Retraining Due to Illness ant its Implications in Nursing Management

There is currently an increased interest in workers’ health. Retraining due to illness is the topic of this study. The objective of this qualitative study was to understand how individuals cope with job retraining in a public hospital, utilizing interviews to understand how nursing professionals coped with the retraining process, which were then analyzed using Content Analysis as proposed by Bardin. The responses revealed problems in several areas of nursing work: “Work Organization”, “Teamwork”, “Sick leave and retraining”, and “Team Management”, altogether generating suggestions for improving the work experience in retraining. The retraining process generated individual, professional and social feelings of incompetence and guilt for workers. Important reflection and attitude changes are urgently needed, supporting team management, which will consequently improve care provided to the public.


Introduction
Workers' health is one of the priorities currently established in health services because it reflects on sick leave and on situations that require functional readaptation.
Systems are supported in the logic of productivity and rationalization of resources in a capitalist society, hence, the discourse about concern with workers' health does not always result in effective actions. Work overload, connivance of managers with poor working conditions might consequently have a negative effect on the quality of care delivered.
This study was carried out in a public hospital and originated from the concern that arose from this context and the desire to better understand it. The perception that workers suffer in the face of the re-adaptation process coupled with the scarcity of publications about the theme triggered the interest in the study, which was guided by the following question: how do workers experience the Batista JM, Juliani CMCM, Ayres JA.

process of illness and functional retraining?
Understanding and reflection about the way readaptation processes develop and also their implications for management in nursing justify the development of this study, since implications for personal, social and managerial spheres can all be identified in these processes. Many of these implications are inherent to nursing teamwork itself, which reflects on the care delivered to patients. Care quality is only achieved when the institution becomes involved and values workers and their respective work conditions. Thus, we aimed to understand the experience of the process "from disease to functional retraining" based on the reports of formally re-adapted members of the nursing team.

The retraining process and the nursing context
Nursing workers whose historical archetypes are focused on intense dedication to work, submission to other professionals in the health fields and who are exposed to environmental and psychosocial risks leave their occupational activities only when harm to their health becomes unbearable.
Functional re-adaptation is defined as "locating employees in functions or activities and responsibilities compatible to their limitation imposed by their physical or mental capacity, verified by medical examination" (1) .
The Quality of working life (QoWL) of nursing professionals is undermined due to aspects related to inadequate remuneration, imbalance between work processes and extra-organizational life, to the lack of prospects for career ascension, to the bureaucratic organizational culture and lack of human resources (2) .
Nursing management requires the leadership to be able to observe her/his team in an integral and integrating way. Nurses can identify the emergence of occupational diseases and interfere in work organization through their educational and leader's role.

Methodological Path
This qualitative study is analyzed through thematic content analysis (3) . This technique objectively and

Results and Discussion
On average, interviewees were 47.9 years, had graduated 21.6 years ago and worked in the institution for 14.1 years. The pathologies that led to the readaptation process were diseases of the musculoskeletal system and connective tissue in seven individuals, mental and behavioral disorders, especially depression in one individual, and injuries, poisoning and some other consequences of external causes in one individual. Three were kept in nursing activities with some limitations after re-adaptation, four were kept in clerical functions and two were still on sick leave. Nursing work overload and shift schedule were perceived as aggravating factors in a work that generates occupational diseases. The evaluation of consequences of diseases on workers and the level of incapacity at the time of diagnosis influence their capacity to resume their activity (4) .
One has to establish a method of organizing work that allows a rotation of activities according to the competence of each category without harming care delivery, patients, or the institution itself (5) .
Nursing workers are exposed to several burdens such as biological, chemical, and psychological and we also observed mechanical and physiological loads such as the manipulation of excessive weight, standing, inappropriate positions and night shifts and shift rotation in the analyzed category (6) .
These conditions contribute to the development of muscoskeletal disorders. The type of activities and the intense work rhythm in addition to the work organization itself are possibly causal factors related to the occurrence of these injuries (7) .
Nursing workers "put aside" their own health, which evidences the influence of the historical archetype, in which self care is subservient to patient care. Professionals resist acknowledging the disease or incorporating preventive actions.
Health workers show a strong concern for client care and little concern for the risks they are exposed to when delivering care (8) . Being constantly exposed to concrete risks, workers tend to naturalize them as a mechanism of defense to preserve psychological survival. Risks are unconsciously accepted as part of the job (9) .
The delay in diagnosing diseases and lack of health care available to health workers contribute to increasing concern over the Single Health System and its representatives in providing health to its health workers. Therefore, resolutions, regulating standards and occupational health committees (COMSAT) in hospital facilities are established (10) .
This scenario is already changing the studied institution with the implementation of a committee called COMSAT, which is constituted by one coordinating nurse, two generalist physicians and two nursing auxiliaries.
Although the team does not meet all the current needs, it attends workers, follows-up on occupational accidents, promotes educational activities and promotes supervisorial activities in the facility supervises.
Difficulties are experienced, especially due to a lack of workers' knowledge regarding their role as agents responsible to prevent the injuries to which they are exposed to and also as participants in the process of recovering their own health.   The team's relationship issues evidence the resistance of health professionals in accepting the disease process. They do not acknowledge or question the severity of the disease. This situation reproduces occupational violence, in which the nursing team is the victim, which seeks to defend itself through verbal aggressions within the group itself and shows indifference to the suffering of any of its members (11) .
Difficulties are manifested during teamwork,

Poor work conditions coupled with difficulties
in relationships harm the daily and private lives of workers (13) . Suffering increases as efforts exerted to satisfy needs in the affective, political, social and material spheres are not fully effective (14) . The quality of working relations along with group conflicts lead to psychological imbalance (15)(16) .
Category C includes the sick leave burden and functional re-adaptation. Relevant facts are expressed in reports through the themes the sick leave burden, negative feelings and benefits of re-adaptation. Given the scarcity of research on this subject, we focused on the discussion that we believe contributes to management in nursing. […] I was and still am a very happy person because I do something for others, even in re-adaptation. I'm happy even with my problem, in the unit (H4).

[…] I say on my last workday in the month: "Thank my
Lord for another month I was able to work!" (seems touched) Working is a source of satisfaction for human beings because it provides for material, emotional, social and power needs.
Some have the impression that some symptoms and pain are only in the mind of patients/workers or that they are pretending. Some believe they want to have some secondary gain when they complain of pain (12) . If this is the case, this behavior should be investigated to find out what are its determinants. "social well being" without giving these conceptions a precise content seems to be a mistake (13) . When work is organized in a humanized way, considering the participation of workers and taking into account group decisions, it promotes change and valorization (5,17) . Hence, a participative administration does not mean the leadership's responsibilities are reduced (12) .
A previous study (18)

Considerations
This study focused on the category Functional Re-adaptation, which was not well represented in the literature. Thus, the importance of this study is to complement knowledge in the field, since it might promote reflection on and changes in this process.
The contradictory feelings that emanate from agents who experience this process, from negative, painful and suffering moments to feeling reborn afterwards, from these who oftentimes are devoid of emotional support, technical guidance and support for work problems, led to the desire to seek for potential solutions.
The recovery of nursing workers' health promotion is essential, stressing that many of these injuries are predictable, hence preventable.
Nursing management can, through its team's knowledge and in an integral way, promote organizational and educational actions to improve the workers' quality of life. These actions should not be restricted to the leadership's sphere of competence but they also should be linked at institutional levels that are related to the problem such as the Human Resources Department, COMSAT and the hospital's command.
Denying or omitting the problem should be avoided so that the way workers' health is addressed is transformed in this historical moment and the concept of integrality in health is effectively considered.