Effects of interprofessional practice on nursing workload in hospitals: A systematic review.

OBJECTIVE: To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS: Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS: A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS: The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.

Collective leadership to improve professional practice, healthcare outcomes and staff well-being.

BACKGROUND: Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge.  OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language. SELECTION CRITERIA: Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention. DATA COLLECTION AND ANALYSIS: Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants).  AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

The effectiveness of faculty development activities for interprofessional education : A systematic review protocol.

Despite increasing international demand for interprofessional education (IPE) in health care, there remains limited understanding of the kind of faculty development (FD) activities needed. This paper reports on a protocol for a systematic review to answer the question: What are the available FD activities for IPE facilitators, and which are more effective? The review aims to identify principles and methods to develop competent facilitators in IPE and to identify the implications and effects of FD for IPE concerning individuals, organizations, education, and health practice. Literature was identified through systematic searches in the electronic databases: MEDLINE (Ovid), Embase (Ovid), Eric (EBSCO), CINAHL (EBSCO), Scopus, and Web of Science. There will be no restrictions on language or publication period. Screening of potential studies will be completed independently by at least two reviewers. The research quality of studies will be assessed for methodological rigor using established instruments based on the Critical Appraisal Skills Programme. Search results will be summarized using the PRISMA flow diagram. The proposed review seeks to provide clarity on the evidence base of FD for IPE facilitators, to strengthen future design and delivery of FD activities, and to enable ongoing success of this educational model.

Occupational risk prevention in hospitals based on the Cultural-Historical Activity Theory. / Prevenção de riscos e agravos à saúde dos trabalhadores hospitalares à luz da Teoria da Atividade Histórico-Cultural.

Hospital managers should target occupational risks and harm prevention since this can contribute to the quality of life at work and patient safety. This article aims to elucidate the activity of prevention of occupational risks and injuries in the hospital setting based on analysis of historical and empirical contradictions of the activity system. An exploratory qualitative study grounded in the Cultural-Historical Activity Theory was conducted at a university hospital in the state of São Paulo. Data were collected between September 2021 and January 2022 via individual semi-structured interviews of 9 professionals from the Occupational Health and Safety services and of five hospital managers, involving 20 hours of field observation and document analysis. Despite the expansion of the object of prevention activity, the other elements of the activity system did not adapt to the new demands, causing incompatibilities and contradictions that compromised the attainment of the expected outcomes. The main response actions observed were centered on complying with regulatory items, such as team composition, medical examinations and others, that contribute little toward promoting occupational health and safety.

A prevenção de riscos e agravos à saúde dos trabalhadores nos hospitais deve ser foco dos gestores, pois contribui para a qualidade de vida no trabalho e a segurança do paciente. O objetivo deste artigo é compreender a atividade de prevenção de riscos e agravos à saúde dos trabalhadores no contexto hospitalar, a partir das contradições históricas e empíricas do sistema de atividade. Estudo qualitativo exploratório, ancorado na Teoria da Atividade Histórico-Cultural, desenvolvido em um hospital universitário do estado de São Paulo. Os dados foram coletados entre setembro de 2021 e janeiro de 2022 por meio de entrevistas semiestruturadas com nove profissionais do Serviço Especializado em Engenharia de Segurança e Medicina do Trabalho e cinco gestores do hospital; 20 horas de observação de campo; e análise documental. Apesar da expansão do objeto da atividade de prevenção, os demais elementos do sistema de atividade não se adaptaram às novas exigências, evoluindo com incompatibilidades e contradições que comprometeram o alcance dos resultados esperados. As principais ações de resposta observadas ficaram centradas em adequações a exigências de itens de normas, como composição de equipe, exames médicos e outras que pouco atuam na promoção e proteção da saúde.

Sleep Quality as a Mediator of Burnout, Stress and Multisite Musculoskeletal Pain in Healthcare Workers: A Longitudinal Study.

