Health problems among nursing workers in a haemodialysis service

Francine Cassol Prestes Carmem Lúcia Colomé Beck Tânia Solange Bosi de Souza Magnago Rosângela Marion da Silva Alexa Pupiara Flores Coelho About the authors

RESUMO

Objetivo

Mensurar os danos à saúde relacionados ao trabalho e associá-los com as características sociolaborais de trabalhadores de enfermagem de um serviço de hemodiálise do Sul do Brasil.

Método

Pesquisa quantitativa, realizada com 46 trabalhadores. Utilizou-se um questionário autopreenchível com dados sociolaborais e a Escala de Danos Relacionados ao Trabalho. Realizou-se a análise descritiva, bivariada e correlacional, com níveis de significância de 5%, usando os programas Epi-info® e Predictive Analytics Software.

Resultados

Os danos físicos, psicológicos e sociais foram avaliados como suportáveis, sendo identificada associação com a satisfação com a remuneração atual e afastamento do trabalho para tratamento de saúde (p< 0,05). As dores nas costas (3,74±2,04) e nas pernas (3,48±2,10) foram consideradas graves. Houve correlação direta entre os danos à saúde (r> 0,31, p< 0,05).

Conclusão

Apesar da avaliação positiva dos danos à saúde na população estudada, reitera-se a necessidade de medidas que favoreçam a saúde dos trabalhadores.

Enfermagem; Saúde do trabalhador; Diálise renal; Enfermagem em nefrologia; Trabalho

RESUMEN

Objetivo

Se objetivó medir los daños a la salud relacionados al trabajo y asociarlos con las características sociolaborales de trabajadores de enfermería de un servicio de hemodiálisis en el Sur de Brasil.

Método

Investigación cuantitativa, realizada con 46 trabajadores. Se utilizó un cuestionario autorrellenable con datos sociolabolares y la Escola de Danos Relacionados ao Trabalho. Se realizó el análisis descriptivo, bivariado y correlacional, con niveles de significación de 5%, utilizándose los programas Epi-info® y Predictive Analytics Software.

Resultados

Los daños físicos, psicológicos y sociales fueron considerados soportables, siendo identificada asociación con la satisfacción con la remuneración actual y licencia del trabajo para tratamiento de salud (p< 0,05). Hubo correlación directa entre los daños a la salud (r> 0,31, p< 0,05).

Conclusión

A pesar de la valoración positiva de los daños a la salud en esta población, se confirma la necesidad de medidas para promover la salud de los trabajadores.

Enfermería; Salud laboral; Diálisis renal; Enfermería en nefrología; Trabajo

ABSTRACT

Objective

The aim was to measure work-related health problems among nursing workers at a haemodialysis unit in southern Brazil and associate these issues with the socio-occupational characteristics of the workers.

Method

This is a qualitative study conducted with 46 nursing workers. Data were collected using a general health questionnaire with socio-occupational information and a work-related health assessment scale. The data were subjected to descriptive, correlational, bivariate analysis with significance levels of 5% using Epi-info® and Predictive Analytics Software.

Results

Physical, psychological, and social problems were considered bearable, and job satisfaction was associated with current income and work absenteeism for health treatment (p< 0.05). Back pain (3.74 ± 2.04) and leg pain (3.48 ± 2.10) were considered severe. There was a direct correlation between the health issues (r> 0.31, p <0.05).

Conclusion

In spite of the positive results of the work-related health assessment among the studied population, the results confirm the need to promote the health of nursing workers.

Nursing; Occupational health; Renal dialysis; Nephrology nursing; Work

INTRODUCTION

Work plays a key role in the lives of individuals and its relationship with the health of workers is never neutral. Its effects tend to be positive and harmonising when there is freedom of creation and expression and the workers have a relative control over the work process. Contrarily, work can destabilise and weaken health when there is no negotiation between the expectations and needs of the workers and requirements of work organisation(11. Dejours C, Abdoucheli E, Jayet C. Psicodinâmica do trabalho: contribuições da escola Dejouriana à análise da relação prazer, sofrimento e trabalho. São Paulo: Atlas; 2011.-22. Mendes AM. Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo; 2007.).

Work-related health problems are the manifestation of the detrimental effects of work on health and the consequences of the demands and experiences in terms of physical and psychosocial harm. The physical issues are defined as the presence of manifestations like body aches and biological disturbances. The psychological problems are characterised by the experience of negative feelings about oneself and life in general, whereas the social problems include isolation and difficulties in social and family relationships(22. Mendes AM. Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo; 2007.).

