O preparo e a administração de medicamento permanecem sendo um ponto crítico na prestação de uma assistência de qualidade para os indivíduos. Este estudo teve como objetivo analisar o efeito da intervenção educativa com profissionais de enfermagem acerca da segurança do paciente na administração de medicamentos injetáveis em um Hospital Público de Porto Alegre. A presente pesquisa teve uma abordagem prospectiva, com delineamento quase-experimental, antes e depois, para detectar e avaliar os não erros e erros durante o preparo e a administração de medicamentos.Os sujeitos foram auxiliares e técnicos de enfermagem, que atuavam na unidade de tratamento intensivo adulto com 59 leitos e em três unidades de internação (clínicas e cirúrgica). O estudo foi desenvolvido em quatro fases: observação não participante das áreas físicas de preparo de medicamento (I), observação não participante do processo de preparo e administração (II), grupos focais com parte dos sujeitos (III), e nova observação não participante (IV). Foram totalizadas 776 observações não participantes nas duas etapas (sendo 427 na II e 349 na fase IV). Cada observação foi correspondente ao preparo e administração de um medicamento injetável por trabalhador, durante o seu turno de trabalho. Realizaram-se no mínimo cinco observações de preparo de medicamentos por sujeito, com 74 sujeitos na etapa II e 61 auxiliares ou técnicos de enfermagem participantes na etapa IV. Na etapa III, a metade dos sujeitos foi convidada a participar dos grupos focais, no entanto, apenas 25 compareceram, formando o grupo intervenção e na IV etapa, os sujeitos da etapa II foram novamente convidados. Dos sujeitos, 81,1% foram do sexo feminino e 67,5% trabalhava apenas nessa instituição. A principal via de administração dos medicamentos injetáveis foi à intravenosa (63,7%, fase II e 58% fase IV). A pesquisa demonstrou consolidação dos pontos positivos da administração dos medicamentos, que foram evidenciados nas duas fases, onde três dos “nove certos” (paciente, medicamento e via certa) mantiveram 100% de execuções corretas pelos sujeitos pesquisados. Como também 99,7% das doses dos medicamentos foram administradas corretamente na quarta fase do estudo. Destacamos que a pesquisa apresentou um dado preocupante, no sentido de constatar que durante o processo de preparo e administração do medicamento ocorreram no mínimo dois erros potenciais de medicação (um no preparo e outro na administração), evidenciando a complexidade desse cuidado assistencial, tendo em vista as 32 etapas a serem realizadas para a segurança do paciente. Assim concluímos que o erro de medicação é a consequência, e não a causa dos problemas assistenciais, e que a abordagem de prevenção do erro foi sempre reativa. Contudo, o erro no preparo e administração de medicamentos injetáveis é decorrente de um conjunto de fatores que envolvem desde a área física inadequada, a falta de supervisão e controle, até o desconhecimento e em consequência a imprudência durante a execução das atividades. Dessa forma, a intervenção educativa por meio de grupos focais com os profissionais de enfermagem acerca de medidas de segurança ao paciente na administração de medicamentos auxiliou a reflexão dos sujeitos sobre as administrações medicamentosas injetáveis com segurança. / The preparation and administration of medicines remains a critical issue in providing quality care to individuals. This study aims to analyze the effect of educational intervention with nursing professionals regarding patient safety in the administration of injectable drugs in a public hospital in Porto Alegre, Brazil. This research adopted a mixed, forward-looking approach, with a quasi-experimental design, in order to detect and evaluate errors and non-errors during preparation and administration of medications. Subjects were nursing auxiliaries and technicians who worked in the adult intensive care unit with 59 beds and three inpatient units (clinical and surgical). The study was developed in four phases: non-participant observation of the physical areas of medication preparation (I), non-participant observation of the preparation and administration process (II), focus groups with part of the subject (III), and new non-participant observation (IV). There have been 776 non-participant observations in total for both phases (being 427 in phase II and 349 in phase IV). Each observation was corresponding to the preparation and administration of an injectable drug per staff professional during their shift. At least five observations of medication preparation were carried out per subject, with 74 subjects in phase II and 61 auxiliary or technical nurses participating in phase IV. In phase III, half of the subjects were invited to participate in focus groups. However, only 25 attended them, forming the intervention group and, in phase IV, subjects from phase II were invited again. From the subjects, 81.1% were