Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 15, 2019

Nursing Staff Members Mental’s Health and Factors Associated with the Work Process: An Integrative Review



Selene Cordeiro Vasconcelos1, *, Sandra Lopes de Souza2, Everton Botelho Sougey2, Elayne Cristina de Oliveira Ribeiro1, José Jailson Costa do Nascimento1, Mariana Bandeira Formiga3, Luciana Batista de Souza Ventura3, Murilo Duarte da Costa Lima2, Antonia Oliveira Silva4
1 Federal University of Paraíba, UFPB, João Pessoa, Paraíba, Brazil
2 Postgraduate Program in Neuropsychiatry and Behavioral Sciences, UFPE, Recife, Pernambuco, Brazil
3 Federal University of Pernambuco, UFPE, Recife, Pernambuco, Brazil
4 Postgraduate Program Nursing and Gerontology Master Program, Federal University of Paraíba, Paraíba, Brazil

Abstract

Background:

The mental health of nursing staff members influences the work process outcomes.

Objective:

Identify the work related factors that harms the nursing team’s mental health.

Methods:

Databases PubMed, Scopus, CINAHL and MEDLINE, by mating between the indexed descriptors in MeSH terms “mental health” and “occupational health nursing”. 783 articles were rescued to give a final sample of 18 articles. Integrative review in order to identify factors associated with the work process of the nursing staff that negatively affects mental health.

Results:

The main associated factors were work demands, psychological demands, violence, aggression, poor relationships with administrators, accidents involving the risk of exposure to HIV, stress and errors in the execution of labor activities. The main findings regarding the nursing staff’s mental health were post-traumatic stress disorder, depression, stress, major depressive episode and generalized anxiety disorder.

Conclusion:

Occupational nurses need to understand the complexities of mental health problems and substance use among nursing staff members to recognize, identify and care for workers at risk and offer adequate mental health care. Although the researches interests in this theme have increased, proving that all these factors contribute to the risk to mental health of nursing professionals, the protective measures and care are being neglected by managers in both private and public network . The health of nursing workers in question here is one more challenge for a profession that takes care of others in need, therefore, requires some caring with their own health.

Keywords: Mental health, Occupational nursing, Occupational risk.


Article Information


Identifiers and Pagination:

Year: 2016
Volume: 12
First Page: 167
Last Page: 176
Publisher Id: CPEMH-12-167
DOI: 10.2174/1745017901612010167

Article History:

Received Date: 26/02/2016
Revision Received Date: 08/09/2016
Acceptance Date: 10/10/2016
Electronic publication date: 23/12/2016
Collection year: 2016

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© Vasconcelos et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Federal University of Paraíba, UFPB, João Pessoa, Paraíba, Brazil; Tel: 52010-290 +55(81)96344249; E-mail: selumares@yahoo.com.br




INTRODUCTION

Problems with occupational health have been related to biotechnologies, information and automation technologies, chemical substances and physical energy, along with the peculiarities inherent to the aging of the working population, making groups vulnerable to occupational diseases of various origins [1WHO, Active aging: a health policy. Organização Pan-Americana de Saúde. Brasília, DF, 2005.]. The relationship between the work process and life style has been considered a cause of stress and health problems, leading to organic and psychological imbalances and compromising the development of one’s labor activities [2Martins VF, Ferreira VM, Guilhem D. Psychophysiological consequences arising from the stress of everyday life and work activities. Salud Ment 2013; 36(2): 141-7.
[http://dx.doi.org/10.17711/SM.0185-3325.2013.017]
].

Workers in the health field are particularly exposed to continuous stress, which causes physical, psychological and cognitive symptoms, demanding prolonged adaptive responses to tolerate, overcome or adapt to stressors [3Almeida AN, Gurgel ER, Silva SR. Quality of life related to health of nurses in the operating room of clinical hospital Dr. Alberto Lima. Rev de Ciên da Amaz 2013; 2(1): 8.]. However, healthcare professionals have been more concerned with improving their activities and the care offered to patients than caring for their own health, especially regarding to occupational risks and mental health [4Neves HCC, Souza ACS, Medeiros M, Munari DB, Ribeiro LCM, Tipple AFV. Security of nursing staff and determining factors for adherence to personal protective equipment. Rev Lat Am de Enf 2011; 19(2): 8.].

