“Discuss the main influences and their impact on the role of the contemporary Occupational Health practitioner.”

INTRODUCTION

Occupational Health is a specialty branch of public health focusing on the care of the working community. It is focused on the care of people at work and attempts to ensure the work is not causing the worker any harm. Since the first official documented occupational health nurse, Phillipa Flowerday, in 1878, there has been a great deal of development in this role. Occupational health is particularly relevant in the 21st century as the workplace environment is becoming more challenging and complex posing potential concerns for the employer as well as the employee (Thornbury 2018). This is partly due to the advances of manufacturing, science and technology as well as the nursing profession itself. The contemporary occupational health practitioner has, and will likely continue to , adapt where able to these advancements. Nursing, as a profession, is bound by the Nursing and Midwifery Council Code of Conduct (2018) and its professional and ethical responsibilities it upholds. Linking to this, the nature of public health and assessing the needs within a community should be strongly evidence based  to decide how it can be best used and inform our practice (Coles 2008). This could be though policies, legislation, professional guidelines and documents or reliable research. The contemporary occupational health practitioner should possess the skills and knowledge to perform an appropriate and comprehensive health needs assessment to the working community in order to protect and promote a healthy lifestyle to the worker in their environment. This essay will discuss: the theories and principles of occupational health and public health, the role of the occupational health practitioner in relation to the professional and ethical dimensions, policy and legislation in relation to evidence and health needs assessment.

THEORIES AND PRINCIPLES OF OCCUPATIONAL AND PUBLIC HEALTH

 Public health incorporates the science and art of avoiding ailments, extending life and promoting health through the systematic efforts and educated choices of society, organisations, public and private communities and individuals (Wanless 2004). Griffiths et al (2005) divided the underpinning principles of public health into health improvement, health protection and improving services. In recent healthcare reforms, there is an increased emphasis and drive about the contribution and role of health care professionals to public health services. The Health Act (1999) notably emphasized the importance of health improvement for the public. Public health comprises health promotion within the field of health improvement. Public health principles aim to change attitudes and improve behaviors towards health issues. Croghan (2004) found that public health professionals working together instead of limiting themselves to their own specific domain may be able to improve the health of large populations for a long period of time. 

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Occupational Health focuses on the health of the working population and encompasses public health objectives. The workplace can have a significant impact on affecting peoples’ health as a context in which to promote health (Naidoo 2016). The Institute of Directors (2006) recognized that fit and healthy staff are essential to ensuring a company remains efficient and valuable.  The contemporary Occupational Health Practitioner has an imperative role within an organisation to plan and deliver the wellbeing and public health agendas, which in turn will contribute to the business plans of the company (Thornbury 2018).

An individual’s work, employment, standards of living and social relationships all have an unequivocal impact on health. Dahlgren and Whitehead (1991) identified the wider determinants of health that are key when considering health and can underpin a holistic approach in an occupational health or public health assessment. These determinants of health include genetic and constitutional factors, individual lifestyle factors, social and community networks and general socio-economic, cultural and environmental conditions. Salutogenisis is a term linking the connection between biological disease and environmental influence on health. Dr Harry Burns (2014) signifies that the wider background and sociological history of the individual or named group can influence biological ailments. It is widely accepted that environmental factors, such as physical and chemical exposures, and also biological, sociological and political processes, can have an effect upon the health of the individual (Thornbory 2018). The contemporary occupational health practitioner must be aware of the factors that can contribute to the health of society, how health trends develop and how they are analysed.

Epidemiology is the scientific and medical analysis of the sources and diffusion of disease within a population and contributes to our knowledge and provides evidence to develop health policies. An understanding of epidemiology is imperative for occupational health practitioners. Epidemiology considers health from a population rather than an individual perspective and is incorporated within the principles of public health. Being such a diverse specialty within healthcare, the occupational health practitioner should be mindful of the variability in the role and the professional and ethical dimensions it entails.

