Workloads and strain process in Community Health Agents

Predictors of burnout, compassion fatigue, and compassion satisfaction experienced by community health workers offering maternal and infant services in New York State

Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well-being of community-based providers, such as Community Health Workers (CHWs), within the United States. Using cross-sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational-level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self-care. Findings should be considered when designing organizational-level preventive measures that mitigate burnout and CF and promote CS.

Self-Efficacy of the Community Health Agent, Importance of Motivation and Empowerment

INTRODUCTION

The community health agent plays an essential role as a link between the community and health institutions; the effectiveness of their work is crucial in promoting health, prevention, and detection of diseases. Motivation and empowerment could affect the performance of the community agent in carrying out his work.

OBJECTIVE

To determine if work motivation and empowerment are factors associated with the self-efficacy of the community health agent.

METHODOLOGY

Observational and cross-sectional study. The study included community health agents in the Non-Governmental Organization ADRA in Imbabura and Pichincha, Ecuador. The sample selected by the census method corresponds to 300 agents. The instruments were the Motivation at Work Scale (R-MAWS), the Psychological Empowerment Scale, and the Professional Self-efficacy Questionnaire (AU10). Descriptive statistical analyses were performed using dispersion and summary measures-a comparative analysis with chi-square. The inferential analysis was done through logistic regression where the B coefficient and the odds ratio (OR) with 95% confidence intervals (CI) were evaluated, P < .05. The theoretical and adjusted model of the structural model allowed us to corroborate the association of the variables.

RESULTS

Motivation had a positive effect on self-efficacy (OR = 10.091, CI [5.509-18.485], P < .05), empowerment had a minimal effect (OR = 0.664, CI [0.363-1.214], P > .05), which is not significant to predict the perception of self-efficacy.

CONCLUSION

This study suggests that to improve the self-efficacy of the work of community health agents, it is necessary to intervene through strategies that keep them motivated in the exercise of their mediation work between the community and health institutions. Likewise, empowering them would contribute to self-efficacy and thus help in the fulfillment of the functions of health agents.

Prevalência de ansiedade e depressão em trabalhadores da Atenção Primária à Saúde

Resumo Introdução A atualização da Política Nacional de Atenção Básica em Saúde, em 2017, trouxe importantes retrocessos para o sistema de saúde brasileiro, dificultando a atuação profissional e favorecendo o adoecimento psíquico dos trabalhadores. Objetivo Avaliar a prevalência de ansiedade e depressão em trabalhadores da atenção primária à saúde. Método Estudo transversal, realizado em 2017, em um município de grande porte do interior paulista. Foram avaliados 173 profissionais das equipes da Atenção Primária à Saúde, utilizando um questionário com variáveis sociodemográficas e profissionais; o Inventário de Ansiedade de Beck (BAI); e o Inventário de Depressão de Beck (BDI-II). Resultados A ansiedade esteve presente em 45,3% dos profissionais, sendo 25,0% com ansiedade leve, 9,9% com ansiedade moderada e 10,5% com ansiedade grave. A depressão esteve presente 41,0% dos profissionais, sendo 28,9% com depressão leve e 12,1% com depressão moderada. Houve maior prevalência de ansiedade (17,3%) e de depressão (28,3%) entre Agentes Comunitários de Saúde e menor prevalência de ansiedade (1,2%) e de depressão (0,6%) entre médicos. Conclusão Há uma prevalência elevada de ansiedade e depressão em profissionais da Atenção Primária em Saúde, especialmente em agentes comunitários de saúde. Os gestores municipais devem implementar medidas de atenção à saúde dos trabalhadores, bem como garantir condições de trabalho favoráveis, para evitar o adoecimento dos profissionais.

