Este documento contempla uma seqüência de três artigos que discorrem sobre o trabalho coletivo da equipe de enfermagem, sendo estes intitulados “O trabalho coletivo da enfermagem: uma revisão da literatura”, ”Mapas Conceituais como ferramenta de análise do trabalho da equipe de enfermagem” e ”Método de análise e discussão de problemas acerca do trabalho coletivo no setor de enfermagem em um hospital”. O objetivo geral é estudar os problemas relativos ao trabalho coletivo em equipes de enfermagem e propor uma sistemática que permita aperfeiçoar as intervenções ergonômicas de cunho participativo neste setor. O primeiro artigo apresenta uma revisão teórica sobre o trabalho coletivo da equipe de enfermagem, visto que ele pode regular positiva ou negativamente o modo operatório das ações desenvolvidas durante o trabalho. Desta maneira, foram revisados 61 artigos, onde evidenciou-se o valor do trabalho coletivo e sua associação com algumas atribuições ocupacionais e organizacionais tais como: aspectos psicossociais, doenças, performance no trabalho, qualidade do trabalho, absenteísmo, autonomia, interdependência, flexibilização, regulação, ainda que algumas delas necessitem ser mais amplamente estudadas (trabalho em turnos e trabalho em turno parcial e integral). O segundo artigo apresenta um método participativo para evidenciar a atividade de trabalho passagem de plantão entre os técnicos de enfermagem de uma unidade de atendimento adulto, demonstrando a utilização de mapas conceituais como método de compreensão da atividade e possibilitando a discussão da concepção da dimensão coletiva para trabalhadores do setor da enfermagem em um hospital. Este artigo explicita os diferentes modelos mentais que os técnicos de enfermagem têm sobre a passagem de plantão, apresentando lacunas de entendimento sobre a tarefa, seus objetivos e necessidades. Desta maneira, o terceiro artigo discute a utilização de um método para análise e resolução de problemas provenientes do trabalho de cunho coletivo expressos pelos técnicos de enfermagem durante a confecção do segundo artigo. O método participativo proposto indica meios de melhorar as problemáticas concernentes ao trabalho coletivo dos técnicos de enfermagem, uma vez que foi um método de fácil entendimento por parte dos colaboradores da pesquisa. / This document includes a series of three articles that discuss the collective work of the nursing team, entitled “The nursing collective work: a review”, “Conceptual Maps as a tool for nursing team work analysis” and “Problem analysis and discussion methodology, about the collective work in a nursing sector of a hospital”. The main objective is to study the problems related to the nursing collective work and to propose a systematic to improve the ergonomics interventions in this sector. The first article presents a theoretical revision of the nurse team´s collective work, since it can regulate positively or negatively the operative mode of actions developed during the work. Thus, 61 articles were reviewed. In conclusion this study demonstrated the value of collective work and its association with some occupational and organizational tasks such as psychosocial, disease, work performance, work quality, absenteeism, autonomy, interdependence, flexibility, regulation, although some of them need to be more widely studied (shift work and shift work part-and full). The second paper presents a participatory methodology to highlight the work activity “shift work” among the nursing staff of an adult care setting, demonstrating the importance of using concept maps as a methodology for understanding the activity and enabling discussion of the concept of collective dimension to those in the nursing in a hospital. This article shows the different mental models that nursing staff have about the shift change, with gaps of understanding about the task, their goals and needs. Thus, the third article discusses the use of a methodology for problem analysis and solving about the collective work expressed by nursing staff during the construction of the second article. The proposed methodology suggests ways to improve the issues concerning the collective work of practical nurses, because it is an easily understood methodology to the research´s collaborators.

