Sobrecarga de trabalho em unidades hospitalares: percepção de enfermeiros / Work overload in hospital units: perception of nurses

Conhecer a percepção de enfermeiros sobre a sobrecarga de trabalho em unidades hospitalares. Pesquisa de abordagem qualitativa, exploratória-descritiva, realizada em um hospital de ensino no Rio Grande do Sul. Participaram enfermeiros atuantes em serviços de internação clínica e cirúrgica. A coleta dos dados ocorreu por meio da observação sistemática não participante e entrevista semiestruturada. Para a análise dos dados foi utilizada a técnica de análise do conteúdo temática. Participaram 12 enfermeiros. Das categorias emergiram relatos de materiais de insumo de baixa qualidade, interrupções no desenvolvimento do trabalho, consequências decorrentes da sobrecarga para a saúde dos profissionais e estratégias de enfrentamento a respeito da mesma. É imprescindível o planejamento de ações que busquem minimizar a sobrecarga de trabalho e, assim, preservar e promover a saúde dos enfermeiros, na perspectiva da valorização e apoio, possibilitando a oferta de uma assistência integral e de qualidade.

Nurses' perceptions on work overload in hospital units are analyzed. Current qualitative, exploratory-descriptive research was conducted in a university hospital in the state of Rio Grande do Sul, Brazil, with the participation of nurses in clinical and surgical hospitalization services. Data were collected through systematic non-participant observation and semi-structured interviews. For data analysis, the thematic content analysis technique was used. Twelve nurses participated. Categories revealed reports on low quality materials, interruptions in work development, consequences resulting from work overload on the health of professionals and their coping strategies. It is important to plan actions that minimize work overload and, thus, preserve and promote nurses health, from the perspective of valorization and support, enabling the provision of comprehensive and quality care.

Carga horária de enfermagem aplicada ao paciente com infarto agudo do miocárdio / Nursing hour load applied to the patient with acute myocardial infarction / Carga horaria de enfermería aplicada al paciente con infarto agudo de miocardio

Objetivo: identificar a Carga Horaria de enfermagem aplicada ao Infarto agudo do Miocárdio, de acordo com a classificação de Killip. Método: pesquisa de campo com abordagem quantitativa, descritiva, exploratória, retrospectiva. Foram utilizados prontuários de pacientes que obtiveram como diagnostico inicial o Infarto Agudo do Miocárdio, e que apresentaram alterações nos marcadores bioquímicos Resultados: foram avaliados 200 prontuários. A partir dos dados obtidos conseguimos traçar uma progressão de carga horaria entre as categorias Killip, sobre as necessidades de assistência prestada. Conclusão: a carga horaria de enfermagem varia de acordo com a complexidade que o Infarto do Miocárdio pode manifestar. O paciente necessita de maior número de pessoal de enfermagem devido alta carga horaria para atender todas as intervenções necessárias

Objective: to identify the nursing time load applied to acute myocardial infarction, according to the Killip classification. field research with quantitative, descriptive, exploratory, retrospective approach. The medical records of patients Methods: who obtained an initial diagnosis of acute myocardial infarction and who presented alterations in the biochemical markers were used. Results: 200 medical records were evaluated. From the data obtained we were able to trace a progression of time load between the Killip categories, on the assistance needs provided. Conclusion: the nursing time load varies according to the complexity that the Myocardial Infarction can manifest. The patient needs a larger number of nursing personnel due to high workload to attend all necessary interventions

Objetivo: identificar la carga horaria de enfermería aplicada al infarto agudo de miocardio, de acuerdo con la clasificación de Killip. Métodos: investigación de campo con abordaje cuantitativo, descriptivo, exploratorio, retrospectivo. Se utilizaron prontuarios de pacientes que obtuvieron como diagnóstico inicial el Infarto Agudo del Miocardio, y que presentaron alteraciones en los marcadores bioquímicos. Resultados: se evaluaron 200 prontuarios. A partir de los datos obtenidos conseguimos trazar una progresión de carga horaria entre las categorías Killip, sobre las necesidades de asistencia prestada. Conclusión: la carga horaria de enfermería varía de acuerdo con la complejidad que el Infarto del Miocardio puede manifestar. El paciente necesita un mayor número de personal de enfermería debido a una alta carga horaria para atender todas las intervenciones necesarias

Relationship between work-related musculoskeletal disorders and ergonomic factor load in shipyard workers / 中国职业医学

OBJECTIVE: To assess the effect of ergonomic factor load on work-related musculoskeletal disorders(WMSDs) in shipyard workers. METHODS: A total of 751 shipyard workers were selected as the research subjects using judgment sampling method. The exposure level of adverse ergonomic factors was assessed using the Quick Exposure Check method. The prevalence of WMSDs was investigated using the revised Musculoskeletal Disorders Investigating Questionnaire of our research group, and the relationship between them was analyzed. RESULTS: The proportions of high or very high level of work load exposure to the neck, back, shoulder and hand in shipyard workers from high to low were 66.4%, 63.5%, 59.8% and 43.7%(P<0.01) respectively. The proportions of occupational stress, driving, vibration and working rhythm at high or very high exposure level were 20.0%, 4.1%, 22.9% and 3.2%, respectively. The prevalence of WMSDs in four body parts of shipyard workers from high to low was the back, neck, hand and shoulder(the prevalence were 44.2%, 31.2%, 26.9% and 26.6%, respectively, P<0.01). After excluding the influence of confounding factors, multiple logistic regression analysis showed that the higher the labor load exposure level and longer of the vibration tool using, the higher the risk of shoulder WMSDs [odds ratio(OR) and 95% confidence interval(CI) were 1.25(1.04-1.51) and 1.33(1.05-1.69), respectively, P<0.05]. The higher the level of occupational stress, the higher the risk of back and neck WMSDs [OR(95%CI) was 1.29(1.05-1.58) and 1.42(1.15-1.77), respectively, P<0.05]. CONCLUSION: There was a dose-effect relationship between the exposure level of shoulder load, the time of using vibration tools and the shoulder WMSDs, and there was a dose-effect relationship between the occupational stress level and the WMSDs in the back and neck.

