INTRODUCTION
Nurses are an integral part of clinical services and have primary responsibility for a significant proportion of patient care in most healthcare settings. As such, nurses are confronted with a variety of biological, physical, and chemical hazards during the course of performing their duties. The level of occupational safety and health training and resources available to nurses, and the incorporation, implementation, and use of such training and resources with management support and leadership are critical factors in preventing adverse outcomes from the occupational safety and health hazards nurses are exposed to on a daily basis.
Given the nature of their working environment, responsibilities, and duties, nurses are on the front-line of numerous occupational hazards. The following are some of the hazards they face;
Biological:
Blood-borne pathogenic exposures (HIV, HCV, HBV, etc) - due to per cutaneous needle stick injuries (NSIs). As mentioned above, between 600,000 and 800,000 NSIs occur each year in all healthcare settings, with injections (21%), suturing (17%) and drawing blood (16%) the top three exposures (Perry et al., 2003).
2. Airborne exposure from various diseases such as SARS, Tuberculosis (TB), Methicillin Resistant Staph. During 2003, and CDC received 34 reports of TB outbreak activity (Department of Health and Human Services, 2004b). In June 2004, a healthcare worker died of TB (Simpson, 2004)
3. Other or combination exposures such as scabies and Norovirus (NIH web site, accessed 3/8/05).
Musculoskeletal injury exposures:
1. Patient movement and handling - 38% of all nurses are affected by back injuries, nearly all of these injuries (98%) are due to nurses lifting and moving patients manually (Meier, 2001).
2. Other work-related musculoskeletal disorders- studies of upper extremity musculoskeletal disorders in nurses have reported prevalence rates of shoulder problems in 43-53% of nurses (Lagerström et al., 1995) and neck injuries between 31-48% (Ando et al., 2000).
Chemical
Related to patient treatment and maintenance of a proper environment, e.g. Disinfectants and sterilants (such as glutaraldehyde, ethylene oxide), hazardous drugs, and latex exposure among others (U.S. Department of Labor, OSHA, 2004).
Ergonomic exposures
Compared to other healthcare workers, nurses face a higher level of risk for violence. More than 9.5% of general nurses working in general hospitals are assaulted annually (Wells & Bowers, 2002). Gerberich et al. (2004) report that rates for both physical (13.2) and non-physical (38.8) violence are on the rise for emergency department, home/long term care, intensive care psychiatric/behavioral care nurses.
A patient’s rapid change in physical and psychological health places nurses at higher risk for injury than most occupations. The rate of nursing injuries is second to construction workers. Medication reactions, stress,and confusion may result in patient combative behavior that places the nurse in a hostile work environment. In addition, the unpredictability of subtle changes in some patients during ambulation and transfers often lead to musculoskeletal injuries sustained by nurses after attempting to avert patient injury.
Occupation stress
Occupational stress has been a long-standing concern of the health care industry. Studies indicate that health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress. In addition to psychological distress, other outcomes of job stress include burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and diagnosis and treatment errors. In a recent American Nursing Association (ANA) survey, nurses cite stress and overwork as their top safety concern (American Nurses Association, 2004).
Terrorism/chemical spill victims
Hospital personnel may be faced with managing patients exposed to unknown chemicals. Hospital personnel need to be trained to reduce the possibility of health hazards spreading from ambulances and emergency rooms (OSHA Interpretation web site, accessed 6/24/04). Another relatively new workplace hazard is the potential for terrorist attacks in the United States. The threat is real for Emergency
Department nurses who play a critical role as first receivers for these types of disasters and thus are at risk for exposure to chemical, biological, radio-logical, nuclear, and explosive
(CBRNE) substances. Healthcare facilities may become primary or secondary targets for terrorists. Therefore, it is paramount that nurses learn new safety skills that address these additional complex and unpredictable types of exposure. Indeed, a recent RAND-NIOSH study states that a new approach is perhaps needed to protect emergency respondents in or during terrorist attacks and disasters (Department of Health and Human Services, 2004c).
Health effects of Occupation stress
The National Institute for Occupational Safety and Health (NIOSH) defines occupational stress as “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.”
Stress may be associated with the following types of re-actions:
· Psychological (irritability, job dissatisfaction, depression)
· Behavioral (sleep problems, absenteeism)
· Physical (headache, upset stomach, changes in blood pressure)
An acute traumatic event could cause post-traumatic stress disorder (PTSD). Not every traumatized person develops full-blown or even minor PTSD. Although individual factors (such as coping strategies) and social resources can modify the reaction to occupational stressors to some degree, working conditions can play a major role in placing workers at risk of developing health problems.
Control measures
The most effective way of reducing occupational stress is to eliminate the stressors by redesigning jobs or making organizational changes. Organizations should take the following measures:
1. Ensure that the workload is in line with workers ‘capabilities and resources
2. Clearly define workers’ roles and responsibilities
3. Give workers opportunities to participate in decisions and actions affecting their jobs
4. Improve communication
5. Reduce uncertainty about career development and future employment prospects
6. Provide opportunities for social interaction among workers
Nurses are an integral part of clinical services and have primary responsibility for a significant proportion of patient care in most healthcare settings. As such, nurses are confronted with a variety of biological, physical, and chemical hazards during the course of performing their duties. The level of occupational safety and health training and resources available to nurses, and the incorporation, implementation, and use of such training and resources with management support and leadership are critical factors in preventing adverse outcomes from the occupational safety and health hazards nurses are exposed to on a daily basis.
