Occupational Health: Core Areas of Knowledge and Competence, Part 1

It is not possible to describe a highly complex and dynamic process such as occupational health nursing simply in terms of core activities or tasks. Occupational Health Nurse (OHA) are constantly learning new skills, adapting current practices to meet new needs and developing new approaches to solving problems and therefore their practice is not static but is constantly improving based upon a core range of skills.

However, within this limitation it is possible to describe those core areas of knowledge and competence that occupational health nurses use. The following list is not intended to be exhaustive, but rather to give an indication of the wide range of competencies that occupational health nurses demonstrate in practice.

The Clinician

Primary prevention

The OHA is skilled in primary prevention of injury or disease. The nurse may identify the need for, assess and plan interventions to, for example modify working environments, systems of work or change working practices in order to reduce the risk of hazardous exposure. Occupational health nurses are skilled in considering factors, such as human behavior and habits in relation to actual working practices. The nurse can also collaborate in the identification, conception and correction of work factors, choice of individual protective equipment, prevention of industrial injuries and diseases, as well as providing advice in matters concerning protection of the environment. Because of the occupational health nurses close association with the workers, and knowledge and experience in the working environment, they are in a good position to identify early changes in working practices, identify workers concerns over health and safety, and by presenting these to management in an independent objective manner can be the catalyst for changes in the workplace that lead to primary prevention.

Emergency care

The OHA is a Registered Nurse with a great deal of clinical experience and expertise in dealing with sick or injured people. The nurse may, where such duties form part of their job, provide initial emergency care of workers injured at work prior to transfer of the injured worker to hospital or the arrival of the emergency services. In many instances, where hazardous conditions exist at work, or where the workplace is far removed from other health care facilities, this role will form a major part of an occupational health nurse’s job. Occupational health nurses employed in mines, on oil rigs, in the desert regions or in areas where the health care systems are not yet fully developed will be familiar with a wide range of emergency care techniques and may have developed additional skills in order to fulfill this role. For others, who are working in situations where the emergency services are on hand, they may simply provide an additional level of support beyond that provided by the industrial first aider.

Nursing diagnosis

Occupational health nurses are skilled in assessing client’s health care needs, establish a nursing diagnosis and formulating appropriate nursing care plans, in conjunction with the patient or client groups, to meet those needs. Nurses can then implement and evaluate nursing interventions designed to achieve the care objectives. The nurse has a prominent role in assessing the needs of individuals and groups, and has the ability to analyze, interpret, plan and implement strategies to achieve specific goals. By using the nursing process the nurse contributes to workplace health management and by so doing helps to improve the health of the working population at the shop floor level. Nursing diagnosis is a holistic concept that does not focus solely on the treatment of a specific disease, but rather considers the whole person and their health care needs in the broadest context. It is a health based model rather than a disease based model and nurses have the skills to apply this approach with the working populations they serve.

General Health advice and health assessment

The OHA will be able to give advice on a wide range of health issues, and particularly on their relationship to working ability, health and safety at work or where modifications to the job or working environment can be made to take account of the changing health status of employees.

In many respects employers are not solely concerned with only those conditions that are directly caused by work, but do want their occupational health staff to help address any health related problems that may arise that might influence the employees attendance or performance at work, and many employees appreciate this level of help being provided to them at the workplace because it is so convenient for them. In particular the development of health care services to men at work, younger populations and those from ethnic groups can be most effective in reaching these sometimes difficult to reach populations.

Research and the use of evidence based practice

In addition to utilizing information and knowledge produced by research in various fields to support activities that relate to the occupational health component of their role, occupational health nurses will also utilize fully research information available from many fields to help support the general health of the working population.

Specialist

Occupational health policy, and practice development, implementation and evaluation

The specialist occupational health nurse may be involved, with senior management in the company, in developing the workplace health policy and strategy including aspects of occupational health, workplace health promotion and environmental health management. The OH nurse is in a good position to advise management on the implementation, monitoring and evaluation of workplace health management strategies and to participate fully in each of these stages. Possibility to perform that role will depend upon level of nurse education, skills and experience.

