Rev. Latino-Am. Enfermagem Original Article 2011 May-Jun;19(3):565-72 www.eerp.usp.br/rlae Pleasure and Suffering in Intensive Care Unit Nursing Staff Helena Eri Shimizu1 Djalma Ticiani Couto2 Edgar Merchan-Hamann3 The aim of this study was to analyze the causal factors of pleasure and suffering in Intensive Care Unit (ICU) nursing staff and to compare the occurrence of these factors at the beginning and end of the career. This was a cross-sectional descriptive study conducted with 26 nurses and 96 nursing technicians. The previously validated Pleasure and Suffering Scale was used. The data were analyzed using descriptive statistics with the SPSS 12.0 software and the Kruskal Wallis test was used to assess the presence of these factors at the beginning and end of the career. The results indicated that, for both the nurses and the nursing technicians, the factors that contribute to feelings of pleasure, professional achievement and freedom of expression, and the factors that cause suffering, professional exhaustion and lack of recognition, were encountered at critical levels. Descriptors: Nurses; Intensive Care Units; Occupational Health. 1 RN, Ph.D. in Nursing. Associate Professor, Universidade de Brasília, DF, Brazil. E-mail: [email protected]. 2 RN, Secretaria de Saúde do Distrito Federal, Brasília, DF, Brazil. E-mail: [email protected]. 3 Physician, Ph.D. in Public Health. Adjunct Professor, Universidade de Brasília, DF, Brazil. E-mail: [email protected]. Corresponding Author: Helena Eri Shimizu Rua SQN 205 Bloco G Apto 605 Bairro: Asa Norte CEP: 70843-070 Brasília, DF, Brasil E-mail: [email protected] 566 Prazer e sofrimento em trabalhadores de enfermagem de Unidade de Terapia Intensiva O objetivo do estudo foi analisar os fatores causadores de prazer e sofrimento em trabalhadores de enfermagem que atuam em unidade de terapia intensiva (UTI) e comparar a ocorrência desses fatores, no início e no final da carreira. Este é um estudo descritivo transversal, realizado com 26 enfermeiros e 96 técnicos de enfermagem. Utilizou-se a escala de prazer e sofrimento, validada previamente. Os dados foram analisados por meio da estatística descritiva, com software SPSS12.0, e, para avaliar a presença desses fatores, no início e no final da carreira, o teste de Kruskal Wallis. Constatou-se que, tanto para enfermeiros como para os técnicos de enfermagem, os fatores que contribuem para os sentimentos de prazer, realização profissional e liberdade de expressão e os fatores que causam sofrimento, esgotamento profissional e falta de reconhecimento se encontram em níveis críticos. Descritores: Enfermeiros; Unidade de Terapia Intensiva; Saúde do Trabalhador. Placer y sufrimiento en trabajadores de enfermería de una Unidad de Terapia Intensiva El objetivo del estudio fue analizar los factores causadores de placer y sufrimiento en trabajadores de enfermería que actúan en una Unidad de Terapia Intensiva (UTI) y comparar la ocurrencia de esos factores en el inicio y al final de la carrera. Se trata de un estudio descriptivo transversal, realizado con 26 enfermeros y 96 técnicos de enfermería. Se utilizó la Escala de Placer y Sufrimiento, validada previamente. Los datos fueron analizados por medio de la estadística descriptiva, con software SPSS12.0, y, para evaluar la presencia de esos factores en el inicio y al final de la carrera, se utilizó la prueba de Kruskal Wallis. Se constató que, tanto para enfermeros como para los técnicos de enfermería, los factores que contribuyen para los sentimientos de placer, realización profesional y libertad de expresión y los factores que causan sufrimiento, agotamiento profesional y falta de reconocimiento, se encuentran en niveles críticos. Descriptores: Enfermeros; Unidade de Terapia Intensiva; Salud Laboral. Introduction The recognition is growing that health care workers, due to frequent interruptions, and the management of especially those of the nursing team, experience a large and variable amount of information due to the stressful situations in the work that lead to suffering. diverse interventions required(1-5). Furthermore, the Several studies have indicated the need to identify, in nursing team are almost constantly confronted with critical areas such as the ICU, the causative factors suffering and death of their fellows, and are exposed of the suffering, as well as the defensive strategies to to the ambiguous feelings that are transferred to them avoid this, in order to maintain the psycho-emotional by both the patient and their family members(1-2). balance of the worker(1-5). Care for critically ill patients These situations invariably provoke feelings of requires from the nurses and nursing technicians, intense anxiety, which contribute to the development hereafter referred to as the nursing team, speed in of mediation strategies that function to try to avoid decision making, a heightened sense of responsibility in tensions which cumulatively threaten the integrity of the prioritization of actions, the resolution of complex their health with the risk of evolving into a framework problems, the