Tradition of Excellence

Agricultural Health Nursing

AGRONURSING
Tantut Susanto, M.Kep., Ns. Sp.Kep.Kom., Ph.D
Departemen Keperawatan Komunitas, Keluarga, dan Gerontik
Fakultas Keperawatan
Universitas Jember

Seminar dan Bedah Buku Agronursing di Kampus D3 Keperawatan Universitas Jember di Lumajang, 15 September 2019
Content Tradition of Excellence

• Literature review agricultural health nursing

• Concept analysis of “agronursing”
• Application of agronursing research
 Tradition of Excellence

INDONESIA

KAYA
Potensi Alam Indonesia
Tradition of Excellence

• Berada di jalur khatulistiwa, Nusantara diberkahi limpahan sinar

matahari dan curah hujan yang tinggi.
• Perbedaan suhu yang tidak terlalu ekstrim di antara dua musim
memudahkan segala jenis tanaman dapat tumbuh subur.
• Ditambah lagi, abu gunung api yang kerap menyembur menjamin
pasokan hara tanah tetap terjaga.
• Berbagai tanaman komersial seperti kopi, teh, kakao, karet, tembakau,
kelapa sawit, serta tanaman pangan seperti padi, jagung, ubi-ubian, dan
buah-buahan tumbuh subur di negeri laksana zamrud khatulistiwa ini.

BPS (2013). Potensi Pertanian Indonesia: Analisis Hasil Pencacahan Lengkap Sensus Pertanian 2013
Agricultural Area Tradition of Excellence

Pertanian

Perkebunan

Peternakan

Perikanan
Farming
Tradition of Excellence
Indonesia Farming
Tradition of Excellence
Profil Rumah Tangga Pertanian
Tradition of Excellence

Hasil Survei Pertanian Sensus 2018

Tradition of Excellence
Tradition of Excellence
Tradition of Excellence
 Tradition of Excellence

Geografi Pertanian: Revolusi Pertanian.

https://www.google.com/search?q=kesehatan+petani+indonesia+ppt&safe=strict&client=safari&channel=mac_bm&sxsrf=ACYBGNRyCNF3ouX9s5aRuqYqs2c7k3pRAA:156816850961
9&source=lnms&sa=X&ved=0ahUKEwj6z9r32sfkAhWVb30KHdCIDr4Q_AUIDCgA&biw=1440&bih=837&dpr=1#
 Penggunaan Pupuk
Kimia Mikro organisme / Biota
Tradition of Excellence
tanah Teracuni

Tanah Mengeras
Kesuburan tanah menurun

Tanah Menjadi Kering

Produktifitas menurun
Keseimbangan alam terganggu
Kerusakan lingkungan

Geografi Pertanian: Revolusi Pertanian.

https://www.google.com/search?q=kesehatan+petani+indonesia+ppt&safe=strict&client=safari&channel=mac_bm&sxsrf=ACYBGNRyCNF3ouX9s5aRuqYqs2c7k3pRAA:156816850961
9&source=lnms&sa=X&ved=0ahUKEwj6z9r32sfkAhWVb30KHdCIDr4Q_AUIDCgA&biw=1440&bih=837&dpr=1#
Kenapa petani perlu diberikan layanan keperawatan
Tradition of Excellence
Risk Assessment

Biol
ogig Social
Theory Paradigm
al
Agricultur
Psycholog Econ Nursing
ical omic processes
al Health Curriculum
Competenci
es
Life Nursing
even Cultural
t Roles
Agricultural Health Nursing Tradition of Excellence

PHN OHN AHN

Agricultural health nursing Tradition of Excellence

• The agricultural health nurse role draws from both occupational

health nursing and public health nursing (Randolph, 1993).
• Thus , the job functions and competencies identified by current
agricultural health nurses should be consistent with professional
guidelines of these two nurse specialties.
Agricultural Health: A New Field of Occupational Health Nursing
Tradition of Excellence
Agriculture remains one of the most dangerous industries in America. To serve this worker
population, agricultural health is emerging as a new nursing specialty in which nurses can use
their vision to establish new areas of practice.

Nurses who are a member of the farming audience can be effective agents of change because
they know the audience in a personal way.

To establish a new agricultural nursing specialty, one must overcome obstacles including
uncertain funding, a rapidly changing work environment, worker preference for independent
decision making, and no existing standards to guide the process.