women and 67.5% worked only in that institution. The main route of administration of injectable drugs was intravenous (63.7% on phase II and 58% on phase IV). Research has demonstrated consolidation of the positive points of medication administration that were highlighted in the two phases, where three out of the nine rights (right patient, drug and via) kept 100% correct executions by researched subjects. Besides that, 99.7% of medication doses were properly administered in the fourth study phase. It is worth highlighting that the research presented worrying data, in the sense of verifying that the process of medication preparation and administration shows at least two medication potential error (one in preparation and in another administration), demonstrating the complexity of assistance care, in view of the 32 steps to be taken to patient safety. Therefore, we conclude that the medication error is a consequence, not the cause of healthcare problems, and the error prevention approach has always been reactive. However, the error in the preparation and administration of injectable drugs is due to a set of factors ranging from inadequate physical area to lack of supervision and control, knowledge and caution, and concern the implementation of activities. Thus educational intervention through focus groups with nursing professionals concerning patient safety measures in medication administration has helped in the reflection of the subjects regarding safe administration of injectable drug. / La preparación y la administración de fármacos sigue siendo un tema crítico en la prestación de una atención de calidad para las personas. Este estudio tuvo como objetivo analizar el efecto de la intervención educativa con los profesionales de enfermería con relación a la seguridad del paciente en la administración de medicamentos inyectables en un hospital público de Porto Alegre. Esta investigación tuvo un enfoque prospectivo, casi-experimental, del tipo antes y después, para detectar y evaluar los no errores y errores durante la preparación y administración de medicamentos. Los sujetos fueron auxiliares de enfermería y técnicos que trabajaban en la unidad de cuidados intensivos de adultos con 59 camas y tres unidades (clínicos y quirúrgicos). El estudio se realizó en cuatro fases: observación no participante de las áreas físicas de la preparación de la medicina (I), la observación no participante del proceso de preparación y administración (II), grupos de enfoque, como parte de los sujetos (III), y nueva observación no participante (IV). Fueron totalizaron 776 observaciones no participantes en dos etapas (con 427 en Segunda y 349 en fase IV). Cada observación era relevante para la preparación y administración de un producto inyectable por trabajador durante su turno. Había por lo menos cinco de preparación de medicamentos de observaciones por tema, con 74 sujetos en estadio II y 61 asistentes o técnicos de enfermería que participan en el paso IV. En la etapa III, la mitad de los sujetos fueron invitados a participar en grupos de enfoque, sin embargo, sólo 25 asistieron, formando el grupo de intervención y el estadio IV, las materias de la fase II se les preguntó de nuevo. De los sujetos, el 81,1% eran mujeres y el 67,5% trabajaba sólo en esa institución. La principal vía de administración de los medicamentos inyectables era intravenosa (63,7% en estadio II y el 58% en estadio IV). La investigación demostró la consolidación de los puntos positivos de la administración de los medicamentos, que se evidencia en dos fases, donde tres de los “nueve correctos (paciente, medicación y via correcta)” tuvieron 100% de realizaciones correctas entre los encuestados. Así como 99,7% de las dosis de medicación se administra correctamente en la cuarta fase del estudio. Hacemos hincapié en que la investigación presentó un dato preocupante, al ver que el proceso de preparación y administración de la droga tiene al menos dos errores potenciales de medicación (uno en preparación y en otro administración), que muestra la complejidad del cuidado asistencial, considerando los 32 pasos para realizarlo para garantizar la seguridad del paciente. Así llegamos a la conclusión de que el error de medicación es la consecuencia, no la causa de los problemas de bienestar y el enfoque de la prevención del error siempre ha sido reactiva. Sin embargo, el error en la preparación y administración de medicamentos inyectables se debe a una serie de factores que intervienen desde inadecuada área física, la falta de supervisión y control, a la desinformación y en consecuencia imprudencia na ejecución de las actividades. Por lo tanto la intervención educativa a través de grupos focales con profesionales de enfermería sobre las medidas de seguridad a la administración de la medicación al paciente ayudó a la reflexión de los sujetos en la inyección de las administraciones de medicamentos de forma segura.

