Occupational health nursing practice, education, and research in Taiwan

Download (0)

Loading.... (view fulltext now)

Full text


Occupational Health Nursing Practice, Education, and Research in Taiwan The main purpose of this paper is to describe the practice, education, research, and future perspectives of occupational health nursing specialty in Taiwan. The paper also provides a brief overview of history, socioeconomic status, health care system, general health status, major occupational health and safety (OHS) problems, OHS laws and regulations, and OHS organizations in Taiwan

Historic and Socioeconomic Background

Taiwan, formally known as the Republic of China (ROC), was established in 1912. The ROC government, led by the Nationalist Party, relocated to Taiwan in 1949 when the Chinese Communist Party founded the People’s Republic of China on the mainland. Taiwan is an island located in the western Pacific between Japan to the north, the Philippines to the south, and southern China to the west.

Historically, Taiwan has had an economy based on agriculture. During 1962-1985, industry in Taiwan underwent a rapid and dramatic transformation, moving from an

agriculture-dominated format to technology and service-based industries. During this period Taiwan’s economy experienced its greatest growth, with an average annual growth rate over twice that of industrialized countries. It was also during this period that the first recording of occupational injuries occurred when five female workers died from exposure to chlorinated solvents in an electronics factory (Luo, 2002). The Taiwanese economy changed again in the 1980s and 1990s when labor-intensive industries yielded to technology- and capital-intensive


industries. Today, the electronics and information-technology sectors have become Taiwan’s pivotal industries (Government Information Office [GIO], 2007).

Taiwan has a large work force with over 18 million workers aged 15 and over. About 60% of the workforce is employed in the service industry and only 6% are in agriculture, forestry, fishing, and animal husbandry. Fifty-eight percent of the working population are males.

The size of population in 2005 was 23 millions. Population growth has declined from 3.5% in 1957 to 0.4% in 2005 with declined fertility rate from an average of five children per family during the 1960s to one children in 2004. Life expectancy for males and females are 74 years and 80 years, respectively. The Council for Economic Planning and Development (GIO, 2007) estimated the elderly population will achieve 18.8% of the population by 2025. Taiwan Health Care System and Health Status

With the goal of providing quality and affordable health care to all, Taiwan’s National Health Insurance system was initiated in 1995. The NHI provides health insurance coverage for 99% of the population. In 2005, the revenue from premium that is being shared by the insured, employers, and government subsidies was 38%, 36%, and 26%, respectively (Department of Health [DOH], 2007a). Most (92%) of the island’s healthcare providers participate in the system, which covers most medical care services aside from plastic surgery, blood, registration fees, and transportation expenses (Chang, 2005).


decade, the number of physicians and registered nurses (RN) is relatively low compared to the U.S. In 2005, Taiwan had approximately 1.7 physicians per 1,000 residents compared to 2.5 physicians per 1,000 residents in the US. The number of RNs per 10,000 residents was approximately 46.7 compared to 78 per 10,000 residents in the US (Directorate-General of Budget, Accounting & Statistics, 2006). Currently, of the 34,093 physicians in Taiwan, approximately 300 specialize in occupational medicine; by contrast, only about 400 occupational health nurses (OHNs) among 105,183 Taiwanese RNs (DOH, 2007b).

Since the 1960s Taiwan has experienced an epidemiological transition. Forty years ago, acute communicable diseases were the major causes of death in Taiwan. Today, with

dramatic changes in lifestyle and population structure, the ten leading causes of death have shifted to chronic diseases including malignant neoplasms, heart disease, cerebrovascular disease, and diabetes mellitus (DOH, 2006). In response to this change there has been an increasing interest in preventing disease via changes in lifestyle. Since 1999, the Taiwan government has put effort into building a healthy community including a healthier workplace. Thirty-four worksites have been subsidized to implement the Workplace Health Promotion Project to create a healthy and safe work environment, such as financial support, educational training, and on-site counseling. The components of workplace health promotion mainly comprise physical fitness, healthy diet, occupational stress, health examinations, and tobacco hazards control.


Under the supervision of the Council of Labor Affairs of the Executive Yuan (CLA), eight occupational disease service centers were created to prevent and treat occupational diseases and injuries. Each center is staffed with approximately one or two occupational physicians, one nurse, and one case manager with one exception that has more staffing. These centers primarily offer clinical services such as identification of occupational hazards;

diagnosis and treatment of occupational-related diseases; pre-placement evaluations; and return to work evaluations, health assessments, and walk-through investigations. Non-clinical services such as educational activities, consultations, and health promotion programs are also provided (Chung-Ho Memorial Hospital, Kaohsiung Medical University, 2007). In addition, over 400 hospitals across the country are authorized by the government to provide regular health examinations for workers. (Council of Labor Affairs [CLA], 2007a).

