Horizon workplace wellness strategy content by Brenna Coles

1 WELNESS PROFILE INITIATIVE

Part one

New Brunswickâ&#x20AC;&#x2122;s current situation New Brunswick faces considerable health and wellness challenges. Current statistics reveal the province is experiencing a wellness crisis. Studies have found that 34 percent of New Brunswick children and youth ages two to 17 are overweight or obese compared to the national average of 26 percent. The daily recommended servings of fruits and vegetables are not being met. Researchers have found that only about 21 percent of children and youth in Atlantic Canada

2 WELNESS PROFILE INITIATIVE are meeting those recommendations. Moreover, it is said that “those who eat vegetables and fruit less than 5 times a day are significantly more likely to be overweight or obese than those who eat fruit and vegetables more frequently” (The Department of Healthy and Inclusive Communities, n.d., p.6). Another factor contributing to the wellness crisis is the low physical activity rates. A study found that the majority of New Brunswicker’s live sedentary lifestyles. The study went on to say that New Brunswicker’s “spend more than 2 hours per day in sedentary activities such as watching TV and computer time” (The Department of Healthy and Inclusive Communities, n.d., p.6). An alarming statistic is the smoking rate in New Brunswick. At 21 percent New Brunswick has on of the highest smoking rates in the country. The Canadian Tobacco Use Monitoring Survey (2007) showed that New Brunswicker’s “smoke more cigarettes per day than anywhere else in the country (17 cigarettes / day) (The Department of Healthy and Inclusive Communities, n.d., p.6). New Brunswick has a high prevalence of heart disease, cancer and diabetes. The prevalence rate for these illnesses continues to increase each year in Canada however New Brunswick’s prevalence rate is higher than the national average. Studies now place high value on lifestyle as a contributing factor for many chronic diseases. Therefore an individual can prevent or lower their susceptibility through lifestyles changes. Contributing risk factors for cardiovascular disease, cancer and diabetes include inactivity, obesity and smoking. Inactivity, obesity and smoking also cause a financial burden to society. It is estimated that obesity and tobacco use costs New Brunswick $200 million and $338 per year, respectively (The Department of Healthy and Inclusive Communities, n.d., p.6). The current situation poses many challenges for New Brunswick’s future. New Brunswick wellness strategy 2009-2013

3 WELNESS PROFILE INITIATIVE The Department of Healthy and Inclusive Communities (formally called the Department of Health, Culture and Sport) developed a provincial wellness strategy. The “live well, be well, New Brunswick wellness strategy 2009-2013 is responsive to the needs of New Brunswicker, identifies gaps and limitations, is theory driven and also takes into account the determinants of health. The strategy is built around the four pillars of wellness model (appendix A). The wellness pillars include healthy eating, physical activity, tobacco-free living and mental fitness and resiliency. Three out of the four pillars of wellness relate to healthy behaviours while mental fitness and resiliency is the foundation because it is “fundamental to positive behavior change in all the wellness Pillars, Mental Fitness & Resilience addresses needs for competence, autonomy and relatedness, which are precursors for positive behavior change.” (The Department of Healthy and Inclusive Communities, n.d., p.3). The vision of New Brunswick wellness strategy is “healthy New Brunswickers who live, learn, work and play in a culture of well-being. (The Department of Healthy and Inclusive Communities, n.d., p. 4). A logic model accompanies the strategy and provides the framework (appendix B). The strategy identifies key settings for wellness which include homes, schools, communities and workplaces. In addition, the framework outlines “five strategic directions through which action will occur, there are: form partnerships and collaborate with stakeholders, build capacity for community development, promote healthy lifestyles, develop and support healthy policies [and] conduct surveillance, evaluations and research” (The Department of Healthy and Inclusive Communities, n.d., p.3). There has been considerable effort made by the Department of Healthy and Inclusive Communities to link other government and non-government departments and agencies with the wellness strategy. Through collaboration, realizing shared responsibility and leadership New

4 WELNESS PROFILE INITIATIVE Brunswick can build a culture of well-being (The Department of Healthy and Inclusive Communities, n.d.). Defining wellness Wellness is not an easily understood concept. The Department of Healthy and Inclusive Communities defines wellness “an ongoing process to enhance the many dimensions of well being that enable people to reach and maintain their personal potential, and contribute to their communities” (The Department of Healthy and Inclusive Communities, n.d., p. 5). Wellness is multidimensional and all dimensions are interconnected. There are seven dimensions of wellness and each play an important role in creating an individuals overall sense of well-being. The dimensions of wellness include emotional wellness which is the “ability to understand ourselves and cope with the challenges life can bring” (The Department of Healthy and Inclusive Communities, n.d., p. 5). Mental wellness which refers to being open minded to new ideas and experiences to enhance an individuals judgement, teamwork abilities and improve the community overall. Physical wellness is being able to participate in daily activities without limitation. Social wellness is the “ability to relate to and connect with other people in our world” (The Department of Healthy and Inclusive Communities, n.d., p. 5). Spiritual wellness is the “ability to establish peace and harmony in our lives” (The Department of Healthy and Inclusive Communities, n.d., p. 5). Occupational wellness is being satisfied with your work and finding the proper work life balance. Environmental wellness is understanding your personal role and impact you have on the natural environment in which we live in (The Department of Healthy and Inclusive Communities, n.d.). Horizon Health Network

5 WELNESS PROFILE INITIATIVE Horizon Health Network is one of the largest employers in New Brunswick and is the largest health authority in Atlantic Canada. Horizon employs nearly 14,000 individuals and is a billion dollar a year organization. Within Horizon there are over 100 facilities across New Brunswick “including 12 hospitals, 35 community health centres &clinics, 33 Public Health & Extra Mural Program locations, 21 Addiction Service & Community Mental Health service locations and nine First Nation communities” (Horizon Health Network, 2010, p. 4). Strategic plan The vision of Horizon is “leading for a healthy tomorrow” (Horizon Health Network, 2010, p. 15). Horizon realizes their role is critical at the individual level, the community level and the provincial level because they see health care as the foundation of creating a healthy and thriving community (Horizon Health Network, 2010). One pillar in the New Brunswick provincial health plan is to improve efficiency; Horizon’s objective to address this issue is to “generate operational and service delivery efficiencies while maintaining a healthy and effective organization. In our communities we will lead by example by providing safe and healthy work environments” (Horizon Health Network, 2010, p. 14). For an overview of Hoizon’s strategic plan framework see appendix B (p. 44).

6 WELNESS PROFILE INITIATIVE

Part two

7 WELNESS PROFILE INITIATIVE

Effects of comprehensive workplace wellness Adopting a comprehensive workplace wellness strategy makes sense. With a large portion of the population working and 60 percent of individuals waking hours spent at work, work settings have been identified as a key area to promote wellness. In many cases large organizations such as Horizon, already have in place effective methods of communication and are already seen as a social support network (Blake, & Lloyd, 2008; Merrill, Aldana, Garett & Ross, 2011; Scotton, 2011). Makrides et al. (2011) explained workplace wellness as “addressing modifiable health risks through comprehensive individual and environmental efforts to promote the health of employees” (p.799). The workplace greatly influences employee’s wellness practices and can even positively influence change for various modifiable risk factors. Risk factors Physical inactivity, poor eating habits, obesity, hypertension and tobacco use are among the most prevalent risk factors in Canada and all of which contribute greatly too many chronic diseases. Research shows that “80% of Canadians aged 20 to 59 years have at least one of five major modifiable health risks such as hypertension, tobacco use, overweight, diabetes, and inactivity, with one in ten of Canadians having three or more risks” (Makrides et al., 2011, p.799). Appendix C describes the “relationship between risk factors and the associated medical condition causally related to heightened risk factors” (Horwitz, Kelly & DiNardo, 2013, p. 5) After decades of research epidemiologists have found associations between various modifiable risk factors and chronic diseases. It is believed that approximately 70 percent of

8 WELNESS PROFILE INITIATIVE diseases can be prevented though healthy behaviours. Five domains have been identified that contribute to early mortality they include “individual behavioral choices (40%), genetic endowment (30%), social circumstances (15%), medical care (10%), and environmental conditions (5%)” (Horwitz, Kelly & DiNardo, 2013, p.4). Obviously, genetics cannot be changed therefore approximately 70 percent of early deaths can explained by modifiable risk factors and thus are preventable (Horwitz, Kelly & DiNardo, 2013). With the health and wellness of Canadians declining due to poor health practices and increased number of contributing risk factors the prevalence rates of chronic diseases is increasing along with medical costs (Merrill et al., 201;Scotton, 2011). It is estimated that the cost of chronic disease accounts for 60 percent of the total medical care expenditure mostly through indirect costs such as absenteeism, pre-absenteeism, short-term and long term disability resulting in lost productivity. It is said that “poor employee health can be two to four times the direct medical costs” (Merrill et al., 2011, p. 799). Employers are now realizing the importance association between their employees health and productivity (Horwitz, Kelly & DiNardo, 2013; Makrides et al., 2011). Cost savings Workplace wellness makes good business sense; employers do see a return on investment. A meta-analysis found that annual medical care costs fall approximately $358 per employee, which translates to $3.27 for every dollar spent on wellness (Horwitz, Kelly & DiNardo, 2013, p.4). Moreover, workplace wellness has many positive effects other than lowering health care costs which include increased productivity, improve employee job satisfaction, improve moral, lower absenteeism and pre-absenteeism, promoting a sense of community, decreased turnover, create a workplace culture and improve health behaviours and

