Musculoskeletal disorder (MSD) prevention practices by nurses working in health care settings: Facilitators and barriers to implementation

The incidence of musculoskeletal disorders (MSD) in the healthcare professional population is concerning. In particular, the high incidence of back injuries is an issue for nurses. Although many MSD prevention initiatives are being implemented, these practices are not succeeding in reducing MSDs. Why are these efforts struggling to close the gap between knowledge and practice? This article aims to report on individual and organizational factors that may influence nurses' implementation of MSD prevention practices. A survey was sent to nurses in the Quebec health and social services network. A total of 399 questionnaires were completed and analyzed. The results revealed that nurses have the required knowledge on MSD prevention practices, but have difficulty applying them in their professional context. It would appear that successful implementation of MSD prevention practices relies mainly on organizational factors, including management support, organizational culture, feedback mechanisms, and training that is adapted to the work environment.

Analyse dimensionnelle du construit « formation par la recherche »

Initial nursing training programs in France have been included under the umbrella of university studies since 2009, when the ministry of higher education recognized an undergraduate program in nursing. The formal training system places great emphasis on research, and a teaching unit that enables nursing students to become acquainted with the research process has been introduced. Knowledge construction now involves the use of research approaches, and the interdependent practice–theory–research triad is implicitly recognized. Research training programs have thus far received little study. I chose to use Schatzman’s dimensional analysis method to clarify the meaning and use of the concept. From my results, nine dimensions of the “research training programs” construct emerged : 1) problematization of the situation, 2) different representations, 3) updating or developing knowledge and changing students’ relationship to knowledge and the world, 4) the development of a scientific culture, 5) the development of the reflective process, 6) identity transformation, 7) self-training, 8) writing as a tool for professionalization, and 9) the integration of various dimensions. Lastly, I present a visual representation of the construct that provides an overview of the results and acts as a conceptual basis for trainers and teachers, and as such helps to promote student nurses’ introduction to the research process in undergraduate nursing programs.

The effects of Hurricane Irma on seagrass meadows in previously eutrophic estuaries in Southwest Florida (USA)

In six contiguous estuaries in Southwest Florida (USA) focused management actions over the past several decades have reduced watershed nutrient loads, resulting in an additional 11,672 ha of seagrass meadows between 1999 and 2016, an improvement of 32%. However, in September of 2017, Hurricane Irma made landfall in the state of Florida, affecting the open water and watersheds of each of these six estuaries. In response, seagrass coverage declined by 1203 ha between 2016 and 2018, a system-wide decrease of 3%. The range of decreases associated with Hurricane Irma varied from less than a 1% loss of seagrass coverage in St. Joseph Sound to declines of 7 and 11% in Clearwater Harbor and Lemon Bay, respectively. Areas with the largest losses between 2016 and 2018 were those systems where seagrass coverage had declined in prior years, indicating the effects of Hurricane Irma might have been intensified by prior impacts.

Widespread recovery of seagrass coverage in Southwest Florida (USA): Temporal and spatial trends and management actions responsible for success

In Southwest Florida, a variety of human impacts had caused widespread losses of seagrass coverage from historical conditions. St. Joseph Sound and Clearwater Harbor lost approximately 24 and 51%, respectively, of their seagrass coverage between 1950 and 1999, while Tampa Bay and Sarasota Bay had lost 46% and 15%, respectively, of their seagrass coverage between 1950 and the 1980s. However, over the period of 1999 to 2016, the largest of the six estuaries, Tampa Bay, added 408 ha of seagrass per year, while the remaining five estuaries examined in this paper added approximately 269 ha per year. In total, seagrass coverage in these six estuaries increased 12,171 ha between the 1980s and 2016. Focused resource management plans have held the line on nitrogen loads from non-point sources, allowing seagrass resources to expand in response to reductions in point source loads that have been implemented over the past few decades.

Positive deviance and hand hygiene of nurses in a Quebec hospital: What can we learn from the best?

BACKGROUND

Although it is well known that hand hygiene is the most effective measure to prevent health care-associated infections, hand hygiene adherence is low in Quebec, as it is elsewhere. For this study, an innovative framework was used to explore the clinical practice of nurses regarding hand hygiene and the factors that influence it: positive deviance, or the idea that there are people who find better solutions to problems than their peers. This study investigated positive deviance at the level of the care team to shed light on group dynamics.

