Issuu

THE OFFICIAL MAGAZINE OF iOH Volume 27 Number 1

Winter 2020

Mental Health:

Returning to Work

Drug and Alcohol Tests · Chemicals and Skin · Libby Morley

Partners of OH Today

The Editor

Lynn Pratt board@ioh.org.uk

Production Editor

Hamish Pratt Deadline for submissions for the next issue: 10 April 2020 Copyright ÂŠ iOH (Formerly AOHNP) 2020 Published by iOH (Formerly AOHNP) ioh.org.uk 61 Waverley Road, Kenilworth, CV8 1JLE email: admin@ioh.org.uk Views expressed in OH Today are those of the contributors and not necessarily those of the iOH. Nor does iOH necessarily endorse any products or services mentioned or advertised in the publication.

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From The President

CONTENTS

The Return to Work IGLOo

Alcohol and Drug Testing

Systematic Literature Reviews

Chemicals and skin

Interview: Libby’s OH Journey

ROI or VOI—Which Should I Use?

Coronavirus

A Focus on Reflective Practice

Recommended Reading

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From The President Lucy Kenyon Right: Angus Baskerville will be performing magic at RAML.

appy New Year. Welcome to the 28th year of iOH and the 25th anniversary of the Ruth Alston Memorial Lecture (RAML). We look forward to welcoming you to OH – It’s a kind of magic, our celebration drinks reception, at the NEC on 10th March. Find out how magic can help you to understand people and situations where perception and reality are different. If you haven’t yet registered to attend, please do here: https://www.eventbrite.co.uk/edit? eid=80583293801

On behalf of iOH I am exploring ways for our members to work with the occupational disease reporting systems 04

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This edition of OH Today reminds us of the importance of reflecting on our practice in order to keep up to date with best practice. Chris Packham describes and demystifies the scope and limitations of COSHH health surveillance and Carol Sanders talks about a new role for immunisation and an innovative and cost effective intervention to manage stress. As my daughter travels round South-East Asia on her gap year, Coronavirus remains in the news as numbers of both infections and deaths increase. We are reminded to keep an open mind about and update our knowledge on sources of infection, vectors modes of transmission. At the time of

writing the number of infections has exceed the total number of SARS infections and the mortality rate remains at 2%. What we do know is that the Catch it, Bin it, Kill it campaign remains as relevant as ever. To keep up to date on Coronavirus add this to your browser pinned pages: https:// www.who.int/emergencies/diseases/novelcoronavirus-2019 Occupational New Year’s resolutions: What are you planning to do to improve your practice in 2020? In 2017 Sanson reported that “Nursing diagnoses have a great potential to predict patient and organisational outcomes. Highquality research is required to better investigate the existence and strength of these relationships.” On behalf of iOH I am exploring ways for our members to work with the occupational disease reporting systems to improve our knowledge and understanding of the actual scale of occupational illness. On a personal level, I plan to ensure that I am as informed as possible to identify, refer and report working diagnoses of occupational disease. I look forward to seeing you all at Health and Wellbeing at Work and at RAML. 

The Return to Work

IGLOo

The Resources Needed to Support an Employee Returning to Work Following Mental Ill-Health Dr Jo Yarker is Director of Affinity Health at Work, a workplace wellbeing consultancy and leads the Professional Doctorate in Organisational Psychology at Birkbeck, University of London. Her work uses evidence based approaches to improve health and wellbeing at work for employees, teams, managers and organisations.

he recent Deloitte report estimates the total cost of poor mental health to employers has now reached ÂŁ45 billion1. With stress, anxiety or depression accounting for 44% of all ill-health related cases of absence and 57% of all working days lost to ill-health in 2017-20182, there is a pressing need for employers to consider how they manage the return to work process for employees following a period of mental ill-health sickness absence.

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Returning to work following sickness absence can be challenging. Too many people struggle to return, and many subsequently relapse and take further absences3. This is not surprising when considering the findings of the BITC annual report which shows that 41% of employees experiencing a mental health problem report no actions taken in the workplace to help them manage their condition, while only 8% of UK managers reported receiving training around

reasonable adjustments and rehabilitation for mental health4. Using the IGLOo model5, our research to identify the key resources that help employees get back and stay in work. Our research Working with Professor Karina Nielsen, University of Sheffield, we conducted interviews with 38 returning employees and twenty managers who have supported return to work. Some returners were interviewed at monthly intervals over a four month period to examine the fluctuations in work and health. We found that employees used a number of resources both in and outside of work, and rely on help and good practice from others in the organisation, to help them stay at work. These resources help to form the employeesâ€™ IGLOO - Individual, Group, Line manager, Organisational and Outside resources.

Individual resources Employees reported that prioritising self care and establishing clear boundaries between work and leisure time – by switching off work emails on their phone or leaving marking at school – was vital in maintaining their ability to work. Many said that they found it difficult to keep focused and struggled when tasks were too large or were unstructured so dividing the work day into small chunks of time or discrete sub-tasks was found to be helpful.

41% of employees experiencing a mental health problem report no actions taken in their workplace

work. Line manger resources The role of line managers’ play in supporting employees as they return is well recognised. However, we found it was particularly important that line managers empower the employee to be in control of what information is shared, and how it is shared, with colleagues. It worked best when managers took the time to discuss the best approach with the returning employee, and helped them share information in the agreed way. The need for continued and Group resources ongoing support was also noted. All too Support from colleagues and friends was often employees reported that their important for many. Receiving feedback managers’ good intentions dwindled on tasks from colleagues, or knowing after the first few days. Weekly or bithat they can ask for help on more weekly check-ins were encouraged. difficult parts of the job, helped them to build their confidence and was an Organisational resources important contributor to them staying at Employees who described successful

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returns noted the importance of workfocused counselling. An opportunity to talk about their work, discussing difficult tasks and conversations helped them to anticipate and manage their response to them. Employees also said that having access to flexible working practices was important in helping them stay on top of their health – especially in the early months of their return. An absence policy that is implemented in a compassionate accommodating way, where fluctuating conditions are not penalised, helps returning employees to sustain work in the long term. Using the IGLOo With the increasing prevalence of mental ill-health, there is an increasing pressure on OH practitioners to provide support for employees returning with complex needs. The IGLOo approach aims to translate complex needs into practical actions that we can each take to support a returning employee. We have created mirrored guidance so that employees, colleagues, line managers, and HR professionals that can sit alongside professional advice and intervention. It is our hope that this approach can help us all work together to give return employees the best possible chance of achieving a success-

ful, sustainable return to work.  The full report and guidance are available here: https:// productivityinsightsnetwork.co.uk www.affinityhealthatwork.co.uk/ ourresearch If you would like to know more about our work or get involved in our research please contact us: Jo Yarker jo@affinityhealthatwork.com

References 1

Hampson, E., & Jacob, A. (2020). Mental health and employers: Refreshing the case for invest-

ment. Deloitte. London, UK. 2

Work-related stress, anxiety or depression statistics in Great Britain, HSE, 2019.

