Ambiente ocupacional e o consumo de substâncias psicoativas entre enfermeiros / Occupational environment and psychoactive substance consumption among nurses

Resumo Objetivo Analisar a relação entre o ambiente de trabalho e o consumo de substâncias psicoativas entre enfermeiros hospitalares. Métodos Estudo transversal e descritivo, realizado com enfermeiros de três instituições hospitalares públicas localizados em um município da Região Sul do Brasil, sendo duas de média complexidade e uma de alta complexidade. A população deste estudo foi composta por 221 enfermeiros. Com base nesse número, calculou-se o tamanho amostral por estratos, considerando-se a proporção de 50%, nível de confiança de 95% e erro máximo de 5%, o que resultou no número mínimo de 175 participantes. Mediante a estratificação proporcional por instituição definiu-se o mínimo de 103 enfermeiros da alta complexidade e 36 de cada instituição de média complexidade. Adotou-se como critérios de inclusão: trabalhar na instituição há pelo menos um ano e não estar afastado por licença. A coleta de dados foi realizada entre outubro de 2015 e abril de 2016. Na coleta de dados utilizaram-se informações sociodemográficas e ocupacionais, o Nursing Work Index - Revised e o Alcohol, Smoking and Substance Involvement Screening Test. Os dados foram analisados no programa Statistical Package for Social Sciences, versão 20.0. Inicialmente, verificou-se a normalidade pelo teste de Kolmogorov-Smirnov. Foram realizadas análises descritivas, por frequências absoluta e relativa para as variáveis categóricas; e medianas e medidas de dispersão para as numéricas. Resultados Álcool, tabaco e sedativos foram as substâncias mais consumidas. Renda mensal apresentou correlação positiva com o consumo de álcool entre enfermeiros dos hospitais de média complexidade (p=0,01). No hospital de alta complexidade, o consumo de álcool relacionou-se negativamente a relação médico-enfermeiro (p=0,03). Autonomia, relação médico-enfermeiro e suporte organizacional estiveram correlacionados negativamente ao uso de sedativos (p<0,01; p<0,01; p=0,02, respectivamente). Conclusão Quanto mais desfavorável o ambiente de trabalho do enfermeiro, sobretudo na relação com médicos, suporte organizacional e autonomia, maior foi o consumo de substâncias psicoativas.

Abstract Objective To analyze the relation between the work environment and psychoactive substance consumption among hospital nurses. Methods Cross-sectional and descriptive study, involving nurses from three public hospitals in a city in the South of Brazil, being two medium-complexity and one high-complexity institution. The study population consisted of 221 nurses. Based on this figure, the stratified sample size was calculated, considering a 50% proportion, 95% confidence level and 5% maximum error, resulting in a minimum number of 175 participants. Through proportional stratification per institution, a minimum of 103 high-complexity nurses was defined, as well as 36 nurses from each medium-complexity institution. The following inclusion criteria were adopted: having worked at the institution for at least one year and not being on leave. The data were collected between October 2015 and April 2016. In the data collection, sociodemographic and occupational information, the Nursing Work Index - Revised and the Alcohol, Smoking and Substance Involvement Screening Test. The data were analyzed in the software Statistical Package for Social Sciences, version 20.0. Initially, the normality was verified by means of the Kolmogorov-Smirnov test. Descriptive analyses were developed by absolute and relative frequencies for the categorical variables; and medians and dispersion measures for the numerical variables. Results Alcohol, tobacco and sedatives were the most consumed substances. The monthly income was positively correlated with alcohol consumption among nurses at the medium-complexity hospitals (p=0.01). At the high-complexity hospital, alcohol consumption was negatively correlated with the physician-nurse index (p=0.03). Autonomy, physician-nurse index and organizational support were negatively correlated with the use of sedatives (p<0.01; p<0.01; p=0.02, respectively). Conclusion The more negative the nurse's work environment, mainly in the relation with physicians, organizational support and autonomy, the greater the consumption of psychoactive substances.

Perfil clínico y demográfico de pacientes atendidos en los servicios de urgencias, por intoxicación aguda con sustancias psicoactivas. Bogotá D.C, julio 2010junio 2011 / Clinical and demographic profile of patients nursed in urgency services due to acute intoxication with psychoactive substances in Bogotá

Antecedentes. El uso de sustancias psicoactivas es un problema de salud pública en el mundo, afectan al individuo y a la sociedad. Se estima que contribuyen a la rápida propagación de enfermedades infecciosas, como VIH y hepatitis; es por ello que la sociedad debe abordar su uso indebido. Objetivo. Determinar el perfil clínico y demográfico de pacientes atendidos en los servicios de urgencias, por intoxicación aguda con sustancias psicoactivas en Bogotá, 20102011. Material y métodos. Estudio descriptivo, retrospectivo, derivado de la revisión de 1073 registros del Sistema Nacional de Vigilancia en Salud Pública relacionados con los casos de intoxicaciones por sustancias psicoactivas, atendidos en los servicios de urgencias de Bogotá, 20102011. Se revisaron historias clínicas correspondientes, para establecer el perfil clínico de los pacientes. Se calcularon las frecuencias simples y estratificadas con intervalos de confianza de 95% (IC95%) de las variables sociodemográficas, tipo de sustancia psicoactiva y manifestación clínica. Resultados. El mayor número de consultas (73%) se presentaron en hombres, con edades comprendidas entre 25 a 34 años, predominando las intoxicaciones con fines delictivos (58%). Las benzodiacepinas son las sustancias implicadas en el 83% de los casos. Las manifestaciones clínicas, correspondieron en su mayoría 80% a manifestaciones neurológicas. Conclusión. El tipo de exposición con intencionalidad delictiva, predominante en los resultados de este trabajo, es un fenómeno no documentado en la literatura científica revisada. Las benzodiazepinas, como sustancia implicada en los casos de intoxicación son consecuentes con el tipo de exposición evidenciado en los resultados aportados por este estudio, similares a los obtenidos por Uribe y cols (2005), y lo documentado en otros estudios.

Background. Psychoactive substance use is public health problem around the world, affecting individuals and society in general. It has been estimated that it contributes towards the rapid propagation of infectious diseases such as HIV and hepatitis. Society thus cannot afford to ignore such threat and must address such abuse. Objective. Determining the clinical and demographic profile of patients suffering acute psychoactive substance poisoning who were attended by emergency services in Bogotá, 20102011. Methods. This was a descriptive, retrospective study which emerged from reviewing 1,073 records kept by the Colombian Public Health Surveillance System (Sistema Nacional de Vigilancia en Salud Pública) related to cases of people suffering from psychoactive substance poisoning who had been attended by emergency services in Bogotá, 20102011. The corresponding clinical histories were reviewed to establish the patients' clinical profile. Simple and stratified frequency were calculated, using 95% confidence intervals (95%CI), for sociodemographic variables, type of psychoactive substance and clinical manifestation. Results. Males aged 2534 years old consulted most (73%), intoxication for criminal purposes predominating (58%) having been drugged to reduce resistance to assault. Benzodiazepines were implicated in 83% of the cases; 80% of clinical manifestations were neurological. Conclusion. Exposure with criminal intent predominated in this work's results; it would seem to be a phenomenon which has not been documented in the scientific literature reviewed here. Benzodiazepine exposure (the substance implicated in poisoning cases) was similar to that obtained by Uribe et al., (2005) and that found in other substancerelated disorder studies.