Violência no trabalho: vivências e estratégias de enfrentamento por enfermeiros de unidades de pronto atendimento

RESUMO Objetivo: Revelar as vivências e as estratégias de enfrentamento diante da violência no trabalho sofrida por enfermeiros de Unidades de Pronto Atendimento. Material e Método: Estudo qualitativo desenvolvido entre novembro e dezembro de 2018 por meio de entrevistas individuais e gravadas em áudio, com 21 enfermeiros de duas Unidades de Pronto Atendimento de uma cidade localizada no interior do Paraná, Brasil. Para a análise de dados utilizou-se a técnica de análise de conteúdo proposta por Bardin. Resultados: Foram identificadas quatro categorias: 1) Motivos para a violência no trabalho de enfermagem; 2) desdobramento da violência no trabalho de enfermagem; 3) os sentimentos dos enfermeiros em relação à violência no trabalho; e 4) as estratégias de enfrentamento dos enfermeiros diante da violência no trabalho. As vivências de violência estão relacionadas à demora na assistência, ser mulher e exercer atividades públicas. Quanto às estratégias de enfrentamento utilizadas estiveram pautadas com o comunicar às autoridades locais, exercer a escuta ativa e empatia, manter a calma e a espiritualidade. Conclusões: Os enfermeiros têm um olhar crítico e abrangente sobre a violência que sofrem no ambiente laboral das Unidades de Pronto Atendimento advindos dos pacientes e acompanhantes devido a fatores como demora no atendimento, recursos humanos em quantidade não adequada, alta demanda de pacientes, bem como a questão de preconceitos com trabalhadores do sexo feminino na enfermagem.

ABSTRACT Objective: To reveal the experiences and coping strategies in the face of workplace violence suffered by nurses in Emergency Care Units. Material and Method: Qualitative study conducted between November and December 2018 through individual and audio-recorded interviews with 21 nurses from two Emergency Care Units in a city located in the state of Paraná, Brazil. For data analysis, the content analysis technique proposed by Bardin was used. Results: The following four categories were identified: 1) Motives for violence in the nursing work; 2) Violence escalation in the nursing work process; 3) The nurse's feelings concerning work-related violence; and 4) The coping strategies among nurses in the face of work-related violence. The experiences of violence were related to delayed care, being a woman and holding important public activities. The coping strategies used were communicating to local authorities, practicing exercising active listening and empathy, keeping calm and spirituality. Conclusions: Nurses have a critical and comprehensive view of the violence they suffer in the work environment of Emergency Care Units from patients and companions due to factors such as delayed care, inadequate human resources, high patient demand, and prejudice against female nursing workers.

RESUMEN Objetivo: Conocer las vivencias y estrategias de afrontamiento ante la violencia laboral que sufren los enfermeros en Servicios de Atención de Urgencia. Material y Método: Estudio cualitativo cuya recolección de datos se realizó entre noviembre y diciembre de 2018 a través de entrevistas individuales y grabadas en audio, a 21 enfermeras de dos Servicios de Atención de Urgencias de una ciudad del interior de Paraná, Brasil. Para el análisis de los datos se utilizó la técnica de análisis de contenido propuesta por Bardin. Resultados: Fueron identificadas cuatro categorías, a saber: 1) Los motivos de la violencia en el trabajo de enfermería; 2) Desdoblamientos de la violencia en el proceso de trabajo de Enfermería; 3) Los sentimientos del enfermero o la enfermera frente a la violencia laboral y 4) Los enfrentamientos utilizados por enfermeros y enfermeras frente a la violencia laboral. Las experiencias de violencia estuvieron relacionadas con el retraso en el cuidado, ser mujer y ejercer actividades públicas. Las estrategias de afrontamiento utilizadas son la comunicación a las autoridades locales, el ejercicio de la escucha activa y la empatía, el mantenimiento de la calma y la espiritualidad. Conclusiones: Las enfermeras tienen una mirada crítica e integral sobre la violencia que sufren en el ambiente de trabajo de las Unidades de Atención de Urgencia de pacientes y acompañantes, en donde están presentes factores como la demora en la atención, recursos humanos inadecuados, alta demanda de pacientes, así como los prejuicios contra las trabajadoras de enfermería.

