AAOHN Certificate Program Barb Maxwell RN, MHA, COHN-S, CCM, CWCP, QRP, FAAOHN Chad Rittle DNP, MPH, RN Debbie Bush RN, COHN-S/CM Marianne Allen RN, BSN,

AAOHN Certificate Program Barb Maxwell RN, MHA, COHN-S, CCM, CWCP, QRP, FAAOHN Chad Rittle DNP, MPH, RN Debbie Bush RN, COHN-S/CM Marianne Allen RN, BSN, COHN-S (authored) Kerri L. Rupe ARNP, FNP-C, COHN-S, DNP, FAANP Tonya F. Grayson, LPN Copyright 2012 American Association of Occupational Health Nurses

Welcome to the Certificate Program This is a 2 ½ day course Partially satisfy AAOHN Certificate Other requirements will be discussed Study Guide and other certifications Copyright 2012 American Association of Occupational Health Nurses

Opening Statement The Occupational Health Nurse specialty has depth and breadth and requires a variety of skills that are seldom attained in an associate or bachelor’s education. The value of the AAOHN Certificate: –Gives prestige and legitimacy to the occupational health specialty. –Allows satisfaction of employer and regulatory requirements. –Promotes the recruitment and retention of certificants. –Certification is a voluntary process that involves the formal recognition of specialized knowledge, skills, and experience demonstrated by achievement of standards. –Periodic renewal of the certificate will require continuing education. Copyright 2012 American Association of Occupational Health Nurses

Obtaining an AAOHN certificate To obtain an AAOHN certificate, the OHN must also show successful completion of: –Pulmonary Function, including fit testing –Audiometry –Ergonomics –Health coaching Copyright 2012 American Association of Occupational Health Nurses

Debbie Bush, RN, COHN-S/CM Occupational and Environmental Nursing – an Overview

Clients and Customers We Serve The mission of occupational health is to “assure as far as possible every Man and Woman working in the Nation safe and healthful working conditions”. (United States Congress, Occupational Health and Safety Act, 1970) Copyright 2012 American Association of Occupational Health Nurses

Our Primary Focus Occupational Health is a complex encompassing social, cultural, political and economical content of work. –Social: The meaning of work –Cultural: Beliefs, attitudes, and values –Political: The ideology in a society, the distribution of power, and government support –Economical: Unemployment, wages, etc Copyright 2012 American Association of Occupational Health Nurses

Occupational Health Nursing A “specialty practice that provides for and delivers health care services to workers and worker populations”. Has focus on the ‘promotion, protection, and restoration of worker’s health within the context of a safe and health work environment. Advocates for workers and encourages and enables them to make informed decisions about health care concerns. Copyright 2012 American Association of Occupational Health Nurses

Essential Elements of Occupational Health Workplace Hazards physical – noise, radiation, ergonomics, lasers chemical – Lead, Xylene, Chlorene biological – Hep B and C, HIV mechanical – machines/guarding and electrical shock psychosocial – stress, fatigue, and burnout Copyright 2012 American Association of Occupational Health Nurses

Work-Related Injuries / Illnesses Any injury that results from a single incident in the work environment Injuries are more likely to be reported than illnesses Both tend to be under reported over all Injury Rate Measurements can serve as an indicator that need to be targeted Copyright 2012 American Association of Occupational Health Nurses

Our History 19 th Century Great Britain and the US 1880s – Department stores were the first to hire industrial nurses as were coal mines 1909 - Milwaukee Nurse Assoc. placed a nurse in their plant to offer services 1916 - Florence Wright delivered an address to the National Safety Counsel Copyright 2012 American Association of Occupational Health Nurses

Our History 1913 – The first industrial nurse registry was opened in Boston for the purpose of supplying factory emergency room nurses. 1997 – AAOHN Core Curriculum for Occupational Health Nursing published Copyright 2012 American Association of Occupational Health Nurses

IT IS A FOREIGN LANGUAGE OSHA STS Medical/Health Surveillance MSDS BBP STD/LTD FMLA HCP NIOSH WC Reserves OSHA Recordkeeping IH PEL TLV Copyright 2012 American Association of Occupational Health Nurses

Learning a New Language: OSHA Occupational Safety and Health Administration Federal agency formed in 1971 charged with the enforcement of safety and health legislation to assist employers in providing a safe working environment Only agency with the power to fine employers for non-compliance Is housed in the Department of Labor and Statistics Copyright 2012 American Association of Occupational Health Nurses

NIOSH A federal agency created along with OSHA whose main responsibility is conducting research into occupational safety and health matters and making recommendations for the prevention of work-related injury and illness Is part of the Centers for Disease Control and Prevention (CDC) and is housed in the Department of Health and Human Services Has no powers of enforcement Copyright 2012 American Association of Occupational Health Nurses

Workers’ Compensation (WC) Developed by the federal government to provide benefits (both medical and indemnity) to employees injured as a result of their employment Medical benefits are 100% paid and are lifetime benefits Indemnity benefits or reduction in earnings are a scheduled percentage of pre-injury earnings Indemnity benefits can be for an indefinite duration or potentially for lifetime On average, 70% are medical only claims (no lost wages) with the remaining 30% indemnity Is basically a state program administered by state agencies Workers’ compensation laws are “no fault” in nature Copyright 2012 American Association of Occupational Health Nurses

Reserves Worker’s compensation insurance covers the cost of medical care and rehabilitation for workers injured on the job A portion of the total WC monies are carefully calculated, state by state, and injury by injury, and placed in “reserve” should the money become necessary for the care of the employee These reserves may be continually adjusted up or down depending on the medical status of the employee Copyright 2012 American Association of Occupational Health Nurses

OSHA Recordkeeping –Part of the OSHA act that requires certain employers to prepare and maintain records of all work-related injuries and illnesses –Covered employers must record, on prescribed forms or equivalents, work-related injuries or illnesses that result in: Death Loss of consciousness Days away from work Restricted activity or job transfer Medical treatment (beyond first aid care) Copyright 2012 American Association of Occupational Health Nurses

Industrial Hygiene (IH) A science or art devoted to the recognition, evaluation, prevention and control of those environmental factors or stressors arising in or from the workplace which may cause sickness, impair health or wellbeing, or cause significant discomfort among workers or citizens of the community Copyright 2012 American Association of Occupational Health Nurses

Permissible Exposure Limit (PEL) OSHA’s legal exposure limits for airborne contaminants (vapors, dusts, etc) Are 8-hour, time-weighted averages of airborne exposure Employers who use regulated substances must keep air contaminants breathed by employees below the PELs for these substances Copyright 2012 American Association of Occupational Health Nurses

Threshold Limit Value (TLV) The amounts of chemicals in the air that most healthy adult workers are predicated to be able to tolerate without adverse effects These are suggested limits recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) on an annual basis Are 8-hour, time-weighted averages with the following exceptions: Ceiling levels, or uppermost TLV levels, cannot be exceeded Short-term exposure levels are the maximum, 15-minute, time-weighted averages permitted over a workday, with at least 60 minutes between successive exposures They are the model for many other air quality limits such as OSHA’s PELs Copyright 2012 American Association of Occupational Health Nurses

Hearing Conservation Program (HCP) An OSHA program located in 29 CFR 1910.95 Mandates “the employer shall administer a continuing, effective hearing conservation program…whenever employee noise exposures equal or exceed an 8-hour time-weighted average (TWA) sound level of 85 decibels measured on the A scale or, equivalently, a dose of fifty percent” Copyright 2012 American Association of Occupational Health Nurses

Standard Threshold Shift (STS) A term used in OSHA’s Hearing Conservation Program that describes an average shift from the baseline measurement in either ear of 10 dB or more at 2000, 3000, or 4000 Hz These frequencies are the most important frequencies in communication and the most sensitive to damage by noise exposure Copyright 2012 American Association of Occupational Health Nurses

Medical/Health Surveillance A process of evaluating the health of employees as it relates to their potential occupational exposures to hazardous agents Includes performing required exams, identifying and ordering required tests and interpreting and communicating results OSHA mandates health surveillance for certain exposures on a substance by substance basis Some companies may have their own health surveillance requirements Copyright 2012 American Association of Occupational Health Nurses

Material Safety Data Sheet (MSDS) A detailed information bulletin prepared by the manufacturer or importer of a chemical that describes the physical and chemical properties, physical and health hazards, routes of exposure, precautions for safe handling and use, emergency and first-aid procedures, and control measures Aids in response to daily exposure situations as well as to emergency situations for both employees and employers Copyright 2012 American Association of Occupational Health Nurses

Bloodborne Pathogens (BBP) A term referring to pathogenic microorganisms present in human blood that may cause disease in humans These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) OSHA’s 29 CFR 1910.1030 is the standard that outlines this program Employers with employees having occupational exposure as defined by the standard shall establish a written Exposure Control Plan to minimize exposure Copyright 2012 American Association of Occupational Health Nurses

Short Term Disability (STD)/ Long Term Disability (LTD) Medical leaves of absence for illness, etc. Each cover a certain number of weeks of disability and percentages of employee pay Based on the benefit plan and company policy Some companies have policies to terminate employment once they move onto LTD although benefits may continue Copyright 2012 American Association of Occupational Health Nurses

Family Medical Leave Act (FMLA) Is the federal law of 1993 that provides unpaid, job- protected leave to eligible employees, both male and female, in order to care for their families or themselves for specified family or medical conditions In January of 2009 new provisions were made to cover employees in the military Copyright 2012 American Association of Occupational Health Nurses

Tonya F. Grayson, LPN Worker Population - Who's on First?

Changes that Affect our Worker Population Fertility rate Job demands Technology Gender rate Minority rate Aging Workforce Contingent workers Union Workers Disabled Workers: World Health Copyright 2012 American Association of Occupational Health Nurses

WHEN? When is it important to know and understand worker population? As OHN developing, implementing and evaluating programs and services, we must ALWAYS consider worker population and current state. Copyright 2012 American Association of Occupational Health Nurses

WHERE? Where are you located and what concerns should you have for that location? Natural Disasters: Perhaps the most unpredictable of all environmental factors. –Hurricane Zone –Tornado Alley –Flood Zone –Forest Fire –Snow Copyright 2012 American Association of Occupational Health Nurses

Other Groups the OHN has to Consider Military Installation/High Security Area Virtual Office Ethnic Groups Union Workers Agricultural Workers Biological Hazards Copyright 2012 American Association of Occupational Health Nurses

SUMMARY We are VITAL to the success of our companies!

Bibliography Salazar, M. (2011) Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, FL: AAOHN Department of Labor Futurework-Trends and Challenges for Work in the 21 st Century, Exectutive Summary and An Overview of Economic, Social and Demographic Trends Affection the US Labor Market. Retrieved on November 10, 2012 http://www.dol.gov/oasam/programs/history/herman/reports/futurework/welcome.html http://www.dol.gov/oasam/programs/history/herman/reports/futurework/welcome.html Rogers, C.D. Environmental Forces that Affect Business. Retrieved November 10, 2012. http://www.dol.gov/oasam/programs/history/herman/reports/futurework/welcome.html http://www.dol.gov/oasam/programs/history/herman/reports/futurework/welcome.html Dun & Bradstreet (2011) 2011 Impact Report of Joplin, Missouri Tornado. Retrieved December 1, 2012. http://www.dnbgov.com/pdf/2011_Impact_Report_of_Joplin_v4.pdfhttp://www.dnbgov.com/pdf/2011_Impact_Report_of_Joplin_v4.pdf Fleury, Michelle (December 7, 2012) Hurricane Sandy expected to impact on US job growth. Retrieved December 9, 2012. http://www.bbc.co.uk/news/business-20637524http://www.bbc.co.uk/news/business-20637524 Copyright 2012 American Association of Occupational Health Nurses

Debbie Bush, RN, COHN-S/CM Prevention and Work-Related Injuries and Illnesses

Objectives Distinguish the difference between an occupational injury and illness List 2 economical impacts to an organization that relates to an occupational injury or illness Name 2 prevention techniques the OHN can implement to reduce injuries/illnesses Copyright 2012 American Association of Occupational Health Nurses

Is there a Difference between Occupational Injuries and Illnesses? Occupational Injury – any injury that results from a single instantaneous exposure or incident in the work environment Occupational Illness – any abnormal condition or disorder which over time through repetitive exposure resulting in an acute or chronic condition Copyright 2012 American Association of Occupational Health Nurses

Prevention Recognition The process of identifying and describing existing workplace hazards. Hazard is the ‘potential’ for harm or damage to people, property, or the environment. Recognizing hazards requires knowledge of the workers, the worksite, the work practices and processes, and industrial materials used. Copyright 2012 American Association of Occupational Health Nurses

Prevention Anticipation ‘The foresight to recognize hazards in equipment and processes during the planning stages so they can be eliminated from the design.’ (Manuele,1994) Copyright 2012 American Association of Occupational Health Nurses

Methods of Identification Site Survey/Walk thru –Get a lay out of the building and have a person of interest with you Inspections –Pull all those performed in the previous one – three years Records Review –Look all OSHA 300 logs for the past five years for trends Job Hazard Analysis –Have any been performed? Accident Investigations –These are critical and will go along with the OSHA Log review Copyright 2012 American Association of Occupational Health Nurses

Physical Material Handling - lifting devices, conveyors, lift truck operations, cranes, hoists, Buildings and Structures - windows, aisles, floors, stairs, and exit signs Temperature controls – check logs Noise – sound level measurements Copyright 2012 American Association of Occupational Health Nurses

Mechanical Machinery - guarding of moving parts and pinch points, barrier safety shields, automatic shut offs Material handling – lifting devices, conveyors, lift truck operations, cranes, hoists Electrical – cords, outlets, electrical gear clearance, shock hazards. Copyright 2012 American Association of Occupational Health Nurses

Psychological Stress – competition, personality issues Fatigue – shift work, overtime Workplace violence – harassments, threats, physical assaults Copyright 2012 American Association of Occupational Health Nurses

Solutions Analysis of the job hazards to prioritize issues Exposure monitoring whether for chemicals, sound, or temperature will give the OHN a baseline to start a program A firm handle of OSHA regulations such as BBP and Respiratory Program along with PPE ( personal protective equipment NIOSH Lifting Guidelines to reduce strains/sprains Ergonomics Analysis to evaluate issues related to musculoskeletal disorders A full review of all data for trends Copyright 2012 American Association of Occupational Health Nurses

Objectives Describe the collection and management of protected health information (PHI) in the occupational health setting Discuss the importance of confidentiality of PHI in the practice setting. Describe the professional and ethical issues related to PHI in the occupational health setting Discuss the use of social media in occupational health. Copyright 2012 American Association of Occupational Health Nurses

Content Outline Review the AAOHN position statement on protecting confidentiality of health information Review the Health Insurance Portability and Accountability Act (HIPPA) of 1996 Outline the use of electronic medical records in the occupational health setting and the electronic transmission of PHI. Define the circumstances when public benefit from disclosure of PHI outweighs the individuals privacy Present the opportunities and concerns associated with the use of social media for health information. Present ethical dilemmas that occur in the occupational health setting Copyright 2012 American Association of Occupational Health Nurses

What is Protected Health Information (PHI)? Personal information obtained about a client related to his/her health status Past health conditions Familial health conditions Current health issues Copyright 2012 American Association of Occupational Health Nurses

When is it Appropriate to Release PHI? When providing treatment, the coordination of care or management of care requires the sharing of the information. To get reimbursed for services provided The operations of health care USDHHS determines the public health benefit outweighs the individuals privacy ⁻Life threatening emergencies ⁻Worker’s compensation ⁻DOT mandated medical examinations ⁻OSHA mandated medical surveillance ⁻Occupational Injury/Illness evaluations ⁻Compliance with gov’t regulations Copyright 2012 American Association of Occupational Health Nurses

What is the role of the occupational health nurse in maintaining confidentiality of PHI at the workplace? AAOHN Position Statement (2006) States “the confidentiality of PHI is integral and central to the practice of the occupational health…and is maintained in accordance with professional codes, laws and regulations”. (p.1) Asserts confidentiality of PHI is necessary to ensure the publics’ trust OHN’s have a professional obligation to prevent inappropriate and/or unauthorized PHI disclosure Copyright 2012 American Association of Occupational Health Nurses

What is the role of the occupational health nurse in maintaining confidentiality of PHI at the workplace? AAOHN Code of Ethics (2004) –OHN’s “strive to safeguard employees’ right to privacy by protecting confidential information and releasing information only upon written consent of the employee or as required by law”. (p.1) Standards of Practice of Occupational & Environmental Health Nursing (AAOHN, 2012) –Issue of confidentiality of PHI is addressed related to assessment, diagnosis and ethical decision making Copyright 2012 American Association of Occupational Health Nurses

Electronic Medical Record (EMR) in Occupational Health Wide range of health information is collected, organized, processed and managed by the OHN Work Injury and Illness data Post-employment physical examinations Surveillance screenings Fitness of duty information Employee health records Copyright 2012 American Association of Occupational Health Nurses

EMR Allows for management of clinical data sets Efficient access to information when needed Easier storage of large amounts of data Data Security Copyright 2012 American Association of Occupational Health Nurses

EMR – Data Security Data Security Externally ⁻ Hackers Internally ⁻ Non-essential personnel access to PHI ⁻ Administrative/Management access to PHI Develop policies and procedures ⁻ Limit access by use of pass codes, screen savers, work station placement ⁻ Restrict access ⁻ Establish and maintain security standards for storage, transmission and destruction of the EMR ⁻ Back up data Copyright 2012 American Association of Occupational Health Nurses

Social Media in Occupational Health Immediate sharing and access of information worldwide Individuals and groups can communicate in real time wirelessly Utilization of hand-held devices to access up-to- date clinical references Utilization of this technology to upload or download PHI from anywhere Confidentiality Issues Copyright 2012 American Association of Occupational Health Nurses

References American Association of Occupational Health Nursing. (2009). AAOHN Code of Ethics and Interpretive Statements. American Association of Occupational Health Nursing. (2004). AAOHN Advisory: Confidentiality of Employee Health Information. American Association of Occupational Health Nursing. (2012). Standards of Occupational & Environmental Health Nursing. American Association of Occupational Health Nursing. (2006). Position statement: Roll of the occupational and environmental and nurse case managers in protecting confidentiality of health information. Damrongsak, M., Brown, K. C.,(2008). Data Security in Occupational Health. AAOHN Journal. 56(10), 417- 421. Rogers, B. (2003). Occupational and Environmental Health Nursing: Concepts and Practice. 2 nd edition. Philadelphia: Pa. Elsevier Science. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Schuren, W.S., & Livsey, K., (2001) Complying with Health Insurance Portability and Accountability Act Privacy Standards. AAOHN Journal, 49(11), 510-507. Copyright 2012 American Association of Occupational Health Nurses