Norder G, van der Ben CA, Roelen CA, Heymans MW, van der Klink JJ and Bültmann U (2017). Beyond return to work from sickness absence due to mental disorders: 5year longitudinal study of employment status among production workers. Eur J Public Health 27, 79-83.

Mental Health at work, BITC, 2019.

Nielsen, K., Yarker, J., Munir, F., & Bültmann, U. (2018). IGLOO: An integrated framework

for sustainable return to work in workers with common mental disorders. Work & Stress, 32(4), 400-417.

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Above: a checklist for following IGLOo when returning to work.

Drug and Alcohol Testing: Is workplace drugs and alcohol testing here to stay?

mployers have a legal duty to take reasonable care for the safety of their employees and a statutory duty to ensure the health, safety and welfare of employees. Drug use amongst 16 -59 year olds has remained relatively constant at about 9% of the population in England and Wales since 2007 but this figure rises sharply to 19.8% in the 16-24 year old age group (Public Health England, 2018). In parallel to this, there has been an increase year on year in the number of employers looking to implement drugs and alcohol testing in the UK workplace and the testing industry is set to rise to ÂŁ231million in 2019 from ÂŁ167 million in 2017 (European Pharmaceutical Review, 2017).

ment at the time of testing. In contrast, urinalysis or hair sampling may result in a non-negative test but the employee may not be impaired at the time of testing as certain substances can remain in urine or hair for much longer periods than in the mouth.

Who should be responsible for testing? Human Resources, Occupational Health and Health and Safety professionals have the ability to implement drugs and alcohol testing alongside a Wellbeing strategy with a focus on rehabilitation for any employees

Testing Procedures There are a wide variety of testing procedures including urinalysis, oral (swab) and hair sampling. The abundance of options can seem bewildering to employers and the testing process can be difficult and embarrassing for employees. Employers should ensure that they implement the most appropriate and unobtrusive testing method possible. Urinalysis can be humiliating, particularly for female employees, and tests for lifestyle, rather than impairment. Oral testing is much more dignified and only tests for impair-

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who are suffering from problems with drugs and alcohol. Not all employers are able to refer employees to internal Occupational Health departments but the NHS and Talk to Frank can help employers to find local assistance. Employers should make it clear to their employees why they are implementing a substance misuse policy and the subsequent impact should a test result in a non-negative sample for substance misuse. Best practice would be to carry out an employee roadshow to fully explain the reasons behind implementing a substance misuse policy which offers employees an opportunity to ask any questions. I would also advise that employers offer an amnesty period so employees are able to approach either their line manager or HR with any concerns they might have about possible addiction or medication that may trigger a non-negative result during testing.

Emerging Trends There has been an increasing number of part-time athletes in various sports taking myriad substances to minimise muscle fatigue or improve performance. Many of these substances have not been tested or

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approved by governing bodies and some have been shown to contain high enough levels of THC (cannabis) as to show a non-negative result in a drugs test. Employers should encourage their employees to only take substances approved by Informed Sport to ensure their samples do not unwittingly result in a non-negative test. Employers must review their policies on a regular basis to keep up-to-date with any new and emerging drugs or changes in the law. In April 2019, two prescription drugs were reclassified as Class C drugs â€“ Pregabalin and Gabapentin. These would not show on traditional screening methods used by an employer or outsourced screening service but would show on a confirmatory (back to lab) test. Employers should keep up to date with new and emerging drug trends and reclassification of prescription drugs in order to keep their substance misuse policies current and fit for purpose. Drugs and alcohol testing will increase within the UK workplace and it is advised that employers ready themselves and their workforces for the impact this may have on their business and personal lives.

OdiliaClark offers state-of-the-art drugs and alcohol testing for organisations supported by specialist HR services. We assist organisations with bespoke policy writing and implementation (including employee roadshows), outsourced drugs and alcohol testing including For Cause and unannounced, random testing and the installation of vehicle alcohol immobilisation devices. OdiliaClark believes that employees should receive help in the case of a positive test and as such, we have partnered with an independent addiction service which offers services including counselling and rehabilitation and personalised plans for the best chance of recovery. For more information, email info@odiliaclark.com or call Emma Horner on 07577 305377. ď‚˘

Performance-enhancing substances are becoming more common in semi-professional athletes

How to conduct a systematic search for a Systematic Literature Review Dr Charlotte Whiffin Senior Lecturer University of Derby c.whiffin@derby.ac.uk

Introduction

iterature reviews are a comprehensive examination of literature which address a common aim and are increasingly popular in nursing and health related sciences (Aveyard and Bradbury-Jones 2019). Literature reviews are required to advance practice as part of an evidence -based approach and are often a requirement of academic advancement in the form of a Dissertation or Thesis. Literature reviews enable conclusions to be drawn from a large number of studies (Harari et al. 2020).

Systematic Reviews are essential to evidence based practice and the cornerstone of improving patient care 12

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However, there are many different types of review, and although most share a commitment to comprehensive searching, these do vary in their structure and methodology (Grant and Booth 2009, Aveyard and BradburyJones 2019). This article will discuss the typical requirements of a systematic search; however, always check the methodolo-

gy required for the type of review being conducted as the acquisition of literature may be different.

Systematic reviews and Systematic Literature Reviews Systematic Reviews are essential to evidence based practice and the cornerstone of improving patient care and advancing professional practice. Systematic Reviews, typified by organisations like the Cochrane Collaboration, use explicit and auditable criteria for undertaking the review. These reviews are a fundamental part of the evidence base and their methodological robustness explain their positioning at the top of the hierarchy of evidence. Systematic Reviews from organisations like the Cochrane Collaboration typically, use a team of independent researchers, review all the existing relevant literature (sourcing unpublished as well as published research, and research in different languages), often investigate

narrow questions typically around treatment efficacy, take months to years to conduct and should provide reliable recommendations to inform clinical practice (Davis 2016). In addition, Systematic Reviews often include meta-analysis whereby data from the original primary research are pooled to determine the overall treatment effect of all the studies when combined.

tically these should be comprehensive and repeatable (Harari et al. 2020). The rigour and transparency of the search is so important that if this is wrong, the findings will be biased. Do not underestimate the time it takes to complete this stage.

