Dedicated to the health and safety of healthcare workers

D E P A R T M E N T S

WINTER 2011 VOL. XXXI, NO. 1

15Interview with Mary J. Ogg, MSN RN CNOR, Perioperative Nursing Specialist, Association of periOperative Registered Nurses (AORN)By Sandra Domeracki, RN FNP COHN-S

21Working During the Pandemic: Fears and Concerns of Health Care WorkersBy Linda Good, RN PhD, and Donna L. Agan, EdD

26Using a Contextual Training Module to Reduce Patient Handling InjuriesBy Debra Vaccaro, RN-C RD MSN, and Pip Maas, RN MSc PGCertErg

29Head Lice: Diagnosis and Therapy: Etiology and PathophysiologyBy Gabriel J. Martinez-Diaz, MD and Anthony J. Mancini, MD

3 President’s Message

5 Vice President’s Update

7 Editor’s Column

8 Association Community Liason Report

11 Ready to Research

13 Executive Board Member Spotlight

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Winter 2011

President’s MessageBy Sandra Domeracki, RN, FNP, COHN-S

I am honored to provide my Executive President’s report to you. I want to again thank all of you who were able to join us at the 2010 Annual National Con-ference in Boston. I also want to thank the Board of Directors for their leadership of AOHP and for all of the work they do on an ongoing basis. On be-half of the Board, I also want to give recognition and thanks to our management company, Kamo (Judy Lyle and Annie Wiest), for all of their support and hard work.

As I enter my last year as your Executive President, my focus for AOHP continues to be to help move it forward in becom-ing a world-class organization. In doing this, I want to share with you what we have ac-complished in 2010 and what is planned for 2011:

• Provided another amazingposter and letter to your CEO, which we plan to do again for 2011.

• E-Byteshasbeeninpublica-tion for more than a year.

• An increased number ofSandra Bobbitt Scholar-ships were offered this year, including a percentage to chapter officers in recogni-tion of the work they do with their chapters.

• Thefive-yearsurveywasde-velopedandconducted.Theresults will be published in the Journal.

• Developed an educationalDVD/e-tutor from last year’s conference sessions with continuing education units.

• Increased the number ofpress releases distributed to our media list.

• Developed and imple-mented a membership directory for you on the Web site.

• Submitted several com-ments, and attended stakeholder meetings for government agencies, regulations and bills.

• AOHPisnowonFacebook,LinkedInandTwitter.

• TheGettingStartedMan-ual was updated this year and is now available for purchase.

• The application and scor-ing tool for the Ann Stin-son President’s Award for Excellence was updated and is available on AOHP’s Web site.

• Astudentratewasofferedfor this year’s Annual Na-tional Conference.

•Ourrelationshipswithsev-eral national organizations – OSHA, CDC, NIOSH, ABOHN, AORN, the Joint Commission, the Alliance to Make US Healthiest,AIHA and American Soci-ety forTestingandMate-rials(ASTM)–continuetobe healthy and strong. We are very excited about the opportunity to work on Ex-pert Review Boards with the CDC for documents that are instrumental to our practice, such as the “Guideline for InfectionControl in Health Care Per-sonnel, 1998” and ACIP’s ImmunizationGuideline.

•Willbeconductingastaff-

ing survey and a sharps in-jury survey.

•WillberenewingourAmer-ican Nurses Credentialing Center Continuing Nursing Education providership.

• Board members will behighlighted in the Journal for you to get to know them better.

• The association’s fourthpublic policy statement will be developed and published in early 2011.

• The AOHP/OSHA Allianceis to be renewed.

I also think it is important that you know how we, as many other associations and orga-nizations, are challenged with keeping officer positions filled and meeting chapter bylaws in the area of number of meet-ings per year. The regionaldirectors are working closely with chapter presidents re-garding these and other is-sues. We do need your help in these areas. We all need to work to keep our chapters vibrant, healthy and active. Without our chapters, we will be unable to continue to grow and move forward as an association. I invite you all to become more involved with your chapter if you are not already.TheExecutiveBoardis here to help guide, support and assist you in any way possible. Please let us know what you need from us.

I believe Dr. Pagana’s keynote speech at the Annual National Conference was so timely for us as individuals and as an as-

Partnership Updates

Sandra Domeracki AOHP Executive President

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sociation. I think of where we have come over the last five to seven years with our part-nerships. As you are aware, partnerships are a two-way interaction. AOHP has been persistent in keeping in touch and initiating activities with our partners to the point that they are now coming to us and requesting our as-sistance with things such as member participation with the National Safety Health Network’s (NSHN) employee safety tool and participating on expert review panels for the CDC/HICPAC documents that guide our practice. We

are very honored and proud to be a part of these initia-tives. AOHP has effectively utilized these opportunities, and we are becoming much more recognized and vis-ible as a leading professional healthcare organization.

Persistence does pay off. I do believe we can increase our membership in this manner as well if we are all persis-tent at the individual chapter, regional and national levels. You, too, can utilize opportu-nities with AOHP to increase your return on investment. What are you passionate

about? Please feel free to let us know. We have so many opportunities available to you via committees at the chapter level and those related to the association’s strategic plan.

Threememberswhoattend-ed the conference were rec-ognized for sharing what they are passionate about with AOHP and how they seized opportunities that were avail-able.LindaGoodisthechair-person for the Research Com-mittee, Curtis Chow oversees ourFacebookpage,andDanaJennings Tucker presentedon behalf of AOHP at AIHA’s

Annual National Conference. AOHP appreciates all of your help and the volunteer assis-tance that we receive from the membership. We look forward to your sharing what you are passionate about with us and how we can provide opportunities for you to plan for your future successes.

I thank you all for your pas-sion and support of AOHP. Together,wecankeeptheas-sociation vibrant and healthy for years to come.

THANKYOU!

The 12th edition of the Getting Started Manual (GSM) is now available for purchase.

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Winter 2011

Vice President’s UpdateBy Dee Tyler, RN COHN-S FAAOHN

The word “professionalism”conjures up different images for different people. Some say it is all about whether or not you are paid for what you do. Others think it is just about appearance and con-duct. Just what exactly is professionalism?

According to the Institute of MedicineandHumanitiesau-thorHMSwick,“Manyhavecalled for a return to medi-cal professionalism as a way to respond to the corporate transformation of the UShealthcare system. Yet, there is no common understanding of what is meant by the word professionalism. To encour-age dialogue and to arrive eventually at some consen-sus, one needs a normative definition.”2 Let’s explore what a “normative defini-tion” of professionalism is for the occupational health pro-fessional.

For the members of theAOHP, the word “profession-als” is our “last name.” As William Shakespeare so el-egantly put it in Romeo and Juliet, “What’s in a name? Thatwhichwecallarosebyany other name would smell as sweet.” In spite of this philosophy, names are sig-nificant.Thestudyofnamesis known as onomastics and includes the fields of linguis-tics, history, anthropology, psychology, philology and more. According to Jewish 1011, “a name is not merely an arbitrary designation, a ran-

dom combination of sounds. The name conveys the na-ture and essence of the thing named. It represents the his-tory and reputation of the be-ingnamed.”Therefore,Ipro-pose to you that it is of the utmost importance that we understand all that the name of “professional” entails.

The Merriam-Webster defi-nition of “professional” is “relating to, or characteristic of, a profession; engaged in one of the learned profes-sions characterized by or conforming to the technical or ethical standards of a pro-fession exhibiting a courte-ous, conscientious, and gen-erally businesslike manner in the workplace.” The OxfordDictionary defines “profes-sional” as a “person compe-tent or skilled in a particular activity.”

AccordingtotheTexasStateLibrary and Archives Com-mission3, the major elements of any profession include an articulated philosophy that is both in written and oral form; a body of professional litera-ture of research, study and comment; leaders or philoso-phers who write about and re-search the profession; guide-lines for behavior, including codes, creeds, oaths and commitment or belief state-ments, such as statements on ethics or professionalism; admission requirements, such as for licensing, certifi-cation, specific educational criteria, for both initial and

ongoing membership; and support and/or professional development opportunities outside the work environ-ment, such as professional organizations or associations.