Nursing is associated with high levels of stress, a low degree of quality of life and burnout syndrome [5Lee JS, Akhtar S. Effects of the workplace social context and job content on nurse burnout. Hum Resour Manage 2011; 50(2): 227-45.
[http://dx.doi.org/10.1002/hrm.20421]
], due mainly to the long hours and professional dissatisfaction [6Gärtner FR, Nieuwenhuijsen K, Ketelaar SM, van Dijk FJ, Sluiter JK. The mental vitality @ work study: effectiveness of a mental module for workers health surveillance for nurses and allied health care professionals on their help-seeking behavior. J Occup Environ Med 2013; 55(10): 1219-29.
[http://dx.doi.org/10.1097/JOM.0b013e31829f310a] [PMID: 24064780]
]. Moreover, symptoms of anxiety, depression, psychological suffering, sleep disorders, fatigue and other somatic complaints are reported to be associated with the work process of the nursing staff and exert a negative impact on the mental health of these healthcare workers [7García-Izquierdo M, Ríos-Rísquez MI. The relationship between psychosocial job stress and burnout in emergency departments: an exploratory study. Nurs Outlook 2012; 60(5): 322-9.
[http://dx.doi.org/10.1016/j.outlook.2012.02.002] [PMID: 22464694]
].

The workplace and work process should be monitored continually, since there is an association between occupational diseases and the execution of specific nursing procedures, which causes a high level of tension in the work process and reduction in nurses' productivity and life quality [8Ferreira RE, Souza NV, Gonçalves FG, Santos DM, Pôças CR. Nursing work with customers HIV/AIDS: psychic potential for suffering. Rev Enferm UERJ 2013; 21(4): 477-82.]. Therefore, an environment that promotes the work process’ organization as well as adequate relationships and communication among staff members, can contribute to the mental health of these workers [9Ribeiro JP, Rocha LP, Pimpão FD, Porto AR, Thofehrn MB. Implications of the environment in the development of the work process of nursing: an integrative review. Enf Global 2012; 11(27): 379-87.].

The present review’s goal was to identify factors associated with the work process of the nursing staff that exerts a negative impact on these healthcare professionals’ mental health. Thus, the following research question was designed: What factors associated with the work process of the nursing staff exert a negative impact on the mental health of these healthcare professionals?

MATERIALS AND METHODOLOGY

An integrative review of scientific production was performed. Searches for articles were performed in the Scopus, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PubMed databases using the MeSh Terms “mental health” and “occupational health nursing”. A total of 783 papers were retrieved, 18 of which were selected for the final sample.

The searches, selection and analysis of the articles were performed by two independent researchers, who compared their findings. In cases of disagreement, a third researcher was consulted and a consensus was reached. The calibration was performed based on the simple means of the correct selection of studies, obtaining 89% agreement during the first calibration exercise and 100% during the second.

For the article’s selection, the titles and abstracts were first read and the following inclusion criteria were considered: studies involving primary data; studies with nursing staff members as the subjects, independently of age, sex, duration of the profession, service or work sector; articles addressing the mental health/illness process and/or substance use by nursing staff; papers published in Portuguese, English or Spanish; articles indexed in at least one of the databases searched. The exclusion criteria were case studies, theses, dissertations, work presented at conferences and review articles. The Fig. (1) shows the flowchart of the study selection process.

Data were extracted from the articles using a validated instrument [11Ursi ES, Gavão CM. Prevention of skin lesions in the perioperative period: integrative literature review. Rev Lat Am Enf 2006; 14(1): 124-31.]. The results were presented in tables and text to facilitate the analysis and summarize the scientific evidence, thereby meeting the present review’s objective.

RESULTS

The final sample comprised of 18 studies: five retrieved from SCOPUS, eight retrieved from PubMed and five retrieved from CINAHL. The four articles retrieved from MEDLINE were not included, as these studies were duplicates of those retrieved from the SCOPUS database. Among the articles selected, seven were published in periodicals specific to occupational health. Regarding the design, two were randomized controlled clinical trials, one was a quasi-experimental study, 13 were exploratory descriptive cross-sectional studies with a quantitative approach and two had a qualitative approach. All studies used an instrument to measure the variables of interest. Tables 1-3 display the main findings of the studies.

