Meeting the Health Needs of the Poor Disadvantaged Worker Kathryn D. Travelbee, R.N .. C.O.H .N .
Mrs . Travelbee is Reg ional Rehabilitation Nurse. Insurance Company of North America , New Orleans, Lou isiana .
n industry today there is a grow ing population of I workers whose disadvantages prevent them from being fully productive and interfere with their ab ility to perform in the safest possible manner. These are both male and female, and usually in their first experience at employment in " big" industry, commercial, public utility or factory. Some of the prevalent disadvantages include (1) language barrier, (2) lack of education or training in a skill, and (3) family responsibilities interfe ring with the employee's ability to report regularly for work . The nurse, working in the industrial setting , first meets the worker e ither when assisting with the health quest ionnaire or physical exam ination in the occupat ional health medical department or when the worker returns from having his physical completed at a designated medical faci lity outside the work setting. The worker proceeds through an orientation period which may vary from periods of one day to one month. Programs are conducted on a formal basis, us ing films, lectures and group discussions. Key people such as the personnel manager, safety director, nurse, and production foremen or supervisors offer information to help the workers understand what is expected of them and what services are available Presented at the session, " How the Occupational Health Nurse Helps Meet the Needs of the Work ing Poor and the Non-White Worker," the sixth sc ientif ic session of the Occupational Health and Safet y Section , 102nd Annual Meet ing of the American Public Health Association, New Orleans, Lou isiana , October 2024, 1974 . Occupational Health Nursing. April 1975
within the industry. The nurse explains services prov ided by the medical department and how the serv ice may be utilized. An explanation of insurance benefits is given by the nurse or a personnel representative. Great effort is made to prepare employee handbooks in clear and concise language explaining benefit and safety programs. The worker is instructed in the use and care of personal protection equ ipment. Following the initia l orientation period, the nurse continues the employee education by including the one-to-one process. Through counseling , the employee is assisted toward obtaining his health care as well as his family's health care through utilizing private physicians and facilities rather than using health care facilities geared toward caring for patients unable to pay. The nurse reviews accident reports and attunes safety programs which deal with the problems encountered in the recurrence of similar accidents. Posters and health information prepared for bulletin boards and house organs require imagination in selecting subjects and terminology understandable to the worker. First aid instructional courses provide ind ividual teaching. The male, in the factory employing three hundred or less and provid ing services of an occupational health nurse and a safety team, has been observed to make the transition from poor to non-poor status with more success. The poor female encounters greater obstacles in making her trans ition. Most frequently she is the only parent in the fami Iy; therefore, she not 15
MEETING THE HEALTH NEEDS OF THE POOR DISADVANTAGED WORKER
continued
only has the responsibility of being the breadwinner, but also assumes the responsibility of being homemaker and for obtaining medical care of the children. Medical care usually is received through the many clinics where no appointments are possible and long hours are required to receive service. The occupational health nurse is unable to accomplish change of the clinic's routine, and thus works through supervision at the industry in attempts to adjust working hours dependent upon the schedule of the clinic providing medical and dental care. With this group, the occupational health nurse has been instrumental in providing speakers from the State and City Health Departments to discuss various health-related subjects, including nutrition and accidental poisoning by household articles such as cleaning agents and insecticides. Home visits by the occupational health nurse have been of great assistance to the ill worker. Utilizing assistance from community agencies aids both the worker and the family. Because of the increasing crime rate, the occupational health nurse encounters such problems as rape, stabbings and gunshot wounds. Such attacks are now a frequent occurrence for workers in small businesses vulnerable to robbery, and the worker who is expected to handle money and valuables in performing a job. These are frightening experiences and have great effect upon the victim's mental health. Early visits by the nurse, utilizing counseling skills, serve to identify developing problems. She intervenes and attempts to avoid chronic complications. Fear of traveling the streets are real, thus assistance with transportation is given. Companionship of a co-worker or use of taxi service may be necessary until the victim's confidence is restored. The Community Relations Division of the New Orleans Police Department provides instructors with a slide presentation to teach women self-protection measures. I n the New Orleans area there are approxi mately 100,000 Spanish-speaking people. Overcoming the language barrier is a real challenge to the nurse and management One nurse took a course in Spanish and by the time she felt comfortable with the language fourteen of the employees had sought other employment and the one remaining had learned English. These Spanish-speaking employees are encouraged to enroll in night adult education programs to learn English. Management endeavors to employ at least one person who can serve as interpreter. Frequently the factory is only a stepping stone for these employees. Many of them have skills and once they can command English, they leave the factory for jobs utilizing these skills. Many industries cannot support the expense of an occupational health program. These same industries 16
