Complexity of occupational exposures for home health-care workers: nurses vs. home health aides

The reality of occupational harm incurred by Japanese home health care nurses, the hazardous situations they face, and protective measures: a cross-sectional study

Objectives: To gain a comprehensive understanding of the occupational hazards encountered by home health care nurses in Japan and to elucidate the reality of harm they incur, the hazardous situations, and the protective measures taken.

Methods:A questionnaire survey of managers of home health care nursing agencies in Japan was conducted, and 355 valid responses were obtained. The survey questions concerned the occupational hazards experienced by home health care nursing staff. The occupational hazards were classified into 6 categories, and responses were obtained regarding harm, hazardous situations, and protective measures in each category.

Results: The types of harm that occurred at highest rates during the previous 3 years were emotional abuse by the patient or their family members, lower back pain resulting from improper posture while providing care, sexual harassment by the patients and their family members, automobile accidents while traveling to home care sites, and allergic reactions to the environment at home care sites. Some hazardous situations were caused by the unique environments of home care sites.

Conclusions: In order to prevent the occurrence of harm, the development of risk assessment tools, educational initiatives to increase awareness of occupational hazards, and consideration of the financial and technical support that will enable the use of assistive devices in the practice of nursing techniques were considered necessary. The development of effective guidelines and manuals specific to the occupational hazards encountered by home health care nurses is an important challenge.

National Estimates of Home Care Workers Nonfatal Emergency Department-Treated Injuries, United States 2015-2020

OBJECTIVE

Home care workers (HCWs) are a critical resource contributing to the well-being of others. Presented are data on HCWs nonfatal emergency department (ED)-treated injuries.

METHODS

Nonfatal injuries among HCWs were extracted from the NEISS-Work data between 2015 and 2020.

RESULTS

Review of NEISS-Work data indicated 117,000 HCWs with nonfatal ED-treated injuries; female HCWs accounted for 93%. Overexertion and bodily reactions accounted for 52% of the injuries. Violence and other injuries by persons or animals accounted for 15% and falls, slips, and trips also accounted for 15% of the HCWs ED-treated injuries.

CONCLUSIONS

The growing demand for home care services is increasing the number of workers at risk for injury. Future analyses should prioritize injury events among HCWs to gain a better understanding of the events contributing to injuries among HCWs.

Safety Considerations for Home Care Providers

Home care is one of the fastest growing industries in the United States, projected to continue increasing as the population ages. However, there are unique safety concerns associated with home care compared to the more controlled hospital or clinic settings, such as driving distractions, potentially dangerous neighborhoods, and in-home risks categorized as environmental, biological, chemical, and emotional. Each home is essentially a new worksite with its own set of safety hazards, increasing the need for home care providers to be aware of safety risks in these ever-changing environments. Ensuring worker safety is essential to the recruitment and retention of home care workers. This article discusses safety risks unique to home care and offers solutions that increase the safety of home care providers. Education around workplace violence, implementation of evidence-based practices, and establishing and adhering to safety policies are paramount.

Home Care Aides' Perspectives of Occupational Tobacco Smoke Exposure: A Q Methodology Study

INTRODUCTION

The increased growth of older adults has generated demand for home care aides (HCAs). Occupational tobacco smoke exposure (OTSE) may risk their health which should be paid attention to.

AIMS AND METHODS

This study explored the HCAs' perspectives of OTSE to inform health promotion programs catering to individual needs. A two-stage Q methodology was employed for data collection and analysis. Thirty-nine Q statements were extracted in the first stage and then 51 HCAs with OTSE were recruited to complete Q sorting in the second stage. PQ Method software was used for data analysis. Principal component analysis was performed to determine the most appropriate number of factors.

