Occupational Health Nursing & safety

Objectives

• Describe the concept and evolution of occupational health.

• Discuss major occupational health stressors

• Describe examples of work related illness and injuries

• Define role of occupational health nurse.

• Discuss appropriate nursing intervention to strengthen clients’ flexible lines

and lines of resistance .

• Discuss WHO initiatives in workforce safety

• Explain importance of disaster planning and management.

 : Think

 Does work environment affects health?

 Is there a difference between occupational
diseases and injuries.
 Does worker’s health affects community
development and productivity?
 Why it is important to study OHN?
 How many hours, worker spend in the work
throughout his life
• At least one- third (1/3)of the average adult’s life is
spent at work; therefore, the workplace has a
significant impact on individual’s health and is a
primary site for the delivery of preventive health
care services.

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Concept and evolution of occupational health/occupational
health nursing

 A result of the changes that have been occurred in nature of

work, workplace, economy and health care system,
impressive developments in occupational health and safety
programs have occurred focusing on controlling and
prevention of work related illnesses and injuries.
 Each work type has its own specific and related health
problems or injuries
 Workers differ in their response to the health related
hazards or diseases based on certain factors
Concept and evolution of occupational health/occupational
health nursing
 OSH means : Occupational safety and health is a concept
that had been raised during industrial revolution where a
labor movement was established concerning workers health.
(one worker works on a machine, his shoulder ripped off).
 NIOSH: national institute for occupational safety and
health.
 AAOHN: American Association of Occupational Health
Nurses
 Nursing care for workers began 1888 and called industrial
nursing. A nurse is to take care about sick employees, their
families in their homes providing emergency care, taught
mothers healthy living habits
Concept and evolution of occupational health/occupational
health nursing
 Employee health services grew rapidly during the early
1900 where companies recognized that providing work site
health services led to a more productive workforce
 Industrial nursing grew rapidly during 20th century where
educational courses were established.
 1942: AAIN first American association of Industrial
Nursing now called American Association of Occupational
Health Nurses was established.
 1960 and 1970: Specific laws were passed to protect
worker’s safety and health led to an increased need for
occupational health nurses.
Concept and evolution of occupational health/occupational
health nursing

 Occupational Safety and Health Administration (OSHA)

and National Institute for Occupational Safety and Health
(NIOSH) were developed resulted in a great need for nurse
at the worksite to meet workers 'need

 1988: the first occupational health nurse was hired by

OSHA to provide assistance in standards development .

 1993: Office of Occupational Health Nursing was

established
• The workplace/ work environment includes multidimensional
factors that affect worker health and safety.

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WHO definition of occupational health: The
promotion and maintenance of the highest degree of
physical, mental and social well-being of workers
in all occupations – total health of all at work.

Definition of occupational health nursing: The specialty

practice that focuses on promoting, prevention, and
restoration of workers’ health within the context/frame
of a safe work environment. It involves the prevention
of adverse health effects from occupational and
environmental health and safety services to workers,
worker population and community groups.

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 Objectives of occupational health nursing
 Protect the worker from occupational health hazard
 Promote a safe and healthful workplace.
 Facilities efforts of the workers to meet their
families’ health and welfare needs.
The importance of studying occupational health nursing.
 Workers as an aggregate
 Workers are considered as a considerable portion of the community
population.
 Each type of work involves specific health hazards and risks
(vulnerability).
 The health of workers affects productivity and, consequently, the family
and the community.
 Workers themselves can be considered as a /group/aggregates (why?).

