Work environment of hospital nurses during the COVID-19 pandemic in Brazil.

AIM: To investigate the nurses' work environment in university hospitals during the COVID-19 pandemic in Brazil. BACKGROUND: The COVID-19 pandemic brought challenging times for nurses worldwide. In Brazil, as well as in several countries, nurses are working hard in hospital settings caring for patients infected with the virus, sometimes with unfavourable work environment conditions. METHODS: This study was a convergent embedded mixed methods research. The sample comprised 104 nurses from three Brazilian university hospitals. Data were collected in April-June 2020 from an online questionnaire with a self-reporting Likert scale survey designed to measure the nurses' perceptions of their work environment. Qualitative data in the form of written comments were also collected through an open question. Data were analysed using descriptive statistics and content analysis. RESULTS: The quantitative results showed that the responses to 'I received training on the correct use of personal protective equipment' and 'I am afraid of being infected' items had the best and worst evaluations, respectively. The qualitative findings revealed five themes: feeling of insecurity, lack of personal protective equipment, lack of diagnostic tests, changes in the care flow and fear of the unknown. CONCLUSION: The study has highlighted the challenges faced by hospital nurses while caring for patients with COVID-19. IMPLICATIONS FOR NURSING AND NURSING POLICY: The gaps identified will assist the policymakers and hospital managers in developing policies to enhance the support offered to nurses and improve the care provided to patients with COVID-19 in university hospitals. The results also indicate the need for attention to the mental health of the professionals due to the increasing workload and treatment of an illness hitherto unknown.

[Environmental education for nursing faculty members: perception and relation to nurse training]. / Educação ambiental para docentes enfermeiros: percepção e relação com a formação do enfermeiro.

OBJECTIVE: to describe the perception of nursing teachers on environmental education and its relation to the professional training received by nurses. METHOD: exploratory-descriptive, qualitative study performed with 17 nurses working in Undergraduate Nursing courses at Federal Institutions of Higher Education of Rio Grande do Sul. Data were collected between January and April 2013, through semi-structured interviews and the analysis of pedagogical projects. Content analysis framework was used for data analysis. RESULTS: the following categories emerged: multiplicity of perceptions about environmental education, where environmental education, although still perceived through a naturalist bias, also includes a well rounded vision for socio-cultural context and human values; and environmental education in in the nursing education program, showing an incipient approach in vocational training, while recognizing its importance in nursing care. CONCLUSIONS: Environmental education must be fostered with the goal of providing training committed to environmental sustainability.

[Permanent health education based on research with professionals of a multidisciplinary residency program: case study]. / Educação permanente em saúde a partir de profissionais de uma residência multidisciplinar: estudo de caso.

This research aims to identify the perception of professional members ofa multi-professional residency program on Permanent Health Education. It is a case study research using a qualitative approach, with sixteen members of a multi-professional residency program. The data were collected from January to May 2012, through semi-structured interviews, document analysis and systematic observation, and analyzed according to Thematic Content Analysis. Two categories were identified: Permanent Health Education establishing collective spaces of reflection of practices and Permanent Health Education that promotes integration between disciplines. The members of the multiprofessional residencyteam were found to be aware that permanent education permeates theirtraining and enables reflection on their clinical practices and multidisciplinary action as producers of health actions.

Ergonomic risks and musculoskeletal pain in hospital cleaning workers: Convergent Care Research with mixed methods.

OBJECTIVE: to analyze exposure to ergonomic risks and the occurrence of musculoskeletal pain in workers in the Hospital Cleaning Service. METHOD: Convergent Care Research, with data production designed using mixed methods, implemented with 149 hospital cleaning workers. The methodological strategy of the convergent parallel project was employed, using observation, photographic records, questionnaires and convergence groups. The results were integrated through joint display. Data analysis with descriptive and inferential statistics and content analysis. RESULTS: the mixing of data highlighted the multifactorial nature of exposure to ergonomic risks (uncomfortable work postures; repetitive movements; prolonged orthostatism; use of equipment not adapted to the psychophysiological needs of workers) and musculoskeletal pain in the population investigated. The latter was prevalent in the lumbar spine, ankles or feet, wrists or hands, thoracic spine and shoulders. The concept of ergonomic risk was expanded and was influenced by the psychosocial aspects of work. CONCLUSION: the workers investigated are exposed to modifiable multifactorial ergonomic risks related to musculoskeletal pain. It is possible to promote innovations and teaching-learning actions to minimize them, such as the continuing education program, collectively constructed with recommendations for improvements.