Care time and quality indicators in Intensive Care Units / Tiempo de atención e indicadores de calidad en Unidades de Terapia Intensiva / Tempo de assistência e indicadores de qualidade em Unidades de Terapia Intensiva

ABSTRACT Objective: To verify the correlation between nursing care time and care quality indicators. Method: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. Results: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. Conclusion: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.

RESUMEN Objetivo: Verificar la correlación entre tiempo de atención de enfermería e indicadores de calidad asistencial. Método: Estudio observacional, correlacional, desarrollado en 11 Unidades de Terapia Intensiva. La población comprendió registros del cuantitativo de los profesionales de enfermería, del número de portadores de, al menos, uno de los dispositivos terapéuticos Sonda Oro/Nasogastroenteral (SONGE), Cánula Endotraqueal (COT) y Cateter Venoso Central (CVC) y de las ocurrencias relativas a las pérdidas de estos artefactos. Resultados: El tiempo correspondió a 18,86 horas (Hospital A), 21 horas (Hospital B) y 19,50 horas (Hospital C); el indicador Incidencia de Salida No Planeada de SONGE presentó una media de 2,19/100 pacientes/día; Incidencia de Extubación no planificada de COT, 0,42/100 pacientes/día; e Incidencia de Pérdida CVC, 0,22/100 pacientes/día. No hubo correlación estadísticamente significativa entre el tiempo y los indicadores analizados. Conclusión: Esta investigación puede apoyar decisiones metodológicas para investigaciones futuras que buscan el impacto de los recursos humanos en la calidad asistencial y seguridad de los pacientes.

RESUMO Objetivo: Verificar a correlação entre tempo de assistência de enfermagem e indicadores de qualidade assistencial. Método: Estudo observacional, correlacional, desenvolvido em 11 Unidades de Terapia Intensiva. A população compreendeu registros do quantitativo dos profissionais de enfermagem, do número dos portadores de, ao menos, um dos dispositivos terapêuticos Sonda Oro/Nasogastroenteral (SONGE), Cânula Endotraqueal (COT) e Cateter Venoso Central (CVC) e das ocorrências relativas às perdas desses artefatos. Resultados: O tempo correspondeu a 18,86 horas (Hospital A), 21 horas (Hospital B) e 19,50 horas (Hospital C); o indicador Incidência de Saída Não Planejada de SONGE apresentou média de 2,19/100 pacientes/dia; Incidência de Extubação não Planejada de COT, 0,42/100 pacientes/dia; e Incidência de Perda CVC, 0,22/100 pacientes/dia. Não houve correlação estatisticamente significante entre o tempo e os indicadores analisados. Conclusão: Esta pesquisa pode apoiar decisões metodológicas para investigações futuras que buscam o impacto dos recursos humanos na qualidade assistencial e segurança dos pacientes.

Nursing Activities Score and the cost of nursing care required and available / El Nursing Activities Score y el costo de la asistencia de Enfermería requerida y disponible / Nursing Activities Score e custo da assistência de enfermagem requerida e disponível

ABSTRACT Objective: To estimate the cost of nursing care required and available through the use of the Nursing Activities Score. Method: Quantitative study, direct costing of nursing care required and available in the Intensive Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category. Results: The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians. Conclusion: The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.

RESUMEN Objetivo: Determinar el costo de la asistencia de Enfermería requerida y disponible con el uso del Nursing Activities Score. Método: Estudio cuantitativo, con análisis de costo directo de la asistencia de Enfermería requerida y disponible en las Unidades de Terapia Intensiva. La recolección de los datos incluyó variables de los pacientes, profesionales de Enfermería y carga de trabajo de Enfermería medida por el Nursing Activities Score. El costo de la asistencia de Enfermería fue determinado por la multiplicación entre el costo de cada hora y el total de horas de la asistencia por categoría. Resultados: La diferencia negativa de 94.791,5 reales entre el costo de la asistencia de Enfermería disponible y requerida indicó un aumento de 3,2 enfermeros y 7,0 técnicos de Enfermería. Conclusión: El costo de la asistencia de Enfermería requerida identificado por medio de la aplicación del Nursing Activities Score, más elevado que el costo de la asistencia disponible, indica la necesidad de ajustar el número de profesionales para atender las demandas de los pacientes.

RESUMO Objetivo: Estimar o custo da assistência de enfermagem requerida e disponível com o uso do Nursing Activities Score. Método: Estudo quantitativo, análise de custo direto da assistência de enfermagem requerida e disponível nas Unidades de Terapia Intensiva. A coleta dos dados incluiu variáveis dos pacientes, profissionais de enfermagem e carga de trabalho de enfermagem medida pelo Nursing Activities Score. O custo da assistência de enfermagem foi estimado pela multiplicação entre o custo de cada hora e o total de horas da assistência por categoria. Resultados: A diferença negativa de R$ 94.791,5 entre o custo da assistência de enfermagem disponível e requerida indicou acréscimo de 3,2 enfermeiros e 7,0 técnicos de enfermagem. Conclusão: O custo da assistência de enfermagem requerida identificado por meio da aplicação do Nursing Activities Score, mais elevado que o custo da assistência disponível, indica a necessidade de ajustar o número de profissionais para atender às demandas dos pacientes.

