07 aohp spring -web · 2020-01-24 · 2 a o h p j o u r n a l aohp journal executive editor...

Spring 2 0 0 7

1

Spring 2007 Volume XXVII, Number 2

3President’s Message

5Vice President’s Update

6Editor’s Column

7Association Community

Liaison Report

1 0Industrial Hygiene

in Healthcare

11Call for Award

Nominees

1 2Talking Points –

Heathcare Ergonomics

1 6Spotlight on an

AOHP Star

1 7Ready to Research

Journalof the

Association of Occupational Health Professionalsi n H E A L T H C A R E

F E A T U R E S D E P A R T M E N T S

19

24

27

31

36

41

Stress ManagementBy Kathryn Tyler

AOHP’s Getting Started on the Road isa GREAT Success!

AOHP Workshop—Getting StartedOn-the-Road 2007By Kathryn Wald, RN, BSN

Are All “No-lift” Policies the Same?By George Byrns, MPH, PhD, CIH, DeniseKnoblauch, RN, BSN, COHN-S/CMand Caroline Mallory, RN, PhD

An Invaluable Resource … AOHP’s“Getting Started Class”By Mary Johnson, RN COHN-S/CM

Overview of Hepatitis C and SkinBy Connie M. Chung; Julia R. Nunley

Leading a Multigenerational NursingWorkforce: Issues, Challenges andStrategiesBy Rose O. Sherman, EdD, RN, CNAA

Movers and Shakers Unite toInitiate a Minimal Lift ProgramBy Phillipa “Pip” Atkinson Maas, RN, MSc

2

A O H P J o u r n a l

AOHP Journal Executive EditorKimberly Stanchfield, RN, COHN-SEditor, Journal of AOHP—in Healthcare235 Cantrell Avenue, Harrisonburg, VA 22801(540) 433–4180 [email protected]

AOHP HeadquartersJudy Lyle, Executive Director109 VIP Drive, Suite 220Wexford, PA 15090(800) 362-4347; Fax: (724) 935-1560E-mail: [email protected]

AOHP Editorial BoardExecutive Board Officers

AOHP Executive Board OfficersPresident: Denise Knoblauch

(309) 965-2217 x2586Vice President: Sandra Domeracki Prickitt

(415) 492-4790Secretary: Diane Dickerson

(703) 279-4307Treasurer: Christine Pionk

(734) 936-9242

Regional DirectorsRegion 1: Rosalie Sheveland

(408) 947-2853Region 2: Lynne Karnitz

(920) 794-5181Region 3: Delynn Lamott

(260) 434-3140Region 4: Carol Cohan

(516) 663-2534Region 5: Lydia Crutchfield

(704) 444-3175

Chapter PresidentsAlabama: Felicia Ellison

(205) 750-5221California

Northern: Susan Borrego(831) 625-4646

Sierra: Betty Sumwalt(559) 624-5016

Southern: Vicky McGavack(949) 764-5886

Colorado: Dana Jennings Tucker(303) 789-8491

Florida: Audrey Sadler(305) 285-2490

Georgia: Lynn Arndt(706) 655-5186

Illinois: Mary Bliss(309) 672-4894

Maryland: Cheryl LeeHlaston-Haapala(410) 368-2805

Michigan: Liane Jensen(248) 471-8495

Midwest States: Tamara Vasta(574) 647-6684

New England: Elizabeth Stowell(207) 791-3484

New York:Nassau/Suffolk: Wendy Bezko-Colligan

(516) 562-6602

North Carolina: Pam Kemp(336) 878-6192

Oregon: Portland Linda Beasley-Freeman(503) 413-7487

Pennsylvania: Central: Gail Opperman

(570) 320-7449Eastern: Stephanie Dillman

(610) 954-4704Southwest: Letitia Goodman

(412) 561-4900 x2425South Carolina: Dianne Linne

(864) 261-2582Virginia: Betsy Holzworth

(540) 829-4102Washington: Seattle Beverly Hagar

(206) 341-0575Wisconsin: Julie Coppens

(920) 288-3011

M i s s i o nThe AOHP is dedicated to promoting the healthand safety of workers in healthcare. This isaccomplished through:• Advocating for employee and safety• Occupational health education and

networking opportunities.• Health and safety advancement through best practice and research.• Partnering with employers, regulatory

agencies and related associations.

Journal of Association of Occupational HealthProfessionals (AOHP) —in Healthcare(© 2006 ISSN 0888-2002) is published quarterlyby the Association of Occupational Health Pro-fessionals in Healthcare and is free to members.

For Information aboutrepublication of any article, visit

www.CopyrightClearanceCenter.com

Statement of Editorial PurposeThe occupational health professional in health-care is in a key position to help insure thehealth and safety of both the employees and thepatients. The focus of this journal is to providecurrent healthcare information pertinent to thehospital employee health professional; providea means of networking and sharing for AOHP’smembers; and thereby improve the quality ofhospital employee health services.

The Association of Occupational Health Profes-sionals in Healthcare and its directors and editorare not responsible for the views expressed in itspublications or any inaccuracies that may be con-tained therein. Materials in the articles are thesole responsibility of the authors.

Guidelines for AuthorsAuthors may submit articles via e-mail attach-ment in Word (version 6) to the editor [email protected].

Manuscript GuidelinesManuscript guidelines are available through yourchapter president or by writing to the editor. (Seeaddress below.)

Advertisement GuidelinesAdvertisement guidelines are available from AOHPHeadquarters (800) 362-4347; Fax: (724) 935-1560; E-mail: [email protected].

All AuthorsInclude your full name, credentials, and hospital/business affiliation. Include your supervisor’s nameand address so that a copy of your printed articlemay be forwarded.

Send Copy toKimberly Stanchfield, RN, COHN-SAOHP Journal Executive Editor235 Cantrell AvenueHarrisonburg, VA 22801

Publication deadlines for the Journal ofAOHP—in Healthcare:Issue Closing DateSpring February 28Summer May 31Fall August 31Win te r November 30

Subscription RatesOne year (4 issues), $140; Back issues when avail-able, $35.00 each. Reader participation welcome.

Membership/Subscript ionsAddress requests for information to AOHPHeadquarters, 109 VIP Drive, Suite 220,Wexford, PA 15090; (800) 362-4347; Fax:(724) 935-1560; E-mail: [email protected].

Journal AdsAddress requests for information to AOHP Head-quarters at (800) 362-4347

Moving?Bulk mail is not forwarded! To receive yourjournal, please notify our business office of anychanges: AOHP Headquarters, 109 VIP Drive,Suite 220, Wexford, PA 15090;1-800-362-4347; Fax: (724) 935-1560;E-mail: [email protected].

Upcoming AOHP Conferences

2007 September 26-29: Savannah, GA

2008 September 17-21: Denver, CO

All material written directly for the Journalof the Association of Occupational HealthProfessionals in Healthcare is peer reviewed.

Spring 2 0 0 7

3

President’s Message

Three Rs of Time ManagementBy Denise Knoblauch, RN, BSN, COHN-S/CM

Denise KnoblauchAOHP Executive

President

To quote Will Rogers, “Half our lifeis spent trying to find something to dowith the time we have rushed throughlife trying to save.” I am sure most of uscan relate to Mr. Rogers’ insight on ourlack of time.

A frequent comment by our members isthat they can’t attend meetings becausethey don’t have the time. I know when Iam asked how my new job is going, myresponse is “It’s busy.” I don’t have thetime to answer e-mails, and I missed myfirst AOHP chapter meeting in years.Many members wear multiple hats in theirjobs and juggle multiple responsibilities.

I share these tips to help you manage allyour activities and reduce your stress.Hopefully, the end result will be the abil-ity to participate in AOHP. As occupa-tional health professionals, we have tolearn to juggle our various roles whilekeeping our sanity!

Think about the principles used in otherresource management projects: Recycle,Reuse, and Refuse.

Recycle your thoughts. Most of us knowwhat tendencies prevent us from using ourtime wisely, such as procrastination, lackof confidence or striving for perfection.

I am writing this article two weeks pastthe deadline, fully aware that procrasti-nation is my weakness. Sometimes wespend more time trying to avoid some-thing than it actually takes to accomplish.Ask yourself, “What am I trying toavoid?” Then answer, “Stop fretting

about it, and just get it done.” Set a goalto accomplish a small piece of the projecttoday. Once you start the project, it isjust easier to keep it going. In my case, Ithink I have to do it perfectly. Perfec-tion can stand in your way of success.Think about “good enough.” Aim for 90percent or 80 percent instead of 100percent for certain tasks, but use dis-cretion when applying this to healthcare.

You may need to readjust your goal ifyou feel anxious about a project. Askfor help. Asking others for help showsyou appreciate their contributions. Re-cycle the thought that asking for helpshows a lack of dedication into the con-cept that asking for help encouragesother people to feel valued. One of thebiggest time wasters is reinventing thewheel. Ask for advice. I see this methodof recycling used continually on our listserv as members share policies, proto-cols, etc. Asking others for advice showsyour respect for their wisdom.

Have confidence in yourself. Don’twaste your time justifying your pri-orities to others. Trying to changesomeone’s point of view or makethem see your point of view often isnothing but a time waster. I used tospend a lot of time tracking statis-tics on the number of cases I casemanaged to prove that a case man-ager was needed. Since I have comeback to this position, I am able toprove the assets of a case mangerby simply doing my job: communi-cating, obtaining timely reports, etc.,so I am not wasting my valuablework time with needless reports thatno one read or asked for.

Learn from your mistakes. Give yourselfpermission to move on. Regretting some-thing eats up valuable energy and time.

Reuse your time. We can’t rewind time,but we can use time twice by implement-ing timesavers like delegating and slow-ing down.

Delegate some work while performingother tasks or duties. I have learned thatI don’t need to be the one to send themedical records requests to companies.The medical records department is verycapable of doing that. I can use my timeto do more complex case managementissues. Use technology to your advan-tage. The board recently saved an houron a conference call by simply e-mailingthe issues and conducting a vote on per-tinent issues.

Slow down and enjoy your time. Avoidconfusing activity with action. Lack oforganization often leads to lots of activ-ity but not much in the way of meaning-ful results. Examine where you spend alot of time but don’t achieve much in theway of results.

4


Refuse, and master your time.

Occupational health professionals be-lieve they have to meet everyone’s ex-pectations: the employees, the boss,Human Resources, management, etc.Focus on priorities in two dimensions– urgency and importance. Some tasksare important but not urgent, and theycan be postponed. Other tasks are ur-gent but not important, and they canbe let go. Focus on those tasks meet-ing both criteria. Resist the urge to actwithout planning.

Planning tips:• Plan your day, and prioritize. Mark

those AOHP meetings on your cal-endar!

• Set aside time in your day to answere-mails and return phone calls.

• Plan for waiting. Use waiting timeas an opportunity. Carry your AOHPJournal with you to read duringdown time.

• Carry paper and pen with you to jotdown to-do items when you are at ared light.

• Learn to be unavailable. Protectyour time by saying “No” to various

interruptions, activities, etc. Turn offyour phone. Close your door. Leavethe scene by going to the library towork on that project (and don’t tellanyone where you are!) Use tech-nology such as voice mail to takeyour calls.

By following these tips, you may findthat you have more time to do things thatmake you happiest.

Denise Knoblauch, Executive President

Spring 2 0 0 7

5

Vice President’s Update

Report on Government Affairs Committee MeetingBy Sandra Domeracki Prickitt, RN, FNP, COHN-S

The Association of OccupationalHealth Professionals in Healthcare(AOHP) 2007 Public Policy Statementwas released on January 10, 2007. Thisis the association’s second such state-ment. It will be utilized during the nexttwo years to focus association activi-ties, whether they are legislative, regu-latory, research or policy making. Thestatement is based upon a survey takenof AOHP membership during the na-tional elections in 2006. The top threeissues for membership at that timewere: bloodborne pathogen exposures,safe patient handling and respiratoryprotection.

