PRAGYAN COLLEGE OF NURSING

BHOPAL

PAPER PRESENTATION
ON

TOPIC: - OCCUPATIONAL HEALTH AND SAFETY.

SUBJECT:-NURSING MANAGEMENT

REMARKS-

SUBMITTED TO SUBMITTED BY

MRS. SHEFALI LATESH MR.SACHIN DWIVEDI.

ASSISSTANT PROFESSOR. M.Sc. NURSING II YEAR

DATE OF SUBMISSION:-30-03-17

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 OCCUPATIONAL HEALTH AND SAFETY

A healthy work environment is a practice setting that maximizes the health and well-
being of nurses, quality patient/client outcomes, organizational performance and societal
outcomes.

INTRODUCTION:
All occupational fields have their own hazards. There are varieties of hazards to
which workers may be exposed and which may cause various diseases. By following the
proper guidelines and precautions, all occupational hazards can be minimized.
OCCUPATIONAL HEALTH
According to THE JOINT ILO/WHO COMMITTEE ON ORGANIZATIONAL
HEALTH,
Occupational health is-
Prevention and maintenance of physical, mental and social well being of workers in
all occupations.
Protection among workers in their employment from risks
Prevention among workers of ill health caused by the working conditions.
Placing and maintenance of the workers in occupational environment.

SAFETY: - the state of being safe; freedom from the occurrence or risk of injury, danger, or
loss.
OCCUPATIONAL HEALTH NURSING
Occupational health nursing is concerned with the health and safety of people at work,
their families, and the general community. Specific concerns include the development,
management and evaluation of health services, programs, and policies designed to promote
health and prevent work related injuries and disease.
Occupational health is concerned with the total health safety and welfare of man in his
places at work and at home.
AIMS OF OCCUPATIONAL HEALTH:-
The main aim of the occupational health as stated by WHO is:

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 The promotion and maintenance of the highest degree of physical, mental and social
well being of the workers in all occupation. The modern concepts of occupational
health include industrial hygiene, industrial diseases, industrial hazards, rehabilitation
and occupational psychology.
PURPOSES OF WORK PLACE HEALTH SAFETY:-
Occupational health and safety initiatives that focus on prevention of injuries and
illnesses and Elimination or control of hazards.
Health promotion/wellness activities.
Supportive organizational culture and leadership practices.
Employee assistance programs to assist employees with personal issues.
Ability management programs including early intervention and return to work
initiatives.
IMPORTANCE OF OCCUPATIONAL HEALTH IN HOSPITAL:-
Provide a safe and healthful working Environment for employees.
Protect employees from special risks and hazards associated with their occupation
such as contagious disease.
Protect patients from risks associated with unhealthy employees.

OCCUPATION HAZARDS:-
Nurses may be exposed to many hazards during his/her work, some hazards are
following-
HAZARDOUS DRUGS: - Drugs are considered hazardous if studies in animals or
humans indicate that exposures to them have a potential for causing cancer,
developmental or reproductive toxicity, or other organ system damage. Hazardous
drugs, such as those used for cancer chemotherapy, antiviral treatments, and hormone
regimens, pose a serious hazard to nurses, particularly in settings where they are used
infrequently, so training about their dangers and how to handle them safely is
inadequate. Even low-level exposures of many drugs can harm nurses' health. Most
nurses are aware of the hazardous potential of chemotherapeutic drugs, but may be
unaware that many other drugs and their byproducts should be handled as hazardous
substances.

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 HAZARDOUS CHEMICALS: - In the current climate of trying to prevent hospital-
associated infections, the no-holds-barred approach to environmental cleaning has
resulted in greater use of hazardous cleaning products and disinfectants than ever
before. These products are often liberally sprayed in healthcare settings to protect
patients from transmission of infectious pathogens, and the result is that they can
easily and insidiously creep into the bodies of nurses and other healthcare workers.
The toll of long-term exposure to healthcare chemicals is unknown, so avoidance is
the only prudent course. Hospitals should actively seek safer alternatives to known
hazardous workplace chemicals.

