Peace and Not So Quiet on the FarmTamara Braley, BSN, RN, Paul Kerschinske, BSN, RN, Debra Braun, BSN, RN, Danielle Holloway, BSN, RN, Theresa Petersen, BSN, RN, Michele Brown, BSN, RN

UNMC College of Nursing, NRSG809 Health Promotion

Background

a

Noise-induced hearing loss (NIHL) is the second most prevailing self-reported occupational illness or injury in the United States (Fernandez, Bartholomew, Alterman, 2009). It is believed that approximately half of the estimated 12 million Americans who have some form of hearing impairment live in rural areas, and of the 2 percent of Americans who are part of a ranch or farm family, roughly 440,000 of them have some form of hearing impairment.  Noise-induced hearing damage begins at an early age on the farm, and over 50 percent of teenagers who live or work on a farm show signs of early noise-induced hearing loss (McCullagh, Lusk, & Ronis, 2010). Many farmers are exposed to potentially hazardous noise levels that come from operating tractors, grain dryers, and chain saws while farming. It is estimated that 10 percent of U.S. farm workers are exposed to average daily noise levels above 85 decibels. NIHL in the farming population is an  irreversible and  progressive condition that can negatively affect a person’s quality of life. Quality of life issues in the farming population include: increased safety risks, impaired communication, and difficulties with social and family interactions. Even though this condition is preventable with the use of hearing protection devices (HPDs), the frequency of using hearing protection devices in the working agricultural community is low (McCullagh, Lusk, and Ronis, 2002). One of the occupational safety and health objectives of  Healthy People 2020 (OSH-10) is to reduce new cases of work-related noise-induced hearing loss by 10 percent. Based on a baseline of 2.2 new cases of work-related, noise-induced hearing loss per 10,000 workers that occurred in 2008, the target objective is to reduce that number to 2.0 new cases of work-related, noise-induced hearing loss per 10,000 workers.

TB, PK, DB, DH, TP, MB

Recommendations, cont.Part II: Treatment

• Participants will be educated on early indicators of NIHL such as 1) ringing in the ears, 2) a sensation of fullness in the ears, and 3) some reduction in the ability to understand conversation.

• Participants will be educated about the effects of noise on hearing and will be provided with examples of common farm sounds and at what decibel each sounds is. Damage to hearing is seen with long-term exposure to sounds above 85 dba as well as brief exposure to very loud noises.

• Participants will be shown the different types of HPDs and taught the proper application of each of them.

• Participants will be taught that HPDs are to be worn on all noisy jobs and they should be protected the minute activity begins.

• Provide participants will be given educational brochures about hearing loss prevention and hearing conservation obtained from NIOSH/CDC.

• Participants will be educated on the common barriers to HPD use and ways to overcome those barriers:

• Fear of not hearing when equipment malfunctions - many farmers report they rely on other senses, such as vision, to monitor equipment and are more aware of changes in vibration that may indicate equipment malfunction.

• Fears of difficulties in communicating with coworkers - many farmers report an enhanced ability to hear in-cab radios with HPDs in use.

• HPDs can be purchased in bulk which reduces cost and facilitates wide distribution around the farm.

• For easier access, HPDs can be stored in a location where they are frequently needed which reduces interruption in farm work to retrieve HPDs from a remote location. HPDs can also be carried with farmers, such as in their pocket, to be used intermittently as exposure to noise is not always continuous.

• HPDs can be stored in an area of high visibility as a reminder to use and restock.

Part III: Evaluation of Therapeutic Effectiveness• Participants will verbalize an understanding of the early indicators of NIHL and sounds on the farm that constitute dangerous decibel levels.

• Participants will be able to verbalize an understanding of where loud noise exposures exist on their farms and potential related engineering controls.

• Participants will demonstrate how to properly apply HPDs.• Self-reported health histories will be evaluated periodically to assess if farmers are wearing HPDs.

• Participants to follow up with annual hearing tests to assess if NIHL is worsening or stable.

Evidence Supporting Recommendations• See Reference List

TB, PK, DB,TP, MB

A health outreach program that screens for hearing impairment to promote hearing conservation amongst Nebraska farm workers in Madison county.

Scope• Disease/Condition: Noise Induced Hearing Loss• Guideline Category: Evaluation, Management, Screening, Treatment• Clinical specialty: Family Practice, Nursing, Preventive Medicine• Intended Users/Stakeholders: Advanced Practice Nurses, Nurses,

Audiologists, County Extension Agencies, Local Implement Dealers• Guideline Objective: To provide a guideline for a hearing impairment

screening, assessment, intervention, and education program that APNs can utilize as a resource for patients exposed to occupational noise hazards.

• Target Population: All farm workers and farm families from Northeast Nebraska, specifically Madison county. Hearing screening provided at the county fair.

• Interventions and Practices Considered: • With the county extension agency, provide screening and assessment

of all farm workers and families for hearing impairment including a written assessment questionnaire and audiometric testing based on results.

• Evaluate screening programs effectiveness on preventing hearing loss in the farming population.

• Major Outcomes Considered:• Identify individuals with NIHL and refer to audiologist.• Improved understanding of the risk of NIHL and types of noises that

cause it.• Improved understanding of the effects of NIHL.• Improved understanding of types of HPDs and how to use them.• Increased use of HPDs within this target population

Clinical Guideline Cont’d

• The Health Belief Model focuses on the reasons some take action to prevent illness while others do not. Action will be taken if two conditions are present: (1) there is a perceived threat to personal health and (2) benefits of taking action outweigh the barriers. Personal susceptibility and the seriousness of the illness produce the threat of the specific illness which motivates a person to take action to prevent the illness. Perceived benefits and barriers to action also affect at persons actions. Perceived barriers have been shown to have the most influence in explaining or predicting preventative behaviors.

• As a motivating factor, we will screen Nebraska farm workers and evaluate hearing loss risk. It is our intention that the threat of hearing loss will be motivating in the use of hearing protection devices (HPDs). By partnering with local sponsors and providing free HPDs, we will attempt to eliminate the barrier of not having HPDs readily available.

Clinical Guideline

Health Belief Model RecommendationsPart I: Screening and Assessment

• Noise-induced hearing loss (NIHL) will be screened in farmers, family member(s), and employee(s) using the Hearing Health Quick Test.

• Based on the results of the Hearing Health Quick Test, participants with scores of 3 or more indicate that he or she may have early NIHL. A score of 6 or more warrants further evaluation by an audiologist or referral to a Public Health office.

• Based upon initial screening results and on-the-job risk, an audiometric self-test for hearing loss will be conducted. This self-test will be conducted in a quiet environment (i.e. enclosed van or building).

• Every participant will be dispensed hearing protection devices (HPDs) such as ear plugs.

TB, PK, DB, TP, MB