In spite of advances in the production of knowledge related to the health of workers, work-related diseases and health problems are still growing. Paradoxically, when health workers, especially nurses, are providing care to others, they often forget to look after themselves and the location in which they work(33. Ribeiro RP, Martins JT, Marziale MHP, Robazzi MLCC. Work-related illness in nursing: an integrative review. Rev Esc Enferm USP. 2012 Apr [cited 2013 Dec 11];46(2):495-504. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342012000200031&lng=en&nrm=iso&tlng=en.
http://www.scielo.br/scielo.php?script=s...
). This neglect may be related to the current configuration of the intense work activities in health services, which tend to reflect negatively on the health of workers(44. Dal Pai D, Krug JS, Lautert L. Psicodinâmica e saúde mental do trabalhador de enfermagem: ritmo acelerado e intensificação do prazer. Enfermagem Foco. 2011 [citado 2014 ago 01];2(1):38-43. Disponível em: http://revista.portalcofen.gov.br/index.php/enfermagem/article/viewFile/72/59.
http://revista.portalcofen.gov.br/index....
).

One of the scenarios where nursing plays a predominant role is haemodialysis units. These units have specific characteristics such as activities with patients suffering from chronic illness and the need for specific knowledge to monitor a procedure with high technical complexity(55. Prestes FC, Beck CLC, Tavares JP, Silva RM, Cordenuzzi OCP, Burg G, et al. Percepção dos trabalhadores de enfermagem sobre a dinâmica do trabalho e os pacientes em um serviço de hemodiálise. Texto Contexto Enferm. 2011 [citado 2015 abr 18]; 20(1):25-32. Disponível em: http://www.scielo.br/pdf/tce/v20n1/03.pdf.
http://www.scielo.br/pdf/tce/v20n1/03.pd...
).

A study conducted in Germany showed that downsizing, budget cuts, the increasing number of patients in haemodialysis with multiple illnesses and the technical handling of complex equipment are emerging demands that can negatively affect the well-being of workers in haemodialysis units(66. Kersten M, Kozak A, Wendeler D, Paderow L, Nübling M, Nienhaus A. Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire. J Occup Med Toxicol. 2014 [cited 2014 Jun 21];9(1):4. Available from: http://www.occup-med.com/content/pdf/1745-6673-9-4.pdf.
http://www.occup-med.com/content/pdf/174...
).

According to a worldwide trend, Brazil is also showing a gradual increase in the prevalence rate of patients undergoing dialytic therapy. In 2012, there were an estimated 97,586 patients receiving this form of treatment in Brazil. In the surveyed dialysis units in 2012, more than 90% of patients were receiving haemodialysis treatment(77. Sesso RC, Lopes AR, Thomé FS, Lugon JR, Watanabe Y, Santos DR. Report of the Brazilian chronic dialysis census 2012. J Bras Nefrol. 2014 [cited 2015 Apr 18];36(1):48-53. Available from: http://www.scielo.br/pdf/jbn/v36n1/en_0101-2800-jbn-36-01-0048.pdf.
http://www.scielo.br/pdf/jbn/v36n1/en_01...
).

In spite of the growing worldwide demand for haemodialysis services(66. Kersten M, Kozak A, Wendeler D, Paderow L, Nübling M, Nienhaus A. Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire. J Occup Med Toxicol. 2014 [cited 2014 Jun 21];9(1):4. Available from: http://www.occup-med.com/content/pdf/1745-6673-9-4.pdf.
http://www.occup-med.com/content/pdf/174...
), only a few studies focus on the health-related aspects of nursing workers in this context(55. Prestes FC, Beck CLC, Tavares JP, Silva RM, Cordenuzzi OCP, Burg G, et al. Percepção dos trabalhadores de enfermagem sobre a dinâmica do trabalho e os pacientes em um serviço de hemodiálise. Texto Contexto Enferm. 2011 [citado 2015 abr 18]; 20(1):25-32. Disponível em: http://www.scielo.br/pdf/tce/v20n1/03.pdf.
http://www.scielo.br/pdf/tce/v20n1/03.pd...
-66. Kersten M, Kozak A, Wendeler D, Paderow L, Nübling M, Nienhaus A. Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire. J Occup Med Toxicol. 2014 [cited 2014 Jun 21];9(1):4. Available from: http://www.occup-med.com/content/pdf/1745-6673-9-4.pdf.
http://www.occup-med.com/content/pdf/174...
, 88. Prestes FC, Beck CLC, Silva RM, Tavares JP, Camponogara S, Burg G. Prazer-sofrimento dos trabalhadores de enfermagem de um serviço de hemodiálise. Rev Gaúcha Enferm. 2010 [citado 2013 out 18];31(4):738-45. Disponível em: http://www.scielo.br/pdf/rgenf/v31n4/a18v31n4.pdf.
http://www.scielo.br/pdf/rgenf/v31n4/a18...
). Consequently, the question is how nursing workers assess work-related health problems at a haemodialysis unit and whether there is an association between the health problems and the socio-occupational characteristics of these workers.

