Trabalho multiprofissional e integralidade do cuidado na percepção dos profissionais do CAPS / Trabajo multiprofesional y atención integral en la percepción de profesionales de CAPS / Multiprofessional work and comprehensive care in the perception of CAPS professionals

RESUMO Este estudo teve como objetivo verificar a percepção dos profissionais dos Centros de Atenção Psicossocial (CAPS) de São Paulo/SP da importância do trabalho multiprofissional em saúde mental para os usuários dos serviços e as relações possíveis com a integralidade do cuidado. Com as reformas sanitária e psiquiátrica, a integralidade passou a ser um princípio fundamental das ações de saúde, conceito que vem sendo entendido a partir de diversas influências. Foram entrevistados 27 profissionais de nível superior e utilizado o referencial metodológico da análise de conteúdo. Os participantes não apresentaram clareza sobre a noção de integralidade do cuidado, valorizando a integralidade e o trabalho de integração disciplinar de forma concomitante a ações tutelares e não favorecedoras de autonomia. Tal fato se deve ao pouco conhecimento teórico do tema sobre a integralidade e a prática ainda persistente centrada na falta de autonomia e ausência de contratualidade na relação profissional e usuário. A efetivação da integralidade do cuidado é aspecto fundamental na compreensão dos usuários de saúde mental como sujeitos de direitos, importante desafio à reforma psiquiátrica brasileira.

RESUMEN Este estudio tuvo como objetivo verificar la percepción de los profesionales de los Centros de Atención Psicosocial (CAPS) en São Paulo / SP de la importancia del trabajo multiprofesional en Salud Mental para los usuarios del servicio y las posibles relaciones con la atención integral. Con las reformas de salud y psiquiátricas, la integralidad se ha convertido en un principio fundamental de las acciones de salud, un concepto que se ha entendido desde diferentes influencias. Veintisiete profesionales de la educación superior fueron entrevistados y se utilizó el marco metodológico del Análisis de Contenido. Los participantes no tenían claro el concepto de atención integral, valorando el trabajo integral y de integración disciplinaria al mismo tiempo que las acciones tutelares que no favorecen la autonomía. Este hecho se debe a la falta de conocimiento teórico sobre el tema de la exhaustividad y la práctica aún persistente centrada en la falta de autonomía y la ausencia de contractualidad en la relación profesional y de usuario. La efectividad de la atención integral es un aspecto fundamental en la comprensión de los usuarios de salud mental como sujetos de derechos, un desafío importante para la reforma psiquiátrica brasileña.

ABSTRACT This study aimed to verify professionals' perceptions of Psychosocial Care Centers (Centros de Atenção Psicossocial - CAPS) in São Paulo / SP regarding the importance of multiprofessional work in Mental Health for service users and the possible relationships with comprehensive care. The Health and Psychiatric Reforms made comprehensiveness a fundamental principle of health actions, a concept understood through various influences. Twenty-seven higher education professionals were interviewed, and the Content Analysis methodological framework was used. The participants were unclear about integrality care, valuing comprehensiveness and disciplinary integration work concomitantly to tutelage actions that do not favor autonomy. This fact is due to the lack of theoretical knowledge on comprehensiveness issues and the still persistent practice centered on the absence of autonomy and contractuality in the professional-user relationship. The effectiveness of comprehensive care is fundamental to understanding Mental Health users as subjects of rights, an important challenge for Brazilian Psychiatric Reform.

Self-compassion and psychological well-being of radiographers at work.

OBJECTIVES: The aim of this study was to assess how self-compassion affects the psychological well-being of radiographers at work. METHODS: An online survey was sent to radiology and radiotherapy departments in Rhône-Alpes, a region of France (from October 2021 to February 2022). The study is mixed: quantitative data, with closed questions and two validated scales, and qualitative data, with open questions aimed at assessing perceptions among radiologists as regards self-compassion. RESULTS: A total of 253 radiographers (mean age 32.9 years), took part in this survey. Radiographers reported a poor level of well-being and a moderate level of self-compassion. We found a link between well-being at work and self-compassion. Gender, age, number of years of experience and the desire to receive training on well-being appear to have an impact on the level of self-compassion. The perception of self-compassion by radiologists is essentially positive. CONCLUSION: Particular attention should be paid to radiologists who are female, young, and with only a few years of experience. Self-compassion is a protective factor for radiologists and may help them take care of themselves to continue caring for others. Training related to self-compassion should be promoted in medical imaging departments.