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 Work place hazards: all the work-related agents/factors
that present potential and actual risks to the health and
safety of workers.
Major occupational health stressors
 Physiological health stressors: on all body organs
especially muscle-skeletal system / lower extremities and
back pain, fatigue, etc…
 Psychological stressors: job strain, inability to take
decision, burn out, inequality, group pressure, poor work
environment
 Social stressors: Inability to meet social activities with
family members, job insecurity, poor communication with
manager, interpersonal conflicts
 Developmental stressors: Lack of promotion
opportunities.
 Spiritual stressors: Inability to practice religious activities.
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 What is the relationship between work & health

• Epidemiological model will explain the

relationship between work & health

• What are the elements of the epidemiological

model/ traid?
• A- -----------------------------------
• B- -----------------------------------
• C- ------------------------------------

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 Epidemiological model
Host
All susceptible people:
worker
worker' families

Agent
Workplace hazards: Environment
Biological All other external factors
Chemical that influence host- agent
Ergonomic interactions: physical
Physical Social
Psychosocial
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 Host factors that increase risk of developing workplace
hazards / diseases

1- Age:
older worker and children are very susceptible to(
occupational hazards
2- Gender:
women in their child bearing- years(
In-service training on new job/ machine -3
Previous experience / lifestyles -4
Health condition/ immunity/ vision -5

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2- Work- related hazards, or agents
• Any work site commonly presents multiple and interacting
exposures from all five categories of agents.

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 Work- related hazards, or agents

Biological and
infectious
agents

Chemical agents
Physical agents

Psychosocial agents

Mechanical agents
Work- related hazards

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 Occupational health hazards
Health effects Exposures Meaning Category
Acute: 1-Radiation, Agents within the 1- Physical
skin rashes, heat 2-temperature extremes, work environments hazards:
stress etc… 3- noise, that may cause
Chronic: hearing tissue damage or
4- electric and magnetic
loss, leukemia, other physical harm.
fields, 5-lasers,
reproductive microwaves and
effects etc… vibration

Whom is the most liable to develop physical hazards

1- Workers in food processing factories: excessive heat / cold
2- Workers in welding : excessive light/ noise
3- Workers in airport: excessive noise
4- x-ray technician : radiation/ cancer
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 Occupational health hazards (cont.,)
Health effects Exposures Meaning Category
Acute: Solutions, Synthetic or natural 2- Chemical
respiratory vapors, gases, occurring Hazards:
irritation, medications, chemicals toxic or Most of chemicals
poisoning etc… pesticides, lead irritating body are carcinogens.
Chronic: etc… system (inhalation, Single chemical
Cancers, asthma skin absorption, exposure at low
etc… ingestion) doses for long time
will affect health.

Whom is the most liable to develop chemical hazards

1- Workers in pharmacy 4- Farmers when using pesticides
2- Lab technician 5- Workers in mines & tunnels
3- Workers of cloth dying & painting

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 Occupational health hazards (cont.,)
Health effects Exposures Meaning Category
Acute: Viruses, Organisms & 3- Biological
Influenza, parasites bacteria, potential hazards
infections etc.. fungi, contaminants
Chronic: tuberculosis, parasites. found in work
hepatitis B etc… environment.

Nurses, lab technician, physicians are more liable to

develop biological hazards
 Occupational health hazards (cont.,)
Health Exposures Meaning Category
effects
Back pain, Repetitive Mechanical 4-environmental
cumulative motions, poor agents may cause /Mechanical
trauma, station work stress on muscles Hazards/
injuries, fit, and lifting or other strains ergonomics
sprain, strain heavy loads. that can have
Slippery negative health
floors effects

Workers of dragging, heavy load carriers, mechanical

technicians, typewriters
 Ergonomics-
Most common injuries- muscle and eye strain

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 Proper postion

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 Occupational health hazards (cont.,)
Health Exposures Meaning Category
effects
Psychological Work- Conditions that 5-
and social related stress create a threat to the Psychosocial
problems or burn- out. psychological and agents
exhaustion, Poor inter /or social well-
depression, personal being of individuals
anxiety, and relationships and groups
gastrointestina
l disturbance)

Any type of workers may develop it because of :

inequality, poor salary, negative motivation, overload
 3- Environment
 The psychosocial environment includes characteristics of the
work itself, as well as the interpersonal relationships required in
a work setting.
 Job characteristics such as low autonomy, poor job satisfaction
 Interpersonal relationships between employees and co-workers
or bosses and managers are often the source of conflict and
stress.