Este documento contempla uma seqüência de três artigos que discorrem sobre o trabalho coletivo da equipe de enfermagem, sendo estes intitulados “O trabalho coletivo da enfermagem: uma revisão da literatura”, ”Mapas Conceituais como ferramenta de análise do trabalho da equipe de enfermagem” e ”Método de análise e discussão de problemas acerca do trabalho coletivo no setor de enfermagem em um hospital”. O objetivo geral é estudar os problemas relativos ao trabalho coletivo em equipes de enfermagem e propor uma sistemática que permita aperfeiçoar as intervenções ergonômicas de cunho participativo neste setor. O primeiro artigo apresenta uma revisão teórica sobre o trabalho coletivo da equipe de enfermagem, visto que ele pode regular positiva ou negativamente o modo operatório das ações desenvolvidas durante o trabalho. Desta maneira, foram revisados 61 artigos, onde evidenciou-se o valor do trabalho coletivo e sua associação com algumas atribuições ocupacionais e organizacionais tais como: aspectos psicossociais, doenças, performance no trabalho, qualidade do trabalho, absenteísmo, autonomia, interdependência, flexibilização, regulação, ainda que algumas delas necessitem ser mais amplamente estudadas (trabalho em turnos e trabalho em turno parcial e integral). O segundo artigo apresenta um método participativo para evidenciar a atividade de trabalho passagem de plantão entre os técnicos de enfermagem de uma unidade de atendimento adulto, demonstrando a utilização de mapas conceituais como método de compreensão da atividade e possibilitando a discussão da concepção da dimensão coletiva para trabalhadores do setor da enfermagem em um hospital. Este artigo explicita os diferentes modelos mentais que os técnicos de enfermagem têm sobre a passagem de plantão, apresentando lacunas de entendimento sobre a tarefa, seus objetivos e necessidades. Desta maneira, o terceiro artigo discute a utilização de um método para análise e resolução de problemas provenientes do trabalho de cunho coletivo expressos pelos técnicos de enfermagem durante a confecção do segundo artigo. O método participativo proposto indica meios de melhorar as problemáticas concernentes ao trabalho coletivo dos técnicos de enfermagem, uma vez que foi um método de fácil entendimento por parte dos colaboradores da pesquisa. / This document includes a series of three articles that discuss the collective work of the nursing team, entitled “The nursing collective work: a review”, “Conceptual Maps as a tool for nursing team work analysis” and “Problem analysis and discussion methodology, about the collective work in a nursing sector of a hospital”. The main objective is to study the problems related to the nursing collective work and to propose a systematic to improve the ergonomics interventions in this sector. The first article presents a theoretical revision of the nurse team´s collective work, since it can regulate positively or negatively the operative mode of actions developed during the work. Thus, 61 articles were reviewed. In conclusion this study demonstrated the value of collective work and its association with some occupational and organizational tasks such as psychosocial, disease, work performance, work quality, absenteeism, autonomy, interdependence, flexibility, regulation, although some of them need to be more widely studied (shift work and shift work part-and full). The second paper presents a participatory methodology to highlight the work activity “shift work” among the nursing staff of an adult care setting, demonstrating the importance of using concept maps as a methodology for understanding the activity and enabling discussion of the concept of collective dimension to those in the nursing in a hospital. This article shows the different mental models that nursing staff have about the shift change, with gaps of understanding about the task, their goals and needs. Thus, the third article discusses the use of a methodology for problem analysis and solving about the collective work expressed by nursing staff during the construction of the second article. The proposed methodology suggests ways to improve the issues concerning the collective work of practical nurses, because it is an easily understood methodology to the research´s collaborators.

Esta dissertação foi idealizada a partir da busca de elementos que permitissem a introdução de melhorias duradouras e de maior porte nas organizações através da ergonomia. Os principais objetivos foram, primeiro, analisar os benefícios do desenvolvimento de ações ergonômicas em um nível mais elevado da organização e mais próximo àqueles que a gerenciam. Posteriormente, descrever e analisar os benefícios da presença de trabalhadores com um alto grau de emancipação em uma intervenção ergonômica. Como referencial teórico partimos da introdução da temática da ergonomia do trabalho, passando pela questão da emancipação no trabalho, e enfim pelo assunto da participação do trabalhador sob a ótica das teorias organizacionais. Um projeto de pesquisa ação numa instituição pública da área da saúde se constituiu um meio útil para o levantamento dos dados, obtidos sobretudo através de entrevistas semi-estruturadas e da participação efetiva do pesquisador nos processos de implantação dos dispositivos de melhoria. Em uma primeira parte foi avaliado e analisado o trajeto das ações ergonômicas desenvolvidas na instituição em estudo, enquanto na segunda parte dos resultados foi analisado o grau de envolvimento dos trabalhadores no processo de melhoria na organização em um nível mais abrangente da instituição. Este trabalho permitiu concluir que um papel proativo dos sujeitos visando uma efetiva transformação do trabalho pode propiciar resultados positivos e duradouros em intervenções ergonômicas, assim como é fundamental para a construção de um processo de emancipação dos trabalhadores (em vários níveis da organização). Fortemente relacionada à conclusão anterior é a confirmação de que quanto mais elevamos a discussão e quanto maior o apoio em níveis elevados de decisão sobre a ergonomia na hierarquia organizacional, maior é o sucesso na implementação de políticas de melhoria. / The aim of this dissertation was to look for elements that allow organizations to introduce important and lasting improvements through ergonomics. Two main strategic goals have been pursued during this work. The first aim analyzes the benefits of ergonomics developed on high levels of organization, closer to managers. The second, instead, investigates the importance of a presence of workers with an high degree of emancipation within ergonomic approaches. From a theoretical point of view, the starting point consists of the introduction, in the working system, of ergonomic themes, worker emancipation and worker participation (analyzed within organization theories). The practical results have been achieved through an action research project applied to a public care organization. The outcomes were achieved mainly through the adoption of semi-structured interviews and the participation of the researcher during the processes of improvement implementation. First of all, the course of ergonomic actions developed in the institution under study have been evaluated and examined. Then the research focused on the degree of employee involvement in this process of improvement in a larger scale. This study revealed that a proactive role carried out by people looking for an effective transformation of the work provides positive and lasting results within an ergonomic intervention. At the same time this is fundamental to build a process of emancipation of workers in the different levels of organization. Therefore, on the basis of this conclusion, the more ergonomics is applied to higher levels of discussions and decisions in the organization hierarchy, the greater the success in implementing improvement policies is.

