Abstract: A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

Abstract: Injections are frequently administered by occupational health nurses in worksite health promotion programs. The purpose of this study was to examine the effect of varying injection speed on the perception of pain. Fifty workers were given intramuscular (i.m.) hepatitis B vaccine at injection speeds of 10 and 30 seconds per cubic centimeter (s/cc). The perception of pain was measured on a visual analogue scale and reported post-injection at three different time intervals. The results showed that no difference in pain was perceived by participants between the two injection speeds. Results also revealed that women consistently had higher mean pain scores than men and significantly more pain at the 0 hour measurement of the 10 s/cc injection. While the results of this study indicate no need to administer an i.m. injection slower than 10 s/cc, occupational health nurses will need to consider gender differences in pain perception when administering injections.

Abstract: A questionnaire designed to study the information seeking behavior of professional nurses was mailed to 600 occupational health nurses who work and reside in New York State. A 28% response rate (165 usable replies) was obtained. Results indicated respondents most need to know about government regulations relating to health care, new developments in their area of specialization, drug information, and the psychological aspects of disease. The respondents most frequently looked to peers and colleagues in their agency, personal files and books, and professional organizations as important sources of information. Whereas respondents were less apt to rely on the Internet, MEDLINE, or the hospital library as sources of information used for professional purposes, 38.8% did report they frequently used the Internet to seek health related information. Also, the majority of respondents (65%) indicated interest in continuing education, if it were available, in using the Internet to access health related information. The present study suggests professional nursing organizations have an opportunity to meet members' needs by expediting members' efforts to access and evaluate information using emerging information technologies.

Abstract: Physical fitness of the American worker is a core element of personal good health and a key factor in corporate cost containment. The Centers for Disease Control and Prevention specifically notes that health professionals should be physically active not only to benefit their own health but also to make more credible their endorsement of an active lifestyle. Guided by Pender's Health Promotion Model, this study gives a profile of the current status of exercise behaviors, physical self efficacy, and perceived health control among a sample of occupational health nurses. Surveys were mailed to a random sample of 300 female members from a midwestern state association of the American Association of Occupational Health Nurses. The mean exercise score was 30.7 MET hours per week, with walking the activity most often selected. Physical self efficacy was a significant positive predictor of exercise practice, while age exerted a significant inverse effect on exercise. The study findings may be used to stimulate discussion among occupational health nurses about how their own physical self efficacy and perceived health control may influence their exercise behaviors, and how in turn these beliefs and exercise practices may influence their decisions about promoting exercise programs at their workplaces.

Abstract: Stress, both positive and negative, is a part of personal and work life. Some stressors in the work environment are so extreme they cause strain to all employees. Such conditions require immediate response by employers to change the work environment. However, understanding most workplace stress requires an approach examining the fit between the individual and the work. Only by holistically examining the relationships between the worker's characteristics and the job's characteristics can successful intervention strategies be planned and implemented. Once occupational and environmental health nurses have completed an occupational stress assessment they can plan primary, secondary, and tertiary interventions to meet the specific needs of the employees and the organization.

Abstract: 1. Minimizing the impact of injury, disability, and disease on employees is important not only to enhance the employee's quality of life, but also to maintain worker performance. Key to the disability management plan is early, aggressive, and safe return to work programs, which minimize personal and corporate costs. 2. The challenge is to improve the delivery of various disability programs (including short term disability, long term disability, and workers' compensation), and minimize escalating costs. 3. Program development provides the foundation for a disability management system. Implementation is key to achieving success. To successfully market case management, the occupational health nurse must articulate the cost benefit, as well as other concepts behind case management. 4. Disability management can be operationally defined as an active process for minimizing the impact of an impairment (resulting from injury, illness, or disease) on the individual's capacity to participate competitively in the work environment.