AOHP emulates the major elements of professionalism. Thereisanarticulatephiloso-phy as noted in the AOHP missionandvision.Thereisabody of professional literature and leaders who write about the profession in the AOHP Journal, occupational health documents and research pa-pers. AOHP drafts position statements to address guide-lines for behaviors and sup-ports educational, licensing and certification standards, as well as supports profes-sional development outside the work environment. Thenature and essence of pro-fessionalism is conveyed by AOHP as the organization strives to represents each member by aspiring to excel-lence in occupational health.

Likewise, we need to recog-nize that, as individual occu-pational health professionals in healthcare, professional-ism should be a part of our daily responsibilities. Our role is to convey the “na-ture and essence” of occu-pational health, conforming to the technical and ethical standards of our profession while exhibiting a courteous, conscientious and generally businesslike manner in the workplace.

What’s in a Name?

Dee TylerAOHP Executive Vice President

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Tosome,thetermprofession-alism is unclear. For AOHP,professionalism is a part of our name, and the associa-tion conveys all the elements central to the term. As we en-deavor to fill the “tall order” of being occupational health

professionals, we need to re-member that we don’t have to go it alone because we have more than 1,000 col-leagues at AOHP to support us along the way as we daily ascribe to professionalism.

References1. Rich, T.R. (nd). The Significance ofNames. Retrieved October 27, 2010, from Jewish 101: http://www.jewfaq.org/name.htm

2.Swick,H.M. (2000, June).TowardaNormativeDefinitionofMedicalProfes-sionalism. Retrieved October 27, 2010,

from PubMed.gove: http://www.ncbi.nlm.nih.gov/pubmed/10875505

3. Texas State Library and ArchivesCommission. Small Library Manage-mentTrainingProgram.RetrievedOcto-ber27,2010, fromTexasStateLibraryand Archives Commission: http://www.tsl.state.tx.us/ld/tutorials/professional-ism/IB.html

Chapters: Reach your members through teleconference. Contact AOHP Headquarters at info@aohp.org to connect remote members to chapter meetings!

Julie Schmid Research ScholarshipAOHP is accepting proposals for original research projects on current and/or anticipated issues in hospital-relatedoccupationalhealth.TheResearchScholarshipAwardis$2,000.Formoredetails,visit Awards and Scholarships at www.aohp.org or call Headquarters, 800 362-4347.

Deadline for submissions is July 1.

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Winter 2011

Please visit the Web site for additional information about the past, present and future of needlestick

safety and prevention.www.healthsystem.virginia.edu/internet/safetycenter/

internetsafetycenterwebpages/nspaconference/NSPAConference.cfm

Editor’s ColumnBy Kim Stanchfield, RN, COHN-S

Kim StanchfieldAOHP Journal Editor

Can you believe that 10 years have passed since President Clinton signed into law the Needlestick Safety and Pre-vention Act? This essentiallegislation was signed on November 6, 2000. On No-vember 5 and 6, 2010, I was happy to represent AOHP at a conference in Charlot-tesville, VA recognizing the 10-year anniversary of that groundbreaking date.

The International HealthcareWorker Safety Center at the University of Virginia (UVA)hosted this conference. Themain goals of the conference were to: assess the impact of the act; identify remaining gaps in sharps safety technol-ogy; and chart a future path that is global in scale. Other questions answered by this conference were: •Whatwilltheglobalsharps

safety and medical device markets look like in anoth-er 10 years?

•How will these changesbenefit those in the poor-est countries around the world?

•How will these changesprotect the healthcare workers who are most

at risk for infection from bloodborne pathogens?

The International HealthcareWorkerSafetyCenteratUVAhas developed a very infor-mative Web site about the conference, located at http://www.healthsystem.virginia.edu/internet/safetycenter/internetsafetycenterweb-pages /nspacon fe rence /NSPAConference.cfm. Thissite currently includes the PowerPoint presentations from the speakers. Soon to come are videos of all speak-ers and sessions, as well as written summaries of all the sessions.

I ask all of you to join me in saluting two wonderful women whose contributions to employee safety greatly influenced the legislation in 2000 and who have provided essential support since that date: Dr. Janine Jagger from theUniversityofVirginia;andElise Handelman, RN MEdCOHN-S CIC, a former Direc-tor, Office of Occupational Health Nursing, OSHA (re-cently retired).

Jagger essentially “pio-neered” the idea that devices,

not people, were responsible for exposures, and continued through tireless research and work to bring change. She is present in the photograph of the Needlestick Safety and Prevention Act signing, prominent at President Clin-ton’s right hand.

Handelman worked in her ca-pacity with OSHA to assist in bringing forth this legislation. Prior to her position at OSHA, she worked in Employee Health and Infection Control and drew from that back-ground of both expertise and contacts. Frequently, Jaggerand Handelman work togeth-er to tackle key issues.

I encourage all of you to join me in recognizing the con-tributions both women have made to the basic core of our work – the safety of our em-ployees.

Please visit the Web site for additional information about the past, present and future of needlestick safety and prevention. It is quite obvi-ous that while we have made tremendous progress, there is much yet remaining to ac-complish.

The 10th Anniversary of the Needlestick Safety and Prevention Act

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MaryAnn GrudenAssociation CommunityLiaison

Alliance Implementation Team Conference CallOn November 30, 2010 an Alliance Implementation Team conference call washeld. Representatives of OSHA, NIOSH and AOHP participated.Thedraftoftheblood/body fluid post expo-sure card for emergency per-sonnel remains under review byOSHAstaff.Thetargetforthe review to be completed by OSHA was mid-Decem-ber. A Web page for health-care professionals is being developed by OSHA. AOHP provided input into the topics that should be included in the page. Debra Novak, NIOSH, has also forwarded additional information on personal pro-tective equipment and the respirator trusted source Web site as links for consid-eration on the page. AOHP offered to review the draft of the page. Review of the above eTool and Safety andHealthTopicpageswasalsodiscussed on the call. Other suggestions included review of the Surgical Suite module by the Association of periOp-erative Nurses (AORN) and the Laser Institute of Amer-ica, as OSHA has alliances with these organizations. OSHA’s distracted driving initiative was discussed, and more details of this initiative follow in this article. AOHP submitted an article on influ-enza for the Alliance Quarter-ly Newsletter that should be published in January. AOHP hopes to have an OSHA speaker at the 2011 Annual National Conference and will submit a letter requesting a

speaker to Alliance coordina-torMorganSeuberling.

Distracted Driving Initiative Announced 10/4/10In an October 4, 2010 press release, OSHA announced its Distracted Driving Initiative. This educational campaigncalls on employers to pre-vent work-related distracted driving, with a special focus on prohibiting texting while driving. In an open letter to employers that was posted online, OSHA requests that companies examine their pol-icies and practices, informs them that they have a legal ob-ligation to prohibit workplace hazards such as texting while driving, and asks them to im-mediately remove any incen-tives that may motivate em-ployees to text while behind the wheel. Prohibiting texting while driving was the subject of the Executive Order signed by President Obama last year for federal employees and the subject of rulemaking by theDepartment of Transpor-tation. OSHA will call upon all employers to follow the lead of President Obama, the De-partment of Transportationand the 30 states that have laws prohibiting drivers from texting. The multi-prongedinitiative will include the fol-lowing: • An educational campaign,

launched during Drive Safe-ly to Work Week (October 2010), calling on employers to prevent occupationally related distracted driving, with a special focus on pro-hibiting texting while driv-ing.

By MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

Association Community Liaison Report

OSHA AllianceReview of Hospital eTool and Safety and Health Topic PagesA recent project that the OSHA Alliance Implementa-tion Team and the Execu-tive Board participated in was the review of the OSHA HospitaleTooland reviewofthe Safety and Health Topicpages related to Bloodborne Pathogens and Needlesticks, and Medical and First Aid.OSHA describes eTools as“stand-alone,” interactive, Web-based training tools on occupational safety and healthtopics.Theyarehighlyillustrated and utilize graphi-cal menus. They may alsouse expert system modules which enable the user to an-swer questions and receive reliable advice on how OSHA regulations apply to their work site. The Safety andHealth Topic pages are as-sembled on the OSHA Web site. These pages cover awide variety of information on more than 160 topics to pro-vide users relevant reference materials including standards, directives, training materials, etc. Individual modules of the HospitaleToolandSafetyandHealth Topic pageswere re-viewed and a variety of sug-gestions were made to add, delete or update content in themodules.Thecommentswill go to the OSHA staff re-sponsible for the update of thesetools.Theseresourcescan be found at www.osha.gov on the home page under TopLinks,SafetyandHealthTopics.