RESULTS

The five factors identified from HCAs' perspective of OTSE explained 51% of the variance. The HCAs agreed that OTSE could increase cancer risk. The HCAs with factor I did not care about OTSE, tending to complete their work. The HCAs with factor II agreed with the health hazards of OTSE, but did not know how to help their clients stop smoking. The HCAs with factor III cared about OTSE but were afraid of disrupting the client-provider relationship. The HCAs with factor IV regarded OTSE as a priority for occupational interventions whereas the HCAs with factor V did not think OTSE was an issue and believed that they could balance work and OTSE health hazards.

CONCLUSIONS

Our findings will inform the design of home care pre-service and on-the-job training courses. Long-term care policies should be developed to promote smoke-free workplaces.

IMPLICATIONS

There are five types of HCAs' perspectives on OTSE. The tailor interventions can be developed to help them avoid the OTSE (eg, opening windows for ventilation or using air purification equipment) and have an OTSE-free space.

Advanced Practice Nurses' Experiences on Patient Safety Culture in Hospital-Based Home Healthcare: A Qualitative Descriptive Study

Purpose

Despite the increasing interest in patient safety, most research have been conducted in hospital settings, thereby demonstrating an overall lack of research regarding patient safety culture in home healthcare. South Korea has three types of home healthcare services based on hospitals, public health centers, and long-term care insurance. Home healthcare nurses in hospitals require a master's degree and advanced nursing skills. They play important roles in ensuring patients' safe transition into home health care. This study aimed to explore the experience of patient safety culture among South Korean advanced practice nurses in hospital-based home healthcare.

Methods

This qualitative descriptive study was conducted through purposive sampling, whereby twenty advanced practice nurses involved in home healthcare were recruited from twelve hospitals located in three different cities throughout South Korea. Face-to-face semi-structured interviews were conducted, and the collected data were analyzed through inductive and deductive content analyses.

Results

Three main categories were finally confirmed: (a) teamwork climate, (b) safety climate, and (c) working condition. The sub-categories of the teamwork climate included the collaboration between patients, caregivers, and nurses, collaboration within medical institutions, and collaboration among the individuals involved in community partnerships. The sub-categories of the safety climate included nurses' commitment to patient safety, the associated institutions' commitment to patient safety, and the government's commitment to patient safety. The sub-categories of the working condition included the frontline working environments and the associated institutions' support aimed at ensuring effective working environments.

Conclusion

Cultivating patient safety culture is crucial for ensuring the safe transition of patients from acute care hospitals to home healthcare. This study revealed significant aspects of patient safety culture in hospital-based home healthcare, allowing for the continuum of care among the associated patients. Such aspects include communicating with caregivers, building community partnerships, understanding unexpected home environments, and enhancing the safety of nurses.

Determinants associated with the incidence of occupational accidents among visiting nurses from home-visit nursing agencies: Secondary analysis of cross-national survey data in Japan

AIM

This study aimed to determine the incidence of occupational accidents among home-visiting nurses from home-visit nursing agencies and relevant factors.

METHODS

Data from a questionnaire survey, conducted in March 2020, concerning home-visit nursing agencies were used as a secondary source. A total of 9979 agencies were surveyed. The questionnaires included items relating to the number of occupational accidents experienced by visiting nurses that occurred during a 3-month period. The occurrence of accidents in an agency was set as a dependent variable, and logistic regression analysis was performed on its association with agency attributes. For agencies in which accidents occurred, the number of accidents per 10 full-time-equivalent nurses was estimated, and multiple regression analysis was administered to investigate its association with agency attributes.

RESULTS

The findings of the logistic regression analysis revealed that new agencies, a greater number of full-time-equivalent nurses, emergency visitation support, and performing an analysis of accident cases for accident prevention were significantly associated with the occurrence of accidents. A median of 3.3 accidents occurred per 10 full-time-equivalent nurses at such agencies. Multiple regression analysis showed that a lower number of full-time-equivalent nurses was significantly associated with an increase in the frequency of accidents.

CONCLUSIONS

These results suggest that to devise and deploy safety measures for visiting nurses, all home-visit nursing agencies must build reporting and analysis systems for occupational accidents among home-visiting nurses. Moreover, ensuring safety measures for nurses working in small-scale agencies is of utmost importance. Geriatr Gerontol Int 2022; ••: ••-••.

