Anelise Bertolino Pereira1; Marcia Eiko Karino1; Júlia Trevisan Martins1; Alessandro Rolim Scholze2; Maria José Quina Galdino2; Renata Perfeito Ribeiro1
OBJECTIVE: To establish the sociodemographic, occupational and clinical profile of labor readjusted workers at a public hospital.
METHOD: Cross-sectional study conducted with 40 labor readjusted workers at a university hospital in Southern Brazil. Data collection was performed by means of an instrument with questions for sociodemographic, occupational and clinical profile. Descriptive analysis of relative and absolute frequencies was performed.
RESULTS: Female sex (72.5%), age range 54 to 59 years old (35%) and technical education level (37.5%) predominated. Most labor readjusted workers were members of the nursing staff (62.5%), and the main reasons for readjustment were musculoskeletal mental and behavioral disorders.
CONCLUSION: One might infer that labor readjustment might related to factors present in the hospital work environment.
Keywords: occupational health; employment, supported; work environment; health personnel.
OBJETIVO: Identificar o perfil sociodemográfico, ocupacional e clínico de trabalhadores readaptados de um hospital público.
MÉTODO: Estudo transversal com 40 trabalhadores readaptados de um hospital universitário do Sul do Brasil. Para a coleta de dados utilizou-se um instrumento com questões relacionadas ao perfil sociodemográfico, ocupacional e clínico. Foram realizadas análises descritivas com frequências relativas e absolutas.
RESULTADOS: Houve predomínio do sexo feminino (72,5%), faixa etária entre 54 e 59 anos (35%) e escolaridade de nível técnico (37,5%). A maioria dos readaptados fazia parte da equipe de enfermagem (62,5%) e o principal motivo que desencadeou a readaptação foram os distúrbios osteomusculares, mentais e de comportamento.
CONCLUSÃO: Infere-se que a readaptação dos profissionais pode estar relacionada com os fatores vivenciados no ambiente laboral dos hospitais.
Palavras-chave: saúde do trabalhador; readaptação ao emprego; ambiente de trabalho; pessoal de saúde.
Globalization and implementation of new technologies in the world ofwork resulted in relevant changes involving the relationship between work and workers, including work process, working time and competition, among other factors that directly interfere with the workers’ health1,2.
Workers’ productivity is increasing in capitalist countries, often without consideration for the corresponding impacts on the physical and mental health of individuals2,3. According to the International Labor Organization (ILO) about 2 million people worldwide die at work every year1.
Work accidents have many consequences for the workers’ health, as they impair the biological integrity of individuals, increase the social security costs and reduce productivity1.
Within this context, hospital workers are daily exposed to occupational hazards originated in the activities they perform and environmental insalubrity, and which might lead to disease1-6. Several authors7,8 stated that upon providing direct care to patients, such workers are exposed to chemical, physical, mechanic, biological, ergonomic and psychosocial occupational hazards, which might contribute to the development of diseases and occurrence of work accidents. Biological hazards are serious, and result from direct contact with bodily fluids and contaminated materials9.
It should be noticed that risk is considered to be present when workers perform an activity that includes one or more potentially harmful factors. Therefore, health care providers who work at hospitals are exposed to an occupational environment that contains a diversity of hazards9,10. Facing this scenario, i.e., the fact that the work environment poses a risk to the health of these workers, and aiming at protecting employees who suffered some work-related or not harm, the Social Security administration enacted laws targeting workers’ safety and protection, such as the ones that regulate function readjustment. Article 24 of the Federal Law no. 8,112/1990 defines function readjustment as: “ascription to an employee of attributions and responsibilities compatible with the limitations to his/her physical or mental capacity as established on medical assessment11."
Therefore, function readjustment affords a way to meet the needs of workers who despite their limitations are still able to perform activities that might be relevant to services and themselves. The reason is the belief in that removing employees from their work activities might further impair their health, resulting in greater mental suffering12.
As a function of the aforementioned considerations, the aim of the present study was to establish the sociodemographic, occupational and clinical profile of readjusted employees at a public hospital. We believe that this study might help managers implement strategies to reduce sickness among hospital workers associated with the hazards to which they are exposed and provide a better work environment for the already sick and readjusted employees.
The present cross-sectional study with quantitative approach was conducted with readjusted workers registered at the Specialized Safety Engineering and Occupational Medicine Service (Serviço Especializado em Engenharia de Segurança e Medicina do Trabalho - SESMT) of a university hospital in Southern Brazil.
The study population comprised 60 employees readjusted in 2016, among which 61.7% (n=37) belonged to the nursing staff (nurses, nursing technicians and assistants) and 38.3% (n=23) were operational assistants (hospital hygiene, kitchen, laundry and reception workers). There was no readjusted technical-administrative personnel (general office work) at the time when the study was conducted. Eight employees on sick leave or not performing their usual activities for other reasons were excluded.
