A nurse-led occupational health promotion program for farmers

Indrakshi BASU,Rajadurai PREMAVATHY,Smritikana MANI

1Department of Nursing,Rani Meyyammai College of Nursing,Annamalai University,Chidambaram,Tamil Nadu,India;2Officer on Special Duty,Nursing Branch,Government of West Bengal,West Bengal,India

ABSTRACT Agrarian occupational health is a neglected primary health-care service in India.A nurse-led health promotion program is planned based on a Conceptual Model for the Occupational Health Nurse Specialist prepared by Ms.Janice Dees (1984) inspired from Orem’s self-care theory.The interventions included are range of motion exercise,progressive muscle relaxation technique,foot and palm massage,and literacy on safety practices.The wellness of field farmers is expected by following this program plan.

Keywords: Field farmers,health problems,health promotion program,nurse,occupational health

INTRODUCTION

Agriculture is a dangerous occupation engaging the world’s largest labor force containing half of the total world labor force.Only 15% of workers have access to basic occupational health services worldwide.[1]Moreover,farmers are highly exposed to biological,chemical,physiological,and environmental hazards.Primary health-care approaches multidirectionally and occupational health is a scope for intervening primary health care.[2]Farmers can sustain life by taking home remedies as well as breathing fresh air but the risk associated with chemicals,heat,musculoskeletal injuries,noise,poisonous insects,reptiles,grain bins,and silos still prevail.[3]Agriculture is one of the most hazardous occupations worldwide.In several countries,the fatal accident rate in agriculture is double the average for all other industries.[1]According to international labour organization(ILO) estimates,workers suffer 250 million accidents every year.Out of a total of 335,000 fatal workplace accidents worldwide,there are some 170,000 deaths among agricultural workers.[4]The intensive use of machinery,pesticides,and other agrochemicals has raised the risks.Machinery such as tractors and harvesters has the highest frequency and fatality rates of injury.In developing countries,the accident rate in agriculture is increasing.Such accidents occur mainly among migrants and daily workers,as well as women and children whose numbers in waged labor are constantly rising.[5]Most prevalent occupational diseases need attention for prevention and health promotion.In musculoskeletal problems,muscle,tendons,ligaments,joints,and supporting cartilage become affected due to static effort and highly repetitive work.The common symptoms are numbness,carpal tunnel syndrome,and pain.[6]Occupational dust exposure leads to lung disease and exposure to pesticides such as pentachlorophenol,formaldehyde,chromium,and arsenic exert a full body effect.Skin disorders such as contact dermatitis,fungal infections,and irritant-based allergy are very common among farmers.Long working hours,financial burden,low profit,high debt,and loans lead to occupational stress,hypertension,and diabetes mellitus so easily with other noncommunicable diseases.Anemia is also common among farmers due to a lack of personal protection and bite of insects and scorpions and high rate of worm infestation.The present research study was based on the rationale to frame the nursing interventions directed to the wellness of farmers.This study is significant in terms of its discussion and supportive knowledge for the interventions.Such interventions are generally implacable for solving various physical and psychological issues in general but this study pursues to highlight their application in the prevention and management of occupational health problems among farmers.

CONCEPTUAL FRAMEWORK

A conceptual framework based on Conceptual Model for the Occupational Health Nurse Specialist prepared by Ms.Janice Dees (1984)[7]inspired from Orem’s self-care theory was followed to prepare this health promotion program for the prevention and management of occupational health problems among field farmers [Figure 1].

Figure 1: Conceptual framework based on Conceptual Model for the Occupational Health Nurse Specialist prepared by Ms.Janice Dees (1984)

This conceptual framework shows that concepts of safety,industrial hygiene,occupational medicine,and management of occupational health issues are basic of any healthy occupation.Occupational health nursing is a specialized activity for guiding occupational health and safety.Healthy occupation can be run through components such as

i. Environment monitoring: environment always harbors some effective and some harmful factors that need control and continuous identification to avoid any deterioration and hassle among the workers.The farmers confront the hazards from nature,machinery,agrochemicals,livestock,etc.

ii.Continuous health surveillance: Health surveillance is needed for assessing and recording health status of individual farmers that may help to plan strategies for health promotion and maintenance to reach optimal physical,psychological,and social functioning by the farmers.

iii.Generating capacity: For early detection of health hazards and following preventive practices targeted to musculoskeletal disorders,skin disease,stress and anxiety due to uncertainty,noncommunicable diseases,and farmers are in need of capacity for practicing occupational health by the support of primary health-care services.

iv.Health and safety education is always required for ergonomics to adopt the advancements.

Table 1: List of nursing interventions for health promotion of field farmers

v.Continuous research on safety and health is basic of any professional growth.In this module,the physical health problem and mental health issues will be assessed,and based on the sound issues,a need-based health promotion program for farmers was planned.After the intervention,reassessment of health status and practices of safety measures are in plan.