The articles addressed mental health related to the work process of the nursing staff or nurses alone as the primary or secondary outcome. When mental health was the object of the study, it was considered the primary outcome; when the aspects analyzed led to associations with mental health, it was considered the secondary outcome.

Fig. (1)
Database searches’ results of article’s selection by independent researchers and comparison of selections for final sample’s determination based on PRISMA Search Strategy Diagram [10Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting itens for systematic reviews and meta-analyses. PRISMA Statement Annals Internal Med 2009; 151(4): 264-70.
[http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00135] [PMID: 19622511]
].


The main factors associated with the work process of the nursing staff that exert a negative impact on the mental health of these healthcare professionals were work demands [12Cho SH, Park M, Jeon SH, Chang HE, Hong HJ. Average hospital length of stay, nurses work demands, and their health and job outcomes. J Nurs Scholarsh 2014; 46(3): 199-206.
[http://dx.doi.org/10.1111/jnu.12066] [PMID: 24502556]
-14Gouva M, Mantzoukas S, Mitona E, Damigos D. Understanding nurses psychosomatic complications that relate to the practice of nursing. Nurs Health Sci 2009; 11(2): 154-9.
[http://dx.doi.org/10.1111/j.1442-2018.2009.00442.x] [PMID: 19519702]
], aggression [15Gillespie GL, Bresler S, Gates DM, Succop P. Posttraumatic stress symptomatology among emergency department workers following workplace aggression. Workplace Health Saf 2013; 61(6): 247-54.
[http://dx.doi.org/10.3928/21650799-20130516-07] [PMID: 23701003]
], violence [16Lawoko S, Soares JJ, Nolan P. Violence towards psychiatric staff: A comparison of gender, job and environmental characteristics in England and Sweden. Work Stress 2004; 18(1): 39-55.
[http://dx.doi.org/10.1080/02678370410001710337]
, 17Estryn-Behar M, van der Heijden B, Camerino D, et al. Violence risks in nursing results from the European NEXT Study. Occup Med (Lond) 2008; 58(2): 107-14.
[http://dx.doi.org/10.1093/occmed/kqm142] [PMID: 18211910]
], work accidents involving the risk of exposure to HIV [18Roets L, Ziady LE. The nursesexperience of possible HIV infection after injury and/or exposure on duty. Curationis 2008; 31(4): 13-23.
[http://dx.doi.org/10.4102/curationis.v31i4.1046] [PMID: 19653533]
], stress [14Gouva M, Mantzoukas S, Mitona E, Damigos D. Understanding nurses psychosomatic complications that relate to the practice of nursing. Nurs Health Sci 2009; 11(2): 154-9.
[http://dx.doi.org/10.1111/j.1442-2018.2009.00442.x] [PMID: 19519702]
, 19Al Hosis KF, Mersal FA, Keshk LI. Effects of job stress on health of saudi nurses working in ministry of health hospitals in qassim region in KSA. Life Sci J 2010; 10(1): 1036-44.] and errors in the execution of labor activities [20Arimura M, Imai M, Okawa M, Fujimura T, Yamada N. Sleep, Mental health status, and medical errors among hospital nurses in Japan. Ind Health 2010; 48(6): 811-7.
[http://dx.doi.org/10.2486/indhealth.MS1093] [PMID: 20616466]
]. The main mental health findings as the primary outcome of the investigation were post-traumatic stress disorder [15Gillespie GL, Bresler S, Gates DM, Succop P. Posttraumatic stress symptomatology among emergency department workers following workplace aggression. Workplace Health Saf 2013; 61(6): 247-54.
[http://dx.doi.org/10.3928/21650799-20130516-07] [PMID: 23701003]
], depression and/or stress [19Al Hosis KF, Mersal FA, Keshk LI. Effects of job stress on health of saudi nurses working in ministry of health hospitals in qassim region in KSA. Life Sci J 2010; 10(1): 1036-44.-23Taghinejad H, Suhrabi Z, Kikhavani S, Jaafarpour M, Azadi A. Occupational mental health: a study of work-related mental health among clinical nurses. J Clin Diagn Res 2014; 8(9): WC01-3.
[PMID: 25386506]
], major depressive episode and/or generalized anxiety disorder [24El Kissi Y, Maarouf Bouraoui M, Amamou B, et al. Prevalence of anxiety and depressive disorders among the nurses of Sousse Farhat Hached hospital: assessment by the Tunisian version of CIDI. Tunis Med 2014; 92(1): 18-23.
[PMID: 24879165]
] and minor psychological disorder [25Urbanetto JS, Magalhães MC, Maciel VO, et al. Work-related stress according to the demand-control model and minor psychic disorders in nursing workers. Rev Esc Enferm USP 2013; 47(3): 1186-93.
[PMID: 24601131]
]. All articles also addressed psychosomatic symptoms of the nursing staff due to occupational risks and factors associated with the work process.

