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Tradition of Excellence



Agricultural Health Nursing AGRONURSING Tantut Susanto, M.Kep., Ns. Sp.Kep.Kom., Ph.D Departemen Keperawatan Komunitas, Keluarga, dan Gerontik Fakultas Keperawatan Universitas Jember Seminar dan Bedah Buku Agronursing di Kampus D3 Keperawatan Universitas Jember di Lumajang, 15 September 2019



Content • Literature review agricultural health nursing • Concept analysis of “agronursing” • Application of agronursing research



Tradition of Excellence



INDONESIA KAYA



Tradition of Excellence



Potensi Alam Indonesia



Tradition of Excellence



• Berada di jalur khatulistiwa, Nusantara diberkahi limpahan sinar matahari dan curah hujan yang tinggi. • Perbedaan suhu yang tidak terlalu ekstrim di antara dua musim memudahkan segala jenis tanaman dapat tumbuh subur. • Ditambah lagi, abu gunung api yang kerap menyembur menjamin pasokan hara tanah tetap terjaga. • Berbagai tanaman komersial seperti kopi, teh, kakao, karet, tembakau, kelapa sawit, serta tanaman pangan seperti padi, jagung, ubi-ubian, dan buah-buahan tumbuh subur di negeri laksana zamrud khatulistiwa ini. BPS (2013). Potensi Pertanian Indonesia: Analisis Hasil Pencacahan Lengkap Sensus Pertanian 2013



Agricultural Area Pertanian Perkebunan Peternakan Perikanan



Tradition of Excellence



Farming



Tradition of Excellence



Indonesia Farming



Tradition of Excellence



Profil Rumah Tangga Pertanian



Tradition of Excellence



Hasil Survei Pertanian Sensus 2018



Tradition of Excellence



Tradition of Excellence



Tradition of Excellence



Tradition of Excellence



Geografi Pertanian: Revolusi Pertanian. https://www.google.com/search?q=kesehatan+petani+indonesia+ppt&safe=strict&client=safari&channel=mac_bm&sxsrf=ACYBGNRyCNF3ouX9s5aRuqYqs2c7k3pRAA:156816850961 9&source=lnms&sa=X&ved=0ahUKEwj6z9r32sfkAhWVb30KHdCIDr4Q_AUIDCgA&biw=1440&bih=837&dpr=1#



Penggunaan Pupuk Kimia



Mikro organisme / Biota tanah Teracuni



Tradition of Excellence



Tanah Mengeras Kesuburan tanah menurun



Tanah Menjadi Kering



Produktifitas menurun Keseimbangan alam terganggu Kerusakan lingkungan Geografi Pertanian: Revolusi Pertanian. https://www.google.com/search?q=kesehatan+petani+indonesia+ppt&safe=strict&client=safari&channel=mac_bm&sxsrf=ACYBGNRyCNF3ouX9s5aRuqYqs2c7k3pRAA:156816850961 9&source=lnms&sa=X&ved=0ahUKEwj6z9r32sfkAhWVb30KHdCIDr4Q_AUIDCgA&biw=1440&bih=837&dpr=1#



Kenapa petani perlu diberikan layanan keperawatan



Tradition of Excellence



Risk Assessment



Biol ogig al Psycholog ical



Social



Nursing processes



Econ omic Life even t



Agricultur al Health Nursing



Theory



Paradigm



Curriculum



Competenci es



Cultural Roles



Agricultural Health Nursing



PHN



OHN



Tradition of Excellence



AHN



Agricultural health nursing



Tradition of Excellence



• The agricultural health nurse role draws from both occupational health nursing and public health nursing (Randolph, 1993). • Thus , the job functions and competencies identified by current agricultural health nurses should be consistent with professional guidelines of these two nurse specialties.



Agricultural Health: A New Field of Occupational Health Nursing Tradition of Excellence



Agriculture remains one of the most dangerous industries in America. To serve this worker population, agricultural health is emerging as a new nursing specialty in which nurses can use their vision to establish new areas of practice. Nurses who are a member of the farming audience can be effective agents of change because they know the audience in a personal way. To establish a new agricultural nursing specialty, one must overcome obstacles including uncertain funding, a rapidly changing work environment, worker preference for independent decision making, and no existing standards to guide the process. Using the early adopters of new ideas in a community Fleming MJ. AAOHNJOURNAL. 2004;52(9): 391-396



17 Public Health Nursing Interventions 1. 2. 3. 4. 5. 6. 7. 8.



Advocacy. Case management. Coalition building. Collaboration. Community organizing. Consultation. Counseling. Delegated medical treatment and observations. 9. Disease investigation. 10. Health teaching.



