INGECHT-SUS: Innovation in Work Conditions for Brazil’s Healthy System Hospitals

ORP 2008

Gestión

Palabras Clave:

working conditions, application

Autor principal:

Maria Yvone

Chaves Mauro

Coautores:

José de Paula

Maciel Neto

Carla Christina

Chaves Mauro

Michele

Alexandrino

Viviane

Gomes

Dra. Maria Yvone Chaves Mauro

Departamento de Salud Publica/ Faculdad de Enfermería de la Universidad del Estado de Río de Janeiro – FENF/UERJ /Prof. InvitadaCordinadora del Proyecto Investigación CNPq Enfermera del Trabajo / Ergónoma00 55 21 25574020 / mycmauro@uol.com.br

José de Paula Maciel Neto

Universidad Politécnica de ValenciaDep. Organización de Empresas.- Valencia - España joma1@upvnet.upv.es

Carla Christina Chaves Mauro

Master Ingieneria de Producción – Rio de Janeiro - Brasil Arquitecta / Ergonóma / Ingeniera del Seguridad de Trabajo carla_mauro@msn.comMichele AlexandrinoUniversidade Estadual de Rio de JaneiroEstudiante de Graduación en Enfermería / Becaria del Pibic, Faperj / Rio de Janeiro -Brasil michelyale@gmail.comViviane GomesUniversidade Estadual de Rio de JaneiroEstudiante de Graduación en Enfermería / Becaria del Pibic, Faperj / Rio de Janeiro -Brasil vivigms@hotmail.com

ABSTRACT

Esta ponencia describe el estudio sobre innovación en la gestión de las condiciones de trabajo en salud para hospitales del sistema único de salud de Brasil desarrollado por el curso de maestría de la Facultad de Enfermería de la Universidad del Estado de Rio de Janeiro en Brasil. Se basa en estudios anteriores del grupo y de una detallada revisión bibliográfica sobre el tema objeto del estudio y temas relacionados con la seguridad y salud en el trabajo. Este proyecto es ambicioso porque tiene la finalidad y el propósito de además de desarrollar actividades de investigación en el ámbito de la gestión del trabajo en salud, pretende innovar añadiendo un software para soporte de dicha gestión. La propuesta es adoptar metodologías que van desvendar las complejas condiciones de trabajo en las actividades hospitalarias a través de una dinámica del proceso de trabajo, donde las personas son el activo mas importante, con una gestión participativa, teniendo en cuenta las buenas practicas adoptadas por la población estudiada. Como resultado se espera colaborar con la mejora de las condiciones de los trabajadores y proporcionar a los mismos unas condiciones mas sanas, concienciación por parte de los mismos para prevenir los riesgos y participar en la

1 Proyecto de Investigación financiado por CNPq – Editalmejora continua de los trabajadores.

Palabras clave

Condiciones de trabajo, Investigación, Aplicación, Desarrollo de software.

INTRODUCTION

This study aims to develop a proposal for innovation for the Management of the conditions of workers in the SUS in Brazil, particularly in hospitals.

This experience has been developed at the School of Nursing, State University of Rio de Janeiro, with students of the Master's Degree and from the perception of nursing workers of the hospital, about their exposure to risk and damage the environment and health problems caused or aggravated by work.

The project aims to:

• Lift the risks and damage to the health of workers in nursing, arising from the work environment;• Identify health's problems caused or aggravated by work;• Verify the existence of programs focused on the workers' health and their participation in the solution of problems;• Using the results of this study for the construction of a simplifiedmethodology of work conditions in the hospital environment;• Create a software as support management in making the diagnosis of hospital work conditions, as allowance for the implementation of improvements appropriate to the situation of work.

SOURCES

Risks, Damages and Health Problems in Labor

According to the global definition of the International Labor Organization (ILO) [1]:

"The purpose of health at work is to develop the promotion and residence of the highest level of welfare physical, mental and social workers in all workplaces, preventing at all the health damage caused by the condition of work; in protecting their jobs from the risks resulting from agents harmful to health; place and keep the employee in his employment suited to physiological and psychological limits, and in short, to adapt the work to man and each man to his activity "[1]

Although there is extensive information about the main risk factors that produce offenses to the health of workers still lack knowledge about the health problems associated with the work shift. In this sense, it is necessary to deepen the study about the degree of exposure of workers to agents at risk, the loads of work physical and mental, psychosocial factors, habits and lifestyle, individual susceptibility, and in some cases, exposure to the combined factors of the work environment and the environment in general, that leads one to potentiating of risks and insecurity of work.

