SELF-MEDICATION AMONG NURSING WORKERS FROM PUBLIC HOSPITALS
1Aline Reis Rocha Barros2 Rosane Harter Griep3 Lúcia Rotenberg4
Barros ARR, Griep RH, Rotenberg L. Self-medication among nursing workers from public hospitals in Rio de Janeiro, Brazil. Rev Latino-am Enfermagem 2009 novembro-dezembro; 17(6):1015-22.
This study describes the prevalence of self-medication and associated factors among nursing workers. This epidemiological sectional study included 1,509 working nurses from two public hospitals in Rio de Janeiro, Brazil. The medications were identified and classified according to the Anatomical Therapeutic Chemical Index. The self-medication prevalence was 24.2% and the most reported anatomical group treated was the nervous system, while the therapeutic group included analgesics. Self-medication was more prevalent among young people, individuals with minor psychiatric disturbances, non-hypertensive individuals, those who did not exercise, those who reported a disease or injury in the last 15 days, with the highest number of self-diagnosed diseases, nurses, professionals with temporary work contracts and those highly involved with their work. Self-medication is a frequent practice among the nursing team members and is associated with factors that should be taken into account when planning strategies aimed at improving workers’ health conditions.
DESCRIPTORS: self medication; drug utilization; occupational health nursing
AUTOMEDICACIÓN ENTRE LOS TRABAJADORES DE ENFERMERÍA DE
HOSPITALES PÚBLICOS
Este estudio investigó la prevalencia de la automedicación y los factores asociados entre los trabajadores de enfermería. Se realizó un estudio epidemiológico seccional que abarcó 1.509 trabajadores de enfermería de dos hospitales públicos en Rio de Janeiro, Brasil. Los medicamentos fueron identificados y clasificados de acuerdo con el Anatomical Therapeutic Chemical Index. La prevalencia de automedicación fue de 24,2%, el grupo anatómico más referido fue el sistema nervioso y el grupo terapéutico incluyó los analgésicos. La prevalencia fue más alta entre: los más jóvenes, en aquellos con disturbios psíquicos menores, los no hipertensos, los que no hacían ejercicios físicos, los que refirieron enfermedad o herida en los últimos 15 días, en aquellos con mayor número de enfermedades autodiagnosticadas, los enfermeros, los de vínculo temporario, y los que refieren mayor envolvimiento con el trabajo. La automedicación es una práctica frecuente en el equipo de enfermería y está asociada a diversos factores que deberían ser considerados en estrategias que buscan mejores condiciones de salud entre ellos.
DESCRIPTORES: automedicación; utilización de medicamentos; enfermería del trabajo
AUTOMEDICAÇÃO ENTRE OS TRABALHADORES DE ENFERMAGEM DE
HOSPITAIS PÚBLICOS
Este estudo investigou a prevalência de automedicação e fatores associados entre trabalhadores de enfermagem. Realizou-se estudo epidemiológico seccional que abrangeu 1509 trabalhadores de enfermagem de dois hospitais públicos no Rio de Janeiro. Os medicamentos foram identificados e classificados de acordo com o Anatomical Therapeutic Chemical Index. A prevalência de automedicação foi 24,2%, o grupo anatômico mais referido foi o sistema nervoso e o grupo terapêutico incluiu os analgésicos. A prevalência foi mais alta entre os mais jovens, aqueles com distúrbios psíquicos menores, não hipertensos, os que não faziam exercícios físicos, os que referiram doença ou ferimento nos últimos 15 dias, aqueles com maior número de doenças autodiagnosticadas, enfermeiros, de vínculo temporário, e os que referem maior envolvimento com o trabalho. A automedicação é prática frequente na equipe de enfermagem e está associada a diversos fatores que deveriam ser considerados em estratégias que buscam melhores condições de saúde entre eles.