Bloodborne Pathogen ExposureThe association is looking to focus ac-tivities around the Centers for DiseaseControl and Prevention’s (CDC) pub-lication titled “Revised Recommenda-tions for HIV Testing of Adults, Ado-lescents, and Pregnant Women inHealth-Care Setting,” released on Sep-tember 22, 2006, in MMWR 55(RR14;)1-17. AOHP plans to work at the na-tional and state levels to effect policyaround HIV consenting for sourcepatients to expedite the process whena healthcare worker sustains a bloodor body fluid exposure in the work-place. AOHP is considering becominga member of a work group(s) that hasbeen organized by the CDC and theAmerican Academy of HIV Medicineto work on ways to publicize these newguidelines and to help ensure theirimplementation. AOHP will also con-tinue its work related to sharps safety

Sandra Domeracki PrickittAOHP Vice President

as it has done in the past. Part of thiswill occur through AOHP’s Alliancewith OSHA in updating the HospitaleTools that focus on this area.

Safe Patient HandlingAOHP continues to monitor any legis-lation at the national level regarding theissue of safe patient handling. At thenational level, there was a bill intro-duced by Mr. Conyers on January 10,2007, titled “Nurse and Patient Safety& Protection Act of 2007” (HR 378IH.) Since the fiscal year 2008 budgethas been released, it is expected thatthe budget and appropriations will takeprecedence over the next few months.AOHP is reviewing the bill at this time.The association is also attempting tomonitor this issue at state levels via itsGovernment Affairs Committee (GAC)members.

Respiratory ProtectionAOHP is looking to work with NIOSHvia its MOU to be involved in the re-search NIOSH will be doing on the N-95 particulate respirators. AOHP alsohas the goal of continuing to be in-volved with legislation and regulationsat the national and state levels. Asmany AOHP members know, over thepast two to three years at the federallevel, a bill has limited money in ap-propriations to prevent OSHA fromgiving fines related to the particulaterespirator in healthcare settings. It isunclear at this time how things will goin appropriations at the federal levelas it relates to this topic. At the statelevel, some self-funded states, such as

California and Washington, have cho-sen to enforce the annual fit testing forthe particulate respirator since theyare only partially funded by the fed-eral government’s program. AOHPhas been active in California on thistopic and plans to continue to be so.

AOHP’s 2007 Public Policy Statementand 2006 survey can be viewed onAOHP’s web site at www.aohp.org.All information in this article is cur-rent as of February 27, 2007. It is sub-ject to change after that time due tothe nature of legislative and regulatoryactivities.

Please free to contact me if you areinterested in active involvement withthe GAC in any of these areas. It isyour volunteerism that keeps AOHPin good health. I look forward to hear-ing from you.

Sincerely,

Sandra Domeracki Prickitt,RN, FNP, [email protected]

6


Editor’s Column

By Kim Stanchfield, RN, COHN-S

In celebration of spring and National Employee Health and Fitness Day (May 17,)I am devoting this column to healthy living and eating!!! Please accept the gift of oneof my own healthy recipes.

I hope you enjoy the healthy recipe and then get plenty of enjoyable exercise onthese nice spring days. To quote Dr. Kenneth Cooper, a well-known fitness andwellness expert, “Fitness is a journey, not a destination. It must be continued forthe rest of your life.”

Celebrating Spring

Kim StanchfieldAOHP Journal Editor

2 1-lb. packages of Shady Brook F

arms Low Fat Turkey Italian Sausage

1 package Hormel Turkey Pepper

oni, chopped

1 large onion, chopped

2 14-oz. packages sliced

mushrooms

1 each yellow, red and gr

een pepper, chopped

2 cloves fresh garlic, cru

shed

1 large container skim milk ricotta ch

eese

1 package reduced fat It

alian cheese

salt, pepper, Italian seas

oning to taste

2 loaves French bread

Brown sausage. Drain and set

aside. Spray pan with cooking spray, and b

rown onions,

pepperoni, mushrooms, peppers,

garlic. Return sausage al

ong with remainder of

ingredients. Keep hot.

Cut French bread into 6-

inch sections, hollow out and fill

with above meat mixture.

Sprinkle with cheese, and bake at 4

00 degrees for 10 minutes or so

(until crust is

browned and cheese is bubbly

.)

Italian Meat, Cheese & Veggie Pizzas

Spring 2 0 0 7

7

Association Community Liaison ReportBy MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

MaryAnn Gruden

The first report provides a brief update,followed by an article from OSHA onits Voluntary Protection Programs (VPP,)which OSHA wanted to share with Alli-ance members. The VPPs are healthand safety programs that AOHP mem-bers should be aware of and may alsowant to consider implementing at theworkplace.

OSHA AllianceRepresentatives of a number of OSHAAlliances, as well as members of theAOHP OSHA Alliance ImplementationTeam, have been participating in the re-vision of the Hospital eTool. The revi-sion process has been broken down intofour priority modules. Each module willbe reviewed and updated by a team com-prised of OSHA staff and Alliance part-ner representatives with an interest andexpertise in the module content. AOHPmembers are participating on three ofthe four teams, including bloodbornepathogens, ergonomics and sonography.Sonography will be a new module forthe eTool and will be the first module onthe priority list. The surgical suite mod-ule is the second module that will be up-dated during this process, and it will in-clude updated information on laser safety.Revision of the bloodborne pathogensand ergonomics modules will follow. Thetargeted completion date is late 2007. Tovisit the eTool, go to www.osha.gov.

AIHA Working Group and “Friendsof NIOSH”The American Industrial Hygiene Asso-ciation (AIHA) held a meeting in mid-December at the National Safety Coun-cil in Washington, D.C. This networkinggroup represents a wide range of occu-pational and safety associations that

have met in the past. The purpose of themeeting was to discuss the possible po-litical changes on Capitol Hill given thenew Congress convening in January2007. A major concern of the approxi-mately 20 representatives in attendancewas the placement and funding of theNational Institute of Occupational Safetyand Health (NIOSH) within the Depart-ment of Health and Human Services atthe Centers for Disease Control andPrevention (CDC.) There were twoguest speakers. Assistant Secretary forOSHA Edwin G. Foulke discussedOSHA’s achievements in 2006 and itsgoals for the future. Dr. John Howardfrom NIOSH spoke about the Work-LifeInitiative. This initiative focuses on theintegration of health and safety for em-ployees not only at work, but at home.For more information on this initiative,go to www.niosh.gov.

A number of representatives at the De-cember meeting are also members of“Friends of NIOSH.” “Friends” held ameeting on February 23, 2007, andAOHP participated in the meeting byconference call. Dr. Howard also ad-dressed this group. Budgetary issueswere one of the primary topics due toreductions in funding. The goals forNIOSH at this time are the NationalOccupational Research Agenda(NORA) and the Work-Life Initiative,mentioned above. The issue of bio-aero-sols as it relates to respirator use is anarea of concern and research forNIOSH. “Prevention through design” isa term now being used at NIOSH andsupported by the National Safety Coun-cil. Those of us in healthcare are alreadyfamiliar with it when we talk about “en-gineering out the sharp.” Engineering out

the occupational hazard is what is neededas new technologies develop.Nanotechnology is also a hot topic andamong the priorities at NIOSH. AOHPmembers will be kept advised of the sta-tus of this group.

VPP – A Proven Way to ReduceInjuries, Illnesses and Costs

OSHA’s Voluntary Protection Pro-grams (VPP) have proven over theyears to be an effective means of re-ducing injuries, illnesses, fatalitiesand costs, all while fostering a moreproductive workforce and increasingemployee morale.

OSHA’s Voluntary Protection Programswere developed and implemented in 1982to encourage cooperative relationshipsamong labor, management, unions andgovernment in an effort to improve safetyand health in the workplace. Approvalinto VPP is OSHA’s official recognitionof the outstanding efforts of employers

8


and employees who have achieved ex-emplary occupational safety and health.VPP sets performance-based criteria fora managed safety and health system,invites sites to apply, and then assessesapplicants against these criteria. OSHA’sverification includes an application re-view and a rigorous on-site evaluationby a team of OSHA safety and healthexperts.

Beyond being a role model for safetyand health, VPP companies generallyexperience many other positive ben-efits, such as: 60 percent to 80 per-cent fewer lost workday injuries; aninjury and illness rate that is 52 per-cent below average (for industries thatfall within the same classification) andreduced workers’ compensation costs.These sites typically do not start outwith such low rates. Reductions in in-juries and illnesses begin when the sitecommits to the VPP approach tosafety and health management, and thechallenging VPP application process.Bill Greehy, Chairman of Valero En-ergy Corporation, says of VPP, “It isour goal to have all of our refineriesdesignated as Star Sites… It’s a greatprogram with proven results, andwe’re thankful to OSHA for their sup-port because they truly treat you likea partner.”

VPP provides opportunities to a widearray of industries ranging from con-struction and agriculture to food manu-facturing. Currently, companies frommore than 270 industries participate inthe program. Over the years, VPP hasgrown flexible enough to meet the de-mand of the workforce. Through sev-eral new initiatives – VPP Corporate,OSHA Challenge and MobileWorkforce Demonstration – VPP hasexpanded its presence and adaptedprograms to meet the needs of differ-ent industries and companies of vary-ing sizes.

VPP Corporate Pilot ProgramThe VPP Corporate Pilot offers expe-dited application and approval proce-dures to encourage organizations to com-mit multiple sites to VPP standards ofexcellence. The U.S. Postal Service(USPS) is one of six corporate partici-pants in this pilot. Before being acceptedinto the pilot in 2005, the USPS had just17 sites in VPP. At the end of fiscal year2006, the USPS had 62 approved sites,with 43 more applications expected tobe approved soon.

The VPP Corporate Pilot is designed totest new VPP processes for “CorporateApplicants” who demonstrate a strongcommitment to employee safety andhealth, and VPP. These applicants, typi-cally large corporations or federal agen-cies, have adopted VPP on a large scalefor protecting the safety and health oftheir employees. VPP Corporate Pilotapplicants and participants must haveestablished, standardized corporate-levelsafety and health management systems,effectively implemented organization-wide, as well as internal audit/screeningprocesses that evaluate their facilities forsafety and health performance.

Under the VPP Corporate Pilot, stream-lined processes have been established toeliminate redundancies and expand VPPparticipation for “Corporate Applicants”in a more efficient manner. Upon accep-tance of the participant into VPP Cor-porate, all eligible participant facilities willfollow the streamlined application andon-site evaluation process when apply-ing for VPP. General Electric and DowChemical Company are among a hand-ful of charter participants in the pilot.Stephen Ramsey, Vice President of Cor-porate Environmental Programs for Gen-eral Electric, remarked, “GE is honoredto be accepted into the OSHA VPPCorporate Program and looks forwardto continuing our cooperative and pro-ductive relationship with OSHA.”

OSHA ChallengeOver the years, many employers haveasked for a program that caters specifi-cally to organizations that are interestedin VPP, but need some help in meetingprogram requirements. A new offering,the OSHA Challenge Pilot, aims to satisfythis need. Although Challenge is open tocompanies of all sizes, smaller companiesfind Challenge especially helpful in prepar-ing for VPP. Fifty-eight percent of Chal-lenge participants employ fewer than 200people. OSHA Challenge recognizes thatthere are many employers at differentstages in the process of working towardimplementing a successful safety andhealth management system.

OSHA Challenge provides opportunitiesfor employers not currently served byexisting OSHA cooperative programs towork with the agency and receive rec-ognition for their efforts. Challenge Par-ticipants link into either a General Indus-try or a Construction track. Within eachtrack, participants follow a detailed three-stage roadmap that guides them to im-prove their safety and health manage-ment systems, and work toward VPPstatus. OSHA Challenge participantsthat have been in the program one yearor more, on average, have reduced theirTCIR and DART rates 37 percent and31 percent respectively. OSHA Chal-lenge has become a pipeline for partici-pants to reach for the VPP Star.

Mobile Workforce DemonstrationOSHA’s newest component of its premierecooperative program – the VPP MobileWorkforce Demonstration for Construc-tion – was launched in October 2006.Edwin G. Foulke, Assistant Secretary,OSHA, said the program, “offers construc-tion employers with mobile constructionworkforces and short-term projects thesame opportunity for recognition that fixed-site employers receive.” And, it “recog-nizes those construction companies thatshould be held up as models of safety andhealth for the rest of the industry.”

