Orientador: Maria Ines Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-09-11T21:13:37Z (GMT). No. of bitstreams: 1 Welle_MariaCristinaStolf_M.pdf: 1876316 bytes, checksum: 9e728217adfbbaf65e8ca43d0d930514 (MD5) Previous issue date: 2008 / Resumo: Nos últimos anos, ocorreram profundas transformações no meio rural brasileiro. O crescimento, a incorporação tecnológica, competitividade no setor de plantas e flores determinou transformações radicais no processo de trabalho, o que gerou mudanças ambientais, nas cargas de trabalho e nos seus efeitos à saúde, ficando os trabalhadores expostos a riscos diversificados. O objetivo desta pesquisa foi caracterizar o perfil sociodemográfico, estilo de vida e condições de trabalho, avaliar a capacidade para o trabalho e percepção de fadiga dos trabalhadores de flores e plantas na região de Holambra. Trata-se de estudo transversal realizado em quatro empresas no qual foi utilizado um questionário com dados sociodemográficos, estilo de vida, trabalho e riscos no trabalho; Índice de Capacidade para o Trabalho (ICT), Occupational Stress Questionnaire (três questões) e questionário de Fadiga. A amostra foi composta por 154 trabalhadores, dos quais 53,9% eram homens, com média de 30,8 anos de idade (DP 10,6) e baixa escolaridade. A capacidade para o trabalho foi ótima para 66 (42,9%), boa para 65 (42,2%); moderada para 21 (13,6%) e baixa para dois trabalhadores (1,3%). Os principais riscos/perigos no trabalho relatados foram: ergonômicos, movimentos repetitivos e pressão no trabalho. Houve uma correlação significativa entre a baixa capacidade para o trabalho e o sexo feminino (p=0,0011). A média de fadiga das mulheres 66,5 (DP 14,3) foi maior que a dos homens 58,9 (DP 16,0). No sexo feminino e masculino a percepção da fadiga se manifestou mais na dificuldade de concentração e atenção, seguida da sonolência e falta de disposição para o trabalho e projeções de fadiga sobre o corpo. Os três escores parciais apresentaram-se mais elevados no sexo feminino. Estes dados sugerem a necessidade de ações que visem a promoção à saúde, facilidade e melhoria do acesso à educação, e da importância da continuidade de estudos sobre saúde, trabalho e gênero, para analisar a interseção entre a esfera produtiva e a doméstica. / Abstract: In recent years, profound changes have occurred in rural Brazil. The growth, the technological incorporation, competitiveness in the sector of plants and flowers determined radical transformation in the work process, which has generated environmental changes in the work loads and its effects on health, leaving workers exposed to multiple risks. The objective of this research was to point out the social-demographic profile, life style and working conditions, to evaluate the capacity for that work and perception of fatigue by workers of flowers and plants in the region of Holambra. A cross-sectional study was conducted in four companies in which the questionnaire was used with social-demographic data, life style, work and occupational risks: Work Ability Index (WAI), Occupational Stress Questionnaire (three questions) and the Questionnaire of Fatigue. The sample was composed by 154 workers, of which 53,9% were men, with an average age of 30,8 years (SD 10,6), low schooled. The work ability was considered excellent for 66 (42,9%), good for 65 (42,2%), moderate for (13,6%) and low for two workers (1,3%). The main risks/hazards at the workplace were reported: ergonomic, repetitive movements and pressure at work. There was a significant correlation between low capacity for work and the female (p=0,0011). The average of fatigue for women 66,5 (SD 14,3) was higher than that of men 58,9 (SD 16,0). Perception of fatigue by the female and male was higher in the difficulty of concentration and attention, followed by drowsiness and lack of disposal to work and projections of fatigue on the body. The three partial scores are higher among females. These data suggest the need for actions that aim to promote healthcare, facility and improvement in the access to education, and the importance of continuity of studies on health, work and gender, to analyse the intersection between the productive and domestic sphere. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Este estudo teve como objetivos subsidiar a proposição de um programa de intervenção para os trabalhadores de saúde expostos aos fluidos biológicos; caracterizar esses trabalhadores; captar seus sentimentos e percepções; identificar as dificuldades vivenciadas no ambiente e analisar estratégias para a minimização dessa exposição. Caracteriza-se como exploratório, de caráter descritivo e de abordagem qualitativa. A amostra foi intencional e compreendeu 15 trabalhadores de saúde expostos a fluidos biológicos na UST em Curitiba, no período de março a agosto de 2005. A técnica de grupo focal foi eleita para a coleta de dados e os discursos dos sujeitos foram tratados e submetidos à análise temática, da qual emergiram quatro categorias empíricas. A análise compreendeu duas etapas: a primeira referiu-se aos dados quantitativos e a segunda aos dados qualitativos.das categorias empíricas. A análise quantitativa mostrou que o sexo predominante foi o feminino (93,00%), entre trabalhadoras de Enfermagem (60,00%); o hospital foi o local de trabalho onde mais ocorreu a exposição (86,60%); o tipo mais comum de acidente foi com instrumentos perfurocortantes; o uso inadequado dos EPIs foi encontrado em 40,00% dos acidentes; 14,40% dos trabalhadores não possuía o esquema vacinal completo e 73,30% dos sujeitos realizaram o monitoramento completo, sem nenhuma soroconversão. A análise qualitativa das quatro categorias empíricas permitiu evidenciar que a primeira - a exposição ocupacional -, ocorreu pela inadequação e/ou falta de recursos materiais; recursos humanos insuficientes; pelo tipo de trabalho