Paramedics' experiences and educational needs when participating end-of-life care at home: A mixed method study.

BACKGROUND: Paramedics face end-of-life care patients during emergency calls and more recently through planned protocols. However, paramedics experiences and educational needs concerning preplanned end-of-life care at home remain largely unknown. AIM: To describe experiences and educational needs of the paramedics included in the end-of-life care protocol. DESIGN: A mixed method study with a questionnaire including open ended questions and numeric evaluations on a Likert scale. SETTING/PARTICIPANTS: The questionnaire was delivered to and answered by all the 192 paramedics working in North Karelia fire and rescue department during the time of the data collection in 2017. RESULTS: Over 80% of the paramedics agreed that the protocol helped them to take care of the patients and to improve the quality of end-of-life care. Visits to the patients were considered useful and the end-of-life care as a meaningful work by 76.5% and 62.5% of the paramedics, respectively. The paramedics expressed challenges in psychosocial aspects, communication, symptom management, and their role in end-of-life care. Encountering and communication with the families as well as managing the most common symptoms were emphasized as educational needs. Using a patient controlled analgesia device emerged as an example of practical educational aspect. CONCLUSIONS: Paramedics considered end-of-life care at home meaningful but called for more competency in supporting and encountering the families and in symptom management. Our results can be utilized when developing end-of-life care protocols and education for the paramedics. Patients' and families' views on the paramedics' participation in end-of-life care should be evaluated in the future.

Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders.

Exposure to suicide is a major factor for suicidality. Mental health professionals and first responders are often exposed to suicide while on-duty. The objective of this scoping review is to describe the state of current research on exposure to suicide among mental health professionals and first responders, focusing on the prevalence and impact of exposure to suicide, and to identify current gaps in the literature. We searched MEDLINE, Scopus, PsychNET, and Web of Science and identified 25 eligible papers. Between 31.5-95.0% of professionals had been exposed to suicide. Exposure to suicide had impacts on personal life, professional life, and mental health; and caused emotional distress. There was little research investigating exposure to suicide among police officers, firefighters, and paramedics. More research existed on mental health professionals, but none assessed exposure to suicide as a risk for suicide amongst this group. The review concludes that exposure to suicide is distressing for mental health professionals, and likely to be for first responder however, more research on these groups, especially paramedics, is required.

Evaluating a multidimensional strategy to improve the professional self-care of occupational therapists working with people with life limiting illness.

BACKGROUND: The term 'life limiting conditions' refers to premature death following decline from chronic conditions, which is a common circumstance in which occupational therapists work with people at the end of life. The challenges for clinicians of working with these patients have long been recognised, and may have a significant impact on their professional self-care. This study aimed to evaluate a multidimensional workplace strategy to improve the professional self-care of occupational therapists working with people living with a life limiting condition. METHODS: A pre and post mixed methods survey approach were utilised, with baseline data collection prior to the implementation of a multidimensional workplace strategy. The strategy included professional resilience education, targeted supervision prompts, changes to departmental culture and the promotion of self-care services across multiple organisational levels. Follow up data collection was undertaken after the strategy had been in place for 2 years. Quantitative data were analysed descriptively, while qualitative data were subjected to thematic analysis. RESULTS: One hundred three occupational therapists responded (n = 55 pre, n = 48 post) across multiple service settings. Complex emotional responses and lived experiences were identified by participants working with patients with life limiting conditions, which were not influenced by the workplace strategy. Working with these patients was acknowledged to challenge the traditional focus of occupational therapy on rehabilitation and recovery. Participants were confident about their ability to access self-care support, and supervision emerged as a key medium. While the strategy increased the proportion of occupational therapists undertaking targeted training, around half identified ongoing unmet need around professional self-care with this patient group. Demographic factors (e.g. practice setting, years of experience) also had a significant impact on the experience and needs of participants. CONCLUSIONS: The multidimensional workplace strategy resulted in some improvements in professional self-care for occupational therapists, particularly around their use of supervision and awareness of available support resources. However, it did not impact upon their lived experience of working with people with life limiting conditions, and there remain significant gaps in our knowledge of support strategies for self-care of occupational therapist working with this patient group.