Using the early adopters of new ideas in a community

Fleming MJ. AAOHNJOURNAL. 2004;52(9): 391-396

17 Public Health Nursing Interventions Tradition of Excellence

1. Advocacy. 11. Outreach or case finding.

2. Case management. 12. Policy development.
3. Coalition building. 13. Provider education.
4. Collaboration. 14. Referral and follow up.
5. Community organizing. 15. Screening.
6. Consultation. 16. Social marketing.
7. Counseling. 17. Surveillance.
8. Delegated medical treatment
and observations.
9. Disease investigation.
10. Health teaching.
Keller (1998)
57 of Competencies PHN were considered essential to
nursing leadership in public health (Misener, 1997) Tradition of Excellence
• Political competencies.
• Business acumen.
• Program leadership.
• Management capabilities.
Promotional information (AgriSafe Occupational Health, 1997)
Tradition of Excellence
• Occupational health physical examinations and screenings.
• Health education and health promotion programs.
• Personal protective equipment education, fit testing, and sales.
• On site farm health hazard and environmental quality testing.
• Comprehensive injury and disease prevention programs.
• Farm safety day camps.
• Mobile clinics.
• Referral services.
Six task/activity statements essential to the certified occupational
health nurse role (Burgel, 1997) Tradition of Excellence

• Document provision of care in the employee health record.

• Use a computer.
• Provide treatment of work related injuries and illnesses.
• Develop a system of employee health records.
• Perform case management activities.
• Manage a workers' compensation program.
Farming is multiple risks in all the categories of hazards
Tradition of Excellence

Chemical-fertilizer, insecticides.

Biological/infectious-fungus, molds, and infections from animals and

soils.

Physical-heat, cold, noise, and sun exposure.

Environmental/mechanical-slippery floors, unsafe equipment.

Psychosocial hazards-stress associated with weather and crop failures.

Lusk SL. 1998. AAOHN JOURNAL;46(90): 465-468

Agricultural Occupational Health Nursing Training Program Curriculum
Tradition of Excellence
1. An overview of rural health and agrimedicine .
2. An overview of occupational health nursing and its application to agriculture.
3. Education and demonstration of general and certain agriculture specific assessment and physical
examination skills.
4. Methods in providing individual health promotion and education to farm family members.
5. Agricultural respiratory diseases (includes certification in spirometry testing).
6. Agricultural auditory alterations (includes certification as an occupational hearing
conservationist).
7. Agricultural dermatological diseases.
8. Agricultural musculoskeletal diseases .
9. General health issues affecting numerous systems including toxicology, cancer, and zoonoses.
10. Agricultural injuries and safety training.
11. Agricultural illness and injury control and prevention.
12. Optional curriculum in developing and implementing a plan for an agricultural health and safety
clinic and an overview of marketing strategies.
Job Functions of Agricultural Health Nurses (n - 24) Ranked by Mean Task
Index, 1998 Tradition of Excellence
1. Serve as a liaison between the agricultural, health and medical, and nonfarm communities.
2. Promote agricultural health and safety issues to agricultural and nonagricultural communities
through the media, newsletters, and newspapers.
3. Implement educational course for various groups (e.g., health care professionals, agricultural
workers, farm families, school aged children, farm agribusiness persons, commodity groups).
4. Conduct follow up assessment of injury, illness, or disease occurring as a result of an agricultural
exposure (may include hospital chart review, conducting interviews with those affected or their
families).
5. Function as a resource for information to victims of agricultural injury and illness and their
families.
6. Function as a source of support for victims of agricultural injury and illness and their families.
7. Collaborate with other agencies to provide health services currently unavailable to agricultural
populations.
8. Surveillance of agricultural injuries, illness, and diseases.
9. Conduct research to determine effectiveness of agricultural health and safety interventions.
Job Functions of Agricultural Health Nurses (n - 24) Ranked
by Mean Task Index, 1998 Tradition of Excellence

10. Recommend or distribute appropriate personal protective equipment.

11. Serve on appropriate professional or community boards, committees, and councils.
12. Summarize findings or results of data gathering or research.
13. Serve as a health counselor.
14. Develop agricultural health and safety educational materials, curriculum, or programs.
15. Analyze data to describe issues associated with agricultural related diseases or injuries.
16. Act as a agricultural safety consultant or resource person.
17. Serve as a representative for agricultural health and safety at agricultural meetings or
events.
18. Coordinate or perform health screening clinics or services.
Job Functions of Agricultural Health Nurses (n - 24) Ranked by
Mean Task Index, 1998 Tradition of Excellence

