ORIGINAL RESEARCH

Contextual meanings and the needlestick accident: repercussions for nursing care

Lígia Santana Rosa^I; Gláucia Valente Valadares^II; Querén-Hapuque Delaquila Machado Pedreira^III; Laura Regina Ribeiro^IV

^I Nurse. MS. Doctorate Student, Federal University of Rio de Janeiro. Brazil. E-mail: lilimatipo@gmail.com
^II Nurse. PhD. Associate Professor, Federal University of Rio de Janeiro. Brazil. E-mail: glauciavaladares@ig.com.br
^III Student of the Nursing Course, Federal University of Rio de Janeiro. Brazil. E-mail: queren_hapuque1993@hotmail.com
^IV Student of the Nursing Course, Federal University of Rio de Janeiro. Brazil. E-mail: laura.regina.ribeiro@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2018.33767

ABSTRACT

Objective: to analyze the contextual meaning in which the accident with sharp equipment occurs. Method: a qualitative study, based on the Grounded Theory, approved by the Research Ethics Committee. Twenty nursing professionals from a municipal public hospital in Rio de Janeiro participated by a semistructured interview from july 2013 to april 2014. Data were analyzed in the light of this method: open, axial and selective coding. Results: three categories reveal the contextual meaning: perceiving the work context: a reality; interacting with teams in the work environment; reflecting on the profession and care with the nursing professional. Conclusion: the categories indicate the complexity of certain sectors, inadequate physical and material resources, disorganization in the work process, lack of support in the care of accidents with biological material as main contexts for this occurrence.

Descriptors: Nursing; nursing care; occupational health; occupational accidents.

INTRODUCTION

Nursing professionals are exposed to accidents with sharp devices depending on their work routine. Thus, the risks for these professionals to experience an accident cause great concern due to the invasive procedures performed with the clientele and the work dynamics. In hospital settings, approximately 65% of the accidents among health professionals result from the manipulation of needlesticks.¹

Despite the possibility of more than 20 pathogens being transmitted by the biological exposure to blood, the viruses of major epidemiological importance are: Hepatitis B and C and the Human Immunodeficiency Virus (HIV).² Given the exposure to biological material, the professional must be submitted to the protocol of attendance, as well as make the notification of the accident.

In order to minimize the risks of accidents and in order to protect the health of professionals, the use of personal protective equipment, the awareness of professionals from an active continuing education, as well as being rigorous regarding the accident victims in the institutions are relevant behaviors. The communication of an accident at work must be carried out, as this guarantees the professional their labor rights.

The unpredictability of the occurrence of accidents may compromise the quality of the care provided.³ The way to react, in the face of this unpredictability, is conditioned to the way in which we are inserted at the moment of care provision to the other. Therefore, the interaction between professional and client must be achieved through dialogue, thus seeking a relationship of approximation and understanding.

From this perspective, the present study had as object the contextual meaning of the needlestick accident for the nursing professionals, and, as objective - to analyze the contextual meaning in which the accident with sharp equipment occurs.

THEORETICAL REFERENCE

In order to understand the meaning given by nursing professionals to the accident with sharp equipment from the process of social interaction, the research had as theoretical reference the Symbolic Interactionism.

The Symbolic Interactionism emerged in the late 19th century, with Georg Mead as inspiration. However, the theory was elaborated by Herbert Blumer, who used the documents left by Mead. It is a theory that starts from an empirical perspective of the social sciences on the study of the human group life and human conduct.⁴ It allows the use of qualitative methodological approaches that connect with the emerging paradigm, producing knowledge from the practical and experienced reality, explaining the different meanings used by individuals in a society.

The Symbolic Interactionism presents the following premises: the action of the human being is based on the meaning that things have for him/her; the meaning of these things is established in and through the interactive process with other human beings; considering the experience of a situation in its different aspects, the meaning of these things are manipulated and modified through the interpretation of the individual in dealing with it, which is configured as a guide to their actions.⁵

The aforementioned theory consists in the understanding of the man as an active being, who is guided by what happens around him and by himself, valuing the interpretations that he attributes to the facts. In short, the reactions are closely linked to the meaning that the individual gives to the world through their social experience.⁶

Therefore, the basic assumptions are that individuals act on the basis of the representative meanings of their social interactions.⁴ In this process, according to the readings that the individual makes of a certain attitude, action or behavior of others, he/she elaborates strategies for his/her behaviors. Therefore, the conclusions of what the individual perceives can be determining parameters for the attitudes that they will have in a certain social group.

