PERFORMANCE OF NURSI NG AUXI LI ARI ES AND TECHNI CI ANS I N MANAGI NG PI ERCI NG
CUTTI NG MATERI AL: A NECESSARY STUDY
Elaine Cr ist ina Car v alho Mour a1 Mar ia de Fát im a Sant ana Mor eir a2 Sor aia Mar t ins da Fonseca3
Moura ECC, Moreira MFS, Fonseca SM. perform ance of nursing auxiliaries and t echnicians in m anaging piercing cut t ing m at erial: a necessary st udy. Rev Lat ino- am Enferm agem 2009 m aio- j unho; 17( 3) : 321- 7.
This st udy aim ed t o analyze t he know ledge of nur sing aux iliar ies and t echnicians in handling and disposing of pier cing- cut t ing m at er ial and descr ibe t heir per for m ance. This qualit at iv e- descr ipt iv e r esear ch w as car r ied out wit h t hree nursing auxiliaries and 12 t echnicians at a m edium - size hospit al, t ot aling 15 part icipant s int erviewed t h r ou gh a sem i- st r u ct u r ed scr ip t . Discou r se w as an aly zed t h r ou gh t h e con t en t an aly sis t ech n iqu e. Resu lt s appoint t hat , ev en t hough t he par t icipant s hav e t heor et ical know ledge on t he m anagem ent of pier cing- cut t ing m at er ial, t hey do not t ot ally follow t heir know ledge, w hich ex poses t hem t o sev er al biological r isks, r ev ealing reproduct ive knowledge and perform ance. Thus, we propose t he im plem ent at ion of cont inuing educat ion program s based on const r uct ivist m et hodological appr oach aim ing at effect ive pr act ices in t he m anagem ent and disposal of p ier cin g - cu t t in g m at er ial. I n t h is p er sp ect iv e, r esear ch clar if y in g h ow ad u lt s ap p r eh en d k n ow led g e can deepen t he r esult s descr ibed in t he st udy .
DESCRI PTORS: k now ledge; m edical w ast e; educat ion, nur sing
ACTUACI ÓN DE AUXI LI ARES Y TÉCNI COS DE ENFERMERÍ A EN EL MANEJO DE
PUNZOCORTANTES: UN ESTUDI O NECESARI O
El present e est udio t uvo com o obj et ivo analizar el conocim ient o del equipo de auxiliares y t écnicos de enferm ería en el m an ej o y separ ación de pu n zocor t an t es, descr ibien do la act u ación de esos pr ofesion ales. Se t r at a de est u d io cu alit at iv o d escr ip t iv o, cu y os su j et os f u er on t r es au x iliar es y d oce t écn icos d e en f er m er ía d e u n a inst it ución de salud de port e m edio, t ot alizando quince suj et os ent revist ados por m edio de guión sem iest ruct urado. El análisis de los relat os fue realizado por la t écnica de análisis de cont enido. Los result ados apunt aron que, a p esar d e q u e los su j et os p oseen con ocim ien t os t eór icos sob r e cu id ad os con p u n zocor t an t es, ellos n o los ut ilizan int egr alm ent e, ex poniéndose a diver sos r iesgos, lo que r evela conocim ient o y act uación que se r epit e. Se propone, aquí, la im plem ent ación de program as de educación cont inuada, basados en abordaj es m et odológicos const r uct iv ist as, con el obj et iv o de obt ener una pr áct ica eficaz en el m anej o y separ ación de punzocor t ant es. De esa for m a, las invest igaciones que aclar en la apr ehensión del conocim ient o por adult os pueden pr ofundizar los r esult ados descr it os en est e est udio.
DESCRI PTORES: conocim ient o; r esiduos de hospit ales; educación en enfer m er ía
ATUAÇÃO DE AUXI LI ARES E TÉCNI COS DE ENFERMAGEM NO MANEJO DE
PERFUROCORTANTES: UM ESTUDO NECESSÁRI O
O present e est udo t eve com o obj et ivo analisar o conhecim ent o da equipe de auxiliares e t écnicos de enferm agem no m anej o e segr egação de per fur ocor t ant es, descr ev endo a at uação desses pr ofissionais. Tr at a- se de est udo qualit at ivo descrit ivo, cuj os suj eit os foram t rês auxiliares e doze t écnicos de enferm agem de um a inst it uição de saúde de m édio port e, t ot alizando quinze suj eit os ent revist ados por m eio de rot eiro sem iest rut urado. A análise dos depoim ent os foi r ealizada pela t écnica de análise de cont eúdo. Os r esult ados apont ar am que, em bor a os suj eit os t enham conhecim ent os t eóricos sobre cuidados com perfurocort ant es, eles não os ut ilizam , int egralm ent e, ex p o n d o - se a d i v er so s r i sco s, o q u e r ev el a co n h eci m en t o e a t u a çã o r ep r o d u t i v i st o s. Pr o p õ e- se, a q u i , im plem ent ação de pr ogr am as de educação cont inuada, baseada em abor dagens m et odológicas const r ut iv ist as, visando a pr át ica eficaz no m anej o e segr egação de per fur ocor t ant es. Dessa for m a, pesquisas que esclar eçam a apr eensão do conhecim ent o por adult os podem apr ofundar os r esult ados descr it os nest e est udo.