9 WELNESS PROFILE INITIATIVE long-term health. All of which benefit the organization by improving its effectiveness and therefore has a positive return on investment (Blake, & Lloyd, 2008; Horwitz, Kelly & DiNardo, 2013; Makrides et al., 2011; Merrill et al., 2011). Mental fitness Canadians workers report high levels of stress. Statistics Canada’s 2010 General Socail Survey reported that one in four Canadian workers “described their day-to-day lives as highly stressful” (Crompton, 2011, para. 1). Another 46 percent of Canadian workers self reported that most days were “a bit stressed”. The survey also went on to have Canadian workers to report their self perceived mental health status, “among the stressed workers who described their mental health as less than good, almost two-thirds (62%) reported that they were highly stressed” (Crompton, 2011, para. 7). Workers stress levels can negatively impact their work. Stress employees can be an indirect financial burden on their employer through low or lost productively due to preabsenteeism and absenteeism and directly through increases work-related accidents and psychological burnouts both resulting in disability claims (Crompton, 2011; Gupta, 2008).Overall mental health issues cost Canadian employers approximately 20 billion dollars per year and “account for over three-quarters of short-term disability claims in Canada” (Crompton, 2011, para. 2). Health care setting Workplace wellness would be greatly beneficial if it were implemented in the health care settings. Primary health care settings would be the idea setting to practice wellness and be a leader in wellness for the rest of the community. Studies have also found that healthcare professional promote health and wellness in their patients however do not always take their own

10 WELNESS PROFILE INITIATIVE advice. Within the healthcare team many self-report low levels of physical activity, poor nutrition, tobacco use, poor sleep and low mood (Blake, & Lloyd, 2008). By implementing workplace wellness in healthcare setting the health and well-being of these professionals will improve having a positive effect on the quality of care they provide their patients. A higher standard of care will be created when workplace wellness is implemented and the employees become more physically and mentally fit and in return more satisfied (Blake, & Lloyd, 2008). Conclusion Workplace wellness places greater emphasis on prevention and is beginning to take a proactive approach to the chronic disease crisis. Work setting adopting health and wellness strategies are creating better futures not only for their employees and business but on the larger scale creating healthier communities (Loeppke, Edington, Bender, & Reynolds, 2013; Scotton, 2011).

11 WELNESS PROFILE INITIATIVE

Part three

Employee wellness profile initiative The Horizon Health Network has identified the need to implement a workplace wellness strategy. One of the preliminary steps to take when developing a wellness strategy is to conduct a needs assessment. The objective of a needs assessment is to collect and analyze baseline data. The results of the needs assessment will outline the current situation of Horizon employees as well as highlight priority areas. A needs assessment is the foundation of a wellness strategy as it will be used to guide the direction of Horizon’s workplace wellness strategy. The following report describes the development, implementation and evaluation plan for Horizon’s needs assessment, referred to as the “wellness profile initiative”. Preliminary logistics

12 WELNESS PROFILE INITIATIVE The preliminary logistics of developing a strategy usually involve answering questions. The following section outlines what information needed for the planning and development process for Horizonâ&#x20AC;&#x2122;s employee wellness profile initiative.

The following table outlines the opportunities and barriers present in the planning and development process. Opportunities Collaboration with stakeholders

Barriers Stakeholder contact

Identify wellness champions

Time restrains

Identify, prioritize and develop action

Financial constraints

plans to address the needs and wants of Horizon's employees

Non-regionalized practices, procedures and policies

13 WELNESS PROFILE INITIATIVE

Logic model The following is a logic model for the initiative and will act as a framework that depicts the necessary resources, activities and outcomes. Short term Inputs

Outputs

Long-term Intermediate outcomes

outcomes

People: Brenna Coles, Marilyn Identify key

Improved

Babineau, stakeholders,

Identify needs

Action plans/ strategic

quality of work

continuous

of employees

plans

life for Horizon

employee health collaboration

employees

nurses, Dr. Christie, other stakeholders Horizon adopts Developed

a Identify

Promotion, prevention,

standard Time

comprehensive preferences of

intervention (tailored

employees

programs and services)

operating practice

workplace wellness framework

14 WELNESS PROFILE INITIATIVE Healthier Developed

Identify

Development and

physical health

availability of

implementation of

profile

employees

strategies and policies

Developed

Identify

employee

stages of

wellness survey Standardized

change

Financial

communities

resources

across New Brunswick

Research Monitoring and evaluating

base Building new hire Materials

partnerships/collaboration immunization s form Identified measures and

Building wellness

indicators for

awareness

Equipment data analysis Teleconferences Engagement and Technology

and PowerPoint mobilization presentations Implementation of the standard operating practice and the adoption of the supporting documents

Knowledge transfer

15 WELNESS PROFILE INITIATIVE Vision The vision for Horizon’s workplace wellness strategy is to promote employee wellness to enhance the quality of work life. Goal and objective The goal for Horizon wellness profile initiative is to establish a strong foundation for employee wellness strategy that promotes health and well-being in the workplace by 2014. This will be made possible by implementing a standard operating practice by mid-April that is intended to drive the wellness profile initiative. The following table outlines the outcome goal and indicator for this initiative: Outcome

Outcome Goal/ Target

Indicator

To develop an effective tool

Finalization, approval and

to be used to collect

implementation of Horizon’s

baseline data by mid-April.

wellness profile initiative.

Develop Horizon’s wellness profile initiative.

Planning process Timeline Key Major tasks

Timeline

Description contributors

16 WELNESS PROFILE INITIATIVE

Complete necessary

January 14-

reading and

January 25,

background research.

2013

Complete a comprehensive scan of Brenna Coles

related material to gain a clear understanding of workplace wellness

January 28Compile all relevant

Develop a working base of notes February 1,

Brenna Coles

information.

pertaining to wellness 2013

Develop an outline

February 4-

for wellness profile

February 8,

initiative

2013

Identify and prioritize what elements Brenna Coles

to be included in the wellness profile initiative

Conduct a literature view of resources

Create a draft employee wellness survey

Brenna Coles,

to validate survey questions based on

Marilyn

the four pillars of wellness model.

Babineau, Dr.

Integrate the Transtheoretical model of

Christie,

stages of change into the survey.

Chantal

Ensure questions do not pose ethical

Cloutier

issues and are written in a clear

February 11February 15, 2013

concise manner.

17 WELNESS PROFILE INITIATIVE

A limitation and gap was identified with the current new hire process. The February 18-

solution was to replace the physicians

Develop draft February 22,

Brenna Coles

form with a new form. The physical

physical health profile 2013

health profile was adapted in part from the old form and is also reflects "best practices".

After the implementation of the new February 18-

Marilyn

February 22,

Babineau,

2013

Brenna Coles

Reconfigure a

immunization policy there was a need

standardized immunization form

for a standardized immunization form to be used across Horizon.

18 WELNESS PROFILE INITIATIVE

A standard operating practice will Develop a draft guide directly affected staff (i.e. standard operating human resources and employee health practice that

February 25-

Brenna Coles, nurses). This is a guideline that spells

incorporates all

March 1,

Marilyn out the appropriate steps to take and

elements of the

2013

Babineau includes instructions on how to use the

wellness profile supporting documents relating to the initiative. wellness profile initiative.

March 11-

Brenna Coles,

Editing, proofing and formatting were

March 22,

Marilyn

a vital stage in order to move forward

2013

Babineau

to the test pilot stage.

Review and revise prior to test pilot Pilot test the Brenna Coles, employee wellness

Employee wellness surveys were March 18-

Marilyn

survey with

distributed to select employees and March 22,

Babineau,

appropriate range

were asked to complete the survey and 2013

select Horizon

reflective of the target

give feedback. employees

population March 18-

Brenna Coles,

March 22,

Marilyn

2013

Babineau

Review and revise post test pilot

19 WELNESS PROFILE INITIATIVE

Teleconference accompanied by a Brenna Coles, PowerPoint presentation describing March 20-

Marilyn

Stakeholder

the overview of the wellness profile March 22,

Babineau,

2013

employee

collaboration part one

initiative. The first part only discussed the physical health profile and the health nurses standard operating practice. Brenna Coles, Teleconference accompanied by a April 2-

Marilyn

Stakeholder

PowerPoint presentation focusing on April 5,

Babineau,

collaborating part two

the revisions made previously and on 2013

employee the employee wellness survey. health nurses Brenna Coles, An informal focus group via Marilyn

Stakeholder

April 4-

teleconference in order to finalize all Babineau,

collaboration final

April 9,2013

supporting documents within the employee wellness profile initiative. health nurses Finalize the immunization form,

April 9-

Brenna Coles,

Finalize all

physical health profile, employee April 12,

Marilyn

supporting documents

wellness survey and standard 2013

Babineau operating practice.

