Marjorie C. McCullagh

An Integrative Review Work Environment Factors Associated With Physical Activity Among White-Collar Workers

The purpose of this review is to synthesize the research evidence for the role of the work environment—workplace physical activity policies and resources and job strain factors—in explaining physical activity in white-collar workers. White-collar workers are at risk for developing a sedentary lifestyle, which contributes to all-cause mortality. Understanding how work environment can influence worker physical activity is important for the development of effective interventions. We reviewed 15 research articles that describe the relationship between work environment factors and physical activity in predominantly white-collar workers. Relatively consistent evidence was found for the effects of supportive workplace policies and resources. Weak evidence was found for the effects of job strain. Both work environment factors have the potential to influence physical activity but require further exploration to fully understand their contribution to physical activity in white-collar workers. Limitations and implications are discussed.

Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy

Purpose Oncology nurses in ambulatory settings are at increased risk for unintentional chemotherapy exposure due to the large volumes of agents delivered and the absence of regulatory enforcement. Given the limited data regarding the correlates of exposure, the authors sought to identify the relationship between the organisational structures and processes of care in ambulatory oncology settings associated with increased risk of unintentional chemotherapy. Methods Between April 2010 and June 2010, a state-wide sample of oncology nurses were surveyed who reported their employment outside of hospital inpatient units (n=1339). The survey examined the likelihood of self-reported exposure to chemotherapy as a function of perceived quality of the practice environment, nursing workload, and seven ambulatory chemotherapy administration safety standards. Results The response rate was 30.4%, with minimal demographic differences observed between respondents and non-respondents. The overall rate of exposure to the skin or eyes in the past year was 16.9%. In multivariable logistic regression models that controlled for demographic characteristics and clustering of nurses in practices, the likelihood of exposure decreased when nurses reported adequate staffing and resources (OR 0.35, 95% CI 0.17 to 0.73; p=0.001), and when nurses reported that chemotherapy doses were verified by two nurses frequently or very frequently (OR 0.17, 95% CI 0.05 to 0.59; p=0.001). Conclusions Oncology nurses in the ambulatory setting report substantial unintentional skin and eye exposure to chemotherapy. Ensuring adequate staffing and resources and adherence to recognised practice standards may protect oncology nurses from harm.

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.

Antineoplastic drug exposure in an ambulatory setting: a pilot study.

Background: Exposure to antineoplastic drugs confers health risks to workers, yet little is known about the exposure after a drug spill, nor has the relationship between exposure and organizational factors such as staffing and work environment been studied. Objective: The aim of this study was to evaluate drug spills prospectively using biological measures and correlate drug spills with organizational factors. Methods: Prospective questionnaires with 8-hour timed urine samples were collected from nursing and pharmacy personnel who reported drug spill events in 1 academic health center’s infusion center. Urine was collected similarly from workers who did not report a spill. Liquid chromatography tandem mass spectrometry techniques identified detectable drug levels. After the prospective sampling period, workers were surveyed on workloads, practice environment, and safety behaviors. Results: From 81 eligible individuals, 40 participated in the prospective study and 19 completed retrospective questionnaires. Four spills were reported by 9 personnel, as multiple employees were exposed to drug spills. Four participants who reported a spill showed detectable levels of antineoplastic drugs. Four participants who did not report a spill had detectable levels of docetaxel. Compared with respondents who did not report a spill, collegial relations with physicians were significantly poorer for workers who reported spills. Conclusions: The study protocol successfully captured drug spill reports and biological samples. Workers have detectable levels of antineoplastic drugs through both drug spills and environmental contamination. Implications for Practice: Multisite research studies and practice-based quality improvement approaches are needed to improve adherence to personal protective equipment use and safe handling procedures.

Addressing adult hearing loss in primary care

AIMS To (a) determine the extent to which primary care providers screen adults for environmental or occupational hearing loss during the primary care visit and (b) determine what techniques are used to screen for hearing loss in the adult primary care patient. BACKGROUND Although the prevalence of hearing loss is high, the frequency and techniques of screening for hearing loss among primary care providers are unknown. According to the United States Preventative Task Force, hearing screening promotes early detection, adequate treatment, and improved quality of life. DESIGN It is a retrospective audit. METHODS Thirty client records were randomly selected from two clinics in 2009 for this retrospective patient record audit. RESULTS/FINDINGS Physical assessment of the structure of the auditory system was completed in all cases selected. Hearing acuity in all cases was determined by patient self-assessment, as indicated on patient-completed history forms; there was no documentation of objective assessment of auditory function. CONCLUSION Given the low correlation between perceived and measured hearing ability, assessment of hearing ability by patient report alone may result in failure to detect hearing loss. Research into the nature and extent of barriers to hearing assessment in primary care needs to be explored, and criteria for screening of adults in the primary care setting should be established.

