RESEARCH ARTICLES

Occupational stress and consumption of anti-anxiety agents by nursing workers

Elias Barbosa de Oliveira^I; Priscilla Moutella de Barros^II; Monica Pereira Queiroz Maia^III; Josiane de Lima Cabral^IV; Damião Mandu de Brito^V; Eledeane Pereira de Figueredo^VI

^INurse, Post Doctorate in Drug Alcohol, PhD in Nursing, Associate Professor of the Postgraduate (Masters) and Graduate School of Nursing at the State University of Rio de Janeiro, Group leader of Mental Health and Work Studies, Rio de Janeiro, Brazil, Email: eliasbo@oi.com.br
^IINurse, Specialist in Occupational Health Nursing, Master student of the Postgraduate program in nursing, State University of Rio de Janeiro, Polyclinic of the military police in Rio de Janeiro, Brazil, Email: primoutella@ig.com.br
^IIINurse, Specialist in Occupational Health Nursing, Institute of Psychiatry, University of Brazil, Military Fire Brigade of the State of Rio de Janeiro, Brazil, Email: monicamaia@yahoo.com.br
^IVNurse, Graduated from the State University of Rio de Janeiro, Brazil, Email: josiane_lima@ymail.com
^VNurse, Graduated from the State University of Rio de Janeiro, Brazil, Email: vandamme001@hotmail.com
^VINurse, Graduated from the State University of Rio de Janeiro, Brazil, Email: dede2381@yahoo.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2014.15510

ABSTRACT: This study aimed to identify the consumption of anxiolytics by nursing staff and correlate it with occupational stress. A quantitative and descriptive method, whose data were collected through a self-administered instrument. The study included 91 nursing professionals from a public hospital in Rio de Janeiro, Brazil, in 2014.  From the subjects, 39 (42.9%), used anti-anxiety agents in life, 18 (19.9%) at the past year and 9 (9.9%) in the month. The main effects reported with the use of anxiolytics were sense of well-being, drowsiness and diminished reflexes. The consumption was associated with problems at work and among them: stress, heavy workload and conflicts with the team. It was concluded that the consumption of anxiolytics is above the established standard and the reported effects may impair the performance and quality of service. The results show the importance of the implementation of preventive strategies and educational programs with the workers.

Keywords: Nursing; anti-anxiety agents; occupational health; prevention.

INTRODUCTION

The professions most at risk for disease are those where workers face stressful circumstances such as shift work, especially night, long working hours and which require constant monitoring. In the healthcare sector, nursing professionals are the ones who are more likely to suffer from health problems resulting from occupational stress, especially in the hospital area, due to the intense pace of work and the type of activity performed, namely; care of dependent patients with diverse health problems¹. 

The different work situations associated with conflicts and feelings of dissatisfaction and demotivation of employees undertake not only the productive performance, but also the physical and mental balance of these workers. Therefore, not only the nursing professionals are affected by this problem, but workers in General, and to the institutions where Act adopt measures of organizational or administrative nature, aimed at controlling the stress factors responsible for absenteeism and illness of the collaborator².

Alert to the fact that health professionals as they face times of difficulty or crisis varied contours and meanings, can perceive the use of psychoactive substances as a strategy to facilitate the conducting of their daily lives and minimize wear before problems under family and work. They contribute to consumption, easy access in the workplace, particularly the nurses and staff who are responsible for their storage and control, while having information about their effects and the risks involved in their consumption³.

When the pattern of use of a psychoactive substance interferes negatively on the performance of the social roles of the individual, they use the denial mechanism to protect themselves from possible discomfort of which other people perceive the problem. This is a dangerous behavior when the professional activity jeopardizes the worker's safety and of third parties. In the same way that the employer must provide suitable working conditions, the employee needs to understand the incompatibility between drug consumption and their workday⁴.

From the exposed and in order to contribute with research that give visibility to issues related to personal use of anti-anxiety drugs for nursing, this study aimed to identify the consumption of anti-anxiety agents for nursing workers and relate it with occupational stress.

LITERATURE REVIEW

In recent studies, society has had great difficulty in defining the word drugs, because for many people, the term refers simply to prescription drugs to treat illness or discomfort. For others, it is an expression that has another meaning, being any chemical agent that affects the life processes, including natural and synthetic products produced in laboratories. Anxiolytic drugs, and among them the benzodiazepines, are products that reduce anxiety and depressive properties by having the central nervous system, cause physiological, psychological and behavioral changes such as relaxation, reduction of consciousness, mood and cognitive functions⁵.