Direct Care in the Occupational Setting Direct care consists of activities involved in the delivery of clinical care to individual clients who are at the on-set basically healthy Activities include the steps necessary for appropriate clinical decision making, such as: –taking a health history –conducting a physical exam –ordering diagnostic or screening studies Copyright 2012 American Association of Occupational Health Nurses

Direct Care Professional Practice Concepts Direct care: defined as hands-on clinical care Advanced practice nursing Primary care Professional & regulatory parameters of practice: AAOHN competencies in occupational and environmental health nursing Copyright 2012 American Association of Occupational Health Nurses

Overview of Direct Care Care for Occupational and/or non- occupational conditions First aid, emergency care, minor acute care, chronic illness management, full service and 24 hour call Prevention based services Case Management Copyright 2012 American Association of Occupational Health Nurses

Overview of Direct Care Offered to all workers: –full time employees –Contractors –Retirees –volunteers Who may deliver the care: –LPNs, RNs, ARNPs, Physicians Copyright 2012 American Association of Occupational Health Nurses

Reasons For On-Site Care Greater convenience Less down time Greater opportunity for case management Fast & accurate determination of work relatedness Ability to make accommodations Opportunity to reinforce safe work practices Copyright 2012 American Association of Occupational Health Nurses

Ethical, Legal & Professional Considerations for Direct Care Ethical: 1.Confidentiality of personal health info 2.Must balance the “duty to warn” against right to privacy 3.Resources dedicated to OH&S are often limited 4.Workers have a right to know about the workplace hazards Copyright 2012 American Association of Occupational Health Nurses

Legal: 1.Documentation must be done according to professional codes of conduct & AAOHN standards 2.ARNPs can prescribe meds, pharmacy laws must be followed. Other staff can carry out. 3.Must comply with OSHA standards Copyright 2012 American Association of Occupational Health Nurses Ethical, Legal & Professional Considerations for Direct Care

Professional: 1.All providers must be competent 2.AAOHN’s Standards of Occupational & Environmental Nursing guide practice 3.Outcomes of clinical care must be measured 4.Secure data management systems Copyright 2012 American Association of Occupational Health Nurses

Knowledge Needs for Direct Care in Occupational Health Knowledge of the physical and mental requirements of the worker’s job Knowledge of the work processes, potential hazards & PPE requirements Recognition of the link between work site exposure & adverse health effects Familiarity with clinical practice & evidence based practice Copyright 2012 American Association of Occupational Health Nurses

Operational Requirements Facility/equipment requirements Private space to maintain confidentiality Client gowns & sheets Hand washing facilities Locked file cabinet for medical records Emergency response equipment Supplies Administrative needs: recordkeeping Copyright 2012 American Association of Occupational Health Nurses

Health History Establish a health care relationship Identify active & potential physical & mental health problems Determine a risk profile for preventable health concerns Copyright 2012 American Association of Occupational Health Nurses

Components of Comprehensive Health History Client profile Chief complaint History of present illness ( HPI) Supportive positive/negative data –PMH, prior workup, significant prior injury/illness –Family history –Social history Copyright 2012 American Association of Occupational Health Nurses

Components of Comprehensive Health History Occupational/Environmental history Review of Systems (ROS) Past Medical History Medications & allergies Copyright 2012 American Association of Occupational Health Nurses

Purpose of Occupational & Environmental Exposure History Identify asymptomatic occ/env illness Provide epidemiological correlation symptoms & exposures Help to correctly diagnosis occ or env health problems Aid in teaching & counseling Copyright 2012 American Association of Occupational Health Nurses

Screening ~ “WHACS” What do you do? How do you do it? Are you concerned about any exposures on or off the job? Co-workers or others exposed? Satisfied with your job? Copyright 2012 American Association of Occupational Health Nurses

Critical Aspects of Exposure History Quantifying the amount, duration & frequency of exposure ( dose ) Detailing route of exposure Separating acute vs. chronic exposures Separating acute vs. chronic health effects Taking an environmental exposure history Copyright 2012 American Association of Occupational Health Nurses

Physical Exam Identify disease Detect disease process in pre-symptomatic stage Determine biological markers Determine any impairment that may impact the ability to do the job Document baseline objective findings Copyright 2012 American Association of Occupational Health Nurses

Evaluating Outcomes Health outcomes are the result or consequences of a process of care Satisfaction with care Use of health care resources Clinical outcomes, such as changes in health status & in the length & quality of life as a result of detecting or treating disease Copyright 2012 American Association of Occupational Health Nurses

Continuous Quality Improvement Identify values Identify work Identify standards Secure measurements Make interpretations and apply results Set goals for improvement Copyright 2012 American Association of Occupational Health Nurses

Tonya Grayson, LPN Safety & Environmental Health Programs

Objectives Recognize the components of environmental health history Identify resources and peer professionals for environmental health programs Copyright 2012 American Association of Occupational Health Nurses

Introduction The science and practice of occupational safety and environmental health nursing are based on the merging of knowledge gained from many disciplines such as nursing, safety, environmental science, industrial hygiene and public health. It is vital for nurses in this field to understand the principles and the sciences of Environmental Health. Copyright 2012 American Association of Occupational Health Nurses

What is Environment? Environmental health addresses all the physical, chemical and biological factors external to a person, and all the related factors impacting behaviors. Copyright 2012 American Association of Occupational Health Nurses

What are environmental risks? Significant environmental conditions capable of harming the health of a human are experienced at work, where exposures are higher than in other settings. Copyright 2012 American Association of Occupational Health Nurses

Risk Matrix A Risk Matrix is a matrix that is used during Risk Assessment to define the various levels of risk as the product of the harm probability categories and harm severity categories. –Catastrophic - Multiple Deaths –Critical - One Death or Multiple Severe Injuries –Marginal - One Severe Injury or Multiple Minor Injuries –Negligible - One Minor Injury Copyright 2012 American Association of Occupational Health Nurses

Safety & Environmental Risk Analysis Risk Assessment Health Hazards Qualitative Risk Assessment Observational Risk Assessment MSDS Hazard Analysis Risk model Management System How to sustain Copyright 2012 American Association of Occupational Health Nurses

What is our social responsibility? We do have a professional and legal responsibility to ensure the safety of our worker population and their families. Copyright 2012 American Association of Occupational Health Nurses

Cause of Illneses/Injuries Hazard- substance capable of causing harm Risk- probability that harm will occur Epidemiology-study of causes of health related events Incidence rate- a rate in incident per unit of time Prevalence-frequency of event Copyright 2012 American Association of Occupational Health Nurses

Cause of Illnesses/Injuries Target Organ- specific organ affected by specific toxin Asphyxiants- chemical that deprives the body tissue of oxygen Corrosive- causes irreversible tissue death Irritants- cause temporary but sometimes severe inflammation Sensitizer- causes allergic reaction after repeated exposure Copyright 2012 American Association of Occupational Health Nurses

Cause of Illnesses/Injuries Carcinogens- capable of causing cancer Mutagens- causing changes to genetic material of cells (harming future generations) Teratogens- causes malformation of unborn child Inhalants- route of exposure, breathed in Cutaneous- route of exposure, absorbed through skin Ingestion- least common route of exposure, taken in through digestive tract Copyright 2012 American Association of Occupational Health Nurses

Cause of Illnesses/Injuries Lethal dose- dosage that produces death in 50% of population tested Lethal concentration- strength of dose that produces death in 50% of population tested Half Lift- describes times it takes for ½ of the absorbed amount to be eliminated from the body PEL- permissible exposure limits (OSHA) legally enforceable TLV- threshold limit value (ACGIH) 8 hr, time weighted averages Copyright 2012 American Association of Occupational Health Nurses

Cause of Illness/Injuries REL- recommended exposure level (NIOSH), levels of exposure will not cause adverse effects Engineering controls- devices or methods used to stop hazards at their source Administrative controls- supervisory and management practices Personal Protective Equipment- safety equipment Copyright 2012 American Association of Occupational Health Nurses

How to perform environmental health history? The Occupational Health History is a systematic way to gather information about work history and past or present exposure to actual or potential health hazards in that work environment. It can also provide information to help the clinician assess the individual risk and counsel the worker regarding hazards and how to reduce their exposure before problems begin or to alleviate growth of health issues. Provides: –Information –Documentation –opportunities Copyright 2012 American Association of Occupational Health Nurses

Components of the Health History Demographic Work History Home Exposure Community Exposure Occupational Exposure Environmental Exposure Physical Assessment Copyright 2012 American Association of Occupational Health Nurses

Respirable Dust Respirable Dust are solid particles that are able to be suspended in the air and ultimately inhaled into the body. –Asbestos –Coal-Dust –Silica Copyright 2012 American Association of Occupational Health Nurses

Examples of Solvents Benzene Carbon disulfide Ethylene oxide Formaldehyde n-Hexane Methylene Chloride Toluene Tricholoroethylene Metabolite Dichloracetylene Tricholoroethylene Copyright 2012 American Association of Occupational Health Nurses

Asphyxiants Asphyxiants are substances that deprive the tissue of oxygen, they are inhaled. Chemical asphyxiants interfere with the body's ability to transport or use oxygen. 2 examples below: –Carbon monoxide –Hydrogen Cyanide Copyright 2012 American Association of Occupational Health Nurses

Regulatory Agencies EPA DOT USDA FDA DOE DOD OSHA NIOSH DHHS CDC National Center for Environmental Health, Agency for Toxic Substance and Disease Registry Copyright 2012 American Association of Occupational Health Nurses

Bibliography http://en.wikipedia.org/wiki/Environmental_health December 17,2012http://en.wikipedia.org/wiki/Environmental_health http://www.radford.edu/~wkovarik/envhist/womens.movement.html Women in Environmental Timeline December 17, 2012 Rogers, B., Randolph, S., Mastroianni, K., (2009) Occupational Health Nursing Guidelines for Primary Clinical Conditions, 4 th Edition, Beverly Farms, Massachusetts. OEM Press Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, FL: AAOHN www.epa.gov www.osha.gov www.cdc.gov www.cdc.gov/niosh Copyright 2012 American Association of Occupational Health Nurses

Objectives Discuss the need for emergency preparedness in the OHN setting Describe both internal and external disaster preparation and planning for the OHN Review the AAOHN Position Statement outlining the role of the OHN in All-Hazard Preparedness. Copyright 2012 American Association of Occupational Health Nurses

Content Outline Definitions of emergencies, disaster, and acts of terrorism. Planning for the Unexpected –Risk –Resources –Coordination of efforts AAOHN Position Statement of the OHN’s Role in All-Hazard Preparedness –Risk Assessment Internal External –Resource Inventory Internal Community –Coordination of Effort –All-Hazard Plan Development and Preparedness Copyright 2012 American Association of Occupational Health Nurses

Why is disaster planning so important in Occupational Health? Multiple levels of impact –September 11, 2001 –Hurricanes Katrina and Sandy –Mass Shootings at Sandy Hook Elementary School and Aurora Colorado Theater –BP oil rig disaster along US Gulf coast Copyright 2012 American Association of Occupational Health Nurses

Emergency Emergency Definition – Sudden, unexpected, or impending situation that may cause injury, loss of life, damage to the property, and/or interference with the normal activities of a person or firm and which, therefore, requires immediate attention and remedial action. (Webster, 2012) Copyright 2012 American Association of Occupational Health Nurses

Acts of Terrorism Acts of Terrorism Definition – The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in the furtherance of political or social objectives. (Code of Federal Regulations, 2001) Copyright 2012 American Association of Occupational Health Nurses

Internal and External Disaster Plan a.Ongoing and evolving as more information becomes available b.Multidisciplinary c.Interacts with local, community, regional and national efforts Copyright 2012 American Association of Occupational Health Nurses

AAOHN ‘s Position Statement The Occupational Health Nurse’s Role in All-Hazard Preparedness (AAOHN, 2004) AAOHN states : “Work and community environments will be healthy and safe”. (p.1) Copyright 2012 American Association of Occupational Health Nurses

The Occupational Health Nurse’s Role in All-Hazard Preparedness OHN has a role in addressing hazardous situations Review and expand current work-place emergency response plans to include all- hazards Participate in the assessment of potential hazards in the community surrounding the workplace and prepare a plan to address the larger community response to an event. Clear definition of roles and responsibilities will be made proactively within the larger community context. During the event the OHN will work collaboratively to identify, manage and evaluate the emergency response. The OHN will actively participate in the identification and management of the delayed reactions to hazardous events to aid the workers to overcome trauma and resume productive lives. Improve future response Copyright 2012 American Association of Occupational Health Nurses

References American Association of Occupational Health Nursing. (2004). Position Statement: The Occupational Health Nurse’s Role in All-Hazard Preparedness American Association of Occupational Health Nursing. (2012). Standards of Occupational & Environmental Health Nursing. Rogers, B. (2003). Occupational and Environmental Health Nursing: Concepts and Practice. 2 nd edition. Philadelphia: Pa. Elsevier Science. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses

Objectives Describe nursing research and its’ use in the OHN setting Discuss evidenced-based practice for the OHN Review the AAOHN and National Occupational Research Agenda (NORA) Copyright 2012 American Association of Occupational Health Nurses

Content Overview Nursing research basics for the OHN Utilization of evidence-based practice guidelines in occupational health Identification future research needs in occupational health Copyright 2012 American Association of Occupational Health Nurses

Why is nursing research in occupational health important? Research seeks to support and expand the knowledge base needed to practice –Improve worker outcomes –Improve working conditions Copyright 2012 American Association of Occupational Health Nurses

Standards of Practice of Occupational & Environmental Health Nursing (AAOHN, 2012) States “the foundation for occupational and environmental health nursing is research-based”. (p. 1) –Standard X. Research The OHN uses research findings in practice Contributes to the scientific base in occupational health nursing to improve practice Advance the profession as a whole –Criteria Practice reflects the integration of currently validated research findings Research activities are participated in at levels appropriate to the individual’s education and experience Identifying researchable problems Preparing proposals for support of research projects Participating in data collection Protecting the rights of research participants Critically reviewing and evaluating reported research Using research findings in the development of policies, procedures and practice guidelines Sharing research findings and activities Collaborating with other disciplines in the development of research studies and the dissemination of research findings Copyright 2012 American Association of Occupational Health Nurses

History of Nursing Research Florence Nightingale Provided care to soldiers during the Crimean War in 1884 Found the environments of the hospitals to be filthy Organized recordkeeping system for mortality and morbidity of soldiers in her care Instituted sanitary reforms Within months after reforms instituted mortality dropped by 60% Copyright 2012 American Association of Occupational Health Nurses

Scientific inquiry Identifying current issues and problems needing answers in the clinical setting Deriving solutions to these issues and problems utilizing a scientific process of inquiry Establishing a Research Agenda for Occupational and Environmental Health Nursing Copyright 2012 American Association of Occupational Health Nurses

AAOHN Nursing Research Priorities AAOHN funded a study to establish nursing research priorities within the profession 12 priorities emerged: –Effectiveness of primary health care delivery at the worksite –Effectiveness of health promotion nursing intervention strategies. –Methods for handling complex ethical issues related to occupational health. –Strategies to minimize work-related health outcomes (e.g. respiratory diseases) –Health effects resulting from chemical exposures at the workplace –Occupational hazards of health-care workers (e.g. latex allergies, bloodborne pathogens). –Factors influencing workers’ rehabilitation and return to work, –Effectiveness of ergonomic strategies to reduce worker injury and illness. –Effectiveness of case management approaches to in occupational illness/injury. –Evaluation of critical pathways to effectively improve worker health and safety and enhance maximum recovery and safe return to work. –Effects of shift work on worker health and safety. –Strategies for increasing compliance with motivating workers to use personal protective equipment. Copyright 2012 American Association of Occupational Health Nurses

National Occupational Research Agenda (NORA-NIOSH, 1996) Developed by NIOSH with over 500 people/agencies contributing 21 research priorities identified in 3 broad categories: Disease and Injury Work Environment and Workforce Research Tools and Approaches Copyright 2012 American Association of Occupational Health Nurses

NORA - Disease and Injury Allergic and irritant dermatitis Asthma and COPD Fertility and Pregnancy Abnormalities Hearing Loss Infectious Disease Low Back disorders Musculoskeletal Disorders of the Upper Extremities Traumatic Injuries Copyright 2012 American Association of Occupational Health Nurses

NORA - Work Environment and Workforce Emerging Technologies Indoor Environment Mixed Exposures Organization of Work Special Populations at Risk Copyright 2012 American Association of Occupational Health Nurses

NORA - Research Tools and Approaches Cancer Research Methods Control Technology and Personal Protective Equipment Exposure Assessment Methods Intervention Effectiveness Research Risk Assessment Methods Social and Economic Consequences of Workplace Injuries and Illness Surveillance Research Methods Copyright 2012 American Association of Occupational Health Nurses

Evidenced-Based Practice Utilizing the best and most current evidence in making decisions about healthcare delivery for clients incorporates each of the following: Systematic search for and critical appraisal of the most relevant evidence to answer a clinical question Clinical expertise Client values and preferences Provides for professional accountability Failure to follow established clinical guidelines without reason Third party reimbursement increased for following best practice guidelines Improves patient outcomes by 25-30% Copyright 2012 American Association of Occupational Health Nurses

Evidenced-Based Practice Five steps of EBP Clinical question Collecting best and relevant evidence available Critically appraising the evidence Integrate evidence with clinical judgment, client preferences and values and make practice decision Evaluate the decision or change Copyright 2012 American Association of Occupational Health Nurses

References American Association of Occupational Health Nursing. (2007). Competencies in Occupational and Environmental Health Nursing. AAOHN Journal. 55(11).442-447. American Association of Occupational Health Nursing. (2012). Standards of Occupational &Environmental Health Nursing. Melnyk, B.M., & Fineout-Overholt, E., (2005). Evidenced-Based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia, Pa. Lippincott Williams & Wilkins McCauley, L. (2012). Research to Practice in Occupational Health Nursing. Workplace Health and Safety. 60(4). 183-189. Rogers, B. (2003). Occupational and Environmental Health Nursing: Concepts and Practice. 2 nd edition. Philadelphia: Pa. Elsevier Science. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses

Objectives List 3 new proactive strategies to enhance the different medical models that are presented today to organizations. Describe Healthy People 2020 and why it is important to the OHN Describe the goals and objectives one needs to implement a safety program within their respective workplace Discuss two wellness models Copyright 2012 American Association of Occupational Health Nurses

Current initiatives Prevention – we are responsible – just ask AAOHN Development of strategies for behavioral change Hold Employees accountable Look at costs and productivity Comprehensive health program EAP Copyright 2012 American Association of Occupational Health Nurses