Satisfação e sobrecarga de trabalho entre profiissionais de equipes da Atenção Primária à Saúde / Satisfaction and work overload among professionals from Primary Health Care teams

Introdução: O trabalho na Atenção Primária em Saúde requer competências dos profissionais que atuam na Rede de Atenção à Saúde. A complexidade laboral exigida pelos profissionais das equipes, considerando as relações interpessoais, as vivências de situações de saúde sociais complexas, bem como a imposição de metas verticalizadas, podem resultar em sobrecarga de trabalho e insatisfação profissional. É preciso que haja sintonia entre gestores e trabalhadores, assim como a desconstrução de práticas assistemáticas já instituídas, gerando motivação em busca de melhorias para a qualidade de vida e trabalho desses profissionais, além de melhor qualidade da assistência e cuidados prestados aos usuários. Objetivos: Analisar a satisfação e sobrecarga com o trabalho de profissionais das equipes de atenção primária à saúde do município de Ritápolis - Minas Gerais. Método: Trata-se de um estudo descritivo, interpretativo, de abordagem mista. A amostra foi constituída de 36 participantes de ambos os sexos, com idades entre 20 e 68 anos, dos quais foram coletados dados demográficos, socioeconômicos e de satisfação e sobrecarga de trabalho. Realizou-se análise estatística descritiva (frequências absolutas e relativas) e multivariada (Regressão de Poisson), com nível de significância de 5% para os dados quantitativos e Análise Temático Categorial para os dados qualitativos. Resultados: Os resultados evidenciaram uma baixa exaustão emocional, baixa despersonalização e alta realização pessoal, caracterizando baixo nível de Síndrome de Burnout. A declaração dos participantes esteve entre os níveis indiferente e satisfeito com o trabalho (µ=2,3), destacando a satisfação intrínseca. Conforme a regressão da amostra estudada, a sobrecarga associou-se à insatisfação com o trabalho em 0,5%. Os principais fatos ressaltados pelos profissionais como influenciadores na sobrecarga e insatisfação com o trabalho foram: desvalorização salarial, práticas assistemáticas, fragmentação da rede de atenção à saúde e tensão emocional. Conclusão: Apesar de baixa sobrecarga e alta satisfação com o trabalho, a maioria dos profissionais relatou a sensação de desvalorização profissional vinculada à questão salarial. Evidenciou-se uma boa relação entre os profissionais e a gestão local, o que reflete positivamente na satisfação com o trabalho e reduz as dificuldades que poderiam impactar negativamente em sobrecarga laboral.(AU)

Introduction The work in Primary Health Care requires skills of the professionals who work in the Health Care Network. The work complexity required by the professionals of the teams, considering the interpersonal relationships; the experiences of complex social health situations, as well as the imposition of vertical goals, can result in work overload and professional dissatisfaction. There must be harmony between managers and workers, as well as the deconstruction of unsystematic practices already in place, generating motivation in looking for improvements to the quality of life and work of these professionals and better quality of care and care provided to users. Objectives: To analyze the satisfaction and overload with the work of professionals of primary health care teams, in the city of Ritápolis - Minas Gerais. Method: This is a descriptive, interpretive, mixed approach study. The sample consisted of 36 participants, of both sexes, aged between 20 and 68 years, from whom demographic, socioeconomic and satisfaction and workload data were collected. A descriptive statistical analysis (absolute and relative frequencies) and multivariate analysis (Poisson regression) with 5% significance level to the figures, and Thematic Categorical Analysis for qualitative data. Results: The results showed a low emotional exhaustion; low depersonalization and high personal accomplishment, characterizing low level of Burnout Syndrome. Participants declared themselves between levels indifferent and satisfied with work (µ = 2.3), highlighting the intrinsic satisfaction with work. According to the regression, in the sample studied, the overload was associated with job dissatisfaction in 0.5%. The main facts highlighted by the professionals as influencers in overload and job dissatisfaction were: wage depreciation, unsystematic practices, network fragmentation of health care and emotional tension. Conclusion: It is noteworthy that despite low overhead and high job satisfaction, most practitioners have reported the feeling of professional devaluation, linked to the salary issue, because they feel devalued daily, as a result. We found a good relationship between professionals and local management, making the most pleasurable work and working as a strategy to reduce the difficulties that could negatively impact on work overload, as well as to reflect positively on job satisfaction.(AU)

Cargas de trabalho do agente comunitário de saúde: pesquisa e assistência na perspectiva convergente-assistencial / Cargas de trabajo del agente comunitario de salud: investigación y asistencia en la perspectiva convergente-asistencial / The workload of the community health agent: research and assistance in the perspective of convergent-care

RESUMO Objetivo: conhecer a percepção dos Agentes Comunitários de Saúde acerca das cargas de trabalho presentes na sua dinâmica laboral e realizar prática assistencial relacionada às cargas de trabalho junto ao grupo. Método: estudo qualitativo, fundamentado na Pesquisa Convergente-Assistencial, realizado em duas unidades de atenção primária à saúde, com três equipes de Estratégia de Saúde da Família, em um município ao Sul do Brasil. Os participantes foram 14 Agentes Comunitários de Saúde atuantes nesses cenários. Os dados foram produzidos por meio de entrevistas semiestruturadas, grupos focais e grupos de convergência. Os dados foram analisados, conforme a análise do discurso do sujeito coletivo. Resultados: os Agentes Comunitários de Saúde convivem com intensa carga física (expressa pela exposição física na comunidade, estrutura precária na unidade e risco de violência); cognitiva (evidenciada pela necessidade de acúmulo de informações e conhecimentos técnicos para a orientação da comunidade e mudanças nos sistemas de informação); e psíquica (manifesta na fragilidade das relações interpessoais na equipe, na sobrecarga de trabalho e frustrações frente à falta de resolutividade do sistema e na falta de reconhecimento). A prática assistencial consistiu na mediação de um espaço de reflexão/ação/reflexão no qual os participantes puderam identificar estratégias para a minimização das cargas. Conclusão: a partir da prática assistencial os participantes realizaram uma reflexão crítica, problematizando a sua realidade laboral, envolvendo-se no desafio da transformação da realidade através da construção de estratégias para minimizar as cargas a que estavam expostos.

