Promoting and Protecting the Health of Adult Women and

Men and Occupational Health

Promoting and Protecting the Health of Adult Women and

Men and Occupational HealthAllender and Spradley - Chapter 29

ObjectivesObjectives• Identify key national and global demographic characteristics of women and

men throughout the adult life-span

• Provide a health profile of adult women and men in the United States

• Identify desirable primary, secondary, and tertiary health promotion activities designed to improve the health of women and men

• Identify potential physical, chemical, biological, ergonomic, and psychosocial stressors in a variety of work environments

• Describe the history of state and federal regulation related to the health of women and men in the occupational setting

• Discuss a variety of occupational health problems, including disorders related to ergonomics and workplace violence

• Compare and contrast three main types of occupational health programs

• Describe the role of the occupational nurse and other members of the occupational health team in protecting and promoting worker’s health and safety.

History of Adult HealthHistory of Adult Health• Men were traditionally the dominant gender

and the focus of health-related research

• Women’s health advanced since the Women’s Health Movement (WHM) of the 1960-70s

• More males die at birth than females, they die earlier from chronic diseases, a greater number commit suicide, and die in vehicular crashes

• Life expectancy has increased consistently over time with females living an average of 8 years longer

Health Profile (Women and Men)Health Profile (Women and Men)

• Teenaged (12-18) - tasks include: physical growth (puberty and menarche), emotional (risk-taking) and developmental (vocational goals, personal identity, body image, sexuality, and disengagement from family); health attitudes and practices start here

• Young adult (18-35) - developmental tasks include establishment of home and long term relationship, planing for children or not, choosing life’s work, and developing a life philosophy and value system

Health Profile ContinuedHealth Profile Continued

• Adult (35-65) - experience mid-life reappraisal and preparation for retirement; chronic illnesses are related to lifestyle choices; females experience menopause

• Mature Adult (65-85) - tasks include managing financially, coping with losses, and finding meaning, satisfaction, support and comfort in remaining years

• Expert Adult (85+) - are survivors with health issues related to safety, housing needs, and socialization

Health Promotion ActivitiesHealth Promotion Activities• Primary - education on safety, illness

prevention (immunizations), use of safety devices and balancing work with leisure or home responsibilities

– Focus on community aggregate needs

• Secondary - screenings and programs (TB skin tests, B/P screening, breast cancer or prostate)

• Tertiary - chronic disease and illness programs to prevent disability

Major Health Problems of AdultsMajor Health Problems of Adults

• Highest mortality conditions - coronary heart disease, cancers (lung and reproductive) stroke, chronic obstructive lung disease, and unintentional injuries, diabetes, pneumonia, Alzheimer’s, liver and kidney disease, HTN

• Major chronic conditions - Diabetes, substance abuse, obesity, chronic lung disease, osteoporosis

• Violence - suicide and homicide

Occupational HealthOccupational Health

• Occupational health - a specialty health practice, focuses on the health and well-being of the working population, includes both paid and unpaid laborers

• The profile and the environment of the workplace is changing from is changing from an industrialized labor force to white-collar workers and professionals

Potential Work StressorsPotential Work Stressors

• Physical - structural elements like temperature and noise extremes

• Chemical - presence of potentially hazardous agents and their toxicity

• Biological - organisms that contaminate the work environment

• Ergonomic - customs, design, and expectations of the job that influence interactions

• Psychosocial - workers’ feelings and behavior

Significant Health LegislationSignificant Health Legislation

• 1970 Occupational Health & Safety Act - protects against personal injury and illness from hazardous working conditions and enforces standards

• 1986 Hazard Communication Act - known as the worker right-to-know legislation

• 1990 Americans with Disability Act - a civil rights law to prevent discrimination against qualified workers with disabilities

OSHA and NIOSHOSHA and NIOSH

• Federal agencies created by the Occupational Health & Safety Act

• the Occupational Safety and Health Administration - promotes and protects worker safety and health through regulation, consultation, training, and outreach

• National Institute for Occupational Safety and Health - part of the CDC and is responsible for research

Work Related Health ProblemsWork Related Health Problems

• Occupational disease - any condition or disorder that results from an exposure that resulted from employment (lung disease, injuries, and cancers)

• Ergonomics - related to increased technological environments and computers

• Emotional - job stress, mental pressures, and emotional disturbances

• Violence - homicides and disgruntled employee syndrome

Occupational Health ProgramsOccupational Health Programs

• Goals - to maintain a healthy, productive workforce by providing a safe and healthy work environment and promoting healthful personal behavior

