Daily work variability in falls prevention of hospitalized patients: nursing team's perception.

BACKGROUND: The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined. METHOD: A mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020. RESULTS: From July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague's expertise, as well as suggesting improvements in the physical environment. CONCLUSION: This study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.

Assessment of indicators and experiences of pain and pleasure in family health teams based on the Psychodynamics of Work. / Avaliação de indicadores e vivências de prazer/sofrimento em equipes de saúde da família com o referencial da Psicodinâmica do Trabalho.

OBJECTIVE: To evaluate indicators and experiences of pain and pleasure among workers of the family health teams based on the theoretical and methodological framework Psychodynamics of Work. METHOD: This is a mixed-method study with 153 workers from the multiprofessional family health team of 12 health units in Porto Alegre. All the participants answered the Pleasure and Pain in the Workplace Scale ("EIPST") between September and November 2011 and 68 also participated in the collective interviews between October and December 2012. Quantitative data were submitted to descriptive and analytical statistics, and qualitative data were subjected to content analysis. RESULTS: The indicators professional achievement (4.22 ± 1.3), freedom of expression (4.21 ± 1.17) and recognition (1.80 ± 1.51) were considered satisfactory by the workers. The indicator professional exhaustion had a moderate result (3.33 ± 1.44). Pleasure at work was linked to professional achievement with autonomy, freedom, and creativity. Lack of recognition and work overload were related to institutional, personal and community issues, and considered sources of suffering in the workplace. CONCLUSIONS: Pleasure at work for the studied teams was associated with freedom of expression, achievement, and professional recognition, and pain was related to professional exhaustion and work overload.

Prevalence and factors associated with minor psychiatric disorders in hospital housekeeping workers.

OBJECTIVE: Investigating the prevalence and factors associated with minor psychiatric disorders (MPDs) in Hospital housekeeping workers. METHOD: A cross-sectional study carried out in 2013 with workers from the cleaning service of a public university hospital in Rio Grande do Sul, Brazil. Data were collected through a form containing sociodemographic, occupational, habits and health variables. The Self-Reporting Questionnaire-20 was used in order to evaluate MPDs. RESULTS: The study population consisted of 161 workers. The overall prevalence of suspected MPD was 29.3%. The chances of suspected MPDs were higher in workers with Effort-Reward Imbalance, those who did not have time or who occasionally had time for leisure activities, and those taking medications. CONCLUSION: The prevalence of MPDs was similar to that found in the literature for health workers. Therefore, we consider it important to include these workers in institutional programs for continuing health education. OBJETIVO: Investigar a prevalência e os fatores associados aos Distúrbios Psíquicos Menores (DPMs) em trabalhadores do Serviço Hospitalar de Limpeza. MÉTODO: Estudo transversal, realizado em 2013, com trabalhadores do serviço de limpeza de um hospital universitário público do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de um formulário contendo variáveis sociodemográficas, laborais, hábitos e saúde. Para avaliação dos DPMs utilizou-se do Self-Reporting Questionnaire-20. RESULTADOS: A população do estudo foi composta pelos 161 trabalhadores. A prevalência global para suspeição de DPM foi de 29,3%. As chances de suspeição de DPMs foram maiores nos trabalhadores em Desequilíbrio Esforço-Recompensa, nos que não tinham ou às vezes tinham tempo para o lazer e naqueles que faziam uso de medicação. CONCLUSÃO: A prevalência de DPMs assemelhou-se à encontrada na literatura em trabalhadores da área saúde. Portanto, considera-se importante a inclusão desses trabalhadores em programas institucionais de educação permanente em saúde.

[Work context, job satisfaction and suffering in primary health care]. / Contexto de trabalho, prazer e sofrimento na atenção básica em saúde.

OBJECTIVE: To evaluate the work context, job satisfaction and suffering from the perspective of workers in primary health care. METHOD: This cross-sectional study was conducted with 242 employees of a municipality of Rio Grande do Sul, Brazil, from May to July 2012. The adopted instruments were the Work Context Assessment Scale (EACT) and the Job Satisfaction and Suffering Indicators Scale (EIPST). Research also included descriptive and inferential statistical analysis. RESULTS: Organization (91.3%) and work conditions (64%) received the worst scores in terms of context. The indicators of job satisfaction were related to professional achievement (55.8%), freedom of expression (62.4%) and recognition (59.9%). However, 64.5% presented professional exhaustion, which had an inverse association with age and years in the institution (p<0.05). CONCLUSION: The workers evaluated their work context as inappropriate and complained of exhaustion, although they claimed their work affords some satisfaction.

[Violence, Burnout and Minor Psychiatric Disorders in Hospital Work]. / Violência, burnout e transtornos psíquicos menores no trabalho hospitalar.

