Noise Exposure and Quality of Life Among Nurses.

BACKGROUND: The purpose of this study was to describe the relationship between noise exposure, selected health conditions, and well-being among nurses. METHODS: A secondary analysis was performed on data obtained from 3,818 U.S. nurses who responded to a survey regarding noise exposure, health conditions, stress, professional quality of life, and workplace support. FINDINGS: Those who reported high noise exposure reported more health conditions, higher stress and burnout scores, and lower supportive environments. High noise exposure was significantly associated with lower professional quality of life. CONCLUSION/APPLICATION TO PRACTICE: Noise may impact the health and quality of professional life of nurses. Occupational health nurses should advocate for the regular monitoring of nurses' exposure to hazardous noise at work, compare it to OSHA permissible levels, and collaborate with the occupational health team to ensure safe noise levels are maintained. Occupational health nurses should advocate for expanded research on effects of noise on health.

Predictors of use of hearing protection among a representative sample of farmers.

Farmers experience higher rates of noise-induced hearing loss (NIHL) than workers in most other industries. We developed a model of farmers' use of hearing protection, and tested it with a random sample (n = 532) of farmers from the upper Midwest. Barriers to using hearing protection (e.g., difficulty communicating; OR = .44, p < .003) were negatively related to use. Greater access/availability of hearing protectors (OR = 1.75, p < .010) and male gender (OR = .43, p < .019) were positively related to use. The model correctly predicted use of hearing protection for 74% of the cases. Overall, farmers demonstrated low hearing protector use, and results were similar to those from previous studies of non-farm workers. Findings from this study will be useful in designing interventions to increase farmers' hearing protector use and decrease their rates of NIHL.

Psychometric testing of the reduced Laffrey Health Conception Scale.

PURPOSE: Laffrey's Health Conception Scale (LHCS), an instrument designed to measure personal definitions of health, was reduced with the intent of creating a useful yet less cumbersome version of the LHCS. DESIGN: The original form of the LHCS was tested in a preliminary study, and results were used as a basis for the reduction of the instrument. The original clinical and new overall wellness subscales were subsequently tested with a larger population of manufacturing plant workers. SETTING: One chemical plant and three Midwestern manufacturing plants. SUBJECTS: The sample for the preliminary study comprised 94 chemical plant workers. For the larger study, the sample comprised 892 subjects; because this instrument was part of a larger questionnaire to identify predictors of workers' use of hearing protection, only those workers who spent some part of their work time in areas of the plant which required hearing protection use were eligible to participate. MEASURES: The original LHCS was used in the preliminary study. The reduced LHCS was used in the larger study and psychometrically evaluated. RESULTS: The reduced LHCS accounted for 51% of the variance in definition of health; all but one item had loaded on one of the two factors with a loading of .41 or greater. The revised LHCS demonstrated excellent internal consistency. Two distinct factors, the clinical subscale and the overall wellness subscale, were isolated. CONCLUSIONS: The researchers recommend the reduced LHCS be used for assessing subjects' definition of health; the reduced instrument requires fewer items, and therefore less time, to measure individuals' definitions of health with excellent reliability.

Applying the health promotion model to development of a worksite intervention.

INTRODUCTION: Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. PURPOSE: The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. SUBJECTS/SETTING: Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. DESIGN: Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. MEASURES: All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). RESULTS: Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. CONCLUSION: Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.

A comparison of multiple indicators--observations, supervisor report, and self-report as measures of workers' hearing protection use.

The purpose of this study was to compare multiple indicators of behavior and identify the most viable measure of blue-collar workers' use of hearing protection. Three measures of use were employed: observations, supervisor report, and self-report. Supervisor report was highly discrepant from both self-report and observed use; self-report and observations were highly correlated, and discrepancies between the two were slight. These results suggest that, for this type of measurement, self-report is an appropriate measure and may be the best choice when time and monetary resources restrict measurement to one indicator.

Health promotion and disease prevention in the worksite.

