Principles of Occupational Health Nursing - Essay Example

BSc Occupational Health Nursing Principles of Occupational Health Nursing Review of evidence assignment Introduction Occupational asthma (OA) is a very common problem that is encountered in occupational health nursing (OHN). OA has been defined as asthma that arises from causes and conditions related to a particular occupational environment, and not related to stimuli outside the work environment. OHN have important roles to play in its management, and evidence based practice is the current standard (Roberts et al., 2004, 327-337). Therefore, it would be pertinent to extract evidence from contemporary nursing literature about OA. In this assignment, this author will critically review evidence related to different aspects of OA and its nursing care from the current research literature. Purpose A thorough literature review provides a foundation on which to base new knowledge. For a clinical problem, such as OA, it would likely also be necessary to learn as much as possible about the “status quo” of current procedures relating to the topic, and to review existing practice guidelines or protocols. Normally, researchers have their research critiqued by peers, consultants, or other reviewers to obtain substantive, clinical, or methodological feedback before implementing the plan (Cormack, 2000, 82-85). Moreover, an integrated and critical review of existing research and theory relevant to the topic should provide a solid rationale and evidence in favour of or against contemporary concepts, practice, or guidelines. The ultimate objective of any research is to undertake a systemic search and collection of data and to analyse and interpret them in order to verify or testify existing knowledge (Clarke, 2004, 100-102). Broadly these data can be classified into two varieties, numerical and descriptive. Depending on the intended type of data, usually a research is designed into different types, and varieties of information may be revealed. However, irrespective of the type of methodology, critical and systemic review of research can serve two purposes. In that sense, critical reviews are both scientific research and the application of common sense. They serve to identify studies relevant to a particular question, to appraise and assess the eligibility of these studies, and to summarise them, using statistical techniques to combine their results, if feasible and appropriate (Chinnock, Siegfried & Clarke, 2005, 367-369). Methodology Quantitative and Qualitative Research methods are techniques used by researchers to structure a study through which information is gathered and analysed to answer the research question. The two alternative paradigms have strong implications for the research methods to be used (Cormack, 2000, 82-85). Broadly speaking, quantitative research involves positivist enquiry where a general set of orderly, disciplined procedures are used to acquire information (Dixon-Woods et al., 2004, 26-35). The methodology usually involves deductive reasoning to test the reality relevant to the question. On the contrary, the qualitative research involves naturalistic enquiry to build a theory, rather than testing existing knowledge as in quantitative research. These are usually descriptive in nature, since these studies often attempts to find out the meaning (Bryman, 2001, 46-53). Strategies of Literature Search To build a scientific basis of evidence, a comprehensive literature search was undertaken and then evaluated critically. For the purpose of the review of literature, to support the rationale, need, and continuation of the project, this author conducted a literature search across databases. Those accessed for information included: CINHAL, Medline and Pubmed along with the Google Scholar internet search engine. Moreover MEDLINE, EMBASE, and CINAHL and Cochrane databases were searched to identify relevant literature on occupational asthma as far as occupational health nursing is concerned. HighWire Press was also searched. The key words in the search included “asthma”, “occupational asthma”, “occupational health”, “occupational health nursing”, “work-related”, “respiratory disease”, "research," and “work-related asthma". Moreover, the references cited in the selected articles were also searched for relevant material. After locating initial articles, peers, colleagues, and professors were consulted for any other more relevant articles (Flemming & Briggs, 2007, 95-100). Inclusion criteria for each article reviewed were answers to the following questions: 1. Was the article a valid research article? 2. Did the article’s study include occupational, employment-related, or work-related asthma? 3. Did the article deal with any clinical, epidemiological, socioeconomic, or management aspect of occupational asthma? 4. Did the article deal with causal relationship between occupational asthma and occupation? 5. Did the study deal with respiratory ailments related to employment? 8. Was the article published within the past 5 years? 9. Did the article have some identification with occupational health nursing? 