Search strategy

Developing the search strategy is a commonly frustrating exercise even Some use the term ‘Systematic though it may initially seem straightLiterature Review’ interchangeably forward (Aveyard 2019). Thinking with Systematic Review. Others use carefully about the search before the Systematic Literature Review to denote searching is commenced is time well a review conducted in a systematic way spent (Aveyard 2019). Once a topic is but without the full rigour of a identified a scoping exercise should be Cochrane style Systematic Review. commenced which identifies possible These ‘Systematised’ Literature search terms by exploring literature, Reviews, as Grant and Booth (2009) websites, textbooks, government would classify them, are commonly publications and other relevant undertaken by an individual, perhaps material. as part of an educational qualification. Such reviews are therefore significantly To plan the formal stage of searching, a limited by time and resources and will well-designed question is required, and often limit the retrieval of literature, so this should be framed within a model the review is feasible. These limits such as PICO (population, intervention, enable a review to be achieved in weeks comparison, outcome), PIO to months (Davis 2016) and thus suit (population, intervention, outcome) or the timeframe of many educational PEO (population, exposure, outcome). programmes. Using a model allows the key concepts within the question to be identified so that a search strategy can be developed A systematic search that will generate as many appropriate The primary aim of a systematic search search terms as possible (Wakefield is to locate literature which answers a 2015) (see Table One for an example). specific question (Davis 2016). The Once the main search terms have been scope, time and resources available for identified, truncation, wild cards and the review will determine if all of the thesaurus terms also need to be literature on a subject is to be sourced, considered. or if a proportion of this is more appropriate. In either case, the search Databases strategy is crucial and must be conducted well. The requirements of the Multiple databases should be searched search are specific to the type of review because different databases will return being conducted; however, characteris- studies from different journals.

Multiple databases should be searched because different databases will return studies from different journals

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Concept

Population

Key words

Nurse Nurses Nursing Nurs*

MeSH term

(MH “Nurses)

Exposure

Outcome

Manual handling Patient handling Moving and handling Patient lifting

(MH “Moving and Lifting Patients”)

Backpain Back Pain Back-ache Backache bad back back spasm back disorder (MH “Back Pain”) (MH “Low Back Pain”)

Table 1: Search terms and synonyms

Popular, and recommended, healthcare databases include Medline, PubMed, Embase, CINAHL, PsychINFO and AMED. However, there are lots of others. Although combined searching is possible in many gateway services, such as EBSCO, and library databases, it is not recommended that you use combined database searches when completing a systematic search. Each database has unique features in the way it searches and indexes literature. Specific thesaurus such as MeSH (Medline Subject Headings) terms will help to identify papers by the way they have been annexed and is more specific than a simple key word search. These thesaurus searches are not transferable between databases. The aim of the initial searches is to build a ‘high sensitivity’ search around each important concept in your question that will identify all of the literature relevant to this concept. Therefore, each key word search should be individually executed in the database. All search terms which are equivalent to each other are then combined using the Boolean operator

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OR. Use of the Boolean operator AND then allows you to move to a ‘high precision’ search where concepts are joined together. In this final search papers will only appear in the results list if all your required concepts appear in the paper together (see Figure One).

Population Nurses

Outcome Backpain

Searches combined with ‘AND’

Exposure - Manual handling

Figure 1: example of ‘AND’ Boolean search

In an ideal world this process would reliably produce a results list that is feasible for the stage of ‘review by title and abstract’. However, having several thousands of papers in the results list is an indicator that the search is not yet precise enough. At this stage limits are useful and appropriate limits for a Systematic Literature Review restricted by time and resources may be publication date, language of publication and peer review. It is worth saying that a

limit of â€˜full textâ€™, which may be tempting, is never appropriate for a Systematic Literature Review, regardless of time and resources, as this feature is licence specific and will only return results which your organisation has a licence to access as full text. Therefore, the aims of a Systematic Literature Review cannot be achieved if this limit is applied. Any papers that are not available immediately full text can be sourced through an interlibrary loan, speak with the librarian about this. If the search is still not precise enough, review the search protocol and consider using limits for any key word searches by restricting these to appearing in the abstracts only. However, even more frustrating than an imprecise search is a search that returns little or no results. It may be that there is no research in this field in which case a Systematic Literature Review may not be possible. Alternatively, the question could be revised by widening its scope, changing the inclusion criteria, and the search reactioned. Although this process can be immensely frustrating, it is crucial to get right. Asking for support and advice from a librarian is often key to a successful search strategy. Additional advice at this stage is to always save the database searches so these are easily available when writing up the review (Bettany-Saltikov 2012).

relevant papers, forward searches of papers that cite relevant papers, hand searching of individual journals, and web based searches (Harari et al. 2020).

Review by title and abstract Once a rigorous, transparent and repeatable search is completed that confidently leads to relevant papers these can be screened by their title and abstract. At this point the results can be downloaded and imported to referencing software such as EndNote or Mendeley so that duplicates can be removed and the process of review by title and abstract can be commenced. At this stage resist the temptation to read the full text. Simply add papers to a folder if they appear relevant to the review question.

Review by full text

Once all the papers returned in the search have been screened, the papers in the folder can be reviewed by full text. This stage of the process requires each paper to be read in full and assessed against the inclusion and exclusion criteria. These criteria need to be set so there is a transparent rationale for why each paper was included or excluded. Most of these criteria will be set before reviewing the papers, other criteria will only be set as the papers are reviewed. For example, excluding paediatric studies may be the Complimentary searches intention from the start but because Not all studies are indexed in the the evidence base is still too large for a databases and it is possible that a feasible review, a criterion that also relevant citation is missed. Therefore, excludes those over 70 may be added. combining a database search with At this stage all decisions must be complimentary searching is essential recorded about why studies were (Davis 2016). Complimentary searching included or excluded from the review includes a review of citations from (Wakefield 2015).

Not all studies are indexed in the databases and it is possible that a relevant citation is missed

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Following completion of this stage a feasible amount of literature will have been identified for the Systematic Literature Review. This literature will then require appraisal and synthesis in a way that is congruent to the review methodology chosen.

Above: Figure 2: PRISMA flowchart (Moher et al. 2009)

However, core texts from BettanySaltikov (2012), Coughlan and Cronin (2017), Aveyard et al. (2016) and Aveyard (2019) are also thoroughly recommended for their clear advice on how to complete a Systematic Literature Review in health sciences.

Conclusion

This article has described the systematic searching process within Systematic Literature Reviews. Recommendations for practitioners and students embarking on a Systematic Literature Review include being realistic about the time it Further reading takes to search, to scope the evidence Further advice on how to conduct base first and plan the search strategy systematic searches are contained in advance and in detail, to seek advice within the guidance for Systematic and support from a librarian and Review from the Cochrane Collaboradocument all decisions so these can be tion (Higgins et al. 2019), The Centre accounted for in the final writing up of for Reviews and Dissemination (2008) the review. A final piece of advice is to and The Joanna Briggs Institute look at other reviews using the same (Aromataris et al. 2017). In addition review methodology published in reporting guidelines have been leading journals which illustrate how developed by Moher et al. (2009) in the others have managed this review type. form of the PRISMA (Preferred These recommendations will help to Reporting Items for Systematic Reviews ensure the review is methodologically and Meta-Analyses) statement and robust. ď‚˘ PRISMA flowchart (See Figure Two).

