Influência da organização do trabalho hospitalar para a saúde do trabalhador e a segurança do paciente

Abstract

The object of this study is the nurses' perception about work organization and its repercussions for critical patient safety. This research aims to: a) identify the perception of intensive care unit nurses about the configuration of the organization and working conditions of this scenario; b) analyze the repercussions of the configuration of work organization in cardiac intensive units for the health of nursing workers; and c) discuss the impacts of the work organization’s configuration on the safety of intensive care patients. This is a qualitative, descriptive and exploratory study. The field of research was a state public hospital located in the city of Rio de Janeiro, in its cardiac intensive units. The participants were 25 nurses working in these sectors. Data were collected from April to June 2019. The interviews were recorded using a semi-structured interview script. For the data treatment, it was used the content analysis of the Bardin’s type. The project was submitted to the Ethics and Research Committee of the State University of Rio de Janeiro, having been approved under number of the Certificate of Presentation for Ethical Appreciation (Certificado de Apresentação para Apreciação Ética, CAAE) identified as 06244819.5.0000.5282. After this process, it was forwarded, for a second consideration, to the Ethics and Research Committee of the co-participant institution, and was approved under CAAE number 06244819.5.3001.5265, the data collect started after approval. After data analysis, three analytical categories were created, named as follows: I) Material, professional and structural resources: primordial conditions for patient safety; II) Characteristics of work organization: conflicts and misconceptions that affect the safety of patients and workers; and III) Impacts on the health and subjectivity of nurses resulting from the organization and working conditions. Regarding the nurses' point of view on the particularities related to material, professional and structural resources, personal dimensioning and staff deficit were highlighted; the lack of inputs needed for assistance; and the equipment precariousness. Regarding the context of the characteristics of work organization and the tensions and misconceptions that permeate the work environment, there was a high workload of professionals, misconceptions in the administration and management of the service, resulting in the elaboration of improvisations and adaptations of hospital materials and supplies. Regarding the impacts on the nurses’ subjectivity as a result of their work in the referred cardiac intensive units the results showed the professional commitment to the quality of care in the face of adversity (3.23%); suffering in the workplace (1.81%); and pleasure at work (1.01%). It was concluded that inadequate working conditions and often misleading and unreasonable work configuration negatively affect patient safety due to the qualitative and quantitative scarcity of materials, the reduced number of nursing staff and the poorly functioning and non-maintained physical structure. As a result of this context, losses to the health of nursing workers were contacted, mainly in the psychosocial dimension.