Práticas profissionais em instituições psiquiátricas: desafios para o atendimento humanizado e integral / Professional practices in psychiatric hospitals: challenges for humanized and comprehensive care

Modelo de estudo: Estudo transversal de abordagem misto (quantitativa e qualitativa). Objetivo: Analisar as prá-ticas de profissionais em hospitais psiquiátricos no atendimento a pessoas com transtornos mentais, com vistas a contribuir para a abordagem humanizada e integral. Metodologia: Estudo realizado em dois hospitais psiquiátricos do Rio Grande do Norte, tendo como participantes 60 profissionais de saúde. Os dados quantitativos foram sub-metidos ao software estatísticoe analisados através de estatística bivariada; e nos dado qualitativos, recorreu-se ao tratamento do software Alceste e a técnica de análise de conteúdo. Resultados: Observou-se o predomínio de práticas profissionais associadas a intervenções tradicionais no contexto da abordagem realizada, reforçados nos dois temas centrais, oriundos dos achados qualitativos, a saber: Práticas profissionais no hospital psiquiátricos: cotidianos e políticas, e, Entraves e caminhos para o atendimento integral e humanizado em instituições psiquiá-tricas. Conclusão: As práticas profissionais desenvolvidas no âmbito das instituições psiquiátricas apontam para o enfoque terapêutico biológico e individual, tendo em vista os desafios de articular um atendimento integral e humanizado condizente com as diretrizes propostas pelo movimento de reforma psiquiátrica brasileiro. (AU)

Study model: cross-sectional study with a mixed approach (quantitative and qualitative). Objective: to analyze the practices of professionals in psychiatric hospitals in the care of people with mental disorders, with a view to contributing to a humanized and integral approach. Methodology: study carried out in two psychiatric hospitals in Rio Grande do Norte, with 60 health professionals as participants. The quantitative data were submitted to statis-tical software and analyzed through bivariate statistics; and in the qualitative data, the Alceste software treatment and the content analysis technique were used. Results: it was observed the predominance of professional practices associated with traditional interventions in the context of the approach performed, reinforced in the two central themes, arising from the qualitative findings, namely: Professional practices in the psychiatric hospital: daily life and policies, and, Barriers and paths to comprehensive and humanized care in psychiatric institutions. Conclusion:the professional practices developed within psychiatric institutions point to the biological and individual therapeutic focus, in view of the challenges of articulating a comprehensive and humanized care consistent with the guidelines proposed by the Brazilian psychiatric reform movement. (AU)

Desgaste laboral en personal prehospitalario en México durante la pandemia de 2020 / Burnout in prehospital staff in Mexico during the 2020 pandemic

El burnout (desgate emocional) es una problemática que tiene consecuencias en las y los trabajadores expuestos a determinados riesgos y exigencias. Durante la pandemia por COVID-19 en México aumentó la carga laboral del personal de salud, por lo que esta investigación tiene como propósito explorar la relación entre los datos sociodemográficos, de salud, de las condiciones laborales y burnout entre los profesionales de salud de atención prehospitalaria a inicios de la pandemia en México. Materiales y Métodos: Estudio cuantitativo y descriptivo, se realizó una encuesta en línea en la que participaron 80 trabajadores/as del área prehospitalaria de un universo de aproximadamente 21 mil personas para indagar sus condiciones laborales y la exposición a factores estresantes, así como la prevalencia de la despersonalización, el agotamiento emocional y la realización personal, dimensiones emocionales que definen el burnout. Resultados: El 11.25% de la muestra presenta burnout de acuerdo con el instrumento; en el resto de la muestra destaca que un porcentaje alto de participantes, no tienen burnout, refieren niveles elevados de despersonalización y agotamiento emocional, lo que indica un síndrome en proceso, por lo que es importante dar seguimiento para evitar el avance del burnout en el personal de salud en general y el prehospitalario en particular. Conclusiones: El personal prehospitalario reconoce su trabajo como actividad de riesgo, no obstante, también destacan que su labor favorece la realización personal y la ayuda a otros, que funcionan como factores protectores(AU)

Burnout (emotional exhaustion) is a problem that has consequences for workers, exposed to certain risks and demands. During the COVID-19 pandemic in Mexico, the workload of health workers increased, so this research aims to explore the relationship between sociodemographic, health, working conditions and burnout syndrome data between prehospital care health professionals at the beginning of the pandemic in Mexico. Materials and Methods: Quantitative and descriptive study, an online survey was carried out in which 80 workers from the pre-hospital area participated to investigate their working conditions and exposure to stressors, as well as the prevalence of depersonalization, exhaustion emotional and personal fulfillment, which are the emotional dimensions that define burnout. Results: 11.25% of the sample presents burnout according to the instrument; In the rest of the sample, it stands out that a high percentage of participants, who do not have burnout, report high levels of depersonalization and emotional exhaustion, which indicates a syndrome in process, so it is important to follow up to avoid the progression of burnout in health personnel in general and pre-hospital personnel in particular. Conclusions: The prehospital staff recognize their work as a risky activity; however, they also emphasize that their work favors personal fulfillment and helps others, which function as protective factors(AU)

Apego a higiene de manos en 5 momentos y protección específica en un hospital de tercer nivel ante la pandemia de COVID-19 / Adherence to hand hygiene at five moments and specific protection in a tertiary care hospital during the COVID-19 pandemic