A survey of Canadian radiation therapists' perspectives on caring for LGBTQ2SPIA+ cancer patients.

PURPOSE: The lesbian, gay, bisexual, trans, queer, two-spirit, pansexual, intersex, asexual, plus (LGBTQ2SPIA+) population faces unique cancer health risks and barriers to competent healthcare. This study aimed to identify current knowledge, attitudes, and practice behaviours amongst radiation therapists regarding the LGBTQ2SPIA+ community to ultimately improve care given to this population. METHODS: A 22-item online survey was sent out to Canadian radiation therapy department managers and forwarded to radiation therapists. The survey collected demographics and addressed knowledge, attitudes, and practice behaviours regarding the LGBTQ2SPIA+ population. Results were analyzed using descriptive statistics, inferential statistics and thematic analysis. RESULTS: 214 radiation therapists completed the survey. Over 70% were unfamiliar with all terms associated with "LGBTQ2SPIA+". 91.6% believed that being conscious of the LGBTQ2SPIA+ community is important to their role as a therapist; however, 34.5% reported "rarely" or "never" adapting practice behaviours when caring for this community. Only 17.3% felt they had received adequate information to comfortably care for the LGBTQ2SPIA+ population, with 86.9% interested in receiving more education on specific patient needs. The open-ended questions revealed four themes: uncertainty regarding knowledge of the LGBTQ2SPIA+ community; willingness and/or desire to improve practice behaviours; therapists are already aware of some unique needs of the LGBTQ2SPIA+ community; and some therapists believe that all patients should be treated equally. National generalizability is limited due to insufficient data collected from all geographical regions. CONCLUSION: Overall, this study was unable to provide national generalizability, however the results suggest that amongst the respondents there are knowledge gaps and inconsistencies in practice when caring for LGBTQ2SPIA+ cancer patients. Given the limited literature available, and the results from this study, more education and research is warranted to bridge knowledge gaps and aid in providing inclusive patient care.

Compassion fatigue and the effectiveness of support structures for diagnostic radiographers in oncology.

INTRODUCTION: Diagnostic radiographers working in oncology will have frequent contact with the same patients over a prolonged period. This can be mentally exhausting for the radiographer. Compassion fatigue (CF) occurs after repeated exposure to stressful situations and it can become overwhelming, leading to irritability and decreased empathy. CF has been known to affect many healthcare professions, however few studies have examined diagnostic radiographers, nor if the current support systems are suitable. METHODS: An exploratory study was conducted as part of a local quality improvement project. An anonymised questionnaire was sent to all radiographers in a single oncology hospital within the UK to assess if the support provided met their needs. RESULTS: Sixty percent of those questioned responded. Almost half found their work affected their mental wellbeing, but they felt they could manage this stress at work. Almost all felt that some sort of support should be offered to the radiographers. The most popular options were already provided by the hospital, however many felt they were not accessible for a variety of reasons. When discussed further, it was found that the timings were prohibitive as most were held when they could not attend. CONCLUSION: Diagnostic radiographers working in oncology settings are at risk of CF. Although support structures are in place, they may not currently meet the needs of this staff group and at times are inaccessible. IMPLICATIONS FOR PRACTICE: Providing specific, accessible support for diagnostic radiographers will help reduce the potential effects of CF, reduce stress-related sickness and ultimately improve the service for patients.

The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation.

INTRODUCTION: Providing high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart. Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level. AIMS: To support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists. METHODS/MATERIALS: Co-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups. RESULTS: An understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; 'embodied connection', 'characteristic expression' and 'indicative communication'. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient. DISCUSSION/CONCLUSION: Adoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.