Abstract: Reaching workers in small worksites presents economic and access barriers for occupational health nurses. Some barriers can be overcome through strategies based on cultural sensitivity. Day care centers employ young, low income, mostly minority women in settings with few workers onsite at any one center. These settings were used to develop a culturally sensitive approach tested through onsite cardiovascular screening, informal interviews, and discussion of behavior change for better health. The study examined both the impact of the Healthier People Health Risk Appraisal (HPHRA) as a culturally appropriate recruitment strategy to involve a group of child day care workers in a cardiovascular disease (CVD) screening and risk reduction program and the effect of that program on observable CVD measures. Faculty and students from an institution of higher education forged a trust relationship with day care providers at nine day care centers in a large metropolitan area. Cardiovascular health was the impetus for the project because minority populations in the southeastern United States have high heart attack and stroke mortality and morbidity rates. Participation rates in the project increased from 26% of the day care workers in the first year of the project to 73% when long term relationships were built on culturally appropriate strategies. The project's culturally sensitive educational intervention focused on individual risks and lifestyle. Statistical analysis of outcomes of the intervention and personal interviews demonstrated the improvement of cardiovascular status in the day care workers. This psychosocial approach can provide the foundation for culturally sensitive care in larger occupational and community settings.

Abstract: 1. The demographic shift to an aging population has significant societal and cultural implications that carry over into the workplace. 2. The occupational and environmental health nurse needs to be aware of the risks associated with the aging process including physiological changes of aging, comorbidities and chronic diseases, and psychosocial factors as well as the impact those risks may have on work ability. 3. Health management strategies for an aging worker population include developing an older worker profile, creative job accommodations, and training programs. 4. The occupational and environmental health nursing scope of practice will require significant change for the profession to take a proactive approach to address this workplace transformation.

Abstract: This study replicated a study by Martin (1993) to examine the corporate perceptions of the current and future roles and activities of the occupational health nurse and the nurse's value added contributions in the local operating units of a large Fortune 100 company. A descriptive design was used for this study. The sample consisted of 44 corporate officials. The study findings are consistent with Martin (1993) and suggested that management is aware of the traditional roles and activities of the nurse, including direct care, education and counseling, and case management. The desired future activities identified were trend analysis, conducting plant rounds, and developing health programs specific to the needs of the corporation. The activities identified as adding value to the corporation included: planning and developing educational programs specific to the needs of the corporation, supervising the provision of nursing care, assisting in rehabilitation of injured workers, and providing follow up on workers' compensation claims. Corporate officials are aware of the traditional roles of the nurse. However, they may not be aware of the newer nursing roles, such as trend analysis, research, and budget development.

Abstract: 1. Training via the Internet (e-training) for adults must be based on the following principles: (1) learning is an active process wherein the learner constructs knowledge rather than acquires it and (2) instruction is a process of supporting this construction rather than communicating knowledge. E-training can successfully accommodate such features using available technologies. 2. Because e-training is self directed, it is uniquely adaptable to learners with different learning styles, interests, and cultural beliefs. E-training also affords flexible pacing, which is ideal for instruction aimed at both new and experienced workers. 3. As the predicted global economy becomes reality, qualified OSH personnel will be needed on a global scale. To meet new and evolving needs worldwide, professionals must have access to information and training regardless of location. E-training is the most promising approach to meeting this demand. 4. Currently, occupational safety and health e-training does not fulfill its potential. Most training programs do not encourage higher level cognition, critical thinking, or transfer of knowledge. Therefore, training effectiveness research is needed to improve the state of e-training.

