Latex exposure

Latex allergy due to exposure to natural proteins in rubber latex is
also a serious problem in health care workers. Diepgen estimated that the
annual incidence rate among all workers is 0.5 to 1.9 cases per 1,000 full-time
workers per year. Symptoms may start with contact dermatitis located in the
glove area, and symptoms can become more severe, such as asthma or anaphylaxis.
The course of latex allergy as described by Amr and Bollinger involves
progressive impairment of nurses from continued exposure to latex, leading to
an inability to continue working as nurses. In fact, the hazard from aerosolizing
of latex particles attached to powder in latex gloves or from latex balloons
bursting is of great concern, as these exposures can lead to occupational
asthma. The American Nurses Association has issued a position statement to
suggest actions to protect patients and nurses from latex allergy in all health
care settings. These include use of low-allergen powder-free gloves and removal
of latex-containing products from the worksite throughout the facility to
reduce the exposure at that institution. Hospital environments that have
gone latex-free need to ensure that they are not allowing balloons into the
facility. As balloons break they can contribute latex into the air that remains
for up to 5 hours.

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Mental Health Effects of Nursing
Work

Working in nursing increases the
risk of experiencing both minor and major psychiatric morbidity with job
strain contributing to this outcome. Minor psychiatric morbidities include
feelings of tension, anger, anxiety, depressed mood, mental fatigue, and sleep
disturbance; these are classified variously as burnout, subthreshold
depression, or adjustment disorders. Mental disorders such as major depression,
anxiety disorders, and psychotic disorders are less common, but they can be
induced or exacerbated by work stress. A variety of exposure types are
associated with psychiatric morbidity. These fall into two categories: the
overall allostatic load demanded by the work, and the organization of the work,
including schedule and such job demands as the emotional toll when caring for
patients.

Allostatic load is a theoretical
concept whereby excessive demands and a persistent sympathetic (adrenergic)
load on the body produce changes in neuronal, immune, and cardiovascular system
structure and function, thus having a detrimental impact on bodily
processes. Changes in neuronal function are associated with anxiety and
depression. Several types of psychosocial risk factors can contribute to this
overall allostatic burden. High physical demands, fast-paced work, adverse work
schedules, role stressors, career insecurity, difficult interpersonal
relationships, nonstimulating jobs, and lack of autonomy have been associated
with symptoms of anxiety and depression, several psychoses, and with substance
use disorders. Some studies have even provided longitudinal evidence
linking job demands, lack of autonomy, and monotony at work to affective and
substance use disorders. Mental disorders in the workplace—depression in
particular—have important consequences for quality of life, the costs and
utilization of health care, safety, and productivity.

Extended work schedules have been
associated with a variety of mental health indicators in nursing and in other
occupations where these schedules are common. Proctor and colleagues found
that both the number of overtime hours and the number of cumulative days worked
by automotive workers were associated with changes in mood States such as
depression and tension. Hospital interns reported subjective deterioration in
mood after long shifts. Japanese managers reported decreased quality of
life (validated by comparison to a measure of psychiatric distress) when
working more than 10 hours per day consistently. French customs workers
used antidepressants at a higher rate when assigned to shift schedules with
rapid rotation. Shift work has been associated with more mental
stress and higher levels of burnout among health care workers.
Depression and anxiety have also been shown to vary with the level of work
pace, variety, control, social support, and conflicting demands made on
workers. Thus with both unfavorable work conditions and extended work
hours, the effect on mental health may be multiplied. Fatigue is thought to be
a central nervous system stressor.

Nursing is emotionally demanding,
with both emotional labor and the need to witness and bear with suffering
taking its toll. Emotional labor is necessary to display socially appropriate
emotions that are congruent with the job requirements in face-to-face
interactions with patients. The more frequent and intense the interpersonal
interactions are with others (staff, visitors, patients), requiring the nurse
to expend emotional effort, the more likely the nurse will experience symptoms
of burnout, including depersonalization and emotional exhaustion. Witnessing
the suffering of others occurs in a variety of nursing care settings, but is
common when end-of-life suffering is unrelieved. Intense feelings of
emotional pain can result and, if unresolved, can affect both physical health
and family life.

Interventions to reduce
work-related mental changes have focused on either changing the organization of
work to reduce the stressors, or changing the workers’ ability to cope with
stress by providing cognitive-behavioral interventions, relaxation techniques
of various types, or multimodal strategies. Although several nationwide
initiatives on the prevention of mental disorders have emphasized the
importance of addressing work organization factors, only a small number of
studies have evaluated this approach, and results have not shown an overall
strong relationship. In nursing, Mimura and Griffiths conducted a
systematic review of interventions for nurses to reduce their work stress. Two
of the reviewed studies used organizational interventions (changing to individualized
nursing care and primary nursing), and only one of the two was deemed
“potentially effective.” Seven studies of strategies to help nurses manage
their stress were presented; music, relaxation, exercise, humor, role-playing
assertiveness, social support education, and cognitive techniques were among
the stress-reducing strategies studied. The authors stated that no
recommendations on the most effective approach were possible due to the small
number of studies.