South African paramedic perspectives on prehospital palliative care.

BACKGROUND: Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. METHODS: A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. RESULTS: Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. CONCLUSION: Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

Strategies to develop student support mechanisms in medical radiation sciences clinical education.

Clinical placement experience is an important component of medical radiation science (MRS) education, equipping students to safely transition into complex healthcare environments. This commentary draws on evidence from the literature that reports challenges allied health students face in clinical environments. As several factors are implicated that could result in a higher prevalence of psychological distress and mental ill-health in MRS students, there is a need to re-emphasize the importance of developing strategies to support students in clinical education. A key recommendation is to identify associated risk factors early as they can impact on the quality of education and in severe cases be detrimental to students' psychological well-being. This requires an understanding of the full extent and nature of the challenges through partnered approaches between professional organisations, clinical departments, academics and students. Developing evidence-based strategies for improving students' well-being in clinical environments is also essential.

[Elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role].

Objectives　The purpose of this study was to identify elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role.Methods　A qualitative inductive research was conducted. Introductions to potential participants were obtained from a patient association that agreed to help with the study. Interviews were conducted from July through October 2014, using an interview guide, with cancer peer supporters who consented to participate in the study. Elements they perceived as important to the performance of their role were inductively identified from interview transcripts. The analysis consisted of coding phrases in the text and organizing the codes generated into categories and subcategories.Results　The study participants consisted of 10 cancer peer supporters (2 men, 8 women), in the age range of 40 to 70 years, who provided private counseling and worked in cancer support groups in hospitals. The analysis generated 129 codes, 11 subcategories, and 5 categories. These 5 categories were: [1.Help service users determine their own paths by listening to and accepting what they say with a non-judgmental attitude]; [2.Offer a perspective distinct from that of the medical staff]; [3.Think of ways to achieve a good balance between one's personal life and cancer peer support work while maintaining a stable state of mind]; [4.Ensure that one maintains the necessary knowledge and skills, and continually improve oneself]; and [5.Build relationships of trust with medical staff and the hospital].Conclusion　Category [1] and category [2] were behaviors regarded as important when interacting with users. They were "matters regarded as important during the practice of cancer peer support working for users," and comprised the core of matters that were regarded as important. Next, as for matters regarded as important in relation to the supporters themselves, the categories were [3] and [4]. These were "matters regarded as important for continuity and qualitative improvement of cancer peer support working." Areas that call for improvement in relation to this are preparation of support systems and learning environments. Another matter regarded as important was category [5]. This was a "matter regarded as important to smoothen and facilitate cancer peer support working." Placing importance on relationships of trust with medical staff and hospitals could be considered a distinctive characteristic of cancer peer supporters working at hospitals.

Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study.

OBJECTIVES: This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction. DESIGN: A large cross-sectional online survey was conducted in July 2018 in China. SETTING: A survey was conducted in 54 cities across 14 provinces of China. PARTICIPANTS: A total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%. OUTCOME MEASURES: A confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson's correlation coefficient and multiple linear regression analysis. RESULTS: The most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction. CONCLUSION: The incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team.

Direct care nurses and support staff thoughts and feelings about the reasons patients fall at a cancer center.

Extensive research addresses the prevalence and high fall risk for cancer patients related to age, diagnosis, treatment side effects, pharmacological side effects, and cognitive and/or motor deficits. The purpose of the study was to explore the thoughts and feelings that inpatient and outpatient oncology direct care nurses (registered nurses) and support staffs have about reasons patients fall; as well as their thoughts on what might be done to prevent falls. This descriptive qualitative study used focus groups as the method for discovery. Six themes were identified: Effect on Me, Guilt, Noncompliance, Poor Choices, Inconsistency, and No Authority. This study is significant and relevant because there is little previous research addressing staff thoughts and feelings about why patients fall and what additional interventions they think can be implemented to prevent falls. Findings from this study may be helpful in developing and/or refining current fall policies. Existing research suggests unlicensed patient care providers often have minimal participation in postfall reviews. This study suggests they can provide insight into why patients fall. Additionally, both registered nurses and unlicensed providers describe barriers that often impede their ability to work as a team to prevent patient falls. Findings from this study identified the need for the patient care team to strengthen collaborative work to create safer patient environments.