Spring 2 0 0 7

9This Demonstration is intended to cre-ate greater opportunity for employers andemployees in the construction industry toparticipate in VPP and, in so doing, tostrengthen worker protections significantly.It will also give OSHA more opportunitiesto explore and test appropriate modifica-tions to VPP, alternative requirements thatwill help bring the benefits of this programto the construction industry. OSHA be-lieves this new Demonstration will workboth for companies that typically functionas controlling general contractors and com-panies that perform specialty trade func-tions, regardless of size. While the core ofthe new program continues to be effec-tive safety and health management sys-tems, there are important differences(compared to site-based VPP participants)aimed to provide some flexibility for con-struction participants.

The Demonstration program involves atwo-phased OSHA verification process:(1) a review of safety and health man-agement system policies and procedures,plus management’s commitment tosafety and health, and VPP; and (2) avisit to one or more worksites to deter-

mine the successful implementation ofthe corporate policies and procedures,and to verify employee involvement.

For more information on VPP, please con-tact OSHA’s Office of Partnerships andRecognition at (202) 693-2213, or visitwww.osha.gov/vpp.

10


Industrial Hygiene in Healthcare

Glutaraldehyde SafetyBy George Byrns, MPH, PhD, CIH and Lee Shands, MPH, CIH

All product information is not endorsed by the author or AOHP but merely is a resource for individuals.

In this issue, we will discuss some of the safety concernsassociated with the use of glutaraldehyde. Glutaraldehyde for-mulations have been used for many years as a high-level dis-infectant or cold sterilizing agent, depending on contact time.Some formulations require the addition of an activator toachieve full potency. Glutaraldehyde used for disinfectionpurposes usually comes in a two percent solution. These so-lutions lose potency over time and especially with repeateduse. Some examples of trade names include Cidex®,Sonicide® and Omnicide®.(NIOSH, 2001) Glutaraldehyde isalso used in a much higher concentration (30 percent to 50percent) as a hardening agent in x-ray film developing or as atissue fixative in histology or pathology.

Glutaraldehyde is considered to be highly toxic to humans viainhalation, ingestion or skin contact, and allergic sensitization canoccur. Skin sensitization has been documented in endoscopynurses, x-ray technicians and others.(OSHA, 2006) The mostserious health effect from exposure is occupational asthma. Be-cause workers were becoming sensitized with low exposures,the American Conference of Governmental Industrial Hygien-ists (ACGIH) lowered the Threshold Limit Value (TLV) to 0.05ppm as a ceiling level. To achieve this ceiling level, the best solu-tion is to eliminate or minimize the use of the product.

The first step in reducing exposure is to make sure that theglutaraldehyde is used appropriately. For example, it shouldnot be used as a cold sterilant for items that do not requiresterilization or that can be steam sterilized. Glutaraldehydeusage may be eliminated by the substitution of glutaralde-hyde-free x-ray film processing units, or digital radiographymay be an option. Substituting equipment that can be steamsterilized for those pieces that require cold sterilization mayalso be feasible. Using glutaraldehyde as a surface disinfec-tant should be prohibited because it can generate exposuresabove the TLV level.

At a minimum, glutaraldehyde solutions must be tightly cov-ered at all times or used in an area with good ventilation to

capture any vapor release.(Rutala, 1996) Inall cases, glutaraldehyde should only beused in locations with total exhaust, notre-circulated, ventilation. When glutaralde-hyde is used as a tissue fixative, it is impor-tant that procedures be done inside a fumehood. The hood should be checked to besure that the sash is at the proper heightand that hood face velocities are between 80 and100 feet per minute.(American Conference of GovernmentalIndustrial Hygienists, 2001) The use of glutaraldehyde in au-tomatic disinfecting units significantly reduces but does noteliminate exposures.

In terms of personal protective equipment, it is safer to uselocal exhaust ventilation than respirators. It is also importantto avoid skin contact. Gloves should be made of nitrile orbutyl rubber because glutaraldehyde has a tendency to pen-etrate latex.(NIOSH, 2001) Other forms of personal protec-tion such as goggles, face shields and gowns may be neces-sary to protect the eyes and skin of workers.

There have been recent efforts to replace glutaraldehyde withalternatives because of exposure concerns. Ortho-phthaladehyde (OPA) is a relatively new germicide that wascleared in 1999 by the FDA for use as an instrumentdisinfectant.(Rutala & Weber, 2001) It is similar in action toglutaraldehyde but has several advantages over glutaralde-hyde. It requires no activation, and it is more stable than glu-taraldehyde. It also has a lower vapor pressure, so it is lesslikely to be volatilized. One disadvantage is that it will stainunprotected skin a gray color. The most serious issue withOPA is that it is a potent skin sensitizer. For example, it shouldnever be used for reprocessing of urological instruments tobe used on patients with a history of bladder cancer becauseof reports of anaphylactic-like reactions. OPA also appearsto be toxic to aquatic environments and may require neutral-izing with glycine before it is discharged to the sewer. Someother alternatives include steam sterilization for heat stable

Spring 2 0 0 7

11instruments or hydrogen peroxide and ozone sterilizers forheat sensitive instruments.

Regardless of where glutaraldehyde is used, it should be included inthe health care facility’s Hazard Communication training program.Topics to be included are an explanation of the material safety datasheets, possible health effects, locations where it is used, methods ofminimizing exposure and steps to take in the event of a spill. For moreinformation on glutaraldehyde safety, see NIOSH’s web site http://www.cdc.gov/niosh/topics/glutaraldehyde/ and OSHA’s Best Prac-tices for the Safe Use of Glutaraldehyde in Health Care http://www.osha.gov/Publications/glutaraldehyde.pdf.

Call for Award NomineesNominees for the following awards are being sought.

Ann Stinson President’s Award for Association Excellence-recognizes achapter that has demonstrated outstanding performance and enhanced theimage of occupational health professionals in healthcare.

Joyce Safian Scholarship Award- recognizes a past or presentassociation officer who best portrays an occupational health professional inhealthcare role model.

Extraordinary Member Award-recognizes a current association memberwho demonstrates extraordinary leadership.

Honorary Membership Award- recognizes a person(s) who has made asignificant contribution to the field of occupational health in healthcare.

NEW! Business Recognition Award- to recognize business(es) thatsupport the occupational health professionals and membership andparticipation in AOHP.

Nominations need to be submitted to the national office by July 15th. Youmay contact your chapter president or regional representative for awardcriteria or at the AOHP website,http://www.aohp.org/Resources/Awards-and-Scholarships.asp

ReferencesAmerican Conference of Governmental Industrial Hygienists (2001.) In-dustrial Ventilation - A Manual of Recommended Practice. (24th ed.) Cin-cinnati, OH: ACGIH.NIOSH (2001.) Glutaraldehyde Occupational Hazards in Hospitals (Rep.No. 2001-115.) Cincinnati, OH: NIOSH-Publications Dissemination.OSHA (2006.) Best Practices for the Safe Use of Glutaraldehyde in HealthCare (Rep. No. OSHA 3258-04N.) Washington D.C.: US Department ofLabor.Rutala, W. A. (1996.) APIC guideline for selection and use of disinfec-tants. 1994, 1995, and 1996 APIC Guidelines Committee. Association forProfessionals in Infection Control and Epidemiology, Inc.Am.J.Infect.Control, 24, 313-342.Rutala, W. A. & Weber, D. J. (2001.) New disinfection and sterilizationmethods. Emerg.Infect.Dis., 7, 348-353.

12


All product information is not endorsed by the author or AOHP but merely is a resource for individuals.

Talking Points – Healthcare Ergonomics

Out with the Old, In with the New - Safe Patient Handlingand Movement Curriculum in Schools:

A Faculty Member PerspectiveBy Carol F. Durham, RN, EdD(c) and

Laurette R Wright, RN, MPH, COHN-S

Florence Nightingale once said, “You ask me why I donot write something....I think one’s feelings waste them-selves in words, they ought all to be distilled into actionsand into actions which bring results.”

With funding by the National Institute for Occupational Safetyand Health (NIOSH,) and support from the University of SouthFlorida College of Nursing, the Tampa VA Patient Safety Re-search Center of Inquiry and the American NursesAssociation’s Handle with Care Initiative, a pilot project wasdeveloped December 2005 to solicit the interest of academicinstitutions in a pilot-test of a safe patient handling curriculummodule which included an evidence-based instructional mod-ule, lifting equipment and other supporting documents.

In this issue of Talking Points, we are pleased to present Part 1of a two-part series which will highlight the perspective of afaculty member, Carol F. Durham, RN, EdD(c,) Director, Clini-cal Education & Resource Center, University of North Carolinaat Chapel Hill (UNC-CH) School of Nursing, as she and hercolleagues journeyed to incorporate the pilot project into theirexisting nursing school curriculum. In Part 2 of this series, wewill feature the perspective of a nursing student who participatedin the UNC-CH School of Nursing revised curriculum. The in-formation is presented in question and answer format.

Laurette Wright, RN, MPH, COHN-S, Column Editor:How did you hear about the NIOSH project?

Carol Durham, RN, EdD(c), UNC-CH School of Nurs-ing: When ANA released the call for proposals to nursingschools to be a pilot site for the Handle with Care: Effec-tiveness of an Evidence-Based Curriculum Module inNursing Schools Targeting Safe Patient Handling and

Movement (SPHM), I thought Ishould apply on behalf of theschool. However, it was the end of the semester. I was verybusy wrapping up the semester. I had been awarded a leavefor the time of the implementation of the pilot and was con-cerned about that as well. Over the next couple of days, nu-merous colleagues forwarded the call for applications to me andencouraged me to apply. Sonda Oppewal, RN, PhD, Associate Deanfor Community Partnerships and Practice, was willing to help pulltogether the materials and so, we decided to put our application for-ward. Lindsay A. Gainer, RN, MSN was slotted to cover my leave,so I discussed the project with her, and she and I collaborated onimplementing the pilot project.

Laurette: What were the top three reasons UNC-CHSchool of Nursing decided to participate in the program?

Carol: We were very excited to be selected as part of thepilot since we value staying on the forefront of practice, andwe felt this would be a way to make sure we remain currentand evidence-based in regard to patient handling and move-ment. Secondly, we are committed to teaching our studentsbest practices for patient safety, and this pilot was focused onthat as well. Thirdly, we teach our students to be patient ad-vocates, as well as advocates for better practice. When welearned that the focus would not only be on patient safety butalso on nurse safety, that was an additional benefit.

Laurette: What was the initial reaction of your facultywhen you introduced the SPHM curriculum? What is theirreaction since the program was introduced?

Carol: When Ms. Gainer and I attended the mandatory fac-ulty training in March 2005, we were amazed at how much

Spring 2 0 0 7

13we did not know about the evidence around body mechanics,patient transfer and positioning. As mentioned earlier, we valuestaying on the cutting edge of practice, but we were not awareof the content presented by Audrey L. Nelson, PhD, RN,FAAN and her colleagues. Dr. Nelson is masterful in her strat-egy to introduce the new material by dispelling myths. Her pre-sentation was a very effective method of helping faculty shiftfrom traditional teaching to evidence-based practice.

I realized when we returned to school that we would be bring-ing a new paradigm for teaching patient handling and move-ment. I informed faculty of the upcoming changes to be imple-mented in the fall courses. The faculty is committed to qualityeducation and is willing to make changes as needed whensupported with evidence. However, when we implementedthe pilot content, there was more resistance than we expected.Faculty were concerned, and rightfully so, that students wouldbe in clinical settings without mechanical lifting equipment.They were concerned if we did not teach the “old way” oftransferring patients using manual lifting, then students would notbe able to transfer and move patients in the clinical setting.

The majority of the faculty were committed to the new cur-riculum. However, one faculty member was adamant thatshe was going to teach her clinical group the “old way” ofpatient handling. She pulled her students into an empty patientcare room and taught them manual lifting techniques. As fac-ulty, we have to be aware not only what we intend to teach,but also of what we are teaching that is not intended. Allow-ing the faculty to circumvent the school’s decision to teachSPHM indirectly teaches students when they disagree with apolicy change that it is appropriate to “ignore it” and continuedoing it the “old way.” We do not want to set that precedent.

Bringing about culture change is always challenging. It wastrue with the implementation of universal precautions and theuse of gloves or with needless systems. In light of the evi-dence, nursing faculty would be negligent if they asked a stu-dent to clean up a blood spill without gloves – you just wouldnot do that! So, with the body of evidence about patient move-ment and its associated risk to the patient and the nurse, fac-ulty should feel compelled to teach the SPHM program.

