Care of Clients in Work Settings Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Community Health Nursing, 5/e Mary Jo Clark 24 CHAPTER

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Clients in Work Settings  Two-thirds of U.S. population over 16 years of age work.

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Employer Awareness of Benefits Cost effectiveness Impact on productivity

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Advantages of Employee Health Programs Amount of time at work Captive audience Risks for health problems Motivation to maintain health Health promotion efficient and cost- effective

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Advantages of Employee Health Programs (continued) Visible costs –Costs of poor health Sickness Absenteeism Employee turnover

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Advantages of Employee Health Programs (continued) Invisible costs –Low productivity –Poor-quality work –Poor customer services –Accidents –Legal claims related to illness and injury

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Goal of Occupational Health Services Ensure working adults reach and maintain full working potential –Health promotion –Protection –Surveillance activities

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Types of Health and Safety Hazards Occupational injuries –Musculoskeletal injuries –Accidents –Exposure to hazardous chemicals

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Types of Health and Safety Hazards (continued) Agricultural injuries –Heavy equipment accidents –Exposure to hazardous chemicals Occupational illnesses

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Biophysical Considerations Age of employees determines health risks –Young adult risks –Older adult risks

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Female Gender Composition Pregnancy Reproductive health

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Physiologic Function Extent of injury and illness

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Psychological Considerations Stress in workplace Mental health and illness

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Stress in Workplace and Health Effects Job strain model Effort-reward imbalance

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Mental Health and Illness in Workplace Depression Risk factor for health conditions Increase costs to employer and employee

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Physical Environmental Considerations Physical hazards –Noise –Lifting –Equipment Chemical hazards –Toxins Electrical and magnetic field hazards Exposure to metallic compounds, allergens, molds

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Sociocultural Considerations Positive or negative influences –Quality of social interactions –Attitudes toward work and health –Presence or absence of racial or other tensions

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Major areas of Sociocultural Assessment Policy and legislation Interactive effects of work and family life Workplace violence Other factors

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Behavioral Considerations Lifestyle factors –Type of work performed –Consumption patterns –Patterns of rest and exercise –Use of safety devices

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health System Considerations Types of services used Reasons for and appropriateness of use Availability of services Availability of health insurance

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Four Spheres of Influence Individual health-related behaviors Coworkers’ attitudes to and influence on health-related behaviors Management’s attitudes and enforcement of health policies Legal, social, and political actions

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Types of Health Care Programs in Work Settings Internal health care systems –Toxic exposure programs –Health promotion programs –Comprehensive programs –Family care

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Toxic Exposure Prevention Programs Control programs Elimination programs

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Control Programs Engineering controls Controlled work practices Safety equipment and devices Elimination programs –Remove substances from workplace –OSHA-regulated

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health Promotion Programs Goal –Limit hospitalizations and acute care expenses Types of services –Education Proper body mechanics Company health policies

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Employee Health Promotion Programs Illness-oriented Wellness-oriented

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Comprehensive Programs Wellness approach –Awareness Stress management programs –Lifestyle changes Exercise programs

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Comprehensive Programs (continued) Wellness approach –Change environmental conditions to promote better health Yoga Massage services

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Family Care Programs On-site child care programs Counseling services On-site elder care services

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. External System Internal system of care interfaces with the external community health care system –Addresses health care needs that cannot be met by the internal system

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Primary Prevention in Work Setting (Refer to Table 24-2) Health promotion Illness prevention Injury prevention Violence prevention

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Health Promotion Exercise programs Stress management Programs to reduce negative effects of commuting Reproductive health education and referral services

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Illness Prevention Immunization Risk factor modification Postexposure prophylaxis Stress reduction/management education

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Injury Prevention Safety education Make provisions for adequate safety equipment Monitor effective use of safety equipment Develop policies and procedures that prevent injury

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Injury Prevention Modify or eliminate injury risk factors in the work setting Develop adequate management support for injury prevention policies and procedures

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Violence Prevention Modify worksite environments that promote violence Encourage the installation of security devices Develop processes and procedures for handling workplace violence or potential for violence

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Violence Prevention Develop reporting procedures Develop disciplinary sanctions for violent behavior in the work setting Employee education on violence prevention, anger management, and recognition of potentially violent situations

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Secondary Prevention Screening and surveillance Treat existing conditions Emergency care

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Screening and Surveillance Preemployment screening Determination of work capacity Recommendations regarding work conditions or accommodations Periodic employee screening Periodic environmental screening Reporting and interpreting screening findings and making referrals for care or environmental modification

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Treat Existing Conditions Treat work-related illness or injury Provide immediate first aid Refer for outside medical assistance as needed Develop health care delivery programs to address high prevalence problems

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Treat Existing Conditions Advocate for adequate employee health insurance coverage Advocate for accessible internal or external health care services

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Emergency Response Assist in developing individual and disaster emergency response plans for the work setting Respond to individual physical or emotional emergencies Refer for continued treatment Respond to care needs in an occupational disaster Evaluate the health effects of occupational disasters

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Tertiary Prevention Prevent the spread of communicable diseases Prevent recurrence of acute health problems Prevent complication of chronic conditions Assess fitness to return to work

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Preventing the Spread of Communicable Diseases Employee immunization programs Education on infection control procedures

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Preventing the Recurrence of Acute Conditions Education of employees Advocacy for environmental modifications

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Preventing Complications of Chronic Conditions Monitor treatment effects and disease status Educate employees for disease self- management Ensure modification of the work environment to accommodate limitations due to disability

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Assessing Fitness to Return to Work Follow-up on worker’s compensation claims Assess recovery status Ensure modification of work environment as needed to promote return to work

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources OSHA has a four-pronged comprehensive approach to ergonomics designed to quickly and effectively address musculoskeletal disorders (MSDs) in the workplace. The four segments of OSHA's strategy for reducing injuries and illnesses from MSDs in the workplace are guidelines, enforcement, outreach & assistance and a National Advisory Committee.OSHAfour-pronged comprehensive approach

Community Health Nursing, 5/e Mary Jo Clark Copyright ©2008 by Pearson Education, Inc. Resources National Institute for Occupational safety & Health (NIOSH) is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services.National Institute for Occupational safety & Health (NIOSH)Centers for Disease Control and Prevention (CDC)Department of Health and Human Services