Adherence to standard precautions in university hospitals during the COVID-19 pandemic: a mixed study.

OBJECTIVE: To analyze adherence to standard precautions by healthcare professionals and associated factors during the COVID-19 pandemic in Brazilian university hospitals. METHOD: Multicenter study, with a mixed approach, with a concomitant incorporated strategy and a sample of 559 health professionals and 53 managers from five university hospitals in Southern Brazil. Data collected online from September 2020 to October 2021 with the Instrument of Variables Related to Standard Precautions and sociodemographic and pandemic-related variables. Descriptive and inferential statistical analysis (Mann-Whitney and Kruskal-Wallis test) and content analysis were performed. RESULTS: High level of adherence to standard precautions, with a significant association with having children (p = 0.014); COVID area (p < 0.001), biosafety training (p = 0.018), and social distancing (p < 0.001). The testimonies demonstrated a high risk perception and search for the use of protective equipment and biosafety knowledge. CONCLUSION: High adherence to standard precautions, associated with having children, working in COVID-19 care units, receiving biosafety guidance/training at the institution and practicing social distancing.

Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study.

OBJECTIVES: to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units. METHODS: mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used. RESULTS: the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit. CONCLUSIONS: there was an association between burnout and ethical climate and elements of the work organization.

Factors associated with the SARS-CoV-2 infection among health professionals from university hospitals. / Factores asociados a la infección por SARS-CoV-2 en profesionales de la salud de hospitales universitarios.

to investigate factors associated with the SARS-CoV-2 infection among health professionals from university hospitals. a multicenter, mixed approach study with concomitant incorporated strategy, carried out with 559 professionals in the quantitative stage, and 599 in the qualitative stage. Four data collection instruments were used, applied by means of an electronic form. The quantitative analysis was performed with descriptive and inferential statistics and the qualitative data were processed by means of content analysis. the factors associated with the infection were as follows: performance of the RT-PCR test (p<0.001) and units offering care to COVID-19 patients (p=0.028). Having symptoms increased 5.63 times the prevalence of infection and adhering to social distancing most of the time in private life reduced it by 53.9%. The qualitative data evidenced difficulties faced by the professionals: scarcity and low quality of Personal Protective Equipment, work overload, physical distancing at work, inadequate processes and routines and lack of a mass screening and testing policy. the factors associated with the SARS-CoV-2 infection among health professionals were mostly related to occupational issues.

investigar los factores asociados a la infección por SARSCoV-2 en los profesionales de la salud de hospitales universitarios. estudio multicéntrico, con abordaje mixto con estrategia incorporada concomitante, realizado con 559 profesionales en la etapa cuantitativa, y 599 en la etapa cualitativa. Fueron utilizados cuatro instrumentos de recolección de datos, aplicados a través un formulario electrónico. El análisis cuantitativo se realizó mediante estadística descriptiva e inferencial y los datos cualitativos mediante análisis de contenido los factores asociados a la infección fueron: realización de la prueba "RT-PCR" (p<0,001) y unidades que atienden a pacientes con COVID-19 (p=0,028). Tener síntomas aumentó la prevalencia de infección 5,63 veces y cumplir la mayor parte del tiempo con el distanciamiento social en la vida privada la redujo un 53,9%. Los datos cualitativos mostraron las dificultades que enfrentaron los profesionales: escasez y baja calidad de equipos de protección personal, sobrecarga de trabajo, distanciamiento físico en el trabajo, procesos y rutinas inadecuados y la ausencia de una política de triage y testeo masivos. los factores asociados a la infección por SARS-CoV-2 en los profesionales de la salud se relacionaron mayormente con cuestiones laborales.

