ISSN: 1981-8963
DOI: 10.5205/reuol.6825-58796-1-SM.0812201410
Oliveira AFC, Teixeira ER.
Profile of nursing workers in oncology intensive...
ORIGINAL ARTICLE
PROFILE OF NURSING WORKERS IN ONCOLOGY INTENSIVE CARE AGAINST
SELF-MEDICATION
PERFIL DOS TRABALHADORES DE ENFERMAGEM EM TERAPIA INTENSIVA ONCOLÓGICA
FRENTE À AUTOMEDICAÇÃO
PERFIL DE TRABAJADORES DE ENFERMERÍA EN TERAPIA INTENSIVA ONCOLÓGICA FRENTE A LA
AUTOMEDICACIÓN
Alessandro Fábio de Carvalho Oliveira 1, Enéas Rangel Teixeira2
ABSTRACT
Objectives: to describe the profile of nursing workers in oncology intensive care; to identify whether the
nursing workers in oncology intensive care make use of self-medication and self-care strategy. Method:
descriptive, exploratory study with qualitative and quantitative approach, carried out in the ICU of the Cancer
Hospital II-INCA-RJ, with 25 nursing professionals, using a questionnaire with 17 questions. The research
project has been approved by the Ethics Committee in Research, under CAAE nº 07330912.1.0000.5274.
Results: 72% of respondents were female, with ages ranging from 26 to 62 years old, 44% from them with
more than 20 years of service, 68% work in more than one location. The practice of self-medication is cited by
92% of workers, being more used the analgesics and anti-inflammatories. Conclusion: the use of selfmedication is present in nursing workers. The description of the profile helps the creation of self-care
strategies. Descriptors: Self-medication; Workers´ health; Nursing; Oncology; Nursing Worker.
RESUMO
Objetivos: descrever o perfil dos trabalhadores de enfermagem em terapia intensiva oncológica; identificar
se os trabalhadores de enfermagem em terapia intensiva oncológica fazem uso da automedicação como
estratégia de autocuidado. Método: estudo descritivo, exploratório com abordagem qualitativa e
quantitativa, realizado no CTI do Hospital do Câncer II – INCA-RJ, com 25 profissionais de enfermagem,
utilizando um questionário com 17 perguntas. O projeto de pesquisa foi aprovado pelo Comitê de Ética em
Pesquisa, sob CAAE nº 07330912.1.0000.5274. Resultados: dentre os entrevistados 72% eram do sexo
feminino, com idades que variam de 26 a 62 anos, 44% da amostra tem mais de 20 anos de serviço, 68%
trabalham em mais de um local. A prática da automedicação é citada por 92% dos trabalhadores, sendo mais
utilizados os analgésicos e anti-inflamatórios. Conclusão: o uso da automedicação está presente nos
trabalhadores de enfermagem. A descrição do perfil auxilia na criação de estratégias de autocuidado.
Descritores: Automedicação; Saúde do Trabalhador; Enfermagem; Oncologia; Trabalhador de Enfermagem.
RESUMEN
Objetivos: describir el perfil de los trabajadores de enfermería en terapia intensiva oncológica; identificar si
los trabajadores de enfermería en terapia intensiva oncológica hacen uso de la automedicación como
estrategia de autocuidado. Método: estudio descriptivo, exploratorio con enfoque cualitativo y cuantitativo,
realizado en el CTI del Hospital de Cáncer II – INCA-RJ, con 25 profesionales de enfermería, utilizando un
cuestionario con 17 preguntas. El proyecto de investigación fue aprobado por el Comité de Ética en
Investigación, sobre CAAE nº 07330912.1.0000.5274. Resultados: dentro de los entrevistados 72% eran del
sexo femenino, con edades que varían de 26 a 62 años, 44% de la muestra tienen más de 20 años de servicio,
68% trabajan en más de un local. La práctica de la automedicación es citada por 92% de los trabajadores,
siendo más utilizados los analgésicos y anti-inflamatorios. Conclusión: el uso de la automedicación está
presente en los trabajadores de enfermería. La descripción del perfil auxilia en la creación de estrategias de
autocuidado. Palabras clave: Automedicación; Salud del Trabajador; Enfermería; Oncología; Trabajador de
Enfermería.
1
Nurse, Master degree in Nursing, ICU Staff, National Institute of Cancer/INCA-RJ. Rio de Janeiro (RJ), Brazil. Rio de Janeiro (RJ), Brazil.
