Healthcare workers' perceptions of the duty to work during an influenza pandemic.

Healthcare workers (HCWs) are often assumed to have a duty to work, even if faced with personal risk. This is particularly so for professionals (doctors and nurses). However, the health service also depends on non-professionals, such as porters, cooks and cleaners. The duty to work is currently under scrutiny because of the ongoing challenge of responding to pandemic influenza, where an effective response depends on most uninfected HCWs continuing to work, despite personal risk. This paper reports findings of a survey of HCWs (n = 1032) conducted across three National Health Service trusts in the West Midlands, UK, to establish whether HCWs' likelihood of working during a pandemic is associated with views about the duty to work. The sense that HCWs felt that they had a duty to work despite personal risk emerged strongly regardless of professional status. Besides a strong sense that everyone should pull together, all kinds of HCWs recognised a duty to work even in difficult circumstances, which correlated strongly with their stated likelihood of working. This suggests that HCWs' decisions about whether or not they are prepared to work during a pandemic are closely linked to their sense of duty. However, respondents' sense of the duty to work may conflict with their sense of duty to family, as well as other factors such as a perceived lack of reciprocity from their employers. Interestingly, nearly 25% of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families.

Remediation of contaminated land and groundwater: experience in England and Wales.

Remediation of contaminated land and groundwater is of common international concern. The context and approach taken to the problem are, however, country-specific. A survey of remedial activity occurring within England and Wales over the period 1996-1999 was commissioned by the Environment Agency (for England and Wales) to establish a baseline against which future trends in remedial activity could be judged. This paper: explains the context of contaminated land and groundwater remediation in England and Wales (Britain); provides an overview of the 1996-1999 survey of remedial activity, discussing its findings within its legislative and institutional context; and, discusses the survey results of significance to the management of contaminated land and groundwater internationally. The survey obtained specific data from 367 remediated sites supplemented by general data from a further 1189 contaminated (not necessarily remediated) sites. The survey aimed to be, and was indicative of remediation practice, and did not seek to identify every remediation scheme operating. Previous anecdotal evidences were generally confirmed. Civil engineering-based techniques dominated and were used at 94% of sites with in situ techniques (predominantly vapour extraction-based) on 16% and ex situ on just 5%. Although disposal to landfill was dominant and occurred at over 80% of sites, integrated use of multiple techniques was common. Remediation was predominantly of soil (rather than water), development-based, designed to protect human health and reflected national development-led and 'suitable for use' policies. Lessons of international relevance from the survey and general British experience are drawn concerning remediation technique selection, regulatory and financial support of innovative remediation techniques and demonstration sites, competent use of risk-based approaches to allow pragmatic remediation and effective use of quality guidelines, need for effective guidance to highlight water quality issues, the necessity of post remediation monitoring to prove remediation effectiveness and the keeping of remediation databases.

Workers' understanding of chemical risks: electroplating case study.

BACKGROUND: There is limited research concerning how small companies in particular, respond to health and safety messages. AIMS: To understand individuals' knowledge and beliefs about chemical risks and to compare these with those of experts. METHODS: The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts. RESULTS: Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms "hazards" and "risks". They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets. CONCLUSIONS: This study provides a method which can be used to gain some understanding of workers' knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers' knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.

Municipal waste management: inequities and the role of deliberation.

Like radioactive waste, municipal solid waste (MSW) requires consideration of a complex mix of intergenerational and intragenerational risks surrounded by uncertain science. Unlike radioactive waste, MSW is a common problem and hence one often perceived to be controllable, at least until a required facility is proposed in a particular community. The intragenerational risks focused on local communities rouse intense public pressures for management. Although some of the risks can be quantified, the risk assessment process cannot deal with all questions. This article examines the multiple dimensions of the decisions required to be made and the weaknesses of a number of decision tools traditionally used. A case is made for the need to integrate decision tools appropriate to the risks into reflexive and iterative decision processes open to public involvement. It is argued that this presents the best hope of both optimizing decisions about the intragenerational risks as well as raising public debate about the importance of sustainable waste management in transgenerational terms.

A review of the detection and treatment of venous air embolism.

Venous air embolism is a common potential complication of several surgical procedures and should be understood by anesthesiologists. The first part of this article, which appeared in a previous issue (Sept/Oct 1991;18(5):29-37), reviewed the pathophysiologic aspects. This concluding segment discusses the detection of venous air embolism and its prevention and treatment.

Some more equal than others?

I have been to RCN Congress many times in the past 10 years and, I think, there has always been an item on the agenda concerning the problems of enrolled nurses who wish to convert.