Implementation of a Novel Home Visiting Nurse Pilot Program for Victims of Violent Penetrating Injury

BACKGROUND

Survivors of violent injuries are at risk for readmission, rehospitalization, and reinjury. In 2017, a novel home visiting nurse pilot program was implemented within a hospital-based violence intervention program (HVIP) to address disparities in care and combat the limited health care literacy and access, and the general mistrust of health care institutions among much of this population.

OBJECTIVE

The purpose of this study was to review the design and implementation of the home visiting nurse component of the HVIP and to report the demographics, clinical characteristics, home care needs, and short-term health outcomes of the pilot sample.

METHODS

This retrospective study was performed using a cohort of patients presenting to the emergency department at an urban, Level I trauma center for a violent penetrating injury between 2017 and 2018. The χ2 and Wilcoxon rank sum tests were used to compare patient demographics and injury characteristics. Cox proportional hazards regression models were used to estimate health outcomes.

RESULTS

Of the 742 victims of violence included in this analysis, the 57 patients enrolled in the home visiting nurse pilot program were more likely to have severe gunshot wounds (68.4% vs. 40.3%, p < .001) requiring hospitalization (80.7% vs. 53.3%, p < .001), with 3.5% requiring rehospitalization within 90 days. The primary interventions provided by the home visiting nurse involved medical navigation and education, wound care, and consultation, underscoring the critical importance of health literacy and outreach for this vulnerable population.

CONCLUSION

The nurse-advocate partnership provides the foundation for this novel program to aid a marginalized population in overcoming health inequities.

Direct-Read Fluorescence-Based Measurements of Bioaerosol Exposure in Home Healthcare

Home healthcare workers (HHCWs) are subjected to variable working environments which increase their risk of being exposed to numerous occupational hazards. One of the potential occupational hazards within the industry includes exposure to bioaerosols. This study aimed to characterize concentrations of three types of bioaerosols utilizing a novel fluorescence-based direct-reading instrument during seven activities that HHCWs typically encounter in patients’ homes. Bioaerosols were measured in an indoor residence throughout all seasons in Cincinnati, OH, USA. A fluorescence-based direct-reading instrument (InstaScope, DetectionTek, Boulder, CO, USA) was utilized for all data collection. Total particle counts and concentrations for each particle type, including fluorescent and non-fluorescent particles, were utilized to form the response variable, a normalized concentration calculated as a ratio of concentration during activity to the background concentration. Walking experiments produced a median concentration ratio of 52.45 and 2.77 for pollen and fungi, respectively. Fungi and bacteria produced the highest and lowest median concentration ratios of 17.81 and 1.90 for showering, respectively. Lastly, our current study showed that sleeping activity did not increase bioaerosol concentrations. We further conclude that utilizing direct-reading methods may save time and effort in bioaerosol-exposure assessment.

Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the COVID-19 Pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, home health aides (HHAs) provided daily medical and personal care to community-dwelling older adults and those with chronic conditions. Prior qualitative studies have found that providing care during COVID-19 left HHAs susceptible to physical, financial, and emotional risks. However, limited quantitative data exist The objective of this study was to assess the impact of COVID-19 on HHAs and to understand the challenges and opportunities for current and future pandemic planning. A cross-sectional survey of 256 HHAs in the downstate New York region was conducted by telephone in English, French Creole, Chine, Spanish, and Russian between August and November 2020. The survey found that HHAs experienced a variety of physical, financial, and emotional challenges during COVID-19. To better support this work force, action by public health officials and policymakers is warranted, particularly with respect to workplace protections and safety, mental health, compensation, and access to basic resources.

Home care workers' experiences of work conditions related to their occupational health: a qualitative study

Background

The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing.

Methods

A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors.

Results

HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting.