Aromataris, E., Munn, Z. & (Editors) (2017) Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute. Available from https://reviewersmanual.joannabriggs.org/ [accessed on 01/02/2020 Aveyard, H. (2019) Doing a literature review in health and social care : a practical guide, Open University, Maidenhead. Aveyard, H. & Bradbury-Jones, C. (2019) An analysis of current practices in undertaking literature reviews in nursing: findings from a focused mapping review and synthesis. BMC Medical Research Methodology, 19(1), 105. Aveyard, H., Payne, S. & Preston, N. (2016) A post-graduate's guide to doing a literature review in health and social care, Open University Press, Maidenhead. Bettany-Saltikov, J. (2012) How to do a systematic literature review in nursing : a step-by-step guide, Open University Press, Maidenhead. Centre for Reviews and Dissemination (2008) Systematic Reviews: CRD's guidance for undertaking reviews in health care, CRD University of York, York. Coughlan, M. & Cronin, P. (2017) Doing a Literature Review in Nursing, Health and Social Care, SAGE, Los Angeles. Davis, D. (2016) A practical overview of how to conduct a systematic review. Nursing Standard, 31(12), 60-71. Grant, M.J. & Booth, A. (2009) A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26(2), 91-108. Harari, M.B., Parola, H.R., Hartwell, C.J. & Riegelman, A. (2020) Literature searches in systematic reviews and meta-analyses: A review, evaluation, and recommendations. Journal of Vocational Behavior. https://doi.org/10.1016/j.jvb.2020.103377 Higgins, J., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. & Welch, V. (eds.) (2019) Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019), John Wiley & Sons, Chichester. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. & The PRISMA Group (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med, 6(7), e1000097. doi:10.1371/journal.pmed1000097 Wakefield, A. (2015) Synthesising the literature as part of a literature review. Nursing Standard, 29(29), 44-51.

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FREE

10 March 2020

During Health and Wellbeing at Work 2020 You are invited to join the Board, members and guests at the 2020 Annual Ruth Alston Memorial Silver Jubilee Celebration and Drinks Reception to be held on the evening of Tuesday 10th March 2020, in the Oasis Suite, Crowne Plaza Hotel, Birmingham NEC. Our Silver Jubilee theme for the evening, which will celebrate 25 years of RAML, will be "Occupational Health - It's a kind of Magic!" This early evening event will be a drinks reception and networking with magic and mentalism to challenge our perceptions and preconceptions from iOH Honorary Member Angus Baskerville and professional pick-pocketing and hypnosis to give insight to power and loss from James Brown. Attendees will be welcomed at 5pm for an informal celebration with 2 free glasses of wine and canapĂŠs. Our President, Lucy Kenyon and Board Members will be on hand to network with you and discuss our exciting agenda for the coming year.

CLICK TO BOOK

Chemicals and the Skin: What might we be missing? Written By

Chris Packham Enviroderm Services

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orkplace skin exposure is still a major cause of damage to health. The EU Agency for Safety and Health has stated â€˜skin diseases are the second most common work-related health problem in Europeâ€™, An analysis of data by the National Institute of Occupational Safety and Health in the USA showed that frequency of occupational skin disease reported outstripped that of

respiratory cases by a factor of 2.4:1. Why should this be? In the first place the interaction between the skin and our immediate environment is far more complex than many realise. It is also something where we still have much to learn. It is also an aspect of safety and health where there are many myths and a great deal of misinformation. It is something where

what may appear logical may not match the scientific evidence. As a result, it is common to find action taken with the best of intentions that is actually a contributory factor in damage to health due to workplace skin exposure. One common error is that many still consider the three routes of exposure inhalation, ingestion and skin â€“ as separate, discrete routes, whereas the reality is quite different. The diagram shows how the three routes can interact.

identify as systemic contact dermatitis. This can be defined as a type IV immune response due to exposure to a skin sensitiser by a route other than the skin. These â€˜other routesâ€™ are, of course, inhalation and ingestion. There are numerous case studies in the literature that demonstrate how this can occur. For example, a change in diet in someone allergic to nickel could increase the intake of dietary nickel resulting in a skin reaction. This is quite common and often results in much time

Below: a diagram showing the interaction between the different routes of exposure.

In the list of effects that can result from the interaction between chemicals and the human body there is one that is commonly overlooked. Most are aware of allergic contact dermatitis, technically a type IV immune response due to skin contact with what is termed a skin sensitiser. Less well-known is the separate category dermatologists

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being spent attempting to identify the – “However, there is no scientific method ono existent – skin exposure. of measuring the results of the body’s exposure to risk through dermal Several case reports were concerned contact. Consequently, no dermal with extensive skin rashes due to the exposure standards have been set.” use of budesonide in an inhaler from “Occupational skin diseases and provided for the treatment of asthma. dermal exposure in the European Union (EU-25): policy and practice overview It is also well documented that skin European Agency for Safety and Health contact with isocyanates can result in a at Work reaction in someone who suffers from asthma. Great attention, and considera- Of course, not every chemical will have ble expense, may have been given to the potential to cause damage to health the provision of respiratory protection, by anything other than a single, wellwhilst far less concern was paid to skin established route. The problem for protection. This was provided by those concerned with the safe manageinexpensive, thin, single-use nitrile ment of chemicals used in a working gloves. These provided virtually no environment is to know which chemiprotection against the solvent in the cals and under what conditions could a paint which could permeate through in health effect by a more than one route less than a minute, taking with it the be significant. When would we need to isocyanate and assisting in its uptake include this in a risk assessment to into the skin. Case studies show that identify the actual, or potential, effects skin uptake of isocyanates can result in from more than one route of exposure. an asthmatic reaction, particularly should the person already be someone The problem is compounded by the fact suffering from asthma. that when we use a chemical during a particular task, we may well subject it to Whilst not normally occupational, change and thus change the hazard that consider the effect on the respiratory it represents. system of someone who develops anaphylaxis due to ingesting peanuts. The table illustrates the changes that can, and frequently do occur when a This interaction between the three chemical is used. This information is routes of exposure presents those concerned with the safe use of chemicals with a problem. Merely taking each route in isolation may fail to identify the risk that one or both of the other routes could be significant. This is made even more difficult in that for inhalation exposure we have defined limits for airborne chemicals and method for its measurement. For ingestion and skin exposures there are no such limits. Furthermore, how would we measure ingestion and skin exposure?

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Below: a table showing the changes to chemicals when used.

rarely shown on the safety data sheet. However, there is a different regulatory requirement that suppliers need to consider. This is found in the Health and Safety at Work etc. Act 1974. Section 6-4 includes the following:

“For the time being, there is no EU-wide system in place to assess the combination effects and risks of chemicals” European Chemicals Agency

What now?

