Search

The Midwest Nursing Research Society (MNRS) recently held its 40th annual conference and celebrated four decades of nursing research in the Midwest. MNRS continues to be one of the largest nursing research societies in the United States. Over the years, a vast majority of programmatic initiatives included education and tangible support for novice and experienced nurse researchers. In this article, the background for development of MNRS is reviewed with examination of driving forces that led to its creation. Three past presidents, Dr. Joyce Fitzpatrick, the first President of MNRS (1980-1981); Dr. Nancy Bergstrom, the eighth President (1993-1995); and Dr. Sally Lusk, the 14th President (2005-2007), discuss challenges, opportunities, and the exceptional progress made toward fostering excellence in nursing research for the Midwest and contributing to nursing science on a national and global scale. Lessons from the past as well as opportunities for the future are addressed.

Although noise as a cause of hearing loss and tinnitus among civilian (Hearing health care for adults: Priorities for improving access and affordability, 2016) and military populations (Noise and military service: Implications for hearing loss and tinnitus, 2006) is well known, studies conducted in the past 15 years document that noise exposures negatively affect health by contributing to many diseases, including cardiovascular diseases, obesity, developmental delays, mental illness, and reduced job and academic performance (Basner et al., 2015; Lusk, Gillespie, Hagerty, & Ziemba, 2004; Münzel, Gori, Babisch, & Basner, 2014; Pyko et al., 2015; Ristovska, Laszlo, & Hansell, 2014; Tzivian et al., 2015; Yoon, Hong, Roh, Kim, & Won, 2015). Reducing noise will decrease the incidence of diseases and also decrease health care costs. The American Academy of Nursing supports efforts to determine sources of harmful noise, establish programs (e.g., educational, surveillance, testing) to reduce noise, and promote policies and legislation to control noise exposures (Lusk, McCullagh, Dickson, & Xu, 2016).

This study assessed attitudes toward the use of hearing protection devices (HPDs) and the effect of an educational intervention on fit-testing results by comparing personal attenuation ratings (PAR50) before and after the intervention. Employees ( n = 327) from a large metal container manufacturer at four geographic locations were tested with a field attenuation estimation system (FAES) to identify workers ( n = 91) requiring intervention. PAR50 values significantly increased from baseline to post-intervention ( p < .001, 15.1 to 26.9) and at the 6-month follow-up ( p < .001, 95% confidence interval = −11.2, −6.3). Perceived self-efficacy scores for using HPDs significantly declined from baseline to post-intervention ( p = .006, 95% confidence interval = 0.3, 1.9), but were not significantly related to PAR50. Therefore, a FAES can assist the occupational health nurse to identify workers at high risk (low PAR50), teach proper fit and use of HPDs, and improve hearing protector selection.

Farmers experience higher rates of noise-induced hearing loss (NIHL) than workers in most other industries. We developed a model of farmers' use of hearing protection, and tested it with a random sample (n = 532) of farmers from the upper Midwest. Barriers to using hearing protection (e.g., difficulty communicating; OR = .44, p

Context Most adults do not achieve adequate physical activity levels. Despite the potential benefits of worksite health promotion, no previous comprehensive meta-analysis has summarized health and physical activity behavior outcomes from such programs. This comprehensive meta-analysis integrated the extant wide range of worksite physical activity intervention research. Evidence acquisition Extensive searching located published and unpublished intervention studies reported from 1969 through 2007. Results were coded from primary studies. Random-effects meta-analytic procedures, including moderator analyses, were completed in 2008. Evidence synthesis Effects on most variables were substantially heterogeneous because diverse studies were included. Standardized mean difference ( d ) effect sizes were synthesized across approximately 38,231 subjects. Significantly positive effects were observed for physical activity behavior (0.21); fitness (0.57); lipids (0.13); anthropometric measures (0.08); work attendance (0.19); and job stress (0.33). The significant effect size for diabetes risk (0.98) is less robust given small sample sizes. The mean effect size for fitness corresponds to a difference between treatment minus control subjects' means on VO 2max of 3.5 mL/kg/min; for lipids, −0.2 on the ratio of total cholesterol to high-density lipoprotein; and for diabetes risk, −12.6 mg/dL on fasting glucose. Conclusions These findings document that some workplace physical activity interventions can improve both health and important worksite outcomes. Effects were variable for most outcomes, reflecting the diversity of primary studies. Future primary research should compare interventions to confirm causal relationships and further explore heterogeneity.

