The Work Environment of Primary Health Care Nurses: An Integrative Review
DOI:
https://doi.org/10.5294/aqui.2024.24.3.7Keywords:
Primary Health Care, Nurses, Workplace, Psychological Burnout, Interpersonal RelationsAbstract
Introduction: Work activities incorporate physical, social, emotional, and technical elements. In a scenario of constant change, it is imperative to understand the current scientific knowledge on the structure and work conditions of nurses in primary health care (PHC). Objective: To identify, in the scientific literature, the aspects related to the work environment that influence the performance of nurses in PHC. Materials and Methods: This is an integrative literature review conducted in August 2023 in the Lilacs, Cinahl, Web of Science, Medline, Scopus, and Embase databases, following the Prisma 2020 Statement guidelines. The inclusion criteria were complete electronic articles, published in Portuguese, English, or Spanish between 2019 and 2023. This review used the ROBIS instrument to assess the risk of bias. Results: The search found 1,417 records in the databases, of which 20 were selected for the final sample. Of these, 30 % were from 2020 (n = 6), published in Portuguese, English, and Spanish. Brazil had the highest number of publications, with 55 % (n = 11), and qualitative studies represented 55 % (n = 11) of the methodological approaches. The following thematic categories emerged from the analysis: “psychological and emotional elements,” “human resources, materials, and infrastructure,” “interpersonal relationships,” “dissatisfaction,” “violence in the workplace,” and “overload.” Conclusion: The precarious environment in PHC has a negative impact on nurses and the care provided to the population. Improvements in infrastructure, personnel, and work conditions are essential to ensure quality care.
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References
Ministério da Saúde (Brasil). Portaria n.º 2.488, de 21 de outubro de 2011. Brasília, DF: Ministério da Saúde; 2011. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2488_21_10_2011.html
Martins MA, Lucas PB. Work environment and quality of nursing care in primary health care: a scoping review. Ann Med. 2021;53(supl. 1):132. DOI: https://doi.org/10.1080/07853890.2021.1896072
Pechacek J, Anderson D, Lund R, Drill-Mellum L. Healthy work environments: An interprofessional partnership model to promote positive workplace culture. Interdiscip J Partnersh. 2022;9(2):7. DOI: https://doi.org/10.24926/ijps.v9i2.4978
Gregory DD, Zborowsky T, Stichler JF. Integrating the environmental domain into the nursing well-being model: A call to action. HERD. 2023;16(2):15-23. DOI: https://doi.org/10.1177/19375867231154499
Bonfim D, Mafra ACCN, da Costa Palacio D, Rewa T. Assessment of staffing needs for registered nurses and licensed practical nurses at primary care units in Brazil using Workload Indicators of Staffing Need (WISN) method. Hum Resour Health. 2022;19(supl. 1):130. DOI: https://doi.org/10.1186/s12960-021-00674-0
Gea-Caballero V, Martínez-Riera JR, García-Martínez P, Casaña-Mohedo J, Antón-Solanas I, Verdeguer-Gómez MV et al. Study of the strengths and weaknesses of nursing work environments in primary care in Spain. Int J Environ Res Public Health. 2021;18(2):434. DOI: https://doi.org/10.3390/ijerph18020434
Kassahun CW, Abate AT, Tezera ZB, Beshah DT, Agegnehu CD, Getnet MA et al. Working environment of nurses in public referral hospitals of West Amhara, Ethiopia, 2021. BMC Nurs. 2022;21(1):167. DOI: https://doi.org/10.1186/s12912-022-00944-9
Silva SCPS, Nunes MAP, Santana VR, Reis FP, Machado Neto J, Lima SO. A síndrome de burnout em profissionais da Rede de Atenção Primária à Saúde de Aracaju, Brasil. Cien Saude Colet. 2015;20(10):3011-20. DOI: https://doi.org/10.1590/1413-812320152010.19912014
Mendes KDS, Silveira RC de CP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64. DOI: https://doi.org/10.1590/S0104-07072008000400018
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372(31):1-9. DOI: https://doi.org/10.1136/bmj.n71
Polit DF, Beck CT. Fundamentos de Pesquisa em Enfermagem: Avaliação de Evidências para a Prática da Enfermagem. 9a ed. Porto Alegre: ArtMed; 2018.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan: A web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. DOI: https://doi.org/10.1186/s13643-016-0384-4
Marziale MH. Instrumento para recolección de datos revisión integrativa. 2015. Disponible en: https://gruposdepesquisa.eerp.usp.br/sites/redenso/wp-content/uploads/sites/9/2019/09/Instrumiento_revision_litetarura_RedENSO_2015.pdf
Dang D, Dearholt SL, Bissett K, Ascenzi J, Whalen M. Johns Hopkins evidence-based practice for nurses and healthcare professionals: models and guidelines. Baltimore, MD: Sigma Theta Tau International; 2022.
