Associação entre ambiente de trabalho, absenteísmo e eventos adversos em enfermeiros e técnicos de enfermagem de uma unidade de urgência e emergência
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2020-02-17
Autores
Oliveira, Priscila Braga de
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Universidade Estadual Paulista (Unesp)
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INTRODUÇÃO: O ambiente de trabalho das instituições de saúde é considerado fator determinante da qualidade e da segurança do cuidado à saúde. As organizações têm buscado a melhoria da qualidade assistencial aos usuários dos serviços, o que implica no aprimoramento contínuo de suas práticas. O absenteísmo é um problema organizacional que prejudica o processo de trabalho das instituições de saúde. Assim, conhecer e compreender como o ambiente de trabalho afeta os trabalhadores promovendo o absenteísmo e os eventos adversos éfundamental para a propositura de estratégias que garantam a qualidade do cuidado. OBJETIVO: Analisar o ambiente de trabalho dos enfermeiros e técnicos de enfermagem da unidade de urgência e emergência de um hospital de ensino. MÉTODOS: Foram realizados dois estudos na abordagem quantitativa (transversal e coorte) e um estudo na abordagem qualitativa (análise de conteúdo). Foram convidados a participar todos os enfermeiros e técnicos de enfermagem da unidade de urgência e emergência de um hospital público terciário de grande porte no interior de São Paulo. A coleta de dados referente à abordagem quantitativa foi por meio da aplicação de um questionário com dados sóciodemográficos laborais, a versão brasileira do Nursing Work Index Revised (B-NWI-R) para enfermeiros com 57 itens e quatro domínios: autonomia, controle sobre o ambiente, relacionamento médico e enfermeiro e suporte organizacional; e o B-NWI-R para técnicos de enfermagem com 15 itens e quatro domínios: autonomia, controle sobre o ambiente, relacionamento médico e equipe de enfermagem e suporte organizacional. Na abordagem qualitativa utilizou-se a vertente da análise de conteúdo, com entrevistas gravadas em áudio e semiestruturadas, com os enfermeiros assistenciais da mesma unidade. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa (Parecer nº. 2.076.259). A análise da chance de absenteísmo em função do ambiente de trabalho medido pela escala B-NWI-R foi realizada por meio de modelo de regressão logística múltipla. Associações foram consideradas estatisticamente significativas se p< 0,05. A análise da chance de absenteísmo e o cálculo do coeficiente de alfa de Cronbach, para a obtenção da confiabilidade da escala B-NWI-R foram realizados com o software Statistical Package for the Social Sciences - SPSS® 21. Para análise das entrevistas foi utilizado o referencial metodológico da análise de conteúdo segundo o modelo de Graneheim e Lundman contemplando unidade de significado, unidade de significado condensada, interpretação do significado subjacente, subtema e tema. RESULTADOS: Foram realizados três artigos: (1) Associação entre absenteísmo e ambiente de trabalho dos técnicos de enfermagem; (2) Compreensão da interferência do ambiente de trabalho nos eventos adversos em uma unidade de urgência e emergência; (3) Absenteísmo de enfermeiros e técnicos de enfermagem na unidade de urgência e emergência: um estudo de coorte. CONCLUSÃO: O estudo permitiu uma análise quantitativa da interferência do ambiente de trabalho no absenteísmo dos enfermeiros e técnicos de enfermagem de uma unidade de urgência e emergência e também compreender como os enfermeiros dessa unidade percebem a interferência do ambiente de trabalho para a ocorrência de eventos adversos. O estudo de coorte única possibilitou, no tempo de um ano, conhecer como o ambiente de trabalho e os fatores sociais, demográficos e laborais se associam evidenciando que os técnicos de enfermagem apresentaram o maior índice de absenteísmo, em comparação com os enfermeiros assistenciais. Os fatores que aumentam a chance de absenteísmo são “ser solteiro ou divorciado” e “trabalhar em período noturno” e os fatores que diminuem esta chance: “ser enfermeiro” e “possuir outro emprego”.
