Care of Clients in Work Settings Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Care of Clients in Work Settings

Copyright ©2008 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.Community Health Nursing, 5/eMary Jo Clark

24CHAPTER

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Clients in Work Settings

Two-thirds of U.S. population over 16 years of age work.



Employer Awareness of Benefits

• Cost effectiveness

• Impact on productivity



Advantages of Employee Health Programs

• Amount of time at work

• Captive audience

• Risks for health problems

• Motivation to maintain health

• Health promotion efficient and cost-effective



Advantages of Employee Health Programs (continued)

• Visible costs– Costs of poor health

• Sickness• Absenteeism• Employee turnover



Advantages of Employee Health Programs (continued)

• Invisible costs– Low productivity– Poor-quality work– Poor customer services– Accidents– Legal claims related to illness and injury



Goal of Occupational Health Services

• Ensure working adults reach and maintain full working potential– Health promotion– Protection– Surveillance activities



Types of Health and Safety Hazards

• Occupational injuries– Musculoskeletal injuries– Accidents– Exposure to hazardous chemicals



Types of Health and Safety Hazards (continued)

• Agricultural injuries– Heavy equipment accidents– Exposure to hazardous chemicals

• Occupational illnesses



Biophysical Considerations

• Age of employees determines health risks– Young adult risks– Older adult risks



Female Gender Composition

• Pregnancy

• Reproductive health



Physiologic Function

• Extent of injury and illness



Psychological Considerations

• Stress in workplace

• Mental health and illness



Stress in Workplace and Health Effects

• Job strain model

• Effort-reward imbalance



Mental Health and Illness in Workplace

• Depression

• Risk factor for health conditions

• Increase costs to employer and employee



Physical Environmental Considerations

• Physical hazards– Noise– Lifting – Equipment

• Chemical hazards– Toxins

• Electrical and magnetic field hazards• Exposure to metallic compounds,

allergens, molds



Sociocultural Considerations

• Positive or negative influences– Quality of social interactions– Attitudes toward work and health– Presence or absence of racial or other

tensions



Major areas of Sociocultural Assessment

• Policy and legislation

• Interactive effects of work and family life

• Workplace violence

• Other factors



Behavioral Considerations

• Lifestyle factors– Type of work performed– Consumption patterns– Patterns of rest and exercise– Use of safety devices



Health System Considerations

• Types of services used

• Reasons for and appropriateness of use

• Availability of services

• Availability of health insurance



Four Spheres of Influence

• Individual health-related behaviors

• Coworkers’ attitudes to and influence on health-related behaviors

• Management’s attitudes and enforcement of health policies

• Legal, social, and political actions



Types of Health Care Programs in Work Settings

• Internal health care systems– Toxic exposure programs– Health promotion programs– Comprehensive programs– Family care



Toxic Exposure Prevention Programs

• Control programs

• Elimination programs



Control Programs

• Engineering controls

• Controlled work practices

• Safety equipment and devices

• Elimination programs– Remove substances from workplace– OSHA-regulated



Health Promotion Programs

• Goal– Limit hospitalizations and acute care

expenses

• Types of services– Education

• Proper body mechanics• Company health policies



Employee Health Promotion Programs

• Illness-oriented

• Wellness-oriented



Comprehensive Programs

• Wellness approach– Awareness

• Stress management programs

– Lifestyle changes• Exercise programs



Comprehensive Programs (continued)

• Wellness approach– Change environmental conditions to promote

better health• Yoga• Massage services



Family Care Programs

• On-site child care programs

• Counseling services

• On-site elder care services



External System

• Internal system of care interfaces with the external community health care system– Addresses health care needs that cannot be

met by the internal system



Primary Prevention in Work Setting (Refer to Table 24-2)

• Health promotion

• Illness prevention

• Injury prevention

• Violence prevention



Health Promotion

• Exercise programs

• Stress management

• Programs to reduce negative effects of commuting

• Reproductive health education and referral services



Illness Prevention

• Immunization

• Risk factor modification

• Postexposure prophylaxis

• Stress reduction/management education



Injury Prevention

• Safety education

• Make provisions for adequate safety equipment

• Monitor effective use of safety equipment

• Develop policies and procedures that prevent injury



Injury Prevention

• Modify or eliminate injury risk factors in the work setting

• Develop adequate management support for injury prevention policies and procedures



Violence Prevention

• Modify worksite environments that promote violence

• Encourage the installation of security devices

• Develop processes and procedures for handling workplace violence or potential for violence



Violence Prevention

• Develop reporting procedures

• Develop disciplinary sanctions for violent behavior in the work setting

• Employee education on violence prevention, anger management, and recognition of potentially violent situations



Secondary Prevention

• Screening and surveillance

• Treat existing conditions

• Emergency care



Screening and Surveillance

• Preemployment screening• Determination of work capacity• Recommendations regarding work conditions

or accommodations• Periodic employee screening• Periodic environmental screening• Reporting and interpreting screening findings

and making referrals for care or environmental modification



Treat Existing Conditions

• Treat work-related illness or injury

• Provide immediate first aid

• Refer for outside medical assistance as needed

• Develop health care delivery programs to address high prevalence problems



Treat Existing Conditions

• Advocate for adequate employee health insurance coverage

• Advocate for accessible internal or external health care services



Emergency Response

• Assist in developing individual and disaster emergency response plans for the work setting

• Respond to individual physical or emotional emergencies

• Refer for continued treatment• Respond to care needs in an occupational

disaster• Evaluate the health effects of occupational

disasters



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



Preventing the Spread of Communicable Diseases

• Employee immunization programs

• Education on infection control procedures



Preventing the Recurrence of Acute Conditions

• Education of employees

• Advocacy for environmental modifications



Preventing Complications of Chronic Conditions

• Monitor treatment effects and disease status

• Educate employees for disease self-management

• Ensure modification of the work environment to accommodate limitations due to disability



Assessing Fitness to Return to Work

• Follow-up on worker’s compensation claims

• Assess recovery status

• Ensure modification of work environment as needed to promote return to work



Resources

• OSHA has a four-pronged comprehensive approach to ergonomics designed to quickly and effectively address musculoskeletal disorders (MSDs) in the workplace. The four segments of OSHA's strategy for reducing injuries and illnesses from MSDs in the workplace are guidelines, enforcement, outreach & assistance and a National Advisory Committee.



Resources

• National Institute for Occupational safety & Health (NIOSH) is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services.

Documents

Care of Clients in Work Settings Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health