Resumen Introducción: Ante la pandemia de COVID-19, el apego a las medidas de higiene es un objetivo para disminuir la morbimortalidad. Objetivo: Evaluar el apego a la higiene de manos y medidas de protección durante la pandemia de COVID-19 en un hospital de tercer nivel. Métodos: Estudio transversal acerca del lavado de manos del personal de salud en los cinco tiempos recomendados por la Organización Mundial de la Salud, así como sobre el uso del equipo de protección personal específico. Resultados: Fueron observadas 117 oportunidades de higiene de manos en personal de salud: 40 (34 %) respecto al lavado de manos y 76 (65 %) respecto a su omisión; sobre el apego al uso de careta en cinco (4 %) y sobre la falta de apego en 112 (96 %). Se identificó apego al uso de mascarilla en 65 profesionales de enfermería (87 %), uso adecuado de mascarilla en 56 de ellos (60 %) y uso de careta en uno (1 %.) Conclusión: El personal mostró baja proporción de apego a la higiene de manos y al uso de equipo para la protección específica durante la pandemia de COVID-19.

Abstract Introduction: During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. Objective: To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. Methods: Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. Results: One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). Conclusion: Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.

Qualidade de vida no trabalho em diferentes áreas de atuação profissional em um hospital / Quality of working life from the perspective of different groups of professionals working in a maternity hospital

Resumo A relação do homem com o trabalho pode impactar diretamente em sua qualidade de vida e condição de saúde. O objetivo deste artigo é comparar as condições de Qualidade de Vida no Trabalho (QVT) de três diferentes áreas de atuação profissional. Estudo transversal com amostra aleatória de 172 trabalhadores de um hospital (37,9±10,3 anos; 73,8% mulheres). Os participantes responderam ao inventário de avaliação de qualidade de vida no trabalho (IA_QVT). A Anova e o teste de Tukey foram utilizados para análise dos dados. 36,4% dos itens que avaliaram condições de trabalho e 35,7% dos itens sobre reconhecimento e crescimento profissional apresentaram diferenças entre os grupos (p<0,05). Nos âmbitos de relações socioprofissionais, organização do trabalho e elo trabalho-vida social, os índices foram de 12,5%, 11,1% e 10,0%, respectivamente. No geral, 21,7% dos itens pesquisados apresentaram diferenças significativas entre os grupos. Foram encontradas diferenças importantes na percepção de QVT entre áreas distintas, sugerindo que um planejamento eficiente pode resultar em promoção da saúde caso atenda demandas setorizadas.

Abstract The relationship between people and work has a direct impact on quality of life and health. The objective of this article is to compare perceived levels of Quality of Working Life (QWL) across three different groups of professionals. Cross-sectional study with a random sample of 172 hospital workers (37.9±10.3 years; 73.8% women). Participants filled out the Quality of Working Life Assessment Inventory (QWL-AI). The data was analyzed using Anova and Tukey's test. Statistically significant differences were found between the groups in 36.4% of the items assessing work conditions, 35.7% of the items assessing professional growth and recognition (p<0.05), 12.5% of the items assessing socioprofessional workplace relationships, 11.1% of the items assessing work organization, and 10% of the items assessing link between work and social life. Overall, 21.7% of the items showed significant differences between groups. We found significant differences in perceived QWL between the different groups, suggesting that QWL interventions should be tailored to the address the specific needs and demands of different sectors and departments to be effective.

Frequency of acute stress disorder in health care workers of a tertiary level pediatric hospital during the National Safe Distance Strategy for COVID-19 prevention / Frecuencia de trastorno por estrés agudo en el personal de salud de un hospital pediátrico de tercer nivel durante la Jornada Nacional de Sana Distancia para la prevención de la COVID-19

Abstract Background: Acute stress disorder (ASD) is one of the most frequent mental illnesses occurring during sanitary emergencies. This study aimed to estimate the frequency of ASD in health care workers of a tertiary level pediatric hospital during the coronavirus disease (COVID-19) pandemic. Methods: We conducted a cross-sectional study in which health care workers completed a virtual questionnaire, including sociodemographic information and the ASD scale. Results: We analyzed 206 questionnaires. The population was divided into three groups: attending physicians, medical residents, and nursing personnel. The frequency of health care workers who showed at least nine symptoms of ASD was 88.8%. No significant differences were found between the studied groups. Conclusions: ASD is a frequent condition in health care workers in the context of the COVID-19 pandemic. We need to investigate further and assess risk and protective factors for developing this and other psychopathologies in this population.

Resumen Introducción: El trastorno por estrés agudo es una de las enfermedades mentales más frecuentemente manifestadas en emergencias sanitarias. El objetivo de este estudio fue conocer la frecuencia con la que se presentó el trastorno por estrés agudo en el personal de salud de un hospital pediátrico de tercer nivel durante la epidemia de COVID-19. Método: Se realizó un estudio transversal en el que trabajadores de la salud contestaron un cuestionario virtual que incluyó datos sociodemográficos y la Escala de Trastorno por Estrés Agudo. Resultados: Se analizaron 206 encuestas. La población se dividió en tres grupos: médicos adscritos, residentes y personal de enfermería. El 88.8% de los trabajadores de la salud reportaron más de nueve síntomas de trastorno por estrés agudo. No se encontraron diferencias significativas entre los grupos de estudio. Conclusiones: Los síntomas del trastorno por estrés agudo son frecuentes en los trabajadores de la salud en el contexto de la COVID-19. Es necesario investigar acerca de los factores de riesgo y protectores asociados al desarrollo de esta y otras psicopatologías en dicha población.