METHODS

We conducted focused ethnographies on 2 care units-a medical-surgery unit and a palliative care unit-at a Montreal university hospital. Data collection consisted mainly of systematic observations and individual interviews with nurses.

RESULTS

The results show that positive deviance related to hand hygiene is instigated by social cohesion within a care team, created, in this study, by the mobilizing leadership of the head nurse in the medical-surgery unit and the prevailing humanist philosophy in the palliative care unit.

CONCLUSIONS

In health care, it can be useful to apply the positive deviance approach to care teams instead of individuals to better understand the ideologic and structural differences linked to better hand hygiene performance by the nurses.

Interventions to promote or improve the mental health of primary care nurses: a systematic review

AIM

To synthesize the evidence on the effectiveness of interventions aiming to promote or improve the mental health of primary care nurses.

BACKGROUND

Primary care nurses have been found to have high levels of emotional exhaustion and to be at increased risk of suffering from burnout, anxiety and depression. Given the increasingly critical role of nurses in high-performing primary care, there is a need to identify interventions that can effectively reduce these professionals' mental health problems and promote their well-being.

EVALUATION

We conducted a systematic review on the effectiveness of interventions at the individual, group, work environment or organizational level.

KEY ISSUES

Eight articles reporting on seven unique studies met all eligibility criteria. They were non-randomized pre-post intervention studies and reported positive impacts of interventions on at least some outcomes, though caution is warranted in interpreting these results given the moderate-weak methodological quality of studies.

CONCLUSIONS

This systematic review found moderate-weak evidence that primary, secondary and combined interventions can reduce burnout and stress in nurses practising in community-based health care settings.

IMPLICATIONS FOR NURSING MANAGEMENT

The results highlight a need for the implementation and evaluation of new strategies tailored for community-based nurses practising in primary care.

Reactogenicity, safety and immunogenicity of a protein-based pneumococcal vaccine in Gambian children aged 2-4 years: A phase II randomized study

Pneumococcal conjugate vaccines (PCVs) have been successful in preventing invasive pneumococcal disease but effectiveness has been challenged by replacement of vaccine serotypes with non-vaccine serotypes. Vaccines targeting common pneumococcal protein(s) found in most/all pneumococci may overcome this limitation. This phase II study assessed safety and immunogenicity of a new protein-based pneumococcal vaccine containing polysaccharide conjugates of 10 pneumococcal serotypes combined with pneumolysin toxoid(dPly) and pneumococcal histidine triad protein D(PhtD) (PHiD-CV/dPly/PhtD-30) in African children. 120 Gambian children (2–4 years, not previously vaccinated against Streptococcus pneumoniae) randomized (1:1) received a single dose of PHiD-CV/dPly/PhtD-30 or PCV13. Adverse events occurring over 4 d post-vaccination were reported, and blood samples obtained pre- and 1-month post-vaccination. Serious adverse events were reported for 6 months post-vaccination. Solicited local and systemic adverse events were reported at similar frequency in each group. One child (PHiD-CV/dPly/PhtD-30 group) reported a grade 3 local reaction to vaccination. Haematological and biochemical parameters seemed similar pre- and 1-month post-vaccination in each group. High pre-vaccination Ply and PhtD antibody concentrations were observed in each group, but only increased in PHiD-CV/dPly/PhtD-30 vaccinees one month post-vaccination. One month post-vaccination, for each vaccine serotype ≥96.2% of PHiD-CV/dPly/PhtD-30 vaccinees had serotype-specific polysaccharide antibody concentrations ≥0.20µg/mL except serotypes 6B (80.8%) and 23F (65.4%), and ≥94.1% had OPA titres of ≥8 except serotypes 1 (51.9%), 5 (38.5%) and 6B (78.0%), within ranges seen in PCV13-vaccinated children. A single dose of PHiD-CV/dPly/PhtD-30 vaccine, administered to Gambian children aged 2–4 y not previously vaccinated with a pneumococcal vaccine, was well-tolerated and immunogenic.

