Project A: Integrated Approaches to Improving the Health and Safety of Health Care Workers

Conditions:Food Studies, Healthy Studies, Insomnia Sleep Studies
Therapuetic Areas:Pharmacology / Toxicology, Psychiatry / Psychology, Other
Age Range:Any
Start Date:April 2012
End Date:August 2016
Contact:Julie V Theron, RN, MSN, C-PNP

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While most of the research on integrated approaches of occupational health and safety and
worksite health promotion to date has focused on manufacturing settings, employment is
shifting to the service sector. Within this sector, health care employs over 12 million
workers, and is the second fastest growing industry in the U.S. economy. In contrast to
workers in other industries, rates of occupational injuries and illnesses among health care
workers have increased over the past decade. The purpose of this study is to lay the
foundation for integrated interventions in health care through examination of the
associations of worker health outcomes and risks on and off the job with work policies and
practices and to address the prevalent issues of musculoskeletal disorders (MSDs),
particularly low back pain disability (LBPD), and health promotions through physical
activity among patient care workers. The specific aims of this study are:

1. To estimate the efficacy and determine the feasibility of an integrated intervention,
addressing both health protection and health promotion in order to reduce MSD symptoms
and improve health behaviors among healthcare workers. We will assess between-group
differences in MSD symptoms, health behaviors, including physical activity, and a set
of secondary outcomes, including unplanned absence, reported injuries, worker
compensation claims and costs, turnover and retention, intention to leave the job, and
work-role function. This study will explore the working hypothesis that: Workers
employed at baseline in patient-care units receiving the intervention will report
greater reductions in their MSD symptoms (primary outcome) and greater improvements in
health behaviors, compared with workers employed at baseline in units assigned to the
Usual Care control group.

2. To determine the factors in the work environment which contribute over time to
reductions in MSD symptoms and improvements in safe and healthy behaviors. (1) The work
environment, work organization, and psychosocial factors, measured in our current
study, will be associated with changes in workers' health behaviors and health outcomes
between the assessments in the current and proposed studies; (2) Improvements in the
work environment over time will be associated with improvements in workers' health
behaviors and health outcomes. We will conduct multilevel modeling analysis to
evaluate the simultaneous effects of worker-level and unit-level factors on MSD
symptoms and safety and health behaviors.

Improving and protecting the health and well-being of healthcare workers requires addressing
key risks in the work environment as well as promoting safe and healthy behaviors.
Healthcare workers are at elevated risk for musculoskeletal disorders (MSDs) due to a range
of job factors, including lifting and transferring patients; working long hours (often at
night); and limited control over decisions on the job. Among these, nurses and nurses aides
bear the largest burden of injury. Back injuries in particular constitute the greatest
source of their disability. These risks are likely to increase in coming years due to the
aging nursing workforce, increase in work demands, and labor shortages. Health behaviors,
including physical activity, inadequate sleep, and dietary patterns associated with being
overweight or obese, are also influenced by the work environment and psychosocial factors on
the job, and are also associated with MSD risk. Traditional approaches to redressing these
risks have focused separately on health protection, including efforts to reduce MSD risk,
and health promotion aimed at improving health behaviors. Little research has
systematically examined the dual and potentially synergistic effects of the work environment
on risk of MSDs and worker health behaviors, and there is insufficient evidence to determine
the most efficacious ways to ameliorate the combined effects of these health risks. Our
long-term goal is to improve the overall health and well-being of healthcare workers by
making available evidence-based worksite policies, programs, and practices that foster a
healthy work environment, reduce potential hazardous job exposures, and promote safe and
healthy behaviors. The proposed study is the next logical step in building this evidence
base. Factors in the work environment, including high work demands, low social support, and
long work hours, have been shown to increase risk of MSDs, as well as risk-related
behaviors. Yet little research has systematically explored these cross-cutting pathways and
their implications for improving the effectiveness of worksite interventions to address the
broad spectrum of worker health outcomes.

The proposed research provides a novel approach to worksite interventions that integrate
occupational safety and health and worksite health promotion, taking into account the shared
factors in the work environment shaping both MSDs and health behaviors. Standard approaches
to occupational health and safety and worksite health promotion are based on a parallel
structure of separate silos functioning relatively independently in the worksite, each
drawing from their own disciplines and training experiences within public health. Although
these parallel efforts share the common mission of improving worker health, their strategies
are based on different assumptions about and approaches to improving worker health outcomes.
The proposed research integrates these parallel approaches. Although our prior research has
rigorously tested the efficacy of this integrated intervention model in changing worker
health behaviors, to our knowledge no prior research has examined the impact of this
integrated model on health outcomes associated with work exposures - here, notably, on MSD

Inclusion criteria:

- Adult and pediatric in-patient care units at Massachusetts General Hospital that have
ceiling lifts in place (n=42 units) are eligible for the intervention.

- Patient care workers, including registered nurses (RNs), licensed practical nurses
(LPNs), patient care assistants (PCAs)/nursing assistants (NAs) and Nurse Leaders
working in in-patient units for at least 20 hours per week (n= 9500).

- Of those patient care workers, those working in adult and pediatric in-patient care
units (n=90 units) are eligible to be randomly selected for surveys.

Exclusion criteria:

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(617) 732-5500
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25 Shattuck Street
Boston, Massachusetts 02115
Boston, MA
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185 Cambridge Street
Boston, Massachusetts 02114
Boston, MA
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