Care of Clients in Work Settings

1. Care of Clients in Work Settings By Dr. Ali Saleh

2. Definitions • Accident: An unplanned event that may or may not result in damage, loss or injury. • Injury: Damage to the body resulting from a delivery of energy to the body above the capacity of the body to cope with that energy or an interference with the normal function and systems within the body.

3. Definitions Hazard: • any thing or any condition which has the potential to cause injury or harm to health. • a source of potentially damaging energy. • a situation with the potential for harm to life, health and property.

4. Definitions Safety: • An individual’s perception of risk. Or • a state of mind whereby workers are made aware of the possibility of injury at all times. Or • a state in which the risk of harm (to persons) or damage is limited to an acceptable level

5. Definitions Risk: • the probability that an event may occur resulting in personal injury or loss to the organization • the probability that a hazard is realized, i.e. leads to an untoward event • the measure of how likely it is that injury will occur in a given situation.

6. Health and safety • Health and safety: is about preventing people from being harmed at work, by taking the right precautions and by providing a satisfactory working environment.

7. Why is health and safety such an important topic? • Nobody chooses to get hurt at work • Working safely and efficiently will often save money • Fatal accidents • Non-fatal accidents • Illness • Putting other peoples ’ lives and health at risk is not acceptable

8. Advantages of providing Health Care in work settings • Amount of time at work • Captive audience • subject to powerful pressures from peers & employer to engage in healthy behaviors • Risks for health problems • Motivation to maintain health to ensure their continued ability to work • Health promotion efficient and cost-effective

9. Advantages of providing Health Care in work settings • Visible costs • Costs of poor health • Sickness • Absenteeism • Employee turnover • Invisible costs • Low productivity • Poor-quality work • Poor customer services • Accidents • Legal claims related to illness and injury

10. Occupational Health Services Goal of occupational health services • Ensure working adults reach and maintain full working potential • Health promotion • Protection • Surveillance activities Or • To secure a safe & healthy environment & enhance the employees’ ability to work.

11. Occupational Health Services • They occur at three levels: • Individual • Health knowledge & skills • Individual health status • Community • Community norms, awareness, attitudes, practices, & behaviors • System • Organizations & social structures

12. Occupational Health Nursing • American Association of Occupational Health Nurses defined occupational health nursing as: • “The specialty practice that focuses on promotion , protection ,& restoration of health within the context of a safe & healthy work environment . It includes the prevention of adverse health effects from occupational & environmental hazards. It provides for & delivers occupational & environmental health & safety programs & services to clients”.

13. Standards for Occupational and Environmental Health Nursing • Standard 1. Assessment • Standard 2. Diagnosis • Standard 3. Outcome Identification • Standard 4. Planning • Standard 5. Implementation • Standard 6. Evaluation

14. Standards for Occupational and Environmental Health Nursing • Standard 7. Resource Management • Standard 8. Professional Development • Standard 9. Collaboration • Standard 10. Research • Standard 11. Ethics

15. Occupational health Nursing Roles • Employee-centered functions: health promotion , protection, illness prevention activities; primary care for health related conditions; crises care; rehabilitation ;& counseling, adaptation of work to the capabilities of workers • Workplace & work community-centered functions: workplace surveillance & hazard detection, as well as communicating risk information to employees & employers, maintaining first aid skills of employees

16. Occupational health Nursing Roles • Collaborative functions: cooperation with other members of occupational health team • Administrative functions: tracking workers’ compensation cases and cost – benefit analyses

17. Care of Clients in Work Settings • Assessing health in Work setting • Planning nursing care in working settings • Implementing health care in work settings • Evaluating health care in work settings

18. Assessing Health in Work Setting Biophysical considerations 1. Maturation & Aging • Young adult risks: injury related to limited experience. • Older adult risks • injury and death related to decreased Musculoskeletal capacity and sensory impairments. • Discrimination in the workplace 2. Genetic Inheritance: factors related to race and gender • The gender composition affects the type of health conditions seen e.g pregnancy

19. Biophysical Considerations 3. Physiologic Function • Injury and illness • Acute and chronic illnesses • Exposure to factors in work settings. • Hospital contributed to most occupational illnesses related to health care industry. • Cancer related to workplace. • Immunization level