Benzodiazepines (diazepam, alprazolam and others), because they have sedative and hypnotic, anxiolytic activity properties, are psychoactive drugs most prescribed worldwide, being effective in the treatment of anxiety, emotional stress and insomnia. Despite having a greater safety margin compared to barbiturates, their effects vary according to the person, the time of use and dosage, being enhanced with concomitant consumption of alcohol and other drugs, and there are risks of dependency development within a few weeks, poisoning, accidents and death due to respiratory impairment⁶.

It is still quite common the idea that drug use is not related to job demands, but with the personal characteristics of the subject, forged by previous experiences to their vocational integration. Among those who admit their relationship with the work, there is a thesis on the existence of a functional use beside a dysfunctional use of these substances.

However, after certain time of consumption, a vicious circle is installed, because the drug is no longer a resource for coping with certain demands of the job and becomes an end in itself. Little by little, its use begins to cause new problems in their work, such as punishments, compulsory transfers, demotion of function, and imposition of less interesting tasks or the pure and simple isolation of the worker⁷.

In hospitals, nursing workers are exposed to biopsychosocial risk factors arising from the responsibility of the care provided to patients in serious condition, the long days of work, the necessary upgrading of knowledge, the recoveries and the difficulties inherent in the profession that involve physical and mental wear and tear to the group. Such factors may contribute to the consumption of psychoactive substances, and the institution consider the social context in which the professional lives and how their mental health can be affected⁸.

In the elaboration of guidelines and actions for the promotion of health and prevention of the consumption of psychoactive substances, one must assess the risk factors in which concern the characteristics or attributes of the persons, groups or social environment. The vulnerability to the use of alcohol and other drugs is higher in individuals who are unhappy with their quality of life, have poor health, do not have adequate information minimally have community integration disabled and easy access to substances. In turn, if such consumption occurs in the community, community to be held under the preventive practices of greater impact on the vulnerability and risks⁹.

METHODOLOGY

We opted for the quantitative method because it is a problem in the area of healthcare workers who, by their nature, require a descriptive study for the initial diagnosis of the situation, with a view to subsequent studies¹⁰. The sample was composed of 91 nursing workers (nurses and nursing technicians), crowded into inpatient sectors a university hospital clinic, located in the municipality of Rio de Janeiro, in 2014.

Non-probabilistic sampling design was adopted, based on the following criteria for recruitment and selection of workers: be crowded in the nursing coordinating body, statutory labor regime, Hired under Employment Laws and precarious, and working for at least one year at the institution. The study excluded professionals with less than one year of experience in the service or who were on sick leave, vacation or other absences at the time the data were collected. To characterize the sample, we worked with the variables - age, sex, marital status and occupational conditions.

For identification of disorders related to the consumption of anxiolytics and work, we used the Questionnaire about the Consumption of Anxiolytics and Work (QRCAT), prepared by one of the researchers, based at the Alcohol User identification Test (AUDIT), developed by the World Health Organization (WHO), in 1980, with the specific goal of identifying the prevalence of alcohol and other drug users, containing 10 questions closed and auto fill validated for Portuguese¹¹. In the QRCAT, anxiolytic consumption patterns were collected from the following variables: estimated consumption in life (experienced) in the last 12 months (if any) and the last 30 days (regular); risk factors associated with the consumption of anxiolytics, experienced effects and implications for professional performance and the organization.

The research project was approved by Opinion No. 2542/13 of the Ethics Committee at Pedro Ernesto University Hospital (HUPE/CEP). After the subjects receiving explanations about their rights, guaranteed anonymity and could decline participation in any phase of the study, all participants signed the consent form. The statistical evaluation occurred through the development of a database on Social Science Statistical Package (SPSS), the results of which were discussed based on studies carried out in the country about the consumption of anxiolytics.

RESULTS AND DISCUSSION

Characteristics of the sample

The sample consisted of 91 nursing workers being nurses - 27 (29.7%) and nursing technicians - 64 (70.3%); most were female - 72 (79.1%) and 19 (20.9%) were men, with ages ranging 25-64 years (84.5%). They declared themselves married- 42 (46.1%), single - 37 (40.7%), divorced - 9 (9.9%) and widowed - 3 (3.3%).

In recent decades, women have expanded their roles in society. However, psychoactive drug advertising (made by laboratories) continues to display them as submissive, household activities, without any occupation or even in a sexy way, well dressed, thin, young, adult and attractive. The exaggerated representation of women, to minimize the need for more complex diagnoses, can form a prototype of depression and anxiety, in which doctors pathologizing their patients when they have circumstantial and/or transient problems. When diagnosed, men are treated for work-related stress¹². On the level of schooling, 48 (52.7%) of participants had complete higher education, 11 (12.1%) incomplete higher education and 32 (35.2%) high school.