Desafios na operacionalização dos projetos terapêuticos singulares nos centros de atenção psicossocial / Desafíos en la operacionalización de proyectos terapéuticos en centros de atención psicosocial / Challenges in the operationalization of singulartherapeutic projects in psychosocial care centers

RESUMO O objetivo deste trabalho foi descrever como os profissionais operacionalizam os projetos terapêuticos singulares (PTS) em Centros de Atenção Psicossocial. Para isso, foi desenvolvida uma pesquisa de abordagem qualitativa de caráter descritivo e exploratório com 58 profissionais de sete Centros de Atenção Psicossocial situados em três municípios do Estado de Goiás, Brasil. A coleta de dados foi feita por meio de grupos focais e registros em diário de campo submetidos à análise temática de conteúdo. A análise dos dados revelou as seguintes categorias temáticas: processos de trabalho relacionados ao Projeto Terapêutico Singular; Influência da lógica ambulatorial no Projeto Terapêutico Singular. Sendo assim, foi revelada a percepção da importância dos PTS para os profissionais, mas a falta de organização e sistematização dos mesmos, sendo que a sua realização sequer existia em alguns dos serviços pesquisados. Concluímos que os profissionais reconhecem a lógica dos projetos terapêuticos singulares como importante para refletir cuidado psicossocial, entretanto a elaboração ainda é precária, médico-centrada e as ofertas de atividades terapêuticas restritas ao interior dos Centros de Atenção Psicossociais. A realidade evidenciada aponta para a necessidade de investimento em Educação Permanente em Saúde para qualificar os processos de trabalho nos CAPS desenvolvidos pelos diversos profissionais que neles atuam, por meio da sistematização dos PTS, de modo a garantir cuidado psicossocial como promotor de cuidado em liberdade. Isso possibilitará maior efetividade de reinserção social e, ainda, a avaliação dos resultados obtidos.

RESUMEN. El objetivo de este trabajo fue describir cómo los profesionales operan proyectos terapéuticos singulares (STP) en los Centros de Atención Psicosocial. Para ello, se desarrolló una investigación cualitativa de carácter descriptivo y exploratorio con 58 profesionales de siete Centros de Atención Psicosocial ubicados en tres municipios del Estado de Goiás, Brasil. La recolección de datos se llevó a cabo por intermedio de grupos focales y registros de diarios de campo sometidos a análisis de contenido temático. El análisis de datos reveló las siguientes categorías temáticas: procesos de trabajo relacionados con el Proyecto Terapéutico Singular; Influencia de la lógica ambulatoria en el Proyecto Terapéutico Singular. Así, se reveló la percepción de la importancia del STP para los profesionales, pero la falta de organización y sistematización de los mismos, y su realización ni siquiera existía en algunos de los servicios encuestados. Llegamos a la conclusión de que los profesionales reconocen la lógica de proyectos terapéuticos singulares como importantes para reflejar la atención psicosocial, sin embargo, la preparación aún es precaria, centrada en lo médico y la oferta de actividades terapéuticas restringidas al interior de los Centros de Atención Psicosocial. La realidad evidenciada apunta a la necesidad de invertir en Educación Permanente en Salud para calificar los procesos de trabajo en los CAPS desarrollados por los diversos profesionales que trabajan en ellos, por intermedio de la sistematización de STP, para garantizar la atención psicosocial como promotor de la atención en libertad. Esto permitirá más efectividad de la reintegración social y también la evaluación de los resultados obtenidos.