DESCRI TORES: conhecim ent o; r esíduos de ser v iços de saúde; educação em enfer m agem
1M.Sc. in Educat ion, Facult y, Universidade Federal do Piauí, Cam pus Senador Helvidio Nunes de Barros, Brazil, e- m ail: elainecrism @bol.com .br; 2RN,
Specialist in Maternal- Child Nursing, Hospital I nfantil Lucídio Portela, Brazil, e- m ail: fsm fonseca@hotm ail.com ; 3RN, Specialist in Occupational Health Nursing,
Hospit al São Marcos, Brazil, e- m ail: soraiam fonseca@gm ail.com .
I NTRODUCTI ON
C
urrent Brazilian prerogat ives relat ed t o t he m an ag em en t of solid r esid u es est ab lish t h at t h e product ion of wast e up t o it s final dest inat ion is t he responsibility of the institution that produces it. These i n st i t u t i o n s h av e t o p r esen t a Heal t h car e Wast e Managem ent Plan, w hich needs t o be subm it t ed t o the appreciation of responsible offices. Healthcare solid waste is classified in groups identified by letters. Due t o it s im port ance, piercing- cut t ing m at erial occupies a specific group denom inat ed group E( 1).Am ong t he occupat ional risks relat ed t o t he m anagem ent of piercing- cut t ing wast e cont am inat ed by biological m aterial, the following stand out: hepatitis B risk of about 30% ; hepatitis C risk of 3% ; and AI DS, transm itted by HI V virus with risk of 0.3% . Regarding t he frequency of accident s, percut aneous inoculat ion is t he m ost evident and r epr esent s one t hir d of all accid en t s, w h ose m ain ev en t s ar e: r ecap p in g of needles and int r av enous cat het er s and inadequat e disposal of piercing- cutting m aterial thrown in com m on t r ash , or in in cor r ect ly assem bled sh ar ps disposal boxes( 2).
I n t h e h o sp i t a l co n t e x t , e x p o su r e t o occupat ional risks and work accident - relat ed inj uries is h igh er in t h e n u r sin g t eam becau se of 2 4 - h ou r cont act wit h pat ient s, delivering care( 3) in a pract ical
per spect iv e.
An ad d it ion al st u d y ad d r essin g accid en t s inv olv ing nur sing pr ofessionals and pier cing- cut t ing m at er ial m ay seem u n n ecessar y sin ce t h er e ar e sev er al st udies on t he char act er izat ion of w or k er s cont am inat ed by accident s and relat ed disorders( 4- 5),
as well as cont inuing educat ion pract ices focusing on knowledge of st andard precaut ions( 6- 7), which shows
t he t hem e’s relevance.
However, studies addressing the perform ance of nursing professionals and t he const ruct ion of t heir k now ledge on t he m anagem ent of pier cing- cut t ing m at erial are scarce. “ Healt h workers know t he risks posed to their health in a generic way [ …] which points to the need for a strategy to change this situation”( 8).
Therefore, t his st udy is j ust ified by t he need t o u n der st an d adequ at e m an agem en t of pier cin g-cut t ing m at erial, reduct ion of accident frequency and r i sk s o f i n f e ct i o u s d i se a se s, i n a d d i t i o n t o environm ental problem s, contributing to the knowledge const r uct ion of nur sing pr ofessionals as fr om t heir daily pract ice.
I n t his per spect ive, nur sing auxiliar ies’ and technicians’ perform ance and knowledge on the them e w er e inv est igat ed, m ainly because t hey r eflect t he perform ance of nursing professionals in t he process of knowledge const ruct ion.
The overall st udy perspect ive is focused on cont inuing educat ion of nursing professionals and it s co n n e ct i o n w i t h k n o w l e d g e a cq u i r e d o n t h e m anagem ent of piercing- cut t ing m at erial, aim ing t o relat e t hese result s wit h current findings in t he area of Adult Educat ion. “Adult s’ cont inuing educat ion has in cr easin gly v alu ed m odalit ies t h at f av or people’s abilities to construct their own knowledge as from the r ev iew of t heir ow n at t it udes and v alues based on t heir learning”( 9).