DESCRITORES: automedicação; uso de medicamentos; enfermagem do trabalho
1Supported by: CNPq, FAPERJ and Mount Sinai School of Medicine (Programa International Training and Research on Environmental and Occupational Health
- ITREOH, Irving Selikoff). 2RN, M.Sc. in Nursing, Hospital Geral de Bonsucesso, Brazil, e-mail: enf.aline@hotmail.com. 3RN, Researcher, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Brazil, e-mail: rohgriep@ioc.fiocruz.br. 4Researcher, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Brazil, e-mail: rotenber@ioc.fiocruz.br.
INTRODUCTION
S
elf-medication is a common form ofself-care and consists of consuming a product on one’s
own initiative in an attempt to relieve perceived
symptoms or diseases(1). It can be also defined as
the “use of medication without prescription, medical
guidance or follow-up”(2). The major use of this
practice has been associated with the following
factors: female, young, higher education and
income levels, knowledge of medication, and lack
of access to the health system(3-5).
T h e c o n s u m p t i o n o f d r u g s w i t h o u t
p r e s c r i p t i o n i s a p h e n o m e n o n o f i n c r e a s i n g
relevance, motivated by a complex set of factors
that are associated with values that predominate
i n m o d e r n s o c i e ty. A m o n g t h e s e f a c t o r s , t h e
increased supply of alternative medication and the
availability, unrestricted selling and propaganda of
p h a r m a c e u t i c a l p r o d u c t s i n t h e m e d i a a r e
noteworthy(6).
Among health workers, there are factors
related to the working environment and conditions
and access to medication. Nursing workers handle
several types of medications in their daily practice
and the easy access can favor self-prescription and
self-medication(7). Even having theoretical and
practical knowledge about these substances and
t h e i r i m p l i c a t i o n s , t h e s e p r o f e s s i o n a l s a r e
oftentimes trying to get rid of uncomfortable
situations to better endure their workday(8). The
reality of nursing workers, who often have more
than one job, coupled with the complex work
performed at hospitals, leads to the conclusion that
these professionals might face difficult moments
or crises, making the consumption of medications
a way to facilitate their lives(8).
Inappropriate self-medication can cause
undesirable consequences and effects, iatrogenic
diseases and mask progressive diseases( 3 ). It
therefore represents an important problem that has
to be acknowledged and prevented.
Although Brazilian studies have investigated
the phenomenon of self-medication, the majority
describe it among the elderly(4-5,9-11). Among the
few studies that investigate self-medication among
health workers, the author and collaborators(3) are
h i g h l i g h t e d . T h e s e s t u d i e s i d e n t i f i e d a 3 2 %
prevalence of self-medication for nurses, below
only that identified for physicians (43%). Articles
about the use of benzodiazepines among nursing
students(12) and workers(13) were found in nursing
publications, however, studies of self-medication
among nursing workers were not found.
This study aimed to analyze the pattern of
self-medication in nursing workers through the
following: (a) to check the prevalence of
self-medication reported by nursing workers; (b) to
identify the medications most consumed without
p r e s c r i p t i o n a n d ( c ) t o i n v e s t i g a t e t h e
sociodemographic occupational characteristics and
health patterns associated with self-medication. We
believe that knowledge about this subject, still little
s t u d i e d a m o n g n u r s i n g w o r k e r s , c a n s u p p o r t
intervention projects that seek to improve working
conditions and the health of nursing professionals
and consequently the health of the population they
care for.
METHOD
D a t a w e r e o b t a i n e d t h r o u g h a c r o s s
-sectional epidemiological study carried out in two
public hospitals in Rio de Janeiro, RJ, Brazil: a large
g e n e r a l h o s p i t a l a n d a r e f e r e n c e c e n t e r f o r
maternal-infant health. The study was based on
c e n s u s d a t a a n d i n c l u d e d a l l n u r s e s , n u r s i n g
technicians and auxiliaries who worked directly with
nursing care, regardless of the work contract. The
following exclusion criterion was used: nursing
workers not providing care such as: head nurses
and workers from the supply center. Of the 1,687
e l i g i b l e n u r s i n g w o r k e r s , 1 , 5 0 9 ( 8 9 . 4 % )
participated in the study.