Estudo com delineamento de método de pesquisa misto sequencial explanatório, no qual adotou-se um desenho transversal retrospectivo na fase quantitativa e acrescentou-se uma estratégia qualitativa, através da discussão em grupos focais e do uso de métodos fotográficos, na perspectiva do pensamento ecológico e restaurativo. O objetivo geral do estudo consistiu em analisar a carga de trabalho de enfermagem e sua potencial relação com a segurança do paciente, em unidades de internação das áreas clínica e cirúrgica de um hospital universitário. Os dados foram coletados no Hospital de Clínicas de Porto Alegre, em duas etapas. Na etapa quantitativa, a população e a amostra consistiram dos pacientes internados e dos profissionais de enfermagem que estavam atuando nas onze unidades de internação, no período de janeiro a dezembro de 2009, dos quais foram obtidos os indicadores mensais de qualidade assistencial e gerencial de segurança dos pacientes, assim como a carga de trabalho das equipes de enfermagem nos doze meses. Na etapa qualitativa, as informações foram coletadas por meio da técnica de grupos focais e métodos fotográficos de pesquisa, com os profissionais de enfermagem de uma das unidades pesquisadas, no período de agosto a novembro de 2011. Na primeira etapa, empregou-se a análise descritiva e analítica dos dados, com o recurso do SPSS/PASW 18.0, e aplicação do teste de Equações de Estimativas Generalizadas, considerando-se o intervalo de confiança de 95% e significância de 5%. Na segunda etapa, as informações foram organizadas, com o recurso do programa NVivo 9, e submetidas à análise de conteúdo temática. Os resultados indicam que a carga de trabalho das equipes de enfermagem, expressa pela razão do número de pacientes por enfermeiro/dia, variou de 2,97 a 8,97 e pela razão do número de pacientes por auxiliar-técnico de enfermagem/dia apresentou variação de 1,13 a 2,17. A partir dos valores de B, que medem a associação entre o fator em estudo e os desfechos, identificou-se que, para cada unidade que se aumenta na razão paciente por enfermeiro, aumenta-se em 0,189 a incidência de queda do leito, em 0,157 a infecção relacionada a cateter vascular central, em 0,171 o turnover e em 0,268 o absenteísmo. Evidenciou-se que, para cada unidade que se acresce na razão paciente por auxiliar/técnico de enfermagem, aumenta-se em 1,437 a incidência de queda do leito, em 1,095 a infecção relacionada a cateter vascular central, em 0,864 o turnover, em 1,933 o absenteísmo, e diminui-se em 10,799 a taxa de satisfação dos pacientes internados com a equipe de enfermagem. Os profissionais participantes do estudo apontaram a complexidade assistencial dos pacientes como um fator determinante para definir as atividades que causam maior impacto na carga de trabalho da equipe e na segurança dos pacientes. Nas discussões dos grupos focais, assim como na caminhada e narrativa fotográficas, foram destacadas as ações de cuidado como a administração de medicamentos, banho de leito e transporte dos pacientes, como aquelas que têm maior repercussão na carga de trabalho da equipe e chance de gerar riscos para a segurança dos pacientes, do ambiente e dos profissionais de enfermagem. / A study employing a mixed explanatory sequential research method, in which a retrospective cross-sectional design was adopted in the quantitative phase with the addition of a qualitative strategy, by means of discussion in focus groups and the use of photographic methods, from the perspective of ecological and restorative thinking. The general objective of the study lies in analyzing the nursing workload and its potential relation to patient safety, in in-patient units in the clinical and surgical wards of a university hospital. Data was collected from Hospital de Clínicas, in Porto Alegre, in two stages. In the quantitative stage, the population and the sample consisted of in-patients and nursing professionals operating in the eleven in-patient wards, in the period from January to December, 2009, from which monthly indicators were obtained for care and management quality concerning patient safety, along with the work load of the nursing teams over the twelve month period. In the qualitative stage, information was collected by means of the focus group technique and photographic research methods, with the nursing professionals from one of the researched units, in the period from August to November, 2011. In the first stage, descriptive and analytical analysis of the data was employed, using the SPSS/PASW 18.0 tool, and application of the generalized estimating equation test, considering an interval of confidence of 95% and significance of 5%. In the second stage, the information was organized using the NVivo 9 program, and submitted to thematic content analysis. Results indicate that the work load of the nursing teams, expressed through the ratio of the number of patients per nurse/day, varied between 2.97 and 8.97 and the ratio of the number of patients per nursing technician assistant/day presented a variation from 1,13 to 