Madeleine J. Kerr

Effectiveness of an Intervention to Increase Construction Workers' Use of Hearing Protection

In this project we tested the effectiveness of a theory-based intervention (video, pamphlets, and guided practice session) to increase the use of hearing protection devices (HPDs) among Midwestern construction workers and a national group of plumber/pipefitter trainers. Posttest measures were collected 10--12 months following this intervention. Penders Health Promotion Model (1987) provided the conceptual basis for development of the training program. A total of 837 highnoise- exposed workers were included in the analysis: 652 regional Midwestern construction workers and 185 national plumber/pipefitter trainers. Effectiveness of the intervention was determined through the sequence of analyses recommended by Braver and Braver (1988) for the Solomon Four-Group Design. Analysis of variance and covariance of postintervention use and intention to use HPDs and a meta-analytic test were done. These analyses indicated that the intervention significantly increased use of HPDs but had no effect on intention to use HPDs in the future. Pretesting had no effect on use. Actual or potential applications of this research include guidance in the development of successful theorybased interventions to increase use of HPDs.

Explaining Mexican American workers' hearing protection use with the health promotion model

BackgroundMexican American workers are vulnerable to noise-induced hearing loss, the most common occupational disease in the United States. ObjectivesThe purpose was to test the applicability of the Health Promotion Model to Mexican American workers’ use of hearing protection devices. MethodA correlational descriptive design and path analysis were used to determine the relationships between cognitive-perceptual factors, modifying factors and use of hearing protection devices. A questionnaire was completed by a total of 119 workers in three garment manufacturing plants. Interviews were conducted with the occupational health nurse or safety director in each plant to determine the policy regarding hearing protection also. ResultsFactors that directly influenced the use of hearing protection devices were a clinical definition of health, benefits of and barriers to use of hearing protection devices, self-efficacy in the use of hearing protection devices and perceived health status (R2 = .25, p < .01). An exploratory analysis allowing a direct relationship of modifying factors with the dependent variable explained additional variance in use of hearing protection devices through the contribution of situational factors (R2 = .55, p < .01). ConclusionsImportant factors related to Mexican American workers’ use of hearing protection devices were identified to provide direction for nursing interventions. Future research should further test the explanatory capabilities of the Health Promotion Model, explore the importance of situational influences on health behavior, and ensure reliable measures of all model components for this population.

Understanding and preventing noise-induced hearing loss

Noise is a major occupational and environmental hazard, causing hearing loss, annoyance, sleep disturbance, fatigue, and hypertension. Although the extra-auditory effects of high-level noise exposure have been reported, noise-induced hearing loss (NIHL) has long been recognized as the primary and most direct health effect of excessive noise exposure. The World Health Organization reported that 16% of the disabling hearing loss in adults is attributable to occupational noise exposure. NIHL has been recognized as an occupational disease and injury since the 18th century among copper workers who suffered hearing loss as a result of hammering on metal. In the 1800s, Fosbroke also mentioned how blacksmiths suffered hearing impairment from continued exposure to noise. The occupational risk of NIHL in industries that expose workers to continuous high levels of noise is well established with more than 30 million U.S. civilian workers estimated to be exposed to potentially damaging noise levels and another 9 million at risk from other ototraumatic agents, including chemicals. In 1996, the NIOSH had established the National Occupational Research Agenda (NORA) that identified NIHL as one of the 21 priority areas to stimulate innovative research and improved workplace practices to reduce NIHL problem. In order to manage this major health problem among workers exposed to occupational noise, it is important to understand the nature of NIHL. Two characteristics of NIHL have been thoroughly established through numerous studies. First, the amount of hearing loss increases with noise intensity and duration of exposure, such that more intense and longer-duration noise exposures cause more severe hearing loss. Second, individual susceptibility to NIHL varies greatly. Not all individuals exposed to a given noise level develop the same degree of hearing loss. Although the reason that some individuals are more susceptible to NIHL than others is not well understood, several factors have been implicated, including age, previous sensorineural hearing loss, cigarette smoking, use of ototoxic medication, type 2 diabetes, and hypertension. The relationship between these factors and NIHL works in reverse as well. For example, a recent animal study by Kujawa and Liberman demonstrated that damage caused by noise exposure early in life made mice more susceptible to age-related hearing loss.

Public Health Nurses Tailor Interventions for Families at Risk

OBJECTIVES To use structured clinical data from public health nurse (PHN) documentation to describe client risk, to describe family home visiting interventions, including tailoring, and to assess the associations between client risk and intervention tailoring. DESIGN AND SAMPLE Retrospective cohort design. A cohort of 486 family home visiting clients who received at least 3 visits from PHNs in a local Midwest public health agency (2000-2005). MEASURES Omaha System variables documenting assessments, interventions, and outcomes. A risk index was created to identify low- and high-risk clients. Descriptive and inferential methods were used to describe interventions, and to assess intervention tailoring between groups. INTERVENTION Routine PHN family home visiting practice. RESULTS The risk index meaningfully discriminated between groups. PHNs provided more visits and interventions to clients in the high-risk group, with variations in problem, category, and target by group, demonstrating that PHNs tailored interventions to address specific client needs. CONCLUSIONS Standardized terminologies and structured clinical data are useful tools to support PHN practice, and may be useful to advance health care quality research, program evaluation, policy development, and population health outcomes.