A questionnaire with structured questions
was used and it addressed, among other aspects,
the following: (i) sociodemographic data, (ii)
c h a r a c t e r i s t i c s r e l a t e d t o w o r k , ( i i i ) r e p o r t e d
diseases and symptoms – high blood pressure,
hospitalization, sleep and digestive disorders and
minor psychiatric disturbances and (iv) the use of
prescribed medication and self-medication. Three
questionnaire. The pilot test was carried out with
120 nursing workers from a federal public hospital
with a social and functional profile similar to that
of the nursing professionals addressed in this study.
Data collection was carried out during
w o r k i n g h o u r s b y t r a i n e d i n t e r v i e w e r s .
Questionnaires were then reviewed, coded and
i n d e p e n d e n t l y t y p e d u p b y t w o p e o p l e u s i n g
Validate (Epi-Info 2000) so as to identify and correct
inconsistencies in data entry.
Information about the use of medication was
collected through two questions included in the
questionnaire: “did you take any medication (allopathic
or homeopathic medication, home remedies, etc) in
the last seven days?”. If yes, the following question
was: “which medication(s) did you take in the last
seven days and who suggested it (them)?” (There
were seven choices for answers.) Medications were
identified and had their active principles separated
and classified according to the Anatomical Therapeutic
Chemical Index (ATC/DDD Index) developed by the
World Health Organization Collaborating Centre for
Drug Statistics Methodology(14). According to this
index, medication is classified in 14 large groups
designated by a letter, given the agency or system in
which the drug act in the anatomic group (for example,
A – digestive tract and metabolism). Each group is in
turn subdivided into subgroups. The first subgroup is
represented by two numbers and corresponds to the
therapeutic group (example: A02 – medication for
dyspepsia). The second subgroup is represented by
a letter and corresponds to the pharmacological group
(example: A02A – Antiacids). The third subgroup is
represented by a letter and corresponds to the
chemical group (example: A02AB – Aluminum
compounds). The fourth subgroup is represented by
two numbers and corresponds to the chemical
substance (example: A02AB01 – Aluminum
hydroxide). In this study, we used the classifications
of medication related to the two first groups (anatomic
and therapeutic subgroup). However, this classification
does not include some products such as teas, which
were classified as natural products.
The prevalence of self-medication was
obtained by dividing the number of workers who
reported the use of at least one medication without
medical prescription in the last seven days by the
number of evaluated workers. Bivariate analyses
were carried out to compare the prevalence of
self-medication according to sociodemographic and
o c c u p a t i o n a l v a r i a b l e s p r o p o s e d i n t h e s t u d y
t h r o u g h t h e P e a r s o n ’ s C h i - s q u a r e ( l e v e l s o f
significance were set at 5%, that is, p<0.05) and
prevalence ratios and their respective confidence
interval at 95%.
Each employee signed a free and informed
consent agreement authorizing the use of data in
research. The Project was approved by the Ethics
Research Committees of the involved institutions
and also submitted to and approved by the National
R e s e a r c h E t h i c C o m m i t t e e ( C O N E P - B r a s í l i a )
b e c a u s e i t i n v o l v e d i n t e r n a t i o n a l c o o p e r a t i o n
(Process nº 1318/2004).
RESULTS
T h e s t u d y p a r t i c i p a n t s p r e s e n t e d t h e
following characteristics: 86.6% were women,
40.1% were 46 years or older, 44.2% were married,
39.5% reported to be mixed (in terms of ethnicity),
5 6 . 7 % h a d a b a c h e l o r ’ s d e g r e e , 5 2 . 3 % w e r e
nursing auxiliaries and 46.2% reported a per capita
family income below 700.00 reais*.
T h e p r e v a l e n c e s e l f - r e p o r t e d u s e o f
medication without medical prescription was 24.2%.
T h e a v e r a g e n u m b e r o f d r u g s u s e d i n s e l f
-medication was 1.41 (varying from 1 to 8 reported
drugs) whereas 71.9% reported the use of only
one and 28.2% reported the use of one or two
medications in the last seven days.