It was evidenced that among the 64 (70.3%) nursing technicians, 21 (32.8%) complete higher education and 11 (17.1%) incomplete higher education. These results reflect the need felt by these professionals to invest in their training, which explains in part the fact that 72 (79.1%) workers, including nurses, claiming that exercised function compatible with schooling and the other, 19 (20.9%) disagree. Organizations and their professionals who invest in training become more valuable, aggregating a set of professional values socially recognized. It is assumed that their competence and qualification to contribute for the development of enterprise and the achievement of their objectives¹³. 

With regard to the type of labor regime, 51 (56%) professionals were statutory, 29 (31.9%) temporary and 11 (12.1%) CLT, 60 (65.9%) reported having more than a link, which explains in part the fact that 45 (49.4%) workers comply hours worked more than 40 hours per week. Temporary contracts translate into precarious working relationship, present even in public institutions, which causes suffering due to labor rights of losses, differential treatment and the need for other links to meet the needs of the individual. As an aggravating factor the situation, overloaded with work injury and psychosocial for the individual, which states the little time devoted to self-care, leisure and living with family¹⁴. 

The consumption of anxiolytics by nursing workers

The consumption of anxiolytics in life (non-experimental) was reported by 39 (42.9%) workers. Of these, 18 (19.8 percent) reported use in the past 12 months preceding the data collection and 9 (9.9%) used them in the last month (regular use). Comparing the results with study carried out in the country by the Brazilian Center for Information About Drugs (CEBRID), it was found that the consumption of anxiolytics by sample, is well above the consumption pattern in the Brazilian population, in which benzodiazepines (anti-anxiety drugs) in third place and whose consumption was 5.6% in the last twelve months 2.6% and regular 1.3%. International bodies, such as the who and the International Narcotics Control Board (INCB), have warned about the indiscriminate and the insufficient control of psychotropic drugs in developing countries, in which it notes the use of these medications without prescription⁵. 

Nursing plays a distinguished work of other workers in hospitals, being a continuous activity, stressful and exhausting, developed from an interpersonal relationship with clients.  Due to all this wear, some workers use psychoactive substances as a way to minimize the tension, stress and coping mechanism to deny or minimize the perception of reality that makes them suffer¹.

The use of psychoactive substances, whether prescribed or not, increases by five times the odds of accidents at work, relating to 15 to 30% of these occurrences and accounts for 50% of absenteeism and sick leave. It is the occupational health service company, focus preventive and educational actions and develop health care programs for the worker, with prevention of misuse of psychoactive substances in the workplace as an employee of the right and duty of the employer⁴.

With regard to access, 35 (38.5%) workers reported they got the medication by prescription, 5 (5.5%) in the workplace, 3 (3.3%) with friends, 2 (2.2%) with family and 1 (1.1%) with co-workers. Study of patients who use regularly anxiolytic drugs, showed that the main strategy used in this group was the acquisition of revenue next to friends or family doctors, and prescription request to different doctors (alternately). Thus, the frequent demand for prescription medication controlled, drove them to an increasing refinement of complaints and the simulation of diseases. Even those who seek to relieve anxiety and stress of life through the use of prescribed anxiolytics, used prescription acquisition strategies with the doctor through simulation and seduction¹⁵.

In another study conducted with nursing workers, identified that professional to obtain the relief of tensions or craving the healing of physical or psychic disorders used to drug therapies, self-medicating. They contribute to consumption, knowledge of drugs available and the ease of access by the employee - that contrary to self-medicate - should seek proper investigation of their state of health and the treatment of experts¹⁶. This ratifies the importance of controlling the dispensing of benzodiazepines, as today the main problems related to improper use are poor clinical indication, misinformation physician and lack of awareness from both the physician and the pharmacist. In addition to the risk of addiction associated with chronic use of anti-anxiety drugs, there is a risk of lethal poisoning, especially when associated with alcohol and other psychotropic substances¹⁶.

The consumption of anxiolytics and its association with work

When assessing the levels of agreement of 35 (38.5%) workers about psychosocial risk factors that contributed to the consumption of anxiolytics the last 12 months - according to the sum of answers - identified individual nature of factors due the personal, financial and family problems. As for the work itself, was associated with occupational stress due to double shifts, night work, heavy workload, dissatisfaction with working conditions and the conflicted interpersonal relationships with managers and colleagues, according to Table 1.

The identification of risk factors involved in the consumption of anxiolytics by nursing staff, must consider the social environment, their life story, the very condition of being human, as anguish and fear, dissatisfaction, frustration, more or less degree, which can propel these individuals to seek ways to bring relief to their problems and pleasure not found1.