Firstly, we need to be sure that we have correctly identified the real chemical hazard that arises when we use one or more chemicals for a particular task. Unless this is done there is a very real It shall be the duty of any person who possibility that our management designs, manufactures, imports or methods will either be insufficient or supplies any substance for use at work:- simply incorrect increasing the potential for damage to health to occur. (c) to take such steps as are necessary to Unfortunately, this is not straightforsecure that there will be available in ward. As the European Chemicals connection with the use of the subAgency (the primary REACH agency) stance at work adequate information has stated: about the results of any relevant tests which have been carried out on or in “For the time being, there is no EUconnection with the substance and wide system in place to assess the about any conditions necessary to combination effects and risks of ensure that it will be safe and without chemicals.” risks to health when properly used. In some situations the solution may be This indicates the need for the provisimple, in others we may need the sion of far more information than is assistance of a specialist, such as a required for the safety data sheet. toxicologist or industrial chemist. Experience suggests that it is seldom automatically provided by a supplier of Secondly, how can we quantify the level chemicals. During 2019 a supplier was of exposure that occurs. With inhalaprosecuted for non-compliance with tion there is an accepted practice that this requirement and fined £500,000. we monitor the level of airborne What this implies is that there should contamination and ensure that this be a closer and more comprehensive remains lower than that permitted by interaction between supplier and end local regulations. For ingestion and skin user. there are no such levels. So we may need to seek guidance, either from It should be clear that the traditional published studies relevant to the approach to risk assessment of noting chemical and task under assessment. those chemicals with hazard statements on the safety data sheet and basing the Thirdly, when we are dealing with a risk assessment solely on those hazards chemical that presents a potential to will frequently fall short of what is cause systemic toxic effects we need to needed. Perhaps it is time for those keep in mind that for the target organ working in health and safety to review or system it is the total dose that their procedures for risk assessment reaches it that is key, regardless of the and exposure management for chemiroute (or routes) by which this occurs. cals when used in the working environ- Here we do have some help in the form ment. of biological monitoring. This will

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indicate the total dose, which, after all, is what we need. This is also a viable technique where we are concerned with cross routes, for example where skin exposure to a chemical could result in a respiratory response. For this to occur the chemical must enter the body and migrate to the required location. Biological monitoring could be a viable means of detecting and quantifying this.

skin disease is irritant contact dermatitis. It its most common, chronic form this is always the cumulative effect of repeated exposures to more than one, possibly many, different irritants. This cumulative effect, normally asymptomatic, can be detected by measuring skin hydration.

As the cumulative â€“ but still invisible damage - increases, the ability of the cells in the stratum corneum to bind Where we are concerned with skin water is progressively reduced. So no reactions due to direct contact between longer is it necessary to wait until the the chemical and the skin matters are damage becomes visible before being more complex. It is beyond the scope of able to recognise that our exposure this article to describe all the factors management is failing. Since the that we need to consider and how to asymptomatic damage also predisposes assess the significance of the skin to the development of sensitisation and exposure. However, some techniques allergic skin reactions it would be wise are available to us. to consider skin hydration measurement as an integral element in any The most common form of occupational occupational skin management system. ď‚˘

Libby’s OH Journey Many health professionals are unaware of what OH can offer as a career. I had the pleasure of catching up with Libby Morley following completion of her MSc in Workplace Health to discuss her inspiration for the specialty and her thoughts for working and studying in the OH arena. Written By

Lynn Pratt

How did you get into OH? I’d never heard of OH as a “thing” until 2011. After a break from “traditional” nursing, the arrival of kids and living in Berlin for 6 years, I completed a Return to Professional Practice (RPP) Diploma and stumbled across OH. I knew that my passion was more about talking to patients than in the practicalities of wound-care or toileting. I had strong beliefs that emotional health and lifestyle were linked to physical health. I wanted to connect with people “before” they became unwell.

An advert caught my eye… OHA on a building site. As I explored the role of an OHA, I became seriously interested. The challenge was then set; in order to work as an OHA I needed a qualification, and in order to gain a qualification I needed to be working in OH! It was a “right place, right time” situation and on applying for the job my new employer agreed to sponsor my studies at Warwick Uni. I did not have a clue during my first weeks. Surrounded by noise, dirt, smells (my office was next to

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the men’s loo in a porta-cabin). I eventually found myself growing in confidence and completing skin checks, hearing tests and giving a million flu vaccines often via massive tattooed arms (after they joked about dropping their trousers, of course!).

What has been your specialist area and why? Whilst working on an assignment for the Diploma in OH, I discovered Mental Health First Aid (MHFA) England and become a trainer in 2014. I felt this truly played to my passion. I found increasingly that management referrals contained elements of stress or mental distress and it became clear that most managers and organisations had limited knowledge on how to support this. In

my twenties I had experience of anxiety and depression and studied Counselling and Transactional Analysis. I have always encouraged people to explore what’s going on “on the inside” and I seem to be able to put people at ease. Like my feelings towards the “hand’son” part of general nursing back in the late 80’s, the part of OH nursing I enjoy the least is health surveillance; let me listen to people, let me guide and support and it just doesn’t feel like work to me! So, this is what I do now! I write and deliver a variety of courses related to stress and mental health as well as ad hoc management referrals. In 2016 I took a leap and build up my training business as Independent OHA and MH trainer.

shortcomings in much of the existing research; it increased my passion to convey the importance of “primary” workplace interventions where a culture change is often required. The module on new and emerging risks to workplace health supported my observation that changes in society, demographics, worker-expectation and globalisation bring risks to the wellbeing of employees. The degree was a massive challenge. The statistics element was tough. The summer of 2019, spent writing up my research, was one of the most demanding times and took its toll on my personal mental fitness. I was always incredibly well supported academically by my tutor, Jonathan Houdmont, and would recommend this course without hesitation.

What led to you studying for an MSc in Workplace Health and Who and what has inspired/ Wellbeing and how was it? guided you most? The truthful answer is, initially “imposter syndrome”! I feel strongly that to declare oneself a specialist, some level of study (obviously combined with experience) is needed. I may be one of the few people who agrees with the NMC revalidation process! My motivation to study was influenced by a desire to bring some kudos to my day to day work; I felt I needed to bring another layer of professionalism to my role, backed by more formal qualifications.

It’s been helpful to work with the worst and the best colleagues, providers and organisations to find my inspiration! In my earliest OHA days, it was report writing that I fumbled with.

My colleague, Sandra Furlong, was a hugely experienced OHA and offered great guidance. The fact that I was presenting a legal document, potentially in need of future defence, as well as a guide for a manager to bring to life felt very scary. The Diploma didn’t really The course modules were highly prepare me for this, and I regularly relevant to my work; each essay enabled approached Sandra for her wise me to explore, in depth, topics includcounsel. ing new and emerging risks to workplace health, work-related stress I rate Debbie Craig and Mary Hobday interventions, models of behaviour from Corazon Health very highly. Both change and sickness absence, rehabili- showed a professionalism that I hope tation and retention. My essay on stress has rubbed off on me. Debbie showed interventions highlighted some me how to be diplomatic in tricky

I always like to explore what’s going on inside and putting people at ease by being myself

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Working for yourself must be tough at times. Where do you get support from? Even when employed, I often worked separately from the wider team; whenever a colleague had reason to pop over or when the whole team got together it was hugging and chatting all round!