Data management for intervention effectiveness research: Comparing deductive and inductive approaches

Management approaches are needed to prepare intervention data sets for research. We identified four management approaches and applied them to Omaha System intervention data from 15 home care agencies (621,385 interventions provided to 2,862 patients). Classifying intervention data created differing numbers of distinct groups for deductive approaches labeled as action category (four groups), theoretical (5), and clinical expert consensus (23). One inductive, data-driven approach generated 150 groups of interventions, of which 24 were meaningful and unique. Interventions in deductive groups were mutually exclusive, and approaches mapped readily according to intervention action terms. The novel, overlapping, inductive groups consisted of diverse actions for multiple problems. The four management approaches created meaningful intervention groups to be employed in future outcomes evaluation studies.

Linking home care interventions and hospitalization outcomes for frail and non-frail elderly patients.

Structured clinical data generated using standardized terminologies such as the Omaha System are available for evaluating healthcare quality and patient outcomes. New intervention management grouping approaches are needed to deal with large, complex clinical intervention data sets. We evaluated 56 intervention groups derived using four data management approaches with a data set of 165,700 interventions from 14 home care agencies to determine which approaches and interventions predicted hospitalizations among frail (n = 386) and non-frail (n = 1,364) elders. Hospitalization predictors differed for frail and non-frail elders. Low frequencies in some intervention groups were positively associated with hospitalization outcomes, suggesting that there may be a mismatch between the level of care that is needed and the level of care that is provided.

Prevalence of hearing loss and accuracy of self-report among factory workers

Noise represents one of the most common occupational health hazards. A Healthy People 2020 objective aims to reduce hearing loss in the noise-exposed public. The purpose of this study was to describe and compare perceived and measured hearing, and to determine the prevalence of hearing loss among a group of factory workers. Data collected as part of an intervention study promoting hearing protector use among workers at an automotive factory in the Midwest were used. Plant employees (n=2691) provided information regarding their perceived hearing ability, work role, and other demographics. The relationships among audiograms, a single-item measure of perceived hearing ability, and demographic data were explored using chi-square, McNemars test, Mann-Whitney U-test, sensitivity, and specificity. The prevalence of hearing loss among noise-exposed factory workers was 42% (where hearing loss was defined as >25 dB loss at the OSHA-recommended frequencies of 2, 3, and 4 kHz in either ear). However, 76% of workers reported their hearing ability as excellent or good. The difference in perceived hearing ability was significant at each tested frequency between those with and without measured hearing loss. Self-reported hearing ability was poorly related to results of audiometry. Although this group of workers was employed in a regulated environment and served by a hearing conservation program, hearing loss was highly prevalent. These findings, together with national prevalence estimates, support the need for evaluation of hearing conservation programs and increased attention to the national goal of reducing adult hearing loss.

Benchmark Attainment by Maternal and Child Health Clients Across Public Health Nursing Agencies

OBJECTIVES Benchmark client outcomes across public health nursing (PHN) agencies using Omaha System knowledge, behavior, and status ratings as benchmarking metrics. DESIGN AND SAMPLE A descriptive, comparative study of benchmark attainment for a retrospective cohort of PHN clients (low-income, high-risk parents, primarily mothers) from 6 counties. MEASURES Omaha System Problem Rating Scale for Outcomes data for selected problems. Benchmark measures were defined as a rating of 4 on a scale from 1 (lowest) to 5 (highest). INTERVENTION Family home visiting services to low-income, high-risk parents. RESULTS The highest percentage of benchmark attainment was for the Postpartum problem (knowledge, 76.2%; behavior, 94.0%; status, 96.6%), and the lowest was for the Interpersonal relationship problem (knowledge, 21.7%; behavior, 69.0%; status, 40.7%). All counties showed significant increases in client knowledge benchmark attainment, and 4 of 6 counties showed significant increases from baseline in behavior and status benchmark attainment. Significant differences were found between counties in client characteristics and benchmark attainment for knowledge, behavior, and status outcomes. CONCLUSIONS There were consistent patterns in benchmark attainment and outcome improvement across counties and family home visiting studies. Benchmarking appears to be useful for comparison of population health status and home visiting program outcomes.

Feasibility of encoding the Institute for Clinical Systems Improvement Depression Guideline using the Omaha System

Evidence-based clinical guidelines are being developed to bridge the gap between research and practice with the goals of improving health care quality and population health. However, disseminating, implementing, and ensuring ongoing use of clinical guidelines in practice settings is challenging. The purpose of this study was to demonstrate the feasibility of encoding evidence-based clinical guidelines using the Omaha System. Clinical documentation with Omaha System-encoded guidelines generates individualized, meaningful data suitable for program evaluation and health care quality research. The use of encoded guidelines within the electronic health record has potential to reinforce use of guidelines, and thus improve health care quality and population health. Research using Omaha System data generated by clinicians has potential to discover new knowledge related to guideline use and effectiveness.

Mining Quality Documentation Data for Golden Outcomes

Increased data reporting requirements, reimbursement changes, and automation capabilities provide new challenges for home health care and public health agencies today. These factors have become the impetus for computerization of practitioner documentation. Standardized documentation systems such as the Omaha System allow agencies to describe client needs, service delivery, and related client outcomes and to generate powerful data when used consistently and reliably in practice settings. This article offers practical suggestions for assuring data quality as well as simple, effective analysis and reporting strategies. Several figures depicting Omaha System documentation data from diverse programs are included as examples.