RESEARCH OF RADIOLOGICAL NURSING PRAXIS: APPLICATION OF THE PSYCHODYNAMIC OF WORK METHODOLOGY

Objective: to report the use of the Psychodynamics of Work Method, highlighting the varioud stages, from the demand to the interpretation of the data, from two different researches performed with nursing staff from hemodynamics and nuclear medicine services. Method: a theoretical-methodological reflection through reporting experiences regarding the use of Psychodynamics of Work in doctoral researches applied to nursing workers in two different services which use radiological technologies. Although both studies have used Psychodynamics as a theoretical-methodological reference, it is possible to highlight differences between them, mainly regarding data collection and analysis. Results: an association of the practice in research and the application of Psychodynamics of Work, in particular regarding demand, material collection, the validation process and data analysis, is carried out throughout the discussion. A table summary table of the method applied in the two surveys is presented at the end of the reflection, which shows the principles and the methodological tools. Conclusion: the report of the experiments shows that when Psychodynamics of Work is used as a methodological theoretical reference, knowledge and familiarity regarding the method is paramount. Undoubtedly, the adaptation of the Psychodynamics of Work methodology and its theoretical contribution, allows for interesting discussions as well as reflections on the part of the workers, mainly regarding the need for changes in praxis. DESCRIPTORS: Qualitative research. Worker. Nursing research. Radiological technology. Occupational health services. http://dx.doi.org/10.1590/0104-07072017000930017


INTRODUCTION
This article reports the use of the Psychodynamics of Work Method, highlighting two doctoral theses that investigated praxis in radiological nursing.Psychodynamics of Work was utilized which was adapted, highlighting the stages from the demand to the data interpretation and analysis.It should be emphasized that the studies investigated the strain on workers who work in radiological nursing and were developed in different specialties: hemodynamic service (research A) and nuclear medicine (research B), which results in characterizing various types of work, especially those with exposure to ionizing radiation.
The need to discuss and share two different examples of the use of the theoretical and methodological framework of the Psychodynamics of work was discussed in this paper, as this theory was initially developed for practice in work clinics and not for academic/scientific research.Although it has well defined methodological steps, it does not represent a directly applicable method for the use in scientific research, however, it can be aggregated to different perspectives, with compatible epistemic bases.
New technologies, the demands of the world of work, the demand for high productivity coupled with the great demand for labor, have imposed new ways of relating to work.This reality is no different in nursing work in services that use radiological technology.In addition to all these requirements, the worker works with ionizing radiation, which can negatively affect the worker's health.
Both presented studies propose an adaptation to the Psychodynamics of work Method recognizing the centrality that the work has in the diverse social spaces.] Psychodynamics of Work was originally developed to be applied by researchers and workers. 3ased on the principles of action research and privileging the qualitative aspects, it allows to intervene in work situations and also to understand the psychological processes as it deals with the relationship between work and mental health. 3he action "has no immediate visibility, it always preserves an abstract side," 3:35 hence the need to mediate it with verbal comments from the workers.The method favors the worker's discourses, particularly the collective, [4][5] as only then is it possible to detect the visible and invisible aspects of the work as each context presents itself differently. 6he Psychodynamics of work methodology is developed in different stages, they include: demand and pre-research, research itself, research material, interpretation method, validation and refutation.The following describes the steps that were taken in the two research examples.

The demand
Demand is the first step of this method and must follow certain criteria which is established by Dejours. 4 These criteria include: who demanded the research?What does it demand?And, to whom is this demand directed?These criteria were followed with some adaptations and are answered in the following description.
The demand consists of a spontaneous request or is even provoked by the workers, and may come from a group of non-institutionalized workers or from a union group, among others.:111 In fact, it conditions the feasibility of the research, requiring a specific explicit work.In order for a demand to be accepted and performed, it is necessary to gather conditions that culminate in the formation of an ad hoc collective, that is to say, a group of workers that will participate in the research. 4The ad hoc collective is the central category in the Psychodynamics of work as it represents the work and produces together, in other words, a collective immersed in the same daily work.This collective must be homogeneous in relation to the professional category or the situations faced in the work and also be a heterogeneous collective regarding the work organization.