Whiting P, Savović J, Higgins JP, Caldwell DM, Reeves BC, Shea B et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225-34. DOI: https://doi.org/10.1016/j.jclinepi.2015.06.005
Barth PO, Ramos FRS, Barlem ELD, Rennó HMS, Brehmer LC de F, Rocha JM. Generating situations of Moral Distress in Primary Care nurses. Rev Bras Enferm. 2019;72(1):35-42. DOI: https://doi.org/10.1590/0034-7167-2018-0378
Atehortúa Mira SM, Castaño Pineda Y, Restrepo Villa RO. Situación de la enfermería en el desarrollo de la atención primaria en salud en Antioquia (Colombia): aproximación desde la perspectiva de los profesionales. Gerenc Políticas Salud. 2019;18(36):1-35. DOI: https://doi.org/10.11144/Javeriana.rgsp18-36.seda
Mendonça Moreira J, Farah BF, Silva Dutra H, Fontoura Sanhudo N, De Castro Friedrich DB. Fatores desencadeadores de (in)satisfação no trabalho dos enfermeiros da atenção básica de saúde. Cienc Enferm. 2019;25(12):1-10. DOI: https://doi.org/10.4067/S0717-95532019000100209
Oliveira AR de, Sousa YG de, Diniz ÍVA, Medeiros SM de, Martiniano C, Alves M. The daily routine of nurses in rural areas in the Family Health Strategy. Rev Bras Enferm. 2019;72(4):918-25. DOI: https://doi.org/10.1590/0034-7167-2018-0243
Oliveira MM de, Pedraza DF. Contexto de trabalho e satisfação profissional de enfermeiros que atuam na Estratégia Saúde da Família. Saúde em Debate [Internet]. 2019;43(122):765-79. DOI: https://doi.org/10.1590/0103-1104201912209
Biff D, Pires DEP de, Forte ECN, Trindade L de L, Machado RR, Amadigi FR et al. Cargas de trabalho de enfermeiros: luzes e sombras na Estratégia Saúde da Família. Cien Saude Colet. 2020;25(1):147-58. DOI: https://doi.org/10.1590/1413-81232020251.28622019
Halcomb E, Williams A, Ashley C, McInnes S, Stephen C, Calma K et al. The support needs of Australian primary health care nurses during the COVID‐19 pandemic. J Nurs Manag. 2020;28(7):1553-60. DOI: https://doi.org/10.1111/jonm.13108
Mendes M, Trindade L de L, Pires DEP de, Biff D, Martins MMFP da S, Vendruscolo C. Cargas de trabalho na Estratégia Saúde da Família: interfaces com o desgaste dos profissionais de enfermagem. Rev Esc Enferm USP. 2020;54:e03622. DOI: https://doi.org/10.1590/s1980-220x2019005003622
Martins C, Potra T, Lucas P. Motivation factors of nurses in Primary Health Care. Pensar Enfermagem. 2020;24(1):27-38. DOI: http://dx.doi.org/10.56732/pensarenf.v24i1.167
Matlala NT, Malema RN, Bopape MA, Mphekgwana PM. The perceptions of professional nurses regarding factors affecting the provision of quality health care services at selected rural public clinics in the Capricorn district, Limpopo Province. Afr J Prim Health Care Fam Med. 2021;13(1): a2830. DOI: https://doi.org/10.4102/phcfm.v13i1.2830
Celestino LC, Leal LA, Lopes OCA, Henriques SH. Riscos psicossociais relacionados ao trabalho do enfermeiro da Saúde da Família e estratégias de gerenciamento. Rev Esc Enferm USP. 2020;54:e03602. DOI: https://doi.org/10.1590/s1980-220x2018055603602
Abdoh D, Shahin M, Ali A, Alhejaili S, Kiram O, Al-Dubai SR. Prevalence and associated factors of stress among primary health care nurses in Saudi Arabia: A multi-center study. J Family Med Prim Care. 2021;10(7):2692-96. DOI: https://doi.org/10.4103/jfmpc.jfmpc_222_21