Continuing education in healthcare as a strategy for occupational safety in the context of the COVID-19 pandemic: reflections on the role of community healthcare agents in construction of care

Community healthcare agents are strategic professionals in delivery of Primary Healthcare activities. This article reflects on the role of continuing education in healthcare as a strategic element in ensuring the occupational health of community healthcare agents faced with combating and managing coronavirus 19 disease (COVID-19). In the current scenario, the work of community healthcare agents is undergoing daily reconstruction of professional practice in order to keep pace with the living territories to which they are assigned. Continuing education in healthcare enables construction of feasible scenarios that make problem solving possible, involving a constant reflective analytical perception of professional practices, permitting (re)construction of social skills such as the capacity to mobilize and motivate other actors to participate in political action. Through problematization, identification of needs, and questioning, continuing education in healthcare leads to (de)construction of the working practices of the very actors who are delivering care. Furthermore, continuing education in healthcare reaffirms the importance of the social, technical, and political training of community healthcare agents, thereby confirming their right to dignified and quality work. In a pandemic scenario, an agenda focused on continuing education in healthcare is essential to the continuity of care delivery to communities, facilitating expansion of access to the right to health.

Avaliação da síndrome metabólica em agentes comunitários de saúde em município do norte de Minas Gerais

Introdução: A síndrome metabólica se relaciona a doenças crônicas, possui prevalência crescente no Brasil e leva riscos cardiovasculares à população. Objetivo: Comparar a prevalência da síndrome metabólica em agentes comunitários de saúde em município do Norte de Minas Gerais segundo diferentes critérios diagnósticos. Métodos: Foi realizada coleta de dados de 675 profissionais que compunham as variáveis dos critérios diagnósticos propostos pela Internacional Diabetes Federation e National Cholesterol Education Program’s Adult Treatment Panel III. Resultados: Segundo critérios da Internacional Diabetes Federation, diagnosticou-se 42,2% de indivíduos com síndrome metabólica e 33,6% segundo National Cholesterol Education Program’s Adult Treatment Panel III. Há aumento diretamente proporcional ao avançar da idade (p=0,000 para ambos os critérios) e relação intrínseca à dislipidemia e pressão arterial elevada. Conclusão: Pôde-se concluir que a síndrome metabólica tem prevalência muito relevante no público estudado. Em relação às variáveis analisadas, encontrou-se similaridade entre critérios. Assim, nota-se que essas informações são importantes para realização de um diagnóstico precoce e manutenção da saúde dos agentes comunitários de saúde.

Challenges for implementing a global mental health agenda in Brazil: The "silencing" of culture

Since its emergence in 2007, Global Mental Health has been a growing and polemic area of study, research and practice in mental health worldwide. Despite having a significant endogenous academic production and innovative policy experiences, the Brazilian mental health field and its actors make few references to, and scarcely dialogue with, the Global Mental Health agenda. This article explores an aspect of this divergence between Global Mental Health initiatives and public mental health care in Brazil regarding the role of culture within mental health policies and practices. Our hypothesis is that part of this difficulty can be attributed to the low relevance of the cultural dimension for the Brazilian mental health field, here referred to as the "silencing of culture." We examine the possible historical roots of this process with reference to theories of "anthropophagy" and "cultural uniformity" in the context of Brazilian cultural matrices. We then describe two recent experiences in public mental health care that incorporate cultural competence through the work of community health workers and the example of community therapy. We argue that the development of cultural competence can be decisive in enabling an improved dialogue between research and practice in Brazilian mental health and global mental health initiatives.

Non-specific low back pain and its relation to the nursing work process

OBJECTIVE

to relate nonspecific low back pain within the nursing work context with their workloads, attrition processes and the risks of illness.

METHOD

a cross-sectional study with 301 workers from a general hospital in the south of the country. The Nordic Musculoskeletal Questionnaire and the Work Context Assessment Scale composed of three dimensions were used: working conditions, work organization and socio-professional relations. The association of variables with low back pain was tested using bivariate and multivariate analyzes. The measure of association used was the Odds Ratio and its respective intervals with 95% confidence. The data collected were discussed under the theoretical framework of the work process within the marxist conception and the theory of social determination of the health-disease process.

