Search

BACKGROUND: Despite the high rate of work-related injuries among hospital nurses, there is limited understanding of factors that serve to motivate or hinder nurses return to work following injury. OBJECTIVES: Perspectives of nurses with work related injuries, as they relate to obstacles and motivations to return to work, consequences of injury, and influences of work climate were documented. METHODS: This was a sub-study of nurses taken from a larger investigation of hospital workers. A purposive sample of 16 nurses was interviewed. Analysis was carried out using grounded theory as the research method. RESULTS: Nurses' responses fell into four concepts: organizational influences, personal conditions, costs and losses, and employee health as influenced by workers' compensation systems. Conceptualization of these concepts resulted in key categories: injury as an expected consequence of hospital work; nursing alone versus nursing together; the impact of injury on professional, family, and social roles; and nurses' understanding of and involvement with the workers' compensation system. DISCUSSION: The findings provide new perspective into features that support or hinder nurses' with injuries return to work and corroborate existing occupational health research. Consideration of these findings by hospital and employee health managers may help promote more effective return to work programs within the hospital setting. Language: en

OBJECTIVES: This study measured violence (physical assault, robbery, or weapon confrontation) in taxi drivers, and determined socio-demographic/work factors associated with violence. METHODS: In 2010, 130 taxi drivers, working in a large city in the Western US, were administered a survey evaluating workplace violence events. RESULTS: The study population was male (94%), mean age 45, married (54%), foreign-born (55%), with 24% speaking Arabic at home. Drivers drove at night (51%), for an average of 9.7 years and 41 hr/week. Almost half reported a history of violence during their driving careers: physical assault, weapon confrontation, or robbery. In the prior 12 months, 12% were physically assaulted, 8% robbed, and 6% confronted with a weapon. Night drivers reported more assaults over their lifetime compared to day drivers (mean = 1.64 [sd 4.29] vs. mean = 0.53 [sd 1.05], P = 0.047). CONCLUSIONS: Taxi drivers experience violence at work. Strategies are needed to prevent violence especially in night drivers. Am. J. Ind. Med. © 2014 Wiley Periodicals, Inc. Language: en

Background The aims of this study were to compare job demand-control (JDC) and effort-reward imbalance (ERI) models in examining the association of job stress with work-related musculoskeletal symptoms and to evaluate the utility of a combined model. Methods This study analyzed cross-sectional survey data obtained from a nationwide random sample of 304 intensive-care unit (ICU) nurses. Demographic and job factors were controlled in the analyses using logistic regression. Results Both JDC and ERI variables had strong and statistically significant associations with work-related musculoskeletal symptoms. Effort-reward imbalance had stronger associations than job strain or iso-strain with musculoskeletal symptoms. Effort-reward imbalance alone showed similar or stronger associations with muscusloskeletal symptoms compared to combined variables of the JDC and ERI models. Conclusions The ERI model appears to capture the magnitude of the musculoskeletal health risk among nurses associated with job stress at least as well and possibly better than the JDC model. Our findings suggest that combining the two models provides little gain compared to using effort-reward imbalance only. Am. J. Ind. Med. 57:214–221, 2014. © 2013 Wiley Periodicals, Inc.

Objective The purpose of the study was to identify the correlates of heavy smoking (defined as more than one pack of cigarettes per day) in building trades construction workers. Design and Sample This study used cross-sectional data from the MassBUILT smoking cessation intervention study at Massachusetts building trades unions with the sample of 763 smokers. Measures Data collected included information about smoking behavior, individual, psychological, interpersonal, and occupational factors obtained through self-reported questionnaires. Results Approximately 21% of smokers were heavy smokers. Significant factors related to heavy smoking were: older age (OR = 1.10; 95% CI: 1.06–1.14), male gender (OR = 4.55; 95% CI: 1.62–12.79), smoking the first cigarette of the day within 30 min of waking (OR = 4.62; 95% CI: 2.81–7.59), smoking initiation at earlier age (OR = 0.93; 95% CI: 0.87–1.00), higher temptation to smoke (OR = 1.55; 95% CI: 1.17–2.05), household smoking (OR = 1.90; 95% CI: 1.18–3.06) or living alone (OR = 4.11; 95% CI: 1.70–9.92), and exposure to chemicals at work (OR = 1.61; 95% CI: 1.06–2.53). Conclusion Addressing the influence of these factors on heavy smoking could lead to the development of targeted, multiple components in comprehensive cessation strategies for blue-collar smokers.