Busnello GF, Trindade L de L, Pai DD, Beck CLC, Ribeiro OMPL. Tipos de violência no trabalho da enfermagem na Estratégia Saúde da Família. Esc Anna Nery. 2021;25(4):e20200427. DOI: https://doi.org/10.1590/2177-9465-ean-2020-0427
Ashley C, James S, Williams A, Calma K, Mcinnes S, Mursa R et al. The psychological well‐being of primary healthcare nurses during COVID‐19: A qualitative study. J Adv Nurs. 2021;77(9):3820-8. DOI: https://doi.org/10.1111/jan.14937
Albendín-García L, Suleiman-Martos N, Ortega-Campos E, Aguayo-Estremera R, Romero-Béjar J, Cañadas-De la Fuente G. Explanatory models of burnout diagnosis based on personality factors in primary care nurses. Int J Environ Res Public Health. 2022;19(15):9170. DOI: https://doi.org/10.3390/ijerph19159170
Fabri NV, Martins JT, Galdino MJQ, Ribeiro RP, Moreira AAO. Workplace violence and professional quality of life among primary care nurses. Acta Paul Enferm. 2022;35:eAPE0362345. DOI: https://doi.org/10.37689/acta-ape/2022AO0362345
Felix RFS, Pinheiro VRM, Júnior TTN, Medeiros RO, Guedes ACCS, Dantas Vieira HW et al. Percepções dos enfermeiros sobre as condições de trabalho e infraestrutura das unidades de Atenção Primária em Saúde. Tempus Actas Saúde Coletiva. 2023;16(4):65-72. DOI: https://doi.org/10.18569/tempus.v16i4.3062
Kueakomoldej S, Liu J, Pittman P, Turi E, Poghosyan L. Practice environment and workforce outcomes of nurse practitioners in community health centers. J Ambul Care Manage. 2022;45(4):289-98. DOI: https://doi.org/10.1097/JAC.0000000000000427
Viana VGA, Ribeiro MFM. Challenges of the nursing professional in the family health strategy: A depreciated key piece. Ciênc Cuid Saúde. 2022;21:e59900. DOI: https://doi.org/10.4025/ciencuidsaude.v21i0.59900
Wali R, Aljohani H, Shakir M, Jaha A, Alhindi H. Job satisfaction among nurses working in king Abdul Aziz medical city primary health care centers: A cross-sectional study. Cureus. 2023;15(1): e33672. DOI: https://doi.org/10.7759/cureus.33672
Šleinytė I, Mikaliūkštienė A. The effect of nurses stressogenic factors and psychoemotic state on care cooperation. Slauga Mokslas ir praktika. 2022;3(306):9-14. DOI: https://doi.org/10.47458/Slauga.2022.3.14
Gelčytė V, Mažionienė A. Relationships between work stress and job satisfaction among nurses. Slauga Mokslas ir praktika. 2023;4(313):1-7. DOI: https://doi.org/10.47458/Slauga.2023.4.1
Alshawish E, Nairat E. Burnout and psychological distress among nurses working in primary health care clinics in West Bank-Palestine. Int J Ment Health. 2020;49(4):321-35. DOI: https://doi.org/10.1080/00207411.2020.1752064
Monteiro WF, Lima KJV, Ferreira DS, Andrade LLC de, Ramos FRS. Existing workloads among managers and healthcare workers during the COVID-19 pandemic: Meanings in the Amazon context. PLoS One. 2023;18(10):e0292541. DOI: https://doi.org/10.1371/journal.pone.0292541
Abad A, Fuentes A, Paredes E, Godoy S, Perera S, Yuguero O. A comparison of emotional wellbeing and burnout of primary care professionals in 2014 and 2021. Front Public Health. 2023;10:1062437. DOI: https://doi.org/10.3389/fpubh.2022.1062437