In 2001, the Taiwan Department of Health set up six additional occupational health centers dedicated to workplace hygiene and healthcare. Since then, the scope of these centers has expanded from occupational disease prevention to worksite health promotion. For

example, to advocate and implement the policy of smoke-free work settings, the Bureau of Health Promotion designated three centers to supervise workplace tobacco hazard prevention and control. To strengthen programs regarding workplace health promotion and tobacco control, the tobacco hazards prevention and control centers and the six occupational health centers were integrated into the Center for Workplace Health Promotion and Tobacco Control


(BHP, 2007).

Major Occupational Health Problems

Along with the rapid, ongoing transformation in industry, advances in technology, and changes in manufacturing processes, workers are facing even more complicated working conditions and environments than before. Consequently, the patterns of occupational hazards and diseases have become more diverse in Taiwan. Among various industries, construction and manufacturing industries demonstrated highest injury rates (CLA, 2007b). In 2006, occupational injury rates for construction and manufacturing industries were 13.4 and 6.3 per 1,000 workers, respectively (CLA, 2007b). The occupational injury related death rate per thousand had decreased from .14% in 1987 and .038% in 2006 (Su, Lai, Yeh, & Han, 2005). This decreasing trend may be due to the implementation of some policies, such as the

voluntary protection program in 1994 (Su, Tsai, & Yu, 2005), a work-related diseases surveillance system in 1995 (Wu et al., 1996), and a policy of declining the number of occupational fatalities by 40% over a four-year period conducted by CLA in 2000 (GIO, 2003). However, the rate is still higher than those for developed countries (CLA, 2007c). In 2005, the fatal injuries per million workers in Taiwan were 45, much higher than others (UK-7, Singapore-20, Japan-23, both US and Germany-26) (CLA, 2007c).

The disease of coal miner’s pneumoconiosis has been the foremost cause for


1950s (Yang et al., 1994). However, with the decline of the mining industry, the number of workers with this illness has been reduced. Currently, when excluding pneumoconiosis, musculoskeletal injuries including occupational-related low back pain and arm, neck, and shoulder diseases have become the most prevalent occupational diseases (Lin, 2003).

According to one nationwide study conducted in Taiwan, 54% of workers reported exposure to ergonomic hazards, such as repetitive stress of the hands (30%). Other ergonomic factors related to occupational injuries included vibration to the whole body, repetitive stress of the hands, frequent use of heavy tools, and lifting and carrying heavy objects (Liang, Kuo, Wang, & Chen, 2002). Workers in construction and agriculture industries showed high incidence rates of upper extremity musculoskeletal pain. Major contributing factors to this problem were main job stressors, such as job content (28.1%) and organizational factors (16.2%) (Lee, Yeh, Chen, & Wang, 2005).

Other occupational injuries are also prevalent in Taiwan. Because it is an island nation, occupational diseases related to marine industries, such as decompression sickness of divers, were noted in 23.9% of fishermen, 22.7% of professional divers, 4.0% of sports diver, and 2.3% of research divers (Niu, Ho, & Chen, 2001). Noise-induced hearing loss is also a serious occupational hazard, with 9.7% of workers suffering at least a moderate degree of hearing loss (Hsu & Chen, 2002). Biological hazards are emerging occupational health issues since the biotechnology industry has become highly developed in Taiwan (Hsu, Chen, Hung


et al., 2004). Finally, increasing compensation claims for acute work-related CVD due to work patterns, such as overtime and unexpected increased workload is a major concern (Chen et al., 2006).

Occupational Health Laws and Regulations

The Labor Safety and Health Law enacted in 1974 was the first and major law related to OH in Taiwan. Since then, more than 25 occupational health-related regulations or standards have been established to assure workers’ rights (Shih et al., 2004). A summary of the

purposes and highlights of the major occupational Laws and Regulations is shown in Table 1. Insert Table 1 about here