RESUMEN Objetivo: conocer la percepción de los Agentes Comunitarios de Salud acerca de las cargas de trabajo presentes en su dinámica laboral y realizar práctica asistencial relacionada a las cargas de trabajo junto al grupo. Método: estudio cualitativo, fundamentado en la Investigación Convergente-Asistencial, realizado en dos unidades de atención primaria a la salud, con tres equipos de Estrategia de Salud de la Familia, en un municipio al sur de Brasil. Los participantes fueron 14 Agentes Comunitarios de Salud actuantes en esos escenarios. Los datos fueron producidos por medio de entrevistas semiestructuradas, grupos focales y grupos de convergencia. Los datos fueron analizados, según el análisis del discurso del sujeto colectivo. Resultados: los agentes comunitarios de salud conviven con intensa carga física (expresada por la exposición física en la comunidad, estructura precaria en la unidad y riesgo de violencia); cognitiva (evidenciada por la necesidad de acumulación de informaciones y conocimientos técnicos para la orientación de la comunidad y cambios en los sistemas de información); y psíquica (manifiesta en la fragilidad de las relaciones interpersonales en el equipo, en la sobrecarga de trabajo y frustraciones frente a la falta de resolutividad del sistema y en la falta de reconocimiento). La práctica asistencial consistió en la mediación de un espacio de reflexión/acción/reflexión en el cual los participantes pudieron identificar estrategias para la minimización de las cargas. Conclusión: a partir de la práctica asistencial los participantes realizaron una reflexión crítica, problematizando su realidad laboral, involucrándose en el desafío de la transformación de la realidad a través de la construcción de estrategias para minimizar las cargas a las que estaban expuestos.

ABSTRACT Objective: to understand the perception of Community Health Agents regarding their workloads and to perform care practices with this group related to workloads. Method: a qualitative study, based on the Convergent-Care Research, carried out in two primary health care units, with three Family Health Strategy teams, in a municipality in the South of Brazil. The participants were 14 Community Health Agents working in these scenarios. Data were produced through semi-structured interviews, focus groups and convergence groups. The data were analyzed, according to the discourse analysis of the collective subject. Results: community health agents coexist with intense physical burden (caused by physical exposure in the community, precarious structure in the unit and the risk of violence); cognitive burdens (evidenced by the need to gather information and technical knowledge to orientate the community and changes in the information systems); and mental burdens (resulting from the poor interpersonal relationships within the team, in the excessive workload and frustrations due to the incapabilities of the health system and lack of recognition). The care practice consisted in the mediation of a space for reflection/action/reflection in which the participants could identify strategies that could minimize the burdens. Conclusion: regarding to the care practice, participants performed a critical reflection, problematizing their work reality, engaging in the challenge of transforming reality through the construction of strategies in order to minimize the burdens they were exposed to.

Ambiente de trabajo: Una evaluación de riesgos psicosociales y carga de trabajo mental en agentes de tránsito / The working environment: An assessment of psychosocial risks and the mental workload in traffic control workers

RESUMEN Introducción: Los factores de riesgo psicosocial del trabajo como estrés, carga laboral, dificultades en las relaciones socioprofesionales y las condiciones inadecuadas del trabajo, pueden considerarse variables que interfieren en la salud mental y física del empleado. Objetivo: Analizar la influencia de factores psicosociales y carga mental sobre los trabajadores de control de tránsito. Metodología: La muestra consistió en 79 trabajadores pertenecientes a la Guardia Municipal de Río de Janeiro, Brasil, en 2015. La recolección de datos se realizó mediante cuestionarios sociodemográficos, COPSOQ, y WHOQOL/Bref. Resultados: Con relación a los factores sociodemográficos que influencian los riesgos psicosociales, se mostró mayor incidencia de los factores de la no-práctica de actividades físicas, uso de alcohol y de psicoactivos. En el análisis del COPSOQ, se verificaron como riesgos para la salud, el ritmo de trabajo, las exigencias emocionales y el estrés. Tras la aplicación del WHOQOL/Bref, se obtuvo un valor promedio de 60,3 puntos para la cuestión global sobre satisfacción con la salud. Conclusiones: Esta investigación permitió verificar la necesidad de mejores condiciones de trabajo para los agentes de tránsito, las cuales pueden reflejarse en la adecuación y mejora en la ejecución de las funciones operativas de esta categoría.

ABSTRACT Introduction: The psychosocial risk factors at work like stress, workload, difficulties on the socio-professional relationships and inadequate work conditions are variables that interfere with the mental and physical health of the employee. Objective: To analyze the influence of psychosocial factors and mental load on traffic control workers. Methods: Sample consisted of 79 traffic control workers from the Municipal Guard of Rio de Janeiro, Brazil, in 2015. Data collection was conducted using socio-demographic, COPSOQ and WHOQOL/Bref questionnaires. Results: Regarding the socio-demographic factors that influence the psychosocial risks, non-practicing physical activities, alcohol and psychoactive drugs use were more important. In the COPSOQ analysis, there was a risk associated with work rate, emotional demands and stress. After applying the WHOQOL/ Bref questionnaire, an average of 60.3 points was obtained for the overall question of satisfaction with health. Conclusions: This research show the need for better working conditions for transit agents, which may be reflected in addressing and improving the performance of operational functions in this category.