ABSTRACT. This work aimed to describe how professionals operate Singular Therapeutic Projects (STP) in Psychosocial Care Centers. For this, qualitative research with a descriptive and exploratory nature was developed with 58 professionals from seven Psychosocial Care Centers located in three municipalities in the State of Goiás, Brazil. Data collection was carried out through focus groups and field diary records submitted to thematic content analysis. Data analysis revealed the following thematic categories: Work processes related to the Singular Therapeutic Project; Influence of ambulatory logic on the Singular Therapeutic Project. Thus, the perception of the importance of STP for professionals was revealed. However, their lack of organization and systematization, and the STP elaboration did not even exist in some of the services surveyed. We conclude that professionals recognize the logic of Singular Therapeutic Projects as important to reflect psychosocial care, even though the elaboration is still precarious, medically-centered, and the offer of therapeutic activities restricted to the interior of Psychosocial Care Centers (known in Brazil as Centros de Atenção Psicossociais - CAPS). The evidenced reality points to the need for investment in Permanent Education in Health to qualify the work processes developed in the CAPS by the various professionals who work in them, through the systematization of STP, in order to guarantee psychosocial care as a promoter of care in freedom. This will enable greater effectiveness of social reintegration and also the evaluation of the results obtained.

Workloads and burnout of nursing workers / Cargas de trabajo y agotamiento de la salud de los trabajadores de la enfermería / Cargas de trabalho e os desgastes à saúde dos trabalhadores da enfermagem

ABSTRACT Objective: to identify workloads in nursing work and its association with nursing worker burnout. Method: a cross-sectional study, including 211 nursing workers from a university hospital, between July and August 2016. For the analysis, the descriptive statistics, Chi-Square Test, Fisher's Exact Test and Mann Whitney U-Test were used. Results: the most evidenced loads were biological. A significant association was found between workloads and workers' occupation, as well as a significant association between workloads and worker burnout. Burnout caused upper limb pain, neck and lumbar pain, lower limb pain, muscle spasm, lower limb edema, mental fatigue, headache, nervousness, and forgetfulness. Conclusion: workloads identification is a subsidy for the promotion of interventions that minimize the burnout generated to the health of the nursing worker.

RESUMEN Objetivo: identificar las cargas de trabajo presentes en el trabajo de la Enfermería y su asociación con los desgastes a la salud de los trabajadores. Método: el estudio transversal, incluyendo 211 trabajadores de enfermería de un hospital universitario, entre julio y agosto de 2016. Para análisis, se utilizó estadística descriptiva y las Pruebas Qui-Cuadrado, Exacto de Fisher y Mann Whitney. Resultados: las cargas más evidenciadas fueron las biológicas. Se verificó una asociación significativa entre las cargas de trabajo y la función de los trabajadores, así como una asociación significativa entre cargas de trabajo y desgastes a la salud de los trabajadores. Los síntomas de agotamiento fueron dolor en miembros superiores, dolor en región cervical y lumbar, dolor en miembros inferiores, contractura muscular, edema en miembros inferiores, cansancio mental, cefalea, nerviosismo y olvido. Conclusión: la identificación de las cargas de trabajo sirve de subsidio para promoción de intervenciones que minimicen los desgastes generados a la salud del trabajador de la Enfermería.

RESUMO Objetivo: identificar as cargas de trabalho presentes no trabalho da Enfermagem e a sua associação com os desgastes à saúde dos trabalhadores. Método: estudo transversal, incluindo 211 trabalhadores de enfermagem de um hospital universitário, entre julho e agosto de 2016. Para análise, utilizou-se estatística descritiva e os Testes Qui-Quadrado, Exato de Fisher e Mann Whitney. Resultados: as cargas mais evidenciadas foram as biológicas. Verificou-se associação significativa entre as cargas de trabalho e a função dos trabalhadores, assim como associação significativa entre cargas de trabalho e desgastes à saúde dos trabalhadores. Os desgastes foram dor em membros superiores, dor em região cervical e lombar, dor em membros inferiores, contratura muscular, edema em membros inferiores, cansaço mental, cefaleia, nervosismo e esquecimento. Conclusão: a identificação das cargas de trabalho serve de subsídio para promoção de intervenções que minimizem os desgastes gerados à saúde do trabalhador da Enfermagem.

Allied Health Clinicians' Understanding of Palliative Care as It Relates to Patients, Caregivers, and Health Clinicians: A Cross-Sectional Survey.