20 WELNESS PROFILE INITIATIVE Marilyn Approval and

April 9-

immediate

April 12,

implementation

2013

Marilyn present the proposed standard Babineau, operating practice intended for the Karen wellness profile initiative. MacDonald Present formal oral presentation to relevant and directly affected staff

Create and deliver

April 15regarding the wellness profile

PowerPoint

April 19,

Brenna Coles initiative and discuss the short and

presentation

2013 long term goals of Horizon's workplace wellness strategy. Final Completion Date: April 19, 2013

Developmental design The employee wellness profile initiative will be the foundation and cornerstone for the Employee Wellness Strategy. The baseline data collected will not only identify the specific health and wellness needs including voluntary health practices relating to the four pillars of wellness but also identify their individual perceptions, interests and preferences, readiness to change and availability. Data collected will be both qualitative and quantitative. The employee wellness profile initiative will be used to guide future employee wellness initiatives to ensure timely and relevant programs and services are offered and are area-specific. The employee wellness profile initiative is comprised of several elements including the immunization form, employee physical health profile, employee wellness survey and a standard operating practice. Immunization policy and form

21 WELNESS PROFILE INITIATIVE A new personnel immunization policy was recently implemented across Horizon (appendix D) . This has prompted the need for the development of a standardized immunization form (appendix E). Horizonâ&#x20AC;&#x2122;s Immunization of Personnel policy states, â&#x20AC;&#x153;all employees and nonemployee personnel are required to comply with immunization and communicable disease surveillance requirementsâ&#x20AC;? (Horizon Health Network, 2012, p.1). The immunization form will complement the policy and ensure the policy is followed and enforced. The new hire immunization form was adapted from the student immunization form as it was identified as an effective well written form. Only slight changes were made, including changes to the orientation of the form to allow for the content to fit on two pages and to be more user friendly for clerical administrative support staff. The process for new hires is to be provided with an immunization form which is distributed by human resources and should be included in the new hire checklist (appendix F). New employees are to have the immunization form completed before coming to their employee health nurses appointment, which takes place within 30 days of the start date. In order to keep records of employee immunizations an Access database was created. Data entry is the primary responsibility of the administrative support staff in each area. If there are no administrative support nurses are expected to take on this responsibility. Physical health profile The physical health profile is a form which will be filled out by the employee health nurse for each new employee at their first health nurse appointment within 30 days of their start date (appendix G). The physical health profile is replacing the physicians form (appendix H). The physicians form was provided to new employees and taken to their family physician to be completed and would be expected to have the completed form at their appointment with the employee health nurse. After an informal environmental scan it was determined that the

22 WELNESS PROFILE INITIATIVE physicians form had many limitations and disadvantages. In some cases, physicianâ&#x20AC;&#x2122;s were charging anywhere from $75 to $150 to have this form completed, which some employees may not be financially able to cover the cost. Often times the form was lacking information needed; a reason for this may be that a percent of the population does not have a family physician. The first part of the physical health profile collects general information necessary to in included in the employee health records. It then collects quantifiable data this section of the form is called physical screening. The data collected in this section includes height and weight so that it can calculate the employees Basal Mass Index (BMI), blood pressure, pulse, blood glucose and total cholesterol are also measured. It is important to note that blood glucose and cholesterol testing not preformed in a laboratory setting is not guaranteed to be highly accurate, instead the results of these tests are only be viewed as a baseline. These tests are also very sensitive and must take into account fasting and non-fasting to be considered when analyzing the results. The physical health profile was developed with current New Brunswick health issues in mind. The physical health profile identifies risk factors related to three main health issues in New Brunswick; cardiovascular disease, respiratory disease and diabetes. Included is a check list of contributing risk factors both modifiable and non-modifiable for each health issue. The more contributing risk factors an employee has increased their risk of developing the health issue. Once modifiable risk factors are identified the employee health nurse can refer the employee to the available resources at that time. One resource already in place is the introduction to employee health services brochure, this resource orientates new employees with the programs and services available to them (appendix I). Employee wellness survey

23 WELNESS PROFILE INITIATIVE The employee wellness survey was created based on the four pillars of wellness model and includes roughly 40 questions mainly multiple choice (appendix J). The four main sections include physical activity, nutrition and healthy weight, smoking and metal fitness. The survey has also integrated the Transtheoretical model into each section. A series of multiple choice questions throughout the survey identify which stage of change an employee is in specific to each pillar of wellness. Employees are also asked what is keeping them from making the change to improve their health and wellness; this data will identify the most common barriers identified by Horizon employees. Another important feature of the employee wellness survey is that it identifies the interests of employees. Employees are asked to rank their top three areas of interest relating to wellness. Employees must also identify their preferred method of resource that would most benefit them, for example books, DVDâ&#x20AC;&#x2122;s or webinars. Lastly, the survey asks employees when the best time to offer programs and services in the workplace. The survey allows the appropriate data to be collected to ensure that the needs and preferences of the employees are identified. Standard operating practice The standard operating practice is a controlled document that guides the directly affected employees (i.e. human resource and employee health nurses) across Horizon on the correct practices relating to Horizonâ&#x20AC;&#x2122;s wellness profile initiative (appendix K). This acts as a guideline and describes the step by step process involved in a new hire relating to Employee Health Services and how to use the supporting documents (immunization policy, immunization form and physical health profile). Adopting a standard operating practice will ensure the enforcement of this initiative. Methodology

24 WELNESS PROFILE INITIATIVE Consultation and review process Collaboration with stakeholders was a main priority. The key stakeholders that were identified were employee health nurses. It was essential to have the support and engagement from them to ensure the success of the Horizon employee profile initiative. The methods of communication were email and teleconferences. The first formal contact was made on March 20, 2013. There was a teleconference accompanied by a PowerPoint presentation giving an overview of the initiative (appendix L). The second scheduled consultation was on April 2, 2013 again there was a teleconference and PowerPoint presentation (appendix M). Both teleconferences were 30 to 45 minutes in length. The final consultation was held on April 9, 2013 and was an informal focus group to get all supporting documents (physical health profile, employee wellness survey and the standard operating practice) finalized and lasted one hour in length. A final oral presentation was delivered in the Moncton area approximately 11 people were in attendance (appendix N). For a account of important email communications please refer to appendix O (p. 75). Theory and framework Horizonâ&#x20AC;&#x2122;s employee wellness profile initiative is theory driven and was created with valid frameworks and models in mind including the four pillars of wellness, the national quality Institute: Healthy workplace model and the stages of change- Transtheoretical model. Four pillars of wellness model As previously discussed the goal and objective for the initiative was adapted from New Brunswickâ&#x20AC;&#x2122;s live well, be well wellness strategy. The four pillars of wellness have been integrated into the wellness survey and the physical health profile. By adopting this model it links the provincial wellness strategy to Horizonâ&#x20AC;&#x2122;s and positively reinforces wellness by being

25 WELNESS PROFILE INITIATIVE present in multiple settings thus maximizing the efforts and increases the likeliness of successfully creating a culture of wellness. National Quality Institute: Healthy workplace model The National Quality Institute (NQI) healthy workplace model (appendix P) is widely used in workplace wellness strategies. The model identifies three elements that strongly impact a healthy workplace they are physical environment and occupational health and safety, workplace culture and supportive environment and health and lifestyle practices. The physical environment and occupational health and safety include organizational efforts to reduce occupational injury and illness. Joint health and safety committees are already in place addressing these issues. Workplace culture and supportive environment relates to the social and psychological culture of the organization. It is created by the social interactions of the people and their relationships. This element of workplace wellness is extremely important as it has a strong impact on mental and physical practices of the employees. Recently, Horizon employees had the opportunity to complete a survey on workplace engagement. Much like the employee wellness profile initiative the engagement survey acts as a needs assessment to help understand the current situation. The results will help guild the initiative to help increase employee engagement. The final element is health and lifestyle practices of the employees. Organizations are strongly encouraged to promote and support positive health and wellness practices among their employees (Province of Nova Scotia, 2012). Transtheoretical model Many psychological and social factors have been identified as risk factors which lead to risky behaviour. Interventions have been implemented to promote positive changes in unhealthy behaviours. There are two categories of health behaviours they are: health enhancing behaviours,

26 WELNESS PROFILE INITIATIVE which are positive; such as regular exercise, healthy eating, regular immunizations and doctor check-ups. Then there are the health compromising behaviours which are unhealthy behaviours, such as smoking, low physical activity, excessive alcohol use and eating foods high in fat (Bunton, Baldwin, Flynn, & Whitelaw, 2000). In order to increase health- enhancing behaviours and decrease health impairing ones, it is important to understand the psychological process that goes on behind these behaviours. The Transtheoretical model identifies stages of change that help move people to make positives health behaviour change. The Transtheoretical model includes 6 major stages in the change process. However, it is important to note that many people in fact move back and forth between stages and not always a unidirectional flow. The 6 stages include: pre-contemplation, contemplation, preparation, action, maintenance, and termination (Bunton et al., 2000). Pre-contemplation is the first stage where the thought of behaviour change doesnâ&#x20AC;&#x2122;t even exist. The individual does not feel the need to change and do not see it as a problem. The second stage is contemplation where the individual starts to realize their behaviour may be an issue. They may have the desire to change but they have yet to take action. In all cases, the benefits of adopting a health enhancing behaviour or stopping a health compromising behaviour must outweigh the costs or effort involved to change for an individual to take serious action. The preparation stage prepares the individual for the action. This usually involved making a plan and taking small steps to prepare them for a successful behaviour change. Goal setting and developing skills that will help carry the person through the entire process are important elements of the preparation stage. The action stage is where the individualâ&#x20AC;&#x2122;s behaviour is modified. Also, changes in a personâ&#x20AC;&#x2122;s environment must also be altered to truly be successful. The action stage requires the most effort and commitment for the individual to move on to the

27 WELNESS PROFILE INITIATIVE maintenance stage. The action stage usually lasts six months before moving on to the next stage. However, if the person falls back into their old behaviour then that is a relapse. The maintenance stage is the process of making the behaviour apart of the personâ&#x20AC;&#x2122;s regular routine, without thinking or having to work on it. It usually takes individuals roughly five cycles through the action stage before a successful behaviour change. The final stage, termination occurs when the change is a part of the individualâ&#x20AC;&#x2122;s routine and is ingrained and under their personal control. If this stage is reached it is assumed that the old behaviour will never return. Reaching this stage is the ultimate goal for behaviour change (Bunton et al., 2000). The Transtheoretical model determines what stage of change an individual is in and it allows for better program planning because it allow the program to meet individuals where they are in their process of change. Developing and implementing a stage-matched is of high importance therefore programs are specifically tailor to the stage of behaviour change and therefore impact the success rate of the program (Bunton et al., 2000).