RADIATION: - Ionizing radiation exposure to patients has received much attention

in terms of its diagnostic uses, but little concern is expressed about occupational
exposure of nurses and other healthcare workers. Ionizing radiation is that which has
enough energy to remove an electron from an atom (creating an ion). The main types
of ionizing radiation are alpha particles, beta particles, gamma rays, and x-rays. Many
nurses work around sources of ionizing radiation, such as x-ray machines, radioactive
isotopes, and radio nucleotides. The possible effects of radiation exposure on health
can be acute or chronic. Lasers, which use nonionizing radiation, can also pose
hazards to health, as in burns from absorption of laser energy or inhalation of the
smoke (plume) produced by lasers.

INFECTIOUS DISEASES:- Nurses in every imaginable healthcare setting are

exposed to potentially infectious organisms. Their close and prolonged contact with
patients places them at risk of contracting such serious infections as SARS, HIV,
influenza, and tuberculosis. Ebola was considered a remote threat before the recent
outbreaks in West Africa led to cases of Ebola being diagnosed in the United States,
and two nurses developed Ebola virus disease after taking care of a patient with
Ebola.
MUSCULOSKELETAL INJURIES: - For decades in nursing, we have been taught
that if we develop "bad backs" from lifting patients, it is our own fault for not using
proper body mechanics. We now know that there is no such thing as safe manual
lifting, regardless of body mechanics, and that every lift, turn, or transfer can cause
micro injuries that can eventually result in a disabling condition. Musculoskeletal

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 injuries in nurses are costly in terms of medical expenses, disability compensation,
pain, absenteeism, and turnover. Assistive lifting devices should be plentiful and
convenient if we are to stem the tide of ergonomic injuries in healthcare.

NEEDLESTICKS/SHARPS:- In 2000, Congress passed the Needle stick Safety and

Prevention Act to increase protection to healthcare workers from HIV, hepatitis, and
other blood borne pathogens. The law requires employers to institute work practice
controls and purchase safer needle technology to eliminate or minimize exposure
from needle stick injuries. The law had an immediate impact, but needle stick and
sharps injuries continue to occur, especially in surgical settings. Injuries are also more
common where the nursing skill mix is characterized by fewer experienced nurses and
heavier patient loads, pointing to adequate staffing as a prerequisite to preventing
these potentially deadly workplace injuries.

VIOLENCE/ASSAULT: - Workplace violence is an increasingly recognized hazard

in healthcare, and frequent close contact with patients and visitors places nurses
squarely in the line of fire. Workplace violence is any act or threat of physical
violence, harassment, intimidation, or other threatening or disruptive behavior and can
range from verbal abuse to physical assault and homicide. The highest rates of
workplace violence have traditionally been reported from emergency department and
mental health settings, but it is generally believed that many episodes of violence
perpetrated against nurses go unreported, so the frequency of violence in healthcare is
likely to be underestimated.

PROBLEMS/ISSUES FACED BY NURSES IN WORKPLACE:-

Organizational Culture and Nursing Outcomes: - climate and culture focuses on
nursing outcomes such as job satisfaction, stress, burnout and autonomy. In nursing
work environments, it is crucial that health and safety be at the heart of the workplace
in order for nurses to provide the best possible patient/client care.

Nurse Turnover: - Nurse Turnover is influenced by characteristics associated with

workload, management style, empowerment and autonomy, promotion opportunities
and flexible scheduling. Nurse turnover includes both direct and indirect costs to the
organization. Direct costs include advertising, recruiting and hiring. Indirect costs

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 include nurse termination, orientation and training, and decreased productivity of new
staff.

Nurses who expected job instability and had experienced violence at work were also
more likely to be dissatisfied with their current position, putting them at risk for
leaving their job and thus creating retention issues for the employer.

Nurse absenteeism is related to violence at work. Administrators, educators and

leaders must deal with workplace violence and safety issues more consistently and
establish a zero tolerance environment where violence will not be condoned and
safety is a priority.