According to the criteria of those who demanded it, the researches were based on a spontaneous process with workers in the hemodynamics and nuclear medicine services, different organizations, but with the same professional category.In research A, the demand came from a nursing meeting in the hemodynamics department, in which the following questions were presented: who should remain in the exam room assisting the hemodynamicist physician?How is the dosimeter used ?At what kind of risk are workers exposed to while working with ionizing radiation?How should occupational control of workers be performed?
The demand for research B arose from the experience and previous experiences of researchers in the nuclear medicine service itself.Unsafe practice was observed, and many workers had doubts regards to ionizing radiation exposure, doubts that are very similar to the demand identified in research A.
The pre research began after the demands were gathered, which consists of preparing the data regarding the demand itself for the actual research.This preparation requires that the researcher clearly defines the research participants, i.e., to whom this demand is directed to.For this to occur it is important to gather information about the work process and its transformations, accessing technical, scientific and legal documents connected to the investigated subject as well as visiting the research site. 3,5:142 In order to gather this information, a survey was used in research A , with the participants of a nursing meeting on hemodynamics in the Southern region of Brazil, through a structured questionnaire.The poll covered: training of participants, time spent working in activities involving exposure to ionizing radiation, number of jobs performed in these activities, weekly workload practiced in activities with ionizing radiations and, finally, health problems.
A pre-research in research B was performed in two nuclear medicine services through the observation of the work itself and the work environment, as well as the application of a semi-structured questionnaire which was used to discover what the work of nursing professionals in nuclear medicine services included, with the option to reiterate or refute the information obtained in the observation.The observation and the questionnaire aimed to understand the relation of the worker to the organization and work process, as well as the perception of the strain and workloads to which they were exposed.
Based on the data obtained from these surveys, the sites and the research participants were selected.The participants are called ad hoc workers.
In both polls, the number of workers per service that participated in the pre-search, the time that the participants were already working in the services surveyed, and the health problems were also considered for the choice of location and the ad hoc worker collective related to work in radiological nursing.
Based on the data obtained and on the criteria established by Dejours, 4 the research question was concerned about the health, radiation protection and strain on nursing staff while working in these services.
In the studies, the ad hoc worker group was composed of: nursing workers from a hemodynamic service (research A) and nursing workers from two nuclear medicine services, one public service and one private service (research B), all of them were located in Florianópolis, Santa Catarina, Brazil.
After the definition of the research site and the ad hoc worker collective, the data collection was started in order to obtain the research material.The material was extracted by means of data collection techniques, i.e., observations and collective interviews.Besides these techniques, research material, data collected through documentary analysis and application of questionnaires were utilized.
:35 The principal of Psychodynamics of work is to understand the position of the subject in the relation and the work space, and it is necessary to predict comings and goings in the interactions between researcher and worker, evidencing the dialectic process.

The research in the hemodynamic serviceresearch material collection
Adapting to what Dejours 5 proposes in this research, the observation went through stages, beginning with the recognition of the research scenario.For such recognition, four meetings were organized, occurring on weekly basis, aiming to familiarize the scenario and the procedures performed there.These meetings were used to focus on the objectives, clarify the research, with special attention given to the method and the importance of worker collaboration, and also to present the Term of Free and Informed Consent, which was signed on that occasion.
The data were collected in 36 meetings with the ad hoc worker collective, in the period between March and November in 2009, with approximately 54 hours of observations, initially performed twice a week, for two months.After, observations were made once a week, for another two months; and, finally, once every fortnight for four months.
6 The complete record, reporting the workers' comments, preserves the workers' way of thinking or imagining the content of their work.
The meetings took place in the morning and afternoon, lasting between one to two hours.This time varied according to the type of examination and the conditions of the patients.At each meeting, concrete situations were discussed regarding that work process, which lead to the workers correcting the researchers' observations, adding to the descriptions about certain activities and the reason for noncompliance with certain prescribed norms, among other contributions.This corroborates the authors' assertion that "comments are advanced during discussions, when they are rejected, or reused and reworked." 3:117 A notepad and voice recorder were used to collect these data.The observations were initially conducted in order to meet the demand, as well as any other demands that arose during the work process.Subsequently, with the workers' trust, they began to inquire about the reason for certain attitudes, such as: incorrect use of dosimeters and non-use by some workers, not wearing protective lead clothing; in summary, corrections were made, and the workers accepted these interventions well.