Risk factors associated with drug-resistant tuberculosis in prisons in Sao Paulo State, Brazil (2006-2016).

INTRODUCTION: Prisons are high-risk settings for drug-resistant tuberculosis because the prevalence of the tuberculosis (TB) is much higher than in the general population. This study to investigated the factors associated with drug-resistant tuberculosis in prisons in the state of São Paulo, Brazil. METHODOLOGY: Retrospective cohort of drug-resistant TB cases for incarcerated people in São Paulo state, reported in the Tuberculosis Patient Control System between 2006 and 2016. To analyze the factors associated with drug-resistant TB, the backward method (likelihood ratio) was used, determining the adjusted odds ratio and respective 95%CI coefficients. Multiple models were proposed to adjust for potential confusion and interaction. The best fit model was selected based on the lowest Akaike information criterion coefficient. RESULTS: In total, 473 drug-resistant tuberculosis cases were reported in the prison population of Sao Paulo state, the majority were male. The cases that presented negative results for sputum smear and sputum culture had, respectively, an aOR=0.6 and aOR=0.16 for drug-resistant tuberculosis in relation to the cases with positive results. The cases where the patient had AIDS and reported alcoholism, respectively, an aOR=1.47 and aOR=1.60 for drug-resistant TB. Individuals with a background treatment history for TB presented a stronger association with drug-resistant tuberculosis, aOR=35.08. CONCLUSIONS: Sputum spear, sputum culture, chest X-ray, AIDS, alcoholism and background treatment history for TB were factors associated with resistance to antituberculosis drugs among prisoners. This is useful for the implementation of disease control measures related to the detection and monitoring of cases in the prison system.

The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil.

INTRODUCTION: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. CONCLUSIONS: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.

Burnout among nursing students: a mixed method study.

OBJECTIVES: Investigate the burnout syndrome among undergraduate students in nursing. METHODS: Explanatory sequential mixed method study conducted at a public university in Brazil. Of the 119 nursing students, 114 consented to participate and answered a questionnaire composed of sociodemographic, academic variables, and the Maslach Burnout Inventory - Student Survey, which were analyzed by multiple linear regression. The participants of the quantitative phase with the indicative / risk of burnout were interviewed individually (n=21) to provide an in-depth understanding of the students' experiences regarding the dimensions of the syndrome, whose statements were analyzed by the Collective Subject Discourse. RESULTS: The prevalence of burnout syndrome was 10.5% among the surveyed. The more advanced the school year, the higher were the exhaustion (p=0.003), depersonalization (p < 0.001) and low academic effectiveness (p=0.012) scores. Students with a higher workload of assignments also had higher scores of exhaustion (p=0.001), depersonalization (p < 0.001) and academic (in)effectiveness (p=0.042). Dissatisfaction with the course was related to higher exhaustion (p=0.049) and depersonalization (p=0.001). The collective speeches showed the daily demands of the course, considered as intense, producing overload and exhaustion, which produced symptoms of physical and mental illness. Thus, there was the student's distancing from the course activities, as a defensive attitude, which culminated in feelings of incompetence and frustration. CONCLUSIONS: The occurrence of burnout syndrome dimensions among nursing students was related to the activities of academic daily life. It is urgent to invest in health promotion and prevention actions of these individuals in the university context.

Burnout among nursing students: a mixed method study

Objective. Investigate the burnout syndrome among undergraduate students in nursing. Methods. Explanatory sequential mixed method study conducted at a public university in Brazil. Of the 119 nursing students, 114 consented to participate and answered a questionnaire composed of sociodemographic, academic variables, and the Maslach Burnout Inventory - Student Survey, which were analyzed by multiple linear regression. The participants of the quantitative phase with the indicative / risk of burnout were interviewed individually (n=21) to provide an in-depth understanding of the students' experiences regarding the dimensions of the syndrome, whose statements were analyzed by the Collective Subject Discourse. Results. The prevalence of burnout syndrome was 10.5% among the surveyed. The more advanced the school year, the higher were the exhaustion (p=0.003), depersonalization (p<0.001) and low academic effectiveness (p=0.012) scores. Students with a higher workload of assignments also had higher scores of exhaustion (p=0.001), depersonalization (p<0.001) and academic (in)effectiveness (p=0.042). Dissatisfaction with the course was related to higher exhaustion (p=0.049) and depersonalization (p=0.001). The collective speeches showed the daily demands of the course, considered as intense, producing overload and exhaustion, which produced symptoms of physical and mental illness. Thus, there was the student's distancing from the course activities, as a defensive attitude, which culminated in feelings of incompetence and frustration. Conclusion. The occurrence of burnout syndrome dimensions among nursing students was related to the activities of academic daily life. It is urgent to invest in health promotion and prevention actions of these individuals in the university context.

