176 unit 3 | Professional Issues
not live past the end of the week.” Nancy was
concerned about the care of the patients as well as
the apparent lack of information her staff had about
prevention of back injuries. She decided to seek
assistance from the nurse practitioner in charge of
Employee Health in order to develop a back injury
prevention program.Assessment of the workplace may require consider-
able data gathering to document the incidence of
the problem and consultation with experts before a
plan of action is drawn up. Health-care organiza-
tions often create formal committees, consisting of
experts from within the institution and representa-
tives from the affected departments, to assess these
risks. It is important that staff members from vari-
ous levels of the organization be allowed to offer
input into an assessment of safety needs and risks.
The third step is to create a planto provide opti-
mal protection for staff members. It is not always a
simple matter to protect staff members without
interfering with the provision of patient care. For
example, some devices that can be worn to prevent
transmission of tuberculosis interfere with commu-
nication with the patient Some attempts have been
made to limit visits or withdraw home health-care
nurses from high-crime areas, but this leaves
homebound patients without care (Nadwairski,
1992). A threat assessment team that evaluates
problems and suggests appropriate actions may
reduce the incidence and severity of problems due
to violent behavior, but it may also increase
employees’ fear of violence if not handled well.
Developing a safety plan includes the following:
■Seeking evidence-based practices and recom-
mendations related to the problem
■Consulting federal, state, and local regulations
■Distinguishing real from imagined risks
■Seeking administrative support and enforcement
for the plan
■Calculating costs of a program
The fourth and final stage in developing a work-
place safety program is implementing the program.
Educating the staff, providing the necessary safety
supplies and equipment, and modifying the envi-
ronment contribute to an effective program.
Protecting patient and staff confidentiality and
monitoring adherence to control and safety proce-
dures should not be overlooked in the implementa-
tion stage ( Jankowski, 1992).
An example of a safety program is the one for
health-care workers exposed to HIV, instituted at
the Department of Veterans Affairs Hospital,
San Francisco (Armstrong, Gordon, & Santorella,
1995). An HIV exposure can be stressful for health-
care workers and their loved ones. This employee
assistance program includes up to 10 hour-long indi-
vidual counseling sessions on the meaning and expe-
rience of this traumatic event. Additional counseling
sessions for couples are also provided. Information
about HIV and about dealing with acute stress reac-
tions is provided. Counseling helps workers identify
a plan to obtain assistance from their individual sup-
port systems, identify practice methods of dealing
with blood-borne pathogens, and return to work.
A systematic review related to needlestick injury pro-
vides evidence for the use of tissue adhesives.
In the past, the options for wound closure have
been limited largely to sutures (needle and thread),
staples, and adhesive tapes. Tissue adhesives (glues)
offer the advantages that there are no sutures to
remove later for the patient and no risk of needle-
stick injury to the health-care worker. The adhesive
is applied over the surgical wound and holds the
edges together until healing has occurred.
Adhesives have been compared with alternative
methods of surgical wound closure in eight ran-
domized clinical trials involving 630 patients.
There was no evidence of a difference in rates of
wound dehiscence or infection after surgical inci-
sion closure with tissue adhesive, sutures, or adhe-
sive tape. The recommendation from the evidence
was that health-care providers may consider the use
of tissue adhesives for the closure of incisions in the
operating room, and a protocol was published in
2004 (Coulthard et al., 2004).Violence
Violence in the workplace is a contemporary social
issue. Newspapers and magazines have reported
numerous violent incidents; one of six violent crimes
occurs in the workplace, and homicide is the second
leading cause of workplace death (Edwards, 1999).
According to the Census of Fatal Occupational
Injuries, there were 551 workplace homicides and
5703 workplace injuries in 2004. The rate of assaults
on hospital workers is much higher than the rate of
assaults for all private-sector industries. The Bureau
of Labor Statistics measures the number of assaults
resulting in injury per 10,000 full-time workers.