July 2010. "Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Occupational Therapy, Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University, Fort Lauderdale, Florida" Objective. The following research questions were posed: (1) Does participatory ergonomic education and programming influence occupational performance among cosmetologists? (2) Does ergonomic education and programming influence quality of life among cosmetologists? (3) Does ergonomic education and programming influence pain among cosmetologists? (4) Does ergonomic education and programming influence numbness and tingling in the upper extremities of cosmetologists? The purpose of this study was to: (1) implement a participatory ergonomic program for cosmetologists and (2) to examine the effectiveness of the implemented program in decreasing signs and symptoms associated with work-related musculoskeletal disorders. Method. A multiple baseline, single subject design was used. Data were collected from seven subjects for a total of 12 weeks. The intervention was introduced to subjects at different times throughout the study and consisted of general ergonomic education, a participatory ergonomic interview session, and basic range of motion stretches. Outcome measures included the QuickDASH, a 10-point pain scale, and a 10-point numbness and tingling scale. Data were analyzed using visual analysis techniques including the two-standard deviation band method and the binomial test method. Data trends were assessed to further support the results. Results. The results of this study indicate that ergonomic programming improved occupational performance, improved quality of life, decreased upper extremity pain, and decreased upper extremity numbness and tingling for several of the participants. The results of this study also produced statistically significant changes in QuickDASH scores indicating improved quality of life and improved occupational performance. Statistically significant change in pain scores and numbness/tingling scores indicated that several participants experienced decreased pain, numbness, and tingling in the upper extremity. Conclusion. The results of this study support the assumption that cosmetologists experience symptoms consistent with work-related musculoskeletal disorders and respond to participatory ergonomic programming similar to other working groups. The results of this study support the main principles of the participatory ergonomic approach which focus on involvement of the worker. The participatory ergonomic approach used in this study aligns with the client-centered principles found in the practice of occupational therapy and therefore provides evidence of effective occupational therapy intervention.

A study was conducted to determine the preferences for the design of distributed meeting rooms used for video enhanced electronic meeting systems (VEMS). Although there is a significant body of literature in the group communication domain, the research in this multidisciplinary area has paid minimal attention to users' environmental preferences in the design of a meeting space. A basic science approach through three studies was used to explore the variables that defined the design of a distributed meeting space from the user's perspective. Twenty-five inexperienced college-enrolled participants and twenty-five experienced Naval professionals used foam-core pieces to create a design of their ideal distributed meeting space. Thirty-seven variables were used to categorize qualitative attributes of the designs. Three types of designs emerged from the sample population: v-shaped, conference (u-shaped or oval), and theater (auditorium) style. A nonexperimental design was used to measure the impact of the heuristics on the users' physical design of their distributed meeting spaces. Post-meeting evaluation results were promising and indicated that the heuristics were usable and that participating in the design could have a positive impact on user's subjective rating of their meeting experience. Overall, inexperienced users did not believe that the heuristics were necessary to determine the best room design for their team's needs. In the third study, six experts conducted an expert evaluation of a distributed meeting room site. Most experts were not able to identify context-specific design issues such as camera angle and lighting with the static information that they were provided. The experts subjective ratings indicated that the heuristics were usable and were useful for room designers. The overall findings indicated that experience level had a significant impact on user's perception of important equipment in a distributed meeting room. Naïve users were more concerned with visual communication and assigned more importance to public displays (p=.035). Experienced users were more concerned with audio communication and assigned more importance to microphone control (p=.024). In addition, general findings from this research include a new methodology for generating participatory ergonomic tools. / Ph. D.