The 2000 United States Census reported significant growth in the number of Hispanic workers. The National Institute for Occupational Safety and Health (NIOSH, 1996) has identified noise-induced hearing loss as a significant occupational threat. Current theoretical models need to be evaluated for their utility with Hispanic workers. The Predictors for Use of Hearing Protection Model (PUHPM) is a framework for increasing workers' use of hearing protection devices (HPDs). Using regression analysis, the explained variance in HPD use by the model predictors was examined in a sample of 208 Hispanic factory workers. Explained variance was lower for Hispanics (R^sup 2^ = .20) than for non-Hispanic Whites (R^sup 2^ = .37). Further research with Hispanic workers is needed to improve the PUHPM fit. Keywords: ethnicity; predictors; hearing protection behavior; model test The 2000 U.S. Census identified a significant growth in the U.S. Hispanic population (U.S. Census Bureau, 2001). While the overall U.S. population increased by 13.2% from the 1990 to the 2000 census, the Hispanic population rose by 57.9%. Additionally, census data showed that the Hispanic population reported a median age (25.9 years) approximately 10 years younger than the overall, suggesting continued proportionally larger population growth. Occupational status and worksite environments can significantly impact individual health and well-being (Lusk & Raymond, 2002). Historically, Hispanics have been disproportionately represented with greater numbers in laborer job classifications versus managerial and professional specialties (Friedman-Jimenez & Ortiz, 1994; Frumkin, Walker, & Friedman-Jimenez, 1999). This phenomenon leads to a proportionally increased risk for exposure to the higher rates of occupational injury and illness for Hispanic workers. Noise is one such exposure of concern. Engineering controls have long been the preferred method to eliminate or reduce worker exposure to noise. Unfortunately, engineering controls have not been able to eliminate hazardous noise exposure for workers. Risk for noise-induced hearing loss (NIHL) has been identified by the National Institute for Occupational Safety and Health (NIOSH, 1996) as the most common occupational disease threat in the United States. Nonetheless, no national surveillance system exists to document hearing loss in workers (NIOSH, 1996; U.S. Department of Health and Human Services, 2000). The protective behavior of hearing protection use remains central to protecting many workers from NIHL. Past studies of hearing protection device (HPD) use have demonstrated that utilization for worker populations in manufacturing (Kerr, Lusk, & Ronis, 2002; Lusk, Kerr, Ronis, & Eakin, 1999; Lusk et al, 2003), construction (Lusk, Ronis, & Kerr, 1995), and farm workers (McCullagh, Lusk, & Ronis, 2002) is below that required to protect workers. The U.S. Bureau of Labor Statistics (2003) indicated that in 2001 the highest percentages of Hispanic workers tend to be found in the areas of agriculture, construction, and manufacturing, suggesting that Hispanics are at significant risk for NIHL. NIOSH has supported the importance of behavioral theories, such as Fender's (1987) Health Promotion Model (HPM) for guiding research toward increasing protective behaviors in workers (NIOSH, 1999). Lusk and colleagues adapted the constructs of the HPM to develop the Predictors of the Use of Hearing Protection Model (PUHPM, Figure 1), specifically for research on the use of hearing protection. PUHPM, which guides this study, evolved from a number of studies with factory and construction workers (Lusk, Hogan, & Ronis, 1997; Lusk & Keleman, 1993; Lusk, Kerr, & Baer, 1995; Lusk, Ronis, & Kerr, 1995; Lusk, Ronis, Kerr, & Atwood, 1994), yet participants were predominantly non-Hispanic White males. Noting the limited cross-cultural testing of the HPM, Kerr et al. …

The provision of reinforcements or boosters to interventions is seen as a logical approach to enhancing or maintaining desired behavior. Empirical studies, however, have not confirmed the effectiveness of boosters nor assessed the optimum number of boosters or the timing for their delivery.This randomized controlled trial contrasted the effect of four booster conditions (a). 30 days; (b). 90 days; (c). 30 and at 90 days; and (d). no boosters of the intervention to increase the use of hearing protection devices (HPDs).A total of 1325 factory workers completed a computerized questionnaire and were randomly assigned to one of three computer-based (tailored, nontailored predictor-based, or control) multimedia interventions designed to increase the use of hearing protection devices. After the intervention, colorful boosters specific to the type of training received were mailed to workers' homes. Posttest measures of use were administered at the time of their next annual audiogram 6 to 18 months after the intervention. RESULTS Repeated measures of analysis of variance (ANOVA) showed a significant main effect for the booster (after 30 days) in the group that received tailored training (F[3442] = 2.722; p =.04). However, in the assessment of the interaction between time (pretest and posttest) and boosters (four groups), the ANOVA did not find significant differences in hearing protection device use for any of the training groups. To assess for significant differences between groups, post hoc comparisons were conducted at the pretest and posttest for the total sample and for the subsample of workers who reported using hearing protection devices less than 100% of the time needed. Sheffé contrasts by intervention group, gender, ethnicity, and hearing ability found no significant changes in the mean use of hearing protection devices for the booster groups.Although the provision of boosters represented a considerable commitment of resources, their use was not effective in this study. However, it would be premature to eliminate boosters of interventions. Further study is needed to explore the effects of different booster types for increasing the use of hearing protection devices, and to assess carefully the effects of boosters on other health behaviors in studies with controlled designs.

