Stephanie Chalupka

There's no place like home: a qualitative study of the working conditions of home health care providers.

Objective: Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. Methods: The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. Results: HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. Conclusions: The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.

Sharps Injuries and Other Blood and Body Fluid Exposures Among Home Health Care Nurses and Aides

OBJECTIVES We quantified risks of sharp medical device (sharps) injuries and other blood and body fluid exposures among home health care nurses and aides, identified risk factors, assessed the use of sharps with safety features, and evaluated underreporting in workplace-based surveillance. METHODS We conducted a questionnaire survey and workplace-based surveillance, collaborating with 9 home health care agencies and 2 labor unions from 2006 to 2007. RESULTS Approximately 35% of nurses and 6.4% of aides had experienced at least 1 sharps injury during their home health care career; corresponding figures for other blood and body fluid exposures were 15.1% and 6.7%, respectively. Annual sharps injuries incidence rates were 5.1 per 100 full-time equivalent (FTE) nurses and 1.0 per 100 FTE aides. Medical procedures contributing to sharps injuries were injecting medications, administering fingersticks and heelsticks, and drawing blood. Other contributing factors were sharps disposal, contact with waste, and patient handling. Sharps with safety features frequently were not used. Underreporting of sharps injuries to the workplace-based surveillance system was estimated to be about 50%. CONCLUSIONS Sharps injuries and other blood and body fluid exposures are serious hazards for home health care nurses and aides. Improvements in hazard intervention are needed.

Sharps injuries and bloodborne pathogen exposures in home health care.

Home health care is one of the fastest growing industries in the United States. Approximately 20,000 provider agencies deliver home health care services to 7.6 million individuals with acute illness, long-term health conditions, permanent disability, or terminal illness. The home health care setting poses many challenges that likely increase the risk of sharps injuries. Home health nurses face unique challenges in preventing and reporting sharps injuries in the home. This article examines the nature of and risk factors for sharps injuries in the home health care setting, the scope of the problem, the legislative and regulatory framework relevant to sharps injuries, and the role of occupational health nurses in promoting a culture of safety to prevent sharps injuries and bloodborne pathogen exposures.

The Impact of Environmental and Occupational Exposures on Reproductive Health

Environmental exposures during critical periods of susceptibility in utero may result in lifelong or intergenerational adverse health effects. Most chemicals in commercial use in the United States have not been tested for possible developmental toxicity to fetuses, infants, and children. Environmental and occupational exposures can result in adverse effects on female and male reproduction. Nurses can identify at-risk patients, provide education about the impact of chemical toxicants, and empower women to take precautionary action.

Studying home health care nurses and aides: Research design and challenges

Home health care (HHC) is growing rapidly and yet health and safety conditions of HHC clinicians are poorly understood. Study of this workforce presents unique challenges because it is decentralised, often part-time and mobile. As part of a larger project on sharps injuries and blood exposures in HHC, this paper addresses the challenges of recruiting a large cohort of HHC nurses and aides and describes novel cross-sectional survey methodology. Recruitment was conducted with cooperation from eight HHC agencies and two labour unions. Intensive personal contacts and a financial incentive (

Essentials of environmental health. Enhancing your occupational health nursing practice (Part II).

25) were employed. Some groups of HHC clinicians could be contacted only by mail, while others were contacted during a promotional “mini-fair” at their agency. A total of 1772, 18-page health and safety surveys were distributed and 1225 usable surveys were collected. This 69% overall response rate is better than that in many recent health surveys. Survey returns were highest (67—91%) where promotional events were held. The mailing-only strategy generated lower response rates (53—55%), despite the same financial incentive. Despite the challenges of reaching out to the decentralised HHC workforce, adequate response to a detailed health survey is possible, using appropriate techniques and with the close cooperation of employers and labour unions.

Preventing bedbug infestation.

1. In the United States, approximately 24 million people use water daily from unregulated water supplies. Agents of water pollution can be categorized as biological (e.g., Cryptosporidium parvum), chemical (e.g., industrial solvents), or radionuclide (e.g., radon). 2. More than 600 chemicals are registered with the Environmental Protection Agency as pesticides in the United States. Human exposure occurs through direct contact or dermal absorption, inhalation, and ingestion of food, water, and breast milk. It is estimated that 50% of all the pesticides ingested in a lifetime are ingested in the first 5 years of life. 3. Children are at particular risk for exposure to environmental toxicants like pesticides because of time spent crawling and playing on floors, lawns, and other potentially contaminated surface areas, and hand to mouth behaviors. At this time, toxicity data for many pesticides in common use are inadequate to determine potential for neurotoxicity and adverse effects on the developing immune and endocrine system. 4. To meet the challenge of environmental health issues, occupational and environmental health nurses have important opportunities to promote health in the workplace and the community through research, direct clinical services, advocacy, and education.

Climate Change and Mental Health.

Bedbugs are increasingly encountered in hotels, motels, office buildings, movie theaters, and modes of transport--anywhere the turnover of occupants is constant.

Greening the 'proclamation for change': healing through sustainable health care environments: nurses advocate sustainable design to transform health care.

: Climate change is an enormous challenge for our communities, our country, and our world. Recently much attention has been paid to the physical impacts of climate change, including extreme heat events, droughts, extreme storms, and rising sea levels. However, much less attention has been paid to the psychological impacts. This article examines the likely psychological impacts of climate change, including anxiety, stress, and depression; increases in violence and aggression; and loss of community identity. Nurses can play a vital role in local and regional climate strategies by preparing their patients, health care facilities, and communities to effectively address the anticipated mental health impacts of climate change.

Occupational silica exposure in hydraulic fracturing.

The influence of the environment on human health has been an important consideration in nursing since its inception. Florence Nightingale thought of environmental influences as fundamental causes of disease, and she focused her nursing interventions on modification of the environment— especially the provision of pure air and water, efficient drainage, cleanliness, and light—as a primary means of promoting health. In the past three decades, researchers have learned a great deal about environmental effects on health, including the ways in which the design and operation of health care facilities can negatively affect the health of patients and employees, communities, and the environment at large. From health care–associated infections and medical errors to pollution caused by the incineration of hospital waste, health care institutions have much to rectify before they can become truly healing environments.