Occupational Health and Safety Organizations

Government Organizations

The CLA of the Executive Yuan was established in 1987 as the highest level of labor administration in Taiwan. In order to maintain a productive and qualified work force, legislative priorities have emphasized workers’ rights and welfare, gender equality, labor-management relations, and safety and health (GIO, 2007). Two branches under CLA relevant to OHS affairs are the Department of Labor Safety and Health (DLSH) and Department of Labor Inspection (DLI). The DLSH is responsible for formulating OHS standards,

researching and analyzing labor safety and health issues, and providing worksite occupational health education and training. By contrast, the DLI is primarily responsible for supervising the execution of labor safety and health inspections as well as the prevention of occupational


hazards. There are two inspection offices in two major cities (Taipei and Kaohsiung) and three regional offices to cover northern, central, and southern regions. Several other

departments under the CLA include the Department of Labor Relations, the Department of Labor Standards, the Department of Labor Welfare, the Department of Labor Insurance, and the Institute of Occupational Safety and Health (IOSH) (CLA, 2007d). In 1992, the IOSH was established by CLA to research the work environment, evaluate occupational diseases and hazards, develop techniques for preventing and controlling problems, and conduct trans-disciplinary research on OHS management.

There are several other governmental agencies: Bureau of Health Promotion (BHP) for workplace health promotion and tobacco control programs; Center for Disease Control (CDC) for the control of communicable diseases; Bureau of Industry for upgrading

manufacturing equipment and improving work environment; Council of Atomic Energy for radiation protection; Division of Environmental Health and Occupational Medicine for environmental and occupational health research; and National Science Council for funding research grants toward OHS and promoting administrative management of OHS in some science-based industrial parks.

Regarding education, the Division of Environmental Protection Education is subordinate to the Ministry of Education and has a duty toward the teaching of OHS in schools. The Center for Environmental, Safety and Health Technology Development, under the Industrial


Technology Research Institute, works on developing and disseminating environmental protection and industrial safety and health technologies to industries (Shih et al., 2004).

Professional Organizations

The Industrial Safety and Health Association of the Republic of China (Taiwan) (ISHA), a nonprofit organization established in 1960, is the first occupational health organization in Taiwan. Its mission is to research OHS issues, prevent occupational hazards, comply with government policies, and offer assistance to industries to improve OHS. Cooperating with the CLA, ISHA has become one of the leading OHS advocacies in Taiwan by providing OHS activities, educational training sessions, technical services, and authorized inspections, etc (Industrial Safety and Health Association of the Republic of China Taiwan [ISHA], 2007).

The first professional organization for OHNs, the Taiwan Occupational Health Nursing Association (TOHNA), was founded in 1991. The TOHNA aims advancing the quality of OHN services assist government to implement health care, and prevent the occurrence of occupational injuries and diseases (Taiwan Occupational Health Nursing Association [TOHNA], 2007). Since then, TOHNA has conducted research related to OHN practice and has collaborated with other associations to offer educational training courses for its members. The TOHNA is governed by a 12 member, elected Board of Directors. Currently, although the TOHNA has around 300 members, there are only 100 active members.

May 6th, 2007, in response to numerous members’ outcry about the ineffectiveness of the TOHNA, Taiwan Association of Occupational Health Nurses (TAOHN) was launched.


Its missions are similar to TOHNA. The TAOHN is also guided by a 12 member, elected Board of Directors. At present, it has approximately 85 members (Taiwan Association of Occupational Health Nurses [TAOHN], 2007).

In 1992, Taiwan Environmental and Occupational Medicine Association (TEOMA) were established in 1992 to improve the work environment, research and prevent

occupational diseases, and conduct educational training programs. TEOMA also aimed at promoting international academic exchange and interactions (Taiwan Environmental and Occupational Medicine Association [TEOMA], 2007). In 1995, the Occupational Hygiene Association of Taiwan (TOHA) was founded with a mission similar to TEOMA

(Occupational Hygiene Association of Taiwan [TOHA], 2007). Other professional

organizations in the field of OHS include the Labor Safety and Health Management Society R.O.C., the Safety and Hygiene of Manpower Association, the Ergonomics Society of Taiwan, and the Chinese Association for Aerosol Research.

Delivering Occupational Health Nursing Services

At present there are approximately 400 OHNs in Taiwan. Regardless of the Labor Health Protection Regulation, which requires industries with 300 or more employees to provide on-site occupational health services, less than half of the industries employ an

adequate number of nurses (Chang, 1993; Chang, Chen, Cheng, & Chen, 2000; Shiao, 2005). Due to the deficit of occupational health-related manpower, especially occupational health


physicians, OHNs are often the sole OH personnel in industries (TOHNA, 2000; Hsu, Chen, & Wu, 2004). Further complicating the shortage of OHNs is the industry structure they must work within. One study found that only 24.5% of nurses worked under the auspices of the industry medical center. The remaining nurses were governed by multiple departments including general affairs (28.7%), personnel (25.0%), and safety and hygiene (16.5%)

(Chang, 1993). Hence, OHNs are frequently required to perform non-health related tasks and may lack an understanding of their roles and duties.