Despite the successes of the US health care system, problems associated with access, affordability, and quality of care remain to be solved. Health services research (HSR) has the potential to aid nurses in addressing these issues; yet the importance of its inclusion in the academic preparation of nurse researchers has not been consistently recognized. This article discusses the relevance of HSR to nursing, provides a brief review of the history of HSR and its imperatives, and presents rationale for nursing's involvement in HSR. Problems identified by the Re-envisioning PhD project 1 conducted by the University of Washingtonare assessed for relevance to HSR and nursing doctoral preparation. Recommendations are included for integrating HSR into nursing doctoral programs and meeting HSR capacity building needs for the future. Nurs Outlook 2002;50:225-231.

Occupational health nursing research contributes to the scientific knowledge base, shapes practice guidelines, lends credibility to the profession, and ultimately benefits worker health and work settings. This descriptive study reviewed occupational health nursing research published from January 1990 through December 1999 in the AAOHN Journal. A single investigator reviewed all articles published during the 10 year period to determine if they qualified for inclusion by applying the inclusion and exclusion criteria. During the 10 year period, a total of 577 articles were published in the AAOHN Journal (the official journal of the American Association for Occupational Health Nurses) with 146 (25.3%) considered to be reports of research. Cumulatively, 261 RNs were authors of the research articles. Of the 146 research articles, 88% addressed the National Occupational Research Agenda (NORA) priorities, 60% addressed the 1989 AAOHN priorities, and 65% addressed the 2000 AAOHN priorities. Occupational health nursing research is performed primarily by graduate and postgraduate level nurses working either alone or with nurse co-investigators. The occupational health nursing research articles addressed NORA priorities often. However, the outcomes focused priorities of AAOHN were addressed less often. Much has been accomplished in the field of occupational health nursing research and more remains to be performed to ensure a strong research base for occupational health nursing practice.

Environmental noise levels in the United States are increasing, yet there are few studies in which the nonauditory effects of workplace noise are assessed. In the current study, the authors examined chronic effects of noise on blood pressure and heart rate in 374 workers at an automobile plant. Data were collected from subjects prior to the start of their workshift. Participants completed questionnaires about diet, alcohol use, lifestyle, noise annoyance, use of hearing protection, noise exposure outside of the work environment, personal and family health histories, and demographic information. Resting blood pressure, heart rate, and body mass index were obtained. Noise exposure levels were extracted retrospectively from company records for each participant for the past 5 yr. Summary statistics were generated for each variable, and the authors performed bivariate correlations to identify any unadjusted associations. The authors then completed statistical modeling to investigate the effects of noise on blood pressure and heart rate, after they controlled for other variables (e.g., gender, race, age). The authors controlled for confounding variables, after which use of hearing protection in high-noise areas was a significant predictor of a decrease in both systolic and diastolic blood pressures. The results suggested that the reduction of noise exposure by means of engineering controls or by consistent use of hearing protection by workers may positively affect health outcomes.

Noise-induced hearing loss is a significant, irreversible impairment, but one that is preventable. The numbers of persons, including children, exposed to high noise is increasing, necessitating the use of hearing protection if the noise cannot be reduced to a safe level. The effectiveness of interventions has been tested with select worker groups, but use of hearing protection continues to be less than necessary when in workers are exposed to high noise. Clinicians have an essential role in educating clients of all ages about this problem and in assisting them in protecting their hearing.

