The situation of nursing work and occupational risks from an ergological perspective 1

Copyright © 2013 Revista Latino-Americana de Enfermagem This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC). This license lets others distribute, remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms. Corresponding Author: Rosane Teresinha Fontana Rua Sete de Setembro, 1126 Bairro: Centro CEP: 98801-726, Santo Ângelo, RS, Brasil E-mail: rfontana@urisan.tche.br Rosane Teresinha Fontana2 Liana Lautert3


Introduction
Societal changes and new demands have changed the social worlds of work and economics and have raised questions about skills, cultures, obsolescence and illness. In this sense, we can observe workers as they transform prescribed work situations that establish rules and standards in order to combine productivity and body economy. This is the operational context of ergology, a science that proposes reinterpretations of work and the concepts of action and activity. The ergological method approaches work based on the experience of the person who performs the work, and it analyzes the relationship between the person and the environment (1) .
Work, according to ergological assumptions, is a human activity situated in time and space that occurs within the process of life (2) . Ergology views work as the use of oneself by others and the use of oneself by oneself.
Thus, activity is a "drama" of the use of oneself because situations vary depending on the capabilities, resources and selected choices (1) . Faced with a lack or deficiency of antecedent norms or prescriptions, the subject needs to renormalize or restandardize, or in other words, to discuss, adapt or change the norms.
Empirically, nursing team workers in many primary health network scenarios can be found working under risky conditions when considering some factors present in this context, such as neglect and impudence by the workers themselves or bad uses of oneself, which are allied with the precarious aspects of the work, the lack of norms and managerial neglect regarding worker health.
However, a discussion of the work conditions associated with nursing, based on the knowledge expressed by individuals who perform the work and focused on occupational risk exposure, could be relevant. This is because such a discussion performs a legitimate diagnosis of the health-disease-work process according to a synergistic dialogue with the protagonists and obtains elements for an intervention intended to improve the worker's quality of life.
In ergology, technical rationality is not sufficient; it is also necessary to consider the rationality of the actual worker activity (1) . It is thought that restricting technical analyses to occupational risks while ignoring other involved dimensions will not lead to a complete understanding of the work process, thus justifying the study from this perspective. should not be confused with 'sub-knowledge', and it is essential that one knows and recognizes the disciplinary knowledge that circulates and that can be recreated while performing the activity (1) .
In Pole III, the knowledge derived from work situations was merged with science to form proposals for a healthy working environment; these were circumscribed by learning and entrepreneurial learning, a form of humility regarding the work activity that leads to the stripping back of intellectual rationality and intellectual discomfort to comprise a pole for the common world, built from ethics and epistemics (1) . The TPDD is therefore the intersection where divisions are broken.
A preliminary analysis of the data (interviews, observations and expert opinions) was presented for discussion and validation. For this purpose, all study participants were invited to a group meeting that was attended by 15 subjects. The aim of this meeting was to validate the data and, from a collective discussion of the data, to build new knowledge that would be represented by proposals for improving the work climate/situation. Those who agreed to participate were asked to sign a Terms of Informed Consent form. The nursing technician who collects blood in the AIDS treatment and care section is also exposed to risks as she performs her duties in a precarious area without proper safety equipment to assist tuberculosis patients;

Work situation conditions and occupational risks
this type of infection is very frequent in these users and confirms the occupational vulnerability of nursing staff to this disease (6) . In all sections, there is a lack of availability of personal protective equipment in terms of quantity, quality and specificity, thus exposing workers to biological, mechanical and accident risks. From the data, it can be inferred that both good and bad uses of oneself coexist in the service working environment; the bad uses are generally due to difficulties in dealing with health system gaps and a lack/deficiency of norms.
At the meeting to discuss and validate the study data, the workers noted some alternatives for creating a healthy environment. These resulted from the merging of the knowledge invested in the activity and the disciplinary concepts, thus constituting learning and entrepreneurial learning (1) .
The workers suggested labor gymnastics programs, a psychology service and health education activities that could be optimized through partnerships with the Regional University, which could also help to develop projects that would improve the unit. Some workers expressed concern about non-compliance with NR 32 (5) .
Recommendations for improvements to the furniture, physical area and logistics were cited for proper activity development, as well as changes in the logistics of production of materials for this population. The workers believed that 90% of their colleagues were committed, but needed a manager to organize the service. The subjects referred to management difficulties that caused problems of all types. They requested a leader who would be responsible for the service, a general unit coordinator and a proposed Career and Salary Plan, elements that would contribute to the organization and regulation of labor relationships.