PURPOSE: The scope of hospice or palliative care has expanded since its inception, which has significant ramifications for the AH workforce. This study sought to elicit allied health (AH) clinicians' understanding and views about palliative care and its relevance to their clinical practice and to identify their educational needs. Results from analysis of free text survey responses to a single open-ended question from a larger survey are presented. METHODS: An online survey was distributed to AH clinicians via email lists for the CareSearch Allied Health Hub, Allied Health Professions Australia, and other groups. Descriptive statistics and content analysis of free text responses were used to analyse the data. RESULTS: A total of 217 AH clinicians responded to an email survey and 187 useable responses were analysed. Four themes were identified: 1) palliative care employs a client-centred model of care, 2) acknowledgement of living whilst dying, 3) interdisciplinary palliative care interventions provide active care in a range of domains, and 4) characteristics of palliative care teams and settings. CONCLUSION: AH clinicians plan an active role in physical, social, and psycho-spiritual care of palliative care patients and caregivers. Burgeoning numbers of palliative care patients in nonspecialist palliative care settings require AH clinicians to develop skills and competencies to work with people who have advanced disease.

Running on empathy: Relationship of empathy to compassion satisfaction and compassion fatigue in cancer healthcare professionals.

OBJECTIVE: The aim of this study is to examine the relationship of empathy and professional quality of life in cancer healthcare professionals. METHODS: A Professional Quality of Life instrument measuring compassion satisfaction and compassion fatigue, and the Interpersonal Reactivity Index measuring empathy were distributed to healthcare professionals working in cancer care in the Republic of Ireland. Final analysis was conducted on 117 participants. RESULTS: A quarter of participants experience high levels of compassion satisfaction, and a quarter are at risk of compassion fatigue. A positive correlation was found between personal distress and compassion fatigue, and a negative correlation was found between personal distress and compassion satisfaction. A positive correlation was found between empathic concern and secondary traumatic stress. CONCLUSION: These findings suggest that healthcare professionals working in cancer care are at risk of compassion fatigue. Also, healthcare professionals working in cancer care experience personal distress that may impact negatively on professional quality of life. Implications for practice include a need to identify those HCPs who are at risk of compassion fatigue. The implication for further research suggests further exploration of the impact of personal distress felt by cancer healthcare professionals during empathic engagement.

Near misses and presenteeism among paramedics.

BACKGROUND: Paramedics need to be in good physical health to be able to respond to emergencies. We hypothesized that near misses by paramedics and unanticipated incidents that cause no harm may be associated with presenteeism during emergency rescues. AIMS: To examine the association between presenteeism and near misses among paramedics. METHODS: A cross-sectional study was conducted among 254 paramedics using a self-administered questionnaire. Presenteeism was measured using the work functioning impairment scale (WFun). RESULTS: Twelve per cent of respondents experienced high work function impairment indicating presenteeism. The rate of near-miss experiences steadily increased with increasing work function impairment among paramedics (WFun score category: middle, odds ratio (OR) 3.62, 95% confidence interval (CI) 1.62-8.11; high, OR 4.36, 95% CI 1.37-13.84; very high, OR 8.62, 95% CI 2.09-35.48). CONCLUSIONS: This study demonstrated a positive relationship between impaired work function indicating presenteeism and near misses among paramedics. This suggests that presenteeism may be associated with errors that have the potential to cause serious accidents. Improved access to treatment for frequent health problems may reduce the number of incidents among paramedics.

Limits and possibilities for teaching and learning about breastfeeding / Límites y posibilidades para la enseñanza-aprendizaje de la temática sobre lactancia materna / Limites e possibilidades para o ensino-aprendizagem da temática sobre aleitamento materno

ABSTRACT Objective: To point out limits and possibilities involved in the teaching and learning process of undergraduate students from Health of a Federal Public Higher Education Institution on breastfeeding. Method: Instantaneous photography study carried out in undergraduate courses in the area of Health with professors and students involved in the teaching and learning process on breastfeeding. For data collection, the Focal Group technique was used with the students and the semi-structured interview with the professors. The speeches were submitted to the thematic content analysis of Bardin. Results: It was identified the thematic category: Limits and possibilities for the teaching and learning process on breastfeeding, from two sub-categories: Structural limitations of the courses; and Advances and obstacles in the relationship between theory and practice. Final considerations: Limits indicated as workload deficit and professor-centered teaching made progress in learning about breastfeeding difficult, and interdisciplinarity was a step forward in this process.