Background: Mexican American workers are vulnerable to noise-induced hearing loss, the most common occupational disease in the United States. Objectives: The purpose was to test the applicability of the Health Promotion Model to Mexican American workers' use of hearing protection devices. Method: A correlational descriptive design and path analysis were used to determine the relationships between cognitive-perceptual factors, modifying factors and use of hearing protection devices. A questionnaire was completed by a total of 119 workers in three garment manufacturing plants. Interviews were conducted with the occupational health nurse or safety director in each plant to determine the policy regarding hearing protection also. Results: Factors that directly influenced the use of hearing protection devices were a clinical definition of health, benefits of and barriers to use of hearing protection devices, self-efficacy in the use of hearing protection devices and perceived health status (R 2 =.25, p

Information is limited about the effects of the availability of over the counter medicines (OTCs) at a worksite on workers' ability to remain at work and the effect on health care utilization. The purpose of this preliminary study was to assess workers' perceptions related to the benefits of having a nurse directed over the counter medication dispensing system (OTCMS) at an automotive manufacturing plant. Fifty-six percent of 257 randomly selected workers who participated in semistructured interviews indicated they used OTCs as the first intervention when at home, and 88% had obtained OTCs from the plant's medical department. The workers were overwhelmingly positive about having an OTCMS available at their worksite. Eighty-nine percent indicated that having OTCs available from the occupational health nurse made it possible for them to stay at work and complete their shift. Not only did the workers find the OTCMS to be an asset in their worksite, but they also highly recommended having an OTCMS available in work settings that do not presently have one in place.

This study replicated the factor model for the Reduced Laffrey Health Conception Scale (RLHCS), which was originally developed by Laffrey (1986) and reduced by Lusk, Kerr, and Baer (1995). Two independent samples of construction workers (n - 697 and n = 510) were used. The samples were predominately Caucasian males (over 97%), with mean ages of 35 and 38 years, respectively. Principal components factor analysis with direct oblimin rotation and structural equation modeling were used to replicate factors and to test the equality of the three observed covariance matrices (factory workers and two groups of construction workers), respectively. Results replicated the two-factor structure (clinical health and overall wellness) found in the earlier study with factory workers (Lusk et al., 1995) and demonstrated factor in variance across different samples.

Introduction. Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. Purpose. The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. Subjects/Setting. Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. Design. Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. Measures. All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). Results. Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. Conclusion. Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.

This report presents data exploring the relationship between perceived psychological stress and several variables implicated in the etiology of upper extremity cumulative trauma disorders (UECTDs). The sample was 354 workers from three different manufacturing companies. The primary job exposure for the subjects was that they were engaged in jobs that involved repetitious movements of the upper extremities, primarily of the hands and arms. Data collection included a detailed health history, a comprehensive physical examination of the upper extremities, limited electrodiagnostic testing, Cohen's Perceived Stress Scale, Karasek's Job Content Questionnaire, demographic information, and a measurement of repetition.Descriptive analyses, analysis of variance, correlational analyses, and multiple linear regression were used to examine the data. Perceived stress, as measured in this study, was only weakly associated with repetition, job dissatisfaction, and subjective complaints related to UECTDs. In addition, factors generally accepted as related to UECTDs (e.g., repetition, female gender, hormonal influences, and existing medical conditions) were not robust predictors of perceived stress. The major limitation is related to the measurement of perceived psychological stress. Like most psychosocial phenomena, perceived stress is a complex construct, one that is difficult to measure and correlate with health outcomes. Further research is necessary to examine what role, if any, perceived stress may have in the etiology of UECTDs.

In this study, the Health Promotion Model (HPM) was used as the basis for a structural equation model of male and female blue collar workers' self-reported use of hearing protection devices (HPDs). Overall use did not differ by gender; in addition, self-efficacy and barriers to use of HPDs were the two best predictors of this behavior for both men and women. Despite the similarities in HPD use and the most important predictors of that use between men and women, the predictive models differed by gender in several ways. Significant predictors of use among men also included age and value of use of HPDs. For women, ethnic status and plant site were additional significant predictors of use. Because the influences of plant site and gender on self-reported use of HPDs could not be separated in this study, further research should address worksite culture and assess differences by gender. Knowledge of these differences will aid development of more effective interventions and may increase the use of hearing protection.