Above: The University of Nottingham campus, where Libby studied for her MSc

relationships between OHA and client that is sometimes required. Diane Romano-Woodward and Lucy Kenyon seem to have always had a presence too! Lucy for cheekily putting me forward to update the chapter on MH in Greta Thornbory’s book and Diane for her generosity in sharing her abundance of knowledge and experience, especially with her focus on evidence-based practice. More recently I have been inspired by my fellow Master’s student, and new friend, Trudi McHugh; her endless enthusiasm and ability to pass with Distinction despite being a mum to 2 young children and working part-time. She is a great reference point when I found myself flagging!

I have always leaned on colleagues who work in similar roles, calling them to off -load or to discuss a case. Jisc-mail and the OH Facebook page is also a great place to access professional support. As a nurse first and foremost, I find that having a business head is tough but my husband is great sounding-board.

Do you have any advice for those considering going into OH or considering further academic study? I would recommend OH as a profession! Firstly, there’s not enough of us and it’s unlikely that you wouldn’t find work. Secondly, the variety of work related to OH is vast. I think in the early days it’s helpful to experience many different sectors and sized organisations.

Be prepared for the extremes of people and environments you might find What inspired you to start your yourself in! From construction workers to scientists, office managers to own business? engineers and musicians to vets! You’re If you had told me 10 years ago that I likely to be wearing safety shoes and would be running my own business, I high-viz clothing one day and “officewould have scoffed! I suppose it smart” the next! Be clear on the role of happened organically; as my interest in an OHA and expect to have the training staff to better understand MH occasional challenge from HR or H & S grew and as demand increased, I needed staff! Do a legal skills course and a more time to devote to this. I took small report writing course! steps to make it happen. I was lucky to have a financial and an emotional Regarding further study I would advise cushion via my husband. having some experience of OH first…

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but then go for it! Don’t think you’re too old to start; I was 51 when I finished.

Above: Mindshift Consultancy, Libby’s business

What about the future, any further studying?

Mindshift is adding to its offerings You need to enjoy reading and it helps during 2020. As well as continuing to if you can read quickly! Academic provide training related to all thing’s writing can be learned… believe me! mental fitness, we offer sickness Stretch your comfort zone and plan absence management that covers all ahead once you start a course and health conditions and specialises in ALWAYS plan to finish your assignment MH. We also provide support with at least 2 weeks before the deadline! strategy writing for workplace wellbeing, stress risk assessments, staff Any hot topics OHAs should be engagement surveys, the creation of MH policies, role descriptions for MH aware of? advocates and of course bringing these Work-related stress is likely to continue initiatives to life. in the future and the HSE may increase their focus on this. A stress risk I am exploring creating a version of assessment is a legal requirement, but MHFA that brings in some more most organisations do not make this practical skills and that can be tailored happen and leave themselves wideto a variety of sectors and looking at the open to litigation. I anticipate more options available regarding getting this rigid inspections in this area. I hope to course accredited. Lastly, I am considsee action being taken by both the ering writing a guidebook for employers inspectors and employers. and OHA’s; I think some clarity is needed by each party on how to get the The demographic of the workplace is most from working together! As far as changing; younger people have very further study goes, it’s on hold for now! different expectations and typically value being supported, flexible working, What’s your real name? professional development, ethical and On the OH Facebook group I am Bill social responsibility and having a voice. Morley, my working name is Libby Employers will need to be cognisant of Morley and the name on my passport is this if they want to retain talent. Elizabeth Hassanali! 

Wellness Measures:

ROI or VOI, which should I use?

Written By

Chris Golby Evolyst

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How do organisations measure the effectiveness of mental health & wellbeing programmes? What metrics do they use to evaluate the results?

Definition of Wellness ROI

The term ROI is often used within varying business sectors and equates to revenue generated in return for an Recently, due to difficulties in measure- investment, or in short, profit. ment within this field, an argument has arisen for the use of Value on InvestTo measure the return of investment (VOI) as a replacement for the ment, organisations would look at how more classically used Return on much they have invested in a program Investment (ROI) model. or service and then, compare that to the amount of money they will get from But what is VOI, and which is a more that investment (or ‘return’ from). effective measure? Is it best to use ROI as the basis of the effectiveness of these The advantage of calculating ROI is that programmes, or do you use a “softer” it yields accurate and measurable and more complicated metric like VOI? results due to its numerical outputs, and many organisations prefer hard, Below we discuss these terms and how tangible data. they play a role in evaluating the effectiveness of a mental health & The positives and negatives are clear, wellbeing programmes. making it easier for organisations to see

where they have a deficit or which products, or services are more profitable; or in the case of mental health & wellbeing programmes, what is working most effectively for the business.

Metrics in measuring Wellness ROI in a company wellness program Calculating ROI is used when measuring the effectiveness of a company wellness program. When it comes to these types of programmes though, getting the ROI is not as easy as there are several factors to look at which can be difficult to track, for example, absenteeism rate, presenteeism rate (productivity at work), reasons for absence, amongst a large set of other HR analytical data (if you would like to read more about HR analytics, and what can be tracked, you can read about HR Analytics here: What is 'HR Analytics'?. In a nutshell, measuring ROI is a more number-focused way of calculating the effectiveness of a mental health & wellbeing program, but can be a difficult task, hence the recent evolution of VOI.

Definition of Value of Investment (VOI)

In a nutshell, measuring ROI is a more numberfocused way of calculating the effectiveness of a mental health & wellbeing program

Have you heard of quantitative versus qualitative data in statistics? This is generally regarded as numerical data, versus non-numerical data such as speech and text. If ROI is the numberfocused, quantitative data in the equation, consider VOI as the qualitative metric in your evaluation. VOI or value of investment is a more complicated method in evaluating the effectiveness of a mental health & wellbeing program. This is mainly

because thereâ€™s human factors involved in this method. What the Value of Investment aims to measure is the overall quality of program an intervention instead of just the numbers alone, usually done through items such as surveys; this means that you are not just counting monetary data as a form of return but other factors that are evaluated at the same time.

Metrics in measuring VOI in an employee wellness program VOI has become a popular term when it comes to evaluating mental health & wellbeing programmes in business, due to the human nature of these interventions. Organisations are starting to consider items such as interviews and case studies which show a more holistic approach to the mental health & wellbeing of employees. Many external providers of mental health & wellbeing interventions will struggle to provide exact ROI figures and they are often estimated; however, they will often demonstrate value provided through case studies with clients, demonstrating how VOI shows additional return and builds a more holistic picture. According to Vitalityâ€™s healthiest workplace survey, employees who engage in mental health & wellbeing programmes have a higher tendency of being screened for health issues. These employees also expressed their satisfaction as they felt that their employers are putting a high priority on their mental health & wellbeing. This can be difficult to measure over time using the classic ROI model.