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The interaction between the host, agent and the environment:
- Humans are surrounded by their social, biological and
physical environments. Change in any of these environments
may initiate change in the others, affecting the relationship
between humans and agents in this environment.

- As long as a state of equilibrium exists between host, agent

and environment, a state of health is maintained. For example;
an increase in the amount of the agent resulting from a
change in the environmental conditions increases the like
hood that a susceptible host will be exposed.
 Protective equipment
. •

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 Protective equipment
. •

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Most common occupational diseases and occupational hazards
Occupational injury
-Any injury such as cut,
fracture, sprain, or
amputation
-Result from a work-
related event or from
single, exposure from work
environment.
Occupational disease
- An abnormal condition or
disorder.
- Caused by factors
associated with worker’s
health condition & type of
work

- It may be intentional or
- -Includes acute or chronic
unintentional illness or disease

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 Occupational injury Occupational disease

Unintentional Musculoskeletal conditions

Skin disease and disorders
Minor (bruises) Noise- induced hearing loss
Major (severe burns)
Respiratory disorders:
injuries, falls,
Asbestosis
overexertion) Silicosis
Brucellosis
Intentional
Other work-related diseases:
Work-place violence: Poisoning and infections
suicide Psychological problems.
homicide
abuse
-

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 Silicosis, is a form of occupational lung disease
caused by inhalation of crystalline silica dust, and
is marked by inflammation and lesions in the
lungs.
It is characterized by shortness of breath, cough,
fever, and cyanosis
Asbestosis is a chronic inflammatory and fibrotic
medical condition affecting the lungs caused by
the inhalation and retention of asbestos fibers. It is
an occupational lung disease. People with
extensive occupational exposure to the mining,
30 manufacturing, handling or removal of asbestos
Brucellosis, also called Malta fever, Mediterranean fever, is a form
of zoonosis caused by ingestion of unsterilized milk or meat from
infected animals or direct contact with their secretions.
Transmission from human to human, through sexual contact or
from mother to child, is rare but possible.[Symptoms include
profuse sweating and joint and muscle pain.

 Bladder cancer and dermatitis: common among dye workers:

 Bronchitis: common among cement workers
 Cataracts: common among glass worker
 Insulators/ ‫ لاـعـزل‬common among mining workers
 Infection and communicable diseases: among hospital workers
 Asbestoses: Automobile workers
 Liver diseases: dye cleaners due to inhalation of solvents
 Stress and burn out: all workers

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Appropriate nursing intervention to strengthen clients’ flexible lines
and lines of resistance:

 To strength flexible line of defense: Primary level of

prevention
1. Utilize in-service training program
2. Maintain healthy work environment
3. Educate worker to receive enough rest and sleep
4. Reduce work stress environment
5. Maintain good ventilation
6. Encourage worker to eat healthy diet
7. Review and complete vaccination chart of the worker
8. Health protection by walk- through of the occupational
health nurse to identify workplace hazards
9. Encourage utilization of personal protective equipment

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 Appropriate nursing intervention to strengthen clients’ flexible
lines and lines of resistance:
 To strength lines of resistance(secondary and tertiary
prevention)
1. Develop problem solving skills
2. Develop coping strategies
3. Early detection of stressors/hazards and early
management
4. Periodical examination of the workers to initiate
early treatment
5. Modification and elimination of the hazards-
producing situations
6. Better utilization of referral system
7. Shift workers who have neurologic systems from
exposure to metals
8. Rehabilitation strategies such as return-to-work
program after heart attack or limited working hours
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 Occupational Health Nursing
Dynamics & Nursing process
Environmental
Human/Biological
determinants
Assessing determinants
of health
of health

Practice Priorities

Diag
Preventing, Promoting, Protecting
g
Evaluatin

no
Scope of Practice

sing
Practice
Imp Interventions
Social lem Medical/technological
determinants ent i ng organizational
of health in g nn determinants of health