Abstract The purpose of the research presented in this thesis was to explore experiences from studies on participatory ergonomics methods conducted during a period of seven years. The phenomenon of interest was participative methods for implementation of best practices in order to improve conditions in different work environments. The posed research questions dealt with the usefulness and applicability of the assessed ergonomics methods/tools. One question concerned the change agents, what those were, and in which way the workers could be empowered in their daily work. The thesis is built on four case studies using a qualitative approach. In the first study an assessment of the Future Workshop as a participatory ergonomics method was made. This was achieved by conducting workshops in which professional cleaners, health care personnel and miners participated, and by assessing their perceptions of the conducted workshops and their immediate and long-term effects on safety work. The second study determined whether home care personnel used their gained knowledge and skills after completing a training programme in patient transfer technique, and identified hindering and supporting factors for the use of safe work technique. The assessment was performed through focus group interviews and individual interviews with home care staff, unit leaders and safety representatives. The third study evaluated a team-based systematic risk assessment method and action plans at two municipal homes for elderly. Lastly, the fourth study described experiences from a participatory ergonomics project in home care services. In this case, an occupational therapist was working together within the home care teams, as well as functioning as an investigator during a period of three years. Studies one to three had an explorative, descriptive design, while the fourth study was inspired by action research. A phenomenological approach for analysing the data was used in the first and fourth study, and the second and third were analysed through qualitative content analysis. The research presented in this thesis contributes to theory and practice in two ways. From a pragmatic point of view, the research provides knowledge (knowing) from reality. The empirical findings in the four studies showed participative methods to be suitable and functional tools in safety and health work in different environments. The research also showed that the essential change agent is empowerment, and that employees are empowered by their own involvement in the work. From a theoretical point of view, the research gives support for earlier research within the area, and connects approaches such as learning by doing and reflective practice with the concept of participatory ergonomics. / Tiivistelmä Tässä väitöskirjassa tutkittiin kokemuksia osallistuvista ergonomiametoditapauksista seitsemän vuoden ajalta. Osallistuvia metodeja käytettiin tapaustutkimuksissa parhaiden toimintatapojen käyttöönottoon työolojen parantamiseksi. Tälle tutkimukselle asetetut tutkimuskysymykset kattoivat ergonomia metodeiden/työkalujen hyödyllisyyden ja soveltuvuuden arvioimisen. Yksi kysymyksistä käsitteli muutosagentteja: mitä ne olivat, ja millä tavalla työntekijät voidaan voimaannuttaa päivittäiseen työhönsä. Väitöskirja on rakennettu neljän tapaustutkimuksen pohjalta käyttäen laadullista lähestymistapaa. Ensimmäisessä tapauksessa tehtiin arvio ”tulevaisuuden työpajasta” osallistuvan ergonomian metodina. Tämä toteutettiin järjestämällä työpajoja ammattisiivoojien, terveydenhuollon työntekijöiden ja kaivostyöläisten keskuudessa ja arvioimalla niiden lyhyen sekä pitkänajan vaikutuksia turvallisuustyöhön. Toinen tapaus määritteli, käyttivätkö kotihoidon työntekijät potilaiden siirtotekniikkakoulutuksessa kartuttamaansa osaamista ja taitoja hyödyksi työssään. Tutkimus toteutettiin fokusryhmä- ja yksilöhaastatteluilla kotihoidon työntekijöiden, yksikönvetäjien ja turvallisuusedustajien parissa. Kolmas tapaus arvioi ryhmäpohjaista systemaattista riskinarviointimenetelmää ja toimintasuunnitelmia kahdessa kunnallisessa vanhustenkodissa. Neljäs tapaus kuvaili kokemuksia kotihoidon palveluita käsittelevästä osallistuvasta ergonomiaprojektista. Viimeisessä tapauksessa toimintaterapeutti työskenteli kotihoidon tiimeissä, osallistuen tutkijana kolmen vuoden ajan. Tapauksissa 1-3 tutkimusotteena oli eksploratiivinen, kuvaileva tutkimusote, kun taas neljäs oli toimintatutkimuksen inspiroima. Fenomenologista lähestymistapaa käytettiin saadun datan analysointiin ensimmäisessä ja neljännessä tapauksessa, kun taas toisen ja kolmannen tapauksen dataa analysoitiin laadullisen sisällönanalyysin keinoin. Tämän väitöskirjan tutkimus edistää teoriaa ja käytäntöä kahdella tavalla. Pragmaattisesta näkökulmasta tämä tutkimus tarjoaa tietämystä todellisuudesta. Neljän tutkimuksen empiiriset löydökset tukivat osallistuvien metodeiden soveltuvuutta ja työsuojelutyön toimivia työkaluja eri ympäristöissä. Tutkimus osoitti, että voimaannuttaminen (empowerment) on oleellinen muutosagentti ja että työntekijöiden oma työhön osallistuminen voimaannuttaa heidät. Teoreettisesta näkökulmasta tämä tutkimus tukee alueen aiempaa tutkimusta ja yhdistää osallistuvan ergonomian konseptiin tekemällä oppimisen ja reflektoivan käytännön.