The data were typed and the recordings were transcribed on a weekly basis, which generated summaries which were later interpreted by the researchers, which were validated by the ad hoc worker collective at the observation site and at the collective interviews.As for collective interviews, it should be noted that this methodology does not rely on a questionnaire or individual interviews.It initially uses research with the ad hoc worker collective.The group discussion contributes to the collective elaboration of topics related to work organization and strain related to working conditions. 3,5Thus, it is important to emphasize that spoken word is a privileged means to work with this methodology, as it is through language that the worker can express "how he experiences the work, how he suffers at work, how he performs at work and how he relates at work".
At the collective interview, also called a group interview, the statements of a worker is confronted with the collective workers participating in the survey. 7:189 Thus, the process of reflection was guided by the statements of the workers, which were developed as they highlighted certain situations that were experienced in their daily work.It should be remembered that this reflection included the summaries that had already been validated in the observations.These were generally added and resulted in new interpretations.:158 The interviews took place in the actual workplace of the participants, where workers gathered for meals, with an average of four to five workers participating in each interview.
In relation to the documentary analysis added to the Method, the monthly reports of individual dosimetry of two years (2008 and 2009), frequency and the accomplishment of the occupational examinations, the radiometric evaluation of the examination room and documents related to the work organization were analyzed, such as work scales, established norms and routines, and reports on the demand for exams in 2008 and 2009.Institutional documents were also analyzed, such as a service contract for individual dosimetry, location of property and building plans, among others.

The research in the nuclear medicine serviceresearch material collection
After the ad hoc worker collective was established, two revisits were carried out in each research area, this was to guarantee the workers commitment to participation, at which time some information regarding the work process was collected and which allowed access to the services, and also allowed that the importance of the research and its demand could be explained to the managers and directors.This procedure was very important as it made it possible to "understand what the workers who participated in the survey say, and to have a representation of the environmental conditions available".The workers signed the Terms of Free and Informed Consent.
In order to understand the strain experienced by the nursing staff in nuclear medicine, it was necessary to adapt some methodological elements of Psychodynamics of work, as it was sought to favor the understanding of the relations between the worker, the work organization and its relation with the task performed.
Firstly, observation was used to try and understand the work process, the work relations and the experiences of each worker in both researched services (public and private).The observation occurred in a non-participant way, that is to say, the researcher did not interfere in the work routine and it was decided to observe complete work shifts, with ten observations in each service performed with an average duration of four hours, totaling an approximately 80 hours of observation time during the period from August to November 2015.The observation periods were varied and all shifts, morning and afternoon, were equally observed.This insertion of the researcher in the workplace and the opportunity to observe the work consisted of fundamental strategies, allowing to understand the position, the relations and all the elements of the singularity of the workers during the working day.
During the observation phase, records were kept and the annotations were later shown to the workers.:152 At the end of each shift, the researcher performed a summary of the main points, identifying those that needed further clarification, paying attention to the reliable record of everything that had been observed.This is an annotated, subjective, live summary.It is not a simple summary or decoding of recorded material. 4,8n the study with nuclear medicine nursing workers, contrary to what is proposed in Psychodynamics of work, the interviews did not happen completely collectively.Due to the fact that it was shift work and localized in two different places, it was decided to conduct individual interviews and, later, to hold collective interviews.This adaptation to the method was necessary to understand the relation of the ad hoc worker collective, with their work and with the work collective while considering the differences in each service.
The interviews were performed in the working environment, usually at lunch time and/or at work intervals, and were recorded and later transcribed.Workers were questioned about the duality between enjoyment and suffering, organization and working conditions, and also about practices performed differently than what is asked.
It must be highlighted that during the interviews it was possible to perform validation and refutation of the aspects noted during the observation.The researchers made notes and records of some perspectives and inferences during the interviews, which were later defined in the collective interviews.