Investigation of mental health among hospital workers in the COVID-19 pandemic: a cross-sectional study

ABSTRACT BACKGROUND: The rapid spread of the COVID-19 epidemic has led to extraordinary measures taken worldwide, and has led to serious psychological disorders. Healthcare professionals face greater severity of stress burden, due both to their direct contact with patients with the virus and to the isolation dimension of this outbreak. OBJECTIVE: To examine psychiatric disorders such as anxiety, depression and sleep disorders among healthcare professionals working in an emergency department and a COVID-19 clinic. DESIGN AND SETTING: Cross-sectional study including healthcare professionals in the emergency department and other units serving patients with COVID-19, of a training and research hospital in Turkey. METHODS: 210 volunteers, including 105 healthcare professionals in the emergency department and 105 healthcare professionals working in other departments rendering services for COVID-19 patients, were included in this study. A sociodemographic data form and the Hospital Anxiety Depression Scale (HAD), Pittsburg Sleep Quality Index (PSQI), World Health Organization Quality of Life scale (WHOQOL-BREF-TR) and Religious Orientation Scale were applied to the volunteers. RESULTS: The perceived stress levels and PSQI subscores were found to be significantly higher among the volunteers working in the emergency department than among those in other departments. The risk of development of anxiety among women was 16.6 times higher than among men. CONCLUSIONS: Healthcare professionals on the frontline need systematic regular psychosocial support mechanisms. Anxiety due to fear of infecting family members can be prevented through precautions such as isolation. However, it should be remembered that loneliness and feelings of missing family members consequent to isolation may increase the risk of depression.

Percepción del equipo de salud sobre los beneficios del calostro como factor protector de enterocolitis necrotizante en recién nacidos prematuros / Health professionals perception about the use of human colostrum, as preventive measure for necrotizing enterocolitis in preterm newborns

INTRODUCCIÓN: La incidencia de enterocolitis necrotizante (ECN), en Chile es de 0,3 a 2,4 por mil recién nacidos vi vos, siendo principalmente afectados los neonatos prematuros, y de 8 a 12 por ciento en prematuros menores a 1.500 gramos. OBJETIVO: Describir la percepción de profesionales de salud sobre el uso de calostro en recién nacidos prematuros, como factor protector de enterocolitis necrotizante. SUJETOS Y MÉTODO: Estudio cualitativo, mediante entrevista semiestructurada a 18 profesionales de la salud en tres hospitales públicos de la región de Valparaíso. La pauta de entrevista incluyó 3 temas: Conocimientos, percepción del suministro temprano de calostro y opinión acerca de la extensión de la medida, y 6 subtemas, 2 para cada tema respectivamente: Autopercepción del nivel de conocimiento y fuentes de información; Experiencia: aspectos positivos/eventos adversos y opinión del calostro como factor protector de enterocolitis; aspectos facilitadores u obstaculizadores y opinión acerca de la medida como política nacional. Procesamiento de datos mediante análisis de contenido cualitativo, temático. RESULTADOS: El uso de calostro en prematuros se da de modo protocolizado en dos de las tres unidades de alta complejidad neonatal de la región de Valparaíso. Los participantes opinan positivamente acerca de los resultados preventivos de esta medida. Aun cuando en un tercer estable cimiento no se aplique, hay una percepción favorable acerca de su potencial beneficio y su bajo costo de implementación. Se señala, no obstante, que ésta requiere de mayor evidencia y de un protocolo de aplicación. Otras limitantes serían la insuficiente dotación y formación del personal, y la necesidad de adquirir equipamiento e insumos. CONCLUSIONES: Profesionales que han aplicado un protocolo de administración de calostro en neonatos prematuros en la Región de Valparaíso, reportan buenos resultados de salud, y promueven la motivación del equipo hacia esta praxis. Sin embargo, se considera relevante la difusión y discusión de protocolos nacionales e internacionales, así como el desarrollo de investigación local. Dadas las experiencias en curso en Chile, y el debate internacional, se considera oportuno que el tema sea abordado y discutido en la comunidad sanitaria nacional.

INTRODUCTION: In Chile, necrotizing enterocolitis (NEC) mainly affects preterm infants, with an incidence of 0.3 to 2.4 per 1,000 live births, and 8 to 12% in preterm infants weighing less than 1,500 grams. OBJECTIVE: To describe health professionals perceptions on the use of human colostrum as a preventive measu re against necrotizing enterocolitis in preterm newborns. SUBJECTS AND METHOD: Qualitative study, using 18 semi-structured individual interviews of health professionals in three public hospitals of the Valparaíso Region. The interview included 3 topics: Knowledge, Perception of early colostrum supply and Opinion about the extent of the measure, and 6 subtopics, 2 for each topic respectively: Self-perception of knowledge level and Sources of information; Experience: positive aspects/adverse events and Opinion of colostrum as a protective factor for enterocolitis; Facilitating or hindering aspects and Opinion about the measure as national policy. Data were processed through qualitative content analysis. RESULTS: Two of the three high-complexity neonatal units of the Valparaíso Re gion have a protocol for administrating colostrum in premature infants. Participants have a positive opinion about the preventive results of this measure. Even in the third hospital where there is no protocol, they have a favorable perception of its potential benefit and its low cost of implementa tion. However, we observed that this procedure requires more evidence and an application protocol. Other limitations would be the lack of staffing and training and the need for equipment and supplies. CONCLUSIONS: Professionals who have applied a colostrum administration protocol in preterm infants in the Valparaíso Region report good health outcomes and promote team motivation towards this practice. However, it is relevant to the dissemination and discussion of national and international protocols, as well as the development of local research. Given the ongoing experiences in Chile and the international debate, we considered appropriate to address and discuss the topic within the na tional health community.