Ther efor e, t he r esult s pr esent ed ar e based on t he following quest ions: what is t he perform ance o f n u r si n g a u x i l i a r i e s a n d t e ch n i ci a n s i n t h e m anagem ent of piercing- cutting m aterial? What is the know ledge of nursing auxiliaries and t echnicians on the handling and disposal of piercing- cutting m aterial? Th e g oal is t o an aly ze t h e k n ow led g e of n u r sin g auxiliaries and technicians in the handling and disposal o f p i e r ci n g - cu t t i n g m a t e r i a l a n d d e scr i b e t h e i r per f or m an ce.
METHODOLOGI CAL PROCEDURES
Th i s q u a l i t a t i v e - d e scr i p t i v e st u d y w a s subm it t ed t o and appr ov ed by t he Resear ch Et hics Com m it t ee at t h e NOVAFAPI , in it ially b ased on a bibliographic research on the m anagem ent of piercing-cu t t in g m at er ial, f opiercing-cu sin g on t h e p er f or m an ce of nursing auxiliaries and t echnicians.
The st udy w as car r ied out at t he m edium -size children’s Hospit al Lucídio Port ela, reference in pediat rics and locat ed in t he Mid- Sout h of Teresina, Pi a u í, Br a zi l . Th e h o sp i t a l h a s 8 6 b e d s f o r hospit alizat ion t hr ough t he Br azilian Unified Healt h System ( SUS) . I ts staff includes 172 nursing workers, nam ely: 28 nurses, 44 nursing technicians, 70 nursing auxiliaries and 21 at t endant s.
out by the researchers from Septem ber to Novem ber 2 0 0 6 . I n t e r v i e w s w e r e t a p e - r e co r d e d a f t e r par t icipan t s’ pr ev iou s con sen t* an d t r an scr ibed as
accurat ely as possible, respect ing t he aut hent icit y of spont aneous dialog.
Collect ed dat a were sort ed and t wo general categories and respective subcategories em erged. The analysis followed the theoretical fram ework of content analysis, including the following phases: “ pre- analysis, m at er ial ex plor at ion, t r eat m ent of obt ained r esult s and int erpret at ion”( 10).
Th e f i r st ca t e g o r y, n u r s i n g t e a m ’ s per for m an ce in t h e m an agem en t of pier cin g- cu t t in g m at er ial, descr ibed t he w ay nur sing aux iliar ies and t echnicians handle pier cing- cut t ing w ast e accor ding t o t he par t icipant s’ t heor et ical- pr act ical k now ledge. The following subcat egories were generat ed: care in t h e m an ag em en t of p ier cin g - cu t t in g m at er ial an d disposal of piercing- cutting waste by the nursing team . The cat egor y n u r sin g t eam ’s k n ow ledge on t h e m an ag em en t o f p i er ci n g - cu t t i n g m at er i al w as
about aspect s relat ed t o inform at ion incorporat ed in t he m anagem ent of piercing- cut t ing wast e and t heir p e r f o r m a n ce w i t h t h i s m a t e r i a l , g e n e r a t i n g t h e f ollow in g su bcat egor ies: t h e m ean in g of pier cin g-cu t t i n g m a t e r i a l f o r t h e n u r si n g t e a m a n d m anagem ent of piercing- cut t ing m at erial: proposals t o im prove pract ice.
RESULTS AND DI SCUSSI ON
The nursing t eam ’s perform ance in t he m anagem ent of piercing- cut t ing m at erial
Aim ing t o char act er ize t he per for m ance of nursing auxiliaries and technicians in the m anagem ent of piercing- cutting m aterial, we discussed the way this m a t e r i a l i s h a n d l e d , r e l a t i n g i t n o t o n l y t o t h e im port ance t hese individuals at t ribut e t o it s disposal but also t o t he Minist ry of Healt h recom m endat ions on it s adequat e m anagem ent .