Practicing a healthy lifestyle improved both the physical and mental health of nurses.

Work environments affect nurses physical and mental health. Decreased health is
linked with working involuntary overtime. Decreased physical and mental health in
nurses was found where violence was present in the workplace.

Nurses anticipating job instability were less likely to be physically healthy.

Frequent shift changes affected nurses mental health.

Violence in the workplace is a hazard confronted by nurses working in all health care
sectors Violence can take many forms aggression, harassment, bullying,
intimidation and assault, and is directly co-relate with sick leave, burnout and low
employee retention rates.

POTENTIAL STRATEGIES TO ACHIEVE A HEALTHY WORKPLACE

CULTURE:-

Potential strategies which include the following:

Creating a balance between leadership and employee participation and involving

nurses in health and safety committees and initiatives (e.g. joint Occupational Health
and Safety Committee);

Mentoring, succession planning and provision of career opportunities.

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 Creating an open, blame-free culture to identify workplace hazards and report near
misses and workplace incidents.

Incorporating key values such as respect, honesty, feedback, trust and cooperation in
order to foster a safe working environment.

Creating a culture where staff feel psychologically safe in order to advocate for
their patients/clients and to whistle blow if necessary to protect themselves and
their patients/clients.

Implementing policies for bullying, harassment, aggression and assault.

Supporting staff health and well-being via specific programs (e.g. social supports,
personal growth and

PREVENTION OF OCCUPATIONAL DISEASES:

The various measures for the prevention of occupational diseases may be grouped under 3
headlines:
Medical measures

Engineering measures

Legislative or statutory measures

1. MEDICAL MEASURES:
Pre-placement examination

Periodical examination

Medical and health care services

Notification

Supervision of working environment

Maintenance and analysis of records

Health education and counselling

2. ENGINEERING MEASURES:
Design of building
Dust enclosure and isolation

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 Good housekeeping
Local exhaust ventilation
General ventilation
Protective devices
Mechanization
Environmental monitoring
Substitution
Statistical monitoring and research

3. LEGISLATION:
Acts on promoting and maintaining occupational well-being are as follows-
Occupational Disease Act 1343/1988
Occupational Disease Decree 347/1988
Personal Data Act 523/1999
Primary Health Care Act 66/1972
Act on the Social Insurance Institutions Rehabilitation Benefits and Rehabilitation
Allowance Benefits 566/2005
Government Proposal 128/2013 to Parliament for Amendments to the Sickness
Insurance Act and to Sections 6 and 7 of the Act on the Social Insurance Institutions
Rehabilitation Benefits and Rehabilitation Allowance Benefits
Act on Equality between Men and Women 609/1986
Act on the Status and Rights of Patients 785/1992
The Act on Occupational Safety and Health Enforcement and Cooperation on
Occupational Safety and Health at Workplaces 44/2006
Act on Co-operation within Undertakings 334/2007
Act on the Protection of Privacy in Working Life 759/2004
Government Decree on the Making of Drug Testing 218/2005
Health Insurance Act 1224/2004
Accident Insurance Act 608/1948
Working Hours Act 605/1996
Working Hours Legislation (1956-2007)

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 Employment Contracts Act 55/2001
The Occupational Health Care Act 1383/2001
Government Decree on Health Examinations in Work Involving Special Danger of
Illness 1485/2001
Government Decree on the Principles of Good Occupational Health Care Practices,
Content of Occupational Health Care and the Education of Professionals and Experts
708/2013
The Occupational Safety Act 738/2002
SCOPE AS AN OCCUPATIONAL HEALTH NURSE:-

M.Sc. Occupational Health & Industrial Safety (2 Years - Semester) M.Sc.