(1) Las cuestiones laborales influyeron en la protección de los profesionales durante la pandemia. (2) La alta adhesión a las precauciones estándar y al distanciamiento no disminuyeron los casos positivos. (3) La baja calidad de los EPP y las fallas en el triage dificultaron la protección en el trabajo. (4) La infraestructura hospitalaria no favoreció el distanciamiento físico entre los equipos.

investigar fatores associados à infecção por SARS-CoV-2 entre profissionais da saúde de hospitais universitários. estudo multicêntrico, de abordagem mista com estratégia incorporada concomitante, realizado com 559 profissionais na etapa quantitativa, e 599 na etapa qualitativa. Foram utilizados quatro instrumentos de coleta de dados, aplicados via formulário eletrônico. A análise quantitativa foi realizada com estatística descritiva e inferencial e os dados qualitativos por meio de análise de conteúdo. os fatores associados à infeção foram: realização de teste "RT-PCR" (p<0,001) e unidades com atendimento a pacientes com COVID-19 (p=0,028). Ter sintomas aumentou em 5,63 vezes a prevalência de infeção e aderir ao distanciamento social na maior parte do tempo na vida particular reduziu em 53,9%. Dados qualitativos evidenciaram dificuldades enfrentadas pelos profissionais: escassez e baixa qualidade de equipamentos de proteção individual, sobrecarga de trabalho, distanciamento físico no trabalho, processos e rotinas inadequadas e ausência de uma política de triagem e testagem em massa. os fatores associados à infecção por SARS-CoV-2 entre profissionais da saúde foram em sua maioria relacionados a questões ocupacionais.

[The approach to the interface between health and environment in the training of nurses]. / A abordagem da interface saúde e meio ambiente na formação profissional de enfermeiros.

This study aimed to know how nursing professors perceive the interface between health and environment. This is a descriptive study with a qualitative approach developed with six nursing professors from different areas in the process of training nurses. The data were collected through semi-structured interviews in 2010 and underwent a process of content analysis. The data analysis allowed the emergence of categories, namely: Health and environmental interface: a relation of cause and consequence, Discussion on the issue of health and environment in vocational training: a gap in the educational process, and Health and environment a cross-sectional content. Based on the understanding that there is interaction between health and environment, the professors emphasize that the environment should be a cross-sectional theme in the curriculum proposal for the Nursing undergraduate major, since they show gaps in addressing the issue.

Risks of illness of nursing professors working in in post-graduation courses.

OBJECTIVE: To identify the risk of illness related to the work context of nurse professors of stricto sensu nursing post-graduation programs of public institutions. METHOD: Mixed study (convergent and parallel) carried out in federal universities in Rio Grande do Sul, with nurse professors, from November 2015 to October 2016. As data collection techniques, the Work Context Assessment Scale and a semi-structured interview were used. The data were analyzed using descriptive statistics and thematic analysis. RESULTS: For the quantitative data, it was identified that all factors on the scale were assessed as critical for the risk of illness. The reports complement the quantitative data, and point to work overload, competitiveness, and inadequate infrastructure. CONCLUSION: This study offers subsidies for the implementation of actions aimed at the health of nursing professors and helps in the understanding of the work context, which presents risks for illness.

The use of selfbody in nurses work in hospital care: an ergology approach.

OBJECTIVE: to know how happens the nurse use of selfbody in the emergency room. METHODS: qualitative study, performed with 23 nurses in an adult emergency room at a university hospital in the South of Brazil. The data gathering was through documental research, systematic observation, and semi-structured interview. According to the thematic modality, the data analysis was carried out anchored in the theoretical reference of ergology. RESULTS: it was evidenced the use of selfbody in the work of the nurse, as much in the development of managerial activities as assistance, especially: in the organization of the environment, in the performance in intercurrences and definition of priorities of attendance, as well as in the conduction of the activities of each work shift, together with the nursing and multi-professional team. FINAL CONSIDERATIONS: the nurse makes use of selfbody at work in the emergency room, based on values, knowledge, and experience, considering the organization of the work process and better nursing assistance.