Given the nature of their working environment, responsibilities, and duties, nurses are on the front-line of numerous occupational hazards. The following are some of the hazards they face;
Biological:
Blood-borne pathogenic exposures (HIV, HCV, HBV, etc) - due to per cutaneous needle stick injuries (NSIs). As mentioned above, between 600,000 and 800,000 NSIs occur each year in all healthcare settings, with injections (21%), suturing (17%) and drawing blood (16%) the top three exposures (Perry et al., 2003).
2. Airborne exposure from various diseases such as SARS, Tuberculosis (TB), Methicillin Resistant Staph. During 2003, and CDC received 34 reports of TB outbreak activity (Department of Health and Human Services, 2004b). In June 2004, a healthcare worker died of TB (Simpson, 2004)
3. Other or combination exposures such as scabies and Norovirus (NIH web site, accessed 3/8/05).
Musculoskeletal injury exposures:
1. Patient movement and handling - 38% of all nurses are affected by back injuries, nearly all of these injuries (98%) are due to nurses lifting and moving patients manually (Meier, 2001).
2. Other work-related musculoskeletal disorders- studies of upper extremity musculoskeletal disorders in nurses have reported prevalence rates of shoulder problems in 43-53% of nurses (Lagerström et al., 1995) and neck injuries between 31-48% (Ando et al., 2000).
Chemical
Related to patient treatment and maintenance of a proper environment, e.g. Disinfectants and sterilants (such as glutaraldehyde, ethylene oxide), hazardous drugs, and latex exposure among others (U.S. Department of Labor, OSHA, 2004).
Ergonomic exposures
Compared to other healthcare workers, nurses face a higher level of risk for violence. More than 9.5% of general nurses working in general hospitals are assaulted annually (Wells & Bowers, 2002). Gerberich et al. (2004) report that rates for both physical (13.2) and non-physical (38.8) violence are on the rise for emergency department, home/long term care, intensive care psychiatric/behavioral care nurses.
A patient’s rapid change in physical and psychological health places nurses at higher risk for injury than most occupations. The rate of nursing injuries is second to construction workers. Medication reactions, stress,and confusion may result in patient combative behavior that places the nurse in a hostile work environment. In addition, the unpredictability of subtle changes in some patients during ambulation and transfers often lead to musculoskeletal injuries sustained by nurses after attempting to avert patient injury.
Occupation stress
Occupational stress has been a long-standing concern of the health care industry. Studies indicate that health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress. In addition to psychological distress, other outcomes of job stress include burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and diagnosis and treatment errors. In a recent American Nursing Association (ANA) survey, nurses cite stress and overwork as their top safety concern (American Nurses Association, 2004).
Terrorism/chemical spill victims
Hospital personnel may be faced with managing patients exposed to unknown chemicals. Hospital personnel need to be trained to reduce the possibility of health hazards spreading from ambulances and emergency rooms (OSHA Interpretation web site, accessed 6/24/04). Another relatively new workplace hazard is the potential for terrorist attacks in the United States. The threat is real for Emergency
Department nurses who play a critical role as first receivers for these types of disasters and thus are at risk for exposure to chemical, biological, radio-logical, nuclear, and explosive
(CBRNE) substances. Healthcare facilities may become primary or secondary targets for terrorists. Therefore, it is paramount that nurses learn new safety skills that address these additional complex and unpredictable types of exposure. Indeed, a recent RAND-NIOSH study states that a new approach is perhaps needed to protect emergency respondents in or during terrorist attacks and disasters (Department of Health and Human Services, 2004c).
Health effects of Occupation stress
The National Institute for Occupational Safety and Health (NIOSH) defines occupational stress as “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.”
Stress may be associated with the following types of re-actions:
· Psychological (irritability, job dissatisfaction, depression)
· Behavioral (sleep problems, absenteeism)
· Physical (headache, upset stomach, changes in blood pressure)
An acute traumatic event could cause post-traumatic stress disorder (PTSD). Not every traumatized person develops full-blown or even minor PTSD. Although individual factors (such as coping strategies) and social resources can modify the reaction to occupational stressors to some degree, working conditions can play a major role in placing workers at risk of developing health problems.
Control measures
The most effective way of reducing occupational stress is to eliminate the stressors by redesigning jobs or making organizational changes. Organizations should take the following measures:
1. Ensure that the workload is in line with workers ‘capabilities and resources
2. Clearly define workers’ roles and responsibilities
3. Give workers opportunities to participate in decisions and actions affecting their jobs
4. Improve communication
5. Reduce uncertainty about career development and future employment prospects
6. Provide opportunities for social interaction among workers
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