Aumento das cargas de trabalho em técnicos de enfermagem na atenção primária à saúde no Brasil / Increased workloads for nurse technicians in primary health care in Brazil / Aumento de las cargas de trabajo en técnicos de enfermería en la atención primaria a la salud en Brasil

Resumo Este artigo analisa os principais aspectos que contribuem para aumentar as cargas de trabalho de técnicos de enfermagem que atuam na atenção primária à saúde no Brasil, identifica o tipo de cargas e classifica os aspectos mais prevalentes para esse grupo ocupacional. Baseia-se em estudo multicêntrico realizado com 24 profissionais das regiões Sul, Centro-Oeste e Norte do Brasil, de 2011 a 2013, por meio de entrevistas semiestruturadas. Os dados foram sistematizados no software Atlas.ti e submetidos à análise temática. Os aspectos que mais contribuem para aumentar as cargas de trabalho são a baixa remuneração mensal, falta de recursos materiais, sobrecarga de trabalho, desgaste e adoecimento, relação com o usuário, e escassez de recursos humanos, prevalecendo cargas psíquicas e fisiológicas. Adequação das condições e organização do trabalho se mostram primordiais para amenizar as cargas de trabalho no cenário da atenção primária à saúde, e para promover a saúde, o bem-estar e a qualidade de vida no ambiente de trabalho dos técnicos de enfermagem.

Abstract In this article we analyze the main aspects that contribute to increase the workloads of nurse technicians working in primary health care in Brazil, we identify the type of loads and rank the most prevalent aspects of this occupational group. It is based on a multicenter study with 24 professionals from the South, Center-west and North regions of Brazil, from 2011 to 2013, using data from semi-structured interviews. The data were systematized in Atlas.ti software and submitted to thematic analysis. The aspects that contribute to increasing workloads are low monthly remuneration, lack of material resources, work overload, wear and illness, relationship with the user, and lack of human resources, prevailing psychological and physiological loads. Adequacy of the conditions and organization of work are shown paramount to ease the workload on the primary health care setting, and to promote the health, wellbeing and quality of life in the nurse technicians working environment.

Resumen Este artículo analiza los principales aspectos que contribuyen para aumentar las cargas de trabajo de técnicos de enfermería que actúan en la atención primaria a la salud en Brasil, identifica el tipo de cargas y clasifica los aspectos más prevalentes para ese grupo ocupacional. Es basado en estudio multicéntrico realizado con 24 profesionales de las regiones Sur, Centro-Oeste y Norte de Brasil, de 2011 a 2013, por medio de entrevistas semiestructuradas. Los datos fueron sistematizados en el software Atlas.ti y sometidos al análisis temático. Los aspectos que más contribuyen para aumentar las cargas de trabajo son la baja remuneración mensual, falta de recursos materiales, sobrecarga de trabajo, desgaste y enfermedad, relación con el usuario, y escasez de recursos humanos, prevaleciendo cargas psíquicas y fisiológicas. Adecuación de las condiciones y organización del trabajo se muestran primordiales para amenizar las cargas de trabajo en el escenario de la atención primaria a la salud, y para promover la salud, el bien-estar y la cualidad de vida en el ambiente de trabajo de los técnicos de enfermería.

Carga horaria laboral y calidad del sueño en médicos residentes del Hospital de Clínicas

Introducción: durante el periodo de residencias médicas se atraviesa por una etapa de gran carga laboral y académica provocando muchas veces una reducción de las horas destinadas al descanso y el sueño. Objetivos: determinar la carga horaria laboral, hábitos de sueño, somnolencia diurna, uso de inductores del sueño y estimulantes de la vigilia de los médicos residentes de primer año del Hospital de Clínicas. Materiales y métodos: diseño observacional, descriptivo, prospectivo y transversal. Muestra probabilística del total de residentes del Hospital de Clínicas. Herramienta utilizada: cuestionarios aplicados a toda la población objetivo, en un período de 14 días. Resultados: muestra de 56 sujetos, 96,4% tienen jornadas laborales de más de 8 horas, de los cuales 44,4% se encuentran en el rango de 8 a 12 horas, 31,5% entre 12 a 15 horas y 24,1% más de 15 horas diarias. Durante las guardias todos realizan jornadas de más de 24 horas, incluso 46,4% completan entre 24 a 36 horas y 53,6% más de 36 horas laborales seguidas. Las horas de sueño entre 4 a 6 hs se halló en 71,4%, mientras que 14,3% duerme menos de 4 horas diarias y 14,3% completan entre 6 a 8 horas de descanso nocturno. El 82,1% presentan somnolencia diurna y 3,6% utilizan inductores de sueño. Conclusiones: revelamos una disminución alarmante de las horas destinadas al descanso y sueño de los residentes con respecto a lo recomendado.

Introduction: During medical residencies physicians are subjected to long work hours and academic burden frequently generating a reduction of the hours dedicated to rest and sleep. Objectives: To determine the working hours, sleep habits, day somnolence, use of sleep inducers and wakefulness-promoting agents of the first year resident physicians of the Hospital de Clínicas. Materials and methods: Cross-sectional descriptive observational design with probabilistic sampling of the total resident physicians of the Hospital de Clínicas. Used tool: questionnaire applied to the target population in a period of 14 days. Results: Sample of 56 subjects, 96.4% had more than 8 working hours, 44.4% of these were in the range of 8 to 12 hours, 31.5% between 12 to 15 hours and 24.1% more than 15 daily hours. During duties all of them have more than 24 hours, 46.4% even had between 24 to 36 hours and 53.6% more than 36 working hours. Sleep hours of 4 to 6 were found in 71.4% while 14.3% slept less than 4 daily hours and 14.3% completed between 6 to 8 hours of night rest; 82.1% presented day somnolence and 3.6% used sleep inducers. Conclusions: We revealed an alarming decrease of the hours dedicated to rest and sleep among resident physician in relation to the recommendations.