Análisis citogenético en linfocitos de trabajadores expuestos a radiación ionizante en una unidad de cardiología intervencional de Chile: estudio piloto y revisión de la literatura / Citogenetic effects upon lymphocyes in subjects exposed to ionizing radiadion in an interventional laboratory cardiology: pilot study and literature review

ANTECEDENTES: Un número creciente de artículos está llamando la atención en forma consistente sobre la eventual asociación que existe entre los denominados trabajadores ocupacionalmente expuestos a bajos niveles de radiación ionizante (POEs) y una mayor frecuencia de aberraciones cromosómicas, a nivel Sudamericano estos estudios son escasos. OBJETIVO: Evaluar la frecuencia de aberraciones cromosómicas en linfocitos de sangre periférica de POEs de un hospital y de sujetos sanos. Adicionalmente, se realizó una revisión exhaustiva de los artículos que a la fecha abordaron este tema. MATERIAL Y MÉTODO: Se condujo un análisis citogenético destinado a cuantificar las aberraciones cromosómicas en sangre periférica de linfocitos de 6 POEs de la unidad de Cardiología Intervencional y, como controles, 6 muestras de sujetos de la población general fueron analizadas. RESULTADOS: Se observó un importante contraste en el número de aberraciones cromosómicas presentadas en los POEs versus la población general no expuesta a radiaciones ionizantes, siendo esta de una relación de 6:1, respectivamente. CONCLUSIÓN: Los resultados preliminares indican una mayor frecuencia de aberraciones cromosómicas en los POEs versus la población general, sin embargo, se deberá esperar los resultados de la segunda fase de investigación, donde al ampliar la muestra en análisis se podrán obtener conclusiones estadísticamente significativas.

BACKGROUND: There is growing evidence of an increased number of chromosomes aberrations in subjects exposed to low levels of ionizing radiation (POEs). There are few studies on this subject in Latin America AIM: To evaluate the frequency of chromosome aberrations in lymphocytes obtained from peripheral blood in subjects working in laboratories where low levels of ionizing radiation are present and to compare these findings to those of unexposed subjects. METHODS: A cytogenic analysis to quantify chromosome aberrations was performed in 6 POs subjects from a cardiology invasive laboratory and 6 controls from a general unexposed population. RESULTS: Compared to controls, an approximately 6-fold increase in the number of chromosome aberrations was observed.in subjects exposed to ionizing radiation CONCLUSION: These preliminary results indicate that there is an increased number of chromosome aberrations in subjects exposed to low levels of ionizing radiation, as occurs in people working in a cardiology interventional laboratory. Studies in large numbers of subjects and preferably followed prospectively are needed to evaluate more precisely this effect.

Personalidade hardiness e fatores associados em profissionais da saúde atuantes em serviços que atendem pacientes críticos / Hardy personality and associated factors in health professionals active in services that treat critical patients

Resumo Objetivou-se identificar os fatores associados à personalidade hardiness em profissionais de saúde atuantes em serviços hospitalares que atendem a pacientes críticos. Estudo epidemiológico, transversal e analítico, realizado com 469 profissionais de saúde. Como instrumento, utilizou-se a Escala Hardiness (EH) associada a um questionário para investigar as condições sociodemográficas, ocupacionais e de saúde. Foi realizada a análise descritiva e bivariada por meio do teste qui-quadrado e modelo múltiplo através de regressão logística múltipla, utilizando o teste Hosmer Lemeshow e PseudoR2, estimando razão das chances (odds ratio). A classificação dos escores totais na EH evidenciou preponderância de moderado hardiness (48,4%). A chance de alto hardiness entre profissionais com estilo de vida fantástico regular ou ruim reduziu em 74% quando comparado aos considerados muito bons e excelentes. Também esteve aumentada entre os profissionais que não tiveram licença/afastamento, que apresentavam alta satisfação por compaixão no trabalho, baixo estresse e baixo burnout. A personalidade hardiness influência direta e indiretamente a saúde e o bem-estar do profissional de saúde atuante em serviços hospitalares que atendem a pacientes críticos.

Abstract This study aimed to identify factors associated with the hardy personality in health professionals working in hospital services that treat critically ill patients. This is an epidemiological, cross-sectional, and analytical study conducted with 469 health professionals. We used the Hardiness Scale (HS), coupled with a questionnaire to investigate sociodemographic, occupational, and health conditions. A descriptive and bivariate analysis was performed using the chi-square test and the multiple model through multiple logistic regression, using the Hosmer-Lemeshow and PseudoR2 tests, estimating odds ratios. The classification of total scores in HS showed prevailing moderate hardiness (48.4%). Professionals with a fair or poor fantastic lifestyle (FL) were 74% less likely to show high hardiness than those with very good and excellent FL. Also, professionals who were not on leave, who had high satisfaction with compassion at work, low stress, and low burnout were more likely to show high hardiness. The hardy personality, directly and indirectly, influences the health and well-being of health professionals working in hospital services that treat critically ill patients.