Changes for the OHN Changes in our economy Factors affecting national and global competiveness Global market – growing Major Business Issues Health Care Reform Managed Care Copyright 2012 American Association of Occupational Health Nurses

Health Belief Model Perceived susceptibility – is for one’s subjective estimation regarding their own personal risk of developing health problems. Perceived severity – own judgment of how serious the health condition is. Perceived susceptibility + Perceived severity = Perceived threat Copyright 2012 American Association of Occupational Health Nurses

Health Promotion Behavior Optimal health represents a balance between physical, emotional, social, spiritual and intellectual health. Targeted 3 different levels: –Awareness –Lifestyle and behavior changes –Supportive environments Copyright 2012 American Association of Occupational Health Nurses

Moderate Level Program Educational (As in Basic) Monitoring –Vital Signs –Weight –Body Mass Index –Fitness (aerobic capacity, strength, endurance, flexibility) –Blood Sugar & Cholesterol Copyright 2012 American Association of Occupational Health Nurses

Complex Level Program Educational (As in Basic) Monitoring (As in Moderate) Intervention –Implement exercise or nutrition program –Immunizations –More complex testing Audio, vision, PFT, etc. Copyright 2012 American Association of Occupational Health Nurses

Program Task Force Representation from all involved. Identifies needs. Develops plan of action. Take information back to their respective peers. Assist in implementation. Copyright 2012 American Association of Occupational Health Nurses

Benefits Management –Safety –Decreased lost work days/overtime costs –Decreased medical expenses –Improved morale –Cost Containment –Increased productivity Copyright 2012 American Association of Occupational Health Nurses

Benefits Employees –Heightened job performance & enjoyment from work. –Improved performance in physical activities. –Reduction of anxiety, stress, tension, & depression. –Enhanced self-esteem. –More restful & refreshing sleep. Copyright 2012 American Association of Occupational Health Nurses

Benefits Labor Unions –Program is educational, non-punitive. –Program will help members perform their duties. –Program will allow members to enjoy the fruits of their labor when they retire. Copyright 2012 American Association of Occupational Health Nurses

What is Healthy People 2020? Provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to: –Encourage collaborations across communities and sectors. –Empower individuals toward making informed health decisions. –Measure the impact of prevention activities. Copyright 2012 American Association of Occupational Health Nurses

Healthy People 2020 Access to Health Services Healthy Aging Adolescent Health Chronic Health Conditions Health Communication – and technology Global Health OSHA And lots more……… Copyright 2012 American Association of Occupational Health Nurses

Why is Healthy People 2020 important? Directly related to health promotion activities and the goals associated with: –increasing physical exercise –obesity and weight loss –tobacco use –substance use –mental health –injury –violence –immunizations Copyright 2012 American Association of Occupational Health Nurses

Why is this important to the OHN? We have to promote, educate and be there for the working force Health People 2020 is the “blue print” every regulatory body will access Read the document and start a strategic plan on how “you and your team are going to get there” Be proactive and not reactive Copyright 2012 American Association of Occupational Health Nurses

What is Next? We need to become full members of the healthcare team Base of Baccalaureate education for professional practice: –leadership content, knowledge of the care delivery system, teamwork collaboration within and across disciplines and settings, client advocacy skills, practicing within an ethical framework, theories of innovation and foundation for quality and client safety. Promoting of Nursing organizations to play a critical role in health policy and mentoring role to develop nursing leadership skills Coordination among multiple professional organizations with the goal of identifying a shared agenda Need to be politically active Business savvy Copyright 2012 American Association of Occupational Health Nurses

Bibliography Health Care Advisory Board: Hardwiring for Service Excellence, 2007 Daly-Gawenda, Hudson, Perea: Occupational Health Nursing Care Guidelines, Berger, S. Fundamentals of Healthcare Financial Management. (2nd Edition). San Francisco, CA.: Jossey-Bass, 2002 Rogers, B. Occupational and Environmental Health Nursing, Concepts and Practice. (2nd Edition). Philadelphia, PA.: Saunders, 2003 Wolper, L. Health Care Administration – Planning, Implementing and Managing Organized Delivery Systems. (3rd Edition). Gaithersburg, MD.: Aspen, 1999 http://www.sixsigmabenchmarking.com/ Studor Group. “Taking you and your organization to the next level.” January 15-16, 2002. Copyright 2012 American Association of Occupational Health Nurses

Objectives Describe 3 “new” added value services the OHN can demonstrate to their employer List 2 future options the OHN can use in their workplace to enhance their professional relationships with others Name 2 “tips” and “tricks” the OHN can use to enhance their role Discuss data to collect and how to do a ROI Copyright 2012 American Association of Occupational Health Nurses

Opening statement Uncertainty impacts all of us during “trying times”. While there are no easy answers, there are definite ways you can “think out if the box” to preserve your role in the workplace. In today’s economy it is critical for the OHN to be maintained in the workplace. Your role can become stronger and indispensable. You can move from just “surviving” the economic dilemma to preparing your organization the worth you bring to your company. This can be done through smart strategic planning and what worth we bring to any organization. Copyright 2012 American Association of Occupational Health Nurses

“New” Added Value Services “Thinking out of the Box” can bring more added services for the OHN to offer their employer: Knowledge of other specialties acronyms – Financial, Strategic Planning, Budgeting Build new “skill sets” “Beneficial” effects the OHN brings Copyright 2012 American Association of Occupational Health Nurses

Other Duties as Assigned: New Terminology The OHN must be knowledgeable regarding a new language – called finance. We must be business savvy to compete within our own corporations. Presentation style is an art! Communication skills are a must. We are perceived as Leaders within our corporations – and if we aren’t – we have to get there!!! Copyright 2012 American Association of Occupational Health Nurses

Benchmarking Compare BDP of your Corporation – Nationally and Locally Look at specific programs or services and compare to others Create trending reports DOR Perform cost analysis – P&L Perform SWOT Document, Document, Document Be the Leader…… Copyright 2012 American Association of Occupational Health Nurses

Strategic Planning and How to Implement Assessment data –Worker population and Environmental Assessment tools to be used –Questionnaires –HRA –Walk-through reports –WC –Case Management reports –OSHA records/logs Copyright 2012 American Association of Occupational Health Nurses

Performing a Strategic Meeting Bring all respective parties involved together No cell phones or pagers Safe environment Brain Storm Lunch and Snacks Copyright 2012 American Association of Occupational Health Nurses

Beneficial Effects of the OHN Disease Management Environmental Health Emergency Preparedness/Disaster planning Employee Treatment/Follow up and Referrals Emergency Care for job-related injuries and illnesses Gatekeeper for Healthcare Services Rehabilitation/Return-to-Work issues Copyright 2012 American Association of Occupational Health Nurses

Future Options Future options can be derived for the OHN through “networking” with other respective professionals Learn new “skill sets” Enhance professional relationships with others Copyright 2012 American Association of Occupational Health Nurses

Business Building Business savvy “Talk the Talk” Understand the “bottom line” Create meaningful projects Create shared leadership roles Consultant Copyright 2012 American Association of Occupational Health Nurses

Financial Knowledge Understand service volumes Understand expenses and costs Understand revenue The Budget cycle DOR Analysis Global measures of success Accounting policy guidelines Copyright 2012 American Association of Occupational Health Nurses

Cost Classifications Costs are classified according to: –Traceability –Variability –Controllability –Time period in which they are examined Copyright 2012 American Association of Occupational Health Nurses

Understanding Service Volumes Analysis of Service Delivery Volumes: –Actual as reported (current month and YTD) –Budgeted –Historical (1 year prior) –Comparative data from other facilities Copyright 2012 American Association of Occupational Health Nurses

How Service Volumes are Measured Number of patients seen Number of procedures performed Number of service interactions completed Which are called……….stats, encounters, industrials, etc. Copyright 2012 American Association of Occupational Health Nurses

Units of Service (UOS) Clinics: Visits, procedures Physical Therapy : ¼ hour increments (15 minutes sessions) Dietary: equivalent meals ED: # of visits Hospitals: MHAA (man hours per adjusted admission) This includes inpatient as well as out patient combined Copyright 2012 American Association of Occupational Health Nurses

Labor Expense (SWB) Salaries Wages Benefits OHN’s will see this information on first notice of injury –Productive hours –Non-productive hours –Paid hours Copyright 2012 American Association of Occupational Health Nurses

Understanding Revenue Gross Revenue = Charges Gross Revenue – Departmental Operating Expenses = Gross Profit Another key point: Gross profit does not equal Net Revenue Copyright 2012 American Association of Occupational Health Nurses

Global Measures of Success Outpatient Factor = gross patient revenue APD = Adjusted Patient Days AA = Adjusted Admissions ADC = Adjusted Daily Census MHAA = Man Hours per Adjusted Admission Copyright 2012 American Association of Occupational Health Nurses

Accounting Policy Guides APG Review Accounting Policy Guides Company Policies for accounting standards Heightened integrity for financial information Contains: –Fixed assets (capital $$’s) –Leases –Inventory –Inter-company Copyright 2012 American Association of Occupational Health Nurses

ICD – 10 It seems there are many changes taking place and the ICD-10 is one of many. It should not be scary and the changes will not be as bad as some may say International Classification of Diseases, 10th Revision, Clinical Module (ICD-10-CM) becomes effective in 2013. ICD-10-CM is a huge change for diagnosis coding. We have to prepare for this change so that we don’t fail the providers who depend on this for their practice success. Copyright 2012 American Association of Occupational Health Nurses

Teamwork Set clear goals Clarity of responsibility Decision making includes entire team Open communication Build trust Empower Give + feedback Copyright 2012 American Association of Occupational Health Nurses

Communication #1 Priority Use honest discussion Ask forthright questions Ask for clarification Communicate directly with person Say “Thank You” Smile Copyright 2012 American Association of Occupational Health Nurses

Innovation “High-five” all ideas Focus on all customers Willingness to fail Know when to be stubborn and when to be flexible –Stubborn with vision –Flexible with tactics Copyright 2012 American Association of Occupational Health Nurses

Customer Service Don’t criticize or complain Give honest, sincere appreciation Arouse in others an “eager want” Be interested Smile Remember names Good listener Make others feel important Copyright 2012 American Association of Occupational Health Nurses

Change creates FEAR The OHN needs to be ready for change and think “out of the box” Along with change comes FEAR Not knowing the “unknown” What are the expectations? Copyright 2012 American Association of Occupational Health Nurses

Alleviate Fears People in change experience the following fears: Failure Invisibility Chaos Losing power Support failure Going unrewarded Copyright 2012 American Association of Occupational Health Nurses

Greater Benefits for Lesser Costs On-site Case Management Ergonomic site assessments Drug Screens Flu vaccines Immunization program Wellness Stay away from Quality, Popularity of Services verbiage “Talk the Talk” like CFO’s Stay with hard numbers Copyright 2012 American Association of Occupational Health Nurses

Bibliography www.dol.gov www.nachc.org www.standupforhealthcare.org Loher, Jim: The Power of Story, 2007 Newkirk, William L. M.D., Editor: Occupational Health Services – Practical Strategies for Improving Quality and Controlling Costs Health Care Advisory Board: Hardwiring for Service Excellence, 2007 Nelson, David: Get Over It!, 2001 Daly-Gawenda, Hudson, Perea: Occupational Health Nursing Care Guidelines, Berger, S. Fundamentals of Healthcare Financial Management. (2nd Edition). San Francisco, CA.: Jossey-Bass, 2002 Kongstvedt, P. Essentials of Managed Health Care. (2nd Edition). Gaithersburg, MD.: Aspen, 1997 Rogers, B. Occupational and Environmental Health Nursing, Concepts and Practice. (2nd Edition). Philadelphia, PA.: Saunders, 2003 Wolper, L. Health Care Administration – Planning, Implementing and Managing Organized Delivery Systems. (3rd Edition). Gaithersburg, MD.: Aspen, 1999 http://www.sixsigmabenchmarking.com/ http://www.reportcenter.com/reportcenter-su.html http://www.acpa.nche.edu/corcouns/PI/bestpracticescriteria/html Nursing Spectrum, July 12, 2004, “Gearing Up for a Management Position.” Studor Group. “Taking you and your organization to the next level.” January 15-16, 2002. Copyright 2012 American Association of Occupational Health Nurses

Objectives Identify the difference between Leadership and Management Define 3 Leadership approaches and styles Define Emotional Intelligence and name the different components Identify 2 behavioral and personality types for Leaders and Managers Copyright 2012 American Association of Occupational Health Nurses

Opening Statement Leaders and Managers are not born into their roles; they are developed. In today’s work environment it is very challenging to be in a management position, facing the on-going changes people face every day. Leadership style impacts others within the organization and can attribute to turn-over rates – good and bad – personnel morale, and even the evolution of “grooming” others to become leaders. Copyright 2012 American Association of Occupational Health Nurses

A Perspective of Leadership Traditional definition: –“Leadership is creating, and influencing others to contribute to a shared set of goals.” Not just use of power, coercion or mandating Not just exercise of positional authority Some Additions Leadership is all about taking ownership Leadership is a journey – not a destination Requires a commitment to continued learning and development Copyright 2012 American Association of Occupational Health Nurses

Leadership Approaches Various Leadership approaches are used in business and industry: Tactical Transactional Collaborative Transformational Servant Copyright 2012 American Association of Occupational Health Nurses

Difference between Leadership and Management Leadership –Sets a direction –Aligns people –Role Model Management –Plans and Budgets –Organizes and Staffs –Day-to-Day Copyright 2012 American Association of Occupational Health Nurses

Leadership vs. Management Both involve: –Deciding what needs to be done. –Creating networks of people and relationships to accomplish an agenda. –Ensuring that people actually get the work done. Both are necessary for success. Management and Leadership, however accomplish their work in very different ways. Copyright 2012 American Association of Occupational Health Nurses

Leadership vs. Management Directors and Supervisors: –Translate the vision into operational action, set direction, and monitor results. –Storytellers and keepers of the organizational culture. –Mentors and develop others. –Take risks and challenges the status quo. –Tackle underlying problems – step back to see the big picture – resist solving the problem. –Possess an ability to work with and through others. Copyright 2012 American Association of Occupational Health Nurses

Sets a Direction Gather data; look for patterns, trends, to help explain things Ensures vision becomes operational action Creates strategies for change needed to achieve that vision Copyright 2012 American Association of Occupational Health Nurses

Leaders – Aligns People Communicates the new direction to create coalitions that understand the vision and are committed to its achievement –Talk with people both inside and outside the organization –Find the right fit between people and the vision Copyright 2012 American Association of Occupational Health Nurses

Managers – Organizes and Staffs Establish an organizational structure that facilitates implementation of plans as efficiently as possible: Have the right people in the right jobs Communicate plans to workforce Delegate responsibility Develop system/process to monitor implementation Copyright 2012 American Association of Occupational Health Nurses

The Powerful Four Eisenhower/Veterans/Traditionalists/Silent –1922-1945 Baby Boomers –1946-1964 Generation X’ers –1965-1980 Generation Y’ers –1981 - present Copyright 2012 American Association of Occupational Health Nurses

Strategic Planning Vision Mission Strategic plans address the following: –Assessing internal/external –Identify SWOT –Indentify strategies –Implement –Evaluate Copyright 2012 American Association of Occupational Health Nurses

Crucibles Crucibles are key opportunities to develop leadership but only help us do so if we take the time to reflect and learn from them. –Warren Bennis & Robert Thomas, Geeks and Geezers Copyright 2012 American Association of Occupational Health Nurses

Leadership Crucible Leadership Crucible: Concentrated forces interact to cause or influence change - “A major life event from which you learned lessons that will shape your leadership behavior in the future”. Examples: –Coping with the death of a loved one –Losing a job –Overcoming a big adversity –Taking action in an emergency –Not taking action in an emergency Copyright 2012 American Association of Occupational Health Nurses

Emotional Intelligence (EI) EI is the ability to manage yourself and your relationships effectively. Consists of 5 components: –Self Awareness –Self Management –Motivation –Empathy –Social Skill Copyright 2012 American Association of Occupational Health Nurses

Coercive Demands immediate compliance Style in a phrase: “Do what I tell you” EI – Drive to achieve, initiative, self-control Style works best – crisis, kick start a turnaround, or with problem employees Overall impact – Negative Copyright 2012 American Association of Occupational Health Nurses

Authoritative Mobilizes people toward a vision Style in a phrase: “Come with me” EI – Self confidence, empathy, change catalyst Style works best – when change require a new vision or clear direction Overall impact – Most strongly positive Copyright 2012 American Association of Occupational Health Nurses

Affiliative Create emotional bonds and build consensus Style in a phrase: “People come first” EI – Empathy, building relationships, communication Style works best – heal rifts in a team or to motivate people during stressful times Overall impact – Positive Copyright 2012 American Association of Occupational Health Nurses

Democratic Forges consensus through participation Style in a phrase: “What do you think” EI – Collaboration, team leadership, communication Style works best – build buy-in, get input from valuable employees Overall impact – Positive Copyright 2012 American Association of Occupational Health Nurses

Pacesetting Sets high standards for performance Style in a phrase: “Do as I do, now” EI – Conscientiousness, drive to achieve, initiative Style works best – obtain quick results from a highly motivated and competent team Overall impact – Negative Copyright 2012 American Association of Occupational Health Nurses

Coaching Develops people for the future Style in a phrase: “Try this” EI – Developing others, empathy, self- awareness Style works best – to help and improve employee performance or develop long-term strengths Overall impact – Positive Copyright 2012 American Association of Occupational Health Nurses

Leadership traits and Personalities Dominance – ability to take charge High Energy – drive, tolerate stress, and have enthusiasm Self-confidence – self assured in judgments, decision making, and ideas Locus of Control – Control over your own destiny Copyright 2012 American Association of Occupational Health Nurses

Continuance of Traits and Personalities Stability – emotionally in control of themselves, secure, and positive Integrity – behavior that is honest, ethical, and trustworthy Intelligence – cognitive ability to think clearly Flexibility – ability to adjust to different situations Sensitivity to Others – understanding the difference between handling individuals and groups Copyright 2012 American Association of Occupational Health Nurses

Management Process Management process is a sequence of steps that enhances the operations on how leaders exert influence. This is performed through Task Cycles. Copyright 2012 American Association of Occupational Health Nurses

Task Cycles and what is involved Making clear and important goals Planning and Problem Solving Facilitating the work of others Obtaining and providing feedback Monitoring and adjusting the process Reinforcing performance Copyright 2012 American Association of Occupational Health Nurses

Planning and Problem Solving Many people will have an initial reaction and ask themselves “How do I do it?” Steps to follow: –Project Management –Budget –Budget Process –Decision making and ethical considerations Copyright 2012 American Association of Occupational Health Nurses