realizado nas unidades de saúde e pelos comportamentos de risco dos trabalhadores. A segunda - os sentimentos envolvidos –identificou o medo de doenças e da chefia, preocupação; indecisão; raiva e revolta; culpa e insegurança. A terceira - as causas de abandono do acompanhamento, - ocorrem pelo descrédito da gravidade e por dificuldades operacionais vividas pelo trabalhador. A quarta categoria - as estratégias institucionais e pessoais - foram propostas pelos sujeitos da pesquisa. Visando a prevenção, intervenção e acompanhamento desses trabalhadores foram feitas propostas de Recomendações aos Serviços de Saúde compostas primeiramente por um Programa de intervenção e acompanhamento dos trabalhadores expostos a fluídos biológicos na UST com algumas recomendações para o atendimento e acompanhamento aos trabalhadores e por uma Matriz de Recomendações ações em saúde, categorizando atividades a serem executadas com gerentes de serviços e suas equipes de saúde em quatro dimensões: administrativas, assistenciais, de ensino e de pesquisa. Em síntese, apreende-se com o estudo que a forma como o trabalho em saúde se organiza é o principal determinante da exposição dos trabalhadores aos fluidos biológicos. O estudo ainda evidencia a necessária e importante articulação entre instituições, unidades de atenção à saúde do trabalhador e secretarias de estado em prol da prevenção desses acidentes com trabalhadores de saúde / This study had as its objectives to subsidize the proposition of a intervention programme for health workers exposed to biological fluids; to describe these workers; to hold the attention to their feelings and perceptions; to identify the difficulties experienced in the environment and to analyze strategies for minimization of these exposure. It was described as exploratory, of descriptive nature and qualitative approach. The intentional sample was made of 15 health workers exposed to biological fluids at the UST in Curitiba from March to August 2005. The focus group technique was elected for collecting the data and the subject discourses were discussed and submitted to thematic analysis, of which emerged four empiric categories. The analysis comprised two stages: the first one refers to the quantitative data and the second comprised the qualitative analysis. The quantitative analysis showed the female gender was the predominant one (93%), among nursing workers (60%); The hospital was the place of work that most happened the exposure (86,60%); the most common type of accident was with puncture cutting instruments; the inappropriate usage of EPIs was found in 40% of the accidents; 14,4% of workers, hasn´t had the vaccinal scheme completed and 73,3% of the subjects made the entire monitoring without any serum conversion. The qualitative analysis of the four empiric categories enabled evident that the first one - occupational exposure - , happened by the inappropriate and/or lack of supply resources; inadequate human resources; type of work made at the work units and risk behavior of the workers. The second one - the feelings involved - identified the fear of disease and chieftainship, worry, indecision; anger and disgust; guilty and insecurity. The third - the causes of abandon the follow-up - occur by the discredit of seriousness and by operational difficulties experienced by the workers. The fourth category - the institutional and personal strategies - was proposed by the subject research. Aiming prevention, intervention and follow-up of these workers were made proposals and Recommendations to the Health Service composed firstly by a Programme of intervention and follow-up of workers exposed to biological fluids at the UST with some recommendations for treatment and follow-up of workers and by a Matrix Recommendations in health operation, categorizing activities to be carried out with service managers and their health teams in four extents: administrative, assistance, teaching and research. In synthesis, it is apprehended with the study that the way the work in health organizes itself is the main determinant of workers exposure to biological fluids. The study also shows the necessary and important articulations among institutions and units of attention towards workers health and secretariat of state in aid of prevention of these accidents with health workers

Computer technology has advanced rapidly in the past few decades and computers have become a very important and powerful tool in our everyday lives. Prolonged computer use by office workers has been reported to result in an increased risk of developing Work-related Neck and Upper Limb Disorders (WRNULD) (Bernard et al.. 1994: Faucett & Rempel. 1994: Tittiranonda et al.. 1999). The occupational risk factors associated with prolonged computer use include static posture and the speed and force of keyboard operation. Past studies have examined different aspects of these risk factors through measuring muscle electrical activity (EMG), kinematics and keyboard forces. However, most of these studies have been conducted on healthy painfree subjects and even the few Case-Control studies have not clearly established any direct relationships between the risk factors and WRNULD. The present research project consisted of a series of three studies aimed at investigating whether there were intrinsic differences among different individuals in response to different physical stressors. These intrinsic differences may have important implications to help explain why some individuals would develop WRNULD while others do not. The individuals' responses to the demands of three physical stressors: static posture, speed and force of keyboard operation were assessed. The internal exposure measures of kinematics, EMG, keyboard dynamics and subjective discomforts were used to evaluate the inter-individual differences. Study I was a field