Occupational health assessment

OHA’s can play an essential role in health assessment for fitness to work, pre-employment or pre-placement examinations, periodic health examinations and individual health assessments for lifestyle risk factors.

Collaboration with occupational physician may be necessary in many instances, depending upon exiting legislation and accepted practice. The nurse can also play an important role in the workplace where informal requests for information, advice on health care matters and health related problems come to light. The nurse is able to observe the individual or group of workers in relation to exposure to a particular hazard and initiate appropriate targeted health assessment where necessary. These activities are often, but not exclusively, undertaken in conjunction with the medical adviser so that where problems are identified a safe system for onward referral exists.

Health surveillance

Where workers are exposed to a degree of residual risk of exposure and health surveillance is required by law the OHA will be involved in undertaking routine health surveillance procedures, periodic health assessment and in evaluating the results from such screening processes. The nurse will need a high degree of clinical skill when undertaking health surveillance and maintain a high degree of alertness to any abnormal findings. Early referral to an occupational health physician or other appropriate specialist will be the responsibility of the occupational health nurse where any abnormality is detected. The nurse will be involved in supporting the worker throughout any further examination or investigation, and may help to monitor their health on return to work. Once alerted to the possibility of an adverse health effect the occupational health nurse is in a good position to co-ordinate efforts to re-evaluate working practices in order to help protect others who may be similarly affected.

It Is Your Right To Receive The Home Health Company Of Your Choice

There seems to be a common misconception in our country regarding the reception of home health services.

First of all, too many people needing home health are under the impression that if they are to receive home health services, they must accept the ongoing or company assigned to them by the discharging hospital or referring physician. This is not only a common myth, but it is also very illegal.

The fact is, if you are needing home health services, all you need is a physician’s order for home health services to satisfy Medicare.

Many physicians are affiliated with rehabilitation companies or home health companies and try to lead you to believe you must take what they give you. Patients are many time too timid to ask for something different.

Nothing could be further from the truth!

When you receive an order for home health services, you can request a specific home health company. In fact, you can even request specific therapists, nurses, or any other facet of home health service or therapy that you like. The discharging hospital or referring physicians are obligated to accommodate your wishes, within reason.

Too many medical groups have created the impression that you have to take what they recommend. This is because many of them have some kind of vested interest in you receiving what they prescribe.

Some physicians have even told patients that if they didn’t accept the home health company or therapist they specified, they would not write the order.

Again, this is illegal and Medicare would be very interested in finding out this information.

Moreover, Medicare is very interested in hospitals or physicians who are only looking after their own interests. Medicare would like to be contacted whenever a physician insists upon you using a certain home health company, rehabilitation group, or medical supply company.

This is called a conflict of interest and again, is very illegal. The reason for this is because many of the physicians referring these services, receive “kickbacks” in the form of financial amenities, or other bonuses. Many times, a physician doesn’t own the company. However, they may own the building the home health company or rehabilitation company works from. When they refer patients for home health services or rehabilitation services, the company receives reimbursement from Medicare. In turn the physician will charge is company outrageous rent fees, and is able to collect by referring patients. This is an indirect form of receiving kickbacks, and again, is illegal.

How To Avoid Being Victimized

You must first be knowledgeable with Medicare laws and regulations. You must also inform your physician that you know the Medicare laws, regulations, and more importantly, your rights as a patient.

Never accept a home health company from your physician if you don’t feel completely comfortable with their services. Even if you receive a referral to receive home health services from a specific company and find that you’re not happy with this company, you have the right to change companies. Furthermore, if you find that the nurses or therapists are not to your liking, you can change nurses or therapists. Many home health companies display behavior that is not consistent with the best interest of the patient. The nurses or nurse liaison, or therapists, may be rude, money driven, or power-hungry, or all of the above. What you need to do is inform the home health company that you wish to change companies and that you are informing your physician of this information.

