Hispanic construction workers and assertiveness training.

BACKGROUND: Hispanic (Latino) construction workers experience disparities in occupational death and injury rates in the United States. The cultural value of respect for those in authority may hinder these workers from requesting safe working conditions from supervisors. OBJECTIVE: To evaluate whether Hispanic construction workers in Las Vegas, Nevada found assertiveness training more useful than non-Hispanic trainees and whether or not they practiced this behavior at work after the training. METHODS: An assertiveness training simulation was part of fall prevention classes offered to area construction workers. Eight weeks after the training, participants were interviewed by telephone about class topics they found most useful and whether or not they had made any subsequent behavior changes at work. RESULTS: More than half of the 760 fall prevention trainees completed telephone interviews. A smaller proportion of Hispanic trainees found assertiveness training to be useful (11%) than non-Hispanics (28%) (p⩽ 0.001). Only 2% of both groups identified practicing assertiveness at work. CONCLUSIONS: A large proportion of Hispanic trainees valued other knowledge more highly. They may weigh job security as more important than speaking up about safety issues, which might threaten their employment. Interventions to improve safety should focus instead on improving work safety climate and engineering controls.

Social marketing to plan a fall prevention program for Latino construction workers.

BACKGROUND: Latino construction workers experience disparities in occupational death and injury rates. The Occupational Safety and Health Administration funded a fall prevention training program at the University of Nevada, Las Vegas in response to sharp increases in fall-related accidents from 2005 to 2007. The grant's purpose was to improve fall protection for construction workers, with a focus on Latinos. This study assessed the effectiveness of social marketing for increasing fall prevention behaviors. METHODS: A multi-disciplinary team used a social marketing approach to plan the program. We conducted same day class evaluations and follow-up interviews 8 weeks later. RESULTS: The classes met trainee needs as evidenced by class evaluations and increased safety behaviors. However, Spanish-speaking Latinos did not attend in the same proportion as their representation in the Las Vegas population. CONCLUSIONS: A social marketing approach to planning was helpful to customize the training to Latino worker needs. However, due to the limitations of behavior change strategies, future programs should target employers and their obligation to provide safer workplaces.

Underreporting of musculoskeletal disorders among health care workers: research needs.

Extensive evidence suggests that the numbers of workplace injuries and illnesses reported annually by the U.S. Department of Labor, Bureau of Labor Statistics, are underestimated for all private employers. Several states have passed safe patient handling legislation to reduce work-related musculoskeletal disorders (WMSDs) among health care workers. Research is needed to improve accurate reporting of these types of injuries to allow assessment of the effectiveness of this legislation and to enable hospitals and nursing homes to better target interventions to areas at high risk for WMSDs. In the interim, occupational health nurses and the American Association of Occupational Health Nurses, Inc., can assist in improving the accuracy of occupational surveillance for these work-related injuries.

Psychosocial factors in musculoskeletal disorders.

Work-related musculoskeletal disorders (MSD) have a multifactorial etiology that includes not only physical stressors but also psychosocial risk factors, such as job strain, social support at work, and job dissatisfaction. Once an injury has occurred, psychosocial factors, such as depression and maladaptive pain responses, are pivotal in the transition from acute to chronic pain and the development of disability. Interventions to prevent MSD incidence and address psychosocial risk factors for delayed recovery are described.

Ergonomic assessment of a critical care unit.

Although direct patient care providers in all settings suffer musculoskeletal injuries at unacceptable rates, high-risk tasks in nursing homes are the most frequently researched. Less is known about the high-risk tasks performed by critical care nurses. To identify the tasks in critical care that differ from those in nursing homes, this qualitative study used the Ergonomic Workplace Assessment Protocol for Patient Care Environments to assess a medical ICU. Results and recommendations for change are presented.

Preventing musculoskeletal disorders in nurses: a safe patient handling curriculum module for nursing schools.