11. Outreach or case finding. 12. Policy development. 13. Provider education. 14. Referral and follow up. 15. Screening. 16. Social marketing. 17. Surveillance.



Keller (1998)



Tradition of Excellence



57 of Competencies PHN were considered essential to nursing leadership in public health (Misener, 1997) Tradition of Excellence • Political competencies. • Business acumen. • Program leadership. • Management capabilities.



Promotional information (AgriSafe Occupational Health, 1997)



Tradition of Excellence



• Occupational health physical examinations and screenings. • Health education and health promotion programs. • Personal protective equipment education, fit testing, and sales. • On site farm health hazard and environmental quality testing. • Comprehensive injury and disease prevention programs. • Farm safety day camps. • Mobile clinics. • Referral services.



Six task/activity statements essential to the certified occupational health nurse role (Burgel, 1997) • Document provision of care in the employee health record. • Use a computer. • Provide treatment of work related injuries and illnesses. • Develop a system of employee health records. • Perform case management activities. • Manage a workers' compensation program.



Tradition of Excellence



Farming is multiple risks in all the categories of hazards Tradition of Excellence Chemical-fertilizer, insecticides. Biological/infectious-fungus, molds, and infections from animals and soils. Physical-heat, cold, noise, and sun exposure.



Environmental/mechanical-slippery floors, unsafe equipment. Psychosocial hazards-stress associated with weather and crop failures. Lusk SL. 1998. AAOHN JOURNAL;46(90): 465-468



Agricultural Occupational Health Nursing Training Program Curriculum Tradition of Excellence 1. 2. 3.



An overview of rural health and agrimedicine . An overview of occupational health nursing and its application to agriculture. Education and demonstration of general and certain agriculture specific assessment and physical examination skills. 4. Methods in providing individual health promotion and education to farm family members. 5. Agricultural respiratory diseases (includes certification in spirometry testing). 6. Agricultural auditory alterations (includes certification as an occupational hearing conservationist). 7. Agricultural dermatological diseases. 8. Agricultural musculoskeletal diseases . 9. General health issues affecting numerous systems including toxicology, cancer, and zoonoses. 10. Agricultural injuries and safety training. 11. Agricultural illness and injury control and prevention. 12. Optional curriculum in developing and implementing a plan for an agricultural health and safety clinic and an overview of marketing strategies.



Job Functions of Agricultural Health Nurses (n - 24) Ranked by Mean Task Index, 1998 Tradition of Excellence 1. 2. 3. 4. 5. 6. 7. 8. 9.



Serve as a liaison between the agricultural, health and medical, and nonfarm communities. Promote agricultural health and safety issues to agricultural and nonagricultural communities through the media, newsletters, and newspapers. Implement educational course for various groups (e.g., health care professionals, agricultural workers, farm families, school aged children, farm agribusiness persons, commodity groups). Conduct follow up assessment of injury, illness, or disease occurring as a result of an agricultural exposure (may include hospital chart review, conducting interviews with those affected or their families). Function as a resource for information to victims of agricultural injury and illness and their families. Function as a source of support for victims of agricultural injury and illness and their families. Collaborate with other agencies to provide health services currently unavailable to agricultural populations. Surveillance of agricultural injuries, illness, and diseases. Conduct research to determine effectiveness of agricultural health and safety interventions.



Job Functions of Agricultural Health Nurses (n - 24) Ranked Tradition of Excellence by Mean Task Index, 1998 10. 11. 12. 13. 14. 15. 16. 17.



Recommend or distribute appropriate personal protective equipment. Serve on appropriate professional or community boards, committees, and councils. Summarize findings or results of data gathering or research. Serve as a health counselor. Develop agricultural health and safety educational materials, curriculum, or programs. Analyze data to describe issues associated with agricultural related diseases or injuries. Act as a agricultural safety consultant or resource person. Serve as a representative for agricultural health and safety at agricultural meetings or events. 18. Coordinate or perform health screening clinics or services.



Job Functions of Agricultural Health Nurses (n - 24) Ranked by Tradition of Excellence Mean Task Index, 1998 19. Evaluate agricultural health and safety educational materials, curriculum, and programs. 20. Prepare written reports relative to agricultural health and safety activities. 21. Obtain health histories. 22. Obtain occupational health histories. 23. Prepare or monitor budget for agricultural health and safety program. 24. Complete grant applications or funding proposals to secure funds for agriculture related research, services, or programs. 25. Conduct audiometric testing. 26. Perform physical health examinations. 27. Administer immunizations.