Implementation Physical health profile The implementation plan for the physical health profile is for every new employee to complete the physical health profile with the employee health nurse during their appointment within 30 days of their start date. The physical health profile will also be completed at any employee health appointment with active employees. Subsequent appointments will employees who already completed the physical health profile should be kept up to date to ensure accuracy. Employee wellness survey

28 WELNESS PROFILE INITIATIVE Short term The short term implementation plan for the employee wellness survey is to distribute paper copies to Horizon employees at health fairs. The employee wellness survey will be first distributed on world hypertension day on May 17, 2013 at blood pressure clinics being held across Horizon (appendix Q). Employees will be asked to complete the survey and bring it back to Employee Health Services. Long term The long term implementation plan for the employee wellness survey is to make the survey accessible on Skyline. Skyline is Horizonâ&#x20AC;&#x2122;s intranet; it provides information and services to Horizonâ&#x20AC;&#x2122;s employees. Ideally, the employee wellness survey will be published on skyline for employees to complete and the data collected will be automatically inputted into the database. By shifting to an electronic method for implementation it reduces paper use and waste and greatly decreases the time and effort involved in data entry for the administrative support staff. Data collection and analysis Database The database for the physical health profile will be developed within the pre-existing immunization database. This will allow simplification for the employee health nurses. During the employee health appointments for new hires the focus will be on the completed immunization form and completing the physical health profile the information collected will then be inputted into the same database and the paper copies can then be destroyed. Horizon is committed to adopting more efficient sustainable practices and the database is a step in the right direction towards a future of electronic health records. Moreover, the data collected from the employee

29 WELNESS PROFILE INITIATIVE wellness survey will be inputted into a separate database. The two databases will be able to generate reports and trends will be revealed through the analysis of the reports. Evaluation Measures and indicators During the development of this physical health profile and employee wellness survey an outline of predetermined measures and indictors was developed as an analyst tool. The measures and indicators were developed to ensure the validity of the questions and data collected (appendix R). The measures and indicators were developed through research of the literature and based on many Canadian standards including eating well with Canadaâ&#x20AC;&#x2122;s food guide, Canadian Society for Exercise Physiology which is supported by the Public Health Agency of Canada, the Heart and Stroke Foundation of Canada, the Canadian Cancer Society and the Canadian Diabetes Association. Future recommendations The development process for Horizonâ&#x20AC;&#x2122;s employee wellness profile initiative is now complete. It is imperative that the implementation plan be carried out, evaluated for effectiveness and modified if necessary. It is strongly recommended that a wellness action committee is created. The employee health nurses across Horizon will be the first committee members identified, next other wellness champions will be asked to be apart of the committee. Wellness champions can be first identified by seeking out Horizon employees who attended either the mental fitness in the workplace; an approach to promoting psychological wellness on April 15 or the Heart and Stroke Workplace Wellness conference on April 15. It would be beneficial to contact these employees sooner rather than later as the hype of workplace wellness is still fresh. The committee will represent the various areas across Horizon and advocate on behalf of its

30 WELNESS PROFILE INITIATIVE employees. The committee will be largely responsible for moving the employee wellness profile initiative forward to ensure Horizon implements a workplace wellness strategy. A wellness action committee should be created within the next six months. When the employee wellness survey is publish on Skyline it should be accompanied by a online toolkit. An online toolkit has already been created by the New Brunswick Workplace Wellness Advisory Committee: Community of Practice. This toolkit is also based upon the four pillars of wellness model and has identified valid resources to be used by employers and employees. It is strongly recommended that the online toolkit be accessible to Horizon’s employees on Skyline in the next four months. In addition it should be made a priority for the employee wellness survey be published on Skyline in the next six months. Furthermore, to get the most accurate information outlining Horizon’s current situation an 80 percent participation rate should be the target. Once enough data is collected and analyzed, priorities should be identified for each area and well planned, detailed action plans should be implemented in a timely manner. It is strongly suggested that Horizon follow the World Health Organization’s (WHO) healthy workplace model (appendix S). The framework outlines steps to take to establish comprehensive workplace wellness (Burton, 2010). To ensure the quality of Horizon’s workplace wellness strategy proper monitoring should be a priority. Ideally a follow up assessment should be implemented every two to three years. This will allow for an overall outcome evaluation. Moreover, for each of the programs that are developed from the employee wellness profile initiative should have an evaluation plan developed within the program design. Often evaluations are an after thought however valuable information can come from a proper evaluation plan that includes a formative, process and outcome evaluation.

31 WELNESS PROFILE INITIATIVE Conclusion The health and wellness of New Brunswicker’s is a major priority. By implementing Horizon’s comprehensive workplace wellness strategy the community will benefit greatly. The primary stage of developing a needs assessment plan (Horizon’s employee wellness profile initiative) has been a major undertaking but because of the careful planning that has gone into it Horizon’s workplace wellness strategy has a strong foundation to be a great success. It is an exciting time for Horizon as we move on to the next stage of implementing Horizon’s employee wellness profile. Angela Lawson, who is studying Organizational Management at Crandall University, will be heading the implementation phase of the initiative for the next year.

Acknowledgments Many thanks go out to the individuals who helped along the way including Chantal Cloutier, Dr. Timothy Christie and Jenna Boomer. I would like to thank all of the employee health nurses for their continuous support and collaboration throughout the developmental process including Anne Masters-Boyne, Anne Price, Deena Thompson, Edie Daniels, Karen Dunham, Karen O'Regan, Linda Poirier, Lisa Hebert, Lola Dickinson, Patricia Bannan and Patsy Irvine. I am very appreciative to Angela Lawson who will be continuing this incentive and I cannot wait to see where it ends up. I would also like to give recognition to Lois Macgregor who is my internship coordinator and without her continued efforts in helping find a placement I would not have had the experiences that I have had. Lastly, I would like to extend a special thank you to my supervisor and mentor, Marilyn Babineau. Marilyn has played a major role throughout my internship and it is her that I owe for having this wonderful opportunity.

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References Blake, H., & Lloyd, S. (2008). Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice. Quality in Primary Care, 16(6), 449-455. Bunton, R., Baldwin, S., Flynn, D., & Whitelaw, S. (2000). The ‘stages of change’ model in health promotion: Science and Ideology. Critical Public Health, 10(1), 55-70. Burton, J. (2010). World Health Organization healthy workplace framework and model: Background and supporting literature and practices. Geneva, Switzerland. Crompton, S. (2011). What’s stressing the stressed? Main sources of stress among workers. Retrieved on April 25, 2013 from http://www.statcan.gc.ca/. Department of Healthy and Inclusive Communities. (n.d.). Live well, be well New Brunswick’s wellness strategy 2009-2013. Retrieved on February 15, 2013 from http://www.gnb.ca/. Gupta, J. (2008). Promoting wellness at the workplace. Work & Industry Special Interest Section Quarterly, 22(2), 1-4. Horizon Health Network. (2010). Strategic plan 2010-2013. Retrieved on February 15, 2013 from http://www.stancassidy.ca/.

33 WELNESS PROFILE INITIATIVE Horizon Health Network. (2012). Horizon Health Network Policy & Procedure Manual Immunization of Personnel. Policy number HHN-CP-000. Loeppke, R., Edington, D., Bender, J., & Reynolds, A. (2013). The Association of Technology in a Workplace Wellness Program With Health Risk Factor Reduction. Journal Of Occupational & Environmental Medicine, 55(3), 259-264. doi:10.1097/JOM.0b013e3182898639 Makrides, L., Smith, S., Allt, J., Farquharson, J., Szpilfogel, C., Curwin, S., & ... Edington, D. (2011). The Healthy LifeWorks Project: A Pilot Study of the Economic Analysis of a Comprehensive Workplace Wellness Program in a Canadian Government Department. Journal Of Occupational & Environmental Medicine, 53(7), 799-805. Merrill, R. M., Aldana, S. G., Garrett, J., & Ross, C. (2011). Effectiveness of a Workplace Wellness Program for Maintaining Health and Promoting Healthy Behaviors. Journal Of Occupational & Environmental Medicine, 53(7), 782-787. doi:10.1097/JOM.0b013e318220c2f4 Province of Nova Scotia. (2012). What is a Healthy Workplace? Retrieved on April 24, 2013 from http://novascotia.ca/. Scotton, L. M. (2011). Wellness and prevention in the workplace. Contemporary Rehab, 67(2), 12-13.

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Appendices

Appendix A

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Four pillars of wellness model (Department of Healthy and Inclusive Communities, n.d.)

Appendix B

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New Brunswick wellness strategy 2009-2013 logic model (Department of Healthy and Inclusive Communities, n.d.)

Appendix C

37 WELNESS PROFILE INITIATIVE

Risk factors and their relationships with medical conditions. Darker lines indicate a stronger relationship (Horwitz, Kelly & DiNardo, 2013).

