Research Paper
E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017
PREVENTION OF PSYCHOSOCIAL RISKS AT WORK IN HEALTH PROFESSIONALS IN BRAZIL AND PERU: ADHESION FOR TRAINING *Luis F. Abregú Tueros 1 | Jussara M. Rosa Mendes 2 1
Federal University of Rio Grande do Sul, Pos graduation in Psychology Social and Institutional Program, Porto Alegre, Brazil - postal code 90010. 2
Federal University of Rio Grande do Sul, Pos graduation in Psychology Social and Institutional Program, Porto Alegre, Brazil - postal code 90010. ABSTRACT Objective: Evaluate and compare the evidence of preventive intervention (PI)for psychosocial risks at work(PRW)in health professionals in Brazil and Peru. Method: A systematic review wasdevelopedbased on scoping study, in databases: PubMed, EBSCO-Host, BioMed Central, Embase, CINAHL, Lilacs, Cochrane Register of Trials y Web of Science; additionally in IBICT (Brasil) and CONCYTEC (Peru). Results: Of 2.461 identified studies they were analyzed to sixteen.Compared IPs are focused on mixed protocols (didactic, interactive) or workshops:a) ascribed to promote changes in complex behaviors and health prevention in hospital environment, with minimum duration of three weeks, b) circumscribed to improve the professional practice in health, and develop leadership in management and teamwork (duration about six months), always premunted for the follow-up and participation of health officials and workers. Conclusion: The most useful PI for PRW in both countries was training aimed essentially at communication team development, both in conflict management and in professional interaction. Keywords: Occupational health. Psychosocial risks at work. Primary interventions. Training. Training - coaching. Healthcare professionals. Scoping study.
Introduction: The psychosocial risk at work (PRW) is an emerging factor turned into a global problem due to its impact on health workers (HW), given the nature of the tasks they perform and because they affect both work performance and health (OIT, 2012; Stavroula y Aditya, 2010; Van Stolk et al, 2012).Globally, the incidence rate of health-related conditions at work is 5,736 x 100,000 cases; In Europe, is the second health problem (OIT, 2013; Van Stolk et al, 2012);; meanwhile, in Australia, 39% of HW revealed to have experienced moral siege in the workplace (Jimmieson et al., 2016), in Brazil, 36.4% of workers were in a situation of high demand or professional demand, and in Peru, 26% perceived labor dissatisfaction due to the presence of several PRW factors (Fortaleza et al., 2010; INSM, 2012). The PRW in addition to being less tangible are difficult to manage and prevent especially when the models are proactive towards the origin (Simões& Santos, 2013; WHO, 2008), and when the overall analysis includes individual consequences as organizational and social, constituting three levels of intervention: The first, primary prevention, which is directed at the PRW factor;the second, oriented to the individual;and the third, a rehabilitation approach (Leka et al., 2008).Being the area of study, analyze within the first level that is based on two types of intervention: a) Awareness and training of workers (ATW) y, b) implementing organizational management policies –OMP– (Luis & Ramos, 2015), so that in the latter type, they include varied and integral strategies but of greater complexity than the first.
Although these interventions have particular requirements for application and its advantages are greater, because they may have positive effects on a set of PRW factors (Jimmieson et al., 2016; Veloso, 2015), some health institutions in several European countries postpone or go unnoticed the PIs oriented towards the management of such risks (EASHW, 2010; Simões& Santos, 2013). It is pertinent to compare PIs from the perspective of good practices for awareness raising and implementation, in a group of health professionals (HP)of higher risk of Ibero-American countries, between a middle-income (Brazil) and a low-income (Peru); and analyze the preventive approach developed in different work situations that create favorable conditions for improving the management of those risks. Being the objective to evaluate and to compare qualitatively the IP applied for the PRW in health professionals of Brazil and Peru.
