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Wright E, Chen JT, Beckfield J, Theodore N, Krieger N. Workplace hazards and health among informally employed domestic workers in 14 cities, United States, 2011-2012: Using four approaches to characterize workers' patterns of exposures. Am J Ind Med 2022; 65:959-974. [PMID: 36222491 DOI: 10.1002/ajim.23433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND We characterized informally employed US domestic workers' (DWers) exposure to patterns of workplace hazards, as well as to single hazards, and examined associations with DWers' work-related and general health. METHODS We analyzed cross-sectional data from the sole nationwide survey of informally employed US DWers with work-related hazards data, conducted in 14 cities (2011-2012; N = 2086). We characterized DWers' exposures using four approaches: single exposures (n = 19 hazards), composite exposure to hazards selected a priori, classification trees, and latent class analysis. We used city fixed effects regression to estimate the risk ratio (RR) of work-related back injury, work-related illness, and fair-to-poor self-rated health associated with exposure as defined by each approach. RESULTS Across all four approaches-net of individual, household, and occupational characteristics, and city fixed effects-exposure to workplace hazards was associated with increased risk of the three health outcomes. For work-related back injury, the estimated RR associated with heavy lifting (the single hazard with the largest RR), exposure to all three hazards selected a priori (worker did heavy lifting, climbed to clean, and worked long hours) versus none, exposure to the two hazards identified by classification trees (heavy lifting, verbally abused) versus "no heavy lifting," and membership in the most- versus least-exposed latent class were, respectively, 3.4 (95% confidence interval [CI] 2.7-4.1); 6.5 (95% CI 4.8-8.7); 4.4 (95% CI 3.6-5.3), and 6.6 (95% CI 4.6-9.4). CONCLUSIONS Measures of joint work-related exposures were more strongly associated than single exposures with informally employed US DWers' health profiles.
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Affiliation(s)
- Emily Wright
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
| | - Nik Theodore
- Department of Urban Planning and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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2
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Silva JMND, Dantas DAC, da Silva LB, Melo IESD, Correia LMADM. Assessment of the influence of psychosocial factors on musculoskeletal disorder symptom intensity. Work 2021; 71:187-200. [PMID: 34924412 DOI: 10.3233/wor-205113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous studies have observed that psychosocial factors are associated with an increase in work-related musculoskeletal disorders (WMSDs) in European countries. However, the influence of psychosocial factors on the WMSD symptoms has not been studied in detail. Additionally, working conditions differ between developing and developed countries. OBJECTIVE In this study, the influence of psychosocial factors on WMSD symptoms among men and women in the footwear industry in northeastern Brazil is investigated. METHODS A questionnaire survey was conducted to evaluate workers' perceptions of psychosocial factors and WMSD symptoms. The influence of psychosocial factors on WMSD symptom trends was observed through ordinal logistic regression models. RESULTS It was found that different psychosocial factors are related to WMSD symptom intensification. Factors such as "job insecurity" and "low social support," which are not associated with the worsening of WMSD symptoms in developed countries, showed a noticeable influence in the sample analyzed. CONCLUSION These findings may be associated with differences in working conditions and economic problems in developing countries, suggesting that some psychosocial factors have a different effect on workers' perceptions in developing countries.
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Affiliation(s)
| | | | - Luiz Bueno da Silva
- Federal University of Paraíba, ProductionEngineering Department, University City, João Pessoa, Paraíba, Brazil
| | - Igor Eduardo Santos de Melo
- Federal University ofPernambuco, Postgraduate Program in Production Engineering, University City, Refice, Pernambuco, Brazil
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3
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Karlsson ND, Markkanen PK, Kriebel D, Galligan CJ, Quinn MM. "That's not my job": A mixed methods study of challenging client behaviors, boundaries, and home care aide occupational safety and health. Am J Ind Med 2020; 63:368-378. [PMID: 31833084 DOI: 10.1002/ajim.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/18/2019] [Accepted: 12/03/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Home care (HC) aide is among the fastest-growing jobs. Aides often work in long-term care relationships with elders or people with disabilities in clients' homes, assisting with daily activities. The purpose of this mixed-methods paper is to elucidate aides' experiences around the boundary-challenging behaviors of clients asking for services beyond aides' job duties and to identify possible interventions. METHODS A cross-sectional survey of HC aides in Massachusetts (n = 1249) provided quantitative data. Post-survey qualitative data were collected from nine HC aide focus groups (n = 70) and seven in-depth interviews with HC industry and labor representatives. RESULTS Quantitatively, aides who reported often being asked to do tasks outside their job duties were more likely to report abuse (prevalence ratio [PR] = 1.93; 95%CI: 1.47-2.52 for verbal, PR = 1.81; 95%CI: 1.13-2.91 for physical/sexual) and pain/injury with lost work time or medical care (PR = 1.58; 95%CI: 1.11-2.25). They were also less likely to want to remain in their job (PR = 0.94; 95%CI: 0.89-1.00) or recommend it to others (PR = 0.94; 95%CI: 0.90-0.98). Qualitative data showed that clients' requests for tasks beyond job duties were frequent and can lead to injuries, abuse, and psychosocial stress. Yet, requests often reflected genuine need. Helping clients stay at home, compassion, and feeling appreciated contributed to job satisfaction; therefore, aides can feel conflicted about refusing requests. CONCLUSION Client task requests outside HC services are a complex problem. Employer support, training, care plans, and feeling part of a care team can help aides navigate professional boundaries while delivering high quality care.