Table 1 presents these drugs according to
t h e AT C a n a t o m i c c l a s s i f i c a t i o n ( l e ve l 1 ) a n d
therapeutic classification (level 2) and natural
products. The most consumed medications were
those for the nervous system (46.7%), digestive
tract (15.4%) and natural products (10%). The
most used subgroup was analgesics (43.4%),
followed by anti-inflammatory and anti-rheumatic
(7.3%) and vitamins (6.2%).
Table 1 – Distribution of the frequency of drugs consumed in self-medication in the last seven days among
nursing workers, Rio de Janeiro, Brazil 2007
Results of the analysis of association between
reported self-medication and the variables considered
in the study are presented on Tables 2, 3 and 4. In
terms of sociodemographic variables, we observed
that the prevalence of self-medication was higher
among young people and those with the highest level
of education (Table 2).
In relation to evaluated health conditions, we
observed a greater prevalence among workers with
minor psychiatric disturbances (depression and
s e l b a i r a
V ATCcode n %
m e t s y s s u o v r e
N N 242 46.7
s c i s e g l a n
A N02 225 43.4
c i t p e l o h c y s
P N05 15 2.8
s c i t e h t s e n
A N01 1 0.2
c i t p e l a n a o h c y s
P N06 1 0.2
m s il o b a t e m d n a t c a r t e v i t s e g i
D A 80 15.4
s n i m a t i
V A11 32 6.2
e c n e l u t a l f d n a s r e c l u c i t p e p g n i t a e r t r o f n o i t a c i d e m , s d i c a i t n
A A02 24 4.5
s t n e g a e v i s l u p o r p d n a c i g r e n il o h c i t n a , c i d o m a p s e i t n
A A03 11 2.1
y p a r e h t r e v il d n a e l i
B A05 3 0.6
s n o i t a r a p e r p l a t n e
D A01A06 2 0.4
s e v i t a x a
L A09A04 2 0.4
s e m y z n e g n i d u l c n i , s e v i t s e g i
D A07A12 2 0.4
s t n a e s u a n i t n a d n a s c i t e m e i t n
A A16 1 0.2
s u o i t c e f n i -i t n a l a n i t s e t n i d n a y r o t a m m a l f n i -i t n a , s l a e h r r a i d i t n
A 1 0.2
s t n e m e l p p u s l a r e n i
M 1 0.2
m s il o b a t e m d n a t c a r t y r a t n e m il a e h t r o f s t c u d o r p r e h t
O 1 0.2
s t c u d o r p l a r u t a
N X 52 10
m e t s y s l a t e l e k s o l u c s u
M M 40 7.7
c i t a m u e h r -i t n a d n a y r o t a m m a l f n i -i t n
A M01 38 7.3
n i a p r a l u c s u m d n a t n i o j r o f s t c u d o r p l a c i p o
T M03 1 0.2
s e s a e s i d e n o b g n i t a e r t r o f s g u r
D M05 1 0.2
t c a r t y r o t a r i p s e
R R 36 7
e s u c i m e t s y s r o f s e n i m a t s i h i t n
A R06 22 4.3
s d l o c d n a s h g u o c r o f s n o i t a r a p e r
P R05 11 2.1
e s u l a s a n r o f s n o i t a r a p e r
P R01 3 0.6
l a r e v e
S V 36 7
s t c u d o r p c i t u e p a r e h t r e h t o ll
A V03 30 5.8
s t n e i r t u n l a r e n e
G V06 6 1.2
e s u c i m e t s y s r o f e v i t c e f n i -i t n a l a r e n e
G J 10 2
e s u c i m e t s y s r o f l a i r e t c a b i t n
A J01 8 1.6
e s u c i m e t s y s r o f s c i t o c y m i t n
A J02 1 0.2
e s u c i m e t s y s r o f l a r i v i t n
A J05 1 0.2
m e t s y s r a l u c s a v o i d r a
C C 8 1.5
s c i t e r u i
D C03 4 0.7
m e t s y s n i s n e t o i g n a -n i n n e r e h t n o t c a t a h t s t n e g
A C09 2 0.4
s e v i t c e t o r p o s a
V C05 1 0.2
s r e k c o l b a t e
B C07 1 0.2