This study aimed to verify whether sleep quality is a mediator of the relationship between burnout, stress and multisite pain in healthcare workers in a longitudinal study with 12 months of follow-up during the COVID-19 pandemic. Online questionnaires were used for data collection. The sociodemographic questionnaire contained personal and occupational data. The short version of the Copenhagen Psychosocial Questionnaire (COPSOQ II-Br) was used to assess burnout and stress. The Pittsburgh Sleep Quality Index (PSQI-Br) assessed sleep quality over one month. The Nordic Musculoskeletal Questionnaire (NMQ) aimed to identify the presence of multisite musculoskeletal pain in the last 12 months and the last 7 days. Mediation analysis was used to verify whether the effect of the predictor variables (burnout and stress) on the dependent variable (number of pain sites in the last 12 months and 7 days) was due to an intervening variable (sleep quality). Stress and burnout were associated with multisite pain in healthcare workers in the last 12 months and the last 7 days. Sleep quality was a significant mediator of this association in the last 12 months, indicating that some of the association between burnout, stress and multisite pain can be explained by poor sleep quality. Thus, a comprehensive approach to long-term multisite pain should consider psychosocial aspects such as burnout, stress and sleep quality.

Association between offensive behaviors and burnout and depression risks in health workers. / Asociación entre comportamientos ofensivos y riesgo de burnout y depresión en trabajadores de la salud.

OBJECTIVE: to evaluate the occurrence of offensive behaviors at work, their characteristics and association with sex, stress, burnout and depression in health workers. METHOD: a cross-sectional, descriptive and quantitative study carried out with 125 workers from the Brazilian Unified Health System. The data were collected from June 2021 to April 2022 through three self-applied questionnaires that assess personal and occupational characteristics; offensive behaviors, stress and burnout; and depressive symptoms. Descriptive statistics, the chi-square association test and logistic regression analysis were applied. RESULTS: 44% of the sample reported 83 behaviors, with threats of violence as the most frequent ones (26%). Nursing technicians/assistants, nurses and physicians were the most exposed professionals. The main aggressors were the patients, except for bullying, which was perpetrated by co-workers (48%). There was an association between offensive behaviors and burnout (OR: 4.73; 95% CI: 1.29-17.3; p=0.02) and between offensive behaviors and depression symptoms (OR: 1.05; 95% CI: 1.01-1.10; p=0.02). CONCLUSION: the occurrence of offensive behaviors in health work is frequent and characteristic and burnout and depressive symptoms respectively increased 4.73 and 1.05 times the chances of workers suffering these offensive behaviors in the work environment.

COVID-19 Pandemic: Analysis of Health Effects on Emergency Service Nursing Workers via a Qualitative Approach.

During the COVID-19 pandemic, longstanding issues involving nursing work, which has always involved significant risks of illness and infection, were intensified. It is necessary to acknowledge the risks and nurses' perceptions about the risks qualitatively during the period of the health crisis. The aim of this study was to examine the health repercussions perceived by nursing workers in emergency services during the outbreak of the COVID-19 pandemic in Brazil. This was a qualitative, descriptive, cross-sectional study. The settings of the study were emergency services with a national scope; the participants were nursing workers. Data were collected via face-to-face virtual calling interviews and analyzed via a content analysis technique, which was supported by IRAMUTEQ software. The formation of textual classes pointed in three thematic directions, from which three categories emerged: nursing workers' exposure, due to a lack of protective equipment, to the risk of being contaminated with, falling ill from, and transmitting the COVID-19 virus; changes in work environments, processes, and relations in response to the pandemic; and physical, mental, and psychosocial alterations perceived by emergency service nursing workers. The exposure to the virus, risk of contamination, and changes in the work environment and relations all resulted in health repercussions, which were perceived as physical, mental, and psychosocial alterations that were described as dietary disturbances, physical fatigue, burnout, increased smoking, anxiety, sleep alterations, fear, exhaustion, stress, social isolation, loneliness, distancing from relatives, and social stigma.

