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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Estratégias de promoção à saúde mental no trabalho de enfermagem hospitalar: revisão integrativa* / Estrategias de promoción de la salud mental em el trabajo de enfermería hospitalaria: revisión integrativa / Strategies for promoting mental health in hospital nursing work: integrative review

Objetivo: identificar estratégias de promoção à saúde mental dos trabalhadores de enfermagem hospitalar disponíveis na literatura. Método: revisão integrativa desenvolvida por meio de acesso a fontes de informação online. Foram incluídos estudos disponíveis na íntegra entre 2012 e 2022 em português, inglês ou espanhol. Realizada seleção em duplo-cego, apresentação descritiva dos resultados e interpretação à luz do referencial teórico-conceitual. Resultados: onze artigos apontam estratégias individuais focadas no treinamento de habilidades, teleassistência e programas de fortalecimento da resiliência que reduziram sintomas de depressão, ansiedade, estresse, burnout, rotatividade e elevaram satisfação no trabalho, estilos de vida saudáveis, bem-estar e saúde geral. Conclusão: as estratégias para promoção da saúde mental no trabalho mantêm o seu enfoque no indivíduo, e não envolvem aspectos organizacionais e coletivos do trabalho, denotando insuficiência ao não enfocar causas centrais do problema. As intervenções devem ser direcionadas a sanar tal lacuna para promover ambientes de trabalho mais saudáveis.

Objective: identify strategies for promoting the mental health of hospital nursing workers available in the literature. Method: integrative review developed through access to online information sources. Studies available entirely between 2012 and 2022 in Portuguese, English or Spanish were included. Double-blind selection was carried out, as well as descriptive presentation of results and interpretation in light of the theoretical-conceptual framework. Results: eleven articles point to individual strategies focused on skills training, teleassistance and resilience-building programs that reduced symptoms of depression, anxiety, stress, burnout and turnover, and increased job satisfaction, healthy lifestyles, well-being and general health. Conclusion: strategies for promoting mental health at work maintain their focus on the individual, and do not involve organizational and collective aspects of work, denoting insufficiency by not concentrating on the central causes of the problem. Interventions should be aimed at closing this gap to promote healthier work environments.

Objetivo: identificar estrategias de promoción de la salud mental para trabajadores de enfermería hospitalaria disponibles en la literatura. Método: revisión integrativa de la literatura en las bases de datos Lilacs, Scopus, Web of Science, Cochrane Library y Medline. Se incluyeron en la muestra estudios primarios publicados en portugués, inglés o español, disponibles en su totalidad en los últimos diez años (2012 - 2022). La selección se realizó de manera doble ciego, y los resultados se presentan de forma descriptiva e interpretados a la luz del marco teórico-conceptual adoptado. Resultados: once artículos señalan estrategias individuales centradas en la formación de habilidades, la teleasistencia y los programas de desarrollo de la resiliencia, que redujeron los síntomas de depresión, ansiedad, estrés, agotamiento y rotación, y aumentaron la satisfacción laboral, los estilos de vida saludables, el bienestar y la salud general. Conclusión: las estrategias de promoción de la salud mental en el trabajo mantienen su enfoque en lo individual, y no involucran aspectos organizativos y colectivos del trabajo, denotando insuficiencia al no concentrarse en las causas centrales del problema. Las intervenciones deberían estar encaminadas a cerrar esta brecha para promover entornos de trabajo más saludables.

Vigilância em Saúde do Trabalhador na perspectiva de gestores e tomadores de decisão / Workers' Health Surveillance from managers' and decision-makers' perspectives