Zabin LM, Zaitoun RSA, Sweity E, Tantillo L. The relationship between job stress and patient safety culture among nurses: A systematic review. BMC Enferm. 2023;22(39):1-7 DOI: https://doi.org/10.21203/rs.3.rs-1972358/v1
Moscatelli M. Design strategies and health planning to improve the primary health care environment: a case study in Brazil. Int J Archit Res Archnet. 2022;16(3):575-94. DOI: https://doi.org/10.1108/ARCH-07-2021-0201
Paguio JT, Yu DSF, Su JJ. Systematic review of interventions to improve nurses’ work environments. J Adv Nurs. 2020;76(10):2471-93. DOI: https://doi.org/10.1111/jan.14462
Halas G, Osahan P. Interprofessional primary care teamwork: Investigating experiences of health care providers. Ann Fam Med. 2023;21(supl. 1): 4416. DOI: https://doi.org/10.1370/afm.21.s1.4416
Novaes LR, de Barros MM, Cirino FS. Analysis of the work environment and burnout among nurses, technicians and nursing assistants in Brazilian institutions. Asploro J Biomed Clin Case Rep. 2022;5(3):128-39. DOI: https://doi.org/10.36502/2022/ASJBCCR.6276
Bahlman-van Ooijen W, Malfait S, Huisman-de Waal G, Hafsteinsdóttir TB. Nurses’ motivations to leave the nursing profession: A qualitative meta‐aggregation. J Adv Nurs. 2023;79(12):4455-71. DOI: http://dx.doi.org/10.1111/jan.15696
Pina D, Peñalver-Monteagudo CM, Ruiz-Hernández JA, Rabadán-García JA, López-Ros P, Martínez-Jarreta B. Sources of conflict and prevention proposals in user violence toward Primary Care staff: A qualitative study of the perception of professionals. Front Public Health. 2022;10:862896. DOI: https://doi.org/10.3389/fpubh.2022.862896
Mutshatshi TE, Munyai V. Challenges experienced by Primary Health Care nurses rendering 24 hours service at designated clinics in Musina local area, Limpopo province. Open Public Health J. 2022;15(1): e187494452202241. DOI: https://doi.org/10.2174/18749445-v15-e2202241
Maghsoud F, Rezaei M, Asgarian FS, Rassouli M. Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach. BMC Nurs. 2022;21:273. DOI: https://doi.org/10.1186/s12912-022-01055-1
Areskoug Josefsson K, Avby G, Andersson Bäck M, Kjellström S. Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: A qualitative study. Scand J Prim Health Care. 2018;36(4):406-14. DOI: https://doi.org/10.1080/02813432.2018.1523987
Pereira LEM, Ramos FRS, Brehmer LCF, Diaz PS. Ambiente de trabalho saudável na Atenção Primária à Saúde: revisão integrativa da literatura. Rev baiana enferm. 2022;36:e38084. DOI: https://doi.org/10.18471/rbe.v36.38084
Dutra CD, Soares MC, Meincke SMK, de Matos GC. Processo de trabalho da enfermagem na atenção primária à saúde: revisão integrativa. Rev Enferm UFPE On Line. 2016;10(3):1523-34. Disponível em: https://periodicos.ufpe.br/revistas/index.php/revistaenfermagem/article/view/11094
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Copyright (c) 2024 Lucas Lorran Costa de Andrade, Laura Cavalcanti de Farias Brehmer, Bruna Alves Machado Amazonas, Wagner Ferreira Monteiro, Amélia Nunes Sicsú, Flávia Regina Souza Ramos
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