Nursing supervision: interfaces with power relations in family health.

OBJECTIVE: To analyze nursing supervision from the perspective of power relations in family health. METHOD: An exploratory, descriptive and interpretive research with a qualitative approach. Data were collected through semi-structured interviews with 37 workers from six health teams in a city in the countryside of São Paulo. They were submitted to thematic content analysis, based on the health work process theoretical framework and Foucault's power category. RESULTS: Two thematic categories were constructed: Nursing supervision from the perspective of surveillance and control in relationships of disciplinary power in family health; The duality of nursing supervision in family health between oppressive power and positive power. CONCLUSION: The power present in nursing supervision is expressed as control and producer of things, which not only oppresses, but also has positive effects on building healthy work environments, valuing interactions, establishing trust, strengthening teamwork and supporting workers, aspects that result in the promotion of psychological safety in family health.

Workers' health policies in Brazil: historical contradictions and possibilities for development. / Políticas de saúde do trabalhador no Brasil: contradições históricas e possibilidades de desenvolvimento.

The Workers' Health (WH) approach understands that it is necessary to expand the object of public policies to transform the work processes that determine the health-disease relationship. This broadening brings challenges that drive the development of the formulation and implementation of policies for the surveillance and prevention of diseases. This article aimed to analyze the development of Brazilian policies on WH from the perspective of historical contradictions. To this end, the analytical concept of contradiction from Cultural-Historical Activity Theory was used. This is a scoping review, including 64 theoretical and empirical studies and gray literature published between 1991 and 2019. The results of the analysis showed that: from the change of the object of prevention inserted by the WH approach, five new contradictions emerged that are related to the predominance of instruments of the previous activity model, normative and training instruments, division of labor for assistance and surveillance actions, intra and intersectoral articulations. and social control. These contradictions have driven some changes, but some limitations persist around a challenging object.

A abordagem de Saúde do Trabalhador entende que é necessário ampliar o objeto das políticas públicas para transformar os processos de trabalho que determinam a relação saúde-doença. Essa ampliação traz desafios que impulsionam o desenvolvimento da formulação e implementação das políticas para a vigilância e prevenção de agravos. O objetivo deste artigo é analisar o desenvolvimento das políticas brasileiras em saúde do trabalhador a partir das contradições históricas. Para este fim, foi usado o conceito analítico de contradição da teoria da atividade histórico-cultural. Trata-se de uma revisão de escopo que inclui 64 estudos teóricos, empíricos e literatura cinza publicados entre 1991 e 2019. Os resultados da análise mostraram que: a partir da mudança de objeto da prevenção inserida pela abordagem da Saúde do Trabalhador, emergiram cinco novas contradições que estão relacionadas ao predomínio de instrumentos do modelo de atividade anterior, instrumentos normativos e de formação, divisão do trabalho para as ações de assistência e vigilância, articulações intra e intersetoriais e controle social. Essas contradições permitiram impulsionar algumas mudanças, mas também existem limitações que persistem em torno de um objeto desafiante.

Poor Health Conditions among Brazilian Healthcare Workers: The Study Design and Baseline Characteristics of the HEROES Cohort.

