Índice de capacidade para o trabalho de enfermeiros hospitalares na vigência da pandemia de COVID-19 / Work ability index of hospital nurses during the COVID-19 pandemic

Uma das principais razões relatadas como determinantes da escassez e evasão dos trabalhadores de saúde no mundo todo refere-se às condições inadequadas de trabalho, especialmente para a enfermagem, bem como as exigências, organização, execução, remuneração e o ambiente de trabalho. Estas precárias condições laborais são responsáveis pelo aparecimento de doenças e estão expressas pelo alto nível de absenteísmo no trabalho. A pandemia do Síndrome Respiratória Aguda Grave Coronavírus 2 (SARS-Cov2) potencializou os riscos de adoecimento dos profissionais, pois a atuação destes em ambientes expostos ao SARS-CoV-2 e as fragilidades estruturais, às quais esses profissionais estão suscetíveis hoje em dia, têm aumentado consideravelmente uma série de desafios físicos, psicológicos e emocionais. Ocorre também um maior aumento da carga de trabalho, muitas vezes decorrentes do déficit de profissionais já anterior à pandemia. O Índice de Capacidade para o Trabalho (ICT) é uma ferramenta que pode contribuir para melhor entendimento dessa situação. O objetivo deste estudo foi identificar o ICT dos enfermeiros hospitalares que atuam em unidades COVID-19 e não COVID-19. Trata-se de estudo transversal analítico, com abordagem quantitativa dos dados, desenvolvido em um hospital de ensino, de grande porte, do interior do Estado de São Paulo. A população foi constituída por todos os enfermeiros alocados nas unidades clínica-cirúrgicas e de terapia intensiva da instituição, e divididos em dois grupos: enfermeiros que trabalharam em unidades com atendimento a pacientes COVID-19 e enfermeiros que atuaram em unidades onde não ocorreu internação de pacientes acometidos por esta patologia, sendo esta uma das variáveis analisadas. Os dados foram coletados por meio de um formulário contendo dados socioeconômicos, demográficos e ocupacionais e de um questionário autoaplicável do ICT. Utilizou-se estatística descritiva para análise e tratamento dos dados e o modelo de regressão logística para avaliar a associação do ICT com variáveis sócio demográficas e ocupacionais. Participaram do estudo 100 enfermeiros, sendo predominante a idade até 39 anos (63%), sexo feminino (81%), solteiro (52%) e com tempo de trabalho na profissão inferior a 24 meses (46%). Quanto a classificação ICT, 68 profissionais obtiveram uma classificação ótima ou boa, considerada a adequada, sendo que destes, 37 atuaram nas unidades de atendimento a pacientes com COVID-19. Dos 32 enfermeiros que obtiveram uma classificação moderado ou baixo, considerada inadequada, 20 atuavam nas unidades não COVID-19. Nenhuma variável independente apresentou evidência estatística de associação, porém, tempo na instituição, tempo na profissão e horas de trabalho semanal mostraram alguma tendência. O conjunto de achados descritos neste estudo pode contribuir para o aprimoramento das discussões sobre o ICT, envolvendo a situação de saúde dos trabalhadores da saúde durante a pandemia de COVID-19

One of the main reasons reported as determinants of the shortage and evasion of health workers worldwide refers to inadequate working conditions, especially for nursing, as well as the requirements, organization, execution, remuneration and the work environment. These precarious working conditions are responsible for the emergence of diseases and are expressed by the high level of absenteeism at work. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov2) pandemic increased the risks of illness for professionals, as their performance in environments exposed to SARS-CoV-2 and the structural weaknesses to which these professionals are susceptible today, have considerably increased a number of physical, psychological and emotional challenges. There is also a greater increase in the workload, often resulting from the shortage of professionals already before the pandemic. The Work Ability Index (WAI) is a tool that can contribute to a better understanding of this situation. The objective of this study was to identify the WAI of hospital nurses working in COVID-19 and non-COVID-19 units. This is an analytical cross-sectional study, with a quantitative approach to the data, developed in a large teaching hospital in the interior of the State of São Paulo. The population consisted of all nurses allocated to the clinical-surgical and intensive care units of the institution, and divided into two groups: nurses who worked in units with care for COVID-19 patients and nurses who worked in units where there was no hospitalization of patients affected by this pathology, being this one of the analyzed variables. Data were collected using a form containing socioeconomic, demographic and occupational data and a self-administered WAI questionnaire. Descriptive statistics were used for data analysis and treatment and the logistic regression model was used to evaluate the association of WAI with sociodemographic and occupational variables. A total of 100 nurses participated in the study, the predominant age being up to 39 years (63%), female (81%), single (52%) and with less than 24 months of experience in the profession (46%). Regarding the WAI classification, 68 professionals obtained an excellent or good classification, considered adequate, and of these, 37 worked in the care units for patients with COVID-19. Of the 32 nurses who obtained a moderate or low rating, considered inadequate, 20 worked in non-COVID-19 units. No independent variable showed statistical evidence of association, however, time in the institution, time in the profession and weekly working hours showed some tendency. The set of findings described in this study can contribute to the improvement of discussions on the WAI, involving the health situation of health workers during the COVID-19 pandemic

