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«FICHA TÉCNICA Título Segurança e Higiene Ocupacionais - SHO 2012 - Livro de Resumos Autores/Editores Arezes, P., Baptista, J.S., Barroso, M.P., ...»

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For this ergonomic work analysis, 8 nursing shifts were randomly selected from a continuous and palliative care hospital ward, 4 of those were morning shifts and the remaining were afternoon shifts. In the morning shift (a), the following average percentages of nursing activity time spent in each one of the ward’s stations were registered: patients’ rooms (52%), corridors (16%), change of shifts (nurses´ handovers) (13%), nursing records (8%) and at the nursing room (4%).

In the afternoon shift (b) there were a few changes: patients’ rooms (26%), corridors (18%), nurses´ handovers (11%), nursing records (18%) and at the nursing room (14%). The observation of in-room nursing activity in the morning period includes both the patients´ hygiene (5-6 for shift) and patients´ periodically mobilization and subsequent repositioning in bed (20 to 45 minutes) and in the afternoon period only the patient mobilization and repositioning in bed was registered, however more frequently (8-9 for shift, 40 to 50 minutes).

The results show that nursing activity varies depending on the shift. That points out to evidence of different workloads in both shifts. At this point in the study becomes clear the need to better organize staff distribution by shift and schedule activities so as to achieve a more balanced allocation of human resources.

Other Studies as Estryn Behar and et al. (Estryn Behar, Milanini-Magny, Deslandes, Fry, & Ravache, 2008) under the “European Nurses’ early exit study” presents different values from the work analysis, namely from average time spent in overall medicine, urology, dermatology and oncology in: patients’ rooms (32%, 28%, 30% and 30%), corridors (24%, 16%, 14%, 11%) and nursing rooms (14%, 15%, 18%, 12%). The results of our study with considerable amount of time spent in nursing care provided in patients´ rooms (52%) is very different from others studies. So the demands may be related to several issues, such as: (1) human resources allocation, namely the (reduced) number of nurses, and the (high) rate of dependency patients per nurse, (2) wards layout, particularly the longitudinally section of the assigned work area that demands extensive travel within the hospital unit, (3) workload organization, specifically the assignment of patients dependency (partially dependent to totally dependent) to nurses in those shifts, among others.

With regards to transferences and to the DINO application, 18 transferences were observed, a sound nurse majority (83,3%), female (88,9%) was accounted for, being in charge of transferring from the bed to the bath chair (33,3%), from the bed to the armchair (27,8%) or from the bath chair to the armchair (22,2%).

The description of the degree of patient dependency was made through the ARJO criteria (Cotrim et al., 2011), ranging from A (autonomous or non-dependent standalone patients) to E (totally dependent patients). The overall majority of observations were collected from patients type C (partially dependent, 38,9%) and type E (totally dependent, 38,9%).

The average DINO score was 14,61 (sd=1,72) and the values range from 10 to 16. It should be stressed that 50% of all transferences got a score of 16, which is the top mark and means that the given task was carried out in compliance within a safety standard technique for the health care worker.

The analysis of the results was outlined by the 3 phases of DINO: (1) preparation, (2) performance and (3) result phase, allowing to highlight respectively (i) as critical factors, the failure to use mechanical aids in 33,3% of transfers where they would be advisable and the equipment not been accurately handled in 16,7% of observations; (ii) the results are in broad terms (a) positive, with the patient Communication and Participation criteria presenting a median value coinciding with the highest point of the scale, (b) the criteria with the lowest follow-through are the “low effort policy”, with a 22,2% presenting a “moderate” classification, and the “load on the back” with a 27,8% placed in “moderate” and a 11,1% placed at the “high” level; (iii) 27,8% of the transfers the patient did not end up in an appropriately functional position, what determined in turn his repositioning with the burden to the professionals (nurses and nurses-aids).

4. CONCLUSIONS The ergonomic work analysis presents several contributions at the hospital setting, particularly when a real work activity analysis is used. Such contributions may be the starting point for the patient´s safety and the health professional´s well being and safety risk management (Serranheira, Uva, Sousa, & Leite, 2009; Uva & Serranheira, 2008; Serranheira, Uva, Sousa, 2010). This study allowed for the analysis of activity in a continuous and palliative hospital ward (nurses shifts), stressing the substantial amount of time that was spent providing that care in the patient´s room (52%). This figure is outstandingly different from those in other mentioned studies in several other hospital wards, where essentially lower values were registered.