THE ROLE OF THE OCCUPATIONAL HEALTH PRACTITIONER IN RELATION TO PROFESSIONAL AND ETHICAL DIMENSIONS

The contemporary occupational health practitioner can take on many different roles within the specifications of the career.  The World Health Organisation (WHO) (1999) produced a document identifying 4 key components for the management of health in the workplace: occupational health and safety, workplace health promotion, social and lifestyle determinants of health and environmental health management. The employment of a thorough workplace health management system can acquire benefits not just from a heath perspective but an economic benefit, social and wellbeing benefit and environmental benefits. Occupational health is predominantly a prevention focused occupation, participating in risk management and proactive policies aimed at promoting the health of the working population. The job of the contemporary OH practitioner is accommodated towards preventing occupational injury and disease, promoting health and work capability and improving environmental health management. Baranski and Whitaker (2001) pointed out that the OH practitioner may also perform multiple, often interrelated and complimentary, roles in workplace health management consisting of clinician, manager, specialist, coordinator, researcher , manager, advisor, counselor, health educator.

All registered nurses are regulated by their professional registering body, the Nursing and Midwifery Council, by their code of practice and advice on confidentiality. Consent and confidentiality are governed by the Data Protection Act (2018) which sides with the European Union’s General Data Protection Regulations (2018). Concerning Occupational Health in particular, confidentiality is an aspect that nurses find toil  in dealing with as they can be habitually asked to divulge information about employees by the human resources department or line manager.

Ethical dilemmas and considerations can be common practice for the contemporary OH practitioner as it may be legally required to disclose information if the nurse deems someone to be at risk of harm or if they may be believed to put others at risk in the workplace (Thornbury 2018). Occupational and public health practitioners have an added ethical responsibility as they have to uphold the rights of individuals at the same times as maximizing the health of the populations at risk. It is always good practice to obtain the patients consent in an attempt to prevent any potential challenging situations at a later period (Kloss 2010).

Freshwater (2004) believed that any concept of practice must include a reflective critique of that practice. Reflection is a major role within a registered nurse’s professional development. Experiences in clinical practice can help the OH practitioner to identify the limits of their knowledge and skills and learn from these encounters which should prompt them to reconsider and rethink their previous knowledge and put together this new learning to their knowledge base to update their practice (Jasper 2013). Professional development, reflective practice and decision making are all inseparably linked (Rolfe 2001).

POLICY AND LEGISLATION IN RELATION TO EVIDENCE

The principles of any care implemented by the contemporary occupational health practitioner should be supported by good sourced reliable evidence. The basis for decision making in clinical care and health policy relies intensely upon evidence-based guidance (Meulen et al 2005). The understanding of evidence-based practice (EBP) is that health care professionals should solely use therapies that have been shown to be effective rather than making use of unproven therapies that may be unproductive or even harmful to the patient. The centre of professional practice requires professional knowledge, clinical appraisal and decision making ( McCarthy et al 2010). Hobbs (2012) states there are 4 components to shape decisions : best available research evidence, clinical expertise, resources and patient preferences.

For a period of time, there has been great importance placed on the need to govern healthcare that is up to date and apprised by effective evidence. The main aim of this being that it helps to make allocation decisions and use available resources in an efficient way (Bick 2013). The main advocates for EBP have come from initiatives, both political and policy, which also initiated the creation of organizations to develop guidance to inform healthcare such as the National Institute for Health and Clinical Effectiveness (NICE).  The responsibility of a national body such as NICE is to make recommendations for cases based on best evidence of clinical and cost effectiveness. Although a respected institution, the role of NICE has generated some criticism that it ‘promotes rationing in healthcare’ (Maynard 2004). Guidelines aim to standardize patient care, lower dissimilarity in health outcomes , deter use of methods with no shown efficiency and promote an efficient assessment of patient outcomes (Meulen 2005).