10. Was the article related to occupational health in the United Kingdom and published in English language? Each article should answer “yes” to all of these questions. Based on these criteria, although many articles were located on occupational asthma, none of these were directly related to occupational health nursing on occupational asthma. It was very surprising, since caring for occupational asthma is fairly common in occupational health nursing practice in the United Kingdom. To further narrow the search, a combination of search words were used so specific areas of occupational asthma are reflected in the research. Hopefully, this would generate articles that focus on occupational asthma and occupational health nursing. After consultation with the library and professor, it was decided that any of the articles that are felt to be relevant will be chosen to review for the purpose of this assignment since at least on the face of paucity of nursing research, this review may guide this author for a future research depending on the evidence extracted. Even though that is not feasible, it can be worthy exercises to update knowledge, which may play a helping role in future practice (Egger et al., 2003, iv). Thus, for this assignment 4 such articles were chosen, and the findings from the review are presented in the following sections. Title and Authors The title should present is synopsis of the study in that the reader has immediately an idea about what could be the content of the study. In all the four articles selected, the titles are appropriate from that angle; however, it would have been better if the titles would have a little more brevity, which could have been possible in all the four studies selected. The credentials of the authors of any research are very important to indicate the eligibility of the author to conduct the research (Cormack, 2000, 82-85). This should connect to the knowledge, expertise, experience, and publications of the authors. In all the four articles, the credentials of the authors have been mentioned in a great detail, and the reader has a chance to examine the reference list to see that almost all the authors have been published before. They are mostly university professors or researchers, and a cross referencing was done to see that these authors have been repeatedly cited in other studies in this area. Ethics The article by Peters et al. (2007) is a review article. It has been mentioned earlier why a review article has been included in this critical review (Peters et al., 2007, 316-326). The article by Francis et al. is also factually a review article to reach a consensus about definition and investigation to treat occupational asthma at a specialist clinic level. Therefore question of ethical issues does not arise (Francis et al., 2007, 361-365). Similar logic holds good for the article by Fishwick and co-workers (2007). When humans are used as study participants, as in nursing research, care must be exercised in ensuring that the rights of those humans are protected. Ethics require that participants be cognizant of their role in a study. While conducting a study, nurses are obliged by the code of ethics to conform to all ethical requirements of a research, remaining aware that all ethical principles are observed (Fishwick et al., 2007. 185-190). Unfortunately, the fourth study by McDonald et al. (2005) is a retrospective study of records of specialist occupational respiratory illness clinic records, and hence there is no need of ethical clearance (McDonald et al., 2005, 836-842). Research Design and Methods Quantitative designs in general share one thing in common. They tend to be fairly structured. Typically, quantitative researchers specify the nature of any intervention, comparisons to be made, methods to be used to control extraneous variables, timing of data collection, the study site and setting, and information to be given to participants—all before a single piece of data is gathered (Cormack, 2000, 82-85). Apart from the first study by Peter et al. mentioned, all other studies were rigorous in terms of design to enhance the reliability and validity of the data collection. Peters et al. (2007) did a systemic review of five studies of variable methodological qualities, all of which related to occupation-related asthma in age groups 18-65 years. The other inclusion criterion of these studies was return to work or risk of job loss. The identified concepts were categorised, and these were risk, employment, income, exposure, ill health, healthcare, screening tools, and personal factors. Then, the authors conducted a methodological analysis of all the studies included (Peters et al., 2007, 316-326). McDonald et al. (2005) collected data from the cases reported from 1992 to 2001 to the SWORD and OPRA national surveillance schemes. These two programmes were selected because all UK chest and occupation physicians participate in these two programmes. The data collected were analysed and stratified according to age, sex, occupation, industry, and cause in order to calculate incidence rate against appropriate variables to generate epidemiologic data (McDonald et al., 2005, 836-842). Fishwick et al. (2007) identified 19 cases of occupational asthma as a part of a larger national cohort in order to develop a case summary in each case. Depending on the presented parameters, 12 physicians were requested to predict the percentage likelihood of occupational asthma in each case. Statistical analyses of these predictions were done to examine the diagnostic agreement between physicians (Fishwick et al., 2007. 