Nursing

Definition of Occupational and Environmental Health Nursing

Occupational and environmental health nursing is the specialty practice that focuses on preventive healthcare, health promotion, and health restoration within the context of a safe and healthy environment (retrieved from www.aaohn.org, December 7, 2011). It includes the prevention of adverse health effects from occupational and environmental hazards and health promotion in general. The practice provides and delivers occupational and environmental health and safety programs and services to clients. Occupational and environmental health nursing is a specialty. Nurses provide healthcare and make nursing decisions within the scope of practice determined by state law (Strasser, AAOHN Journal, January 2011; Beitz, AAOHN Journal, August 2010; Noel, AAOHN Journal, January 2010).

The foundation for occupational and environmental health nursing is research-based. Recognizing the legal context for occupational health and safety, this specialty practice derives its theoretical, conceptual, and factual framework from a multidisciplinary base including, but not limited to:

• nursing science;
• medical science;
• public health sciences such as epidemiology and environmental health;
• occupational health sciences such as toxicology, safety, industrial hygiene, and ergonomics;
• social and behavioral sciences; and
• business management and administration principles (Core Curriculum, 3rd Ed., 2006).

Guided by an ethical framework made explicit in the AAOHN Code of Ethics, OHNs motivate and enable clients to make informed decisions about healthcare concerns. Confidentiality of health information (AAOHN Position Statement on Confidentiality of Health Information, 2004) is essential and central to the practice. OHNs are advocates for client(s), fostering equitable and quality healthcare services and safe and healthy environments in which to work and live.

Scope of Practice

OHNs collaborate with workers, employers, members of the occupational health and safety team, and other professionals to:

• identify health and safety needs;
• prioritize interventions;
• develop and implement interventions and programs; and
• evaluate care and service delivery.

The nurse is the key to the coordination of a holistic, multidisciplinary approach to delivery of safe, quality, and comprehensive occupational and environmental health programs and services that include:

• clinical and primary care, including assessment, diagnosis, management, and documentation of occupational and non-occupational illness and injury;
• case management for occupational and non-occupational illnesses and injuries;
• health hazard assessment and surveillance of worker populations, workplaces, and community groups;
• investigation, monitoring, and analysis of illness and injury episodes and trends, as well as methods to promote and protect worker health and safety;
• compliance with laws, regulations, and standards governing health and safety for workers and the environment;
• management and administration of occupational and environmental health services;
• health promotion and disease prevention strategies using primary, secondary, and tertiary principles;
• counseling, health education, and training programs using adult learning approaches; and
• research related to occupational and environmental health.

Occupational and environmental health nursing practice is dynamic and recognizes socio-cultural, community, economic, political, technological, and ecological influences and the impact of policy issues. Consequently, OHNs must understand the legal parameters of practice and respond to legislative mandates that govern worker health and safety. OHNs are professionally accountable to the client(s) (Core Curriculum, 3rd Ed., 2006).

Standard I. Assessment

The OHN systematically assesses the health status of the client(s).

Criteria:

1. The client’s(s’) immediate status and needs determine the priority of data collection.

2. Subjective and objective data representing the broad spectrum of client needs is collected.

3. Information is obtained from the client, other healthcare professionals, other professionals, and the environment as indicated using appropriate data collection techniques.

4. The client’s(s’) values, preferences, expressed needs, and knowledge of the healthcare situation are obtained and honored as appropriate.

5. The data used in making an assessment provides a baseline for future comparative purposes.

6. Relevant data is documented in a retrievable form that maintains confidentiality.

7. Findings are appropriately communicated.

8. The assessment process synthesizes available information, data, and knowledge relevant to the situation to identify patterns and variances.

9. The data collection process is systematic and ongoing.

Additional criteria for the Advanced Practice Registered Nurse (APRN):

1. Diagnostic tests and procedures relevant to the client’s(s’) current status are ordered and interpreted.

Standard II. Diagnosis

The OHN analyzes assessment data to formulate diagnoses.

Criteria:

1. Diagnoses are derived from the assessment data.

2. Diagnoses are validated with the client and, when appropriate, with healthcare professionals and other professionals while maintaining confidentiality.

3. Diagnoses identify actual or potential risks.

4. Diagnoses guide and establish priorities for intervention.

5. Diagnoses are documented in a manner that facilitates the determination of expected outcomes, the plan of care, choice of interventions, and evaluation.

Additional criteria for the Advanced Practice Registered Nurse (APRN):

1. Clinical findings are systematically compared and contrasted with normal and abnormal variations and developmental events in formulating differential diagnoses.

2. The APRN utilizes complex data and information obtained during interview, examination, and diagnostic processes in identifying diagnoses.

Standard III. Outcome Identification

The OHN identifies outcomes specific to the client(s).

Criteria:

1. Expected outcomes are derived from the diagnoses.

2. Outcomes are formulated with the client(s), healthcare professionals, and other professionals as appropriate for continuity of care.

3. Outcomes are culturally appropriate, realistic, and attainable in relation to available resources.

4. Expected outcomes include a time estimate for attainment.

5. Outcomes are documented as measurable goals and objectives.

6. Expected outcomes are modified according to changes in the status.

Standard IV. Planning

The OHN develops a goal-directed plan that is comprehensive and formulates interventions to attain expected outcomes.

Criteria:

1. The plan is developed with the client(s), healthcare professionals, and other professionals as needed to foster cost-effective health outcomes.

2. The plan is based on current knowledge of scientific evidence and trends in nursing, medicine, public health, occupational health, social and behavioral sciences, environmental sciences, management and administration principles, and laws and regulations governing practice.