Hospice nurses and drug disposal: The convergence between nursing practice and the environment

In the United States, for the past decades, poison control centers have long recommended discarding medications to sewerage to prevent accidental and purposeful poisonings from occurring. The first federal disposal guidelines for drug disposal were published in 2007. In 2008, an Associated Press investigation revealed that pharmaceuticals were found in drinking water supplies of many Americans. However, pharmaceuticals in our drinking water are not a new finding; since humans began to use medicine for healing purposes, deposits of ingredients have been added to water. As pharmaceutical agents in the water have been linked to abnormalities in aquatic life, concerns about impact to human health have arisen. As public concern grows about the impact of pharmaceuticals in the water, hospice home care nurses, as the only nurse specialist required to ensure disposal of unused medications upon a patients death, are also beginning to question if there is a better way to dispose of unused medication. This article will discuss (1) pharmaceutical agents in the water, (2) environmental pathways and aquatic exposure, (3) possible human health effects, (4) gaps in data about hospice nursing knowledge and practice, and (5) recommendations for hospice nursing practice, research, and advocacy.

Definition and Management of Hypertension among Haitian Immigrants: A Qualitative Study

Hypertension is a major health concern among Haitian immigrants, one of the largest Caribbean immigrant groups in the United States. Yet, little is known about how Hatian immigrants define and manage hypertension. For this qualitative study, face-to-face semi-structured interviews were conducted with 31 Haitian immigrants in Miami Dade County, Florida. Results indicated that most Haitian immigrants used the Haitian Creole word tansyon to represent hypertension. Tansyon was considered as either a normal condition of the human body or a maladi (illness). Both traditional biomedical and alternative approaches were used to manage hypertension. The findings show that how Haitian immigrants defined hypertension shaped their beliefs about its occurrence and the resulting management strategies used. Those who believed tansyon was a normal body condition did not take any management measures. Awareness and understanding of Haitian immigrants’ beliefs about and approaches to hypertension management can enhance culturally sensitive care and improve health outcomes.

Strategies to enhance participant recruitment and retention in research involving a community-based population

Challenges associated with recruiting and retaining community-based populations in research studies have been recognized yet remain of major concern for researchers. There is a need for exchange of recruitment and retention techniques that inform recruitment and retention strategies. Here, the authors discuss a variety of methods that were successful in exceeding target recruitment and retention goals in a randomized clinical trial of hearing protector use among farm operators. Recruitment and retention strategies were 1) based on a philosophy of mutually beneficial engagement in the research process, 2) culturally appropriate, 3) tailored to the unique needs of partnering agencies, and 4) developed and refined in a cyclical and iterative process. Sponsoring organizations are interested in cost-effective recruitment and retention strategies, particularly relating to culturally and ethnically diverse groups. These approaches may result in enhanced subject recruitment and retention, concomitant containment of study costs, and timely accomplishment of study aims.

Why Breastfeeding Matters to Occupational Health Nurses and Employers

Women with children are the fastest growing segment of the U.S. work force. Employers must comply with the 2010 Patient Protection and Affordable Care Act, requiring them to provide acceptable facilities for breastfeeding employees. This article discusses resources for examining the economic costs and benefits of becoming a breastfeeding-friendly organization, current legislation affecting breastfeeding women in the workplace, resources related to breastfeeding, and recommendations for initiating and managing a workplace lactation program. Research demonstrating the effects of lactation programs on health care and employee replacement costs (i.e., recruiting, hiring, and training staff) is reviewed. Implementation issues are discussed, including providing breastfeeding women with sufficient time, adequate space, and support from employers and coworkers. The role of occupational health nurses in initiating and coordinating workplace lactation programs is also discussed.

Predictors of obesity in Michigan Operating Engineers.

Blue collar workers are at risk for obesity. Little is known about obesity in Operating Engineers, a group of blue collar workers, who operate heavy earth-moving equipment in road building and construction. Therefore, 498 Operating Engineers in Michigan were recruited to participate in a cross-sectional survey to determine variables related to obesity in this group. Bivariate and multivariate analyses were conducted to determine personal, psychological, and behavioral factors predicting obesity. Approximately 45% of the Operating Engineers screened positive for obesity, and another 40% were overweight. Multivariate analysis revealed that younger age, male sex, higher numbers of self-reported co-morbidities, not smoking, and low physical activity levels were significantly associated with obesity among Operating Engineers. Operating Engineers are significantly at risk for obesity, and workplace interventions are needed to address this problem.