• Assess workers and workplace and identify sub-populations at risk to institute programs for: disease prevention, protection, health promotion (employee assistance), and health services (non-occupational)

The Occupational Health NurseThe Occupational Health Nurse• Activities - emergency care and nursing of ill

employees, as well as assessment, counseling, and education on safety, hygiene, nutrition, and improvement of working conditions

• Skill training - Identifying and managing of the physical, chemical, biologic, ergonomic, and psychosocial factors

• Roles are unique and the team may include safety engineer, industrial hygienist, epidemiologist, toxicologist, and/or occupational physician

Future Trends and IssuesFuture Trends and Issues

• Financial issues include decreased economy with increased competition and health care costs, coupled with increased technology and hazards

• Future nursing roles may include: analyzing trends and developing programs and services that are efficient and cost effective

Promoting and Protecting the Health of Older Adults:

Aging in Place

Promoting and Protecting the Health of Older Adults:

Aging in PlaceAllender and Spradley - Chapter 30

ObjectivesObjectives• Describe the global and national health status of older

adults

• Identify and refute at least four common misconceptions about older adults

• Describe characteristics of healthy older adults

• Provide an example of primary, secondary, and tertiary prevention practices among the older population

• Discuss four primary criteria for effective programs for older adults

• Describe various living arrangements and care options as older adult age in place

• Describe the future of an aging America and the role of the CHN

Global Health StatusGlobal Health Status

• 420 million people worldwide > 65 years of age

• Death rates have fallen

• Countries with 16% > 65 years include Italy, Sweden, Norway, Greece, Belgium, Spain, Bulgaria, Japan, Germany, France, and United Kingdom.

• Women outlive men by 6 years

• 2050 the world population will be 8.7 billion

World Population Growths 1800-2050World Population Growths 1800-2050

National Status of 65+ AdultsNational Status of 65+ Adults

• Large and fastest growing population group

• Life expectancy: women (80), men (74)

• Challenges: to maximize independence, continue societal contributions and maintain quality of life

• Problems: fixed incomes, increased chronic disease and disability, decreased functional capacity, and ongoing losses

• Health care adjustments: greater protective and preventive services are required due to economic, environmental, and social changes

United States Population StatisticsUnited States Population Statistics

Myths and MisconceptionsMyths and Misconceptions

• Stereotyping older adults and perpetuating false information and negative images and characteristics regarding older adults is called ageism

• Myth: Older adults cannot live independently Fact: 94% live in the community

• Myth: Chronological age determines oldness Fact: Aging is individualized relative to holistic parameters, genetic traits, and life experiences

Myths and Misconceptions 2Myths and Misconceptions 2

Myth: Elderly have diminished intellectual capacity

Fact: intelligence, learning ability, intellectual and cognitive skills do not decline with age, but are influenced by risk factors

Myth: All older people are content and

serene

Fact: advancing age brings increased

Problems for harassment and worry

Myths and Misconceptions 3Myths and Misconceptions 3• Myth: Older adults cannot be productive or

active

Fact: If healthy they remain active in retirement activities or continue to work

• Myth: All older adults are resistant to change Fact: learning depends on personality traits or, sometimes, on socioeconomic difficulties

• Myth: Social Security won’t be there for me Fact: the schedule needs adjustment, but present revenues can last at 75% disbursement of benefits for the next 75 yrs

Characteristics of Healthy Older AdultsCharacteristics of Healthy Older Adults

• A lifetime of healthy habits and circumstances

• A strong social support system

• A positive emotional outlook (personality traits, adaptability, resourcefulness, and optimism)

• Ability to function (physical health and activity)

Prevention StrategiesPrevention Strategies

• Primary - providing health education, supporting sound personal health practices and adhering to immunization schedules

• Secondary - encouraging routine screening for diseases (hypertension, cancer, anemia, depression and glaucoma) and establishing programs based on demographics

• Tertiary - follow up and rehab for chronic diseases that are common among older adults (CHF, emphysema, Alzheimer’s, arthritis, depression, diabetes, and osteoporosis)

Needs of the ElderlyNeeds of the Elderly

• Physical - nutrition, exercise, independence

• Psychosocial - love and belonging (companionship), self-esteem, and self-actualization (life purpose), multiple losses