[The Humanistic Model of Nursing Care - UdeM : an innovative and pragmatic perspective]

As in many other countries, Québec is not immune to healthcare reforms, which can unfortunately hinder quality of care as well as induce some dehumanization, both for the patients and the healthcare professionals. Thus, the « Humanistic Model of Nursing Care - UdeM » (HMNC-UdeM) aspires to offer an innovative perspective that aims at improving the quality and the safety of care, in addition to satisfaction and well-being for both patients and nurses. While respecting their theoretical influences, the authors present their vision of the central concepts of the discipline and the Model’s key concepts, seeking to make them more understandable, accessible, and applicable in nurses’ daily practice. Therefore, the aim of this article is to raise awareness of the Model into the nursing community, to promote its implantation in nursing’s spheres of activities, in addition to demonstrate its applicability and impact in nursing research. It appears that this model is promising for the renewal and the development of humanistic interventions for patients’ care.

Reflective Practice: A Comparative Dimensional Analysis of the Concept in Nursing and Education Studies

AIM

This paper reports on an analysis of the concept of reflective practice.

BACKGROUND

Reflective practice, a concept borrowed from the field of education, is widely used in nursing. However, to date, no study has explored whether this appropriation has resulted in a definition of the concept specific to the nursing discipline.

DATA SOURCES

A sample comprised of 42 articles in the field of nursing drawn from the CINAHL database and 35 articles in education from the ERIC database (1989-2013) was analyzed.

REVIEW METHOD

A concept analysis using the method proposed by Bowers and Schatzman was conducted to explore the differing meanings of reflective practice in nursing and education.

RESULTS

In nursing, the dimensions of the concept differ depending on context. In the clinical context, the dimensions may be summarized as theory-practice gap, development, and caring; in training, as learning, guided process, and development; and in research, as knowledge, method, and social change. In education, the concept is also used in the contexts of training (the dimensions being development, deliberate review, emotions, and evaluation) and research (knowledge, temporal distance, and method). The humanist dimension in nursing thus reflects a use of the concept more specific to the discipline.

CONCLUSION

The concept analysis helped clarify the meaning of reflective practice in nursing and its specific use in the discipline. This observation leads to a consideration of how the concept has developed since its appropriation by nursing; the adoption of a terminology particular to nursing may well be worth contemplating.

Critical Review on Suicide Among Nurses

Background: Research shows that there is a high prevalence of suicide among nurses. Despite this, it has been 15 years since the last literature review on the subject was published. Aim: The aim of this article is to review the knowledge currently available on the risk of suicide among nurses and on contributory risk factors. Method: A search was conducted in electronic databases using keywords related to prevalence and risk factors of suicide among nurses. The abstracts were analyzed by reviewers according to selection criteria. Selected articles were submitted to a full-text review and their key elements were summarized. Results: Only nine articles were eligible for inclusion in this review. The results of this literature review highlight both the troubling high prevalence of suicide among nurses as well as the persistent lack of studies that examine this issue. Conclusion: Considering that the effects of several factors related to nurses' work and work settings are associated with high stress, distress, or psychiatric problems, we highlight the relevance of investigating work-related factors associated with nurses' risk of suicide. Several avenues for future studies are discussed as well as possible research methods.

Defining patient deterioration through acute care and intensive care nurses' perspectives

AIM

To explore the variations between acute care and intensive care nurses' understanding of patient deterioration according to their use of this term in published literature.

BACKGROUND

Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses' help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains.

DESIGN

Dimensional analysis was used as a framework to analyze papers retrieved in a nursing-focused database.

METHOD

A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses' perspectives on patient deterioration was conducted.

FINDINGS

No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses' accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored.

CONCLUSIONS

From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology towards critical illness. Contextual factors relating to acute care units (ACU) appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modelling the concept of patient deterioration, which could be specific to ACU.

RELEVANCE TO CLINICAL PRACTICE

The findings suggest that it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issue.