METHODOLOGY

This research of qualitative approach has the Grounded Theory (GT) as method. Qualitative nursing research makes it possible to understand the subjective dimensions of human experiences, actions and interactions.⁷ The GT arose from the combination of the characteristics of the researchers Barney Glaser (University of Columbia) and Anselm Strauss (School of Chicago), both North Americans.⁸ It is considered that the GT has its roots in the Symbolic Interactionism, because it allows the understanding of how people give meaning to social interactions and interpretations that they attribute to social symbols, such as language.⁹

The GT is a theory contrary to traditional qualitative research methodologies, especially in nursing. The main characteristic of the GT is the fundamentals of concepts in data.⁷ There are procedures to be followed in relation to the coding processes: open coding, axial coding and selective coding.⁹ It is a method that seeks the conceptual density through constant comparisons by developing categories in terms of properties and dimensions.⁷

In this method, data collection and analysis occur simultaneously. The theoretical sampling technique is used, which is the collection of data guided by the concepts that emerge during the study.⁹ That is, the researcher takes notes of indicators or words, actions or real events of the social scene, identified in the data. In addition, concepts or abstractions are developed from the indicators. The data analysis should be comparative and continuous until its saturation.¹⁰

The research scenario was a municipal public hospital in Rio de Janeiro. The study comprised 20 nursing professionals who accepted to participate voluntarily, whose ethical aspects were respected, being the project submitted to the Brazil Platform and approved by the Research Ethics Committee.

As for the number of participants of the research, the theoretical sampling was used, in which the definition of the sample size is not defined a priori, but throughout the process until it is reached the theoretical saturation that consists in the repetition of the data. The theoretical saturation occurs when no further data develops a new category in terms of properties and dimensions.

Before starting the data collection, the objectives of the research were explained to each professional in a clear way, enabling the withdrawal of their consent to participate in the study at any time. After the consent was given and no doubts to be cleared, all signed the Free and Informed Consent Term provided for the Resolution No. 466/2012 of the National Health Council.

The data collection took place through semi-structured interviews, recorded in MP3, from July 2013 to April 2014. The participants were identified by the letter P of (professionals) followed by numerical order (P1, P2, P3, ...). They were selected after a survey in the occupational health sector on reports of accidents with needlesticks. The inclusion criteria were: nursing professionals who had the experience of the accident with needlesticks. The exclusion criteria established were professionals on leave, vacation and maternity leave.

The data analysis was carried out according to the GT procedures. After the collection, the data were transcribed, initiating the coding process in three steps. The first step comprises open coding, in which the raw data was opened, generating the first codes in the vertical distribution of the speech. In the axial stage, these codes were grouped by similarities giving rise to the first subcategories. These subcategories were refined from the selective coding; giving rise to the central category that explains the contextual phenomenon of the investigated phenomenon.

RESULTS

According to the GT methodological procedures, the central category was composed after an immersion in the data, concepts and codes, which allowed its comprehension. It was called: knowing the context of action of nursing professionals.

The phenomenon, knowing the context of action of the nursing professionals, reflects the context of interaction through the accident with sharp equipment. This context is related to the environment experienced by all those involved in the care provision, that is, the context covered here includes the human relations and the advent of consequences that these bring to care.

For a better understanding of the phenomenon, it was necessary to expose its three categories, namely: perceiving the work context: a reality; interacting with the teams in the work environment; and reflecting on the profession and care with the nursing professional.

Realizing the work context: a reality

This first category reveals that there is a collective consciousness that differentiates workplaces, because some sectors are more dangerous than others. Contradictory, since even in a low complexity environment there may be important infections and contaminated instruments that pose risks to professionals.

Another issue to be observed, from the data, is the work dynamics of the nursing professionals. There is not always a physical structure and adequate material resources for providing customer service. This creates risks for the occurrence of accidents. Visualizing the speeches obtained, it is possible to perceive the desire for a more organized environment.

Interacting with teams at the work environment

The second category demonstrates the need and importance of the organization in the work process. Often, when the client is a newborn or even a child, the professional ends up thinking that they do not need help.

It is highlighted in this category, the perception of how each human being visualizes the world that surrounds them from their cultural background. However, it reveals that the relationship between professionals in the workplace is often satisfactory. This leads to reflection - the current context of relationships translates increasingly individualistic beings.