Conclusions

This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

Psychometric properties of the Persian version of the attitude scale for home care: a study of reliability and validity

It is important to evaluate nursing students' attitudes toward home care to improve home health nursing profession and increase the number of nursing students willing to work in home care in the future. However, there is no valid and reliable scale for measuring attitudes toward this care method in Iran. This study aimed to determine the psychometric properties of the Persian version of the Attitude Scale for Home Care (ASHC) for nursing students. Data were collected from 280 nursing students. A methodological study was conducted to assess face, content and construct validity and reliability. The results showed good content validity. Only item 17 was considered unfavorable and was omitted. After excluding three items in the confirmatory factor analysis, a 25-item model with good fit indices was obtained. Cronbach's alpha showed a high internal consistency. This is a valid and reliable scale for assessing nursing students' attitudes toward home care.

Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides

PURPOSE OF REVIEW

To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research?

RECENT FINDINGS

HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.

Design and development of the home healthcare worker observation tool

BACKGROUND

The rapidly growing number of home healthcare workers (HHCW) are exposed to unique occupational hazards within each patient home. This article describes the development of an observation tool to document occupational hazards HHCWs encounter.

METHODS

Tool development followed three steps: determining content domain, content validity, and inter-rater agreement.

RESULTS

Expert feedback guided the revision of content domain to 636 items. Scale level content validity index (S-CVI) was 0.90. Inter-rater agreement tests resulted in percent agreement and accuracy mean of 89.5% and frequency variables resulted in standard deviations from 0 to 8.62.

CONCLUSIONS

The observation tool encompasses the diverse range of occupational hazards HHCWs encounter; inter-rater percent agreement and overall accuracy scores were acceptable. Future pilot testing of this tool among broader raters and populations is recommended to characterize its usability, internal consistency, and reliability to assess HHCW occupational hazards.

Home health aides' experiences of their occupational health: a qualitative meta-synthesis

Home health aides (HHA) have high sickness absence while the need for home care services is rapidly growing. The aim of this study was to derive new conceptual understandings by identifying, describing and interpreting key concepts across qualitative studies on how HHA experience their occupational health related to their working conditions.A qualitative ethnographic meta-synthesis was used as a method to analyze 27 articles included from systematic searches in CINAHL, MEDLINE and PsycINFO.HHA experience physical strenuous work task demands in combination with unfortunate organizational conditions in an uncontrolled and ever-changing psychosocial and physical working environment as the main obstacle to their occupational health, although many positive presence factors with opposite effects were reported.More research is needed to investigate whether physical demanding work tasks can have positive effects on HHA's occupational health by reorganizing their work while preserving patients' empowerment at their home.

Workers' compensation costs for healthcare caregivers: Home healthcare, long-term care, and hospital nurses and nursing aides

BACKGROUND

Healthcare workers (nurses and nursing aides) often have different exposures and injury risk factors depending on their occupational subsector and location (hospital, long-term care, or home health care).

METHODS

A total of 5234 compensation claims for nurses and nursing aides who suffered injuries to their lower back, knee, and/or shoulder over a 5-year period were obtained from the Ohio Bureau of Workers' Compensation and analyzed. Injury causation data was also collected for each claim. The outcome variables included indemnity costs, medical costs, total costs, and the number of lost work days. The highest prescribed morphine equivalent dose for opioid medications was also calculated for each claim.

RESULTS

Home healthcare nurses and nursing aides had the highest average total costs per claim. Hospital nurses and nursing aides had the highest total claim costs, of $5 million/year. Shoulder injuries for home healthcare nursing aides (HHNAs) had the highest average total claim costs ($20,600/injury) for all occupation, setting, and body area combinations. Opioids were most frequently prescribed for home healthcare nurses (HHNs) and nursing aides (18.9% and 17.7% having been prescribed opioids, respectively). Overexertion was the most common cause for HHN and nursing aide claims.

CONCLUSIONS

With the rapidly expanding workforce in the home healthcare sector, there is a potential health crisis from the continued expansion of home healthcare worker injuries and their associated costs. In addition, the potential for opioid drug usage places these workers at risk for future dependence, overdose, and prolonged disability. Future research is needed to investigate the specific and ideally reversible causes of injury in claims categorized as caused by overexertion.