This study describes health and safety concerns and self-care strategies of San Francisco taxi drivers. Focus groups and a written cross-sectional survey were done in a convenience sample of taxi drivers working in San Francisco. Sessions were audiotaped, transcribed in English, and independently coded to identify major health and safety themes, using thematic content analysis. Strategies to manage health and safety issues are the focus of this analysis. Five focus groups were held in 2009 with 36 participants. Major health and safety themes included stress, body pain, danger, vulnerable employment status, and concerns related to unhealthy working conditions. Self-care strategies included diffusion/decompression to manage stress, maintaining a positive attitude, maintaining power and control, and practicing proactive self-care. Creative self-care strategies were described by taxi drivers to keep healthy and safe at work. These data will inform future self-care interventions to reduce health and safety risks of taxi driving.

Background Blue-collar workers smoke at higher rates than white-collar workers and the general population. Occupational factors may contribute to smoking behavior in this group. However, little is known about the role of occupational factors in explaining cigarette-smoking patterns. Methods This study used cross-sectional data from the MassBUILT smoking cessation intervention study. Multivariable logistic regression analysis was conducted to investigate the association of occupational factors with current cigarette smoking among 1,817 building trades workers. Results Current cigarette smoking was significantly associated with the following occupational factors: union commitment (OR = 1.06; 95% CI: 1.00–1.12); exposure to dust (OR = 1.50; 95% CI: 1.15–1.95), exposure to chemicals (OR = 1.41; 95% CI: 1.11–1.79); and concern about exposure to occupational hazards (OR = 0.93; 95% CI: 0.91–0.95). Conclusion The findings highlight the need to explicate the pathways by which occupational factors may contribute to current smoking behavior among building trades workers. Smoking cessation programs for this population should consider work-related occupational factors along with individual approaches. Am. J. Ind. Med. 55:429–439, 2012. © 2012 Wiley Periodicals, Inc.

PurposeAccumulating evidence suggests an important role for psychosocial work factors in injury, but little is known about the interaction between psychosocial factors and previous injury experience on subsequent injury risk. We examined the relationships between psychosocial work factors and new or recurrent injury among hospital workers.MethodsWe studied 492 hospital workers including 116 cases with baseline injury and 376 injury-free referents at baseline over follow-up. Job strain, total support, effort-reward imbalance, overcommitment, and musculoskeletal injury at baseline were examined in logistic regression models as predictors of new or recurrent injury experienced during a 2-year follow-up period.ResultsThe overall cumulative incidence of injury over follow-up was 35.6 % (51.7 % for re-injury among baseline injury cases; 30.6 % for new injury among referents). Significantly increased risks with baseline job strain (OR 1.26; 95 % CI 1.02-1.55) and effort-reward imbalance (OR 1.42; 95 % CI 1.12-1.81) were observed for injury only among the referents. Overcommitment was associated with increased risk of injury only among the cases (OR 1.58; 95 % CI 1.05-2.39).ConclusionsThe effects of psychosocial work factors on new or recurrent injury risk appear to differ by previous injury experience, suggesting the need for differing preventive strategies in hospital workers.

OBJECTIVE: Hospital violence is a growing concern, yet little is known about existing programs. This study compared workplace violence programs in high-risk emergency departments among a representative sample of 116 hospitals in California and 50 hospitals in New Jersey. METHODS: Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. RESULTS: California had significantly higher scores for training and policies and procedures, but there was no difference for security and environmental approaches. Program component scores were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. CONCLUSIONS: Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found. Language: en

Background The combined effect of socioeconomic, organizational, psychosocial, and physical factors on work-related musculoskeletal disorders (WRMSDs) were studied in a heterogeneous, socioeconomically diverse sample (cases and their matched referents) of hospital workers. Methods Cases were defined by a new acute or cumulative work-related musculoskeletal injury; referents were matched by job group, shift length, or at random. Information was obtained through telephone interviews and on-site ergonomics observation. Questionnaire items included sociodemographic variables, lost work time, work effectiveness, health status, pain/disability, and psychosocial working conditions using Effort Reward Imbalance (ERI) and Demand-Control (DC) models. Two multivariate models were tested: Model 1 included occupation as a predictor; Model 2 included education–income as a predictor. Results Cases reported greater pain, disability, lost time, and decreased work effectiveness than the referents. Model 1 was statistically significant for neck/upper extremity injury (Chi-square = 19.3, P = 0.01), back/lower extremity injury (Chi-square = 14.0, P = 0.05), and all injuries combined (Chi-square = 25.4, P = 0.001). “Other Clinical” occupations (34% mental health workers) had the highest risk of injury (OR 4.5: 95%CI, 1.7–12.1) for all injuries. The ERI ratio was a significant predictor for neck and upper extremity (OR 1.5: 95%CI, 1.1–1.9) and all injuries (OR 1.3; 95%CI, 1.04–1.5), per SD change in score. Conclusions In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income. Am. J. Ind. Med. 2007. © 2007 Wiley-Liss, Inc.

