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FOHNEU Federation of Occupational Health Nurses within the European Union - Est.1993 |
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OCCUPATIONAL HEALTH NURSING IN DENMARK Julie Staun and Christine Wolff June 2005 Introduction Denmark is a small country in Scandinavia with a population of around 5,5 million people. The Kingdom of Denmark is the oldest monarchy in the world and the present Queen Margrethe II succeeded her father King Frederik IX to the throne in 1972. The country consists of around 500 hundred islands, including Zealand, which is surrounded by the Baltic Sea and the Kattegat. The capital Copenhagen is situated on this island. The largest peninsula is Jutland on the West of Denmark bordering with Germany to the South and facing the North Sea to the West. In the middle of Zealand and Jutland and connected by bridges over the Little Belt and Great Belt lies the island Fynen the birthplace and home of the fairytale writer Hans Christian Andersen. Other famous Danish writers include the philosopher Soeren Kirkegaard, Karen Blixen and Peter Hoegh. In the field of architecture and design Arne Jacobsen, Jorgen Utzon and Hans Wegner are among many who have achieved international acclaim. The political system is based on the Constitution of 1849, last revised in 1953. In recent years the parliament has comprised up to twelve political parties, and at present there are seven. Traditionally the Social Democratic Party has been the largest, but at the last General Election in 2000 the Liberal Party took over this lead position and together with the Conservatives form the present Government. The Danish Gross National Product (GNP) in 2002 was DKK 337 billion (approxi-mately USD 51 billion), of which 8,5% was allocated to the health sector. Responsibility for the health service is very decentralised. The main principles are as follows: The State is responsible for legislation, supervision and guidelines; county councils are responsible for the hospital service, health insurance and special nursing homes, whereas municipalities are responsible for health care, home nursing, nursing homes and child and school health care. County councils and municipalities have the operational responsibility. The hospital service is placed organisationally under the counties, and the county councils are the responsible authorities. The counties own most of the hospitals. The hospitals in the City of Copenhagen and Frederiksberg municipality, and The State University Hospital (Rigshospitalet) have been merged into the Joint Metropolitan Hospital Service. There are a few private hospitals which have an agreement of usership with the county in which they are located, and a few small private hospitals which operate totally independently of the public hospital service. The Danish Workforce In 2002 the workforce was approximately 2.8 million employed in 99 sectors. The investigations of the health of the workforce carried out by the Danish Institute of Occupational Health for the period 1990-95 has shown no documented improvement. The Institute also coordinates data in a Job Sector Register with Ministry of Health (Hospital admissions) and the Danish National Register of all Statistics. This correlation between diagnoses and job has shown that a "health gap" exists: The health of blue colour workers is deteriorating while the health of white colour workers is improving. Occupational Health and Safety Legislation A new national Working Environment Act implemented in 1977 consolidated all previous legislation, and covered the entire labour market. Agreement was based on the principles of consensus and tri-partied (the governmental authority, the employers and the employees). The Act is a framework act designed to enable the enterprises to solve health and safety problems at work themselves. The employer is responsible for implementation of the statutory requirements and the act is aimed at all fields of activity. This framework Act is still in force and periodically revised to adjust to the develop-ment of the labour market. Occupational Health Service (OHS) Legal requirement to have access to an OHS has been established stage-wise since 1980 based on risk assessment, especially in the areas of occupational injuries and diseases. Emphasis is placed on preventive activities. The majority of the professio-nals are technicians and ergo/physiotherapists, while health care personnel such as Occupational Physicians and Occupational Health Nurses are represented on a much smaller scale. Only physicians and nurses have specialised training within the field. In 2003 the government has put forward a proposal to reorganise the entire Work Environment system. This includes radical changes in the social party agreements concerning the OH Services. The present Occupational Health system will be liberalised. The mandatory requirement for companies to have access to an OHS will be abolished if the enterprise can obtain a certificate OHSAS 18001. The Labour Inspectorate will be responsible for categorising all enterprises and assessing the need for professional advisors. Health Care Needs There are many factors contributing to the current changes in working life including:
