Descanso noturno: influências da ergonomia na adaptação do trabalho de enfermagem / Nocturnal rest: influences of ergonomy in the adaptation of nursing work

O propósito dessa pesquisa é estudar a influência do trabalho no turno noturno e sua relação com as variáveis sócio-demográficas e fisiológicas no contexto da saúde do trabalhador de enfermagem, considerando as necessidades biopsicossociais do ser humano. A pesquisa tem como objeto de estudo a adaptação do trabalhador de enfermagem ao trabalho noturno e suas repercussões na saúde destes profissionais, visando aprofundar a compreensão desta temática e subsidiar as discussões sobre a regulamentação do descanso noturno de modo adequado durante os plantões. O sono não é simplesmente um descanso, pois segundo Medeiros et al. (2009) dormir é um processo ativo em que algumas regiões do cérebro continuam com as mesmas atividades como durante o estado de alerta. Quando a privação do sono é excessiva e persistente, pode gerar fadiga, diminuição do nível de alerta, irritabilidade, dentre outros sintomas. Os objetivos dessa pesquisa são: Objetivo Geral Avaliar as influências do serviço noturno em relação aos problemas de saúde e bem-estar, dos trabalhadores de enfermagem no turno noturno auto-percebido por esses profissionais em um hospital de grande porte. Objetivos Específicos: Identificar os aspectos sócio-economico, fisiológico e legais dos profissionais de enfermagem que atuam no turno noturno por categoria profissional; Verificar as condições do descanso noturno dos trabalhadores de enfermagem; c) Discutir os sinais e sintomas percebidos pelos trabalhadores sobre os aspectos relacionados ao trabalho noturno. O Método utilizado para essa pesquisa, foi um estudo descritivo-exploratório com abordagem quantitativa composto de 89 profissionais de enfermagem do serviço noturno, distribuídos entre 36 enfermeiros, 19 técnicos de enfermagem e 34 auxiliares de enfermagem. Empregou-se um questionário semiestruturado, com a coleta de dados realizada entre agosto e setembro de 2016. Os Resultados revelam que os enfermeiros sentem-se exaustos após o plantão, pelo tempo dedicado ao serviço de enfermagem e a familiar e apresentaram maior ganho de peso durante o período de tempo de trabalho noturno. O local de repouso foi considerado adequado para a maioria dos participantes das três categorias, porque possibilitou um sono compensatório durante as horas permitidas de descanso pela Organização. Conclui-se que sendo o descanso noturno em local adequado, este é considerado uma das estratégias ergonomicamente eficaz, para adaptação cognitiva dos trabalhadores de enfermagem no turno noturno. Contudo, supõe-se ser insuficiente e inadaptado à outras estratégias de garantia de qualidade de vida essenciais ao trabalhador como a alimentação, lazer e convívio familiar saudável. Sugere-se que outras estratégias são impresisdíveis para enfrentar os efeitos do trabalho noturno, devendo envolver dois níveis básicos: individual e organizacional. Só assim o trabalho noturno será saudável para o trabalhador e proporcionar mais qualidade de assistência aos clientes, e evitar acidentes para o trabalhador e para os clientes, porque somente ceder tempo de descanso noturno não é suficiente.