I n this perspective, it is pertinent to describe the profile of the studied individuals according to the param eters age, gender, tim e of work and education, nam ely : 53. 4% w er e bet w een 35 and 45 y ear s of
age; 33.3% bet w een 45 and 55 y ear s; and 13.3% bet ween 25 and 35 years, wit h predom inance of t he fem ale gender ( 86.7% ) . Regar ding t im e of w or k at t he inst it ut ion, 46.7% had worked t here bet ween 20 and 30 years; 40.0% bet ween 10 and 20 years; and on ly 1 3 . 3 % bet w een 0 an d 1 0 y ear s. I n t er m s of edu cat ion , 7 4 . 4 % of t h e par t icipan t s h ad f in ish ed secondary school and 26.6% had a bachelor’s degree. The Minist ry of Healt h recom m endat ions on t he handling and disposal of pier cing- cut t ing w ast e were used in the subcategory care in t he m anagem ent of piercing- cut t ing m at erial as param eters of analysis,
so as t o com pare part icipant s’ answers on t he care taken to adequately m anage piercing- cutting m aterial. A t ot al of 4 6 . 7 % of t h e p ar t icip an t s r ep or t ed n o t
recapping needles ( T1, T2, T4, T5, T6, T10, T12) and 73.3%
reported separat ing and discarding piercing- cut t ing m at erial in
a shar ps disposal box ( T1, T2, T3, T5, T8, A2, T7, A3, T9, T1 0 , T1 2 ) .
The adopt ion of st andar d pr ecaut ions aim s t o m i n i m i ze r i sk s o f a cci d e n t a l e x p o su r e a n d em ph asizes specif ic car e du r in g t h e h an dlin g an d disposal of pier cing- cut t ing w ast e. The m aj or it y of m easures was m ent ioned in t he obt ained answers.
Am ong t he recom m endat ions t o be com plied w i t h , t h e f o l l o w i n g st an d o u t : p ay i n g m ax i m u m attention during procedures, not using finger as shield, not recapping, twisting or rem oving needles with hands, not using needles t o hold papers and discarding any piercing- cut t ing m at erial in lidded cont ainer resist ant t o perforat ion( 11).
Th e m e r e m e n t i o n o f t h e se m e a su r e s, how ev er, does not necessar ily indicat e t his pract ice in t he work rout ine of t he st udied nursing auxiliaries and t echnicians. This fact is observed in st at em ent s report ing neglect in t he use of gloves and recapping of n eedles an d scalps, as can be obser v ed in t h e following statem ents: I have t he habit of recapping, t hough
I know it ’s wrong. We, who work wit h pat ient s in t he daily rout ine, didn’t adapt t o t he use of gloves yet , especially in vein punct ure ( A2) . We know we can’t do it , but forget . Cannot recap needles, scalp, cannot t hrow it in ordinary t rash, have t o put it in cont ainer specific for it ( T5) .
Most pier cing- cut t ing accident s occur w hen t h e se m e a su r e s a r e n e g l e ct e d , t h a t i s, d u r i n g inadequat e discarding and recapping of needles and
*The free and inform ed consent term was signed by all studied individuals according to Decree nº 93933, issued on January 14th 1987, Resolution 196/ 1966
scalps. This procedure violat es st andard precaut ions. Nursing auxiliaries and t echnicians are appoint ed in t his case as t hose who m ost frequent ly perform t his pr ocedur e inadequat ely( 3).
I n t h e su bcat egor y d iscar d in g of p ier cin g -cut t ing m at erial by t he nursing t eam, which refers to
t h e ca r e w i t h t h e sh a r p s d i sp o sa l b o x , 6 0 % o f participants affirm ed follow ing t he recom m endat ion not t o
ex ceed t h e f illin g lim it ( T3, A2, T4, T6, T7, A3, T10, T11,
T12) and 66% report ed adequat e assem bling and closing of
t he sharps disposal box ( A1, T1, T2, T3, T5, T7, A3, T8, T9,
T1 0 ) . Wh en t h ese m easu r es ar e p er f or m ed , t h ey
cont ribut e t o adequat e m anagem ent .
I t is im port ant , however, t o heed t o t he fact t h at p ier cin g - cu t t in g w ast e sh ou ld b e sep ar at ely discarded where it is generat ed right aft er it s use or in case it needs t o be discar ded. Rigid and lidded cont ainers, resist ant t o perforat ion and appropriat ely iden t if ied, sh ou ld be u sed. Th e com plet ion of t h e container should not exceed 2/ 3 of its capacity and it is expressly forbidden t o em pt y it for reuse( 12).
An o t h er i m p o r t an t f act i s r el at ed t o t h e av ailab ilit y of d isp osal b ox es u sed f or d iscar d in g piercing- cutting waste. Most tim es, they are not readily av ailable for r eplacem ent in places of easy access, which leads to filling them above established lim its( 3).
The difficult access t o sharps disposal boxes f or r ead y r ep lacem en t , as w ell as t h eir in cor r ect assem bly wit hout placing int ernal reinforcem ent s or p l ast i c b ag s, i n cr eases t h e r i sk of p er cu t an eou s exposure due t o t he box overcrow ding and fragilit y caused by inadequat e assem bly( 13).