Tiempo máximo aceptable de trabajo para tareas ejecutadas con miembros superiores e inferiores / Maximum acceptable work time for the upper and lower limbs tasks

Introducción: La carga física de trabajo es uno de los principales factores de riesgo a los que se enfrentan los trabajadores. En la actualidad los métodos propuestos para evaluar la carga física dinámica contemplan el trabajo con todo el cuerpo y no discriminan por segmentos corporales. Objetivo: Determinar el tiempo máximo aceptable de trabajo cuando el trabajo se ejecuta con todo el cuerpo, con los miembros superiores o los miembros inferiores. Métodos: Se realizó medición de consumo de oxígeno mediante ergoespirometria y monitorización de la frecuencia cardiaca en 30 trabajadores expuestos a diversas cargas ejecutadas con todo el cuerpo, miembros inferiores y miembros superiores. Se determinó el umbral anaeróbico por coeficiente respiratorio, el cual sirvió de base para de determinación del tiempo máximo aceptable de trabajo. Resultados: Los tiempos máximos aceptables de trabajo fueron similares para tareas con todo el cuerpo y con miembros inferiores, pero significativamente menores para tareas realizadas con miembros superiores. Se halló un modelo de correlación exponencial negativo entre en tiempo de trabajo, el consumo de oxígeno, y la frecuencia cardiaca, R > 0,9 en todos los casos. Se plantearon 9 ecuaciones de regresión para determinar el tiempo máximo aceptable de trabajo. Conclusiones: El tiempo máximo aceptable de trabajo para miembros inferiores y para todo el cuerpo se comportan de manera similar. El tiempo máximo aceptables de trabajo con miembros superiores es significativamente inferior a los anteriores. La frecuencia cardiaca relativa parece ser el mejor indicador para medir el tiempo máximo aceptables de trabajo en campo.

Introduction: The physical workload is one of the major risk factors for the workers. At present the proposed methods to assess physical dynamic work load contemplate working with the whole body and not discriminate on body segments. Objective: Determine the maximum acceptable dynamic work time when the work is with the whole body, with the upper and lower limbs. Methods: Oxygen consumption was measurement by ergospirometry and heart rate was monitoring in 30 workers exposed to various loads executed with the whole body, legs and upper limbs. Anaerobic threshold was determined by respiratory quotient, this was used by calculate the acceptable dynamic work time. Results: Statistically significant differences between acceptable dynamic work time for upper limbs and lower limbs were found. Negative exponential correlation model was found between the time the work load and the oxygen consumption and heart rate, R> 0.9 in all cases. Nine regression equations were proposed to determine the acceptable dynamic work time. Conclusion: The acceptable dynamic work time for lower limbs and whole body is similar. The acceptable dynamic work time with upper limbs is significantly lower than the previous. The relative heart rate seems to be the best indicator to measure acceptable dynamic work time.

¿Puede la frecuencia cardíaca ser un estimador del consumo de oxígeno para segmentos corporales? / ¿Can heart rate be an estimation of body segments oxygen consumption?

Introducción: La frecuencia cardíaca es un indicador que se usa con frecuencia para la estimación del consumo de oxígeno. Ha sido empleado para evaluar la carga física global sin embargo su uso para evaluar el trabajo que no involucra todo el cuerpo no ha sido lo suficientemente comprobado. Objetivo: Determinar la relación entre el consumo de oxígeno por segmentos corporales y la frecuencia cardíaca. Métodos: Se estableció la relación entre frecuencia cardíaca, el consumo de oxígeno y el porcentaje de consumo máximo de oxígeno mediante ergoespirometria y pulsometría en 30 individuos expuestos a cargas máximas ejecutadas con todo el cuerpo, miembros inferiores y miembros superiores. Resultados: Se encontraron diferencias estadísticamente significativas entre el consumo de máximo oxígeno por género y por segmentos corporales. No hubo diferencias representativas entre las proporciones de consumo de oxígeno por géneros. La relación entre frecuencia cardíaca y consumo de oxígeno por segmentos y por género fue lineal, con un coeficiente de correlación mayor de 0.9. Conclusiones: Es posible predecir el consumo de oxígeno de miembros superiores y de miembros inferiores y el VO2 máximo a partir de los valores de la frecuencia cardíaca, la cual puede ser usada como estimador del consumo de oxígeno para los segmentos corporales.

Introduction: The Heart rate is an indicator that can be used to estimate oxygen consumption. It has been used to assess physical work load. However its use to assess the work that does not involve the whole body has not been sufficiently proved. Objective: To determine the relationship between oxygen consumption by body segments and heart rates. Methods: The relationship between heart rate, oxygen consumption and percentage of maximum oxygen consumption by ergospirometry and pulsometry in 30 individuals exposed to maximum loads executed with the whole body, legs and upper limbs was established. Results: Statistically significant differences between maximal oxygen consumption by gender and body segments were found. No significant differences between the proportion of oxygen consumption by genres was found. The relationship between heart rate and oxygen uptake by segment and by gender was linear with a correlation coefficient greater than 0.9. Conclusion: It's possible to predict the arms and legs oxygen consumption and oxygen uptake from the heart rate values, the heart rate can be used as an estimate of the oxygen consumption by body segments.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges;staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5’s, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Estimativa das contribuições dos sistemas anaeróbio lático e alático durante exercícios de cargas constantes em intensidades abaixo do VO2max / Estimation of contributions of the anaerobic lactic and alactic systems during constant-load exercises at intensities below the VO2max