E-mail: [email protected]; 2Nurse and Psychologist, PhD Professor in Nursing, Nursing Department, Nursing School Aurora
de Afonso Costa/EEAAC, Fluminense Federal University /UFF. Rio de Janeiro (RJ), Brazil. E-mail: [email protected]
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INTRODUCTION
Self-medication is the administration of
medication without prescription, orientation
or medical follow-up.1 the consumption of
medication has greatly grown in the world,
influenced by economic power, by the media,
by the pharmaceutical industries marketing
appealing by symbolic effectiveness in health,
adding to the desire for esthetic, health and
well-being, to carry out the duties and
obligations of everyday life.2
Self-medication is considered by some
people as part of life, habit according to a
number of factors in the day-to-day of each of
them.3
When
this
self-medication
is
accomplished in a responsible manner, it is
seen as part of the self-care actions where
they can be treated minor health problems,
which
have
already
been
diagnosed
previously.
Responsible self-medication is understood
as part of a set of actions of self-care,
directed by rules that take care alone only of
minimal symptoms, already diagnosed or
known, choosing only medication without
prescription, preferably with the help of an
enabled professional; always read the
information from the product packaging
before taking it; stop taking the medication if
the symptoms continue.4
The nurses, in their daily practice, deal
with various medications, accumulating
empirical knowledge, coming from diverse
cultures and family practices, and scientific
knowledge, from undergraduate and graduate
courses, acquiring experiences and knowledge
about the job of these medications in daily
therapy. Also as motivating elements for long
journeys to work, high levels of physical and
psychological stress that surround the
profession, the accumulation of labor
relations and their efforts to remain
productive
in
every
job,
sometimes
overcoming pain, suffering and wear.5
Studies dealing with self-medication
suggests that it is a practice most common
among women with higher education level,
and it seems to be related to the
environment, working conditions and ease of
access to medicines.5,6,7 We can see there is a
similarity to the profile of the nursing
workers, predominantly composed of women,
with overwork due to long journeys and high
workload often added to the housework and
family, double or triple journeys.8.9
In Brazil, the health authorities have seen
the practice of self-medication as a public
health issue, with lack of appropriate
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DOI: 10.5205/reuol.6825-58796-1-SM.0812201410
Profile of nursing workers in oncology intensive...
guidelines. The Ordinance of the Ministry of
Health number 3,916 of October 30 1998,
instituted the National Medicines Policy,10
based on the principles and guidelines of the
Unified Health System (SUS). It is an integral
part of article 6 of Law 8,080/1990,
establishing the area of SUS to formulate the
medication policy of interest to health.11 This
Ordinance ensures the safety, effectiveness
and quality of medicines, the rational use and
access of the population to which are
considered essential.
We understand such concerns to check the
statistics of the National System of Toxicpharmacological Information (SINITOX), about
the registered cases of human poisoning by
toxic agent in Brazil, in which registered
101,086cases of human poisoning, where 27%
of cases are arising from the use of medicines
irregularly.12
Then, there is the need to guide and
educate nursing workers regarding the
responsible use of self-medication, as they use
their knowledge to self-medicate. Thus, the
research
project
contributes
to
the
implementation of the national medicines
policy, educative measure for the rational use
of medicines, assisting in upgrading of
healthcare professionals and corroborating for
better worker's perception about his health. It
becomes apparent the importance of studies
that evaluate behaviors related to medication
consumption among nursing workers, this
group widely associated with the long working
days, to high levels of stress, and the easy and
continuous access to medicines during the
process of care.
OBJECTIVE
● To describe the profile of workers in
nursing oncology intensive care.
● To identify whether workers in nursing
oncology intensive care use of self-medication
and self-care strategy.
METHOD
Article elaborated from socio-demographic
data of the dissertation << Communication
strategies on self-medication in nursing
workers in oncology intensive care: a
qualitative approach to the collective
subject
discourse
>>
presented
to
professional master's in Nursing Care of
Nursing School Aurora of Afonso Costa from
Fluminense Federal University-UFF/EEAAC/RJ.
Niterói-RJ, Brazil. 2013.