Studying the health problems of nursing workers at a haemodialysis unit and relating these problems to their socio-occupational characteristics can help identify the possibility of health issues among this population. Similarly, the purpose of this study is to shed light on the subject of nursing workers’ health in a specific field that is rarely explored in Brazilian studies.

The aim of this study is to measure work-related health problems and associate them with the socio-occupational characteristics of nursing workers at a haemodialysis unit in southern Brazil.

METHOD

This is a quantitative correlational study conducted at a haemodialysis unit in southern Brazil. The research comes from a master’s dissertation(99. Prestes FC. Danos à saúde dos trabalhadores de enfermagem em hemodiálise [dissertação]. Santa Maria (RS): Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Maria; 2011.) and was conducted at a private intra-hospital institution associated to the unified health system (SUS) that provides a regular haemodialysis programme for around 300 patients.

The population consisted of 51 nursing workers (six nurses, 33 technicians and 12 nursing assistants). The inclusion criterion was to have been a member of the nursing staff of the service for at least six months, and the exclusion criterion was employees on vacation or any other type of work leave during the data collection period from March to April 2011.

The workers were approached individually at their workplace, notified of the research objectives and invited to participate in the study. The workers who agreed were handed a research questionnaire in an envelope and were later given instructions on how to answer the questionnaire. The participants could choose whether or not to answer the questionnaire during their work shift.

Of the 51 nursing workers at the units, 46 participated in this study. Three did not meet the established criteria. Two workers did not return the completed questionnaire after three contact attempts from the researcher and were considered losses.

The research questionnaire contained information related to socio-occupational data (gender, age, marital status, function, work shift, work time, presence of another job, occurrence of an accident at work, need to stay away from work for health treatment in the past year and satisfaction with current remuneration) and a scale to assess work-related problems (EADRT). The EADRT is one of the four scales that form part of the self-applicable inventory of work and risks of illness (ITRA) that was created and validated in Brazil in 2003(1010. Ferreira MC, Mendes AM. Trabalho e riscos de adoecimento: o caso de auditores fiscais da previdência social brasileira. Brasília: Ler, Pensar e Agir; 2003.) to evaluate some dimensions of the interrelation between work and risk of illness. In this study, we used the third version of the instrument that was revalidated and published in 2007(22. Mendes AM. Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo; 2007.).

The EADRT has 29 items and consists of three factors: physical problems (items 1 to 12), psychological problems (items 13 to 22) and social problems (items 23 to 29). It is a seven-point scale that is used to assess work-related problems suffered in the past six months. The seven points of the scale are 0 = never, 1 = once, 2 = twice, 3 = three times, 4 = four times, 5 = five times and 6 = six or more times(22. Mendes AM. Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo; 2007.).

The information was processed by means of independent double data entry in the programme Epi-info® version 6.04. After error correction, the data were analysed using PASW Statistic® (Predictive Analytics Software) version 18.0 for Windows. The variables were subjected to descriptive analysis. The qualitative variables were described by means of absolute and relative frequency, whereas the quantitative variables with normal distribution were described by means of average and standard deviation.

For the EADRT analysis, the results were classified into four levels: above 4.0 = negative rating, presence of occupational health problems; between 4 and 3.1 = moderate to frequent rating, serious; between 3 and 2 = moderate rating, serious; below 1.99 = positive rating, bearable.

Next, bivariate analyses were conducted. The associations between EADRT factors and sociodemographic and occupational variables (categorical) were determined using the Chi-square test or Fisher’s exact test, with levels of significance of 5%.