This study was conducted to describe the health conditions (the psychosocial aspects, sleep quality, and musculoskeletal symptoms) among Brazilian healthcare workers in the context of the pandemic. Workers answered an online questionnaire, including the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ II), the Pittsburgh Sleep Quality Index (PSQI), the Nordic Musculoskeletal Questionnaire (NMQ), and the Beck Depression Inventory (BDI). The most unfavourable psychosocial factors were work pace (61%; 95% CI: 52-69%), emotional work demands (75%; 95% CI: 67-82%), predictability (47%; 95% CI: 39-56%), work-family conflict (55%; 95% CI: 46-64%), burnout (86%; 95% CI: 78-91%), and stress (81%; 95% CI: 73-87%). Most workers (74%; 95% CI: 66-81%) were classified as poor sleepers. Musculoskeletal symptoms were frequent in the neck (64%; 95% CI: 55-72%), shoulders (62%; 95% CI: 54-70%), upper back (58%; 95% CI: 50-67%), and lower back (61%; 95% CI: 52-69%). Depressive symptoms were also highly prevalent (mild: 22%; 95% CI: 15-30%, moderate: 16%; 95% CI: 11-23%, severe: 8%; 95% CI: 4-14%). Most healthcare workers experience unfavourable psychosocial factors, poor sleep quality, as well as musculoskeletal and depressive symptoms. These findings underscore the urgent need to acknowledge and address psychological and physical distress to improve the personal and professional well-being of this population.

Using technological innovation as a tool to monitor nursing workers' health. / A inovação tecnológica como ferramenta para monitoramento da saúde dos trabalhadores de enfermagem.

The objective of the present study is to describe the development of the "Monitoring System for Nursing Workers' Health" software, a technological innovation designed to identify the health hazards caused to nursing workers' and their determinants, i.e., strain and/or strength potentials, monitoring their health using indicators. The software development comprises the phases of defining the objective, chosing the thoeoretical framework, organizing the content, and developing the system's architecture. It is important to socialize this process with researchers, managers, and workers interested in this subject, because monitoring the health of nursing workers is indispensible when planning strategies to minimize the occurrence of accidents and occupational illnesses, promoting better working conditions and improving their quality of life.

Occupational psychosocial stressors and mental distress among healthcare workers during COVID-19 pandemic.

OBJECTIVE: To analyze the factors associated with mental distress among health workers who cared for patients with a suspected or confirmed diagnosis of coronavirus disease 2019 (COVID-19). METHODS: A cross-sectional analytical study of national scope, carried out between in the second quarter of 2020. A total of 437 health professionals, who filled out an electronic form about sociodemographic data, occupational aspects, psychosocial characteristics of work and mental distress. Multiple logistic regression was performed to analyze the covariables associated with mental distress. RESULTS: There was a predominance of workers on the nursing team (65.0%), female (71.0%), from Southeastern region of the country (68.6%) and with no morbidities (36.2%). The prevalence of mental distress was 61.6%. Job strain was reported by 24% of participants, and the perception of low support from coworkers was described by 52.9%. The final multiple regression model showed that mental distress was associated with females (odds ratio - OR: 1.93; 95%CI: 1.22-3.07), age up to 40 years (OR: 1.64; 95%CI: 1.07-2.52), weekly working hours equal or over 60 hours (OR: 1.87; 95%CI: 1.15-3.11), job strain (OR: 2.45; 95%CI: 1.41-4.40) and low support from co-workers (OR: 3.47; 95%CI: 2.26-5.38). CONCLUSION: Six out of ten participants presented mental distress, which was associated to both individual characteristics and factors related to the work carried out during the pandemic. There is an urgent need to map services that have such characteristics, to outline actions to promote mental health and prevent emotional distress at different levels of health care.

Prevalence of COVID-19 testing among health workers providing care for suspected and confirmed cases.

OBJECTIVES: To describe the prevalence of testing among health workers providing care for suspected and confirmed cases of COVID-19. METHODS: This quantitative, cross-sectional study was conducted from April to June 2020, using a convenience sample. An online questionnaire was used for collecting sociodemographic, occupational, and clinical data, which were analyzed descriptively. RESULTS: In total, 437 health workers participated in the study, with a predominance of nursing workers (58.68%), women (70.3%), age between 30 and 49 years (54.2%), individuals living in the Southeast region of Brazil (60.54%), working in the public care system (69.11%), and focused on primary care (30.89%). Among the participants, 36% reported comorbidities, 21.1% had symptoms suggestive of COVID-19, and only 27% had undergone some type of COVID-19 testing. CONCLUSIONS: Despite the existence of risk comorbidities and symptoms suggestive of contamination, the frequency of testing was below one third among respondents. The lack of action compromises health surveillance and protection strategies for workers providing care for the population and may favor the contamination of new patients and the community.

