ORIGINAL RESEARCH

Research topics of the Study Group on Occupational Health of Nursing and Health Personnel

Silmar Maria da Silva^I; Anna Claudia Mauricio Telles^II; Cristiane Helena Gallasch^III; Mirian Cristina dos Santos Almeida^IV; Patricia Campos Pavan Baptista^V; Vanda Elisa Andrés Felli^VI

^I Nurse. Master in Nursing. PhD in Sciences, Post-Graduation Program in Nursing Management, University of São Paulo. Brazil. E-mail: silmarmaria@uol.com.br
^II Nurse. Master in Nursing. PhD student in Sciences, Post-Graduation Program in Nursing Management, University of São Paulo. Brazil. E-mail: annacmauricio@yahoo.com.br
^III Nurse. PhD in Nursing. Adjunct Professor, Faculty of Nursing, Rio de Janeiro State University. Brazil. E-mail: cristiane.gallasch@gmail.com
^IV Nurse. Master in Nursing. PhD student, Graduate Program in Nursing Management, University of São Paulo. Brazil. E-mail: miriandresp@hotmail.com
^V Nurse. Associate Professor, Department of Professional Orientation, School of Nursing, University of São Paulo. Brazil. E-mail: pavanpati@usp.br
^VI Nurse. Senior Professor, School of Nursing, University of São Paulo, Brazil. E-mail: vandaeli@usp.br

DOI: http://dx.doi.org/10.12957/reuerj.2016.22974

ABSTRACT

Objective: to examine topics of scientific production by the Study Group on Occupational Health of Nursing and Health Personnel, from 1997 to 2014. Method: this was a quantitative and descriptive documentary study. Data collection and document analysis, in the first half of 2015, was based on information from the Lattes résumés of the group's researchers. Results: 261 scientific publications on workers' health were identified in that time period. The predominant theme in those publications was "exposure to overwork and/or job strain", followed by "implications for worker and job", "workers' health management and proposals for intervention" and "workers' health surveillance". Conclusion: study of the research topics points to gaps that should guide the construction of new studies.

Keywords: Research groups; nursing research; occupational health; health-disease process.

INTRODUCTION

Research in the worker health area has studied the relationships between the worker and the work environment to understand the dynamics of his health-disease process¹. Work can greatly influence this process, promoting health or resulting in illness. In this approach, worker health should be analyzed from an interdisciplinary perspective and work as an organizational space of social life, where the psychosocial aspects of work are relevant^2,3.

The configuration of the sickness profile of nursing workers has been influenced, particularly, by the changes in the work process, determined by the economic policies adopted. In this sense, there is a high workload, low remuneration, extremely demarcated hierarchical and power relationships, low autonomy in the work process and high demands to achieve institutional objectives and to improve productive and quality indicators. These conditions make work precarious and, consequently, contribute to the emergence of several health problems among nursing workers⁴.

In the nursing area, studies have focused predominantly on descriptive approaches and, in some cases, intervention proposals focused on coping strategies, with difficulties related to their implementation⁵. In this context, the Research Group on the Nursing and Health Worker Health (GESTES), which began its scientific activities in 1997, under the leadership of a professor at the School of Nursing of the University of São Paulo (EEUSP), has been producing knowledge on the subject. The group is registered in the Directory of Research Groups of the National Council for Scientific and Technological Development (CNPq), and today it has one more teacher in its leadership, six doctoral students, two master's degrees and four research members from other universities. GESTES holds monthly meetings with leaders, researchers, and undergraduate and graduate students.

Over the last 18 years, GESTES has published significant scientific output through the development of scientific initiation studies, course completion work, dissertations, and theses, contributing to the training of human resources and to developing exchanges with other national and international research groups, through surveys, technical visits and partnerships. In the development of GESTES, several studies were focused on the subject, under different theoretical-methodological approaches, which generated important scientific knowledge. Thus, it is considered relevant to rescue this production, allowing greater visibility on what has already been published and look for the gaps of the specialty to be investigated.

Thus, this article aimed to analyze the published scientific production of the group, in the study themes.

THEORETICAL REFERENCE

Nursing work has been shaped by neoliberal and globalized politics, leading to the precariousness of conditions and labor relationships, favoring the sickness of the worker and influenced the quality of care provided⁶. The precariousness of work arises in response to the demands of the globalized world, prompted by the competitiveness of the neoliberal model, generating a restructuring of work organization to reducing expenses and increasing productivity, to the detriment of worker health^7,8.