Occupational Health and Industrial Safety course has an interdisciplinary approach
that integrates various disciplines to address the problems in a comprehensive manner.
This innovative course is one of its kind as a full time two years regular programme.
A range of conceptual and practical issues on occupational health raised in the course
are, on the one hand, tested in the field set up and, on the other hand, enriched by
networking with experts and practitioners.
Eligibility- B.Sc. Nursing.
Mode of Selection: - Candidates for this Courses will be selected based on
merit & personal interview.
Name Of Institute In India:- Chettinad Academy of Research and Education,
Chettinad Health City Campus, Rajiv Gandhi Salai, Kelambakkam Tamil
Nadu .603103

ROLE OF OCCUPATION HEALTH NURSE:

Occupational health nurses, as the largest single group of health care professionals
involved in delivering health care at the workplace, have responded to these new challenges.
They have raised the standards of their professional education and training, modernized and
expanded their role at the workplace, and in many situations have emerged as the central key
figure involved in delivering high quality occupational health services to the working
populations. Occupational health nurses, working independently or as part of a larger multi
professional team, are at the frontline in helping to protect and promote the health of working
populations.

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ROLE OF THE OCCUPATIONAL HEALTH NURSE IN WORKPLACE HEALTH
MANAGEMENT
The occupational health nurse may fulfil several, often inter related and complimentary, roles
in workplace health management, including:
1. Clinician
2. Specialist
3. Manager
4. Co-ordinator
5. Adviser
6. Health educator
7. Counsellor
8. Researcher
1. CLINICIAN:
Primary prevention - The occupational health nurse is skilled in primary prevention
of injury or disease. The nurse may identify the need for, assess and plan interventions
to, for example modify working environments, systems of work or change working
practices in order to reduce the risk of hazardous exposure.

Emergency care - The occupational health nurse is a Registered Nurse with a great
deal of clinical experience and expertise in dealing with sick or injured people. The
nurse should provide initial emergency care of workers injured at work, transfer of the
injured worker to hospital and emergency services. Occupational health nurses
employed in mines, on oil rigs, in the desert regions are more responsible for this
work.

Treatment services - In some countries occupational health services provide curative

and treatment services to the working population, in other countries such activities are
restricted.

Nursing diagnosis - Occupational health nurses are skilled in assessing clients health
care needs, establish a nursing diagnosis and formulating appropriate nursing care
plans, in conjunction with the patient or client groups, to meet those needs. Nurses
can then implement and evaluate nursing interventions designed to achieve the care
objectives. The nurse has a prominent role in assessing the needs of individuals and
groups, and has the ability to analyse, interpret, plan and implement strategies to
achieve specific goals.

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 Individual and group care plan - The nurse can act on the individual, group,
enterprise or community level.

General Health advice and health assessment - The occupational health nurse will
be able to give advice on a wide range of health issues, and particularly on their
relationship to working ability, health and safety at work or where modifications to
the job or working environment can be made to take account of the changing health
status of employees.

2. SPECIALIST:
Occupational health policy, and practice development, implementation and
evaluation- The specialist occupational health nurse may be involved, with senior
management in the enterprise, in developing the workplace health policy and strategy
including aspects of occupational health, workplace health promotion and
environmental health management.

Occupational health assessment - Occupational health nurses can play an essential

role in health assessment for fitness to work, pre employment or pre placement
examinations, periodic health examinations and individual health assessments for
lifestyle risk factors.

Health surveillance - Where workers are exposed to a degree of residual risk of

exposure and health surveillance is required by law the occupational health nurse will
be involved in undertaking routine health surveillance procedures, periodic health
assessment and in evaluating the results from such screening processes. The nurse will
need a high degree of clinical skill when undertaking health surveillance and maintain
a high degree of alertness to any abnormal findings.

Sickness absence management - Occupational health nurses can contribute by

helping managers to manage sickness absence more effectively. The nurse may be
involved in helping to train line managers and supervisors in how to best use the
occupational health services.

Rehabilitation - Planned rehabilitation strategies, can help to ensure safe return to

work for employees who have been absent from work due to ill health or injury. The
occupational health nurse is often the key person in the rehabilitation programme who
will, with the manager and individual employee, complete a risk assessment, devise

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 the rehabilitation programme, monitor progress and communicate with the individual,
the occupational health physician and the line manager.