Data collection was performed from September through December 2016 by means of an instrument with questions on the employees’ sociodemographic, occupational and clinical profile. This step involved two stages: first we identified the readjusted employees at SESMT based on their medical records; then we invited the located readjusted employees to participate in the study. The ones who agreed to participate were requested to respond the questionnaire in a secluded room at the workplace to protect them from exposure and preserve the confidentiality of the collected information. From 52 eligible employees, 12 refused participation.
Data analysis was performed using software Statistical Package of Social Sciences (SPSS), version 20.0. Descriptive analysis included calculation of absolute and relative frequencies.
The study was approved by the research ethics committee of State University of Londrina, CAAE (Certificate of Presentation for Ethical Appraisal) no. 56996816.6.0000.5231.
Among the 40 participants, 72.5% (n=29) were female, 35.0% (n=14) were aged 54 to 59 years old, and 37% (n=15) had technical education level (Table 1).
Most readjusted employees belonged to the nursing staff (62.5%; n=25); 56.0% (n=14) were nursing technicians, 24.0% (n=6) nurses and 20.0% (n=5) nursing assistants. Operational assistants were the second largest group of readjusted employees (37.5%; n=15).
Relative to their job function before readjustment, among the 6 nurses 83.3% (n=5) had previously provided direct patient care and 16.7% (n=1) performed managerial tasks. Among the 14 nursing technicians, 50.0% (n=7) had worked at the intensive care unit, 28.6% (n=4) at the emergency department, 14.3% (n=2) at the surgery department and 7.1% (n=1) at the infectious diseases unit. All 5 nursing assistants had worked at adult wards. In regard to the operational assistants, 46.7% (n=6) had worked at the laundry, 33.3% (n=5) in hospital hygiene and 24.0% (n=4) had been receptionists.
As concerns the reasons for readjustment, musculoskeletal, mental and behavioral disorders were the most frequent among the nursing staff, and musculoskeletal disorders and nervous system problems among operational assistants (Table 2).
The detected musculoskeletal disorders were: herniated disk (19.4%; n=6), tendon tear (19.4%; n=6), arthrosis (19.4%; n=6), bursitis (12.9%; n=4), lupus (6.5%; n=2), arthritis (6.5%; n=2) and unspecific backache (16.1%; n=5). Mental and behavioral disorders comprised depression (66.6%; n=4) and unspecific mental disorders (33.3%; n=2). Finally the neurological problems were all cases of carpal tunnel syndrome (100%; n=3).
In regard to the destination of the readjusted nursing staff, 4 out of the 6 nurses were reallocated to managerial positions and 2 to the hemodialysis unit. Four out the 5 nursing assistants remained in the same department, but were attributed tasks compatible with their degree of limitation, and 1 was transferred to the central sterilization department. Eight out of the 14 nursing technicians remained in the same department with changes in their work routine in compliance with the medical orientation, 3 were transferred to the central sterilization department, 1 to the milk bank and 1 to the hemodialysis unit.
All the operational assistants remained in their original positions (laundry, hospital hygiene and reception) but their activities were readjusted as a function of their limitations, except for one hygiene worker who was reallocated to the storage department.
The time for readjustment was 1 to 5 years in 45.0% of the cases (n=18), 6 to 10 years in 32.5% (n=13) and more than 10 years in 22.5% (n=9) — most of these employees (47.5%; n=19) perform their job in an alternative shift.
The results showed that women predominated among the nursing staff — a fact evidenced all along the history of the profession9,13,14.
The higher rate of illness among women might be related to their daily activities, because women often have a double burden, i.e., their jobs and household chores, in addition to suffering from inequality in the labor relations. All these factors favor the development of diseases and comorbidities15.
Most participants were 54 to 59 years old. This finding disagrees from the results of a study in which the average age of readjusted employees at a public hospital was 47.9 years old16.
Several authors observed that starting at age 45 years old workers exhibit a trend to reduced functional capacity due to loss of muscle mass and strength and increase of the adipose tissue, which are common signs of aging17.
Reduced functional capacity makes workers more vulnerable to hazards at the workplace. In a study that investigated reasons for work accidents among nursing professionals, 60.9% were unpredictable events related to the work process, 17.4% were due to lack of attention and 15.2% to stress9.
As workers age, comorbidities related to their work environment and lifestyle become common. These aspects favor the development of incapacity for work and physical, physiological or mental disorders18.