Con f lict in g sit u at ion s r elat ed t o t h e f illin g lim it s of t he disposal box es w er e obser v ed am ong participants. Despite their claim that boxes should not be ov er cr ow ded, t her e w er e doubt s r egar ding t heir lim its, as can be inferred by the following statem ent:
I ’m not really sure, I ’ve heard t hat you have t o close it when it ’s half full ( T3) .
How ev er, lat er on , t h e sam e in t er v iew ee reports that all instructions related to the disposal box assem bling and filling lim it are listed on the box itself and com m ents: [ …] t here’s a “ lit t le inst ruct ion” on t he box
t elling how t o close it . I guess t hat anyone who knows how t o read has no hard t im e, unless you don’t want t o have t he work t o
read ( T3) . We observed that, despite the interviewee’s
aw ar eness t hat t he box cont ained inst r uct ions, she cont radict ed her self.
We also perceived t he dist ancing of nursing professionals from the disposal box and the im portance
of disposing it, as illustrated in the following discourse w hen A3 r efer s t o it as an obj ect dist ant fr om her practice, evidenced by the term “ that ”. I don’t know how
t o assem ble t hat box, but I guess you have t o be careful t o assem ble it really right [ …] our group failed on t he com pet it ion because we didn’t know how t o assem ble t he box ( A3) .
Th e f r e q u e n cy o f i n co r r e ct l y a sse m b l e d disposal box es ex poses pr ofessionals t o accident al r i sk s i n p r act i ce, as ex p r essed b y t h e f o l l o w i n g st at em ent s: t he m ost com m on t hing t hat happens at t his
hospit al is t hat people exceed, a lot , t he volum e of cont am inat ed m at erial.I see colleagues get t ing a syringe, pulling t he plunger, and for cing it int o t he box , I find it danger ous ( T6) . Som e colleagues get a syringe and get like [ …] ( shows how) “ forcing it ” , som et im es it ’s r eally laziness of get t ing and assem bling anot her box, or because t hey don’t know how t o assem ble it (A3).
Th ese at t it u d es r ev eal t h at , ev en t h ou g h i n st i t u t i o n s en co u r ag e co n t i n u i n g ed u cat i o n an d com pet it ions, and inst ruct ions are also available on the container itself, professionals are not incorporating t h e k n ow led g e n ecessar y f or ef f ect iv e p r act ices. Occupational risks have been underestim ated because p r o f e ssi o n a l s k n o w m o st r e co m m e n d a t i o n s f o r adequat e m anagem ent of pier cing- cut t ing m at er ial. I n pract ice, however, t hey do not properly value t he m ost im portant step of the process: its disposal, which con t r ibu t es t o a sign ifican t in cr ease in t h e r isk of accident s.
The nur sing t eam ’s know ledge on t he m anagem ent of piercing- cut t ing m at erial
I n t h i s i t e m , t h e st u d y f o cu se s o n p r of ession als’ k n ow led g e ab ou t t h e h an d lin g an d disposal of pier cing- cut t ing m at er ial, based on t he m eaning nursing auxiliaries and t echnicians at t ribut e t o i t s r e si d u e s, so a s t o v e r i f y t h e l e v e l o f incorporat ion of specific knowledge, t he part icipant s’ educat ion and cont ribut ion of cont inuing educat ion.
I n t e r m s o f c a r e d e l i v e r y , n u r s i n g t ech n i ci an s h a v e t h e r esp o n si b i l i t y, d u r i n g t h ei r p r o f e s s i o n a l p r a c t i c e , n o t t o p o s e r i s k s t o t h e m se l v e s, t o t h e h e a l t h t e a m a n d t o cl i e n t s, t h r ou gh t h e u se of biosaf et y pr ot ocols( 1 4 ). I n t h is
Co n ce p t s a n d t h e cl a ssi f i ca t i o n s o f Resolu t ion s n . 3 0 6 an d n . 3 5 8 w er e u sed in t h e subcat egor y : m ean in g of p ier cin g - cu t t in g w ast e so
as to com pare them with participants’ answers on their underst anding regarding piercing- cut t ing w ast e( 1,16).
The following result s were obt ained: it ’s m at er ial t hat
cut s and pier ces, such as scalpel blades, needles, glass and ot her s ( T1, T2, T8, T11) ; t hey ar e needles, scalpel blades, razor, glass and glass slides ( T3, T5, T6, T7, T9, T10, T12) ;
m at erial t hat causes accident s ( A2, T4, A3, T12) ; t hese residues are rem nant s of blood, secret ions wit hin t he needle or t he scalpel blade ( A1) .