O objetivo do estudo foi estimar as contribuições do metabolismo anaeróbio lático (MAL) e alático (MAA) em intensidades abaixo do consumo máximo de oxigênio (VO2max). Dez homens (23 ± 4 anos, 176,4 ± 6,8 cm, 72,4 ± 8,2 kg, 12,0 ± 4,5 % de gordura corporal) realizaram um teste progressivo até a exaustão voluntária para identificação do VO2max, da potência correspondente ao VO2max (WVO2max) e do segundo limiar ventilatório (LV2). Na segunda e na terceira visita foram realizados seis testes de cargas constantes (três testes por sessão) com intensidades abaixo do VO2max. Houve uma predominância do MAL sobre o MAA durante os exercícios submáximos a partir da intensidade correspondente ao LV2, sendo significativamente maior em 90% VO2max (p < 0,05). Dessa forma, esses resultados podem auxiliar treinadores a aplicarem cargas de treinamento adequadas aos seus atletas, de acordo com a exigência metabólica da competição...

The purpose this study was that estimated contributions of the anaerobic lactic (MAL) and alactic (MAA) metabolism during constant load exercises at intensities below the maximal oxygen capacity uptake (VO2max). Ten males (23 ± 4 years, 176.4 ± 6.8 cm, 72.4 ± 8.2 kg, 12.0 ± 4.5 % of fat body) performed in the first visit a progressive test until exhaustion to identification of VO2max, power output corresponding to the VO2max (WVO2max) and second ventilatory threshold (LV2). On the second and third visit, the participants performed six constant workload tests (3 per session) with intensities below VO2max. There was a predominance of MAL about MAA during the exercises sub-maximal from intensity corresponding to the LV2, being significantly higher at 90% VO2max (p < 0.05). Thus, these results may help coaches to implement training loads appropriate to their athletes, according to the metabolic demand of the competition...

Percepção da qualidade de vida no trabalho dos neurocirurgiões em São Paulo / Perception on quality of life at work by neurosurgeons in São Paulo

Contexto: Estudos da percepção da qualidade de vida no trabalho (QVT) permitem estimar a percepção de uma classe profissional inteira, identificar desequilíbrios específicos e proporcionar políticas de desenvolvimento profissional. Objetivo: Avaliar a percepção da QVT dos neurocirurgiões que trabalham em Serviços de Emergência em São Paulo usando instrumentos de validação disponíveis na língua portuguesa. Método: A percepção da QVT dos neurocirurgiões da cidade de São Paulo (Capital) foi estudada com questionário validado para língua portuguesa. Resultados: Cinquenta e oito neurocirurgiões responderam ao questionário. A análise revelou fortes tendências negativas na maioria das áreas de QVT. As áreas com forte tendência negativa deveriam ser tratadas com políticas específicas. Conclusão: Há fortes tendências negativas em quase todos os domínios da QVT.

Context: Studies of the perception of quality of work life (QWL) allow estimating the perception of an entire professional class, identifying specific imbalances and provide professional development policies. Objective: To evaluate the perception of QWL of neurosurgeons working in Emergency Services in São Paulo, using available validated instrument in Portuguese language. Method: The city of São Paulo (Capital) was defined as the geographical area to be studied with a validated questionnaire. Results: Fifty-eight neurosurgeons answered the QWL questionnaire revealing strong negative trends in most areas of QWL. These responses can be compared across institutions and over different periods of time, potentially allowing the identification of locations with more suitable development areas related to QWL. To improve the perception of QWL means, areas with strong negative trend should be treated with specific policies. Conclusion: There is strong negative trends in almost all areas of QWL.

Estudio de la carga global de trabajo y percepción de molestias músculo-esqueléticas en embarazadas atendidas en la unidad de maternidad del Hospital Clínico de la Universidad de Chile / Study of global work load and perception of musculoskeletal discomforts in pregnant women treated in the maternity unit of the Hospital Clínico of the Universidad de Chile

Objetivo: Describir la percepción de molestias músculo-esqueléticas y carga global de trabajo en mujeres embarazadas laboralmente activas e inactivas. Método: Muestra de 30 embarazadas entre las 20 y 34 semanas de gestación atendidas en el Hospital Clínico de la Universidad de Chile. Se evaluó la percepción de molestias músculo-esqueléticas a través del Body Part Discomfort Scale y la Carga Global de Trabajo, mediante el método NASA-Task Load Index. Resultados: El 83,3 por ciento de la muestra presentó percepción de molestias músculo-esqueléticas, siendo pelvis-cadera la región más frecuente. En las mujeres laboralmente activas, un 89,47 por ciento presentó esta percepción y, en las temporalmente inactivas, la percepción de molestias estaba presente en un 81,81 por ciento. Respecto a la Carga Global de Trabajo las dimensiones de exigencia mental y temporal obtuvieron el mayor puntaje en las embarazadas laboralmente activas. Conclusión: El estudio precoz de la percepción de molestias músculo-esqueléticas en mujeres embarazadas, así como también la pesquisa de la carga global de trabajo, es relevante para desarrollar estrategias de prevención de trastornos músculo-esqueléticos tempranas. Se debe avanzar en estudios que determinen el nivel de relación entre los factores de riesgos y el desarrollo de trastorno músculo-esquelético en mujeres embarazadas.