Effect of radiation on endothelial functions in workers exposed to radiation

SUMMARY OBJECTIVE Our aim is to determine whether radiation affects the endothelial function of hospital staff working in the radiation unit for diagnostic and therapeutic purposes. We have evaluated endothelial function with vascular imaging parameters such as flow-mediated dilatation (FMD) and aortic stiffness index (ASI). METHODS A total of 75 employees, 35 of whom are exposed to radiation due to their profession and 40 as the control group, were included in our single-centered study. Demographic data, FMD, aortic stiffness, and echocardiographic findings of the two groups were compared. RESULTS There were no significant differences in demographic data. Median FMD values tended to be lower in the radiation exposure group [7.89 (2.17-21.88) vs. 11.69 (5.13-27.27) p=0.09]. The FMD value was significantly lower in the catheter laboratory group than in the radiation-exposed (p=0.034) and control (p=0.012) groups. However, there was no statistically significant difference between the non-catheter lab radiation exposed group and the control group (p=0.804). In addition, there was no statistically significant difference in the ASI value between the groups (p=0.201). CONCLUSION We have found that FMD is decreased among hospital staff working in radiation-associated areas. This may be an early marker for radiation-induced endothelial dysfunction.

RESUMO OBJETIVO O nosso objetivo é determinar se a radiação afeta a função endotelial de funcionários do hospital que trabalham em unidades com exposição à radiação para fins diagnósticos e terapêuticos. Avaliamos a função endotelial com parâmetros de imagens vasculares, tais como dilatação fluxo-mediada (FMD) e o índice de rigidez aórtica (ASI). METODOLOGIA Um total de 75 funcionários, 35 expostos à radiação devido à sua ocupação e 40 como grupo de controle, foram incluídos em nosso estudo monocêntrico. Os dados demográficos, de FMD, rigidez aórtica e ecocardiográficos dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas nos dados demográficos. Os valores médios de FMD, em geral, foram mais baixos no grupo de exposição à radiação [7,89 (2,17-21,88) e 11,69 (5,13-27,27) p=0,09]. O valor de FMD foi significativamente menor no grupo laboratorial com cateter do que no exposto à radiação (p=0,034) e no de controle (p=0,012). No entanto, não houve diferença estatisticamente significativa entre o grupo laboratorial sem cateter e exposto à radiação e o grupo de controle (p=0,804). Além disso, não houve diferença estatisticamente significativa quanto ao valor de ASI entre os grupos (p=0,201). CONCLUSÃO Observamos que a FMD é menor entre funcionários que trabalham em setores hospitalares associados à radiação. Isso pode ser um marcador inicial de disfunção endotelial induzida por radiação.

Satisfacción laboral y motivación en profesionales obstetras en un hospital en Chile / Job satisfaction and motivation in obstetric professionals of a Chilean hospital

El principal activo de las organizaciones está constituido por sus trabajadores, por lo cual se debe prestar una especial atención a su motivación y satisfacción, y también a la relación con el desempeño. La satisfacción laboral de los profesionales del sistema de salud se relaciona directamente con la calidad de servicio ofrecido, de ahí la importancia de su medición. La insatisfacción puede repercutir negativamente en la calidad de atención. La presente investigación tiene por objetivo determinar el nivel de satisfacción y motivación laboral de los y las profesionales matronas del Hospital de Puerto Montt-Chile, para lo cual se realizó un estudio de carácter cuantitativo, descriptivo y transversal. Para medir la motivación se empleó el Job Diagnostic Survey y para la satisfacción se utilizó la escala de satisfacción laboral SL-SPC. Se logró determinar que los profesionales poseen niveles de motivación media-alta en todas las dimensiones estudiadas. Respecto a los factores de satisfacción, el estudio arrojó un nivel medio-bajo, en la mayoría de los factores medidos.

The main asset of an organization is its workers. Special attention must be paid to their motivation and satisfaction and also to how they relate to performance. Job satisfaction of health care professionals is directly related to the quality of care provided, hence the importance of its measurement. Dissatisfaction can negatively impact the quality of care. The purpose of this study is to determine the level of satisfaction and work motivation of the midwifery professionals of the Hospital of Puerto Montt (Chile). We used a quantitative, descriptive, and cross-sectional study. To measure motivation, we used the Job Diagnostic Survey, and to measure satisfaction, we used the SL-SPC scale. It was possible to determine that the professionals have medium-high levels of motivation in all the dimensions studied. Regarding satisfaction factors, the study showed a medium-low level, in most of the factors measured.

Patient safety culture from the perspective of all the workers of a general hospital / Cultura de seguridad del paciente desde la perspectiva de todos los trabajadores de un hospital general / Cultura de segurança do paciente na perspectiva de todos os trabalhadores de um hospital geral

ABSTRACT Objective: To assess the patient safety culture among the workers of a hospital institution in southern Brazil. Method: This is a cross-sectional study, which was performed with 630 hospital workers, at Santa Rosa, Rio Grande do Sul, Brazil, through the Safety Attitudes Questionnaire tool, in the month of April 2017. Results: We found positive scores in all the safety culture domains, except for the perceived stress domain. Conclusion: Job satisfaction and teamwork spirit showed better scores for nursing and health professionals, when compared to the support team. Schooling, gender, operation time and the choice of workplace positively influenced the safe atmosphere.