Obtaining and Providing Feedback Skill set for Leaders include: Communication –Listening –Negotiating –Conflict Resolution –Effective Writing Performance Management Process –Job descriptions –Evaluations Copyright 2012 American Association of Occupational Health Nurses

Monitoring and Adjusting the Process Another question that Leaders asked is: “How to I fix my mistakes? How do I exercise positive control to serve the commitments made?” –Set Policies and Procedures –Protocols –Benchmarking Copyright 2012 American Association of Occupational Health Nurses

Reinforcing Performance It is critical to recognize employee contributions Rewards and Recognition Basic Praise –Personal –Written –Public –Electronic Copyright 2012 American Association of Occupational Health Nurses

Bibliography Accel-Team. (2004). Employee motivation, the organizational environment and productivity. Retrieved on November 15, 2004, from http://www.accelteam.com/humanrelations/hrels_05_herzberg.html. http://www.accelteam.com/humanrelations/hrels_05_herzberg.html Clark, D. (2000). Concept of leadership. Retrieved October 9, 2004, from http://www.nwlink.com/donclark/leader/leadcon.html. http://www.nwlink.com/donclark/leader/leadcon.html Bradberry, Travis and Greaves, Jean. (2009). Emotional Intelligence 2.0. Kersten, Denise. “Today’s Generations Face New Communications Gap,”USA Today, November 15, 2002 Sago, Brad. “Uncommon Threads: Mending the Generation Gap at Work,” Executive Update, July 2000 Lancaster, Lynne C.; Stillman, David. When Generations Collide: Who They Are, Why They Clash, How to Solve the Generational Puzzle at Work. HarperCollins Publishers, Inc. 2002 Karp, Hank; Fuller, Connie; Sirias, Danilo. Bridging the Boomer Xer Gap: Creating Authentic Teams for High Performance at Work. Palo Alto, CA.: Davies-Black Publishing, 2002 Covey, S. R.. The eighth habit: From effectiveness to greatness. New York, NY: FranklinCovey Co. 2004 Copyright 2012 American Association of Occupational Health Nurses

Important Epidemiology Terms Distinguish between incidence rate and prevalence. Strength of Association Relative Risk Odds Ratio Attributable Risk Inferential Statistics Confidence Interval Power of a Study Copyright 2012 American Association of Occupational Health Nurses 267

Content Overview Community health nursing, epidemiology and toxicology play key roles in OHN. Incidence rate is an epidemiological term that describes the occurrence of new disease or injury per unit of time among persons at risk. Prevalence is an epidemiological term that describes the proportion of the population with the condition at a given point in time in a given period. –NOTE: The majority of the information for this section was developed using information extracted from Chapter 5 of the Third Edition of “Core Curriculum for Occupational & Environmental Health Nursing. –Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 268

Reference Sources Additional detail for this presentation may be found at: Gordis, L. (2000). Epidemiology, 2 nd edition. Philadelphia: Saunders. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 269

Occupational Health Nursing Current approaches to occupational and environmental health nursing can be viewed according to a model of public health developed by the Section of Public Healh Nursing of the Minnesota Department of Health (Keller et al., 2004). Copyright 2012 American Association of Occupational Health Nurses 270

Wheel of Public Health Interventions Copyright 2012 American Association of Occupational Health Nurses Wheel of Public Health Interventions: A Collection of “Getting Behind the Wheel” Stories, 2000-2006. Retrieved on December 4, 2012 from: http://www.health.state.mn.us/divs/cf h/ophp/resources/docs/wheelbook20 06.pdf 271

Occupational and environmental health nurses perform interventions depicted by the Intervention Wheel model. Some examples include: –Surveillance, investigation, outreach, and screening functions at system, community and individual levels – e.g. heavy metal screening programs and registries –Working with health departments, worker populations and high risk individuals to identify cases of tuberculosis, treatment, and prevent further spread of disease –Teaching, counseling and consultation about the risks of agricultural hazards –Create safe play areas for urban children are examples of collaboration, coalition building and community organizing –Promote and enforce employer policies to prevent transmission of workplace hazards into the home environment: for example – clothing changes, shower facilities, and worker training. Copyright 2012 American Association of Occupational Health Nurses Wheel of Public Health Interventions 272

Epidemiology – What Are We Studying? Biological factors – genetic background as well as physical and mental health status Behaviors – occur in response to an individual’s experiences and may either cause biological changes or be influenced by biology. Example – smoking (behavior) may cause lung cancer (biology) Social Environment – includes interaction with others, housing, community services, schools and places of worship. Physical Environment – can be the source of exposure to harmful agents, chemicals, pathogens or physical hazards. Copyright 2012 American Association of Occupational Health Nurses 273

Epidemiology – Other Areas Other factors – include policies and interventions relating to health behaviors and health outcomes AND access to quality care – essential for optimizing the health of all. Hazard – a substance capable of causing harm. Example – asbestos Risk – the probability that harm will occur Epidemiology – The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems Copyright 2012 American Association of Occupational Health Nurses 274

Incidence Rate – A Key Term! Incidence rate – describes the occurrence of new disease or injury per unit of time among persons at risk The numerator – includes only new cases of disease during a given time period The denominator – includes everyone at risk of developing disease Incidence rates – are useful for tracking trends in the development or resolution of disease. Example: For an incidence rate per thousand people: No. of new cases in the population during a specified period of time No of persons at risk during that period of time Copyright 2012 American Association of Occupational Health Nurses X 1000 275

Prevalence –Prevalence – describes the proportion of the population with the condition at a given point in time or during a given time period. –The numerator – includes new and existing cases –The denominator – includes all who are at risk of developing the disease, including those who have it. –Prevalence – measures the current burden of disease and is useful for measuring and projecting health care and health resource needs –Example: For a prevalence rate per thousand people: No. of cases in the population during a specified period of time No. of persons in the population during that period of time Copyright 2012 American Association of Occupational Health Nurses X 1000 276

Examples of Epidemiologic Research –Controlling infectious diseases – tuberculosis –Controlling the effects of chemical hazards – asbestosis, mesothelioma, lung cancers related to asbestos –Understanding genetic susceptibility to disease, such as coronary heart disease or cancer – often a combination of heredity and environmental factors –Understanding the effects of nutritional status – link between calcium intake and osteoporosis –Linking pathogens to specific disease processes – West Nile virus –Identifying risk factors for illness or injury, such as work factors that lead to back injuries in health care workers Copyright 2012 American Association of Occupational Health Nurses 277

Why is Epidemiology Important? –It serves as a tool for recognizing, identifying and preventing hazardous exposures –Findings from epidemiological studies of worker and community populations are often reported in the occupational and environmental health literature –Epidemiological studies help occupational and environmental health nurses provide high-quality health services. Copyright 2012 American Association of Occupational Health Nurses 278

Measures of Association Measures of Association – Evaluation of associations among exposures and health outcomes is central to epidemiology. The criteria to evaluate causality based upon observed association includes the following: –Strength of the association –Consistence of the association –Temporality of the association –Dose-response relationship –Plausibility of the association Copyright 2012 American Association of Occupational Health Nurses 279

Sources of Epidemiologic Data –Census data –Vital statistics –National health surveys –NHANES – National Health and Nutrition Examination Surveys –Mandatory reporting systems to capture data –NEDSS – National Electronic Disease Surveillance System –OSHA-recordable illnesses and injuries –Disease and death registries Copyright 2012 American Association of Occupational Health Nurses 280

Exposure Data – How Is It Collected? Exposure data are often more difficult to obtain, especially in environmental and occupational settings –Air monitoring data and biomarkers of exposure –Data can be obtained from exposure registries such as heavy metal exposure, certain pharmaceuticals, and needle-stick injuries –Exposure status is sometimes estimated indirectly from information such as occupational history, occupational history, or location of residence Copyright 2012 American Association of Occupational Health Nurses 281

Relative Risk Relative Risk – (rate ratio) a measure of the relationship between two incidence rates, that of the exposed and that of the unexposed population Example: Relative risk = Incidence in exposed = 28.0 = 1.61 Incidence in non-exposed 17.4 Therefore, the exposed group is 1.61 times more likely to develop the disease. Copyright 2012 American Association of Occupational Health Nurses 282

Odds Ratio Odds Ratio – a good estimate of relative risk, but is derived from case control or cross-sectional studies If the exposure is not related to the disease, the odds ratio will equal 1 If the exposure is positively related to the disease, the odds ratio will be greater than 1 If the exposure is negatively related to the disease, the odds ratio will be less than 1 Copyright 2012 American Association of Occupational Health Nurses 283

Attributable Risk Attributable Risk – a measure of the difference between two rates, one for the exposed and one for the unexposed population. It describes the increased amount of risk attributed to the exposure. To look at this from the other side – How much of the risk (incidence) or disease can we hope to prevent if we are able to eliminate exposure to the agent in question? OR – what would happen to the incidence of lung cancer if we eliminated smoking in the population? Source for this Section 8 – Gordis, L. (2000). Epidemiology, 2 nd edition. Philadelphia: Saunders. Copyright 2012 American Association of Occupational Health Nurses 284

Types of Rates –Crude Rates – based on the actual number of events for a given time period but do not reflect true differences in risk among subgroups in the population –Characteristic-specific rates – allow one to compare rates for similar subgroups of two or more populations (e.g., age- specific or gender-specific rates). –Adjusted (or standardized) rates – reflect population differences by taking into consideration the distribution of important characteristics that may affect the group (e.g., age- adjusted rates) Copyright 2012 American Association of Occupational Health Nurses 285

Inferential Statistics Inferential Statistics – are taken from a sample of a population, and are used to make inferences about the entire target population. Hypothesis – a supposition, resulting from observation or reflection A hypothesis leads to predictions that can be tested Hypothesis testing involves conducting a test of statistical significance and quantifying the degree to which sampling variability may account for the observed results. Copyright 2012 American Association of Occupational Health Nurses 286

Inferential Statistics – Typical Tests –The t-test and the chi-square test are very commonly used. –The t-test assesses whether the means of two groups are statistically different from each other. This analysis is appropriate whenever you want to compare the means of two groups. Source: http://www.socialresearchmethods.net/kb/stat_t.phphttp://www.socialresearchmethods.net/kb/stat_t.php The chi-square test is used to determine whether there is a significant difference between the expected frequencies and the observed frequencies in one or more categories. –Source: http://www.enviroliteracy.org/pdf/materials/1210.pdf Copyright 2012 American Association of Occupational Health Nurses 287

Inferential Statistics – More Info –p-value is a quantitative statement of the probability that the observed difference (or association) in a particular study could have heppend by chance along. p<0.05 means that the probability that the observed difference occurred by chance is less than 5% p<0.05 is a frequently used level for referring to an association as statistically significant –Confidence interval – describes the magnitude of the effect and the inherent variability in an estimated statistic 95% Probability Copyright 2012 American Association of Occupational Health Nurses 288

Power Power of a study – is its likelihood of detecting a real association if one exists; power is affected by the following four variables The magnitude of the effect (or association) or difference The variability of the measures of interest The level of statistic significance selected The size of the sample studies –Larger sample sizes increase the stability of measurements made in an epidemiologic study –Power calculations based on the above variables suggest the appropriate sample size needed for an epidemiologic study Copyright 2012 American Association of Occupational Health Nurses 289

Study Designs Experimental designs – preferred for determining causality Randomized clinical trials and intervention studies Limited by ethical constraints; that is, purposeful exposures of study subjects are not always appropriate Non-experimental designs – attempt to simulate the results of an experiment (had one been possible). Also known as descriptive studies or analytic (ex post facto) studies Copyright 2012 American Association of Occupational Health Nurses 290

Descriptive Studies Descriptive studies – generate a hypothesis and are not intended to determine causality Cross-sectional study – examines the relationship between diseases (or other health-related characteristics) and other variables of interest as they exist in a defined population at one point in time Ecologic study – looks at the group rather than the individual as the unit of analysis, usually because information is not available at the individual level Copyright 2012 American Association of Occupational Health Nurses 291

Analytic Studies Analytic studies – the investigator systematically determines whether the risk of, or a health-related condition is different for exposed and non-exposed individuals –Cohort study (also called a prospective study or longitudinal study) – an analytic study in which persons who are initially free of the disease (or outcome) but vary in one or more factors (such as exposure or potentially protective factors) are followed over a period of time for the occurrence of the disease (or outcome) –Case-control study – a group of persons with a disease (cases) are compared with a group without the disease (controls) to study the characteristics (such as exposure) that might predict, cause, or protect against the disease Copyright 2012 American Association of Occupational Health Nurses 292

Bias and Confounding in Epidemiological Studies Bias refers to systematic error in an epidemiologic study that results in an incorrect estimate of the association between exposure and the risk of disease Selection bias – the identification of subjects for inclusion in the study Information (or observation) bias – systematic differences in the way data on exposure or outcomes are obtained from various study groups –Information bias –Recall bias Interviewer bias –Lost to follow-up –Misclassification –Selection –Self-selection Copyright 2012 American Association of Occupational Health Nurses 293

Types of Bias Type of BiasDescription Information Exposure and outcome data are ascertained differently from study groups Recall Individuals with negative outcomes are more likely to remember and report exposure Interviewer Interviewers' prior knowledge of outcome status affects ascertainment of exposure information in the interview Lost to Follow-up Prospectively, those with negative outcomes may be lost to follow-up at a greater rate than controls Misclassifica tion Ascertainment of either exposure or outcome status is incorrect form some subjects Selection Entry into the study or control group is affected by factors related to exposure (case-control) or outcome (cohort) Self- selection Individuals' participation is affected by their knowledge of disease or exposure status Copyright 2012 American Association of Occupational Health Nurses 294

Confounding Confounding – results when the estimate of the effect of the exposure of interest is distorted because it is mixed with the effect of an extraneous factor Example – age, gender, and smoking status are often important confounding variables –Methods to avoid/manage bias and confounding Strict study protocol with attention to how subjects are selected Systematic, standardized data collection techniques that are consistent for all participants Making comparisons only among individuals with the same level of confounding variables Copyright 2012 American Association of Occupational Health Nurses 295

Screening The practice of testing people who are asymptomatic to classify them with respect to their likelihood of having a disease Sensitivity – the ability of a test to correctly identify those who have a disease ⁻A sensitive test yields few false negatives Specificity – the ability of a test to correctly identify those who DO NOT have the disease ⁻A specific test yields few false positives Sensitivity and specificity do not change when the prevalence of the disease in the population changes Copyright 2012 American Association of Occupational Health Nurses 296

Predictive Value Predictive value of screening tests is the ability to predict disease status from test results Positive predictive value – likelihood that an individual with a positive test truly has the disease Negative predictive value – likelihood that an individual with a negative test truly does not have the disease Levels of predictive value change when the prevalence of disease in a population changes –As the prevalence of disease in a population increases, the positive predictive value of the test will increase –As the prevalence increases, the negative predictive value will decrease Examples of screenings: –Asbestos, cadmium, cotton dust (OSHA medical surveillance) –Breast cancer, prostate cancer, colon cancer (early detection) Copyright 2012 American Association of Occupational Health Nurses 297

References Gordis, L. (2000). Epidemiology, 2 nd edition. Philadelphia: Saunders. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 298

Content Overview Examples of sources of injuries: –Mechanic or kinetic –Thermal energy –Electric energy –Radiation –Chemical energy – Absence of energy NOTE: The majority of the information for this section was developed using information extracted from Chapter 5 of the Third Edition of “Core Curriculum for Occupational & Environmental Health Nursing. –Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 301

Occupational Injury Epidemiology Occupational Injury Epidemiology – The study of the natural history of injuries helps to define the host, agent, vector, and environmental (psychosocial and physical) factors that contribute to injury. Copyright 2012 American Association of Occupational Health Nurses 302

Characteristics of Occupational Injuries They are not random events They are predictable and preventable Injuries result when energy is exchanged in a manner and dose sufficient to overcome the host’s threshold of resistance in the presence or absence of certain environmental conditions Copyright 2012 American Association of Occupational Health Nurses 303

Example of Risk Factor Analysis for Injury Occurrence: A Fracture HostInjuryAgentVector Exposure EventPhysical EnvironmentSociocultural Environment IndividualFracture Kinetic Energy Cement Floor Slip and fall oil, grease, dirt and water on the floorattitude toward housekeeping * Age painted cement floor costs associated with injuries and lost time not accounted for under department budget * Sex equipment and supplies on floor * Health Status lighting * Physical Condition integrity of floor Copyright 2012 American Association of Occupational Health Nurses Source: Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. 304

Examples of Sources of Injuries Mechanical or kinetic energy Thermal energy Electric energy Radiation Chemical energy Absence of energy-producing mechanisms The energy-exchanging event causing an injury can be studied as a sequence of interactions viewed in pre-event, event, and post-event phases. Copyright 2012 American Association of Occupational Health Nurses 305

Haddon Matrix Case example of control countermeasures – slips and falls on the same level in a maintenance area. Source: Haddon, 1963 and 1979, 1990. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. PhaseHuman factors Environmental and engineering factorsSocial, legal and political factors Pre-event * Shoes - non-skid soles; * Safety training - increase awareness; * Establish work practices, including housekeeping * non-skid floor (paint strips); * Oil/grease absorbing material for spills; * Good lighting; * Proper storage and use of equipment and supplies * OSHA inspections and regulation compliance; * Safety audit; * Risk management - insurance losses and litigation Event * Padded clothing; * Optimal physical condition of workers * Energy absorbing floors (with nonskid surface; * Emergency notification system * Injury investigation, reporting and tracking; * Coordination of medical care Post-event * Effective first-aid response; * Interaction with ambulance and hospital emergency services * Prompt access to work location; * Access to first-aid equipment and supplies * Emergency response system - triage, first aid, evaculation, and definitive medical care Copyright 2012 American Association of Occupational Health Nurses 306

Implications for Occupational and Environmental Health Nurses –An understanding of occupational injury epidemiology will enable occupational and environmental health nurses to analyze, characterize and minimize the potential for injury in the work setting. –The occupational and environmental health nurse can use injury prevention and control principles to study, prevent and control the occurrence of injury-producing events and the extent of injury. Copyright 2012 American Association of Occupational Health Nurses 307

Effects of Social Conditions and Behavior on Health Modern approaches to health services have been influenced by a variety of factors: Life expectance has substantially increased Patterns of disease have changed Traditional approaches such as the medical model are not responsive to many modern-day health problems Copyright 2012 American Association of Occupational Health Nurses 308