Resumo Objetivo: analisar as ações de implantação da Vigilância em Saúde do Trabalhador (Visat) na esfera municipal, pela perspectiva de gestores e tomadores de decisão. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado em duas etapas: (1) levantamento documental da legislação relacionada à Saúde do Trabalhador; (2) entrevistas semiestruturadas com 15 gestores e tomadores de decisão na área, que foram gravadas, transcritas e analisadas segundo análise temática. Resultados: a análise documental incluiu seis documentos, sendo três relacionados às ações de Visat e três relacionados às ações que guardam interface com a Saúde do Trabalhador. Sete categorias emergiram na análise temática: Aspectos legais da Saúde do Trabalhador; Implementação das ações de Visat; Fluxos de informação e comunicação da Visat; Papéis e competências relacionados à ST no Sistema Único de Saúde; Articulação entre os setores envolvidos na Visat; Atuação do Centro de Referência em Saúde do Trabalhador regional; Relevância do controle social e participação sindical para implementação da Visat municipal. Conclusão: o estudo evidenciou fragilidades na consolidação da Visat, com desarticulação dos setores envolvidos, ações fragmentadas, ausência de definições de papéis e fluxos de trabalhos e, ainda, desconhecimento dos aspectos relacionados à atenção à saúde dos trabalhadores pelos atores envolvidos em sua consolidação.

Abstract Objective: to analyze the implementation of Workers' Health Surveillance (WHS) at a regional level, from managers' and decision-makers' perspectives. Methods: descriptive-exploratory study with a qualitative approach performed in two steps (1) documental analysis related to Workers' Health legislation; (2) semi-structured interviews with 15 managers and decision-makers, that were recorded, transcribed, and analyzed by thematic analysis. Results: documental analysis found six documents, with three related to WHS and three related to actions interfacing Workers' Health. Seven categories were found in the speeches: Legal aspects of Workers' Health; Implementation of WHS actions; Communication and information flows of WHS; Roles and competencies related to Workers' Health in the Brazilian Unified Health System; Articulation among sectors involved in WHS; Role of the Regional Center of Reference in Workers' Health; and Relevance of social control and union participation for WHS implementation. Conclusion: this study shows flaws in the WHS consolidation, including non-articulation of involved sectors, fragmented actions, lack of defined roles and competencies, and lack of knowledge about Workers' Health care by the actors involved in its consolidation.

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

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

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

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

Nursing supervision: interfaces with power relations in family health.

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

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

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

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

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

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

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

Satisfação no trabalho de trabalhadores da atenção primária à saúde: um estudo exploratório / Satisfacción laboral de los trabajadores de atención primaria de salud: un estudio exploratorio / Job satisfaction of primary health care workers: an exploratory study

RESUMO Objetivo: identificar os fatores relacionados à (in)satisfação no trabalho de trabalhadores da Atenção Primária à Saúde (APS). Métodos: estudo exploratório com abordagem quantitativa, conduzido em 23 unidades da APS no estado de São Paulo. Foi utilizada a Escala de Satisfação no Trabalho, que abrange o grau de contentamento com chefia, colegas, salário, promoções e trabalho realizado, além de um questionário sócio-ocupacional. Resultados: participaram 70 trabalhadoras, sendo a grande maioria auxiliares de Enfermagem e agentes comunitárias de saúde, com idade média de 45±10,6 anos. Constatou-se indiferença nos campos colegas, chefia e natureza do trabalho. Por outro lado, verificou-se insatisfação com os campos salário e promoções. Conclusão: foi constatada insatisfação no trabalho na APS, e os achados demonstram a necessidade de revisão do plano de carreira e ajustes salariais.

RESUMEN Objetivo: identificar los factores relacionados con la (in)satisfacción laboral de los trabajadores de la Atención Primaria de Salud (APS) Métodos: estudio exploratorio con enfoque cuantitativo, realizado en 23 unidades de APS del estado de São Paulo. Se utilizó la Escala de Satisfacción Laboral, que abarca el grado de satisfacción con la dirección, los compañeros, el salario, las promociones y el trabajo realizado, además de un cuestionario sociolaboral. Resultados: participaron 70 trabajadoras, la gran mayoría auxiliares de enfermería y agentes de salud comunitarios, con una edad media de 45±10,6 años. Hubo indiferencia en los compañeros de campo, el liderazgo y la naturaleza del trabajo. Por otro lado, se comprobó la insatisfacción con los campos salariales y las promociones. Conclusión: se ha constatado la insatisfacción laboral en APS, los resultados demuestran la necesidad de revisar el plano de carrera y los ajustes salariales.

