NURSES’ ATTENTI ON DEMANDS I N THE W ORK SETTI NG
1Luciana Soar es Cost a Sant os2
Edinêis de Br it o Guir ar dello3
Sant os LSC, Guir ar dello EB. Nur ses’ at t ent ion dem ands in t he w or k set t ing. Rev Lat ino- am Enfer m agem 2007
j an eir o- f ev er eir o; 1 5 ( 1 ) : 2 7 - 3 3 .
Th is descr ipt iv e st u dy aim ed t o iden t if y at t en t ion dem an d sit u at ion s ex per ien ced by n u r ses in t h eir
w or k place and t o v er ify if t hese dem ands w er e j udged differ ent ly depending on socio- dem ogr aphic v ar iables.
Dat a w er e collect ed t hr ough t he “ Dir ect ed At t ent ion Dem ands” inst r um ent , t r anslat ed and v alidat ed in Br azil.
SAS st at ist ics soft w ar e w as used for dat a analysis. The follow ing dem and sit uat ions scor ed higher : “ w at ching a
pat ient suffer ” , “ a num ber of r apid decisions had t o be m ade” , “ car ing for fam ilies w it h em ot ional needs” , “ not
enough t im e t o pr ov ide em ot ional suppor t t o a pat ient ” , and “ fam ily t eaching r equir ed” . Ther e w er e st at ist ical
d if f er en ces f or v ar iab les su ch as: ag e, m ar it al st at u s, p r of ession al q u alif icat ion , w or k sh if t an d n u m b er of
hour s w or ked w eekly . The im por t ance of t hese findings should be point ed out t o m anager s and adm inist r at or s
in t he adopt ion of st r at egies t hat can m inim ize t hese sour ces of dem and for nur ses.
DESCRI PTORS: nur sing; at t ent ion; healt h facilit y env ir onm ent
DEMANDAS DE ATENCI ÓN DEL ENFERMERO EN EL AMBI ENTE LABORAL
Est e est udio descr ipt iv o busca ident ificar las sit uaciones de dem anda v iv enciadas por enfer m er os en
su am b ien t e lab or al y v er if icar si h ay d if er en cias en el j u ício d e las d em an d as en r elación a las v ar iab les
sociodem ogr aficas. Par a colect ar dat os, se ut ilizó el I nst r um ent o Dem andas de At ención Dir igida, t r aducido y
v alid ad o en Br asil. En el an álisis d e los d at os, se u t ilizó el p r og r am a est ad íst ico SAS. Las sit u acion es d e
dem an das de at en ción con m ay or es m edias ar it m ét icas f u er on : obser v ar el su f r im ien t o del pacien t e, t om ar
m uchas decisiones r ápidas, cuidar de fam ilias con necesidades em ocionales, t iem po insuficient e par a apoy ar
em ocionalm ent e al pacient e y necesidad de or ient ar a la fam ilia. Los dat os m ost r ar on difer encias est adíst icam ent e
sign ifican t es par a las v ar iables: edad, est ado civ il, calificación pr ofesion al, t u r n o del t r abaj o y car ga h or ar ia
sem anal. Se r esalt a la im por t ancia de los hallazgos par a ger ent es y adm inist r ador es en el sent ido de adopt ar
est r at egias par a m inim izar esas fuent es de dem anda par a los enfer m er os.
DESCRI PTORES: enfer m er ía; at ención; am bient e de inst it uciones de salud
DEMANDAS DE ATENÇÃO DO ENFERMEI RO NO AMBI ENTE DE TRABALHO
Tr at a- se de est u do descr it iv o qu e v isa iden t ificar as sit u ações de dem an da de at en ção, v iv en ciadas
por enfer m eir os em seu am bient e de t r abalho, e ver ificar se exist em difer enças no j ulgam ent o dessas dem andas
em função das v ar iáv eis sociodem ogr áficas. Par a a colet a de dados, ut ilizou- se o inst r um ent o Dem andas de
At enção Dir igida, t r aduzido e v alidado no Br asil. Na análise dos dados, ut ilizou- se o pr ogr am a est at íst ico SAS.
Dent r e as sit uações de m aior dem anda dest acam - se: “ obser var o sofr im ent o de um pacient e” , “ m uit as decisões
r áp id as t iv er am q u e ser t om ad as” , “ cu id ar d e f am ílias com n ecessid ad es em ocion ais” , “ t em p o in su f icien t e
par a dar apoio em ocion al a um pacien t e” e “ n ecessidade de dar or ien t ação à fam ília” . Os dados m ost r ar am
que há difer enças est at ist icam ent e significat ivas par a var iáveis com o: idade, est ado civil, qualificação pr ofissional,
t u r n o d e t r a b a l h o e ca r g a h o r á r i a se m a n a l . Re ssa l t a - se a i m p o r t â n ci a d o s a ch a d o s p a r a g e r e n t e s e
adm inist r ador es na adoção de est r at égias que m inim izem essas font es de dem andas par a os enfer m eir os.