Reflecting on the profession and care with the nursing professional

This category reveals the perception about the care offered to the research participants at the time of the needlestick accident. Thus, thinking about the perspective of the occurrence, the professional seeks help. However, often they do not obtain satisfactory answers, considering that there is partial ignorance about the protocol of care in the face of exposure to biological material. Therefore, training and continuing education are key.

DISCUSSION

The categories mentioned above point to the complexity of certain sectors, inadequate physical and material resources, lack of organization in the work process, lack of support in the attendance in the event of an accident with biological material, as main contexts. It is also observed that some nursing professionals take into account the importance of knowledge and updating regarding protocols.

Based on the data, it was possible to perceive the different meanings attributed by nursing professionals to accidents. Thus, the adequacy of the Symbolic Interactionism to explain this phenomenon is highlighted, because it is a theory that seeks to understand the meaning that people give to things, based on human relations in society.¹¹ It is understood that the human behavior can be influenced by experiences. Therefore, it is perceived that the human being is able to constantly signify and re-signify the world that surrounds him/her.

Regarding the accident with needlesticks, the professional must have the capacity to carry out procedures under their ability range, with safety and awareness of the risks. There are several variables that contribute to the occurrence of accidents, such as ignorance and non-application of the principles and practices that regulate safety actions in health services.¹

Regarding the situations that expose the professional to the risk of accident with sharp equipment, we have that: 70.3% of the nursing professionals mention the lack of attention as the main risk factor for the occurrence of an accident during the performance of procedures.¹

However, other factors contribute to an accident such as fatigue, which is closely linked to distraction, improper handling and disposal of equipment, overwork due to the various employment links of the professional, as well as professional inexperience.²

It should be emphasized that care, whether in the technical and/or expressive dimension, is important in relation to the recovery of a client in its totality.¹² The articulation of care models is of paramount importance for the treatment success. In the execution of both expressive and procedural care, the professional must be alert and cautious so that the accident does not occur.

The interaction between professional and client permeates meanings. Meaning is the central concept where individual and collective actions are built through the interaction between people, who define situations and act in the social context to which they belong.¹³ Therefore, professional experience and respect for biosafety standards can minimize exposure to risks. The unpreparedness of the professional, expressed by the lack of knowledge of the correct use of the standard recommendations, by the lack of ability to perform the procedures, can facilitate the occurrence of the accident with needlesticks. The lack of professional training contributes to the vulnerability of the professional.

It is also important to consider that when the individual interacts with their conscience they perform self-interaction and social interaction to define their behaviors. As they interact with others, they define themselves and continually modifies it, and the society is the context in which they develop.¹³ In this way, it can be deduced that the way of acting of an individual is conditioned to the way in which the situations are presented in their daily life, being able to modulate their behavior.

In the relation with the Symbolic Interactionism, when the self is expressed, the self-care reveals authenticity, and values and principles are revised through self-reflection. Considering self-care, nursing professionals need to reflect on their actions, so that when caring for each other, they only have benefits in their accomplishment.¹⁴

Pragmatically, excessive demand, low wages, excessive working hours are factors mentioned as a source of increased workloads. Thus, it is understood that this becomes a major factor for the occurrence of needlestick injuries.¹⁵

Corroborating the abovementioned, another issue is the employability in nursing. Many professionals end up signing several employment contracts because of low wages. The numerous contracts associated with intense working hours lead to fatigue, which can result in accident.

The nursing work environment sometimes becomes harmful to health due to conditions unfavorable to the well-being and personal satisfaction. It is important to reflect that the environment must satisfy and not stress. The good performance of professionals depends on a harmonious and balanced environment, favoring better relations between client and professional and between the professionals themselves.^16,17

The difficult experience of nursing professionals about the inadequate working environment requires measures, such as intensifying actions to improve conditions, organizations and labor processes. Thus, the importance of a critical analysis so that the professionals are sensitized with the measures of individual protection, respecting the norms of biosafety, reducing risks. Following standard precaution guidelines minimizes the risk of occupational exposure. Such precautions are effective, for example, in reducing the chances of blood pathogens transmission.¹⁸

Studies in a hospital in Nigeria have shown a high prevalence of accidents among health workers and a low incidence of injuries to those responsible. The consequence of this is poor post-exposure prophylactic adhesion. ¹⁹ Thus, there is an oversight of professionals with their own health.

Regarding the presented data, it is observed that the coping of the nursing professionals is different. This is due to the complexity of the human thinking, as well as the meaning that the professional attributes to the accident. The coping with the situation occurs according to the definition that the human being attributes to the experience.