According Sanchez [2], the risk factors may be causal or predisposing. It is understood by the determinant factors of accidents and diseases of the worker and predisposing factors for those conditions that favors the conditions of permanent risk in the place of work.

Most of these factors are in connection with an absence or lack of implementation of preventive measures needed to ensure a safe work. The danger inherent in many positions are determined by their conditions of work (e.g.: the use of dangerous machines, working with animals, etc…), barely controlled with a single strategy of prevention.

Therefore, exposure to certain risks without adequate control, assumes a finding of a deficient preventive action in the company, derived from themanagement of prevention, a fact that could trigger an accident.

Thus the proper control of these risk factors could prevent the accident "at its origin."

The Standard Regulatory NR-9 [3] established the requirement to identify the risks to human health in the work environment. The risk factors, called occupational risks, according to the Ministry of Labor in Brazil (NR-9), shall be classified according to the type of agent involved:

Environmental risks:

A) Physical Agents: noise, vibration, temperature and pressure abnormals, ionizing and non-ionizing radiation, lighting, humidity, etc.;

B) Chemical Agents: fog, mists, dust, fumes, gases and vapors;

C) Biological agents: bacteria, viruses, fungi, riketsias, helminth and protozoa;

D) Mechanical Agents: unsafe conditions that can lead to falls, injuries, etc..

These agents are possible to produce unhealthy and dangerous conditions capable of causing adverse effects to the health of professionals, and only if materialized with the accident.

Ergonomic risks:

These are the factors of nature bio-psycho-social that can cause imbalance in the process of adapting the work to humans, which includes the study of:

A) Machine: furniture, equipment and materials with their characteristics and size in relation to the appropriateness to the worker;

B) The Workplace: jobs, and environmental comfort;

C) Labor Organization: involving the hierarchy, division of labor, communication, and adaptation characteristics of the worker and work process;

D) Human Factors: nutrition, metabolism, static and dynamic work, loads bearable, fatigue and stress.

These factors when increase the workers capacity of tolerance, whether by intensity or receptivity, lead a suffering at the work.

These conditions of exposure to occupational hazards and diseases, in most cases, become routine, and often are not perceived neither by managers, nor by the workers themselves who are unable to establish a link between the condition of work and the offenses to the health, whose signs and symptoms remains in auto control, often using self-medication, without seeking clarify the problems and their causes, which can lead low productivity, accidents and illnesses and absenteeism.

The ILO [1] estimates that are lost, 4% of GDP worldwide (1,251,353 million USD) for claims, absenteeism, disruption of production, training and renewal work and medical costs, among other things.

Therefore, can say that a healthy worker, performs his work with high quality and satisfaction, minimizing licenses, avoiding congestion in health's system and on everything, allowing the employee, at the end of their active life, enjoy the appropriate level of welfare with quality of life [4].

Emphasis on the problems of the worker's health

In all countries of the world, the health professional category is a large and diverse. According to the Department of Labor Statistics of the US, among the areas of employment that will have the greatest increment over the next 10 years are: 1st place is the computing area, 2nd is the Health category which expected an increase of 1.7 million to 1.97 million in this area. [5]

The recent economic crisis has shown the need for a more effectiveadministration with relation to hospital costs, which includes human capital as most costly element and most important source of losses.[5]

On the other means of work, there is a paradox when it comes to health care professionals who have demonstrated their later interest by what is part of the contents of their profession, that is, recovery of their own health, subjected to loads, bonds and risks to which they are subject, and the ability to withstand the difficulties of those who are the object of your attention (person with health affected). In this context, the notion of health and safety for managers is constituted only a part of the organization, as for health professionals suffering is a great need for humanization at work and special attention to their own health, even little considered.

There is an attitude of detachment from the worker, which employs all its energy to customers (patients) and the progress of scientific and technological knowledge in health, abstaining is pay attention to their own health needs and Leisure, which reinforces the reality above.

The nurses work condition in hospitals has long been considered inadequate due to the specific environment and the activities carried unhealthy.

The physical and emotional exhaustion, low payment and social disrepute are factors associated with the working conditions of nurses, which reflect negatively on the quality of care provided to the client.

