Promoting and Protecting the Health of Adult Women and Men and Occupational Health

1. Promoting and Protecting the Health of Adult Women and Men and Occupational Health Allender and Spradley - Chapter 29

2. Objectives • Identify key national and global demographic characteristics of women and men throughout the adult life-span • Provide a health profile of adult women and men in the United States • Identify desirable primary, secondary, and tertiary health promotion activities designed to improve the health of women and men • Identify potential physical, chemical, biological, ergonomic, and psychosocial stressors in a variety of work environments • Describe the history of state and federal regulation related to the health of women and men in the occupational setting • Discuss a variety of occupational health problems, including disorders related to ergonomics and workplace violence • Compare and contrast three main types of occupational health programs • Describe the role of the occupational nurse and other members of the occupational health team in protecting and promoting worker’s health and safety.

3. History of Adult Health • Men were traditionally the dominant gender and the focus of health-related research • Women’s health advanced since the Women’s Health Movement (WHM) of the 1960-70s • More males die at birth than females, they die earlier from chronic diseases, a greater number commit suicide, and die in vehicular crashes • Life expectancy has increased consistently over time with females living an average of 8 years longer

4. Health Profile (Women and Men) • Teenaged (12-18) - tasks include: physical growth (puberty and menarche), emotional (risk-taking) and developmental (vocational goals, personal identity, body image, sexuality, and disengagement from family); health attitudes and practices start here • Young adult (18-35) - developmental tasks include establishment of home and long term relationship, planing for children or not, choosing life’s work, and developing a life philosophy and value system

5. Health Profile Continued • Adult (35-65) - experience mid-life reappraisal and preparation for retirement; chronic illnesses are related to lifestyle choices; females experience menopause • Mature Adult (65-85) - tasks include managing financially, coping with losses, and finding meaning, satisfaction, support and comfort in remaining years • Expert Adult (85+) - are survivors with health issues related to safety, housing needs, and socialization

6. Health Promotion Activities • Primary - education on safety, illness prevention (immunizations), use of safety devices and balancing work with leisure or home responsibilities • Focus on community aggregate needs • Secondary - screenings and programs (TB skin tests, B/P screening, breast cancer or prostate) • Tertiary - chronic disease and illness programs to prevent disability

7. Major Health Problems of Adults • Highest mortality conditions - coronary heart disease, cancers (lung and reproductive) stroke, chronic obstructive lung disease, and unintentional injuries, diabetes, pneumonia, Alzheimer’s, liver and kidney disease, HTN • Major chronic conditions - Diabetes, substance abuse, obesity, chronic lung disease, osteoporosis • Violence - suicide and homicide

8. Occupational Health • Occupational health - a specialty health practice, focuses on the health and well-being of the working population, includes both paid and unpaid laborers • The profile and the environment of the workplace is changing from is changing from an industrialized labor force to white-collar workers and professionals

9. Potential Work Stressors • Physical - structural elements like temperature and noise extremes • Chemical - presence of potentially hazardous agents and their toxicity • Biological - organisms that contaminate the work environment • Ergonomic - customs, design, and expectations of the job that influence interactions • Psychosocial - workers’ feelings and behavior

10. Significant Health Legislation • 1970 Occupational Health & Safety Act - protects against personal injury and illness from hazardous working conditions and enforces standards • 1986 Hazard Communication Act - known as the worker right-to-know legislation • 1990 Americans with Disability Act - a civil rights law to prevent discrimination against qualified workers with disabilities

11. OSHA and NIOSH • Federal agencies created by the Occupational Health & Safety Act • the Occupational Safety and Health Administration - promotes and protects worker safety and health through regulation, consultation, training, and outreach • National Institute for Occupational Safety and Health - part of the CDC and is responsible for research

12. Work Related Health Problems • Occupational disease - any condition or disorder that results from an exposure that resulted from employment (lung disease, injuries, and cancers) • Ergonomics - related to increased technological environments and computers • Emotional - job stress, mental pressures, and emotional disturbances • Violence - homicides and disgruntled employee syndrome

13. Occupational Health Programs • Goals - to maintain a healthy, productive workforce by providing a safe and healthy work environment and promoting healthful personal behavior • Assess workers and workplace and identify sub-populations at risk to institute programs for: disease prevention, protection, health promotion (employee assistance), and health services (non-occupational)

14. The Occupational Health Nurse • Activities - emergency care and nursing of ill employees, as well as assessment, counseling, and education on safety, hygiene, nutrition, and improvement of working conditions • Skill training - Identifying and managing of the physical, chemical, biologic, ergonomic, and psychosocial factors • Roles are unique and the team may include safety engineer, industrial hygienist, epidemiologist, toxicologist, and/or occupational physician

15. Future Trends and Issues • Financial issues include decreased economy with increased competition and health care costs, coupled with increased technology and hazards • Future nursing roles may include: analyzing trends and developing programs and services that are efficient and cost effective