Because the role and function of OHNs has not been specified in the Labor Health Protection Regulation, the duties of OHNs vary widely. Shiao (2005) conducted a study using a mailed survey with a sample of 401 OHNs from industries with 300 workers or more (response rate: 82.2%; mean age: 37 with an average of 8.4 years of clinical experience). The study reported that duties of OHNs in Taiwan were interpreting health examination results, providing periodic health examinations, executing duties consistent with the Labor Health Protection Regulation, providing health examinations for specific hazards, and ensuring compliance with the Labor Safety and Health Law. By comparison, the responsibilities most cited by nurses included planning health examinations, providing periodic health

examinations, providing workplace health promotion programs, providing emergency care, selection of hospitals for health examinations, and management of occupational injuries and diseases. With the exception of hazard planning and post-hazard safety assessment, the


majority of OH related services were implemented by nurses (Shiao, 2005). Education and Training for Occupational Health Nurses

According to Shiao (2005), the majority (51.5%) of nurses have an associate’s degree, with 27% having a bachelor’s degree or higher. Some OHNs have received continuing education regarding workplace health promotion, periodic health examinations, the Labor Safety and Health Law, implementation of health examinations, reading and evaluating health examination results, and occupational safety and health. However, most continuing education was less than 4 hours, with over one quarter of the nurses having no continuing education at all in the past year (Shiao, 2005).

Basic Nursing Education System

The basic nursing education system in Taiwan is divided into three categories: 2-5 year junior college associate degree (AD) programs; 2- or 4-year college programs for a bachelor of science in nursing (BSN) degree; and 4-year school of nursing programs for BSN degrees. Most nurses have an AD with approximately 25% of nurses prepared in BSN programs or above (Chang, 2005).

In 1988, industrial nursing was renamed as OHN by the Science and Technology Advisory Board Meeting of Executive Yuan. In the same year, the first elective course in OHN was initiated by the Taiwan Provincial Junior College of Nursing (later renamed the National Taipei College of Nursing [NTCN]). Over time, NTCN offered additional content in OHN as a part of its undergraduate nursing program. These classes included three credits (48


hours) of theoretical studies and three credits (144 hours) of practical studies in OHN (Chang, 1998). Unfortunately, the program ended in 2003. In addition to NTCN, the Chang Gung Institute of Technology has provided an elective course in OHN for 5-year junior college students since 1999. The content of this 2 credit (32 hour) course includes an introduction to OHN, OH related laws and regulations, OHS, occupational medicine, ergonomics,

toxicology, roles and functions of OHNs, workplace health promotion programs, and trends in OHN with a 4-hour worksite visit. College of Nursing, Taipei Medical University also began offering a similar opportunity for the RN to BSN program of study in 2005. However, the numbers of students attending the elective courses were varied approximately from 0 to 60 at each school annually.

In Taiwan, formal OH nursing education is typically restricted to two to four lecture hours and few field studies. There is no formal OHN graduate program. Difficulty in

curriculum development for OHN specialty program can be attributed to the extreme shortage of faculty members who were trained in the field of OHN. Although recently master’s level education for OHN has been recommended by nursing leaders, shortage of OHN faculty is still a major barrier to formal education of OHN, either bachelor’s or master’s level.

Continuing Education and Training

According to the Labor Health Protection Regulation, OHNs should participate in training courses related to occupational medicine, OHN, and labor safety and hygiene.


However, there is no requirement regarding the total amount of hours in continuing education or training for the nurses. In 2007, article 8 of the Nurses Law was amended to add the continuing education requirement for RN license renewal. Since then, nurses have been required to obtain continuing education for a cumulative credit of one hundred and fifty hours in a 6-year period. Below, some of the continuing education programs are outlined.

Orientation Course. Since 1989, a workshop on OHN has regularly been held by the CLA and DOH, Executive Yuan. The workshop lasts about five days and is offered six times each year. The course is available to OHNs and nurses working in the health examination center, and aims to introduce OH and the roles and functions of OHNs. Nurses working in the occupational health field are required to participate in the course only one time in their careers. Until 2005, the cumulative participants of the OHNs were 932. Originally, the course was designed for OHNs at the time of their appointment. Gradually however, the focus has shifted to nurses working in the health examination center. Thus, the purpose of this

workshop has changed, and recently the administrators have noticed this change and started considering the improvements.

