CLINICAL OCCUPATIONAL HEALTH
The nurse’s role in workplace assessment Christine Meusz RON. is Nursing Adviser (Assessment), Employment Medical Advisory Service, Health and Safety Executive, Birmingham.
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Christine Meusz (and friend): Employees must be made aware of the potential problems in the workplace and taught how to use their equipment, and their own bodies, safely and effectively.
N E IL O 'C O N N O R
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In September 1991, the Health & Safety Executive (HSE) launched its biggest ever national aware ness campaign relating to health at work.. Called ‘Lighten the Load’, the campaign aims to raise awareness ofwork-related musculoskeletal disorders and encourage employers to reduce thefrequency with which they occur. Occupational health nurses are ideally placed to play a major and active part in the campaign and assist in increasing awareness in both employers and the workforce.
The role of the occupational health nurse (OHN) has changed and extended in recent years, moving away from a purely treatment model to encompass all those factors which affect the health of people at work (1). Defining the extended role of the OHN, the Royal College of Nursing stresses the funda mental principles of prevention of disease or
injury arising through work activity, and the promotion of health of all workers (2). Working alone or as part of a team which includes other professionals such as doctors, hygienists and safety officers, the OHN usu ally performs many functions including assessment of hazards in the workplace and monitoring of the control measures to ensure their continued effectiveness. OllNs need to be familiar with the princi ples of the wide ranging health and safety legislation which already exists and is being constantly reviewed and updated. Further leg islation is proposed as a result of the issue of several European Directives on health and safety, which are due to come into force at the end of 1992. The Health and Safety Execu tive’s (HSE) ‘Lighten the Load’ campaign addresses particularly the directives concernAugust 26/Volume 6/Number 49/1992 Nursing Standard 29
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CLINICAL OCCUPATIONAL HEALTH
Males •
1
c
U
________________
P e r c e n ta g e
Females
20
10
'
Fig. 1. Males/females - days certified absence due to
196 2/3
musculoskeletal disorders
1976/7
1971/2
1966/7
1982/3
1986/7
Years
(millions) ing manual handling of loads, work with dis
joints and skeleton. They can affect any part
play screen equipment and the use ot work
of the body but the most common sites are the
equipment.
back and upper limLss.
A common problem Work related musculo
The work processes most likely to con
skeletal disorders are by no means a new
tribute to the development of such disorders
problem,
are incorrect methods of manual handling and
having
been
first
described
by
Ramazzini almost three centuries ago. He
lifting, frequent repetitive movements against
referred
irregular
resistance and unsuitable post ures. Methods of
motions and unnatural postures of the body,
payment for work, such as piece-work or where
to
‘certain
violent
and
which could cause serious disease and injuries.
bonuses arc paid when high levels of output
In recent years there has been evidence of
are achieved, may also contribute to the prob
an increase in the prevalence of musculo
lem. No industry could be said to be without
skeletal disorders in a wide range of industries
risk of these disorders occurring, but signifi
(Fig. 1). In 1989/90, 30 per cent of all acci
cant measures can be taken to reduce them.
dents and injuries reported to the enforcing
In affected individuals, the signs and symp
authorities under the Reporting of Injuries,
toms to look for include discomfort, soreness
Diseases & Dangerous Occurrences Regul
and stiffness, pain, swelling, numbness, tin
ations (RIDDOR) fell into this category (3).
gling and functional disability. It is important
Estimates of the size of the problem vary, but
to remember, however, that in the early stages,
the most recent annual figures show that a
there may be no outwardly visible sign that
staggering 52 million working days were lost
anything is wrong.
through back problems alone.
A detailed history of social and occupation al activities which have resulted in the onset of symptoms may indicate that a work-relat
Cost to the NHS
ed musculoskeletal disorder has occurred, but
Costs to the employer are also considerable in
care must be taken to exclude possible under
terms of the loss of skilled and experienced
lying causes such as arthritis.
workers, lost production and claims in the
Referral The diagnosis should be confirmed,
civil courts. Added to this is the pain and suf
preferably by an occupational physician or,
fering
to the
where no such arrangements exist, by the
National Health Service of investigations and
employee’s general practitioner (GP). When
treatment and the costs of rehabilitation or re
referring the employee to his or her own doc
of the
individual,
the cost
training. Prevention, therefore, is the first line
tor, the OHN should ensure that the GP is
of defence.
aware that a work-related cause is suspected.
Causes of muscoskeletal disorders The term
As part of the campaign, HSF. has issued
‘musculoskeletal disorders’ includes a variety
guidance to GPs on musculoskeletal disorders.
of conditions affecting the muscles, tendons,
Early diagnosis and appropriate action may
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CLINICAL OCCUPATIONAL HEALTH prevent an individual’s problem becoming chronic and disabling. As a result of employee referrals, workplace visits and talking with employers and safety representatives, the OHN may be the first to recognise that the company has a potential problem. He or she can then work with man agement to carry out an assessment of the workplace, assessing each work activity to determine the potential health risks.