DESCRI TORES: enfer m agem ; at enção; am bient e de inst it uições de saúde
1 St udy ext ract ed fr om Mast er ’s Thesis; 2 M.Sc., RN at t he I CU of t he Hospit al Alem ão Osvaldo Cr uz, e- m ail: ls- cost a@uol.com .br ; 3 RN, PhD, Pr ofessor at t he St at e Univer sit y of Cam pinas College of Medical Sciences, e- m ail: guir ar @fcm .unicam p.br
I NTRODUCTI ON
T
h e n at u r e of n u r sin g w or k it self r eq u ir es m u lt ip le at t en t ion d em an d s. Th ese d em an d s d er iv efr om t he com plex it y of t he deliv er ed car e, fr om t he
w or k en v ir on m en t it self an d f r om t h e r equ ir em en t s
posed by pat ient car e deliver y as w ell as by t he healt h
inst it ut ion it self. Thus, nurses need increased focusing
capacit y in dealing w it h crucial sit uat ions t hat involve
ag i l i t y an d p r eci si o n . Ho w ev er, t h i s v ar i es am o n g
differ ent w or k unit s( 1).
Nur ses have char act er ized t he nat ur e of t heir
w or k as a sou r ce of su f f er in g an d ex h au st ion , bot h
physically and em ot ionally( 2). Ot her aut hor s( 3) pr esent
i t a s a p o t e n t i a l ca u se o f ca r e q u a l i t y d e cr e a se ,
associat ed w it h pr ofessionals’ exposur e t o inadequat e
w or k sit uat ions, low w ages and social discr edit , m aking
it a sour ce of excessive m ent al bur den( 4). Nurses have
a l s o i n d i c a t e d p r o f e s s i o n a l e x h a u s t i o n ,
deper son alizat ion an d r edu ced per son al sat isfact ion ,
b e ca u se t h e se a r e r e l a t e d t o t h e n a t u r e o f t h e i r
w or k( 5). This source of suffer ing can be due t o fr equent
con t act w it h deat h an d pain sit u at ion s( 1 ), w h ich can
generat e feelings of t ension and fear of t he unknow n,
m ain ly f or p r of ession als w or k in g in h ig h ly com p lex
care delivery. Anot her feeling refers t o isolat ion, w hen
p r of ession als n eed t o m ak e d ecision s at t h e m ost
conflict ing m om ent s( 6).
Nur ses acknow ledge t he hospit al envir onm ent
as a place w h er e f r agile liv es ar e aler t ly obser v ed,
car ed f or an d p r eser v ed , w h ich r eq u ir e k n ow led g e,
abilit y and t echnical com pet ence. Mor eover, em ot ional
cont r ol is needed in v iew of t his pr act ice, com for t ing
m easur es t o pat ient s need t o be pr om ot ed and
self-help r elat ions need t o be est ablished bet w een nur ses
and pat ient s( 6).
Noise lev els h av e b een ap p oin t ed b ecau se
t h ey in t er f er e in people’s at t en t ion lev el, m ain ly at
cr it ical car e u n it s, w h er e t h ese n oises ar e con st an t
and oft en unpr edict able and uncont r ollable( 7- 8). They
a r e p e r m a n e n t l y p r e s e n t i n t h e n u r s i n g w o r k
env ir onm ent and ar e alr eady par t of t heir daily w or k
r ealit y( 9 ).
For cr it ical car e n u r ses, t h e m ost bot h er in g
n o i se s a r e : e q u i p m e n t a l a r m s, l o u d t a l k s i n t h e
cor r idor s, v iolen t open in g an d closin g of door s an d
f a l l i n g o b j e ct s, b e si d e s a n e x ce ssi v e n u m b e r o f
people passing t hr ough t he unit( 8). These fact or s, in
com binat ion w it h inadequat e k now ledge and sk ills t o
per for m t asks, exhaust ion due t o high w or k load and
p r o f e ssi o n a l f r u st r a t i o n ca n r e su l t i n e t h i ca l a n d
per sonal pr oblem s w it h t he w or k t eam( 7- 8).
At t e n t i o n i s e sse n t i a l i n n u r si n g w o r k t o
p er f or m d aily act iv it ies, su ch as car e p lan n in g an d
d e l i v e r y t o a l l k i n d s o f p a t i e n t s, i n cl u d i n g t h o se
requiring highly com plex care and in risk of im m inent
deat h; coor dinat ing ot her act iv it ies inher ent in t heir
r ole at t h e u n it , ev en w h en f act or s lik e ex cessiv e
n o i s e , i n t e n s e i l l u m i n a t i o n 2 4 h o u r s / d a y, w o r k
ov er load an d con flict s ar e pr esen t( 1 0 ). Con sequ en t ly,
t hese pr ofessionals need incr eased focusing capacit y,
ev en w hen t hese fact or s ar e pr esent . Their const ant
ex posur e t o t hese sour ces of at t ent ion dem ands can
r esu lt in f at igu e, ch ar act er ized by r edu ced f ocu sin g
capacit y, w hich can direct ly affect pat ient care planning
an d d eliv er y.
Hen ce, d u e t o t h e n at u r e of n u r sin g w or k ,
t hese pr ofessionals can be ex posed t o m ult iple car e
dem ands t hat can int er fer e w it h t heir capacit y t o focus
on im por t ant aspect s in t heir w or k pr act ice.
OBJECTI VE
Th i s st u d y a i m s t o : a ) i d e n t i f y a t t e n t i o n
d e m a n d si t u a t i o n s e x p e r i e n ce d b y n u r se s a n d b )
v e r i f y w h e t h e r d e m a n d s i t u a t i o n s a r e j u d g e d
differ ent ly depending on sociodem ogr aphic v ar iables.