P la
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 Occupational and environmental health
nursing roles
Clinician

Case manager

Coordinator

Health promotion specialist

Consultant

Manager

Practitioner

Corporate director
Policy maker

Researcher

36 Health educator
 Assessment of occupational settings:
1. Assess the worker's lifestyle: nutrition, smoking,
exercise, substance abuse, rest and exercise, use of safety
devices and type of work performed.
2. Assess for evidence of psychological problems: stress
level at work and outside and relationships among
employees and management.
3. Assess physical environment:
• Presence of hazards from equipment and tools.
• Potential for exposure to toxic substances.
• Potential for exposure to vibration.
• Potential for exposure to temperature extremes.
• Potential for exposure to radiation and noise.
• Poor lighting or ventilation.
• Potential for falls.
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 4. Assess worker's health:
• Immunization status.
• Presence or absence of health conditions.
• Past and present complaints.

5. Health care system:

• Assess availability of health care services.
• Extent of health insurance coverage.

6. Assess presence and utilization of safety measures

• Protective eye glasses
• Gloves / gown /mask
• Ear plugs
• Special shoes

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 Nursing diagnosis:

1- Risk for joint dislocation related to mechanical

machine vibration

2- High risk for impaired respiratory function

related to mining as manifested by bluish skin
discoloration

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 1. Primary prevention:
• Health promotion: health education about nutrition, stress
management and exercise. Provide prenatal care to
pregnant workers.
• Illness prevention:
Education to employees about prevention of specifying
illness through immunization.
Modifying risk factors: e.g. smoking increases one's risk
of developing heart disease and lung cancer, so smoking
is a risk factor for these two problems.
• Injury prevention: teaching about safety procedures to
prevent accidents, e.g. wearing protective clothes. Proper
use of machines, fluid replacement in high-heat areas and
good body mechanisms.

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 2. Secondary prevention
•Screening:
• Pre employment screening
• Periodic screening: e.g. blood test for exposure to
toxic substances.
• Environmental screening: e.g. measure noise levels at
work, measure of radiation level.
Treatment of existing conditions:

3. Tertiary prevention
• Prevention of complications of chronic conditions.
• Preventing the recurrence of acute conditions.

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 WHO initiatives in workforce safety:2010
1. Reduce death from work-related injuries
2. Reduce work-related injuries
3. Reduce rate of injury and illness cases to be absent
due to repetitive motion
4. Reduce number of persons who have elevated lead
level
5. Reduce cases of Nosie induced hearing loss
6. Reduce occupational skin diseases
7. Reduce work related assault
8. Reduce occupational needle stick injuries among
health care team

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Importance of disaster planning and management:

 Goals of disaster plan are to prevent or minimize injuries

and workers & residents death, minimize property
damage, provide effective triage
 It requires cooperation of different personnel in the
company
 The nurse is a key person on the disaster planning team
with safety professionals, physicians, industrial hygienist,
fire chief and company management.
 Potentials for disaster are: explosion, fires, leak
 Disaster plan well designed by people who are familiar
with work process, materials, workplace and community
resources
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 Importance of disaster planning and management:
 Written disaster plan should be shared with all who will
be involved and should receive a copy such as personnel,
hospitals fire services, emergency services with the
current hazards assessment
 Employee should trained on first aid, CPR, fire fighting

 It should be clear, specific and comprehensive

 Should coordinated with transportation plan, fire

response and emergency call services

 It should be updated periodically and tested annually and

results should be evaluated for more modifications

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Importance of disaster planning and management:

 In disaster plan, the nurse assumes the responsibility of

coordinating plan, works with key persons. Also, she has
to educate employees, management and assess equipment
used in disaster.

 Post disaster interventions include ongoing assessment of

workers needs, collect epidemiological data, assess causes
of disaster to prevent recurrence

 Disaster plan should includes three levels of prevention

and occupational health nurse should participate actively
in its implementation

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