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Affiliation(s)
- Nicole D Karlsson
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Pia K Markkanen
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - David Kriebel
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Catherine J Galligan
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Margaret M Quinn
- Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
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Kołcz A, Główka N, Kowal M, Paprocka-Borowicz M. Baropodometric evaluation of foot load distribution during gait in the group of professionally active nurses. J Occup Health 2019; 62:e12102. [PMID: 31837089 PMCID: PMC6970405 DOI: 10.1002/1348-9585.12102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Nurses are extremely exposed to musculoskeletal overloads. Prolonged standing postural balance distributions, functional deficits and pain may affect the symmetry of the load on the feet. The study aimed to assess the distribution of foot load during gait among nurses. METHODS The sample of this prospective and observational study consisted of 37 female nurses with mean age of 39 years. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal disturbances and baropodometric gait analysis (BGA) was performed to register distribution of foot load during gait. RESULTS We showed that 68% of nurses declare that they know the principles of workplace ergonomics, but only 14% comply with them. NMQ results indicate that as many as 73% of the respondents feel ailments in the "lower back" area. An asymmetry was observed in the load of IV-V of the metatarsal head between the left and right foot (P = .000) and in the load of the left and right lateral part of the heel (P = .028) in the BGA test. Correlations between ailments occurring in the neck area and loading of the lateral arch of the right foot (P = .032) were found. Moreover, the load in this area correlated positively with the occurrence of "lower back" pain (P = .045). CONCLUSIONS Nurses have asymmetric distribution of foot load during gait, which results in a discrepancy between the loads on the three main support points of the foot and which may affect nurses' work productivity.
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Affiliation(s)
- Anna Kołcz
- Laboratory of Ergonomics and Biomedical Monitoring, Wroclaw Medical University, Wroclaw, Poland
| | - Natalia Główka
- Laboratory of Ergonomics and Biomedical Monitoring, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland
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Theodore N, Gutelius B, Burnham L. Workplace Health and Safety Hazards Faced by Informally Employed Domestic Workers in the United States. Workplace Health Saf 2018; 67:9-17. [DOI: 10.1177/2165079918785923] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Informally employed domestic workers encounter a range of workplace hazards, though these have been poorly documented and are typically left unacknowledged. Safety concerns include exposure to toxic cleaning products, a high prevalence of ergonomic injuries, and inadequate access to medical care. Presenting the results of an in-person survey of 2,086 informally employed nannies, housecleaners, and caregivers in 14 U.S. cities, this article documents the range of common health and safety hazards faced by domestic workers and suggests some interventions that could improve their working conditions. The survey was conducted in nine languages and data were collected from workers from 71 countries, including a substantial proportion with irregular immigration status. We observed that substandard workplace health and safety conditions are shaped by three aspects of domestic work: long-standing exclusions from federal employment protections, the common disregard of the home as a workplace, and the complexity of care work and the bonds of intimacy that often form through caregiving. Together these factors have served to perpetuate substandard working conditions. Regulatory reforms, as well as worker and employer education, are necessary to improve health outcomes for domestic workers.