INTRODUCTION: The work environment of health institutions is considered a determining factor of the quality and safety of health care. Organizations have sought to improve the quality of care to users of services, which implies the continuous improvement of their practices. Absenteeism is an organizational problem that impairs the work process of health institutions. Thus, knowing and understanding how the work environment affects workers promoting absenteeism and adverse events is fundamental for the proposition of strategies that guarantee the quality of care. OBJECTIVE: To analyze the working environment of nurses and nursing technicians of the emergency unit of a teaching hospital. METHODS: Two studies were performed in the quantitative approach (cross-sectional and cohort) and one study in the qualitative approach (content analysis). All nurses and nursing technicians from the urgency and emergency unit of a large tertiary public hospital in the interior of São Paulo were invited to participate. The data collection regarding the quantitative approach was through the application of a questionnaire with sociodemographic labor data, the Brazilian version of the Nursing Work Index Revised (B-NWI-R) for nurses with 57 items and four domains: autonomy, control over environment, physician and nurse relationship and organizational support; and the B-NWI-R for nursing technicians with 15 items and four domains: autonomy, control over the environment, medical relationship and nursing staff, and organizational support. The qualitative approach was based on content analysis, with interviews recorded in audio and semi-structured, with the nurses of the same unit. The research was approved by the Research Ethics Committee (Opinion No. 2,076,259). The analysis of the chance of absenteeism as a function of the workplace measured by the B-NWI-R scale was performed using a multiple logistic regression model. Associations were considered statistically significant if p <0.05. 15 The analysis of the odds of absenteeism and the calculation of Cronbach's alpha coefficient to obtain the reliability of the B-NWI-R scale were performed using the Statistical Package for the Social Sciences - SPSS® 21 software. Methodological framework of content analysis according to the model of Graneheim and Lundman contemplating meaning unit, condensed meaning unit, interpretation of the underlying meaning, subtheme and theme. RESULTS: Three articles were made: (1) Association between absenteeism and work environment of nursing technicians; (2) Understanding work environment interference with adverse events in an emergency unit; (3) Absenteeism of nurses and nursing technicians in the urgency and emergency unit: a cohort study. CONCLUSION: The study allowed a quantitative analysis of the interference of the work environment in the absenteeism of nurses and nursing technicians of an urgency and emergency unit and also to understand how the nurses of this unit perceive the work environment interference to the occurrence of adverse events. . The single-cohort study made it possible, over a year's time, to know how the work environment and social, demographic and work factors are associated, showing that nursing technicians had the highest absenteeism rate, compared to the nurses. Factors that increase the chance of absenteeism are “being single or divorced” and “working at night” and factors that decrease this chance: “being a nurse” and “having another job”.
INTRODUCTION: The work environment of health institutions is considered a determining factor of the quality and safety of health care. Organizations have sought to improve the quality of care to users of services, which implies the continuous improvement of their practices. Absenteeism is an organizational problem that impairs the work process of health institutions. Thus, knowing and understanding how the work environment affects workers promoting absenteeism and adverse events is fundamental for the proposition of strategies that guarantee the quality of care. OBJECTIVE: To analyze the working environment of nurses and nursing technicians of the emergency unit of a teaching hospital. METHODS: Two studies were performed in the quantitative approach (cross-sectional and cohort) and one study in the qualitative approach (content analysis). All nurses and nursing technicians from the urgency and emergency unit of a large tertiary public hospital in the interior of São Paulo were invited to participate. The data collection regarding the quantitative approach was through the application of a questionnaire with sociodemographic labor data, the Brazilian version of the Nursing Work Index Revised (B-NWI-R) for nurses with 57 items and four domains: autonomy, control over environment, physician and nurse relationship and organizational support; and the B-NWI-R for nursing technicians with 15 items and four domains: autonomy, control over the environment, medical relationship and nursing staff, and organizational support. The qualitative approach was based on content analysis, with interviews recorded in audio and semi-structured, with the nurses of the same unit. The research was approved by the Research Ethics Committee (Opinion No. 2,076,259). The analysis of the chance of absenteeism as a function of the workplace measured by the B-NWI-R scale was performed using a multiple logistic regression model. Associations were considered statistically significant if p <0.05. 15 The analysis of the odds of absenteeism and the calculation of Cronbach's alpha coefficient to obtain the reliability of the B-NWI-R scale were performed using the Statistical Package for the Social Sciences - SPSS® 21 software. Methodological framework of content analysis according to the model of Graneheim and Lundman contemplating meaning unit, condensed meaning unit, interpretation of the underlying meaning, subtheme and theme. RESULTS: Three articles were made: (1) Association between absenteeism and work environment of nursing technicians; (2) Understanding work environment interference with adverse events in an emergency unit; (3) Absenteeism of nurses and nursing technicians in the urgency and emergency unit: a cohort study. CONCLUSION: The study allowed a quantitative analysis of the interference of the work environment in the absenteeism of nurses and nursing technicians of an urgency and emergency unit and also to understand how the nurses of this unit perceive the work environment interference to the occurrence of adverse events. . The single-cohort study made it possible, over a year's time, to know how the work environment and social, demographic and work factors are associated, showing that nursing technicians had the highest absenteeism rate, compared to the nurses. Factors that increase the chance of absenteeism are “being single or divorced” and “working at night” and factors that decrease this chance: “being a nurse” and “having another job”.
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Enfermagem, Gerenciamento da prática profissional, Ambiente de trabalho, Absenteísmo, Segurança do paciente, Nursing, Professional practice management, Absenteeism