METHODOLOGY
Place of st udy
Th is st u dy w as car r ied ou t at t w o h ospit als
called A and B. Bot h ar e locat ed in t he cent r al ar ea of
São Pau lo Cit y. A is a g en er al an d p r ivat e h osp it al
and can at t end 220 adult pat ient s. B is a philant hr opic,
lar ge- sized inst it ut ion t hat can at t end 1,750 adult and
pediat r ic pat ien t s.
Popu lat ion an d sam ple
The st udy populat ion consist ed of all nur ses
active in care delivery at institutions A and B. At A, these
nurses worked at hospit alizat ion unit s, em ergency care
and I CU. At B, only I CU professionals were considered,
because t hey m ainly carry out care act ivit ies.
How ev er, t h e sam p le on ly in clu d ed n u r ses
per for m ing car e act iv it ies, pr ofessional ex per ience of
s i x m o n t h s o r m o r e , t h r e e m o n t h s o r m o r e o f
ex per ience at t he unit and agr eeing t o par t icipat e in
t he st udy.
I n st r u m en t
The Dir ect ed At t ent ion Dem ands inst r um ent
w as d ev elop ed an d lat er t r an slat ed t o Por t u g u ese,
an d aim s t o id en t if y d if f er en t sou r ces of at t en t ion
d e m a n d s n u r s e s a r e e x p o s e d t o i n t h e i r w o r k
en v ir on m en t( 1 , 1 0 ). I t con sist s of t w o par t s. Th e f ir st
con t ain s 3 9 sit u at ion s, g r ou p ed in t h r ee d om ain s:
Psy ch ological, Beh av ior al an d Ph y sical En v ir on m en t .
I t has t w o t ypes of m easur es: fr equency and int ensit y.
Nur ses m ar k t he fr equency at w hich t hey ex per ience
a cer t ain sit u at ion on a Lik er t - t y pe scale, ch oosin g
one out of fiv e alt er nat iv es, r anging fr om “ nev er ” t o
“ oft en/ all t he t im e”.
The second par t m easur es int ensit y, t hat is,
how m uch m ent al effort t hat specific sit uat ion required,
and used a v isual analogue scale r anging fr om zer o
t o 100 m illim et ers. This inst rum ent has good int ernal
consist ency, w it h a Cr onbach’s alpha of 0. 91.
Dat a collect ion pr ocedu r e
I n i t i al l y, t h e p r o j ect w as ap p r o v ed b y t h e
Resear ch Et h ics Com m it t ee at t h e UNI CAMP Facu lt y
o f Me d i ca l Sci e n ce s a n d b y t h e Re se a r ch Et h i cs
Com m it t ee of bot h par t icipant inst it ut ions.
At bot h inst it ut ions, all nur ses w ho at t ended
t o t h e in clu sion cr it er ia w er e in v it ed t o par t icipat e.
Nur ses w ho agr eed t o par t icipat e w er e ask ed t o sign
t h e Fr ee a n d I n f o r m ed Co n sen t Ter m . Nex t , t h ey
r eceiv ed adv ice about how t o fill out t he inst r um ent
and t he ident ificat ion for m .
Th ese pr of ession als per son ally r eceiv ed t h e
inst r um ent in an envelope and a t im e w as set t o r et ur n
it . Com plet ion t im e var ied bet w een 15 and 25 m inut es.
Dat a w er e collect ed bet w een Febr uar y and May 2004.
Dat a t r eat m ent and st at ist ical analy sis
SAS Syst em for Window s ( St at ist ical Analysis
S y s t e m ) s o f t w a r e , v e r s i o n 6 . 1 2 , w a s u s e d f o r
st at ist ical dat a analy sis.
To descr ibe t h e sam ple pr of ile accor din g t o
t he st udy var iables, a fr equency t able w as elabor at ed
f or cat eg or ical v ar iab les lik e g en d er, m ar it al st at u s
an d p r o f essi o n al q u al i f i cat i o n ; an d f o r co n t i n u o u s
v ar iables lik e age, pr of ession al ex per ien ce, n u m ber
of em p loy m en t r elat ion sh ip s an d n u m b er of h ou r s
w or k ed w eek ly. Ch i- squ ar e an d Man n - Wh it n ey w er e
u sed t o com p ar e m or e t h an on e v ar iab le w it h t h e
at t ent ion dem and sit uat ions. A five percent significance
lev el, t hat is, p< 0.05 w as adopt ed.
RESULTS
Ch ar act er izat ion of n u r ses
A t h o s p i t a l A , 1 2 7 i n s t r u m e n t s w e r e
dist r ibut ed, 96 of w hich w er e r et ur ned ( 75% ) . At B,
8 0 i n st r u m en t s w er e d i st r i b u t ed a n d 6 2 r et u r n ed
( 7 7 . 5 % ) . St u d y p ar t i ci p an t s w er e 1 5 8 n u r ses, 9 6
( 6 0 . 8 % ) fr om inst it ut ion A and 6 2 ( 3 9 . 2 % ) fr om B.
These dat a ar e pr esent ed in Table 1.