2,17. Based on the values of B, which gauge the association between the factor under study and the outcome, it was noted that, for each unit in which the patient ratio per nurse is increased, the occurrence of falls from beds increases by 0.189, while infection related to central vascular catheter increases 0.157, the turnover by 0.171 and absenteeism by 0.268. It was shown that, for each unit in which the patient ratio is increased per nursing technician/assistant, there is an increase of 1,437 in the occurrence of bed falls, a 1,095 increase in infection related to central vascular catheters, a 0,864 increase in turnover, a 1,933 rise in absenteeism, and a reduction of 10,799 in the in-patient satisfaction rate regarding the nursing team. The professionals participating in the study point out patient care complexity as a determining factor in defining the activities that cause the greatest impact on the work load of the team and the safety of patients. In the focus group discussions, as well as in the photographic narrative and walk-through, care actions such as medication administration, bed bathing and the transport of patients were highlighted as those with the highest repercussion on the team workload and the chance of generating risks to the safety of patients, the environment and the nursing professionals. / Estudio con delineación de método de investigación mixto secuencial explanativo, en el cual se adoptó un diseño transversal retrospectivo en la etapa cuantitativa y se añadió una estrategia cualitativa, mediante una discusión en grupos focales y del uso de métodos fotográficos, en la perspectiva del pensamiento ecológico y restaurativo. El objetivo general del estudio constituye en analizar la carga de trabajo de enfermería y su potencial relación con la seguridad del paciente, en unidades de internación de las áreas clínica y quirúrgica de un hospital universitario. Los datos fueron recolectados en el Hospital de Clínicas, de Porto Alegre, en dos etapas. En la etapa cuantitativa, la población y la muestra consistieron de los pacientes internados y de los profesionales de enfermería que estaban actuando en las once unidades de internación, en el período de enero a diciembre de 2009, de los cuales se obtuvieron los indicadores mensuales de calidad asistencial y administrativa de seguridad de los pacientes, así como la carga de trabajo de los equipos de enfermería en los doce meses. En la etapa cualitativa, las informaciones fueron recolectadas por medio de la técnica de grupos focales y métodos fotográficos de investigación, con los profesionales de enfermería de una de las unidades investigadas, en el período de agosto a noviembre de 2011. En la primera etapa, se empleó el análisis descriptivo y analítico de los datos, con el recurso del SPSS/PASW 18.0, y aplicación del test de Ecuaciones de Estimativas Generalizadas, considerándose el intervalo de confianza del 95% y significancia del 5%. En la segunda etapa, las informaciones se organizaron, con el recurso del programa NVivo 9, y sometidas al análisis de contenido temático. Los resultados indican que la carga de trabajo de los equipos de enfermería, expresa por la razón del número de pacientes por enfermero/día, varió de 2,97 a 8,97 y por la razón del número de pacientes por auxiliar-técnico de enfermería/día presentó variación de 1,13 a 2,17. A partir de los valores de B, que miden la asociación entre el factor en estudio y los resultados, se identifica que, para cada unidad que se aumenta en la razón paciente por enfermero, se aumenta en 0,189 la incidencia de caída del lecho, en 0,157 la infección relacionada a catéter vascular central, en 0,171 el turnover y en 0,268 el absentismo. Se evidenció que, para cada unidad que se añade en la razón paciente por auxiliar/técnico de enfermería, se aumenta en 1,437 la incidencia de caída del lecho, en 1,095 la infección relacionada a catéter vascular central, en 0,864 el turnover, en 1,933 o absentismo, y se disminuye en 10,799 la tasa de satisfacción de los pacientes internados con el equipo de enfermería. Los profesionales participantes del estudio señalan la complejidad asistencial de los pacientes como un factor determinante para definir las actividades que causan mayor impacto en la carga de trabajo del equipo y en la seguridad de los pacientes. En las discusiones de los grupos focales, así como en la caminata y narrativa fotográficas, se destacaron las acciones de cuidado como la administración de medicamentos, baño de lecho y transporte de los pacientes, como aquellas que tienen mayor repercusión en la carga de trabajo del equipo y oportunidad de generar riesgos para la seguridad de los pacientes, del ambiente y de los profesionales de enfermería.