Effects of Social Conditions and Behavior on Health Research in the behavioral sciences has examined the relationship between human behavior and the occurrences of illness and injury: People often make choices that they know are not good for their health The key to effecting behavioral change is understanding the human thought processes that affect behavior Focusing on behavioral strategies may result in healthier behavioral choices Copyright 2012 American Association of Occupational Health Nurses 309

Effects of Social Conditions and Behavior on Health Behavioral approaches to research may also facilitate a better understanding of the neurologic and behavioral effects of certain exposures Theories and models have been developed to help us understand behavior Models provide a rich source of ideas that can be used to further our understanding of behavior Models enable health care providers to develop more effective intervention Copyright 2012 American Association of Occupational Health Nurses 310

Effects of Social Conditions and Behavior on Health Research in the social sciences has examined the contribution of social environments to the occurrence of illness and injury Increased recognition of the relationship of social phenomena to health in illness outcomes Examples include rates of violence, divorce and unemployment, and the degree to which individuals have care-giving responsibilities or hold multiple jobs The provision of appropriate health services depends on complete understanding and appreciation of the nature of work and the social context of the workplace Copyright 2012 American Association of Occupational Health Nurses 311

Health Promotion and Risk Reduction There is a need to develop organizational “healthy policy” as a strategy to improve workers’ health Healthy policy facilitates and supports healthy behaviors Health-promoting and health-damaging policies of organizations are likely to receive increased scrutiny in the coming years Organizational change is a critical factor in achieving a healthy occupational work environment Copyright 2012 American Association of Occupational Health Nurses 312

Health Promotion and Risk Reduction An important area that would benefit from the attention of the social and behavioral sciences is health promotion that reduces the effects of occupational and environmental exposures. The true benefit of this approach may not be apparent until several years later Copyright 2012 American Association of Occupational Health Nurses 313

Health Promotion and Risk Reduction Social and behavioral sciences can identify and examine factors that threaten the health of workers The psychosocial environment of the workplace plays a critical role in the occurrence of occupational injury and illness ⁻Examples include workplace violence, homicide, mistreatment and harassment, unemployment and underemployment, shift work, workload, role stress, technostress and occupational stress – stresses that occur when the requirements of the job fail to match the capabilities, resources, or needs of the worker. The organization of work in influenced by the ideologies, values and beliefs of people within the organization (managers and workers) and outside of the organization (scientists and governments ⁻These ideologies affect the social dimensions of the workplace The organization of work has been identified as a research priority by NIOSH Implementing strategies based on findings from social and behavioral investigations is likely to result in cost savings to employers and result in a better quality of life for workers Copyright 2012 American Association of Occupational Health Nurses 314

Content Overview –Asphyxiants – deprive the body of oxygen –Corrosives – cause irreversible tissue death –Irritants – cause temporary, but sometimes severe, inflammation –Sensitizers – cause allergic reactions after repeated exposure –Carcinogens – capable of causing cancer –Mutagens – cause changes in genetic makeup –Teratogens – cause malformation in an unborn child –NOTE: The majority of the information for this section was developed using information extracted from Chapter 5 of the Third Edition of “Core Curriculum for Occupational & Environmental Health Nursing. –Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 317

Toxicology –Toxicology – the study of the adverse effects of chemicals on biologic systems –A target organ – the organ that is selective affected by a harmful agent –A chemical is toxic, meaning it can cause harm, if all of the following five conditions are met: Its properties make it capable of producing harm It is present in sufficient amount It is present for sufficient time It is delivered by an exposure route that allows it to be absorbed It reaches the target body organ(s) Copyright 2012 American Association of Occupational Health Nurses 318

Toxic Agent Classification Toxic agents can be classified by their form of action on the biologic system Asphyxiants – deprive the body tissue of oxygen Corrosives – cause irreversible tissue death Irritants – cause temporary, but sometimes severe, inflammation or the eyes, skin, or respiratory tract Sensitizers – cause allergic reactions after repeated exposures Carcinogens – are capable of causing cancer Mutagens – are toxins that cause changes to the genetic material of cells that can be passed on to future generations Teratogens – cause malformations in an unborn child Toxins may have more than one form of action and may act at more than one biologic site Copyright 2012 American Association of Occupational Health Nurses 319

Potential toxic effects by system, with examples of toxins SystemEffectsSources of Exposure RespiratoryIrritationHydrogen chloride, ammonia SensitizationIsocyanates FibrosisSilica, asbestos, beryllium CarcinogensAsbestos, arsenic, chromium VI DermatologicIrritationAcetone, carbon disulfide Corrosive burnsAlkali, hydrogen flouride SensitizationChromate, nickel CarcinogenesisUltraviolet light, arsenic Nervous SystemDepressed/altered consciousnessCarbon monoxide, solvents, lead, mercury, manganese Behavior and mood disturbanceLead, solvents, toluene, mercury Cognitive disturbance, cerebellar impairmentCarbon monoxide, manganese, pesticides Peripheral neuropathyAcrylamide, n-hexane, methyl n-butyl ketone Hearing and VisionAcid burns of eyesHydrochloric and tannic acid Alkali burns of eyesSodium hydroxide, calcium oxide BlindnessMethanol DeafnessNoise HematopoieticBone marrow supressionIonizing radiation, benzene Red cell lysisArsine, trinitrotoluene (TNT), naphthalene HepaticNecrosisCarbon tetrachloride, chloroform, tetrachloroethane CirrhosisCarbon tetrachloride MalignancyVinyl chloride monomer Renal and BladderNephrotoxicityHeavy metals, carbon tetrachloride, chloroform Renal cancerCoke oven emissions Bladder cancerBenzidine, B-naphthylamine ReproductiveDecreased sperm productionIonizing radiation, heat Decreased female fertilityIonizing radiation, carbon disulfide Spontaneous abortionsEthylene oxide Congenital defectsRubella, varicella Copyright 2012 American Association of Occupational Health Nurses 320

Dose of Toxic Agent The dose of an agent is the amount that reaches the target organ –The dose is usually impossible to determine accurately –The dose is usually estimated by measuring the amount administered (as with drugs) or the amount in the environment to which the person has been exposed –Another means of estimating dose is by measuring biomarkers in body tissues Copyright 2012 American Association of Occupational Health Nurses 321

Indicators of Exposure Vapors or gases in the environment are normally measured as parts per million (ppm) Solids (dusts or fumes) are expressed according to their weight per volume of air (mg/m 3 ) Higher concentrations are generally absorbed in greater amounts Longer or more-frequent periods of exposure also lead to greater absorbed doses Copyright 2012 American Association of Occupational Health Nurses 322

Exposure Acute exposure occurs when exposure is short- term and absorption is fairly rapid Chronic exposure refers to longer duration or repeated periods of contact In general, acute toxic exposures tend to be at higher levels, and chronic exposures tend to occur at lower concentrations Copyright 2012 American Association of Occupational Health Nurses 323

Industrial Hygiene Refers to the anticipation, recognition, evaluation and control of environmental factors or stresses arising in or from the workplace, which can cause injury, sickness, impaired health and well-being, or significant discomfort among workers or among citizens –Includes engineering, physics, chemistry and biology Copyright 2012 American Association of Occupational Health Nurses 324

Assessments –Qualitative Assessments Communication with key personnel – plant management and supervisors to learn about materials and processes Communication with occupational and environmental health professionals to learn about health problems related to exposures Communication with workers and their representatives to learn about their perceptions of the exposures –Observational Assessments walk-through surveys, focused inspections, and job hazard analysis Copyright 2012 American Association of Occupational Health Nurses 325

Material Safety Data Sheets (MSDS) Identify the material Hazardous chemicals and their common names Physical and chemical properties Routes of exposure Acute and chronic health effects First aid information Exposure limits Precautions for safe handling and use Control measures Organization responsible for preparing the MSDS and contact information Copyright 2012 American Association of Occupational Health Nurses 326

MSDS Precautions The quality is variable – information can be outdated and unclear, may be inconsistent among manufacturers. Recommended protective measures must be considered in the context of the material’s actual use and the control measures in effect An MSDS for a mixture may not include all chemical components, particularly if their concentration is low or if they are not recognized as hazardous Copyright 2012 American Association of Occupational Health Nurses 327

Sampling Sampling methods – some measure exposure before absorption has occurred –Skin wipes or cloth patches – measure amounts of materials that come in contact with the skin –Noise dosimeters – record work-site noise levels –Airborne contaminants – personal monitoring of the worker’s breathing zone or environmental monitoring in the work area Factor to consider when sampling –Location of the sampling device. Take into account worker movements and location –Workers to be sampled should be those most highly exposed –Timing – consider seasonal changes, shifts, unintentional releases, and other variations –Length of sampling time – should represent a full shift Number of samples required include type of instrument, concentration of the contaminant, and the purpose of sampling Copyright 2012 American Association of Occupational Health Nurses 328

Exposure Records Exposure records should be maintained for at least 30 years Guidelines and standards: Threshold limit values- reflects the level of exposure that the typical worker can experience without an unreasonable risk of disease or injury. TLVs® are not quantitative estimates of risk at different exposure levels or by different routes of exposure. Permissible exposure limits - the maximum amount or concentration of a chemical that a worker may be exposed to under OSHA regulations. Guidelines and standards indicate upper limits of exposure concentrations that are not felt to pose a danger to workers who are exposed over normal work hours Published limits cannot be viewed as definitely “safe” levels Guidelines and standards may be controversial Copyright 2012 American Association of Occupational Health Nurses 329

Control Strategies –Control strategies for occupational exposures Engineering controls – enclose or isolate operations, improve ventilation, and removal or substitution of toxic materials Administrative controls – minimize exposure and include monitoring or surveillance programs, worker rotation, and training to address work practices Personal protective equipment – earplugs and muffs, safety goggles, gloves, coveralls, respirators. These are considered the least-preferred control strategy Copyright 2012 American Association of Occupational Health Nurses 330

Cutaneous Cutaneous - the skin is an effective barrier to most substances, but effectiveness depends upon condition, site, and the properties of the agent –Some agents enter through hair follicles, by trauma or injection –In general, gases penetrate most freely, liquids less freely, and solids insoluble in water or fats do not penetrate –Longer contact promotes higher levels of absorption –Damage to the skin can promote absorption –Clothing and gloves trap substances and lead to longer exposure periods Example – a “paint thinner” rag in the back pocket! Copyright 2012 American Association of Occupational Health Nurses 332

Inhalation Inhalation – the most important route of exposure in the occupational environment –Occurs in the alveoli, and influenced by rate and depth or respirations –Some substances (such as solvents and carbon monoxide) are absorbed through the lungs but exert system effects Copyright 2012 American Association of Occupational Health Nurses 333

Ingestion Ingestion – the least common route of entry –Increases in importance via hand-mouth activity – food, water, and other substances –Caustic or irritant chemicals can have direct adverse affect on the GI tract –Some toxins act systemically following their absorption –Smoking or eating at work sites can lead to consumption of toxins by way of contaminated hands, food, or smoking materials Copyright 2012 American Association of Occupational Health Nurses 334

The Dose-Response Relationship Higher doses are generally associated with responses in a greater proportion of individuals Identification of a dose-response relationship lends support to a theory that a substance causes a given effect Dose-response curves provide a basis for evaluating a chemical’s relative toxicity LD 50 (lethal-dose, 50%) – produces death in 50 of a group of experimental animals (Also known as LC 50 (lethal concentration, 50%) Example – LD 50 of acetone is 5,340 mg/kg, while the LD 50 of cyanide (a much more toxic compound) is 0.5 mg/kg. Animal studies must be interpreted cautiously because of the many differences in response that exist among species Copyright 2012 American Association of Occupational Health Nurses 335

The Nature of Effects Effects of toxins with long latency periods may not be apparent until years after the exposure period Work-related exposures commonly consist of mixtures of substances –Synergistic effects – caused by exposure to more than one toxin Example – smoking and asbestos exposure –Antagonism – between toxins results in an overall effect that is less than the sum of their separate effects –Potentiation – a chemical has no adverse affect on its own, but its presence increases the effect of another substance or makes that substance capable of exerting an effect Often seen with carcinogens Copyright 2012 American Association of Occupational Health Nurses 336

Fate of Toxins in the Body Elimination from the body Excretion – elimination via expired air, urine, feces, bile or perspiration Milk, spinal fluid, saliva, hair Most chemicals and their metabolic products are excreted through the kidneys/urine pathway Biotransformation – can be made less toxic or more toxic prior to elimination from the body The rate of biotransformation can affect individual susceptibility to a toxin Factors affecting the excretion of a substance Many agents are deposited in body tissue and slowly released and excreted over time Half-life – the time it takes for one half of the total absorbed amount to be eliminated from the body Length of the half-life depends on the agent and the tissue where it is stored Example – the half-life of lead is more than 20 years in bone, compared with 25- 30 days in the blood Copyright 2012 American Association of Occupational Health Nurses 337

Endogeneous Factors Endogeneous Factors – factors beyond the control of the individual Gender Genetic differences Aging Pregnant women – exposure can cause perinatal malignancies Pre-existing conditions can influence the effects of exposure to toxins Copyright 2012 American Association of Occupational Health Nurses 338

Exogeneous Factors Exogeneous Factors – factors one may be able to control Nutrition factors – deficiencies can enhance or inhibit absorption or toxic responses Obesity – can promote more storage of lipid-soluble substances Lifestyle factors – such as smoking or alcohol consumption can increase chemical exposures that must be eliminated and may increase susceptibility due to debilitation Stress – can effect organ function, such as cardiovascular, immune, and GI systems Some adverse health conditions are temporary and manageable, but may affect a person’s vulnerability to toxins Copyright 2012 American Association of Occupational Health Nurses 339

Work-related Musculoskeletal Disorders Can be caused or aggravated by work-site factors Affected areas include muscles, tendons, ligaments, peripheral nerves, blood vessels, joints, cartilage and bones Can affect both the upper and lower body Symptoms can include pain, swelling, erythema, numbness and paresthesia Copyright 2012 American Association of Occupational Health Nurses 340

Work-site Risk Factors Repetition – a series of motions Force – lifting weights, handling heavy tools, pinching with fingers, applying grips Carpal tunnel syndrome – combines repetition and force Mechanical stress – worker’s direct contact with work surfaces or tools Compressive forces – striking objects with hand-held tools or from leaning against hard surfaces or corners on work tables – nerve compression disorders Copyright 2012 American Association of Occupational Health Nurses 341

Common Work-site Injuries and Causes Cervical spine – extreme neck flexion and twisting Back injury – twisting at waist, lifting (below knees or above shoulders), awkward postures, carrying, pulling, pushing Shoulder injury – raising arm or elbow above mid torso without support, reaching behind the body Forearm/elbow injury – repeated rotation (supination and pronation) Wrist/hand – repeated wrist flexion and extension, holding in ulnar deviation Copyright 2012 American Association of Occupational Health Nurses 342

Other Common Risks Vibration – power tools or other equipment Whole body vibration – truck drivers, jack- hammer operators Cold environments- can affect manual dexterity and muscle strength Copyright 2012 American Association of Occupational Health Nurses 343

Evaluating Risk Factors Interviews or questionnaires – ask workers about their work ⁻Advantages – worker has the most complete view of the task throughout all work periods. May reveal factors not otherwise noted ⁻Disadvantages – may be a high variability in how workers report their perception of work performance. Observation and use of a checklist – observe workers noting any risk factors ⁻Advantages – look at all workers in the same way, less variability ⁻Disadvantages – workers may change behavior when they are under observation Videotaping and analysis – done on the job and later analyzed ⁻Advantages – does not rely on one person’s assessment ⁻Disadvantages – expensive equipment and experienced personnel Copyright 2012 American Association of Occupational Health Nurses 345

Ergonomic Improvements General environment – adequate illumination ⁻Comfortable temperature and humidity ⁻Good visibility of labels and signs ⁻Clear, audible auditory signals Workstations and chairs – adjustable to accommodate different sized workers Layout – place tools and materials in front of worker to prevent twisting, reaching, bending ⁻Keep work space free of obstacles Postures – avoid static postures ⁻Locate and orient work to promote neutral positions Repetition – engineer the process or product to reduce repetition ⁻Vary tasks or rotate workers ⁻Allow rest time Copyright 2012 American Association of Occupational Health Nurses 346

Ergonomic Improvements Forces – reduce size and weight of objects held ⁻Use power grips vs. pinch grips ⁻Balance tools ⁻Correctly fitted gloves ⁻Sharpen tools often Mechanical stresses – ensure handles fit the workers hands ⁻Pad or eliminate sharp edges Vibration – eliminate vibrating tools if possible ⁻Isolate sources of vibration ⁻Keep tools properly maintained ⁻Maintain even floor surfaces ⁻Reduce driving speeds of vehicles, such as forklifts Lifting – reduce size and weight of tools and objects lifted often ⁻Use mechanical lifting devices ⁻Use gravity to move work ⁻Raise or lower work for the operator ⁻Provide grips and handles Work organization – staff adequately ⁻Alternate physically and mentally demanding tasks ⁻Vary rate and nature of tasks as much as possible ⁻Provide breaks – more frequent breaks are better than long ones! Copyright 2012 American Association of Occupational Health Nurses 347

Objectives Participants will be able to: List 3 Case Management terms List 3 common legal defenses from loss claims under workers compensation Discuss the OHN role as worker advocate Recognize at least 2 models for coaching Copyright 2012 American Association of Occupational Health Nurses

Case Management Definition Case Management is a process in coordinating a workers’ health care services to deliver optimal, quality care in a cost-effective manner. (AAOHN, 2004a) Copyright 2012 American Association of Occupational Health Nurses

Disability Case Management Definition Disability Case Management is: the coordination and management of work- related and nonwork-related injury and illness and includes aspects related to group health, workers’ compensation, short term disability, Family and Medical Leave Act (FMLA), and long- term disability benefits. Copyright 2012 American Association of Occupational Health Nurses

Benefits Services owed an individual, as defined by law. Employment benefits –Health, Dental, 401k plans Workers’ Compensation benefits –Evaluation, Treatment, Rehabilitation, Retraining Copyright 2012 American Association of Occupational Health Nurses

CASH BENEFITS Cash that is paid – –as part of workers’ compensation benefits. –according to an employer’s defined disability plan. – negotiated in a union contract to replace a worker’s loss of income or earning capacity due to disability resulting from an occupational or non- occupational injury or illness. Copyright 2012 American Association of Occupational Health Nurses

4 Classifications of Monetary WC Disability Benefits Temporary Total Disability (TTD) Temporary Partial Disability (TPD) Permanent Total Disability (PTD) Permanent Partial Disability (PPD) Copyright 2012 American Association of Occupational Health Nurses