Nursing educators who teach outmoded manual patient handling techniques contribute to the widespread problem of musculoskeletal disorders in student and practicing nurses. The authors discuss the development and implementation of a new safe patient handling curriculum module, which was pilot tested in 26 nursing programs. The module changes the focus of patient handling education from body mechanics to equipment-assisted safe patient lifting programs that have been shown to protect nurses from injury and improve care.

Effectiveness of an evidence-based curriculum module in nursing schools targeting safe patient handling and movement.

Nursing schools in the United States have not been teaching evidence-based practices for safe patient handling, putting their graduates at risk for musculoskeletal disorders (MSDs). The specific aim of this study was to translate research related to safe patient handling into the curricula of nursing schools and evaluate the impact on nurse educators and students' intentions to use safe patient handling techniques. Nurse educators at 26 nursing schools received curricular materials and training; nursing students received the evidence-based curriculum module. There were three control sites. Questionnaires were used to collect data on knowledge, attitudes, and beliefs about safe patient handling for both nurse educators and students, pre- and post-training. In this study, we found that nurse educator and student knowledge improved significantly at intervention schools, as did intention to use mechanical lifting devices in the near future. We concluded that the curriculum module is ready for wide dissemination across nursing schools to reduce the risk of MSDs among nurses.

Back pain in direct patient care providers: early intervention with cognitive behavioral therapy.

Back pain and injury are a widespread problem for direct care providers and can lead to disability and job loss. Although most intervention studies focus on the number of reported injuries as the outcome variable, pain is a leading indicator of impending injury. More secondary prevention interventions focusing on early detection and treatment of pain are needed to reduce injuries. The primary aim of this study was to assess the feasibility and effect size of a cognitive behavioral therapy (CBT) intervention to reduce the measures of back pain, stress, and disability in direct care providers working with back pain. The secondary aim was to assess the association between affect and outcome variables, particularly unscheduled work absence, which is a component of disability. This randomized clinical trial recruited 32 registered nurses and nursing assistants with a history of back pain in the past year and assigned them to either an intervention or a control group. The CBT intervention was a weekly stress and pain management session over 6 weeks led by a clinical psychologist. Data for both groups were collected at baseline and at 6 weeks, with work absence data caused by back pain self-reported for 12 weeks. Pain intensity scores declined in the intervention group, indicating a large effect. However, stress scores increased. Depression scores accounted for one-third of the variance in hours absent because of back pain. Although there was a high dropout rate in the intervention group, a cognitive-behavioral intervention shows promise as a secondary prevention intervention.

The physical workload of nursing personnel: association with musculoskeletal discomfort.

Direct care-nursing personnel around the world report high numbers of work-related musculoskeletal disorders. This cross-sectional study examined the association between the performance of high-risk patient-handling tasks and self-reported musculoskeletal discomfort in 113 nursing staff members in a veterans' hospital within the United States. Sixty-two percent of subjects reported a 7-day prevalence of moderately severe musculoskeletal discomfort. There was a significant association between wrist and knee pain and the number of highest-risk patient-handling tasks performed per hour interacting with the load lifted. On units where lifting devices are readily available, musculoskeletal risk may have shifted to the wrist and knee.

Back pain prevalence in nursing personnel: measurement issues.

1. The problem of work related musculoskeletal disorders of the low back in nursing personnel has been well documented in the literature by cross sectional studies showing high prevalence rates in licensed nurses and nursing aides. However, it is difficult to compare findings among these studies because of the use of nonstandardized symptom surveys, variations in case definitions, and other methodological inconsistencies. 2. Measuring the change in current back pain prevalence yields more timely information about the effectiveness of an ergonomic intervention than assessing injury incidence rates, because of the high percent of nursing staff members who work in pain but delay filing workers' compensation claims. 3. As employers attempt to reduce manual handling injuries, occupational health nurses may be called upon to survey workers for musculoskeletal symptom prevalence and document the effectiveness of ergonomic interventions. Before using or developing any musculoskeletal disorder symptom survey for workplace surveillance or research, occupational health nurses should determine whether the survey has adequate reliability, validity, responsiveness, and practicality.