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

28. Publish written material in professional publications.

29. Conduct pulmonary function testing.
30. Serve as an advocate for agricultural health and safety issues through the legislative process.
31. Make appropriate health service referrals.
32. Manage staff of agricultural health and safety programs.
33. Perform occupational health examinations or assessment.
34. Collect information to determine if Worker Protection Standards (Environmental Protection
Agency, 1992) have been taught to agricultural workers and migrant workers.
35. Perform blood draws to test cholinesterase levels.
36. Assess communicable diseases and follow up or perform mandatory disease reporting.
37. Provide primary care to farmers, farm workers, and agricultural workers and their families.
38. Provide emergency and trauma care services to victims of farm injury or illness.
39. Provide or assist in providing appropriate surgical intervention to victims of farm injury
Competencies of Agricultural Health Nurses (n =24) Ranked in
Order of Importance, 1998 Tradition of Excellence

1. Interpersonal communication skills.

2. Knowledge of injury prevention principles and measures.
3. Ability to recognize hazards that might create unsafe working/living environment.
4. Written communication skills.
5. Strong sense of self.
6. Knowledge of safety principles and how they relate to agricultural environments.
7. Flexibility and ability to perform multiple tasks or skills simultaneously.
8. Knowledge of agriculture related illnesses, injuries, and diseases.
9. Knowledge of and appropriate use of community resources to complement
agricultural health programs.
10. Networking skills.
Competencies of Agricultural Health Nurses (n =24) Ranked in
Order of Importance, 1998 Tradition of Excellence

11. Leadership skills.

12. Knowledge of epidemiological principles.
13. Public speaking and presentation skills.
14. Knowledge gained from courses addressing issues affecting health, safety, and well
being of agricultural populations.
15. Knowledge of appropriate personal protective equipment for agricultural workers.
16. Ability and willingness to become involved in local community.
17. Knowledge and use of a team approach toward problem solving.
18. Knowledge of common disease processes.
19. Knowledge and use of nursing process in problem solving.
20. Knowledge of the hazards associated with handling chemicals.
Competencies of Agricultural Health Nurses (n =24) Ranked in
Order of Importance, 1998 Tradition of Excellence

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

31. Computer knowledge and database management skills.

32. Community assessment skills.
33. Knowledge of normal human growth and development and the ability to recognize abnormal
findings.
34. Knowledge of "anticipatory guidance" with injury prevention and health promotion being the
primary focus.
35. Survey skills.
36. Ability to recognize cultural factors that may affect willingness to practice safety measures.
37. Knowledge of health screening skills (e.g., blood pressure, vision, ear examination).
38. Coalition building skills.
39. Knowledge of research methodologies.
40. Data analysis skills.
Competencies of Agricultural Health Nurses (n =24) Ranked in
Order of Importance, 1998 Tradition of Excellence

41. Case management skills.

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

51. Health policy development skills.

52. Knowledge of emergency care and trauma interventions for agricultural
injuries and illnesses.
53. Nursing background in a rural hospital setting.
54. Ability to perform pulmonary function testing.
55. Certification in performing audiometric testing.
56. Knowledge of External Cause of Injury codes (E-codes) and International
Classification of Diseases-Code 9 (ICD 9).
57. Certification in performing pulmonary function testing.
58. Knowledge of trauma registry.
59. Ability to communicate bilingually.
 Tradition of Excellence

Aplication Agronursing
Occupational health nurses Tradition of Excellence

• Nurses in general practice are likely to encounter clients with

occupation related health risks.
• Collaborative efforts between nursing faculty and occupational health
nurses working in local industries can provide useful learning
experiences for nursing students.
• Health care providers knowledgeable about occupational health and
safety risks can better serve individuals working in hazardous
occupations, such as farming.