U.S. and Canadian research studies (n = 73) on health promotion/disease prevention programs in the worksite reported from 1990 through 1994 were reviewed for this chapter. In those studies, diverse intervention foci were provided and outcomes specific to the foci, as well as numerous additional outcomes, cost and cost benefit being the most common, were measured. To aid future researchers, two appendices list reports by foci of intervention and by outcomes measured. Deficiencies and inadequacies in reports and studies are described. Nearly all (68 out of 73) of the published studies obtained positive results in terms of benefiting health or reducing costs. The Johnson & Johnson LIVE FOR LIFE Program is presented as an exemplar of a comprehensive, multifaceted, worksite health promotion/disease prevention program whose effects were consistently assessed. Although health promotion and prevention of disease has always been an important component of nursing practice, few reports included nurse scientists as authors or coauthors. Potential explanations for the limited involvement by nurse scientists and recommendations regarding future research directions are presented. The worksite remains the best place to promote improved health for adults and this area of research represents an opportunity for greater involvement by nurse scientists.

Evaluation of the Facts on Aging Quizzes I & II.

The Facts on Aging Quizzes (FAQ) I and II (Palmore, 1977, 1981) were designed to assess knowledge and to measure misconceptions regarding the elderly. This study compared results on the FAQ I and II administered to freshmen nursing students. In contrast with Palmore's (1981, 1988) findings, the FAQ I and II were not related (r=.04) and alpha coefficients were low (a=.45 and .32 respectively). However, use of theta coefficients (which make fewer stringent assumptions about items being parallel) resulted in values of .60 and .64 respectively. The factors emerging in this study differed from Palmore's (1977, 1981, 1988) conceptual structure and explained only 45% of the variance. Results from this study suggest that while the FAQ I and II may be useful as a stimulus for discussion, revisions and testing need to be done if they are to be used for research purposes.

Using incentives to promote workers' participation in worksite research.

We designed this study to examine the effects of two types of incentives on the participation rate of workers from two plants in worksite research. There were 186 workers in the study, some of whom received chances for savings bonds. Given reductions in funding and concerns of management, no comparison could be made between the incentives; however, the study provided valuable information regarding planning for incentives in worksite research.

Factor replication of the Reduced Laffrey Health Conception Scale.

This study replicated the factor model for the Reduced Laffrey Health Conception Scale (RLHCS), which was originally developed by Laffrey (1986) and reduced by Lusk, Kerr, and Baer (1995). Two independent samples of construction workers (n = 697 and n = 510) were used. The samples were predominately Caucasian males (over 97%), with mean ages of 35 and 38 years, respectively. Principal components factor analysis with direct oblimin rotation and structural equation modeling were used to replicate factors and to test the equality of the three observed covariance matrices (factory workers and two groups of construction workers), respectively. Results replicated the two-factor structure (clinical health and overall wellness) found in the earlier study with factory workers (Lusk et al., 1995) and demonstrated factor invariance across different samples.

Corporate expectations for occupational health nurses' activities.

1. Reports from corporate management personnel indicated occupational health nurses currently performing fewer activities than the reports from occupational health or medical personnel, but they did not differ in regard to future activities. 2. Two areas, "generate analyses on trends in health promotion, risk reduction, and health care expenditures" and "conduct research to determine cost effective alternatives for health care programs and services," may represent an opportunity for occupational health nurses to expand their roles and receive recognition for their contributions. 3. Occupational health nurses can use this information regarding corporate expectations: to promote support for the development of new programs; to select educational programs which will prepare them to perform these activities; and to justify corporate support for advanced education. 4. Many of the desired future activities relate to corporate interest in cost containment. Occupational health nurses may be able to use this knowledge to obtain support for new programs they wish to develop.

Selling health promotion programs: recommendations for occupational health nurses.

1. Although some suggest that health promotion programs should not be conducted in the workplace, there is generally strong support for workplace programs by both the public and private sectors. 2. Many published reports of cost savings attributed to health promotion programs are available. The calculations of cost savings contain many flaws and generally do not reflect a comprehensive analysis of all costs associated with programs, especially those associated with changes in death rates and longevity. 3. Specific recommendations for occupational health nurses include: analysis of the corporate situation; integration of programs with occupational health and safety activities; involvement of all levels of workers in planning and promoting the programs; evaluation through employee participation and satisfaction, not by cost benefit analysis; and consideration of offering programs to family members. 4. Nursing as a whole should provide leadership for implementing programs to promote health and prevent disease. The worksite offers unique opportunities for occupational health nurses to implement the Healthy People 2000 objectives to enhance the health of working adults.