Health symptoms and impacts of work on nursing professionals in a public hospital.

OBJECTIVE: To relate self-reported health symptoms and the impacts of work in terms of physical, social, and psychological illness in nursing professionals. METHOD: Cross-sectional, correlational study carried out in a public hospital in the southern region of Brazil. A sample of nursing professionals who worked in direct care participated in the study. A social-occupational questionnaire of self-reported health symptoms and the Work-Related Damage Assessment Scale were used. The analysis was descriptive and analytical. Chi-square test and Spearman's correlation coefficient were used, with a significance level of 5%. RESULTS: A total of 308 professionals participated, with a prevalence of physical illness and higher means for pain in the body, legs and back. Significant relations were identified among the social-occupational variables, health symptoms, and physical, social or psychological illness. High and moderate correlations among the factors investigated were evidenced. CONCLUSION: The impact of work on nursing professionals' health is evidenced by the association between self-reported health symptoms and illness, especially the physical or social one, and reinforces the need for professional awareness over situations that are harmful to health.

Changes implemented in the work environment of nurses in the COVID-19 pandemic.

OBJECTIVE: to describe the changes implemented in the work environment of nurses in university hospitals considering the COVID-19 pandemic. METHODS: this qualitative and descriptive research was developed from an online survey with 75 nurses from three Brazilian university hospitals. Data processing occurred through textual analysis with the aid of software IRAMUTEQ. RESULTS: five semantic classes were obtained: Organization of units for exclusive care of patients with COVID-19; Adaptations in the use of personal protective equipment; Physical structure adaptation; Care flow institution; Increased number of beds and training courses. Final considerations: the results show the effort of healthcare and nursing professionals/managers in the development of structural adaptations and reorganizations of care processes, in the hospital context, to respond with quality and efficiency to the demands arising from the COVID-19 pandemic.

[Pleasure-suffering of nursing workers in a hemodialysis service: a qualitative study]. / Prazer-sofrimento dos trabalhadores de enfermagem de um serviço de hemodiálise.

One of the perspectives on investigations approaching the area of workers' health is the relationship among work, health and sickening. This study aimed to identify the factors which generate pleasure and suffering to nursing workers in a hemodialysis service. It is a qualitative research which was developed with twelve nursing workers. Data collection occurred from March to April of the year 2009. The collections consisted of semi-structured interviews. Thematic analysis technique was used for data analysis. It was noted that the factors which generated pleasure at work were: appreciating the job, being valued, helping patients and having no complications on duty. The reported factors of suffering were: witnessing patients' suffering, a sense of helplessness, suffering with patients' anger, and relationship problems with co-workers. The results point to the need of group discussions on the issue of pleasure-suffering factors at work in such services.

What is said and unspoken about the autonomy of a nurse: (dis) continuity in discourses.

OBJECTIVE: to know how autonomy is constituted in the nurse's professional practice in the hospital context. METHODS: Qualitative analytical study, based on Foucault's methodological theoretical framework. The empirical material consisted of articles published in the Revista Brasileira de Enfermagem and narrative interviews conducted with 18 nurses from a public hospital in southern Brazil. Data collection took place between December 2017 and May 2018, being analyzed through Foucauldian discourse analysis. RESULTS: Autonomy in the professional practice of nurses goes through the core of knowledge, the political positioning and the working conditions. These factors are revealed as power instruments in the construction of nurse governability. Final Considerations: It is believed that the investment focused on the debate of the nurse's autonomy interfaces could raise new attitudes about professional practice and favor the transformation of nursing practice.

Structural empowerment of nurses in the hospital setting.