Comprehensive Course. Between 1992 and 2000, the National Nurses Study Center, located in the School of Nursing, National Taiwan University, provided a 1-year

comprehensive course for OHNs. The course was designed for nurses with at least two years of job experience in OHN, or nurses who were currently responsible for workers’ health


examination in a hospital setting. The curriculum for this course included 57-72 lecture hours at the school and 136-162 hours of field practice in trainees’ own work settings. The content of the lectures encompassed introduction to OH (6-8 hours), occupational and environmental toxicology (6-12 hours), environmental management (11-15 hours), health management (28-31 hours), and prevention and management of occupational injuries (6 hours). The field studies were composed of two worksite visits (16 hours), practices performing pulmonary function and audiometry tests (8 hours), discussion with instructor regarding field practice (16 hours), presentation of individual and group projects (16 hours), and field practice (96 hours). After completing the course, nurses attained OHN certification from the DOH. During a 9-year period, 9 to 12 nurses were certified in the course annually, and eventually up to 100 persons.

Since the TOHNA was established in 1991, the organization has been providing a short term (1-2 day) continuing education programs for OHNs irregularly. Topics covered health promotion (i.e., physical fitness, weight reduction, nutrition and healthy diet, smoking cessation, managing stress, ergonomics), disease prevention (i.e., hypertension, colorectal, oral, breast, and cervical cancer), and rehabilitation nursing. Most programs were under the cooperation with other institutes, such as CLA, public health bureau, and hospitals. The average participation rate was over 90%.


2-day international conference concerning OHS annually. However, several courses are regarded as irrelative to OHN because they are not tailored for the nurses, thus greatly lowering the participation rates. Plus in recent years, the education for OHN is seriously deficient to cover the knowledge and skills necessitated to be a competent OH nurse. By virtue of this reason, the newly established TAOHN has been intensively devoted to recommend the CLA that a separated basic and advanced training course be designed to equip the nurses with the knowledge and skills needed to offer professional OH services.

Recently, the president of the TOHNA proposed providing advanced training courses to enhance OHNs’ competencies in occupational health management. The program is expected to connect with the credentialing program for certification of OHNs. The proposed content of the curriculum includes theoretical, practical, and operational courses in six major areas: health project strategy and management, occupational safety and health risk assessment, planning and integration of health management, health group management and

communication, systematic technology tool of health management, and practical application and evaluation of health management. The program was recently supported by the CLA, and 70 OHNs were trained. This is a good start for increasing educational opportunities for OHNs.

Research in Occupational Health Nursing


been implemented due to the lack of academic experts in OHN, research capacity among OHNs, and availability of funding for research. Since 1993, some research has been executed on behalf of the TOHNA commissioned by DOH. These studies have examined factors influencing OHN practice in Taiwan (Chang, 1993), hypertension prevention at the

workplace (Chang, 1997), workplace health promotion programs to improve health-related physical fitness of workers (Chang, 1999), workplace health-related physical fitness programs (Huang, 2003), as well as work patterns and health conditions among OHNs (Shiao, 2005).

Other areas of research interest by experts in OHN or nursing graduate students have included hairdressers’ hand dermatitis (Shiao, Wong, Chang, & Guo, 1995), musculoskeletal discomfort (Shiao, Chen, Du, & Guo, 1996), influence of nursing interventions on

hypertensive workers’ self-care (Chang, Chen, Hsu, & Lin, 1999), smoking cessation counseling (Chang & Chang, 1999), effects of teaching programs on female employees’ cervical cancer screening knowledge, health beliefs and behavior (Huang & Chang, 2000), OH services in factories employing more than 300 workers (Chang et al., 2000), labor health promotion assistance plan (Hsu, 2001), the risk of bloodborne pathogens to health care workers after a needle stick injury (Shiao, Guo, & McLaws, 2002), the effectiveness of workplace health promotion program (Hsu, Chang, Peng, & Chen, 2003), occupational hand dermatoses among electronics workers (Shiao, Sheu, Chen, Tsai, & Guo, 2004), and exercise


behavior (Chen & Chang, 2004; Wang & Chang, 2006).

Future Perspectives in OHN Practice, Education, and Research

As previously mentioned, OHN in Taiwan has not established a firm foundation because of the incompleteness of legislation, lack of formal and continuing education in OHN

resulting in a shortage of professional OHNs, and the fact that OHN has long been ignored by employees, employers, and government. However, there seems to be an increasing trend toward increased effort by health authorities and the CLA on activities of workplace health promotion instead of prevention of occupational diseases and hazards. These strategies have gradually caused some industries provide for the physical and psychological health of their employees, and further extend the roles as well as functions of OHNs. In addition, leaders of the TOHNA and the TAOHN have been diligent in promoting the quality of continuing education and training for OHNs as well as the delivery of OH services.