3. The plan reflects realistic and measurable goals and objectives to maximize functional capabilities of the client(s), provide for continuity of care, and foster compliance with government regulations.

4. The plan identifies strategies that emphasize self-care capabilities, health promotion, and disease and injury prevention.

5. The plan is documented using standardized language and terminology.

6. The OHN participates in the strategic and long-range planning for the client(s) related to health and safety.

7. The plan is modified according to the ongoing assessment.

Additional criteria for the Advanced Practice Registered Nurse (APRN):

1. The plan identifies assessment, diagnostic, and therapeutic interventions based on current evidence-based medicine and clinical knowledge.

2. The plan creates inter-professional processes to address the current diagnoses.

Standard V. Implementation

The OHN implements interventions to attain desired outcomes identified in the plan.

Criteria:

1. Interventions are consistent with the established plan.

2. Interventions are evidence-based and treatments are specific to the diagnoses or problem(s).

3. Interventions apply appropriate knowledge of health problems and diversity.

4. Interventions include health teaching and health promotion.

5. Interventions are implemented in a professional, safe, and timely manner with the understanding, consent, and participation of the client(s).

6. Community resources and systems are utilized as needed to implement the plan.

7. Interventions may be delegated when appropriate.

8. Implementation is documented to provide evidence of interventions, including any modifications to the original plan.

Standard VI. Evaluation

The OHN systematically and continuously evaluates responses to interventions and progress toward the achievement of desired outcomes.

Criteria:

1. Evaluation is guided by the results of nursing intervention, alterations in the client’s(s’) health status, and achievement of desired outcomes.

2. Evaluation includes measurement of immediate and long-term outcomes, quality of intervention, and cost/benefit analysis.

3. Evaluation requires access to information that allows for coordination of optimum care regarding the client’s(s’) health status.

4. Evaluation of nursing intervention is documented with respect to results, effectiveness, and potential for research.

5. Quality is maintained by correcting deficits identified through evaluation and continuous quality improvement.

Standard VII. Resource Management

The OHN secures and manages the resources that support occupational health and safety programs and services.

Criteria:

1. Decisions to secure resources are based on the client’s(s’) goals and objectives, identified health needs, health hazards, and associated costs.

2. The occupational health and safety programs and services are strategically aligned within the scope of the client’s(s’) needs.

3. Operational management of the occupational health and safety programs and services is provided, including formulation of policies and procedures.

4. The OHN participates in decision-making regarding operational and capital resources needed for cost-effective occupational health and safety programs and services.

5. Factors related to quality, cost, safety, and availability of resources are evaluated when choosing among alternative approaches to health service delivery.

Standard VIII. Professional Development

The OHN assumes accountability for professional development to enhance professional growth and maintain competency.

Criteria:

1. Individual performance is continually evaluated using professional practice standards and other quality improvement mechanisms to identify areas of strength as well as areas where professional development would be beneficial.

2. Constructive feedback and peer review is sought.

3. A plan of action is established to achieve competence in the areas identified during the evaluation process.

4. Self-competency is enhanced by maintaining and updating professional knowledge and skills.

5. Credentialing is achieved and maintained by participation in required activities.

6. Professional responsibility is demonstrated by participating in professional organizations and promoting the profession.

7. The OHN serves as a role model and mentor.

Standard IX. Collaboration

The OHN collaborates with clients for preventive health, health promotion, and restoration of health within the context of a safe and healthy environment.

Criteria:

1. Goals, plans, and decisions are formulated.

2. The OHN participates in health, safety, environmental, and management activities in solving problems, setting policy, and planning programs and services for clients.

3. Conflict management and engagement is promoted.

4. Standards and applicable codes of conduct that govern behavior among peers and colleagues are followed to create a work environment that promotes cooperation, respect, and trust.

5. The OHN engages in teamwork and team-building processes.

Additional criteria for the Advanced Practice Registered Nurse (APRN):

1. The APRN as a licensed independent practitioner participates as a team leader and/or member in providing health and medical care and interacting with professional colleagues in providing comprehensive care.

Standard X. Research

The OHN uses research findings in practice and contributes to the scientific base in occupational and environmental health nursing to improve practice and advance the profession.

Criteria:

1. Practice reflects the integration of currently validated research findings.

2. Research activities are participated in at levels appropriate to the individual’s education and experience, such as:

   • identifying researchable problems;
   • preparing proposals for support of research projects;
   • participating in the data collection process;
   • protecting the rights of research participants;
   • critically reviewing and evaluating reported research;
   • using research findings in the development of policies, procedures, and practice guidelines;
   • sharing research findings and activities; and
   • collaborating with other disciplines in the development of research studies and the dissemination of research findings.

Standard XI. Ethics

The OHN uses an ethical framework for decision-making in practice.

Criteria:

1. Practice is guided by the AAOHN Code of Ethics and Interpretive Statements (AAOHN Code of Ethics and Interpretive Statements, 2009).

2. Confidentiality of health information is maintained in accordance with professional codes, statutes, and regulations.

3. The rights of client(s) and the occupational and environmental health nurse are protected.

4. Care is delivered to client(s) that is respectful of self-determination, capabilities for self-care, and diverse personal attributes.

5. The OHN acts as an advocate to promote client’s(s’) self-determination and to preserve autonomy, dignity, and rights.

6. Resources to facilitate ethical decision-making and resolve ethical dilemmas are utilized.

7. Instances of illegal, inappropriate, or unethical behavior that can endanger or jeopardize the best interests of the client or situation are acted upon appropriately.