• Safety - personal (use of drugs and immunizations), home (falls), community (pedestrian and driving, crime, environmental exposures)

• Spirituality and Advance directives

Assessment ToolsAssessment Tools• OARS Mental Health Screening Questions

and the OARS Social Resource Scale

• Capacity for Self-Care Index

• The Barthes Index for functional functional independence

• The Katz Index of ADL

• The Instrumental Activities of Daily Living Scale

• Ability to Perform Work-Related Activities survey

Criteria for Effective ProgramsCriteria for Effective Programs

• Service is comprehensive (financial, prevention, education, in-home, recreation, and transportation)

• System is coordinated (multi-service agencies for information and referral)

• Programs are accessible (conveniently located and affordable)

• Quality programs are promoted

Care OptionsCare Options• Adult day care provides social activities, nutrition,

nursing care, and physical and speech therapies

• Home care services include skilled nursing care, psychiatric nursing, physical and speech therapies, homemaker services, social work services, and dietetic counseling

• Hospice care offers support services for the dying

• Respite care gives temporary institutional housing for the elderly while caregivers take a break

Living ArrangementsLiving Arrangements

• Skilled nursing facilities -both nursing and personal care (non-skilled or custodial care)

• Long-term care facilities - care at different stages of dependence for extended periods

• Intermediate care facilities - less costly, provide less skilled health care

• Personal care homes - basic custodial care

• Group homes - alternatives for specific (alcoholic, mentally ill) elderly populations

• Continuing care centers - all levels (total care)

Role of the NurseRole of the Nurse

• Keep abreast of new developments, programs, regulations, and social and economic forces and their impact

• Be proactive, designing interventions that maximize resources and provide benefits

• Educate the elderly about health conditions, safety, and use of their medications

• Support healthy lifestyles and prevent accidents

Vulnerable Aggregates: Rural Health Care

Vulnerable Aggregates: Rural Health Care

Allender and Spradley - Chapter 31

ObjectivesObjectives• Define the term rural

• Discuss population characteristics of rural residents

• Identify at-risk populations of rural residents

• Describe five barriers to health care access for rural clients

• Discuss how the terms out-migration and in-migration relate to the population trends associated with rural communities in recent decades

• Relate the broad objectives of Healthy People 2010 to the concept of “social justice” in rural communities

• Discuss activities to assist in the orientation of a new community health nurse to a rural community

• Compare and contrast the “circle of formal support” and the “circle of informal support” themes apparent in rural communities

• Discuss challenges and opportunities related to rural community health nursing practice.

Status of CommunitiesStatus of Communities

• Rural - fewer than 10,000 residents with population density of fewer than 1,000 persons per square mile

• Frontier area - sparsely populated places with six or fewer persons per square mile

• Health professional shortage areas (HPSAs) - urban or rural geographic areas, population groups, or facilities with shortages of health professionals

More Status TermsMore Status Terms• Urban - densely settled territory

– Urban Areas (UA) contain 50,000 or more people

– Urban Clusters (UC) have at least 2,500 people but fewer than 50,000

• Statistical areas - newer term

– Metropolitan have at least one UA with population of at least 50,000

– Micropolitan have at least one UC of at least 10,000 but less than 50,000

Rural Population CharacteristicsRural Population Characteristics

• In rural areas: poverty is common, residents are more likely to be older and less diverse, less educated and usually work at minimum wage jobs

• Each rural community is unique, and populations differ in: age and gender, race and ethnicity, education, income and occupation

• Populations change by out-migration, in-migration and by births

At Risk PopulationsAt Risk Populations

• Problems are compounded by limited access to health and social services

• Factors: Limited transportation, few shelters and housing alternatives, limited work opportunities, and job hazards

• Some at risk populations include: Homeless families, Perinatal clients, Elderly, Mentally Ill, Native Americans, and Agricultural farm workers

Barriers to Health CareBarriers to Health Care

• Self-management of health care problems via folk treatments and home remedies

• Cost, travel, weather, and distance are barriers to obtaining health services as are limited choices of formal health are providers

• Home health care (HHC), when available, supports self-management, but requires more time because clients are more ill

• Lack of insurance and/or problems implementing the Managed Care model

New ApproachesNew Approaches

• Access to care is a social justice issue

• Use of mobile health clinics for health screenings, immunizations, and other service delivery

• School based clinics - affordable, and culturally acceptable care, conveniently located