Appendix D Immunization policy

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Appendix E Immunization form

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Appendix F New hire checklist

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Appendix G Physical health profile

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Appendix H Physicians’ form

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Appendix I Employee health services brochure

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Appendix J Employee wellness survey

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Appendix K Standard operating practice

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Appendix L PowerPoint presentation part one

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Appendix M PowerPoint presentation part two

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Appendix N Final PowerPoint presentation

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Appendix O Email communications Communications between Brenna and Marilyn

Hi Marilyn, I am still not able to access your calendar. How about you choose a date and time that works for you. I am very flexible. What we need to discuss are the goals and objectives for my internship (I have attached my draft goals and objectives to this email) and develop a brief description of my special service project. The description of the special service project which is the new employee immunization/testing policy and the new employee "health risk assessment" must be sent into my internship coordinator, Lois Macgregor. Thank you, Brenna

Hi Marilyn,

60 WELNESS PROFILE INITIATIVE Here are the three documents that I promised to send to the employee Health Nurses. I have made a few changes to them so please take a look at them. Attached is the SOP, Physical Profile and the Employee Wellness Survey. Let me know what you think and a complete list of the nurses to send it to. Thanks, Brenna

P.S. let me know what time you would like to meet for practice* Hi Marilyn, I am wondering where I can find information for my written component of my special service project. I would like to have any information regarding Horizon's demographics (i.e. age, gender, social economic status), retention rates/ turnover rates, job satisfaction, workplace injuries, employee engagement, long term disability, short term disability, moral and absenteeism. I realize this may not be possible to get but anything would help. Thanks, Brenna Communications between Brenna and Dr.Tim Christie Dear Dr. Christie, My name is Brenna Coles, Marilynâ&#x20AC;&#x2122;s internship student. As per Marilynâ&#x20AC;&#x2122;s earlier email this morning I would like to gain your feedback on a project I am working on. But first, I would tell you briefly about my educational background and information about the project. I am graduating from Dalhousie University with a Bachelor of Science in Health Promotion in May. I also have a Certificate of Disability Management also from Dalhousie.

61 WELNESS PROFILE INITIATIVE I am in the process of completing a 14 week internship with Marilyn in employee health. My main task is to develop an employee health survey and the tentative name is the Employee Health Profile. I have incorporated the four pillars of wellness: mental fitness/ resiliency, physical activity, nutrition, and smoke-free; I have tried to integrate measurable indicators within the survey. Another key element to this survey is to measure the employees’ “readiness to change” based on the Transtheoretical Model. This document will be replacing the “Medical Assessment for Employment” form which was to be completed by a physician. By mid- April we plan to have all new employees across Horizon complete the survey at their employee health appointment. The survey will act as a needs assessment to guide us in our initiatives by telling us the health needs of the employees and where our efforts will be most effective. I have attached the draft survey, it’s in the beginning stages of development and I would greatly appreciate your feedback. Mainly, if you feel that there are any ethical concerns with the questions. Kind regards, Brenna

Hi Brenna, Please give me a call at 647-6579 and we can discuss. Sincerely, Tim

Hi Tim, I would like to thank you again for giving me feedback this morning on the survey. Your input is greatly appreciated!

62 WELNESS PROFILE INITIATIVE kind regards, Brenna

Communications between Patty McQuinn Hi Patty, My name is Brenna Coles, I am graduating with a BSc in Health Promotion in May and I am currently completing my internship with Marilyn Babineau. I am looking for some information on cholesterol testing kits/strips. Marilyn remembers that you had used them in the past. We would like to get some information on perhaps, availability, accuracy, cost, etc. as we are looking into the possibility of using them in a health fair. Any information you can provide would be greatly appreciated. Talk soon, Brenna

Hello When we used the strips to check cholesterol they we donated by a community pharmacy as arranged by the organizing event group. We did not get any research or information on them in relation to the questions you posed other than what came with their instructions. I am sure there are studies out there. Good luck and enjoy your event. Regards Patty

63 WELNESS PROFILE INITIATIVE

Hi Patty, Thank you for your response. I have been doing a review of the literature to see what I can find. Brenna Communications between Chantal Cloutier and Brenna Hi Chantal, I was able to check out those links, there are great resources. I will be referencing them in my final literature review! I just have two questions regarding a survey. The first question is about alcohol intake and how to measure or find an indicator for binge drinking. Here is what I have so far: Alcohol intake: In a typical week, how many alcoholic beverages would you drink? b. 0- 7 drinks per week/ averaging 1 drink per day c. 8- 14 drinks per week/ averaging 2 drinks per day d. 15- 21 drinks per week/ averaging 3 drinks per day e. More than 21 drinks per week/ averaging 4 or more drinks per day Would you say this is a good question to include on the survey? I am trying to identify "red flags". So the indicator or red flag would be "More than 21 drinks per week/ averaging 4 or more drinks per day" Would you say I would cover the binge drinking by asking in this manner? Furthermore, the second question is in regards to the stages of change for mental fitness. Here is what I have come up with: 1) In terms of your current coping skills:

64 WELNESS PROFILE INITIATIVE a.

There's nothing that I really need to change.

I really think I should work at it.

I am really working hard to change.

I may need a boost right now to help me maintain the changes I've already

made. 2) In terms of feeling depressed or anxious: a. There's nothing that I really need to change. b. I really think I should work at it. c. I am really working hard to change. d. I may need a boost right now to help me maintain the changes I've already made. 3) In terms of feeling depressed or anxious affecting your social activities: it’s a bit redundant …I would go more general …in terms of life satisfaction ….any area of your life your think needs to change ????? a. There's nothing that I really need to change. b. I really think I should work at it. c. I am really working hard to change. d. I may need a boost right now to help me maintain the changes I've already made. I related the question back directly to the original questions and have set up the responses to all coordinate with this the same indicator/ answer key: Answer choice (A) – Precontemplation Stage Answer choice (B) - Contemplation Stage Answer choice (C) - Action Stage Answer choice (D) - Maintenance Stage

65 WELNESS PROFILE INITIATIVE Please let me know what you think and if you have any feedback that would be greatly appreciated! Thanks, Brenna Hi there, I made some comments , no sure if they are helpful or if this is what you are looking for?? Regarding your first question: Uhmmm, someone who drinks excessively will love those questions ….because a drink to them is not the same as a drink to most people …5 oz of wine 1.5 oz of hard liquor etc…. Ex: yes I take 2 drinks a day which equal 1 bottle of wine ….denial is part of this disease…..what about the most common drug after alcohol?….narcotics…. I am not sure where the question of alcohol would fit ? The best questionnaire which is most often use is call C.A.G.E. (4 questions) C: Cut …have you ever tried to cut down on your usage? A: Annoyed …is anyone annoyed by your usage? G: Guilty …do you ever feel guilty about your usage? E : Eye opener…do you have to take a drink/drug first thing in the morning to get rid of a hangover or to stop the shakes? Last question, In terms of feeling depressed or anxious affecting your social activities: a.

There's nothing that I really need to change.

I really think I should work at it.

I am really working hard to change.

66 WELNESS PROFILE INITIATIVE d.

I may need a boost right now to help me maintain the changes I've already

made. it’s a bit redundant …I would go more general …in terms of life satisfaction ….any area of your life your think needs to change ?????

Thanks Chantal for your feedback, I have added in the drink quantities like you suggested. Unfortunately, we have decided to remove the drug questions from the survey because we anticipate implications with union and ethics. We are also playing it safe with the alcohol questions. I will see what I can do to incorporate the C.A.G.E. questionnaire into the survey. Lastly, I have changed the last question to reflect your suggestion and used "life satisfaction". I agree that sounds better! Thanks again, Brenna

Communication between Jenna Boomer and Brenna Hi Brenna, Good afternoon. I’m sorry for the delay in getting back to you. Please take a look at the link and let me know if this will work for you: http://www.stevens.ca/generic.htm?ECINFO=PREVU Thanks, Jenna

Hi Jenna,

67 WELNESS PROFILE INITIATIVE This looks great! Can you provide us with a quote for 10 machines plus the accessories? Thanks so much, Brenna

Hi Brenna, Good morning. Please see the attached quote from Stevens. Please let me know if you have any questions. Thanks, Jenna

Communication between Scott Dolliver and Brenna Hi Scott, I have just about all of the IP addresses for those who will be attending the net meeting this afternoon at 1pm (just waiting on one more). I am wondering what the next step is to set up the net meeting. Do I have to input the IP address into the system? Also, is it possible to test run my PowerPoint do I first have to upload it? I just want to be clear on how things work as I do not want to run into any technical problems. Thanks, Brenna

Hello Brennaâ&#x20AC;Ś please call the number below and we can get this setup for you and do a trial with me Scott Dolliver

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Communications between Angela Smith Hi Angela Expert on Forms! If I am developing new forms for use within Employee Health do they need to go to the Forms Committee? The second part of the question is if we are developing our own Health Risk Assessment form for distribution by Employee Health does it need to go through the process (maybe after it is validated???) Thanks Marilyn

Communications between Angela Lawson Angela, Here are the most important documents: 1.) PowerPoint for employee health nurses part 1 2. ) PowerPoint for employee health nurses part 2 3.) Standard operating practice (SOP) 4.) Physical Health Profile 5.) Employee Wellness Survey 6.) Immunization form I will most definitely provide you with my final report on Friday! If I find more I will email you more files :) Chat soon,

69 WELNESS PROFILE INITIATIVE Brenna P.S. I am so excited for you to take this farther than I ever could in my 14 weeks! Thank you

Hi Brenna and Marilyn: Here is another possible “presentation” for the survey. I tried to keep with the Horizon Brand Standards which makes it difficult to really make too pretty. There isn’t much different from Brenna’s original, just a slightly different format. Thank You Regards Angela Lawson