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The main point when measuring VOI is to measure the intangible but important human factors in mental health & wellbeing programmes. There is a huge correlation between employee satisfaction, productivity and efficiency. Employees who feel that their mental health & wellbeing are given importance can feel more loyal to the company. They are also more inclined to increase performance, have fewer absences and deliver more effective outputs.

These factors include: • The overall goal of the mental health & wellbeing program. • The availability of the necessary tools to measure the program. • The size and culture of the company. • The demographics of the employees vs the style of your program.

Because these mental health & wellbeing programmes involve people, there is not a one-size-fits-all program that will work for everyone. Therefore, However, there is still no specific way to it is best to take into consideration measure these factors other than these factors in creating, implementing surveys, interviews and case studies, and measuring the effectiveness of your which, unlike ROI, are subjective and do company’s mental health & wellbeing not yield specific results. Nevertheless, programmes. we can say that VOI is an important factor to consider in evaluating mental At the end of the day, you decide what’s health & wellbeing programmes and best for the company. However, using can be used to create this more holistic the combination of ROI and VOI overview. together, should really form a holistic picture of what is going on across your Which is Better for my wellness organisation, and help you to truly understand the effectiveness, and most assessment, ROI or VOI? effective way of running your mental In conclusion, we come down to an ‘age health and wellbeing programmes. old’ question, ‘do the numbers tell the whole story?’. Which is really the most Companies will often pick VOI over ROI effective way to provide a comprehenas a sole measure, because they do not sive wellness assessment? Do you use know how to track ROI. If you would just ROI, just VOI or the combination of like to start investigating ways of both? calculating ROI, then you can download our free mental health and wellbeing To be able to answer this, you will have ROI calculator here.  to look at several factors, to see which would be the best fit for your company.

Coronavirus COVID-19

Above: A woman wearing a mask against novel coronavirus at a train station.

new (novel) coronavirus was identified in December 2019 in China causing severe respiratory disease. It has been named Novel Coronavirus and is referred to as COVID -19. The virus originated in Wuhan Hubei Province, China. The infection has been linked to a seafood market in Wuhan. The Coronavirus is spreading between people globally. It is a newly identified virus and there is currently no human immunity to it and no vaccine is available to prevent infection. Coronaviruses are a common family of viruses. In general, someone infected will present with mild to moderate respiratory like symptoms. Those with underlying illness and co morbidity are the most seriously affected and this appears to be the case with this new strain. Other examples of Coronavirus include MERS Co-V and SARS.

For further up to date information,

please refer to the following: WHO situation repost dashboard

Foreign and Commonwealth Office travel advice. https://www.gov.uk/government/news/ coronavirus-public-informationcampaign-launched-across-the-uk https://www.nhs.uk/conditions/wuhannovel-coronavirus/ https://www.gov.uk/government/ collections/wuhan-novel-coronavirus https://www.gov.uk/government/news/ wuhan-novel-coronavirus-and-avianflu-advice-for-travel-to-china https://www.gov.uk/government/ publications/wuhan-novel-coronavirusinfection-prevention-and-control https://www.who.int/emergencies/ diseases/novel-coronavirus-2019/

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A Focus on

Reflective Practice

ecently the leaders of eight health and care regulators have joined with the The Nursing and Midwifery Council (NMC) to stress the benefits and importance of good reflection among professionals in the health and care sector. Taking part were the NMC, The General Chiropractic Council, The General Dental Council, General Medical Council, General Optical Council, General Pharmaceutical Council, Health Care Professionals Council and The Pharmaceutical Council. The chief executives have signed a joint statement â€“ Benefits of becoming a reflective practitioner â€“ in which the processes and advantages of being a good reflective practitioner for individuals and teams is outlined. The statement encourages practitioners to make time for reflection, as a way of helping their development, improving wellbeing and deepening professional commitment.

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The NMC have advised on how reflection can be more effective by making it less of a tick box exercise, considering both positive and negative experiences such as a significant clinical or professional event and involving people who use services, such as patients, families and their carers in the reflective process. Utilising a systematic and structured approach also helps to draw out learning outcomes and the NMC recommend many good models which can help in the process. Neil Loach, iOH Director of Education and recently appointed as a Senior Lecturer in Post- Graduate Healthcare at the University of Derby had completed his own reflective account on his nursing journey. Neil hopes to inspire more nurses to undertake post graduate courses in OH. If you would like more information on the Specialist Post Graduate Nursing Courses, please contact Neil on 01332 591153 or for further information, Click here.

Personal Reflective account: 12,985 days What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? I handed my notice on 4th December 2019. I have been a Nurse for over thirty-five years, including my training. 35 whole years.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice? Reflection is paramount in Nursing. We do it every day. We write about experiences frequently and it helps us to make sense of situations that have occurred, learn from them and it boosts our resilience to carry on. It certainly make me a better version of me. It helps me to breath, when I feel stifled with emotion. It frees me from the chains that hold me back and it allows me to grow. When I look back at my time in nursing, I realise that it has been a monumental privilege. To have

been involved in many thousands of patient / client / service user personal struggles with health and wellbeing is something that has helped shape who I am today. It has shaped me beyond what I thought possible and taught me the value of life, empathy and understanding and has shown me the personal struggles that people go through on their journeys. I have learnt the value of teamwork in its various guises, the value of friendship and the value of talking. All these things are what make us human. If I thought for one minute when I walked into the School of Nursing on my very first day, that I would have experienced what I have, I do not know if I would have stayed beyond 10 minutes. The highs and lows have been epic. Walking over to the Mortuary with the body of a recently departed baby in my arms, having lung tissue coughed over me from a patient with decompression sickness,

fish curry vomited all over me to the point of it dripping off my nose. These are some of the extreme issues that live with me today, there are many, many more. There have been many more highs than lows and sometimes even the lows make me value my time as a clinical nurse. We touch a life, sometimes in a very small way, a smile, a knowing look or the holding of a hand, a touch on the shoulder of a person in pain or in grief means so much. If you asked me if nursing was a career then, I would have said yes. One that I wanted to enter into since I was 13 years old. I was told it was what women did. I defied convention and entered my training as one of only 2 men in my class. Looking back, I now realise it is a vocation, like taking a spiritual journey, it sounds dramatic, I know, but think about it for a minute. We donâ€™t do it for money, so it must be a calling of some kind, to touch a life and help a fellow human being is cer-

tainly not just a career. (cont.)

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(cont.) Having worked in Accident and Emergency for 6 years, I encountered many people injured at work and decided there must be something in this. I went to see the Sister of the local NHS Occupational Health Department and quizzed her to within an “ inch of her life. She encouraged me to apply for a post. I am so glad I did! This was the start of a new journey into Occupational Health Nursing. My passion was ignited and has never gone out. I have now spent 28 years in Occupational Health in various jobs in many industries including lead -acid battery manufacture, NHS, waterways, manufacturing to name but a few. But my passion has always been the NHS. The treasure of many, the enemy of none. The values of the NHS are very dear to me and it is with a heavy heart that I leave the NHS on 31st December 2019.