Descriptive study, exploratory type with a
quantitative and qualitative approach, held at
the Center of Intensive Therapy at the Cancer
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Hospital II (HCII), reference unit in Gynecology
cancer treatment, Bone and Connective Tissue
(BCT) and Clinical Oncology of the National
Cancer Institute José Alencar Gomes da Silva
(INCA) by the federal health network in Rio de
Janeiro State.
The universe of study includes 11 nurses
and 27nursing technicians. Sampling was used
for convenience, where we adopted as criteria
for inclusion in the research work on direct
nursing care to the patient, having at least 1
year of experience in cancer patient care and
having interest and willingness to participate
in the study, under free acceptance by signing
an informed consent. Exclusion criteria were
the nursing professionals who were on
vacation, were graduates of the service,
whether for reasons of medical leave,
maternity leave and those who refused to
participate in this study, generating a sample
of 25 respondents, accounting for 65.8% of the
universe considered, i.e. the members of the
local staff in total of this study.
For data collection a questionnaire to
characterize research participants was used,
through open and closed 17 objective
questions, including gender, age, race, work
time in nursing, wage income, as the data
controller for simple descriptive statistics.
The project was submitted for approval by
the Ethics Committee in Research (CEP) of the
National
Cancer
Institute/INCA-RJ,
in
accordance with Resolution number 466/2012,
of the National Health Council (CNS).13
establishing standards and guidelines for
research behaviors involving human beings,
after prior registration in Brazil Platform,
being approved in December 21, 2012,
according to the opinion 156,271 CAAE
07330912.1.0000.5274, revalidated by opinion
363,664.
Each participant of the research was
briefed on this research and received an
informed consent authorizing the use of their
data in the research.
DOI: 10.5205/reuol.6825-58796-1-SM.0812201410
Profile of nursing workers in oncology intensive...
not brought any damage to nursing care. It is
noteworthy that despite the ICU structure
provide a meeting room, we often had to use
the kitchen or the resting room because they
were the only ones available. Night service
workers were also interviewed in the evening,
at the beginning of their shift, which is a little
more agitated and ran, because it is common
for patients being admitted after surgery in
times close to duty changes and these teams
rely on reduced number of personnel.
There was a bit of difficulty in the
collection of interviews, since workers have
the habit of exchange with their colleagues
the day on duty, causing misunderstandings
between this and the researcher, extending
the period of data collection.
The research included 25 nursing workers.
The
respondents
had
the
following
characteristics: 72% were female, with ages
ranging from 26 to 62 years old, being 28%
between 36 and 40 years old and 24% of 26 to
30 years old; 46% claim to be white, 36%
brown and 12% black. As for marital status
56% are married, 60% have children, 44% of
respondents have wage income between 11
and 14 minimum wages and 36% between 8
and 10 minimum wages.
Regarding the occupation situation, 7
workers are nurses and 18 were nursing
technicians. Vocational training shows that
44% possess expertise while 40% have
technical as the greatest course training. As
regards the working time in nursing, 36% have
more than 20 years in the profession, 44%
working in this hospital between 3 and 6 years
and 48% work in the ICU between 3 and 6
years. The workers during the day were 64%,
with 56% still work in another location in
nursing assistance and 12% work in two or
more locations. We see according to Tables 1
and 2 the general data of the participants of
the research.
RESULTS
The interviews took place during the period
of professional work, in moments that have
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Profile of nursing workers in oncology intensive...
Table 1.Description of participants of the research, RJ 2013 (n=25)
Variables
Greater professional training
Technical Course
Graduation
Especialization/Residence
PhD
Time working in nursing
Up to 5 years
6 a 10 years
11 a 15 years
16 a 20 years
More than 20 years
Time working at this
Up to 2 anos
3 to 6 years
7 to 10 years
11 to 15 years
More than 15 years
Time working in this area
Up to 2 years
3 to 6 years
7 to 10 years
11 to 15 years
More than 15 years
Shif in this hospital
Day time
Night time
Day worker
Working in assistance nursing in other place
No
Yes, 1 place
Yes, 2 places
n
%
10
3
11
1
40%
12%
44%
4%
2
5
3
6
9
8%
20%
12%
24%
36%
4
11
3
2
5
16%
44%
12%
8%
20%
5
12
2
2
4
20%
48%
8%
8%
16%
16
7
2
64%
28%
8%
8
14
3
32%
56%
12%
Table 2. Description of medication use by the participants of the research, RJ
2013 (n=25)
Variables
n
%
Having any disease
No
10
40%
Yes
15
60%
Use prescribed medication at this moment
No
7
28%
Yes
18
72%
Self-medication
No
2
8%
Yes
23
92%
The practice of self-medication is cited by
92% of workers participating in the research,
since only two participants said not taking
medications on their own. The most used are
simple
analgesics,
followed
by
antiinflammatory medications. There are also
Table 3. Medications consumed
Medication
Analgesics
Anti-inflammatories
Anxiolytics
Antidepressants
Antibiotics
Vitamin
Anti-hipertensive
Phytotherapy
Descongesting nasal
Creams
Total of consumption
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J Nurs UFPE on line., Recife, 8(12):4261-8, Dec., 2014
reports of use of anxiolytics, antidepressants
and antibiotics, medication that require
retention of prescription in pharmacies and
drugstores that are sold. It is observed that
many
reported
using
two
or
more
medications.