Abstract: Agricultural health nurses address the health and safety issues of farmers, agricultural workers, and farm families. This nurse role incorporates both public health and occupational health nurse specialty practice. The purpose of this study was to describe agricultural health nurse job functions and competencies used in providing services to agricultural populations. A two round modified Delphi technique was used to attain a consensus among participants related to agricultural health nurse functions and competencies. In Round I, a mailed survey assessing demographic characteristics, and job functions and competencies was sent to an identified list of 61 nurses. A second mailed survey, with categorized job function and competency responses elicited through Round I, was sent to the 32 Round I respondents to assess the importance of the job functions and competencies and the frequency of performing each job function. Twenty four Round II surveys were returned. Job functions rated highest were: Serve as a liaison for the agricultural, health and medical, and nonfarm communities. Promote agricultural health and safety issues through the media. Implement educational courses for various groups. Conduct follow up assessment of injury, illness, or disease occurring as a result of an agricultural exposure. Function as a resource for information to victims of agricultural injury and illness and their families. The competencies of greatest importance were interpersonal communication skills, knowledge of injury prevention principles and measures, ability to recognize potential hazards within the work and home environment, and demonstrate a strong sense of self. This study adds to the body of knowledge needed to define the agricultural health nurse role.

Abstract: The Privacy Rule: Limits the use and disclosure of PHI to purposes of treatment, payment, or routine health care operations. Requires covered entities to provide advance notice to the public of its policy governing disclosure of PHI. Requires entities covered by the Standard to secure general client consent to use and to disclose PHI for treatment, payment, or routine health care operations and to obtain specific client authorization to use or to disclose PHI for all other purposes unless the disclosure is specifically permitted without consent or authorization (e.g., a covered entity may disclose PHI to a health care oversight agency such as the Office of the Inspector General without first obtaining client authorization). In certain situations, a covered entity need only obtain client agreement to disclose PHI which may be oral or inferred from the circumstances surrounding the disclosure. For example, a covered entity could disclose PHI to a relative caring for the individual who is the subject of the health information. Expects covered entities to take measures to protect PHI from both inadvertent and deliberate misuse and disclosure. Requires, except in certain circumstances, the amount of PHI disclosed on any occasion to be limited to the minimum necessary to achieve the purpose of the disclosure. Gives individuals more control of their health information by permitting them to review and amend health information pertaining to themselves and to demand an accounting of persons to whom their health information has been disclosed. Establishes terms under which a covered entity may disclose PHI to a business associate. Permits states to maintain state laws that are more stringent than the Privacy Rule. The statute provides for significant civil and criminal penalties for failure to comply with the Standards. Violations are punishable by fines as much as $250,000 and 10 years imprisonment. The HHS, Office of Civil Rights is charged with enforcing the Standards. The HHS is expected to issue a single Enforcement Rule applicable to all three of the HIPAA Administrative Simplification Standards. Many worksite records will not be protected under the HIPAA Privacy Rule because employers are not covered entities and few occupational health professionals meet the criteria of being considered a covered entity. Nevertheless, occupational health professionals need to be knowledgeable about the application of HIPAA in the occupational health care setting. Furthermore, given that the Rule does not preempt state privacy laws that are more stringent than the Standards, occupational health professionals should monitor legislative activity related to privacy in the states in which they practice. To date, Oregon, Texas, and New Jersey have broadened HIPAA's definitions to create more covered entities and services.

Abstract: 1 The scope of professional nursing practice obligates the individual nurse to make participation in public policy formulation part of their professional work Helping to shape the health and welfare of our communities and the nation fulfills part of nursing's contract with America's citizens 2 Nurses have valuable, special knowledge and skills which "fit" very well with political involvement and policy making activities 3 Occupational and environmental health nurses have a special responsibility to influence public policies that affect America's work force by using the five Cs of political action to enable effective involvement 4 Nursing's professional associations act as advocates for nursing's unique interests and causes Nurses who join and become active in associations such as AAOHN and ANA are instrumental in protecting the profession of nursing and ensuring that health care issues are at the top of the political agenda at all government levels

Abstract: Traditional corporate approaches toward anger and anxiety in the workplace have ignored or exacerbated the problem. Human emotions are not only essential for job performance, they are a free resource that can be harnessed in ethical ways to enhance job productivity. Most of the causes and costs of workplace anger and anxiety can be prevented. In an ideal workplace, employees are internally motivated and self regulating because they are hired with care, placed in jobs serving them as well as the company, and supported with the required resources to accomplish their jobs. When companies treat employees with dignity and make efforts to empower them, employee self confidence and performance grows. Occupational and environmental health nurses are in positions to alter dysfunctional aspects of corporate culture while simultaneously working with individual employees who are angry or anxious. Successful companies are those that nurture their workers while achieving their mission. They treat employees with dignity and respect while challenging them to reach their full potential.