Objetivo. Estudiar el síndrome de Burnout entre estudiantes de enfermería. Métodos. Estudio de método mixto secuencial explicativo realizado en una universidad pública de Brasil. De los 119 alumnos de enfermería, 114 consentieron en participar y respondieron un cuestionario compuesto por variables sociodemográficas, académicas y el Maslach Burnout InventoryTM - Student Survey. Los participantes de la fase cuantitativa con el indicador de riesgo de burnout se entrevistaron individualmente (n=21) para proporcionar una comprensión profunda de las experiencias de los estudiantes acerca de las dimensiones del síndrome, cuyos testimonios se analizaron con la técnica de Discurso del Sujeto Colectivo. Resultados. La prevalencia de sindrome de burnout fue de 10.5% entre los investigados. Cuanto más avanzado el año de estudio del alumno, eran mayores los puntajes de agotamiento (p=0.003), despersonalización (p<0.001) y baja eficacia académica (p=0.012). Los estudiantes con mayor carga horaria de asignaturas también presentaron mayores puntuaciones de agotamiento (p=0.001), despersonalización (p<0.001) e (in)eficacia académica (p=0.042). La insatisfacción con el curso se relacionó con un mayor agotamiento (p=0.049) y despersonalización (p=0.001). En los discursos colectivos se evidenciaron las exigencias cotidianas del curso, consideradas como intensas, generadoras de sobrecarga y agotamiento, que producían síntomas de enfermedad física y mental. Por lo tanto, como una actitud defensiva, hubo distanciamiento del estudiante de las actividades del curso que culminó en sentimientos de incompetencia y frustración. Conclusión. La aparición de las dimensiones del síndrome de burnout entre los estudiantes de enfermería estuvo relacionada con las actividades de la vida diaria académica. Es urgente establecer acciones de promoción y prevención en salud para estos individuos en el contexto de la universidad.

Objetivo. Investigar a síndrome de burnout entre estudantes de graduação em enfermagem. Métodos. Estudo de método misto sequencial explanatório realizado em uma universidade pública do Brasil. Dos 119 alunos de enfermagem, 114 consentiram a participação e responderam a um questionário composto de variáveis sociodemográficas, acadêmicas e o Maslach Burnout InventoryTM - Student Survey, que foram analisados por regressão linear múltipla. Os participantes da fase quantitativa com indicativo/risco de burnout foram entrevistados individualmente (n=21) para fornecer uma compreensão aprofundada das experiências dos estudantes acerca das dimensões da síndrome, cujos dizeres foram analisados pelo Discurso do Sujeito Coletivo. Resultados. A prevalência de síndrome de burnout foi de 10.5% entre os pesquisados. Quanto mais avançado o ano letivo maiores foram os escores de exaustão (p=0.003), despersonalização (p<0.001) e baixa eficácia acadêmica (p=0.012). Os estudantes com maior carga horária de disciplinas/matérias também apresentaram maiores pontuações de exaustão (p=0.001), despersonalização (p<0.001) e (in)eficácia acadêmica (p=0.042). A insatisfação com o curso foi relacionada a maior exaustão (p=0.049) e despersonalização (p=0.001). Nos discursos coletivos evidenciaram-se as exigências cotidianas do curso, tidas como intensas, produtoras de sobrecarga e exaustão, que produziam sintomas de adoecimento físico e mental. Assim, houve o distanciamento do estudante das atividades do curso, como uma atitude defensiva, que culminou em sentimentos de incompetência e frustração. Conclusão. A ocorrência das dimensões da síndrome de burnout entre os estudantes de enfermagem esteve relacionada às atividades do cotidiano acadêmico. Torna-se premente investir em ações de promoção e prevenção da saúde desses indivíduos no contexto da universidade.