How did you change or improve your practice as a result? In September 2018, I was offered the chance to be part of the teaching team at the University of Derby, Specialist Community Public Health Nursing courses and led on the Occupational Health Pathway. I was still employed in the NHS as Lead Nurse in one of the biggest OH Departments in the UK and seconded for 2 days a week. This has allowed me to consolidate my learning over the many years and pass on some of the knowledge and skills that will help shape the future of nursing in OH, even if in only a minor way. I have had my passion renewed. To see a student graduate at the end of the course is another high. The emotion was immense and still catches me today. For a second, I feel smug when saying, “That’s my student”. In November 2019 I applied to work for the University full time. I was competitively interviewed and secured a new post. Now this was the biggest high in 35 years or 12,985 days to be precise. It’s also the lowest of lows. Leaving what I have known for my entire working life will be hard. I will cry tears of happiness and grief.

How is this relevant to the Code? Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

The Code (2018) is the life blood of nursing. I will prioritise people I will practise effectively I will preserve safety I will promote professionalism and trust. I will continue to do this for the rest of my life. As a Nurse, its what we do, its instilled in our very being. I am proud to call myself a Registered Nurse. What a journey!

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Recommended Reading Carol Sanders Director of Research and Professional Practice, iOH

he following are taken from my recent reading, listening and watching pile! Iâ€™ve selected the following six books and five research papers as I think they all have something useful to offer and inspire our OH nursing practice. I hope you find these resources interesting and useful to your OH nursing professional development.

Books

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Research Papers Need for Recovery Wentz, K., Gyllensten, K., Sluiter, J.K. et al. Need for recovery in relation to effort from work and health in four occupations. Int Arch Occup Environ Health (2019) doi:10.1007/s00420-019-01476-7

The relationship between self-reported unfavourable working conditions and severe health consequences such as cardiovascular disease has been repeatedly established. Exposure to stress may be translated into an experience in terms of the time frame of recovery from the exposure. This time frame could, at an intermediate level, be translated into the mental load reaction that is present at the end of the working day, termed need for recovery (NFR). This study found important predictors of NFR were resources availability that make good quality work, recovery opportunities, and reversely effort from rumination when off work. Occupation-wise predictors could guide interventions.

HAVS amongst Roadworkers Clemm, T., Færden, K., Ulvestad, B., et al (2020) Dose–response relationship between hand–arm vibration exposure and vibrotactile thresholds among roadworkers. Occupational and Environmental Medicine Published Online First: 09 January 2020. doi: 10.1136/oemed-2019-105926

Exposure to hand–arm vibration from vibrating tools can cause vascular and neurological signs and symptoms related to hand–arm vibration syndrome (HAVS). Testing of vibration perception threshold (VPT) at the fingertips as a quantitative measure of tactile sensitivity is a commonly used tool in diagnosing hand–arm vibration syndrome. There is limited research on dose–response relationships between hand–arm vibration (HAV) exposure and VPT on an individual level. HAV exposure was associated with elevated VPT, also at exposure levels below the common exposure action value of 2.5 m/s2(A8). Lowering the HAV exposure can contribute to prevent increasing VPTs in these workers. There is a need to protect workers and monitor their exposure to hand–arm vibrations also at exposure levels below the common exposure action value of 2.5

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Occupational exposures to metal fumes Torén K, Blanc PD, Naidoo RN, et al (2020) Occupational exposure to dust and to fumes, work as a welder and invasive pneumococcal disease risk. Occupational and Environmental Medicine;77:5763.

Occupational exposures to metal fumes have been associated with increased pneumonia risk. This population-based case–control study provides evidence that work as a welder as well as occupational exposure to fumes more broadly and to silica dust confer increased risk for invasive pneumococcal disease, supporting and clarifying relationships observed in relation to pneumonia generally but not defined previously by invasive pneumococcal disease. Work specifically as a welder, but also occupational exposures more broadly, increase the odds for IPD. Welders, and potentially others with relevant exposures, should be offered pneumococcal vaccination. Workers exposed to fumes, especially metal fumes, may be at increased risk for invasive pneumococcal disease. Strategies for risk reduction should be considered, including targeted pneumococcal vaccination for workers being exposed.

Occupational exposure to metals have been associated with increased pneumonia

An innovative Mindfulness-Based Stress Reduction Program impact on nurse’s health Bazarko, D., Cate, R.A., Azocar, F., and Kreitzer, M.J. (2013) The Impact of an Innovative Mindful-

ness-Based Stress Reduction Program on the Health and Well-Being of Nurses Employed in a Corporate Setting. Pages 107-133 doi.org/10.1080/15555240.2013.779518

This study implemented an innovative new model of delivering a MindfulnessBased Stress Reduction (MBSR) program that replaces six of the eight traditional in-person sessions with group telephonic sessions (tMBSR) and measured the program's impact on the health and well-being of nurses employed within a large health care organization. Findings suggest that the tMBSR program can be a low cost, feasible, and scalable intervention that shows positive impact on health and well-being, and could allow MBSR to be delivered to employees who are otherwise unable to access traditional, on-site programs.

Personality traits and work performance Sosnowska, J., Hofmans, J., and de Fruyt, F. (2019) Revisiting the neuroticism – performance link: A dynamic approach to individual differences. Journal of Occupational and Organizational Psychology. doi.org/10.1111/joop.12298

Conventionally, research on the personality–performance relation has focused on predicting between-person differences in job performance from between-person differences in personality traits. Even though meta-analytical research demonstrates that personality traits predict job performance. However, only looking at how people behave, feel and think on average is restrictive. This study highlights the importance of integrating traits and states in personality research. The study findings demonstrate the importance of considering within-person fluctuations in personality when predicting work performance. 

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BSc (Hons) / PG Dip SPECIALIST COMMUNITY PUBLIC HEALTH NURSING in Occupational Health The course is for NMC Registered Nurses who want to gain a specialist qualification in Occupational Health Nursing. If you have either a Diploma, Advanced Diploma in Nursing Studies or Degree, the course can be studied at either BSc (Hons) to top up your qualifications or MSc level for those that are ready to progress.

Applications are now open University of Derby Kedleston Road Derby DE 22 1GB Neil Loach Senior Lecturer and Pathway Lead for Occupational Health Core Modules:

Option Modules:

•

Evidence Based Project

•

Ergonomics in Practice

•

Leading for Quality

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Principle of Long Term Conditions Management

•

Principles of Practice Assessment

•

V100 NM Prescribing

•

Public Health and Health Improvement

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V300 NM Prescribing (2 Modules)

Duration: 1 year Full Time or 2 Years Part-Time

Apply: derby.ac.uk/applyonline