Índice de capacidad de trabajo en enfermeras en atención primaria de salud, Lima-Perú / Work capacity index in nurses in primary health care, Lima-Perú

Resumen Objetivo: Determinar el índice de capacidad de trabajo estimado por los profesionales de enfermería en atención primaria de salud. Metodología: Estudio cuantitativo-descriptivo de corte transversal. Participaron 72 enfermeras y se utilizó un instrumento conformado por información general y el índice de capacidad de trabajo, el cual fue validado por medio de juicio de expertos y prueba piloto, resultando un coeficiente de 0,741 de alfa de Cronbach. Se cumplió con la entrega del consentimiento informado y se usó la estadística descriptiva y el chi-cuadrado para el análisis de datos. Resultados: El índice de capacidad de trabajo fue excelente para 37,5 %, bueno para 43,1 %, moderado para 194 % y ningún participante estimó un índice bajo, además, estadísticamente se evidenció que el número de hijos presenta una asociación significativa con el índice (chi-cuadrado = 14798, p = 0,022). Conclusión: Prevalece un índice de capacidad de trabajo bueno; por lo tanto, se sugiere el respaldo de medidas para la mejora o mantenimiento de la capacidad laboral.

Resumo Objetivo: Determinar o índice de capacidade de trabalho estimado pelos profissionais de enfermagem em atendimento primário de saúde. Metodologia: Estudo quantitativo-descritivo de corte transversal. Participaram 72 enfermeiras e utilizou-se um instrumento formado pela informação geral e o índice de capacidade de trabalho, que foi validado por meio do julgamento de especialistas e teste-piloto. O resultado foi um coeficiente de 0,741 de alfa de Cronbach. Cumpriu-se com a entrega do consentimento informado e utilizou-se a estatística descritiva e o qui-quadrado para a análise de dados. Resultados: O índice de capacidade foi excelente para 37,5 %, bom para 43,1 %, moderado para 19,4 % e nenhum participante estimou um índice baixo, além disso, estatística-mente ficou evidente que o número de filhos apresenta uma associação significativa com o índice (qui-quadrado = 14.798, p = 0,022). Conclusão: Prevalece um índice de trabalho bom; portanto, sugere-se o respaldo de medidas para melhorar ou manter a capacidade laboral.

Abstract Objective: To determine the estimated work capacity index estimated by nursing professionals in primary health care. Methodology: Quantitative-descriptive cross-sectional study. Seventy-two nurses participated, and an instrument consisting of general information and the working capacity index was used, which was validated through expert judgment and pilot testing, resulting in a coefficient of 0.741 Cronbach's alpha. The delivery of informed consent was fulfilled, and the descriptive statistic and chi-square were used for data analysis. Results: The working capacity index was considered excellent for 37.5 %, good for 43.1 %, moderated to 19.4 % and no participant estimated a low rate; moreover, it was shown statistically that the number of children has a significant association with the index (chi-square = 14.798, p = 0.022). Conclusion: A good working capacity index prevails; therefore, it is suggested to support measures for the improvement or maintenance of work capacity.

The Development of an Instrument to Measure the Work Capability of People with Limited Work Capacity (LWC).

Purpose Participation in regular paid jobs positively affects mental and physical health of all people, including people with limited work capacities (LWC), people that are limited in their work capacity as a consequence of their disability, such as chronic mental illness, psychological or developmental disorder. For successful participation, a good fit between on one hand persons' capacities and on the other hand well-suited individual support and a suitable work environment is necessary in order to meet the demands of work. However, to date there is a striking paucity of validated measures that indicate the capability to work of people with LWC and that outline directions for support that facilitate the fit. Goal of the present study was therefore to develop such an instrument. Specifically, we adjusted measures of mental ability, conscientiousness, self-efficacy, and coping by simplifying the language level of these measures to make the scales accessible for people with low literacy. In order to validate these adjusted self-report and observer measures we conducted two studies, using multi-source, longitudinal data. Method Study 1 was a longitudinal multi-source study in which the newly developed instrument was administered twice to people with LWC and their significant other. We statistically tested the psychometric properties with respect to dimensionality and reliability. In Study 2, we collected new multi-source data and conducted a confirmatory factor analysis (CFA). Results Studies yielded a congruous factor structure in both samples, internally consistent measures with adequate content validity of scales and subscales, and high test-retest reliability. The CFA confirmed the factorial validity of the scales. Conclusion The adjusted self-report and the observer scales of mental ability, conscientiousness, self-efficacy, and coping are reliable measures that are well-suited to assess the work capability of people with LWC. Further research is needed to examine criterion-related validity with respect to the work demands such as work-behaviour and task performance.

The capacity to work puzzle: a qualitative study of physicians' assessments for patients with common mental disorders.