The understanding of the relation work process, its organization and the impact that generates to the nursing workers, has been studied from a critical and reflective view, allowing the understanding that the nursing work, like the others, is inserted in a macroeconomic and political context that undergoes influence and influences workers´ way of living and working⁷. In this context, there is an increase in studies on the health of the nursing worker in the last two decades, with emphasis on injuries related to the psychic apparatus, accidents with biological material and musculoskeletal problems, due to the way in which nursing work has been organized^9-11. The social division of labor, the routinization of tasks, the low autonomy, as well as the work developed under high pressure - with a demand for speed of action and demand for work - expressed by a large volume of work, representing important factors of the process of work and having an impact on nursing workers' illness¹².

Therefore, the investigations emerge from the needs experienced by nursing workers in the context of work, and they aim to construct a diagnosis of the morbidity profile of the workers to the identification of a fertile field for transformations.

METHODOLOGY

This is a descriptive documentary study, with a quantitative approach, referring to the publications carried out by GESTES, from 1997 to 2014.

Data collection and document analysis took place in the first half of 2015, following the following steps:

- Identification with the leaders of the group, of the graduates and current researchers;

- Access to the curriculum lattes (http://lattes.cnpq.br/) of alumni and current members of the group for the identification of publications in partnership with the leaders of the group;

- Organization of publications in an electronic matrix, containing order number, name of the first author, title of the publication and complete reference of the publication;

- Capture of the scientific production identified, according to the references, in the format of full text or abstract in the databases of the research portal of the Virtual Health Library (http://bvsalud.org/), Google School, Annals of National and international scientific events, Dedalus - USP Bibliographic Database (http://dedalus.usp.br/F), USP Bank of Thesis (http://www.teses.usp.br/), Banco de Monographs of the EEUSP (http://www.ee.usp.br/site/index.php/paginas/mostrar/413/51).

- Reading of the full text or abstract of all identified production and deletion of duplicate publications;

- Classification of publications according to the content studied (themes and subthemes), after analysis of the texts, and the type of publication (article, book chapter, thesis, dissertation, monograph, publication in Annals of events).

The eligibility criteria applied for the selection of the data to be analyzed all the surveys published by alumni and researchers in partnership with the GESTES leaders, from 1997 to 2014.

The results are presented in a table and a figure, after simple descriptive analysis, using absolute and relative frequencies, using spreadsheets in MicrosoftExcel®.

RESULTS AND DISCUSSION

A total of 261 scientific papers related to workers' health were identified and published by the GESTES members from 1997 to 2014. The abstracts of this study were analyzed, highlighting the main objective of each study. From the analysis of this material, 10 themes emerged. The 10 subjects investigated are related in Figure 1. The most frequent were 1 - Exposure to workloads and/or wear process at work (122; 46.74%), followed by 4 - Implications for the worker and work (39; 14.94%), 5 - Management and intervention proposals for workers' health (36; 13.79%) and 9 - Worker Health Surveillance (26; 9.96%). The other item is surveys that involve personal protective equipment (PPE) and legal approaches to worker health.

The analysis of the classified publications in each of the 10 themes allowed the identification of 29 subthemes studied, as evidenced in Table 1. The following subthemes were highlighted: Worker´s health problems (30; 10.14%) and Indicators (27, 9.12%). On the other hand, there is reduced production on the use of PPE, Epidemiological profile of the worker, Prevention of accidents and Policies of the health of the worker.

TABLE 1: Distribution of the scientific publications of GESTES in the period from 1997 to 2014, according to the themes and subthemes studied. São Paulo, 2016.

^(*) Some studies address more than one subtheme.

It is worth noting the importance of these themes since the knowledge of the real intervening factors of the health-disease process of the worker allows to obtain a precise diagnosis and to carry out interventions to reduce the incidence of illness and injuries. Thus, the identification and analysis of the themes studied and published by GESTES, between 1997 and 2014, implying the discussion of the determinants of occupational diseases and injuries, favoring the diagnosis, interventions, prevention and health promotion of the nursing worker in the Brazilian reality.