Hi Brenna, I’ve been working more on the survey as I am concerned with the response rate that we would get in the facility as it is lengthy. It was tough to decide which pieces to take out but I was attempting to have it fit on 2 pages (double sided) and significantly shorten the amount of reading that needed to be done by employees. I have reviewed several survey’s in existence inside the facilities and it seems as though most are trying to stick with 1-2 pages. Since the information that is being gathered is so valuable, it was hard to reduce it that far! Attached is what I have managed to reduce it down to. Thank You Regards Angela Lawson

70 WELNESS PROFILE INITIATIVE Hi Angela, Sorry I have been out of the office since Monday mid-morning so I am late responding. I have looked at the form and your right there's not much we can do to make it "pretty" but I like what you've done with it. Also I realize that the length of the survey would be an issue that would impact participation rates I had a look over the shortened version and think it has not decreased it's effectiveness because you have kept the essentials (4 pillars of wellness, Transtheoretical model- stages of change and the interests and availability). I think it will be more successfully implemented by using the shortened version especially without incentives for employees to complete and return the surveys. Perhaps when it is on skyline we can offer employees the option of the short and long version. I am hard at work trying to write my final paper due Friday and I am writing it with you in mind so that I give you a very detailed account of what I have done up until this point. I look forward to seeing you at my presentation tomorrow! Brenna

Communications between Employee Health Nurses Hi Patsy, Would you have time to have a meeting to discuss the project I am working on again? It should only take 30 minutes. When ever time you are available is good. The meeting can be in my office. Just let me know a time. Thanks so much, Brenna

71 WELNESS PROFILE INITIATIVE Is 1300 OK then? Patsy

Hi Patsy, Attached is the most recent draft of the employee health profile. Feel free to make changes or comments directly on the word document. Thank you for taking the time to look at this and providing your feedback. Brenna

Dear Employee Health Nurse, My name is Brenna Coles, I am a fourth year Health Promotion student at Dalhousie University. I am completing my internship at the Moncton Hospital with Marilyn Babineau. Over the course of my 14 week internship, I will be developing a new process for the new employees of Horizon Health. This form will be replacing the physician's form required by new employees. I have attached a copy to this email and I am looking for individual feedback. Please have your comments back to me by 4:00PM Friday, March 15. Thank you, Brenna

72 WELNESS PROFILE INITIATIVE Marilyn I will be sending out a complete package to each of you with the Standard Operating Practice, New Employee Immunization form and the Physical Profile form. Also, I have asked Marilyn to have the Standard Operating Practice on the agenda for the next teleconference so we can discuss further. If anyone was unable to attend the teleconference today but would like to discuss this with me please contact me anytime as I would be happy to do so! Again, thank you very much for your questions and comments. I realize that communication and consultation is an extremely important step and it will also ensure successful implementation! Sincerely, Brenna

Very good work Brenna. It is obvious that you have put a lot of work into this. Edie

Thanks for all your work on this Brenna. We look forward to seeing the next draft! Anne

Brenna You have done a ton of work here for us â&#x20AC;&#x201C; awesome. It is exciting to see progress in this direction. It is what I was interested in when I became an employee health nurse and so exciting to think we are heading there. Edie

Hello Everyone,

73 WELNESS PROFILE INITIATIVE As promised I have compiled the 3 important documents that we have been discussing which are: the Physical Health Profile, Standard Operating Practice and the Employee Wellness Survey. Please remember that these are drafts. The majority of the next teleconference will be spent discussing. Please have your comments and feedback prepared prior to the teleconference on April 9th. By the end of the teleconference we will have finalized the 3 documents so that I can send them for final approval. Agenda for April 9th teleconference 10 minutes on Physical health profile 10 minutes Standard Operating Practice 30 minutes on the Wellness Survey 10 minutes on next steps and updates from Marilyn Thank you very much for your continued support and collaboration! Regards, Brenna

Hi everyone, I wanted to share my thought on the Immunization form: I still think that we should have Td included as all the standards are saying one adult dose of Tdap, even though that is what we are currently providing. Also in the sections re MMR & Varicella, I think it should read “OR” after the 2nd date and before titre. In the section for TB testing I think under the “if required: CXR that there should be another space to say IGRA date & results as well.

74 WELNESS PROFILE INITIATIVE Beast regards to everyone, Deena

Hi Ladies I thought I would reply to all on the email from Deena with her comments regarding the immunization form. This form was adapted from the one we have been successfully using for student immunization requirements when doing a placement within Horizon, I only changed the title and the layout based on the feedback from the clerical staff in Human Resources, who wanted a two page form. The policy for immunization of new employees and students is that we require a dose of Tdap in the past five years, at this time I am not willing to change this practice so we will leave Td off the form. I again looked at the MMR and Varicella sections and we are providing guidance to the physician or Nurse Practitioner as to the test requirements based on age and childhood disease history plus serology. In regards to your concerns re TB testing all we need is to know if the test was negative or positive and if they were positive the MD/NP will follow through as they would with anyone regarding a positive TB test. I have discussed the IGRA testing when we were expecting the shortage and at that time this test was not recommended for routine use. I would expect the health care provider to use their expertise in determining next steps when faced with positive testing. Thanks for your comments Deena Have a great day everyone~

75 WELNESS PROFILE INITIATIVE Marilyn

Hi Ladies I thought I would reply to all on the email from Deena with her comments regarding the immunization form. This form was adapted from the one we have been successfully using for student immunization requirements when doing a placement within Horizon, I only changed the title and the layout based on the feedback from the clerical staff in Human Resources, who wanted a two page form. The policy for immunization of new employees and students is that we require a dose of Tdap in the past five years, at this time I am not willing to change this practice so we will leave Td off the form. Yes, I agree if they have not had an adult dose, but I don’t think we should ignore their past history of Td vaccine, as it is a vaccine, so I think it should be included in their record…and that it is included in their Immunization record on Access. I again looked at the MMR and Varicella sections and we are providing guidance to the physician or Nurse Practitioner as to the test requirements based on age and childhood disease history plus serology. I am wondering if I am confused re the purpose of this form, I understand it being the way it is if it is for students, but is it going to be given to every job applicant before they are hired…or after they have accepted a position with Horizon? So many new employees do not have access to a family MD or have a clue where and how to look for old records. I was under the impression that this is the recommended form that we will all be using for new employees on hire…if so then I think it needs to be clearer.

76 WELNESS PROFILE INITIATIVE In regards to your concerns re TB testing all we need is to know if the test was negative or positive and if they were positive the MD/NP will follow through as they would with anyone regarding a positive TB test. I have discussed the IGRA testing when we were expecting the shortage and at that time this test was not recommended for routine use. I would expect the health care provider to use their expertise in determining next steps when faced with positive testing. Yes, I understand that we do not use IGRA for routine testing, however if we have a positive TST result and do the CXR, we always follow up with a MD and request the IGRA to be done…I just thought having the space to include that info in the same spot on the chart would be helpful. Thanks for your comments Deena You are welcome Marilyn, I am not trying to be difficult, I’m just trying to work through the process and the time to address things is now before it gets set in stone. It’s unfortunate in the timing of my surgery as I was really looking forward to us all getting together as a working group to work through some of this stuff. Have a great day everyone~ Marilyn Have a great w/e Marilyn, hope the sun is out there as well! Deena

Hi, here are my quick notes which I will try to finish today. Physical Health Profile •

Please add “Date of profile” beside name in general information

•

SIN will remain on, zones that do not use it can leave it blank

77 WELNESS PROFILE INITIATIVE •

BMI formula will be built into database when height & weight entered

•

Typo under history of skin condition: aggravate should be aggravated & ei should be i.e.

•

Add tick off boxes for all items under 3 categories on page 2

•

Query: is there a standard package to give to employees if risks are identified? Answer from Brenna: no this is early stage with short term goals? On line tool kit on skyline will be available at some time in future. I think this needs a more solid footing before intiation!

•

Typo under Respiratory Risk, 3rd bullet, delete the e off “breath”

•

Under N95 fit testing, please add line: If previous testing please indicate date _____________ & respirator fitted __________________

SOP New Hire Wellness •

Delete sentence under purpose/principle: Failure to have these forms completed will delay the employment process. Instead add a statement after “complete physical health profile” which says something like “Failure to complete the profile/immunizations through Employee Health Services within 30 days of hire will result in the notification of Human Resources for further actions” This actually means that their pay will be held until all screening aspects have been completed but that may differ from zone to zone so this generic statement hopefully will meet everyone’s needs.

•

Under process, 7th bullet: Check contributing risk factors for cardiovascular disease, lung disease, and diabetes. Please add: “If risk factors are identified, the Employee Health Nurse will review strategies and information that may help reduce these personal risks.” I think that is pretty generic & leaves it open as to discussion or providing written information or referring to a health care provider if they have one, etc.

78 WELNESS PROFILE INITIATIVE Immunization Form •

Under Tuberculosis, I would change “if required” to “if test is positive”. Keep the CXR and results. Add IGRA and results.

