Work accidents and self-esteem of nursing professional in hospital settings

Abstract Objective: to analyze the occurrence of work accidents and the self-esteem of nurses in hospitals of a municipality of Minas Gerais. Method: descriptive-analytical and cross-sectional study developed with 393 nursing professionals from three hospitals of a municipality in southern Minas Gerais. The Rosenberg Self-Esteem Scale and a questionnaire to characterize the population and work accidents were used for data collection. Data analysis was performed using Person's chi-squared test, Fisher's exact test, Cronbach's alpha, odds ratio and logistic regression. Results: of the professionals studied, 15% had suffered an accident at work and 70.2% presented high self-esteem. Through the analysis, it was observed that smoking, religious belief and an outstanding event in the career were significantly associated with work accidents. In relation to self-esteem, family income, length of time working in the profession and an outstanding event in the career presented significant associations. Conclusion: factors such as smoking, religious belief, family income, length of time working in the profession and an outstanding event in the career can cause professionals to have accidents and/or cause changes in self-esteem, which can compromise their physical and mental health and their quality of life and work.


Introduction
With the changes occurring in the working world in the twenty-first century, professionals now face greater demands in the workplace, increasing their psychological and work burden. With this, the number of accident reported in the workplace has increased. In 2010 there were 709,974 workplace accidents in Brazil, in 2013 this number increased to 717,911 reports (1)(2) .
Work can often be seen as a causative factor in changes in the conditions of living, illness and death of people. Thus, the work itself, which values and dignifies people, can cause suffering and illness when not performed in adequate conditions that do not favor the psychophysiological capabilities of individuals. This is especially the case for those that work in healthcare, such as nursing professionals (3) .
The representation of nursing professionals in the Brazilian labor market is high. A survey of health professionals conducted in 2015 showed that of the 3.5 million health workers, 1,800,000 were nursing professionals. This highlights the importance of these workers in the health context in the country (4) .
The work carried out by nursing professionals involves physical proximity of the patient, due to the care process. Thus, these workers are exposed to occupational risk factors, such as physical, biological, chemical, ergonomic and psychosocial factors, which can cause occupational diseases and/or work accidents.
Among the most frequent accidents suffered by nursing professionals are accidents with biological materials and with sharps objects (5) .
The exposure of nurses to biological material caused by accidents is a factor that causes suffering at work. These workers, in addition to facing emotional difficulties, such as the fear of falling ill and family and work repercussions, are also subject to embarrassment due to suffering the accident. These factors can lead to personal and social problems, causing changes in wellbeing and psychological effects, including changes in self-esteem (6) .
Self-esteem reflects the positive or negative attitudes towards oneself. It is considered a set of feelings and thoughts about self-worth, competence and adequacy (7) . Considering this, it is necessary to relate the occurrence of accidents with nursing professionals to changes in their self-esteem, since emotional problems can affect individuals in their work and in their lives.
In a study conducted in the United States, it was shown that loss of productivity of workers was related to emotional problems, reducing their performance by almost 36% (8) . National and international studies (5)(6)(7)(8) have observed the occurrence of accidents at work of nursing professionals and their exposure to psychological harm, such as anxiety, depression, stress and low self-esteem.
Given these findings, due to the problems that work accidents and changes in self-esteem can cause for workers and considering the lack of studies addressing this subject (work accidents and selfesteem), the importance of analyzing the occurrence of workplace accidents suffered by nurses and their self-esteem is justified. This analysis can support knowledge to strengthen the promotion of health of these professionals, leading to better quality of life and mental health, which in turn, can influence the quality of care provided to users.
Thus, the aim of this study was to analyze the occurrence of workplace accidents and the self-esteem of nursing professionals in hospitals of a municipality of Minas Gerais. to assess the positive and negative feelings of the individual. The range of the scale score is 10 to 40, with higher scores indicating higher the levels of selfesteem. Therefore, the classification of the self-esteem is measured considering the following cut-off scores: more than 30 points = high self-esteem, 20 to 30 points = normal self-esteem, and lower than 20 points = low self-esteem (9) .

Method
The collected data were entered into a MS-Excel, In this study, a 5% level of significance was adopted, that is, data were statistically significant when

Results
The sample was mainly composed of female  Regarding the self-esteem of the professionals, Table 2 shows the distribution of nursing professionals according to the classification observed. In the assessment of the distribution of the nursing professionals according to the classification of self-esteem, it was found that the majority presented high self-esteem. However, a relevant percentage of professionals were classified as having normal selfesteem and low self-esteem, as shown in Table 2.
In assessing the internal consistency of the In the univariate analysis of the factors associated with self-esteem, only two variables were significantly associated, according to Table 3.