OBJECTIVE: to measure the level of structural empowerment of nurses working in a university hospital. METHOD: a descriptive, analytical, and cross-sectional study, carried out with 237 nurses, who developed care and management activities. Data collection took place through a self-administered questionnaire with questions on the personal and professional characterization and the Work Effectiveness Conditions Questionnaire II. Data analysis used descriptive and inferential statistics. RESULTS: it was identified that nurses have a moderate level of structural empowerment (18.06±SD 0.9). The greatest value was obtained in the Opportunity dimension (4.08±SD 0.8), followed by the Resources (3.17±SD 0.8) and Informal power (3,04±SD 0.9) dimensions; while the scores of Support (2.67±SD 1.0), Formal power (2.59±SD 0.9), and Information (2.51±SD 0.9) were lower. CONCLUSION: the level of structural empowerment of the nurses was moderate, which means partial access to opportunities, resources, support, and information of the institution.

Association between individual, work-related and organizational factors and adherence to standard precautions.

OBJECTIVE: To verify the association between individual, work-related and organizational factors with adherence to standard precautions. METHOD: Cross-sectional study, carried out from January to June 2016 with 602 nursing workers from a university hospital. Ten Likert-type psychometric scales were used, with 57 items, organized in three domains: individual, work-related and organizational factors. Data were analyzed with descriptive and inferential statistics. RESULTS: The adherence to the standard precautions obtained a mean intermediate score (4.30 ± 1.03) and a positive correlation with the Risk Personality Scales (r = 0.136, p <0.0001), Prevention Efficacy (r = 0.109 , p <0.0001), Obstacles to follow the precautions (r = 0.394, p <0.0001), PPE availability (r = 0.189 p <0.0001), Safety Climate (r = 0.325, p <0 , 0001) and Training on Prevention of Occupational Exposure (r = + 0.308, p <0.0001). CONCLUSION: Adherence to standard precautions is associated with individual, work-related, and organizational factors.

Reflexivity, knowledge and ecological awareness: premises for responsible action in the hospital work environment.

The article aims to analyze the interface of reflexivity, knowledge and ecologic awareness in the context of hospital work, based on data collected in a qualitative case study carried out at a public hospital. Field observation data and interviews are discussed in the light of sociologic and philosophic references. Workers expressed the interface between knowledge and action, in which there is a cycle of lack of knowledge, automatism in the actions and lack of environmental awareness, posing limits to individual awareness and to responsibility towards environmental preservation. Increased debate and education, including the environmental issue, are needed in the context of hospital work. Although hospital work is reflexively affected by the environmental problem, that does not guarantee the reorientation of practices and responsible action towards the environment.

[A view about the interface hospital work and the environmental problems]. / Um olhar sobre a interface trabalho hospitalar e os problemas ambientais.

This study aimed at verifying how the ecologic reflexivity appears in the context of hospital work and its influence on the workers' performance. Research of qualitative approach, carried out with hospital workers of a public institution. The data were collected by means of a document analysis, field observation and individual and group interview. The data revealed that the worker has a distant relation with the environmental issue, and the regulation of the management of solid residues is the main topic to approach the issue. The development of effective actions of environmental preservation by the hospital worker, the adoption of this question is related to the adoption of this question as an institutional policy, thus this subject should be approached in the permanent education process of the workers, based on serious ethical consideration.

Patient advocacy actions by intensivist nurses. / Ações de advocacia do paciente pelos enfermeiros intensivistas.

OBJECTIVE: To explore the actions and factors associated to patient advocacy by intensivist nurses using the Protective Nursing Advocacy Scale. METHOD: A quantitative, descriptive-exploratory, cross-sectional study. The questionnaire was answered by nurses who worked in Intensive Care Units in the South and Southeast regions of Brazil. A factorial exploratory analysis of the data, T-tests and the chi-square test were used for association between factors. RESULTS: 451 nurses participated in the study. A greater number of nurses disagreed with the negative consequences that patient advocacy may have or bring to them. Greater dialogue among nursing staff would enhance teamwork results. Nurses with two or more job relationships need more physical and mental effort, which compromises their quality of life and work, leading to them being those who least practice patient advocacy. CONCLUSION: Nurses understand patient advocacy as an important part of their work, as well as factors which may influence their decision to defend their patients, but are still unaware of the benefits of advocacy.