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

Ventilation and posture effects on inhalation exposures to volatile cleaning ingredients in a simulated domestic worker cleaning environment

Associations between cleaning chemical exposures and asthma have previously been identified in professional cleaners and healthcare workers. Domestic workers, including housecleaners and caregivers, may receive similar exposures but in residential environments with lower ventilation rates. Study objectives were to compare exposures to occupational exposure limits (OELs), to determine relative contributions from individual cleaning tasks to overall exposure, and to evaluate the effects of ventilation and posture on exposure. Airborne chemical concentrations of sprayed cleaning chemicals (acetic acid or ammonia) were measured during typical cleaning tasks in a simulated residential work environment. Whole-house cleaning exposures (18 cleaning tasks) were measured using integrated personal sampling methods. Individual task exposures were measured with a sampling line attached to subjects' breathing zones, with readings recorded by a ppbRAE monitor, equipped with a photoionization detector calibrated for ammonia and acetic acid measurements. Integrated sampling results indicated no exposures above OELs occurred, but 95th percentile air concentrations would require risk management decisions. Exposure reductions were observed with increased source distance, with lower exposures from mopping floors compared to kneeling. Exposure reductions were also observed for most but not all tasks when ventilation was used, with implications that alternative exposure reduction methods may be needed.

Homecare nurses' length of conversation and intention to remain at the workplace: A multilevel analysis

AIMS

To examine the relationship between homecare nurses' length of conversation with nurse managers and colleagues and intention to remain at the workplace.

BACKGROUND

Nurse turnover is an important issue. Previous studies focused on the perceived function of communication. However, we do not know the contribution of homecare nurses' actual conversations to nurse turnover prevention.

METHODS

We conducted a cross-sectional study in 330 homecare nurse organisations in Japan. We recruited 2,315 homecare nurses and analysed the data of 608 nurses. We used a questionnaire to investigate participants' intention to remain.

RESULTS

Nearly 68% had the intention to remain. The mean length of conversation was 34 min/day with the manager and 68 min/day with colleagues. Multilevel logistic regression analysis showed that long conversations with the nurse manager (20 min and more) and colleagues (40 min and more) were significantly related to the intention to remain.

CONCLUSIONS

Ensuring the time of conversation with a manager and colleagues may contribute to preventing potentially avoidable nurse turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should encourage homecare nurses to have daily conversations of 20 min or more with the nurse manager and 40 min or more with colleagues to continue working at their current workplace.

Home Health and Community Care Workers' Occupational Exposure to Secondhand Smoke: A Rapid Literature Review

INTRODUCTION

Although many workers are protected from exposure to secondhand tobacco smoke (SHS), home health and community care workers enter domestic settings where SHS is commonly present. Little is known about the extent of SHS exposure among this occupational group.

METHODS

A rapid review to examine the literature on home health and community care workers' exposure to SHS at work and identify research gaps. Systematic searches combining terms for SHS exposure (eg, "tobacco smoke pollution") with terms for home health and care workers, patients and settings (eg, "home health nursing") were run in CINAHL and Medline (with no date or language limitations). Web site and backward-forward citation searches identified further papers for narrative review.

RESULTS

Twenty relevant publications covering seventeen studies considered home health or community care workers' exposure to SHS either solely or as part of an assessment of other workplace hazards. Eight studies provided data on either the proportion of home care workers exposed to SHS or the frequency of exposure to SHS. No studies provided quantification of SHS concentrations experienced by this group of workers.

CONCLUSIONS

Exposure to SHS is likely to be common for workers who enter private homes to provide care. There is a need for research to understand the number of workers exposed to SHS, and the frequency, duration, and intensity of the exposure. Guidance should be developed to balance the rights and responsibilities of those requiring care alongside the need to prevent the harmful effects of SHS to workers providing care in domestic settings.