In 2018 IKEA Industry, the largest producer of wood-based furniture for IKEA customers presented their sustainability strategy for Financial Year 2025. In Health & Safety, they want to minimize ergonomic risks at their factories. To be able to understand what risks the factories contain, the first step is a common ergonomic risk assessment methodology. Because of a lack of knowledge in ergonomics at IKEA Industry, the responsibility was laid on this master thesis project. This project has with the help of interviews, surveys and observations found what needs the factories have in ergonomic risk assessment. A literature review also found things that the factories should have but haven´t asked for. Using benchmarking, several common methods used on the market has been summarized and analyzed by the requirements. Three methods, KIM, RAMP and HARM were chosen to be tested by the factories. In a user test, it was clear that KIM was easiest to use. HARM was eliminated because of the lack of evaluating lifting and pushing movements. To choose between KIM and RAMP they were evaluated in terms of the requirements. The results showed that KIM was the best method for IKEA Industry factories. At some places RAMP had good assessment methods. In order to not ignore these, they have been implemented into KIM to make it suit the factories even better. The result ended up in a document called Global standard of ergonomic risk assessment. The method is divided into three different methods depending on if you have lifting/ carrying work, pushing work or repetitive work. The results are then summarized in a chart that shows what needs to be investigated. This project has also with the help of the literature and the analysis of the factory, decided which roles that will participate in the assessment. The suggestions are manager, ergonomist and a production co-worker. With the help of this method, the factories will be able to understand what ergonomic risks they have. They will only need to evaluate the work tasks with the help of this method and will then be presented all high, medium or low ergonomic risks in the factories to minimize these before FY2025. / 2018 presenterade IKEA Industry, världens största möbeltillverkare, deras hållbarhetsstrategi inför finansiella året 2025. Inom Hälsa & säkerhet vill dem minska sina ergonomiska risker på fabrikerna. För att förstå vilka risker som finns har dem kommit fram till att skapa en bedömningsmetod som är gemensam bland fabrikerna. Då företaget har en brist i kunskap inom ergonomi har företaget valt att lägga över ansvaret på detta exjobb. Detta projekt har med hjälp av intervjuer, enkäter och observationer kommit fram till vad för behov fabrikerna har vad gäller ergonomisk riskbedömning. Med litteratur har även andra behov hittats som anses behövs men fabrikerna har inte insett behovet. För att hitta metoder har det genomförts en benchmarking där flera av de mest vanliga och erkända ergonomiska riskbedömningsmetoder har sammanfattats. Dessa metoder har sedan analyserats med hjälp av behoven och KIM, RAMP och HARM blev utvalda. Dessa har sedan testats av fabrikerna med hjälp av ett användartest. Resultatet visade på att KIM var enklast att användas. HARM valdes även bort på grund av dess brist i bedömning av lyft och drag. För att kunna välja vilken metod som passar IKEA Industry bäst bedömdes KIM och RAMP med avseende på de olika krav som sattes upp. Här visade det sig att KIM var den mest lämpade metoden för IKEA Industry. Då KIM ibland hade brister i bedömningen som RAMP var bättre på valdes det att lägga in vissa delar från RAMP för att komplettera KIM. Resultatet blev ett dokument vid namn ”Global standard inom ergonomisk riskbedömning”. Metoden är uppdelad i tre olika metoder beroende på om lyftarbete, drag/skjutande arbete eller repetitivt arbete skall bedömas. Resultaten är sedan sammanfattade i en tabell som visar vilka områden som behövs undersökas. Projektet har även med hjälp av teori och analys av fabrikerna kommit fram till vilka roller som skall deltaga i ett bedömningsarbete. Förslaget blev slutligen, ansvarig chef, ergonom och en produktionsarbetare. Med hjälp av denna metod skall fabrikerna kunna förstå vad för risker dem har i fabrikerna. Dem kommer endast behöva använda dokumentet, utvärdera och sedan få information om alla höga, medium och låga risker för att minimera dessa innan FY2025.