Cultural adaptation and updating of the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire.

OBJECTIVE: to translate and culturally adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire to the Brazilian context and to develop and evaluate a sociodemographic and occupational characterization questionnaire to compose the adapted questionnaire. METHOD: five stages were conducted to adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire, namely: translation, synthesis of the translations, evaluation by a committee of judges, back translation and pre-test. As for the complementary questionnaire, it was elaborated and evaluated by a committee of judges and a pre-test was carried out. RESULTS: the questionnaires were validated and the pre-test stage was conducted with health workers and students. CONCLUSION: the final version adapted to the Brazilian context was called Questionário de avaliação de risco e gestão da exposição de trabalhadores e estudantes de saúde no contexto da covid-19 and is available for use, together with the final version of the Sociodemographic and occupational questionnaire: Risk assessment and management of exposure of health care workers and students in the context of covid-19. These questionnaires may assist in mitigating the risks of infection, illness and death of health workers and students due to covid-19.

Analysis of an interprofessional education activity in the occupational health field.

OBJECTIVE: to analyze the results of an Interprofessional Education activity in the ​​Occupational Health field. METHOD: this is an Action Research, which encompassed the implementation and evaluation stages of the activity. It was developed in a Public Higher Education Institution through 15 meetings, totaling 60 hours. It had 16 participants, five undergraduate students, three graduate students, five teachers and three health professionals, representing the areas of Nursing, Physical Education, Physiotherapy, Gerontology and Psychology. Data regarding the implementation of the activity were collected in a field diary and analyzed through Thematic Analysis. An evaluation form constructed exclusively for this purpose was applied, whose data were submitted to descriptive statistical analysis. RESULTS: three thematic categories were identified: (1) Comprehensive care; (2) Work as a social determinant of the health-disease process; and (3) Interprofessional teamwork. The activity of Interprofessional Education was positively evaluated by the participants, who pointed out the contributions of this strategy in the construction of knowledge directed to Occupational Health. CONCLUSION: the activity of Interprofessional Education proved to be possible and important in the context of the formation of health professions to strengthen occupational health care.

Musculoskeletal pain: comparison between administrative and production employees of a poultry farming company.

BACKGROUND: Work-related musculoskeletal disorders are the most frequently reported group of diseases in Brazil, their occurrence being favored by work in the industrial sector. The present study is justified by the need to investigate more thoroughly the occurrence of musculoskeletal symptoms among poultry farming workers, since this subject is scarcely explored in the Brazilian literature. OBJECTIVE: To analyze the prevalence of musculoskeletal symptoms among production and administrative employees of a poultry farming company, describe the sociodemographic and occupational profile of both groups of workers and test associations between pain and sociodemographic and occupational variables. METHODS: Cross-sectional correlational study which included sociodemographic and occupational characterization and administration of the Nordic Musculoskeletal Questionnaire and a numeric pain rating scale. RESULTS: The sample comprised 154 production employees and 24 administrative workers. Pain was the single musculoskeletal symptom reported, with prevalence of over 85% in both groups. Female production employees exhibited 2.9 times higher odds of pain compared to the males. The body sites most frequently involved were the neck and upper and lower back among the administrative employees and the shoulders and the upper and lower back among the production workers. CONCLUSION: Pain was the most prevalent musculoskeletal symptom in the analyzed sample of poultry farming workers. Statistically significant difference was not found between the groups despite their different work processes. Both groups exhibited extremely high rates of illness, which points to the need for more thorough investigation of the causal relationships of musculoskeletal symptoms.