We observed during t he analysis of answers t hat only 26.7% of t he part icipant s defined piercing-cutting waste, 46.7% were able to exem plify it, 26.6% associat ed t h em t o t h e r isk of con t am in at ion an d accident s. A1 specifically confounded it wit h organic m at t er. This way, we perceived t hat t he m aj orit y of t he indiv iduals has som e not ion of pier cing- cut t ing m at erial, not ion of concept ualizat ion, exem plificat ion or relat ion wit h occupat ional exposure.
I n t h e su b ca t e g o r y : p i e r c i n g - c u t t i n g m a n a g e m e n t : p r o p o sa l s t o i m p r o v e p r a ct i ce, w e
aim ed t o ident ify t he individuals’ know ledge on t he handling of piercing- cutting waste through suggestions t h at can con t r ib u t e t o t h e im p r ov em en t of t h eir per for m ance. The r epor t s ar e: u sin g g lov es ( A1 , A2 ,
T8); m ore inform at ion ( T2, A2, T4, T5, A3, T9); disposal box
at t he nursing w ard ( T3, T8); ideal place only for vein punct ure
( T3, T12); m or e at t ent ion ( A2, T6) ; gr eat er aw ar eness ( A2,
A3) ; m ore care ( T5, T6); t aking risks m ore seriously ( T7); m ore
im port ance t o it s disposal ( A3); creat ing a flow chart and t eam s t o orient in case of accident s ( T11) .
Accor din g t o an sw er s, t h e m ost r ecu r r en t suggestion was the need for m ore inform ation related t o t h e m a n a g e m e n t o f p i e r ci n g - cu t t i n g w a st e addressing risk fact ors, prevent ion m echanism s and conducts t o be adopt ed in case of accidents wit h the m a t e r i a l , e m p h a si zi n g t h e n e e d f o r co n t i n u i n g educat ion.
On e of t h e par t icipan t s su ggest ed pu t t in g d isp osal b ox es n ear b ed s in n u r sin g w ar d s. Th is practice has already been im plem ented at the Hospital Al e m ã o Osv a l d o Cr u z i n Sã o Pa u l o , w h i ch h a s dem onst rat ed a reduced num ber of accident s in t he t r an spor t at ion of pier cin g- cu t t in g m at er ial( 13). Th e sam e part icipant acknowledges however t hat , in t he case of a pediat ric hospit al, t his m easure has t o be
reconsidered: a box in each nursing ward would be ideal, but
we work wit h children, so where would we put it ? We cannot put it high, t here was a case of an em ployee who was sued because she put a box high and a short em ployee got pierced ( T3) .
Despite constant updating or training courses on handling and disposal of piercing- cut t ing m at erial for professionals at t he st udied inst it ut ion, effect ive changes in at t it udes have not appeared according t o A2: t here’s always a course, who adm inist ers it always insist s
on t he sam e t hing. I guess it ’s only a m at t er of people who work in t he area t o get m ore at t ent ive, ‘cause t here’s t he box, gloves, so how com e t hey aren’t used?
Nur ses usually adm inist er updat ing cour ses o f f e r e d i n h o sp i t a l s, w h i ch su g g e st s t h e r e a r e e sse n t i a l w e a k n e sse s i n t e a ch i n g a n d l e a r n i n g processes of these professionals in study. Thus, there is a lack of m ore com plex rat ionales involving self-r ef lect ion an d con st self-r u ct ion of cself-r it ical k n ow led g e. “ Hist orically, t echnical st aff is t rained t o do w it hout thinking, as they are alienated in com piling techniques an d in apply in g t h em u n cr it ically as soon as t h ey receive an order”( 17).
We a l so b e l i e v e t h e r e a r e o t h e r f a ct o r s co m p r o m i si n g a ch a n g e o f a t t i t u d e i n t h e se professionals. Am ong them , we can nam e the lack of cont inuing educat ion, focused on nursing auxiliaries’ an d t ech n i ci an s’ r eal n eed s, i n cl u d i n g p l an n i n g , previous knowledge, adequat e language, evaluat ion, supervision and follow- up in t he work environm ent .
Coupled t o t hese fact ors, cult ure and hist ory of the nursing profession also reflect the problem , “ it is t h e r ole of g r ad u at e n u r ses, w h ose t r ain in g is focused on t eaching and adm inist r at ion of nur sing ca r e, t o m a n a g e ca r e d el i v er y, d i st r i b u t i n g a n d delegat ing specific t ask s t o t he r em aining nur sing w orkers”( 18).
Cu r r e n t p e r sp e ct i v e s a p p o i n t a g r e a t challenge for nur ses r esponsible for t eaching t hese professionals because t here are dichot om ies bet ween t he educat ion of nurses and t echnicians. The lat t er, being “ m anual workers”, perform funct ions in which there is no control of the process or end product and r e m a i n a l i e n a t e d [ …] n u r se s a r e a l so sa l a r i e d em ploy ees, t heir educat ion is int ellect ual and t hey m anage care delivery”( 18).