While these accomplishments are good start, there are many areas that need to be addressed for future advancement in the field of OHN. These include:

․ Amendment of the Labor Health Protection Regulation specifying the qualifications, roles, and functions of OHNs, occupational physicians, and other OHS team members to ensure the quality of OHN services.

․ Establishing formal graduate education programs in the area of OHN.

․ Adopt effective communication to articulate and demonstrate the value of OHN, and further encourage responsibility for and commitment to workers’ health from employers including


increasing workers’ engagement in health promotion and disease prevention activities. ․ Increasing funding for the provision of OH services to underserved workplaces, especially small scale industries (Over 75 % of labor force in Taiwan are employed by small and medium scale industries).

․ Establishing a computerized health record system to facilitate management of workers’ health data.

․ Development of effective workplace health promotion interventions.

․ Revision of OHN practice guidelines based on the needs of a changing work force (including foreign workers) and work situations.

․ Examination of potential problems associated with a growing trend in agency nurses within OHN in Taiwan. For example, nurses are not familiar with the work environment and the health of workers.

․ Increasing funding for research in the area of OHN in collaboration with multidisciplinary professionals within and outside Taiwan.

․ Promoting active involvement in workplace intervention studies based on theoretical frameworks to evidence their effectiveness including quality and cost.

In Summary

1. Occupational health nursing in Taiwan has long lagged behind that of other countries. Many reasons can account for this disparity including poorly established legislation, low sense of value for OHNs by employees, employers, and government officials, a lack of


understanding by OHNs of their roles and functions, and deficient formal and continuing education in OHN.

2. Recently, the government and professional organizations, including the TAOHA and TOHNA, have been working to promote professional competence for OHNs through the reformation of specialized training courses and establishment of a credentials program. 3. Although a small number of OHNs’ roles and functions have expanded to include health

promotion and risk reduction, the majority of OHNs simply provide curative measures. 4. Increased emphasis is being placed on occupational health research. Studies that are

based on theoretical frameworks are being promoted to develop effective strategies aimed at increasing healthy lifestyle activities and reducing risk behaviors. These efforts will increase the focus on workplace health promotion and risk reduction intervention

programs thus improving workers’ health and productivity. It is hoped that through these efforts the field of OHN will expand and improve for the health and safety of all workers in Taiwan.



Bureau of Health Promotion, Executive Yuan. (2007, June). Center for workplace health promotion and tobacco control work outline. Retrieved June 2, 2007, from

http://www.bhp.doh.gov.tw/english/category.php? table=research&page=detail&id=48&pid=86

Chang, M. (1993). An exploration of factors influencing occupational health nursing practice in Taiwan (DOH82-HP-098-5M08). Taipei: Department of Health.

Chang, M. (1997). A project on the control of high blood pressure at the worksite. Taipei: Taiwan Occupational Health Nursing Association.

Chang, M. (1999). A project on the improvement of health related physical fitness of workers by workplace health promotion program. Taipei: Taiwan Occupational Health Nursing Association.

Chang, P. (2005). Taiwan health outlook 2005. Taipei: Department of Health.

Chang, P. J. (1998). Introduction of occupational health nursing (pp. 22, 339). Taipei: Farseeing Publishing.

Chang, T. Y. & Chang, M. (1999). A study of smoking cessation counseling behaviors to employees and influential factors for occupational health nurses in Taiwan area. Public Health Quarterly, 25(4), 257-268.


Chang, P. J., Chen, P. C., Cheng, T. J., & Chen, C. J. (2000). Occupational health services in medium- and large-sized factories and industrial zones of Taiwan. Journal of

Occupational Safety and Health, 8(4), 373-387.

Chang, M, Chen, Z. T., Hsu, H. M., & Lin, Y. C. (1999). The influence of nursing

intervention on hypertensive employees’ self-care. Chinese Journal of Public Health, 18(4), 247-254.

Chen, C. M., & Chang, M. (2004). Exercise behavior and related factors in career women— the case of a bank in Taipei City. The Journal of Nursing Research, 12 (3), 180-190. Chen, J. D., Chang, W. L., Lin, Y. C., Hsiao, S. T., Lei, Y. C., & Cheng, T. J. (2006). Work

characteristics and cardiovascular disease—A hospital-based study. Journal of Occupational Safety and Health, 14(1), 36-47.

