It is necessary to begin by introducing the main international organisa- tions related to occupational health nursing. Figure 7.1 shows the web sites of international and European organisations related to occupa- tional health and occupational health nursing that are discussed in this chapter.
The International Labour Organisation (ILO) was established in 1919 and in 1946 became the first specialised organisation within the United Nations framework following World War II. The ILO is directly related to occupational health, as it brings together the three main partners in the world of work: that is, the state, the employers and the workers. Its main aim is to promote better working conditions throughout its mem- ber states. Today there are 178 member states in the ILO, representatives of which participate in the annual International Labour Conference. Its main objective is to study working conditions, prioritise emerging prob- lems and propose ‘conventions’ and ‘recommendations’ to its member states, which sign them and assume responsibility for adopting them into their legislation systems. Currently, the ILO aims to eliminate child labour, improve gender equality and establish decent employment and income (ILO 2007). The organisation and function of occupational health services is part of the remit of the ILO and throughout its history it has proposed numerous conventions and recommendations on the subject (Forastieri 2007).
The World Health Organisation (WHO) was also established within the UN framework in 1946 and its aim today is to ‘direct and coor- dinate health issues worldwide. It is responsible for providing lead- ership on global health matters, shaping the health research agenda,
International European World Health Organisation
www.who.int
International Labour Organisation www.ilo.int
International Commission on Occupational Health www.icohweb.org
International Council of Nurses www.icn.ch
American Association of Occupational Health Nurses
www.aaohn.org
Occupational Health Nurses Association of Nova Scotia, Canada
www.ohnans.com
Australian College of Occupational Health Nurses www.acohn.com.au
University of Occupational and Environmental Health, Japan
www.uoeh-u.ac.jp/dept/hokengakubu e.html National Institute of Occupational Safety and Health
www.cdc.gov/niosh
Occupational Safety and Health Administration – USA
www.osha.gov
European Commission europa.eu
European Agency for Safety and Health at Work osha.europa.eu
European Foundation for the Improvement of Living and Working Conditions
www.eurofound.europa.eu
European Federation of Nurses Associations www.efnweb.org
European Specialists Nurses Organisation www.esno.org
Federation of Occupational Health Nurses within the European Union
www.fohneu.org
European Federation of Regulatory Bodies www.fepi.org
Finish Institute of Occupational Health www.ttl.fi
Figure 7.1 International and European Occupational Health and Occupational Health Nursing Organisations
setting norms and standards, articulating evidence-based policy op- tions, providing technical support to countries and monitoring and as- sessing health trends’ (www.who.int). Occupational health is therefore one of the topics included in its agenda. One of the most recent docu- ments accepted by the WHO was the Declaration on Workers Health, which refers to the global right of working people to work without the risk of becoming ill or injured because of their work (WHO 2006).
The International Council of Nurses (ICN) is a federation of na- tional nurses’ associations (NNAs), representing nurses in more than 128 countries. Founded in 1899, the ICN is the world’s first and largest international organisation of health professionals. The ICN works to ensure quality nursing care for all, influence health policies worldwide
and advance nursing knowledge and recognition and respect for nursing.
The ICN Code for Nurses is the foundation for ethical nursing practice throughout the world, while its standards, guidelines and policies for nursing practice, education, management, research and socio-economic welfare are used as the basis for international nursing policy. The ICN also actively promotes occupational health and safety for the nurs- ing workforce. It is worth mentioning that the theme for International Nurses’ Day 2007 was ‘Positive Practice Environments: Quality Work- places=Quality Patient Care’ (www.icn.ch).
The International Commission on Occupational Health (ICOH) is an international independent professional society, founded in 1906 in Milan as the Permanent Commission on Occupational Health. Today the ICOH has individual members from 93 countries and collaborates with all organisations that have common interests. The ICOH triennial World Congresses on Occupational Health are a stage for scientific in- formation exchange. The International Code of Ethics for Occupational Health Professionals (ICOH 2002) is a very important document guiding practice today, and has been translated into several languages.
The ICOH has 33 Scientific Committees, one of which is the Scien- tific Committee on Occupational Health Nursing (SCOHN). A study by Burgel et al. (2000), supported by SCOHN, presented information on OHN practice for countries from all continents. This useful document gives an insight into the changes in OHN over recent decades in rela- tion to education, range of activities undertaken, role descriptions and working titles.
Although OHN exists in countries throughout the world, it would not be possible to refer to each one individually in this chapter; rather we will focus on the countries with the greatest influence on the specialisation today.
United States of America
Occupational health nursing has a long tradition in the USA and this is reflected in the numerous postgraduate programmes in its various higher education institutions.
The National Institute of Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) regu- late occupational health in the USA, and they are an invaluable resource for occupational health professionals worldwide. OHNs are considered one of the core professions providing occupational health services, and they participate in decision making in both organisations.
