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In the first of two articles on assessing an employee's fitness to work as part of a management referral, Anne Harriss and Dr Sue Smith offer advice on taking a health history.
History taking is a skill that continues to improve and mellow with clinical experience. It is important not to forget what a professional privilege it is to be able to ask someone, whom we may never have met before, quite personal questions about anything, from their innermost thoughts and feelings to their bowel movements.
Taking a good history and trying to improve one’s technique can be one of the most challenging and rewarding aspects of the work of an occupational health nurse (OHN).
The effect of work on health, and health on work, is the essence of OH practice. Fundamental questions about functional ability and how work affects health and vice versa must underpin the whole approach to OH history taking.
For an experienced OHN, the actual assessment of fitness may take only a few moments once all the facts have been identified. However, without a systematic, thorough and relevant history, there is a risk of giving inappropriate advice with potentially costly safety and legal consequences.
Some managers may wrongly assume that referral to OH will solve the poor attendance levels within their department. OH practitioners have neither a magic wand nor a crystal ball. A successful outcome associated with a management referral depends on the manager understanding the role and function of an effective OH service and providing information such as the employee’s job requirement and their absence patterns. Of further importance to the success of the consultation is that the client understands the reason for that referral.
1. Client profile
2. Previous occupations
3. Work effects on health
4. Health effects on work
5. Health effects on activities outside work
The client should give their informed consent to an OH referral. They should be advised of the purpose and nature of the assessment and know what will be included within any reports provided to their manager. Guidance from the Faculty of Occupational Medicine highlights that ideally this consent should be in writing but this is difficult in the case of telephone consultations.
Dr Sue Smith, BSc (Hons) MBBS, AFOM is an occupational medical adviser. Anne Harriss MSc, BEd, RGN, OHNC, RSCPHN, NTFHEA, PFHEA, CMIOSH is associate professor of OH and a reader in educational development at London South Bank University.