Chung-Ho Memorial Hospital, Kaohsiung Medical University. (2007, June). Department of Occupational and Environmental Medicine. Retrieved June 2, 2007, from


Council of Labor Affairs, Executive Yuan, Taiwan (CLA). (2007a, June). A simple checklist. Retrieved June 6, 2007, from http://statdb.cla.gov.tw/statis/webproxy.aspx?sys=100 Council of Labor Affairs, Executive Yuan, Taiwan (CLA). (2007b, June). Labor

insurance--occupational injuries and diseases. Retrieved June 6, 2007, from http://statdb.cla.gov.tw/statis/WebProxy.aspx?


Council of Labor Affairs, Executive Yuan, Taiwan (CLA). (2007c). [1999-2005 International estimates of fatal occupational injuries per million workers]. Unpublished data.

Council of Labor Affairs, Executive Yuan, Taiwan (CLA). (2007d, June). Organization structure. Retrieved June 6, 2007, from http://www.cla.gov.tw/cgi-bin/SM_theme? page=43322668

Department of Health, R.O.C. (Taiwan). (2006). Taiwan public health report 2005. Taipei: Author.

Department of Health, R.O.C. (Taiwan). (2007a, November). Premium receivable by beneficiary category and source of funding. Retrieved November 19, 2007, from http://www.doh.gov.tw/statistic/data/ the national health insurance statistics 2005 / 94/1/94-T12.XLS

Department of Health, R.O.C. (Taiwan). (2007b, November). Medical affairs. Retrieved November 19, 2007, from http://www.doh.gov.tw/statistic/data/major indicators of health statistics 2005/94/2.xls

Directorate-General of Budget, Accounting & Statistics, Executive Yuan, R.O.C. (Taiwan). (2006). Social indicators 2005. Taipei: Author.

Government Information Office (GIO). (2003). Taiwan yearbook 2002. Taipei: Author. Government Information Office (GIO). (2007). Taiwan yearbook 2006. Taipei: Author.


Hsu, J. H. (2001). Labor health promotion assistance plan for business health promotion (IOSH90-M341).Taipei: Institute of Occupational Safety and Health, Council of Labor Affairs.

Hsu, J. H., Chang, P. J., Peng, S. M., & Chen, P. C. (2003). The effectiveness of health promotion program in workplace (IOSH91-M341). Taipei: Institute of Occupational Safety and Health, Council of Labor Affairs.

Hsu, J. H., & Chen, C. J. (2002). Surveillance on noise-induced hearing loss in Taiwan. Journal of Occupational Safety and Health, 10(3), 232-240.

Hsu, P. C., Chen, C. J., Hung, P. C., Wang, S., Lin, W. Q., & Chen, K. H. (2004). Assessment of occupational safety and health management and adverse effects in biotechnology industries. Journal of Occupational Safety and Health, 12(2), 105-117. Hsu, J. H., Chen, R. Y., & Wu, C. E. (2004). The investigation of health promotion in

industries and the function planning of their health center (IOSH92-M344). Taipei: Institute of Occupational Safety and Health, Council of Labor Affairs.

Huang, S. M. (2003). A project on the workplace health related physical fitness program. Taipei: Taiwan Occupational Health Nursing Association.

Huang, H. L., & Chang, M. (2000). Effects of two teaching programs on workplace women's cervical cancer screening knowledge, health beliefs and behavior. The Journal of Nursing Research, 8(1), 111-123.


Industrial Safety and Health Association of the Republic of China (Taiwan) (ISHA). (2007, June). About ISHA. Retrieved June 4, 2007, from


Lee, H. Y., Yeh, W. Y., Chen, C. W., & Wang, J. D. (2005). Prevalence and psychosocial risk factors of upper extremity musculoskeletal pain in industries of Taiwan: A nationwide study. Journal of Occupational Health, 47(4), 311-318.

Liang, W. M., Kuo, H. W., Wang, C. B., & Chen, C. J. (2002). Occupational hazards of the workplace in 1999 among Taiwanese workers. Journal of Occupational Safety and Health, 10(4), 285-294.

Lin, M. H. (2003). Distribution of musculoskeletal injuries in labor-insurance compensation database. Newsletter on Occupational Safety and Health, 61, 17-18.

Luo, G. M. (2002). An event of the Feige Electronics Company. Retrieved June 10, 2007, from http://www.catholic.org.tw/cicm/cicm_works/Chingjen/detail.asp.24.htm

Niu, K. C., Ho, J. J., & Chen, C. J. (2001). Prevalence and determinants of decompression sickness of divers. Journal of Occupational Safety and Health, 9(2), 179-197.