The reference is the Canadian Tuberculosis Standards, 6th Edition (2007) which is a PHAC document. Pages 393-396 discuss IGRA in more detail. The IGRA does not replace the TST and is only used if the TST is positive. It is recommended for contact of a case of active infectious TB or low risk persons with a positive TST result (such as health care workers). A positive test may be indicative of a latent TB infection (LTBI) which should be treated with 6-9 months of INH. However a TST can be positive for other reasons such as previous BCG vaccination, false positive, previous exposure, etc. The IGRA is the only way to determine the LTBI status. If the IGRA is negative, no further treatment is required. A chest x-ray is very limited as it will only show abnormal results if the TB is quite advanced. We do follow up on employees with positive TB tests to ensure they have seen a health care provider & document the outcomes, such as IGRA, IHN therapy, etc. in zone 3. We need to do this to ensure employee and patient safety. Employee Wellness Survey I have no specific suggestions regarding content but this needs to be linked somehow with information for the employee to access at the time of completion as that is the ideal learning moment. Thanks, Anne

Hi Anne,

79 WELNESS PROFILE INITIATIVE Thank you for offering to draft a statement to be added into the Standard Operating Practice document. I was also wondering if you could forward along that employee health services brochure you had mentioned. I would love an electronic copy. Also with regards to the immunization form- TB. Is this what you had in mind? Step 1 Date planted: Date of results: mm of induration: Step 2 Date planted: Date of results: mm of induration: If required: Date of chest x-ray Results: If positive: IGRA: Results: All I require is the reference so I can add it in to my proposal. Thanks, Brenna

80 WELNESS PROFILE INITIATIVE Hi, I have reviewed your newest attachments and there are still two missing revisions as below. Please resend these 2 documents once changes are made. Thanks so much, Anne

Hi Anne, I looked at the documents I attached to the email sent last week. I did make the changes to the Physical Health Profile. Here is what it looks like: Fredericton area: N95 Mask Fit testing:

Yes

Date fitted: _______________ Respirator fitted: ______________ If no, appointment: _________________ In regards to the TB section, I had made the changes as suggested but with further discussions and after I proposed it to Marilyn it was decided not to include it as it is not necessary. Brenna

Hi ladies, the IGRA is necessary. Please refer to the TB standards for Canada. Anne

Brenna, The Health Profile looks great but I would also want a place for Social Insurance number, recent address with phone number, next of kin, and department they will be working. Anne Price

Hi Brenna,

81 WELNESS PROFILE INITIATIVE Deena & I have taken a few minutes to review today. Lola & Karen, you may have other things to add so I have copied you in. General information: please add Date on Staff, Address, Work Area/Unit, Job Classification, Phone numbers (home & cell) & e-mail (home if they do not have e-mail at work which is almost all nursing staff) Physical Screening – BMI (delete or add formula), we have a glucometer but no cholesterol test kits so unless it is the plan for us all to have these machines/test stripes, I would delete this. However you do need to add under laboratory testing: Anti-HBS, Rubella IGG, Rubeola IGG, & Varicella IGG, if required. Health Care History – delete question regarding last physical exam. Since we do not have access to this, it is useless information for us to gather. Cardio/Respiratory/Diabetes Risk: Please add tick off boxes or some way of employee checking off what is appropriate. Add Asthma to Respiratory risk. Bigger question is what do we plan to do with this information? Employees feel bad about themselves when “short comings” are identified. It gives us an educational opportunity but if we are identifying risks, what is the plan to address the risks? In other words, is this a risk assessment leading into a formal intervention program? If not, then do not ask the questions. Immunization form complete – what does this draft look like? Please add: N95 respirator testing in past 2 years ___ yes

____ no

If yes, please indicate respirator manufacturer/number fitted: ____________ If no, appointment for fit testing booked on: ____________________

82 WELNESS PROFILE INITIATIVE Add section on TST testing as most employees have not had TST in past 12 months. This may already be part of the immunization form so it would be useful for us to review that as well before proceeding. Thanks for all your hard work on this Brenna! Anne & Deena Thanks Anne. Your comments covers all of my comments except on. Under History of skin condition I would add a, If yes , please explain and define conditions which aggravate ( eg. Frequent hand washing/wearing gloves/specific products) ( something like that)) Thanks. Karen

Hi Karen, I realize you are working out of the office today (March 19) so I thought I would send this email regarding setup for tomorrow's webinar from 1:00-1:30. I require your IP address to you computer. Although it looks like a lot of steps it only should take 5 minutes or so to retrieve this information. Windows Net Meeting Setup 1. Click on the windows “Start” button 2. Click on the “Run” button 3. Type “conf” in the text field and then click “OK” 4. Net Meeting setup/configuration will start (for those who have already done this, it will automatically open to the Net Meeting window and you can jump to the “Get IP Address” instructions) 5. Click “Next”

83 WELNESS PROFILE INITIATIVE 6. You only have to fill in the “First Name” field in full, then simply place any letter in the “Last Name” and “Email” field and then click “Next” 7. Please select the “Do not list my name in the directory” option from this next screen and then click “Next” 8. The speed of our connections is “Cable/XDSL”, select this and then click “Next” 9. You can place a shortcut on your desktop, but DO NOT include the “Quick Launch” option... click “Next” 10. The rest is just audio setup, which is not generally used, so just continue to click “Next” until the final window appears and shows “Finish” 11. Net Meeting will now start and the status window will open. Get IP Address 1. While leaving the Net Meeting window open, click the “Start” button 2. Click on the “Run” button 3. Type “cmd” in the text field and then click “OK”… this opens a DOS Command Prompt window 4. Type the following “ipconfig”, and then hit “Enter” 5. Go to the “Ethernet Adapter Local Area Connections” section and find the line that says “IP Address…” 6. Write down or e-mail this number, including “.” to the host of the Net Meeting session. (Example IP is 10.7.16.66, and will vary for every machine) Please email me your IP address no later than 11:00AM tomorrow morning. If you have any questions please contact me. Brenna

84 WELNESS PROFILE INITIATIVE

Hello Brenna, Today I am out of office working at another facility. Iâ&#x20AC;&#x2122;ll be back at my regular computer tomorrow morning so I will follow these instructions first thing in the am. Karen Hi Brenna, I will send you the IP address in the morning. The computer that the nurses will be using is locked as Pat Bannan has left for the day. Thanks Lori Mason

Employee Health Nurses, I wanted to thank you for your participation in the teleconference. I appreciate the feedback you have provided and I will incorporate your suggestions in future drafts. Although, the Standard Operating Practice is still in the early stages of development I am working hard to have it move to the next step. Once I complete my final recommendations and present to my professor and Marilyn I will be sending out a complete package to each of you with the Standard Operating Practice, New Employee Immunization form and the Physical Profile form. Also, I have asked Marilyn to have the Standard Operating Practice on the agenda for the next teleconference so we can discuss further. If anyone was unable to attend the teleconference today but would like to discuss this with me please contact me anytime as I would be happy to do so!

85 WELNESS PROFILE INITIATIVE Again, thank you very much for your questions and comments. I realize that communication and consultation is an extremely important step and it will also ensure successful implementation! Sincerely, Brenna

Hi Anne, I have taken all of the feedback and made the appropriate changes to the 3 documents. Marilyn is back today and have a meeting scheduled with her to discuss the comments made during the teleconference. I will be in touch with all of the Employee Health Nurses. Take care, Brenna

Thanks for all your work on this Brenna. We look forward to seeing the next draft! Anne

Very good work Brenna. It is obvious that you have put a lot of work into this. Edie

Edie, This is so comforting to hear! I too am very excited about the direction of where employee health services is moving. I strongly support taking a more proactive, preventative approach as that is the essence of health promotion! I feel privileged to help implement the new Employee Wellness Strategy as I know it will have a great long term impact! I am very glad you are as passionate about this as I am!

86 WELNESS PROFILE INITIATIVE Brenna

Sorry I missed your presentation but this looks great. Anne Price RN

Dear Employee Health Nurses, I had the opportunity to presented the drafts of the Physical Health Profile, Standard Operating Practice, Employee Wellness Survey and the Immunization Form to Marilyn. These drafts were with the changes made to them from our discussion on April 9th. Once again I would like to show you the revised draft and let you know that Marilyn is to get final approval from Karen MacDonald. This is a very exciting and I am pleased to have brought it to this step. I will be in contact next week. Enjoy your weekend! Cheers, Brenna

Hi, I have reviewed your newest attachments and there are still two missing revisions as below. Please resend these 2 documents once changes are made. Thanks so much, Anne

Here's a response to Anne, Please let me know if I should change my wording: Hi Anne, I looked at the documents I attached to the email sent last week. I did make the changes to the Physical Health Profile. Here is what it looks like:

87 WELNESS PROFILE INITIATIVE Fredericton area: N95 Mask Fit testing:

Yes

Appendix P

88 WELNESS PROFILE INITIATIVE

National Quality Institute: Healthy workplace model (Province of Nova Scotia, 2012).