IMPLICATIONS

Very little is known about home health and community care workers' exposure to SHS. There is a need for research to quantify how many workers are exposed, how often and for how long exposure occurs, and the concentrations of SHS experienced. In many countries, home health care workers may be one of the largest working groups that experience exposure to SHS as part of their employment. The public health community needs to engage in a debate about how home health care workers can be best protected from SHS.

Home Healthcare Workers' Occupational Exposures

Home healthcare workers (HHCWs) belong to one of the fastest growing industries and have an unpredictable work environment, potentiating their risk of exposures to occupational hazards. More patients seeking care for chronic health conditions, and improvements in technology and medical advancements are allowing more complex patient care to be provided at home. A comprehensive integrative review was completed, identifying nine articles that provide an overview of the occupational hazards HHCWs face. Analysis of the articles indicates occupational hazards are similar across studies. Occupational exposures reported by HHCWs align within all the studies and include exposures to blood, saliva, dangerous conditions walking to and within the home, secondhand smoke, aggressive pets, violence, and ergonomic concerns. These studies have been methodologically limited to self-reports, including surveys, interviews, and focus groups but include quantitative and qualitative data. Future research can further describe and identify specific occupational exposures and health hazards, subsequently leading to modifications to protect the health and safety of HHCWs, personal care workers, and the informal caregivers who provide care in the home.

Patient care aides: Differences in healthcare coverage, health-related behaviors, and health outcomes in a low-wage workforce by healthcare setting

OBJECTIVES

Patient care aides, who provide basic care to patients in a variety of healthcare settings, have been observed to have higher prevalences of adverse health metrics than the general US workforce. However, few studies have examined how healthcare access and health behaviors and outcomes among patient care aides differ by work setting (home health, nursing home, and hospital).

METHODS

Data from the 2013 to 2016 Behavioral Risk Factor Surveillance System were used to assess the prevalences of healthcare access, health-related behaviors, and health outcomes among patient care aides in different work settings, and among nurses (licensed vocational/practical and registered). Adjusted prevalence ratios were used to compare prevalences for healthcare workers to those for nonhealthcare clerical workers.

RESULTS

Overall, patient care aides are a low-wage workforce with high prevalences of multiple adverse health metrics and low prevalences of positive health behaviors compared to clerical workers. Results differed by work setting. Home health aides had the lowest income levels and most adverse results for multiple metrics; nursing home aides had better healthcare access and somewhat better health outcomes. Most metrics were best (though still quite poor) for hospital aides, who showed few significant differences from clerical workers.

CONCLUSIONS

These results show the need to focus resources on the patient care aide workforce, particularly those in home health. While some needs of nursing home aides, such as improving influenza vaccination coverage and reducing the prevalence of arthritis-related conditions, would benefit from standardized workplace interventions, alternate, workplace-specific approaches are needed for home health aides.

Efficacy and Usability of a Virtual Simulation Training System for Health and Safety Hazards Encountered by Healthcare Workers

OBJECTIVE

This study evaluated the efficacy, usability, usefulness, and desirability (UUD) of a Home Healthcare Interactive Virtual Simulation Training System (HH-VSTS) designed to train home healthcare workers (HHWs) and healthcare students to identify and respond to health and safety hazards in client homes.

MATERIALS AND METHODS

Participants were randomly assigned to either the HH-VSTS training group or to the paper-based training group. The HH-VSTS group completed three HH-VSTS Training Modules on a laptop/desktop computer. The training modules addressed hazard identification, hazard rationale, and hazard response to electric/fire/burn, slip/trip/lift, and environmental hazards. The paper-based training group reviewed identical information in a written hard-copy format. Both groups completed an HH-VSTS Assessment module. Participants completed demographic/background and UUD questionnaires, and in-system metrics measured their performance on hazard identification, rationale, and response.