• Telehealth - electronically transmitted clinician consultation between the client and the health care provider

Rural Nursing OrientationRural Nursing Orientation• Start without preconceived ideas

• Assess people, places, and activities at different times of day and use your senses

• Identify key informants and talk with them

• Review demographic data (morbidity and mortality statistics) for the locale

• Determine potential strengths and problems

• Verify your impressions with community members and health care providers

Description of Rural Nurses Description of Rural Nurses

• Active members of the community and highly respected professionals (always on duty)

• Use the levels of primary, secondary, and tertiary prevention in their practice

• Autonomous, lower pay scale, may be isolated

• Roles include: advocate, coordinator/case manager, health teacher, referral agent, mentor, change agent/researcher, collaborator, activist

• Their rural system may be smaller and slower

Migrant and Seasonal Farmworkers

Migrant and Seasonal Farmworkers

Allender and Spradley - Chapter 33

Objectives Objectives• Discuss the historical background of migrant workers including their

demographics and patterns

• Describe the migrant lifestyle

• Explain how hazardous living and working conditions contribute to migrant worker’s increased risk for health problems

• Identify at least three health problems common to migrant workers and their families

• Describe social issues resulting from the migrant lifestyle

• Discuss barriers and challenges to migrant health care

• Identify methods for effective health care delivery to migrant populations

• Discuss goals and implications for effective health care delivery to migrant populations

Background and DemographicsBackground and Demographics

• Migrant farmworkers endure backbreaking, menial labor for low wages, often deprived of basic rights to safe working conditions, adequate sanitation, decent housing, education for children, and health care

• Most are from undeveloped countries and Mexico, some are legal residents, others undocumented

• The Bracero Agreement of 1942

• Migrant Health Act of 1962

• Cesar Chavez and the United Farmworkers

Migrant LifestyleMigrant Lifestyle

• Homebase - a permanent residence

• Seasonal farmworkers live in one location and labor in the fields of that particular area

• Three major migrant streams - migrant farmworkers travel, usually state to state, following the harvest seasons, usually along predetermined routes

• Seasonal harvesting occurs from June to September, 8 weeks is spent traveling, and the rest of the time there may be no employment

Migrant Lifestyle 2 Migrant Lifestyle 2 • Migrant laborers travel in crews, family units

with women and children, or “solos,” (single men) and crew leaders negotiate for work

• Migrant workers often drive night and day as they move from crop to crop

• A migrant farmworker may earn as little as 40 cents per 5-gallon bushel of harvested crops

• Children are often neglected, left to play in fields, in cars or boxes, or stranded in camp with one young female to watch everyone

Migrant Health RisksMigrant Health Risks

• Mortality rates, including infants, are increased, life expectancy is reduced (49)

• Abysmal conditions, occupational injuries, and pesticide poisoning affect health

• Work in all weather extremes and neglect of minor injuries because leaving work means loss of pay

• Housing is substandard or not provided, pests abound, sanitation facilities and fresh drinking water often are not provided

Common Health ProblemsCommon Health Problems

• Correlated with poverty, mobility, poor nutrition, neglect, crowded housing, and occupational hazards

• Most frequent problems: nutritional deficiencies for all ages, urinary tract infections, diabetes, dental caries, skin infections, and head lice

• High incidence of communicable diseases, drug and alcohol use, prostitution, TB, and AIDS

Barriers and Challenges to Care Barriers and Challenges to Care

• Barriers to primary health care access are isolation, powerlessness, economics, limited health resources, language, and culture

• Lack of trust, fear of deportation and job loss, inability to obtain medicaid or insurance because of residency requirement are other challenges

• Mobile lifestyle makes long-term health goals difficult to establish and long-term follow-up of any chronic illness doubtful

Improvement of Health Care DeliveryImprovement of Health Care Delivery• Evaluating existing services, improving,

advocating, and networking

• Practicing cultural sensitivity

• Using lay personnel for community outreach (camp health aids)

• Utilizing unique methods of health care delivery (Mobile health vans, migrant ministries)

• Employing information tracking systems (HEARTFAX and MSRTS)

Goals and ImplicationsGoals and Implications

• Goals include the promotion of better health, fewer risk factors, increased awareness, and improved services

• Objectives include improvement of nutrition, immunization, occupational safety, prenatal care, dental health, preventive services, and medical records; and reduction of drug and alcohol abuse, violent behavior, mental illness, adolescent pregnancy, and HIV transmission