Maintenance of work ability - The occupational health nurse may develop pro-
active strategies to help the workforce maintain or restore their work ability.

Health and safety & Hazard identification - The occupational health nurse often
has close contact with the workers and is aware of changes to the working
environment. Because of the nurses expertise in health and in the effects of work on
health they are in a good position to be involved in hazard identification.

Risk assessment - Legislation is increasingly being driven by a risk management

approach. Occupational health nurses are trained in risk assessment and risk
management strategies depending upon their level of expertise.

3. MANAGER:
Management - In some cases the occupational health nurse may act as the manager
of the multidisciplinary occupational health team, directing and co-ordinating the
work of other occupational health professionals. The OH nurse manager may have
management responsibility for the whole of the occupational health team, or the
nursing staff or management responsibility for specific programmes.

Administration - The occupational health nurse can have a role in administration.

Maintaining medical and nursing records, monitoring expenditure, staffing levels and
skill mix within the department, and may have responsibility for managing staff
involved in administration.

Budget planning - Where the senior occupational health nurse is the budget holder
for the occupational health department they will be involved in securing resources and
managing the financial assets of the department. The budget holder will also be
responsible for monitoring and reporting within the organization on the use of
resourses.

4. CO-ORDINATOR:
Occupational health team - The occupational health nurse, acting as a coordinator,
can draw together all of the professionals involved in the occupational health team. In

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 many instances the nurse will be the only member of the team who is permanently
employed by the institution.

Worker education and training - The occupational health nurse has a role in worker
education. This may be within existing training programmes or those programmes
that are developed specifically by occupational health nurses to, for example, inform,
educate and train workers in how to protect themselves from occupational hazards,
workplace preventable diseases or to raise awareness of the importance of healthy
practices.

Environmental health management - The occupational health nurse can advise the
enterprise on simple measures to reduce the use of natural resources, minimise the
production of waste, promote re-cycling and ensure environmental health.

5. HEALTH EDUCATOR:
Workplace Health promotion - Health education as one of the key prerequisites of
workplace health promotion is integral aspect of the occupational health nurses role.
In some countries the nurse is required to support activities aimed at adoption of
healthy lifestyles within on-going health promotion process, as well as participate in
health and safety activities. Occupational health nurses can carry out a needs
assessment for health promotion.

6. COUNSELLOR:
Counselling and reflective listening skills - Where the nurse has been trained in
using counselling or reflective listening skills they may utilise these skills in
delivering care to individuals or groups.

Problem solving skills - Due to the close working relationship which occupational
health nurses have with the working population, and because of the nurses position
of trust, occupational health nurses are often approached for advice on personal
problems.

7. RESEARCHER:
Research skills - Nurses are becoming increasingly familiar with both quantitative
and qualitative research methodologies, and can apply these in occupational health

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 nursing practice. In the main, occupational health nurses working at the enterprise
level, are more likely to use simple survey techniques, or semi-structured interviews,
and to use descriptive statistical techniques in their presentation of the data.

Evidence based practice - Occupational health nurses are skilled in searching the
literature, reviewing the evidence available, which may be in the form of practice
guidelines or protocols, and applying these guidance documents in a practical
situation. Occupational health nurses should be well skilled in presenting the
evidence, identifying gaps in current knowledge.

Epidemiology - The most widely used and accepted form of investigation into
occupational related ill health and disease is based on large-scale epidemiological
studies
8. ADVISER
To management and staff on issues related to workplace health management
Occupational health nurse act in an advisory role when seeing individuals who may
have problems that, whilst not directly related to work may affect work attendance or
performance.

RELATED RESEARCH:-
1. Tiwari RR, Sharma A, Zodpey SP, Khandare SM. Does occupational health
nursing exist in India?
Occupational health services are important to develop healthy and productive work
forces, which should be delivered through occupational health team. Occupational
health nurse (OHN) is an important member of this team and is required to apply
nursing principles in conserving the health of workers in occupational settings.