investigation comparing the neck-shoulder kinematics between symptomatic ("Case", n=8) and asymptomatic ("Control", n=8) office workers. Results showed trends for consistently greater head tilt and neck flexion angles, and greater ranges of movements in the Case Group than the Control Group. / The Case Group also exhibited a trend for increased acromion protraction compared to the Control Group. The Case Group also reported significantly greater discomfort scores compared to the Control Group. Neither the discomforts nor the kinematics displayed any significant changes over a working day. Study 2 was a laboratory study comparing the responses of Case and Control Groups in terms of EMG, kinematics and subjective discomforts, while a standardised computer task was performed continuously for one hour. The responses of Case (n=23) and Control (n=20) Groups were compared to examine the effects of static posture. The results showed similar trends to those in Study I, with increased neck flexion mean angles and ranges of movements in the Case Group compared to the Control Group. In terms of EMG results, there were trends for EMG amplitude differences in the right upper trapezius (UT) and cervical erector spinae (CES) muscles between Case and Control Groups. These trends became statistically significant when the Case subjects were sub-divided into the High (n=15) and Low (n=8) Groups based on their mean discomfort scores. Study 3 was also a laboratory study to compare the Case (n=21) and Control (n=20) Groups when they were challenged by the physical stressors of speed and force of keyboard operation. In this study, each subject's EMG and discomforts were examined in three typing conditions of normal speed and force, increased typing speed and increased typing force. The Case Group showed trends for higher increases in both UT and CES muscle activities than the Control Group, and when divided into the High-Low Groups, the High Group (n=8) showed trends for much higher muscle activities in all three conditions. / Beside muscle activity changes, the High Group subjects also demonstrated a trend for much higher within-subject Speed and Force Variabilities in their keystroke performance, compared to the Low Group and the Control Group. This result implied that the High Group subjects had a more erratic motor control of the keystroke actions. Based on these results, conceptual models were developed to describe the relationships among the physical stressors, internal exposure responses and discomforts. The Altered Motor Control Model refers to the programmed changes in motor control strategies involving muscle recruitment and joint movement patterns, and these changes were closely related to the subjects' musculoskeletal discomforts. The Heightened Sensitivity Model describes the higher sensitivity levels of individuals with more severe discomforts, in response to the demands of physical stressors. These models are closely related and heightened sensitivity may be an 'effect-modifier" of the motor control mechanisms and the perception of discomforts or pains within the individual. In conclusion, the present research has identified important differences between individuals on the basis of their motor control strategies which may contribute to the development of WRNULD. While the present research has mainly examined the individual responses to three physical stressors, it is possible that the models developed may be applicable to other physical stressors. These findings may also have important implications for future ergonomic research, emphasising the need to address interindividual differences in ergonomic interventions to workers. Further research should be directed towards better understanding of these intrinsic individual differences in both physical and non-physical factors that contribute to the development of WRNULD.

The historic use of asbestos-containing materials during the manufacturing of automobiles has resulted in a perception of an increased risk of asbestos-related pulmonary diseases within mechanics. This study was conducted to assess the potential asbestos exposures mechanics encounter while servicing vehicles assembled with parts containing asbestos, in addition to compare the cumulative lifetime asbestos exposures for different maintenance activities against theorical threshold exposures for asbestosis, lung cancer and mesothelioma. Exposure data were assembled from four independent exposure assessments performed to elucidate the airborne asbestos levels generated during the removal and replacement of brakes, gaskets, clutches and seam sealants containing asbestos. The phase contrast microscopy (PCM) and phase contrast microscopy equivalent (PCME) fiber concentrations for personal samples and air sampled identified to contain asbestos fibers through Transmission Electron Microscopy (TEM) analysis were applied to calculate the cumulative lifetime asbestos exposures. This index of exposure was compared to no-effect exposure thresholds identified through an extensive literature review for the selected pulmonary diseases. The results of this study indicate that mechanics encounter PCM fiber concentrations approximately 10 to 100 times lower than the current Occupational Safety Health Administration (OSHA) Permissible Limit Exposure (PEL) of 0.1 fibers per cubic centimeter (f/cc). Additionally, the cumulative lifetime asbestos exposures ranged from <1 fiber-year/cubic centimeter of air (f-yr/cc) to 2.0 f-yr/cc, and did not exceed the no-effect exposure thresholds for asbestosis, lung cancer and mesothelioma. The findings of this study provide additional support to previously published epidemiologic investigations and exposure assessments against an increased risk of asbestos-related disease within mechanics historically employed to service vehicles containing asbestos fibers.