20. Examples of occupational illnesses and injuries • Illnesses not related to work but can be worsen by work e.g. arthritis. • Asthma • Cardiovascular diseases • Reproductive problems • Neurotoxic conditions • Noise induced hearing loss • Infectious diseases • Dermatologic conditions • Work related injuries • Musculoskeletal injuries

21. Psychological Considerations • Stress in the workplace • Mental health and illness in the workplace • Depression→ heart diseases, high cholesterol, hypertension • Schizophrenia • Substance abuse • Increased cost for both employee and employer • Employers are not permitted to ask about psychiatric illness in hiring decision, and employees are not required to disclose such diagnoses unless they are requesting accommodations.

22. Psychological Considerations • Indicators for psychological problems • Increased absenteeism • Mood changes and changes in relationships with others • Increased incidence of minor accidents on and off the job • Complaints of fatigue, weakness, or a general decrease in energy. • Sudden weight loss or gain • Increased blood pressure. • Frequent stress related illnesses

23. Physical Environmental Considerations • Type of work settings • Examples of hazards • toxins • Radiation • Noise • Vibration • Exposure to heat and cold • Electrical and magnetic field hazards • Fire • Heavy lifting and uncomfortable working positions • Potential for falls • Exposure to metallic compounds, allergens, molds • Equipments in workplace

24. Sociocultural Considerations • These sociocultural factors affects health status and employee productivity: • Quality of social interactions among employees • Attitudes toward work and health • The presence or absence of racial or other tensions

25. Sociocultural Considerations Policy and Legislation • Occupational Safety and Health Act of 1970 (OSHA) • Worker’s compensation • The Americans with Disabilities Act • Other local and business -specific policies and regulations

26. Sociocultural Considerations Work and family • Non standard wok schedules (e.g. nights or evening) • Effects on partner and children (emotional and behavioral problems) • Adjustments and coping abilities on rotating shifts • Women are more influenced by interrelationships between work and family than men (more responsibilities) .

27. Sociocultural Considerations Work and Family (cont) • Occupational injuries and illnesses affects family also. • Para occupational exposure: employees are exposed to hazardous substance and in turn expose their families. Workplace Violence

28. Sociocultural Considerations Other sociocultural factors affecting health: • Health related behaviors of employees themselves • Groups of coworkers behaviors • Management sphere • Legal, social, and political actions • Languages spoken and cultural beliefs and behaviors • Social capital (the value of social relations and the role of cooperation and confidence to get results ) • Immigration status

29. Behavioral Considerations • Type of work performed (also Multiple jobs) • Consumptions patterns • Food and nutrition • Smoking • Drug and alcohol use • Rest and exercise e.g Night shift, Work that needs too much sitting. • Use of safety devices • Working while ill (sickness presenteeism)

30. Health System Considerations • The external system considerations: the availability and accessibility of healthcare services outside the workplace • Insurance coverage • The internal system (health services and programs provided in work settings) • Programs to control toxic exposures • Health promotion programs • Comprehensive programs (awareness, lifestyle change, change in environmental conditions) • Family care programs

31. Planning Nursing Care in Work Settings • Primary Prevention • Health promotion • Illness prevention • Injury and violence prevention

32. Primary Prevention Health Promotion • Exercise programs • Stress management • Reproductive health education and referral services Illness Prevention • Immunization • Risk factor modification • Postexposure prophylaxis: treating communicable diseases after exposure. • Stress reduction/management education

33. Primary Prevention Injury Prevention • Safety education • Make provisions and effective use of safety equipment • Develop policies and procedures that prevent injury • Modify or eliminate injury risk factors in the work setting • Develop adequate management support for injury prevention policies and procedures

34. Planning Nursing Care in Work Settings • Secondary prevention • Screening and surveillance • Preemployment screening • Periodic screening • Environmental screening • Treatment of existing conditions • Employee assistance program (EPA): to counsel employees with psychological problems and assist them dealing with these problems • Emergency response: planning physical and psychological emergencies.

35. Planning Nursing Care in Work Settings • Tertiary Prevention • Prevent the spread of communicable diseases • Prevent recurrence of acute health problems • Prevent complication of chronic conditions • Assess fitness to return to work