For this, it is necessary to point out that GESTES adopts the theoretical reference of social determination, proposed by Laurell and Noriega ¹³ and adapted for the nursing workers¹⁴ describing the workloads as elements of the labor process that interact with each other and with the body of the worker, demanding continuous efforts of adaptation and regulation, generating wear represented by the physical or psychic illness, as well as by the accidents of work.

In this sense, workloads are responsible for the war processes that affect nursing workers, whether in the work accidents and/or health problems¹⁵.

From the GESTES publications, the theme 2 - Exposures to workloads and/or wear process at work was predominant. The study of workloads and wear processes has also been the object of other research, such as an integrative review of 27 productions, which analyzed the relationship of these factors with the health of the nursing worker¹⁶.

Regarding the workloads, the most studied were the psychic loads, followed by the biological, physiological and chemical ones, according to Table 1. Among the contents that deal with the psychic loads are psychological aggression, monotonous and repetitive work, constant attention, female work, lack of collective defenses, alcohol and drug abuse, the speed of work, lack of communication, strict supervision of the bosses and other professionals, lack of creativity and autonomy^17,18.

Sometimes, it is possible to observe that the wear associated with psychic loads was accompanied by reports of discrimination by colleagues and supervisors, as well as feelings of guilt about illness^17,19. It can also rethink how much the psychic suffering can impact on the work developed by these workers and, consequently, on the quality of nursing care.

Recent research brings the concern of nursing managers about the safety of patients, considering the number of nursing workers with psychic disorders²⁰.

Corroborating this problem, a qualitative study carried out in a teaching hospital showed that the psychic loads were related to the painful work inherent to the nursing activity, to living with pain and death, and also due to the life history and socioeconomic difficulties of the individual, having necessary preventive and assistance actions to the physical and mental health of nursing workers²¹.

The absence of these actions, aimed at psychic injuries resulting from exposure to psychic loads and the interaction of other loads, leads to physical and mental exhaustion, mental and behavioral disorders, which have been the object of different research due to their numerical expressiveness and impact on the quality of life of the worker, as well as in the organization of services, signaling the need for interventions^18,22.

Regarding the biological loads, the exposure is due to contact with infective agents in the exercise of labor activity, such as contact with patients with infectious or parasitic diseases and handling of infected materials and equipment, especially the sharps instruments. Physiological loads are present in the handling of equipment and patients, excessive weight, night and shift work, repetitive activity, and the adoption of inappropriate postures during work. Chemical loads are due to exposure to chemical substances in the preparation and administration of drugs and the process of disinfection and sterilization of materials²³. Research that focuses on musculoskeletal problems were developed through validated instruments, seeking to locate the most affected segments of the body²⁴ or the deeper analysis of work-related musculoskeletal disorders.

Musculoskeletal health problems were also identified as major causes in other studies, which used Simoste software²⁵ to monitor the health of nursing workers. In a study carried out in São Paulo, it was possible to show that osteoarticular problems were the most prevalent, followed by accidents with biological material and mental and behavioral disorders. In Recife, there was different wear among nursing workers, and among them osteoarticular disorders^26,27. In São Paulo, another study that followed the monitoring of nursing workers in a hospital in a three-month period, through the software Simoste²⁵, was able to capture 1847 occurrences, with a high prevalence of osteoarticular disorders, respiratory system, consequences of external causes (traumas), infectious diseases, mental and behavioral disorders, demonstrating the importance of identifying these diseases for intervention and prevention²⁸.

Work accidents, which are still frequent in the daily practice of nursing, were also approached in different studies, such as accidents with sharps and biological material, with an emphasis on prevention strategies. This type of accident is related to both biological and mechanical loads. It should be noted that exposure to the biological material can also trigger the worker´s psychological suffering, expressed by feelings and emotions of fear, guilt, and despair, culminating in the conflict of feeling between life and death¹⁹.

The theme 4 - Implications for workers' health and work was the second most studied, with emphasis on the subthemes Quality of life, Ability to work and Absenteeism. The quality of life publications, especially at work, included teachers, professionals, and students of nursing, as well as workers in the cleaning sector. They dealt with both aspects of daily life of the worker, such as those related to working conditions, transfer to the night shift, the relationship between management and quality of life at work, and repercussions of occupational diseases, such as musculoskeletal disorders, on workers' quality of life.