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-09T13:38:42Z No. of bitstreams: 1 Gustavo Dias da Silva.pdf: 3137873 bytes, checksum: f82f8f22e1838a52d011f8d20995b925 (MD5) / Made available in DSpace on 2015-12-09T13:38:42Z (GMT). No. of bitstreams: 1 Gustavo Dias da Silva.pdf: 3137873 bytes, checksum: f82f8f22e1838a52d011f8d20995b925 (MD5) Previous issue date: 2013 / Mestrado Profissional em Enfermagem Assistencial / O objeto deste estudo é o erro nos processos do sistema de medicação da Unidade de Terapia Intensiva Neonatal (UTIN), tendo como objetivo geral elaborar um processo de reestruturação do sistema de medicação da UTIN, com base nos erros de medicação identificados por meio de incidentes críticos. Os objetivos específicos são descrever os sistemas de medicação e de notificação dos incidentes envolvendo medicamentos na UTIN; caracterizar os erros de medicação na UTIN relatados por profissionais de enfermagem; e discutir as situações, comportamento e consequências envolvendo os erros de medicação na UTIN. Foi realizada uma pesquisa aplicada do tipo descritiva, com uma abordagem quanti-qualitativa adotando-se a técnica dos incidentes críticos com base no referencial metodológico de Flanagan. Os sujeitos do estudo incluíram enfermeiros, técnicos e auxiliares de enfermagem da UTIN de uma maternidade do Rio de Janeiro. A coleta de dados compreendeu duas etapas: observação não-participante e entrevista individual com o uso de um instrumento semi-estruturado. Os incidentes coletados foram categorizados e submetidos à análise estatística e de conteúdo. Foram incluídos no estudo 40 sujeitos, dos quais 13 (32,5%) eram enfermeiros, 26 (65%) técnicos de enfermagem e 1 (2,5%) auxiliar de enfermagem. A média de tempo de experiência profissional foi de 12,6 anos (± 6,6) e de experiência na instituição foi de 8 anos (± 5,3). 65% dos sujeitos eram extra quadro e 77,5% tinham 2 ou mais vínculos de trabalho. Existem três grupos de profissionais diretamente envolvidos nos processos do sistema de medicação: equipe médica, de enfermagem e serviço de farmácia. A caracterização dos relatos dos profissionais de enfermagem revela que o tipo de erro mais freqüente é o de paciente errado (28,2%), seguido de medicamento errado e dose errada (17,0% cada), houve predominância de relatos de incidentes entre os enfermeiros (r=0,98), servidores estatutários, com média de tempo de experiência profissional de 12,6 anos (± 6,6) e tempo de vínculo na instituição de 8,4 anos (± 5,3). Através da análise de conteúdo das entrevistas emergiram 12 temas que foram agrupados nas categorias que compõem o Incidente Crítico: Situações (Sistema de Medicação, Processo de Trabalho e Comunicação); Comportamentos (Proatividade, Admissibilidade, Mestria, Negação); e Conseqüências (Inadequado Gerenciamento do Cuidado, Sofrimento Psíquico, Near miss ou Evento Adverso, Punição e Estratégias de Prevenção). O produto gerado pela análise e interlocução das características peculiares do sistema e do processo de trabalho dos profissionais de enfermagem com as situações, comportamentos e conseqüências dos erros de medicação foi um fluxograma gerencial para reestruturação do sistema de medicação. Os resultados desta pesquisa apontam que a ocorrência de erros e iatrogenias é freqüentemente associada às características sistemáticas e fatores latentes institucionais, sendo a interface destas características do sistema de medicação com o processo de trabalho vivo em ato do profissional de enfermagem, fator determinante para a ocorrência de incidentes críticos negativos envolvendo o uso de medicamentos na UTIN / The object of this study is the error in the processes of the medication system of Neonatal Intensive Care Unit (NICU), aiming to propose a general restructuring of the NICU medication system, based on medication errors identified by critical incidents. The specific objectives are to describe the medication systems and notification of incidents involving drugs in the NICU; characterize medication errors reported by the NICU nurses, and discuss situations, behavior and consequences involving medication errors in the NICU. We performed a descriptive type of applied research with a quantitative and qualitative approach adopting the critical incident technique based on the methodological framework of Flanagan. The study subjects included nurses, technicians and nursing assistants of a maternity in Rio de Janeiro. Data collection involved two stages: non-participant observation and individual interviews using a semi-structured instrument. The incidents were categorized collected and subjected to statistical analysis and content. The study included 40 subjects, 13 (32.5%) nurses, 26 (65%) nursing technicians and 1 (2.5%) nursing assistant. The average professional experience was 12.6 years (± 6.6) and experience in the institution was 8 years (± 5.3). 