Adherence to standard precautions in university hospitals during the COVID-19 pandemic: a mixed study / Cumplimiento de las precauciones estándar en hospitales universitarios durante la pandemia de COVID-19: un estudio mixto / Adesão às precauções padrão em hospitais universitários na pandemia de COVID-19: estudo misto

ABSTRACT Objective: To analyze adherence to standard precautions by healthcare professionals and associated factors during the COVID-19 pandemic in Brazilian university hospitals. Method: Multicenter study, with a mixed approach, with a concomitant incorporated strategy and a sample of 559 health professionals and 53 managers from five university hospitals in Southern Brazil. Data collected online from September 2020 to October 2021 with the Instrument of Variables Related to Standard Precautions and sociodemographic and pandemic-related variables. Descriptive and inferential statistical analysis (Mann-Whitney and Kruskal-Wallis test) and content analysis were performed. Results: High level of adherence to standard precautions, with a significant association with having children (p = 0.014); COVID area (p < 0.001), biosafety training (p = 0.018), and social distancing (p < 0.001). The testimonies demonstrated a high risk perception and search for the use of protective equipment and biosafety knowledge. Conclusion: High adherence to standard precautions, associated with having children, working in COVID-19 care units, receiving biosafety guidance/training at the institution and practicing social distancing.

RESUMEN Objetivo: Analizar la adherencia a las precauciones estándar por parte de los profesionales de la salud y los factores asociados durante la pandemia de COVID-19 en hospitales universitarios brasileños. Método: Estudio multicéntrico, con enfoque mixto, estrategia incorporada concomitante y muestra de 559 profesionales de la salud y 53 gestores de cinco hospitales universitarios del sur de Brasil. Datos recopilados en línea de septiembre de 2020 a octubre de 2021 con el Instrumento de Variables Relacionadas con Precauciones Estándar y variables sociodemográficas y relacionadas con la pandemia. Se realizaron análisis estadísticos descriptivos e inferenciales (prueba de Mann-Whitney y Kruskal-Wallis) y análisis de contenido. Resultados: Alto nivel de adherencia a las precauciones estándar, con asociación significativa con tener hijos (p = 0,014); área COVID (p < 0,001), capacitación en bioseguridad (p = 0,018) y distanciamiento social (p < 0,001). Los testimonios indican una alta percepción de riesgo y búsqueda del uso de equipos de protección y conocimientos de bioseguridad. Conclusión: Alto cumplimiento de las precauciones estándar, asociadas con tener hijos, trabajar en unidades de atención de COVID-19, recibir orientación/capacitación en bioseguridad en la institución y practicar el distanciamiento social.

RESUMO Objetivo: Analisar a adesão às precauções padrão por profissionais da saúde e os fatores associados durante a pandemia de COVID-19 em hospitais universitários brasileiros. Método: Estudo multicêntrico, de abordagem mista, com estratégia incorporada concomitante e amostra de 559 profissionais da saúde e 53 gestores de cinco hospitais universitários do Sul do Brasil. Coleta de dados realizada de setembro de 2020 a outubro de 2021, online, com o Instrumento de Variáveis Relativas às Precauções Padrão, variáveis sociodemográficas e relacionadas à pandemia. Realizada análise estatística descritiva e inferencial (teste de Mann-Whitney e Kruskal-Wallis) e análise de conteúdo. Resultados: Alto nível de adesão às precauções padrão, com associação significativa para ter filhos (p = 0,014); área COVID (p < 0,001), treinamento sobre biossegurança (p = 0,018) e distanciamento social (p < 0,001). Depoimentos demonstraram percepção de risco elevada e busca pela utilização de equipamentos de proteção e por conhecimentos relacionados à biossegurança. Conclusão: Alta adesão às precauções padrão, associada a ter filhos, trabalhar em unidades de atendimento à COVID-19, receber orientações/capacitação sobre biossegurança na instituição e realizar distanciamento social.