INTRODUÇÃO: Distúrbios osteomusculares relacionados ao trabalho constituem o grupo de doenças ocupacionais mais registradas no Brasil, sendo as indústrias ambientes favoráveis para seu desenvolvimento. Este estudo justifica-se pela necessidade de aprofundar investigações sobre a manifestação de sintomas osteomusculares no ramo industrial agroavícola, temática pouco explorada na literatura nacional. OBJETIVOS: Analisar a prevalência de sintomas osteomusculares em trabalhadores da linha de produção e do setor administrativo de uma indústria agroavícola, caracterizar o perfil sociodemográfico e ocupacional dos dois grupos e identificar ocorrência de associações entre dor e variáveis sociodemográficas e ocupacionais. MÉTODO: Estudo correlacional e transversal, realizado por meio de caracterização sociodemográfica e ocupacional, Questionário Nórdico de Sintomas Osteomusculares e Escala Numérica de Intensidade da Dor. RESULTADOS: Participaram 154 trabalhadores do setor de produção e 24 do de administração. O único sintoma osteomuscular apresentado foi a dor, com prevalência superior a 85% para ambos os setores. Mulheres do setor de produção apresentaram 2,9 vezes mais chances de terem dor do que homens. As regiões mais afetadas no setor administrativo foram pescoço e partes inferior e superior das costas. Já no setor de produção, prevaleceram a região inferior das costas e dos ombros e a parte superior das costas. CONCLUSÕES: A dor foi descrita como o sintoma osteomuscular mais prevalente entre os trabalhadores da indústria agroavícola. Apesar das diferenças nos processos de trabalho entre os trabalhadores administrativos e produtivos, não houve diferenças estatisticamente significativas entre os setores. Por outro lado, ambos apresentaram um altíssimo nível de adoecimento, o que sugere a necessidade de aprofundamento em estudos da relação causal desses sintomas.

Fortalecimento da Rede Nacional de Atenção Integral à Saúde do Trabalhador pela mobilização social: relato de experiência / Strengthening the National Network for Comprehensive Occupational Healthcare through social mobilization: an experience report

Resumo Introdução: a participação social é o pilar da implementação da Política Nacional de Saúde do Trabalhador e da Trabalhadora que estabelece as ações de atenção à Saúde do Trabalhador no Sistema Único de Saúde, a partir da Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast). Objetivo: descrever a parceria ensino-serviço para fortalecer a atenção à Saúde do Trabalhador em um município, em consonância com os princípios da Renast, a partir da formação e mobilização social em saúde. Métodos: trata-se de um relato do projeto de extensão desenvolvido por demanda da Comissão Intersetorial de Saúde do Trabalhador e da Trabalhadora municipal. Foram realizadas três oficinas de trabalho que utilizaram o diálogo em grupos de discussão como método para produção de conhecimento associado a estratégias de ensino-aprendizagem. Resultados: profissionais de saúde, estudantes, trabalhadores e representantes de entidades participaram das oficinas, que versavam sobre: organização da Renast; a epidemiologia e papel dos diversos atores para fortalecimento da Renast; a articulação intra e intersetorial da Renast, suas fragilidades e potencialidades; e a relevância de cada ator no sentido de mobilizá-los para mudança de suas realidades. Conclusão: as oficinas apresentaram-se como estratégia possível de formação e ponto de partida, visando à mobilização social para fortalecer a Renast.

Abstract Introduction: social participation is a cornerstone in implementing the National Policy for Occupational Heath, which establishes care actions for worker's health within the Unified Health System, based on the National Network for Comprehensive Occupational Healthcare (Renast). Objective: to describe the educational-service partnership aimed at strengthening occupational care in a municipality according to Renast principles by education and social mobilization in health. Methods: This experience report focuses on the outreach project developed to answer the demands of the municipal Intersectoral Commission on Occupational Health. Three workshops were conducted using discussion groups as a method for knowledge production associated with teaching and learning strategies. Results: health professionals, students, workers, and representatives of entities participated in the workshops, which addressed Renast organization; epidemiology and the role of various actors in strengthening Renast; Renast intra and intersectoral articulation, its weaknesses and potentialities; and the relevance of each actor in changing their realities. Conclusion: the workshops proved to be a feasible strategy for education and social mobilization aimed at strengthening Renast.