Ta b l e 1 - Fr e q u e n cy a n d p e r ce n t a g e d i st r i b u t i o n
a c c o r d i n g t o n u r s e s ’ s o c i o d e m o g r a p h i c
char act er ist ics. São Paulo, 2004 ( n= 158)
* Widow ed/ divor ced/ fixed par t ner
s a c i t s i r e t c a r a
C Distribucióndelamuestra )
n
( (%)
r e d n e G
e l a m e
F 140 88.6
e l a
M 18 11.4
) s r a e y ( e g A
9 2 -0
2 54 34.2
9 3 -0
3 67 42.4
> 04 37 23.4
s u t a t s l a t i r a M
e l g n i
S 81 51.3
d e i r r a
M 60 38.0
* s r e h t
O 17 10.7
n o i t a u d a r G
9 7 9 1 -5 7 9
1 8 5.1
9 8 9 1 -0 8 9
1 32 20.3
9 9 9 1 -0 9 9
1 78 49.4
>2000 40 25.3
n o i t a c i f i l a u Q l a n o i s s e f o r P
e t a u d a r g r e d n
U 38 24.1
n o i t a z il a i c e p
S 114 72.2
s ' r e t s a
M 4 2.5
l a r o t c o
D 2 1.38
p i h s n o i t a l e r t n e m y o l p m E
1 126 79.7
2 32 20.3
y l k e e w d e k r o w s r u o h f o r e b m u N
0 4
< 57 36.1
0 4
= 35 22.2
0 4
> 66 41.7
t f i h s k r o W
g n i n r o
M 64 40.6
n o o n r e t f
A 41 25.9
t h g i
Acco r d i n g t o Ta b l e 1 , m o st n u r se s w e r e
w om en ( 88.6% ) , single ( 51.3% ) and bet w een 30 and
3 9 y ear s old ( 4 2 . 4 % ) . A m aj or it y h ad gr adu at ed at
least t en year s ago ( 49.4% ) and possessed a specialist
degr ee ( 72.2% ) . Most par t icipant s ( 79.7% ) had only
on e em p loy m en t r elat ion sh ip . As t o t h e n u m b er of
hour s w or ked per w eek, a m aj or it y of nur ses indicat ed
an hour load of m or e t han 4 0 hour s ( 4 1 . 7 % ) . Most
n u r ses w or k ed m or n in g sh if t s ( 4 0 . 6 % ) , f ollow ed by
25.9% in t he aft er noon and 33.5% at night .
Nu r ses’ at t en t ion dem an ds
Ac c o r d i n g t o Ta b l e 2 , t h e f i v e a t t e n t i o n
dem and sit uat ion w it h t he highest ar it hm et ic m eans
w er e: “ w at ching a pat ient suffer ”, “ a num ber of rapid
decisions had t o be m ade”, “ car ing for fam ilies w it h
e m o t i o n a l n e e d s ” , “ n o t e n o u g h t i m e t o p r o v i d e
em ot ional suppor t t o a pat ient ” and “ fam ily t eaching
r equir em ent “ , w hich ar e r elat ed t o t he psy chological
an d beh av ior al dom ain .
Table 2 - Dist r ibut ion of m ean scor e and st andar d dev iat ion nur ses at t r ibut es t o at t ent ion dem and sit uat ions.
São Paulo, 2004 ( n= 158)
s n o i t a u t i S d n a m e D n o i t n e t t
A AM* SD**
r e f f u s t n e i t a p a g n i h c t a
W 51.6 31.7
e d a m e b o t d a h s n o i s i c e d d i p a r f o r e b m u n
A 39.6 25.6
s d e e n l a n o i t o m e h t i w s e il i m a f r o f g n i r a
C 39,6 29,7
t n e i t a p a o t t r o p p u s l a n o i t o m e e d i v o r p o t e m i t h g u o n e t o
N 39,4 30,3
d e r i u q e r g n i h c a e t y l i m a
F 39,1 27,7
k r o w l a c i r e l c s a h c u s , d e r i u q e r s k s a t g n i s r u n n o
N 38,9 30,6
t r o p p u s l a n o i t o m e e s n e t n i e r i u q e r o h w s t n e i t a p r o f g n i r a
C 38,6 29,2
d e t e l p m o c e b o t d a h s k s a t g n i s r u n e l p i t l u
M 35,9 26,1
t i n u e h t r e v o c y l e t a u q e d a o t f f a t s h g u o n e t o
N 35,7 30,8
d e r i u q e r g n i h c a e t t n e i t a
P 35,1 27,3
s k s a t g n i s r u n r u o y f o ll a e t e l p m o c o t e m i t h g u o n e t o
N 34,8 26,2
t i n u e h t t a l e v e l e s i o n h g i
H 33,9 29,0
r e t t e b t e g o t s l i a f o h w t n e i t a p a f o e s a c e h t n i s s e l p l e h g n il e e
F 33,5 25,1
g n il u d e h c s d n a g n i f f a t s e l b a t c i d e r p n
U 31,8 28,7
l u f n i a p s a e c n e i r e p x e s t n e i t a p t a h t s e r u d e c o r p g n i m r o f r e
P 31,2 24,0
t n e i t a p a g n i t a e r t n i e k a t s i m a g n i k a m f o r a e
F 27,4 30,9
t i n u e h t t a s m e l b o r p t u o b a l e n n o s r e p t i n u r e h t o h t i w y l n e p o k l a t o t y t i n u t r o p p o n a f o k c a
L 25,1 30,0
e c a p s k r o w d e d w o r
C 23,2 26,7
t i n u e h t t a l e n n o s r e p r e h t o h t i w s g n il e e f d n a s e c n e i r e p x e e r a h s o t y t i n u t r o p p o n a f o k c a
L 23,1 27,6
a e r a d e z i n a g r o s i d r o g n i s u f n o
C 19,7 23,3
s t n e i t a p d r a w o t s g n il e e f s s e r p x e o t y t i n u t r o p p o n a f o k c a