1. Over 30 million workers are exposed to hazardous noise on the worksite. Continual exposure to high noise levels damages and destroys hearing cells within the ear, making noise induced hearing loss an irreversible impairment. 2. Hearing conservation programs are required by law for workers in industrial settings where noise exposures equal or exceed 85 dB(A). Many workers, such as those in construction and agricultural industries, are not covered by these programs. 3. Reducing noise through engineering or administrative controls is the first line of defense. When this is not sufficient, two types of personal hearing protection devices are available: passive hearing protection devices such as ear muffs, canal caps, and ear plugs, which reduce noise mechanically; and active noise reduction devices, which electronically cancel sound waves at the ear. 4. The most effective hearing protection devices are those with which the worker is most comfortable will use 100% of the time. The occupational health nurse has a major role in promoting increased use of hearing protection devices through continued contact with workers, administrators, and safety personnel.

The health promotion model (HPM) was tested as a causal model of construction workers' use of hearing protection (N = 359). Theoretical and exploratory models fit well, with the theoretical model accounting for 36.3% of variance and the exploratory model accounting for 50.6% of variance in hearing protection use. Value of use (benefits of using hearing protection), barriers to use, and self-efficacy were significant predictors in both the theoretical and exploratory models, but perceived health status was a predictor only in the theoretical model. In the exploratory model, where modifying factors were allowed direct relationships with use of hearing protection, two modifying factors--noise exposure and interpersonal influences-modeling--were significant predictors. Results of this test of the HPM are consistent with the revised HPM (Pender, 1996). There were significant direct paths from modifying factors to behaviour. Use of hearing protection was best predicted by behavior-specific predictors, such as perceived barriers to use of hearing protection. Results support the use of the HPM to predict use of hearing protection.

U.S. and Canadian research studies (n = 73) on health promotion/disease prevention programs in the worksite reported from 1990 through 1994 were reviewed for this chapter. In those studies, diverse intervention foci were provided and outcomes specific to the foci, as well as numerous additional outcomes, cost and cost benefit being the most common, were measured. To aid future researchers, two appendices list reports by foci of intervention and by outcomes measured. Deficiencies and inadequacies in reports and studies are described. Nearly all (68 out of 73) of the published studies obtained positive results in terms of benefiting health or reducing costs. The Johnson & Johnson LIVE FOR LIFE Program® is presented as an exemplar of a comprehensive, multifaceted, worksite health promotion/disease prevention program whose effects were consistently assessed. Although health promotion and prevention of disease has always been an important component of nursing practice, few reports included nurse scientists as authors or coauthors. Potential explanations for the limited involvement by nurse scientists and recommendations regarding future research directions are presented. The worksite remains the best place to promote improved health for adults and this area of research represents an opportunity for greater involvement by nurse scientists.

The purpose of this study was to compare multiple indicators of behavior and identify the most viable measure of blue-collar workers 'use of hearing protection. Three measures of use were employed: observations, supervisor report, and self-report. Supervisor report was highly discrepant from both self-report and observed use; self-report and observations were highly correlated, and discrepancies between the two were slight. These results suggest that, for this type of measurement, self-report is an appropriate measure and may be the best choice when time and monetary resources restrict measurement to one indicator

Purpose. Laffrey's Health Conception Scale (LHCS), an instrument designed to measure personal definitions of health, was reduced with the intent of creating a useful yet less cumbersome version of the LHCS. Design. The original form of the LHCS was tested in a preliminary study, and results were used as a basis for the reduction of the instrument. The original clinical and new overall wellness subscales were subsequently tested with a larger population of manufacturing plant workers. Setting. One chemical plant and three Midwestern manufacturing plants. Subjects. The sample for the preliminary study comprised 94 chemical plant workers. For the larger study, the sample comprised 892 subjects; because this instrument was part of a larger questionnaire to identify predictors of workers' use of hearing protection, only those workers who spent some part of their work time in areas of the plant which required hearing protection use were eligible to participate. Measures. The original LHCS was used in the preliminary study. The reduced LHCS was used in the larger study and psychometrically evaluated. Results. The reduced LHCS accounted for 51 % of the variance in definition of health; all but one item had loaded on one of the two factors with a loading of .41 or greater. The revised LHCS demonstrated excellent internal consistency. Two distinct factors, the clinical subscale and the overall wellness subscale, were isolated. Conclusions. The researchers recommend the reduced LHCS be used for assessing subjects' definition of health; the reduced instrument requires fewer items, and therefore less time, to measure individuals' definitions of health with excellent reliability.

1. With increasing national concern about adult health and reducing health care costs, more research about these issues is being carried out in the worksite. 2. The worksite generates a variety of complications that may not be present in many other research settings; these include management policies, plant regulations, and management/labor relations. 3. The researchers review issues related to conducting research at the worksite and, based on their experience in this setting, make recommendations for resolving these issues.