Regarding factors that lead to dissatisfaction with the job, one must pay attention to working conditions, salary, staff supervision, policy and administration of the company. Nursing professionals, in addition to complying with strenuous load, don't always have good working conditions13. There is a relationship between the characteristics of work organization and stress levels among nurses working in shifts, especially at night due to the impediment of sleep, resulting in the use of medications to relax and fall asleep at the end of the workday, for having changed the circadian rhythms and sleep impaired¹⁷.

Effects experienced with the use of anxiolytics and performance

Because the nursing professionals, who participated in the study, working in sectors of medium and high complexity, whose patients have varying degrees of reliance on care on the part of the team, it is relevant to know the effects obtained with the use of anxiolytics for part of the group. After all, by the fact, the anxiolytic drugs affect cognitive, emotional and motor individual consumption while providing sense of well-being by reducing stress and anxiety, causes other proven effects and including drowsiness, dizziness, gait abnormality, risk of falls, depression and sleep pattern changes with damage to health and well-being⁵.

Among the 35 workers who have used sleeping pills in the last 12 months, the main effects experienced, according to the level of agreement, were: sleepiness 24 (68.5%) feeling of well-being 17 (48.5%) and decreased reflexes 8 (22.8%). Such effects entail repercussions for performance and organization, according to table 2.

Study of nurses who do not use of benzodiazepines, compared to those who used them, found in that portion of workers, changes in quality, latency and sleep duration, with the consequences sleepiness during the day, decreased state alert, unwell to perform the daily activities and high level of stress¹⁷. Therefore, it should be recommended for the good guidance with precise, careful, and monitoring of benzodiazepine users, as well as problems within organizations, there are repercussions for the individual and, including dependency, tolerance and abuse⁶.

Workers to position themselves about the experienced effects and anxiolytic consumption of the impact on performance and organization, as shown in Table 2, there was problems that affect the health of workers due to the need for medical care during the shift and work related accidents. On the quality of service offered, there was reference to errors in performing technical procedures and overloading of other workers due to early departures and other problems.

The anti-anxiety drugs stimulate brain mechanisms that generally balance States of tension and anxiety and, in addition, the mechanisms that inhibit work excessively due to day-to-day tensions that lead to alertness. As a result of this inhibition, the person expressed greater tranquility and is less responsive to external stimuli. These drugs still complicate the learning and memory processes, they also change the motor functions and affect activities that require quick reflexes¹⁷.

In the process of nursing work and the numerous responsibilities inherent to the function, carry physical and mental demands, being factors of fatigue and illness generators due to work burden. The recovery times or pauses for rest are nonexistent or are too short and insufficient for the recovery of energy. Thus, the demands of work, undertake the organic plasticity, producing a gradual erosion that may potentiate the use of drugs by professionals¹.

This reiterates that the traditional motivations humans the use of psychoactive substances should be the need for compensation before an adverse reality of imbalances in the various dimensions of life such as family, work, study and leisure. Research conducted in nursing showed that those who consumed some type of psychoactive substance, developed a second working day at home, did not practice leisure and despite having positive feelings towards work, considered a stressful activity³.

CONCLUSION

It was evidenced that a significant number of nursing professionals, more than a third, anxiolytics consumed in life, a part of the past 12 months and the other in the month of data collection (regular use), the anxiolytic drugs being obtained by prescription, in the workplace, with friends and family. It is ratified that the sample consumption profile is well above the standard identified in major Brazilian cities, and whose use still occurs without prescription, despite the restrictions imposed in the country as compared to the control and distribution.

The consumption of anxiolytics was associated with problems of personal, family and work order, and in the workplace were identified risk factors for use as a heavy workload, the double employment and night work. Among the effects experienced, there was reference to sensation of well-being, sleepiness, decreased reflexes, hypotension, slurred speech, memory lapses and depression. Such effects, and affect the health of the worker due to the demand for medical attention, bring implications for performance and quality of service offered due to the association with errors in procedures, workload of other workers, anticipated outputs and faults.

Despite the impossibility of generalization of the results for other contexts of work due to the limitation of the sample and for having been used only one of the services of the hospital complex, it was found that there is no relationship between the consumption of anxiolytics and work, with losses to the professional practice and the organization. This reiterates the importance of the control of the dispensing of anxiolytics and awareness of professionals about the risks involved in their consumption, whose nomination must be made by specialized professional, avoiding self-medication.

There is need for support from the institution and employee participation in projects that enable working conditions as strategies of prevention of consumption and minimizing the wear due to problems in the social and occupational environment.

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