L 19,7 26,8
d e f f a t s -t r o h s e r a h c i h w s t i n u r e h t o o t g n i t a o l
F 19,5 25,4
n o i t i d n o c l a c i d e m s 't n e i t a p a t u o b a n a i c i s y h p a m o r f n o i t a m r o f n i e t a u q e d a n
I 19,0 24,8
n o i t i d n o c s 't n e i t a p e h t t u o b a d l o t e b o t t h g u o y l i m a f s 't n e i t a p / t n e i t a p a t a h w g n i w o n k t o
N 18,5 21,9
t n e m t a e r t s 't n e i t a p a t u o b a t n e m e e r g a s i
D 17,7 20,3
t n e i t a p a f o h t a e
D 17,6 20,6
a e r a k r o w r u o y n i e l p o e p y n a m o o
T 16,9 24,4
n a i c i s y h p a y b m s i c i t i r
C 16,2 24,1
e l b a l i a v a n u s i n a i c i s y h p e h t n e h w t n e i t a p a g n i n r e c n o c n o i s i c e d t n e m e g a n a m t l u c i f f i d a g n i k a
M 15,6 19,1
t s e r r a c a i d r a c g n i c n e i r e p x e t n e i t a
P 15,3 19,2
y c n e g r e m e l a c i d e m a f o t r a t s e h t t a t n e s e r p g n i e b t o n n a i c i s y h p
A 15,1 24,4
r o s i v r e p u s a y b m s i c i t i r
C 15,0 24,3
t n e m p i u q e d e z il a i c e p s f o g n i n o i t c n u f d n a n o i t a r e p o e h t t u o b a y t n i a t r e c n
U 14,2 15,9
t i n u e h t t a e s r u n r a l u c i t r a p a h t i w k r o w o t y t l u c i f f i
D 14,0 21,3
p i h s n o i t a l e r e s o l c y r e v a d e p o l e v e d u o y m o h w h t i w t n e i t a p a f o h t a e
D 13,7 18,9
r o s i v r e p u s a h t i w t c il f n o
C 12,5 23,3
n a i c i s y h p a h t i w t c il f n o
C 9,4 15,1
s e i d t n e i t a p a n e h w t n e s e r p g n i e b t o n n a i c i s y h
P 8,4 21,3
h t a e d g n i h c a o r p p a r e h / s i h t u o b a t n e i t a p a h t i w g n i k l a
T 6,3 12,6
* AM - Ar it hm et ic Mean * * SD - St andar d Deviat ion
Th e an al y si s o f d i f f er en ces o f h o w n u r ses
j u d g e d t h e s e d e m a n d s i t u a t i o n s d e p e n d i n g o n
s o c i o d e m o g r a p h i c v a r i a b l e s s h o w e d s t a t i s t i c a l l y
significant differ ences in t er m s of: age, pr ofessional
qu alif icat ion , m ar it al st at u s, w or k sh if t an d n u m ber
of h ou r s w or ked w eek ly.
Nur ses bet w een 20 and 29 and bet w een 30
a n d 3 9 r e p o r t e d g r e a t e r a t t e n t i o n d e m a n d s f o r
“ Non - n u r sin g t ask s r equ ir ed, su ch as cler ical w or k ”
( p= 0.045, Kr uskall- Wallis) and “ Lack of an oppor t unit y
t o t a l k o p e n l y w i t h o t h e r u n i t p e r s o n n e l a b o u t
pr oblem s at t h e u n it ” ( p= 0 . 0 2 4 , Kr u sk all- Wallis) , in
com par ison w it h nur ses older t han 40.
Wit h respect t o professional qualificat ion, only
t w o c a t e g o r i e s w e r e u s e d : u n d e r g r a d u a t e a n d
w i t h a g r a d u a t e d e g r e e j u d g e d t h a t “ p a t i e n t
e x p e r i e n c i n g c a r d i a c a r r e s t ” d e m a n d e d g r e a t e r
at t ent ion ( p= 0.012; Mann- Whit ney) , w hile nur ses w it h
an under gr aduat e degr ee consider ed t hat “ lack of an
o p p o r t u n i t y t o e x p r e ss f e e l i n g s t o w a r d p a t i e n t s”
r eq u i r ed g r eat er at t en t i o n i n co m p ar i so n w i t h t h e
gr ou p w h o possessed a gr adu at e degr ee ( p= 0 . 0 2 7 ;
Man n - Wh it n ey ) .
As t o m arit al st at us and t he sit uat ions “ m ult iple
n u r sin g t ask s h ad t o be com plet ed” ( p= 0 . 0 3 0 ) an d
“ pat ient experiencing cardiac arrest ” ( p= 0.015) , t hese
were indicat ed by single professionals as t he sit uat ions
wit h t he highest at t ent ion dem ands in com parison wit h
ot her cat egor ies.
The gr oup of nur ses w it h a w eekly hour load
o f 4 0 h o u r s o n m o r e a p p o i n t e d h i g h e r a t t e n t i o n
d e m a n d s f o r 1 7 si t u a t i o n s. So m e e x a m p l e s a r e :
“ w at ch in g a pat ien t su f f er ” ( p= 0 . 0 0 1 ) , “ n ot en ou gh
t i m e t o p r o v i d e e m o t i o n a l su p p o r t t o a p a t i e n t ”
( p= 0 . 0 4 9 ) , “ a n u m ber of r apid decision s h ad t o be
m ade ( p= 0 . 0 0 1 ) , “ n on - n u r sin g t ask s w er e r equ ir ed,
su ch as cler ical w or k ” ( p= 0 . 0 2 1 ) , “ n ot en ou gh st aff
t o adequat ely cov er t he unit ” ( p= 0.045) .