[Moral distress of nurses: literature review]

During their careers, nurses in all fields of the health care systems are likely to experience a period of moral distress at some point during their career. Moral distress has both short and long-terms consequences for the health care system, for the nurses' health as well as for the quality and safety of patient care. The actions to prevent moral distress are still poorly documented. The aim of this article circumscribes the concept of moral distress amongst nurses and proposes interventions that can contribute to its prevention. The psychodynamic of work theoretical framework was chosen to analyze and structure the literature in terms of: the source of suffering at work and the defensives strategies developed by nurses in response to such suffering. Through a review of the literature, this article identifies factors influencing moral distress amongst nurses and the consequences it can have. The interventions identified and interventions proposed represent important recommendations for health organizations and managers seeking to reduce, or even prevent moral distress amongst nurses.

[An evolutionist analysis of competence]

For several years, many nursing education institutions have implemented the recommendations made in 2003 by the Institute of Medicine. Some have conducted a redesign of the structure of their program to integrate competency-based approach. What is a competence in this context? The purpose of this concept analysis is to clarify the meaning of the concept of competence from its recent use in nursing education. Rodgers' method of concept analysis was selected as it is relevant to explore this concept. A literature review in nursing was conducted from the CINAHL database. After analyzing the results, although no consensus appears in the literature, it seems that a competence could be defined as a formal action of systemic skills, contextualized and which is continuously developing. This definition differs from the behaviorist one sometimes used, where competences are synonymous with technical skills. To continue the development of this concept, it would be interesting to explore how it has evolved in other disciplines, such as education sciences or medicine.

[Introduction to research in the initial training in nursing education: research and professionalization]

BACKGROUND

At the national level, the process which integrates nurse education curriculum to university studies, as well as the creation of a program of nursing and paramedical research in the hospital are contributing to the promoting of these professions inside the scientific community. The research introduction is now a teaching unit, which emphasizes professionalizing and training through research and opens the question of the visibility and the development in France, of a discipline in nursing.

OBJECTIVE

To establish an inventory of the implementation of the teaching units concerning introduction to research.

METHOD

A survey was sent to 305 educational institutions through an online questionnaire.

RESULTS/DISCUSSION

it emerges some obstacles to the development of research including a low expertise in paradigms and research methods, the need for training of trainers, a low use of research articles and a gap between the teachings of the program and teachings made.

CONCLUSION

The results highlight the difficulties in the implementation of the research initiation and the heterogeneity in the implementation of the teaching unit that could affect the process of professionalization of the student.

[Difficulties/suffering experienced by nurses : strategies for maintaining their mental health, the calling of the profession and their job performance]

The nursing profession is faced with an issue of growing concern, that of the mental health of its practitioners. The many difficulties that nurses experience in the workplace may prove to be detrimental to the maintenance of an optimal mental state. With respect to these difficulties, several strategies can be implemented and used by nurses and managers. The present literature review aims to identify the difficulties and suffering experienced by nurses and the strategies employed to ensure the preservation of mental health, as well as maintaining the calling of the profession and job performance. It also aims to provide nurses and managers of the health care system with ideas to promote optimal mental health for nurses. In this context, « psychodynamique du travail » was chosen as the framework to structure the analysis of the literature dealing with elements surrounding the suffering and difficulties experienced by nurses. The use of this theoretical framework deepens and supports the relationship between the suffering experienced at work and the mental health of nurses.

[Practices surrounding developmental care: exploration of barriers and remedy strategies suggested by the experts]

Developmental care represents a new approach in care promoting a harmonious development of the premature baby. Although this approach is increasingly common,the recommended behaviors for these cares are not sufficiently adopted by the neonatal nurses.This research aims to explore the barriers the neonatal nurses encounter when adopting the practices surrounding developmental care and the strategies that need to be implemented in order to overcome these barriers. In order to achieve this, semi-directed interviews based on open questions have been held with experts in the field, and were analyzed with a qualitative approach.This results in multiple barriers (mainly difficulties to redefine the role of the nurse) and a large amount of strategies to overcome these barriers with individual, organizational and institutional levers.To reach a larger individualization of the care for the premature infant, it is ultimately important to invest every level by suggesting an individual and a collective reflexive practice but also by raising awareness of each tier for developmental care.