Objective: We sought to better use qualitative approaches in occupational health research and integrate them with quantitative methods. Methods: We systematically reviewed, selected, and adapted qualitative research methods as part of a multisite study of the predictors and outcomes of work-related musculoskeletal disorders among hospital workers in two large urban tertiary hospitals. Results: The methods selected included participant observation; informal, open-ended, and semistmctured interviews with individuals or small groups; and archival study. The nature of the work and social life of the hospitals and the foci of the study all favored using more participant observation methods in the case study than initially anticipated. Conclusions: Exploiting the full methodological spectrum of qualitative methods in occupational health is increasingly relevant. Although labor-intensive, these approaches may increase the yield of established quantitative approaches otherwise used in isolation.

Background There is a large gap in research with regard to back pain (BP) among home care nursing personnel (HCNP); only seven studies have been conducted worldwide. There is a need to identify the magnitude of and risk factors for BP that are unique to Hong Kong (HK) HCNP. Methods A total population sampling technique was employed in this cross-sectional questionnaire-based study. Hierarchical multiple logistic regression analyses were used to control for potentially confounding variables. Results The 12-month prevalence of upper and lower BP was 71.2% (n = 265). Three predictors were identified: physical risk factors in the office (OR = 3.57, 95% CI = 1.55–8.24), static postures (OR = 1.41, 95% CI = 1.04–1.90), and psychological job demands (OR = 1.11, 95% CI = 1.01–1.22). Conclusion HCNP in HK have a high prevalence of BP. BP in HK HCNP is independently attributable to physical work factors in the office, static postures, and psychological job demands, and is not primarily associated with patient lifting and transferring which are traditionally identified as risk factors for BP in hospital nursing personnel. Am. J. Ind. Med. 49:14–22, 2006. © 2005 Wiley-Liss, Inc.

Background: In 1999, licensed health care facilities in California (N = 2532) were invited to participate in a survey about occupational bloodborne pathogens exposure surveillance activities, recordkeeping methods, and use of safety-enhanced sharps devices. Results: A total of 1274 facilities responded to the survey from January 1999 through August 1999 (response rate=50%). Sharps-related injuries were recorded for multiple departments on various forms in diverse manners. Only 66% of hospitals, 37% of home health agencies, and 33% of skilled nursing facilities reported sharps injuries on a mandated sharps injury log. More than 70% of facilities stated that they used some type of safety device or needleless system, but this figure varied by type of device and facility type. Eighty-four percent of general acute care hospitals, 28% of home health agencies and skilled nursing facilities each had evaluated at least 1 safety-enhanced device. Almost 90% of all facilities expressed a need for educational materials on topics such as device selection and evaluation. Conclusions: Standardization of surveillance and recordkeeping activities does not exist across facility types. Standards and regulations demand complex recordkeeping activities. Increased funding for distribution of educational materials and on-site training should accompany changes in mandated reporting activities when appropriate. Increased testing and evaluation of devices across facility types are necessary to ensure that safety-enhanced devices are protective of health care workers and patients. (Am J Infect Control 2002;30:269-76.)

This study evaluated injury severity in a group of construction workers who sustained nonfatal falls at work. The sample consisted of 255 adults who were identified from Doctor's First Reports (DFRs) submitted to the California Department of Industrial Relations. For those that fell from heights (n = 195), the mean height of fall was 9.2 feet (SD = 7.1). The mean number of lost work days was 44.3 days (SD = 58.6) and the median was 10 days. Two measures of injury severity were used--the Injury Severity Score and the disability section of the Health Assessment Questionnaire (HAQ). Seventeen participants (7%; 95% CI, 4-10%) were deemed permanently disabled. A simultaneous multiple regression model, using five independent variables, explained approximately 21% of the variance in HAQ scores. Nonunion status and safety climate scores indicating increased risk were positively correlated with higher functional limitation as measured by HAQ scores, as were greater heights and impact on concrete surface. Higher scores on both injury severity measures were significantly and moderately associated with a greater number of days lost from work. These findings suggest that injury severity and permanent disability associated with falls in construction are notable, and identify key target areas for intervention and prevention.