TEMPORARY TOTAL DISABILITY (TTD) Tax-free reimbursement for partial wages when a worker is temporarily totally disabled. Example: Employee sustains work related injury and requires surgery. Employee is out of work post-op until cleared to return to work on light duty. Copyright 2012 American Association of Occupational Health Nurses

TEMPORARY PARTIAL DISABILITY (TPD) Tax-free reimbursement for partial wages when a worker is temporarily partially disabled. Example: Employee sustains work related injury and is able to work light duty assignment with restricted schedule such as half days or 3 days a week instead of full days, 5 days per week. Copyright 2012 American Association of Occupational Health Nurses

PERMANENT TOTAL DISABILITY (PTD) Tax-free reimbursement for partial wages when a worker is permanently totally disabled. Example: Employee sustains work related injury has no formal education, cannot read and physical restrictions are such that they are not employable in any capacity. Copyright 2012 American Association of Occupational Health Nurses

PERMANENT PARTIAL DISABILITY (PPD) Tax-free reimbursement for partial wages when a worker is permanently partially disabled. Example: Employee sustains a knee injury working as a carpenter requiring extensive kneeling. After surgery, permanent restriction is no kneeling requiring he seek another career which pays much less. Copyright 2012 American Association of Occupational Health Nurses

DEDUCTIBLE The amount that a member of the health care plan must pay for covered services per specified period,(policy year), before the insurer will pay benefits. From WC standpoint, first 40 hours of lost time wages(full time employee), the employee will utilize their PTO. Only if they are out 21 days or more, that PTO pay will be reimbursed. (Not Time) Copyright 2012 American Association of Occupational Health Nurses

EARNING CAPACITY The potential wages a worker could achieve given his or her: –Education –Training –Skill level –Previous experience –Medical condition –Proximity to available work –Other factors Copyright 2012 American Association of Occupational Health Nurses

FUNCTIONAL CAPACITY EVALUATION (FCE) A professional assessment to specifically determine a disabled person’s residual physical abilities. Copyright 2012 American Association of Occupational Health Nurses

INDEPENDENT MEDICAL EXAMINATION (IME) A second medical opinion related to a worker’s health condition that can be legally finding in some jurisdictions. Copyright 2012 American Association of Occupational Health Nurses

THIRD-PARTY ADMINISTRATOR (TPA) A company that handles all the administrative tasks involved in managing claims for self- insured employers who fund their own benefit plans. Copyright 2012 American Association of Occupational Health Nurses

LEGAL DEFENSES Before the passage of workers’ compensation laws, injured workers and the survivors of workers killed on the job could be compensated for their loss or medical costs only through litigation. In the United States, the first workers’ compensation law was passed in Wisconsin in 1911. Copyright 2012 American Association of Occupational Health Nurses

LEGAL DEFENSES Employers were historically protected from loss claims under 3 common legal defenses: –The assumption of risk defense –The fellow servant rule –The concept of contributory negligence Copyright 2012 American Association of Occupational Health Nurses

FELLOW SERVANT RULE Assumed that if a co-worker contributed to an accident or injury, that co-worker should be responsible for compensating the injured worker. Copyright 2012 American Association of Occupational Health Nurses

CONTRIBUTORY NEGLIGENCE Concept holds that the employer was not liable if the employee contributed in any way to the injury: –this defense strategy argued that physical harm would not have come to the worker had he or she been paying attention to the task, overriding the importance of a lack of protective devices. Copyright 2012 American Association of Occupational Health Nurses

Objectives of W/C Laws Ensure prompt and reasonable benefits to injured employees Relieve public and private charitable institutions from bearing the burden of costs Eliminate, insofar as possible, attorney fees and time-consuming trials Encourage maximum employer interest in safety and rehabilitation through experience rating approaches to premiums Copyright 2012 American Association of Occupational Health Nurses

Objectives of W/C Laws Promote research and study in the area of accident causes, with the aim of reducing the occurrence and the human suffering that results Ensure prompt and effective medical treatment to reduce long-term disability Encourage all employers to anticipate and manage on-the-job injuries/illnesses Copyright 2012 American Association of Occupational Health Nurses

CONFLICTS THE OHN FACES The Occupational Health Nurse often faces conflicts between the role of management consultant and client advocate. Copyright 2012 American Association of Occupational Health Nurses

STRATEGIES TO REDUCE CONFLICT OHN serves as first line contact with the ill or injured worker OHN provides case management with an emphasis on return to pre-injury function. OHN acts as a liaison with the worker, other health care professionals, insurers, TPA’s the employer and the workers’ compensation board. Copyright 2012 American Association of Occupational Health Nurses

STRATEGIES TO REDUCE CONFLICT Educate the worker about the benefits of the workers’ compensation or disability system & importance of working as a collaborative team with claims manager and human resources. OHN coordinates transitional duty assignment & communicates with manager & HR. OHN maintains contact between manager, human resources and worker during the disability. Copyright 2012 American Association of Occupational Health Nurses

COACHING Coaching is “a system that grows people by enabling them to learn through guided discovery and hands-on experience” (Renke, 1999) “A coach is not a problem-solver, a teacher, an advisor or even an expert: he or she is a sounding board, a facilitator, a counselor, an awareness raiser.” (Whitmore, 2002) Copyright 2012 American Association of Occupational Health Nurses

THE IDEAL COACH IS: PATIENT DETACHED SUPPORTIVE INTERESTED A GOOD LISTENER PERCEPTIVE AWARE SELF-AWARE ATTENTIVE RETENTIVE (Whitmore, 2002) Copyright 2012 American Association of Occupational Health Nurses

COACHES FACILITATE SELF-DISCOVERY BY: Listening for meaning rather than words. Engaging in expert question-asking Encouraging critical thinking Sharing relevant experiences Copyright 2012 American Association of Occupational Health Nurses

TAKE-AWAY STRATEGIES Treat injured workers with respect and dignity. Respect the worker’s right to confidentiality of medical information whenever possible. Advocate and assist the worker with the multitude of potential issues with the health care system Copyright 2012 American Association of Occupational Health Nurses

Bibliography Salazar, Mary K.:Core Curriculum for Occupational & Environmental Health Nursing Third Edition. Renke,W.J. (1999)Manage Like a Coach Not a Cop Whitmore,J. (2002). Coaching for Performance: Growing People, Performance and Purpose. American Association of Occupational Health Nurses. (2004a). Standards of occupational and environmental health nursing. Copyright 2012 American Association of Occupational Health Nurses

Debbie Bush, RN, COHN-S/CM Professionalism – What Does it Take?

Objectives List (2) aspects of professional development Provide the new OHN with practical tips for networking Describe different audiences the OHN presents to Copyright 2012 American Association of Occupational Health Nurses

Professional Practice Standards From the AAOHN Core Curriculum for Occupational Health Nursing states under Standard I : Professional Development/Evaluation “The occupational health nurse assumes responsibility for professional development and continuing education and evaluates personal professional performance in relation to practice standards.” Copyright 2012 American Association of Occupational Health Nurses

Professional Practice Standards Standard V : Ethics “The occupational health nurse uses an ethical framework as a guide for decision making in practice.” Copyright 2012 American Association of Occupational Health Nurses

OHN Legal Responsibility Maintain knowledge of the law – state/federal Be aware of actual practice and legal guidelines –OSHA, ADA-AA, FMLA, EOC, HIPAA –Documentation –Recordkeeping Copyright 2012 American Association of Occupational Health Nurses

Professional Certification Consumer protection & accountability Employers look for credentials SME – Subject Matter Expert CCM, CRRN, CDMS, CRC, COHN, COHN-S/CM Copyright 2012 American Association of Occupational Health Nurses

Presentation Style Approach –Professionalism image –Dress Appropriately –Think “bottom line” –Know ROI –Be brief – no rambling –Be prepared! –Frequency –Follow up communication Copyright 2012 American Association of Occupational Health Nurses

Key Competencies Managing relationships Building and strengthening current ones Have a heart-to-heart talk with your supervisor Movement toward Upper Management Leading Vision and Mission Initiative Motivating and Influencing Copyright 2012 American Association of Occupational Health Nurses

Key Competencies - continued Standards & Accountability –Accountability –Service orientation – Customer Focus Planning & Decision Making –Critical Thinking –Financial knowledge –Process Management –Prioritizing & Delegating Copyright 2012 American Association of Occupational Health Nurses

Key competencies - continued Communication –Effectively –Giving feedback Developing People –Identify and recruit talent –Develop & Retain talent –Become active in your professional organization –Stay involved –Network Copyright 2012 American Association of Occupational Health Nurses

Planning For Your Personal/ Professional Development Join AAOHN/AOHP Local Chapter –Attend national conferences –Attend local meetings for contact hours –Run for office or volunteer to serve a committee –Attend an OSHA Compliance Course in BBP, Audiometry, Respiratory Protection, and/or Recordkeeping Network with other OHNs Find a mentor! Copyright 2012 American Association of Occupational Health Nurses

Question to Ask Yourself What is the one thing that I and only I can do, that if done well, will make a difference? How do you plan to get there? Copyright 2012 American Association of Occupational Health Nurses

Content Overview The OHN may be an LPN, RN or APRN. In the workplace there may be paramedics, MDs, Industrial Hygienists, safety and infection control professionals, health educators, plus HR and many others. Plus, there are implications for the nurse who engages in mobile health and/or telemedicine OHN practice is impacted by many regulations and legislation that may be unfamiliar to other nurses. NOTE: The majority of the information for this section was developed using information extracted from Chapter 3 of the Third Edition of “Core Curriculum for Occupational & Environmental Health Nursing. –Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 401

Laws vs. Rules and Regulations Law – This is legislation passed be either the State Legislature or the Federal Congress. Regulation – regulations specify definitions, authority, eligibility, benefits and standards. New regulations or existing regulations are known as “Proposed Rules”. Once a regulation takes effect, it becomes a “Final Rule” Copyright 2012 American Association of Occupational Health Nurses 403

Legal Concepts Basic Legal Concepts Relevant to Occupational and Environmental Health Nursing Practice –Tort –Nursing Negligence Standard of Care Duty Breach of duty Copyright 2012 American Association of Occupational Health Nurses 404

Negligence –Examples of negligence include: –Failure to assess and make proper nursing diagnosis –Failure to observe and monitor –Failure to take action –Failure to communicate danger –Delay in obtaining assistance –Medication errors –Failure to obtain informed consent Copyright 2012 American Association of Occupational Health Nurses 405

Informed Consent This means that a worker’s decision about a treatment or action plan is made with a clear understanding, including material risks, benefits, and alternative treatments (i.e., complete notice) To give informed consent, the worker must be advised of the following: ⁻Nature and purpose of proposed treatment ⁻Diagnosis ⁻Materials risks of proposed treatment ⁻Alternative treatments ⁻Consequences of lack of treatment Copyright 2012 American Association of Occupational Health Nurses 406

Malpractice & Statute of Limitations –Malpractice This is negligence that involves professional misconduct or unreasonable lack of skill –Statute of Limitations This is a period of time within which a lawsuit must be filed after a tort occurs Copyright 2012 American Association of Occupational Health Nurses 407

Legal Responsibilities Occupational and environmental health nurses are responsible for maintaining a current knowledge of the laws affecting occupational health practice in the jurisdiction (state) where they practice. Copyright 2012 American Association of Occupational Health Nurses 408

Changes in the administrative rules by the following MAY affect the practice of occupational and environmental health nursing The State Board of Nursing The State Board of Pharmacy The State Board of Medicine Changes in State and Federal laws Copyright 2012 American Association of Occupational Health Nurses Legal Responsibilities 409

There may be inconsistencies between actual practice and the legal guidelines of practice Since laws, rules and regulations that are enacted are dynamic, they may be challenged as professional practice evolves Therefore, the interpretation of laws, rules, and regulations may change as new cases are decided (common law) and legal precedents are established. Copyright 2012 American Association of Occupational Health Nurses Legal Responsibilities 410

Other Professionals Found Working in Occupational and Environmental Health EMTs and Paramedics Physicians Industrial Hygienists Occupational Health and Safety Officers Epidemiologists/Infection Control Specialists Health Educators Human Resources There may be other professionals working in your own facility. Copyright 2012 American Association of Occupational Health Nurses 411

OHN Mobile Health or Telemedicine What about the OHN who does mobile health or telemedicine? –Oil rig companies are using Telemedicine to link workers to physicians, nurses and other health professionals Source – Anscombe, D. (2010). Healthcare delivery for oil rig workers plays a vital role. Telemedicine and e-Health. 16(6):659-663. –Smartphone apps can “interface wirelessly with medical devices such as blood pressure and blood glucose monitors, providing patients with recommendations based on the monitors’ readings” “The technology allows patients to see trends and react to them in real time” Source – Hampton, T. (2012). Recent advances in mobile technology benefit global health, research and care. JAMA. 307(19):2013-2014. Copyright 2012 American Association of Occupational Health Nurses 412

OHN Mobile Health or Telemedicine “Mobile phones are emerging as an important method of encouraging better nurse-patient communication and are estimated to increase in use and application over coming years.” Health promotion areas of focus include dietary interventions, smoking cessation interventions, and physical activity intervention. Health monitoring areas include cancer, asthma, and diabetes. Source – Blake, H. Innovation in practice: Mobile phone technology in patient care. British Journal of Community Nursing. 13(4):162-5. Copyright 2012 American Association of Occupational Health Nurses 413

Reference Anscombe, D. (2010). Healthcare delivery for oil rig workers plays a vital role. Telemedicine and e-Health. 16(6):659-663. Blake, H. Innovation in practice: Mobile phone technology in patient care. British Journal of Community Nursing. 13(4):162-5. Bureau of Labor Statistics, EMTs and Paramedics. Occupational Outlook Handbook (n.d.) Retrieved on November 27,: http://www.bls.gov/ooh/Healthcare/EMTs-and-paramedics.htm http://www.bls.gov/ooh/Healthcare/EMTs-and-paramedics.htm Bureau of Labor Statistics, Epidemiologists. Occupational Outlook Handbook (n.d.) Retrieved on November 27, 2012 from: http://www.bls.gov/ooh/life-physical-and-social-science/epidemiologists.htm http://www.bls.gov/ooh/life-physical-and-social-science/epidemiologists.htm Bureau of Labor Statistics, Health Educators. Occupational Outlook Handbook (n.d.) Retrieved on November 27, 2012 from: http://www.bls.gov/ooh/community-and-social-service/health-educators.htm http://www.bls.gov/ooh/community-and-social-service/health-educators.htm Bureau of Labor Statistics, Human Resources Managers. Occupational Outlook Handbook (n.d.) Retrieved on November 27, 2012 from: http://www.bls.gov/ooh/management/human-resources-managers.htm http://www.bls.gov/ooh/management/human-resources-managers.htm Industrial Hygiene, Industrial Hygienists. United States Department of Labor (n.d.) Retrieved on November 27, 2012 from: http://www.osha.gov/dte/library/industrial_hygiene/industrial_hygiene.htmlttp://www.osha.gov/dte/library/industrial_hygiene/industrial_hygiene.html Bureau of Labor Statistics, Occupational Health and Safety Specialists. Occupational Outlook Handbook (n.d.) Retrieved on November 27, 2012 from: http://www.bls.gov/ooh/healthcare/occupational-health-and-safety-specialists.htmhttp://www.bls.gov/ooh/healthcare/occupational-health-and-safety-specialists.htm Bureau of Labor Statistics, Physicians and Surgeons. Occupational Outlook Handbook (n.d.) Retrieved on November 27, 2012 from: http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm Federal Regulations – The Laws Behind the Acts of Congress (n.d.) About.com: US Government Info. (Retrieved on November 27, 2012 from: http://usgovinfo.about.com/od/uscongress/a/fedregulations.htmhttp://usgovinfo.about.com/od/uscongress/a/fedregulations.htm Hampton, T. (2012). Recent advances in mobile technology benefit global health, research and care. JAMA. 307(19):2013-2014. Industrial Hygiene, United States Department of Labor (n.d.) Retrieved on November 27, 2012 from: http://www.osha.gov/dte/library/industrial_hygiene/industrial_hygiene.html http://www.osha.gov/dte/library/industrial_hygiene/industrial_hygiene.html Mason, D., Leavitt, J., Chaffee, M. (2012). Policy & Politics in Nursing and Health Care, 6 th edition. St. Louis:Elsevier. Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 414

Content Overview The OHN may be an LPN, RN or APRN. In the workplace there may be paramedics, MDs, Industrial Hygienists, safety and infection control professionals, health educators, plus HR and many others. Plus, there are implications for the nurse who engages in mobile health and/or telemedicine OHN practice is impacted by many regulations and legislation that may be unfamiliar to other nurses. NOTE: The majority of the information for this section was developed using information extracted from Chapter 3 of the Third Edition of “Core Curriculum for Occupational & Environmental Health Nursing. –Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 417

Occupational Safety and Health Administration (OSHA) Occupational Safety and Health Act (Public Law 91-596) –Signed into law on December 29, 1970 –The purpose of the act is to “Assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resources”. Copyright 2012 American Association of Occupational Health Nurses 418

OSHA A regulatory agency within the U.S. Department of Labor, was created as a result of the OSH Act. –The Occupational Safety and Health Administration (OSHA) is responsible for enacting, administering, and enforcing standards to provide workplace health and safety and was the first attempt by Congress to provide a comprehensive program to protect the health and safety of American workers. –States may choose to administer their own occupational health and safety program, with the following provisions. OSHA approves the program The state program applies to all workers and includes state, local and private sector workers The state’s statutes must be as strict as federal OSHA requirements, otherwise OSHA statutes apply. (See Figure 1 where State Plans apply) General Duty Clause of the OSH Act –Employers are required to furnish all workers “employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm”. Copyright 2012 American Association of Occupational Health Nurses 419

The following states have approved State Plans:  Alaska Alaska  Arizona Arizona  California California  Connecticut Connecticut  Hawaii Hawaii  Illinois Illinois  Indiana Indiana  Iowa Iowa  Kentucky Kentucky  Maryland Maryland  Michigan Michigan  Minnesota Minnesota  Nevada Nevada  New Jersey New Jersey  New Mexico New Mexico  New York New York  North Carolina North Carolina  Oregon Oregon  Puerto Rico Puerto Rico  South Carolina South Carolina  Tennessee Tennessee  Utah Utah  Vermont Vermont  Virgin Islands Virgin Islands  Virginia Virginia  Washington Washington  Wyoming Wyoming Copyright 2012 American Association of Occupational Health Nurses NOTE: The Connecticut, Illinois, New Jersey, New York and Virgin Islands plans cover public sector (State & local government) employment only. State Occupational Health and Safety Plans. (n.d.). United States Department of Labor. Occupational Health and Safety Administration. Retrieved on November 27, 2012 from: http://www.osha.gov/dcsp/osp/in dex.html http://www.osha.gov/dcsp/osp/in dex.html Figure 1 420

