Contemporary Occupational Health Nursing

A Guide for Practitioners

Greta Thornbory, Susanna Everton, Greta Thornbory, Susanna Everton

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351787918
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

This textbook – now thoroughly revised and updated – provides a practical guide for those in training, or practising within, occupational health nursing. Concerned with the health of people at work and the effects of work on health and health on work, this distinctive branch of public health nursing requires specific knowledge and skills.

Contemporary Occupational Health Nursing includes chapters on: public health, leadership, health promotion and protection, health surveillance, health assessment, case management and rehabilitation, mental health, management of occupational health services and epidemiology and research, quality assurance and audit. The second edition includes additional content on health risk assessment and the Fit for Work Service, occupational health management systems, psychosocial factors and mindfulness, among other things.

Discussion of ethical issues is woven throughout and each chapter is written by an experienced occupational health nurse practitioner and includes features such as case studies, activities, learning objectives and chapter summaries. This book can be used as a text by those undertaking specialist community public health nursing qualifications and as an important resource for all nurses working in occupational health practice.

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1	An introduction to occupational health nursing Greta Thornbory and Susanna Everton

Learning objectives

After reading this chapter you will be able to:

• discuss the historical aspects of occupational health (OH) nursing

• appreciate the international and national influences on OH and the health and wellbeing of the workers

• describe the role of statutory bodies and the statutory and mandatory aspects of OH nursing registration

• identify the legal and ethical aspects of OH nursing practice

• identify how education and continuing professional development contribute to improving quality of practice.

According to the International Council of Nurses (ICN)¹

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

Occupational health (OH) nursing is the branch of nursing that focuses on the care of the working community and certainly fulfils most of the criteria from the ICN definition. The main purpose of this book is to act as a guide and resource for OH nurse practitioners, particularly those new to OH.

OH is not a new medical or health discipline, despite the fact that it is often confused with occupational therapy. Occupational therapy is a holistic healthcare profession that aims to promote health by enabling individuals to perform meaningful and purposeful activities across their lifespan; it deals with ensuring that people can cope with the day-to-day activities of living after accident or illness whilst OH deals specifically with the health and wellbeing of the working population in their place of work. OH aims to work with other disciplines to ensure that the working-age population have the best opportunity to benefit from employment and that they are not injured or made ill by the work they undertake. In the UK, people are able to leave school from about the age of 16 depending on their nation (in England they need to be in full-time education; on an apprenticeship or training, spending 20 hours or more per week working or volunteering while in part-time education or training until the age of 18²) and therefore may work from then until retirement. Today, under the Equality Act,³ as there is no default retirement age, people may continue to work for as long as they want. This means that a person’s working life may be for over 50 years. We must not forget that in the UK children and young people are allowed to undertake certain work roles after school or college and at weekends, although there are strict laws and guidelines for this. Also there is a large population of unpaid voluntary workers in many organisations, particularly the service sector, who are entitled to the same care as those in paid work.

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People spend roughly one-third of their time at work, one-third of their time sleeping and one-third is left for all other activities, such as eating, household and personal chores and socialising. Therefore, work is the single activity that dominates the waking hours, so health and wellbeing are important aspects of working life.

The historical aspects of OH and OH nursing

In 1863 Florence Nightingale said ‘the hospital should do the sick no harm’⁴ and we can apply her sentiments to the workplace by saying ‘the work should do the worker no harm’. It has been seen in historical papers and pictures that workers’ health has been a source of concern, even as early as ancient Egypt where there are hieroglyphic pictures depicting slaves covering their faces to protect them from the dust created when building the pyramids.

The person regarded as the ‘father of occupational medicine’ is the seventeenth-century Italian Professor of Medicine, Bernardino Ramazzini. He published in Latin De Morbis Artificum Diatriba or Diseases of Tradesmen and Craftsmen.⁵ This was an exhaustive work outlining the health hazards of chemicals, dust, metals, repetitive or violent motions, odd postures and other disease-causative agents encountered by workers in 52 occupations; these included stone cutters, millers, masons, bricklayers, chemists, metal diggers, potters and glass makers, surgeons and wet nurses as well as learned men. The latter were affected by the more commonly known ‘writer’s cramp’, or as it is known today, repetitive strain injury or work-related upper-limb disorder. Through personal example, Ramazzini demonstrated the importance of talking directly with workers and of visiting workplaces to investigate the working environment in order to improve it. He focused on the need for providing workers with adequate information about health hazards and he suggested practical measures to protect workers from illness and injury.

It was the Industrial Revolution (1750–1850) in the UK that brought about many changes to the working environment. The mechanisation of agriculture, manufacturing, mining and transportation and the advent of technology had a profound effect on the social, economic and cultural conditions in the UK, as workers migrated from cottage industries in the country to the factories and mills of the towns and cities. At this time a few philanthropic employers introduced some form of healthcare for their workers – companies whose names are still known today, such as Debenhams, Cadbury, Clarks (shoes) and Coleman’s Mustard. Most of this early history of OH, or, as it was known then, industrial health can be read about in Irene Charley’s book The Birth of Industrial Nursing, published in 1954.⁶ As Radwanski⁷ wrote in 1978 when the book was reissued, ‘OH practitioners . . . should read this account of the courageous efforts to establish OH nursing on a sound professional basis’.

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Charley gives details of the first recorded ‘occupational health nurse’ as Phillipa Flowerday. Miss Flowerday, aged 32, was appointed on 28 October 1878 to Coleman’s Mustard in Norwich where she worked with the doctor at the factory in the morning and visited the workers’ families in their homes in the afternoons.

Since those early times, the working environment has changed a great deal with scientific advances and the advent of electronic and computerised technology. Some of the industrial diseases remain and new ones have taken the place of those that have disappeared. The work of the qualified and registered nurse has changed from that of a handmaiden to the doctor to that of an independent and professionally accountable practitioner governed and guided by his or her own professional body and code of practice.⁸ OH was originally called ‘industrial’ medicine and nursing because of the industrial revolution in the eighteenth century when factory work was so very dangerous, affecting the health and welfare of many people. This was not just adults but also children; they were often given the most dangerous jobs that only small people could do. In those days, and until the later part of the twentieth century, OH was used as a casualty department that treated workers’ injuries and illnesses and was more generally called the Medical Department. By the end of the century, treatment services had been disc...