Occupational Health: Core Areas of Knowledge and Competence

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

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

The Clinician:

Primary prevention:

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

Emergency Care:

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

Nursing diagnosis:

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

General Health advice and health assessment:

The OHA will advise on a wide range of health issues, particularly on their relationship to working ability, health, and safety at work or where modifications to the job or working environment can be made to take account of employees’ changing health status. In many respects, employers are not solely concerned with only those directly caused by work. Still, they want their occupational health staff to help address any health-related problems that might arise that might influence the employee’s attendance or performance at work. Many employees appreciate this level of help being provided to them because it is so convenient for them. In particular, the development of health care services to men at work, younger populations, and those from ethnic groups can be most effective in reaching these sometimes difficult to reach populations.

Research and the use of evidence-based practice:

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


Occupational health policy, and practice development, implementation and evaluation:

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

Occupational health assessment:

OHA’s can play an essential role in health assessment for fitness to work, pre-employment or pre-placement examinations, periodic health examinations, and individual health assessments for lifestyle risk factors. Collaboration with an occupational physician may be necessary for many instances, depending upon exiting legislation and accepted practice. The nurse can also play an important role in the workplace where informal requests for information, advice on health care matters, and health-related problems come to light. The nurse can observe the individual or group of workers about exposure to a particular hazard and initiate appropriate targeted health assessments where necessary. These activities are often, but not exclusively, undertaken in conjunction with the medical adviser so that where problems are identified, a safe system for onward referral exists.


Health surveillance:

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

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