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• AWebsitewhichcarriesavideo message and an open letter to employers from As-sistantSecretaryMichaels.It will also showcase mod-el employer policies and partner with employer and labor associations to com-municate OSHA’s message (www.osha.gov/distracted-driving/initiative.html).

• Forging alliances with theNational Safety Council and other key organizations to help OSHA reach out to employers, especially small employers, to combat dis-tracted driving and prohibit texting while driving.

• Placing special emphasison reaching young work-ers by collaborating with other Labor Department agencies, as well as OSHA alliance partners and stake-holders.

•Whenacrediblecomplaintis documented where an employer requires texting while driving or who orga-nizes work so that texting is a practical necessity, OSHA will investigate and when necessary issue cita-tions and penalties to end this practice.

NIOSH UpdateNORA Sector to Host Roundtable on Synergy of Patient and Employee SafetyTeriPalermo,NIOSH,sharedthat The Joint Commission(TJC)announceditwasseek-ing examples of patient and healthcare worker efforts that demonstrate synergy between these two popula-tions. These examples willbe used at an upcoming roundtable meeting as part of the National Occupational Research Agenda’s (NORA) Healthcare and Social As-sistance Sector’s work. Thegoal of the roundtable is to publish a white paper on the

relationship between patient and employee safety. AOHP has spoken with TJC repre-sentatives who are involved with this project, and they were delighted that AOHP had contacted them. AOHP has submitted an example of how employee safety im-pacts patient safety and has also shared the AOHP con-ceptual model of the rela-tionship among occupational health and employee and pa-tient safety.

AOHP Partners with NIOSH on Workplace Violence On-Line Course Research ProjectAOHP participated in a part-ner meeting to review draft content for the Workplace Vi-olence On-Line Best Practice Course research project that NIOSH is developing. Theall-day meeting was held at theUniversityofMarylandinBaltimore on September 27, 2010. Draft course content was developed earlier in 2010 by NIOSH content experts and an external educational company with experience developing and disseminat-ing online continuing educa-tion. Partners were asked to review and comment on the draft content prior to the meeting. AOHP reviewed and commented on the draft content and participated in the meeting in Baltimore. Draft content was divided into three modules that in-cluded background, preven-tion and case scenarios. It was evident when reviewing the draft content that a great deal of time, energy and thought went into the devel-opment of the draft and that the final product would be a useful resource to nurses.

At the meeting in Baltimore, DanHartley,EdDandMarilynRidenour, MPH, the NIOSH

Co-Project Officers, were present. Discussion was fa-cilitated by a representative from the online education company. Other partners included representatives from academia, occupational health and safety, profes-sional nursing organizations and healthcare worker union representatives. Several part-ners also participated by tele-conference.Thegoalsoftheall-day discussion included re-viewing: the scope of content objectives and key points; ad-equacy of detail and level of the content; and organization of content. The facilitateddiscussion gave partners the opportunity to address a wide variety of concepts and is-sues that had been identified in the draft content, as well as other content that should be considered for inclusion in the course. The plan is thatby the spring of 2011, the content will be in the online format, and partners will have the opportunity to review the online format. Updates onthe project will be provided in future issues of the Journal.

AOHP Signs on to National Open Letter to the American People on InfluenzaIn November, AOHP received an invitation from Secretary of Health and Human Ser-vices Kathleen Sebelius to sign the Open Letter to the American People, encourag-ing vaccination as the best way to prevent the spread of theflu.Thiswas thesec-ond year for the letter. Last year’s letter was widely circu-lated at www.flu.gov and at www.cdc.gov and in news-papers around the country. The purpose of the letter isto demonstrate to Americans that healthcare providers and public health experts strongly

support vaccinations. Again this year the letter was to run in some of the nation’s most widely-read newspapers, on-line at www.flu.gov, and on state public health depart-ment Web sites around the country. AOHP signed on again this year by sending a letter of support and a copy of our logo to be used when the letter was published.

10th Anniversary of the Needlestick Safety and Prevention ActNovember marked the 10th anniversary of the signing of the Needlestick Safety and Prevention Act. AOHP partic-ipated in two events marking thisoccasion.Theseincludeda meeting sponsored by the American Nurses Association (ANA) at the National Press Club in Washington, DC on November 4, 2010 and a conference at theUniversityof Virginia in Charlottesville. The second event was the“10th Anniversary of the Needlestick Safety and Pre-vention Act: Mapping Prog-ress,ChartingaFuturePath”conference held November 5-6, 2010.

Audrey Sadler, AOHP mem-berfromtheMarylandChap-ter, attended the ANA event in Washington, DC, which served as the kick-off of the Safe Needles Saves Lives campaign to educate health-care workers (HCWs) about the law and how to make the workplace safer. Sadler shared the following high-lights of the meeting. Themoderator for the meeting was Marla Weston, ChiefExecutive Officer, ANA. Her opening remarks emphasized employer responsibility, in-cluding the demonstration of new technology, updating the facility’s exposure control

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plan, maintaining a confiden-tial sharps exposure log and soliciting input from employ-ees who use the equipment when new equipment is be-ing evaluated. Panelists in-cluded representatives from professional associations, cli-nicians and the government.

Karen Daley, ANA President, spoke about ANA’s goal to maintain a safer workplace. She shared how she became an advocate of safer sharps due to a significant exposure to blood/body fluids while working in the Emergency Department. As a result of the exposure, she contracted HIV and Hepatitis C. Although there is greater access to safer sharps, 2008 statis-tics have revealed that there were 100,000 bloodborne ex-posures among HCWs. In her view, the goal of legislation is not to fix the problem but to help move the issue of sharps safety forward. She stressed the importance of educat-ing employees to become involved with the selection of safety products and that manufacturers continue to develop innovative products.

MaryOgg fromtheAssocia-tion of periOperative Nurses (AORN) reported that since the legislation was enacted, there has been a 31.6 per-cent reduction in non-surgical injury rates but an increase of 6.5 percent in sharps injuries in the surgical environment. Themajority (75 percent) ofsurgical injuries occur during the passing of instruments. Useofasafeorneutralzonefor the passing of instru-ments has demonstrated a 35-50 percent drop in surgi-calinjuries.Toachievefurtherdecreases in surgical injuries, entire surgical teams need to embrace a culture change

that includes the need for the selection and use of safety products such as blunt nee-dles, double gloving and use of a safe or neutral zone for passing sharps.

Annie Lewis O’Connor, Pro-gram Director of Nursing Practice, Center for Women and Newborns at Brigham and Women’s Hospital, Bos-ton, discussed the need for facilities to have a standard-ized response that includes close follow-up when a signif-icant exposure to blood/body fluid occurs. She shared her story of having a significant exposure.Theneedforinsti-tutional commitment, a clear follow-up procedure, coun-seling and support, and a root cause analysis to determine how to prevent the exposure in the future was stressed.

Susan Dolan from the Asso-ciation for Professionals in Infection Control and Epide-miology’s (APIC) Public Policy Committee addressed work practices. She recommended conducting safety rounds, the removal of garbage bins below sharps containers, and staff education and train-ing about the proper use of safety devices. She identi-fied dialysis and ambulatory care settings as two areas of focus for the implementation of safety devices. In addition, she recommended that prod-uct evaluation be continuous and that cost should not pro-hibit the purchase of safety devices. APIC’s goal is that every healthcare institution should be working toward the goal of zero needlesticks and sharps injuries to protect the HCW and patients from expo-sure to infectious disease.

Angela Laramie, Massachu-setts Sharps Injury Surveil-

lance Program, Department of Public Health, Project Co-ordinator, spoke about the 2001 Massachusetts legisla-tion requiring all hospitals to report sharps injuries to the Massachusetts Departmentof Health. Requirements are similar to the OSHA require-ments and include mainte-nance of a sharps injury log. Hospitals are required to sub-mit annual sharps injury data with information contained in the sharps injury log. Eight years of data have been col-lected. Total sharps injuriesfor calendar year 2008 were 3,126, and this was similar to previousyears.Thejobcate-gory breakdown reveals that 30 percent of the HCWs who reported injuries were nurses, and the department where the majority of exposures occurred was the operating room(32percent).Theshort-term state goal is to increase the use of safety devices that require one hand to activate the safety feature, and in the long term, to increase the use of devices that require no activation (passive) of the safety feature by the user.