Violence experienced by nurses' aides in nursing homes: an exploratory study.

1. The growing aged population in the United States will result in an increase in nursing home patients, and in numbers of employees in these homes providing care to patients. Nurses' aides, an employee group that has not received much attention, will be the primary providers of this patient care. 2. In this preliminary study the abuse experienced by nurses' aides in nursing homes was both a psychosocial and ergonomic stressor, because it had emotional and psychological components, as well as actual physical injury. 3. Nurses' aides, like other workers, deserve a safe and healthful workplace. A large scale study should be done to determine the extent of abuse/violence directed toward nursing home employees. 4. If abuse is validated as a problem, aides should receive training in handling abusive patients. In addition, it is important to identify the factors related to patients' abusive behaviors and to test mechanisms for reducing these behaviors.

Noise exposures. Effects on hearing and prevention of noise induced hearing loss.

1. Over 30 million workers are exposed to hazardous noise on the worksite. Continual exposure to high noise levels damages and destroys hearing cells within the ear, making noise induced hearing loss an irreversible impairment. 2. Hearing conservation programs are required by law for workers in industrial settings where noise exposures equal or exceed 85 dB(A). Many workers, such as those in construction and agricultural industries, are not covered by these programs. 3. Reducing noise through engineering or administrative controls is the first line of defense. When this is not sufficient, two types of personal hearing protection devices are available: passive hearing protection devices such as ear muffs, canal caps, and ear plugs, which reduce noise mechanically; and active noise reduction devices, which electronically cancel sound waves at the ear. 4. The most effective hearing protection devices are those with which the worker is most comfortable will use 100% of the time. The occupational health nurse has a major role in promoting increased use of hearing protection devices through continued contact with workers, administrators, and safety personnel.

Conducting worksite research: methodological issues and suggested approaches.

1. With increasing national concern about adult health and reducing health care costs, more research about these issues is being carried out in the worksite. 2. The worksite generates a variety of complications that may not be present in many other research settings; these include management policies, plant regulations, and management/labor relations. 3. The researchers review issues related to conducting research at the worksite and, based on their experience in this setting, make recommendations for resolving these issues.

Perceived psychological stress and upper extremity cumulative trauma disorders.

This report presents data exploring the relationship between perceived psychological stress and several variables implicated in the etiology of upper extremity cumulative trauma disorders (UECTDs). The sample was 354 workers from three different manufacturing companies. The primary job exposure for the subjects was that they were engaged in jobs that involved repetitious movements of the upper extremities, primarily of the hands and arms. Data collection included a detailed health history, a comprehensive physical examination of the upper extremities, limited electrodiagnostic testing, Cohen's Perceived Stress Scale, Karasek's Job Content Questionnaire, demographic information, and a measurement of repetition. Descriptive analyses, analysis of variance, correlational analyses, and multiple linear regression were used to examine the data. Perceived stress, as measured in this study, was only weakly associated with repetition, job dissatisfaction, and subjective complaints related to UECTDs. In addition, factors generally accepted as related to UECTDs (e.g., repetition, female gender, hormonal influences, and existing medical conditions) were not robust predictors of perceived stress. The major limitation is related to the measurement of perceived psychological stress. Like most psychosocial phenomena, perceived stress is a complex construct, one that is difficult to measure and correlate with health outcomes. Further research is necessary to examine what role, if any, perceived stress may have in the etiology of UECTDs.

Benefits of a nurse directed over the counter medication dispensing system in an automotive plant. A preliminary study.

Information is limited about the effects of the availability of over the counter medicines (OTCs) at a worksite on workers' ability to remain at work and the effect on health care utilization. The purpose of this preliminary study was to assess workers' perceptions related to the benefits of having a nurse directed over the counter medication dispensing system (OTCMS) at an automotive manufacturing plant. Fifty-six percent of 257 randomly selected workers who participated in semistructured interviews indicated they used OTCs as the first intervention when at home, and 88% had obtained OTCs from the plant's medical department. The workers were overwhelmingly positive about having an OTCMS available at their worksite. Eighty-nine percent indicated that having OTCs available from the occupational health nurse made it possible for them to stay at work and complete their shift. Not only did the workers find the OTCMS to be an asset in their worksite, but they also highly recommended having an OTCMS available in work settings that do not presently have one in place.