer representatives (n = 8) to explore return to work and accommodation processes, successes, and challenges. An inductive thematic analysis approach was used to analyze the data. RESULTS: Four types of accommodations were recommended: (1) graduated return to work plans and flexible scheduling, (2) modification of work duties and performance expectations, (3) retraining and supports at the workplace, and (4) modification of the physical work environment and/or the provision of adaptive aids/technologies. Processes relevant to ensuring effective accommodations included: (1) developing knowledge about accommodations, (2) employer's ability to accommodate, (3) negotiating reasonable accommodations, (4) customizing accommodations, and (5) implementing and monitoring accommodation plans. Accommodation challenges included: (1) survivors' fears requesting accommodations, (2) developing clear and specific accommodations, (3) difficult to accommodate jobs, and (4) workplace challenges, including strained pre-cancer workplace relationships, insufficient/inflexible workplace policies, employer concerns regarding productivity and precedent setting, and limited modified duties. CONCLUSIONS: Accommodations need to be customized and clearly linked to survivors' specific job demands, work context, and available workplace supports. Survivors need to feel comfortable disclosing the need for accommodations. Ongoing communication and monitoring are required to ensure accommodations are implemented and changes made to the return to work plan as required. IMPLICATIONS FOR CANCER SURVIVORS: The provision of appropriate workplace accommodations can enhance survivors' abilities to stay or return to work.

Evaluating the implementation of health and safety innovations under a regulatory context: a collective case study of Ontario's safer needle regulation.

BACKGROUND: Implementation effectiveness models have identified important factors that can promote the successful implementation of an innovation; however, these models have been examined within contexts where innovations are adopted voluntarily and often ignore the socio-political and environmental context. In the field of occupational health and safety, there are circumstances where organizations must adopt innovations to comply with a regulatory standard. Examining how the external environment can facilitate or challenge an organization's change process may add to our understanding of implementation effectiveness. The objective of this study is to describe implementation facilitators and barriers in the context of a regulation designed to promote the uptake of safer engineered medical devices in healthcare. METHODS: The proposed study will focus on Ontario's safer needle regulation (2007) which requires healthcare organizations to transition to the use of safer engineered medical devices for the prevention of needlestick injuries. A collective case study design will be used to learn from the experiences of three acute care hospitals in the province of Ontario, Canada. Interviews with management and front-line healthcare workers and analysis of supporting documents will be used to describe the implementation experience and examine issues associated with the integration of these devices. The data collection and analysis process will be influenced by a conceptual framework that draws from implementation science and the occupational health and safety literature. DISCUSSION: The focus of this study in addition to the methodology creates a unique opportunity to contribute to the field of implementation science. First, the study will explore implementation experiences under circumstances where regulatory pressures are influencing the organization's change process. Second, the timing of this study provides an opportunity to focus on issues that arise during later stages of implementation, a phase during the implementation cycle that has been understudied. This study also provides the opportunity to examine the relevance and utility of current implementation science models in the field of occupational health where the adoption of an innovation is meant to enhance the health and safety of workers. Previous work has tended to focus almost exclusively on innovations that are designed to enhance an organization's productivity or competitive advantage.

International guidelines for the in vivo assessment of skin properties in non-clinical settings: Part 2. transepidermal water loss and skin hydration.

BACKGROUND: There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, representing a non-clinical environment, can be highly variable and difficult to control, thereby presenting unique measurement challenges not typically encountered in clinical settings. METHODS: An expert working group convened a workshop as part of the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals (OEESC) to develop basic guidelines and best practices (based on existing clinical guidelines, published data, and own experiences) for the in vivo measurement of transepidermal water loss (TEWL) and skin hydration in non-clinical settings with specific reference to the workplace as a worst-case scenario. RESULTS: Key elements of these guidelines are: (i) to minimize or recognize, to the extent feasible, the influences of relevant endogenous-, exogenous-, environmental- and measurement/instrumentation-related factors; (ii) to measure TEWL with a closed-chamber type instrument; (iii) report results as a difference or percent change (rather than absolute values); and (iv) accurately report any notable deviations from this guidelines. CONCLUSION: It is anticipated that these guidelines will promote consistent data reporting, which will facilitate inter-comparison of study results.

A systematic review of contact dermatitis treatment and prevention.

BACKGROUND: Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention. METHODS: Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence. RESULTS: In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications. CONCLUSIONS: A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.