The reliability of the EADRT was evaluated by estimating internal consistency using Cronbach’s alpha. Values above 0.80 were identified in the three factors of the scale (psychological problems α = 0.91; social problems α = 0.83 and physical problems α = 0.83).

The correlation between the EADRT factors was analysed by means of Spearman’s rank correlation coefficient. The strength of association was classified according to the intensity of the correlation, which ranges from +1 to -1, as follows: r = 1 perfect correlation; 0.80 < r < 1 very high; 0.60 < r < 0.80 high; 0.40 < r < 0.60 moderate; 0.20 < r < 0.40 low; 0 < r < 0.20 very low; r = 0 null(1111. Hair JF, Anderson RE, Tatham RL, Black WC. Análise multivariada de dados. Porto Alegre: Artmed; 2009.).

The research complied with ethical guidelines for research with human beings established in Resolution 466/12 of the national health council. The study was approved by the research ethics committee of the Universidade Federal de Santa Maria with the certificate of presentation for ethical appreciation (CAAE) number 0364.0.243.000-10. All the participants read and signed two copies of an informed consent statement.

RESULTS

Most of the participants were women (80.4%, n = 37), married (65.2%, n = 30), nursing technicians (67.4%, n = 31), who did not have another job (73.9%, n = 34). The average age of the participants was 39.9 (SD = 10.02) and the average time working at the service was 10.28 years (SD = 6.64). Most of the workers (56.5%, n = 26) claimed they were 75% satisfied with their current remuneration, had not suffered an accident at work (82.6%; n = 38) and had not been away from work for health reasons in the past year (67.4%; n = 31).

Table 1 shows the descriptive statistics of the factors that assess the work-related health problems and the two items with the highest averages in each factor.

Table 1
– Descriptive statistics and items with higher averages in the scale to assess work-related problems (EADRT). Santa Maria/RS, Brazil, 2011. (N = 46)

The work-related problems were classified as bearable by the nursing workers of the haemodialysis unit, and the factor physical problems presented the highest average (µ = 1.77; SD = 1.08).

The factor physical problems was rated as bearable as a whole, whilst the items “back pain” and “leg pain” presented the highest averages and were considered as being serious by the workers. With regard to the association of the factor with the socio-occupational data, physical problems showed a significant association with dissatisfaction with the current remuneration (p = 0.004) and the need to be away from work for health treatment in the past year (p = 0.008). No statistically significant associations were identified in the remaining variables (p > 0.05).

For the factor psychological problems, all the items were evaluated as bearable. The items with the worst rating were “sadness” and “bad mood”, with a borderline value in the classification of bearable. With regard to the association of the factor with the socio-occupational data, there was an association between the factor psychological problems and satisfaction with the current remuneration (p = 0.045). No differences were identified between the groups for the remaining variables (p > 0.05).

The social problems were also considered bearable and presented the lowest average among the surveyed factors (µ = 1.12; SD = 0.85), as shown in Table 1. Although the items “desire to be alone” and “impatience with people” presented the highest averages of the items of this factor, they are not characterised as a health problem because they were considered bearable by the workers. In this factor, no significant associations with the variable of interest were identified (p>0.05).

Table 2 presents the Spearman’s correlation coefficient between the EADRT factors.

Table 2
– Spearman’s correlation coefficient between EADRT factors. Santa Maria/RS, Brazil, 2011. (N = 46)

The social problems presented a high, direct and significant correlation with the psychological problems (r= 0.61, p < 0.01) and a low, direct correlation with the physical problems (r= 0.31, p < 0.05). No correlation was identified between the physical and psychological problems (p > 0.05), as shown in Table 2.

DISCUSSION

As in the case of other studies with health workers(1212. Campos JF. Trabalho em terapia intensiva: avaliação dos riscos para a saúde do enfermeiro [dissertação]. Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro; 2008.

13. Maissiat GS. Prazer e sofrimento de trabalhadores da atenção básica a saúde, à luz da psicodinâmica do trabalho [dissertação]. Porto Alegre (RS): Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013.
-1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.), this study showed a good internal consistency of the factors that make up the EADRT among the investigated population, with Cronbach’s alpha exceeding 0.80.

The investigated population mostly consisted of women workers with a relatively solid life and work experience at the haemodialysis unit and without another job, which is similar to the results of other studies with nursing workers(1212. Campos JF. Trabalho em terapia intensiva: avaliação dos riscos para a saúde do enfermeiro [dissertação]. Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro; 2008., 1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.).