Next, contact your physician and request a different home health company, nurse, or therapist. Most of the time, your physician will be cooperative. However if you need to be more insistent, you can inform your physician or the referring nurse, that you are well aware of the Medicare laws and regulations. Let them know that you will indeed file a complaint regarding this matter if your wishes are not respected.

Filing A Complaint With Medicare

It is always a good idea to let the physician know that you are knowledgeable of your rights, along with Medicare rules and regulations. If your physician is stubborn, or resists your wishes, it is your right, and obligation, for other patients, to file a Medicare complaint.

To file a Medicare complaint all you need to do is go to the Medicare government web site and inform them of the complaint. You can also contact Medicare through a contact hotline on the telephone to communicate with them. The Medicare hotline is 1-800-447-8477. You can contact Medicare and get more information regarding home health care and your rights at via their website at http://www.medicare.gov/HHCompare/Home.asp

Remember, you not have to take the home health company that is assigned to you. It is your right to receive the home health company, the nurse, and the home health therapist of your choice. It is your right to change home health care companies if you are not completely satisfied.

Diabetes – Stop the Madness!

CNN reports today by the year 2034 that 44.1 million Americans will be living with diabetes and the cost will rise from $113 billion to $336 billion per year. For the most part I believe, after having done the research, this is a disease that should be going down in cost. Why? Well if we start taking responsibility for our own health and stop leaving it with the Doctors and Pharmaceutical companies,

Diabetes would be reduced rather than increased. This is a disease that is brought on by our diet unless you suffer from type 1 Diabetes. Type 2 Diabetes is brought on primarily by What we eat! That would include not only what we eat with our mouths but what we are eating with our eyes.

Fast food companies are not only guilty of saturating us with their fats and high fructose corn syrup but they also saturate our minds with commercial after commercial of individuals happily scarfing down their non nutritional food. What they don’t show you is their consumers having to test their blood day after day to try and maintain their normal insulin levels. They don’t show the individuals Who have to have their leg amputated from poor circulation nor do they show you people who have to take dialysis and the problems associated with it.

Back in the 50’s, yes way back before Ronald had his McDonald’s and his Big Mac heart attack, Doctors used to puff on their healthy cigarettes and tell us that it did not matter what we ate. Cigarette companies ran ad after ad telling us the benefits of smoking and how refreshing it was. Since that time cigarette companies are no longer allowed to run commercials on television to teach us about the wonders of smoking and our view of tobacco has changed. Not only has that changed but they have also been found liable for the promotion of death in the case of some individuals. Perhaps it is time we started to treat the fast food industry like we have treated the Cigarette company. Perhaps we need to put a warning label on Fast Food packaging and stop the commercial bombardment of their advertising. Maybe they are not as innocent as they claim to be when they are being tried for their accountability with regards to an individuals health, but then again neither are we.

How wrong it was in the past to not really teach nutrition and profess that your diet had little if anything to do with a persons health. How wrong it is proving to be. Not being concerned about eating healthy has made us very unhealthy and dependent on the world of pharmaceuticals to save us. For the most part, aside from a few exceptions, The pharmaceutical companies seemed to have made our world worse not better. They have fed us with a victim mentality and told us not to worry we have a drug for you. That is as long as you have insurance. Oh and don’t worry we are not going to cut your doctor out, you will need a prescription. If you don’t have insurance we are going to make up for the discount we give the insurance companies with our astronomical charge that we are going to lay on you. For the Medical industry, and I am talking about the commercial part of it, I’m sure they are looking at the article in CNN and thinking about all their profits for the future. For you and I, I hope we are thinking about stopping the Madness!

Common Side Effects to a Well Known Drug for Type 2 Diabetes

Metformin is a blood sugar controlling drug and considered as a first step in controlling type two diabetes. The main reason Metformin is so widely used is that it generally involves less side effects than other medications.

Not all who take Metformin have side effects and the majority of those that do are treatable in some way. With that said, there are some people who choose to discontinue treatment with Metformin because of persistent discomfort.

What are the side effects?