RESULTS

there was a statistically significant association between the dimensions of work organization and working conditions with low back pain and they obtained a critical classification meaning moderate risks to the professional illness.

CONCLUSION

the study allowed a better understanding of the nursing work process and its relation with nonspecific low back pain and signaled that changes in the organization and working conditions should occur in order to reduce the risks of nursing workers' illness.

TRABALHO FEMININO E SAÚDE NA VOZ DE CATADORAS DE MATERIAIS RECICLÁVEIS

RESUMO Objetivo: analisar a interface trabalho feminino e saúde na perspectiva de mulheres catadoras de materiais recicláveis e realizar uma atividade educativa em direção ao seu empoderamento. Método: estudo qualitativo realizado com base na Pesquisa Convergente-Assistencial. As participantes foram 11 mulheres catadoras de uma cooperativa de materiais recicláveis. Os dados foram produzidos entre abril e junho de 2015 por intermédio da observação não sistemática participante, entrevistas semiestruturadas e grupo de convergência. A análise seguiu os passos estabelecidos pelo referencial metodológico (apreensão, síntese, teorização e transferência). Resultados: da análise emergiram duas categorias temáticas que apontam para trajetórias de vida marcadas por fragilidades econômicas, familiares e sociais, tais como a vivência do trabalho infantil, exclusão do mercado de trabalho, dificuldades impostas pela maternidade e casamento, bem como o preconceito racial. Apontam, ainda, a visão das catadoras acerca do trabalho na vida da mulher, evidenciando-se elementos como o machismo, a divisão sexual do trabalho e a interface entre trabalho e família. A atividade educativa em grupo em direção ao empoderamento se mostrou positiva e ajudou as catadoras a reavivar os sentimentos de confiança em suas capacidades. Conclusão: o trabalho feminino é um fator relevante para a saúde da mulher. Nesse sentido, ações educativas de enfermagem que estimulem o empoderamento como elemento para a saúde podem ser eficazes junto a grupos singulares, como as catadoras de materiais recicláveis.

CARGAS DE TRABALHO DO AGENTE COMUNITÁRIO DE SAÚDE: PESQUISA E ASSISTÊNCIA NA PERSPECTIVA CONVERGENTE-ASSISTENCIAL

RESUMO Objetivo: conhecer a percepção dos Agentes Comunitários de Saúde acerca das cargas de trabalho presentes na sua dinâmica laboral e realizar prática assistencial relacionada às cargas de trabalho junto ao grupo. Método: estudo qualitativo, fundamentado na Pesquisa Convergente-Assistencial, realizado em duas unidades de atenção primária à saúde, com três equipes de Estratégia de Saúde da Família, em um município ao Sul do Brasil. Os participantes foram 14 Agentes Comunitários de Saúde atuantes nesses cenários. Os dados foram produzidos por meio de entrevistas semiestruturadas, grupos focais e grupos de convergência. Os dados foram analisados, conforme a análise do discurso do sujeito coletivo. Resultados: os Agentes Comunitários de Saúde convivem com intensa carga física (expressa pela exposição física na comunidade, estrutura precária na unidade e risco de violência); cognitiva (evidenciada pela necessidade de acúmulo de informações e conhecimentos técnicos para a orientação da comunidade e mudanças nos sistemas de informação); e psíquica (manifesta na fragilidade das relações interpessoais na equipe, na sobrecarga de trabalho e frustrações frente à falta de resolutividade do sistema e na falta de reconhecimento). A prática assistencial consistiu na mediação de um espaço de reflexão/ação/reflexão no qual os participantes puderam identificar estratégias para a minimização das cargas. Conclusão: a partir da prática assistencial os participantes realizaram uma reflexão crítica, problematizando a sua realidade laboral, envolvendo-se no desafio da transformação da realidade através da construção de estratégias para minimizar as cargas a que estavam expostos.

Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit

OBJECTIVES

To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit.

METHODS

This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared.

RESULTS

The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16.

CONCLUSION

The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.