s e n o m r o h x e s d n a m e t s y s y r a n i r u o t i n e
G G 7 1.3
m e t s y s l a t i n e g e h t f o s r o t a l u d o m d n a s e n o m r o h x e
S G03 7 1.3
s n a g r o c i t e i o p o t a m e h d n a d o o l
B B 5 1
s n o i t a r a p e r p c i m e n a i t n
A B03 3 0.6
s c i g a h r r o m e a h i t n
A B02 1 0.2
s n o i t u l o s n o i s u f n i d n a s e t u t i t s b u s d o o l
B B05 1 0.2
s e n o m r o h x e s g n i d u l c x e , s n o i t a r a p e r p l a n o m r o h c i m e t s y
S H 1 0.2
y p a r e h t d i o r y h
T H03 1 0.2
s t n e ll e p e r d n a s e d i c i t c e s n i , s t c u d o r p c i t i s a r a p i t n
A P 1 0.2
s c i t n i m l e h t n
A P02 1 0.2
l a t o
anxiety); those who reported no physical activity;
individuals dissatisfied with their sleep patterns; those
who reported some disease or injury in the last 15
days and among those who reported the highest
number of self-diagnosed diseases. Hypertensive
individuals, however, reported less frequent
self-medication (PR=0.75; CI95%=0.59-0.94) (Table 3).
In terms of occupational variables,
self-medication prevalence was lower among nursing
auxiliaries and technicians when compared to nurses.
In addition, the highest prevalence were found among
those who were not public employees and those who
reported not being able to stop thinking about work
even when they were off duty (Table 4).
s e l b a i r a
V Prevalence PR**(CI95%)
N % r e d n e G e l a m e
F 319 24.4 1.00
e l a
M 47 23.3 0.98(0.91-1.07)
* 5 2 7 . 0 = p e g A 5 3 o t 6
1 142 30.3 1.00
5 4 o t 6
3 100 23.6 0.79(0.59-1.08)
r e d l o r o 6
4 120 19.8 0.65(0.53-0.81)
* 0 0 0 , 0 < p s u t a t s l a t i r a M d e i r r a
M 158 23.7 1.00
e l g n i
S 141 26.4 1.11(0.91-1.35)
d n a d e c r o v i D d e w o d i
w 65 21.5 1.03(0.96-1.10)
* 9 5 2 . 0 = p n o i t a c u d E l o o h c s y r a m i r
P 22 19.1 1.00
l o o h c s y r a d n o c e
S 120 22.4 1.17(0.78-1.76)
e g e ll o
C 223 26.1 1.36(0.92-2.01)
* * 1 4 0 . 0 = p r o l o c / e c a R e t i h
W 140 25 1.00
d e x i
M 140 23.5 0.94(0.77-1.15)
k c a l
B 85 24.6 0.98(0.78-1.24)
* 7 3 8 . 0 = p a t i p a c r e
p income(minimumwage)
½ o t p
U 38 21.6 1.00
2 o t
½ 74 23.9 1.11(0.78-1.56)
3 o t 1 .
2 77 21.7 1.00(0.71-1.42)
4 o t 1 .
3 60 28.2 1.30(0.92-1.86)
* * 0 4 2 . 0 = p
Table 2 – Prevalence of self-medication and prevalence
ratios (PR) according to sociodemographic
characteristics of nursing workers, Rio de Janeiro,
Brazil 2007 (n= 1,509)
* Pearson’s Chi-square test
**linear trend test; both significant at <0.05
**Prevalence ratio (PR) and respective confidence intervals (CI); association
was considered when intervals do not include the value 1
DISCUSSION
The prevalence of self-medication reported
by the studied nursing workers was 24.2%, below
that identified among nurses in the basic health care
network in Pelotas, RS, Brazil (32.4%)(3), though this
study evaluated the use of medication in the last 15
days. The frequencies were also below those found
in a study of residents in Santa Maria, RS, Brazil
(53.3%)(15) and in another that evaluated
self-medication in elderly people in Salgueiro, PE, Brazil
(77%)(9). However, the prevalence found in this study
was higher than that observed in adult populations of
other countries, such as Spain (12.7%)(6).