Strategies to minimize medication errors in emergency units: an integrative review.

OBJECTIVE: To assess the strategies used by the Nursing team to minimize medication errors in emergency units. METHOD: Integrative literature review in the PubMed, BDenf, Cochrane and LILACS databases. Timeless research, without language limitation, performed by peers. Articles published in full that answered the guiding question were included in research. RESULTS: Educational strategies (conducting campaigns, elaborating explanatory manuals, creating a multidisciplinary committee involved in the prevention and reduction of adverse drug events); organizational (meetings, Deviance positive, creation of protocols and changes in the work process) and new technologies (implementation of prescription by computerized system, introduction of the unit doses and of the bar code in the administration of medicines) were evidenced in the studies with the purpose of minimizing medication errors in an emergency unit. CONCLUSION: The strategies identified were effective in minimizing medication errors in emergency units.

Prevenção de riscos e agravos à saúde dos trabalhadores hospitalares à luz da Teoria da Atividade Histórico-Cultural / Occupational risk prevention in hospitals based on the Cultural-Historical Activity Theory

Resumo A prevenção de riscos e agravos à saúde dos trabalhadores nos hospitais deve ser foco dos gestores, pois contribui para a qualidade de vida no trabalho e a segurança do paciente. O objetivo deste artigo é compreender a atividade de prevenção de riscos e agravos à saúde dos trabalhadores no contexto hospitalar, a partir das contradições históricas e empíricas do sistema de atividade. Estudo qualitativo exploratório, ancorado na Teoria da Atividade Histórico-Cultural, desenvolvido em um hospital universitário do estado de São Paulo. Os dados foram coletados entre setembro de 2021 e janeiro de 2022 por meio de entrevistas semiestruturadas com nove profissionais do Serviço Especializado em Engenharia de Segurança e Medicina do Trabalho e cinco gestores do hospital; 20 horas de observação de campo; e análise documental. Apesar da expansão do objeto da atividade de prevenção, os demais elementos do sistema de atividade não se adaptaram às novas exigências, evoluindo com incompatibilidades e contradições que comprometeram o alcance dos resultados esperados. As principais ações de resposta observadas ficaram centradas em adequações a exigências de itens de normas, como composição de equipe, exames médicos e outras que pouco atuam na promoção e proteção da saúde.

Abstract Hospital managers should target occupational risks and harm prevention since this can contribute to the quality of life at work and patient safety. This article aims to elucidate the activity of prevention of occupational risks and injuries in the hospital setting based on analysis of historical and empirical contradictions of the activity system. An exploratory qualitative study grounded in the Cultural-Historical Activity Theory was conducted at a university hospital in the state of São Paulo. Data were collected between September 2021 and January 2022 via individual semi-structured interviews of 9 professionals from the Occupational Health and Safety services and of five hospital managers, involving 20 hours of field observation and document analysis. Despite the expansion of the object of prevention activity, the other elements of the activity system did not adapt to the new demands, causing incompatibilities and contradictions that compromised the attainment of the expected outcomes. The main response actions observed were centered on complying with regulatory items, such as team composition, medical examinations and others, that contribute little toward promoting occupational health and safety.