[Positive deviance: concept analysis using the evolutionary approach of Rodgers]

Positive deviance is a relatively new concept in healthcare. Since 2006, it has been applied to infection control in order to increase the awareness to good hand hygiene practices. This article focus on presenting analytical results of this concept using the evolutionary approach of Rodgers based on the philosophical postulate that concepts are dynamical and changing with time. For doing so, a census of the writings in nursing, medicine and psychology was carried out. By going through the CINAHL, Medline and PsyclNFO databases using positive deviance as a keyword for the time period: 1975 to May 2012, and in accordance with the method of Rodgers, ninety articles were retained (30 per discipline). The analysis enables one to notice that positive deviance described as an individual characteristic at first, is now used as a behavioral changing approach in nursing and medicine as well. At the end of the analysis and apart from this article, positive deviance will be used in order to study the practice of nurses that adheres to hand hygiene despite limiting constraints within hospital. We will then be able to continue the development of this concept in order to bring it, as Rodgers recommends, beyond the analysis. It would then be an important contribution to good nursing practices in the field of infection control and prevention.

[Nursing in prison: inmates as patients]

There are very few studies investigating the work nurses do in prisons. Based on data stemming from a research in Psychodynamics of Work and a literature review, this paper describes nursing practices in a Canadian penitentiary institution. Three male nurses and two female nurses participated in three two-hour long focus group sessions. Central sources of pleasure that emerged from the focus groups were the scope of nursing care practice ; the autonomy and collaboration with physicians; nursing care practices devoid of moral value judgments, the humanitarian approach, caring and the wish to make a difference in the lives of the inmates ; the pride connected to this unusual professional context, and the recognition by peers and inmates. The main sources of suffering on the other hand were the feeling that rehabilitation was more an ideal than reality ; the paradox of providing both care and safety ; the scary characteristics of working alone ; the fear of lawsuits, and the feeling of being observed continuously. The resulting data we discuss show the issues of a certain dissociation that exists between the patient and the inmate, the fear of contamination of a healthcare nursing identity by the place of practice, but also the feeling of plenitude and sublimation. The conclusion stresses the tension that exists between security and caring, distance and proximity.

[An evolutionary analysis of the concept of self-care]

The nursing community seems to agree on the general meaning of "self-care" as a concept allowing the individual to take care of his health. Yet the terms self-care and other "self-concepts" are often used interchangeably. Since this concept is central to nursing, it appeared crucial to lead an effort to clarify and to deepen the understanding of its development within the field of nursing. The objective of this evolutionary concept analysis was to identify the state of precision or clarity of the concept in the available nursing literature. The identification of attributes, antecedents and consequences has highlighted the characteristics as it has been used by various authors and ultimately provides a basis for further research. After this analysis, it is possible to propose that the concept of self-care refers to an activity initiated, consciously and following learning, which is appropriate to the situation and focused on a goal. Furthermore, this concept is widely used in contexts of long-term illnesses and much less so in contexts of acute diseases. In conclusion, work remains to be done to better differentiate the concept of self-care from other self-concepts when used in situations where a third party is involved in the realization of self-care.

[Physiologic stability: a concept analysis]

Physiologic stability is a omnipresent concept in the scientific literature. However, there is a limited number of conceptual definition of this concept in the literature. A concept analysis about physiologic stability is a way to set the theoric basis of this multidimensional concept. Mutilidimension illutrated by the multiples utilisations of the concept in a various way. In this meaning, the identification of the attributes, the antecedents and the consequences of the physiologic stability concept conduct to the elaboration of a conceptual definition for the concept. The aim of this scientific contribution is also to develop a reflexion about the utilisation of the concept physiologic stability without defining it at first.

[Towards understanding human ecology in nursing practice: a concept analysis]

Human ecology is an umbrella concept encompassing several social, physical, and cultural elements existing in the individual's external environment. The pragmatic utility method was used to analyze the "human ecology" concept in order to ascertain the conceptual fit with nursing epistemology and to promote its use by nurses in clinical practice. Relevant articles for the review were retrieved from the MEDLINE, CINAHL, PsycINFO, and CSA databases using the terms "human ecology," "environment," "nursing," and "ecology." Data analysis revealed that human ecology is perceived as a theoretical perspective designating a complex, multilayered, and multidimensional system, one that comprises individuals and their reciprocal interactions with their global environments and the subsequent impact of these interactions upon their health. Human ecology preconditions include the individuals, their environments, and their transactions. Attributes of this concept encompass the characteristics of an open system (e.g., interdependence, reciprocal).