Th e st u d y d a t a a l so i n d i ca t e d t h a t t h e se
n u r s e s p e r c e i v e d a t t e n t i o n d e m a n d s d i f f e r e n t l y
depending on t heir w or k shift . Nur ses w or k ing in t he
aft er noon consider ed “ t oo m any people in y our w or k
ar ea” as t he m ost at t ent ion- dem anding sit uat ion, in
com par ison w it h ot her w or k shift s ( p= 0.028) .
DI SCUSSI ON
Ch ar act er izat ion of n u r ses
Pr ofessionals w er e m ainly w om en. Accor ding
t o t h e Sã o Pa u l o St a t e Reg i o n a l Nu r si n g Co u n ci l ,
9 2 . 5 % of n u r ses w or k in g in h osp it als in São Pau lo
Cit y ar e w om en( 11).
Par t icipant s’ m ean age indicat es a young adult
gr oup, w hose gr aduat ion t im e gives a per fect view of
t h e n eed s an d d em an d s t h is p r of ession r eq u ir es in
t heir daily w or k . Anot her im por t ant aspect w as t hat
m ost n u r ses r ep or t ed t h ey h ad a sp ecialist d eg r ee
( 7 2 . 2 % ) , w h ich su g g est s a sear ch f or p r of ession al
q u alif icat ion in f u n ct ion of lab or m ar k et d em an d s.
S t u d i e s e m p h a s i z e t h e r e l e v a n c e o f c o n s t a n t
p r o f essi o n al q u al i f i cat i o n an d r ecy cl i n g i n v i ew o f
pat ient com plex it y and t echnological and t her apeut ic
adv ances in t he healt h ar ea.
Alt hough m ost par t icipant s r epor t ed only one
em ploy m en t r elat ion sh ip, dat a su ggest t h at , du e t o
t he need for t heir services or t he chances of get t ing a
bet t er salar y, t h ese n u r ses pr ef er r ed t o w or k m or e
h o u r s t h a n t h e j o u r n e y e s t a b l i s h e d i n t h e i r j o b
con t r act .
As t o t he num ber of hour s w or ked per w eek,
fin din gs dem on st r at ed t h at pr ofession als w or k m or e
t han 40 hour s per w eek ( 41. 7% ) . These dat a ar e in
lin e w it h r ecen t st u dies t h at descr ibe t h e ex cessiv e
hour load, in addit ion t o ot her daily nursing act ivit ies,
as pot ent ial m ediat or s of phy sical and m ent al healt h
disequilibr ia, besides pr oblem s in t hese pr ofessionals’
social and fam ily life( 12).
An ex cessiv e hour load w it hout a br eak can
creat e difficult ies for nurses t o deal w it h daily sit uat ions
i n t h ei r w o r k en v i r o n m en t , a s i t m a y d em a n d a n
in cr eased capacit y t o focu s, w it h a v iew t o decision
m ak in g an d pr oblem solv in g w h ile r ealizin g n u r sin g
f u n ct ion s.
Wit h r espect t o w or k shift , dat a show ed t hat
scor es for nur sing w or k ing m or ning and night shift s
w er e sim ilar in com par ison w it h t he aft er noon gr oup.
Th is in f or m at ion h ig h lig h t s t h at w or k d em an d s an d
dy n am ics v ar y acr oss sh if t s, ex posin g pr of ession als
t o d if f er en t sou r ces of at t en t ion d em an d s. To g iv e
on e ex am ple, at t en din g t o cer t ain m edical r equ est s
t o suppor t t he pat ient ’s diagnosis and t r eat m ent and
at t ending t o r elat ives’ needs dur ing visit ing hour s can
v ar y bet w een shift s and unit s.
Sh i f t s a r e co n si d er ed t o ex er t a n eg a t i v e
i n f l u e n c e o n n u r s i n g w o r k , d i r e c t l y a f f e c t i n g
phy siological aspect s, fam ily and social r elat ions and
l e i su r e , w h i ch ca n f a v o r f a t i g u e a n d p r o f e ssi o n a l
dissat isfact ion( 3 ).
Thus, nur ses in t his st udy show hom ogeneous
char act er ist ics, w it h som e aspect s t hat ar e sim ilar t o
r ecen t n u r sin g st u dies descr ibed abov e.
Nu r ses’ at t en t ion dem an ds
Th is st u d y allow ed u s t o id en t if y at t en t ion
dem and sit uat ions am ong nur ses. Sit uat ions r equir ing
g r eat er at t en t ion w er e r elat ed t o t h e p sy ch olog ical
an d beh av ior al dom ain .
When com par ing at t ent ion dem and sit uat ions
w i t h s o c i o d e m o g r a p h i c v a r i a b l e s , r e s u l t s
d em on st r at ed st at ist ically sig n if ican t d if f er en ces in
t er m s of t h e n u r ses’ age r an ge in r elat ion t o som e
These finding suggest t hat at t ent ion dem and sit uat ions
for nur ses differ accor ding t o age r ange, w it h younger
a n d l i t t l e e x p e r i e n c e d p r o f e s s i o n a l s r e p o r t i n g
difficu lt ies t o deal w it h sit u at ion s dir ect ly r elat ed t o
dir ect pat ient car e, as t hese r equir e decision m ak ing
an d p r ior it y set t in g . Nu r ses in a h ig h er ag e r an g e
per ceive pat ient s’ car e needs bet t er, becom ing m or e
cr it ical and dem anding. This can be explained by t heir
p r o f e ssi o n a l e x p e r i e n ce , w h i ch r e su l t s i n a m o r e
obj ect iv e v isualizat ion of t heir w or k dy nam ics.