Asociación entre comportamientos ofensivos y riesgo de burnout y depresión en trabajadores de la salud / Association between offensive behaviors and burnout and depression risks in health workers / Associação entre comportamentos ofensivos e risco de burnout e de depressão em trabalhadores de saúde

Objetivo: evaluar la incidencia de conductas ofensivas en el trabajo, las características y la asociación con el sexo, el estrés, el burnout y la depresión en trabajadores de la salud. Método: estudio transversal, descriptivo, cuantitativo, realizado con 125 trabajadores del Sistema Único de Salud brasileño. Los datos fueron recolectados entre junio de 2021 y abril de 2022, por medio de tres cuestionarios autoadministrados que evalúan características personales y ocupacionales; comportamientos ofensivos, estrés y burnout y síntomas de depresión. Se aplicó estadística descriptiva, prueba de asociación chi-cuadrado y análisis de regresión logística Resultados: el 44% de la muestra declararon 83 conductas y las amenazas de violencia fueron las más frecuentes (26%). Técnicos/auxiliares de enfermería, enfermeros y médicos fueron los profesionales más expuestos. El principal agresor fue el paciente; excepto en el caso del bullying, que fue perpetrado por los compañeros de trabajo (48%). Hubo asociación entre conductas ofensivas y burnout (OR: 4,73; IC 95%: 1,29-17,3; p=0,02) y entre conductas ofensivas y síntomas de depresión (OR: 1,05; IC 95%: 1,01-1,10; p=0,02). Conclusión: la práctica de conductas ofensivas en el trabajo en salud es frecuente y característica; el burnout y los síntomas de depresión aumentaron, respectivamente, 4,73 y 1,05 veces las posibilidades de que el trabajador sufriera esas conductas ofensivas en el ambiente de trabajo.

Objective: to evaluate the occurrence of offensive behaviors at work, their characteristics and association with sex, stress, burnout and depression in health workers. Method: a cross-sectional, descriptive and quantitative study carried out with 125 workers from the Brazilian Unified Health System. The data were collected from June 2021 to April 2022 through three self-applied questionnaires that assess personal and occupational characteristics; offensive behaviors, stress and burnout; and depressive symptoms. Descriptive statistics, the chi-square association test and logistic regression analysis were applied. Results: 44% of the sample reported 83 behaviors, with threats of violence as the most frequent ones (26%). Nursing technicians/assistants, nurses and physicians were the most exposed professionals. The main aggressors were the patients, except for bullying, which was perpetrated by co-workers (48%). There was an association between offensive behaviors and burnout (OR: 4.73; 95% CI: 1.29-17.3; p=0.02) and between offensive behaviors and depression symptoms (OR: 1.05; 95% CI: 1.01-1.10; p=0.02). Conclusion: the occurrence of offensive behaviors in health work is frequent and characteristic and burnout and depressive symptoms respectively increased 4.73 and 1.05 times the chances of workers suffering these offensive behaviors in the work environment.

Objetivo: avaliar a ocorrência de comportamentos ofensivos no trabalho, suas características e associação com o sexo, estresse, burnout e depressão em trabalhadores de saúde. Método: estudo transversal, descritivo, de natureza quantitativa, realizado com 125 trabalhadores do Sistema Único de Saúde brasileiro. Os dados foram coletados no período de junho de 2021 a abril de 2022, por meio de três questionários autoaplicáveis que avaliam as características pessoais e ocupacionais; comportamentos ofensivos, estresse e burnout e sintomas depressivos. Estatística descritiva, teste de associação Qui-Quadrado e análise de regressão logística foram aplicados. Resultados: 44% da amostra referiram 83 comportamentos, sendo as ameaças de violência mais frequentes (26%). Técnicos/auxiliares de enfermagem, enfermeiros e médicos foram os profissionais mais expostos. O principal agressor foi o paciente, exceto quanto ao bullying, perpetrado por colegas de trabalho (48%). Houve associação entre comportamentos ofensivos e burnout (OR: 4,73; IC 95%: 1,29-17,3; p=0,02) e entre comportamentos ofensivos e sintomas de depressão (OR: 1,05; IC 95%: 1,01-1,10; p=0,02). Conclusão: a ocorrência de comportamentos ofensivos no trabalho em saúde é frequente e característica; o burnout e os sintomas depressivos aumentaram, respectivamente, 4,73 e 1,05 vezes as chances de o trabalhador sofrer estes comportamentos ofensivos no ambiente de trabalho.