The basis of the meaning is the result of social interactions, from which symbols emerge. Through an interpretive process, individuals create an awareness of these symbols by modifying their meaning.²⁰ This process makes possible the formation of the personal convictions of the nursing professionals, and this will reflect in the different forms of coping with the accident occurred.

CONCLUSION

There were several contexts for the occurrence of the accident with needlesticks exposed by the research participants. Therefore, it is a great challenge is to reduce the number of accidents involving biological material.

These accidents constitute an important problem for the public health since the scope of epidemiological magnitude. Public bodies need to be more committed to this working class, which, in turn, plays a key role regarding the health of the population.

Regarding the limitation of the study, the fact that the research occurred in only one study scenario stands out. However, considering that knowledge is dynamic and complex, this potential limitation is also indicative of new investigative movements.

REFERENCES

1.Silva SMS, Gomes IVMPS, Anjos MS. Acidente perfurocortante: conhecimento e uso de dispositivos de segurança. Rev. Saúde. Com. [Portal de Periódicos UESB] 2016 [citado em 07 fev 2018]; 12(2):522-7. Disponível em: http://periodicos2.uesb.br/index.php/rsc/article/view/406.

2.Nowak NL, Campos GA, Borba EO, Ulbricht L, Neves EB. Fatores de risco para acidentes com materiais perfurocortantes. Mundo Saúde. [LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde] 2013 [citado em 10 fev 2018]; 37(4):419-26. Disponível em: http://bvsms.saude.gov.br/bvs/artigos/mundo_saude/fatores_risco_acidentes_materiais_perfurocortantes.pdf.

3.Sousa AFL, Queiroz AAFLN, Oliveira LB, Moura MEB, Batista OMA, Andrade D. Social representations of biosecurity in nursing: occupational health and preventive care. Rev. bras. enferm. (Online). [Scielo-Scientific Electronic Library Online] 2016 [cited in 2018 Feb 12]; 69(5):810-17. Available from: http://www.scielo.br/pdf/reben/v69n5/en_0034-7167-reben-69-05-0864.pdf. DOI: http://dx.doi.org/10.1590/0034-7167-2015-0114

4.Salaun JC, Mills J, Usher K. Linking symbolic interactionism and grounded theory methods in a research design: from Corbin and Strauss' assumptions to action. Sage Open. [SCOPUS] 2013 [cited in 2018 Mar 17]. 3(3):1-10. Available from: http://journals.sagepub.com/doi/pdf/10.1177/2158244013505757. DOI: 10.1177/2158244013505757

5.Blumer H. El interacionismo simbólico: perspectiva y método. Barcelona (Es): Hora SA Editora Distribuidora; 1982.

6.Bueno T, Alves M, Ferreira FV. Interaccionismo simbólico como una herramienta teórica y metodológica para el estudio en el ciberespacio. Razón Y Palabra. [Google Scholar] 2017 [citado en 22 ene 2018]. 21(1): 456-75. Disponible en: http://www.revistarazonypalabra.org/index.php/ryp/article/view/843.

7. Solano LC, Miranda FAN, Enders BC, Sousa FGM. By avenue: dialoging about Grounded Theory. Rev. enferm. UERJ. [LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde] 2018 [cited in 2018 Dec 3]. 26(e28047):1-5. Available from: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/28047/26493. DOI: https://doi.org/10.12957/reuerj.2018.28047

8.Gomes IM, Hermann AP, Wolff LDG, Peres AM, Lacerda MR. Grounded Theory in nursing: integrative review. Rev. enferm. UFPE on line. [MEDLINE - Medical Literature Analysis and Retrieval System Online] 2014 [cited in 2018 Mar 8]; 9(suppl.1):466-74. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/10360/11084. DOI: 10.5205/reuol.5221-43270-1-RV.0901supl201527

9.Costa MCMDR, Lima SP, Santos LMC, Silva ER, Erdmann AL. Grounded Theory in research on women's healt: bibliometric study. Rev. enferm. UFPE on line. [MEDLINE - Medical Literature Analysis and Retrieval System Online] 2013 [cited in 2018 Mar 9]; 7(spe.):4153-60. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/11644. DOI: http://dx.doi.org/10.5205/reuol.4134-32743-1-SM-1.0705esp201308

10.Santos JLG, Erdmann AL, Sousa FGM, Lanzoni GMM, Melo ALSF, Leite JL. Methodological perspectives in the use of grounded theory in nursing and health research. Esc. Anna Nery Rev. Enferm. [Scielo-Scientific Electronic Library Online] 2016 [cited in 2018 Mar 23]; 20(3): e20160056. Available from: htpp//dx.doi.org/10.5935/1414-8145.20160056.