RESUMEN Objetivo: Evaluar la cultura de seguridad del paciente entre los trabajadores de una institución hospitalaria de Santa Rosa, Río Grande del Sur, Brasil. Método: Estudio transversal, el cual se desarrolló con un equipo multidisciplinario de una institución hospitalaria, mediante el instrumento Safety Attitudes Questionnaire, en el mes de abril de 2017. Resultados: Se encontraron puntuaciones positivas en todos los dominios de la cultura de seguridad, excepto para el dominio sobre la percepción del estrés. Conclusión: La satisfacción laboral y el clima de trabajo en equipo demostraron mejores puntuaciones para profesionales de la enfermería y del área de la salud, en comparación con el equipo de apoyo. La escolaridad, el género, el tiempo activo en la profesión y la elección por el sitio de trabajo influenciaron el clima de seguridad de manera positiva.

RESUMO Objetivo: Avaliar a cultura de segurança do paciente entre todos os trabalhadores de uma instituição hospitalar no sul do Brasil. Método: Estudo transversal, realizado com 630 trabalhadores de um hospital de Santa Rosa, no Rio Grande do Sul, Brasil, por meio do instrumento Safety Attitudes Questionnaire, no mês de abril de 2017. Resultados: Encontraram-se escores positivos em todos os domínios da cultura de segurança, exceto para o domínio percepção do estresse. Conclusão: A satisfação do trabalho e o clima de trabalho em equipe demonstraram melhores escores para profissionais da enfermagem e da área da saúde, se comparado à equipe de apoio. Escolaridade, gênero, tempo de atuação e a escolha pela unidade de trabalho influenciaram positivamente o clima de segurança.

Presencia de microorganismos en teléfonos móviles del personal de cuidados intensivos de un hospital de España / Presence of microorganisms in mobile phones of intensive care staff at a hospital in Spain

RESUMEN Con el objetivo de identificar la presencia de microorganismos en los teléfonos móviles del personal de la unidad de cuidados intensivos (UCI) de un hospital en España se realizó un estudio transversal descriptivo entre los profesionales sanitarios y no sanitarios que tuvieran teléfonos móviles durante su jornada laboral. La recogida de muestras se llevó a cabo mediante hisopo y siembra en placa de cultivo con análisis e identificación de los microorganismos. Se analizaron 111 teléfonos móviles, de los cuales 56 estaban contaminados siendo 41,5% y 41,1% para los que pertenecían a las enfermeras y los médicos respectivamente y 60,6% para la encontrada en los auxiliares de enfermería, destaca el crecimiento de Pseudomonas aeruginosa (12,5%), Staphylococus aureus meticilin-resistente (10,9%), y Stenotrophomonas maltophila (4,7%). En conclusión, los teléfonos móviles presentaron presencia de microorganismos de relevancia clínica. La presencia de estas bacterias y hongos deben alertarnos sobre la posibilidad de que sirvan de reservorio para la transmisión al paciente crítico.

ABSTRACT In order to identify the presence of microorganisms in mobile phones of the staff from the intensive care unit (ICU) at a hospital in Spain, a cross-sectional descriptive study was carried out among healthcare and non-healthcare professionals who had mobile phones during their working day. Samples were collected by swabbing and sowing on a culture plate with analysis and identification of microorganisms. One hundred eleven (111) mobile phones were analyzed, of which 56 were contaminated: 41.5% and 41.1% of those belonging to nurses and physicians, respectively, and 60.6% found in nursing assistants. The growth of Pseudomonas aeruginosa (12.5%), methicillin-resistant Staphylococcus aureus (10.9%), and Stenotrophomonas maltophila (4.7%) stand out. In conclusion, mobile phones presented the presence of clinically relevant microorganisms.

Acidentes de trabalho entre profissionais da limpeza hospitalar em uma capital do Nordeste, Brasil / Workplace accidents among hospital cleaning professionals at a hospital in the city of Maranhão, Brazil

Resumo O objetivo deste estudo foi investigar a prevalência e os fatores associados aos acidentes de trabalho entre profissionais da limpeza hospitalar. Foram entrevistados 199 trabalhadores da limpeza de seis hospitais em São Luís, Maranhão, Brasil. Primeiramente, realizou-se análise univariada e, posteriormente, utilizaram-se as análises de regressão de Poisson com variância robusta, com modelagem hierarquizada dos dados a fim de estimar razões de prevalências (RP) entre as variáveis independentes e o desfecho (acidentes de trabalho). Houve prevalência de 13,57% de acidentes de trabalho, destes, 81,48% ocorridos com materiais perfurocortantes. Ao final da análise multivariada, identificaram-se fatores associados á ocorrência de acidentes de trabalho: idade de 18 a 30 anos, ter ensino médio incompleto, tempo de serviço de 2 a 5 anos, segregação inadequada dos resíduos de serviços de saúde (RSS), ter capacitação somente na admissão, não considerar os riscos dos resíduos à saúde e o não uso de equipamento de proteção individual (EPI). Os fatores avaliados apresentaram-se associados significativamente aos acidentes de trabalho e ressaltam a importância da educação permanente em saúde, com ênfase em capacitações periódicas e uso de EPI.