In a case-control study comprising 589 cases of male lung cancer in northern Sweden longitudinal data concerning occupations, employments and smoking habits were collected by questionnaires. Pipe smoking was as common as cigarette smoking and gave very similar relative risk. The pipe smoking cases, however, had significantly higher mean age and mean smoking years at the time of diagnosis than the cigarette smoking cases. In ex- smokers, the relative risk gradually decreased from 5 years after smoking cessation but this decrease was much less pronounced in ex-pipe smokers than in ex-cigarette smokers. High relative risks were obtained for small cell and squamous cell carcinomas. For adenocarcinoma the relative risk was considerably lower but still significantly increased. The population etiologic fraction attributable to smoking was about 80% in this series. Some occupational groups (underground miners, copper smelter workers, electricians and plumbers) exposed to previously known lung carcinogenic agents had considerably increased odds ratios, which persisted after adjustment for smoking. A slightly elevated odds ratio was observed in a group of blue collar workers potentially exposed to lung carcinogenic agents but this elevation generally disappeared after adjustment for smoking. For two specific subgroups, asphalt and concrete workers and pulp workers, the overrisk persisted after adjustment for smoking. Farmers and foresters had strikingly low odds ratios, which could only partly be explained by their more moderate smoking habits. The population etiologic fraction attributable to occupation was in the reported material assessed to 9 per cent. Professional drivers had higher average tobacco consumption than non-drivers, which explained the slightly increased crude odds ratio found for the occupational group as a whole. Smoking drivers in an upper age group (70 and over), however, had a high relative risk of lung cancer, while in a lower age group (under 70) no significant increase was found. The results in the older age group suggested a multiplicative effect between smoking and the occupational exposure. The study clearly verified the increased lung cancer risk in underground miners. An obvious dose-response relation was found with high risk after long time exposure. All analyses concerning underground miners suggested an interaction of a multiplicative type between underground mining and smoking in the causation of lung cancer. The cases of small cell carcinoma among the underground miners had shorter average latency time and in contrast to the other part of the material, shorter average age than the cases with epidermoid cancer. / <p>S. 1-40: sammanfattning, s. 41-136: 6 uppsatser</p> / digitalisering@umu

Low back pain (LBP) remains one of the most common and challenging primary care issues in the developed world. Manual occupations such as nursing are known to involve a high risk of occupational LBP, which is associated with enormous health care expenditure as well as indirect work and disability-related costs. Despite extensive efforts to reduce LBP in nurses, evidence supporting the efficacy of any specific intervention to prevent LBP is limited. / The majority of LBP prevention strategies are directed at occupational risk factors in working nurses. However, as there is some evidence that LBP is already a significant problem in nurses prior to commencing full time employment, it is proposed that nursing students should be the focus of prevention interventions. This would require prevention interventions targeting personal rather than occupational LBP risk factors. As the best personal predictor of future LBP is currently a previous history of LBP, further investigation of modifiable personal LBP risk factors is required. Consequently, the aim of this doctoral research was to identify modifiable personal characteristics that predict LBP in nursing students. / Firstly, a large survey was conducted on undergraduate nursing students and recently graduated nurses to determine patterns of LBP prevalence. Results from this study indicated that LBP prevalence was very high at the commencement of undergraduate training. Prevalence of LBP did not significantly change during nursing training, but did increase further in the first year of commencing work as a nurse. This increase may be partly explained by the reported increase in occupational exposure to bending and lifting. Age was consistent across the undergraduate year groups and did not influence these findings. It was concluded that nursing students would provide a sufficient number of new-onset LBP episodes (and thus sufficient statistical power) for a prospective study design. Further, as these nursing students were not yet exposed to the occupational LBP risk factors of working nurses, a clearer indication of the influence of modifiable personal factors on the development of LBP could be determined by examining a student cohort. / A cross-sectional study investigating the influence of personal physical, psychological and social/lifestyle factors was then conducted on nursing students. Preliminary analysis revealed clear gender differences across multiple domains. Therefore, the focus of further analysis was on the larger female sample. / In Part 1 of the cross-sectional study, an investigation of regional differences in lumbar spine posture and movement was undertaken. Analysis of spinal kinematics in this study supported and extended previous literature that has found global lumbar spine kinematics do not accurately reflect the kinematics of the upper lumbar or lower lumbar spinal regions in common postures and movements. Rather, these two regions have a degree of functional independence. This finding has implications for interpretation of measures of spinal posture, motion and loading. Further, body mass index influenced regional lumbar posture and movement, possibly representing adaptation due to load. It was concluded that regional rather than