Job Functions of Agricultural Health Nurses (n - 24) Ranked by Mean Task Index, 1998 Tradition of Excellence 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39.



Publish written material in professional publications. Conduct pulmonary function testing. Serve as an advocate for agricultural health and safety issues through the legislative process. Make appropriate health service referrals. Manage staff of agricultural health and safety programs. Perform occupational health examinations or assessment. Collect information to determine if Worker Protection Standards (Environmental Protection Agency, 1992) have been taught to agricultural workers and migrant workers. Perform blood draws to test cholinesterase levels. Assess communicable diseases and follow up or perform mandatory disease reporting. Provide primary care to farmers, farm workers, and agricultural workers and their families. Provide emergency and trauma care services to victims of farm injury or illness. Provide or assist in providing appropriate surgical intervention to victims of farm injury



Competencies of Agricultural Health Nurses (n =24) Ranked in Order of Importance, 1998 Tradition of Excellence 1. 2. 3. 4. 5. 6. 7. 8. 9.



Interpersonal communication skills. Knowledge of injury prevention principles and measures. Ability to recognize hazards that might create unsafe working/living environment. Written communication skills. Strong sense of self. Knowledge of safety principles and how they relate to agricultural environments. Flexibility and ability to perform multiple tasks or skills simultaneously. Knowledge of agriculture related illnesses, injuries, and diseases. Knowledge of and appropriate use of community resources to complement agricultural health programs. 10. Networking skills.



Competencies of Agricultural Health Nurses (n =24) Ranked in Tradition of Excellence Order of Importance, 1998 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.



Leadership skills. Knowledge of epidemiological principles. Public speaking and presentation skills. Knowledge gained from courses addressing issues affecting health, safety, and well being of agricultural populations. Knowledge of appropriate personal protective equipment for agricultural workers. Ability and willingness to become involved in local community. Knowledge and use of a team approach toward problem solving. Knowledge of common disease processes. Knowledge and use of nursing process in problem solving. Knowledge of the hazards associated with handling chemicals.



Competencies of Agricultural Health Nurses (n =24) Ranked in Order of Importance, 1998 Tradition of Excellence 21. Ability to work with various farm groups (e.g., extension, 4-H, farm bureau). 22. Patient assessment skills (e.g., biological, psychological, social, spiritual). 23. Knowledge of teaching principles and skill as an educator (e.g., use of equipment, creative educational strategies). 24. Ability to translate medical information into lay terms. 25. Use of investigative skills, including the ability to draw others into conversation. 26. Ability to express empathy toward clients. 27. Familiarity with health and safety regulations appropriate for agriculture related industries. 28. Management skills. 29. Research and data gathering skills. 30. Sense of spiritualism to assist in work with families of agricultural fatalities.



Competencies of Agricultural Health Nurses (n =24) Ranked in Order of Importance, 1998



Tradition of Excellence



31. Computer knowledge and database management skills. 32. Community assessment skills. 33. Knowledge of normal human growth and development and the ability to recognize abnormal findings. 34. Knowledge of "anticipatory guidance" with injury prevention and health promotion being the primary focus. 35. Survey skills. 36. Ability to recognize cultural factors that may affect willingness to practice safety measures. 37. Knowledge of health screening skills (e.g., blood pressure, vision, ear examination). 38. Coalition building skills. 39. Knowledge of research methodologies. 40. Data analysis skills.



Competencies of Agricultural Health Nurses (n =24) Ranked in Order of Importance, 1998 Tradition of Excellence 41. Case management skills. 42. Budgeting skills. 43. Marketing skills. 44. Knowledge of "family centered care." 45. Knowledge of occupational health theory and occupational health practice. 46. Nursing background in public health. 47. Nursing background in occupational health. 48. Personal experience with farming or a farming background. 49. Ability to perform audiometric testing. 50. First aid or cardiopulmonary resuscitation certification.



Competencies of Agricultural Health Nurses (n =24) Ranked in Order of Importance, 1998 Tradition of Excellence 51. Health policy development skills. 52. Knowledge of emergency care and trauma interventions for agricultural injuries and illnesses. 53. Nursing background in a rural hospital setting. 54. Ability to perform pulmonary function testing. 55. Certification in performing audiometric testing. 56. Knowledge of External Cause of Injury codes (E-codes) and International Classification of Diseases-Code 9 (ICD 9). 57. Certification in performing pulmonary function testing. 58. Knowledge of trauma registry. 59. Ability to communicate bilingually.