OBJECTIVE: Identifying the violence suffered by the health team workers and their association with Burnout and minor psychiatric disorders. METHODS: Cross-sectional study with 269 health team professionals of a public hospital in southern Brazil. Data were collected through the use of the Survey Questionnaire: Workplace Violence in the Health Sector, Maslach Inventory Burnout and Self-Report Questionnaire. RESULTS: Workplace violence struck 63.2% of workers, prevailing mostly in women (p = 0.001), among nursing auxiliaries/technicians (p=0.014) and was associated with minor psychiatric disorders (p<0.05), as exposure to different forms of violence increased the chances of these disorders by 60% (CI 95%: 1.2-2.1). The three Burnout dimensions were also associated to violence at work (p<0.05). CONCLUSION: Health workers experience violence in the workplace and this exposure is associated with Burnout symptoms and minor psychiatric disorders.

Professional quality of life and occupational stress in nursing workers during the COVID-19 pandemic.

OBJECTIVE: To identify the levels of professional quality of life and the occupational stress in nursing professionals. METHOD: Cross sectional study conducted between April and August 2020, with nursing professionals working in inpatient units for clinical and surgical patients of a large hospital. The Work Stress Scale and the Professional Quality of Life Scale were applied. RESULTS: The sample consisted of 150 professionals, with a mean age of 43 ± 8.89 years, being 84.7% (127) female. The mean of the work stress scale was 1.9 (± 0.71), a moderate level of stress. It was found that compassion satisfaction had a median of 50.3 (9.1 - 64.6), burnout of 48.5 (32.2 - 84.8) and post-traumatic stress disorder of 47.1 (38.6 - 98.3). CONCLUSION: Stress at work and Compassion Fatigue were identified in the sample, especially in secondary-level professionals, demonstrating the need to implement strategies to reduce psycho-emotional harm in these professionals.

Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health.

OBJECTIVE: to analyze the implications of the pandemic on the Nursing team's occupational health according to its performance in COVID-19 and non-COVID-19 units. METHOD: a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection. RESULTS: the pandemic exerted impacts on the professionals' health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands. CONCLUSION: the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.

Effect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial.

OBJECTIVE: to assess the effect of cardiovascular biofeedback on nursing staff stress when compared to an activity without self-monitoring. METHOD: a randomized controlled clinical trial, carried out with nursing professionals from a university hospital. The intervention group (n=58) performed cardiovascular biofeedback, and the control (n=57) performed an online puzzle without self-monitoring, totaling nine meetings over three weeks. The outcome was assessed using the Stress Symptoms and Work-Related Stress scales, and the biological marker heart rate variability. The generalized estimating equations method was used. RESULTS: the intervention had no effect on self-reported instruments (p>0.050). However, there was an effect of time (p<0.050) on all heart rate variability indicators, demonstrating changes over the sessions. CONCLUSION: cardiovascular biofeedback showed promising results in the biological marker, suggesting that it can be used in nursing staff as a complementary therapy by promoting better autonomic nervous system regulation.

"We try to save lives and our own lives": nursing work in the COVID-19 pandemic.

OBJECTIVE: To understand the implications of working conditions during the COVID-19 pandemic for Nursing professionals. METHOD: Qualitative, exploratory, and descriptive study conducted in four hospitals in southern Brazil. A total of 349 records made by nurses and nursing technicians/assistants through an electronic form were selected and submitted to content analysis. Ethical aspects were respected, and the participants consented to the Free and Informed Consent Form. RESULTS: The increase in work demands and exhaustion were evidenced; the lack of hospital institutional support in assisting infected workers and in view of the need for further testing; and the impacts of the devaluation of Nursing, expressed by feelings of vulnerability and lack of recognition. FINAL CONSIDERATIONS: The pandemic increased the wear and tear of Nursing with a projection of the lack of structure for crises situations. It is suggested to invest in the emotional and managerial resources of health care teams to better cope with similar health crises in the future.

[Influence of work shift and chronotype on the quality of life of nursing professionals]. / Influência do turno de trabalho e cronotipo na qualidade de vida dos trabalhadores de enfermagem.

The purpose of this study was to investigate the influence of shift work and chronotype on the quality of life of nursing staff at a university hospital in the state of Rio Grande do Sul, Brazil. It is an analytical and cross-sectional study, developed with a sample of 101 nursing professionals working in clinical and surgical units for adult inpatients. Chronotype and quality of life were evaluated using the Horne and Ostberg Morningness-Eveningness Questionnaire (MEQ) and the WHOQOL-Brief None of the WHOQOL-Brief domains demonstrated any association with shift work (p > 0.05). It was observed however, that individuals with a certain chronotype agreeing with the shift in which they work (67.01 +/- 10.8) showed higher means than those disagreeing (59.16 +/- 14.67) on the WHOQOL field that assesses the environment (p = 0.03). Thus, it is suggested that agreement with the chronobiological shift might be a factor determining quality of life for the nursing staff

Satisfaction and self-confidence of nursing students as participants and observers in realistic simulations.