DINO results show that healthcare professionals were carried out the transfers in compliance within a safety standard technique for the health care worker, but the real work analysis also show that some patients transfers (27,8%) didn’t end at the best conditions and that demands a patient repositioning without mechanical transfers.





This is a clear example of some critical factors that may be identified during this work analysis and that allows to equate preventive measures for the elimination or minimization of risks during nurses’ activity, namely at patients’ transfers.

This points out higher workload for ongoing and palliative care nurses, which should be object of further study, in order to face the real nurses’ capacities and the work demands, so as to think of eventual interventions at an organizational level, work layout and equipments distribution and design.

This study is part of another study with a broader scope where the nurse work analysis, including the risk assessment and workload evaluation, contributed to spot situations of either dysfunctional stations or widespread systemic dysfunction, and call on those demanding situations an ergonomic intervention (risk management).

Ergonomic work analysis at nurse’s workplaces contributes to identify, classify and analyze the work activity in each station, in every ward, so as to improve human resources management tools, adapting working areas and equipment design to workers, that together may contribute to prevent adverse results, for both healthcare providing professionals (e.g. work related musculoskeletal disorders) and patients (e.g. falls).

5. REFERENCES Cotrim, Teresa (2006). A Ergonomia em Contexto Hospitalar. Ed. by Arezes, P., Baptista, J.S., Barroso, M., Carneiro, P., Cordeiro, P., Costa, N., Melo, R., Miguel, A.S., Perestrelo, G., Proccedings Book of the International Symposium on Occupational Safety and Hygiene, Guimarães, Portugal, 5-6 February.

Cotrim, T., Francisco, C., Correia, L., Fray, M., Hignett, S. (2011). Patient Handling Risk Assessment: First Steps for Applying the “Intervention Evaluation Tool” in Portuguese Hospitals, Proceedings of the 3rd International Conference on Healthcare Systems Ergonomics and Patient Safety - HEPS 2011, Oviedo, Spain.

Estryn Behar, M., Milanini-Magny, G., Deslandes, H., Fry, C., & Ravache, A. E. (2008). Participatory ergonomics in health care.

Methods to implement changes deriving from a broad statistical analysis (the European Nursesʼ early exit study). Strasbourg:

Proceedings. HEPS.

Occupational Safety and HygieneInternational Symposium on

Johnsson, C., Kjellberg, K., Kjellberg, A., Lagerstrom, M. (2004), A Direct Observation Instrument for Assessment of Nurses’ Patient Transfer Technique (DINO), Applied Ergonomics 35, 591 – 601.

Serranheira, F., Uva, A., & Sousa, P. (2010). Ergonomia hospitalar e segurança do doente: mais convergências que divergências.

Revista Portuguesa de Saúde Pública, Vol Temático (10), 58-73.

Serranheira, F., Uva, A., Sousa, P., & Leite, E. (2009). Segurança do doente e saúde e segurança dos profissionais de saúde: duas faces da mesma moeda. Saúde & Trabalho, 7, 5-30.

Uva, A., & Serranheira, F. (2008). A segurança do doente também depende da saúde e segurança de quem presta cuidados. Hospital do Futuro.

O Lado Menos Visível dos Efeitos do Trabalho na Saúde: Reflexão sobre a Emergência dos Riscos Psicossociais The Less Visible Side of the Work Effects on Health: Reflection on the Emergence of Psychosocial Risks Silva, Catarinaa, Costa, Cláudiab, Saraiva, Davidc a Faculdade de Motricidade Humana, Cruz Quebrada - Portugal, email: csilva@fmh.utl.pt; b Serviços Municipalizados de Água e Saneamento de Oeiras e Amadora, Oeiras-Portugal, e-mail: cfcosta@smas-oeiras-amadora.pt; Faculdade de Motricidade Humana, Cruz Quebrada-Portugal, e-mail: davidp11s@gmail.com