185-190). Francis et al. (2007) desired to establish a consensus definition of occupational asthma through a modified RAND appropriateness method among clinicians who were running specialist occupational asthma clinic. It has been repeatedly indicated by nursing theorists that methodology should be clearly delineated to facilitate replicability of the study. Moreover, methodology should be strongly connected to design with reasons so sample size, sampling techniques, exclusion and inclusion criteria, possibility of bias and measures to control them, and control measures of extraneous variables are explicitly mentioned (Francis et al., 2007, 361-365). Unfortunately, all the other studies except by Peters et al. (2007) had the defect of lack of explanation of the rationale, and the reader has considerable difficulty in understanding the design. Data Analysis and Results Despite the many advantages of doing multimethod research, it is nevertheless true that a successful integrated data analysis is a challenging task. The researcher may be confronted with issues about how best to combine numeric and narrative data or about how to resolve and interpret inconsistent or contradictory findings. However, the outcome of such challenges may well be more refined conceptualizations of the phenomenon under study. The data analyses in all these studies have been presented in a detailed manner (Cormack, 2000, 82-85). The study by Peters et al. (2007) being a review and descriptive design, the data analysis seems to be coherent and appropriate, and the basic themes associated with occupational asthma have been delineated. They have presented the data in a tabulated manner and the results have been presented with the help of graphics, and the findings presented there have not been repeated in the article. The reader has no problem understanding how the analysis is leading to the conclusion (Peters et al., 2007, 316-326). McDonald et al. (2005) have presented the results in a concise manner, and reader can identify the causes of occupational asthma and causal relationships of different agents. The presentation of the results is clear, explicit, and definitely adds to the knowledge of this author. This knowledge may turn out to be very helpful in clinical practice. The data analysis in McDonald et al. (2005) indicates that the rate of diagnosis of occupational asthma is more in case of occupational physicians, and occupational asthma was prevalent in 25% of cases with craft related cases being predominant (McDonald et al., 2005, 836-842). Similarly Fishwick et al. (2007) did extensive statistical analysis of the data to show that physicians varied considerably in terms of diagnosis of these cases of occupational asthma. The details of statistical analysis indicated that the agreement was less on the basis of clinical criteria; however, a high probability rating was possible with the presence of positive serial peak expiratory flow rate (Fishwick et al., 2007. 185-190). In contrast, Francis et al. (2007) study indicated that there was consensus among physicians on 10 terms defining occupational asthma (Francis et al., 2007, 361-365). Discussion A report of the findings is never sufficient to convey their significance. The meaning that researchers give to the results plays a rightful and important role in the report. The discussion section is devoted to a thoughtful and insightful analysis of the findings, leading to a discussion of their clinical and theoretical utility. In all the studies, the authors discussed the main findings, the meaning of these findings, the correlation of these findings with the results, the discussion of the validity and limitation of these results, similarities and differences from the prior findings, and in all the cases, the authors have reached conclusion about these findings with probable implications of these on future practice or research (Cormack, 2000, 82-85). Apart from the Peter et al. (2007) article, however, the discussions are very brief, limited, but adequate, so the reader does not have any problem understanding the themes. The discussion section of Peter et al. reveals many facts that add to the knowledge on occupational asthma (Peters et al., 2007, 316-326). Limitations All these studies have limitations, however, the authors perhaps chose to remain silent on these issues since these are retrospective studies based on recorded data or the designs did not have any experiment involved in them. Limitations of any study is important since these give a clue as to how a study is limited in the values of evidence that it generates, and depending on these gaps, the reader has a chance to contemplate as to how newer knowledge can be built through further research. Nevertheless, the study by Peters et al. (2007) mentions the limitations of the design in that there had been difficulty synthesizing the themes from the studies that they reviewed (Peters et al., 2007, 316-326). Implications and Recommendations The Peter et al. (2007) study indicates that predictors of non-return to work or job loss with occupational asthma or respiratory ill-health in a general working population is limited, but a detailed understanding is necessary to design and implement interventions to reduce long-term disability (Peters et al., 2007, 316-326). Fishwick et al. (2007) concludes assessment of paper cases of possible occupational asthma bears acceptable agreement, but there remain certain variations in diagnostic assessments among physicians. The authors recommend a more unified national approach to these patients (Fishwick et al., 2007. 