Jordan Barab, Deputy As-sistant Secretary of Labor, OSHA, spoke about the Bloodborne Pathogen Stan-dard from 1991 and the legis-lationfrom10yearsago.Theregulations have emphasized engineering controls and in-creased worker participation in the selection of devices. Progress has been made since the regulations were enacted, including a signifi-cant decrease in reported sharps injuries, the issue of Hepatitis B moving from one of infection among HCWs to vaccination of HCWs, per-sistence for the use of safe products and the use of the continuous process improve-

ment model to continue to reduce injuries.

A question and answer ses-sion was held at the end of the meeting. The topicsincluded the need to con-tinue to educate legislators about the value of a culture of safety in healthcare, the need to continuously evalu-ate the quality of safety prod-ucts, support for innovation in safety engineering devices and the importance of health-care facility leadership in de-veloping a safety culture as a priority.

It was important for AOHP to be present at this meeting, as we are often the champions in our organizations for sharps injury reduction and the use of safer sharp devices. Formore information on the ANA program Safe Needles Saves Lives, visit www.nursing-world or www.needlestick.org.Thesitescontaintoolkitswith information for both the HCW and employer.

Kim Stanchfield, Virginia Chapter and Journal Editor, attended the conference in Charlottesville, and her report can be found in her column in this edition of the Journal. Many thanks to thesemem-bers for taking the time to attend these meetings on AOHP’s behalf.

SummaryAOHP continues to move for-ward with our efforts to be a voice in the discussions that affect our practice. I am grate-ful for the members of the Ex-ecutive Board, the OSHA Alli-ance Implementation Teamand individual members who have answered the call to as-sist in these efforts. If we all do a little, we can accomplish greatthings!

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Winter 2011

Ready to ResearchBy Linda Good, RN, PhD, COHN-S

Linda GoodColumn Editor

MyfirstyearintheEmployeeHealth Clinic was quite frus-trating and had me feeling rather lonely. Even though I worked side by side with oth-ers, it still felt like we were facing each and every chal-lenge so common to every Employee Health Department all alone. We struggled to rein-vent the wheel at every turn. How do we better promote vaccination? What types of TBtestdocumentationshouldwe accept? Should we be moving to electronic medi-cal records? And, there were many other hurdles so many of us have faced. We seemed to be doing the right thing ac-cording to our supervisor, but our best didn’t feel good be-cause nothing seemed to be flowing easily. We felt like salmon swimming upstream, and we weren’t even sure it was the right stream.

At the 2010 AOHP Annual Na-tional Conference in Boston, we heard that many others faced the same challenges and used many of the same tactics. However, the infor-mation felt different. Theyweren’t facts and figures alone.Theywererealpeoplewith real experiences who had similar thoughts, feelings

and frustrations. I learned just as much from those sitting around me as I did from the people on the stage, maybe more!Thepeoplearoundmeshared their stories.

Did you know: •One of our colleagues

walks through her hospital and confronts people face to face. She asks people to leave work until they have theirTBtestdone.Ihadthepleasure of sitting next to her in two workshops.

• An inspector found anequipment exhaust valve right next to the ventilation intake valve for the entire facility. It had been there for years, contaminating the air,andnoonehadnoticed!This information was con-veyed by a presenter, but it stuck in my mind because of the genuine horror in his voice when describing the situation, and I don’t even perform inspections.

• Somehospitalsdon’tallowany type of pay raise or pro-motion unless Employee Healthsignsoff.Thiscameout in a small group discus-sion.

I know all of the speakers spent a huge amount of time

preparing for their presenta-tions. I am sure they worked on tone of voice, images on the slides and layouts of their posters.Theirmaterialwasin-formative. In contrast, I doubt any of the people I sat next to spent a moment considering how to give me a suggestion or tell me why they did some-thing in a particular manner. And yet, I remembered their information just as much, if not more. Do you know why? People retain simple, emo-tional images the best. Call them “mini movies” so you aren’t deceived into thinking a single still shot will do the trick.

What are the most memora-ble things that you took away

Telling the Story By Melissa Locketz, RN

This issue’s Ready to Research column explores a foundational aspect of research – Tellingthe Story – essential to the beginning (developing a concept), the middle (sharing results), and the finale (changing culture). A well-told story distills an unwieldy research experience into an evocative “ah-ha” moment that can transform practice, get the financial nod and inspire inno-vation. As a new AOHP member and first-time AOHP Annual National Conference attendee, Melissa “Missy” Locketz shares how telling the story can be the difference between the mediocrity of reinventing the wheel and the exhilaration of forward momentum.

Melissa Locketz

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from the conference? Or a class you once attended? Does a mental image pop up, or a scene that either the speaker described or that you created based on how the in-formation related to you? What if the people I talked to had just said: • All my employees arerequired to get the TBScreen.

•Don’t put exhaust valvesnext to intake vents.

• Require employees tocomply.

There are simple, obviousthings that every hospital does.Thesegoodsolid factswere almost too simple to be meaningful. Tremendousresearch statistics backed all of these statements. But, statistics are not memorable. The visual memory of that

woman confronting people to get their TB tests done, notstatistics on how important it istogetaTBtestfromallem-ployees, is what I remember. It is what most people would retain.Thereisnogoodvisualin “Don’t let them work with-outaTBtest.”

Stories are full of details and include the thought process-es that caused the action, as well as the emotional state of the storyteller at the time. People need these details to feel the relevance and impor-tance of what they are being told. Let’s go over the emo-tions in the simple stories re-lated earlier:1. Confrontation almost al-

ways results in some type of emotion, most notably anger.

2. Contaminating the air in a hospital is shocking, and not noticing it for years pushes it close to horrifying.

3.Fear of not getting a payraise or promotion is an aw-ful thought for anyone.

There is no emotion in thesentence “Don’t put exhaust valves next to intake vents.” It’s a no brainer. And, that is probably how it came to be for years with no one having noticed. Who thinks of look-ing for an intake vent next to an exhaust valve? But, after hearing that story, I know I will do a double take when-ever I see an intake vent.

Regardless of whether you are presenting formal, statisti-cal-based data or sharing from the expertise of your lived experience, people are more likely to remember emotional

stories that they can relate to. Tellyourstory.Makeitsimple,and do your best to describe the emotions you felt and the events that led you to your conclusions. What caused you to learn this? How did you feel before, during and after? By telling a story, your audience is more likely to un-derstand what you learned andwhyitisimportant.Theymight even change their be-havior or practices.

Share the lessons you have learned from the school of life with your AOHP peers so we can build one wheel rather than reinvent many.

Missy Locketz, RN, is the Employee Health Nurse at Santa Clara Valley Medical Center, San Jose, CA.Linda Good, RN PhD COHN-S, Column Editor

BeyondGettingStarted–AResourceGuide:PreparingforMassImmunization/Prophylaxis of Healthcare Workers Healthcare Workers are among the most important individuals to protect in the

event of an infectious disease outbreak. AOHP has developed a resource guide

foryouruseintheeventofamassimmunization/prophylaxis.Thisdocumentis

providedinpdfformat.ThesamplepagesarealsoprovidedinWordformatso

that you may tailor for use at your institution.

ThisresourceisfreetomembersontheAOHPWebsiteunderMarketplace/

BeyondGettingStarted.

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Winter 2011

AOHP Executive Board Member SpotlightDee Tyler, RN COHN-S FAAOHN, AOHP Executive Vice President

Editor’s Note: This is the second in a se-ries of Executive Board member spot-lights by Executive President Sandra Domeracki. We hope members enjoy an additional “chat” with our AOHP leaders as they serve this wonderful and progressive organization. It is my pleasure to share this interview with AOHP’s newly elected Executive Vice President, Dee Tyler.

Question: How long have you served on the AOHP Board of Di-rectors?

Dee: I have served two terms as Sec-retary (1998-2002), two termsasTrea-surer (2003-2006), Annual National Con-ference Chair 2007, Web Coordinator 2008-2010, and in 2010 I was elected to the position of Executive Vice Presi-dent.

Question: When did you join AOHP?

Dee: I joined the organization in 1996

Question: How did you hear about AOHP, and what attracted you to join?