65% of subjects were extra frame and 77.5% had 2 or more working links. There are three groups of professionals directly involved in the processes of the medication system: medical staff, nursing and pharmacy service. The characterization of the reports of nurses reveals that the most frequent type of error is to the wrong patient (28.2%), followed by wrong drug and wrong dose (17.0% each), there was a predominance of reported incidents between nurses (r = 0.98), servers with average professional experience of 12.6 years (± 6.6) and time to bond with the institution of 8.4 years (± 5.3). Through content analysis of the interviews revealed that 12 subjects were grouped in categories of the Critical Incident: Situation (Medication System, Work Process and Communication); Behaviors (Proactivity, Admissibility, Mastery, Denial) and Consequences (Inadequate Management Care, Suffering Psychic, near miss or adverse event, Punishment and Prevention Strategies). The product generated by analysis and dialogue of the characteristics of the system and the working process of nursing with the situations, behaviors and consequences of medication errors was a flowchart for managerial restructuring of the medication system. The results of this study indicate that the occurrence of iatrogenic errors and is often associated with systemic features and latent institutional factors, and the interface of these characteristics of the medication system in the process of work in action nursing professional factor for the occurrence of negative critical incidents involving the use of drugs in the NICU

Abstract Cold is a very common physical risk factor in workplaces in circumpolar regions. Cold has many detrimental effects on human health and performance, and on the safety, quality and productivity of work. In this study a systematic general Cold Risk Management Model was developed, applied and evaluated. The model can be integrated in a company’s or an organization’s occupational safety, health, environment and quality (SHEQ) management systems and practices in workplaces. The Cold Risk Management Model and methods were later included in ISO 15743 Ergonomics of the thermal environment – Cold workplaces – Risk assessment and management. The Cold Risk Management Model and methods were applied in two case company’s SHEQ systems and practices in the fields of construction and maritime administration and services. Based on the case studies, the concrete cold risk management activities and the personnel training campaign resulted in immediate positive results and improved attitudes towards further development. At the national level, working in the cold was estimated to increase personnel costs in the construction industry annually by €50M, which is 3% of the industry’s annual personnel costs. This study also showed that the Cold Risk Management Model and methods are profitable. In the case construction company, the savings achieved by cold risk management activities at a construction site were 2.5 time the costs of those activities. A follow-up study in the case company in the field of maritime administration and services showed that implementation and dissemination of the Cold Risk Management Model and methods require systematic work also after the initial development process. The implementation process could and should be enhanced by early establishment of organization-wide guidelines, visible concrete actions, a training campaign and use of necessary external experts. This study also presents a Safety Management Matrix Model for analyzing development and implementation activities during the process time span. / Tiivistelmä Kylmä on yksi yleisimmistä työympäristön riskitekijöistä pohjoisissa oloissamme. Kylmästä aiheutuu haittaa ihmisen toimintakyvylle ja terveydelle sekä työn turvallisuudelle, laadulle ja tuottavuudelle. Tässä väitöstutkimuksessa kehitettiin systemaattinen kylmäriskien hallintamalli osaksi yrityksen työterveys- ja työturvallisuus-, ympäristö- ja laatujohtamisjärjestelmiä (SHEQ). Kehitetty kylmäriskien hallintamalli menetelmineen on nykyisin osa standardia ”SFS-EN ISO 15743 Lämpöolojen ergonomia. Kylmät työpaikat. riskin arviointi ja hallinta”. Kylmäriskien hallintamallia ja sen menetelmiä sovellettiin ja edelleen kehitettiin kahdessa tapausyrityksessä rakennusalalla sekä merenkulun tukipalveluissa. Konkreettisista kehittämistoimenpiteistä ja henkilöstön koulutuksesta koettiin tapausyrityksissä saadun välitöntä hyötyä, ja ne johtivat positiivisiin asenteisiin jatkokehittämistyötä kohtaan. Tutkimuksessa arvioitiin kylmätyön myös lisäävän rakennusalan henkilöstökustannuksia vuosittain 50 miljoonalla eurolla, mikä oli 3 % alan vuotuisista palkkakustannuksista. Tapaustutkimuksen avulla osoitettiin, että kylmänhaittojen hallinta on kannattavaa. 20 henkilön rakennustyömaalla kylmänhaittojen hallinnalla saavutettavat säästöt olivat 2,5-kertaiset toimenpiteistä aiheutuneisiin kuluihin verrattuina. Merenkulun tukipalvelujen alalla toimivassa tapausyrityksessä tehdyn seurantatutkimuksen mukaan kylmäriskien hallintamallin käyttöönotto ja levittäminen yrityksessä vaatii kuitenkin aikaa ja systemaattista työtä. Mallin käyttöönottoa ja levittämistä voidaan tutkimuksen perusteella nopeuttaa kehittämistyön näkyvyydellä ja konkreettisuudella, koulutuksella, organisaatiotasoisten ohjeiden laatimisella aikaisessa vaiheessa sekä erityisesti asiantuntijatuen saatavuudella koko implementointivaiheen ajan. Tutkimuksessa syntyi myös turvallisuusjohtamismatriisi työkaluksi kehittämistyön suunnitteluun ja arviointiin.