The purpose of this research is to study the influence of night shift work and its relations with sociodemographic and physiological variables in the context of the health of a Nursing professional, considering a human being's biopsychosocial needs. The research has as a study object the adaptation of the nursing workers to nocturnal work and its repercussions in the health of said professionals, aiming to deepen the understanding of the theme and subsidize the discussions about regulamentation of nocturnal rest in an adequate fashion while on duty. Sleep is not simply rest, seeing as according to Medeiros et al. (2009) sleeping is an active process during which some parts of the brain display the same activities as when in an alert state. When sleep deprivation is excessive and persistent, it can cause fatigue, decrease in mental alertness, irritability, amongst other symptoms. The objectives of this research are: General Objetive: Assess the influences of night shit work in relation to health and well-being problems, of the night shift workers as noticed by said professionals in a large-scale hospital. Specific Objectives: Identify the socioeconomic, physiological and legal aspects of nursing professionals who are active in night shifts as professional categories; Verify the conditions of nocturnal rest of nursing workers; discuss the signals and symptoms perceived by said workers about the aspects of night shift work. The utilized method for this research was that of a descriptive exploratory study, with a quantitative approach made up of 89 night shift nursing professionals, distributed between 36 nurses, 19 nursing technicians and 34 nursing assistants. The results reveal that the nurses feel exhausted after the shift, because of the time dedicated to both nursing and family responsibilities, and they show a greater weight gain during periods of night shift work. The rest site was considered adequate by most of the participants of the three categories, for it made possible for them to compensate for the lost sleep during rest hours allowed by the Organization. In conclusion, being the nocturnal rest held in an adequate place, it is considered one of the most effective ergonomic strategies for cognitive adaptation of night shift nursing professionals. However, the nocturnal rest is assumed to be insufficient and inadaptive to other strategies of warranting essential quality of life for the professional such as nourishment, leisure (recreation) and healthy time with the family. It suggests that other strategies are essential to face the effects of nocturnal work, involving two basic levels: individual and organizational. Only then will nocturnal work be healthy for professionals, provide better quality assistance for clients and avoid accidents for both workers and patients, for the concession of nocturnal rest time during night shifts is not enough.

Desarrollo de un instrumento para la evaluación del malestar emocional para pacientes renales en diálisis / Development of a questionnaire to assess emotional distress in renal patients undergoing dialysis

Objetivo: Actualmente no existen herramientas validadas para evaluar el malestar emocional en pacientes con enfermedad renal crónica, pese a su alta prevalencia en todas las etapas de la patología. Este trabajo describe el desarrollo de un instrumento breve semiestructurado para la Evaluación del malestar Emocional de los pacientes renales en Diálisis (EE-D). Método: El EE-D incluye cinco preguntas con distintos formatos de respuesta (dicotómico, Likert y preguntas abiertas) para evaluar tristeza, ansiedad, preocupaciones, recursos para afrontar la enfermedad, signos externos de malestar y observaciones. Los ítems de la primera versión se sometieron a un estudio interjueces (N= 10). Posteriormente se realizó un estudio piloto multicéntrico (N= 25 pacientes en 5 hospitales). Resultados: Tras el estudio interjueces un ítem fue eliminado, y otro añadido. Tras el piloto no hubo modificaciones. La puntuación media (sobre 10) fue 4,16 (DT: 3,41) en tristeza y 3,68 (DT: 3,48) en ansiedad. El 48% refirió preocupaciones familiares, el 44% preocupaciones sobre su estado emocional-psicológico y el 40% sobre su enfermedad/tratamientos. Los principales recursos identificados fueron la esperanza en la posibilidad de trasplante y el apoyo social. A juicio de enfermería el 24% presentan expresión facial de malestar y el 16% otros signos de malestar. Discusión: El EE-D muestra unas garantías psicométricas preliminares. Ha sido distribuido en las Unidades de Diálisis de todo el territorio nacional con el objetivo de su implementación clínica en un marco investigador, lo que permitirá el desarrollo de futuros estudios de validación multicéntricos (AU)

Objective: Currently there are no validated assessment tools to explore emotional distress in patients with chronic kidney disease, even though it is very prevalent in all the phases of the disease. This study describes the development of a brief semi-structured interview to assess emotional distress in renal patients undergoing Dialysis (EE-D). Method: The EE-D includes five questions with different response formats (dichotomized, Likert scales and open-questions) to assess sadness, anxiety, concerns, and resources to cope with illness, external signs of distress and other considerations. An interjudge process was used with the items of the first version of the EE-D (N= 10 experts). Hereafter a pilot multicentric study was carried on (N= 25 patients in 5 hospitals). Results: After the interjudge analysis one item was removed from the EE-D, and one item was added. After the pilot study there were no changes in the tool. The average score (range 0 to 10) in sadness was 4.16 (SD= 3.41) and 3.68 (SD= 3.48) in depression. A total of 48% of the participants reported family concerns, 44% concerns about their psychological/ emotional state and 40% about their illness/treatments. The most important resources to cope with the illness were their hope in the possibility of a transplantation and their social support. According to the nursing staff who conducted the interviews 24% of the patients showed facial expression of distress and 16% other external signs of distress. Discussion: The EE-D has shown adequate preliminary psychometric properties. It has been recently distributed to all the dialysis units in Spain with the objective of conducting a multicentric validation study (AU)

Widows and widowers in today's society.