Tradition of Excellence



Aplication Agronursing



Occupational health nurses



Tradition of Excellence



• Nurses in general practice are likely to encounter clients with occupation related health risks. • Collaborative efforts between nursing faculty and occupational health nurses working in local industries can provide useful learning experiences for nursing students. • Health care providers knowledgeable about occupational health and safety risks can better serve individuals working in hazardous occupations, such as farming. Hodge BD, Ackerman S, Evans C, Erb T, MS, and Cook MLW, 2002. AAOHN JOURNAL. 50(6): 257-261



Rural health



Tradition of Excellence



• Students will explore a variety of health and safety issues unique to rural populations. The interdisciplinary team concept will be used throughout the course to foster collaboration that facilitates sharing of the expertise of students and faculty. • Learn to function in an interdisciplinary team to conduct a community project related to rural health and safety issues. • Explore various dimensions of rurality including, but not limited to, demographics, cultural, and socioeconomic factors. • Demonstrate the use of appropriate strategies in addressing health and safety issues unique to rural populations. • Investigate barriers affecting rural health care. • Differentiate the meaning of "rural life" among various population groups. • Investigate contemporary issues related to the health care delivery system.



Tradition of Excellence



Prevalence of health problems among farmers (n=179). Prevalence of health problems



n (%)



Tradition of Excellence



95% Confidence Interval Lower limit



Higher limit



109 (60.9)



51.7



70.0



51 (28.5) 19 (10.6)



16.1 - 4.4



40.9 23.4



Normal Anemia



67 (37.4) 112 (62.6)



25.8 56.7



49.0 74.0



No pain Pain



89 (49.7) 90 (50.3)



39.3 39.9



60.1 60.6



Nutritional problems Normal Underweight Overweight Anemia



Paint of joint and bone



Note. Nutritional status categorized by BMI (Underweight: BMI less than 18.5; Normal: BMI 18.5 – 24.9; Overweight: BMI 25 – 27; and Obesity: BMI more than 27). Anemia categorized by Hemoglobin (Anemia: less than 12 gr/dl and normal more than 12 gr/dl).



Education



Smoking Drink of coffee



51 (28.5) 88 (49.2) 40 (22.3)



10 (19.6) 19 (37.3) 22 (43.1)



36 (33.0) 58 (53.2) 15 (13.8)



5 (26.3) 11 (57.9) 3 (15.8)



18.186 (0.001)



16 (23.9) 39 (58.2) 12 (17.9)



35 (31.2) 49 (43.8) 28 (25.0)



3.525 (0.172)



23 (25.6) 40 (44.4) 27 (30.0)



28 (31.5) 48 (53.9) 13 (14.6)



6.112 (0.047)



Women Man



23 (12.8) 156 (87.2)



3 (5.9) 48 (94.1)



15 (13.8) 94 (86.2)



5 (26.3) 14 (73.7)



5.369 (0.068)



2 (3.0) 65 (97.0)



21 (18.8) 91 (81.2)



7.950 (0.005)



8 (8.9) 82 (91.1)



15 (16.9) 74 (83.1)



1.874 (0.171)



Not attending school Elementary school Junior high school



41 (22.9) 80 (44.7) 35 (19.6)



14 (27.5) 25 (49.0) 8 (15.7)



25 (22.9) 49 (45.0) 20 (18.3)



2 (10.5) 6 (31.6) 7 (36.8)



10 (14.9) 34 (50.7) 15 (22.5)



31 (27.7) 46 (41.0) 20 (17.9)



4.364 (0.225)



22 (24.4) 41 (45.6) 17 (18.9)



19 (21.3) 39 (43.8) 18 (20.3)



0.684 (0.877)



Senior high school and more



23 (12.8)



4 (7.8)



15 (13.8)



4 (21.1)



8 (11.9)



15 (13.4)



10 (11.1)



13 (14.6)



Yes No



97 (54.2) 82 (45.8)



28 (54.9) 23 (45.1)



64 (58.7) 45 (41.3)



5 (26.3) 14 (73.7)



44 (65.7) 23 (34.3)



53 (47.3) 59 (52.7)



4.971 (0.026)



53 (58.9) 37 (41.1)



44 (49.4) 45 (50.6)



1.252 (0.263)



121 (67.6) 58 (32.4)



31 (60.8) 20 (39.2)



82 (75.2) 27 (24.8)



8 (42.1) 11 (57.9)



47 (70.1) 20 (29.9)



74 (66.1) 38 (33.9)



0.159 (0.690)



64 (71.1) 26 (28.9)



57 (64.0) 32 (36.0)



0.723 (0.395)



75 (41.9) 104 (58.1)



18 (35.3) 33 (64.7)



53 (48.6) 56 (51.4)



4 (21.1) 15 (78.9)



6.331 (0.042)