Purpose: This article attempts to map the occupational health nursing courses in India
and design competencies and curriculum for such a course.

Materials and Methods: Information through the Internet, printed journals, and
perspectives of the key stakeholders were the principal sources of data. Discussion: In
India, there is a need to initiate a course on occupational health nursing to provide
occupational health services for the organized and unorganized sector workforce. A
certificate course for occupational health nursing for 3-4 months duration offered

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 through contact session mode can be an opportune beginning. However, to cater
employed nurses an online course can be another effective alternative. The theoretical
part should essentially include modules on occupational diseases, industrial hygiene,
and occupational health legislation, whereas the modules on practical aspects can
include visits to industries. Taking into account the existing norms of Indian Factories
Act for hazardous units of organized sector an estimated 1,34,640 OHNs are required.

RESULTS:-
The total workforce in the organized sector in India is 26.92 million
(2,69,28,000). [1] As per the Directorate General Factories Advisory Services and
Labour Institutes estimates of 2007, there are 2,54,951 working registered industrial
factories in India with approximately 11.16 million (1, 11, 62,501) workers. [6] Taking
into account the existing norms of Indian Factories Act [7] for hazardous units and
assuming each of the working factories employ more than 200 workers, 1,34,640
OHNs are required for the organized sector, thereby indicating a huge deficit. Further
assuming that all these units are nonhazardous and following the norms of Indian
Factories Act of one OHN for 500 workers, the estimated numbers are 53,856 OHNs.

Conclusion: There is a need-supply gap in the number of occupational health nursing

manpower in India, which can be attributed to the absence of any course to train such
manpower.

PRSENTER VIEW: - Occupational health nurses, as the largest single group of health
professionals involved in delivering health services at the workplace, have important role to play
in the workplace health management. They are at the frontline in helping to protect and promote
the health of working populations.

SUMMARY: - Workers in every occupation can be faced with a multitude of hazards in the
workplace. Nurses can be more productive and healthy in safe, ergonomically sound work
environments, with access to supplies, services and the technology they need to improve
efficiency, and work life enhancements to decrease stress and ease the home-work interface.

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CONCLUSION: - Occupational Health is aimed at the promotion and maintenance of the
highest degree of physical, mental and social well-being of workers in all occupations. This is
done by ensuring that all work-related hazards are prevented and managed, where they occur.

BIBLIOGRAPHY:-

BOOKS

1. B.T Basavanthappa, Text book of community health nursing. (2008) Jaypee brothers
New Delhi.
2. T. Bhaskara Rao Text book of community medicine. (2006) paras. New Delhi.
3. Park K. Preventive And Social Medicine, (2005); Jabalpur, Banarsidas Bhanot
publishers
4. Alexander,DavidPrinciples Of Emergency Planning And Management(2002)
Harpenden, Terra publishing.
5. Haddow,George D;Jane A Bullock,(2001) Introduction To Emergency Management
Amsterdam;Butterworth-Heinemann
6. K.Deepak, A Comprihensive Textbook of Nursing Management, Bangalore,
EMMESS Publishers.

JOURNALS

7. Dr Joy.E Wachs, Journal of workplace Health Safety, Vol-64, Issue-8, 2016

8. Singh J; Indian Journal of public health;Vol-20, 2002.

INTERNET

9. Tiwari RR, Sharma A, Zodpey SP, Khandare SM. Does occupational health nursing
exist in India?. Indian J Occup Environ Med [serial online] 2014 [cited 2017 Mar
29];18:113-7from: http://www.ijoem.com/text.asp?2014/18/3/113/146907

10. Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HBV, HCV, and HIV and Recommendations for Postexposure
Prophylaxis. Centers for Disease Control and Prevention (CDC) Morbidity and
Mortality Weekly Report (MMRW) 50(RR11);1-42, (2001, June 29).

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