One of the studies on the quality of life of nursing workers with musculoskeletal disorders showed that the injury was related to the presence of pain and consequent limitations and inadequacies in the organization and work process, impacting the quality of life-related to health and work²⁹. The worker's quality of life has an important meaning because it interferes with the work process and, consequently, in the safety of the worker and the patient³⁰. An integrative review of the literature indicates that the physical and psychological shocks to which the nursing worker are exposed, precarious working conditions, dissatisfaction with pay, double working hours, dissatisfaction with work, overloading of activities, inadequate staffing, exhausting work processes, night work, lack of professional recognition and work accidents are among the factors that interfere with the quality of life³¹.

The ability to work was studied, primarily with nursing workers, along with other factors such as fatigue, musculoskeletal disorders, worker's health-illness process and feelings about being disabled and returning to work. One study carried out in a teaching hospital, revealed that 35% of nursing staff in medical and surgical clinic units present inadequate (moderate and low) functional capacity, being associated with fatigue, longer working time and the role of Nursing technician³².

Nursing research has shown an association between musculoskeletal disorders and psychic disorders with an incapacity for work and absenteeism. After being removed by these disorders, the return to work is quite complex, since it involves prejudice and stigma, and must be carefully monitored since it requires the performance and understanding of several actors to be a healthy process and not to boost or worsen the incapacity. Among the interventions in this scenario, the clarification about the implications of these injuries to workers and the resizing of the team are highlighted^22,33.

As for the subtheme Absenteeism, a study corroborates the findings of other researchers in which musculoskeletal, mental and behavioral disorders are among the main causes of removal. A survey analyzing sick leave in nursing professionals at a university hospital in one year showed that mental and behavioral disorders represented 3,393 days (28.4%) of sick leave, the second cause of absences in the work, preceded only by diseases of the musculoskeletal system and connective tissue (4,957 days, 41.5%) 34. These findings point to the problem of absenteeism and its influence on the quality of the care provided and the work overload to other healthy workers of the teams, which can result in a cycle of illness and disability.

The third most studied theme, 5 - Management and intervention proposals for workers' health, presents 18 publications focused on management issues and intervention proposals. The research conducted at GESTES points to the role of nursing managers in the sense of collaborating and influencing changes necessary for prevention, rehabilitation and health promotion of the nursing worker. Support to managers is essential for organizational changes, with the implementation of health promotion programs in the workplace, for the physical and psychosocial well-being of health professionals³⁵. According to the World Health Organization, in a healthy work environment, workers and managers collaborate in the process of continuous improvement, protecting and promoting the health, safety, and well-being of workers and the sustainability of the work environment³⁶.

Programs and research aimed at health workers grew later when compared to other labor sectors. The planning and implementation of interventions to prevent accidents and diseases or to promote health in this population should be carried out with the participation of the subjects, support networks, and appropriate instruments to verify the results in the short, medium and long term³⁷. Also, interventions must be tailored to each workplace to promote an adequate environment and the proper development of health work, encouraging workers to promote significant differences in the lives of their patients and to interact and collaborate with their colleagues and managers³⁸.

Theme 9, Occupational Health Surveillance was the fourth with more publications. The increase in this production was accompanied by the awareness of managers and professionals about the importance of worker health indicators, through the dissemination and publication of the data to health services to facilitate the planning, execution, and evaluation of the promotion, prevention, and intervention.

From this point of view, the initial research on the subject was aimed at understanding the problems involved in the nursing worker's illness, such as the identification of the loads they were exposed and the wearing processes, with a view to constructing the indicators for the monitoring of working conditions and health, in search of measures to intervene and promote quality of life at work³⁹.

This initiative of mapping the health of the worker and elaborating health indicators to guide the actions follows the trend of other publications in the area. When conducting a brief survey in the Virtual Health Library, there is an increase in the surveillance study from the end of the 1990s and a progressive increase from the decade of 2000. In this perspective of the Surveillance to the health of the worker, and to carry out a situational diagnosis and to support the necessary interventions in the work environment, GESTES developed and patented software for this purpose, named Nursing Worker Health Monitoring System (SIMOSTE)²⁵. Its main objective is to capture the health problems of nursing workers, referring to workloads and the determinants of the wear process, as well as to characterize the institutional profile. SIMOSTE was implemented in seven hospitals in different regions of Brazil, and from the 27 publications on the topic of worker health surveillance, 17 originated from SIMOSTE, allowing the monitoring of nursing workers in each institution, and a knowledge of the context of the work of these professionals, both at national and regional level, allowing managers to base their interventions in an individualized way to meet the needs of their context²⁵.