Cette thèse décrit les applications du traitement automatique des langues (TAL) à la gestion des risques industriels. Elle se concentre sur le domaine de l'aviation civile, où le retour d'expérience (REX) génère de grandes quantités de données, sous la forme de rapports d'accidents et d'incidents. Nous commençons par faire un panorama des différentes types de données générées dans ce secteur d'activité. Nous analysons les documents, comment ils sont produits, collectés, stockés et organisés ainsi que leurs utilisations. Nous montrons que le paradigme actuel de stockage et d’organisation est mal adapté à l’utilisation réelle de ces documents et identifions des domaines problématiques ou les technologies du langage constituent une partie de la solution. Répondant précisément aux besoins d'experts en sécurité, deux solutions initiales sont implémentées : la catégorisation automatique de documents afin d'aider le codage des rapports dans des taxonomies préexistantes et un outil pour l'exploration de collections de rapports, basé sur la similarité textuelle. En nous basant sur des observations de l'usage de ces outils et sur les retours de leurs utilisateurs, nous proposons différentes méthodes d'analyse des textes issus du REX et discutons des manières dont le TAL peut être appliqué dans le cadre de la gestion de la sécurité dans un secteur à haut risque. En déployant et évaluant certaines solutions, nous montrons que même des aspects subtils liés à la variation et à la multidimensionnalité du langage peuvent être traités en pratique afin de gérer la surabondance de données REX textuelles de manière ascendante / This thesis describes the applications of natural language processing (NLP) to industrial risk management. We focus on the domain of civil aviation, where incident reporting and accident investigations produce vast amounts of information, mostly in the form of textual accounts of abnormal events, and where efficient access to the information contained in the reports is required. We start by drawing a panorama of the different types of data produced in this particular domain. We analyse the documents themselves, how they are stored and organised as well as how they are used within the community. We show that the current storage and organisation paradigms are not well adapted to the data analysis requirements, and we identify the problematic areas, for which NLP technologies are part of the solution. Specifically addressing the needs of aviation safety professionals, two initial solutions are implemented: automatic classification for assisting in the coding of reports within existing taxonomies and a system based on textual similarity for exploring collections of reports. Based on the observation of real-world tool usage and on user feedback, we propose different methods and approaches for processing incident and accident reports and comprehensively discuss how NLP can be applied within the safety information processing framework of a high-risk sector. By deploying and evaluating certain approaches, we show how elusive aspects related to the variability and multidimensionality of language can be addressed in a practical manner and we propose bottom-up methods for managing the overabundance of textual feedback data / Тoзи реферат описва приложението на автоматичната обработка на естествен език (ОЕЕ) в контекста на управлението на риска в гражданското въздухоплаване. В тази област докладването на инциденти и разследването на произшествия генерират голямо количество информация, главно под формата на текстови описания на необичайни събития. На първо време описваме раличните типове (текстови) данни, които секторът произвежда. Анализираме самите документи, методите за съхраняването им, как са организирани, както и техните употреби от екперти по сигурността. Показваме, че съвремените парадигми за съхраняване и организация не са добре приспособени към реалната употреба на този тип данни и установяваме проблемните зони, в които ОЕЕ е част от решението. Две приложения, отговарящи прецизно на нуждите на експерти по авиационна сигурност, са имплементирани: автоматична класификация на доклади за инциденти и система за проучване на на колекции, основаваща се върху текстовото сходство. Въз основа на наблюдения на реалната употреба на приложенията, предлагаме няколко метода за обработка на доклади за инциденти и произшествия и обсъждаме в дълбочина как ОЕЕ може да бъде проложено на различни нива в информационнo-обработващите структури на един високорисков сектор. Оценявайки методите показваме, че трудностите свързани с многоизмерността и изменимостта на човешкия език могат да бъдат ефективно адресирани и предлагаме надеждни възходящи методи за справяне със свръхизобилието на доклади за инциденти в текстови формат

The existence of an occupational health and safety policy is believed to be evidence of management accepting their occupational health and safety role in terms of the Occupational Health and Safety Act. It is accepted that this results in management ensuring the provision of a safe workplace. Despite the emphasis in legislation (the Occupational Health and Safety Act) on the need for management to implement comprehensive occupational health and safety policies, there is a lack of research on the implementation and efficacy of occupational health and safety policies in the workplace. This study investigates the efficacy with which management carries out their occupational health and safety duties and responsibilities when implementing the provisions of an occupational health and safety policy in the workplace. A number of factors are essential to the efficient performance of management in this regard. These factors include managerial commitment, practices and strategies; communication practices and structures; training initiatives and information; the extent of employee and trade union involvement; and the infrastructure of the organisation. This research study is primarily qualitative in nature. Semi-structured interviews were the primary tool used by the researcher to collect the data. The case-study research method was employed to assist the researcher in collecting the data. The participants involved in the research were selected using the principles of strategic informant sampling and expert choice sampling. The participants consisted of a sample of management, employees and shop stewards. The research findings indicate that firstly, the presence of occupational health and safety policies, practices, strategies and systems in the workplace do not automatically result in reduced hazards, accidents or deaths in the workplace. Secondly, the participation schemes and the communication practices put in place by management are weak. The reason for their weakness is their ineffective implementation by management and use by employees and the trade union. Thirdly, management has a definite impact on the involvement, attitudes and actions of the employees and the trade union in occupational health and safety issues. Fourthly, there is an unequal partnership between management and employees as a result of the educational differences regarding occupational health and safety between them. The outcome is that management and employees are faced with numerous challenges in relation to occupational health and safety. Contributing to this challenge is a lack of sufficient resources allocated to training, resulting ultimately in the ineffective monitoring of occupational health and safety in the workplace. The existence of occupational health and safety structures and systems does not provide the essential evidence to suggest that their mere presence makes a difference to the workplace safety level. However, through more co-operation and participation by all the parties, these structures and systems have the potential to be effective. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Diploma thesis is focused on occupational risk management, safety and health protection at work. The aim of my diploma thesis was to review level of OHSAS 18001 requirement filfilment in a particular organisation. Inseparabily part of standard requirements is observing the state legislation. Since the firm chosen carry on business in SR, the teoretical part of the thesis compares czech and slovak state legislation with purpose of illustrating differences between czech and slovak legislative environment in field of occupational safety and health protection. Practical part of the thesis contains review of OHSAS 18001 requirements fulfilment in organization and evaluates the possibility of succesful certification.