BACKGROUND: Entitlement to sickness benefits is a legal process requiring health-related reduced work capacity confirmed by a physician via a sickness certificate. However, there is a knowledge gap concerning physicians' clinical practice of work capacity assessments for patients with common mental disorders (CMD). Physicians claim more knowledge and skills in how to actually do the assessments. The aim of this study was to explore physicians' tacit knowledge of performing assessments of capacity to work and the need for sickness absence in patients with depression and anxiety disorders. METHODS: We performed a qualitative study with open-ended interviews and a short video vignette of a physician and a patient with depression as stimuli. Participating physicians (n = 24) were specialized in general practice, occupational health or psychiatry and experienced in treating patients with depression and anxiety. Interviews were audio-recorded and transcribed verbatim. Inductive content analysis was used as the analytical tool. RESULTS: Five categories were identified. Category 1 identified work capacity assessment as doing a jigsaw puzzle without any master model. The physicians both identified and created the pieces of the puzzle, mainly by facilitating strategies to make the patient a better supplier of essential information. The finished puzzle made up a highly individualized comprehensive picture required for adequate assessment. Categories 2-4 identified the particular essential pieces of information the participants used, relating to the patient's disorder, capacity in the work place and contextual everyday life. For the sickness absence assessment, apart from decreased work capacity, the physicians also took particulars of the work place into account; e.g. could the work place handle an employee with reduced capacity. CONCLUSIONS: Physicians' tacit knowledge of assessing work capacity and the need for sickness absence for patients with CMD was identified as doing a jigsaw puzzle. The physicians became identifiers and creators of the pieces of the puzzle using a broad palette of essential information. Our findings contribute to the knowledge gap on clinical assessment and can be used as an educational tool. Because they are based on the professions' tacit knowledge, acceptance of the model can be expected to be high.

Swedish use and validation of Valpar work samples for patients with musculoskeletal neck and shoulder pain.

I studien beskrivs vad e bedömning av arbetskapacitet (BAK) innehåller Vid en bedömning av arbetskapacitet jämförs kraven för att utföra ett specifikt arbete, definierat i "The dictionary of Occupational Titles" (DOT), och patientens förmåga att utföra ett arbote vilket definieras med hjälp av sju variabler. Allmän utbildnings nivä. Speciella yrkesförberedelser. Anlag, Intresseområden, Personlig läggning. Fysiska drav och Miljöpåverkan. En bedömning av arbetskapaciteten kan ske antingen genom att observera patienten under arbete påarbetsplatsen eller under simulerat arbete tex genom att använda Valpar systemets arbetsprover.Vid Rehabiliteringsmedicinska kliniken, Karolinska Sjukhuset har tvä av de standardiserade arbetsprovema använts. VCWS 8 "Simulerad moontering" och VCWS 9 "Simulerade rorelser for hela kroppen" for att förbättra bedömningen av patientens arbetskapacitet. VCWS 8 mäter "en persons förmaga att utföra ett monteringsarbete som kräver repetetiva fysiska manipulationer" och VCWS 9 mäter "en persons formåga att röra på bålen, nacken, armarna, händerna och fingrama när de relaterar till funktionellt utförande av ett arbete". Valideringen av arbetsprovema för Svensk anvandning gjordes på en grupp patienter (n = 97) med muskuloskelettal nack- och skulder smärta som deltog i ett rehabiliteringsprogram. VCWS 9 utfördes av åttiofem patienter och VCWS 9 av sextionic patienter.Medelvärdet for patienterna som slutförde VCWS 8 var 83.1% av industriell standard nivå (mätt enligt MTM-Method-Time-Measurement) där den lä gsta gränsen är 87.5% för ett godkännt utförende. Detta innebär att de "inte moter" kraven för detta specifika arbete. I motsats till detta sä nädde patientema som utförde VCWS 9 ett medelvärde pä 108.6% vilket overstiger kravet (87.5%) för industriell standard. Det oväntade resultatet kan kanske förklaras av att patienternas intresseområden vad gäller arbetsfalt endast sammanfoll med iintresseområdena för VCWS 8 och yeWS 9 i 32% av fallen. En retrospective jämförelse mellan att vara sjukskriven eller inte vara sjukskriven och deras förmåga att utföra ett arbetsprov och uppnå minimi kravet for industriell standard visade inte på något samband. Mänga faktorer kan ha påverkat resultatet som tex patientens motivation, andra psyko-sociala omstandigheter och arbetsterapeutemas beslut att endast använda sig av två stycken av ett flertal arbetsprov.Konklusiionen ar att en bedörning av patientens arbetskapacitet skall utföras prospektivt och bör ta i beräknng de krav arbetet ställer enligt DOT och därefter bör rätt arbetsprov väijas för den individuella patienten. Sker detta på ett riktigt sätt så år Valpars arbetsprover valida och till stor hjälp vid en medicinsk bedomning och för beslut när det gäller fortsatt sjukskrivning eller vid yrkesrådgivning.