Objective: To describe the perception of musculoskeletal discomforts and global work load in occupationally active pregnant women. Method: A sample of 30 women between 20 and 34 weeks ofgestation who were treated in the Hospital Clínico of the Universidadde Chile. Perception of musculoskeletal discomforts was assessed using the Body Part Discomfort Scale and the Global Work Load with the NASA-Task Load Index method. Results: A 83,3 percent showed the perception of musculoskeletal discomforts, especially in the pelvis and hip region. The percentage of occupationally active pregnant women that presented this perception was 89,47 percent while thepercentage of non-working women was 81,81 percent. Regarding the Global Work Load, dimensions of mental and temporal demand obtained the highest score in working pregnant women. Conclusion: This early study of the perception of musculoskeletal discomforts in occupationally active pregnant women, as well as the screening of the global work load is significant in developing prevention strategies for early musculoskeletal disorders. It is recommended to continueresearch that determines the relationship level between risk factorsand musculoskeletal disorder development.

Factores que influyen en la calidad de atención de enfermería en pacientes con carcinoma mamario / Factors that influence the quality of attention of nursing

Resumen

Introducción: la necesidad de mejorar la efectividad de los cuidados de enfermería ha llevando a numerosos autores a realizar estudio en este sentido, e implementar medidas que ayudan a mejorar la calidad de atención que brindan.

Objetivo: identificar los factores que influyen en la calidad de atención que proporciona el personal de enfermería a pacientes con carcinoma mamario, en un hospital público de Mexicali, Baja California.

Metodología: estudio descriptivo, observacional, transversal y correlacional, la selección de población mediante técnica de censo.

Instrumentos: cuestionarios autoadministrados para el personal y pacientes, que midieron calidad de atención y nivel académico; guía de observación de actividades del personal para determinar carga de trabajo; se utilizó regresión lineal para comprobación de hipótesis.

Resultados: la calidad en la atención, según percepción del sujeto de estudio se clasificó como Buena 82.52 %; carga de trabajo, Regular 24.28 % y nivel académico, Regular 66.6 %. Prueba estadística p = 0.017 (p 0.05) muestra que no existe asociación.

Conclusiones: la carga de trabajo del personal de enfermería sí influye en la calidad de atención de enfermería, no así el nivel académico.

Summary

Introduction: the need to improve the effectiveness of nursing care has brought numerous authors to conduct studies in this regard, implementing measures that help improve quality of care offered.

Objective: to identify the factors that influence in the quality of care provided by nursing staff to patients with breast carcinoma, in a public hospital in Mexicali, Baja California.

Methodology: descriptive, observational, cross-correlation and correlational; Selection of population census through technique.

Instruments used: self-administered questionnaire to staff and patients that measured quality of care and academic level; guide observation of staff activities to determine burden, was used for regression testing of hypotheses.

Results: the quality of care, perceived as a subject of study is classified as Good (82.52 %); work load, Regular (24.28 %) and academic level Fair (66.6 %). Statistical test p = 0.017 (p 0.05) shows that there is no association.

Conclusion: the workload of nurses it affects the quality of nursing care, not the academic level.

Evaluación de un método de cálculo para estimar la carga de trabajo en trabajadores expuestos a condiciones térmicas extremas / Evaluation of a calculation method for estimating work load in workers exposed to thermal stress

La estimación de la carga de trabajo es un problema central cuando se debe determinar el tiempo de trabajo y la distribución de tareas en el diseño de un sistema de trabajo. Para ello, se requiere contar con herramientas que permitan realizar una evaluación rápida y objetiva con el fin de establecer períodos de trabajo y de reposo de los trabajadores -carga de trabajo- en entornos industriales. En esta investigación se usó como eje central de estudio la actividad de los trabajadores utilizando la metodología de los actogramas analíticos de la acción, el registro de datos se realiza con la ayuda del software Kronos, y para la estimación de la carga de trabajo se modificó la ecuación para el cálculo de la tasa metabólica media presentada en los TLV`s y la guía de seguridad: exposition professionnelle à la chaleur, finalmente para determinar el índice de confort térmico se tomó como referencia los índices de estrés térmico y los índices de exigencia térmica desarrollados por Malchaire (1986). Los resultados del estudio permiten establecer la necesidad del uso de un modelo de cálculo que integre las diversas variables (estructura de las tareas y actividades, tiempo efectivo de exposición, índice WBGT). El modelo de análisis desarrollado permite determinar la carga de trabajo. Sin embargo, se debe tomar en cuenta que la estimación de la carga de trabajo requiere una correcta identificación de la relación entre la situación de trabajo y las exigencias de orden fisiológico en el trabajo. Aplicación industrial: el método desarrollado en este estudio es un instrumento fiable y válido para evaluar la carga de trabajo físico para las condiciones de estrés térmico.

Accurate estimation of physical load represents a challenge when determining optimal working times and distribution of tasks in work system design. Tools that allow a rapid and objective evaluation, for the purpose of establishing adequate work-rest cycles, are needed in industrial environments. In this study, worker activity was measured through the use of action analytical actigrams, aided by Kronos data logging software. For estimation of physical work load we used a modified equation based on the average metabolic rate calculation described in the TLV booklet and on the safety guide "Exposition professionnelle à la chaleur". Calculation of the thermal comfort index was based on the thermal stress and thermal demands indices developed by Malchaire (1986). Results from this study establish that physical work load estimation requires the use of a model that calculates and integrates several variables (tasks and activities structure, effective time of exposure, and WBGT index). The analytical method used allows estimation of physical work load. However, it should be recognized that physical work load estimation requires the correct identification and understanding of the relationships between work conditions and the physiological demands of the job. Industrial application: the method developed in this study represents a reliable and valid tool for assessing physical work load under conditions of thermal stress.