The most common ones occur when the drug affects normal digestion. These include diarrhea, nausea, indigestion and abdominal discomfort. Weakness and headaches are reported in clinical trials as well. Also Metformin makes it more difficult to absorb vitamin B12, sometimes resulting in long-term users requiring a vitamin B12 supplement.

Hypoglycemia is not likely to occur just by using Metformin. However, low blood sugar is possible if Metformin is used in combination with other anti-diabetic medications. Some common symptoms of hypoglycemia include unusual appetite, lethargy, dizziness, shaking and sweating, and loss of consciousness.

It is possible to have an allergic reaction to Metformin. Although this isn’t common, its best to be cautious and look out for any unusual signs. These could actually be allergy symptoms. Common allergic symptoms include skin irritation, respiratory problems and swelling. Other symptoms include chills, dizziness, and unusual drowsiness. If you believe you are having an allergic reaction, you should contact your doctor immediately.

Although it’s very rare, it must be made clear that Lactic Acidosis has a connection to Metformin users. Lactic Acidosis is a serious condition when there is too much Lactic Acid in the blood and requires immediate medical attention. Doctors are very careful in screening out patients who are prone to the disease, and when used properly, Metformin by itself is low risk for developing Lactic Acidosis.

For those who have liver and kidney problems, there is the possibility of Metformin building up and not filtering out of the body properly. Most doctors believe that Metformin itself doesn’t adversely affect the liver and kidneys unless the patient has a precondition.

Do the common side effects last long?

The minor ones are usually temporary as the body attempts to adjust to the medication. Metformin side effects could last for several weeks, but many report that they experience discomfort for only days instead. There is the possibility of more long-term side effects, which may require consulting your doctor who may recommend a lower dose.

Can I allieviate some of the side effects?

Whether or not they occur depends on which brand of Metformin, how big of dose you’re prescribed and how your individual body will respond to it.

Most report less severe side effects when taking a long-acting form of Metformin. Many brands have an ER (extended release) form that usually only requires one dose per day. However, some side effects still occur often enough to mention such as diarrhea, and nausea or vomiting.

It should be noted that if you are experiencing distress due to the medication, it’s not recommended that you alter the dosage yourself but instead notify your doctor. There are many brands available that your doctor may prescribe as an alternative, but unfortunately, a few people just cannot tolerate any kind of Metformin.

The side effects outlined here are by no means a complete list of side effects of Metformin. This is just to give you an idea of the most common ones that have been reported by Metformin patients. A more complete list should be provided and discussed by your healthcare provider.

Avandia Side Effect Lawyer: Diabetes Drug Damages Liver

Avandia, a compound of rosiglitazone maleate, is an oral antidiabetic agent. Avandia pills increase insulin sensitivity for patients with type 2 diabetes, or non-insulin-dependent diabetes. Avandia also improves glycemic control as it reduces the circulation of insulin levels. If diet, exercise, and a single drug are not enough to control blood sugar levels, Avandia can be used in conjunction with another drug.

Avandia is not to be used for type 1 diabetes (juvenile onset diabetes) or diabetic ketoacidosis. It is questionable whether people with heart failure, fluid retention, or active liver disease should take Avandia at all. Since Avandia became available there have been reports of the development of hepatitis (the inflammation of the liver) due to elevated liver enzymes. Patients taking Avandia should have their liver enzymes monitored regularly.

Additionally, Avandia is in the same class of drugs as Rezulin, a very dangerous drug that has been associated with devastating liver injury including liver failure that can only be cured with transplant. Without immediate transplant, many Rezulin liver failures have resulted in death. Because of this close association with a dangerous drug, users of Avandia should be in close contact with a doctor if they notice any symptoms of liver problems such as nausea, vomiting, stomach pain, fatigue, dark urine, or jaundice. Avandia is also very dangerous for pregnant women and their unborn children.

It is also advised, should you suffer adversely from the use of Avandia, to consult a lawyer. The recent proliferation of dangerous drugs into the marketplace is a disturbing trend, and should a drug threaten your health you should be repaid for damages and the drug should be taken off the market.