16. Promoting and Protecting the Health of Older Adults: Aging in Place Allender and Spradley - Chapter 30

17. Objectives • Describe the global and national health status of older adults • Identify and refute at least four common misconceptions about older adults • Describe characteristics of healthy older adults • Provide an example of primary, secondary, and tertiary prevention practices among the older population • Discuss four primary criteria for effective programs for older adults • Describe various living arrangements and care options as older adult age in place • Describe the future of an aging America and the role of the CHN

18. Global Health Status 420 million people worldwide > 65 years of age Death rates have fallen Countries with 16% > 65 years include Italy, Sweden, Norway, Greece, Belgium, Spain, Bulgaria, Japan, Germany, France, and United Kingdom. Women outlive men by 6 years 2050 the world population will be 8.7 billion

19. World Population Growths 1800-2050

20. National Status of 65+ Adults • Large and fastest growing population group • Life expectancy: women (80), men (74) • Challenges: to maximize independence, continue societal contributions and maintain quality of life • Problems: fixed incomes, increased chronic disease and disability, decreased functional capacity, and ongoing losses • Health care adjustments: greater protective and preventive services are required due to economic, environmental, and social changes

21. United States Population Statistics

22. Myths and Misconceptions • Stereotyping older adults and perpetuating false information and negative images and characteristics regarding older adults is called ageism • Myth: Older adults cannot live independently Fact: 94% live in the community • Myth: Chronological age determines oldness Fact: Aging is individualized relative to holistic parameters, genetic traits, and life experiences

23. Myths and Misconceptions 2 Myth: Elderly have diminished intellectual capacity Fact: intelligence, learning ability, intellectual and cognitive skills do not decline with age, but are influenced by risk factors Myth: All older people are content and serene Fact: advancing age brings increased Problems for harassment and worry

24. Myths and Misconceptions 3 • Myth: Older adults cannot be productive or active Fact: If healthy they remain active in retirement activities or continue to work • Myth: All older adults are resistant to change Fact: learning depends on personality traits or, sometimes, on socioeconomic difficulties • Myth: Social Security won’t be there for me Fact: the schedule needs adjustment, but present revenues can last at 75% disbursement of benefits for the next 75 yrs

25. Characteristics of Healthy Older Adults • A lifetime of healthy habits and circumstances • A strong social support system • A positive emotional outlook (personality traits, adaptability, resourcefulness, and optimism) • Ability to function (physical health and activity)

26. Prevention Strategies • Primary - providing health education, supporting sound personal health practices and adhering to immunization schedules • Secondary - encouraging routine screening for diseases (hypertension, cancer, anemia, depression and glaucoma) and establishing programs based on demographics • Tertiary - follow up and rehab for chronic diseases that are common among older adults (CHF, emphysema, Alzheimer’s, arthritis, depression, diabetes, and osteoporosis)

27. Needs of the Elderly • Physical - nutrition, exercise, independence • Psychosocial - love and belonging (companionship), self-esteem, and self-actualization (life purpose), multiple losses • Safety - personal (use of drugs and immunizations), home (falls), community (pedestrian and driving, crime, environmental exposures) • Spirituality and Advance directives

28. Assessment Tools • OARS Mental Health Screening Questions and the OARS Social Resource Scale • Capacity for Self-Care Index • The Barthes Index for functional functional independence • The Katz Index of ADL • The Instrumental Activities of Daily Living Scale • Ability to Perform Work-Related Activities survey

29. Criteria for Effective Programs • Service is comprehensive (financial, prevention, education, in-home, recreation, and transportation) • System is coordinated (multi-service agencies for information and referral) • Programs are accessible (conveniently located and affordable) • Quality programs are promoted

30. Care Options • Adult day care provides social activities, nutrition, nursing care, and physical and speech therapies • Home care services include skilled nursing care, psychiatric nursing, physical and speech therapies, homemaker services, social work services, and dietetic counseling • Hospice care offers support services for the dying • Respite care gives temporary institutional housing for the elderly while caregivers take a break

31. Living Arrangements • Skilled nursing facilities -both nursing and personal care (non-skilled or custodial care) • Long-term care facilities - care at different stages of dependence for extended periods • Intermediate care facilities - less costly, provide less skilled health care • Personal care homes - basic custodial care • Group homes - alternatives for specific (alcoholic, mentally ill) elderly populations • Continuing care centers - all levels (total care)

32. Role of the Nurse • Keep abreast of new developments, programs, regulations, and social and economic forces and their impact • Be proactive, designing interventions that maximize resources and provide benefits • Educate the elderly about health conditions, safety, and use of their medications • Support healthy lifestyles and prevent accidents

33. Vulnerable Aggregates: Rural Health Care Allender and Spradley - Chapter 31

34. Objectives • Define the term rural • Discuss population characteristics of rural residents • Identify at-risk populations of rural residents • Describe five barriers to health care access for rural clients • Discuss how the terms out-migration and in-migration relate to the population trends associated with rural communities in recent decades • Relate the broad objectives of Healthy People 2010 to the concept of “social justice” in rural communities • Discuss activities to assist in the orientation of a new community health nurse to a rural community • Compare and contrast the “circle of formal support” and the “circle of informal support” themes apparent in rural communities • Discuss challenges and opportunities related to rural community health nursing practice.