It is interesting to note that in the second year of the newSPHM curriculum, the same faculty member was surprisedwe were still not teaching the “old way.” Some things taketime to bring about change (smile.)

Laurette: What was the initial reaction of your studentswhen the SPHM curriculum was introduced? What was

the students’ reaction following introduction of the SPHMcurriculum?

Carol: Students in a program of study take at face valuewhat is taught. They trust faculty to know what they need toknow and how to help them to acquire the knowledge, skillsand attitudes they need for the profession.

Students do not have the knowledge base to have a reaction.We explained to them that we were teaching them new evi-dence-based practice and that it is a culture change. As such,they would be encountering settings that would not have lift-ing equipment. If that was the case, they were to do theirassessment of the patient, as well as the environmental as-sessment. If the assessment revealed they should use anassistive device and it was not available, they should let theirfaculty patient care nurse know what they had done and thatthey could not safely move the patient. Students seemed tobe reassured that we were providing them with the best pos-sible educational experience.

Laurette: How many faculty have taught the curriculumand/or are qualified to teach SPHM curriculum?

Carol: Initially, there were two faculty trained to teach SPHM,who in turn trained six teaching assistants (graduate studentsin our master’s program.) Currently, there are five facultyand seven teaching assistants who are qualified to teach por-tions, if not all, of the SPHM curriculum.

Laurette: Do you think the students considered they are “atrisk” when assigned to their clinical teaching facility?

Carol: Students did not consider themselves “at risk” in clini-cal. At their clinical sites, the students would observe nursesmanually moving patients without concern for risk. The manualmovement of patients within healthcare has not been consis-tently highlighted as a risky behavior, contrasted with drawingblood on an HIV positive patient as an example. So, under-standably, the students would accept the activity as a functionof their role without concern about risk for themselves or fortheir patients.

Laurette: What teaching methods did you use to intro-duce the SPHM program to your students?

Carol: The pilot project partnered participating nursing schoolswith vendors of assistive equipment and patient-handling de-vices. UNC-CH had equipment on loan from ARJO, Inc.,including gait belts with handles, a stand-assist lift, a mobilemechanical full-body lift, a floor-mounted over-bed lift, a lat-

14


eral transfer device and friction reducing devices for movingpatients in bed. The ability to have the equipment to practicewith was very important to the students. The educators wereall trained on the equipment.

Specific patient assessment criteria and algorithms were devel-oped by Dr. Audrey Nelson and researchers at the Tampa VA toassist with clinical decision-making based on the patient’s depen-dency level and other factors. The assessment criteria and algo-rithms are available from the VA National Center for PatientSafety and can be found at http://www.patientsafetycenter.com/Safe%20Pt%20Handling%20Div.htm.

Prior to lab, students had to do readings and watch a video onthe CD-ROM, as prepared by Dr. Nancy N. Menzel, RN,PhD, of the University of South Florida College of Nursing.When they arrived at lab, they were given a packet contain-ing four assessment forms and the algorithms. To prepare forclinical rotations, each student practiced selecting and usingeach device in simulated patient care scenarios following atwo-step process. First, the students assessed the patient andthe environment using these key assessment criteria:

• The ability of the patient to provide assistance.• The ability of the patient to bear weight.• The upper extremity strength of the patient.• The ability of the patient to cooperate and follow in-

structions.• Patient height and weight.• Special circumstances likely to affect transfer or reposi-

tioning tasks such as abdominal wounds, contractures,presence of tubes, etc.

• Specific physician orders or physical therapy recommenda-tions that relate to transferring or repositioning patients. Forexample, a patient with a knee or hip replacement may needa specific order or recommendation to maintain the correctangle of hip or knee flexion during transfer.

• Type of task to be completed, such as transferring, repo-sitioning, ambulating or toileting.

Second, using the algorithms, the students selected the appro-priate equipment or assistive device to use and the number ofcaregivers needed to complete the task safely. Under the su-pervision of faculty or teaching assistants, students actuallypracticed with the different types of lifting equipment. Thestudents rotated through three rooms in groups of eight to 10students. Each had different simulated patient scenarios andtypes of equipment, requiring students to use critical thinkingto determine the correct algorithm to follow. The emphasiswas on patient safety as well as nurse safety.

The access to the curriculum, patient assessment tools, algo-rithms and equipment made the process as easy as it could be.The vendor was very responsive to training needs and helped tomake the access to equipment as convenient as possible. Thechallenging aspect was the culture change among faculty andaffiliate agencies. This will take time and be an ongoing process.

Laurette: Were there situations where students did nothave mechanical lifting devices available when they ar-rived to their assigned units? What did they do?

Carol: We taught students to use the assessment forms andalgorithms found at the VA National Center for Patient Safetyh t t p : / / w w w . p a t i e n t s a f e t y c e n t e r . c o m /Safe%20Pt%20Handling%20Div.htm. If their assessment de-termined they needed an assistive device and it was not avail-able, they were not to transfer the patient. They would need toinform their faculty and the patient care nurse of the situation,including their assessment.

Laurette: Did students follow through with SPHM tech-niques/concepts during their clinical assignments?

Carol: As far as we know, they did.

Laurette: Did you develop an ongoing curriculum forSPHM?

Carol: We adapted the curriculum developed by Dr. Menzel.Additionally, Jean LeCluyse, RN, BSN, a medical illustrator,created drawings (non-vendor specific) to assist studentconceptualization of the equipment used for various patienthandling tasks. (See Figure 1 & Figure 2.) We duplicated the

Figure 1

Spring 2 0 0 7

15

materials on a CD and made packets for all 177 BSN stu-dents and faculty. Now, we post the materials on our coursemanagement system.

Faculty were given multiple times to come to hands-on labs tobecome familiar with the equipment. The Dean of the Schoolof Nursing participated in one of these sessions, exemplifyingher support.

Often, schools of nursing are asked to add more and morecontent to an already overloaded curriculum. It is importantto realize that this curriculum replaces what schools are cur-rently teaching and does not require more curricular time. Wedid not have a didactic lecture. We offered the content as apsychomotor lab that was three hours long. This was the sameamount of time we had dedicated to this topic previously. Wewere able to teach 30 students at time and ran the labs acrossone week to accommodate all 177 students.

Laurette: What would you do differently if you wereasked to re-introduce this program to a new class ofnursing students?

Carol: As we continue to implement the SPHM curriculum,we plan to enhance our work with faculty adoption. Addition-ally, we will continue to empower students and faculty to knowwhat to do when they do not have lift equipment at an agency.

Laurette: Have you highlighted your SPHM curriculumin your recruitment efforts for nursing students?

Carol: At this time, SPHM curriculum has not been high-lighted in our recruitment of nursing students.

Laurette: Has your teaching hospital attained magnetcertification? If not, would the teaching hospital incorpo-rate SPHM in its magnet application process?

Carol: Our teaching hospital is preparing its magnet applica-tion and plans to highlight SPHM as part of the application.

Laurette: Do you think programs should be a mandatorypart of magnet?

Carol: I do think that SPHM programs should be a manda-tory part of the magnet application.

Laurette: What is your opinion about students who mayrefuse to work at a healthcare facility without an SPHMprogram?

Carol: We teach our students, when conducting their job in-terviews, to ask if the agency has a minimal lift policy. If yes,they are to explore what equipment is available and how ac-cessible the equipment would be to them as they deliver pa-tient care. If the agency does not have an SPHM programcurrently, or if there is not one on the horizon, we suggestthey decline the job and go to the next interview.

Laurette: Do you see this as having any affect to change/motivate employers to develop safe patient handling pro-grams?

Carol: This approach is having an affect locally among ouraffiliating agencies. Agencies are noting that our students areasking these questions in the interviews. The decision to adopt anSPHM program is multi-factorial, but I do think new graduates’decisions to work for an agency or not is one of those factors.

Laurette: Are you willing for others to call you if theyhave questions?

Carol: Certainly. I can be contacted as follows:Carol F. Durham, RN, EdD(c)Director, Clinical Education & Resource CenterClinical Associate ProfessorThe University of North Carolina at Chapel [email protected] (Please enter SPHM in the subject line.)919-966-1753

Laurette: Do you have any other thoughts you would liketo share?

Carol: It is exciting to be on the forefront of a culture changein nursing. Once you become familiar with the evidence for

Figure 2

16


this new practice, you are compelled to teach the safer meth-ods to your students.

Acknowledgements:Carol Durham wishes to express sincere appreciation to thefollowing individuals for their support and efforts in the imple-mentation of the Safe Patient Handling and Movement cur-riculum at the University of North Carolina at Chapel HillSchool of Nursing.

Linda R. Cronenwett, PhD, RN, FAANDean and ProfessorThe University of North Carolina at Chapel Hill School ofNursing

Lindsay A. Gainer, RN, MSNClinical Assistant ProfessorThe University of North Carolina at Chapel Hill School ofNursing

Jean LeCluyse, RN, BSNMedical Illustrator and Clinical Education & Resource Cen-ter staffThe University of North Carolina at Chapel Hill School ofNursing

ReferencesAllen, L. K. & Durham, C. F. (2006.) Handle with care: A new curriculumfor safe patient handling and movement at the University of North Caro-lina at Chapel Hill. Tar Heel Nurse, (April-May-June,) 21-23.

American Nurses Association. (2003.) “Handle with Care” Campaign:Fact Sheet. Retrieved May 6, 2005 from http://www.nursingworld.org/handlewithcare.

American Nurses Association. (2002.) Preventing Back Injuries: SafePatient Handling and Movement. Retrieved May 30, 2005 from http://www.nursingworld.org/osh/ergonomics.pdf.

Nelson, A., Fragala, G., & Menzel, N. (2003.) Myths and facts about backinjuries in nursing. AJN, 103(2,) 32-41.

Nelson, A., Owen, B. (2003.) Safe patient handling movement. AJN, 103(3)32-44.

VA National Center for Patient Safety. (2005.) Creating a Culture ofSafety. Retrieved May 6, 2005 from http://www.patientsafety.gov/vision.html.

VA National Center for Patient Safety. (2001.) Patient Care ErgonomicsResource Guide: Safe Patient Handling and Movement. Tampa. FL: Ergo-nomics Technical Advisory Group.

VISN 8 Patient Safety Center. (2005.) Safe Patient Handling and Move-ment Algorithms. Retrieved May 30, 2005 from http://www.patientsafetycenter.com/Safe%20Pt%20Handling%20Div.htm.

AOHP and this Journal arepleased to recognize another worthymember, Cynthia Harmer, from LosGatos, California. Cynthia was nomi-nated by fellow Northern CaliforniaChapter colleague Sandy Prickitt.“Cynthia is a fairly new member to theEmployee Health profession and toAOHP, but she is doing an excellent jobin a tough situation,” Sandy states. “Shealso willingly offered her assistance forthe social events for the 2006 nationalconference, and ended up doing an ab-solutely splendid job! Cynthia rallied ad-ditional chapter members to step up andcreate a fun, elegant and delightful galaat the conference. She problem-solvedissues with skill and a smile!”

Spotlight on an AOHP Star

CynthiaHarmer

Cindy has been the Manager of Em-ployee Health at Community Hospitalof Los Gatos for the past three years.Her major job responsibilities includeEH standards, Workers’ Compensationcoordination, Return to Work, manag-ing the Safe Patient Handling Program,Bloodborne Pathogens and EmployeeWellness.

Currently serving as Treasurer of theNorthern California Chapter of AOHP,Cindy has been an AOHP member forthree years. She credits AOHP’s Get-ting Started with assisting her in learn-ing her role, and she greatly relies on fel-low AOHP members as valued mentors.

Cindy recently published a ColleagueConnection article in the Journal on hersuccessful wellness initiatives at her fa-cility, and her current goal is to becomeCOHN certified within the next year.

Congratulations, Cindy, on a well-de-served “spotlight;” you truly shine in thisorganization. We are lucky to have youas a member, colleague and friend!!