RESUMEN Objetivo: Aponte límites y posibilidades involucrados en el proceso de enseñanza-aprendizaje de graduandos del área de la Salud de una Institución de Enseñanza Superior Pública Federal sobre el tema "lactancia materna". Método: Estudio de fotografía instantánea realizado en los cursos de graduación del área de la Salud con profesores y estudiante involucrados en el proceso de enseñanza-aprendizaje de la temática sobre lactancia materna. Para la recolección de datos se utilizó la técnica de Grupo Focal con los estudiantes, y la entrevista semiestructurada con los profesores. Las palabras se sometieron al análisis de contenido temático de Bardin. Resultados: Se identificó la categoría temática: Límites y posibilidades para el proceso de enseñanza-aprendizaje en la temática sobre lactancia materna, a partir de dos subcategorías: Limitaciones de la estructura de los cursos; y Avances y obstáculos en la relación entre teoría y práctica. Consideraciones finales: Los límites apuntados como déficit de carga horaria y enseñanza centrada en el profesor dificultaron el progreso en el aprendizaje de la temática sobre lactancia materna, siendo la interdisciplinaridad un avance para ese proceso.

RESUMO Objetivo: Apontar limites e possibilidades envolvidos no processo de ensino-aprendizagem de graduandos da área da Saúde de uma Instituição de Ensino Superior Pública Federal sobre o tema "aleitamento materno". Método: Estudo de fotografia instantânea realizado nos cursos de graduação da área da Saúde com docentes e discentes envolvidos no processo de ensino-aprendizagem da temática sobre aleitamento materno. Para a coleta de dados foi utilizada a técnica de Grupo Focal com os discentes, e a entrevista semi-estruturada com os docentes. As falas foram submetidas à análise de conteúdo temática de Bardin. Resultados: Foi identificada a categoria temática: Limites e possibilidades para o processo de ensino-aprendizagem na temática sobre aleitamento materno, a partir de duas sub-categorias: Limitações da estrutura dos cursos; e Avanços e entraves na relação entre teoria e prática. Considerações finais: Os limites apontados como déficit de carga horária e ensino centrado no docente dificultaram o progresso na aprendizagem da temática sobre aleitamento materno, sendo a interdisciplinaridade um avanço para esse processo.

Radiographer mammographers' attitudes towards implementing new techniques for imaging the augmented breast, after viewing a training DVD or receiving cascade training: A survey.

INTRODUCTION: Mammographers in the NHSBSP are required to implement the Eklund ('Pushback') technique after viewing a training DVD or receiving cascade training. This study aims to evaluate Radiographers' attitudes towards imaging the augmented breast following viewing the training DVD or receiving cascade training. METHODOLOGY: Questionnaires containing both open and closed questions collected quantitative and qualitative data across three breast screening units. A total of 60 radiographers were targeted. Their responses were analysed using Pearson's Chi-Square. An evaluation of likelihood and association of variables was performed using inferential statistics. RESULTS: Of the 60 mammographers targeted, 38 (63%) completed the questionnaires. Quantitative results indicated that most mammographers (78%) had watched the DVD. Of these responders, (51.14%) found the DVD somewhat helpful in raising their confidence to attempt the new techniques. When inferential statistics was used to evaluate if confidence was associated with location or level of qualifications, these showed no significance ('p' = 0.085 and 0.312 respectively). Results indicated that longer years of practice had an association with ability to attempt techniques, however, this was not statistically significant (χ2 = 3.939, df = 6, p = 0.685). Qualitative responses indicated that cascade training increased confidence more than viewing the DVD. Both qualitative and quantitative data indicated that cascade training in addition to the DVD is required. CONCLUSION: Although the DVD was a helpful training tool, it did not sufficiently raise confidence for all viewers. Cascaded training in addition to the DVD was required to effectively raise confidence.