Challenges for Nurse Anesthetists Reentering Practice Following Substance Use Disorder Treatment

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared with other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of certified registered nurse anesthesiologists (CRNAs) to obtain or maintain employment after treatment for SUD treatment is not well documented. The purpose of this qualitative study was to explore challenges encountered by CRNAs in recovery as they attempt to reenter practice following SUD treatment. The phenomenon was explored through multiple-case study, using qualitative semistructured interviews with participants in four cases: CRNAs in recovery, CRNA colleagues, CRNA employers, and professional health program employees. Thirty-six participants conveyed their perspectives about challenges that CRNAs in recovery face upon reentry into practice following SUD treatment. The Worker Well-Being conceptual model was used to guide this study. The study revealed that more SUD education is a key facilitator for reentry, risk of relapse was a major concern, and stigma was the most significant barrier for CRNAs in recovery. Stigma persists as a considerable barrier in many facets of SUD, contributing to an increase in shame associated with having the disease.

COVID-19 and worker mental distress

BACKGROUND

This analysis posits that COVID-19-related worker mental distress may be different for those continuously employed and for those who faced temporary job loss.

METHODS

Mental distress during COVID-19 is characterized using two nationally representative surveys, the American Trend Panel (ATP) and the Household Pulse Survey (HPS). Using a probit model, we examine workplace perceptions for the mentally distressed in the ATP sample. We use graphical analysis to identify barriers to seeking mental healthcare using the 2021-22 HPS sample.

RESULTS

In October 2020, the probability of mental distress increased between 7.1 and 9.1 percentage points in response to worsening work-life balance, lowered job security, lowered work productivity and lowered work satisfaction. Workers' perception of advancement denial and poor connectivity with coworkers increased the probability of mental distress by 3.0-5.8 percentage points. In October 2021, over 40% of workers who had experienced job loss reported mental distress as compared to 20% of those with jobs. Only 25% of those with mental distress sought counseling. These high levels of mental distress continued into October 2022.

CONCLUSIONS

Mitigation strategies for worker mental health should include prosocial nudges, attention to employment history, managerial sensitivity and worker resilience training.

ECG-Based Stress Detection and Productivity Factors Monitoring: The Real-Time Production Factory System

Productivity and production quality have become primary goals for the success of companies in all industrial and manufacturing sectors. Performance in terms of productivity is influenced by several factors including machinery efficiency, work environment and safety conditions, production processes organization, and aspects related to workers' behavior (human factors). In particular, work-related stress is among the human factors that are most impactful and difficult to capture. Thus, optimizing productivity and quality in an effective way requires considering all these factors simultaneously. The proposed system aims to detect workers' stress and fatigue in real time using wearable sensors and machine learning techniques and also integrate all data regarding the monitoring of production processes and the work environment into a single platform. This allows comprehensive multidimensional data analysis and correlation research, enabling organizations to improve productivity through appropriate work environments and sustainable processes for workers. The on-field trial demonstrated the technical and operational feasibility of the system, its high degree of usability, and the ability to detect stress from ECG signals exploiting a 1D Convolutional Neural Network (accuracy 88.4%, F1-score 0.90).

Thriving from Work Questionnaire: Dimensionality, reliability, and validity of the long and short form questionnaires

INTRODUCTION

Thriving from Work is defined as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential at work, at home, and in the community. The purpose of this study was to develop a psychometrically-sound questionnaire measuring the positive contribution that work can have on one's well-being both at, and outside of, their work.

METHODS

We used both a qualitative and quantitative approach of item reduction, domain mapping dimensionality testing, development of "long-" and "short-" versions of the questionnaire, reliability, and construct and criterion validity testing. This was established in two independent online samples of US based workers (n = 1550, n = 500).

RESULTS

We developed a bi-factor model 30-item long-form and a uni-factorial 8-item short-version. The long-form measures both the latent construct of Thriving from Work and six domains (psychological/emotional; work-life integration; social; experience of work; basic needs; health). Both long- and short- forms were found to have high empirical reliability (0.93  and 0.87 respectively). The short-form captures 94% of variance of the long-form. Construct and criterion validity were supported. Test-retest reliability was high.