ABSTRACT Objective: to identify factors related to (dis)satisfaction at work among Primary Health Care (PHC) workers. Methods: exploratory study with a quantitative approach, conducted in 23 PHC units in the state of São Paulo, Brazil. The Job Satisfaction Scale was used, which covers the degree of satisfaction with management, colleagues, salary, promotions, and work performed, in addition to a socio-occupational questionnaire. Results: 70 workers participated, most of them Nursing assistants and community healthcare agents, with a mean age of 45±10.6 years. Indifference was found in the fields of colleagues, management, and nature of work. On the other hand, there was dissatisfaction with the salary and promotions fields. Conclusion: job dissatisfaction was found in PHC, and the findings demonstrate the need to review the career plan and salary adjustments.

Risk of COVID-19 in frontline healthcare workers and interventions: a systematic review / Risco de COVID-19 em profissionais de saúde da linha de frente e intervenções: revisão sistemática

Objective: to identify the evidence related to the risks of SARS-CoV-2 exposure in healthcare workers and the interventions adopted. Method: systematic literature review in eight scientific databases and three gray literature repositories. Results: 26 studies identified as risk factors: scarcity, inadequate use or reuse of personal equipment; low adherence to precautionary measures; working in intensive care and COVID-19 sectors; long stay in a closed work environment; sharing eating areas without the use of masks and distance; low knowledge and unpreparedness for disease management. 12 studies identified as interventions: health surveillance programs with early detection, diagnosis and early withdrawal; organization of care flows; double triage; telemedicine; limitation of visits; creation of exclusive sectors for care to COVID-19; qualification and training with virtual tools and simulation. Conclusion: besides the risk of infection, individual, psychosocial and organizational factors made the healthcare work environment unsafe. Interventions should be adopted to mitigate the risks and decrease the professionals' morbidity and mortality.

Objetivo: identificar as evidências relacionadas aos riscos de exposição ao SARS-CoV-2 em profissionais de saúde e as intervenções adotadas. Método: revisão sistemática de literatura em oito bases de dados científicas e três repositórios de literatura cinzenta. Resultados: 26 estudos identificaram como fator de risco: escassez, uso inadequado ou reuso de equipamentos individuais; baixa adesão às medidas de precaução; atuação em terapia intensiva e setores COVID-19; longa permanência em ambiente de trabalho fechado; compartilhamento de espaços para alimentação sem uso de máscara e distanciamento; baixo conhecimento e despreparo para atendimento à doença. 12 estudos identificaram como intervenções:  programas de vigilância em saúde com detecção precoce, diagnóstico e afastamento precoce; organização de fluxos de atendimento; triagem dupla; telemedicina; limitação de visitas; criação de setores exclusivos para atendimento à COVID-19; capacitações e treinamentos com ferramentas virtuais e simulação. Conclusão: além do risco de infecção, fatores individuais, psicossociais e organizacionais tornaram o ambiente de trabalho em saúde inseguro. Intervenções devem ser adotadas para mitigar os riscos e diminuir a morbimortalidade dos profissionais.

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

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

Competências profissionais para a atenção à saúde do trabalhador / Professional competencies for occupational health care