OBJECTIVE: To analyze the satisfaction and self-confidence of Nursing students regarding the learning process, in the roles of participants and observers, in realistic simulation scenarios. METHOD: Observational study with 44 nursing college students in the south of Brazil. Data collection occurred from September to November 2018, through the application of the Learning Satisfaction and Self-Confidence Scale to realistic simulation scenarios. Data were analyzed using descriptive statistics and generalized estimating equations complemented by Bonferroni. RESULTS: The level of satisfaction was 4.78 (±0.35) and self-confidence in learning was 4.46 (±0.39). Students in the 8th and 9th semesters had the highest means of self-confidence factor (p<0.001) when compared to the others. CONCLUSION: It was concluded that there was no statistically significant difference in the satisfaction and self-confidence in learning of nursing students with different roles in the simulation scenario.

Burnout and resilience in intensive care Nursing professionals in the face of COVID-19: A multicenter study. / Burnout e resiliência em profissionais de enfermagem de terapia intensiva frente à COVID-19: estudo multicêntrico.

OBJECTIVE: to analyze the relationship between the Burnout dimensions and the work resilience of intensive care Nursing professionals in the COVID-19 pandemic in four hospitals from southern Brazil. METHOD: this is a multicenter and cross-sectional study, composed of 153 nurses and nursing technicians of the Intensive Care Units. Sociodemographic, health and work-related questions were collected, and the Maslach Burnout Inventory and Resilience at Work Scale 20 instruments were applied. The data were submitted to descriptive analysis and to bivariate and partial correlations (network analysis). RESULTS: work resilience presented an inverse correlation to emotional exhaustion (r=-0.545; p=0.01) and depersonalization (r=-0.419; p=0.01) and a direct one to professional achievement (r=0.680; p=0.01). The variable with the greatest influence on the correlation network was the perception of the impact of the pandemic on mental health. CONCLUSION: resilience interferes in the emotional exhaustion and low professional achievement domains of Burnout. Emotional exhaustion is conducted through minor psychological disorders, with an impact on the workers' physical and mental health variables. The development of institutional resilience should be encouraged in order to moderate the illness.

Costs of hospital admission authorizations due to falls among older people in the Brazilian National Health System, Brazil, 2000-2020: a descriptive study. / Custos das autorizações de internação hospitalar por quedas de idosos no Sistema Único de Saúde, Brasil, 2000-2020: um estudo descritivo.

OBJECTIVE: To describe the costs of hospital admission authorizations (AIHs) due to falls among older people within the Brazilian National Health System (SUS). METHODS: This was a descriptive cost analysis study, based on data from the SUS's Hospital Information System, related to AIH due to falls among older people (60 years and older), between 2000 to 2020. A descriptive analysis was performed and cost measurement was based on a macro-costing method. RESULTS: 1,746,097 AIHs due to falls among older people were recorded, and the total cost was found to be BRL 2,315,395,702.75. The proportion of hospitalization costs was higher among those aged 80 years and older (36.9%), female (60.4%) and the Southeast region of the country (57.3%). The average length of stay in hospital ranged from 5.2 to 7.5 days. CONCLUSION: The high costs identified showed the need for investments in more effective measures in order to prevent and mitigate the damage caused by falls among older people.

Factors associated with the quality of life of multi-professional health residentes.

OBJECTIVES: to analyze factors associated with the quality of life of multi-professional health residents. METHODS: cross-sectional and analytical design, carried out with 94 residents who answered a questionnaire containing general data, the Maslach Burnout Inventory, the Self Reporting Questionnaire, and the World Health Quality of Life. Data was submitted to multiple linear regression, considering p < 0.05. RESULTS: minor mental disorders increased, respectively, by 0.31, 0.64 and 0.35 in the Physical, Psychological and General domains of quality of life. Emotional exhaustion had an inverse influence of 0.28 on the Physical and Environment domains. Satisfaction with residence increased the overall quality of life outcome by 0.20; Living alone, at 0.02 the Psychological domain; and Race/color, at 0.19 the Environment domain. CONCLUSIONS: there is a relationship between emotional exhaustion of the burnout, minor psychic disorders and the quality of life of multi-professional residents.

Modeling of adult patient falls and the repercussions to Nursing as a second victim. / Modelagem de quedas de pacientes adultos e as repercussões à Enfermagem como segunda vítima.