Recent studies have discussed the morbidity of health professionals related to work, night shift, stress and anxiety, especially in the group of professional nursing. [6],[7],[8].

Portela [9] points as main complaints in professional nursing a headache / migraine, varicose veins of the lower limbs, anxiety / insomnia, allergies and respiratory minor psychiatric morbidity. However, these are considered as outcomes of the "potential risks".

The articles of Silveira [6] and Gelsema [10] claimed that the suffering and illness of professional nursing at the hospital was related to the organization of the work process, the hierarchical relationships, the ties of precarious labor, the lack of clarity about the activities to be performed and devaluation professional.

Studies isolated in hospitals in Rio de Janeiro, shows various kinds of problems at work, and more frequent problems of posture (85,3%) and stress (86.6%) [11] and with needles stick injuries (66.6%)[12], among many others cited.

In this alarming context, it is imperative study and find solutions to the health of workers of Health, to work and enjoy[13] not to incur the same chaos of the work of nursing in the European Community, as studies of Estryn-Behar[14], which showed a turnover of 2 years of professional nurses, caused by the abandonment of employment, because of the work conditions, this very issue discussed in the seminar "Citizenship, Health and Nursing's Decent Work, held between 21 and 23, September 2005, the School of Nursing UERJ in Rio de Janeiro.

Importance of diagnosis of the situation

OTERO [15] and Benavides [16] pointed to professionals and managers of health, the need to study the situation of Health Workers' Health, and suggests the adoption of appropriate measures of safety, health and ergonomics, applied the Conditions of Work , and favoring measures that improve their quality of life.

The application of a participatory approach to research and risk assessment, brings to light a diagnosis that has three dimensions: related to the environment and work processes (a technical dimension), related to work relationships (a political dimension), and those regarding subjectivity (the psychodynamics of work dimensions). [17]

Relevance of worker's participation

The problems at work are not restricted only to the individual scope, but also the collective context.

The situation that allows the development of diagnostic, should be through actions involving the number of people involved. Thus, through the participatory management, allows to discussion of the problems and the implementation of individual programs for risk prevention and health promotion, avoiding the verticalization of the management process.

The worker in this context has the opportunity to report the problem experienced, allowing reliable results, since it is protagonist of the process and also the main component in the transformation of the situation. In most cases, the employee is both the subject of insecurity and agent for the change in their work conditions.

PROPOSAL OF SIMPLIFIED METHODS

In general, the preparation of diagnosis method requires professionals that include ergonomists, epidemiologists, and experts in the field of health and safety at work and management.

It is necessary to invest in create a management model of the health risks less technical, more humanistic, involving the employee in the process, by a team work, highlighting the importance of their work and the right to active participation with knowledge of the facts in decisions about work process to which it is part.

The Project INGECTH-SUS, has its innovative character by adapting the original model of the instrument to collect data from Boix & Vogel as for a self- application model with the interference of the worker for the diagnosis of the situation.

It is proposed in this project innovate the application of models with the involvement of management and workers.

It is a social construction, which has the opportunity to respond, reflect and assess the possibilities of prevention or elimination of risks marking two points separate:

• The risk assessment with the concept of the damage by workers in the focus of working conditions and factors related, and the awakening of consciousness for the prevention with comprehensive solutions.

• The learning of preventive practices that raise the part of the hidden iceberg of problems arising from work to be circumvented through collective measures.

RESULTS EXPECTED

This project is ambitious because it has a purpose of developing a methodology of research in the management of work, added to the establishment of a software support and management, offering the possibility of managers of hospitals draw up the diagnosis of working conditions and consequently development of a Program for the Promotion of Health Workers in the search for collective solutions to health in order to improve the quality at work, the reduction of effort spent, increased satisfaction of the employee, and the consequent increase in productivity.

PARCIAL CONSIDERATIONS:

The process, which started in ------ 2006, is in the process of validation and application of instruments for collecting data for diagnosis. And with the diagnosis,selecting the most significant for the development of the program of improvements with goals and targets, allowing the tracking of the measures of prevention and control related working conditions, the subject of the proposed platform software.