Table 3 – Prevalence of self-medication and prevalence
ratios (PR) according to health conditions among
nursing workers, Rio de Janeiro, Brazil 2007 (n= 1,509)
* Pearson’s Chi-square test; significant at <0.05
**Prevalence ratio (PR) and respective confidence intervals (CI); association
was considered when intervals do not include the value 1
s e l b a i r a V -f l e s f o e c n e l a v e r P n o i t a c i d e
m RP(CI95%)
n % h tl a e h f o n o i t p e c r e p -fl e S d o o g r o d o o g y r e
V 297 24.3 1.00
r o o p r o e g a r e v
A 69 24.6 1.01(0.75-1.37)
8 1 9 . 0 = p s e c n a b r u t s i d c i r t a i h c y s p r o n i M o
N 217 20.9 1.00
s e
Y 149 31.8 1.52(1.27-1.82)
1 0 0 0 . 0 < p e r u s s e r p d o o l b h g i H o
N 292 25.9 1.00
s e
Y 74 19.4 0.75(0.59-0.94)
0 1 0 . 0 = p s e s i c r e x e l a c i s y h P s e
Y 97 20.7 1.00
o
N 269 25.9 1.25(1.01-1.53)
0 3 0 . 0 = p s n r e t t a p p e e l s h t i w d e i f s i t a S s e
Y 116 19.2 1.00
o
N 250 27.7 1.44(1.18-1.75)
1 0 0 0 . 0 < p s y a d 5 1 t s a l e h t n i y r u j n i r o e s a e s i D o
N 200 19.9 1.00
s e
Y 165 32.9 1.65(1.39-1.97)
1 0 0 0 . 0 < p s e s a e s i d d e s o n g a i d -fl e s f o r e b m u N e n o
N 88 17.1 1.00
o w t r o e n
O 117 25.1 1.47(1.14-1.88)
e r o m r o e e r h
T 161 30.6 1.79(1.42-2.26)
The most consumed medications were those
for the nervous system (46.7%), while the most used
subgroup was analgesics (43.4%), a pattern described
by several authors(3,5,9,15). The results presented here
were different from those of another study(11) that
identified medications for the cardiovascular system
as the most used therapeutic category. However, it
involved elderly people, an age when the prevalence
of cardiovascular disease is high. The findings of this
study are relevant when it comes to the category of
nursing workers because the excessive use of
analgesics might be a reflection of poor working
conditions, with minimum rest, which leads to fatigue
and the need for medication, and consequently,
self-medication. Another factor possibly related to the use
of analgesics could be the prevalence of
musculoskeletal disorders already reported among
nursing workers(16-17).
s e l b a i r a V
e c n e l a v e r P
) % 5 9 I C ( R P
n %
y r o g e t a c l a n o i s s e f o r P
e s r u
N 117 28.1 1.00
n a i c i n h c e t g n i s r u
N 61 20.1 0.71(0.54-0.94)
y r a il i x u a g n i s r u
N 188 23.8 0.85(0.69-1.03)
1 4 0 . 0 = p
e e y o l p m e c il b u P
s e
Y 155 21.1 1.00
o
N 210 27.3 1.29(1.08-1.55)
5 0 0 . 0 = p
s b o j f o r e b m u N
e n
O 222 23.7 1.00
e r o m r o o w
T 144 25.1 1.05(0.88-1.27)
4 5 5 . 0 = p
s r u o h g n i k r o W
y a
D 187 24.1 1.00
t h g i
N 91 24.7 1.02(0.81-1.29)
d e x i
M 78 23.2 0.96(0.73-1.27)
6 5 8 . 0 = p
y t u d f f o n e h w n e v e k r o w t u o b a g n i k n i h t p o t s t o n n a C
e e r g a s i
D 298 23 1.00
e e r g
A 68 32.5 1.14(1.03-1.26)
3 0 0 . 0 = p
s r u o h g n i k r o w y l k e e W
6 3 o t p
U 141 22.6 1.00
0 5 o t 7 3 m o r
F 100 26.3 1.16(0.93-1.45)
0 5 n a h t e r o
M 119 24.5 1.08(0.88-1.34)
2 9 3 . 0 = p
Table 4 – Prevalence of self-medication and prevalence
ratios according to professional characteristics of
nursing workers, Rio de Janeiro, Brazil 2007 (n=
1,509)
*Pearson’s Chi-square test - both significant at <0.05
**Prevalence ratio (PR) and respective confidence intervals (CI); association
was considered when intervals do not include the value 1
Other studies(4-6,9) reported different results
such as: more frequent self-medication among
women, which can be explained by the fact that
women usually seek health services more frequently
and take better care of themselves.