In addition, most of the workers claimed to be satisfied with the current remuneration, had not suffered any accidents at work and had not taken time off work due to health problems in the past year. This description can be characterised as favourable for the health of workers at the surveyed nursing service.

The work-related health problems were considered bearable by the participants of this study. This result diverges from the findings of an investigation with intensive care nurses who identified their health problems as critical in all three factors(1212. Campos JF. Trabalho em terapia intensiva: avaliação dos riscos para a saúde do enfermeiro [dissertação]. Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro; 2008.). Other studies identified the physical problems as critical and the psychological and social problems as bearable among professionals who worked in primary care services in a city of southern Brazil(1313. Maissiat GS. Prazer e sofrimento de trabalhadores da atenção básica a saúde, à luz da psicodinâmica do trabalho [dissertação]. Porto Alegre (RS): Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013.) and among nursing workers of surgery units at university hospitals in the state of Rio Grande do Sul, Brazil(1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.).

In the factor physical problems, back and leg pain were assessed as serious by the nursing workers of the haemodialysis unit. This result converges with the findings of other studies(1212. Campos JF. Trabalho em terapia intensiva: avaliação dos riscos para a saúde do enfermeiro [dissertação]. Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro; 2008., 1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.) with nursing workers in a hospital environment and denotes the possible repercussions of occupational activities on the health of workers.

A study with the nursing team of a dialysis unit identified the occurrence of back pain, especially in the lumbar region, among most of the participants. The study also mentions the absence of care in relation to the correct ergonomic posture when the workers move patients or perform procedures, which can contribute to musculoskeletal discomfort(1515. Morais EM, Fontana RT. Dialytic unit as a scenario of exposure to risk. J Res: Fundam Care. 2014 Apr./Jun. [cited 2015 Apr. 19];6(2):539-49. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/2648/pdf_1238.
http://www.seer.unirio.br/index.php/cuid...
).

A study(55. Prestes FC, Beck CLC, Tavares JP, Silva RM, Cordenuzzi OCP, Burg G, et al. Percepção dos trabalhadores de enfermagem sobre a dinâmica do trabalho e os pacientes em um serviço de hemodiálise. Texto Contexto Enferm. 2011 [citado 2015 abr 18]; 20(1):25-32. Disponível em: http://www.scielo.br/pdf/tce/v20n1/03.pdf.
http://www.scielo.br/pdf/tce/v20n1/03.pd...
) describes some characteristics of the nursing work process at haemodialysis units, such as the repetition of tasks, pressure to complete activities in a given period, pressure to get things right and the need to constantly monitor patients and equipment during the procedure. These characteristics may promote a work overload and the manifestation of health problems among workers.

In this study, the workers who were less satisfied with their remuneration assessed the factor physical problems as being more critical. A remuneration that is consistent with the work activities is important for the workers since, in addition to providing for their basic needs, it represents the recognition of the work they conduct(1616. Neves MJAO, Branquinho NCSS, Paranaguá TTB, Barbosa MA, Siqueira KM. Influência do trabalho noturno na qualidade de vida do enfermeiro. Rev Enferm UERJ. 2010 [citado 2014 jun 22];18(1):42-7. Disponível em: http://www.facenf.uerj.br/v18n1/v18n1a08.pdf.
http://www.facenf.uerj.br/v18n1/v18n1a08...
). This contradiction between the expectations of the workers and their reality requires mediation in order to prevent the appearance or aggravation of work-related pathological processes.

Physical problems were also associated with the need to spend time away from work for treatment in the past year. A similar result was found in a study that classified time away from work due to spinal injuries as routine among the nursing workers, especially the nursing technicians and assistants of a haemodialysis unit(1717. Silva MKD, Zeitoune RCG. Riscos ocupacionais em um setor de hemodiálise na perspectiva dos trabalhadores da equipe de enfermagem. Esc Anna Nery. 2009 [citado 2014 jan 02];13(2):279-86. Disponível em: http://www.scielo.br/pdf/ean/v13n2/v13n2a07.pdf.
http://www.scielo.br/pdf/ean/v13n2/v13n2...
).