In regard to the educational level of the sample, employees with technical education predominated. This finding agrees with the results of another study which detected the same predominance17. This fact is related with the job demands at hospitals and the fact that the activities performed by these employees tend to be manual and to demand physical effort as a function of the loads involved.
Developing this notion further, some authors assert that educational level has positive correlation with work ability. This is to say, the higher the educational level, the higher the odds for workers to maintain their work ability, because the physical demands of the job are lower, and these workers develop skills to easily control their work environment, resulting in lower rates of illness19.
It is worth noticing that many of the employees at the institution where the study was conducted had attended higher education, but worked in positions incompatible with their educational level.
When employees need to be reallocated to another area and have merely attended secondary school or technical education, readjustment is more difficult. The reason is that in this case, inclusion into another environment is more complex as a function of the employees’ difficulty to accept and understand their new activity, which thus limit their ability to perform other functions20.
Among the professional categories, nursing professionals predominated, which might be explained by the fact that such workers represent the largest workforce at hospitals as a function of the j ob characteristics. In the United States, the nursing staff corresponds to 63% of the cost of human resources at hospitals21. These data point to the need to promote work environments that protect employees, seek to reduce illnesses, and thus afford better quality of life and reduction of the costs derived from sick leaves, readjustment and disability retirement.
Nursing professionals are the most exposed to environment hazards at the workplace, because they handle hospital inputs, among other particularities related to the practice of the profession7-9. For providing direct patient care, they are exposed to occupational hazards much longer than other workers.
As a result, they are exposed to accidents and work-related diseases, the main factors associated with this risk being: insufficient number of employees, work overload, work in night shifts, mental and emotional exhaustion, improper physical conditions, lack of professional training, exposure to toxic chemicals, unavailability or undue use of individual protective equipment and inadequate working conditions22.
Therefore, managers should pay attention to the working conditions and together with the employees look for strategies to reduce hazards at the workplace to thus avoid occupational illnesses and afford a safer and high-quality environment23.
It is worth observing that while the goal of hospital services is prevention and recovery of the patients’ health, employees must perform their work within an environment that exposes them to many hazards along their professional career4. In addition, the capitalist society demands productivity and rationalization of resources2. As a result, the work overload does not decrease, while managers accept the precarious working conditions, which directly impair the quality of life of workers, and consequently the care provided to patients16.
Some authors24 further observe that workers eventually come to neutralize the hazards to which they are exposed, resulting in the development of a defense mechanism that makes hazards become and be accepted by workers as a natural part of the work process.
In regard to affected body parts, the musculoskeletal system was the most frequently involved. This finding might be directly related with the peculiarities of the work process of this population of workers, in which physical risk is inherent to most activities. Performance of repetitive movements together with work overload might favor the occurrence of diseases25.
In agreement with the results of the present study, another study conducted at a general hospital in the interior of the state of São Paulo with members of the nursing staff undergoing readjustment found that the disorders leading to this situation were mainly related to the musculoskeletal system, followed by the connective tissue16.
Also depression was one of the motives that led to readjustment. According to World Health Organization (WHO) estimates, depression represents 4.3% of the global burden of disease, being one of the main causes of disability worldwide, especially among women26.
The rate of depression is high among the Brazilian overall population (about 18.4% of Brazilians had one depressive episode) losing only to France, where about 21.0% of inhabitants exhibited at least one episode, and the United States (19.2% of the population)27,28. Therefore, preventive measures are needed in work environments seeking the satisfaction of workers, because the better the work environment is, the more satisfied workers become and their performance improves.
One study conducted with hospital employees found that the main causes of disability retirement were mental and behavioral disorders (45%), musculoskeletal disorders (25%), cardiovascular problems and neoplasms (7.5%)9.
Therefore, it is of paramount importance that, together with the readjusted workers, hospital managers look for strategies to promote health and prevent the occurrence of other diseases, thus improving the quality of life at work. Also, actions must be implemented targeting all workers pursuing one and the same goal: to promote health and avoid disease, thus reducing the need for function readjustment.
The present study had some limitations derived from the number of employees undergoing function readjustment, the fact it was conducted at one single hospital, and lack of studies with similar populations. However, we believe that the present study might contribute to the knowledge on workers’ health, and the data might be used by managers and workers in their everyday routine to implement measures and policies at this type of institution.
The results of the present study allow inferring that the workers’ health-disease process might be related with hazards present at the hospital work environment.
Therefore, such risk factors must be indispensably discussed with the employees so that they can protect themselves from the harm originated in the work environment. Managers should implement programs targeting workers in general to promote health and avoid physical and mental disorders, thus contributing to improve the quality of life at work and the care provided to patients and their relatives.
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19 de Maio de 2017.
Aceito em 6 de Novembro de 2017.
Fonte de financiamento: nenhuma