CONCLUSIONS

The Thriving from Work Questionnaire appears to be a valid and reliable measure of work-related well-being in United States workers. Further testing is needed to refine and test the instrument in specific industries, unique worker populations, and across geographic regions.

Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Difficult Airway Society and the Association of Anaesthetists: Guidelines from the Difficult Airway Society and the Association of Anaesthetists

Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker well-being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non-technical skills, such as teamwork and communication, human factors is a broad-based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.

Development of the National Institute for Occupational Safety and Health Worker Well-Being Questionnaire

OBJECTIVE

This article describes development of the National Institute for Occupational Safety and Health (NIOSH) Worker Well-Being Questionnaire (WellBQ).

METHODS

The NIOSH WellBQ was developed through literature reviews and expert panel recommendations. We drew from a representative sample of the civilian, noninstitutionalized, US working population to pilot the questionnaire. Psychometric analyses were performed on data from 975 respondents to finalize items and optimize the NIOSH WellBQ's psychometric properties.

RESULTS

The final questionnaire consists of 16 scales, 5 indices, and 31 single items across 5 domains: (1) work evaluation and experience; (2) workplace policies and culture; (3) workplace physical environment and safety climate; (4) health status; and (5) home, community, and society (experiences and activities outside of work). The instrument demonstrated adequate reliability and validity.

CONCLUSIONS

The NIOSH WellBQ is a reliable and valid instrument that comprehensively measures worker well-being.

Health Equity and Worker Justice in Temporary Staffing: The Illinois Case

Temporary staffing has an increasing role in world economies, contracting workers and dispatching them to work for leasing employers within countries and across borders. Using Illinois as a case study, co-authors have undertaken investigations to understand the occupational health, safety, and well-being challenges for workers hired through temporary staffing companies; to determine knowledge and attitudes of temp workers and temp staffing employers; and to assess temporary staffing at a community level. Temporary staffing workers in Illinois tend to be people of color who are employed in the most hazardous sectors of the economy. They have a higher rate of injury, are compensated less, and often lose their jobs when injured. Laws allow for ambiguity of responsibility for training, reporting, and compensation between the staffing agency and host employers. Our findings illustrate the ways in which principles of fairness and equity are violated in temporary staffing. Shared responsibility for reporting injuries, providing workers' compensation insurance, and training workers should be mandated in law and required in contractual language between temporary staffing and host/contracting employers. Monitoring, enforcement, and adjustment of the law based on experience are required to "promote inclusive and sustainable economic growth, employment and decent work for all.

Telework and Worker Health and Well-Being: A Review and Recommendations for Research and Practice

Telework (also referred to as telecommuting or remote work), is defined as working outside of the conventional office setting, such as within one’s home or in a remote office location, often using a form of information communication technology to communicate with others (supervisors, coworkers, subordinates, customers, etc.) and to perform work tasks. Remote work increased over the last decade and tremendously in response to the COVID-19 pandemic. The purpose of this article is to review and critically evaluate the existing research about telework and worker health and well-being. In addition, we review and evaluate how engaging in this flexible form of work impacts worker health and well-being. Specifically, we performed a literature search on the empirical literature related to teleworking and worker health and well-being, and reviewed articles published after the year 2000 based on the extent to which they had been discussed in prior reviews. Next, we developed a conceptual framework based on our review of the empirical literature. Our model explains the process by which telework may affect worker health and well-being in reference to individual, work/life/family, organizational, and macro level factors. These components are explained in depth, followed by methodological and fundamental recommendations intended to guide future research, policies, and practices to maximize the benefits and minimize the harms associated with telework, and offer recommendations for future research.

Closure of Anchor Businesses Reduced COVID-19 Transmission During the Early Months of the Pandemic

OBJECTIVES

To investigate the relationship between the closure of "anchor businesses" - manufacturing plants and distribution centers employing >1000 workers - and the daily, county-level COVID-19 rate between March 1, 2020 and May 31, 2020.