global lumbar spine measures needed to be investigated in further analyses of this doctoral research. / In Part 2 of the cross-sectional study, personal characteristics associated with LBP were investigated. Approximately one third of all subjects reported significant LBP in the 12-months preceding the study. Analysis of factors associated with LBP supported the biopsychosocial nature of LBP. Higher stress levels and use of passive coping strategies, increased physical activity levels, holding the lower lumbar spine further from end-range flexion during functional tasks and increased age, all contributed independently to the presence of LBP. These findings supported the hypothesis that modifiable personal characteristics were associated with LBP. / The importance of identifying sub-groups of LBP patients has become widely accepted. In Part 3, further exploratory analysis was conducted on this crosssectional data to determine if differences in physical and psychological characteristics were evident in two defined sub-groups of female nursing students with LBP. These sub-groups were based on O’Sullivan’s mechanism based classification system. Results indicated that two sub-groups of LBP subjects had differing physical and psychological characteristics associated with their LBP. Further, control subjects could be distinguished from each of these two sub-groups by different factors. These findings add validity to O’Sullivan’s LBP classification system. Further, the findings may suggest that different combinations of psychological and physical factors are linked to LBP in different sub-groups in this population, and therefore may require different intervention approaches based on these factors. / In the final stage of this doctoral research, the cohort of female nursing students was followed prospectively for 12-months. The focus of further analysis was on identifying modifiable personal predictors in a sub-group of subjects with new-onset LBP. The results of this study strongly supported that personal factors from multiple domains are predictors of new-onset LBP. After controlling for previous LBP, age and body weight, regression analysis identified that smoking, increased physical activity levels (both exercise and spinal loading), higher stress levels, reduced back muscle endurance, greater posterior pelvic tilt in slump sitting and more accurate spinal repositioning in sitting were all independent predictors of new-onset LBP. These findings have implications for the development of prevention and management interventions for LBP in nurses. / Results from this doctoral investigation support the multi-factorial and biopsychosocial nature of LBP. The important distinction of this research when compared to previous work is the selection of a cohort at the beginning of their working life, with a focus on modifiable personal, rather than occupational factors, associated with LBP. Factors from physical, psychological and social/lifestyle domains were all independently associated with significant new-onset LBP in female nursing students. Interventions utilising a prevention approach that targets modifiable characteristics, such as those identified in this cohort of nursing students, may have the potential to reduce the impact of occupational LBP in this group. These preliminary findings have important implications for future LBP research and clinical interventions.

Objetivou-se nesse estudo identificar os fatores de risco psicossocial que o enfermeiro residente encontra-se exposto em unidades especializadas; descrever as repercussões dos fatores de risco psicossocial para a saúde do enfermeiro residente em unidades especializadas e analisar as formas de enfrentamento adotadas pelo enfermeiro residente diante dos riscos psicossociais em unidades especializadas. Pesquisa qualitativa do tipo exploratória descritiva, cujo campo foi um hospital universitário situado no município do Rio de Janeiro. A partir dos critérios de seleção adotados participaram do estudo 20 enfermeiros residentes do 1 e 2 anos, lotados em unidades especializadas (CTI adulto, UTI neonatal, CTI cardíaco, UI clínica, Unidade Coronariana e Unidade de Doenças Infecto Parasitárias). O estudo obedeceu aos aspectos éticos em conformidade com a Resolução 466/12 sendo aprovado pelo Comitê de Ética em Pesquisa (067/2012). Utilizou-se a técnica de entrevista semiestruturada mediante um instrumento contendo em sua primeira parte as características dos sujeitos e na segunda um roteiro com questões abertas que possibilitaram ao residente falar sobre os riscos no ambiente laboral, o modo como era afetado e os mecanismos de enfrentamento adotados. Ao término das entrevistas, realizadas no segundo semestre de 2012 e registradas em meio digital, aplicou-se a técnica de análise de conteúdo, sendo os resultados discutidos a luz da Psicodinâmica do Trabalho. Os resultados evidenciaram que o enfermeiro residente de unidades especializadas encontra-se exposto a inúmeros fatores de risco psicossocial e entre eles: a sobrecarga física e psíquica do trabalho, a ambiguidade de papéis, o relacionamento interpessoal conflituoso, a pouca autonomia, o baixo controle em relação ao processo de trabalho e a precariedade das condições de trabalho. Tais fatores, além de afetarem o processo de formação do residente, acarretam prejuízos a sua saúde física e mental; identificados a partir de queixas como: cansaço, estresse, desgaste, padrão de sono ruim, problemas gastrintestinais, dermatológicos e osteomusculares. Diante do sofrimento no trabalho, o enfermeiro residente elabora estratégias de manejo centradas na emoção (autocontrole, aceitação das responsabilidades, fuga, confronto e resignação) e no problema (negociação, tentativa de solução, suporte social, reavaliação positiva). Concluiu-se que o enfermeiro residente encontra-se exposto a inúmeros fatores de risco psicossocial em unidades especializadas que afetam a sua saúde física e mental. No intuito de concluir a residência