185-190). McDonald et al. (2005) concluded that there had been decline in incidence in a 10-year period in their study. However, population surveys disagree based on prevalence and still now, incidence of new cases of OA is substantial (McDonald et al., 2005, 836-842). Francis et al. (2007) expect that outcome of consensus processes will improve definition and investigation of OA across the UK (Francis et al., 2007, 361-365). Abstract and Reference A relook into the titles after completely going through the articles provides newer implications of the articles. All the studies are well referenced, and all the references were crosschecked for validity. The abstract in Peters et al. (2007) was very concise, clear, succinct, and well-written, and the reader gets a clear idea about what he is going to encounter in the article. Summary Without repeating any content of these reviewed articles, it can be stated that despite not being related to OHN, all these articles carry a wide body of knowledge and can be used to construct a theme in nursing practice related to occupational asthma. These articles clearly enumerate the different causative parameters, incidence, relation to work loss, diagnostic aids to reach an agreed upon diagnosis, and perhaps a new insight as to which occupations need to be targeted to better manage these cases. From that angle, this review has been able to extract evidence and hence has met its objectives. Reference List Bolen, AR., Henneberger, PK., Liang, X., Sama, SR., Preusse, PA., Rosiello, RA., and Milton, DK., (2007). The validation of work-related self-reported asthma exacerbation. Occupational and Environmental Medicine; 64: 343 - 348. Bryman, A. (2001) Social Research Methods. Oxford University Press, Oxford. 46-53 Chinnock, P., Siegfried, N. & Clarke, M. (2005) Is evidence-based medicine relevant to the developing world? Systematic reviews have yet to achieve their potential as a resource for practitioners in developing countries. PLoS Medicine, 2 (5), 367–9. Clarke, M. (2004) Doing new research? Don’t forget the old: nobody should do a trial without reviewing what is known. PLoS Medicine, 1, 100–2. Cormack, D. F. S.(ed)(2000) .The Research Process in Nursing (4th. Ed.) Blackwell Science, Edinburgh pp. 82-85 Dixon-Woods, M., Agarwal, S., Young, B., Jones, D. & Sutton, A. (2004) Integrative Approaches to Qualitative and Quantitative Evidence. Health Development Agency, London. 26-35 Eagan, TM., Gulsvik, A., Eide, GE., Bakke, PS., (2002). Occupational airborne exposure and the incidence of respiratory symptoms and asthma. American Journal of Respiratory and Critical Care Medicine;166: 933–938. Egger, M., Juni, P., Bartlett, C., Holenstein, F. & Sterne, J. (2003) How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technology Assessment, 7 (1), iv. Elder D, Abramson M, Fish D, Johnson A, McKenzie D, Sim M., (2004). Surveillance of Australian workplace Based Respiratory Events (SABRE): notifications for the first 3.5 years and validation of occupational asthma cases. Occupational Medicine (Lond);54:395–399. Filios, MS. and Pechter, E., (2006). Health care workers and asthma. American Journal of Nursing; 106(4): 96. Fishwick, D., Bradshaw, L., Henson, M., Stenton, C., Hendrick, D., Burge, S., Niven, R., Warburton, C., Rogers, T., Rawbone, R., Cullinan, P., Barber, C., Pickering, T., Williams, N., Ayres, J., and Curran, AD., (2007). Occupational asthma: an assessment of diagnostic agreement between physicians. Occupational and Environmental Medicine; 64:185-190. Flemming, K. & Briggs, M. (2007) Electronic searching to locate qualitative research strategies: evaluation of three strategies. Journal of Advanced Nursing, 57 (1), 95–100. Francis, HC., Prys-Picard, CO., Fishwick, D., Stenton, C., Burge, PS., Bradshaw, LM., Ayres, JG., Campbell, SM., Niven, RM., (2007). Occupational and Environmental Medicine;64:361-365 Johnson, A., Toelle, BG., Yates, D., Belousova, E., Ng, K., Corbett, S., and Marks, G., (2006). Occupational asthma in New South Wales (NSW): a population-based study. Occupational Medicine; 56: 258 - 262. Mapp, CE., Boschetto, P., Maestrelli, P., Fabbri, L., (2005). Occupational asthma. American Journal of Respiratory and Critical Care Medicine;172: 280–305. McDonald, JC., Chen, Y., Zekveld, C., Cherry, NM., (2005), Incidence by occupation and industry of acute work related respiratory diseases in the UK, 1992–2001. Occupational and Environmental Medicine; 62:836-842. Muñoz, X., Cruz, MJ., Orriols, R., Torres, F., Espuga, M., and Morell, F., (2004). Validation of specific inhalation challenge for the diagnosis of occupational asthma due to persulphate salts Occupational and Environmental Medicine; 61: 861 - 866. Peters, J., Pickvance, S., Wilford, J., MacDonald, E., Blank, L., (2007). Predictors of Delayed Return to Work or Job Loss with Respiratory Ill-Health: A Systematic Review. Journal of Occupational Rehabilitation. 17:317–326 Roberts, JL., Janson, S., Gillen, M., Flattery, J., and Harrison, R., (2004). Processes of care for individuals with work related asthma: treatment characteristics and impact of asthma on work. American Association of Occupational Health Nursing Journal; 52(8): 327-37. Read More