Considering that the objective of the research is to identify the relationship between the collective and the work, 4 the collective interviews occurred after previous analysis of the information from the individual interviews, and was performed with the ad hoc worker collective of each service at shift change.A meeting was held in the form of a talk wheel, in which the workers debated different themes, agreed or disagreed, and were free to express their point of view.:149 The collective interviews were also transcribed in full and gave rise to the research material which was transferred and organized using the QualiQuantiSoft® software for further analysis.

The validation process in Psychodynamics of Work
Validation in Psychodynamics of work is as important as research itself, because it is inherent to all stages of research and is characterized by an intrinsic process in observation and interviews.The purpose of validation is to ensure the distance between the researcher's experience and the workers' discourse, [3][4][5] i.e. the discourses must be listened to and interpreted.
Validation usually takes place in two steps.As already mentioned, validation occurs concurrently by listening and observing the workers, the interpretations and hypotheses are performed dur-ing the research itself, which generate new analysis material, which must be discussed again with the workers. 4,6,8he second stage of validation is not treated as an obligation to the method, but is usually recommended, as it is a devolution to the workers, through a synthesis of the results, interpretations and outcomes with emphasis on the demand that the search was based on.It is highlighted that in Psychodynamics of Work there is the possibility of this stage "being submitted to discussion with other workers who did not directly participate in the research", 3:126 allowing the validation process to occur by including workers who did not compose the ad hoc worker collective, but who are part of the functional framework of the studied services.
In both surveys, the validation steps were operationalized.The first stage of validation took place during the observations and interviews at the research site with the ad hoc worker collective.The data were validated at the same time and were interpreted and compared with the literature.Thus, new information was generated that were revalidated in the following meetings.
In the research with the workers from the hemodynamics service, the second stage occurred with the inclusion of other workers who did not participate in the research, but who were part of the functional work of the service researched.In the research with the workers from the nuclear medicine service, the validation happened with the ad hoc worker collective of the two services (public and private), who met for the first time.The workers were invited to an extended meeting, aiming to validate the interpretation of the results, which occurred outside the formal workplace.] During the validation process, the reports were discussed and modified, based on the comments and suggestions of the ad hoc workers.

Data analysis: the experience with Content Analysis and Collective Subject Discourse
Psychodynamics of Work was developed to be applied to clinical work practices.Therefore, data analysis is one of the main challenges in academic studies.This technique, based on the discourse of the workers and, especially, on the collective discourse of the ad hoc workers, generates a substantial amount of analysis material, with the majority consisting of extensive statements.In view of this complexity, many questions were asked regarding the most appropriate method of data analysis.In order to choose the best method of data analysis, the researchers considered the applied collection methods, as well as the objective of each research, based on the theoretical-methodological reference of Psychodynamics of work.Content Analysis was used in research A, and Collective Subject Discourse in research B (CSD).
In research A, the validated material was classified into analysis categories and subcategories according to the similarity of the contents, using the data extracted from the reports, which are the categories related to the thesis and the objectives, that is to say, work organization strain on the workers; as well as what emerged from the study, i.e., the training and permanent education for the nursing praxis in hemodynamics services.Situations experienced by both the researcher and ad hoc workers were described in these categories and subcategories as well as the steps already described in the research, including pre-research data.
In view of these categorizations, the data interpretation commenced, as according to the reference "interpretation material is commented observation". 4:154 Thus, the authors [3][4][5]8 draw attention to the subjectivity of research in Psychodynamics of Work and propose the interpretation of the data together with the worker and researcher collective.
Considering that this is an academic work, data interpretation occurred in a more isolated way and not in conjunction with researchers, another reason justifying the adaptation of the methodology for each study.This analysis took into account the experience of the researchers who interpreted the research material in light of the theoretical corpus proposed in this study, driven by the subjective experiences of the workers.
Finally, it should be highlighted that all categories and subcategories had a direct relation with the observation of the work process, with the analyzed data and with the statements of the workers, as well as the opinions of the ad hoc worker collective and of the institution participating in the entire investigative process in all stages of the research.