e preservar a saúde, o residente elabora estratégias de manejo, que apesar de essenciais não eliminam o sofrimento no trabalho e os problemas vivenciados no dia a dia. Cabe ao órgão formador identificar, monitorar e combater os riscos referidos pelo residente no intuito de promover a capacitação, a satisfação e o bem estar no trabalho, ao se considerar a responsabilidade social pela formação, saúde e inserção do futuro profissional no mercado de trabalho. / This study aimed to identify the psychosocial risk factors to which the resident nurse is exposed in specialized units; describe the impact of psychosocial risk factors for the resident nurse's health in specialized units and examine coping methods adopted by resident nurses towards psychosocial risks in specialized units. An exploratory descriptive qualitative study whose field was a university hospital located in the municipality of Rio de Janeiro. From the selection criteria, adopted 20 nurses participated in the study residents from the 1st and 2nd years, crowded into specialized units (adult ICU, NICU, ICU, CIU, IU clinic, Cardiac Care and Infectious and Parasitic Diseases Unit). The study followed the ethical aspects in accordance with the Resolution 466/12 being approved by the Committee for Ethics in Research (067/2012). The semi-structured interview technique was used through an instrument containing the characteristics of the subjects in its first part and in the second a script with open-ended questions that allowed the resident talk about risks in the work environment, how they were affected and the adopted coping mechanisms. At the end of the interviews, carried out in the second half of 2012 and recorded by digital medium, a content analysis technique was applied, and the results discussed in light of Psychodynamics of Work. The results showed that the specialized unit resident nurse is exposed to numerous psychosocial risk factors and among them: the physical and mental burdens of work, the ambiguity of roles, the interpersonal relationship confrontational, little autonomy, the low control in relation to the work process and the precarious work conditions. Such factors, besides affecting the resident training process, impairing their physical and mental health; identified from complaints such as fatigue, stress, wear, poor sleep patterns as well as gastrointestinal, dermatological and musculoskeletal problems. Given the suffering at work, the nurse prepares resident management strategies focused on emotion (self, acceptance of the responsibilities, escape confrontation and resignation) and the problem (negotiation, attempted solution, social support, and positive revaluation). It was concluded that the resident nurse is exposed to numerous psychosocial risk factors in specialized units that affect their physical and mental health. In order to complete the residence and preserve their health, the resident produces management strategies, which although not essential eliminate suffering at work and the problems experienced in their everyday life. The agency instructor identifying, monitoring and combating the risks referred to by the resident in order to promote empowerment, satisfaction and well-being at work, when considering social responsibility for education, health and of future professionals integration in the labor market.

Este trabalho trata do entendimento das condições desfavoráveis de trabalho causadoras de lombalgias em clínicas geriátricas e tem como objetivo geral propor uma sistemática de avaliação de sobrecarga ocupacional para analisar condições desfavoráveis de trabalho relacionadas a lombalgias de caráter ocupacional em profissionais de enfermagem. Para alcançar o objetivo geral, foram estabelecidos objetivos específicos, que correspondem aos três artigos constituintes dessa dissertação. A metodologia utilizada neste trabalho tem caráter exploratório. O primeiro artigo desenvolve uma revisão da literatura, visando a mapear relações das causas das lesões lombares e o impacto na vida profissional e pessoal dos trabalhadores de enfermagem. No segundo artigo, através de uma revisão sistemática de métodos, suas características e abrangência, utilizados para mensurar a sobrecarga de trabalho causada por condições ocupacionais desfavoráveis em trabalhadores de enfermagem. Já o terceiro artigo propõe uma sistemática de avaliação de sobrecarga de trabalho de profissionais de enfermagem, bem como a aplicação da mesma a partir de um estudo de caso. Como resultado pôde-se perceber quais são as características inerentes ao trabalho dos profissionais de enfermagem, no contexto de clínicas geriátricas, assim como quais fatores e cofatores devem ser avaliados para identificar a existência de risco de lesões lombares relacionadas ao trabalho. / This research focuses unfavorable working conditions capable of induce problems related to low back pain in nursing activities in geriatric clinics and the specific objectives were propose a systematic evaluation of overhead to analyze occupational unfavorable working conditions related to occupational back pain in professional nursing., corresponding to the three articles performing this dissertation and the methodology used in this study is exploratory. The first paper proposes a systematic review about the relationships between low back pain causes and the impact on professional and personal life of nursing. The second paper is a systematic review of methods and characteristics to measure the workload caused by unfavorable occupational conditions. The third paper proposes and implements a systematic evaluation of workload in nursing in a case study. This approach contains more parameters than those founded in the literature including enterprise organization and personal characteristics. The results pointed out what are the characteristics related to the nursing professionals work in geriatric clinics and that factors and cofactors should be evaluated to identify the risk of low back injuries.