Legislation is a law which has been generated by a governing body in order to sanction, grant, restrict, declare, regulate or authorize. Specifically, within occupational health there are many that are essential legislations to be aware of such as The Control of Noise at Work Regulations (2005), RIDDOR 1995, The Equality Act (2010) and Health and Safety at Work Act (1974). When concentrating on the legal requirements relating to the occupational health needs of the business, it is crucial for the occupational health practitioner to be familiar with the ideologies of the Health and Safety at Work act (1974) and the statutory regulations that are relevant to the work-related activities and risk which form part of the company profile (Thornbury 2018). The Control Of Substances Hazardous to Health (COSHH) Regulations (2002) provides guidance and legislation for both patients and professionals when assessing any potential exposure to substances that may be of harm to an individual. Thorough risk assessment using these guidelines can give the employer or occupational health practitioner an indication of how the workers are exposed, to what extent is there harm and if any action is required to reduce the workers exposure (COSHH 2002).

At a primary level, the contemporary occupational health practitioner is required to audit their practice and ensure care is of a high standard to meet their professional obligation to the Nursing and Midwifery Council Code of Conduct (2018). Rising public expectations, rising costs of healthcare and different political views about what constitutes a ‘reasonable need’ have underpinned many policy changes (Cowley 2008).

HEALTH NEEDS ASSESSMENT

The search for health needs describes a community public health approach to the surveillance and assessment of the population’s health and well-being (Cowley 2008). The principles of any action or change should be completed following a comprehensive health needs assessment. Understanding the community and identifying health needs is a requirement for an occupational and public health practitioner (Naidoo 2010). The data explored is essential for forming effective health improvement interventions for individuals and communities within the workplace and furthermore recognizing the importance of facilitating ongoing employment. Methods of health needs assessment differ in models depending upon the community’s needs. It can provide the opportunity to gain a grasp of the current health priorities of the workforce and recognize gaps in the healthcare provision. With these gaps identified the practitioner can then make recommendations to the individual or organization (Thornbury 2018).  Additionally, a health needs assessment provides a process of examining and promoting equality in the delivery and use of health services and conversely, addressing inequalities in health (Mooney 1994).

 NICE guidance (2005) suggests a five-step approach to health needs assessment: getting started, identifying health priorities, assessing a health priority for action, action planning for change, moving on/project review. Before commencing an assessment, it is principle to consider what the belief of what a ‘health need’ actually is. Economists argue that the word ‘need’ has connotations associating with emotion and what is meant is more what people want or demand and identifying health needs becomes more of an identification of priorities (Naidoo 2016). Within the general public, there are undoubtedly judgements made regarding prioritization of needs and what might be seen as a need by one person may be seen as a luxury by another (Thompson 2014). Rising public expectations, rising costs of healthcare and different political views about what constitutes a ‘reasonable need’ have underpinned many policy changes (Cowley 2008).

Needs assessment may be influenced by the organizational agenda, targets and individual professional’s own beliefs and values (Watson 2002). The contemporary occupational health practitioner must assess health needs with the question in mind of ‘ need for what’ (Cowley 2008). The working environment itself can be a major influence on an individual’s well-being (Black 2008). Bradshaw (1972) introduced widely recognized categorizations of different types of need. He presented his categories of four basic types of needs: normative, felt, expressed and comparative. Not long following, Engle in 1977 developed the biopsychosocial framework for the assessment of health needs. This framework even currently, 40 years since its primary introduction, is used as a model structure in public health assessments (Alon et al 2004). Engle’s belief was that health and illness are consequences of biological, social and psychological factors.  Each of these factors interact and have some bearing on the other to impact physical and mental health. 

Overall, needs assessments are carried out on a well population, at the level of the community or individual for purposes of preventive care and health promotion (Cowley 2008). Regarding the contemporary occupational health practitioner, these assessments can distinguish the elements that stand in the way of good health and prompt ways to overcome them (Black 2008).

CONCLUSION

 In conclusion the contemporary occupational health practitioner has several influences that can impact of their role. Policy and legislation along with an evidence-based approach should underpin the knowledge and practice of the OH practitioner’s profession. The role of the OH practitioner can be varied and take on many different responsibilities depending on the needs of the establishment. An ample health needs assessment can help guide the OH practitioner in gauging the needs of the workplace community. The UK government has reported that it has pledged to improve the health and wellbeing of the UK workforce and in turn reduce the expense associated with health-related job loss (Thornbury 2018).  Occupational health will continue to grow as the economy and demand for service also continues to evolve.

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