With the increasing life span in our society, the number of widowed individuals has increased dramatically. The loss of a spouse is one of the most stressful life events for both women and men, yet there is little nursing research on the physical and psychosocial needs of older adults who are experiencing this loss. Some studies suggest that widowed women and men develop significant physical and mental health problems and complicated grief. Thus, it is important for nurses to recognize the diversity of grieving experiences and the increased vulnerability of widowed individuals to psychiatric illnesses that may result in suffering and impairment of daily functioning. With a better understanding of these needs, nurses can provide interventions that help these individuals maintain their health and independence.

[Failure of a mourning ritual and reactive depression]. / Echec d'un rituel de deuil et dépression réactionnelle.

In some African societies, mourning rituals are a way of isolating death from the territory of the living and to allow the bereaved to regain, after a certain time, their place in society. However, for a young educated woman confronted with the brutal death of her sister, the traditional ritual to which her family subjected her resulted in a prolonged reactive depression combined with cognitive disorders..

"Not always smooth sailing": mental health issues associated with the transition from high school to college.

Students who transition from high school to college are often excited by the new phase of their lives. However, they are exposed to circumstances and expectations which place them at risk for psychiatric disorders or that may exacerbate pre-existing problems. In this paper, we discuss risk factors and other issues associated with students transitioning to college or university life, identify challenges for health professionals, and suggest possible strategies to improve the mental health of young adults on college campuses. Academic staff and health care providers need to be aware of how best to engage and assist students during an important phase of their life. Processes and care pathways also need to be easily understood, user friendly, and appropriately resourced. It is anticipated that staff, students, and industry health care providers will benefit from a greater awareness of some of the mental health issues that may occur in higher education.

Screening for distress and supportive care needs during the initial phase of the care process: a qualitative description of a clinical pilot experiment in a French cancer center.

OBJECTIVE: To provide a qualitative description of a clinical pilot experiment in a French cancer center, conducted by a nurse after the treatment decision consultation attended by new cancer patients during the initial phase of the care process. METHODS: The Psychological Distress Thermometer (PDS) and a problem checklist were administered to 255 patients before nurse consultation, helping her to manage the clinical interview, explore patient's distress and supportive care needs, and finally refer the patients in need to the required Supportive Care units. RESULTS: Patients were primarily referred to the social service unit (35% patients), followed by the physiotherapy unit (23.9%) and the psycho-oncology unit (19.6% of patients). In cases of significant distress (43% patients with PDS>3), the percentage of patients referred to the psychosocial units increased (44% referred to the Social Unit, 35% to the Psycho-Oncology Unit). However, the main interest of our screening procedure resides in its qualitative and didactic dimension, based on clinical training and cooperation with healthcare professionals during the process of investigating patients' distress and their supportive care needs. Difficulties and limitations are also described. CONCLUSIONS: This first clinical experiment conducted among dedicated nurses involved in a Therapeutic Decision Consultation in a French cancer center has provided evidence in support of the idea that non-specialist professionals are able to identify patients' distress and their Supportive Care needs (particularly in the psychosocial field) provided that they have received appropriate training.

Program evaluation of a community crisis stabilization program.