25 (37.3) 42 (62.7)



50 (44.6) 62 (55.4)



0.649 (0.421)



39 (43.3) 51 (56.7)



36 (40.4) 53 (59.6)



0.057 (0.811)



40 (22.3) 139 (77.7)



16 (31.4) 35 (68.6)



23 (21.1) 86 (78.9)



1 (5.3) 18 (94.7)



5.687 (0.058)



14 (20.9) 53 (79.1)



26 (23.2) 86 (76.8)



0.031 (0.861)



27 (30.0) 63 (70.0)



13 (14.6) 76 (85.4)



5.256 (0.022)



108 (60.3) 71 (39.7)



30 (58.8) 21 (41.2)



73 (67.0) 36 (33.0)



5 (26.3) 14 (73.7)



11.243 (0.004)



36 (53.7) 31 (46.3)



72 (64.3) 40 (35.7)



1.535 (0.215)



51 (56.7) 39 (43.3)



57 (64.0) 32 (36.0)



0.733 (0.392)



92 (51.4) 87 (48.6)



27 (52.9) 24 (47.1)



55 (50.5) 54 (49.5)



10 (52.6) 9 (47.4)



0.099 (0.952)



37 (55.2) 30 (44.8)



55 (49.1) 57 (50.9)



0.407 (0.524)



53 (58.9) 37 (41.1)



39 (43.8) 50 (56.2)



3.487 (0.036)



87 (48.6) 92 (51.4)



27 (52.9) 24 (47.1)



48 (44.0) 61 (56.0)



12 (63.2) 7 (36.8)



2.905 (0.234)



39 (58.2) 28 (41.8)



48 (42.9) 64 (57.1)



3.364 (0.067)



41 (45.6) 49 (54.4)



46 (51.7) 43 (48.3)



0.450 (0.502)



8.113 (0.230)



7.000 (0.030) 9.281 (0.010)



Normal n (%)



χ2 (P)



Pain of Joint and Bone Pain No Pain χ2 n (%) n (%) (P)



Less than 40 year 40 - 60 year More than 60 year



Yes No Hours worked per week More than 40 hours Less than 40 hours Recess per worked Less than 30 minutes More than 30 minutes Working days per week More than 5 days Less than5 days Workload Not stress Stress Working position Ergonomis Unergonomis



χ2 (P)



Anemia Anemia n (%)



Total



Variable



Age



Gender



Nutritional Status Normal Overweight n (%) n (%)



Underweight n (%)



Tradition of Excellence



Variable



Regression Coeficient



Standard Deviation



Walad χ2 value



P



Less than 40 year 40 - 60 year More than 60 year



-1.283 -1.383 Ref



0.530 0.452 -



5.867 9.362 -



0.015 0.002 -



0.28 0.25 -



0.10 0.10 -



0.78 0.61 -



No Yes



-1.031 Ref



0.424 -



5.913 -



0.015 -



0.36 -



0.16 -



0.82 -



-2.635 Ref



1.274 -



4.281 -



0.039 -



0.07 -



0.01 -



0.87 -



-2.807 Ref



0.982 -



8.172 -



0.004 -



0.06 -



0.01 -



0.41 -



-0.331 -0.952 Ref



0.478 0.431 -



0.481 4.885 -



0.488 0.027 -



0.72 0.39 -



0.28 0.17 -



1.83 0.90 -



-2.341 Ref



0.778 -



9.049 -



0.003 -



0.10 -



0.02 -



0.44 -



-0.744 Ref



0.343 -



4.702 -



0.030 -



0.48 -



0.24 -



0.93 -



0.906 0.406 Ref



0.446 0.406 -



4.124 4.718 -



0.042 0.030 -



2.48 2.41 -



1.03 1.09 -



5.94 5.35 -



0.891 Ref



0.384 -



5.386 -



0.020 -



2.44 -



1.15 -



5.17 -



OR value



Underweighta Age



Drink of coffee Overweighta Recess per worked



Anemiab



Less than 30 minutes More than 30 minutes Working days per week More than 5 days Less than 5 days



95% Confidence Interval Lower limit Higher limit



Tradition of Excellence



Age More than 60 year 40 - 60 year Less than 40 year Gender



Man Women Working days per week Less than 5 days More than 5 days b Joint and bone pain Age More than 60 year 40 - 60 year Less than 40 year Recess per worked Less than 30 minutes More than 30 minutes



Implication for practices



Tradition of Excellence



Develop nursing curriculum and short course of agronursing Conduct research for agronursing services Center of agronursing Integrated agronursing on PHC Apply for model health services of agronusring



Tradition of Excellence