METHODS

We conducted a comparative, interrupted time series analysis of publicly available county-level data. Our main variable of interest was closure, indicating whether one or more of the anchor businesses within the county experienced a full or partial closure of at least 22 days (main analysis) or at least 1 day (sensitivity analyses).

RESULTS

Closure of an anchor business was associated with 142 fewer positive COVID-19 tests per 100,000 population over a 40-day period. Even short-term and partial closures were associated with reduced spread.

CONCLUSIONS

Temporary closure of anchor businesses appears to have slowed, but not completely contained, the spread of COVID-19.

Has the COVID-19 Pandemic Accelerated the Future of Work or Changed Its Course? Implications for Research and Practice

The COVID-19 pandemic is a unique transboundary crisis which has disrupted people's way of life more dramatically than any event in generations. Given the ambiguity surrounding the end of the COVID-19 pandemic and its enduring negative effects, it is important to understand how this has affected important future of work trends. The aim of the current paper is to assess the impact of the COVID-19 pandemic on commonly discussed future of work trends relevant to occupational safety and health priority areas. These topics include work arrangements, compensation and benefits, and the organization of work. For each topic, we assess trends leading up to the COVID-19 pandemic, discuss the impact of the pandemic on these trends, and conclude with implications for research and practice. Overall, the pandemic appears to have both accelerated and disrupted various trends associated with future of work topic areas. These effects are discussed in terms of implications for both policymakers and organizations.

Leveraging Strategic Foresight to Advance Worker Safety, Health, and Well-Being

Attending to the ever-expanding list of factors impacting work, the workplace, and the workforce will require innovative methods and approaches for occupational safety and health (OSH) research and practice. This paper explores strategic foresight as a tool that can enhance OSH capacity to anticipate, and even shape, the future as it pertains to work. Equal parts science and art, strategic foresight includes the development and analysis of plausible alternative futures as inputs to strategic plans and actions. Here, we review several published foresight approaches and examples of work-related futures scenarios. We also present a working foresight framework tailored for OSH and offer recommendations for next steps to incorporate strategic foresight into research and practice in order to advance worker safety, health, and well-being.

Thriving from Work: Conceptualization and Measurement

Work is a major contributor to our health and well-being. Workers' thriving is directly influenced by their job design, work environment and organization. The purpose of this report is to describe the qualitative methods used to develop the candidate items for a novel measure of Thriving from Work through a multi-step iterative process including: a literature review, workshop, interviews with experts, and cognitive testing of the candidate items. Through this process, we defined Thriving from Work as the state of positive mental, physical, and social functioning in which workers' experiences of their work and working conditions enable them to thrive in their overall lives, contributing to their ability to achieve their full potential in their work, home, and community. Thriving from Work was conceptualized into 37 attributes across seven dimensions: psychological, emotional, social, work-life integration, basic needs, experience of work, and health. We ultimately identified, developed and/or modified 87 candidate questionnaire items mapped to these attributes that performed well in cognitive testing in demographically and occupationally diverse workers. The Thriving from Work Questionnaire will be subjected to psychometric testing and item reduction in future studies. Individual items demonstrated face validity and good cognitive response properties and may be used independently from the questionnaire.

How Will the Future of Work Shape OSH Research and Practice? A Workshop Summary

Growth of the information economy and globalization of labor markets will be marked by exponential growth in emerging technologies that will cause considerable disruption of the social and economic sectors that drive the global job market. These disruptions will alter the way we work, where we work, and will be further affected by the changing demographic characteristics and level of training of the available workforce. These changes will likely result in scenarios where existing workplace hazards are exacerbated and new hazards with unknown health effects are created. The pace of these changes heralds an urgent need for a proactive approach to understand the potential effects new and emerging workplace hazards will have on worker health, safety, and well-being. As employers increasingly rely on non-standard work arrangements, research is needed to better understand the work organization and employment models that best support decent work and improved worker health, safety, and well-being. This need has been made more acute by the SARS-CoV-2 global pandemic that has resulted in dramatic changes in employment patterns, millions of lost jobs, an erosion of many economic sectors, and widespread disparities which further challenge occupational safety and health (OSH) systems to ensure a healthy and productive workplace. To help identify new research approaches to address OSH challenges in the future, a virtual workshop was organized in June 2020 with leading experts in the fields of OSH, well-being, research methods, mental health, economics, and life-course analysis. A paradigm shift will be needed for OSH research in the future of work that embraces key stakeholders and thinks differently about research that will improve lives of workers and enhance enterprise success. A more transdisciplinary approach to research will be needed that integrates the skills of traditional and non-traditional OSH research disciplines, as well as broader research methods that support the transdisciplinary character of an expanded OSH paradigm. This article provides a summary of the presentations, discussion, and recommendations that will inform the agenda of the Expanded Focus for Occupational Safety and Health (Ex4OSH) International Conference, planned for December 2021.