Training and Education of OH Nurses In 1956 the first 2-week course in Industrial Nursing was established by a small group of around 7 nurses. The programme included work-related diseases, health promotion and education and administration of the Danish Social Act. From 1966 OH nurses began to participate in other educational arrangements and congresses and the group arranged annual meetings for members. During the years there have been various courses on the initiative of both the Danish Labour Inspection Service and the Danish Nurses. In 1987 a post graduate education became a reality when the Danish Nurses Organisation organised a 3-week course. A new area in the attempts began in 1988, when a group of Danish OH nurses met the late Ruth Alston at a course arranged by the Nordic Institute for Advanced Occupational Health (NIVA) in Hanasaari, Finland. As many will recall, Ruth Alston was Education Officer at the English National Board of Education for Nursing, Midwifery and Health Visiting with specialist responsibility for occupational health nursing. In the years to follow she came to Denmark several times, teaching on workshop courses. On these occasions we discussed our situation and the need for specialisation. She was a great inspiration and supported us in our development of a new strategy for our attempts. In the meantime important issues had developed in favour of our efforts. New legislation on the quality of OH services had a much stronger focus on the demands for education of the professionals than previously. In the autumn of 1998 the first course was launched. The work was carried out by members of the previous working group and the Education Department of the Danish Nurses Organisation. Post-graduate Education to Occupational Health Nurses in Denmark The education is based on the Core Curriculum for occupational health nursing in Europe developed in 1997 by the Federation of Occupational Health Nurses within the EU (FOHNEU). The education department at the Danish Nurses Organisation promotes and organises the course as a joint venture project between Denmark and The University of Sheffield UK. The University sends lecturers to teach on the course and carrys out audits on the quality of the work. Through the university merit system, credits are given allowing access to further academic qualifications. The Target Group Nurses who are newly employed in an occupational health service (OHS) or nurses who have an interest in working within the area of OHS. The Criteria for Eligibility Four years post registration experience including work experience of teaching and/or project management. The Diploma of Education qualification from the Danish College of Nursing is an advantage. The Aim That the participants gain a professional knowledge within the areas of the working environment in order to participate in the prevention of occupational diseases and accidents and to promote health at the workplace. Duration The syllabus consists of a five modules residential course for 23 days = 232 hours. Homework between the modules for preparing the individual assignments: 120 hours. In total 352 hours within a year. The University of Sheffield, UK, participates with an experienced OHN lecturer in the first module, and audits the work at the end of module 5.
Module 1 (5 days)
Module 2 and 3 (10 days)
Module 4 (5 days)
Module 5 (3 days)
The Hanasaari Conceptual Model for Occupational Health Nursing
It was perhaps a breakthrough in 1988 when NIVA (The Nordic Institute for Ad-vanced Training in Occupational Health) and Kitta Rossi from the Institute of Occu-pational Health in Finland arranged an International Workshop at the Finnish town of Hanasaari. Under the unique skills of Ruth Alston U.K .a dynamic conceptual model emerged. Another workshop arranged by the same group took place in Aspenas, Sweden, in 1992 and included delegates from the then newly independent Baltic States, Iceland, Switzerland and Africa. Description of the Elements of the Model The Total Environment Concept The general environment system, which incorporates health and safety aspects, is represented by the large outer circle-a global concept. Within the outer circle the influences, which have global effects, which in turn may affect health, are represented by economic, political, social, ecological and organisational factors. These are inte-resting areas for practice and education innovation in occupational health nursing. Man Work and Health Concept is represented by the man, work and health triangle and operates within the total environment, aspects of the total environment having a significant (although indirect) effect on workplace health. Political and social polices for example will either expand or contract the development of occupational health. Organisational cultures and strategies may exert a stronger more direct influence on the man, work, and health triangle Occupational Health Nursing is presented in the centre of the model. Flexibility was interpreted as being proactive rather than reactive. Flexibility is represented by a curving circle of arrows, which exerts influence and develops the concepts identified, ultimately improving the health of people at work and affecting the health of commu-nities outside the workplace, in the total environment. The outward proactive approach may influence politically, socially, economically and ecologically, particu-larly if OH Nurses raise the level of awareness of their real contribution to health issues in a wider environment.
