Latex exposureLatex allergy due to exposure to natural proteins in rubber latex isalso a serious problem in health care workers. Diepgen estimated that theannual incidence rate among all workers is 0.5 to 1.
9 cases per 1,000 full-timeworkers per year. Symptoms may start with contact dermatitis located in theglove area, and symptoms can become more severe, such as asthma or anaphylaxis.The course of latex allergy as described by Amr and Bollinger involvesprogressive impairment of nurses from continued exposure to latex, leading toan inability to continue working as nurses.
In fact, the hazard from aerosolizingof latex particles attached to powder in latex gloves or from latex balloonsbursting is of great concern, as these exposures can lead to occupationalasthma. The American Nurses Association has issued a position statement tosuggest actions to protect patients and nurses from latex allergy in all healthcare settings. These include use of low-allergen powder-free gloves and removalof latex-containing products from the worksite throughout the facility toreduce the exposure at that institution. Hospital environments that havegone latex-free need to ensure that they are not allowing balloons into thefacility.
As balloons break they can contribute latex into the air that remainsfor up to 5 hours. Mental Health Effects of NursingWorkWorking in nursing increases therisk of experiencing both minor and major psychiatric morbidity with jobstrain contributing to this outcome. Minor psychiatric morbidities includefeelings of tension, anger, anxiety, depressed mood, mental fatigue, and sleepdisturbance; these are classified variously as burnout, subthresholddepression, or adjustment disorders. Mental disorders such as major depression,anxiety disorders, and psychotic disorders are less common, but they can beinduced or exacerbated by work stress. A variety of exposure types areassociated with psychiatric morbidity. These fall into two categories: theoverall allostatic load demanded by the work, and the organization of the work,including schedule and such job demands as the emotional toll when caring forpatients.Allostatic load is a theoreticalconcept whereby excessive demands and a persistent sympathetic (adrenergic)load on the body produce changes in neuronal, immune, and cardiovascular systemstructure and function, thus having a detrimental impact on bodilyprocesses.
Changes in neuronal function are associated with anxiety anddepression. Several types of psychosocial risk factors can contribute to thisoverall allostatic burden. High physical demands, fast-paced work, adverse workschedules, role stressors, career insecurity, difficult interpersonalrelationships, nonstimulating jobs, and lack of autonomy have been associatedwith symptoms of anxiety and depression, several psychoses, and with substanceuse disorders. Some studies have even provided longitudinal evidencelinking job demands, lack of autonomy, and monotony at work to affective andsubstance use disorders. Mental disorders in the workplace—depression inparticular—have important consequences for quality of life, the costs andutilization of health care, safety, and productivity.
Extended work schedules have beenassociated with a variety of mental health indicators in nursing and in otheroccupations where these schedules are common. Proctor and colleagues foundthat both the number of overtime hours and the number of cumulative days workedby automotive workers were associated with changes in mood States such asdepression and tension. Hospital interns reported subjective deterioration inmood after long shifts.
Japanese managers reported decreased quality oflife (validated by comparison to a measure of psychiatric distress) whenworking more than 10 hours per day consistently. French customs workersused antidepressants at a higher rate when assigned to shift schedules withrapid rotation. Shift work has been associated with more mentalstress and higher levels of burnout among health care workers.Depression and anxiety have also been shown to vary with the level of workpace, variety, control, social support, and conflicting demands made onworkers. Thus with both unfavorable work conditions and extended workhours, the effect on mental health may be multiplied.
Fatigue is thought to bea central nervous system stressor. Nursing is emotionally demanding,with both emotional labor and the need to witness and bear with sufferingtaking its toll. Emotional labor is necessary to display socially appropriateemotions that are congruent with the job requirements in face-to-faceinteractions with patients. The more frequent and intense the interpersonalinteractions are with others (staff, visitors, patients), requiring the nurseto expend emotional effort, the more likely the nurse will experience symptomsof burnout, including depersonalization and emotional exhaustion. Witnessingthe suffering of others occurs in a variety of nursing care settings, but iscommon when end-of-life suffering is unrelieved. Intense feelings ofemotional pain can result and, if unresolved, can affect both physical healthand family life. Interventions to reducework-related mental changes have focused on either changing the organization ofwork to reduce the stressors, or changing the workers’ ability to cope withstress by providing cognitive-behavioral interventions, relaxation techniquesof various types, or multimodal strategies. Although several nationwideinitiatives on the prevention of mental disorders have emphasized theimportance of addressing work organization factors, only a small number ofstudies have evaluated this approach, and results have not shown an overallstrong relationship.
In nursing, Mimura and Griffiths conducted asystematic review of interventions for nurses to reduce their work stress. Twoof the reviewed studies used organizational interventions (changing to individualizednursing care and primary nursing), and only one of the two was deemed”potentially effective.” Seven studies of strategies to help nurses managetheir stress were presented; music, relaxation, exercise, humor, role-playingassertiveness, social support education, and cognitive techniques were amongthe stress-reducing strategies studied. The authors stated that norecommendations on the most effective approach were possible due to the smallnumber of studies.