Theme 10 classified as Others has contents on legislation, with three publications, and PPE, with a publication. Although they are less published subthemes, GESTES considers its importance and hopes that, in the future, this production will be expanded, guided by the National Health Policy of the Worker and by the Nursery Worker's Handbook. However, it is believed that a specific policy for the health of the nursing worker is still needed⁴⁰.

CONCLUSION

When analyzing the scientific production of GESTES, it was possible to perceive that Exposures to workloads and wear processes at work have been the topics most approached by its researchers, followed by Implications for the worker and work, Management and intervention proposals for the Workers' health and Occupational Health Surveillance.

The analysis also managed to identify the existence of knowledge gaps in the ​​worker health area. Such gaps may guide researchers in the development of new research, along with less explored topics, such as studies that implement interventions and evaluate their results, studies that relate the working conditions and sickness of the nursing worker with the repercussions in clinical practice, such as the occurrence of errors and the compromise of patient safety, studies that associate worker health, engagement and the organizational climate, or even studies that may contribute to the promotion of worker health, such as those of resilience.

REFERENCES

1.Abreu RMD, Gonçalves RMDA, Simões ALA. Reasons attributed by professionals of an Intensive Care Unit for the absence at work. Rev. bras. enferm. [Internet]. 2014 June [cited 2015 Sep 07]; 67(3):386-93. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672014000300386&lng=en . http://dx.doi.org/10.5935/0034-7167.20140051

2.Campos JF, David HMSL, Souza NVDO. Pleasure and suffering: assessment of intensivist nurses in the perspective of work psychodynamics. Esc. Anna Nery [Internet]. 2014 Mar [cited 2015 Sep 07]; 18(1): 90-5. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452014000100090&lng=en . http://dx.doi.org/10.5935/1414-8145.20140013

3.Cruz EJER, Souza NVDO, Correa RA, Pires AS. Dialectic feelings of the intensive care nurse about the work in Intensive Care. Esc. Anna Nery [Internet]. 2014 Sep [cited 2015 Sep 07]; 18(3): 479-85. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452014000300479&lng=en . http://dx.doi.org/10.5935/1414-8145.20140068

4.Rodrigues EP, Rodrigues US, Oliveira LMM, Laudano RCS, Sobrinho CLN. Prevalence of common mental disorders in nursing workers at a hospital of Bahia. Rev. bras. enferm. [Internet]. 2014 Apr [cited 2015 Sep 07]; 67(2):296-301. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672014000200296&lng=en . http://dx.doi.org/10.5935/0034-7167.20140040

5.Ribeiro RP, Martins JT, Marziale MHP, Robazzi MLCC. Work-related illness in nursing: an integrative review. Rev esc enferm USP [Internet]. 2012 Apr [cited 2015 Sep 15]; 46(2): 495-504. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342012000200031&lng=en . http://dx.doi.org/10.1590/S0080-62342012000200031

6.Gonçalves FGA, Souza NVDO, Zeitoune RCG, Adame GFPL, Nascimento SMP. Impacts of neoliberalism on hospital nursing work. Texto contexto - enferm. [Internet]. 2015 Sep [cited 2015 Oct 01]; 24(3):646-53. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072015000300646&lng=en . http://dx.doi.org/10.1590/0104-07072015000420014

7.Gonçalves FGA, Souza NVDO,Pires AS, Santos DM, D'Oliveira CAFB, Ribeiro LV. Modelo neoliberal e suas implicações para a saúde do trabalhador de enfermagem. Rev enferm UERJ. 2014; 22(4):519-25.

8.Nideck RLP, Queiroz PP. Professional training and labour crises: contradictions in the unified health system: a dialectical method. OBJN [Inernet]. 2012 Oct [cited 2015 Oct 01]; 11(2): 496-9. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/3964

9.Davis KG, Kotowski SE. Prevalence of musculoskeletal disorders for nurses in hospitals, long-term care facilities, and home health care: a comprehensive review human factors. Human factors.2015; 57(5): 754-92.