Musculoskeletal disorders were the predominant causes of absenteeism for illness among the nursing workers of a haemodialysis service(1818. Dissen CM, Beck CLC, Prestes FC, Freitas NQ, Coelho APF, Sangoi TP. Characterization of absenteeism-disease in nursing workers of a hemodialysis service. J Nurs UFPE on line. 2014 [cited 2014 Aug 01];8(2):272-8. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/download/3395/8438.
http://www.revista.ufpe.br/revistaenferm...
), which ratifies the association between physical problems and the need to stay away from work for treatment in the past year shown in this study.

With regard to psychological problems, the satisfactory evaluation of the study participants matches the results of other studies with health professionals who worked with haemodialysis patients(66. Kersten M, Kozak A, Wendeler D, Paderow L, Nübling M, Nienhaus A. Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire. J Occup Med Toxicol. 2014 [cited 2014 Jun 21];9(1):4. Available from: http://www.occup-med.com/content/pdf/1745-6673-9-4.pdf.
http://www.occup-med.com/content/pdf/174...
, 1919. Umann J, Guido LA, Grazziano ES. Presenteeism in hospital nurses. Rev Latino-Am Enfermagem. 2012 Feb [cited 2014 Jun 22];20(1):159-66. Available from: http://www.scielo.br/pdf/rlae/v20n1/21.pdf.
http://www.scielo.br/pdf/rlae/v20n1/21.p...
). Research carried out in dialysis centres in Germany identified that 25% of the health professionals were under stress triggered by the suffering or death of their patients(66. Kersten M, Kozak A, Wendeler D, Paderow L, Nübling M, Nienhaus A. Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire. J Occup Med Toxicol. 2014 [cited 2014 Jun 21];9(1):4. Available from: http://www.occup-med.com/content/pdf/1745-6673-9-4.pdf.
http://www.occup-med.com/content/pdf/174...
). An investigation with nurses of units that provide care for critical and potentially critical patients at a university hospital in southern Brazil identified a greater level of stress in the team of the nephrology unit(1919. Umann J, Guido LA, Grazziano ES. Presenteeism in hospital nurses. Rev Latino-Am Enfermagem. 2012 Feb [cited 2014 Jun 22];20(1):159-66. Available from: http://www.scielo.br/pdf/rlae/v20n1/21.pdf.
http://www.scielo.br/pdf/rlae/v20n1/21.p...
).

In another study, despite the satisfactory assessment for physiological problems, the items “sadness” and “bad mood” achieved the highest averages, with borderline values in the bearable assessment(1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.).

Authors mention that dealing with the same patient on an everyday basis for long periods is a key characteristic of haemodialysis work that causes both pleasure and suffering. The established ties arouse mixed feelings among the workers, who feel recognised and valued due to the demonstrations of affection, but also overburdened due to the affective, family-related and financial needs of the patients(88. Prestes FC, Beck CLC, Silva RM, Tavares JP, Camponogara S, Burg G. Prazer-sofrimento dos trabalhadores de enfermagem de um serviço de hemodiálise. Rev Gaúcha Enferm. 2010 [citado 2013 out 18];31(4):738-45. Disponível em: http://www.scielo.br/pdf/rgenf/v31n4/a18v31n4.pdf.
http://www.scielo.br/pdf/rgenf/v31n4/a18...
).

A study in a dialytic unit identified that the occupational risks perceived by the nursing staff were, respectively, biological, chemical, physical, ergonomic and, less frequently, psychosocial risk. Nevertheless, some participants stated that the work produces mental suffering. This suffering was attributed to their work in a closed environment with depressive patients and the tension generated by the responsibility with human lives(1515. Morais EM, Fontana RT. Dialytic unit as a scenario of exposure to risk. J Res: Fundam Care. 2014 Apr./Jun. [cited 2015 Apr. 19];6(2):539-49. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/2648/pdf_1238.
http://www.seer.unirio.br/index.php/cuid...
).

Thus, the results for the factor psychological problems can refer to the workers’ capacity to correctly redefine the suffering and pleasure experienced at work in the haemodialysis unit. Also, the satisfactory result found in this study may be related to the difficulty of characterising work-related diseases, especially psychological issues.

The association between the absence of psychological problems and the satisfaction with the current remuneration was also revealed. This result confirms that satisfaction with the remuneration reflects positively on the recovery and recognition of the workers, which, in turn, reflects positively on their mental functioning and overall health(22. Mendes AM. Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo; 2007.).