Abstract: 1. Bioterrorism is the intentional release of a biological agent--bacterial, viral, or genetically altered--to instill fear or create chaos, massive casualities, illness, and death in humans, animals, or plants. 2. The threat of bioterrorism is real. Although every community is vulnerable, terrorists seek densely populated, highly visible targets. 3. Occupational and environmental health nurses must to be able to recognize and report signs and symptoms of an early bioweapons outbreak in their workplaces and communities. Only thorough preparedness and planning will result in effective mitigation and treatment. 4. The Bioterrorism Readiness Plan (at http://www.apic.org and http://www.CDC.gov/ncidod/hip) is a template for health care professionals to help plan a realistic response to bioterrorism. It serves as a tool for successful collaboration and communication among all disciplines and public health agencies for the best possible outcomes.

Abstract: Combining the talents and skills of CON faculty and students with those of the CAVHS health professionals has demonstrated the synergy that can be obtained through collaboration. The health care needs of CAVHS employees continue to provide a fertile ground for the education, service, and research missions of the CON. The Program outcomes and employee satisfaction ratings, combined with the positive educational outcomes in the CON, have led to strengthened relationships between nursing education and the veterans health care system. The results of this partnership are illustrated by the recent signing of an additional 3 year contract for the CAVHS.

Abstract: 1. Increasing work force diversity is reflected in the Healthy People 2010 goal to eliminate health disparities. 2. At the organization level, a framework of cultural competence defines the developmental process toward cultural proficiency. 3. Strategies are suggested for organizations and nurses to engage in cultural competence.

Abstract: 1. Premenstrual syndrome (PMS) is defined as the cyclic recurrence of physical, psychological, or behavioral symptoms that appear after ovulation and resolve with the onset of menstruation. These symptoms can be severe enough to disrupt personal relationships, social activities, or job performance. 2. The exact cause of PMS is unknown. The best tool to diagnose PMS is a daily symptoms rating calendar. To have the diagnosis of PMS, the symptoms must be severe enough to disrupt normal daily activities. 3. The occupational health nurse can provide information about first line treatment modalities for PMS symptoms including dietary modifications, nutritional supplements, aerobic exercise, and stress management skills. 4. More research is needed about PMS in the workplace and the effect of treatments on outcomes such as job attendance and work performance.

Abstract: The assessment and management of clinical problems of employees related to occupational and non-occupational health are key components within the scope of the occupational and environmental health nurse practice. Employees present with various physical or psychosocial problems. The occupational and environmental health nurse must be equipped to make appropriate assessments and decisions related to the employees' care and referral. Use of a structured health assessment tool provides a systematic approach to identification of health needs given the stated goals of maintaining employee health and securing a safe work setting.

Abstract: According to DiBenedetto, "Occupational health nurses enhance and maximize the health, safety, and productivity of the domestic and global work force" (1999b). This project clearly defined the multiple roles and activities provided by an occupational and environmental health nurse and assistant, supported by a part time contract occupational health nurse. A well defined estimate of the personnel costs for each of these roles is helpful both in demonstrating current value and in future strategic planning for this department. The model highlighted both successes and a business cost savings opportunity for integrated disability management. The AAOHN's Success Tools (1998) were invaluable in launching the development of this cost effectiveness model. The three methods were selected from several tools of varying complexities offered. Collecting available data to develop these metrics required internal consultation with finance, human resources, and risk management, as well as communication with external health, safety, and environmental providers in the community. Benchmarks, surveys, and performance indicators can be found readily in the literature and online. The primary motivation for occupational and environmental health nurses to develop cost effectiveness analyses is to demonstrate the value and worth of their programs and services. However, it can be equally important to identify which services are not cost effective so knowledge and skills may be used in ways that continue to provide value to employers (AAOHN, 1996). As evidence based health care challenges the occupational health community to demonstrate business rationale and financial return on investment, occupational and environmental health nurses must meet that challenge if they are to define their preferred future (DiBenedetto, 2000).