10.López-Montesinos MJ. Psychosocial study about the consequences of work in hospital nurses as human resource management. Rev. Latino-Am. Enfermagem [Internet]. 2013 Feb [cited 2015 Oct 01]; 21(spe):61-70. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692013000700009&lng=en . http://dx.doi.org/10.1590/S0104-11692013000700009

11.Sousa SS, Costa NA, Mascarenhas MDM. Caracterização das exposições ocupacionais a material biológico entre trabalhadores de hospitais no Município de Teresina, Estado do Piauí, Brasil, 2007 a 2011. Epidemiol serv saúde. 2013; 22(1): 165-70.

12.Urbanetto JS, Magalhaes MCC, Maciel VO, SantAnnaVM, Gustavo AS, Poli-de-Figueiredo CE et al. Work-related stress according to the demand-control model and minor psychic disorders in nursing workers. Rev esc enferm USP [Internet]. 2013 Oct [cited 2015 Oct 15]; 47(5): 1180-6. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342013000501180&lng=en . http://dx.doi.org/10.1590/S0080-623420130000500024

13.Laurell AC, Noriega M. O processo de produção e saúde: trabalho e desgaste operário. São Paulo: Hucitec; 1989.

14.Silva VEF. O desgaste do trabalhador de enfermagem: estudo da relação trabalho de enfermagem e a saúde do trabalhador [PhD thesis]. São Paulo: Universidade de São Paulo; 1996.

15.Felli VEA, Baptista PCP, Karino ME. Abordagens teórico-metodológicas de estudos sobre a saúde do trabalhador. In: Felli VEA, Baptista PCP, organizadoras. Saúde do trabalhador de enfermagem. Barueri (SP): Manole; 2015. p. 20-41.

16.Schmoeller R, Trindade LL, Neis MB, Gelbcke FL, Pires DEP. Nursing workloads and working conditions: integrative review. Rev. Gaúcha Enferm. (Online) [Internet]. 2011 June [cited 2015 Nov 15]; 32(2): 368-77. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472011000200022&lng=en . http://dx.doi.org/10.1590/S1983-14472011000200022

17.Mininel VA, Baptista PCP, Felli VEA. Psychic workloads and strain processes in nursing workers of brazilian university hospitals. Rev Latino-Am Enfermagem [Internet]. 2011 [cited 2015 Nov 15]; 19(2): 340-7. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692011000200016&lng=pt . http://dx.doi.org/10.1590/S0104-11692011000200016

18.Baptista PCP, Tito RS, Carvalho MB. A exposição às cargas psíquicas e os processos de desgaste emtrabalhadores de enfermagem. In: Felli VEA, Baptista PCP, organizadoras. Saúde do trabalhador de enfermagem. Barueri (SP): Manole; 2015. p. 189-203.

19.Bernardes CL, Baptista PCP. Occupational exposures to biological fluids – rethinking intervention strategies: a qualitative study. OBJN. 2015; 14(3): 332-42.

20.Baptista PCP. Incapacidade no trabalho: a compreensão de gerentes de enfermagem [livre-docência]. São Paulo: Universidade de São Paulo; 2014.

21.Secco IAO, Robazzi MLCC, Souza FEA, Shimizu D S.Cargas psíquicas de trabalho e desgaste dos trabalhadores de enfermagem de hospital de ensino do Paraná, Brasil. SMDA Rev eletrônica saúde mental álcool drog. (Ed. port.). 2010; 6(1): 1-17.

22.Penteado PE. Retorno ao trabalho de trabalhadores de enfermagem oncológica após afastamento por transtornos mentais [master degree]. São Paulo: Universidade de São Paulo; 2014.

23.Costa TF, Takayanagui AMM. A exposição às substâncias químicas e o gerenciamento de resíduosperigosos. In: Felli VEA, Baptista PCP, organizadoras. Saúde do trabalhador de enfermagem. Barueri (SP): Manole; 2015. p. 130-55.