The course of activities occupational health nurses is to interact with individual workers,their family,community,and organization which help them for being more equipped with knowledge education and positive attitude.If individual farmers are able to cope with occupational health nursing activities they will be able to participate more in self-care activities such as care of body posture,prevention of musculoskeletal pain and discomfort,care of skin,and protection through practicing personal safety and safety from occupational hazards.On the other hand,if farmers are not able to cope with safety intervention and practices there will be decreased participation in self-care activities;their practice and knowledge for safety will have little change over time and in long term,there will be a low level of wellness,increased absenteeism,decreased job satisfaction,decreased productivity,increased accidents.Overall useful occupational health nursing lead to a high level of wellness and safer work environment,longer and healthier life span with increased job satisfaction,increased productivity among the farmers there will be less weight of the job and shift into any other occupations.

COMPONENTS OF HEALTH PROMOTION PROGRAM

Health promotion program enables individual and communities to control their own health.The nursing procedures for this health promotion program is shown in Table 1.[8]

DISCUSSION

Patilet al.[9]performed a cross-sectional analytical study on randomly selected sample of 1150 farmers.Musculoskeletal disorders among farmers were found in body parts such as knee (34%),lower back (33%),neck (24.7%),upper back (24.5%),shoulder (23.7%),hip/thigh (18.5%) feet (17.5%),wrist/hand (9.7%),and elbow (6.2%).These musculoskeletal disorders were prevalent in respect to postural activities such as weeding,squatting,picking crops,weeding with bending,carrying seeds,riding,planting seeds,spading,sprinkling water,and carrying crops.Musculoskeletal disorders were significantly common among farmers above 50 years of age and all three lower limb joints were significantly high among persons with underweight people (χ2=20.7);tobacco addiction (χ2=53.65) at aPof 0.00.79.1% of farmers required medical treatment;78.2% and 13.2% of farmers,respectively,took medication for pain relief by consulting a doctor and self.

Lugeret al.[10]presented very low-quality evidence supporting that work break frequencies may have a positive effect on productivity and work performance but he reconsidered possible effect on musculoskeletal outcome in combination with ergonomic training or counseling.Mertens[11]conducted a systematic review and meta-analysis that discussed the highlights that exercise therapy is effective in improving range of motion function reducing pain.The range of motion movements helps to keep joints flexible,reduce pain,and improve balance and strength.The work-related musculoskeletal disorders are world wild public health problem leading to temporary and permanent disability.Susantoet al.[12]conducted a randomized controlled trial to evaluate the effects of progressive muscle relaxation and stretching exercises for managing blood pressure over 3 months period among rural agriculture workers.It was concluded that after a 3-month follow-up,progressive muscle relaxation and stretching exercises were proved as effective occupational health nursing intervention as systolic blood pressure ad diastolic blood pressure remained at baseline for the control group;whereas in the experimental group,x value (P＜ 0.001) were respectively for systolic blood pressure ad diastolic blood pressure 43.2 and 34.7.So the difference was statistically significant.Stier-Jarmeret al.[13]focused on the rise of farmers’ mental health conditions due to increased stress and burnout followed by occupation and the farmers participated in a 12-day stress prevention program called Im Moor zum inneren Gleichgewicht which incorporated one or more of the following common health resort medicine techniques:Relaxation,physical exercise,and Balneotherapy.The results were positive and 93.4% of participants provided feedback and felt the stress prevention program provided them to make distance from everyday life stressors and increased ways to find peace with stressors.

Improvement of blood circulation,reduction of congestion,protection from germs and maintaining the warmth of skin are benefits of skin massage of feet and palms.[14]

Kimet al.[15]conducted the study to explore the effectiveness of participatory action-oriented training to promote farmer’s health and reducing agricultural work-related injuries.The sample for this study was 595 farmers in eight rural villages in South Korea.The 1-day course participatory training was administered to 36.5% of farmers and included an action checklist,a good example presentation,and group discussion.The follow-up visit to participants’ houses and farms was performed after 1-3 months for 10 times.In major findings,these were observed that 61.5% of action plans (respectively short-term and long-term plans were 72.2% and 41.3%) were completely implemented.Followed by the training,the proportion of current smokers was reduced from 29.8% to 25.3%;pesticide intoxication was reduced from 16.1% to 4.8% and the agricultural injury rate was unchanged in both groups.Musculoskeletal problems in the shoulder,hand,and lower back were reduced among participants who got training.This study reported significant beneficial effects of participatory training in the agriculture sector in Korea.

CONCLUSION

Occupational health nursing is a budding issue globally to date.This content of the nurse-led health promotion program is prepared based on nursing research evidence.A change and effectiveness are expected for occupational health promotion and management of diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.