OBJECTIVE: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. METHOD: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. RESULTS: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged. CONCLUSION: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Resilience and the reduction of occupational stress in Nursing.

OBJECTIVE: to analyze the association between resilience and occupational stress of Nursing professionals from a general hospital. METHOD: an observational, cross-sectional study involving 321 Nursing professionals. The data collected were: socio-demographic and labour variables, stress and resilience, analyzed with descriptive and inferential statistics. RESULTS: 54.5% of the participants presented moderate resilience and 36.4%, high; 73.5% were at risk of exposure to occupational stress; the relationship between psychological demands and professional category (p=0.009), between control over work and age (p=0.04), professional category (p<0.001), having a management position (p=0.009), being a specialist (p=0.006) and between social support and professional category (p<0.001), having a management position (p=0.03), daily working hours (p=0.03), being a specialist (p<0.001) were verified. There was an association between resilience Factor I - resolutions of actions and values and control over work (p=0.04) and social support (p=0.002). CONCLUSION: the Nursing professionals of a general hospital have moderate to high resilience which, associated with high control over their work and high social support, may contribute to the reduction of exposure to occupational stress.

Network of correlations between quality of life, resilience and effort-reward imbalance in military police officers. / Rede de correlações entre qualidade de vida, resiliência e desequilíbrio esforço-recompensa em policiais militares.

OBJECTIVE: To analyze the network of correlations between the realms of the Effor t-Reward Imbalance (ERI) model, resilience, and quality of life among military police officers. METHOD: This is a cross-sectional study conducted with 258 police officers from the Special Opera tions Battalion of the Military Police in a city in Rio Grande do Sul, Brazil. The scales of the ERI model, resilience, and World Health Quality of Life (WHOQOL-bref) assessed psychosocial stress, resilience, and quality of life. Descriptive and analytical statistics were performed em ploying the network analysis. RESULTS: The realms of the ERI model and resilience correlated with all the WHOQOL's realms (p<0.001). The network model showed a negative association between effort, overcommitment, and physical and environmental realms. The environmental realm was positively associated with reward, while resilience was positively associated with the general, physical, and psychological realms. CONCLUSION: We concluded that psychosocial stress interferes in the quality of life of military police officers, and resi lience may work as a protective factor.

OBJETIVO: Analisar a rede de correlações entre as dimensões do Modelo Desequilíbrio Esforço-Recompensa (DER), resiliência e qualidade de vida em policiais militares. MÉTODO: Estudo transversal realizado com 258 policiais do Batalhão de Operações Especiais (BOE) da Polícia Militar de uma cidade do Rio Grande do Sul. As escalas do Modelo DER, de resiliência e World Health Quality of Life (WHOQOL-bref) avaliaram o estresse psicossocial, resiliência e qualidade de vida. Foram realizadas estatísticas descritiva e analítica, com análise de rede. RESULTADOS: As dimensões do Modelo DER e a resiliência se correlacionaram com todos os domínios do WHOQOL (p<0,001). O modelo de rede indicou associação negativa entre o esforço, o excesso de comprometimento e os domínios físico e meio ambiente. O domínio meio ambiente foi associado positivamente à recompensa, e a resiliência associou-se positivamente com os domínios geral, físico e psicológico. CONCLUSÃO: Concluiu-se que o estresse psicossocial interfere na qualidade de vida dos policiais militares e a resiliência pode atuar como um fator de proteção.

Protocol for visits of patients' pets in palliative care in a hospital.

OBJECTIVE: To report the experience of the multidisciplinary health team in the construction and implementation of the assistance protocol for pets visiting patients admitted to a palliative care unit. METHOD: This is an experience report about the construction and implementation of a protocol in a university hospital in the South of Brazil by a working group from the multidisciplinary team of the Palliative Care Program and composed of three nurses, a physician, a psychologist, a social worker, a manager, and a nutritionist. The period of construction and implementation of the protocol was from September 2017 to April 2019. RESULTS: The construction of the protocol by the multidisciplinary team followed three stages: planning, execution, and implementation, which enabled the release of visits of patients' pets in palliative care. CONCLUSION: The construction of the protocol allowed for the institutionalization of the visit of patients' pets in palliative care in a university hospital, bringing benefits to patients and their families.

The impact of a bundle to prevent hospital-acquired pneumonia in a cohort of nonventilated patients on enteral nutrition.

We conducted a quasi-experimental study to evaluate a bundle to prevent nonventilator hospital-acquired pneumonia (NV-HAP) in patients on enteral tube feeding. After the intervention, there was an increase in bundle compliance from 55.9% to 70.5% (P < .01) and a significant decrease (34%) in overall NV-HAP rates from 5.71 to 3.77 of 1,000 admissions.