Occupational Hygiene Association of Taiwan (TOHA). (2007, June). TOHA association work. Retrieved June 4, 2007, from http://www.toha.org.tw/new_web/

Shiao, J. S. (2005). A study on work patterns and health conditions among occupational health nurses (DOH94-HP-1407). Taipei: Bureau of Health Promotion, Department of Health.


Shiao, J. S., Chen, C. J., Du, D., & Guo, Y. L. (1996). Prevalence and risk factors of occupational musculoskeletal discomforts in electronic workers. Chinese Journal of Occupational Medicine, 3(3), 111-118.

Shiao, J. S., Guo, Y. L., & McLaws, M. L. (2002). Estimation of the risk of blood borne pathogens to health care workers after a needle stick injury in Taiwan. American Journal of Infection Control, 30(1), 15-20.

Shiao, J. S., Sheu, H. M., Chen, C. J., Tsai, P. J., & Guo, Y. L. (2004). Prevalence and risk factors of occupational hand dermatoses in electronics workers. Toxicology & Industrial Health, 20(1-5), 1-7.

Shiao, J. S., Wong, B. J., Chang, S. J., & Guo, Y. L. (1995). Risk factors of hairdressers’ hand dermatitis in graduates of hairdressing professional schools. Journal of

Occupational Safety and Health, 3(1), 17-24.

Shih, T. S., Chang, H. Y., Yeh, W. Y., Su, T. S., Huang, Y. S., Chang, C. P., et al. (2004). Occupational health research in Taiwan. Industrial health, 42(2), 124-134.

Su, T. S., Lai, C. C., Yeh, C. Y., & Han, B. C. (2005). A study on the occupational accident reporting system in Taiwan. Journal of Occupational Safety and Health, 13(1), 35-45. Su, T. S., Tsai, W. Y., & Yu, Y. C. (2005). An integrated approach for improving

occupational health and safety management: The voluntary protection program in Taiwan. Journal of Occupational Health, 47(3), 270-276.


Taiwan Association of Occupational Health Nurses (TAOHN). (2007). Manual of formal meeting for establishment. Taipei: Author.

Taiwan Environmental and Occupational Medicine Association (TEOMA). (2007, June). About TEOMA. Retrieved June 4, 2007, from

Taiwan Occupational Health Nursing Association (TOHNA). (2000). Guidelines for occupational health nursing practice. Taipei: Author.

Taiwan Occupational Health Nursing Association (TOHNA). (2007, June). Aim of the TOHNA. Retrieved June 4, 2007, from http://taohn.myweb.hinet.net/new_page_3.htm Wang, H. W., & Chang, M. (2006). The effects of exercise intervention based on the

transtheoretical model for employees in a worksite. Formosan Journal of Medicine, 10(3), 292-301.

Wu, T. N., Liou, S. H., Wang, J. D., Shen, C. Y., Ko, K. N., Yang, G. Y., et al. (1996). Establishment of a work-related diseases surveillance system in Taiwan, republic of china. Preventive Medicine, 25(6), 725-729.

Yang, G. Y., Lin, H. L., Li, S. P., Yeh, W. Y., Su, C. C., Shih, W. Y., et al. (1994). A proportionate mortality study of coal-miners and stone-workers in northern Taiwan. Journal of Occupational Safety and Health, 2(1), 25-34.


Table 1

Purposes and Characteristics of the Laws and Regulations

Year Name Purpose/Highlights

1974 Labor Safety and Health Law

• To prevent occupational accidents and protect labor safety and health.

• Prohibits women and youths under 16 years of age from exposure to dangerous or harmful work environments. 1976 Labor Health

Protection Regulation

• Requires employers to implement pre-employment health examinations for new employees and periodic health examinations during employment.

• Workers who are exposed to hazardous material or chemicals should receive frequent and specific health examinations. • Requires businesses with more than 300 workers to have an on-site medical center and full-time OHNs and part-time and/or full-time occupational physicians.

1984 Labor Standards Law

• Describes the rights and obligations of workers and employers including labor contracts, wages, work hours, leave, and the employment of women and children.

• Employers are responsible for preventing occupational hazards and building appropriate work and welfare facilities for their workers.

1993 Labor Inspection Law

• To create a labor inspection system, enforce labor laws, preserve labor-management rights and benefits, and maintain social stability as well as economic development.

• Focuses more heavily on safety issues in specific industries (e.g., construction) than on labor health protection.