The major tasks are shown n the above figure. Focus is on the primary prevention and health promotion. Emphasis is on health education and guidance. Due to the Danish National Health Service system, only specific medical examina-tions and screening programmes regulated by legislation take place at the work place. Examples of these are employees exposed to lead and night shift workers. The Danish Occupational Health Nurses Association In 1939 the first Occupational Health Nurse in Denmark, Agnes Henriksen, dis-covered the need for health promotion and prevention among employees at the Danish enterprises. In 1950 there were eight Danish Industrial Nurses. On the initiative of Agnes Henriksen the group gathered at her home to discuss education and exchange ideas. This laid the foundation of the Danish OH Nurses Association founded in 1954. The Association was and continues to be affiliated to the Danish Nurses Organisation and has currently 90 members. The objectives of the Danish OHN Association are
Nordic Co-operation of Occupational Health Nurses The Finnish Association of Occupational Health Nurses took the initiative to establish a formalised Nordic cooperation, and NORDSAM was founded in Sweden in 1976. The purpose of NORDSAM is to encourage the exchange of ideas, knowledge and professional experience to develop OH nursing and education in the Nordic Countries. Norway, Finland, Sweden, Denmark and Iceland are represented and the Faeroe Islands has also recently joined the Association. The major activities of NORDSAM are the participation in the annual seminars of the other countries associations and to exchange journals. This way important news and knowledge is circulated to a much broader target-group. The Federation of Occupational Health Nurses within the European Union (FOHNEU) The Federation of OH Nurses within the European Union is an organisation representing OH Nurses working in industry, commerce, national health and safety executive, clinics of occupational medicine, governmental advisory boards, as mana-gers as teachers and many other areas within the field. It was formed in London in 1993 and held its first meting in Strasbourg the same year. It has an estimated 45,000 members in the 15 member states, representing the largest single group within the field. With the EU expansion in 2004 more members are expected to join the Federation. Collective membership is open to all OHN organisations or OHN Groups within the European Union. As a member state Denmark is an active participant in FOHNEU. Delegates from Switzerland and Norway attend meetings in the capacity of observers. From a nursing perspective the aims of FOHNEU are: • to contribute to the total health, safety and well being of the European working population. • to raise the profile of Occupational Health Nursing within the European Union. • to promote European training, education and standards for professional qualifica-tions. • to encourage research into areas of occupational health practice, education management and service with publication of the results In 1996 FOHNEU developed a core curriculum for occupational health nurses. The project received funding from EU. The FOHNEU Education Group revised the document in 2002. The curriculum is intended as a European baseline covering the development of occupational health nurse practice. There is an emphasis on flexibility and the need for national and local interpretation. Although being primarily con-structed for nurses within the European Union, the document can be used as a tool for other nations when developing an educational working program for Occupational Health Nurses. Conclusions The Danish Occupational Health Nurses will continue to influence and promote change to improve conditions at the workplace. They will also continue to play an increasing significant role in the prevention of illness, old-age disabilities and accidents by establishing and implementing health education programs and health promotion strategies for the workforce. The story of Agnes Henriksen (interview fra "Tidens Kvinder") In 1951 the most estimated women´s magazine of the times brought an article based on an interview with Agnes Henriksen. The article was illustrated with photographs from her office and the factory. In the interview Ms. Henriksen discussed her daily work and how the job had been created. The concept of a factory nurse, as they were called, came from England, USA and the other Scandinavian countries. Unfortunately Denmark was not very progressive and only 6 other companies had employed a factory nurse. In the beginning she spent most of her time treating small injuries. Later she developed her work function to include what today is called the psycho-social area. Counselling soon became a central element covering not only the working life but also social issues outside the factory. Counselling Another important area was the hygiene, both the personal and industrial hygiene. As TB was a severe health threat at the time, high standards were necessary, espe-cially at a factory producing chocolate and confectionery. Agnes Henriksen also visited the workers with long sickness, providing her with knowledge of family and social situations. The Company provided a car at her dis-position to carry out the visits.
Ready for home visits Accidents and injuries statistics were monitored and results used as criteria for pre-ventive strategies. In the interview focus is on the importence of professional nur-sing care with special emphasis on mental health, two key areas of OH nursing still prevalent in 2003. References - Nordic Medical Statistical Committee (2000), Health Statistics in the Nordic Countries - Krogsrud N., Pryds K., Staun J. & Wolff C. (1996), Education and training of Occupational Health Nurses. Scientific Committee of Occupational Health Nurses, report no.9, ICOH - Staun J., Wolff C. (2000), The Efforts to Establish a Post-graduate Education for Occupational Health Nurses, FOHNEU Journal - Alston R. (1994), Concepts and Theories and their application to Occupational Health. University of New England Press - FOHNEU (2003), The FOHNEU Core Curriculum. Helsinki Finland - WHO (2001), The role of the Occupational Health Nurse in Workplace Health. WHO Regional Office for Europe - Tüchsen F. Hannerz H. Bach E. (1998), Sundhedskløften belyst ved sygdomsvariation i erhvervs-grupper, Arbejdsmiljøinstituttet Copenhagen, Denmark About the Authors Christine Wolff RN.SD.OHN - Chief Nursing Officer, Clinic of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark - Co-ordinator The University of Sheffield, UK/Danish OHN education project Julie Staun, RN.CRNA.OHN - Manager, Occupational Health Service, Haldor Topsøe A/S, Denmark - Chairman of the Danish OHN Association - President of the Federation of Occupational Health Nurses within the European Union (FOHNEU) - Co ordinator The University of Sheffield UK/Danish OHN education project Visit our website: www.ditarbejdsmiljo.dk
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