Alcohol Consumption in the Australian Mining Industry: The Role of Workplace, Social, and Individual Factors

BACKGROUND

Coal miners have been reported to have higher rates of risky/harmful alcohol misuse; however, it is not known if metalliferous mining employees whose working conditions differ in workplace practices, also have increased rates of risky/harmful alcohol misuse. This study aimed to examine alcohol consumption in a sample of Australian metalliferous mining workers and to examine the demographic and workplace factors associated with risky/harmful alcohol use.

METHODS

All employees from a convenience sample of four Australian mine sites were invited to complete a paper-based cross-sectional survey between June 2015 and May 2017. The survey contained questions relating to social networks, health behaviors, psychological distress, demographic characteristics, and risky/harmful drinking. Current alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated measure of risky and/or harmful drinking. Factors associated with risky/harmful drinking were investigated using univariate and multivariable logistic regression.

FINDINGS

A total of 1,799 participants completed the survey (average site response rate 95%). Overall, 94.8% of males and 92.1% of females reported using alcohol in the preceding 12 months. The odds of risky/harmful alcohol use were significantly higher in those who were male, younger, and reported higher psychological distress.

CONCLUSIONS/APPLICATION TO PRACTICE

This study identified that metalliferous mining employees engage in at-risk levels of alcohol consumption significantly higher than the national average despite workplace policies and practices that restrict alcohol use. Personal and workplace risk factors that may help target specific employee groups and inform the development of tailored, integrated multicomponent intervention strategies for the industry were identified.

Preliminary Study Exploring Caretaker Perspectives of Euthanasia on Swine Operations

The purpose of this study was to gain a better understanding of euthanasia training, caretaker perceptions of euthanasia, and available resources for individuals who perform euthanasia as part of their job on swine operations in the United States. An online survey was distributed via an e-newsletter and in-person recruitment at swine industry events. Survey questions were related to training, attitudes towards performing euthanasia, work environment, and communication. Forty-five responses (17 workers, 21 managers, 7 owners) were recorded and summarized. The majority of workers (n = 14, 82%) agreed that they had "received enough training to euthanize pigs correctly" and that training had made them "confident about performing euthanasia", yet 35% (6) also indicated they would like more euthanasia training. Less than one-third of workers indicated that strategies for dealing with "personal stress" (4, 24%) and "emotional wellness" 29% (5) were included in training programs but the majority (14, 82%) agreed that "trainings included human safety while performing euthanasia". Most caretakers (37, 82%) agreed that they felt they could "communicate with my supervisors" if they felt uncomfortable performing euthanasia. Opportunities for the future include enhancing euthanasia training opportunities and content to include more awareness of strategies to deal with stress related to euthanasia.

Envisioning the future of work to safeguard the safety, health, and well-being of the workforce: A perspective from the CDC's National Institute for Occupational Safety and Health

The future of work embodies changes to the workplace, work, and workforce, which require additional occupational safety and health (OSH) stakeholder attention. Examples include workplace developments in organizational design, technological job displacement, and work arrangements; work advances in artificial intelligence, robotics, and technologies; and workforce changes in demographics, economic security, and skills. This paper presents the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health's Future of Work Initiative; suggests an integrated approach to address worker safety, health, and well-being; introduces priority topics and subtopics that confer a framework for upcoming future of work research directions and resultant practical applications; and discusses preliminary next steps. All future of work issues impact one another. Future of work transformations are contingent upon each of the standalone factors discussed in this paper and their combined effects. Occupational safety and health stakeholders are becoming more aware of the significance and necessity of these factors for the workplace, work, and workforce to flourish, merely survive, or disappear altogether as the future evolves. The future of work offers numerous opportunities, while also presenting critical but not clearly understood difficulties, exposures, and hazards. It is the responsibility of OSH researchers and other partners to understand the implications of future of work scenarios to translate effective interventions into practice for employers safeguarding the safety, health, and well-being of their workers.