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Shnayder MM, Brannan D, Murphy LA, Asfour LS, Hecht EM, Lee DJ, Caban-Martinez AJ. Musculoskeletal Pain and Interest in Meditation and Yoga in Home Health Aides: Evidence From the Home Health Occupations Musculoskeletal Examinations (HHOME) Study. Home Healthc Now 2018; 36:103-113. [PMID: 29498990 DOI: 10.1097/nhh.0000000000000644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Michelle M Shnayder
- Michelle M. Shnayder, BS, is an MD/MPH Candidate, Division of Environment and Public Health, Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida. Debi Brannan, PhD, is an NTT Assistant Professor of Psychology, Division of Behavioral Sciences, College of Liberal Arts & Sciences, Western Oregon University, Monmouth, Oregon. Lauren A. Murphy, PhD, is an Assistant Clinical Professor of Physical Therapy, Movement & Rehabilitation Science, Department of Physical Therapy, Movement & Rehabilitation Science, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts. Lila S. Asfour, MS, is an Research Assistant, Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida. Eric Hecht, MD, is a Voluntary Associate Professor, Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida. David J. Lee, PhD, is a Professor, Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida. Alberto J. Caban-Martinez, DO, PhD, MPH, is an Assistant Professor, Division of Environment and Public Health, University of Miami, Miller School of Medicine, Miami, Florida
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Schoenfisch AL, Lipscomb H, Phillips LE. Safety of union home care aides in Washington State. Am J Ind Med 2017; 60:798-810. [PMID: 28744929 DOI: 10.1002/ajim.22747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION A rate-based understanding of home care aides' adverse occupational outcomes related to their work location and care tasks is lacking. METHODS Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides' demographic and work characteristics. Injury narratives and focus groups provided contextual detail. RESULTS Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern. CONCLUSIONS Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides' improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce.
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Affiliation(s)
- Ashley L. Schoenfisch
- Duke University School of Nursing; Durham North Carolina
- Division of Occupational and Environmental Medicine, Department of Community and Family Medicine; Duke University School of Medicine; Durham North Carolina
| | - Hester Lipscomb
- Division of Occupational and Environmental Medicine, Department of Community and Family Medicine; Duke University School of Medicine; Durham North Carolina
| | - Leslie E. Phillips
- Service Employees International Union (SEIU) Healthcare NW Health Benefits Trust; Seattle Washington
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Love M, Tendick-Matesanz F, Thomason J, Carter D, Glassman M, Zanoni J. "Then They Trust You …": Managing Ergonomics in Home Care. New Solut 2017; 27:225-245. [PMID: 28554305 DOI: 10.1177/1048291117712544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The home care workforce, already at 2.7 million caregivers, will become the nation's fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients' physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.
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Affiliation(s)
- Marsha Love
- 1 Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | | | | | | | - Myra Glassman
- 5 SEIU Healthcare, Illinois/Indiana/Missouri/Kansas, Chicago, USA
| | - Joseph Zanoni
- 1 Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
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Abstract
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.
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Affiliation(s)
- Noma Agbonifo
- Noma Agbonifo, CSP, MIIRSM, MSc, is an Occupational Safety and Ergonomics Trainee, Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio. Beverly Hittle, MSN, RN, is an Occupational Nursing Trainee, College of Nursing, University of Cincinnati, Cincinnati, Ohio. Rassull Suarez, MD, is an Occupational Medicine Resident, Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio. Kermit Davis, PhD, CPE, is an Associate Professor, University of Cincinnati, Cincinnati, Ohio
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Hittle B, Agbonifo N, Suarez R, Davis KG, Ballard T. Complexity of occupational exposures for home health-care workers: nurses vs. home health aides. J Nurs Manag 2016; 24:1071-1079. [PMID: 27406330 DOI: 10.1111/jonm.12408] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2016] [Indexed: 12/28/2022]
Abstract
AIM To identify occupational exposures for home health-care nurses and aides. BACKGROUND Home health-care workers' occupational injury rates in the USA are higher than the national average, yet research on causative exposures and hazards is limited. METHODS Participants were interviewed about annual frequency of occupational exposures and hazards. Exposure and hazard means were compared between home health-care nurses and aides using a Wilcoxon two-sample test. RESULTS A majority of the sample was over 40 years old and obese, potentially increasing injury risks. Home health-care nurses performed more clinical tasks, increasing exposure to blood-borne pathogens. Home health-care aides performed more physical tasks with risk for occupational musculoskeletal injuries. They also dispensed oral medications and anti-cancer medications, and were exposed to drug residue at a frequency comparable to home health-care nurses. Both groups were exposed to occupational second-hand smoke. CONCLUSIONS Establishing employee safety-related policies, promoting healthy lifestyle among staff, and making engineered tools readily available to staff can assist in decreasing exposures and hazards. IMPLICATIONS FOR NURSING MANAGEMENT Implications for nursing management include implementation of health-promotion programmes, strategies to reduce exposure to second-hand smoke, ensuring access to and education on assistive and safety devices, and education for all staff on protection against drug residue.
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Affiliation(s)
- Beverly Hittle
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Noma Agbonifo
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Rassull Suarez
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kermit G Davis
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Tangela Ballard
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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