The teaching proposal based on the Curricular Par am et er s an d Gu i d el i n es i n v ol v es t h e n eed t o prom ot e changes in t he t eaching- learning process. I t at t em p t s t o sen sit ize in d iv id u als t o p er f or m saf e practice and to privilege standard precautions for their p r ot ect ion , ev en in sit u at ion s of st r ess an d w or k overload, em phasizing t he im port ance of self- est eem and self- care”( 18).
Th i s w a y, n u r se s, i n t h e r o l e o f h e a l t h e d u ca t o r s, sh o u l d v a l u e t h e Mi n i st r y o f He a l t h r ecom m endat ions so as t o cont ex t ualize t eaching-l e a r n i n g co n d i t i o n s o f n u r si n g a u x i eaching-l i a r i e s a n d t echnicians t hr ough cont inuing educat ion, enabling education strategies that perm it trainees to m ake the lin k b et w een t h e em p ir ical an d scien t if ic p r act ice without getting lost in intuitive experiences, especially in conditions of risk, like in the case of piercing- cutting m an agem en t .
CONCLUSI ONS
This study appoints the need for adj ustm ents in nur sing t eam s’ w or k w it h a view t o const r uct ing critical and reflexive knowledge on daily practice. For t hat , nurses, in t he role of educat ors and m anagers o f n u r si n g ca r e , sh o u l d co n d u ct t h e co n t i n u i n g education process, taking into account the knowledge of nur sing aux iliar ies and t echnicians, aim ing at a t r ansfor m ed pr act ice.
Therefore, in view of t he count less pot ent ial occupat ional risks posed by inadequat e m anagem ent of piercing- cutting m aterial, personal and institutional invest m ent s are needed, valuing workers’ experience and aim ing to strengthen their perform ance, so as to pr om ot e effect iv e daily pr act ices and adher ence t o biosafet y m easur es.
I n t his cont ext , t he ident ificat ion of problem sit uat ions t hat can be addressed t hrough t raining is essential, so as to face the challenges and alternatives necessary t o break t he t ies of t he t echnicist m odel. The developm ent of research addressing t he reason w h y st r at eg ies d ev elop ed so f ar d o n ot p r om ot e significant changes in healt h professionals’ pract ice, w hich is t he focus of t his st udy, is cr ucial. I n t his per spect iv e, t her e ar e pr ospect s in cur r ent st udies addressing adult educat ion.
REFERENCES
1. ANVI SA. Minist ério da Saúde ( BR) . Resolução n.306, de 07 de dezem bro de 2004. Diário Oficial da República Federativa do Brasil. Brasília, DF, 10 dez 2004. Seção 1, p. 49. 2. Silva CER, edit ores. O processo de t rabalho da lim peza e colet a int erna do lixo hospit alar na em ergência do Hospit al Municipal Paulino Werneck [ dissert ação da I nt ernet ] . Rio de Janeir o ( RJ) : Escola Nacional de Saúde Pública, Cent r o de Est u d o s d e Sa ú d e d o Tr a b a l h a d o r e Eco l o g i a Hum ana; 1999. [ Acesso em 02 abr il 2006] . Disponív el em : ht t p: / / por t alt eses.cict .fiocr uz.br / t ransf.php.
3. Marziale MHP, Rodrigues CM. A produção cient ífica sobre os acident es de t rabalho com m at erial perfurocort ant es ent re t r a b a l h a d o r e s d e e n f e r m a g e m . Re v La t i n o - a m Enferm agem [ serial online] 2002 Jul- Ago [ Acesso em 21 abril 2 0 0 6 ] 1 0 ( 4 ) : 5 7 1 - 7 ; D i sp o n ív e l e m : w w w . sci e l o . b r / s c i e l o . p h p ? s c r i p t = s c i _ a r t t e x t & p i d = S 0 1 0 4 -1 -1 6 9 2 0 0 2 0 0 0 4 0 0 0 -1 5 .
4 . Mar ziale MHP, Nish im u r a KYN, Fer r eir a MM. Riscos de cont am inação ocasionados por acident es de t r abalho com m aterial pérfuro- cort ant e ent re t rabalhadores de enferm agem . Re v La t i n o - a m En f e r m a g e m 2 0 0 4 j a n e i r o / f e v e r e i r o ; 1 2 ( 1 ) : 3 6 - 4 2 .
