Roadmap for the protection of disaster research participants: Findings from the world trade center evacuation study

Qureshi, K. A., Gershon, R. R., Smailes, E., Raveis, V. H., Murphy, B., Matzner, F., & Fleischman, A. R.

Publication year

2007

Journal title

Prehospital and Disaster Medicine

Volume

22

Issue

6

Page(s)

486-493
Abstract
Introduction: This report addresses the development, implementation, and evaluation of a protocol designed to protect participants from inadvertent emotional harm or further emotional trauma due to their participation in the World Trade Center Evacuation (WTCE) Study research project. This project was designed to identify the individual, organizational, and structural (environmental) factors associated with evacuation from the World Trade Center Towers 1 and 2 on 11 September 2001.Methods: Following published recommended practices for protecting potentially vulnerable disaster research participants, protective strategies and quality assurance processes were implemented and evaluated, including an assessment of the impact of participation on study subjects enrolled in the qualitative phase of the WTCE Study.Results: The implementation of a protocol designed to protect disaster study participants from further emotional trauma was feasible and effective in minimizing risk and monitoring for psychological injury associated with study participation. Conclusions: Details about this successful strategy provide a roadmap that can be applied in other post-disaster research investigations.

Infection control practices among correctional healthcare workers: Effect of management attitudes and availability of protective equipment and engineering controls

Green-McKenzie, J., Gershon, R. R., & Karkashian, C.

Publication year

2001

Journal title

Infection Control and Hospital Epidemiology

Volume

22

Issue

9

Page(s)

555-559
Abstract
OBJECTIVES: To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison health care setting, and to explore the effect on IC practices of a perceived organizational commitment to safety. DESIGN: Cross-sectional survey. SETTING: The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland. PARTICIPANTS: All full-time Maryland correctional health care workers (HCWs) were surveyed, and 225 (64%) of the 350 responded. METHOD: A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies. RESULTS: A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided. CONCLUSION: These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of "custody versus care" in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will most likely prove effective in improving employee compliance with IC practices in this health care setting.

Behavioral-diagnostic analysis of compliance with universal precautions among nurses.

DeJoy, D. M., Searcy, C. A., Murphy, L. R., & Gershon, R. R.

Publication year

2000

Journal title

Journal of occupational health psychology

Volume

5

Issue

1

Page(s)

127-141
Abstract
This study used the PRECEDE model (L.W. Green, M.W. Kreuter, S.G. Deeds, & K.B. Partridge, 1980) to examine individual, job-task, and environmental-organizational factors related to compliance with universal precautions (UP) among nurses. Structural equation modeling showed that the hypothesized model did a better job predicting general compliance (R2 = .41) than compliance with personal protective equipment (PPE; R2 = .18). All 3 categories of diagnostic factors (predisposing, enabling, and reinforcing) influenced general compliance, but predisposing factors were relatively unimportant for compliance with PPE. With a set of nested models, the greatest improvement in model fit occurred when the indirect effects of reinforcing factors were added. A positive safety climate may increase the likelihood that the work environment will contain features that enable workers to comply with safe work practices.

TB control in the hospital environment.

Gershon, R. R., McArthur, B. R., Early, E. T., & Grimes, M. J.

Publication year

1993

Journal title

Healthcare facilities management series

Page(s)

1-33
Abstract
Tuberculosis is again on the rise in the United States. Several outbreaks of TB in hospitals have heightened interest in the development and use of mechanisms that prevent the spread of this airborne pathogen. Controlling the spread of TB to hospital patients, workers, and others can be accomplished through various administrative engineering and design controls, and infection control programs, as recommended by the Centers for Disease Control and Prevention (CDC). The hazard of TB is real, but workers, patients, and visitors can be protected by implementing programs that guard against the diseases spread in the hospital environment.

The use of total quality improvement techniques to determine risk factors for back injuries in hospital workers.

Lin, M. Y., Ahern, J. E., Gershon, R. R., & Grimes, M.

Publication year

1998

Journal title

Clinical performance and quality health care

Volume

6

Issue

1

Page(s)

23-27
Abstract
OBJECTIVE: To identify the risk factors for back injuries among hospital employees using quality-management techniques. METHODS: Data from employee-health records were collected from 1993 to 1995 on a total of 100 back injuries. The data were reviewed retrospectively for risk factors using quality-management techniques. RESULTS: We identified two major categories of risk factors: administrative and environmental. The five most common causes of back injuries were as follows: inadequate or lack of proper training in body mechanics, not enough help in lifting, the load being lifted was too heavy, poor condition of the floor surface (slippery or uneven), and the patient was unable to help. The Workers' Compensation costs for the 100 back injuries was in excess of $600,000. CONCLUSION: Based on these findings, several preventive strategies are identified.