are deficient in safety and health education. They are unable to provide many of the benefits that would assist the ill or injured worker other than those benefits requ ired by law. I t is this large g rou p of workers who need direction to health agencies. What community services are available to fill this void? A growing number of insurance companies are offering services of rehabilitation assistance through departments employing specialized nurses. The rehabilitation nurse is mobile, traveling an average of 20,000 mi les each year. Visits are made to the patient, family, physician and employer. The rehabilitation nurse visits and tours the work setting. Findings are coordinated with the safety departments of the insurance company with the objective of accident prevention and improvement or expansion of occupational health and safety programs. Medical and vocational rehabilitation programs are developed by coordinating efforts of all parties concerned. Specialized treatment facilities are used when needed. Every effort is made to reduce the residual disabi lity of the patient. I n many cases the patient is returned to work with the same employer. When the injury results in marked limitation of the patient's performance, a re-training program is coordi nated. I nsurance Company of North America provides testing and evaluation through vocational exploration. The patient with spouse or a concerned family member is transported to I.NA Mend Institute located at Human Resources Center in Albertson, Long Island. This experience is geared toward motivating the handicapped to re-train for an occupation dependent upon his mental and physical capability. The majority of patients seen by the rehabilitation nurse are employed by small industries which lack the service of an occupational health nurse. The industry staff is too small and frequently lacks provision for employer contact with the ill or injured. Concern and interest shown by the nurse and restoration of communication between the worker and employer can serve to return the worker to a job dependent upon his physical limitations. The worker becomes productive, earning a salary while continuing his rehabilitation toward full productivity. The more disadvantages encountered, the more challenging the patient becomes for the rehabilitation nurse. Mr. V., a nineteen-year-old European, speaking no English, sustained a mutilating injury to the left foot, while operating a saw. A below-the-knee amputation was necessary. The rehabilitation nurse first saw the patient on the day following the accident. An Englishspeaking cousin served as interpreter for the patient and his mother. Two important factors were initially observed: (1) the mother was not giving moral and emotional support to the patient and (2) the patient
had given indication he would attempt to take his life. The rehabilitation nurse immediately began work with the physician, hospital nursing staff, social worker and chaplain, and a social worker from the association representing the patient's native country, It was this worker who helped the rehabilitation nurse to understand the cultural background and developing problems. The mother considered her son's role as being a financial contributor to the family, and her son, trained to accept this role, considered himself now unworthy and of no value, The mother rejected the son, refusing to care for him, Through concern and efforts by the rehabilitation nurse, nursing home care was made avai lable for the patient, where the rehabi litation process cou Id be continued, Two young women from his native country were on the staff, The rehabilitation nurse made it known the patient was approaching his 20th birthday, The staff arranged a birthday party- his first ever, In his new environment an improved change in his attitude and personal hygiene has been observed, He now accepts assistance through vocational rehabilitation, Efforts to assist the mother to accept the son with his handicap continue, Nurses must have an open mind, be patient and understanding and have a sincere interest in all
people in order to recognize and help meet their needs, The majority of patients seen by the rehabilitation nurse have similar patterns: less than one year experience on the job, young, and contributing to their own accident, working in an industry lacking a formal occupational health program. Accidents occurring in industries with occupational health programs occur less frequently, When disabling injuries do occur, the occupational health nurse works toward a rehabilitation program and greatly facilitates the role of the rehabilitation nurse, Private industry is investing millions of dollars each year striving to provide a safer, healthier work place, There remains, however, much to be accomplished in assisting the small businessman in providing improved services to his worker, His time, money and knowledge limits many toward implementing the programs of big industry, Who will provide it? Can this gap be closed by those in Public Health?
ACKNOWLEDGMENT Deep gratitude is expressed to occupational health nurse colleagues in the New Orleans area and to rehabilitation nurses in Central Region. Insurance Company of North America. for assistance given the author.