35. Status of Communities • Rural - fewer than 10,000 residents with population density of fewer than 1,000 persons per square mile • Frontier area - sparsely populated places with six or fewer persons per square mile • Health professional shortage areas(HPSAs) - urban or rural geographic areas, population groups, or facilities with shortages of health professionals

36. More Status Terms • Urban - densely settled territory • Urban Areas (UA) contain 50,000 or more people • Urban Clusters (UC) have at least 2,500 people but fewer than 50,000 • Statistical areas - newer term • Metropolitan have at least one UA with population of at least 50,000 • Micropolitan have at least one UC of at least 10,000 but less than 50,000

37. Rural Population Characteristics • In rural areas: poverty is common, residents are more likely to be older and less diverse, less educated and usually work at minimum wage jobs • Each rural community is unique, and populations differ in: age and gender, race and ethnicity, education, income and occupation • Populations change by out-migration, in-migration and by births

38. At Risk Populations • Problems are compounded by limited access to health and social services • Factors: Limited transportation, few shelters and housing alternatives, limited work opportunities, and job hazards • Some at risk populations include: Homeless families, Perinatal clients, Elderly, Mentally Ill, Native Americans, and Agricultural farm workers

39. Barriers to Health Care • Self-management of health care problems via folk treatments and home remedies • Cost, travel, weather, and distance are barriers to obtaining health services as are limited choices of formal health are providers • Home health care (HHC), when available, supports self-management, but requires more time because clients are more ill • Lack of insurance and/or problems implementing the Managed Care model

40. New Approaches • Access to care is a social justice issue • Use of mobile health clinics for health screenings, immunizations, and other service delivery • School based clinics - affordable, and culturally acceptable care, conveniently located • Telehealth - electronically transmitted clinician consultation between the client and the health care provider

41. Rural Nursing Orientation • Start without preconceived ideas • Assess people, places, and activities at different times of day and use your senses • Identify key informants and talk with them • Review demographic data (morbidity and mortality statistics) for the locale • Determine potential strengths and problems • Verify your impressions with community members and health care providers

42. Description of Rural Nurses • Active members of the community and highly respected professionals (always on duty) • Use the levels of primary, secondary, and tertiary prevention in their practice • Autonomous, lower pay scale, may be isolated • Roles include: advocate, coordinator/case manager, health teacher, referral agent, mentor, change agent/researcher, collaborator, activist • Their rural system may be smaller and slower

43. Migrant and Seasonal Farmworkers Allender and Spradley - Chapter 33

44. Objectives • Discuss the historical background of migrant workers including their demographics and patterns • Describe the migrant lifestyle • Explain how hazardous living and working conditions contribute to migrant worker’s increased risk for health problems • Identify at least three health problems common to migrant workers and their families • Describe social issues resulting from the migrant lifestyle • Discuss barriers and challenges to migrant health care • Identify methods for effective health care delivery to migrant populations • Discuss goals and implications for effective health care delivery to migrant populations

45. Background and Demographics • Migrant farmworkers endure backbreaking, menial labor for low wages, often deprived of basic rights to safe working conditions, adequate sanitation, decent housing, education for children, and health care • Most are from undeveloped countries and Mexico, some are legal residents, others undocumented • The Bracero Agreement of 1942 • Migrant Health Act of 1962 • Cesar Chavez and the United Farmworkers

46. Migrant Lifestyle • Homebase - a permanent residence • Seasonal farmworkers live in one location and labor in the fields of that particular area • Three major migrant streams - migrant farmworkers travel, usually state to state, following the harvest seasons, usually along predetermined routes • Seasonal harvesting occurs from June to September, 8 weeks is spent traveling, and the rest of the time there may be no employment

47. Migrant Lifestyle 2 • Migrant laborers travel in crews, family units with women and children, or “solos,” (single men) and crew leaders negotiate for work • Migrant workers often drive night and day as they move from crop to crop • A migrant farmworker may earn as little as 40 cents per 5-gallon bushel of harvested crops • Children are often neglected, left to play in fields, in cars or boxes, or stranded in camp with one young female to watch everyone

48. Migrant Health Risks • Mortality rates, including infants, are increased, life expectancy is reduced (49) • Abysmal conditions, occupational injuries, and pesticide poisoning affect health • Work in all weather extremes and neglect of minor injuries because leaving work means loss of pay • Housing is substandard or not provided, pests abound, sanitation facilities and fresh drinking water often are not provided

49. Common Health Problems • Correlated with poverty, mobility, poor nutrition, neglect, crowded housing, and occupational hazards • Most frequent problems: nutritional deficiencies for all ages, urinary tract infections, diabetes, dental caries, skin infections, and head lice • High incidence of communicable diseases, drug and alcohol use, prostitution, TB, and AIDS

50. Barriers and Challenges to Care • Barriers to primary health care access are isolation, powerlessness, economics, limited health resources, language, and culture • Lack of trust, fear of deportation and job loss, inability to obtain medicaid or insurance because of residency requirement are other challenges • Mobile lifestyle makes long-term health goals difficult to establish and long-term follow-up of any chronic illness doubtful