Abstract The goal of this study was to investigate the prevalence and factors associated with workplace accidents among hospital cleaning professionals. This is a cross-sectional, analytical study of a sample of 199 cleaning workers at six hospitals in São Luís, Maranhão, Brazil. We first ran a univariate analysis, and later the Poisson regression analyzes with robust variance were used, with hierarchized modeling of the data in order to estimate the prevalence ratios (PR) between the independent variables and the outcome (workplace accidents). The prevalence of workplace accidents is 13.57%, 81.48% of them with sharps. At the end of the multivariate analysis the following were found to be associated with workplace accidents: age between 18 and 30, not having a high-school degree, on the job for 2 to 5 years, inadequate segregation of health service waste (HSW), training only on admission, failure to consider the health hazards of hospital waste and failure to use personal protective equipment (PPE). Our findings reinforce the importance of continued health education, stressing periodic training and the use of PPE.

Incidência de ganho de peso em trabalhadores de um hospital: análise de sobrevivência / Incidence of weight gain in hospital workers: survival analysis

Resumo O ganho de peso na vida adulta pode ser responsável por doenças crônicas, e seu acompanhamento pode ser um subsídio para evitar esses agravos. O objetivo foi analisar o ganho de peso e fatores associados em trabalhadores de um hospital privado no município do Rio de Janeiro. Trata-se de uma coorte retrospectiva com 686 trabalhadores, que realizaram ao menos dois exames de saúde ocupacionais (admissional e periódico) entre os anos de 2010 e 2015. O método de Kaplan-Meier e o modelo de regressão semiparamétrico de riscos proporcionais de Cox foram utilizados. A incidência de ganho de peso dos trabalhadores do hospital foi de 22 casos/100 pessoas-ano. O ganho de peso nos trabalhadores com mais de 30 anos foi 35% menor (p < 0,001), quando comparado ao ganho de peso naqueles de até 30 anos. Em relação à escolaridade, as taxas de incidência de ganho de peso nos trabalhadores de níveis fundamental e médio se apresentaram maiores, com magnitude de até 61%, comparadas aos de nível superior completo (p < 0,001); e no setor de trabalho considerado fechado foi 63% maior quando comparada ao setor aberto (p < 0,001). Ganho de peso é um fenômeno multifacetado e complexo, podendo os setores de trabalho de uma unidade hospitalar contribuir fortemente para a ocorrência do mesmo.

Abstract Weight gain in adult life may be responsible for chronic diseases, and follow-up of this may be a subsidy to avoid these diseases. The objective was to analyze the weight gain and associated factors in workers of a private hospital in the city of Rio de Janeiro. This is a retrospective cohort of 686 workers, who performed at least two occupational health exams (admission and periodic) between 2010 and 2015. The Kaplan-Meier method and the Cox proportional hazards regression model were used. The incidence of weight gain of hospital workers was 22 cases / 100 person-years. The weight gain in workers over 30 years old was 35% lower (p < 0.001) when compared to weight gain in those up to 30 years of age. Regarding schooling, the incidence rates of weight gain among workers at primary and secondary levels were higher, with a magnitude of up to 61%, compared to those at a higher level (p < 0.001); And in the closed sector it was 63% higher when compared to the open sector (p < 0.001). Weight gain is a multifaceted and complex phenomenon, being the work sectors of a hospital unit a strong causer of occurrences of the event.

Percepción de apoyo en duelo por profesionales y técnicos de cuidados intensivos pediátricos de hospitales públicos / Perception of support in professional's and technician's grief of pediatric intensive care units in public hospitals

INTRODUCCIÓN: La muerte en la infancia es una realidad a la que se ven enfrentados los profesionales de salud, especialmente en unidades de alta complejidad como son los cuidados intensivos. Esto genera en los profesionales impotencia y frustración, comprometiendo su salud física, emocional y mental, agravada por la sensación de bajo soporte social y deficiente preparación para el afrontamiento de la muerte y el apoyo a los familiares de sus pacientes. OBJETIVO: Develar la percepción de apoyo en duelo de profesionales y técnicos en unidades de cuidado intensivo pediátrico de hospitales públicos, tras la muerte de los pacientes. SUJETOS Y MÉTODO: Estudio cualitativo con enfoque fenomenológico. Se realizaron 16 entrevistas en profundidad a profesionales y técnicos de cuidados intensivos pediátricos de cinco hospitales públicos de Santiago. Como criterios de inclusión se consideraron el trabajar por más de un año en la unidad, haber vivenciado la muerte de pacientes, y reconocer que ha cursado un duelo profesional. La entrevista fue guiada por la siguiente pregunta: ¿Cómo ha vivenciado usted el apoyo en duelo recibido, tras la muerte de pacientes en su unidad? Una vez trascritas las narrativas se realizó el análisis fenomenológico y posterior triangulación de los datos, logrando la saturación. RESULTADOS: Se develó que los participantes se sienten poco apoyados en sus duelos tras la muerte de los pacientes, existiendo obstáculos para su afrontamiento. Aunque enfrentar la muerte es algo complejo para ellos, reconocen que son capaces de generar estrategias de protección y además se sienten apoyados por personas de su entorno. A pesar de lo complejo de esta experiencia, ellos consideran que existen aprendizajes al enfrentar la muerte que los lleva a dar sentido a su labor profesional. CONCLUSIÓN: Los profesionales requieren que las pérdidas en el ámbito laboral sean reconocidas, y por ello, contar con un apoyo formal y continuo de su equipo de trabajo e institución.