RESULTS

Participants (n = 74) were HHWs and students in health profession programs. There were no significant differences in participants' ability to correctly identify hazards, rationale, or how to address them. Participants identified over 90% of hazards, although fewer participants were able to correctly identify what makes an item a hazard or how to manage it. For those in the HH-VSTS group, over 83% found the HH-VSTS easy to use, over 94% agreed the HH-VSTS was useful, and over 80% liked it.

CONCLUSION

The HH-VSTS provided and engaging, efficacious training that was as effective as a typical paper-based training. In addition, the HH-VSTS is usable by a variety of end users, regardless of computer or gaming experience.

Musculoskeletal Pain and Interest in Meditation and Yoga in Home Health Aides: Evidence From the Home Health Occupations Musculoskeletal Examinations (HHOME) Study

Home healthcare aides (HHAs) are a growing U.S. workforce highly susceptible to workplace stressors and musculoskeletal pain. In the present study we: 1) examine the association of musculoskeletal pain to life satisfaction and emotional exhaustion; and 2) characterize interest in meditation and yoga in a sample of HHAs. A nonprobabilistic sample of HHAs employed at home healthcare agencies in Florida, Massachusetts, and Oregon (n = 285 total) completed a self-administered questionnaire with standard survey measures on musculoskeletal pain location, duration, and severity; life satisfaction; emotional exhaustion; and interest in meditation techniques and yoga. Among HHAs responding, 48.4% reported pain in the last 7 days and 46.6% reported pain in the last 3 months. Home healthcare aides who reported current pain and chronic pain had a significant (P < .05) decrease in satisfaction with life score and a significant increase in emotional exhaustion score. The majority of HHAs reported an interest in learning about the benefits (65.6%) and practice (66.4%) of meditation and a willingness to participate in a yoga class (59.2%) or stress management meeting (59.1%). The HHAs reported both acute and chronic musculoskeletal pain that was correlated with lower life satisfaction and greater emotional exhaustion. More efforts are needed to reduce the sources of injury and emotional exhaustion.

Workplace Hazards Faced by Nursing Assistants in the United States: A Focused Literature Review

Nursing assistants (NAs) make up a large share of the healthcare provider workforce and their numbers are expected to grow. NAs are predominantly women who earn a low wage and report financial, work, and family demands. Working as a NA is hazardous; this manuscript specifically examines the biological/infectious, chemical, enviromechanical, physical and psychosocial hazards that appear in the literature to date. A focused search strategy was used to review literature about hazards that fell into each of the five aforementioned domains. While some hazards that were documented were clear, such as exposure to influenza because of close contact with patients (biological/infectious), or exposure to hazardous drugs (chemical), literature was limited. The majority of the literature we reviewed fell into the domain of psychosocial hazards and centered on stress from workplace organization issues (such as mandatory overtime, lack of managerial support, and feeling rushed). More research is needed to understand which hazards NAs identify as most concerning and tailored interventions are needed for risk mitigation.

Occupational Exposures of Home Healthcare Workers

Population demographics in the United States are rapidly changing with increased dependence on home healthcare (HHC) by an aging population, patients suffering from chronic diseases, and inability to perform activities of daily living. Despite the occupational injury rates for HHC workers (HHCW) being higher than the national average, an understanding of the occupational safety and health experiences and exposures of HHCW is limited. The purpose of this study was to understand the health and safety risk factors for HHCW. One-on-one interviews were conducted with HHCW to elicit frequency of daily occupational exposures to hazards and risk factors during visits to patients' homes. Approximately 67% of the study population was over 40 years old and mostly obese, potentially increasing risk for injury. HHCW routinely perform physical tasks with increased risk for occupational musculoskeletal injuries. Exposures to drug residue from dispensing oral medications and anticancer medications and exposure to potentially infectious agents and cleaning chemicals used for infection prevention were reported. The majority of HHCW were also exposed to secondhand smoke and occasionally experienced violence. Developing and implementing intervention strategies that address engineering controls, establish employee safety-related policies, provide training and retraining, promote a healthy lifestyle among HHCW, and providing suitable personal protective equipment may help to decrease occupational injury rates.