Section 6 of the OSH Act states Section 6 of the OSH Act states – OSHA has the responsibility to promulgate legally enforceable occupational health and safety standards. –Standards are developed to eliminate or reduce risks; compliance with standards must occur to the technologic and economic extent possible –OSHA standards must be reasonably necessary or appropriate to provide safe or healthful employment and places of employment –The development of standards is an interdisciplinary process involving individuals from the fields of health care, epidemiology, law, economics, and industrial hygiene. Standards are written by OSHA employees and invited consultants. –OSHA standards are developed by a public rule-making process that includes the following features: –OSHA has enacted published standards, a current list of which can be found at the OSHA website: Regulations – (Standards – 29 CFR) at: http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=0&p_k eyvalue= http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=0&p_k eyvalue –OSHA can implement emergency standards as proposed permanent standards effective for 6 months. –There are 28 standards that have medical surveillance provisions. (Figure 2) –OSHA Part 1910 Occupational Safety and Health Standards sub-part Z is a series of tables, known as the Z tables, which list permissible exposure limits for substances for which standards are in place and for those for which a standard has not been generated. »A current listing of the Z-tables can be found at the following: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9992 http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9992 Copyright 2012 American Association of Occupational Health Nurses 421

General Industry (29 CFR 1910)29 CFR 1910 General Industry (29 CFR 1910)29 CFR 1910 1910 Subpart H, Hazardous materials1910 Subpart H –1910.120, Hazardous waste operations and emergency response [related topic page]1910.120related topic page 1910 Subpart I, Personal protective equipment [related topic page]1910 Subpart Irelated topic page –1910.134, Respiratory protection [related topic page]1910.134related topic page 1910 Subpart Z, Toxic and hazardous substances [related topic page]1910 Subpart Zrelated topic page –1910.1001, Asbestos [related topic page]1910.1001related topic page Appendix H, Medical surveillance guidelines for asbestos (Non-mandatory)Appendix H –1910.1003, 13 Carcinogens (4-nitrobiphenyl, etc.)1910.1003 –1910.1004, alpha-Naphthylamine1910.1004 –1910.1006, Methyl chloromethyl ether1910.1006 –1910.1007, 3,3'-Dichlorobenzidine (and its salts)1910.1007 –1910.1008, bis-Chloromethyl ether1910.1008 –1910.1009, beta-Naphthylamine1910.1009 –1910.1010, Benzidine1910.1010 –1910.1011, 4-Aminodiphenyl1910.1011 –1910.1012, Ethyleneimine1910.1012 –1910.1013, beta-Propiolactone1910.1013 –1910.1014, 2-Acetylaminofluorene1910.1014 –1910.1015, 4-Dimethylaminoazobenzene1910.1015 –1910.1016, N-Nitrosodimethylamine1910.1016 –1910.1017, Vinyl chloride1910.1017 –1910.1018, Inorganic Arsenic [related topic page]1910.1018related topic page Appendix C, Medical surveillance guidelinesAppendix C –1910.1025, Lead [related topic page]1910.1025related topic page –1910.1027, Cadmium [related topic page]1910.1027related topic page –1910.1028, Benzene [related topic page]1910.1028related topic page Appendix C, Medical surveillance guidelines for benzeneAppendix C –1910.1029, Coke oven emissions1910.1029 Appendix B, Industrial hygiene and medical surveillance guidelinesAppendix B –1910.1030, Bloodborne pathogens [related topic page]1910.1030related topic page –1910.1043, Cotton dust [related topic page]1910.1043related topic page –1910.1044, 1,2-dibromo-3-chloropropane1910.1044 Appendix C, Medical surveillance guidelines for DBCPAppendix C –1910.1045, Acrylonitrile1910.1045 Appendix C, Medical surveillance guidelines for acrylonitrileAppendix C –1910.1047, Ethylene oxide [related topic page]1910.1047related topic page Appendix C, Medical surveillance guidelines for ethylene oxide (Non-mandatory)Appendix C –1910.1048, Formaldehyde [related topic page]1910.1048related topic page –1910.1050, Methylenedianiline1910.1050 Appendix C, Medical surveillance guidelines for MDAAppendix C –1910.1450, Occupational exposure to hazardous chemicals in the laboratories1910.1450 Medical Screening and Surveillance.(n.d.). United States Department of Labor. Occupational Health and Safety Administration. Retrieved on November 27, 2012 from: http://www.osha.gov/SLTC/medicalsurveillance/index.html http://www.osha.gov/SLTC/medicalsurveillance/index.html Copyright 2012 American Association of Occupational Health Nurses Figure 2 422

OSHA OSHA is authorized to enforce established standards by performing inspections, with or without advance notice to the employer. –Inspections may include a review of records, walk-through, and worker interviews –OSHA has established a system of inspection priorities in the following order: Imminent danger situations Fatalities and catastrophes resulting in hospitalization of three or more workers. Worker complaints of alleged violation of standards or previously identified violations Planned inspections aimed at special high hazard industries, occupations or substances. –Workers or authorized worker representatives may request OSHA to perform an inspection –OSHA may issue citations identifying violations and specifying the penalty associated with each violation Copyright 2012 American Association of Occupational Health Nurses 423

OSHA OSHA consults with business and industry about health and safety issues. These consultation services primarily target small business –Employers can request an OSHA consultation to accomplish the following: Identify and correct hazards Provide technical assistance related to work site hazards Provide education and training to health and safety personnel –OSHA provides basic to advanced occupational health and safety classes through the OSHA Training Institute Copyright 2012 American Association of Occupational Health Nurses 424

OSHA’s Voluntary Protection Program (VPP) OSHA’s Voluntary Protection Program (VPP) was adopted in 1982. (http://www.osha.gov/dcsp/vpp/index.html)http://www.osha.gov/dcsp/vpp/index.html VPP Requirements include the following: A comprehensive written program demonstrating management commitment and planning A thorough work site analysis Hazard prevention and control systems Safety and health training Active worker involvement A lost workday case rate of below 50% of the national average for the specific industry (based on a review of 3 years of OSHA 300 logs) Periodic program evaluation with annual report submission Worker commitment Copyright 2012 American Association of Occupational Health Nurses 425

OSHA VPP Participating employers are eligible for VPP awards. Award levels are as follows: Star – exemplary work sites with comprehensive, successful safety and health management systems Merit – effective stepping-stone to “Star”. Merit sites have good safety and health management systems, but these systems need some improvement to be judged excellent. Star Demonstration – designed for work sites with Star Quality safety and health protection to test alternatives to current Star requirements. Copyright 2012 American Association of Occupational Health Nurses 426

OSHA In 1988 OSHA instituted measures to ensure nursing representation in policy making. 1988 – the first occupational and environmental health nurse was hired by OSHA 1988 – an Occupational Health Nurse Intern Program was introduced, available to nurses in graduate school who are specializing in occupational health 1993 – the Office of Occupational Health Nursing was formally recognized and established Copyright 2012 American Association of Occupational Health Nurses 427

National Institute for Occupational Safety and Health (NIOSH) A part of the Centers for Disease Control and Prevention (CDC), was also created by the OSH Act Conducts or funds occupational health and safety research to establish safe levels of toxic materials. This research is the basis of OSHA standards. NIOSH also provides training and education to occupational health and safety professionals, including graduate programs for occupational health nurses. Copyright 2012 American Association of Occupational Health Nurses 428

The Occupational Safety and Health Review Commission (OSHRC) An independent regulatory commission authorized by the OSH act (http://www.oshrc.gov/)http://www.oshrc.gov/ Members are appointed by the President with Senate approval OSHRC is responsible for handling appeals filed by employers who have received OSHA citations Copyright 2012 American Association of Occupational Health Nurses 429

Americans with Disabilities Act (ADA) of 1990 The ADA is wide-ranging legislation intended to make American society more accessible to people with disabilities. (http://www.ada.gov/) –Disability is defined as A physical or mental impairment that substantially limits one or more major life activities A record of such an impairment Being regarded as having such an impairment –Title I of the ADA applies to employers (including public and private employers, employment agencies, and labor unions) with more than 15 employees. –Businesses must protect the rights of “qualified individuals with disabilities” in all aspects of employment, including the application process, hiring, firing, compensation and benefits, and training. Copyright 2012 American Association of Occupational Health Nurses 430

ADA Qualified person with a disability is one who can perform the essential functions of the job with or without “reasonable accommodation”. –Reasonable accommodations may include the following: Making existing facilities used by workers readily accessible to and usable by persons with disabilities Restructuring the job, modifying work schedules, or reassigning the worker to a vacant position Acquiring or modifying equipment or devices; modifying examinations, training materials, or policies; or providing qualified readers or interpreters –Considerations related to providing reasonable accommodation include the following (AAOHN, 1994): Decisions should be made by a multidisciplinary team that includes health and safety professionals, human resource staff, and management The affected worker should be consulted regarding accommodations Copyright 2012 American Association of Occupational Health Nurses 431

ADA The ADA affects employment inquiries and medical examinations in the following ways (Equal Employment Opportunity Commission [EEOC], 2000). –Employers may not ask job applicants about the existence, nature, or severity of a disability; however, they may ask about the applicants ability to perform specific job functions. –A medical examination may be performed after a conditional offer of employment has been made, if examinations are required for all entering workers in similar jobs; the post-offer examination does not have to be job related. –If an individual is not hired because of the post-offer examination: The reason for not hiring must be job-related and consistent with business need. The employer must show that no reasonable accommodation was available or that accommodation would impose an undue hardship The EEOC enforces and regulates Title I of the ADA Copyright 2012 American Association of Occupational Health Nurses 432

Family and Medical Leave Act (FMLA) of 1993 (29CFR825.118) FLMA entitles eligible workers to take up to 12 weeks of unpaid, job-protected leave in a 12- month period for the following reasons: (http://www.dol.gov/whd/fmla/#.ULT-C2eOwkY)http://www.dol.gov/whd/fmla/#.ULT-C2eOwkY –The birth and care of the worker’s newborn child –Adoption or foster placement of a child with the worker –The care of a parent, spouse, or child with a serious health condition –The worker’s inability to work because of a serious health condition –any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” –Twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember’s spouse, son, daughter, parent, or next of kin (military caregiver leave). To be eligible for leave under the FMLA, the following conditions must be satisfied: –The worker must work for a covered employer in a covered location (at least 50 workers employed within 75 miles) –The worker must have worked for the employer for a total or 12 months and worked at least 1250 hours during the 12 months immediately before the leave. Copyright 2012 American Association of Occupational Health Nurses 433

FMLA Under some conditions, workers may take FMLA leave on an intermittent basis –For example, in blocks of time or by reducing a normal week schedule A serious health condition includes the following: (http://www.gpo.gov/fdsys/pkg/CFR-2010-title29-vol3/xml/CFR-2010- title29-vol3-sec825-115.xml)http://www.gpo.gov/fdsys/pkg/CFR-2010-title29-vol3/xml/CFR-2010- title29-vol3-sec825-115.xml –Incapacity and treatment –Pregnancy or pre-natal care –Chronic conditions –Permanent or long-term conditions –Conditions requiring multiple treatments –Absences plus treatment –The full text of the regulations in included in Figure 3 Copyright 2012 American Association of Occupational Health Nurses 434

FMLA Rights and responsibilities under FMLA include the following: The worker has the right to return to the same or equivalent position with equivalent benefits, compensation, and conditions of employment The worker has a responsibility to provide the employer with reasonable notice of the leave (at least 30 days when foreseeable). The employer has the right to require medical certification to support the worker’s claim for leave related to health conditions of self or a family member The Department of Labor has devised a “Certificate of Health Care Provider Form” to obtain medical certification (available at http://www.dol.gov/whd/forms/WH-380-E.pdf)http://www.dol.gov/whd/forms/WH-380-E.pdf The employer has a responsibility to keep and maintain records regarding compliance with act. They must also conspicuously post a notice containing information about the FMLA. Several states have their own legislation governing family and medical leave The United States Department of Labor’s (USDL) Employment Standards Administration, Wage and Hour Division administers and enforces FLMA. Copyright 2012 American Association of Occupational Health Nurses 435

Code of Federal Regulations Copyright 2012 American Association of Occupational Health Nurses Title 29 - LaborVolume: 3Date: 2010-07-01Original Date: 2010-07-01Title: Section 825.115 - Continuing treatment.Context: Title 29 - Labor. Subtitle B - Regulations Relating to Labor (Continued). CHAPTER V - WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR. SUBCHAPTER C - OTHER LAWS. PART 825 - THE FAMILY AND MEDICAL LEAVE ACT OF 1993. Subpart A - Coverage Under the Family and Medical Leave Act. § 825.115 Continuing treatment. A serious health condition involving continuing treatment by a health care provider includes any one or more of the following: (a) Incapacity and treatment. A period of incapacity of more than three consecutive, full calendar days, and any subsequent treatment or period of incapacity relating to the same condition, that also involves: (1) Treatment two or more times, within 30 days of the first day of incapacity, unless extenuating circumstances exist, by a health care provider, by a nurse under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders of, or on referral by, a health care provider; or (2) Treatment by a health care provider on at least one occasion, which results in a regimen of continuing treatment under the supervision of the health care provider. (3) The requirement in paragraphs (a)(1) and (2) of this section for treatment by a health care provider means an in-person visit to a health care provider. The first (or only) in- person treatment visit must take place within seven days of the first day of incapacity. (4) Whether additional treatment visits or a regimen of continuing treatment is necessary within the 30-day period shall be determined by the health care provider. (5) The term “extenuating circumstances” in paragraph (a)(1) of this section means circumstances beyond the employee's control that prevent the follow-up visit from occurring as planned by the health care provider. Whether a given set of circumstances are extenuating depends on the facts. For example, extenuating circumstances exist if a health care provider determines that a second in-person visit is needed within the 30-day period, but the health care provider does not have any available appointments during that time period. (b) Pregnancy or prenatal care. Any period of incapacity due to pregnancy, or for prenatal care. See also § 825.120. (c) Chronic conditions. Any period of incapacity or treatment for such incapacity due to a chronic serious health condition. A chronic serious health condition is one which: (1) Requires periodic visits (defined as at least twice a year) for treatment by a health care provider, or by a nurse under direct supervision of a health care provider; (2) Continues over an extended period of time (including recurring episodes of a single underlying condition); and (3) May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.). (d) Permanent or long-term conditions. A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzheimer's, a severe stroke, or the terminal stages of a disease. (e) Conditions requiring multiple treatments. Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, for: (1) Restorative surgery after an accident or other injury; or (2) A condition that would likely result in a period of incapacity of more than three consecutive, full calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), or kidney disease (dialysis). (f) Absences attributable to incapacity under paragraph (b) or (c) of this section qualify for FMLA leave even though the employee or the covered family member does not receive treatment from a health care provider during the absence, and even if the absence does not last more than three consecutive, full calendar days. For example, an employee with asthma may be unable to report for work due to the onset of an asthma attack or because the employee's health care provider has advised the employee to stay home when the pollen count exceeds a certain level. An employee who is pregnant may be unable to report to work because of severe morning sickness. 436

Health Insurance Portability and Accountability (HIPAA) Act, 1996 The Health Insurance Portability and Accountability Act of 1996 was designed to address industry inefficiencies related to health insurance plans and to protect health care coverage for millions of workers and their families –Title I – Healthcare access, portability, and renewability, which focuses on allowing persons to qualify immediately for comparable health insurance when they change employment –Title II – Preventing health care fraud and abuse and providing for administrative simplification that reduces the costs and administrative burden of health care by providing electronic standards to be used throughout the health care industry. –Title III – Tax-related provisions, which address various issues, including medical savings and long-term services and contracts. –Title IV – Application and enforcement of group health plan requirements and clarification of continuation of coverage requirements. –Title V – Revenue offsets, which address company owned life insurance and treatment of individuals who lose citizenship Copyright 2012 American Association of Occupational Health Nurses 437

HIPAA HIPAA includes important new protections for workers through: –It limits exclusions for pre-existing conditions –Prohibits discrimination against workers and dependents based on their health status –Guarantees renewability and availability of health coverage to certain employers and individuals –Protects many workers who lose health coverage by providing better access to individual health insurance coverage Copyright 2012 American Association of Occupational Health Nurses 438

HIPAA HIPAA’s Privacy Rule went into effect in April 2003: Covered entities” may not use or disclose protected health information (PHI), except as allowed by the HIPAA Privacy Rule for treatment, payment or health care operations, or under a specific authorization from the individual who is the subject of the PHI, or for “Public Policy Exceptions”. Protected Health Information (PHI) is health plan information that: ⁻Identifies the individual ⁻Relates to the individual’s health, health care treatment, or health care payment ⁻Is maintained or disclosed electronically, by paper, or orally The three categories of covered entities are: ⁻Healthcare providers ⁻Healthcare clearinghouses ⁻Health plans Copyright 2012 American Association of Occupational Health Nurses 439

HIPAA Plans covered by the Privacy Rule include: –Medical insurance plans, including prescription drug benefits –Dental insurance plans –Vision insurance plans –Health care flexible spending accounts –Employee assistance programs (EAP) to the extent that they offer medical care Plans not covered by the privacy rule include: –Short-term and long-term disability –Accidental death and dismemberment (AD&D), a type of supplementary insurance –Worker’s compensation –Dependent care spending accounts –Life insurance –Other work-life benefits Copyright 2012 American Association of Occupational Health Nurses 440

HIPAA and OHNs OHNs must determine if they are a “covered entity” –Are they involved in a “prior authorization” for care? –Perform “disease management” for the plan? –Perform health risk assessments for the plan? –The computer system contains information that comes from the plan (e.g., medical information, demographics) –Provides services and submit bills to the plan –Provides case management for persons covered by the health plans. Occupational and environmental health nurses who work with health plan operation and PHI must be “fire-walled” from the rest of the company. –Workers outside the unit cannot access PHI from the fire-walled unit –The unit must comply with the privacy rule Copyright 2012 American Association of Occupational Health Nurses 441

HIPAA and OHN An OHN subject to HIPAA as a “covered entity” MUST: –Notify workers of their privacy rights and how their information can be used –Obtain specific client authorization to use or disclose PHI for all purposes other than treatment, payment, or healthcare operations and “Public Policy Exceptions” –Protect PHI from inadvertent misuse and disclosure –Train staff in appropriate administrative, physical, and technical safeguards to protect PHI. –Limit PHI disclosure to the “minimum necessary” to achieve the purpose, except in limited circumstances. –Permit individuals to review and amend health information –Maintain an accounting of persons to whom PHI has been disclosed –Appoint a “privacy officer” –Establish Business Associate Contracts –Comply with more stringent state laws. Copyright 2012 American Association of Occupational Health Nurses 442