Resumo: Introdução: As competências profissionais para as ações em saúde direcionadas à população trabalhadora são imprescindíveis para a formação exitosa dos profissionais de saúde. Embora relevantes e bem definidas pela Política Nacional de Saúde do Trabalhador e da Trabalhadora, ainda existem lacunas sobre as competências mínimas requeridas e pouco conhecimento sobre como esses saberes profissionais se articulam para a promoção do trabalho integrado e o atendimento às necessidades dessa população. Objetivo: Este estudo teve como objetivo identificar as competências profissionais para atenção à saúde do trabalhador no contexto da APS. Método: Trata-se de pesquisa descritivo-exploratória, de abordagem qualitativa, desenvolvida por meio da triangulação de métodos, realizada em uma cidade do interior do estado de São Paulo. Os dados foram coletados em três etapas: 1. análise documental das Diretrizes Curriculares Nacionais dos cursos da saúde e dos projetos pedagógicos de sete cursos da área da saúde de uma instituição de ensino superior; 2. revisão sistemática da literatura; e 3. entrevistas com docentes dos cursos da saúde da referida instituição e com profissionais da Rede de Atenção Primária à Saúde municipal. Resultado: A análise documental permitiu identificar que somente os cursos de Educação Física, Enfermagem, Fisioterapia e Terapia Ocupacional possuem competências específicas para atenção à saúde do trabalhador, e a análise dos projetos pedagógicos apontou disciplinas obrigatórias e optativas que abordam a temática. A revisão de literatura e as entrevistas apontaram as competências gerais e específicas necessárias para atenção à saúde do trabalhador, como o cuidado integral, a compreensão dos determinantes sociais de saúde, a comunicação, a liderança, o trabalho em equipe, a gestão de conflitos, o acolhimento e a escuta qualificados, a gestão em saúde e a educação permanente. Conclusão: A identificação das competências profissionais gerais e específicas para atenção à saúde do trabalhador mostrou-se de extrema relevância para construção de uma assistência integral e humanizada na formação e prática interprofissional.

Abstract: Introduction: For health actions aimed at the working population, the development of professional competencies during the graduation is essential. Although relevant and well defined by the National Occupational Health Policy, there are still gaps regarding the minimum skills required and lack of knowledge about how the articulation of this competencies to promote integrated work and meet the needs of this population. Objective: This study aimed to identify the professional competencies for occupational health care. Method: Descriptive-exploratory research, with a qualitative approach, developed through the triangulation of methods, carried out in a city in the interior of the State of São Paulo, Brazil. Data were collected in three stages: 1. document analysis of the National Curriculum Guidelines for health courses and pedagogical projects for seven courses in the health area of a higher education institution; 2. systematic literature review; and 3. interviews with professors from the health courses of that institution and with professionals from the municipal Primary Health Care Network. Result: The document analysis allowed us to identify that only the Physical Education, Nursing, Physiotherapy and Occupational Therapy courses have specific competences for worker health care; the analysis of the pedagogical projects pointed to mandatory and optional subjects that address the theme. The literature review and interviews pointed out the general and specific skills needed for worker health care, such as comprehensive care, understanding the social determinants of health, communication, leadership, teamwork, conflict management, welcoming/qualified listening, health management and continuing education. Conclusion: The identification of general and specific professional skills for occupational health care proved to be extremely relevant for the construction of comprehensive and humanized care in training and interprofessional practice.

Educação em saúde mental no trabalho: protagonismo dos trabalhadores no contexto sindical / Mental health education at work: worker's protagonism within unions

Resumo Objetivo: relatar a experiência de uma atividade de extensão sobre saúde mental no trabalho, utilizando a estratégia de Educação em Saúde, desenvolvida por docentes de uma universidade pública federal, por demanda do Sindicato dos Metalúrgicos e trabalhadores de uma empresa do interior do Estado de São Paulo. Métodos: a atividade foi planejada conjuntamente por docentes e trabalhadores. Foram desenvolvidos cinco encontros com base em estratégias participativas de Educação em Saúde de forma a provocar a reflexão dos participantes a partir das experiências vivenciadas. Foram feitos ajustes ao longo do processo direcionados às demandas que surgiam nos encontros. Resultados: as discussões versaram sobre os tópicos: (a) temas emergentes em saúde mental; (b) depressão, ansiedade e uso de álcool/drogas; (c) Rede de Atenção Psicossocial municipal; (d) saúde mental no trabalho. Além disso, partindo das experiências prévias vivenciadas no cotidiano do trabalho, foram feitas reflexões sobre a importância da identificação precoce das situações de sofrimento, da rede de suporte entre trabalhadores e da organização do fluxo de cuidado na Rede de Atenção Psicossocial municipal. Conclusão: a parceria entre trabalhadores, sindicato e universidade se mostrou potente para ações de Educação em Saúde e fortalecimento do protagonismo do trabalhador no contexto do trabalho.