Anot her int er est ing aspect w as r elat ed t o t he
pr of ession al qu alif icat ion of n u r ses w it h a gr adu at e
degr ee ( specializat ion , m ast er or doct or al) an d can
der iv e fr om an incr easingly dem anding labor m ar k et
in t he r ecr uit m ent of t hese pr ofessionals. The sear ch
for car e specializat ion and k now ledge acquisit ion can
affect t he for m and qualit y of car e deliv er y, besides
r eassessin g em er gen cy car e cr it er ia m or e st r ict ly in
funct ion of t his im pr ov ed nur sing pr act ice.
Par t icip an t s w it h an u n d er g r ad u at e d eg r ee
o n l y, o n t h e o t h e r h a n d , j u d g e d t h e l a c k o f a n
oppor t unit y t o ex pr ess feelings t ow ar ds t he pat ient s
as t he gr eat est dem and. This m akes us r eflect about
t he bond bet w een nur ses and pat ient s, w hich can be
st r en g t h en ed b y t h e sear ch f or n ew k n ow led g e or
pr ofessional r ecy cling, t his pr om ot ing t he opening of
new hor izons in car e pr act ice.
These dat a pu t a st r onger em ph asis on t he
inst it ut ion’s need t o ident ify m aneuvers or inst rum ent s
t hat allow nur ses t o seek indiv idual im pr ov em ent s in
t h e i n st i t u t i o n s t h e y a r e a f f i l i a t e d w i t h , d i r e ct l y
influencing t heir w or k and t he t eam as a w hole.
Re s u l t s a l s o p o i n t t o w a r d s s t a t i s t i c a l l y
s i g n i f i c a n t d i f f e r e n c e s f o r t h e w e e k l y h o u r l o a d
v ar iable, w it h at t ent ion dem ands for nur ses w or k ing
m or e t h an 4 0 h ou r s p er w eek . Th ese p r of ession als
c o n s i d e r e d 1 7 s i t u a t i o n s a s s o u r c e s o f h i g h e r
d em an d s, r elat ed t o t h e p sy ch olog ical d om ain an d
p h y sical en v ir on m en t .
An ex cessi v e h o u r l o ad can cau se m en t al
f a t i g u e i n p r o f e s s i o n a l s , e n t a i l i n g a l t e r e d
con cen t r at ion , sleep d isor d er s, p h y sical d iscom f or t ,
i n c r e a s e d s e n s i t i v i t y t o l i g h t a n d n o i s e . Th e s e
sy m pt om s ar e m or e com m on am ong nur ses w or k ing
night shift s, follow ed by t hose w or k ing m or ning and
aft er noon shift s( 3).
These findings can reflect t hese professionals’
lack of pr epar at ion t o cope w it h sit uat ions of deat h or
w or sening am ong pat ient s under t heir car e, affect ing
t h e i r r e l a t i o n s w i t h p a t i e n t s a n d r e l a t i v e s .
Adm inist r at ive issues also dem and m or e at t ent ion fr om
pr ofessionals w or k ing m or e t han 40 hour s per w eek ,
m ain ly issu es r elat ed t o h u m an r esou r ces an d t h e
w or k space it self. Alt hough w it h differ ent foci, t hese
dem ands can negat ively affect t he w ay t hey per ceive
t h e i r w o r k co n t e x t , m a i n l y w h e n a sso ci a t e d w i t h
insufficient hum an r esour ces in t he t eam( 12).
Som e aut hor s em phasize t hat t he ex cessiv e
hour load and nur sing w or k it self ar e consider ed as
a l a r m i n g a n d c a n b e a n i m p o r t a n t c a u s e o f
d e t e r i o r a t i n g n u r s i n g c a r e q u a l i t y( 4 ), p r o d u c i n g
an x iet y( 1 3 ), m en t al su f f er in g, occu pat ion al st r ess( 1 4 ),
ex h a u st i o n a n d p r o f essi o n a l d i ssa t i sf a ct i o n( 5 ). We
f o u n d t h a t t h e b e l i e f t h a t p r o f e ssi o n a l st r e ss i s
experienced m ore int ensely am ong crit ical care nurses
in com parison w it h professionals from ot her unit s does
not cor r espond t o r ealit y. Nur ses fr om open unit s r epor t
high st ress levels due t o t heir relat ion w it h ot her unit s
an d su p er v isor s, p at ien t car e d eliv er y, coor d in at ion
of unit act ivit ies and w ork condit ions t o develop t heir
act iv it ies( 15).
I n v iew of t hese findings, w e em phasize t he
i m p o r t a n ce o f i d e n t i f y i n g t h e so u r ce s o f n u r se s’
at t ent ion dem ands in t heir w or k env ir onm ent , w it h a
view t o m inim izing t he negat ive consequences of t his
e x ce ssi v e e x p o su r e , w h i ch ca n a f f e ct t h e i r d a i l y
pr act ice and, t hus, im pair t he planning and execut ion
of new car e act iv it ies.