continuous reorganization of the activities of pathogenesis(1-3). www.eerp.usp.br/rlae Shimizu HE, Couto DT, Merchan-Hamann E. 567 The work carried out by the nursing team in the end of the career, to develop management strategies this environment, although essential, has little social that foster improvement in the work processes in order recognition; is undervalued and invisible to the other to contribute to a more satisfying working life. health professionals and the patients(1-2,6). Additionally, This study aims to analyze the factors that cause in recent years in Brazil, mainly in the public health pleasure and suffering in the work of nurses and nursing institutions, nursing care in general has been penalized technicians in the ICU, and to compare the degree of with a deficiency of human and material resources that occurrence of these factors at the beginning and end of directly influences the quality of care provided to the the career. population(1-2). It appears that the experience of suffering in the work in an ICU would be intense due to the Methods constant exposure of the workers to extremely stressful This was a cross-sectional descriptive study situations, which are often unconsciously, characterized, conducted with nurses and nursing technicians of the ICU according to the psychodynamics of the work(7), as of a tertiary public hospital, prominent within the network individual or shared experiences, which have their origins of the Department of State and Health, the Federal in situations of conflict between the desire/needs of the District Base Hospital. The sample was selected in a non- employee and the organization of the work(7). Distress in probabilistic way and consisted of 122 participants who the work is manifested as a form of emotional, physical were divided into two categories: the first composed of and social exhaustion, and when this is pronounced it may cause the impoverishment of the personality, Nurses (n = 26), and the second of Nursing Technicians leading the individual to an emotional numbness, i.e. (n ​​= 96). The inclusion criterion adopted was for workers an “erasure” of emotional manifestations(7-8). Such to have more than 6 months of work and those who experiences also cause the failure of the professional if were absent from work for more than 90 consecutive confronted with their own feelings, which may lead them days in the ICU studied were excluded. For the data to conceal from themselves the psychic suffering, their collection, a questionnaire was used to characterize the painful emotional experiences(9). study population which included: marital status, level of Despite the possible health injuries arising from the schooling, number of jobs, and the Pleasure-Suffering organizational context, the positive significance of the at Work Scale (PSWS). This scale includes a Work and work is being rediscovered as a means of preventing and Risk of Illness Inventory (WRII), constructed based on overcoming these negative effects, through a position the Psychodynamics of Work theoretical framework, that emphasizes the positive subjective experiences in comprising a total of four independent scales, and is an improving the quality of life of the workers and preventing auxiliary diagnostic instrument of critical indicators in (14) pathologies(9-13). These work experiences, when positive, the work, having previously been validated . help to enrich the identity of the individual, leading to The PSWS consists of four factors, two for joy the maximum development of their potential. From this and two for suffering. The factors that are indicators of perspective, the process of caring for critically ill patients, pleasure are: professional achievement and freedom of which involves a meeting between the subjects - who expression; and the factors that are indicators of suffering care and who are cared for, due to its dynamism and are professional exhaustion and lack of recognition. The complexity, demands choices, arbitrations, prioritization first factor, professional achievement, consists of nine of actions and goals, and guidance in the decision making items, with an alpha = 0.89, and relates to the experience of the workers, which makes it somewhat possible to of professional gratification, pride and identification with overcome the fragmentation of the work process. The the work performed. Factor two, freedom of expression, workers can appropriate the management of their work(10- with five items, and an alpha = 0.69, relates to the 11) by means of permanent negotiations between what is experiences of freedom to think, organize and talk prescribed, i.e. the standards, routines, procedures and about their work. Factor three, professional exhaustion, unexpected demands of the care quotidian. It is possible contains six items, with an alpha = 0.84, related to to discover a new way to develop the work that is more frustration, insecurity, worthlessness and disqualification rewarding for the workers and provides higher quality concerning performance expectations, producing care for the patients.