Trata-se de um estudo não experimental apoiado na ergonomia, epidemiologia e bioestatística. Utilizou-se uma abordagem quantitativa, descritiva e transversal. Apresenta como objeto de estudo a percepção dos trabalhadores de enfermagem de um Hospital Universitários sobre os fatores de riscos no trabalho e sua relação com os seus problemas de saúde. Teve como objetivo avaliar a relação entre os fatores risco no trabalho e os problemas de saúde dos trabalhadores de enfermagem no ambiente hospitalar. Foi desenvolvido em um Hospital Universitário do estado do Rio de Janeiro, com uma amostra constituída de 296 trabalhadores de enfermagem das enfermarias, no ano de 2008. Utilizou-se para coleta de dados um questionário de Mauro adaptado de Boix e Vogel (1997). Os dados foram analisados através do Programa Statical Package for the Social Sciences (SPSS) versão 12.0. Foram evidenciados neste estudo os conceitos que fundamentam as características pessoais e profissionais do trabalhador de enfermagem, a organização, o conteúdo e as condições de trabalho, além das situações política, jurídica e social vivenciada no cotidiano dos trabalhadores. Dentre os resultados destacam-se como fatores de riscos por ordem de maior incidência, o risco biológico, os riscos ergonômicos e psicossociais, o riscos mecânicos ou de acidentes, o risco químico e o risco físico. Tais riscos configuram um ambiente inadequado, capaz de produzir reflexos na saúde dos trabalhadores caso não sejam controlados ou eliminados. Em relação aos problemas de saúde evidenciados, os que se destacaram como relacionados com o trabalho, foram os distúrbios osteomusculares, representados pelas lombalgias, lesões da coluna vertebral, as varizes e os problemas psicossociais, como estresse e depressão. Conclui-se que a hipótese levantada neste estudo de que os fatores de risco interferem nos problemas de saúde dos trabalhadores de enfermagem é verdadeira no hospital estudado. Recomenda-se a discussão dos resultados com os trabalhadores e gerentes, assim como a criação de um Comitê de Ergonomia, para avaliar e implementar mudanças de melhorias no ambiente de trabalho do HU. / Its about a no experimental study bent on ergonomics, epidemiology and biostatics. It was used a quantitative approach, descriptive and transverse. It is presented as a study target the nursing employees perception from a university hospital about the work risk factors and its relation with the health problems. The goal was to evaluate the relation between risk factors and the nursing employees health. It was developed at the university hospital from the State of Rio de Janeiro, with a sample consisting of 296 nurses from the nursing department, in 2008. It was used for the data collect a questionnaire from Mauro adapted from Boix and Vogel (1997). The data were analyzed through the Statical Package for the Social Sciences Program (SPSS) version 12.0. It was pointed in this study the concepts that support the professional and personal features of the nursing worker, the organization, the content and the job conditions, besides the political, legal and social situation lived by the workers day by day. Among the results it is highlighted as risk factors by order of incidence, the biological risk, the ergonomics and psychosocial risks, the mechanical or accident risks, the chemical and physical risk. The so called risks create a inadequate environment, capable of producing reflexions on the workers health in case they are not controlled or eliminated. In relation to the health problems highlighted here, the ones related to the work, were the musculoskeletal troubles, represented by back pains, injuries in the spine, as varicose veins, and the psychosocial problems, as stress and low-spiritedness. It is concluded that the hypothesis raised on this study that the risk factors interfere on the health problems of the nursing workers is true in the studied hospital. It is recommended the discussion of the results with the workers and managers, as well as the creation of a Ergonomics committee to evaluate and implement changes and improvements in the work environment of the university hospital.

