Highlights

Psychological Hazards

Each dental facility should systematically conduct hazard assessments for the work environment and tasks performed by dental personnel and identify if and where the potential exists for psychological hazards. In this section, examples are provided of psychological hazards that may be encountered in any healthcare setting, and possible control measures will be suggested.

Employers should carefully evaluate the potential for exposure to hazards in all areas and ensure that they have an effective hazard control plan in place. This information will be useful for inclusion into hazard assessments. Please note, this is not designed to be an exhaustive treatment of the subject, but is rather an overview summarizing the some of the reported psychological hazards in healthcare settings.

 
Potential Psychological Hazards or Effects of Workplace Stressors  Summary of Major Control Strategies 
  w.r.t. Engineering (Technical aspect) w.r.t. Administrative  w.r.t. Personal Protection Equipment (PPE)
Depression, anxiety, sleep disorders, other mental illness as a response to excessive workplace stressors    Worker education about the signs and symptoms of depression, anxiety, sleep disorders, other mental illness. Elimination of workplace risk factors for depression, anxiety, sleep disorders, other mental illness. Provision of support services and programs. Benefit plans provision. Effective return to work programs.  Programs to maintain or build resilience or copingskills. Development of support system. Communication with family physician. 
Substance abuse as a response to excessive workplace stressors    Worker involvement in substance abuse policy and procedures development. Worker education about substance abuse. Training workers and supervisors to recognize the signs of substance abuse. Procedures to limit individual access to narcotics. . Provision of counselling services and return to work plans. Increase awareness of substance abuse signs and symptoms. Communication with counsellors. Report to family physician. Participate in treatment programs and return to work programs
Stress related to work-life conflict    Management policies and procedures that support work-life balance (e.g. voluntary reduced hours, voluntary part-time work, phased in retirement, telecommuting, job sharing, paid and unpaid leaves, dependent care initiatives, etc.). Work designed to address workload and work demands issues. Reliance on paid and unpaid overtime is reduced. Supportive management culture. Work-life balance policies are communicated to workers. The use and impact of work-life balance policies is measured.  Time log used to track time. Work-life balance programs are utilized. Work activities are isolated from home time. Time is effectively managed. Days off are protected. Appropriate sleep habits. Social support system is in place. 
Abuse by clients or members of the public  Isolation areas for agitated clients. Furniture arrangement to prevent workers entrapment. Lockable washrooms for workers separate from client or visitors. Controlled access. Grating or bars on street level windows. Bright lighting in parking lots. Alarm systems and panic buttons. Video surveillance.  Management policies and procedures related to no tolerance of violence or abuse. Worker education in violence awareness, avoidance and de-escalation procedures. Well-trained security guards. Escort services to parking lots. Liaison and response protocols with local police. Policies related to control of keys. Working alone policies. Reporting procedures for incidents and near misses. Use of nametags.  Ability to request support. Use of counselling services. 
Abuse by co-workers  Alarm systems and panic buttons. Video surveillance.  Management policies and procedures related to no tolerance of violence or abuse. Worker education in violence awareness, avoidance and de-escalation procedures. Well-trained security guards. Escort services to parking lots. Working alone policies. Reporting and investigation procedures or incidents and near misses. Assertiveness training. Use of mediation and/or counselling services. 
Hazards related to working alone  Communication devices. Restricted access. Workplace design considerations. Panic alarms. Bright lighting. Mirrors to facilitate seeing around corners or hallways, surveillance cameras.  Scheduling to avoid having workers work alone. Worker training. Working alone policies. Adequate security. Escort services to parking lots.   
· Threat of violence 
· Medical emergencies when alone 
 
Stress related to critical incidents    Training to increase awareness of signs and symptoms of critical incident stress. Critical incident stress team to respond to incidents. Communication and call procedures to mobilize team. Defusings and debriefings.   Development of support systems to assist in dealing with stress. Use of counselling services. 
“Technostress” related to the introduction of new technology  Design of instruments or equipment with user-friendly features.  Selection procedures to ensure user-friendly technology choices. Provision of sufficient training for workers. Worker participation in selection and implementation of new technology. Provision of problem solving resources and support workers. Back-up plans in the event of failures. Change management strategy for introduction of new technology. Realistic expectations regarding use of communication technology. Limit use of technological monitoring of worker productivity. Setting and communication of priorities.  Self-education concerning new technologies. Time management strategies. Open communication about stress related to change. Healthy lifestyles. Setting realisticgoals. Limiting the need to multi-task. Technology“time outs”. E - vacations. 
       
Hazards related to impacts of aging on workers  Management policies and procedures that ensure no age discrimination. Proactive policies to accommodate aging workers. Training opportunities for aging workers. Education for all workers on intergenerational communication. Aging workers as trainers/mentors. Flexible work arrangement. Job redesign to accommodate aging workers.   Healthy lifestyle. Use of client and material handling equipment. Adequate sleep. Awareness of potential side effects of medication.  
Hazards related to shiftwork and hours of work Work environment designed to improve alertness (and minimize drowsiness). Appropriate lighting levels. Lighting levels that are adjustable by workers. Appropriate thermal environment. Well lit, safe and secure working environment Management policies and procedures to address working hours and shift design. Worker involved in design of shift schedule. Limit hours of work and overtime. Shifts designed so workers get enough rest between shifts. Split shifts are avoided, if possible. Train workers and management in fatigue and shift work issues. Work shift schedules designed to minimize fatigue (e.g. maximum number of consecutive night shifts, forward rotation, etc.). Work designed so that critical tasks are not conducted at ends of shifts or “low points” in shift. Quality breaks are in place. Policies to encourage the reporting of concerns associated with fatigue. Thorough investigation of incidents and near misses with fatigue as a possible cause. Appropriate sleep schedule and sleep environment. Strategies in place to promote sleep. Diet adjusted to accommodate shift schedule. Healthy lifestyle. Physical exercise. Safe plan for commute to work. Plan for family and friends. Use of stimulants and sedatives are minimized. Alertness strategies are utilized (e.g. bright lighting levels, regular short breaks, communication with co-workers, etc.).
Exposure to nuisance or irritating noise levels that may induce stress  Any engineering controls required to abate noise to allowable levels, if over PEL. Sound absorber panels. Personal communication devices rather than overhead pagers. Maintenance and repair of facility equipment, including the ventilation system. Lubrication of equipment with moving parts. Design considerations related to noise reduction in new/renovated facilities. Padded chart holders and pneumatic tube systems. Sound-masking technology.  Lower rings on telephones. Encourage use of soft-soled shoes. Worker education on noise levels created by various activities. Posted reminders to reduce noise. Purchasing decisions that take into account noise levels of equipment. Location of noisy equipment to more isolated areas. Work organization at nursing stations to reduce noise.   
Exposure to poor indoor air quality that may induce stress  Proper ventilation system design. Ventilation system maintenance activities. Isolation/segregation of work processes that may create contaminants.  Contractor requirements to reduce air contamination. Selection of low-pollutant cleaning chemicals. Cleaning schedules. Infection prevention and controls standards. Rules regarding the use of personal appliances that may impact operations. Procedures to report and investigate indoor air quality complaints. Worker involvement in indoor air quality investigation. Communication to enable frank and timely discussion of issues and what is being done to resolve them.