23rd Annual AAIN Presidents' Meeting The Biltmore
New York, New York
September 27 & 28, 1975 Occupational Health Nursing, April 1975
17
Mrs . Travelbee is Reg ional Rehabilitation Nurse. Insurance Company of North America , New Orleans, Lou isiana .
n industry today there is a grow ing population of I workers whose disadvantages prevent them from being fully productive and interfere with their ab ility to perform in the safest possible manner. These are both male and female, and usually in their first experience at employment in " big" industry, commercial, public utility or factory. Some of the prevalent disadvantages include (1) language barrier, (2) lack of education or training in a skill, and (3) family responsibilities interfe ring with the employee's ability to report regularly for work . The nurse, working in the industrial setting , first meets the worker e ither when assisting with the health quest ionnaire or physical exam ination in the occupat ional health medical department or when the worker returns from having his physical completed at a designated medical faci lity outside the work setting. The worker proceeds through an orientation period which may vary from periods of one day to one month. Programs are conducted on a formal basis, us ing films, lectures and group discussions. Key people such as the personnel manager, safety director, nurse, and production foremen or supervisors offer information to help the workers understand what is expected of them and what services are available Presented at the session, " How the Occupational Health Nurse Helps Meet the Needs of the Work ing Poor and the Non-White Worker," the sixth sc ientif ic session of the Occupational Health and Safet y Section , 102nd Annual Meet ing of the American Public Health Association, New Orleans, Lou isiana , October 2024, 1974 . Occupational Health Nursing. April 1975
within the industry. The nurse explains services prov ided by the medical department and how the serv ice may be utilized. An explanation of insurance benefits is given by the nurse or a personnel representative. Great effort is made to prepare employee handbooks in clear and concise language explaining benefit and safety programs. The worker is instructed in the use and care of personal protection equ ipment. Following the initia l orientation period, the nurse continues the employee education by including the one-to-one process. Through counseling , the employee is assisted toward obtaining his health care as well as his family's health care through utilizing private physicians and facilities rather than using health care facilities geared toward caring for patients unable to pay. The nurse reviews accident reports and attunes safety programs which deal with the problems encountered in the recurrence of similar accidents. Posters and health information prepared for bulletin boards and house organs require imagination in selecting subjects and terminology understandable to the worker. First aid instructional courses provide ind ividual teaching. The male, in the factory employing three hundred or less and provid ing services of an occupational health nurse and a safety team, has been observed to make the transition from poor to non-poor status with more success. The poor female encounters greater obstacles in making her trans ition. Most frequently she is the only parent in the fami Iy; therefore, she not 15
MEETING THE HEALTH NEEDS OF THE POOR DISADVANTAGED WORKER
continued
only has the responsibility of being the breadwinner, but also assumes the responsibility of being homemaker and for obtaining medical care of the children. Medical care usually is received through the many clinics where no appointments are possible and long hours are required to receive service. The occupational health nurse is unable to accomplish change of the clinic's routine, and thus works through supervision at the industry in attempts to adjust working hours dependent upon the schedule of the clinic providing medical and dental care. With this group, the occupational health nurse has been instrumental in providing speakers from the State and City Health Departments to discuss various health-related subjects, including nutrition and accidental poisoning by household articles such as cleaning agents and insecticides. Home visits by the occupational health nurse have been of great assistance to the ill worker. Utilizing assistance from community agencies aids both the worker and the family. Because of the increasing crime rate, the occupational health nurse encounters such problems as rape, stabbings and gunshot wounds. Such attacks are now a frequent occurrence for workers in small businesses vulnerable to robbery, and the worker who is expected to handle money and valuables in performing a job. These are frightening experiences and have great effect upon the victim's mental health. Early visits by the nurse, utilizing counseling skills, serve to identify developing problems. She intervenes and attempts to avoid chronic complications. Fear of traveling the streets are real, thus assistance with transportation is given. Companionship of a co-worker or use of taxi service may be necessary until the victim's confidence is restored. The Community Relations Division of the New Orleans Police Department provides instructors with a slide presentation to teach women self-protection measures. I n the New Orleans area there are approxi mately 100,000 Spanish-speaking people. Overcoming the language barrier is a real challenge to the nurse and management One nurse took a course in Spanish and by the time she felt comfortable with the language fourteen of the employees had sought other employment and the one remaining had learned English. These Spanish-speaking employees are encouraged to enroll in night adult education programs to learn English. Management endeavors to employ at least one person who can serve as interpreter. Frequently the factory is only a stepping stone for these employees. Many of them have skills and once they can command English, they leave the factory for jobs utilizing these skills. Many industries cannot support the expense of an occupational health program. These same industries 16