The American Association of Occupational Health Nurses (AAOHN) works to advance, guide, promote and protect the profession though various activities, such as continuous education and publication
(www.aaohn.org). Its journal has a wide readership and is very often the primary resource for OHNs worldwide, both those wishing to obtain information and those wanting to publish their articles.
Education of OHNs is organised at both specialisation and postgrad- uate level, including master’s and doctorate, while literature is extensive in terms of textbooks and articles in professional and scientific journals.
A recent document (AAOHN 2003) has defined the competencies of OHNs. The AAOHN’s definitions are presented in Figure 7.2, in com- parison with the competencies published by other organisations.
Research is well established and there are opportunities for OHNs to obtain funding for research projects in various occupational health topics. A study on research priorities for occupational health nursing revealed that they were similar to general OH research priorities (Rogers et al. 2000) and did not differ substantially from those revealed in a study a decade earlier (Rogers 1989).
Canada
Canada is a much smaller country in terms of population and therefore working population than the USA, but has equally well-established oc- cupational health and occupational health nursing. In Canada, OHNs are registered nurses holding a diploma or degree in nursing and a certificate, diploma or degree in occupational health and safety from a community college or university.
The Canadian Nurses Association grants nurses who have this ex- pertise the right to use the title of certified OHN. The role of OHNs in Canada includes improving the health and safety of workers, and thereby the health of the community. The association aims at advancing the profession, encouraging the development of national standards for OHN and continuing education (www.cohna-aciist.ca).
Australia
The Australian College of Occupational Health Nurses is the profes- sional body for occupational health nurses in Australia. It was formed in 1976 as the Australian Occupational Health Nurses Association to meet the needs of the increasing number of nurses employed in private and public workplaces. It currently ‘promotes the professional standing of Occupational Health Nurses and provides members with support, educational and professional development’ (www.acohn.com.au).
In a recent study it was found that Australian occupational health nurses engage both in traditional curative tasks and in health promo- tion, management and research activities, but it was concluded that tra- ditional activities still dominate their work. Participants believed that in the future activities related to wellness, management and research
AmericanAssociationofOHNRCN/UKcompetenciesWHOEuropecompetencies competencies(AAOHN2003)(BannisterandMaw2005)(WhitakerandBaranski2001) Competencecategories rclinicalandprimarycare rcasemanagement rworkforce,workplaceand environmentalissues r regulatory/legislativeissues r management r healthpromotionanddisease prevention roccupationalandenvironmental healthandsafetyeducationand training rresearch rprofessionalism. Levelsofpractice rcompetent rproficient rexpert.
Corecompetencies rcommunication rpersonalandpeople development r health,safetyandsecurity r serviceimprovement r quality requalityanddiversity. Levelsofpractice rcompetent rexperienced rexpert.
rClinician(primaryprevention,emergency,treatmentservices, nursingdiagnosis,individualandgroupcareplan,generalhealth adviceandhealthassessment,researchandtheuseof evidence-basedpractice). rSpecialist(occupationalhealthpolicyandpracticedevelopment, implementation,occupationalhealthassessment,health surveillance,sicknessabsencemanagement,rehabilitation, maintenanceofworkability,healthandsafety,hazard identification,riskassessment,adviceoncontrolstrategies, researchandtheuseofevidence-basedpractice,ethics). r Manager(managementandadministration,budgetplanning, marketing,servicelevelagreements,qualityassurance, professionalauditandcontinuingprofessionaldevelopment). rCo-ordinator(occupationalhealthteam,workereducationand training,environmentalhealthmanagement). rAdviser(tomanagementandstaffonissuesrelatedtoworkplace healthmanagement,asaconduittootherexternalhealthorsocial agencies). rHealtheducator(workplacehealthpromotion). rCounsellor(counsellingandreflectivelisteningskills,problem solvingskills). rResearcher(healthneedsassessment,researchskills, evidence-basedpractice). Figure7.2ComparisonofOHN’sCompetenciesasDefinedbytheUSA,UKandWHO/Europe
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would be more important to their practice and that they would need to devote more time to them, but they sensed that their education needed to be updated before they could fulfil these new roles (Mellor & St John 2007).
Japan
Nursing in Japan is well established and nurses have worked in occu- pational health services for a long time, although their roles and com- petencies are not clearly described in national legislation (Muto 2007).
Ishihara et al. (2004) reported that OHNs’ roles include direct care to employees, education/advice and management. They compared these roles to those reported from other countries and found both similarities and differences between OHNs in Japan and the USA. These findings indicate that the needs of the working population are similar regardless of the country or the part of the world where they are employed.
Japan, however, has a unique organisation of occupational health ed- ucation, with a specialised University of Occupational and Environmen- tal Health. Within this university is the Department of Public Health and Occupational Health Nursing, in the School of Health Sciences, where nurses are educated for this specific role. OHNs study for four years and, along with other OH specialists, are seen as the supporting staff for OH physicians.
Japanese OHNs also have a leading role in the wider East Asian environment, collaborating with OHNs in other countries in the region and organising scientific and educational events.