Operationalizing theoretical constructs in bloodborne pathogens training curriculum

Sinclair, R. C., Gershon, R. R., Murphy, L. R., & Goldenhar, L. M.

Publication year

1996

Journal title

Health Education and Behavior

Volume

23

Issue

2

Page(s)

238-255
Abstract
This article describes how the protection motivation theory (PMT) was used to inform the production of video curriculum for a bloodborne pathogens training program for hospital nurses. Although hospital nurses are well acquainted with the work practices designed to prevent bloodborne pathogen exposures (universal precautions), there is evidence that they do not always follow them. First, the onginal PMT is adapted to reflect what is currently known about the role of affect in health behavior prediction. Second, the authors show how the four PMT message constructs-probability of occurrence, magnitude of noxiousness, response efficacy, and self-efficacy-guided the planning, shooting, and editing of the videotapes. Incidental to this process was the operationalization of these message constructs in such a way that affective reactions would result. The results show that this video curriculum successfully aroused negative affect in the target audience. Only by carefully planning and documenting how message constructs are operationalized in health education materials can one be sure of achieving theory-based (and thus the most replicable) message design.

A work-systems analysis of compliance with Universal precautions among health care workers

DeJoy, D. M., Gershon, R. R., Murphy, L. R., & Wilson, M. G.

Publication year

1996

Journal title

Health Education and Behavior

Volume

23

Issue

2

Page(s)

159-174
Abstract
Universal precautions are work practices designed to protect health care workers from occupational exposure to HIV and other bloodborne pathogens. However, despite aggressive dissemination efforts by CDC and regulatory action by OSHA, compliance remains less than satisfactory. This article argues that the minimization of risk from bloodborne pathogens requires a multilevel or work-systems perspective that considers individual, job/task, and environmental/organizational factors. The available literature on universal precautions suggests the potential of such an approach and provides insight into the limited success of current worker-focused mitigation efforts. In particular, specific opportunities exist to develop and apply engineering controls, to improve the design and organization of jobs and tasks, and to create organizations that facilitate and reinforce safe behavior.

Work-related stress and psychological distress in emergency medical technicians.

Revicki, D. A., & Gershon, R. R.

Publication year

1996

Journal title

Journal of occupational health psychology

Volume

1

Issue

4

Page(s)

391-396
Abstract
Emergency medical technicians (N = 65) participated in a study on work environment characteristics, work-related stress, and psychological distress. Data were collected at baseline and 6 months. Work-related stress was associated with lower work group support and poor supervisory behavior. Work-related stress was strongly related to psychological distress. Changes in work-related stress were significantly related to changes in psychological distress. Findings support the work-related stress, psychological distress model.

The influence of employee, job/task, and organizational factors on adherence to universal precautions among nurses

Dejoy, D. M., Murphy, L. R., & Gershon, R. M.

Publication year

1995

Journal title

International Journal of Industrial Ergonomics

Volume

16

Issue

1

Page(s)

43-55
Abstract
Universal precautions (UP) refer to recommended work practices designed to help prevent occupational exposure to HIV/AIDS and other blood-borne pathogens in health care settings. However, despite widespread dissemination of UP guidelines and subsequent government regulatory action, worker adherence remains less than satisfactory. The present study used hierarchical, multiple regression analysis to examine the relative influence of four sets of factors on worker adherence to UP: demographics, personal characteristics, job/task factors, and organization-level factors. Data were analyzed on a sample of 451 nurses employed at a large U.S. medical center. Consistent with the general hypothesis of the study, job/task and organization-level factors were the best predictors of adherence. Using the results from the study, a heuristic model of the adherence process is proposed that highlights the contributions of job hindrances and organizational safety climate to UP-related behavior. A three-pronged intervention strategy is also presented that emphasizes (1) the availability and accessibility of personal protective devices, (2) the reduction of UP-related job hindrances and barriers, and (3) improvements in safety performance feedback and related communications. Given the preliminary nature of this study, several recommendations for future research are also offered.

Coping Behavior and Risk of Post-Traumatic Stress Disorder among Federal Disaster Responders

Loo, G. T., Dimaggio, C. J., Gershon, R. R., Canton, D. B., Morse, S. S., & Galea, S.

Publication year

2015

Journal title

Disaster Medicine and Public Health Preparedness

Volume

10

Issue

1

Page(s)

108-117
Abstract
Background Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings. Methods Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders. Results In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22). Conclusion This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research.
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