Occupational Health Nursing Practice: Clinical Care and Health Assessment
Exposure history comes first
Every occupational health encounter starts with a targeted work history: current and past job titles, specific tasks, agents handled, duration and frequency of exposure, ventilation, PPE use, and the latency between exposure and symptom onset. The same complaint means different things in a welder, a call-center worker, and a farm laborer. Without the exposure history, the assessment is generic and the work-relatedness question cannot be answered.
Screening, surveillance, diagnosis
Keep three terms separate. Screening detects disease early in asymptomatic workers (audiometry, spirometry, vision testing, blood lead, TB testing). Surveillance is the ongoing, systematic collection and use of that data across a workforce. Neither is a diagnosis. Nurses commonly perform screening and refer; they do not label disease.
Target-organ assessment
Direct the physical assessment to likely targets: solvents to CNS and liver, lead to hematologic and neurologic systems, noise to hearing, airborne vapors to lungs, repetitive motion to the upper extremities. Always ask whether hobbies, second jobs, or home exposures could explain the findings.
Traps
- Attributing every finding to work, or conversely dismissing work as a contributor.
- Confusing an OSHA-mandated surveillance exam with an employer-requested fitness-for-duty evaluation.
- Releasing diagnoses or raw records to a supervisor. Employers receive work-restriction and fitness conclusions, not medical detail; medical records stay in a confidential file separate from personnel records.
Rule of thumb
Exposure before diagnosis. If it is not in the exposure history, it is not in the note. Worked example: a 44-year-old assembly worker reports numbness in thumb, index, and middle fingers. Document work tasks, vibration, force, and posture; note non-occupational contributors; refer for evaluation; recommend an ergonomic review - without diagnosing carpal tunnel syndrome yourself.