Dee: I was President of the Detroit Employee Health Nurse (DEHN) Asso-ciation, which desired to be a member ofAOHP. TheDEHN applied toAOHPto form a chapter, which later became theAOHPMichiganChapter.TheDEHNwanted to join AOHP to connect with other hospital-based occupational health professionals and liked the specific fo-cus on healthcare that is offered by af-filiating with AOHP.

Question: What attracted you to run for a Board position?

Dee: I never thought about running for national office until Kathleen VanDoren, who was AOHP President at the time, asked me to run for Secretary. She told me that she thought I would do a good job. I enjoyed the interaction with oc-cupational health professionals from across the nation and thrived with sup-porting the organization in this way by serving in a leadership roll.

Question: What do you see as your greatest challenge in your current Board position?

Dee:Mygreatestchallengeinmycur-rent Board position is managing all the information that is vital to my lead role in governmentalaffairs.Thereissomuchinformation to review and consider to keep members apprised of issues that it can be a little overwhelming at times to manage.

Question: What do you think is the greatest strength of AOHP?

Dee: I believe the greatest strength of AOHP is our members, who are dedi-cated to occupational health and the population we serve.

Question: What, personally, is your greatest reward serving on the AOHP Board?

Dee:Mygreatest reward, so far,wasserving AOHP during a time (2001-2003) when the organization was literal-ly on the brink of dissolution, and work-ing with the other Board members, as well as the AOHP membership, to bring the organization back to thriving once again.

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Question: Our AOHP members would love to learn some more about you personally. Would you please share a glimpse into your life outside AOHP?

Dee: I am married to Randy, my hus-band of 32 years. We have a son who is 31 and lives on the Gulf Coast ofAlabama and a daughter who is 18, at-tending CentralMichigan University inMt.Pleasant,MI. IattendLivingWordLutheran Church and have been a vol-unteer high school youth leader for al-most 23 years, leading Bible studies, attending youth gatherings, participat-ing in servant events, and leading other youth activities. I am a volunteer sports trainer for the Lutheran High Northwest HighSchoolGirlsBasketballTeam,andI am completing my term as President of the Parent Network at the same high school. I founded theMichiganHealthCare Safety Association in 1995, which is comprised of safety professionals fromalloverMichigan.Currently, IamoutgoingchairoftheCoalitionofMichi-gan Organization of Nurses (COMON)that is comprised of 35 nursing organi-zationsinMichiganandisrecognizedasone of the major voices for nursing in the state.My husband and I love din-ing out, entertaining friends, gardening and cooking together, and attending all levels of sporting events.

Question: What advice would you give to AOHP members to en-courage volunteerism within the organization?

Dee: I would encourage members to look beyond what they currently see as boundaries and extend themselves to

do something that they might not have done in the past or that might be out of their comfort zone. All of our members have so much they can offer to the orga-nization, as well as abundantly receive from the organization, if they would only takethefirststepbysaying,“Yes!”toserving within AOHP.

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Winter 2011

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Interview with Mary J. Ogg, MSN RN CNOR, Perioperative Nursing Specialist, Association of periOperative Registered Nurses (AORN)

By Sandra Domeracki, RN FNP COHN-S

Editor’s Note: The following interview concludes our series of interviews with key AOHP partners. AOHP and AORN have had a partnership for several years as a result of the AOHP and OSHA Al-liance. Mary J. Ogg is our liaison with AORN, and below is a recent interview with her by AOHP’s Executive President.

Question: Can you explain your role and responsibilities with AORN?

Answer: As a perioperative nursing specialist at AORN, I am responsible for developing recommended practices, products and educational materials that support patient safety and the periop-erative professional’s safe workplace practice.

As the staff liaison for AORN’s alliance withOSHAandAORN’sMemorandumof Understanding with NIOSH, I workwith OSHA and NIOSH to advance the health and safety of perioperative personnel. For example, AORN andNIOSH presented a respiratory protec-tion Webinar following the outbreak of H1N1. I represented AORN at the stakeholder meetings that developed NIOSH’s Health and Safety Practices Survey of Healthcare Workers. In an-other instance, AORN provided input for OSHA’s Hospital eTool’s surgical suitefor workplace hazards of: waste anes-thetic gases; bloodborne pathogens; smoke plume; hazardous chemicals; and slips, trips and falls.

Question: What is your role be-tween AORN and AOHP?

Answer: My role is to educate occu-pational health professionals about the

unique workplace hazards of the periop-erative environment. Perioperative per-sonnel are being exposed to toxic gases, vapors and viruses multiple times a day every day they are in the operating room. In the OR, the laser or electric surgical procedures may produce a smoke by-productor“plume.”Thesmoke is cre-ated when tissue is thermally destroyed and may contain toxic gases and vapors such as benzene hydrogen cyanide, and formaldehyde, bio-aerosols, dead and live cellular materials (including blood fragments), and viruses.

Question: What do you see as the role of AORN moving forward with issues for healthcare workers in the hospital setting?

Answer: AORN will continue to moni-tor current issues of concern that im-pact the health and welfare of the surgi-cal team and be on alert to new issues where our members may need educa-tion, guidelines and/or position state-ments to assist in successfully meet-

ing the new challenges. Current issues include injury from sharps, ergonomic injuries, surgical smoke plume, fires, medical gases/chemicals and civility among members of the surgical team.

We also partner proactively with equip-ment manufacturers to assist with the design and implementation of equip-ment to include safety features for both patients and staff. We will continue to support and partner with the EPA, NIOSH and OSHA, as well as state and local regulators, to promote workplace safety in the perioperative environment

Question: From AORN’s stand-point, what do you expect for AORN’s relationship with AOHP?

Answer: AOHP and AORN can mu-tually share information pertaining to healthcare workers’ safety. AOHP can provide unique contributions and in-sights to workplace safety issues in the perioperative environment.

Question: What do you foresee being the issues of priority for healthcare workers in the hospi-tal setting?

Answer:Theprioritywillvarywiththehealthcare facility and what is occurring at the facility. If sharps injuries are occur-ring, a program should be implemented to prevent sharp injuries, including neg-ative consequences for not following the policy. One of the most important issues is that leadership must acknowl-edge and embrace a culture of safety for healthcare workers. AORN believes that safe patient care and healthcare worker safety are connected – there cannot be one without the other.

Mary J. Ogg

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Question: What will be the pri-orities for AORN over the next several years related to health and safety issues in the work-place?

Answer: One of AORN’s priorities over the next several years includes the psy-chosocial and cultural aspects of the workplace. Areas of concern are hours of work (10- and 12-hour shifts), man-datory overtime, on call schedules, the impending nursing shortage, absence of respect from peers and other health-care professionals, and the absence of a code of conduct for all the members of the surgical team. We have a number of tool kits that address areas of health-caresafety,including:FireSafety;SafePatient Handling andMovement; JustCulture;HumanFactors inHealthcare;and Surgical Smoke Evacuation. In ad-dition, we have position statements that provide guidelines in the areas of: Environmental Responsibility; Ergo-nomically Healthy Workplace Practices; Healthy Perioperative Work Environ-ment; Safe Work On-Call Practices; Surgical Smoke and Bio-Aerosols; and Workplace Safety.

AORN is a member of The Councilon Surgical and Perioperative Safety (CSPS) -- a multidisciplinary coalition of seven professional organizations in-volved in the care of surgical patients, with one of the guiding principles being a commitment to collaboration and ef-fective communication among all team members involved in perioperative care. Health and safety issues in the work-place begin with all members of the team committed to achieving a healthy and safe environment. AORN will con-tinue to foster, support and collaborate with other organizations committed to improving the workplace environment.

Question: What does AORN believe are and will be the most important issues for occupa-tional health professionals to be focused on for healthcare work-ers in the hospital setting?

Answer: AORN is very concerned about the rise of sharps injuries in the perioperative environment. Sharps inju-ries have decreased by 31.6 percent in non-surgical settings, while they have increased by 6.5 percent in surgical set-tings.

Musculoskeletal injuries also continueto be a problem in the operating room. The majority of surgical patients areanesthetized and unconscious for the procedure, requiring the surgical team to move them into the necessary posi-tion (e.g., prone or lateral) for optimum siteexposure.Thelackofperioperative-specific equipment that can assist in positioning patients puts perioperative personnel at an increased risk for a musculoskeletal injury.