Objetivou-se nesse estudo identificar os fatores de risco psicossocial que o enfermeiro residente encontra-se exposto em unidades especializadas; descrever as repercussões dos fatores de risco psicossocial para a saúde do enfermeiro residente em unidades especializadas e analisar as formas de enfrentamento adotadas pelo enfermeiro residente diante dos riscos psicossociais em unidades especializadas. Pesquisa qualitativa do tipo exploratória descritiva, cujo campo foi um hospital universitário situado no município do Rio de Janeiro. A partir dos critérios de seleção adotados participaram do estudo 20 enfermeiros residentes do 1 e 2 anos, lotados em unidades especializadas (CTI adulto, UTI neonatal, CTI cardíaco, UI clínica, Unidade Coronariana e Unidade de Doenças Infecto Parasitárias). O estudo obedeceu aos aspectos éticos em conformidade com a Resolução 466/12 sendo aprovado pelo Comitê de Ética em Pesquisa (067/2012). Utilizou-se a técnica de entrevista semiestruturada mediante um instrumento contendo em sua primeira parte as características dos sujeitos e na segunda um roteiro com questões abertas que possibilitaram ao residente falar sobre os riscos no ambiente laboral, o modo como era afetado e os mecanismos de enfrentamento adotados. Ao término das entrevistas, realizadas no segundo semestre de 2012 e registradas em meio digital, aplicou-se a técnica de análise de conteúdo, sendo os resultados discutidos a luz da Psicodinâmica do Trabalho. Os resultados evidenciaram que o enfermeiro residente de unidades especializadas encontra-se exposto a inúmeros fatores de risco psicossocial e entre eles: a sobrecarga física e psíquica do trabalho, a ambiguidade de papéis, o relacionamento interpessoal conflituoso, a pouca autonomia, o baixo controle em relação ao processo de trabalho e a precariedade das condições de trabalho. Tais fatores, além de afetarem o processo de formação do residente, acarretam prejuízos a sua saúde física e mental; identificados a partir de queixas como: cansaço, estresse, desgaste, padrão de sono ruim, problemas gastrintestinais, dermatológicos e osteomusculares. Diante do sofrimento no trabalho, o enfermeiro residente elabora estratégias de manejo centradas na emoção (autocontrole, aceitação das responsabilidades, fuga, confronto e resignação) e no problema (negociação, tentativa de solução, suporte social, reavaliação positiva). Concluiu-se que o enfermeiro residente encontra-se exposto a inúmeros fatores de risco psicossocial em unidades especializadas que afetam a sua saúde física e mental. No intuito de concluir a residência e preservar a saúde, o residente elabora estratégias de manejo, que apesar de essenciais não eliminam o sofrimento no trabalho e os problemas vivenciados no dia a dia. Cabe ao órgão formador identificar, monitorar e combater os riscos referidos pelo residente no intuito de promover a capacitação, a satisfação e o bem estar no trabalho, ao se considerar a responsabilidade social pela formação, saúde e inserção do futuro profissional no mercado de trabalho. / This study aimed to identify the psychosocial risk factors to which the resident nurse is exposed in specialized units; describe the impact of psychosocial risk factors for the resident nurse's health in specialized units and examine coping methods adopted by resident nurses towards psychosocial risks in specialized units. An exploratory descriptive qualitative study whose field was a university hospital located in the municipality of Rio de Janeiro. From the selection criteria, adopted 20 nurses participated in the study residents from the 1st and 2nd years, crowded into specialized units (adult ICU, NICU, ICU, CIU, IU clinic, Cardiac Care and Infectious and Parasitic Diseases Unit). The study followed the ethical aspects in accordance with the Resolution 466/12 being approved by the Committee for Ethics in Research (067/2012). The semi-structured interview technique was used through an instrument containing the characteristics of the subjects in its first part and in the second a script with open-ended questions that allowed the resident talk about risks in the work environment, how they were affected and the adopted coping mechanisms. At the end of the interviews, carried out in the second half of 2012 and recorded by digital medium, a content analysis technique was applied, and the results discussed in light of Psychodynamics of Work. The results showed that the specialized unit resident nurse is exposed to numerous psychosocial risk factors and among them: the physical and mental burdens of work, the ambiguity of roles, the interpersonal relationship confrontational, little autonomy, the low control in relation to the work process and the precarious work conditions. Such factors, besides affecting the resident training process, impairing their physical and mental health; identified from complaints such as fatigue, stress, wear, poor sleep patterns as well as gastrointestinal, dermatological and musculoskeletal problems. Given the suffering at work, the nurse prepares resident management strategies focused on emotion (self, acceptance of the responsibilities, escape confrontation and resignation) and the problem (negotiation, attempted solution, social support, and positive revaluation). It was concluded that the resident nurse is exposed to numerous psychosocial risk factors in specialized units that affect their physical and mental health. In order to complete the residence and preserve their health, the resident produces management strategies, which although not essential eliminate suffering at work and the problems experienced in their everyday life. The agency instructor identifying, monitoring and combating the risks referred to by the resident in order to promote empowerment, satisfaction and well-being at work, when considering social responsibility for education, health and of future professionals integration in the labor market.