Materials and Methods: A systematic review was developed based on the scoping study, where the approach and search question are broad but the evaluation of the quality of the studies is less rigorous (Arksey and O'Malley 2005;Levac et al., 2010). For the review question the PIC scheme (participants, object of interest, context) represented with "P" (Health Professionals), "I" (interventions to prevent PRW) and "C" (context: Brazilian health establishments And Peruvian); adapted from the general scheme PICOS that the protocol PRISMA (preferred reporting items for systematic reviews and meta-analyses) indicates for the analysis of included studies (Moher et al., 2015).Two
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Research Paper
E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017
search strategies were used: a) The first, in the databases; PubMed, EBSCO-Host, Lilacs, BioMed Central, CINAHL and Embase; using descriptors as “Health and safety at work”, “primary prevention”, “clinical trial”, “humans” y “healthcare”; b) In the second, the descriptors were used “intervention¨, “health human resources”, “innovation & research” and “healthcare staff”. They were also consulted in the databases of institutions related to health at work (The Cochrane Library, The Campbell Collaboration), and additionally in (Brazil) and CONCYTEC (Peru). The period of search for scientific production ranged from 1 January 1995 to 31 July 2016 limited to the English, Portuguese and Spanish languages (articles, thesis). They were excluded from the review when subjects of interest were not health professionals and when interventions were not preventative for PRW. For the systematization of data, each included study was evaluated in four items, using for that a qualitative-quantitative analysis and interpretation record: a) Method employed, b) participants, c) Interventions (sessions, number and duration, control group, sequence), d) Qualitative results (developed issues) and quantitative results (effect size, percentage change). In order to label the case, the type and dimension of the PRW was identified. Of the total included studies (n=16) we identified randomized controlled trials –RCT (n=8; 50%), following quasi-randomisation –QR (n=5) and descriptive studies –DE (n = 3), whose subjects are linkedto: a) Execution and content of tasks, b) The organizational culture in the health establishment.
Results: In selecting studies for the first search strategy they identified 2,461 documents, which were excluded for duplicates, by analysis of titles and abstracts (stage screening) and not respond to the question PIC elements -stage eligibility- 94 removed), resulting in 16 eligible studies for the qualitative assessment (Figure 1). About participants involved in 95 health facilities (Peru: Brazil 69.5% versus 30.5%) were reported 1,974 health professionals (Brazil: 85.7%).
Included
Eligibility
Screening
Identification
Figure 1: Selection process the studies included for systematic review Literature search in databases of
(Brazil-Peru) are: i) For the promotion of group cohesion and the awareness of teamwork, among health professionals, which involves improving communication, interpersonal relationships and institutional participation (Arévalo et al., 2003; Brischialiari et al., 2008; De Lima, 2013; Garcia et al., 2003;Girot& Enders, 2004; Huaroto et al., 2013; Huaroto& Espinoza, 2009; Henriques&Saporiti, 2008; Tsuji et al., 2009; Westphal et al., 1995);ii) To increase the active participation during the promotion of professional practices of the health, that involve changes of varied and complex behavior for the execution of tasks(Amaral et al., 2012; Arévalo et at., 2003; Brischialiari et al., 2008; De Lima, 2013; Garcia et al., 2003; Girot& Enders, 2004; Huaroto& Espinoza, 2009; Marra et al., 2011; Mendoza, 2012; Tsuji et al., 2009; Westphal et al., 1995); iii) For the management of hospital work conditions, which required adapting personal strategies, work gymnastics and breaks during the day (Arévalo et at., 2003; De Lima, 2013; Huaroto& Espinoza, 2009; Mendoza, 2012). B) The PIs in different training formats in two phases are: i) In Brazil, for the development of leadership skills in the prevention of PRW (greater than 3 weeks) which involve the management of interpersonal conflicts (Amaral et al., 2012; Arévalo et al., 2003; De Cássia, 2012; Huaroto et al., 2013; Marra et al., 2010; Marra et al., 2013); for building trust and emotional support, improved personal interaction and improvement of team communication, Including the development of group dynamics exercises for the change of mentality in Health Professionals and officials(Brischialiari et al., 2008; De Lima, 2013; Girot& Enders, 2004; Henriques&Saporiti, 2008; Tsuji et al., 2009; Westphal et al., 1995); ii)In Peru, to generate awareness in maintaining healthy work environments and to encourage the exchange of ideas (Arévalo et at., 2003; Huaroto& Espinoza, 2009; Mendoza, 2012).Sustained institutional support is considered as a condition of change.
Additional records identified
related articles with a sensitive
through other sources:
methodological filter
1 (Ibicit, Bras.) + 3 (Concytec, Perú)
(n= 2,461)
(n= 4)
Literature search of related articles using specific text search terms (n= 146
Literature search of related articles using
Articles excluded from
specific text search terms
full-text article review
(n= 52)
(n= 36)
The reports related to the second type of intervention (OMP) are still incipient, approaching only the evaluation of the management of PRW and the performance of the health professional, which includes the use of reports (Henriques&Saporiti, 2008;Marra et al., 2010; Tsuji et al., 2009), Leaving the PIs suggested for the organizational changes, the working days, and for the redesign and enrichment of the post Luís& Ramos, 2015). Standing out the first type of intervention (ATW) Eight studies targeting five to seven PRW factors (Figure 2). Confirming the advantages of these IPs pointed out by Jimmieson et al (2016) and Veloso (2015) for its positive effects on a set of risk factors.