are deficient in safety and health education. They are unable to provide many of the benefits that would assist the ill or injured worker other than those benefits requ ired by law. I t is this large g rou p of workers who need direction to health agencies. What community services are available to fill this void? A growing number of insurance companies are offering services of rehabilitation assistance through departments employing specialized nurses. The rehabilitation nurse is mobile, traveling an average of 20,000 mi les each year. Visits are made to the patient, family, physician and employer. The rehabilitation nurse visits and tours the work setting. Findings are coordinated with the safety departments of the insurance company with the objective of accident prevention and improvement or expansion of occupational health and safety programs. Medical and vocational rehabilitation programs are developed by coordinating efforts of all parties concerned. Specialized treatment facilities are used when needed. Every effort is made to reduce the residual disabi lity of the patient. I n many cases the patient is returned to work with the same employer. When the injury results in marked limitation of the patient's performance, a re-training program is coordi nated. I nsurance Company of North America provides testing and evaluation through vocational exploration. The patient with spouse or a concerned family member is transported to I.NA Mend Institute located at Human Resources Center in Albertson, Long Island. This experience is geared toward motivating the handicapped to re-train for an occupation dependent upon his mental and physical capability. The majority of patients seen by the rehabilitation nurse are employed by small industries which lack the service of an occupational health nurse. The industry staff is too small and frequently lacks provision for employer contact with the ill or injured. Concern and interest shown by the nurse and restoration of communication between the worker and employer can serve to return the worker to a job dependent upon his physical limitations. The worker becomes productive, earning a salary while continuing his rehabilitation toward full productivity. The more disadvantages encountered, the more challenging the patient becomes for the rehabilitation nurse. Mr. V., a nineteen-year-old European, speaking no English, sustained a mutilating injury to the left foot, while operating a saw. A below-the-knee amputation was necessary. The rehabilitation nurse first saw the patient on the day following the accident. An Englishspeaking cousin served as interpreter for the patient and his mother. Two important factors were initially observed: (1) the mother was not giving moral and emotional support to the patient and (2) the patient
had given indication he would attempt to take his life. The rehabilitation nurse immediately began work with the physician, hospital nursing staff, social worker and chaplain, and a social worker from the association representing the patient's native country, It was this worker who helped the rehabilitation nurse to understand the cultural background and developing problems. The mother considered her son's role as being a financial contributor to the family, and her son, trained to accept this role, considered himself now unworthy and of no value, The mother rejected the son, refusing to care for him, Through concern and efforts by the rehabilitation nurse, nursing home care was made avai lable for the patient, where the rehabi litation process cou Id be continued, Two young women from his native country were on the staff, The rehabilitation nurse made it known the patient was approaching his 20th birthday, The staff arranged a birthday party- his first ever, In his new environment an improved change in his attitude and personal hygiene has been observed, He now accepts assistance through vocational rehabilitation, Efforts to assist the mother to accept the son with his handicap continue, Nurses must have an open mind, be patient and understanding and have a sincere interest in all
people in order to recognize and help meet their needs, The majority of patients seen by the rehabilitation nurse have similar patterns: less than one year experience on the job, young, and contributing to their own accident, working in an industry lacking a formal occupational health program. Accidents occurring in industries with occupational health programs occur less frequently, When disabling injuries do occur, the occupational health nurse works toward a rehabilitation program and greatly facilitates the role of the rehabilitation nurse, Private industry is investing millions of dollars each year striving to provide a safer, healthier work place, There remains, however, much to be accomplished in assisting the small businessman in providing improved services to his worker, His time, money and knowledge limits many toward implementing the programs of big industry, Who will provide it? Can this gap be closed by those in Public Health?
ACKNOWLEDGMENT Deep gratitude is expressed to occupational health nurse colleagues in the New Orleans area and to rehabilitation nurses in Central Region. Insurance Company of North America. for assistance given the author.
23rd Annual AAIN Presidents' Meeting The Biltmore
New York, New York
September 27 & 28, 1975 Occupational Health Nursing, April 1975
17