CSD was used in research B, which is a data analysis technique which searches to process different testimonies, with similar meanings, regarding a specific theme, joining them together in discourses written in the first person singular. 9his technique seeks to highlight the discourse, a characteristic of collective thought, in all steps of research, from question planning, data collection and data analysis. 9This attribute draws attention as it is in harmony with the precepts of Psychodynamics of Work which is not concerned with who is the speaker, but with the consensual themes of the collective or ad hoc workers. 3or the construction of CSD, 10 the creators of the method formulated four methodological figures that must be applied during the elaboration of the discourses, these include: key expressions, central idea, anchorage (not obligatory) and CSD itself.
:19 That is to say, based on individual discourses, a reconstruction of a synthesis discourse which contemplates the collective representation of a certain phenomenon.
The methodological figures were carefully systematized, with the exception of anchoring, as it was understood that the correlation between the key expressions and the central idea, together with nonparticipant observation, satisfactorily contributed to the description of the meaning of the analyzed discourses.
The number of times a given topic is mentioned is not relevant to DSC, but rather the importance that the discourse has for the worker, who in the end will compose the collective discourse that represents the discourse of the ad hoc workers.
It should be observed, that the central idea describes the main meaning of each discourse and therefore, individualizes the set of discourses that have the same meaning, thus representing the collective.In turn, the key expressions contribute to qualify the central meaning of a discourse, its relation being indisputable to the central idea.The key expressions and central idea are indispensable for making sense of the statements, with the central idea being identifying function and the key expressions being the function of incorporating the meaning. 9he two researches were submitted to the Committee on Ethics in Research with Human Beings, as the method requires "specific ethical conditions, like every action, due mainly to the confrontation of opinions" 3:81 and the subjectivity of workers, which is characteristic of scientific research.
For a better understanding of the application of the Psychodynamics of Work Method, Table 1 summarizes the principles adopted (P) and the methodological tools applied in the two surveys.Analytical categories emerged from the analysis of the data, which responded to the research objectives from the collected material and the validation process.Although the categories were different, they highlighted that when the strain resulting from exposure to ionizing radiation manifests, workers do not associate it with the physical workload.They use defense strategies, such as denial and relate strain to genetic predisposition, to being women and even to chance.They also indicated that radiological technologies are considered work instruments which are external to nursing, which may be related to the invisibility of ionizing radiation in the researched environments.It was also shown that radiological nursing is a unique area of nursing which requires knowledge, skills and attitudes inherent to nursing education and specific physics and radiological protection.

CONCLUSION
Research using the Psychodynamics of Work methodology begins with a demand, which occurred in the investigation processes referred here.Thus, the acceptance of the pre-research demand was essential for linking the other steps which were established in this methodology: the research itself, the research material, interpretation and validation, as well as the extended validation, which was configured as one of the main moments of apprehension of the study object, in which the relations inside the work and outside of it, the contradictory opinions, among other revelations, were clearly evident.
The research materials extracted from the techniques used to collect data were modified at each meeting, because in addition to being partially validated, these data consisted of joining each comment and each absence of comment to what is inscribed as contradictory in relation to the study object.Therefore, the findings were revealed in parts, and only fully discovered in the extended validation.
By proposing the adaptation of this method, it was identified that although it was developed to investigate mental suffering, it had a direct relation with the proposed studies.Thus, although the adaptation of this methodology was not simple, because the available framework deals with the mental workloads, it was possible to give visibility to the various workloads present in the daily work routine.
It must be emphasized that the theoretical and methodological foundations adapted to achieve the objectives are consistent with the epistemological foundations of the main intervention disciplines related to health and worker safety, and also because the central issue is the same: health and radiation worker protection.
In spite of recognizing the limitations of the studies, such as the subjectivity expressed by the workers, it is believed that it is relevant, as it allows a better understanding of nursing work in services that use radiological technologies as working instruments.Undoubtedly, the adaptation of the Psychodynamics of Work methodology with its theoretical contributions, contributed to a lot of discussions and allowed the collective workers to reflect, and therefore change attitudes regarding their health, safety and protection for nursing workers. .