This result can also be considered positive because the existence of conditions that trigger suffering and burden, such as low wages and double employment, is no longer contested in the labour context of nursing. Nevertheless, the repercussions that exposure to these conditions has on the health of workers are still fairly unknown(2020. Rodrigues EP, Rodrigues US, Oliveira LMM, Laudano RCS, Sobrinho CLN. Prevalence of common mental disorders in nursing workers at a hospital of Bahia. Rev Bras Enferm. 2014 Apr [cited 2015 Apr 19];67(2):296-301. Available from: http://www.scielo.br/pdf/reben/v67n2/0034-7167-reben-67-02-0296.pdf
http://www.scielo.br/pdf/reben/v67n2/003...
).

In the factor social problems, which were evaluated as bearable for all the items, the desire to be alone and impatience with people in general presented the highest averages and consequently confirm the study results(1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.). These results can be considered positive if compared to those found in other investigations in which these items also presented the highest averages, although they were classified as critical(1212. Campos JF. Trabalho em terapia intensiva: avaliação dos riscos para a saúde do enfermeiro [dissertação]. Rio de Janeiro (RJ): Universidade Federal do Rio de Janeiro; 2008.

13. Maissiat GS. Prazer e sofrimento de trabalhadores da atenção básica a saúde, à luz da psicodinâmica do trabalho [dissertação]. Porto Alegre (RS): Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013.
-1414. Silva RM. Cronotipo e danos relacionados ao trabalho em trabalhadores de enfermagem [tese]. São Paulo (SP): Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2014.).

In this study, the presence of work-related social problems was not identified. A study that compared workers of a dialysis with workers of inpatient units identified that it is easier for the dialysis team to reconcile work and private life than for hospital nurses(66. Kersten M, Kozak A, Wendeler D, Paderow L, Nübling M, Nienhaus A. Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire. J Occup Med Toxicol. 2014 [cited 2014 Jun 21];9(1):4. Available from: http://www.occup-med.com/content/pdf/1745-6673-9-4.pdf.
http://www.occup-med.com/content/pdf/174...
).

Therefore, it is important to list some of the characteristics of the studied service, such as whether the night shift ends at 10:00 p.m. and whether the team works on Sundays. Furthermore, most of the participants did not have another job, which may favour the practice of leisure activities and reflect positively on the social aspects of the workers’ lives.

The social problems correlated directly with the physical and psychological problems, that is, the workers who most positively assessed social problems also presented the lowest averages for the factors physical and psychological problems. This correlation can be explained by the fact that work is an activity that involves individuals in all its dimensions. Thus, the relationships that individuals establish with their work are fundamental for the construction of human subjectivity and has repercussions on their physical and mental health(11. Dejours C, Abdoucheli E, Jayet C. Psicodinâmica do trabalho: contribuições da escola Dejouriana à análise da relação prazer, sofrimento e trabalho. São Paulo: Atlas; 2011.-22. Mendes AM. Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo; 2007.).

CONCLUSION

The health problems of the nursing workers of the studied haemodialysis unit were evaluated as bearable. For the factor physical problems, which had the highest averages, the presence of back pain and leg pain was considered serious.

The physical problems showed an association with satisfaction with the current remuneration and the need to take time off work for treatment in the past year. The factor psychological problems was related to satisfaction with the current remuneration.

In spite of the positive evaluation of health problems among the studied population, we cannot discard the need to maintain, constantly evaluate and promote work conditions that promote the health of workers, especially considering that we identified signs of health problems related to musculoskeletal pain and an association of physical problems with absenteeism due to illness.

In view of these signs, we recommend the creation of institutional spaces for listening, discussion and individual and collective evaluation where the workers can be instrumentalised to identify and prevent work-related health issues. In this way, the nursing workers themselves can point out situations that require intervention and subsequently prevent work-related health problems in the haemodialysis units.

The results may have been underestimated since the studied workers are active and may not have remembered the number of times they presented the manifestations listed in the EADRT in the last six months. Another study limitation is the size of the studied population, which can limit any generalisations and more complex statistical analyses.

Although the EADRT is not a specific instrument for nursing workers, it was internally consistent when applied to this population. The instrument proved useful in enabling an initial diagnosis of health problems that can be extended with qualitative techniques and the application of other instruments in investigations that address the health of nursing workers in haemodialysis units.

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Publication Dates

  • Publication in this collection
    2016

History

  • Received
    03 Oct 2014
  • Accepted
    16 Dec 2015
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