Question: What recommenda-tions do you have, on behalf of AORN, for AOHP to support its members to best serve their hos-pital population?

Answer: Don’t be afraid to go behind the closed doors of the operating room because there are numerous occupa-tional health risks in the OR that need your attention and expertise. Call your OR director and ask what you can do to help; ask to observe for a few hours or longer, if your schedule permits; and collaborate with the OR to develop a process to make it easier and more ef-ficient to follow up on a needlestick in-jury. Whether it’s reporting or drawing blood samples, we need to be consid-erate of their needs. Consider becom-ing an AORN member to gain free ac-cess to articles and recommendations regarding ourworkplace issues.Mem-bers have a community platform called OR Nurse Link where they can share experiences and ask questions of their peers.Thissitecanbecomeavaluableresource for occupational health profes-sionals seeking to uncover and solve workplace safety issues in the operat-ing room. In the OR, it’s always about teamwork. There is a lot to be gainedwhen we work together.

Question: Are there other com-ments you and/or AORN would like to make to the AOHP mem-bership?

Answer: AORN and AOHP are both striving for the same goals of provid-ing safe patient care and a safe work environment for all healthcare person-nel. The ambulatory environment is apotential area for collaboration between AORN and AOHP. Since more than half ofallsurgicalprocedures intheUnitedStates are performed in an ambulatory surgery setting, we need to determine how we can reach workers in that en-vironment who are working without the resources of a dedicated occupational healthprofessional.TheH1N1outbreaklast year demonstrated the need for occupational health resources in the ambulatory environment. Many ASCsstruggled to provide respiratory fit test-ing for their employees.

On behalf of AOHP, I would like to thank Mary Ogg and AORN for their time, ex-pertise and responses to this interview. AOHP looks forward to its ongoing work and opportunities through its partner-ship with her and AORN.

This will be the final interview with our partners until new partnerships are de-veloped and/or if any changes occur with AOHP’s current partnerships. I hope that you have found these articles beneficial and informative.

Thank you!Sandy

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Winter 2011

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AOHP members can now be connected on Facebook, LinkedIn and Twitter

These social networks are great ways to communicate with other professionals in the field. We invite you to join and share information/ideas. You are welcome to post any message and links related to our practice.

AOHP has gone VIRTUAL!

The AOHP 2010 Annual National Conference

Syllabus is available for purchase

Contact AOHP Headquarters:

info@aohp.org or 800 362-4347

Member Non-MemberNotebook $45 $55CD $20 $130

MakeMyJobEasier!TheGettingStartedOntheRoad(GSR)Workshop will help you• Communicatethevalueof

occupational health within your organization

• Identifyfederal,stateandlocalregulations

• Teachinfectioncontrolandsafetyinyour workplace

• CNEcontacthoursawarded

Interested?GetinvolvedinGettingStarted!This8-hourprogramoffersvaluable resources to new and seasoned occupational health professionals.

ConsiderhostingorparticipatinginaGSRWorkshop in your area. Contact AOHP HQ (info@aohp.org or 800 362-4347) for details.

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Winter 2011

VIRTUAL!

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ROC a Colleague’s World By Betsy Holzworth, RN, COHN-S/CM, Human Resources Committee Chair

In 2010, our ROC campaign yielded 20 new members.TheAOHPboardhasdecidedto continue this program, which runs from October 1, 2010 through June 30, 2011.

Grand Prize- “Whole Shebang”:Themember who recruits 10 or more new members.Thisprizeincludes:2012nationalconference registration and 4 nights hotel. In the event that no member recruits 10 or more members, the member who recruits at least 4 new members will receive a 2012 National Conference Registration.

2nd place: Annual membership fee paid for 2012.

Chapter Award: TheChapterwhorecruitsthemost new members will receive a check for $250.00 to be used at their discretion.

We are 1064 members strong but there are many Occupational Health Professionals who may not know about the benefit of AOHP membership.Thereare7000hospitalsintheU.S.

Reach out and share the benefits of AOHP membership and you too can “ROC” someone’sworld!!!!

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Winter 2011

Working During the Pandemic: Fears and Concerns of Health Care Workers

By Linda Good, RN PhD, and Donna L. Agan, EdD

Editor’s Note: Linda Good and Donna L. Agan were awarded the AOHP Julie Schmid Research Scholarship in 2009 for this research paper. The Julie Schmid Research Scholarship was established to encourage, promote and strengthen the knowledge base and expertise of the oc-cupational health professional in health-care. The award has only been granted three times since 2005 and recognizes significant original research projects on current and/or anticipated issues in healthcare-related occupational health. The award is $2,000 and includes pre-sentation of the project for publication in the Journal.

Background and Significance of the ProblemFor years, occupational health profes-sionals have contemplated an impend-ing worldwide influenza pandemic. Most healthcare organizations haveresponded by including a pandemic contingency in their disaster plan. How-ever, traditional disaster plans often as-sume that healthcare workers (HCWs) will report to duty outside their normal working pattern. A review of previous large-scale mass casualty incidents re-vealed a gap between this assumption and the actual intentions of HCWs (Cone & Cummings, 2006; Wong et al., 2010). Thisgapwidenedifthedisasterinvolveda contagious disease component (Irvin, Cindrich, Patterson, Ledbetter & South-hall, 2008; Moore, Gilbert, Saunders,Bryce & Yassu, 2005; Syrett, Benitez, Livingston&Davis,2006).Missingfromthese discussions was an exploration of the added burden of a sustained event as would be experienced in a prolonged biologic disaster, either natural such as an influenza pandemic or a bioterrorism

event related to a weaponized viral or bacterial agent.

Considering the critical role of hospital-based HCWs, O’Boyle, Robertson, and Secor-Turner(2006)studiedthebeliefs,concerns and feelings of nurses who anticipated that they would be expect-ed to work during a biological disaster event. Anticipation of loss of order, loss of security, loss of trust and loss of freedom contributed to HCWs’ fears and concerns. First person accountsof HCWs on duty during actual disas-ters confirmed that these feared loss-es were often very real, reinforcing a sense of abandonment by their hospital organization (Fager,2006;French,Sole&Byers,2002;Mooreetal.,2005;Pow-ell-Young, Baker & Hogan, 2006). As a consequence of these fears, there was areluctancetoreporttowork(RTW)inadisaster (Irvin et al., 2008; Kruus, Karras, Seals,Thomas&Wydro,2007;O’Boyleet al., 2006; Qureshi et al., 2005). Natu-rally, when faced with a disaster, fear and apprehension exist. However, HCWs’ confidence that the organization has addressed these factors may lead toanincreasedwillingnesstoRTW.

Purpose of the StudyThe purpose of this study was to de-termine whether HCWs’ fears and concerns are a predictor of their willing-nesstoRTWduringasustainedbiologicemergency, addressed by the following aims: Aim 1: To quantitatively identify fearsand concerns that HCWs have in regard to working during a sustained biologic emergency. Aim 2:Todevelopandtestaninstrumentdesigned to study the relationship be-

tween these fears and concerns and the HCWs’RTWdecision.

Findingsfromtheuseofthisresearcher-developed (LG) instrument, known asthe Provider Response to Emergency Pandemic (PREP) Tool©, could informthe development of next generation di-saster planning.

Review of the LiteratureLoss in Disaster Disaster and loss go hand in hand; both general phenomena encompass a wide range of traumatic events and experi-ences.Murphy(1989)elaboratedonthisconnection by describing disaster as un-controllable traumatic events that affect individuals in varying degrees as they experience related losses. Traumatic is a key component in this definition, derived from the Latin word for wound. Individu-als experiencing loss associated with disaster events often emerge wounded in body, mind and spirit. Traumatic di-saster has been explored widely by re-searchers and across many disciplines. Studies of World War II and Vietnam veterans illustrated the effect of war-associateddisasterloss(Leifer&Glass,2008;Walsh,2007).Thephenomenaofloss has been investigated in relation to victims of catastrophic natural disas-ters, including earthquakes (Chiang, Lu & Wear, 2005; Sattler et al., 2006), hur-ricanes(Giarrantano,Orlando&Savage,2008),volcaniceruption(Murphy,1989),and fire (Keane et al., 2002). In addition to natural disasters, loss related to inten-tional disasters, such as terrorist attacks, hasbeenexplored(Grieger,Fullerton&Ursano, 2004;Hayward, 2003;Hobfoll,Tracy & Galea, 2006; Riba & Reches,2002). Recovery from disaster loss is a

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long-term process requiring resolution of many physical and psychological fac-tors (Beaton & Murphy, 2002; Hasin,Keyes, Hatzenbuehler, Aharonovich & Alderson, 2007; Holloway, Norwood, Fullerton&Ursano,1997;Norris,2002;Walsh, 2007; Wu et al., 2009).