Spring 2 0 0 7

17

Ready to Research

Preparing a Research Manuscript for PublicationBy MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM, Column Editor

During the past year, wehave had four guest authors forthis column. They have writ-ten about a variety of topicsthat hopefully stimulated you, themembership, to venture into theworld of the nurse researcher. Col-umn topics have included informationabout journal clubs, how to critically readresearch articles, evidence-based practice,steps in the research process, the internalreview board (IRB) and how to search theliterature online. If you have conducted re-search, now is the time to think about pub-lishing the research findings. First, you mustprepare yourself; then, you must preparethe manuscript. To some, the former maybe more daunting than the latter!

Preparing yourselfWhy publish?The purpose of research is to add to a spe-cific body of professional knowledge andto share expertise. For healthcare, newresearch findings may lead to practicechanges that will improve patient outcomes,whether those patients are inpatients oremployees. To share this new knowledgeor evidence, the researcher must be will-ing to communicate the research processand outcomes with professional colleagues.Research findings can be communicatedin several ways. Podium presentations orposter sessions provide opportunities topresent “live” at conferences. The thirdway is publishing research findings in a pro-fessional journal. Publishing findings offersmany professionals the opportunity to keepabreast of the latest science in their re-spective professions. The importance ofcommunicating research findings cannot bestressed enough.

MaryAnn Gruden

Sometimes new writers arefearful of publishing in a pro-fessional journal. Writersshould consider that they mayhave already published bywriting for a newsletter in theworkplace or the community.

Consider teaming up with an experiencedauthor for the first time. Working togetherwill help build confidence. Even if the ideais not accepted by the first publisher, tryothers until you find one who will acceptit. It is best to submit a manuscript to onlyone journal at a time.

Writing is one more thing to doResearch investigators have multiple re-sponsibilities. However, they recognize theneed to publish and work to accomplishthis priority. Set a target date for comple-tion of a draft of the manuscript. Identifythe best time of the day to write. Start themanuscript draft. It does not have to beperfect. Manuscripts are usually rewrit-ten three times before they are finalized.Find a mentor who will be willing to re-view the manuscript and provide feedbackprior to its submission.

Select the journalSelect a journal that has the target audi-ence you are trying to reach with the re-search findings. Many professional jour-nals have internet sites that include “guide-lines for authors.” Check to see that thejournal is peer-reviewed; that the manu-script is subject to a double-blind reviewprocess. In this process, the reviewers donot know who the author is, and the au-thor does not know who the reviewers are.

A query letter can be sent to the journaleditor to determine whether or not the jour-nal is interested in the research topic. Ifthe editor indicates interest, follow thejournal’s guidelines for authors to preparethe manuscript. Once the manuscript is sub-mitted, it will enter the peer review pro-cess and be accepted either without revi-sion, accepted with request for revisionsor rejected. The peer review process maytake several weeks, even with electronicsubmission. Do not be discouraged if revi-sions are suggested. It is up to the authorto decide whether or not to make the revi-sions. Moving through the process fromsubmission to acceptance and then to finalprint may take a number of months orlonger, depending on the backlog of articlesfor the journal.

Preparing the manuscriptAs the manuscript is prepared, be sureto follow the author’s guidelines for sub-mission. These will include the page set-up, the number of copies that are to besubmitted, the format for submission andother journal requirements. If electronicsubmission is acceptable, this will eliminatethe need for multiple copies and mailing.

18


Write the abstractThe abstract summarizes the essentialinformation about the research study andfindings. There may be requirementsthat the abstract be less than a certainnumber of words. Writing the abstractcauses the author to describe the re-search in a “nutshell.” Houser andBokovoy identify five elements of anabstract. They are the:• Introduction – This usually an-

swers the question as to why the re-search was done and serves to grabthe reader’s attention to read on.

• Objective – The purpose or aim ofthe research is stated in one or twosentences. If the objective of the re-search is the same as the researchquestion in the introduction, do notrepeat it.

• Methods – This part of the abstractdescribes the design of the study andthe methods used to achieve thestudy’s purpose. Include samplingstrategies, variables and statisticalmethods used. Do not overload thissection with detail.

• Results – Summarize the results, in-cluding whether or not they werestatistically significant. Limit the report-ing of statistical results to the p values.

• Conclusion – Describe the mostimportant implications of the re-search, including application issues.

Once created, the abstract may be usedfor multiple purposes. In addition to pub-lication, abstracts – which should includethe above elements – are required whensubmitting poster and podium presenta-tion inquiries. Once the abstract isdrafted, review and revise it yourself.Then have a peer review for commentsand feedback. Revise it again as neededbefore it is submitted.

Writing about the research study shouldfollow the steps of the research process.Since the researcher has already pre-pared a research proposal, portions ofthe proposal may be used, modified or con-densed for the article. Oman et al, statethat the average length of a research re-

port is 15 to 20 double-spaced pages, ex-clusive of references and tables.

Check the journal’s author’s guidelinesfor acceptable length. Tables should notduplicate the content of the manuscript;rather, they should include unique infor-mation. No more than two to five tablesshould be included. Also, identifywhether or not copyright permission willbe needed for any part of the publica-tion. If so, obtain the needed permission,and submit it with the manuscript.

Writing the manuscriptThe abstract will introduce the researchmanuscript. The remainder of a researchmanuscript will usually follow a standardformat. Nursing experts identify any-where from five to eight sections for theremainder of the manuscript. Houser andBokovoy’s sections include the introduc-tion, methods and procedures, results,discussion and references.• Introduction – Describe the research

question and why it is important toconduct the research. Include a re-view of the most relevant sources ofthe literature review. Identify a theo-retical framework and the specificpurpose of the study, the researchquestion or hypothesis.

• Methods and procedures – Take thereader through the process of thestudy. What was the sample size andwhy? Describe the data collection pro-cess. Include measures of reliabilityand validity. Procedures for treatmentsor the use of placebos should be in-cluded. Describe analysis procedures.

• Results – Only the results of the sta-tistical analysis are included in this sec-tion. Describe the type of statisticalanalysis that was performed. Tablesand figures can be included in this sec-tion if the information in them is uniqueand not stated in the content of themanuscript.

• Discussion – Interpretation of theresults is stated in this section, includ-ing clinical relevance and implicationsfor practice. Were the results expectedor unexpected as compared to other

studies? Identify the strengths and limi-tations of the study. What are the ar-eas for future research?

• References – List all references forthe manuscript. If listing a citation morethan five years old, it should be includedonly if it is considered a “classic” inthe field.

Publishing is a process that can be a greatlearning experience and opportunity.Working through the process success-fully leads to seeing your name in print.It is a symbol of a job well done by con-tributing evidence-based knowledge tothe profession. It is also a positive re-flection on both you and your employer.Last, but not least, is the satisfaction andincreased self-esteem when seeing yourname in print to know that you havemade a difference in the profession.

ReferencesHouser, J. and Bokovoy, J. (2006.) Clinical re-search in practice: A guide for the bedside scientist.Jones and Bartlett, Boston.

Lockhart, J. (2004.) Unit-Based Staff Developmentfor Clinical Nurses. Chapter 9: Helping clinicalnurses share their expertise through publishing: pp.188-212. Oncology Nursing Society, Pittsburgh.

Oman, K., Krugman, M.A., Fink, R.M. (2003.)Nursing Research Secrets: Questions and answersreveal the secrets to successful research and publi-cation. Hanley and Belfus, Philadelphia.

AOHP ResearchCommittee seeking

members!

Are you interested in becominginvolved in this committee that hasthe following focuses: safe patienthandling and bloodbornepathogens. The committee wouldlike to have a least one memberfrom each AOHP region.

Please send an email [email protected] to indicate yourinterest.

Spring 2 0 0 7

19

Are All “No-lift” Policies the Same?By George Byrns, MPH, PhD, CIH, Denise Knoblauch, RN, BSN, COHN-S/CM

and Caroline Mallory, RN, PhD

Nursing home workers suffered more than 280,000work-related injuries and illnesses in 2004.(Bureau of LaborStatistics, 2002) Because of the severity of this problem, in2002 the Occupational Safety and Health Administration(OSHA) included nursing homes in its National EmphasisProgram (NEP). NEP status means that OSHA gives thenursing home industry a higher priority in its attempts to re-duce the number of occupational injuries and illnesses.(OSHA,2002) Researchers have found that the under use of safetydevices, such as mechanical patient lifts, contributes to thehigh prevalence of low back pain (LBP) in nursingpersonnel.(Engkvist, Hjelm, Hagberg, Menckel, & Ekenvall,2000; Owen & Garg, 1999; Lynch & Freund, 2000) What isneeded is a program that promotes the usage of mechanicallifts and discourages manual lifting of nursing home residents.In our study, this approach was referred to as a “no-lift” policy.However, simply having a policy that is not comprehensiveand rigorously enforced may not be adequate. Our researchquestion was “Are all no-lift policies the same in their abilitiesto reduce the frequency of manual lifting of residents?”

The purpose of this study was to assess lifting patterns at twonursing homes. At one site, there was a conventional pro-gram where mechanical lifting equipment was only requiredfor transfers involving non-ambulatory (bed-ridden) residents.At the other site, there was an enforced, corporate-wide “no-lift” policy that applied to both non-ambulatory and partiallyambulatory residents. Our hypotheses are that health careworkers who routinely use mechanical lifts will have a lowerprevalence of work-related back pain and that workers atfacilities with a rigorously enforced “no-lift” policy will per-form fewer manual lifts and transfers of residents than facili-ties with less enforcement.

Prior research demonstrated that approximately 36 percentof registered nurses (RNs) had LBP from occupational expo-sure so severe that it interfered with movement or routineperformance of tasks.(Byrns, Reeder, Jin, & Pachis, 2004) Inthis earlier study, only about 10 percent to 11 percent of RNsreported using mechanical lifts on a daily basis. There are somedifferences between hospitals and nursing homes. Nursing homestypically employ a higher percentage of certified nursing assis-tants (CNAs) than RNs, and CNAs would be expected to domore manual lifting than RNs. Therefore, the 36 percent LBP

prevalence measured in the prior study was expected to be anunderestimate of the prevalence in nursing homes.

In the prior study, the frequency of lifting patients or heavyobjects had the strongest association with LBP (b = 0.03,S.E. = 0.01, Wald = 8.9, p-value = 0.003.) Another significantfinding was that individuals who worked more years as nursesreported more LBP (b = 0.06, S.E. = 0.03, Wald = 6.0, p-value = 0.014.) While age and years of experience are highlycorrelated, it is hypothesized that this effect is due to cumula-tive physical exposures.

In a follow-up study conducted approximately one year later,the highest incidence of new cases of LBP occurred in younger,less experienced RNs (3.9 years of nursing experience onaverage.)(Byrns, Jin, Mallory, Reeder, & Harris, 2005) It wasalso interesting to note that those individuals who becamepain free at year two had the most experience (16.6 years onaverage.) These findings are consistent with a phenomenonknown as “the healthy worker survivor effect” and with otherresearch that has demonstrated that younger, less experiencedworkers have the highest incidence of injury.(Bigos et al.,1986) The healthy worker survivor effect has not been previ-ously described among nursing home workers, but may havebeen an issue in our current research.

The above findings demonstrate some of the complexity inthe study of LBP. While the lifetime prevalence of LBP in-creases with age, it is the younger and least experiencedworker who is most at risk of becoming a new case. Thishigher incidence of LBP in the younger, less experiencedworker is also a problem because prior history of LBP is themost important predictor of future LBP.(Feyer et al., 2000;van Poppel, Koes, Deville, Smid, & Bouter, 1998; Bigos et al.,1992) The initial onset of LBP must be prevented, as it is adebilitative cycle once started.

Our prior research also shed light on the relationship betweenfrequency of exercise and LBP. In the initial survey, morefrequent exercise appeared to prevent LBP.(Byrns et al., 2004)Using a longitudinal design, we were able to show that thosein pain are less likely to exercise than those who are painfree.(Byrns et al., 2005) In contrast to the conclusions thatemerged from the first cross-sectional study, these findings

20


do not support a protective relationship between frequent ex-ercise and prevention of LBP. This conclusion is consistentwith research conducted by de Looze, et al., who found thathaving greater muscle strength was not protective againstdeveloping LBP.(de Looze, Zinzen, Caboor, Van Roy, & Clarijs,1998) This is not surprising given that manual patient liftingexceeds safe manual lifting criteria established by the Na-tional Institute for Occupational Safety andHealth.(Steinbrecher, 1994) These results lend credence tothe importance of using mechanical devices to move patientsor nursing home residents.