5. Canini SRMS, Gir E, Hayashida M, Machado AA. Acident es perfurocort ant es ent re t rabalhadores de enferm agem de um h ospit al u n iv er sit ár io do in t er ior pau list a. Rev Lat in o- am Enfer m agem 2002 m ar ço/ abr il; 10( 2) : 172- 8.
6. Melo DS, Souza ACS, Tipple AFV, Neves ZCP, Pereira MS. Com pr eensão sobr e pr ecauções padr ão pelos enfer m eir os d e u m h osp it al p ú b lico d e Goiân ia - GO. Rev Lat in o- am Enfer m agem 2006 set em br o/ out ubr o; 14( 5) : 720- 7. 7. Brevidelli MM, Cianciarullo TI . Análise dos acident es com agulhas em um hospit al universit ário: sit uações de ocorrência e t endências. Rev Lat ino- am Enferm agem 2002 novem bro/ dezem br o; 10( 6) : 780- 6.
8. Oliveira BRG, Murofuse NT. Acident es de t rabalho e doença ocupacional: est udo sobr e o conhecim ent o do t r abalhador hospit alar dos riscos à saúde de seu t rabalho. Rev Lat ino- am Enfer m agem j aneir o/ fev er eir o 2001; 9( 1) : 109- 15.
9 . Ber n ar d o ASS, Gom es I D, Alm eid a MPP. An álise d as Prát icas: um a est rat égia de const rução de saberes na prática dos cuidados de enferm agem . Form ar: Rev Form adores 2004 m ar ço; 4 6 ( 5 0 ) : 4 2 - 5 2 .
1 0 . Mi n a y o MCS. Pe sq u i sa So ci a l : Te o r i a , m é t o d o e cr iat ividade. 21ª ed. Pet r ópolis ( RJ) : Vozes; 2002.
biológico: HI V e HEPATI TE B e C. Brasília ( DF) ; 2004. 1 2 . Ag en cia Nacion al d e Vig ilân cia San it ár ia [ Pág in a d a I n t e r n e t ] . Br a síl i a : Mi n i st é r i o d a Sa ú d e . Ma n u a l d e Ger en ciam en t o d e Resíd u os d e Ser v iços d e Saú d e[ ser ial online] ; 2006; [ Acesso em 03 dezem bro 2006] . Disponível e m : h t t p : / / w w w . a n v i sa . g o v. b r / se r v i co sa u d e / m a n u a i s/ m anual_ger enciam ent o_r esiduos.pdf.
1 3 . Lopes MHBM, Mor om izat o SS, Veiga JFFS. Adesão às m edidas de pr ecaução- padr ão: r elat o de ex per iência. Rev Lat ino- am Enferm agem [ serial online] 1999 out ubro; [ Acesso em 11 dezem bro 2006] . 7( 4) : 83- 88. Disponível em : ht t p: / / w w w . s c i e l o . b r / s c i e l o . p h p ? p i d = S 0 1 0 4 -1 -1 6 9 -1 9 9 9 0 0 0 4 0 0 0 -1 -1
1 4 . Mi n i st é r i o d a Sa ú d e ( BR) . D i r e t r i ze s Cu r r i cu l a r e s Nacionais para o Ensino Técnico Área da Saúde. Brasília (DF); 1999. [ Acesso em 12 dezem bro 2006] . Disponível em : http: / / www.opas.org.br/ rh/ adm in/ diret rizes_curriculares.pdf
15. Serviço Nacional de Aprendizagem Com ercial[ hom epage na I nt er net ] . Rio Gr ande do Sul: SENAC. [ Acesso em : 07 ab r il 2 0 0 7 ] . Disp on ív elem : h t t p : / / w w w . sen acr s. com . b r / passodar eia/ t ec_lab_enfer m agem . asp
16. Conselho Nacional do Meio Am bient e ( BR) . Resolução da Diret oria Colegiada n. 358, de 29 de abril de 2005. Diário Oficial da República Feder at iv a do Br asil. Br asília, 04 m ai. 2005. Seção 1, p.63.
1 7 . Andrade LS, Pinho CC, Sant ana MMV. O. Pesquisa no Currículo do Curso de Técnico em Enferm agem : Um Relat o de Experiência. Sit ient ibus, Feira de Sant ana. [ serial online] 2005 j ul./ dez [ Acesso em 11 dezem bro 2006] ; 33( 1) : 53-6 0 Dispon ív el em : h t t p: / / w w w . u ef s. br / sit ien t ibu s/ pdf / 3 3 / pesquisa_no_cur so_t ecnico_de_enfer m agem . pdf.
18. Br ut scher SM. Análise da At uação da Enfer m agem em Am bulat ório: à dist ância ent re ser e dever Ser. São Paulo: Edit or a Univ er sidade de Br asília; 2000.