Healthcare Worker Response to Loss in DisasterMost studies in the area of disasterloss focus on the victims of the disaster event; few explore the loss experienced by HCWs on duty in the disaster’s after-math.Good(2008)bridgedthisgapwitha review of the HCWs’ disaster loss ex-perience, classifying it as Loss of Order, LossofSecurity,LossofTrustandLossofFreedom.

Loss of Order. Numerous variables influ-ence one’s reaction to disaster chaos, including the degree to which the indi-vidual is directly affected by the emer-gency event (Grieger et al., 2004; Lai& Yu, 2010; Lukes, 2002). Even with preparation, disaster response and com-munication challenge hospitals globally (Lukes, 2002;Moore et al., 2005; Riba& Reches, 2002). Concern with the reli-able flow of information during an actual disaster event has been a source of con-siderable anxiety for HCWs, particularly among evening and night shift personnel (O’Boyle et al., 2006). Often changes in in-formation, even if based on progressively more accurate updates, were interpreted as lacking in authority or candor (Iserson &Pesik,2003;Mooreetal.,2005).

Ethical challenges contributed to loss of order as HCWs were confronted with conflicting obligations in allocating lim-ited resources, personnel and time in an emergency. The standard principles ofthe non-crisis nurse-patient relationship (e.g., candor, patient autonomy, equity, justice, beneficence) might require a shift in application within the crisis set-ting.Medicalandnursingcodesofeth-ics fail to provide guidance on what is expected from HCWs during communi-cable disease outbreaks, leaving a pro-fessional commitment to the patient’s wellbeing at odds with safeguarding one’s own wellbeing and the health of family members and friends whom they

fear infecting (American Nurses Asso-ciation, 2001; Ruderman et al., 2006).

Loss of Security and Safety. A hospital’s safety climate is related to employee perceptions of the organization’s over-all commitment to safety and security (Gershonetal.,2000).Potentialforenvi-ronmental safety disruptions and threats to security exist in any type of disaster, whether caused by nature, accident or terrorism. An incident involving a conta-gious biological component intensifies fear for self, family and society (Chaf-fee, 2006; Iserson & Pesik, 2003; Koh et al., 2005; Smith, 2007; Syrett et al., 2006). HCWs experienced work safety concerns related to personal needs, both physical and psychosocial. Disas-ter policies have often failed to include basic provisions for food, water, pillows, bedding, uniforms, hygiene supplies and restneeds (Frenchetal.,2002;McVey&Bertolasi, 2005;Mooreet al., 2005).Other physiologic needs that concerned nurses included the availability of pro-phylaxis and/or antidotes (Gershon,Gemson, Qureshi & McCollum, 2004)and assurance of adequate protection from contamination, infection and injury (O’Boyle et al., 2006).

HCWs reported a lack of attention to their psychosocial needs in past domes-tic disaster events (Beaton &Murphy,2002;Frenchetal.,2002)aswellas ininternational disasters (Chiang et al., 2003;Mooreetal,2005;Riba&Reches,2002). Nurses anticipated a similar lack of provision for psychosocial support in the event of a biologic emergency (O’Boyle et al., 2006). Desired support during the emergency included respite and privacy away from patient care areas and the ability to communicate with loved ones. The opportunity to debrief following adisaster response or to be periodically updated in a prolonged event was ben-eficial for coping.

Loss of Trust. Just as a hospital’s reputa-tion for its safety climate must be estab-lished over time, a facility’s reputation for honesty and transparency must also be based on past performance (Gersohonet al., 2000). Even the most transparent, trusted administration faced communi-

cation challenges in a disaster event. As the disaster unfolded, adjustments and updates to the response plan became necessary. Sometimes these changes were drastic departures from the tra-ditional practice model with which the HCWs were comfortable, such as co-horting patients in the absence of indi-vidual negative pressure isolation rooms or reusing PPE in the event of supply shortages (Lai & Yu, 2010). How the or-ganization conveyed updates during a di-saster reinforced a pre-existing sense of trust or mistrust.

HCWs anticipated that, in the event of a bioterrorism disaster, they would be functioning in a chaotic environment without the presence of hospital admin-istration or a clear chain of command (O’Boyle et al., 2006). HCWs who actu-ally experienced the chaos of disaster response reinforced the need for the vis-ible, reassuring presence of leadership (Frenchetal.,2002;Mooreetal.,2005).The traditional Hospital Incident Com-mand System (HICS) plan gathers the leadership team in a command center to direct operations. While this is a well-respected model, HCWs’ observations emphasized the importance of adminis-trators rotating out of the command cen-ter and into the patient care areas with regularity to demonstrate their support to those providing front-line care.

Loss of Freedom of Choice. The choice toRTW during disasters was influencedby the HCWs’ perceived safety, both in traveling to work as well as in the work-place (Kruus et al., 2007; Qureshi, et al., 2005). Other factors identified as influ-encing the decision to RTW includedconfidence in available PPE, perceived risk of contracting illness, family sup-portiveness, and concerns with being able to perform their job-related duties effectively (Irvin et al., 2008).

Regardless of how stressful a work shift had been, the HCW could look forward to the rejuvenation of going home. Re-alizing the potential for the loss of free-dom to leave the hospital during a disas-ter was disconcerting. While this aspect has not been studied in an actual biologic disaster, O’Boyle and colleagues (2006)

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conducted research on nurses’ antici-pated response to a hypothetical bio-logic disaster scenario. Specific loss-of-freedom concerns included mandatory shifts due to lack of replacement staff. Thefocusgroupnursesanticipatedthatmanyco-workerswould fail toRTWorwould even quit their jobs rather than place themselves in harm’s way.

Another aspect in loss of freedom cen-tered on the concerns of being free to choose between professional and fam-ily priorities. Attending to family safety was the most frequently cited reason for hospital employees being unwilling to report for duty in a disaster (Davidson etal.,2009;Frenchetal.,2002;Mooreet al.; Qureshi, et al., 2005; Riba & Rech-es, 2002). In addition, HCWs expressed anxiety over inadvertently endangering their family by bringing something home that might contaminate or infect their loved ones (Koh & Sng, 2010; Wong et al.,2010).Thepossibilitythatquarantinemight be imposed in an actual exposure, preventing them from returning home, further compounded their concern.

MethodologyDeveloping the New InstrumentQuestionnaires used in previous stud-ies did not adequately meet the goals of this research project, necessitating the development of a new instrument. An expert panel was convened to generate the introductory pandemic scenario, and loss-themed statements were present-ed with a four-point Likert-type scale ranging from strongly agree to strongly disagree. In addition to the concept-relat-ed items, questions were developed to examinedemographic information.The31-item instrument was then pilot test-ed with a cross-sectional convenience sample of 452 HCWs over a three-month period at one hospital campus. Descriptive statistics, reliability assess-ment, correlations and exploratory factor analysis were used. All items retained in thefinalPREPTool©demonstratedreli-ability (Cronbach’s alpha reliability coef-ficient .81-.85) and significant correlation withtheRTWresponse(Spearman’srho[ρ]; p < .001). Exploratory factor analysis was useful in constructing themes and in evaluating item retention.

Survey AdministrationBased on psychometric evaluation, the original PREP Tool© was refined to a28-item instrument and converted to an electronic survey using Zoomerang™. In September 2009, announcements were electronically transmitted to all hospital employees at five urban campuses in the southwestern United States. Par-ticipants had the option of faxing a com-pletion certificate to enter five weekly incentive drawings for a home disaster-preparation kit. Data were collected elec-tronically, analyzed using the Statistical Package for the Social Sciences (SPSS), version 12.0, and reported in aggregate.

ResultsA total of 1,645 hospital employees com-pletedat leastpartofthePREPTool©,with good representation across hospi-tal sites. Analysis of fears and concerns expressed by all respondents resulted in several recurring themes.