n
21
7
3
2
2
2
1
1
1
1
41
%
51,21
17,07
7,32
4,88
4,88
4,88
2,44
2,44
2,44
2,44
100%
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DISCUSSION
The research shows known delicated and
critical situations regarding nursing as a
profession emerged in the area of health,
having its focus of work in care. Care for
themselves has been relegated to a second
plan, contributing to the use of medication
without proper guidance. The presence of
factors stressors at work, high workload,
working multiple jobs and conferences,
exposure to occupational risks, disability of
staff to work is common to various scenarios
of nursing assistance, and has negatively
impacted the quality of such assistance and
care for who take care of others.
The knowledge of medications and their
risks from the perspective of nursing
professionals
allows
showing
their
understanding, which contributes to the use
or non-use of medications. The medications
are trying to evade or work as palliative for
the suffering of individuals, through the
reality of their scientific effectiveness,2 but
the professional takes this knowledge to
understand the risks to which it is undergoing,
and decide whether or not to go through with
this risk.
Before this, we find that analgesics are
cited as the most used by the workers,
following the works found in national and
world literature.5,6,7,14 The use of analgesics is
strongly linked to work on assistance and care
to the other, in which this is used because of
the pain, until they can no longer solve their
problems in this way and have to skip the
service to go to the doctor.15 This pain is
related to stress from the care due to
conditions that are subject to nursing teams,
by the pressure exerted by superiors in
results, exhausting number of procedures and
services performed, having a number of
professionals
and
also
reduced
musculoskeletal injuries, which are common
in these workers, showing physical and
psychological symptoms of stress.16
Studies show physical important overloads
at work of nursing that can culminate in
musculoskeletal problems, interfering in
workers´ health, where there is a
predominance of postural defect in the
execution of procedures or in the mobilization
of patients. There is also the repetition of
movements, pressure on certain bodily areas,
shocks and impacts that are believed to be
major causes of injuries,16 reflecting in the
use of analgesics.
The services of national and global public
health have discussed heavily restrictive
measures for the safe use of antimicrobials.17-8
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In Brazil since 2009, the sale of antibiotics is
effected by the retention of prescription,19
but it is seen the free sale by clerks of
pharmacies, which is interested in satisfying
customers´ needs and obtain greater profit.
The health workers´ know that the
indiscriminate use of antimicrobials can result
in infections more difficult to be treated,
selection of resistant strains, health risks due
to errors in dosage or interactions.
We cannot ignore a fact that has become
increasing in health workers which is the
consumption of psychoactive medications,
also known as psychotropic or controlled
drugs, targeted studies on nursing service.8.20
These substances are drugs that alter the
functioning of the central nervous system, and
can change their behavior and cognition and
induce a state of addiction to such
substances.21
It should also be understood in this
context, the gender that makes up the
majority of the workforce in nursing, the
female. It is taking into account the
assumptions due to the many functions
performed by women in front of society, the
home caregiver, caring for children, husband,
studies and work, falls on this strenuous
loading, maintaining double and triple journey
without taking time to care for themselves.
The study reveals that 72% of the sample is
formed by women, a reflection of the
profession still quite feminine, as it has in its
care values being historically a womenoriented work.22 We note that 60% have
children and 64% report that their household
income is shared by three or more people,
being that many of these people who make up
the family income turn out to be dependent
on the professional and she is the provider of
their needs which also include care,
decreasing the time that this dedicated to the
care of themselves. There is a personal
satisfaction in the profession exercising, but
still the sum of wage labor and domestic
journeys exacerbates fatigue, symptoms of
stress, fatigue, depression and irritability
contributing with wear and maladjustment of
these professionals.