The purpose of this program evaluation was to evaluate the outcomes of treatment for participants in a community crisis stabilization (CCS) program. This CCS incorporated a patient-centered and wellness model of treatment. A descriptive study was conducted to assess change in psychological symptoms and quality of life of participants from admission to discharge. The sample (n = 42) was evaluated on admission and at discharge with four measurements: the Brief Symptoms Inventory (BSI), the Revised 24-Item Behavior and Symptom Identification Scale (BASIS-24), the Brief Psychiatric Rating Scale (BPRS), and the World Health Organization Quality of Life Scale-Brief Measure (WHOQOL-BREF). Changes in total scores on the BSI (t = 6.263, P < .001), the BASIS-24 (t = 6.964, P < .001), the BPRS (t = 4.638, P < .001), and the WHOQOL-BREF (t = 6.574, P < .001) demonstrated improvement at discharge.

Trastornos adaptativos al medio hospitalario en pacientes con VIH / Adaptive disorders in a Hospital setting when dealing with HIV patients

Desde su inicio la infección por VIH ha estado relacionada con trastornos psicopatológicos, pero en la actualidad la prevalencia de patología psiquiátrica se encuentra significativamente elevada. Ello justifica que los problemas derivados de sus cuidados durante el proceso de hospitalización multipliquen su complejidad cuando al internamiento se asocian condicionantes emocionales y conductuales derivados de trastornos psicopatológicos, asociados al binomio infección-VIH, y que requieren estrategias de intervención específicas, individuales y consensuadas por equipos multidisciplinares expertos. En consecuencia se esgrimen las situaciones asociadas al proceso de la infección con mayor riesgo para desencadenar problemas conductuales durante la hospitalización, y se desarrollan estrategias y técnicas de intervención para detectar y abordar de forma precoz posibles conductas y comportamientos que pudieran llegar a interferir en la progresión de los cuidados y en el régimen terapéutico durante el proceso de internamiento hospitalario, ya sea de forma puntual o progresiva según sea la necesidad particular. A partir de la propia experiencia profesional en el abordaje hospitalario de este tipo de pacientes y de la participación en grupos expertos para la mejora de sus cuidados, apuntamos la necesidad de desarrollar un plan de cuidados específico que responda a sus necesidades psico-emocionales a través de una justificación teórica del planteamiento. La intervención psicológica y el apoyo emocional son las únicas vías para facilitar la percepción de control a los afectados, amortiguar el impacto emocional, maximizar el éxito del tratamiento y favorecer actitudes y conductas que propicien el afrontamiento del estado de salud y la autogestión de los cuidados. Para ello se precisa la implicación de equipos multidisciplinares que abarquen el problema desde una perspectiva bio-psico-social que aborde los problemas fisiológicos, emocionales y conductuales mediante intervenciones individuales que deben derivarse de planes de cuidados específicos(AU)

Since its start, HIV infection has been related to psychopathological disorders, but at present times, the prevalence of psychiatric pathologies lies at a significantly high level, a factor which justifies that problems derived from care of HIV infected patients during their hospitalization multiply their complexity when being kept in a hospital becomes associated with emotional and behavioral conditioners derived from psychopathological disorders associated with the HIV-infection binomially and these require specific individualized intervention strategies agreed upon by multidisciplinary teams of experts. The authors fend off situations associated with this infection’s process which have the greatest risk in order to link up behavioral problems during hospitalization and to develop intervention strategies and techniques to, in a prompt manner, detect and deal with possible behaviors which could interfere in the progress of treatment and in the therapeutic program during enforced hospitalization, be those interventions either specific one time actions or progressive actions depending on the pertinent circumstances and needs. Based on actual professional experiences in hospital situations created by these kinds of patients and by the participation of groups of experts to improve treatment given, the authors point out the necessity to develop a specific treatment plan which responds to these patients’ psycho-emotional needs by means of a theoretical justification of the proposed treatment. Psychological interventions and emotional help are the only ways to facilitate a perception of control to those affected, to reduce the emotional impact, to maximize treatment success and to promote attitudes and behaviors which enable a patient to confront his/her state of health and self-regulation of their treatment. To these ends, it is essential that a multidisciplinary team becomes involved to deal with this problem from a bio-psycho-social perspective and to include physiological, emotional and behavioral by means of individual interventions which must be derived from specific treatment plans(AU)

Learning from practice--reflections on a critical incident.