In general, the consumption of medication
increases as people get older(4,9). However,
self-medication tends to be higher among younger
people(3,5-6). This pattern was also identified in this study.
Marital status was not associated with
self-medication among the studied nursing workers. The
association between this variable and self-medication
did not reach a consensus in literature. For example,
results similar to those of this study were reported by
another Brazilian study(5) that addressed a population
of elderly people. However, a Spanish study identified
a higher level of self-medication among adults who
live alone(6).
Similar to this study’s results, people with
higher levels of education tend to self-medicate
themselves more frequently(3,6). The reasons have
been attributed to the following factors: more
knowledge about medication, higher economic status,
less confidence in physicians and a greater feeling of
personal autonomy in the face of decisions about their
own health(6).
Studies have shown that self-medication is
associated with the presence of less severe signs and
symptoms of acute characteristics such as pain and
fever. Chronic diseases that in general involve medical
follow-up favor the use of prescribed medication(10).
Corroborating these findings, a higher level of
self-medication was found among those who reported a
disease or injury in the last 15 days and lower level
among hypertensive individuals. Additionally, a higher
consumption was found among those classified with
minor psychiatric disturbances, among those
dissatisfied with their sleep patterns and those with a
higher number of self-diagnosed diseases. These
aspects deserve more specific studies so as to
understand how getting ill is related to the use of
medication among nursing workers.
Similar to this study’s results, other studies
reveal that individuals with low physical activity present
a higher consumption of medication(9). Although one
cannot establish a cause-effect relation based on
cross-sectional studies, we know that physical activity
is associated with improved health.
This study evidenced higher frequencies of
study(3) had already described a higher prevalence of
self-medication among professionals with a bachelor’s
degree (including nurses) when compared to
professionals with only secondary education completed.
The high prevalence found among those who
were not public employees can be attributed to the
age of the studied population. Although the difference
for age was not presented in this study’s analysis,
the reported group was much younger than the public
employees.
It is noteworthy that such a high prevalence
was identified among professionals excessively
involved with their work, who are unable to stop
thinking about their work even when they are off duty.
The importance of occupational stress is
acknowledged as a risk factor for workers’
diseases(3,6). Therefore, studies that better clarify the
influence of the psychosocial work environment on
the use of medication are needed.
This study’s findings should be evaluated
considering the main limitations of cross-sectional
studies, which do not permit establishing a clear
temporal relation between events, hindering the
establishment of cause and effect. One can also
assume some degree of underestimation of
information about the use of medication, due to
forgetfulness or because participants did not want to
report the use of certain drugs. Some medications
could not be identified according to the adopted
classification, because some participants did not
provide sufficient information since they would have
to recall the names or active substances of
medications.
CONCLUSIONS
The issue “self-medication” is controversial
in relation to the benefits and harms it causes to
workers’ health. This practice can be favored by
factors such as easy of access to drugs and difficult
of access to health services (as users of health
services), whether due to a lack of time or money to
pay for health insurances or because they find
self-care difficult.
Self-medication is an old, universal problem
of large proportions. Although it is very difficult to
eliminate such a practice, it is necessary to provide
guidance to the population in general about the use
of medications in order to discourage unbridled
consumption.
The potentially dangerous effects of
self-medication might be underestimated by nursing
workers. This subject should be addressed in schools
and in strategies focused on improving the health of
workers.
ACKNOWLEDGMENTS
We appreciate the support of the occupational
health commission of the studied hospitals.
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