CONCLUSI ON
I n v i ew o f t h e p r o p o sed st u d y o b j ect i v es,
t hese r esult s allow for t he follow ing conclusions:
Ad m in ist r at or s an d n u r se m an ag er s sh ou ld
v a l u e t h e w a y n u r s e s ’ p e r c e i v e t h e i r w o r k
environm ent , m ainly because of t he negat ive r eflexes
t his ent ails in daily nur sing pr act ice.
Nur ses consider ed t he follow ing sit uat ions as
represent ing t he highest at t ent ion dem ands: “ wat ching
a pat ient suffer ”, “ a num ber of rapid decisions had t o
be m ade”, “ car ing for fam ilies w it h em ot ional needs”,
“ not enough t im e t o pr ov ide em ot ional suppor t t o a
pat ient ”, and “ fam ily t eaching required”. This allows us
t o infer about t he fact t hat we are const ant ly exposed
t o m ult iple and differ ent at t ent ion dem and sit uat ions
in our daily pr act ice, m ak ing us alt er our capacit y t o
focus on sit uat ions t hat require abilit y and agilit y.
This st udy also show ed t hat som e sit uat ions
nur ses j udged t hem depending on sociodem ogr aphic
v a r i a b l e s. Co n cl u si o n s ca n m a k e h e a l t h se r v i ce s
r et h in k t h e w or k env ir on m en t it self, w it h a v iew t o
m inim izing t hese sour ces of dem ands.
REFERENCES
1 . Gu ir ar d ello EB. Fact or s in t h e cr it ical car e an d m ed ical sur gical envir onm ent s t hat incr ease r equir em ent s for dir ect ed at t en t ion . [ disser t at ion ] . Madison ( WI ) : Sch ool of Nu r sin g; 1 9 9 3 .
2 . Pad ilh a KG. Dês- cu id ar : as r ep r esen t ações sociais d os enfer m eir os de UTI sobr e as iat r ogenias de enfer m agem . São Paulo. [ t ese] São Paulo ( SP) : Escola de Enfer m agem da USP; 1 9 9 4 .
3. Mar ziale MHP, Rozest rat en RJA. Tur nos alt er nant es: fadiga m en t al de en f er m agem . Rev Lat in o- am En f er m agem 1 9 9 5 ; 3 ( 1 ) : 5 9 - 7 8 .
4 . Ma r z i a l e MH P. En f e r m e i r o s a p o n t a m a s i n a d e q u a d a s con dições de t r abalh o com o r espon sáv eis pela det er ior ação da qualidade da assist ência de enfer m agem . Rev Lat ino- am En f er m agem 2 0 0 1 ; 9 ( 3 ) : 1 .
5 . Lau t er t L. O desgast e pr of ission al: est u do em pír ico com e n f e r m e i r a s q u e t r a b a l h a m e m h o s p i t a i s . Re v Ga u c h En f er m ag em 1 9 9 7 ; 1 8 ( 2 ) : 1 3 3 - 4 4 .
6. Hopkinson JB, Hallet t CE, Luker KA. Car ing for dying people in h ospit al. J Adv Nu r s 2 0 0 3 ; 4 4 ( 5 ) : 5 2 5 - 3 3 .
7. Topf M, Dillon E. Noise - induced st r ess as a pr edict or for bur nout in cr it ical car e nur ses. Hear t & Lung 1988; 17( 5) : 567-7 3 .
8. Topf M. Hospit al noise pollut ion: an env ir onm ent al st r ess m od el t o g u id e r esear ch an d clin ical in t er v en t ion s. J Ad v Nu r s 2 0 0 0 ; 3 1 ( 3 ) : 5 2 0 - 8 .
9. Topf M. Effect s of per sonal cont r ol over hospit al noise on sleep. Res Nu r s & Healt h 1 9 9 2 ; 1 5 : 1 9 - 2 8 .
1 0 . Gu i r a r d e l l o EB . A d a p t a ç ã o c u l t u r a l e v a l i d a ç ã o d o i n s t r u m e n t o d e m a n d a s d e a t e n ç ã o d i r i g i d a . Re v Es c En f er m ag em USP 2 0 0 5 ; 3 9 ( 1 ) : 7 7 - 8 4 .
1 1 . Co n s e l h o Re g i o n a l d e En f e r m a g e m d e S ã o Pa u l o [ hom epage na I nt er net ] . São Paulo; [ Acesso em 2004 agost o 01] . Disponív el em : w w w .cor ensp.or g.br
12. Lino MM. Qualidade de v ida e sat isfação pr ofissional de en f er m eir as d e Un id ad es d e Ter ap ia I n t en siva. São Pau lo. [ t ese] São Paulo ( SP) : Escola de Enfer m agem da USP; 2004. 1 3 . B a r r o s A LB L, H u m e r e z D C, Fa k i h FT, M i c h e l JLM . Sit u ações g er ad or as d e an sied ad e e est r at ég ias p ar a seu cont r ole ent r e enfer m eir as: est udo pr elim inar. Rev Lat ino- am En f er m ag em 2 0 0 3 ; 1 1 ( 5 ) : 5 8 5 - 9 2 .
1 4 . Ba r st o w J. St r ess v a r i a n ce i n h o sp i ce n u r si n g . Nu r s Ou t l o o k 1 9 8 0 ; 2 8 ( 1 2 ) : 7 5 1 - 4 .
1 5 . Bian ch i ERF. En f er m eir o h ospit alar e o st r ess. Rev Esc En f er m ag em USP 2 0 0 0 ; 3 4 ( 4 ) : 3 9 0 - 4 .