New works show that the oncology nursing
professionals who work with patients
considered terminally ill situation have
feelings of sadness, fear, worry and
apprehension,23 because the cancer has the
power to change people, both patients with
their families like the professionls, given that
the coexistence with this daily situation
weakens a worker.16 Cancer patient is still
seen as sentenced to death leading this stigma
to the hospital when they are in treatment,
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and professionals share all these emotions
with patients, acting in the patient's psychic
care, within a holistic nursing care.
Studies show the higher probability of
consulting a doctor in individuals who work
less than 40 hours per week, are offering more
free time, this worker has greater opportunity
to take care of their own health.20
Professional is aware that the search for
specialized care is important, but is the lack
of time to keep self-medicating.
Several studies point out that the nursing
work overloaded, either by excess of tasks
performed during the journey, or a
patient/caregiver relationship far short of
recommended class bodies, due to the
reduced number of nursing professionals in
health institutions, and even by many labor
links that involve,5,16,20,24-5 being embedded
risks for accidents at work resulting from
these bad conditions. The work of excellence
provided by nursing ends up on its side, due to
wear and tear caused by excess activities
assigned to them.
CONCLUSION
The use of self-medication is seen as a
multidimensional problem, not just being
professional and only medicine. It is necessary
to consider the relationship of both, including
aspects of values, beliefs, social, economic
relations, including the work.
The presence of occupational risks,
exposure to stressors agents, human resource
deficiency, the multitude of jobs, positions
and functions are factors that have impacted
the quality of the work carried out and the
quality of life of the worker, and taking this
nursing worker to add their lifestyle the
practice of self-medication.
This study may serve to describe the
objectives of the nursing workers in Oncology
intensive care, identifying whether such
workers make use of self-medication and selfcare strategy. Thus, we created the basis to
analyze the meaning of adoption of selfmedication and formulate communication
strategies to guide the worker to the safe use
of medicines.
Training and continuing education coupled
with the practice of everyday life with the
medicines makes the nursing professional a
knower of the modalities of care, from
disease, from clinical symptoms and
medicines used for the treatments. As we
could raise in this study, most professionals
have over 6 years of work in the nursing
service, endorsing this practical training.
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DOI: 10.5205/reuol.6825-58796-1-SM.0812201410
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Workers of nursing Oncology intensive care
understand what is defined as self-medication
and make use of this in their day to day, citing
the analgesics and anti-inflammatories as the
most used and demonstrate in a natural way
and acceptable use of medications to treat
their problems. It is worrying the admissibility
of the use of psychoactive drugs such as
antidepressants and anti-anxiety drugs in
addition to antimicrobials, with aggravating
for the abuse of these drugs.
Raising the level of information, not only
on quantification, but mainly on the quality of
the information made available to workers
becomes fundamental, either by advertising
pieces, is in the knowledge of medications and
medicines available for therapy of selfmedication. It is raised by the study as
possible strategies to improve the medical
assistance to the professional in the
workplace, better control of pharmaceuticals
available
in
the
labor
sector
and
improvements in working conditions that
surround the professionals, with the inclusion
of socialization spaces and alternative
therapies targeting the quality of life and
quality of work.
We believe that this study may encompass
contributions to nursing education, for
research and for assistance and occupational
health nursing. It is necessary a revalidation
of self-care, since workers´ negligence of
their care, giving up time for them to work,
reference to concern about the indiscriminate
use of self-medication. Educational factors
can contribute to self-medication safer and to
reduce the risks. We see the need to develop
health education projects to reduce the harms
caused by self-medication. When the
principles of safe self-medication are
observed, it is believed that it is possible the
reduction of complications, enabling the
professional to participate in the maintenance
of their health.
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J Nurs UFPE on line., Recife, 8(12):4261-8, Dec., 2014
Submission: 2014/07/20
Accepted: 2014/09/16
Publishing: 2014/12/01
Corresponding Address
Alessandro Fábio de Carvalho Oliveira
Rua Cosmorama, 900
Rua Sabias, 89
Bairro Mesquita
CEP 26582-020  Rio de Janeiro (RJ), Brazil
4268