Bringing troubles to the job: How OHNs can help
Bringing troubles to the job: How OHNs can help
Life events, conflict outside work can affect job
It is rare that any person can leave his or her troubles at home and not let it affect life at work. Psychosocial stressors such as grief and loss, family responsibilities, financial burdens, domestic violence, and health problems may cause employees to present to the occupational health nurse (OHN) with physical ailments that, with some investigation, can be attributed to stress.
The OHN can identify employees whose stressors are threatening their job performance — and perhaps their well-being — and offer helpful assessment and referral if he or she knows what to look for.
"My perspective is that people will bring their personal problems into the workplace — it's unavoidable," according to Betsy Gilbert, PhD, RN, assistant professor at Seattle University College of Nursing. "The main things occupational health nurses will encounter will be the reactions to normal life events — stress related to life changes; life phases, including birth and death; grief and loss; interpersonal issues; violence; reactions to the job."
Sometimes, the employee's behavior and demeanor clearly suggest the stress he or she is under. But often, the stress manifests itself in ways that are not as easily deciphered.
"Knowing the effects of all these is one of the big things that an occupational health professional can concentrate on," says Gilbert. "Knowing a little about how they affect people, whether it's shock, anger, depression, a period of lower productivity."
Life events can pile on
Even events as universal as the birth of a child and a child leaving home, marriage and divorce; and the aging of parents can inflict tremendous amounts of stress.
"All the stress reactions have the same physiological symptoms — gastrointestinal symptoms, muscular symptoms, emotional systems," Gilbert points out.
When an employee approaches the OHN complaining of a stomach ache, "it would be a nice opportunity to ask about stressors," she continues. Doing so is important because the real malady is the stressor, not the stomach ache, Gilbert points out.
"Don't stop with treating just the stomach. You can help people connect the dots [between their physical complaint and stress that might be contributing to it] in the spirit of the whole-person view. People with injuries even might have stressors that are preoccupying them and contributing to their injury, so you might be able to help them understand that," says Gilbert.
One troubled employee might be dealing with a really acute stressor; another might be a chronic worrier. Each will be affected differently by the events occurring in their lives.
Health care workers may be particularly affected by life stresses, because as professional caregivers they often end up with the lion's share of family responsibilities, for example, when parents get older.
"They might find themselves caring for older family members and children – the idea of the sandwich generation – and that can put a lot of demand on someone," says Gilbert.
Interpersonal issues require resolution
Interpersonal stressors may come from outside work or may involve coworkers, but regardless of the setting, conflict is a normal human occurrence. It helps if the OHN can provide advice, resources, and referrals for resolving conflict, Gilbert suggests.
The health care environment lends itself to interpersonal stress, with high-demand jobs, frequent situations over which the employee has little control, and stress affecting coworkers, patients, and visitors.
"Health care tends to be more stressful, so there's the importance of the occupational health nurse having the skills to solve interpersonal problems, since the work involves so many relationships with coworkers, managers, clients, families, and the organization," Gilbert points out.
Interpersonal relationships turn violent for health care workers more commonly than in other professions. Health care workers are among the most likely to be the target of violence on the job so the OHN working in the health care setting needs an armament of resources and knowledge on the subject. (See resources list, below.)
|
Resources Stress Violence and Conflict Resolution Anxiety Depression |
When violence happens away from work but the effects — physical or not — are seen in the workplace, the OHN can elicit information on how to help by doing a routine domestic violence screening. The mnemonic RADAR, developed by the Philadelphia Family Violence Working Group, can provide some guidance:
- Routine screening —It is important to establish privacy, safety, and rapport. Never ask about abuse if a partner, friend, or relative is in the room. Never use a friend or family member as an interpreter when asking about abuse.
- Ask direct questions — For example: We all fight at home. What happens when you and your partner fight? Have you ever been in a relationship in which you felt you were treated badly? Are you here today as a result of battering?
- Document your findings.
- Assess patient safety and discuss an emergency plan.
- Review options and referrals.
Stressors causing or exacerbating a mental health crisis for your employee can present in suicide attempts, violence against self or others, or the first or an acute appearance of a major mental disorder. Even if an employer provides an employee assistance program, the OHN is often the first line of help in a crisis. "The role of the occupational health nurse has to do with understanding that psychosocial issues may affect a person's work, and you're in a unique position to assist with screening and resource placement," observes Gilbert. "Workers look to occupational health nurses for help, even if an EAP available. Nurses are always the people workers want to talk to."
If a mental health issue is suspected, Gilbert offers another mnemonic — FRAMES — to guide the OHN in making the appropriate referrals:
Feedback. Make a direct statement of personal risk, impairment, and observations. "Confront them with reality and inform them that, based on your experience, if people don't get help, here's what we know can happen," Gilbert suggests;
Responsibility. Make it clear that the responsibility for change and taking the next steps are up to the client;
Advice. The OHN provides advice on where to go from here;
Menu. The nurse provides a choice of ideas for self-help, treatment, and other options for solving the problem or, in the case of substance abuse, quitting;
Empathy. Use an empathetic approach, projecting a willingness to help;
Self-efficacy. Foster an optimistic, empowering attitude that emphasizes the clients' strengths. "You can do this" is the message Gilbert says the OHN should reinforce.
Employee's willingness to change
The nurse's approach to the employee, regardless of the stress in his or her life and its effects, should be keyed whenever possible to how open the employee is to change. Can he or she delegate care of a parent? Is the person in denial about an abusive relationship? Is he or she eager to quit a substance addiction?
A model proposed by Prochaska (see table, below) suggests that when it comes to change, people go through changes in attitude toward change. A person in the precontemplative stage might be resistant to the idea of change just now, while someone in the action stage might approach the nurse about getting help.
|
Stages of Change Model Precontemplation Contemplation Preparation/Determination Action/Willpower Maintenance Relapse Adapted from Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Am Psychol 1992;47:1102-1104. |
"Look at where that person is, and try to interact at the right level," advises Gilbert. "There is lots of self-help available for anxiety and stress management, but for depression, people need extra guidance and support in recognizing it and getting help with follow-through."
Health care workers might need additional coaxing to recognize and address problems.
"The fact is that they're not immune to these problems, including substance abuse, but sometimes health care workers feel they are sort of immune or untouchable," she points out.
[For more information, contact:
Betsy Gilbert, PhD, RN, assistant professor, Seattle (WA) University College of Nursing. E-mail: [email protected].]
It is rare that any person can leave his or her troubles at home and not let it affect life at work.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.