INTRODUÇÃO: Os trabalhadores dos Serviços de Nutrição Hospitalar são submetidos às exigências físicas, cognitivas e psíquicas que levam à distúrbios osteomusculares relacionados ao trabalho. O objetivo deste estudo foi implantar ações de melhorias nas situações de trabalho de um serviço de nutrição hospitalar e avaliar a percepção dos trabalhadores e as repercussões sobre os sintomas osteomusculares. MÉTODO: Esta pesquisa foi desenvolvida em um hospital público especializado em cardiologia, localizado em São Paulo, Brasil, após aprovação pelo comitê de ética da instituição. A coleta de dados foi realizada por meio da aplicação de questionários e análise ergonômica do trabalho. Os questionários continham dados sócio-demográficos, história ocupacional, situação de trabalho atual, sintomas osteomusculares e satisfação no trabalho. Do total de 130 trabalhadores, 115 participaram voluntariamente. A análise ergonômica do trabalho foi efetuada de acordo com Guérin et al (2001), sendo realizadas entrevistas, medições do ambiente da cozinha e análises biomecânicas. A partir dos resultados foram implantadas ações de intervenção baseadas na ergonomia participativa durante um ano. Após esta fase, 89 (77%) trabalhadores responderam novamente ao questionário, sendo incluídas perguntas sobre a percepção das modificações. A análise dos dados incluiu testes estatísticos para verificar se houve mudança da prevalência de sintomas antes e após as intervenções, com nível de significância de 5%, por meio dos Programas SPSS 13.0 e Excel 2003. Além disso, foram analisados os dados de percepção dos trabalhadores e dos especialistas em ergonomia sobre o impacto das melhorias na saúde e no processo de trabalho. RESULTADOS: A população constitui-se, em sua maioria, por mulheres, na faixa etária de 25 a 34 anos, com grau médio de escolaridade, casadas, com filhos, e ocupavam o cargo de atendente de nutrição. A maioria trabalhava de 5 a 10 anos no hospital e em jornada de trabalho de 40 horas semanais. Os principais problemas observados foram espaço físico reduzido, equipamentos e materiais de trabalho inadequados, absenteísmo e déficit de pessoal, volume excessivo de trabalho com elevado esforço mental, alta prevalência de sintomas osteomusculares, principalmente nos membros inferiores e ombros. Após as intervenções realizadas, houve melhoria na situação de trabalho com redução nos sintomas osteomusculares e os trabalhadores perceberam as seguintes mudanças nas situações de trabalho: melhoria na iluminação e no controle do ar condicionado, aquisição de batedeira de tamanho médio, conserto de equipamentos, substituição dos pratos de vidro por descartáveis, aquisição de cadeiras, introdução de pausas durante a jornada de trabalho, ginástica laboral e treinamento em liderança para as chefias. Neste período houve ampliação no número de leitos do hospital com conseqüente aumento no volume de trabalho e diminuição da satisfação no trabalho associados à crise financeira da instituição com suspensão de contratações e da compra de materiais e equipamentos. CONCLUSÕES: As intervenções repercutiram em melhorias, principalmente quanto ao ambiente e equipamentos, e na redução dos sintomas osteomusculares nos membros inferiores, ombros, pescoço/região cervical, antebraço e região lombar, apesar desta redução não ter sido estatisticamente significativa. / INTRODUCTION: Hospital food service workers have high level of physical, cognitive and mental demands that are associated with musculoskeletal disorders. The objective of this study was to introduce improvements in the working conditions in a hospital food service and to evaluate the workers perceptions and its effects on musculoskeletal symptoms. METHOD: this study was performed in a public cardiac hospital in São Paulo, Brazil, after its approval by the Ethics Committee. The data were collected by questionnaires and ergonomic analysis of the work. The questionnaire included: socio-demographic, workhistory, work conditions, musculoskeletal symptoms and job satisfaction. A hundred and fifteen questionnaries were applied from 130 workers. The work ergonomic analysis was carried out in accordance with Guérin et al (2001), by means of interviews, observations of kitchen working conditions and biomechanical analyses. Based on the results, interventions have been undertaken by means of a participatory ergonomic approach over one year. After this, another ergonomic analysis was carried out and 89 workers (77%) answered a new questionnaire that also included questions about their perception of the improvements. Data analysis was done by statistical tests to verify symptom prevalences before and after the interventions with a 5% level of significance. SPSS 13.0 and Excel 2003 software was used. RESULTS: The workers were women in the 25-34 age-group, had secondary education, were married, had children and occupied the position of nutrition attendants. They were in this hospital for from 5 to 10 years and on a 40 hour working week schedule. Most of problems observed were reduced space, inadequate equipment and work materials, absenteeism, insufficient number of workers, great volume of work with mental demands, high prevalence of musculoskeletal symptoms mainly in lower members and shoulders. After the improvements in working conditions, the symptoms of musculoskeletal disorders reduced and the workers perceived the following changes in the work process: better lighting and control of air conditioning, acquisition of low capacity mixer, repair of equipment, use of disposable utensils instead of glass plates, acquisition of more chairs, introduction of breaks during working hours, work related gymnastics, workshops for leadership training. In this period the number of hospital beds was increased with a corresponding intensification of the work load and a decline on job satisfaction. The hospital was in a financial crisis with consequences in terms of the hiring of personnel and the acquisition of equipment and materials. CONCLUSION: Interventions brought improvements mainly as regards the work environment and equipment and in the reduction of musculoskeletal symptoms in the lower members, shoulders, neck/cervical region, forearm and lumbar region, though this reduction has not been statistically significant.