Confidence interval
In this analysis, it was found that the variables monthly family income and an outstanding event in the career were significantly associated with self-esteem. It was evidenced that the nursing professionals who had a monthly family income of up to R$3,000 were nearly 2 times more likely to have low/normal self-esteem, and the professionals who had undergone some outstanding event in their career were nearly 2 times more likely to have low/normal self-esteem, according to Table 3 The logistic regression model of the variables that were significant for the occurrence of occupational accidents and the measure of self-esteem is presented in Table 4.  Table   4. Thus, the final model showed that the professional who was Catholic was 2.8 times more likely to suffer an accident at work. In addition, the nursing professionals who experienced an outstanding event in the career were 2.4 times more likely to suffer a workplace accident.
After  Table   4. Thus, professionals with over 10 years of professional experience in the field of nursing were 2 times as likely to have low/normal self-esteem and those who experienced an outstanding event in their career were nearly 2 times more likely to have low/normal self-esteem.
When evaluating the association of the self-esteem variable with the occurrence of work accidents among the nursing professionals, it was clear that there was no significant association between these two variables (p=0.966).

Discussion
It was observed in this investigation that some of the nursing professionals suffered some kind of accident at work. The majority of these accidents were with sharp objects, occurred during the night shift and were reported in the CAT by the professionals. A study conducted in a city of the state of Paraiba, with 39 nursing professionals, showed that 49% of them suffered an accident at work, 84% of the accidents were caused by sharps objects and 79% of the cases were not reported (10) . Another study developed in northeastern Brazil, with 45 nursing professionals, found that 60% of them had accidents and 24% of these occurred during the night shift (11) .
Work accidents are often justified by the fact that some institutions do not have effective policies to promote safety at work, leaving workers exposed to risks. The main factors that favor the occurrence of these accidents with sharps objects are linked to the working conditions, highlighting unsanitary conditions and the dangers of handling work material (1,12) . Regarding the work shift, professionals who work at night, due to the workload and long working hours, have more risk of developing occupational diseases and being involved in accidents, due to fatigue, physical and mental wear and biological changes in the body (13) .
After having an accident professionals should record the occurrence. However, it was noted that the number of CAT registrations is still low considering the real health situation of the professionals. This is because some companies neglect aspects related to the health of the workers and their working conditions (1) .
In this study, the main cause of accidents at work was a lack of attention and work overload. Thus, it appears that diverse factors of the work environment of the nursing professionals may have contributed to the occurrence of accidents. Among these factors, performing tasks quickly, lack of attention during the execution of a procedure, physical and mental fatigue of the worker and work overload have been reported (14) .
In this study, it was noted that the professional who used tobacco had a higher chance of suffering work accidents. This factor may be justified because the use of tobacco can cause psychiatric disorders such as anxiety and attention deficit, among others (15) .
precarious work regime. This factor may also lead the professional to the need to seek additional employment.
Thus, workers sacrifices their leisure and rest time to perform another job (6,19) . The importance of the hospitals providing decent wages for the professionals can be perceived, since this can promote better health and work conditions and thus increase the self-esteem and self-confidence of nursing professionals.
The length of time in the nursing profession variable was also significantly associated with self-esteem. It was shown that the professionals who had more than 10 year in their nursing career, were more likely to have low or normal self-esteem. It should be noted that there are aspects in nursing work that can worsen over time.
These aspects relate to the everyday life of nursing work, such as stress, requirements and work overload, among others. Over the years engaged in the profession, these factors can cause mental disorders in professional, such as boredom and the feeling of fatigue, resulting in low self-esteem (19)(20) .
It was observed that an outstanding event in the career variable was significantly associated with selfesteem. Professionals who had experienced some outstanding event in the career were more likely to have low or normal self-esteem. Many factors that may be associated with these events can cause emotional distress and lead to feelings of helplessness and discouragement, resulting in psychological overload and impaired self-esteem (16) .
It should be noted that the innumerable loads generated by the occurrence of outstanding events are related to the rapid and repetitive work, lack of interaction of the team, pressure from the management and colleagues and physical and mental fatigue, among others. These situations can place professionals in situations that are not conducive for mental health in the nursing practice (6) .
When checking for a possible association between the self-esteem and the accident at work variables, it was found that there was no significant association.
However, it should be noted that the occurrence of workplace accidents can be a psychological distress factor for professionals.
Psychological disorders are part of the reality of the health of the worker, influencing the work performance and productivity of professionals, favoring illness and the occurrence of accidents. Therefore, it is important to mention that the complexity of nursing tasks, plus the responsibilities and technical-scientific concerns may contribute to possible changes in self-esteem. Thus, these workers may not be able to perform their tasks safely, impairing their professional performance and exposing them to the risk of accidents at work (1,21) .

Conclusion
It was concluded that some of the professionals