REFERENCE

1. Organización Internacional del Trabajo, OIT (2003). Actividades normativas de la OIT en el ámbito de La seguridad y la salud en el trabajo: estudio detallado para a discusión con miras a la elaboración de un plan de acción sobre dichas actividades. 91ª. Conferencia Internacional del Trabajo. Suiza: OIT
2. Sánchez Milla J.J, Sanz Bou, M.A. S.E.S.L.A.P. (2006) Vol. II Nº 1 Revisão conceitual do acidente do trabalho. A investigação como resposta ao fenômeno multicausal. Conceitual revisão do acidente industrial The investigation as answer al phenomenon multicausal.
3. Trabalho, Ministério do. NR 9 PROGRAMA DE PREVENÇÃO DE RISCOS AMBIENTAIS (BRASIL,1995) Disponivel em: http://www.mte.gov.br/legislacao/normas_regulamentadoras/nr_09.pdf. Acesso em 22.02.2008.
4. Díaz ,J. E., Antúnez, N. V., Couto, M. D. & Rojas, M. (2007). Trabajo, ergonomía y calidad de vida. Una aproximación conceptual e integradora. Salud de los trabajadores, v.15,n.1, 5157
5. ICN – Consejo Internacional de Enfermería (1988). ENFERMERAS: Na salud y na seguridad. Ginebra/Suiza.
6. Silveira GRM. Trabalho e saúde no hospital: o caso das trabalhadoras de enfermagem do Instituto de Pesquisa Clínica Evandro Chagas/Fiocruz (dissertação). Rio de Janeiro: Escola Nacional de Saúde Pública, Fiocruz; 2003.
7. Rotenberg L, Portela LF, Marcondes WB, Moreno C & Nascimento CP. Gênero e trabalho noturno: sono, cotidiano e vivências de quem troca o dia pela noite. Cad Saúde Pública 2001; 17(3):63949.
8. Braga D. Acidente de trabalho com material biológico em trabalhadores da equipe de enfermagem do Centro de Pesquisas Hospital Evandro Chagas (dissertação). Rio de Janeiro: Escola Nacional de Saúde Pública, Fiocruz; 2000
9. Portela LF. Morbidade referida e gerenciamento do tempo em profissionais de enfermagem: relações com o horário de trabalho, jornada semanal e trabalho doméstico (dissertação). Rio de Janeiro: Escola Nacional de Saúde Pública, Fiocruz; 2003.
10. Gelsema, T. I., Van der Doef M., Maes,S., Akerboom, S., Verhoeven, C. Job Stress in the Nursing Profession: The Influence of Organizational and Environmental Conditions and Job Characteristics. 2005, Vol. 12, No. 3, 222– 240.
11. Moraes, Claudia de Souza (2005). CONDIÇÕES DE TRABALHO E SAUDE DOS TRABALHADORES DE ENFERMAGEM QUE ATUAM EM CLÍNICA MÉDICA. Monografia de Conclusão do Curso Mestrado em Enfermagem – Faculdade de Enfermagem – FENF/UERJ, Rio de Janeiro/RJ.
12. Hipólito, R.L (2005). CONDIÇÕES DE TRABALHO E SAÚDE DA EQUIPE DE ENFERMAGEM INTENSIVISTA NA REDE PARTICULAR DO MUNICÍPIO DE CAMPOS DE GOYTACAZES: Um estudo de caso. Monografia de Conclusão do Curso Mestrado em Enfermagem – Faculdade de Enfermagem – FENF/UERJ, Rio de Janeiro/RJ.
13. Bernhoeft, Renato. (1991) TRABALHAR E DESFRUTAR – Equilibrio entre vida pessoal e profissional. Ed. Nobel, São Paulo/SP/Brasil.
14. EstrynBehar, M (2005). SANTÉ ET SATISFACTION DES SOIGNANTES AU TRAVAIL EN France ET EN EUROPE – Preventión des déspartes prématurés de la profession. Resultats de l’enquête PRESST – NEXT, Assistance Publique, Hôspitaux de Paris, Paris/FR.
15. OTERO,J.J.G. (1993). RIEGOS DEL TRABAJO DEL PERSONAL SANITÁRIO. Interamericana – Mc Graw Hill, 2ª ed. Madri/ESPAÑA.
16. Benavides, F. G. ; Frutos, C. R.; Garcia, A. M. G. (2005). SALUD LABORAL: Conceptos y Tecnicas para la Prevención de Riesgos Laborales. Masson S.A. Barcelona/ES.
17. Hökerberg, Y. H. M., Santos, M. A. B., Passos, S.R.L, Rozemberg. B., Cotias,