INTRODUÇÃO: Os trabalhadores dos Serviços de Nutrição Hospitalar são submetidos às exigências físicas, cognitivas e psíquicas que levam à distúrbios osteomusculares relacionados ao trabalho. O objetivo deste estudo foi implantar ações de melhorias nas situações de trabalho de um serviço de nutrição hospitalar e avaliar a percepção dos trabalhadores e as repercussões sobre os sintomas osteomusculares. MÉTODO: Esta pesquisa foi desenvolvida em um hospital público especializado em cardiologia, localizado em São Paulo, Brasil, após aprovação pelo comitê de ética da instituição. A coleta de dados foi realizada por meio da aplicação de questionários e análise ergonômica do trabalho. Os questionários continham dados sócio-demográficos, história ocupacional, situação de trabalho atual, sintomas osteomusculares e satisfação no trabalho. Do total de 130 trabalhadores, 115 participaram voluntariamente. A análise ergonômica do trabalho foi efetuada de acordo com Guérin et al (2001), sendo realizadas entrevistas, medições do ambiente da cozinha e análises biomecânicas. A partir dos resultados foram implantadas ações de intervenção baseadas na ergonomia participativa durante um ano. Após esta fase, 89 (77%) trabalhadores responderam novamente ao questionário, sendo incluídas perguntas sobre a percepção das modificações. A análise dos dados incluiu testes estatísticos para verificar se houve mudança da prevalência de sintomas antes e após as intervenções, com nível de significância de 5%, por meio dos Programas SPSS 13.0 e Excel 2003. Além disso, foram analisados os dados de percepção dos trabalhadores e dos especialistas em ergonomia sobre o impacto das melhorias na saúde e no processo de trabalho. RESULTADOS: A população constitui-se, em sua maioria, por mulheres, na faixa etária de 25 a 34 anos, com grau médio de escolaridade, casadas, com filhos, e ocupavam o cargo de atendente de nutrição. A maioria trabalhava de 5 a 10 anos no hospital e em jornada de trabalho de 40 horas semanais. Os principais problemas observados foram espaço físico reduzido, equipamentos e materiais de trabalho inadequados, absenteísmo e déficit de pessoal, volume excessivo de trabalho com elevado esforço mental, alta prevalência de sintomas osteomusculares, principalmente nos membros inferiores e ombros. Após as intervenções realizadas, houve melhoria na situação de trabalho com redução nos sintomas osteomusculares e os trabalhadores perceberam as seguintes mudanças nas situações de trabalho: melhoria na iluminação e no controle do ar condicionado, aquisição de batedeira de tamanho médio, conserto de equipamentos, substituição dos pratos de vidro por descartáveis, aquisição de cadeiras, introdução de pausas durante a jornada de trabalho, ginástica laboral e treinamento em liderança para as chefias. Neste período houve ampliação no número de leitos do hospital com conseqüente aumento no volume de trabalho e diminuição da satisfação no trabalho associados à crise financeira da instituição com suspensão de contratações e da compra de materiais e equipamentos. CONCLUSÕES: As intervenções repercutiram em melhorias, principalmente quanto ao ambiente e equipamentos, e na redução dos sintomas osteomusculares nos membros inferiores, ombros, pescoço/região cervical, antebraço e região lombar, apesar desta redução não ter sido estatisticamente significativa. / INTRODUCTION: Hospital food service workers have high level of physical, cognitive and mental demands that are associated with musculoskeletal disorders. The objective of this study was to introduce improvements in the working conditions in a hospital food service and to evaluate the workers perceptions and its effects on musculoskeletal symptoms. METHOD: this study was performed in a public cardiac hospital in São Paulo, Brazil, after its approval by the Ethics Committee. The data were collected by questionnaires and ergonomic analysis of the work. The questionnaire included: socio-demographic, workhistory, work conditions, musculoskeletal symptoms and job satisfaction. A hundred and fifteen questionnaries were applied from 130 workers. The work ergonomic analysis was carried out in accordance with Guérin et al (2001), by means of interviews, observations of kitchen working conditions and biomechanical analyses. Based on the results, interventions have been undertaken by means of a participatory ergonomic approach over one year. After this, another ergonomic analysis was carried out and 89 workers (77%) answered a new questionnaire that also included questions about their perception of the improvements. Data analysis was done by statistical tests to verify symptom prevalences before and after the interventions with a 5% level of significance. SPSS 13.0 and Excel 2003 software was used. RESULTS: The workers were women in the 25-34 age-group, had secondary education, were married, had children and occupied the position of nutrition attendants. They were in this hospital for from 5 to 10 years and on a 40 hour working week schedule. Most of problems observed were reduced space, inadequate equipment and work materials, absenteeism, insufficient number of workers, great volume of work with mental demands, high prevalence of musculoskeletal symptoms mainly in lower members and shoulders. After the improvements in working conditions, the symptoms of musculoskeletal disorders reduced and the workers perceived the following changes in the work process: better lighting and control of air conditioning, acquisition of low capacity mixer, repair of equipment, use of disposable utensils instead of glass plates, acquisition of more chairs, introduction of breaks during working hours, work related gymnastics, workshops for leadership training. In this period the number of hospital beds was increased with a corresponding intensification of the work load and a decline on job satisfaction. The hospital was in a financial crisis with consequences in terms of the hiring of personnel and the acquisition of equipment and materials. CONCLUSION: Interventions brought improvements mainly as regards the work environment and equipment and in the reduction of musculoskeletal symptoms in the lower members, shoulders, neck/cervical region, forearm and lumbar region, though this reduction has not been statistically significant.