Abstract: The IOM study does an admirable job of discussing trends affecting the future of workers and the workplace. Based on theses trends, there will be vast unmet needs, as well as tremendous opportunities, for occupational health and safety professionals, particularly occupational health nurses, to help meet these needs. Individual occupational health and safety professionals will do well to study the trends, assess their current knowledge and skills, and seek the education and training required to develop and enhance the necessary competencies. They will need to: pay special attention to areas of behavioral health, work organization, communication (especially risk commnication), management, team learning, work force diversity, information systems, prevention interventions, health care delivery systems, and evaluation methods (IOM, 2000). They will need to develop, document, and communicate new and creative models for providing occupational health and safety services. Also, see the Advisory, "Job Security for the 21st Century," on page 164A.

Abstract: 1. As the population of adults with limited English proficiency plays an increasingly important role in the United States workplaces, there has been a growing recognition that literacy and limited English skills affect health and safety training programs. 2. Several important principles can be used as the underlying framework to guide teaching workers with limited English proficiency: clear and vivid way of teaching; contextual curriculum based on work; using various teaching methods; and staff development. 3. Two feasible strategies were proposed to improve current situation in teaching health and safety to workers with limited English proficiency in one company: integrating safety and health education with ongoing in-house ESL instruction and developing a multilingual video program. 4. Successful development and implementation of proposed programs requires upper management support, workers' awareness and active participation, collaborative teamwork, a well structured action plan, testing of pilot program, and evaluation.

Abstract: 1. Implementation of a medical/health surveillance program can prevent the damaging effects of lead toxicity. Lead toxicity may be a result of acute or chronic exposure and can affect the hematopoietic, nervous, renal, and reproductive systems. 2. Minority groups tend to be overrepresented in lead industries. Further, an increase in high lead levels can be compounded by cultural influences. Education must be geared toward the specific employee populations. 3. Successful programs require assistance from all team members--occupational health nurse, safety engineer, industrial hygienist, and environmental engineer. Occupational health nurses play an important role in implementation of medical/health surveillance programs by scheduling regular blood testing, monitoring results, and educating employees.

Abstract: United States companies recognize health care costs are rising and the prevention, early detection, and treatment of disease can help with cost control. Onsite mobile mammography can provide a convenient, effective, and time saving service for employees. Establishing a mobile mammography program requires some planning, but is relatively easy to administer and maintain.

Abstract: A sampling pool of 4,808 farms in 10 parishes across southeast Louisiana was used to examine the risk factors of farm women who engage in activities putting them at risk for tetanus and to examine ...

Abstract: Content analysis of the view of occupational stress presented in the Annual Reports of an Australian public hospital revealed scant attention to occupational health and safety issues and less still to the issue of workplace stress. The hospital aimed to "provide for all employees a working environment with maximum job satisfaction and opportunities for personal growth," yet stepped up surveillance of "sick leave not absolutely necessary or related to medical conditions." Investigation of the hospital's employee assistance programs revealed a "band aid" approach of individually focused stress management techniques rather than preventative organizational procedures. The researchers concluded that management considered workplace stress to be a problem in the employee not in the workplace, evident also in an increase of almost 1,000% in the number of clients visiting the staff counseling center in a 10 year period. Although a shift to focus on prevention was noticed in most recent reports consistent with the World Health Organization's target of stress prevention, the holistic public safety of workers appears an unmet challenge in this health industry.