Work-Related and Personal Factors Associated With Mental Well-Being During the COVID-19 Response: Survey of Health Care and Other Workers

BACKGROUND

The response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created an unprecedented disruption in work conditions. This study describes the mental health and well-being of workers both with and without clinical exposure to patients with coronavirus disease (COVID-19).

OBJECTIVE

The aim of this study is to measure the prevalence of stress, anxiety, depression, work exhaustion, burnout, and decreased well-being among faculty and staff at a university and academic medical center during the SARS-CoV-2 pandemic and describe work-related and personal factors associated with their mental health and well-being.

METHODS

All faculty, staff, and postdoctoral fellows of a university, including its medical school, were invited in April 2020 to complete an online questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, and decreased well-being. We examined associations between these outcomes and factors including work in high-risk clinical settings and family/home stressors.

RESULTS

There were 5550 respondents (overall response rate of 34.3%). Overall, 34% of faculty and 14% of staff (n=915) were providing clinical care, while 61% of faculty and 77% of staff were working from home. Among all workers, anxiety (prevalence ratio 1.37, 95% CI 1.09-1.73), depression (prevalence ratio 1.28, 95% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95% CI 1.13-1.36) were independently associated with community or clinical exposure to COVID-19. Poor family-supportive behaviors by supervisors were also associated with these outcomes (prevalence ratio 1.40, 95% CI 1.21-1.62; prevalence ratio 1.69, 95% CI 1.48-1.92; and prevalence ratio 1.54, 95% CI 1.44-1.64, respectively). Age <40 years and a greater number of family/home stressors were also associated with these poorer outcomes. Among the subset of clinicians, caring for patients with COVID-19 and working in high-risk clinical settings were additional risk factors.

CONCLUSIONS

Our findings suggest that the pandemic has had negative effects on the mental health and well-being of both clinical and nonclinical employees. Mitigating exposure to COVID-19 and increasing supervisor support are modifiable risk factors that may protect mental health and well-being for all workers.

Total Worker Health® 2014⁻2018: The Novel Approach to Worker Safety, Health, and Well-Being Evolves

Background: The objective of this article is to provide an overview of and update on the Office for Total Worker Health^® (TWH) program of the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (CDC/NIOSH). Methods: This article describes the evolution of the TWH program from 2014 to 2018 and future steps and directions. Results: The TWH framework is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. Conclusions: The CDC/NIOSH TWH program continues to evolve in order to respond to demands for research, practice, policy, and capacity building information and solutions to the safety, health, and well-being challenges that workers and their employers face.

The Perils of Integrating Wellness and Safety and Health and the Possibility of a Worker-Oriented Alternative

In response to the article by Michael B. Lax, MD entitled "The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative," the National Institute for Occupational Safety and Health (NIOSH) provides updated information on the current focus and priorities and addresses concerns raised regarding the Total Worker Health® initiative. Many of the concerns and criticisms in the report echo those NIOSH publicly shares on a regular basis. The theory and practice of Total Worker Health (TWH) continues to evolve in response to valuable stakeholder input like that provided by Dr. Lax. In 2015, NIOSH updated the TWH concept to emphasize the main focus of TWH is the primacy of traditional health protection which prioritizes employer responsibilities for the organization of work over individual worker health behaviors. NIOSH acknowledges the past lack of "fit" between theory and practice in some publications of TWH-funded grantees as Dr. Lax points out. NIOSH is hopeful that the solicitation of new research, which is now underway, will clarify the work-centered priorities for TWH-funded research. Based on input from Dr. Lax and other stakeholders, NIOSH looks forward to contributing more effectively to protecting and promoting worker safety and health in the new twenty-first century world of work.