The purpose of this study was to estimate the contribution of occupational factors to smoking cessation among building trades workers. Longitudinal data came from the MassBUILT smoking cessation intervention study for unionized building trades workers. Multivariable logistic regression analyses were applied to identify the significant predictors of smoking cessation, which was defined as abstinence from smoking during the previous 7 days at the 1-month monitoring and prolonged abstinence for at least 6 months at the 6-month monitoring. Greater concern about exposure to occupational hazards was significantly associated with increased likelihood of smoking cessation at 1 month (odds ratio = 1.06; 95% confidence interval = 1.01–1.11). Additionally, smokers who had a more positive view of their unions had at least marginally increased likelihood of smoking cessation at 1 month. Furthermore, older age, higher levels of educational attainment and household income, and fewer cigarettes smoked per day were important covariates that predicted smoking cessation. Concerns about exposures to work hazards should be incorporated into comprehensive intervention approaches for building trades workers. Additionally, the findings emphasize that blue-collar workers with lower income and education levels and heavy smokers should be considered target groups for implementing cessation interventions.

Background Patient handling is a major risk factor for musculoskeletal (MS) injury among nurses. The aims of the study were to describe nurses' work behaviors related to safe patient handling and identify factors influencing their safe work behaviors, including the use of lifting equipment. Methods A cross-sectional study using a mailed questionnaire with a nationwide random sample of 361 critical care nurses. Nurses reported on the physical, psychosocial, and organizational characteristics of their jobs and on their MS symptoms, risk perception, work behaviors, and demographics. Hierarchical multiple linear regression analyses were used to identify significant factors. Results More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort–reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior. Conclusions Safe work behaviors are best understood as socio-cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury. Am. J. Ind. Med. 53:886–897, 2010. © 2010 Wiley-Liss, Inc.

Background Hospital workers are at high risk of work-related musculoskeletal disorders (WRMSDs), but outcomes following such injuries have not been well studied longitudinally. Aims To ascertain functional recovery in hospital workers following incident WRMSDs and identify predictors of functional status. Methods Cases (incident WRMSD) and matched referents from two hospitals were studied at baseline and at 2 year follow-up for health status [SF-12 physical component summary (PCS)], lost workdays, self-rated work effectiveness and work status change (job change or work cessation). Predictors included WRMSD and baseline demographics, socio-economic status (SES), job-related strain and effort–reward imbalance. Logistic regression analysis tested longitudinal predictors of adverse functional status. Results The WRMSD-associated risk of poor (lowest quartile) PCS was attenuated from a baseline odds ratio (OR) of 5.2 [95% confidence interval (CI) 3.5–7.5] to a follow-up OR of 1.5 (95% CI 1.0–2.3) and was reduced further in multivariate modelling (OR = 1.4; 95% CI 0.9–2.2). At follow-up, WRMSD status did not predict significantly increased likelihood of lost workdays, decreased effectiveness or work status change. In multivariate modelling, lowest quintile SES predicted poor PCS (OR = 2.0; 95% CI 1.0–4.0) and work status change (OR = 2.5; 95% CI 1.1–5.8). High combined baseline job strain/effort–reward imbalance predicted poor PCS (OR = 1.7; 95% CI 1.1–2.7) and reduced work effectiveness (OR = 2.6; 95% CI 1.6–4.2) at follow-up. Conclusions Baseline functional deficits associated with incident WRMSDs were largely resolved by 2 year follow-up. Nonetheless, lower SES and higher combined job strain/effort–reward imbalance predicted adverse outcomes, controlling for WRMSDs.