Studies included in systematic review for qualitative assesment (n= 16)
In relation to the first type of intervention (ATW): A) The common format training PIs in two phases
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E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017 RevPeruMedExp Salud Publica, 20(2), 8, p. 84-91.
Figure 2: Effect of PI in several PRF Psychosocial risk factors Tsuji et al. 2009 Amaral et al 2012 Huaroto et al 2013 Arévalo et al 2003 Girot & Enders 2004 Westphal 1995 De Lima 2013 García 2003 PI: inte rve n.pre ve ntiv.; PRF: psychosoc.risk factors
Since the reports are focused on coach and continued training for the first type of PI –ATW– based on mixed protocols (didactic-interactive) or workshops, it is evident that it is the privileged and useful intervention for PRW in professionals of health in both Brazil and Peru, is training. In this regard, the reflection is that, although such intervention is necessary for the correct implementation of interventions for PRW(Veloso, 2015). The tendency in the last two decades to solve the majority of risks with the training resources can cause IPs to end up without achieving the desired effects, when such actions are not properly adapted and complemented with other strategies of an operational nature such as organizational and procedural models (OMP). The limitations are related to the frequency of studies (50% are not RCTs, six studies do not report baseline and intervention control), the quantitative outcomes are partial in 31.2% and three studies do not reveal number of participants.
Conclusion and Recommendations: The most useful PI for PRWs in health professionals in both countries, are adherence to training, oriented basically to team communication development, both in conflict management and in professional interaction. Itis recommended to promote the prevention of PRW based on preconized and contractual working conditions such as the participation of workers, and to evaluate the PI from the perspective of engineering in resilience.The new lines of research should be oriented to systematic reviews on interventions involving workers, good practices in resolving interpersonal conflicts and on work-family compatibility.
REFERENCES 1. Amaral, E., Campos, H., Friedman, S., Morahan, P., Araújo, M., Carvalho, V. et al. (2012). An educational international partnership responding to local needs: Process evaluation of the Brazil FAIMER Regional Institute. Education for Health, 25(2), 8, p. 116-123. 2. Arévalo, H., Cruz, R., Palomino, F., Fernández, F., Guzmán, E. &Melgar, R. (2003). Aplicación de un programa de control de infecciones intrahospitalarias en establecimientos de salud de la región San Martín, Perú,
3. Arksey, H. and O'Malley, L. (2005). Scoping studies: Towards a methodological framework. Int J Soc Res Methodol, 8(1), 1, p. 19–32. 4. Brischialiari, A., Alves, M., Pagliarini, M. & De Azevedo, V. (2008). Sensibilizando a equipe de enfermagem ao cuidado humanizado em saúde mental mediante oficinas educativas. Rev. Eletr. Enf., 10(4), 11, p. 1080-1090. 5. De Cássia, R., Martins, E., Pio, V., Américo, E., Ferreira, A., Gonçalves, P. et al. (2012). Positive deviance: Using a nurse call system to evaluate hand hygiene practices. American JournalofInfectionControl, 40(1), 5, p. 946-950. 6. De Lima, Leni. (2013). Propostas de intervenções à saúde dos trabalhadores apoiadas em indicadores. Dissertação do Mestrado, Programa de Pós-Graduação em Enfermagem, Setor de Ciências da Saúde, Universidade Federal do Paraná. 7. European Agency for Safety and Health at Work –EASHW–. (2010). European survey of enterprises on new and emerging risks. Luxembourg: Publications Office oftheEuropean Union. 8. Fortaleza, S., Martins, F., De Araújo, T. & Porto, L. (2010). Fatores psicossociais do trabalho e transtornos mentais comuns em eletricitários. Rev Saúde Pública, 44(4), 8, p. 710-717. 9. Garcia, P., Hughes, J., Carcamo, C. and Holmes, K. (2003). Training pharmacy workers in recognition, management, and prevention of STDs: district-randomized controlled trial. Bulletinofthe World Health Organization, 81(1), 9, p. 806-814. 10. Girot, E. and Enders, B. (2004). International educational partnership for practice: Brazil and the United Kingdom. JournalofAdvancedNursing, 46(2), 8, p. 144-151. 11. Henriques, S. &Saporiti, E. (2008). Estratégias de gerenciamento de riscos psicossociais no trabalho das equipes de saúde da família. Rev. Eletr. Enf., 10(4), 9, p. 915-923. 12. Huaroto, L., Mucha, R., Chávez, J., Tanta, J., Alvarezcano, J. &Ticona, E. (2013). Impacto de un programa de capacitación para la prevención de infecciones intrahospitalarias en un hospital general. Trauma Fund MAPFRE, 24(2), 6, p.126-131. 13. Huaroto, L. & Espinoza, M. (2009). Recomendaciones para el control de la transmisión de la tuberculosis en los hospitales. Rev Peru MedExp Salud Publica, 26(3), 6, p. 364-369. 14. Instituto Nacional de Salud Mental-INSM. (2012).
INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL
22
Research Paper
E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 3 | MARCH 2017
Estudio epidemiológico de salud mental en la Selva rural 2009. Informe General. Lima: INSM “Honorio Delgado-HideyoNoguchi”. 15. Jimmieson, N., Tucker, M. and Bordia, P. (2016). An assessment of psychosocial hazards in the workplace. Queensland: AustralianGovernment/AustralianResearch Council. 16. Leka, S., Cox, T. and Zwetsloot, G. (2008). Monitoring psychosocial risks at work. In: Leka, S. and Cox, T. (Ed.). The european framework for psychosocial risk management: PRIMA-EF. Nottingham: IWHO, WHO, OIT. pp. 17-36. 17. Levac, D., Colquhoun, H. and O’Brien, K. (2010). Scoping studies: advancing the methodology. Implementation Science, 5(69), 9, p. 1-9. 18. Luís, E. & Ramos, S. (2015). Diagnóstico de riscos psicossociais e intervenção numa indústria transformadora portuguesa. International Journal on Working Conditions, 10(2), 17, p. 41-57. 19. Marra, A., Danilo Teixeira, D., Westheimer, A., Sampaio, T., Puzzo, R., Souza, M. et al. (2013). A multicenter study using positive deviance for improving hand hygiene compliance. American JournalofInfectionControl, 41(1), 5, p. 984-988. 20. Marra, A., Reis, L., Pereira, C., Saraiva, J., Almeida, M., Vallone, C. et al. (2011). Positive deviance: A program for sustained improvement in hand hygiene compliance. American Journal of Infection Control, 39(1), 5, p.1-5. 21. Marra, A., Reis, L., Pereira, C., Saraiva, J., Lamblet, L., Silva, M. et al. (2010). Positive deviance: A new strategy for improving hand hygiene compliance. InfectionControland Hospital Epidemiology, 31(1), 9, p. 12-20.
caminhos. International Journal on Working Conditions, 3(1), 20, p. 39-58. 27. Stavroula, L. and Aditya, J. (2010). Health impact of psychosocial hazards at work: An overview. Switzerland: WHO Library Cataloguing in Publication Data. 28. Tsuji, S., Atallah, A., Aranha, F., Tonhom, A., Siqueira, A. and Matos, D. (2009). Cluster randomized clinical trial (ISRCTN23732000) to evaluate the effectiveness of a diagnosis recognition and treatment guide for depressive disorders in primary care. JournalofEvaluation in Clinical Practice, 15(1), 4, p. 222-225. 29. Van Stolk, C., Staetsky, L., Hassan, E. and Woo, Ch. (2012). Management of psychosocial risks at work: An analysis of the findings of the european survey of enterprises on new and emerging risks (ESENER). Luxembourg: EASHW-EU. 30. Veloso, Hernani. (2015). Estratégias organizacionais de gestão e intervenção sobre riscos psicossociais do trabalho. International Journal on Working Conditions, 5(1), 21, p.1-21. 31. Westphal, M., Taddei, J., Venancio, S. and Bogus, C. (1995). Breast-feeding training for health professionals and resultant institutional changes. Bulletinofthe World Health Organization, 73(4), 8, p. 461-468. 32. World Health Organization–WHO–. (2008). PRIMA-EF: Guidance on the European framework for psychosocial risk management: A resource for employers and worker representatives. Nottingham: WHO Library Cataloguing in Publication Data.
22. Mendoza, Alberto. (2012). Tuberculosis como enfermedad ocupacional. RevPeruMedExp Salud Publica, 29(2), 5, p. 232-236. 23. Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M. et al. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. SystematicReviews, 4(1), 9, p.1-9. 24. Organización Internacional Del Trabajo-OIT. (2013). La prevención de las enfermedades profesionales. Ginebra: OIT-Safe Work. 25. Organización Internacional del Trabajo-OIT. (2012). SOLVE: Integrando la promoción de la salud a las políticas de SST en el lugar de trabajo. Ginebra: OIT. 26. Simões, L. & Santos, M. (2013). Fatores psicossociais de risco no trabalho: Lições aprendidas e novos INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL
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