Abstract The road freight transport industry as a labour-intensive sector is dependent on the work ability and well-being at work of employees. The majority of the occupational accidents are related to work phases outside the cab. These work phases, which are performed in various different work environments, contain several kinds of ergonomic discomforts. This poses complex challenges for the employers from a safety and productivity point of view. The framework of this thesis is based on the foundations of ergonomics and design science. The main objective was to provide knowledge that can be implemented into the design and management of work systems for local and short haul delivery operations. Material was obtained from two sources. A meta-synthesis was performed to frame holistic management in a human perspective. Furthermore, additional in-depth design knowledge was obtained through participatory ergonomics video analyses on drivers’ work outside the cab. Video analyses resulted in 262 identifications of demanding work situations where ergonomic discomforts and risks of accidents occurred. Sudden over-exertions and strains, falls and slips as well as losing control of work equipment were the most common deviations related to drivers’ work outside the cab and mainly related to physical activities of movement and carrying by hand. The majority of the work situations identified were performed in cargo spaces or elsewhere within the truck structure or at premises and yards that are administered by the customers or other stakeholders. In these environments, drivers tend to perform their work manually or using different types of work equipment. This thesis provides new in-depth knowledge on drivers’ work outside the cab. The results show that different stakeholders can contribute to drivers’ work systems. The knowledge provided by drivers and other stakeholders can be applied to holistic design and management processes at company level. Moreover, the knowledge can also be applied to broader value chain design and management processes. / Tiivistelmä Tieliikenteen tavarankuljetus työvoimavaltaisena toimialana on riippuvainen henkilöstön työkyvystä ja -hyvinvoinnista. Suurin osa tapaturmista liittyy työtehtäviin ohjaamon ulkopuolella. Näitä töitä tehdään hyvin vaihtelevissa työympäristöissä ja niihin työtehtäviin liittyy monenlaisia ergonomisia haittakuormitustekijöitä. Tämä asettaa haasteita niin työsuojelun kuin tuottavuuden näkökulmasta. Väitöskirjan viitekehys pohjautuu ergonomiaan sekä suunnittelutieteeseen. Tavoitteena on tuottaa tietoa, jota voidaan hyödyntää työjärjestelmien suunnittelussa ja johtamisessa erityisesti maaliikenteen jakelukuljetuksissa. Materiaali koostui kahdesta osiosta. Metasynteesillä muodostettiin näkemys kokonaisvaltaisesta johtamisesta ihmisnäkökulmasta. Lisäksi kuljettajat ja sidosryhmien edustajat analysoivat osallistuvan ergonomian keinoin videoaineistoa jakelukuljettajien työstä ohjaamon ulkopuolella. Videoanalyyseissa tunnistettiin yhteensä 262 työtilannetta, jossa esiintyy erilaisia ergonomisia haittakuormitustekijöitä sekä mahdollisia tapaturmariskejä. Äkilliset fyysiset kuormitukset, putoamiset, liukastumiset ja kaatumiset sekä työvälineiden hallinnan menettäminen olivat yleisimpiä tunnistettuja poikkeamia kuljettajan työssä. Pääasiassa nämä liittyivät kuljettajan liikkumiseen sekä erilaisten taakkojen kantamiseen. Valtaosassa (85 %) havainnoista kuljettaja työskenteli ajoneuvon kuormatilassa tai päällirakenteissa tai asiakkaiden tai muiden sidosryhmien hallinnoimissa työympäristöissä. Näissä työympäristöissä kuljettaja työskenteli sekä manuaalisesti käsin että hyödyntäen erilaisia apuvälineitä. Väitöskirja tarjoaa uudenlaista syvällistä tietoa kuljettajan työstä ohjaamon ulkopuolella. Eri sidosryhmät voivat osaltaan vaikuttaa kuljettajan työjärjestelmiin. Kuljettajien ja sidosryhmien tuottamaa tietoa voidaan soveltaa työjärjestelmien kokonaisvaltaisessa suunnittelussa ja johtamisessa niin yritystasolla kuin myös suunniteltaessa ja johdettaessa laajempia arvoketjuja.