1. INTRODUÇÃO As condições de trabalho, nas sociedades modernas, têm sofrido mudanças importantes nas últimas décadas. Assistimos à introdução generalizada de novas tecnologias de informação e comunicação, a novas formas de organização do conteúdo e do tempo de trabalho e a alterações profundas nas relações laborais. Estas mudanças acarretam transformações no quotidiano profissional (e também pessoal) dos trabalhadores, mas os riscos que lhes estão associados e as respetivas consequências são muitas vezes pouco percetíveis. Referimo-nos à emergência que se assiste de fatores de risco de natureza psicossocial (Brun & Milczarek, 2007). O facto da sua visibilidade não ser imediata, torna imprescindível dar oportunidade aos trabalhadores que os vivem/sentem de os denunciar. E, quando lhes é dada essa oportunidade, os trabalhadores acabam também por expressar incómodos, queixas, perceções acerca dos efeitos desses riscos na sua saúde e no seu bem-estar, configurando um cenário mais de pequenos problemas, de infrapatologias, do que de doenças clinicamente comprovadas. Mas, a ausência de um diagnóstico efetivo das relações causa-efeito, dá lugar a um vazio em termos do seu reconhecimento (Barros-Duarte, 2005) As abordagens normativas que muitas empresas/instituições preconizam acabam por comprometer essa compreensão mais abrangente do problema, porque apenas põem em evidência os efeitos óbvios, imediatos e simples. É necessário, pois, sair da lógica de que o estado de saúde e de bem estar das populações trabalhadoras se afere apenas por indicadores como o absentismo por doença, as doenças profissionais diagnosticadas ou os acidentes de trabalho. É necessário ainda olhar para as queixas, os sentimentos, os incómodos não como aspetos marginais irrelevantes, mas como aspetos que condicionam efetivamente o quotidiano do trabalhador.

Estas preocupações estão presentes na V e última edição do European Working Conditions Survey (EWCS) promovido pela Eurofound (Fundação Europeia para a Melhoria das Condições de Vida e de Trabalho http://www.eurofound.europa.eu/surveys/index.htm). Nessa edição foi introduzido um conjunto de questões novas, que procuram precisamente cercar melhor os fatores de risco psicossociais, para além dos fatores de risco monitorizados há já algum tempo, contribuindo para outra leitura dos efeitos das condições de trabalho na saúde e na qualidade de vida.

É determinante a forma como abordamos as relações saúde-trabalho, se queremos dar visibilidade aos fatores de risco menos visíveis e às suas consequências. Apostamos numa abordagem plurifatorial dos problemas de saúde relacionados com o trabalho, centrada no trabalhador, auscultando a sua perspetiva, o vivido/sofrido no trabalho.

Neste artigo propomo-nos refletir sobre “O lado menos visível dos efeitos do trabalho na saúde”, suportando-nos nos resultados de um projeto de monitorização das condições de trabalho, realizado nos Serviços Municipalizados de Água e Saneamento de Oeiras e Amadora com a colaboração da Faculdade de Motricidade Humana, Universidade Técnica de Lisboa.

2. METODOLOGIA

2.1. O instrumento e sua aplicação O inquérito INSAT – Saúde e Trabalho (Barros-Duarte & Cunha, 2010), é um inquérito português, que tem como objetivo “compreender de que forma os trabalhadores avaliam as características e as condições do seu trabalho, o seu estado de saúde, e que tipo de relações estabelecem entre a sua saúde e o seu trabalho” (Barros-Duarte, Cunha & Lacomblez, 2007, p.59).

Procedemos à aplicação deste instrumento a colaboradores dos Serviços Municipalizados de Água e Saneamento (SMAS) de Oeiras e Amadora. A aplicação do inquérito decorreu em sessões coletivas em sala de, no máximo, 10 trabalhadores, sendo o preenchimento individual e anónimo.

2.2. Participantes De um universo de 404 trabalhadores o inquérito foi aplicado a 351 (87%). Foram constituídos dois grupos de trabalhadores, um designado de “Colarinho Branco” (n=192) e outro de “Colarinho Azul” (n=159). O primeiro é constituído maioritariamente por trabalhadores do sexo feminino (61%), com habilitações académicas entre os níveis 3º ciclo e pós-graduação, com 43,6±9,6 (x±sd) anos de idade e correspondendo aos colaboradores com as funções de dirigentes, técnicos superiores, administrativos e de apoio técnico. O segundo é composto unicamente por trabalhadores do sexo masculino, com habilitações literárias situadas entre os níveis 1º ciclo e secundário, com 48±8,9 (x±sd) anos de

–  –  –

idade, correspondendo aos colaboradores com as funções de operadores de água, saneamento e armazém, motoristas e outros operadores com funções diversas nas áreas oficinais, estações elevatórias e fiscalização.

2.3. Tratamento dos dados Procedeu-se a uma análise estatística descritiva para todas as questões do inquérito e a uma análise de regressão logística multivariada – método Forward – englobando como covariáveis, as variáveis de exposição e de incómodo à exposição a condições e características do trabalho e como variável dependente o problema de saúde, aceitando-se como fator explicativo do problema de saúde as associações que apresentaram valores de probabilidade p≤.05.

3. OS EFEITOS MENOS VÍSIVEIS DO TRABALHO NA SAÚDE



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