Public Policy Exceptions –As required by law –For public health –About victims of abuse, neglect or domestic violence –For health oversight activities –For judicial & administrative proceedings –For law enforcement purposes –About decedents (to coroners, medical examiners, funeral directors) –For cadaveric organ, eye or tissue donations –For research purposes –To avert a serious threat to health or safety –For specialized government functions (military, veterans, national security, protective services, State Dept, correctional) –For Workers’ Compensation Copyright 2012 American Association of Occupational Health Nurses 443

HIPAA and OHN If an independent nurse case manager is working for a “covered entity”, that nurse would be considered a business associate and would need to sign an agreement to protect PHI in accordance with the Privacy Rule –Even if not a “covered entity”, OHNs are affected by HIPAA regulations when they obtain PHI from other health care providers who are covered entities –Covered health care providers will require worker authorization for release of Short-term and long-term disability information Pre-placement medical information Information on workers covered by the Family and Medical Leave Act and the Americans with Disabilities Act Fitness for duty medical information –Employers can mandate “blanket” authorizations as a condition for employment –If exams are performed in-house, authorizations are not needed –Covered health care providers should require HIPAA authorization forms –Authorization is not required for medical surveillance to comply with OSHA or for workplace injury/illness information needed for OSHA recordkeeping –Covered health care providers must provide written notice to the worker that medical surveillance data will be disclosed to the employer. (Notice may be posted at the worksite if the service is provided there) –Employers are not “covered entities” although their “Health Plans” are. –Worker records (including worker health records held in the occupational health department) are excluded from the definition of PHI –Once an employer receives worker-related PHI, it is no longer protected by the Privacy Rule Copyright 2012 American Association of Occupational Health Nurses 444

References 1910.1000 Table Z-1 Limits for Air Contaminants (n.d.). Occupational Safety and Health Standards. Retrieved November 20, 2012 from: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9992ttp://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9992 Americans With Disabilities Act (n.d.). U.S. Department of Justice. Retrieved on November 29, 2012 from: http://www.ada.gov/ http://www.ada.gov/ Certificate of Health Care Provider Form (n.d.). U.S. Department of Labor. Retrieved on November 29, 2012 from: http://www.dol.gov/whd/forms/WH-380-E.pdf http://www.dol.gov/whd/forms/WH-380-E.pdf Family and Medical Leave Act (n.d.). U.S. Department of Labor. Retrieved on November 29, 2012 from: http://www.dol.gov/whd/fmla/#.ULjTk2eOwkZ http://www.dol.gov/whd/fmla/#.ULjTk2eOwkZ Medical Screening and Surveillance.(n.d.). United States Department of Labor. Occupational Health and Safety Administration. Retrieved on November 27, 2012 from: http://www.osha.gov/SLTC/medicalsurveillance/index.htmlhttp://www.osha.gov/SLTC/medicalsurveillance/index.html Occupational Safety and Health Review Commission (n.d.). Retrieved on November 29, 2012 from: http://www.oshrc.gov/ http://www.oshrc.gov/ Regulations (Standards – 29 CFR) (n.d.). Occupational Safety & Health Administration. Retrieved November 29, 2012 from: http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=0&p_keyvalue= http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=0&p_keyvalue Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Serious Health Condition (n.d.). 29(CFR)-Code of Federal Regulations. Retrieved on November 29, 2012 from: http://www.gpo.gov/fdsys/pkg/CFR-2010-title29-vol3/xml/CFR-2010-title29-vol3-sec825-115.xml http://www.gpo.gov/fdsys/pkg/CFR-2010-title29-vol3/xml/CFR-2010-title29-vol3-sec825-115.xml State Occupational Health and Safety Plans. (n.d.). United States Department of Labor. Occupational Health and Safety Administration. Retrieved on November 27, 2012 from: http://www.osha.gov/dcsp/osp/index.htmlhttp://www.osha.gov/dcsp/osp/index.html Voluntary Protection Programs (n.d.). Occupational Health & Safety Administration. Retrieved November on 29, 2012 from: http://www.osha.gov/dcsp/vpp/index.html http://www.osha.gov/dcsp/vpp/index.html Copyright 2012 American Association of Occupational Health Nurses 445

Content Overview OHNs have confidentiality responsibilities for personal medical information and must balance that with injury and Personal Protected Information (PPI) NOTE: The majority of the information for this section was developed using information extracted from Chapter 3 of the Third Edition of “Core Curriculum for Occupational & Environmental Health Nursing. –Salazar, M. (2011). Core Curriculum for Occupational & Environmental Health Nursing, 3 rd edition. Pensacola, Fl:AAOHN. Copyright 2012 American Association of Occupational Health Nurses 447

Professional Position on Ethics AAOHN Standards of Occupational and Environmental Health Nursing, Standard XI, Ethics: The occupational and environmental health nurse uses an ethical framework for decision-making in practice (AAOHN, 2004c). (see Appendix I) Copyright 2012 American Association of Occupational Health Nurses 449

Standards of Occupational and Environmental Health Nursing* Standard I: Assessment –The occupational and environmental health nurse systematically assesses the health status of the client(s). Standard II: Diagnosis –The occupational and environmental health nurse analyzes assessment data to formulate diagnoses. Standard III: Outcome Identification –The occupational and environmental health nurse identifies outcomes specific to the client. Standard IV: Planning –The occupational and environmental health nurse develops a goal-directed plan that is comprehensive and formulates interventions to attain expected outcomes. Standard V: Implementation –The occupational and environmental health nurse implements interventions to attain desired outcomes identified in the plan Standard VI: Evaluation –The occupational and environmental health nurse systematically and continuously evaluates responses to interventions and progress towards the achievement of desired outcomes. Standard VII: Resource Management –The occupational and environmental health nurse secures and manages the resources that support occupational health and safety programs and services. Standard VIII: Professional Development –The occupational and environmental health nurse assumes accountability for professional development to enhance professional growth and maintain competency. Standard IX: Collaboration –The occupational and environmental health nurse collaborates with clients for the promotion, prevention, and restoration of health within the context of a safe and healthy environment Standard X: Research –The occupational and environmental health nurse uses research findings in practice and contributes to the scientific base in occupational and environmental health nursing to improve practice and advance the profession. Standard XI: Ethics –The occupational and environmental health nurse uses an ethical framework as a guide for decision-making in practice. Copyright 2012 American Association of Occupational Health Nurses 450

Professional Position on Ethics The AAOHN Code of Ethics (AAOHN, 2009) provides the ethical framework to guide the conduct of the occupational and environmental health nurse –Ethics is synonymous with moral reasoning. Ethics is not law, but a guide for moral action. Professional nurses, when making judgments related to the health and welfare of the client, utilize these significant universal moral principles. These principles are: Right of self-determination Confidentiality Truth telling Doing or producing good Avoiding harm Fair and nondiscriminatory treatment Copyright 2012 American Association of Occupational Health Nurses Ethics is what you do when no one else is watching! 451

Professional Position on Ethics The Following Are The Code of Ethics Interpretive Statements Occupational and environmental health nurses provide health, wellness, safety and other related services to clients with regard for human dignity and rights, unrestricted by considerations of social or economic status, personal attributes or the nature of the health status. Occupational and environmental health nurses, as licensed health care professionals, accept obligations to society as professional and responsible members of the community. Occupational and environmental health nurses strive to safeguard clients’ rights to privacy by protecting confidential information and releasing information only as required or permitted by law. Occupational and environmental health nurses promote collaboration with other professionals, community agencies, and stakeholders in order to meet the health, wellness, safety and other related needs of the client. Occupational and environmental health nurses maintain individual competence in nursing practice, based on scientific knowledge, and recognize and accept responsibility for individual judgments and actions, while complying with appropriate laws and regulations. Copyright 2012 American Association of Occupational Health Nurses 452

Ethics: Definitions Definitions assure a common understanding of ethical terms. –Ethics – the philosophic study of conduct an moral judgment. –Morals – principles of right and wrong. –Morality – society’s expectation as to what people should or should not do. –Value – an expression of worth or goodness. –Moral justification – the reason for conduct. Copyright 2012 American Association of Occupational Health Nurses 453

Ethics: Principles – Part 1 Ethical principles underpin ethical practices –Autonomy - means self-governance – the ability to make individual decisions and choices, to act, and to think; self-determination –Nonmaleficence – the principle of doing no harm to others. –Beneficence – the principle of doing good for others. –Distributive justice – the benefits should be equally distributed and equally shared in pursuit of the following three types of equality: Equality of moral worth Equality of opportunity Equality of outcome Copyright 2012 American Association of Occupational Health Nurses 454

Ethics: Principles – Part 2 Other principles important to occupational and environmental health nursing practice include the following: –Confidentiality – the implicit promise that information divulged to another will be respected and not released or repeated. (See Case Study) –Veracity – truthfulness –Honesty – freedom from deceit –Promise-keeping – the act of following through on a pledge –Integrity – refers to unimpaired moral principles Copyright 2012 American Association of Occupational Health Nurses 455

Ethical Conflicts – Your Responsibility Assuring workers’ and others’ confidentiality is an important ethical responsibility. –Employers are charged with the responsibility for maintaining the occupational health and safety records of their workers. –The occupational and environmental health nurse, who is an agent of the employer, is charged with providing occupational health service to workers and maintaining health records; the occupational and environmental health nurse has a duty to accomplish the following: Document care and services provided to a client. Maintain the confidentiality of the client’s health records. Copyright 2012 American Association of Occupational Health Nurses 456

Ethical Conflicts – What To Do When In Doubt –If asked to divulge information contained in a worker’s health record or to provide health records, the occupational and environmental health nurse should consider the following issues: For what purpose is the information being sought? Is the requested information work related? Who is requesting the information? Is the requested information aggregate data or individual data? Why was the information gathered? Is the information being sought pursuant to an authorization for release of health records signed by the worker? Copyright 2012 American Association of Occupational Health Nurses 457

Ethical Conflicts – What You Might See In The Workplace Conflicts of interest and other ethical dilemmas may arise in workplaces. –The occupational and environmental health nurse has multiple roles in the workplace, including worker, health care provider, client advocate, and coworker; these multiple roles can result in ethical dilemmas that require choosing between two or more compelling ethical or moral values. –The occupational and environmental health nurse may be asked to provide the employer with information about the health needs of workers for use in developing benefit plans, planning health education programs and services, and identifying work site health issues. –The occupational and environmental health nurse may provide non-work- related health care, such as periodic health assessments and screening programs and services. Copyright 2012 American Association of Occupational Health Nurses 458

Please Note: The Release of non-work-related health records requires an authorization for release of health records BY THE CLIENT whose records are being released! Copyright 2012 American Association of Occupational Health Nurses 459

Case Study #1 – Confidentiality N.O. Moore, an occupational and environmental health nurse at E.Z. Con, Ltd., performed spirometry testing and respirator fit testing for Joe Cool. This was Mr. Cool’s pre-placement evaluation at E.Z. Con. During the initial evaluation, Ms. Moore noted that Mr. Cool had smoked two packs of cigarettes daily for the past 25 years, and that he was an HVAC (heating, ventilation, and air conditioning) specialist. Mr. Cool admitted that he used to smoke 2-6 joints of marijuana per day, but stopped 10 years earlier. Ms. Moore talked with Mr. Cool about his smoking, risk factors for disease, and environmental hazards at E.Z. Con. Two years later, Ms. Moore received several letters in the mail and several phone calls about Mr. Cool. The first letter, from an attorney who said he represented Mr. Cool, requested medical records from E.Z.Con. An authorization signed by the attorney was enclosed. The second letter, from Mr. Risk at ABC Company, requested a copy of Mr. Cool’s medical records at E.Z.Con. An authorization signed by Mr. Cool, and dated 2 days before Ms. Moore received the letter was enclosed. The third letter from Mrs. Cool, stated that Mr. Cool had died of a mesothelioma 3 months earlier and requested his medical records from E.Z.Con. An authorization signed by Mrs. Cool was enclosed. Ms. Snoopy from personnel called Ms. Moore and instructed Ms. Moore to make a copy of Mr. Cool’s medical records for the vice president. Snoopy said that she would be down to get the records in 15 minutes. An attorney from H.E.L.P., E.Z.Con’s corporate counsel, called and demanded a copy of Mr. Cool’s medical records. Copyright 2012 American Association of Occupational Health Nurses 460

Case Study #2 – Ethics Nancy Cohn is an occupational and environmental health nurse for a large manufacturing company. The company is self-insured for worker short-term disability (STD) benefits. It is Ms. Cohn’s responsibility to obtain medical information and approve/deny STD. The medical information is provided by the worker’s attending physicians. The form used to obtain the medical information is signed by the worker and includes a specific consent to release pertinent information to his employer. On a regular basis Ms. Cohn provides company management with a list of workers who are off work on STD and estimated return to work dates Ms. Cohn’s recently hired environmental health and safety (EHS) manager, Steve Manager, requests that Ms. Cohn forward all completed STD medical information forms to him so that he can verify how Ms. Cohn is managing the program. Ms. Cohn refuses the request, citing legal and ethical issues. The company attorney is consulted who opines that there is nothing legally preventing release of the information since the worker has signed a consent for release of the information to the company. Copyright 2012 American Association of Occupational Health Nurses 461

Opening Statement The Occupational Health Nurse specialty has depth and breadth and requires a variety of skills that are seldom attained in an associate or bachelor’s education. The value of the AAOHN Certificate: –Gives prestige and legitimacy to the occupational health specialty. –Allows satisfaction of employer and regulatory requirements. –Promotes the recruitment and retention of certificants. –Certification is a voluntary process that involves the formal recognition of specialized knowledge, skills, and experience demonstrated by achievement of standards. –Periodic renewal of the certificate will require continuing education. Copyright 2012 American Association of Occupational Health Nurses

Obtaining an AAOHN certificate To obtain an AAOHN certificate, the OHN must also show successful completion of: –Pulmonary Function, including fit testing –Audiometry –Ergonomics –Health coaching Copyright 2012 American Association of Occupational Health Nurses

Pulmonary Function The National Institute for Occupational Safety and Health (NIOSH) has the responsibility to approve courses in spirometry for instruction of those individuals who will be administering screening pulmonary function testing to employees. Pulmonary Function Training must be a NIOSH approved course. Copyright 2012 American Association of Occupational Health Nurses

Pulmonary Function The course design must include at least 16 hours of instruction with the following components: At least four hours of formal lectures and/or audio visual material. At least eight hours of small group practical instruction. At least two hours per student devoted to evaluation and testing of the student's spirometry testing skills. Evaluation consists of a written and a practical examination. Copyright 2012 American Association of Occupational Health Nurses

Pulmonary Function The course content should include: Basic physiology of the forced vital capacity maneuver and the determinants of airflow limitation with emphasis on the relation to repeatability of results. Instrumentation requirements including calibration check procedures and sources of error and their correction. Performance of testing including subject coaching, recognition of improperly performed maneuvers, and corrective actions. Data quality with emphasis on repeatability. Actual use of the equipment under supervised conditions. Measurement of tracings and calculation of results. Though all NIOSH-approved courses must have the minimal required content in common, the courses vary somewhat in the additional topics that are covered, and some courses are more than 16 hours in length. Copyright 2012 American Association of Occupational Health Nurses

Audiometry The Council for Accreditation in Occupational Hearing Conservation's (CAOHC) main objective is to provide education, information and guidance to industry and those serving industry regarding the successful implementation of an occupational hearing conservation program. It seeks to prevent occupational hearing loss. Copyright 2012 American Association of Occupational Health Nurses

Audiometry Course Objectives: To prepare students to be eligible for certification through the Council for Accreditation in Occupational Hearing Conservation (CAOHC). Students will gain background knowledge as well as a basic and fundamental understanding of the following: –Responsibilities and limitations of an Occupational Hearing Conservationist, (OHC). – Responsibilities of other members of the OHC Program Team, with particular attention to the professional supervisor –Basic anatomy and physiology as they relate to hearing evaluation –Types and causes of hearing loss –Parameters of sound as they relate to hearing conservation –Hearing Conservation Regulations: Federal (OSHA) (and, as applicable: State, MSHA, and Department of Defense) –Types of audiometric instrumentation –Performance check and calibration of audiometric instrumentation –Care and troubleshooting of instrumentation –Pure-tone threshold testing and otoscopic screening techniques –Appropriate feedback to employees concerning test results and criteria for employee referral. –Basic concepts and principles of noise measurement and control –Personal hearing protection devices –Employee hearing conservation education, training, and motivation –Basics concepts and principles of hearing conservation program evaluation –Recordkeeping Copyright 2012 American Association of Occupational Health Nurses

ERGONOMICS Ergonomics “is the science of designing and arranging the physical environment, equipment and organization of work to most safely and effectively fit the human body of the worker” (AAOHN, n.d.). The goal of this practice is to prevent work- related musculoskeletal disorders. Copyright 2012 American Association of Occupational Health Nurses

ERGONOMICS Ergonomic certification certifies that you are able to perform a basic office and industrial/manufacturing/healthcare ergonomics analysis using OSHA ergonomics assessment tools. Copyright 2012 American Association of Occupational Health Nurses

HEALTH COACHING Health Coaching The means of generating responsibility, self-motivation and awareness to enhance performance leading to improved health. Health Coach Certification Training focuses on evidence-based health coaching for healthcare providers. Techniques used engage the patient/client and guide them (not direct them) toward goals. By empowering them, it taps into his or her personal motivation to change unhealthy behavior. National Society of Health Coaches provides a certification course which is endorsed by AAOHN. Copyright 2012 American Association of Occupational Health Nurses

Bibligraphy American Association of Occupational Health Nurses (AAOHN), (n.d.) Ergoresources Retrieved. November 14, 2004 www.occupational.comwww.occupational www.cdc.gov www.caohc.org Copyright 2012 American Association of Occupational Health Nurses

AAOHN Certificate Program Barb Maxwell RN, MHA, COHN-S, CCM, CWCP, QRP, FAAOHN Chad Rittle DNP, MPH, RN Debbie Bush RN, COHN-S/CM Marianne Allen RN, BSN,

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AAOHN Certificate Program Barb Maxwell RN, MHA, COHN-S, CCM, CWCP, QRP, FAAOHN Chad Rittle DNP, MPH, RN Debbie Bush RN, COHN-S/CM Marianne Allen RN, BSN,

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Presentation on theme: "AAOHN Certificate Program Barb Maxwell RN, MHA, COHN-S, CCM, CWCP, QRP, FAAOHN Chad Rittle DNP, MPH, RN Debbie Bush RN, COHN-S/CM Marianne Allen RN, BSN,"— Presentation transcript:

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