Abstract Objective: to report an extension activity on mental health at work, based on Health Education strategies, conducted by university professors-upon request by the Steelworkers Union-with participation of industrial workers, in São Paulo, Brazil. Methods: carried out by professors and workers, the planning resulted in five meetings based on Health Education participative strategies. Throughout the process, adjustments were made aimed at the demands that arose in the meetings. Results: the discussions included (a) emerging issues in mental health, (b) depression, anxiety and alcohol/drug use, (c) municipal Psychosocial Care Network, (d) mental health at work. Moreover, based on previous experiences in the daily work routine, the participant reflected on the importance of early identification of mental suffering, the need for a support network among workers, and the organization of the care flow within the municipal Psychosocial Care Network. Conclusion: the partnership between workers, the Union and university proved to be an important tool to develop Health Education actions and strengthen worker's protagonism.

Supervisão de enfermagem: instrumento gerencial de qualificação da equipe e do cuidado / Nursing supervision: team management tool for qualification and care / Supervisión de enfermería: instrumento gerencial de cualificación del equipo y del cuidado

Objetivo: refletir sobre a supervisão de enfermagem como instrumento gerencial para qualificação da equipe e do cuidado. Método: estudo reflexivo, fundamentado em publicações científicas e vivência acadêmico-profissional. Resultados: para desenvolver a supervisão de enfermagem para além do controle de produção e reprodução de relações autoritárias, o enfermeiro precisa promover articulação entre os membros da equipe e adotar estratégias de corresponsabilização pelo cuidado de enfermagem, por meio de abordagens que promovam qualificação e segurança do cuidado, em uma perspectiva flexível, educativa, compartilhada, com vistas a avançar na utilização desse instrumento de gestão em novas dimensões, como a supervisão clínica e colaborativa. Conclusão: compreender as estruturas e os processos relacionados ao desempenho da supervisão pode favorecer a implementação de estratégias para apoiar os enfermeiros em suas funções, o que possibilita diminuir a distância entre teoria e prática profissional, superando adversidades do cotidiano de modo a qualificar a equipe e o cuidado.

Objective: to reflect on nursing supervision as a management tool for staff qualification and care. Method: reflective study, based on scientific publications and academic-professional experience. Results: to develop nursing supervision beyond the control of production and reproduction of authoritarian relationships, nurses need to promote articulation between team members and adopt strategies of co-responsibility for nursing care, through approaches that promote qualification and safety care in a flexible, educational, shared perspective, with a view to advancing the use of this management instrument in new dimensions, such as clinical and collaborative supervision. Conclusion: understanding the structures and processes related to the performance of supervision can favor the implementation of strategies to support nurses in their functions, which makes it possible to reduce the distance between theory and professional practice, overcoming daily adversities in order to qualify the team and the care.

Objetivo: reflexionar sobre la supervisión de enfermería como instrumento gerencial con el fin de cualificar al equipo y al cuidado. Método: se trata de un estudio reflexivo, basado en publicaciones científicas y en vivencia académico-profesional. Resultados: para desarrollar la supervisión de enfermería más allá del control de producción y reproducción de relaciones autoritarias, el enfermero necesita promover la articulación entre los miembros del equipo y adoptar estrategias de corresponsabilización en el cuidado de enfermería mediante enfoques que susciten cualificación y seguridad desde una perspectiva flexible, educativa, compartida, con miras al avance de la utilización del instrumento de gestión en nuevas dimensiones, como la supervisión clínica y colaborativa. Conclusión: comprender las estructuras y los procesos relacionados con el desempeño de la supervisión puede favorecer la implementación de estrategias que apoyen a los enfermeros en sus funciones, disminuyendo la distancia entre la teoría y la práctica profesional y superando las adversidades de lo cotidiano con el intuito de cualificar al equipo y al cuidado.