Discussion
In every activity, there is a dynamic into which disruptions and discontinuities are introduced that require the worker to make constant restandardizations regarding the creation of new norms for the performance of his/her task (7) . Each day, the worker weaves his/her activity in an intersection between the 'weft', or technical and organizational knowledge tools and users, and the 'warp', the person's own history, with a body that learns and grows older along with his/her values, knowledge and desires (1) . It can be difficult to establish health work competencies because the subject is complex, the work situations are difficult to standardize and the care process involves eternally singular encounters between people (8) .
Antecedent norms, which the individual can restandardize, almost always exist before the activity and are often prepared by experts with characteristics that are different from the uniqueness of the users for whom the norms are intended. It is known that, to work, the subject requires antecedent norms, which in this study are characterized by manuals, technical notes, prescriptions and standardized procedures. However, it is possible to recreate, reinterpret and develop those norms as a singular activity through successive restandardizations, thus constructing an environment that belongs to oneself (9) and allowing activity ownership by the worker and body economy. However, the choice to transgress from the norm can impose responsibilities on those who work, due to the risks that micromanagement can introduce to the work process. Additionally, the 'secret' of uses of oneself might place the worker in solitude. Thus, it is necessary to publicize the technical act of use of oneself because this attitude confers recognition upon the subject's skill and his/her inventiveness (10) . However, attention should be paid to contraventions of norms that involve bad uses of oneself because contraventions can induce colleagues and become catastrophic when an individual change in work method is significant to the collective.
Work in this context constitutes an industrious activity in the sense of mastery and skill (9) in the management of one's own performance. For ergology, this supposes a constant debate between norms that "go beyond the work environment, but lie within the work environment" (11) .
The antecedent norm, Ordinance 500 (12) of the State of Rio Grande do Sul, prescribes that medical item processing sites must provide equipment for the cleaning, disinfection or sterilization of materials. Resolution no.
42 (13) establishes the mandatory provision of alcohol for hand antisepsis by health services. According to the RDC50 (5) , the physical area for AIDS outpatient care should include an individual inhalation room for treatment, and there are regulatory standards (4) that make it compulsory for employers to provide PPE; these were missing elements in the field under study.
The service's disengagement with and disrespect of worker protections in the workplace is a demotivating and unsettling factor that leads to a greater likelihood of mistakes and accidents. Thus, management and organizational practices have significant effects on the healthiness of the work environment (14) .
Regarding the lack/deficiency of norms, it is worth noting that, while antecedent norms are valued, "they fall short due to a lack of other important factors for job viability that allow the achievement of health, ways of doing things and the conditions for doing so" (15) . Thus, there may be a sort of weakening of the possibility of environmental (re) creation that is established by the work organization and offered conditions.
Among other things, these norms were not fully met in the studied field due to difficulties in micromanagement -management of oneself and of the environment by the workers -that were caused by difficulties in macromanagement adherence. It should be noted that micromanagement exists in all work because "in the space between the work prescribed and actually performed, there is a requirement for micromanagement of the situation and the constant trading of collective exchanges" (7) .
Thus, the worker is asked to restandardize in his/ her own way to make work possible, while making some There is always an engagement of the body-self in work, and thus some risk is inevitable and is not solely the responsibility of the activity protagonists, considering that, in a work situation, this is not possible due to the relationship between autonomy and heteronomy and also to the subordinate relationship of workers to employers (17) .

Repetitive Strain Injuries (RSI) and Work-Related
Musculoskeletal Disorders (WMSDs), which were cited by the workers, are multifactorial (18) . These transform work into suffering, which extends into the rest period because symptom onset occurs during peak production and at the end of the working day, thus requiring the worker to rest the affected area at night, while at home.
A study that evaluated the association between musculoskeletal pain intensity and the ability to work in nursing professionals identified that ratings of severe pain and unbearable pain were positively associated with a reduced ability to work (19) . That result confirms the Fontana RT, Lautert L.
influences of this type of injury on both worker health and the quality of the work process (19) .
Another issue discussed by the workers was physical risk. The antecedent norm, or NR 17 (4) , requires temperatures of 20-23ºC for thermal comfort and noise levels between 30-55 dB(A) for acoustic comfort (20) , parameters that were not observed in this service.
Together with the worker that uses oneself, restandardizes and makes his/her activity possible through micromanagement, it is possible to wonder about the effective adherence of 'macro and mesomanagement' in the workplace and the co-management of all that contributes to health in this area.
Collective strategies to prevent harm and health risks should aim to improve work organizations and involve the provision of a safe environment and materials for activity development, the implementation of educational programs and an awareness of behavioral changes by both workers and managers (21) . The latter is essential for the environment to develop in a way that adds value and attention to the caregivers and service users.

Conclusion
The studied service nursing team experienced some occupational risks in their daily work that were expressed through synergistic dialogues and participant observations. The occupational risks that caused the greatest subject exposure to suffering and physical and mental illnesses were psychosocial risks, which were characterized by verbal abuse and a lack of security.
The subjects also expressed distress with regard to the precariousness of the service, specifically a lack of adequate materials and facilities, which was a situation that caused worker embarrassment when it led to poor quality work.
Profound insights on work conditions and risk exposure on the basis of studies in primary health units are imperative for all system managers, from micro to macrospace, who aim to propose alternatives to minimize suffering at work.
Effectiveness and efficiency, which are associated with access to and improvements of the health system, and cross-disciplinary knowledge are key to addressing this critical problem in public health service provision.
For the population, educational campaigns about the health system are imperative to an understanding of the dynamics of this network and the valuation of public servants.