Sources of trouble Work involving manual handling, carrying, pushing, pulling, adopting awkward pos tures, bending, and working in restricted spaces could all be potential sources of trou ble. The introduction of new activities, changes in working methods and increases in production may all increase the risk and war rant a reassessment, even where no problems have been evident in the past. The USE has drawn up guidance on assessing seating at work (4) and avoiding upper limb disorders (5), both of which are extremely useful. Assessment in the workplace The OHN can further assist management in the assessment process by reviewing employees' occupational health records which note problems that have occurred in the workplace. A reporting system should be set up for VDU operators are at risk of developing back and neck injuries as a result of poor posture, and upper limb disorders due to prolonged periods of keyboard work.
3
r.
musculoskeletal disorders to ensure that they are entered in the accident book. While remaining mindful of a nurse's professional duty to maintain client confidentiality, the review of employees' health problems and accident statistics should be an ongoing process, producing information which can be used as a tool for evaluating the effectiveness of any control measures introduced. Once an assessment has been carried out and potentially hazardous activities identified, steps should be taken to reduce the risk. It may be necessary for an employer to consider redesign of the workstation or process and this may require expert advice from, for example, an ergonomist. Other control measures could include the introduction of mechanical aids, changes in the pattern of rest breaks or job rotation. The OHN, or the employer, may find it useful to contact HSE’s Employment Medical Advisory Service (EMAS) who might have advised on a similar problem elsewhere. Control measures should be monitored and the OHN can play a significant part in this process using observational skills and clinical knowledge as well as reviewing records. A summary of a workplace assessment and inter vention schedule is given in Eig. 2. Confirmed diagnosis Where a diagnosis of work-related musculoskeletal disorder in an
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£8 I & Av
t -s,
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CLINICAL OCCUPATIONAL HEALTH
Systematic assessment ▼
Musculoskeletal problems
▼
Undertake informal discussions with management/workforce
i
Significant problems likely?
▼
Review medical information (if available) initiate health survey
Carry out detailed job/task
Health problem Describe the particular problem. Specify risky job/task components. Identify anatomical sites/nature of disorder
Select appropriate and practicable intervention methods
i
Design an intervention strategy: consult/involve workforce as appropriate. Consider retraining needs
i
Implementation: on trial/pilot basis - full scale
t
Monitor effectiveness
Fig. 2. Workplace assessment and intervention schedule
Review periodically
Scource: HSE
employee is confirmed, che OHN has an
important. They must be made aware of the
important role to play in the management of
potential problems and taught how to use
the individual. Temporary restriction on work
equipment, and their own bodies, safely and
activity may be advised, although it may be
effectively. Training in correct lifting and
possible to keep the employee at work if suit
handling techniques is essential for workers
able alternative duties are available.
involved with the movement of heavy or awkward loads. Other groups have their own special needs. Visual display unit (VDU) oper
Great benefit
ators, for example, are at risk of developing
Close liaison between the employer and the
back and neck injuries as a result of poor pos
occupational health department will be of
ture, or upper limb disorders due to prolonged
great benefit to all concerned. In some cases,
periods of keyboard work.
even with job adaptation, it may not be pos
Similar disorders may occur in assembly
sible for the employee to continue in his or her
workers, particularly those who receive pro
job and the OHN should be aware of the
ductivity bonuses as an incentive for output.
assessment, rehabilitation and retraining ser
Employees should
vices
the
their employer has a duty under the Health
network of local
and Safety at Work Act 1974 to ensure their
teams of employment services staff can pro
health and safety, they too have a responsibil
available
through
employment services.
contact
A
with
understand
that,
while
vide specialist advice to both employers and
ity to co-operate with training and health and
References
employees.Occupational assessment for alter
safety
1. Harrington J M, Gill I' S. Pocket Consultant - Occupational Health. Oxford, Blackwell Scientific Public
native work areas can be carried out to assist
guidance booklets are also available, one for
ations. 1992. 2. RCN Society of Occupational Health Nursing. /\ Guide to an Occupational Health Nursing Service - A Handbook for Employers and Nurses. Harrow, Scutari Press. 1991. 3. Health & Safety Executive. Reporting an Injury or a Dangerous Occurrence. London, HMSO. 1986. 4. Health & Safety Executive. Seating at Work. London, HMSO. 1990. 5. Health & Safety Executive. Work Related Upper Limb Disorders: a Guide to Prevention. London, HMSO. 1990.
initiatives. Two ‘Lighten the Load’
in resettlement or, in some cases, aids can be
employers and the other for employees, which
provided which will enable the employee to
can be obtained free of charge from the HSE.
continue in his or her present job. These ser
The doctors and nurses of EMAS are actively
vices are available free of charge and referral is
involved in the promotion of this campaign
via the Disablement F.mployment Adviser
and will be happy to provide support and assis
(formerly Disablement Resettlement Officer)
tance to occupational health staff.
at the local Job Centre. The 'Lighten the Load’ campaign may pro
EMAS professional staff are also available to give presentations about the campaign in sup
vide the basis for a formal workplace health
port
promotion programme aimed at reducing the
wishing to obtain help or advice should con
incidence of musculoskeletal disorders with
tact
in the company.
telephone number is listed in the directory
Education and training of workers at risk is
32 Nursing Standard from AugustRCNi.com 26A'olume 6by Number 39/1992 Downloaded ${individualUser.displayName}
of workplace their
local
initiatives
EMAS
and
area office
OHNs -
under Health & Safety Executive.
on Sep 22, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
the