Hodge BD, Ackerman S, Evans C, Erb T, MS, and Cook MLW, 2002. AAOHN JOURNAL. 50(6): 257-261
Rural health Tradition of Excellence

• Students will explore a variety of health and safety issues unique to rural
populations. The interdisciplinary team concept will be used throughout the
course to foster collaboration that facilitates sharing of the expertise of students
and faculty.
• Learn to function in an interdisciplinary team to conduct a community project
related to rural health and safety issues.
• Explore various dimensions of rurality including, but not limited to,
demographics, cultural, and socioeconomic factors.
• Demonstrate the use of appropriate strategies in addressing health and safety
issues unique to rural populations.
• Investigate barriers affecting rural health care. • Differentiate the meaning of
"rural life" among various population groups.
• Investigate contemporary issues related to the health care delivery system.
Tradition of Excellence
Prevalence of health problems among farmers (n=179). Tradition of Excellence
Prevalence of health problems n (%) 95% Confidence Interval
Lower limit Higher limit
Nutritional problems
Normal 109 (60.9) 51.7 70.0
Underweight 51 (28.5) 16.1 40.9
Overweight 19 (10.6) - 4.4 23.4
Anemia
Normal 67 (37.4) 25.8 49.0
Anemia 112 (62.6) 56.7 74.0
Paint of joint and bone
No pain 89 (49.7) 39.3 60.1
Pain 90 (50.3) 39.9 60.6
Note. Nutritional status categorized by BMI (Underweight: BMI less than 18.5; Normal: BMI 18.5 – 24.9; Overweight: BMI 25 – 27; and Obesity: BMI more than
27). Anemia categorized by Hemoglobin (Anemia: less than 12 gr/dl and normal more than 12 gr/dl).
 Nutritional Status Anemia Pain of Joint and Bone
Underweight Normal Overweight χ2 Normal Anemia χ2 Pain No Pain χ2
Variable Total n (%) n (%) n (%) (P) n (%) n (%) (P) n (%) n (%) (P)
Age
Less than 40 year 51 (28.5) 10 (19.6) 36 (33.0) 5 (26.3) 18.186 16 (23.9) 35 (31.2) 3.525 23 (25.6) 28 (31.5) 6.112
40 - 60 year 88 (49.2) 19 (37.3) 58 (53.2) 11 (57.9) (0.001) 39 (58.2) 49 (43.8) (0.172) 40 (44.4) 48 (53.9) (0.047)
More than 60 year 40 (22.3) 22 (43.1) 15 (13.8) 3 (15.8) 12 (17.9) 28 (25.0) Tradition of Excellence
27 (30.0) 13 (14.6)
Gender
Women 23 (12.8) 3 (5.9) 15 (13.8) 5 (26.3) 5.369 2 (3.0) 21 (18.8) 7.950 8 (8.9) 15 (16.9) 1.874
Man 156 (87.2) 48 (94.1) 94 (86.2) 14 (73.7) (0.068) 65 (97.0) 91 (81.2) (0.005) 82 (91.1) 74 (83.1) (0.171)
Education
Not attending school 41 (22.9) 14 (27.5) 25 (22.9) 2 (10.5) 8.113 10 (14.9) 31 (27.7) 4.364 22 (24.4) 19 (21.3) 0.684
Elementary school 80 (44.7) 25 (49.0) 49 (45.0) 6 (31.6) (0.230) 34 (50.7) 46 (41.0) (0.225) 41 (45.6) 39 (43.8) (0.877)
Junior high school 35 (19.6) 8 (15.7) 20 (18.3) 7 (36.8) 15 (22.5) 20 (17.9) 17 (18.9) 18 (20.3)