11.Faller JW, Zilly A, Alvarez AM, Marcon SS. Filial care and the relationship with the elderly in families of different nationalities. Rev. bras. enferm. (Online). [Scielo-Scientific Electronic Library Online] 2017 [cited in 2018 Mar 22]; 70(1):18-25. Available from: http://www.scielo.br/pdf/reben/v70n1/en_0034-7167-reben-70-01-0022.pdf. DOI: 10.1590/0034-7167-2015-0050

12.Leite BS, Camacho ACLF, Queiroz RS, Feliciano GD. Vulnerability of caregivers for the elderly with dementia: integrative review. Rev. Fund. Care Online. [LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde] 2017 [cited in 2018 Mar 24]; 9(3):888-92. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/4513/pdf. DOI: 10.9789/2175-5361.2017.v9i3.888-892

13.Silva CMC, Vargens OMC. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery. Rev. latinoam. enferm. (Online). [Scielo-Scientific Electronic Library Online]. 2016 [cited in 2018 Mar 24]; 24:e2780. Available from: http://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-24-02780.pdf. DOI: http//dx.doi.org/10.1590/1518-8345.1081.2780

14.Tomaschewski-Barlem JG, Piexak DR, Barlem ELD, Lunardi VL, Ramos AM. Scientific production of nursing about self-care: an integrative review. Rev. Fund. Care Online. [LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde] 2016 [cited in 2018 Jul 12]; 8(3): 4629-35. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/download/3560/pdf. DOI: http://dx.doi.org/10.1590/1518-8345.1081.2780

15.Pires DEP, Machado RR, Soratto J, Schere MA, Gonçalves ASR, Trindade LL. Nursing workloads in family health: implications for universal access. Rev. latinoam. enferm. (Online). [Scielo-Scientific Electronic Library Online] 2016 [cited in 2018 Mar 04]; 24:e2682. Available from: http://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-0992-2682.pdf. DOI: http://dx.doi.org/10.1590/1518-8345.0992.2682

16.Alves DFS, Guirardello EB. Nursing work environment, patient safety and quality of care in pediatric hospital. Rev. gaúch. enferm. [Scielo-Scientific Electronic Library Online] 2016 [cited in 2018 Mar 18]; 37(2): e58817. Available from: Disponível http://www.scielo.br/pdf/rgenf/v37n2/en_0102-6933-rgenf-1983-144720160258817.pdf. DOI: http://dx.doi.org/10.1590/1983-1447.2016.02.58817

17.Oliveira EM, Barbosa RL, Andolhe R, Eiras FRC, Padilha KG. Nursing practice environment and work satisfaction in critical units. Rev. bras. enferm. (Online). [Scielo-Scientific Electronic Library Online] 2017 [cited in 2018 Mar 24]; 70(1):73-80. Available from: http://www.scielo.br/pdf/reben/v70n1/en_0034-7167-reben-70-01-0079.pdf. DOI: http://dx.doi.org/10.1590/0034-7167-2016-0211

18.Sheth SP, Leuva AC, Mannari JG. Post exposure prophylaxis for occupational exposures to HIV and hepatitis B: our experience of thirteen years at a rural based tertiary care teaching hospital of western India. J. Clin. Diagn. Res. [MEDLINE - Medical Literature Analysis and Retrieval System Online] 2016 [cited in 2018 Mar 04]; 10(8): OC39-OC44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028526/pdf/jcdr-10-OC39.pdf. DOI: http://dx.doi.org/10.7860/JCDR/2016/19876.8387

19.Isara AR, Oguzie KE, Okpogoro OE. Prevalence of needlestick injuries among healthcare workers in the accident and emergency department of a teaching hospital in Nigeria. Ann. Med. Health Sci. Res. [MEDLINE - Medical Literature Analysis and Retrieval System Online] 2015 [cited in 2018 Mar 11]; 5(6): 392-96. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804649/?report=printable. DOI: http://dx.doi.org/10.4103/2141-9248.177973

20.Marques ES, de Melo GC, dos Santos RM. O significado de cuidar do paciente obeso para um grupo de enfermeiras. Rev. eletrônica. enferm. [LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde] 2014 [citado em 15 mar 2018]; 16(1):151-60. Disponível em: http://dx.doi.org/10.5216/ree.v16i1.20658.