Reflective practice is considered not only as a valuable tool for providing appropriate levels of care but also as an important prerequisite for the provision of professional nursing. Indeed, there appears to be consensus in the literature that reflections have the potential to assist practitioners to tap into knowledge gained from experience and connect theory to practice. However, evidence suggests that nurses, including emergency nurses, neglect reflective techniques. This paper outlines how the processes of reflection led to one emergency nurse developing new insights and understandings on nursing practice.

Journal writing as a complementary therapy for reactive depression: a rehabilitation teaching program.

Brief, recurrent, reactive, or situational depression is a common and costly comorbidity that affects chronically ill patients and their family members. This article describes a program that teaches those individuals how to monitor and cope with symptoms of depression by writing daily in a journal. Twenty patients and family members attended teaching sessions at which videotaped scenes of other patients managing symptoms of depression were shown. After viewing the six scenes, participants wrote about their reactions to each scene and listed the emotions they had experienced that were similar to those shown in the tape. They were then asked to record daily for 4 months their emotions and reactions to situations and to also daily self-rate their levels of energy. They were also provided with a list of recommended activities in which to engage when they were depressed. Two psychiatric nurses evaluated the writings and concluded that the program was influential in helping patients and families overcome many emotionally draining reactions to adverse circumstances.

The effect of psychosocial nursing intervention on the mood state of patients with implantable cardioverter defibrillators and their caregivers.

This study sought to determine whether mood state and psychosocial adjustment four months after implantable cardioverter defibrillator (ICD) placement were better for patients and caregivers who received a program of psychosocial interventions than for those who received usual postoperative care and follow-up. Thirty-four adult ICD recipients (17 experimental and 17 control) and their significant other (SO) caregivers were randomly assigned to an experimental or control group. The intervention consisted of weekly, postoperative telephone follow-up, evaluation and counseling by a psychiatric liaison nurse, and participation in an ICD support group. There were no significant differences between treatment and control groups on the outcome measures of adjustment (Profile of Mood States, Psychosocial Adjustment to Illness Scale). Outcomes were not associated with age, ejection fraction, length of hospital stay or family income, and there were no differences in outcomes based on gender, employment status, thoracotomy versus non-thoracotomy procedure, or shocked versus unshocked status. The results do not indicate that the extra time spent to provide individualized attention to these ICD recipients and their SOs was advantageous for the outcomes measured. Adaptation to the device may occur over time regardless of intervention.

Hidden scars: posttraumatic stress disorder.

Memories of traumatic incidents or experiences can cause deep but invisible scars. Without intervention, the emotional pain associated with the incident can continue unabated. For the most part, painful memories are likely to be suppressed. However, when a memory is "triggered" for some reason, a variety of symptoms may occur which may be termed "posttraumatic stress disorder" (PTSD). A nurse can use an understanding of unhealed psychological scars to gain awareness of unresolved personal stress. In addition to personal reflection, as nurses assess and care for patients, it is important to be alert to indications of unresolved emotional pain.

A randomized trial of a nursing intervention to promote the adjustment of children with chronic physical disorders.

OBJECTIVE: This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. METHODOLOGY: A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. RESULTS: Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. CONCLUSION: The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.

Differences in color preferences of well school-age children and those in varying stages of illness.

The purpose of this descriptive comparative study was to determine the preferences in color of 89 children ages 7-12 who were well and those in varying states of ill health. The authors collected information about diagnoses, days hospitalized, siblings, and projective information. Data were analyzed using chi-square statistics. Independent variables of sex, age, and health were examined in a multivariate manner by fitting logistic regression models having indicator regressor variables to represent the various levels of these factors. The only regressor for these models that was significant was health state. Significant differences were found (p < .05 level) in color preferences of (a) children with adjustment problems and those who were well; (b) children with adjustment problems and those who were ill; (c) acutely ill and chronically ill children; and (d) physically disabled and acutely ill children. Significant differences were also found in color preferences of children ages 7-9 and 10-12.