Senior high school and more 23 (12.8) 4 (7.8) 15 (13.8) 4 (21.1) 8 (11.9) 15 (13.4) 10 (11.1) 13 (14.6)
Smoking
Yes 97 (54.2) 28 (54.9) 64 (58.7) 5 (26.3) 7.000 44 (65.7) 53 (47.3) 4.971 53 (58.9) 44 (49.4) 1.252
No 82 (45.8) 23 (45.1) 45 (41.3) 14 (73.7) (0.030) 23 (34.3) 59 (52.7) (0.026) 37 (41.1) 45 (50.6) (0.263)
Drink of coffee
Yes 121 (67.6) 31 (60.8) 82 (75.2) 8 (42.1) 9.281 47 (70.1) 74 (66.1) 0.159 64 (71.1) 57 (64.0) 0.723
No 58 (32.4) 20 (39.2) 27 (24.8) 11 (57.9) (0.010) 20 (29.9) 38 (33.9) (0.690) 26 (28.9) 32 (36.0) (0.395)
Hours worked per week
More than 40 hours 75 (41.9) 18 (35.3) 53 (48.6) 4 (21.1) 6.331 25 (37.3) 50 (44.6) 0.649 39 (43.3) 36 (40.4) 0.057
Less than 40 hours 104 (58.1) 33 (64.7) 56 (51.4) 15 (78.9) (0.042) 42 (62.7) 62 (55.4) (0.421) 51 (56.7) 53 (59.6) (0.811)
Recess per worked
Less than 30 minutes 40 (22.3) 16 (31.4) 23 (21.1) 1 (5.3) 5.687 14 (20.9) 26 (23.2) 0.031 27 (30.0) 13 (14.6) 5.256
More than 30 minutes 139 (77.7) 35 (68.6) 86 (78.9) 18 (94.7) (0.058) 53 (79.1) 86 (76.8) (0.861) 63 (70.0) 76 (85.4) (0.022)
Working days per week
More than 5 days 108 (60.3) 30 (58.8) 73 (67.0) 5 (26.3) 11.243 36 (53.7) 72 (64.3) 1.535 51 (56.7) 57 (64.0) 0.733
Less than5 days 71 (39.7) 21 (41.2) 36 (33.0) 14 (73.7) (0.004) 31 (46.3) 40 (35.7) (0.215) 39 (43.3) 32 (36.0) (0.392)
Workload
Not stress 92 (51.4) 27 (52.9) 55 (50.5) 10 (52.6) 0.099 37 (55.2) 55 (49.1) 0.407 53 (58.9) 39 (43.8) 3.487
Stress 87 (48.6) 24 (47.1) 54 (49.5) 9 (47.4) (0.952) 30 (44.8) 57 (50.9) (0.524) 37 (41.1) 50 (56.2) (0.036)
Working position
Ergonomis 87 (48.6) 27 (52.9) 48 (44.0) 12 (63.2) 2.905 39 (58.2) 48 (42.9) 3.364 41 (45.6) 46 (51.7) 0.450
Unergonomis 92 (51.4) 24 (47.1) 61 (56.0) 7 (36.8) (0.234) 28 (41.8) 64 (57.1) (0.067) 49 (54.4) 43 (48.3) (0.502)
Variable Regression Standard Deviation Walad χ2 P 95% Confidence Interval
Coeficient value OR value Lower limit Higher limit
Underweighta
Age
Less than 40 year -1.283 0.530 5.867 0.015 0.28 0.10 0.78
40 - 60 year -1.383 0.452 9.362 0.002 0.25 0.10 0.61
More than 60 year Ref - - - - Tradition of Excellence
- -
Drink of coffee
No -1.031 0.424 5.913 0.015 0.36 0.16 0.82
Yes Ref - - - - - -
Overweighta
Recess per worked
Less than 30 minutes -2.635 1.274 4.281 0.039 0.07 0.01 0.87
More than 30 minutes Ref - - - - - -
Working days per week
More than 5 days -2.807 0.982 8.172 0.004 0.06 0.01 0.41
Less than 5 days Ref - - - - - -
Anemiab
Age
More than 60 year -0.331 0.478 0.481 0.488 0.72 0.28 1.83
40 - 60 year -0.952 0.431 4.885 0.027 0.39 0.17 0.90
Less than 40 year Ref - - - - - -
Gender
Man -2.341 0.778 9.049 0.003 0.10 0.02 0.44
Women Ref - - - - - -
Working days per week
Less than 5 days -0.744 0.343 4.702 0.030 0.48 0.24 0.93
More than 5 days Ref - - - - - -
b
Joint and bone pain
Age
More than 60 year 0.906 0.446 4.124 0.042 2.48 1.03 5.94
40 - 60 year 0.406 0.406 4.718 0.030 2.41 1.09 5.35
Less than 40 year Ref - - - - - -
Recess per worked
Less than 30 minutes 0.891 0.384 5.386 0.020 2.44 1.15 5.17
More than 30 minutes Ref - - - - - -
Implication for practices Tradition of Excellence

Develop nursing curriculum and short course of agronursing

Conduct research for agronursing services

Center of agronursing

Integrated agronursing on PHC

Apply for model health services of agronusring

Tradition of Excellence