INTRODUCTION: Death in childhood is a reality faced by health professionals, especially in highly com plex units such as intensive care ones. This leads to feelings of helplessness and frustration in health professionals, compromising their physical, emotional, and mental health, which is worsened by the feeling of low social support and poor preparation for coping with death and support for the patient's family. OBJECTIVE: To expose the perception of sorrow support of professionals and techni cians in pediatric intensive care units of public hospitals, after the death of the patients. SUBJECTS AND METHOD: Qualitative study with a phenomenological approach. 16 in-depth interviews were conducted with pediatric intensive care professionals and technicians from five public hospitals in Santiago, Chile. Inclusion criteria considered working for more than a year in the Unit, having experienced the death of patients, and recognizing that they have gone through a professional sorrow. The in terview focused on the following question: How have you experienced the sorrow support received after the death of patients in your unit? Once the narratives were transcribed, the phenomenological analysis and subsequent data triangulation were carried out, achieving saturation. RESULTS: It was observed that the participants feel little supported in their sorrows after the death of the patients, where there are obstacles to face the situation. Although facing death is something complex for the participants, they recognize that they can generate protection strategies and also feel supported by the people around them. Despite the complexity of this experience, the participants consider that there are lessons learned in facing death which leads them to give meaning to their professional work. CONCLUSION: Professionals need the recognition of deaths in the workplace and, therefore, formal and continuous support from their work team and institution.

Ganho de peso por década entre trabalhadores de um hospital público: estudo de coorte histórica / Weight gain in public hospital workers: a retrospective cohort study

Resumo O objetivo do estudo foi avaliar as modificações no perfil nutricional dos trabalhadores de um hospital público por três décadas e sua associação com fatores ocupacionais. Estudo de coorte histórica com trabalhadores ativos em 2013 admitidos em três períodos. Foram coletados dados sociodemográficos, de peso e de estatura, e calculado o índice de massa corporal (IMC) do exame admissional e de dois exames periódicos/década. Avaliados 386 trabalhadores (76,4% mulheres, 88,1% de cor de pele branca e 29,3±7,3 anos). A média do peso corporal e do IMC da admissão foram maiores naqueles admitidos em 2000 (P = 66,3 ± 12,5 kg; IMC = 21,3 ± 2,5 kg/m2), em comparação àqueles admitidos em 1980 (P = 56,7 ± 10,2 kg; IMC=21,3 ± 2,5 kg/m2) e 1990 (P = 62,2 ± 11,5 kg; IMC = 22,9 ± 3,3 kg/m2). A variação do peso e do IMC/década foi maior nos trabalhadores admitidos em 2000, em comparação com aqueles admitidos em 1990 e 1980. Quando essa comparação foi estratificada por sexo, a diferença na variação do peso e do IMC/década foi observada apenas nos homens. Turno de trabalho e categoria profissional não foram associados com a variação do peso corporal e IMC. O aumento ponderal e do IMC refletem a transição nutricional observada no País, o que reforça a necessidade de vigilância nutricional e educação continuada desses trabalhadores.

Abstract This study assessed changes in the nutrition profile of public hospital workers over a period of three decades and the association between nutritional status and occupational factors. A retrospective cohort study was conducted with staff taken on in 1980, 1990, and 2000 still working in the hospital in 2013. The following data was obtained from staff records: sociodemographic characteristics; and body weight and height, recorded during pre-employment and periodic medical examinations. The latter was used to calculate body mass index (BMI).The final sample consisted of 386 workers (76.4% women and 88.1% white) with a mean age of 29.3 ± 7.3 years. Mean body weight and BMI at admission were highest in the 2000 cohort (W = 66.3 ± 12.5kg; BMI = 21.3 ± 2.5 kg/m2), compared to 1980 (W = 56.7 ± 10.2 kg; BMI = 21.3 ± 2.5 kg/m2)and 1990 (W = 62.2 ± 11.5 kg; BMI = 22.9 ± 3.3 kg/m2) cohorts. Variation in weight and BMI between the pre-employment examination and final periodic examination was highest in the 2000 cohort. When stratified by sex, this difference in variation was observed only in men. No association was found between variation in body weight and BMI and work shift and occupation. The increase in weight and BMI reflects the nutritional transition in Brazil, underscoring the need for nutritional surveillance and the implementation of health education programs directed at staff.

Reforma da Atenção Hospitalar para modelo de saúde baseada em valor e especialidades multifocais / Remodeling hospital care - an account of experiences in the Federal District of Brazil

Resumo A saúde pública em Brasília sofreu diversas melhorias desde sua implementação devido à mudança do perfil econômico, social e de escolaridade da população. Foi realizada uma reforma na Atenção Hospitalar por gestão baseada em evidências, através de um conjunto normativo que estabeleceu o ordenamento dos Serviços Hospitalares de Emergência, Atenção Ambulatorial Secundária, Regulação de Serviços de Saúde e modelagem organizacional da Secretária de Saúde do Distrito Federal. Tais mudanças permitiram que os profissionais nos seus diferentes níveis de atenção estejam interligados. Ou seja, os profissionais passam a prestar um serviço de saúde de forma contínua para a população, proporcionando um cuidado de saúde integral ao paciente. Essa abordagem garante ganho de eficiência no tratamento do paciente, pois os profissionais multifocais e focais trabalham de maneira integrada. Com a implementação da gestão da organização por processos de trabalho e o planejamento adequado, foi possível redesenhar o modelo assistencial utilizado nos dias atuais, permitindo através da gestão do conhecimento a ampliação do acesso e da interatividade, proporcionado ao cidadão através do modelo de gestão em saúde que agregue valor.

Abstract Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.