[Emotional labour of nursing care: an evolutionary concept analysis]

Caring is considered as the essence of nursing. Underpinning caring, the internal regulation of emotions or the emotional labour of nurses is invisible. The concept of emotional labour is relatively underdeveloped in nursing.

DATA SOURCES

A literature search using keywords 'emotional labour', 'emotional work' and 'emotions' was performed in CINAHL, psycINFO and REPERE from 1990 to January 2008. We analysed 72 papers whose main focus of inquiry was on emotional labour.

REVIEW METHODS

We followed Rodgers' evolutionary method of concept analysis.

RESULTS

Emotional labour is a process whereby nurse adopt a 'work persona' to express their autonomous, surface or deep emotions during patient encounters. Antecedents to this adoption of a work persona are events occurring during patient-nurse encounters, and which consist of three elements : organization (i.e.social norms, social support), nurse (i.e.role identification, professional commitment, work experience and interpersonal skills) and job (i.e.autonomy, task routine, degree of emotional demand, interaction frequency and work complexity). The attributes of emotional labour have two dimensions : nurses' autonomous response and their work persona strategies (i.e. surface or deep acts). The consequences of emotional labour include organizational (i.e.productivity, 'cheerful environment') and nurse aspects (i.e. negative or positive)

CONCLUSION

the concept of emotional labour should be introduced into preregistration programmes. Nurses also need to have time and a supportive environment to reflect, understand and discuss their emotional labour in caring for 'difficult' patients to deflate the dominant discourse about 'problem' patients.

Work structure in the chronic care setting: possible consequences for nurses' mental health

The purpose of this study was to add to the body of knowledge on nurses' work environment in order to better understand their collective experience and the reasons for their mental health issues. A psychodynamic approach to work was used. The results show that the main source of nurses' dissatisfaction with their work is the perceived failure of management and other professionals to accord them due recognition, autonomy, and professional power. This situation is largely the result of an inappropriate organization of nurses' work, with nursing responsibilities unmatched by their degree of recognition, autonomy, and power. The author concludes that the organization of nursing must be transformed, not only to lower the rate of absenteeism but also to improve nursing care and enhance the professionalization of nursing.

[Psychodynamic analysis of nurses' work in long term care units: between pleasure and suffering]

Motivated by the constant increase in nurses'mental health problems, the study of Alderson (2001)--using the psychodynamic approach of work ("Psychodynamique du travai")--looks at the subjective and collective experience of nursing in a chronic care facility. The results of the study show that the major source of suffering in the nurses'work experience is their perceived lack of recognition, of autonomy and of professional power, deficits that are largely maintained by an inadequate organization of the nurses'work. Suggested solutions, according to the nurse subjects, include a necessary transformation of work and its context.

La psychodynamique du travail et le paradigme du stress : une saine et utile complémentarité en faveur du développement des connaissances dans le champ de la santé au travail

Cet article fait état des principales similitudes et divergences entre les approches de la psychodynamique du travail et du stress. Il démontre comment la psychodynamique du travail (PDT) constitue une approche complémentaire intéressante au paradigme du stress en termes de développement des connaissances en santé mentale au travail.

La psychodynamique du travail : objet, considérations épistémologiques, concepts et prémisses théoriques 1

L’article définit l’approche de la psychodynamique du travail qui a été développée en France au début des années 1970 par Christophe Dejours. Il s’agit d’une approche interdisciplinaire qui s’intéresse à l’organisation du travail comme source de plaisir et de souffrance et comme lieu d’émergence de stratégies défensives permettant aux individus de transiger avec les exigences de leur situation de travail afin de demeurer en santé. La psychodynamique du travail s’inscrit dans le paradigme subjectiviste d’approche compréhensive et réfère à la philosophie herméneutique. L’auteur vise à mieux faire connaître cette approche dans l’espoir qu’elle soit davantage utilisée par les chercheurs qui s’intéressent à une meilleure compréhension des problèmes de santé mentale vécus par les personnes dans le cadre de leur activité de travail.