Author(s): Burgel, Barbara Jean | Advisor(s): White, Mary C | Abstract: PSYCHOSOCIAL WORK FACTORS AND SHOULDER PAIN IN HOTEL ROOM CLEANERSBarbara J. BurgelAims: To measure, among hotel room cleaners, the relationship between psychosocial work factors (job strain, iso-strain, and effort-reward imbalance [ERI]) and severe shoulder pain, controlling for selected socio-demographic, behavioral, anthropometric, biomechanical, and hotel factors. Background: Hotel room cleaners have physically demanding jobs that place them at high risk for work-related shoulder pain (WRSP). Biomechanical factors have been associated with WRSP. Psychosocial work factors, including job strain (high psychological demand with low decision latitude), iso-strain (job strain with low coworker and supervisor support), and ERI (high effort with low rewards), may also play a role in WRSP, but this is not well studied. Methods: 941 of 1,276 (74%) hotel room cleaners from 5 hotels in Las Vegas completed a survey in 2002. Of them, 493 with complete data for the shoulder pain outcome, the 3 key psychosocial independent variables, and 17 covariates were included in logistic analyses using Stata, Version 9.2.Results: Fifty-six percent (n=274) reported WRSP in the prior 4-weeks. The sample was female (98%), Latina (78%), married/partnered (69%), born outside the USA (85%), and age 41 (SD 9.67). On average, participants had worked as a room cleaner 7.74 (SD 5.41) years, 40.26 hours (SD 11.00) per week, and made 19.35 beds/day (SD 6.72). In fully adjusted models, job strain and iso-strain were not associated with WRSP. However, ERI was significantly associated with WRSP: those with an ERI score greater than 1.0 had 3 times the odds of reporting severe shoulder pain, after adjusting for age, years of education, caregiving at home, current smoking and alcohol, height, number of years worked as a room cleaner, number of hours worked/week, number of beds made/day, and physical workload, work intensification and ergonomic indices (AOR 2.98, 95% CI 1.93-4.59, p=0.000). Implications for nursing: These findings will aid occupational health professionals in developing "healthy work" policies to prevent WRSP. Creative job design and an enhanced reward system for hotel room cleaners may help to achieve a better balance between effort and rewards of work.

Background Physicians, nurses, and others are at risk of needlesticks, yet little national information is available regarding incidence across demographic and occupational categories. Methods Analysis was conducted on national data on occupational injuries for 1992-2003 from the Bureau of Labor Statistics (BLS). Because BLS data were limited to cases with 1 or more days of work loss, and reasons related to reporting of incidents, the data only reflected a subset of all needlesticks. Nevertheless, the data were internally consistent across categories so that relative magnitudes were reliable. Statistical tests for differences in proportions were conducted that compared needlesticks with all other occupational injuries and employment. Results Cases with 1 or more days of work loss numbered 903 per year, on average, from 1992 through 2003. Women comprised 73.3% (95% CI: 72.5%-74.2%) of persons injured. For those reporting race, white, non-Hispanic comprised 69.3% of the total (95% CI: 68.1%-70.4%); black, non-Hispanic, 14.8% (95% CI: 13.9%-15.6%); and Hispanic, 13.8% (95% CI: 12.9%-14.6%). The age bracket 35 to 44 years had the highest percentage of injuries at 34.0% (95% CI: 33.1%-34.9%). Ages over 54 years reported smaller percentages of needlestick injuries than either all other injuries or employment. Occupations with greatest frequencies included registered nurses, nursing aides and orderlies, janitors and cleaners, licensed practical nurses, and maids and housemen. Occupations with greatest risks included biologic technicians, janitors and cleaners, and maids and housemen. Almost 20% (95% CI: 18.88%-20.49%) of needlesticks occurred outside the services industry. Seven percent (95% CI: 6.56%-7.53%) of needlesticks resulted in 31 or more days of work loss in contrast to 20.46% (95% CI: 20.44%-20.48%) of all other injuries. Conclusion In this nationally representative sample, the most frequent demographic and occupational categories were women; white, non-Hispanic; ages 35 to 44 years; and registered nurses.

Background Psychosocial working conditions are likely to contribute to work-related musculoskeletal disorders (WRMSDs), but a lack of standardized measurement tools reflects both the theoretical and methodological limitations of current research. Methods An interdisciplinary team including biomedical, behavioral, and social science researchers used an iterative process to adapt existing instruments for an interviewer-administered questionnaire assessing psychosocial workplace exposure related to musculoskeletal disorders. Results The resulting questionnaire included measures of psychosocial workplace factors based on two theoretical models (the demand-control-support and the effort-reward imbalance models), supplemented by the additional constructs of “emotional demands,” and “experiences of discrimination.” Other psychosocial and physical measures selected for questionnaire inclusion address physical workload, sociodemographic and anthropometric characteristics, social relations and life events, health behaviors, and physical and psychological health. Conclusion Using an interdisciplinary approach facilitated the development of a comprehensive questionnaire inclusive of key measures of psychosocial factors that may play a role in the complex mechanisms leading to WRMSDs. Am. J. Ind. Med. 45:428–439, 2004. © 2004 Wiley-Liss, Inc.