Appendix Q World Hypertension day poster

89 WELNESS PROFILE INITIATIVE

Appendix R Measures and indicators Do you have a family physician? Yes No Indicator: No Overall Health In your opinion, would you say your health isâ&#x20AC;Ś Excellent Very good Good Fair Poor Indicator: Fair, Poor Identify your own health view: I am as healthy as anybody I know I seem to get sick a little easier than other people I expect my health to get worse

90 WELNESS PROFILE INITIATIVE I have a serious health problem Indicator: I expect my health to get worse, I have serious health problems In general, how satisfied are you with your overall health? Mostly satisfied Partly satisfied Mostly dissatisfied Not sure Indicator: Mostly dissatisfied, not sure Physical activity In general, would you say your physical health isâ&#x20AC;Ś Excellent Very good Good Fair Poor Indicator: Fair, Poor In the past month, how often do you participate in moderate physical activities? (i.e. walking at a brisk pace, dancing, leisurely bicycling, roller skating, canoeing, golfing, softball, badminton, downhill skiing, pushing a power lawn mower, gardening, shovelling light snow, moderate housework, hand washing/waxing a car, actively playing with children) Less than once per week At least once per week 2-4 times per week 5 or more times per week In the past month, how often do you participate in vigorous physical activities(i.e. jogging, running, bicycling fast or uphill, jumping rope, swimming continuous laps, singles tennis, beach volleyball on sand, basketball game, soccer, cross-country skiing, carrying items weighing 25 pounds or more up a flight of stairs) Less than once per week At least once per week 2-4 times per week 5 or more times per week Indicator: Less than once per week, At least once per week In the past month, how often do you do participate in muscle and bone strengthening activities? (i.e. walking, jogging, basketball, soccer, dancing, jumping rope) Never Once per week Twice per week

91 WELNESS PROFILE INITIATIVE More than twice per week Indicator: Never, Once per week In the past month, to what extent has your physical health interfered with your normal social activities? None at all Slightly Moderately Quite a bit Extremely Indicator: Quite a bit, Extremely In the past year, which best describes your desire to increase your level of participation in physical activities? I haven’t thought about increase my level of participation in physical activities I plan to increase my level of participation in physical activities I recently started (last 6 months) to increase my level of participation in physical activities I already participate in daily physical activity (more than 6 months) Indicator: Pre-contemplation: I haven’t thought about increase my level of participation in physical activities Contemplation/ preparation I plan to increase my level of participation in physical activities Action stage: I recently started (last 6 months) to increase my level of participation in physical activities Maintenance: I already participate in daily physical activity (more than 6 months) Nutrition and Weight In the past month, how many servings per day did you get of fruits and vegetables? 1 or fewer servings per day 2-3 servings per day 4-6 servings per day 7 or more servings per day Indicator: 1 or fewer servings per day, 2-3 servings per day In the past year, which best describes your desire to improve your nutritional habits? I haven’t thought about changing my nutritional habits I plan to change my nutritional habits in the next 6 months I plan to change my nutritional habits this month I recently started (last 6 months) to improve my nutritional habits I already have healthy nutritional habits (more than 6 months) Indicator:

92 WELNESS PROFILE INITIATIVE Pre-contemplation: I haven’t thought about changing my nutritional habits Contemplation:I plan to change my nutritional habits in the next 6 months Preparation: I plan to change my nutritional habits this month Action stage: I recently started (last 6 months) to improve my nutritional habits Maintenance/ not applicable: I already have healthy nutritional habits (more than 6 months) In the past year, which best describes your desire to lose weight? I haven’t thought about losing weight within the next 6 months I plan to lose weight within the next 6 months I plan to lose weight within the next 30 days I recently have taken some steps to lose weight (last 6 months) I have already lost weight within the past 6 months I have lost weight in more than 6 months ago and I am maintaining a healthier weight. I already maintain a healthy weight Indicator: Pre-contemplation: I haven’t thought about losing weight within the next 6 months Contemplation: I plan to lose weight within the next 6 months Preparation: I plan to lose weight within the next 30 days Action stage: I recently have taken some steps to lose weight (last 6 months) Maintenance: I have lost weight in more than 6 months ago and I am maintaining a healthier weight. Not applicable: I already maintain a healthy weight Smoking Do you smoke? No Cigarettes Cigars/pipe Indicator: Cigarettes, Cigars/pipe Did you smoke in the past? No Cigarettes Cigars/pipe Indicator: Cigarettes, Cigars/pipe How long ago did you stop smoking? Indicator: Less than 6 months ago How much do (did) you smoke each day?

_______months _______years

93 WELNESS PROFILE INITIATIVE 40 or more cigarettes 20-39 cigarettes 10-19 cigarettes 1-9 cigarettes 5 or more cigars or pipes (inhaled) Less than 5 cigars or pipes (inhaled) 5 or more cigars or pipes (not inhaled) Less than 5 cigars or pipes (not inhaled)

In the past year, which best describes your desire to quit smoking? I haven’t thought about quitting smoking I plan to quit smoking in the next 6 months I plan to quit smoking this month, I recently quit smoking (last 6 months) I have already quit smoking (more than 6 months) I have never smoked Indicator: Pre-contemplation: I haven’t thought about quitting smoking Contemplation: I plan to quit smoking in the next 6 months Preparation: I plan to quit smoking this month, Action stage: I recently quit smoking (last 6 months) Maintenance: I have already quit smoking (more than 6 months) Not applicable: I have never smoked Mental Fitness In the past month, how many days would you say you were stressed? 0-5 days 6-12 days 13- 21 days 22-31 days Indictor: 13-21 days, 22-31 days In the past 12 months, would you say that most days were… Not at all stressful Somewhat stressful Quite stressful Extremely stressful Indictor: Quite stressful, extremely stressful

94 WELNESS PROFILE INITIATIVE In the past year, have you attempted to reduce the amount of stress in your daily life? I havenâ&#x20AC;&#x2122;t thought about reducing the amount of stress in my daily life I plan to reduce the amount of stress in my daily life my in the next 6 months. I plan to reduce the amount of stress in my daily life this month I recently reduced the amount of stress in my daily life I have a moderate level stress in my daily life that is reasonably tolerable. Indictor: Pre-contemplation: I havenâ&#x20AC;&#x2122;t thought about reducing the amount of stress in my daily life Contemplation: I plan to reduce the amount of stress in my daily life my in the next 6 months. Preparation: I plan to reduce the amount of stress in my daily life this month Action stage: I recently reduced the amount of stress in my daily life Maintenance/ not applicable: I have a moderate level stress in my daily life that is reasonably tolerable. In the past month, how well do you feel you are coping with the demands of your personal life? Coping very well Coping fairly well Trouble coping at times Often have trouble coping Feel unable to cope anymore Indicator: Often have trouble coping, Feel unable to cope anymore In the past month, how well do you feel you are coping with the demands of your work life? Coping very well Coping fairly well Trouble coping at times Often have trouble coping Feel unable to cope anymore Indicator: Often have trouble coping, Feel unable to cope anymore In terms of your current coping skills: There's nothing that I really need to change I really think I should work at it I am really working hard to change I may need a boost right now to help me maintain the changes I've already made. Indictor: Pre-contemplation: There's nothing that I really need to change Contemplation/ preparation: I really think I should work at it Action stage: I am really working hard to change

95 WELNESS PROFILE INITIATIVE Maintenance/ not applicable: I may need a boost right now to help me maintain the changes I've already made. In the past month, have you experienced any of the following? (Check all that apply) Minor problems throw me for a loop I find it difficult to get along with people I used to enjoy Nothing seems to give me pleasure anymore I am unable to stop thinking about my problems I feel frustrated, impatient or angry much of the time I feel tense and anxious much of the time None of the above Indicator: Three or more (except none of the above) In the past month, to what extent have you accomplished less than you would like in your daily activities due to feeling depressed or anxious? None at all Slightly Moderately Quite a bit Extremely Indicator: Quite a bit, Extremely In terms of feeling depressed or anxious: There's nothing that I really need to change I really think I should work at it. I am really working hard to change. I may need a boost right now to help me maintain the changes I've already made. Indicator: Pre-contemplation: There's nothing that I really need to change Contemplation/ preparation: I really think I should work at it Action stage: I am really working hard to change Maintenance/ not applicable: I may need a boost right now to help me maintain the changes I've already made. In the past month, to what extent have your emotional problems interfered with your normal social activities? None at all Slightly Moderately Quite a bit Extremely

96 WELNESS PROFILE INITIATIVE Indicator: Quite a bit, Extremely In terms of life satisfaction, are there any areas of your life you need to change? There's nothing that I really need to change I really think I should work at it I am really working hard to change I may need a boost right now to help me maintain the changes I've already made. Indicator: Pre-contemplation: There's nothing that I really need to change Contemplation/ preparation: I really think I should work at it Action stage: I am really working hard to change Maintenance/ not applicable: I may need a boost right now to help me maintain the changes I've already made. Do you have friends/family with which you can share problems with? Yes No Indicator: No If yes, would you be able to get help from friends/family if needed? Yes No Indicator: No Alcohol Intake In a typical week, how many alcoholic beverages would you drink? (1 drink is 550ml (11.5 oz) beer, 150ml (5oz) wine, or 50ml (1.5oz) liquor). 0- 7 drinks per week/ averaging one drink per day 8- 14 drinks per week/ averaging 2 drinks per day 15- 21 drinks per week/ averaging 3 drinks per day More than 21 drinks per week/ averaging 4 or more drinks per day Indicator: More than 21 drinks per week. averaging 4 or more drinks per day In the past year, which best describes your desire change your alcohol intake? I havenâ&#x20AC;&#x2122;t thought about changing my alcohol intake I plan to change my alcohol intake in the next 6 months I plan to change my alcohol intake this month I recently changed my alcohol intake I already drink in moderation

97 WELNESS PROFILE INITIATIVE I do not drink alcohol Indictor: Pre-contemplation: I havenâ&#x20AC;&#x2122;t thought about changing my alcohol intake Contemplation: I plan to change my alcohol intake in the next 6 months Preparation: I plan to change my alcohol intake this month Action stage: I recently changed my alcohol intake Maintenance: I already drink in moderation Not applicable: I do not drink alcohol Sleep In the past month, how often did you get 7-8 hours of sleep? Always Most of the time Less than half the time Seldom or never Indictor: Less than half the time, Seldom or never In the past month, how often did you have trouble sleeping? More than once a week Once per week or less Never Indictor: More than once per week Does your position require rotating shifts beyond 8 hour days? Yes No Indictor: Yes If you do shift work, how are you coping with the change in sleep patterns? Coping very well Coping fairly well Trouble coping at times Often have trouble coping Indictor: Trouble coping at times, Often have trouble coping

98 WELNESS PROFILE INITIATIVE

Appendix S

World Health Organization: Healthy workplace model (Burton, 2010).