Availability of antiviral medications. Find-ings indicated a significant positive cor-relation between antiviral availability and theRTWquestion(ρ = .561, p < .001). Themorestronglyanemployeebelievedthat antiviral medications were available, themorelikelytheywouldRTW.Signifi-cant, but slightly lower correlation was seeninRTWevenifantiviralswerenotavailable (ρ = .487, p < .001).

Family responsibilities. Sense of duty to familywasanimportantfactor.Theabil-ity to adjust family needs to maintain job responsibility strongly correlated with RTW (ρ = .524, p < .001). Being re-quired to stay at work beyond their usual shift (ρ = .535, p < .001) was a concern among those disagreeing with the state-ment that theywould RTW (No-RTW),likely related in part to family duties (MannWhitneyU=40642.5,p<.001).

Knowledge base. Adequate understand-ing about pandemic influenza correlated withtheRTWdecision.Thosewhofeltwell-informed expressed a sense of confidence in carrying out their regular job duties and indicated that they would RTW (ρ = .445, p< .001). Thosewhowere not confident in their knowledge base were significantly less likely to

RTW(MannWhitneyU=42953.0,p<.001).

Trust in co-workers. While 92 percent saidthattheywouldRTWasusual,only73 percent believed their co-workers woulddo thesame.Thisdisparitysug-gests doubt that in an emergency others would“watchtheirback”.Trust(ormis-trust) in the intention of their colleagues correlatedwiththeirownRTWdecision(ρ = .461, p < .001).

Safety concerns. A number of safety fac-tors emerged as areas of concern to par-ticipants, as indicated by low agreement scores (although overall average was above neutral). Some participants indi-cated unease with the hospital’s ability to remain secure if there was chaos and rioting in the community. Concern with being able to safely travel to and from work was found to have a strong corre-lationwiththeRTWdecision(ρ = .536, p < .001). While those agreeing with theRTWstatement(Yes-RTW)believedthe hospital had the supplies needed to manage a large patient surge, uncertain-tywasexpressedbytheNo-RTWgroup(ρ=.299,p=.002;MannWhitneyU=51045.0, p < .001).

Dealing with death. The following sur-vey item elicited strong reaction: I will be able to work despite having people I know personally (e.g. friends, co-work-ers) die as a result of this disaster. Manyexpressed concern with this issue as evidenced by lower agreement scores (although the overall average was above neutral). In addition, this item stood out as an area of trepidation among those whoindicatedthattheywouldnotRTWasusual(MannWhitneyU=37956.0,p< .001).

Strongest AgreementThe survey item with the strongestagreement among participants was, A safe work environment is a priority in our hospital. The intensity of responseto this item also strongly correlated to the intensityof theRTWdecision (ρ = .401,p<.001).Thefollowingitemsarealso highlighted because of the strength with which employees agreed to these statements:

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•Mysenseofdutytomyfamilyisanim-portant factor in my decision whether or not to report to work.

• Hospitalleadershipvaluesmysafety.• Iwillreporttoworkifthereisaneffec-

tive antiviral medication available.• Iwillreporttoworkasusual.

Lowest AgreementStatements with the least agreement, although with an overall average above a neutral response, were as follows start-ing with the weakest agreement:• Iwill still come toworkeven if anti-

viral medications are not available for my protection.

•Mostofmyco-workerswill reporttowork as usual.

• Iwill beable toworkdespitehavingpeople I know personally (e.g., friends, co-workers) die as a result of this di-saster.

• Thehospitalhasaplanandallneededsupplies in place to manage a large in-crease in the number of patients.

• Thehospitalwillremainsecure,evenif there is chaos and rioting in the com-munity.

Report to Work Correlations In addition to providing basic safety, other issues emerged as important to employees. The following items arehighlighted because of their strong cor-relationwiththeRTWdecision:• It is acceptable tome that Imay be

required to stay at work beyond my usual shift (ρ = .535, p < .001).

•My sense of duty to my patients isan important factor in my decision whether to report to work (ρ = .531, p < .001).

•My sense of duty to my hospital isan important factor in my decision whether to report to work (ρ = .530, p < .001).

Concerns of the No-RTW GroupWhile gratifying that the vast majority of the employees surveyed indicated that they would set aside fears and report to work as usual, examining the responses of the seven percent (n = 108) who indi-catedthattheywouldnotRTWasusualprovided insight and perspective into is-sues of highest concern:• Iwill still come toworkeven if anti-

viral medications are not available for my protection.

•Mostofmyco-workerswill reporttowork as usual.

• Iwill beable toworkdespitehavingpeople I know personally (e.g. friends, co-workers) die as a result of this di-saster.

• I will be able to safely travel to andfrom work during a pandemic.

• It is acceptable tome that Imay berequired to stay at work beyond my usual shift.

•My current knowledge of pandemicflu gives me a sense of confidence that I can do my regular duties under these circumstances.

• I believe that I will be able tomakenecessary adjustments in meeting my family needs to maintain my job re-sponsibilities.

Respondent Characteristics in Relation to RTW DecisionToexploretheroleof respondentchar-acteristics in theRTWdecision, appro-priate statistical testing was done. Re-sponses were no different between the Yes-RTWandtheNo-RTWgrouprelatedto gender, job category, work shift, years in the profession, years working at the facility or pets in the home. While sta-tistically there was no difference in the RTWdecisionbyage, ninepercentofGeneration X (32-43 year olds, n = 35 out of 390) responded with No-RTW,but all of the 30 people reportedly over 75 years of age reported that they would RTW.

Several respondent characteristics did result in a statistically significant dif-ference in the RTW decision. Respon-dents with minor children in the home were more likely than expected to say noonRTW,whilethosewithnominorsat home were less likely to respond No-RTW.Employeeswhohadadultdepen-dents at home were also more likely to sayno to theRTWstatement. In addi-tion, exempt employees were signifi-cantlylesslikelytorespondNo-RTW.

ConclusionsPerhaps the most distinguishing aspect of this study was its timing, studying pandemic fears and concerns during an

actual worldwide influenza pandemic. At the time of data collection (September 2009), local, national and international media coverage of the H1N1 influenza pandemic was pervasive. Hospitals had experience with gravely ill H1N1 pa-tients, giving HCWs their first encoun-ters with the novel virus. H1N1 influenza vaccination was being urged; however, supplies were delayed, adding an ele-ment of frustration and concern. At the timeofthePREPTool©survey,theactu-al impact of the pandemic was unknown and unfolding daily.

The purpose of this study was not topredict howmany people would RTWin a pandemic event, as a multitude of facts and emotions figure into the de-cision of how one reacts in a disaster. One 28-item survey tool cannot possibly encompass all facets of this complex decision. Instead, this study aimed for greater insight into the apprehensions of HCWs and analyzed the difference between those who intended to RTWand those who could not overcome their fears and concerns.

Key Findings • Fearsandconcernsexist.• Despiteconcerns,most felt that the

hospital was committed to their safe-ty.

• Asaresult,92percentsaidthattheywouldRTWasusual.

Implications for Occupational Health ProfessionalsAlthough many aspects of disaster defy predictability and are out of one’s con-trol, HCWs’ anticipation of such an event with fear of abandonment and refusing to report to work need not be inevitable. Currently, a deficit exists between quali-tative understanding of this issue and quantitative evaluation. The PREP Toolbridges this gap, providing an instru-ment that can be used by hospitals to assess their employees’ concerns and intentions. Results could be beneficial to theorganizationsinseveralways.First,identifying specific areas of confidence (or lack of confidence) in HCWs’ percep-tions of existing disaster plans could pro-vide opportunities for evidenced-based strategic planning. Second, channeling

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resources and education toward actual identified needs could result in a more focused and practical disaster response plan. A third implication for practice is the opportunity to gain measurable insight into predictors of the report-to-work decision. This information couldallow hospitals to mitigate factors that they can influence and plan for around factors that theycannot.This iscrucialin any disaster event, all the more so in a sustained disaster scenario such as an influenza pandemic. Acting upon the in-sightsgainedfromaPREPToolassess-ment could result in a stronger, more achievable disaster plan carried out by a loyal, more confident staff, resulting in a safer, more protected community. ReferencesAmerican Nurses Association (2001). Code of ethics for nurses with interpretive statements. Washington, DC.

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