24.Ferrari AL, Baptista PCP, Felli VEA, Coggon D. Translation, Adaptation and Validation of the "Cultural and Psychosocial Influences on Disability (CUPID) Questionnaire" for Use in Brazil. Rev. Latino-Am. Enfermagem [Internet]. 2010 Dez [citado 2015 Dez 07]; 18(6): 1092-8. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692010000600008&lng=pt . http://dx.doi.org/10.1590/S0104-11692010000600008

25.Felli VEA, Mininel VA, Sarquis LMM, Karino ME, Silva FJ, Costa TF et al. Sistema de Monitoramento da Saúde do Trabalhador de Enfermagem– Simoste. In: Felli VEA, Baptista PCP, organizadoras. Saúde do trabalhador de enfermagem. Barueri (SP): Manole; 2015. p. 204-55.

26.Silva SM, Silva FJ, Tito RS.Identificação de cargas de trabalho e processos de desgastes nos trabalhadores de Enfermagem em Recife. Referência revista de enfermagem. 2011; 3(Supl): 557.

27.Baptista PCP, Vitorino DC, Silva FJ, Costa TF, Tito RS. Identificação de cargas de trabalho e processos de desgaste nos trabalhadores de enfermagem em São Paulo.Referência revista de enfermagem. 2011; 3(Supl): 556.

28.Bernardes CL, Vasconcelos LHS,Baptista PCP, Felli VEA,Silva SM, Pustiglione M et al. Health problems of nursing workers in a public educational institution. Rev esc enferm USP [Internet]. 2014 Aug [cited 2015 Dec 07]; 48(4): 677-83. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342014000400677&lng=en . http://dx.doi.org/10.1590/S0080-623420140000400015

29.Ratier APP. Qualidade de vida de trabalhadores de enfermagem com distúrbios osteomusculares relacionados ao trabalho [master degree]. São Paulo: Universidade de São Paulo; 2012.

30.Kogien M, Cedaro JJ. Public emergency department: the psychosocial impact on the physical domain of quality of life of nursing professionals. Rev. Latino-Am. Enfermagem [Internet]. 2014 Feb [cited 2015 Dec 07]; 22(1): 51-8. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692014000100051&lng=en . http://dx.doi.org/10.1590/0104-1169.3171.2387

31.Amaral JF, Ribeiro JP, Paixão DX. Qualidade de vida no trabalho dos profissionais de enfermagem em ambiente hospitalar: uma revisão integrativa. Espac saude. 2015; 16(1):66-74.

32.Silva FJ, Felli VE, Martinez MC, Mininel VA, Ratier AP. Association between work ability and fatigue in Brazilian nursing workers. Work. 2016; 53(1):225-32.

33.Silva SM, Baptista PCP. A incapacidade vivenciada por trabalhadores de enfermagem no retorno ao trabalho. Cienc cuid saude.2013; 12(3):522-8.

34.Sancinetti TR, Gaidzinski RR, Felli VEA, Fugulin FMT, Baptista PCP, Ciampone MHT et al. Absenteeism - disease in the nursing staff: relationship with the occupation tax. Rev esc enferm USP [Internet]. 2009 Dec [cited 2016 Feb 15]; 43(spe2): 1277-83. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342009000600023&lng=en . http://dx.doi.org/10.1590/S0080-62342009000600023

35.Zhang Y,Flum M,West C,Punnet L. Assessing organizational readiness for a participatory occupational health/health promotion intervention in skilled nursing facilities. Health promot pract.2015; 16(5): 724-32.

36.Burton, J. WHO Healthy workplace framework and model. Geneva (Sw): World Health Organization; 2010.

37.Reinhardt EL, Fischer FM. Barreiras às intervenções relacionadas à saúde do trabalhador do setor de saúde no Brasil. Rev panam salud publica. 2009; 25(5): 411-7.

38.Smith LH, Aust B, Flyvholm MA. Exploring environment-intervention fit: a study of a work environment intervention program for the health care sector. Scientific World Journal [Pubmed] 2015 [cited 2015 Dez 15]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562090/pdf/TSWJ2015-272347.pdf

39.Baptista PCP, Ratier APP, Vasconcelos LHS. Propostas de intervenção para a melhora da saúde dos trabalhadores. In: Felli VEA, Baptista PCP, organizadoras. Saúde do trabalhador de enfermagem. Barueri (SP): Manole; 2015. p. 330-44.

40.Almeida MCS, Silva A, Cianciarullo TI, Baptista PCP. Políticas públicas na saúde do trabalhador. In: Felli VEA, Baptista PCP, organizadoras. Saúde do trabalhador de enfermagem. Barueri (SP): Manole; 2015. p. 345-66.