A final complication in the study of low back pain is that thereis evidence that worker psychological stress contributes tomusculoskeletal pain.(Bigos et al., 1991; Bongers, de Winter,Kompier, & Hildebrandt, 1993; Hoogendoorn et al., 2001;Houtman, Bongers, Smulders, & Kompier, 1994) Psychologi-cal stress may affect LBP due to increased muscle tension,guarded movements, or disuse syndrome.(Waddell & Main,1998) Researchers have found that jobs high in physical andpsychological demand, low in the control of job performance,and low in the availability of social support tend to be morestressful than jobs with the opposite characteristics.(Karaseket al., 1998) Karasek’s Job Content Questionnaire is a usefulway of measuring each of these potential jobstressors.(Karasek, 1985)

MethodsDesign and Target PopulationIn the summer of 2005, a cross-sectional study was conductedwith 108 health care personnel (19 RNs, 19 Licensed Practi-cal Nurses and 70 CNAs) currently employed by two nursinghomes in central Illinois. Information was entered into adatabase using the software SPSS 13.0, and all data entrywas double-checked for accuracy. The response rate forthe survey was 81.1 percent (108 of 132 participants re-sponded.) We originally expected a much higher numberof potential participants; however, 17 worked only inter-mittently, 17 left employment before the start of the sur-vey and 3 were on disability.

Instrument Description and MeasurementsThe questionnaire was similar to the one used in our initialsurvey of nurses.(Byrns et al., 2004) Prior results suggestthat the questionnaire is valid and reliable for the study ofLBP in nurses. Minor revisions were made to the question-naire with the assistance of the nursing personnel at one ofthe two study sites to make the questionnaire applicable tonursing homes. Self-administered questionnaires were distrib-uted by hand and collected by the research team or returnedusing pre-paid postage.

Information was gathered on work history, job tasks, descrip-tion of work, basic health history, leisure time activities, cur-

rent health, potential causes of back painand basic personal information. Employ-ees were asked to estimate the numberof times they performed certain lifts eachday, either manually or using a mechani-cal device. Site #1, with the limited “no-lift” policy, had three full-body lifts fortotally dependent residents and three sit-to-stand lifts for partially dependent resi-dents. Site #2, with the more rigorouslyenforced “no-lift” policy, had three full-body lifts and four sit-to-stand units. Atboth sites, a senior nurse had the respon-sibility to train and coach other person-nel in the use of the mechanical lifts.

In our study, the primary outcome of in-terest was any self-reported pain, ach-ing, stiffness or cramping in the lowerback within the last 12 months that lim-ited movement or interfered with workat home or on the job and that was notdue to a sports injury or other non-occu-pational cause. This is the same defini-TABLE I: Demographic characteristics of study participants*

Spring 2 0 0 7

21tion used in the prior nursing study andin research on LBP in garment work-ers. See Byrns et al., for a complete de-scription of the surveyinstrument.(Byrns, Agnew, & Curbow,2002)

Data AnalysisKarasek’s job strain model was used toassess the effects of psychological stresson LBP.(Karasek et al., 1998) The sur-vey results for these and other measureswere dichotomized into high vs. low fora number of important variables. Bivari-ate analyses using chi-square and oddsratio were used to determine associations between the de-pendent variable and independent variables. Further analysesdetermined if associations existed between any two of theindependent variables. If two independent variables were bothassociated with LBP, a stratified analysis was used to verifythat none were confounding factors.

ResultsThe 108 health care providers in this study represented allshifts. Table I shows the demographic characteristics of studyparticipants. They had a median age of 40 years old, and 97percent were female. The median total number of yearsworked in health care was 13, and they had been working intheir facility an average of 4.8 years (data not shown.) Themajority (55.8 percent) had a high school education, and 41.3percent had a college degree. They had a mean body massindex (BMI) of 26.6, and according to the new BMI criteria,40.2 percent (37 of 92) were normal, 38.0 percent (35 of 92)were overweight, and 21.7 percent (20 of 92) were obese.

Table II shows the total prevalence of LBP and the preva-lence by location. There were 34 of 73 (46.6 percent) partici-

pants who met the case definition of severe LBP. The preva-lence of LBP was 50 percent (22 of 44) at site #1 and 41.4percent (12 of 29) at site #2. Those individuals who reportedhaving a prior sports or other non-occupational injury wereexcluded from the analysis.

Table III provides information on the risk of LBP due tomanually lifting a fallen resident and the risk for those whodid not use a mechanical lifting device when moving par-tially dependent residents. The odds of having LBP if youmanually lifted a fallen resident were 3.5 (p = 0.016,) andthe odds of LBP if you failed to use the mechanical liftswas 2.8 (p = 0.041.) Both results were significant. Whilethere was a higher prevalence of LBP at site #1 than site#2, the results were not significant.

Comparison of manual lifting patterns at site #1 vs. site #2Table IV explores differences in lifting patterns betweenthe two study sites. The average number of manual lifts ortransfers performed by an individual was 4.3 per day. Atsite #1, the average was 6.2 per day, and the average atsite #2 was 2.2 per day. The average use of mechanical

lifting devices by an individual was 1.1per day. At site #1, the equipment wasused on average 0.9 times each day,and at site #2, 1.7 times each day.

The odds of manually lifting a residentwere 2.9 times greater at site #1 com-pared to site #2 (p = 0.017.) In addi-tion, the odds were 10.3 times greaterthat a fallen ambulatory resident (onewith some muscle function) would bemanually lifted at site #1 (p < 0.001.)The other comparisons were manuallylifting a fallen non-ambulatory resident,

TABLE II: LBP prevalence

TABLE III: LBP from lifting residents

TABLE IV: Lifting patterns

22


and manually transferring a resident from the bed to astretcher or to the toilet. If you were a health care workerat site #1, the odds were 4.7 that you would manually lift afallen non-ambulatory resident (p = 0.001.) The odds were2.9 and 2.4, respectively, that you would manually transferresidents to a stretcher or to the toilet (p = 0.018 and p =0.035.) All results were significant.

Psychological stress measuresTable V provides the results of psychological stress mea-sures using Karasek’s Job Strain Model. Participants ratedtheir workplaces high in both psychological and physicaldemand, but they also rated their ability to control their jobtasks as high. Participants also rated both co-worker andsupervisor social support high. Table VI displays differ-ences between site #1 and site #2 in two of the job strainmeasures; physical demand and supervisor social support.Participants at site #1 perceived that their job demandswere significantly higher than at site #2 (OR = 3.2, p =0.004.) However, they also perceived that their supervisorsupport was higher (OR = 2.7, p = 0.018.) Perceived de-mand was highly correlated with self reports of manuallifting and repositioning of residents (Pearson correlation= 0.330, p = 0.001 and Pearson correlation = 0.416, p <0.001) respectively.)

DiscussionIn this study, we explored the relation between lifting poli-cies and LBP in nursing home health care workers. Site#2 had a corporate-wide, rigorously enforced no-lift policythat included the provision of additional lifting equipmentwhen the program was implemented. Site #1 had a no-liftpolicy, but it was limited to only non-ambulatory residents.While the prevalence of LBP was higher at site #1, due to

small sample size, this difference between sites #1 and #2was not significant.

In a prior study, we found that more frequent manual lift-ing was strongly associated with increased LBP.(Byrns etal., 2004) However, in that study, too few nurses usedmechanical devices to assess their effectiveness. Our cur-rent results found that those who routinely used mechani-cal lifting devices reported significantly less LBP, espe-cially when performing the most dangerous type of lift, afallen resident. Our results also demonstrated that healthcare workers at site #1 were significantly more likely tomanually lift fallen residents or transfer residents from thebed to a chair or a stretcher than those at site #2. Workersat site #2 also used mechanical equipment more frequentlythan site #1, but the difference was not significant. It isimportant to note that even at site #2, the ban on manuallylifting was not totally effective.

The Karasek Psychological Strain model predicts that in-dividuals who report high physical and psychological de-mand, low job control, and low social support are at riskfor stress-related diseases, including low backpain.(Karasek & Theorell, 1990; Symonds, Burton, Tillotson,& Main, 1996) Psychological strain did not appear to be animportant risk factor of LBP in our study because, whileparticipants reported high levels of demand, they also re-ported high levels of control and social support. Personnelat site #1 reported significantly higher levels of perceivedphysical demand and supervisor social support than site#2. The reports of higher perceived demand at site #1 areconsistent with higher levels of self-reported manual lift-ing since these were highly correlated. The reasons forthe lower level of supervisor social support at site #2 are

unknown, but one explanation might beemployee irritation due to the more rig-orous enforcement of no-lifting poli-cies.

Since this was a pilot study, the samplesize was small, and this limited the pos-sibility of exploring all risk factors.Also, the cross-sectional design usedin this study limits the ability to deter-mine if risk factors such as manual lift-ing preceded the onset of LBP. A lon-gitudinal design will be necessary toclarify this finding. Recall bias may bea problem when past information is col-lected using a questionnaire. However,

TABLE V: Psychological stress measures

TABLE VI: Comparison of psychological stress measures at site #1 verse site #2

Spring 2 0 0 7

23we believe that the use of functional limitations instead ofduration of symptoms in the LBP case definition reducedthe impact of recall bias.

ConclusionThis study provided support for both of our hypotheses.We found that workers who reported more frequent manuallifts and transfers reported significantly more LBP. Fur-thermore, there was evidence that a rigorously enforced,comprehensive “no-lift” policy was associated with a lowerfrequency of manual lifts and transfers of residents. Nurs-ing home facilities may find that strict enforcement of com-prehensive “no-lift” policies will reduce the prevalence ofLBP. In addition, facilities should also provide an adequatesupply of lift equipment. Reducing the risk for disablingLBP among nursing personnel could result in substan-tial cost savings and higher quality work settings, andLBP is one of the most costly occupational problems inthe United States.

ReferencesBigos, S. J., Battie, M. C., Spengler, D. M., Fisher, L. D., Fordyce, W.E., Hansson, T. et al. (1992.) A longitudinal, prospective study ofindustrial back injury reporting. Clinical Orthopedics, 21-34.Bigos, S. J., Battie, M. C., Spengler, D. M., Fisher, L. D., Fordyce, W.E., Hansson, T. H. et al. (1991.) A prospective study of work percep-tions and psychosocial factors affecting the report of back injury [pub-lished erratum appears in Spine 1991 Jun;16(6):688.] Spine, 16, 1-6.Bigos, S. J., Spengler, D. M., Martin, N. A., Zeh, J., Fisher, L., &Nachemson, A. (1986.) Back injuries in industry: a retrospective study.III. Employee-related factors. Spine, 11, 252-256.Bongers, P. M., de Winter, C. R., Kompier, M. A., & Hildebrandt, V. H.(1993.) Psychosocial factors at work and musculoskeletal disease. Scandi-navian Journal of Work and Environmental Health, 19, 297-312.Bureau of Labor Statistics (2002.) Injury Data 2002 (Rep. No. http://www.bls.gov/iif/oshsum.htm).Byrns, G. E., Agnew, J., & Curbow, B. (2002.) Attributions, stress,and work-related low back pain. Applied Occupational and Environ-mental Hygiene, 17, 752-764.Byrns, G. E., Jin, G., Mallory, C. M., Reeder, G. D., & Harris, J. E.Longitudinal Research in Low Back Pain among RNs: Advantages andPotential Pitfalls. Professional Safety, (in press.)Byrns, G. E., Reeder, G. D., Jin, G., & Pachis, K. A. (2004.) RiskFactors for Work-Related Low Back Pain in Registered Nurses andPotential Obstacles in Using Protective Equipment. Journal of Occu-pational and Environmental Hygiene, 01, 11-21.de Looze, M. P., Zinzen, E., Caboor, D., Van Roy, P., & Clarijs, J. P.(1998.) Muscle strength, task performance and low back load in nurses.Ergonomics, 41, 1095-1104.Engkvist, I. L., Hjelm, E. W., Hagberg, M., Menckel, E., & Ekenvall, L.(2000.) Risk indicators for reported over-exertion back injuries amongfemale nursing personnel. Epidemiology, 11, 519-522.Feyer, A. M., Herbison, P., Williamson, A. M., de, S., I, Mandryk, J.,Hendrie, L. et al. (2000.) The role of physical and psychological fac-tors in occupational low back pain: a prospective cohort study. Occu-pational and Environmental Medicine, 57, 116-120.

