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.

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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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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

Occupational health: the nurse's role in workplace assessment.

In September 1991, the Health & Safety Executive (HSE) launched its biggest ever national awareness campaign relating to health at work. Called 'Light...
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