L'évolution de l'environnement du travail, de l'organisation du travail, et des modes de gestion des hommes, introduit de nouvelles pathologies de travail à côté des pathologies traditionnelles dites physiques : il s'agit de pathologies mentales. Ces dernières sont liées à des contraintes organisationnelles ou de marché comparativement aux pathologies traditionnelles rattachées aux conditions physiques et matérielles de la tâche. Dans ce contexte d'émergence de nouvelles formes de mal-être au travail, le concept de souffrance au travail, concept « fantôme » en sciences de gestion, apparaît pertinent car il interroge le fonctionnement organisationnel et le rôle de la gestion des ressources humaines. Cette recherche possède un double objectif : contribuer à une meilleure compréhension de la souffrance au travail par la production d'une définition claire de ce concept, et théoriser le lien entre souffrance et implication au travail en définissant de quelle manière ces construits s'influencent mutuellement. Notre recherche est animée par la question suivante : quelles relations existe-t-il entre souffrance et implication au travail ? Pour y répondre, nous nous appuyons sur la théorie de la conservation des ressources. Les résultats de la recherche montrent que la souffrance au travail naît d'une perte de ressources organisationnelles engendrant une érosion des ressources subjectives permettant à l'individu de se définir, et crée une forme d'implication au travail précise : le sur-engagement. Celui-ci trouve ses origines dans la souffrance au travail elle-même et est orienté par des expériences de travail négatives forçant des sentiments négatifs envers l'organisation. / The evolution of the work environment, work organization, and practices of human ressource management, introduces new pathologies work alongside the traditional pathologies so-called physical pathologies : there are mental pathologies. These are related to organizational or market constraints compared to traditional pathologies related to physical and material task's conditions. In this context of new forms of ill-being at work, the concept of suffering at work, "ghost" concept in management science, appears relevant because it queries the organizational functioning and the role of human resource management. This research has two objectives: contribute to a better understanding of suffering at work in producing a clear definition of this concept, and theorize the link between suffering at work and work commitment in defining how these constructs influence each other. Our research is motivated by the question : what relationship is there between suffering at work and work commitment ? To answer, we rely on conservation of resources theory. The results of this research show that suffering at work arises from a loss of organizational ressources causing an erosion of subjective resources that allow the individual to define himself, and creates a specific form of work commitment : the over-involvement. It is rooted in the suffering at work itself and it is guided by negative experiences of work forcing of negative feelings toward the organization.

The purpose of this project was to develop an employer handbook to assist them in developing a return to work program for industrially injured workers.

Background: Low morale is classified as a latent condition for performance variability in safety-critical environments. Morale management may assist in the control of performance variability as part of a systems approach to safety. A context-specific model for measuring and managing morale with reference to followership in a safety-critical air traffic control (ATC) environment could not be found. Purpose/Aim: The purpose of this study was to develop a model that enables the measurement and management of air traffic controller (ATCO) team morale. Research Design: An exploratory sequential mixed method design was adopted. A census approach to sampling was used to conduct 21 focus group sessions as the qualitative phase, providing the definition and drivers of morale. The Measure of Morale and its Drivers (MoMaD) survey instrument was created from qualitative data, then administered to 256 ATCOs in the quantitative phase. Statistical methods included exploratory factor analysis, correlation and regression analysis to construct the final MoMaD model. Results: A context-specific definition of morale is provided and communication management, team cohesion, leadership interaction, staff incentive, staffing level, workplace health and safety and mutual trust were found to be the drivers of morale in a safety-critical ATC environment. A single-item measure of perceived morale reflected the state of context-specific ATCO team morale more accurately than an existing generalisable multi-item measure. Conclusion: This study contributes to the body of knowledge by integrating applicable aspects of morale, followership, performance variability and organisational culture and climate in safety-critical ATC environments into a new theoretical framework. The MoMaD instrument is presented as a context-specific model for measuring and managing ATCO team morale in an ATC environment. Recommendations: Future research opportunities include the possible influence of morale as a predictor of morale in safety-critical environments and the development of a context-specific multi-item measure of morale for integration into the MoMaD model. / Business Management / D. B. L.