Hoogendoorn, W. E., Bongers, P. M., de Vet, H. C., Houtman, I. L.,Ariens, G. A., van Mechelen, W. et al. (2001.) Psychosocial workcharacteristics and psychological strain in relation to low-back pain.Scand.J.Work Environ.Health, 27, 258-267.Houtman, I. L., Bongers, P. M., Smulders, P. G., & Kompier, M. A.(1994.) Psychosocial stressors at work and musculoskeletal problems. Scan-dinavian Journal of Work and Environmental Health, 20, 139-145.Karasek, R. (1985.) Job content questionnaire Los Angeles: Depart-ment of Industrial and Systems Engineering, University of SouthernCalifornia.Karasek, R., Kawakami, N., Brisson, C., Houtman, I. L., Bongers, P.M., & Amick, B. (1998.) The Job Content Questionnaire (JCQ): Aninstrument for internationally comparative asessments of psychoso-cial job characteristics. Journal of Occupational Health Psychology, 3,322-355.Karasek, R. & Theorell, T. (1990.) The environment, the worker, andillness: Psychological and physiological linkages. In Healthy Work:Stress, Productivity, and the Reconstruction of Working Life (pp. 83-116.) New York: Basic Books, Inc.Lynch, R. M. & Freund, A. (2000.) Short-term efficacy of back injuryintervention project for patient care providers at one hospital. AIHAJ.,61, 290-294.OSHA (2002.) National Emphasis Program for Nursing and PersonalCare Facilities (Rep. No. http://www.bls.gov/iif/oshsum.htm.)Owen, B. & Garg, A. (1999.) Back injury prevention in health carePart 2: An ergonomic approach to reducing back stress in nursingpersonnel. In W.Charney (Ed.,) Handbook of Modern Hospital Safety(pp. 717-755.) Boca Raton: Lewis Publishers.Steinbrecher, S. M. (1994.) The revised NIOSH lifting guidelines. Ap-plication in a hospital setting. AAOHN.J., 42, 62-66.Symonds, T. L., Burton, A. K., Tillotson, K. M., & Main, C. J. (1996.)Do attitudes and beliefs influence work loss due to low back trouble?Occupational Medicine (Oxford,) 46, 25-32.van Poppel, M. N., Koes, B. W., Deville, W., Smid, T., & Bouter, L.M. (1998.) Risk factors for back pain incidence in industry: a prospec-tive study. Pain, 77, 81-86.Waddell, G. & Main, C. J. (1998.) A new clinical model of low backpain and disability. In G.Waddell (Ed.,) The Back Pain Revolution (pp.223-240.) Edinburgh: Churchhill Livingstone.

This research was supported with grants from the Illinois State Uni-versity and the Association of Occupational Health Professionals inHealthcare (AOHP).

George Byrns, MPH, PhD, CIH is an Associate Profes-sor in the Department of Health Science at Illinois StateUniversity. Denise Knoblauch, RN, BSN, COHN-S/CMis a Case Manager for Saint Francis Medical Centerin Peoria, Illinois and the current Executive Presidentof the AOHP. Caroline Mallory, RN, PhD, is an Associ-ate Professor in the Mennonite School of Nursing atIllinois State University.

24


AOHP’s Getting Started on Jan Frustaglia had aconcern. Why offer theGetting Started programonly one time a year, andonly at the national AOHPconference site? Jan knewmany more employee healthprofessionals needed thevaluable information andguidance Getting Startedoffered, but needed betteraccess at different times.

Her concern turned into a wonderful idea. Why not reachout to employee health professionals in various parts ofthe country throughout the year and take Getting Startedon the road? Jan teamed up with other experienced em-ployee health professionals and they have presented to 58

Attendees at GS on the Road – St. Louis, March 9, 2007.

What is a perfect match toyour job description, offers CEUs andis close enough to home to entice youto attend? That offering is GettingStarted On-the-Road 2007! When Ireceived an e-mail recently form DebRivera, RN addressing Kansas CityArea Employee Health Nurses, I wasimpressed. She enthusiastically en-dorsed this workshop. It had been pre-sented in multiple locations across thecountry and had received overwhelm-ingly positive feedback from attendees. I had been in my position for less thana year, working PRN and knew this“wealth of information” would be verymeaningful to me. I was impressed that

AOHP Workshop—Getting Started On-the-Road 2007By Kathryn Wald, RN, BSN

it was presented by AOHP because Ihad been seeking an organization likethis to use as my guide in this new job.My supervisor was equally enthusias-tic and we agreed to split the cost ofthe workshop. The information Iplanned to share with my co-workersand supervisor was the AOHP GettingStarted Manual on CD. I also plannedto make a hard copy to keep in theEmployee Health office as a conve-nient resource. On the day of the workshop in St.Louis, I was excited to see a smallgroup of eight Employee HealthNurses with varied backgrounds. Someattendees had never worked a day in

attendees in 4 different lo-cations so far this year.

When AOHP requested at-tendees write about their ex-periences at Getting Started,we were thrilled that two“stepped up to the plate” andwrote the following thought-ful insights on their experi-ences “on the road.”

Many thanks to Katie Waldwho writes about her experience at the St. Louis presen-tation, and Mary Sullivan who shares her experiences inArizona. Special thanks and congratulations to Jan and theother presenters for making Getting Started on the Road araving success!!!

employee health, while one was anexperienced AOHP board member.Their positions were based at hospi-tals as well as at community free-standing facilities.

I discovered there are updates to thisworkshop approximately every twoyears which enables the nurse to keepcurrent with new information. The in-structors represented three differentstates who spoke in tag team fashionin a very organized manner outliningthe manual and answering questions.I was very impressed that JanFrustaglia had the insight and heart to

(Continued on page 26)

Spring 2 0 0 7

25

n the Road is a GREAT Success!

Are you interested in hosting or participatingin Getting Started on the Road in your area? Ifso, contact AOHP Headquarters (800 362-4347

or [email protected]) to get further details.

An Invaluable Resource …AOHP’s “Getting Started Class”By Mary Johnson, RN COHN-S/CM

I would like to share with fellow AOHPmembers what I found extremely helpfulabout attending “Getting Started on theRoad.” Having worked as both InfectionControl Director and Employee HealthNurse for a year and half, I found myselfin the position of establishing a separateEmployee Health Department that couldevolve into an Occupational Health De-partment. Additionally, for the three and ahalf years I had been in this position, I triedto develop Employee Health policies andprocedures that were consistent with Evi-denced Based Practice developed from anEmployee Health and Occupational Healthperspective.

Web research did not provide me with theinformation I needed. I even tried to lo-cate books or sources to purchase policiesand procedures for an Employee Health/Occupational Health program. I visited sev-eral different healthcare organizations totry to find the answers and information Ineeded. Some policies were discoveredbut the leaders in my organization wantedmore in-depth policies and procedures thatmet our diverse needs. It was very frus-trating trying to find what I needed to de-velop our Employee Health Program.

I am an ABOHN-certified OccupationalHealth Specialist and Case Manager. I

have worked in Occupational Healthsince 1989 in Industry. There were somesimilarities to healthcare which helped,but the majority of the policies and pro-cedures were totally different andneeded different resources.

Through my resources and colleagues,I finally found the AHOP organizationand learned about Getting Started on theRoad. I was so excited when the flyerarrived about the Getting Started Program.Finally there were resources to help an-swer all of the questions I had about start-ing an evidenced-based Employee Health/Occupational Health program.

Jan Frustaglia was wonderful and pa-tiently answered all of my questionsabout AOHP, how long it has been inexistence, what resources it offers, whatthe benefits are and – most important tome - what’s involved in starting an Em-ployee Health or Occupational Healthprogram in healthcare.

I attended Getting Started on the Roadon January 26, 2007 in Phoenix, AZ, hop-ing to get answers and support aboutEmployee Health and OccupationalHealth programs.

The class took us through what an Oc-cupational Health program inhealthcare involves and how to de-velop the program. We were providedmany position papers includingAOHP’s confidentiality and medicalrecords. I found this an excellent toolto get “buy in” in adopting policies andprocedures. “Getting Started” andAOHP also established credibility withmy employer that there was an orga-nization with the needed evidence-based practice information.

The eight-hour plus class detailedprogram development with an exten-sive table of contents. Power point lec-tures and question-and-answer sessionslaid out pertinent program information stepby step. At the conclusion of each session,our questions were answered with a lot ofinformation given from other healthcareorganizations based on their experience.

The class included a CD with sample poli-cies and procedures. Topics also includedwriting your job descriptions and evalua-tions emphasizing the most important com-ponents. Sample questionnaires and physi-cal assessments that address a post joboffer screening were distributed and dis-

(Continued on page 26)

26


reach out to non-members of AOHPand develop this offering “On-the-Road.” It had previously only been of-fered at the annual conference. The content of the presentations in-volved twelve different areas includ-ing History, Roles, Networking andResources. Some topics were famil-iar to me while others were new andenlightening. Being PRN, it is great tohave the manual at my fingertips as aresource. I was especially interestedto learn more about FMLA and Work-ers’ Compensation. I found the Healthand Safety section very interesting andpertinent. During each presentationthe speaker shared real life examplesgathered from their roles at differentinstitutions. These shared examplesprovided us a sense of unity as wellas perspective from different enti-ties and situations. I would highly recommend this work-shop to anyone new to the role ofEmployee Health Nursing. I plan to joinAOHP now that I have experiencedthis workshop because I realize theorganization offers more than just edu-cational opportunities. I know AOHPis a strong advocate for the EmployeeHealth Nurse through its affiliationwith OSHA, NIOSH, and the JointCommission’s Nursing Advisory Coun-cil. The Journal, electronic newslet-ter, listserv and the national conferenceprovide professional support in my roleas Manager, Clinician, Case Manager,Educator, and Consultant.

Kathryn Wald, RN BSN, is currentlyan Employee Health Nurse at SaintLuke’s South Hospital in OverlandPark, Kansas.

cussed. I learned that these are essentialin determining the employees’ ability to per-form essential functions of their job. Theinformation I received in this program wasinvaluable and made it much easier to goback to my work site and develop policiesand procedures and ultimately my goal ofan excellent employee health program.

When I arrived back at work I immedi-ately shared this information with man-agement. I now had the tools and knowl-edge to finally develop the program weneeded. Our end result would be astrong, evidence-based program. I wasthen able to use the information aboutthe confidentiality and all of the positionpapers to take a stand on how these poli-cies needed to be implemented.

Additionally, I utilized the information andposition paper on patient lifting to startworking on training and to look at whatequipment is needed to develop a lift pro-gram for the unique needs of our organi-

AOHP Workshop—GettingStarted On-the-Road 2007

(Continued from page 24) (Continued from page 25)

An Invaluable Resource …AOHP’s “Getting Started Class”

zation. Some of those needs included thelifting of 300-500 pound patients, many ofwhom are in wheelchairs. At this time Ihave been able to design and use indica-tors to drive the lifting program and to lookat a stretching program based on our work-ers’ compensation information. There aremany more programs that need to be de-veloped and evaluated by looking at theavailable indicators and data.

A big thank you goes to AHOP for theclass, the wonderful resources, materials,and experienced employee contacts avail-able to answer questions! Thanks so muchfor the data and research to support ourquestions and program needs.

I am currently the Director of EmployeeHealth at Gila River Health Care Cor-poration. While I am in the process ofchanging jobs, I know we have madehuge strides in developing our programand I am happy to be able to leave ma-terial that will train my replacement.Thank you again!!!

AOHP is already planning the 2007 National

Conference which will be held September

26-29, in Savannah, GA. If you know a

vendor who would be interested in

“Experiencing AOHP Hospitality In Savannah”

contact AOHP Headquarters at 800 362-4347

or [email protected]. You can also find details

about this conference at the AOHP website,

www.aohp.org.

Spring 2 0 0 7

27

Stress ManagementRestructuring policies and workloads, along with providing training and

support services, can help reduce employee stress.By Kathryn Tyler

Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or [email protected] to purchase a copy of

this Journal issue.

Spring 2 0 0 7

31

Overview of Hepatitis C and SkinBy Connie M. Chung; Julia R. Nunley


this Journal issue.

36


Leading a Multigenerational Nursing Workforce:Issues, Challenges and Strategies

By Rose O. Sherman, EdD, RN, CNAA


this Journal issue.

Spring 2 0 0 7

41

Movers and Shakers Unite toInitiate a Minimal Lift Program

By Phillipa “Pip” Atkinson Maas, RN, MSc

I arrived as a Travel Nurse from London four and halfyears ago and braced myself for the cultural changes I wouldencounter. The technology that greeted me in my work envi-ronment was mind-blowing – computerized med carts, scan-ners to identify patients, touch screen dispensing of medicines,all decades ahead of what I had been used to. The culturalchange that had the most impact on me, however, had nothingto do with “high tech” – it was not being able to find a Maxislideto help me reposition my patient in bed. No one I asked evenknew what a Maxislide was! The nearest equivalent was pullinga patient around the bed using a geri-pad.

Government legislation in Britain makes it mandatory for hos-pitals to provide caregivers with suitable equipment to lift andreposition patients. No Lift policies exist in every hospital, andstaff is expected to comply by attending training and by con-sistently using the equipment. Nursing in Britain, therefore,conditions nurses to expect to have equipment provided tothem to help move and handle patients. I was surprised thatmy new colleagues did not have the same expectation.

I learned that Mary Washington Hospital (MWH) inFredericksburg, Virginia, was not the only hospital in the UnitedStates without lift equipment or a policy to support its use. I fearedfor my personal safety against physical injury, so on one of mytrips home to England, I made a couple of phone calls to find outthe name of the company who supplied the London teachinghospitals with equipment. Coincidentally, the company’s localrepresentative lived around the corner from where I was stayingwith my parents. So, 15 minutes after our introductory telephonecall, the rep and I were sharing a cup of tea in my parents’ livingroom, enthusing about the joys of the Maxislide, with me proudlyholding onto my complimentary Maxislide kit!

Back in the U.S., I proceeded to do a pilot study on the unitwhere I was working using my solitary Maxislide kit. The aimof the study was to gauge reaction to the slide sheets fromboth staff and patients. Around that time, my Travel Nurse

**Editor’s Note: Rosemary Burke, RN, MS, Director of Health & Wellness at Mary Washington Hospital, MediCorpHealth System, in Fredericksburg, Virginia, forwarded the following article. Rosemary’s facility had been reallytrying and struggling to improve the use of devices to move and lift patients. She found a “fire-starter” in Ms. Maas,who has wonderfully triggered a slow-starting minimal lift program.

status changed, and I was relocated to a new unit. I continuedpromoting the Maxislides, but I had become a PRN nurse andopted to take on an additional role as a consultant for a com-pany that assisted hospitals to establish Minimal Lift Programs,as well as train staff in the use of patient handling equipment.Over a three-year period, I traveled America with this com-pany, specializing in training caregivers. All the while, I heldon to my vision that I might one day see Maxislides and me-chanical lifts on the units of MWH.

In 2004, I proceeded to carry out a small survey on my unit toinvestigate existing patient moving and handling practices, butthis time, without promoting the Maxislides. I wanted to get aclearer perspective of how staff had coped with handling pa-tients’ mobility. I was saddened to read in many of the responseshow experienced CNAs and nurses had improvised over theyears, using blankets and sheets to lift patients from the floorwho had fallen. Many commented about injuries they had sus-tained and how they struggled to ensure the patient was safe atthe cost of their own wellbeing. Respondents appeared to be-lieve that “good body mechanics” would protect them, but thiswas plainly impossible for those involved with lifting anyone morethan 100 pounds on a daily basis. How did caregivers ever cometo believe that 100 pounds is light? Some described the “deadlift,” which involved recruiting as many staff as possible to grabhold of every limb of a patient in their efforts to lift him or her. Myheart sank, and my resolve to see change was heightened.

In early 2005, I wrote to the chief executive officer at MWH,protesting at the injustice of nurses having to lift a dead weightusing physical strength alone. I received a quick response.The CEO was ready to address the matter, and within twoweeks he had initiated support to help address the problem.This led to the formation of the Lift Team and the creation ofa Minimal Lift policy.

A term I picked up when I first moved to America was how aperson can be a “mover and shaker.” While I could see that,

42


in the process of becoming socialized to the American way oflife, I had become a mover and shaker, I also recognized thatI had become part of a culture of movers and shakers atMWH. I encountered this at every level in this journey ofchange. The nucleus of the Lift Team is comprised of moversand shakers who are directors of varying Nursing Depart-ments, including MHS Health & Wellness. Other importantmovers and shakers have been managers responsible forMaterials Management, Environmental Services, Engineer-ing, Biomed and the Nursing Units throughout the hospital.Together, these individuals have teamed together to lay thefoundation for a viable Minimal Lift Program at MWH.

The opportunity for other movers and shakers at MWH tomake themselves known is now possible, as we are in theprocess of creating a Mobility Resource Team. “Safety First”is our motto! In this instance, the priority is to promote safetyfirst for the caregiver and then for the patient. We want toreplace the dead lift and the use of blankets and geri-padswith mechanical lifts and Maxislides, as they are designed tohandle weights that our backs and limbs cannot!

Participation in this project requires ingenuity and some cour-age, because “moving” and “shaking” old practices that havebeen established forever will not necessarily come easily! Theinvitation to rise to the challenge, however, is open to every-one. This is because every caregiver has experience withmoving and handling patients. Sharing skills and experienceswill open up innovative ways of integrating the lifts and

Maxislides so they become a part of every-day practice, muchthe same as using disposable gloves and hand washing.

Changes in patient moving and handling practices have beenslow to occur in America. But, by all accounts, the “safetyfirst” mentality is gathering momentum. The Lift Team andthe new Mobility Resource Team hope that you will capturethe same vision that we have and actively participate in thechange process. You may even feel inspired to initiate yourown pilot study using a Maxislide kit!

Pip Atkinson Maas, RN, MSc, is a staff RN and MobilityResource Team Coordinator with Mary Washington Hospi-tal in Fredericksburg, Virginia. Ms. Mass recognizes the es-sential support and valuable work of fellow MWH associ-ates, including:- Mr. Fred Rankin, Chief Executive Officer, MediCorp

Health System- Lisa Lucas, RN, BSN, Director, Cardiac Services- Rosemary Burke, RN, MSN, Director of Associate

Wellness- April Wills, RN, MWH, Health & Wellness- Linda Koch, RN, BSN, Director, Medical Care Services- Sidney Stone, Med-Surg Supply Chain Manager- Drema Hopson, Operations Supervisor, Environmental

Services- Ken Patton, Director, Engineering- Steve Lee & Charles Hicks, Biomed Technicians

AOHP ROC Campaign ContinuesIt’s not too late! Our “Recruit Our Colleagues—ROC”campaign is still going strong and will do so through June2007 . . . providing you with the opportunity to be eligible towin some great prizes!

One Grand Prize – 2007 Conference Registration plus 4nights hotel accommodations will be awarded to the one mem-ber who recruits the highest number of new members >/=15members through June 30, 2007. If no member recruits 15new members, the member who recruits the greatest numberunder 15 will receive a 2007 conference registration!

One 2nd Place Prize – The member who recruits the secondhighest number of new members will be awarded a FREEone-year membership to AOHP.

AND . . . The Chapter that recruits the most memberswill be awarded $500 to be used at their discretion to sup-port their members!

In the event of a tie, a drawing will be held to select theprize winners.

To date, we have 210 new members of which 56 were re-cruited through our ROC campaign. Please join in and re-cruit your colleagues so that they can also enjoy the manygreat benefits of membership in AOHP…..and you could bea winner too! You can download a membership applicationfrom the AOHP website (www.aohp.org) and start recruit-ing! Contact AOHP Headquarters at 800 362-4347 [email protected] with any questions you may have.

AOHP…Dedicated to the health and safety of healthcare workers!

Spring 2 0 0 7

43

2007 Call

for Nominations

• Executive President

• Executive Secretary

• Regional Directors for Regions 2 and 4

Would you like a great opportunity to use your experience and commitmentto AOHP in a leadership role? Now is an excellent time to accept thechallenge and take advantage of this opportunity for professional growthand networking !

AOHP is seeking leaders to fill these Executive Board of Directors’ positions for a two-year term (October2007- October 2009).

Executive PresidentPosition Summary: Provides leadership to the Executive Board of Directors and the general membership-at-large by collaborative development, promotion, coordination, planning, and evaluation of theassociation’s philosophy, bylaws, and short and long term goals and objectives.

Executive SecretaryPosition Summary: Maintains current historical written records of the association, chairs the MembershipCommittee, and coordinates continuing education records. This individual must have been a member ofthe association for at least four years, be employed in the field of occupational health in healthcare, have aninterest and/or experience in continuing education, have access to clerical and/or computer support, andbe an employee health role model for the association.

Regional DirectorPosition Summary: Provides leadership through effective communication to the designated chapters andchapter presidents by supporting the development, planning, coordination, and evaluation of regionalactivities; promotes the association’s philosophy, objectives and goals; and serves on the Executive Boardof Directors.

Additional information may be obtained from your chapter president or the business office. If you are aqualified candidate, wish to nominate a qualified member, or would like to explore beingnominated please contact:

Kim Stanchfield, Nominations Chair Lydia Crutchfield Christine Pionk540-433-4180 704-444-3175 [email protected] [email protected] [email protected]

Nominations will be accepted until Friday, June 15, 2007.

All nominees shall be verified by telephone. Nominees who agree to run for office:· Will be provided with a complete job description· Shall submit a brief (2 paragraph ) philosophy and platform statement, and· Shall submit a curriculum vitae to the nomination chairperson by June 15, 2007.

Elections shall be held in August 2007. Elected officers shall be installed at the annual membership meeting heldduring the national conference in October.

PRSRT STDU.S. Postage

PAIDWarrendale, PAPermit No. 20

Dedicated to the health and safety of healthcare workers

109 VIP Drive, Suite 220Wexford, PA 15090

Address Service Requested

AOHP 2007 Annual Conference • Savannah, GA September 26-29, 2007

The AOHP 2007 Annual Conference in Savannah, GA from September 26 -29, 2007 promises to be very exciting. OurConference Committee has nearly finalized the agenda. This year we are featuring “Learning Tracts” to help participants tobetter identify topics and their content. “Learning Tracts” include general learning areas of the Aging Worker, Business Side ofOH, Clinical, Construction, Emotional Health, Ergonomics, Injury Prevention, Legislative, Program Development/Management,Wellness, and Workers’ Compensation. Some of the sessions you can expect to be offered are:

• 2007 Spirometry Update • Developing and Implementing a Respiratory Protection Program • Emotional Intelligence: TheNext Competency • Accident and Cost Reduction Through Safe Patient Handling • Can Management Really Control

Musculoskeletal Costs in Workers’ Compensation • Business of Health and Safety: Metrics that Work • Auricular Acupuncture: ANew Needle in Employee Health Services • Understanding the Maze of Non-Rational Thinking • Getting to Zero: An Open

Forum On Reducing Needlesticks and Sharps Exposures • Workers’ Compensation: Challenges and Opportunities inOrthopedics • Construction and Hard Hats • MRSA & VISA/VRSA • Research: HBV & HCV Transmission and Prevention

Promoting Safe Needle Devices • Target HCV - HBV • How Many Ill? Estimating the Impact of the Next Influenza Pandemic onthe Workforce • Stress & Depression in the Workplace

Not only does the AOHP 2007 Annual conference promise great learning opportunities, we also are planning to offer a variety ofoutstanding leisure experiences for attendees, including a “High Tea” Party, River Cruise, Ghost Walk, and a post conferenceMini-Vacation/Retreat option for those who want to relax before returning home and putting their noses back to “the oldgrindstone.” It promises to be a wonderful time in a very quaint and charming city which is abundant in “Southern Hospitality!” SO PLAN NOW!!!! Come and join us as so that you can see firsthand that AOHP’s hospitality and charm is as notable as that ofthe city we will be visiting.

–Dee Tyler, RN, COHN-S AOHP 2007 Conference Chair

07 aohp spring -web · 2020-01-24 · 2 a o h p j o u r n a l aohp journal executive editor...

Documents