The strategies employed for mental health care of the nursing staff were all group-oriented, such as workshops for training emotional intelligence [26Sharif F, Rezaie S, Keshavarzi S, Mansoori P, Ghadakpoor S. Teaching emotional intelligence to intensive care unit nurses and their general health: a randomized clinical trial. Int J Occup Environ Med 2013; 4(3): 141-8.
[PMID: 23860544]
], meetings with an active methodology, followed by individual counseling [27Uchiyama A, Odagiri Y, Ohya Y, Takamiya T, Inoue S, Shimomitsu T. Effect on mental health of a participatory intervention to improve psychosocial work environment: a cluster randomized controlled trial among nurses. J Occup Health 2013; 55(3): 173-83.
[http://dx.doi.org/10.1539/joh.12-0228-OA] [PMID: 23585499]
] and a psycho-education group for training communication skills [28Ghazavi Z, Lohrasbi F, Mehrabi T. Effect of communication skill training using group psychoeducation method on the stress level of psychiatry ward nurses. Iran J Nurs Midwifery Res 2010; 15(Suppl. 1): 395-400.
[PMID: 22069416]
]. Despite not addressing mental health as the primary focus, these strategies were able to improve the mental health of the nursing staff and the work process. One article demonstrated that healthy nutrition improved mental health, the work process, job and life satisfaction, as it represented an important aspect of self-care [29Nemcek MA. Registered nurses self-nurturance and life and career satisfaction. AAOHN J 2007; 55(8): 305-10.
[http://dx.doi.org/10.1177/216507990705500802] [PMID: 17847624]
].

Based on the findings, the work process of the nursing staff was identified as a source of stress and psychological suffering with physical, mental, individual and collective repercussions. Thus, the work process exposes nurses to occupational risks involving psychological, personal safety, biology and social aspects, all of which are related to mental health.

Table 1
Characterization of the CINAHL’s articles included in the sample, 2015.


Table 2
Characterization of the articles included in the sample and rescued by PubMed, 2015.


Table 3
Characterization of the articles included in the sample and rescued by SCOPUS, 2015.


DISCUSSION

Nursing staff members are involved in different aspects of health care in which the traditional care model predominates, giving priority to work demands in detriment of the subjective nurses and patients’ needs [30Silva AA, Terra MG, Freitas FF, Ely GZ, Mostardeiro SC. Self-care under the perception of the mental health nursing professionals. Rev RENE 2013; 14(6): 92-1002.]. The nursing care process is often centered in the individual’s body and health protection, with no ties to the social, historical, cultural, economic and singular aspects of the subject receiving the care. Care also occurs in the form of the knowledge transmission and information aimed at changing the patients’ behavior. This understanding of the nursing work process distanced nursing staff members from concerns regarding their own health and their role as subjects that also require care [31Almeida AN, Feitosa RM, Boesmans EF, Silveira LC. Clinical care nursing in mental health: reflections on a practice nurse. J Res Fundam Care 2014; 6(1): 213-31.].

The relationship a healthcare professional establishes with oneself and the process of knowing oneself influences the way by which one perceives oneself as a subject that also needs care, thereby affecting the development of actions directed at self-care [32Bernardes AG, Guareschi NM. Technologies in mental health: take care of yourself and know yourself. Psicol em Foco 2007; 1(1): 29-48.]. Nurses in open sectors generally deal directly with the public and therefore experience higher levels of stress in comparison to those who work in closed units [33Santos TM, Frazão IS, Ferreira DM. Occupational stress in nurses of a university hospital. Cogitare Enf 2011; 16(1): 76-81.]. Factors associated with stress include the patients’ impatience, irritated accompaniers, intolerant physicians, child and emergency care in two sectors at the same time [34Farias SM, Teixeira OL, Moreira W, Oliveira MA, Pereira MO. Characterization of the physical symptoms of stress in the emergency health care team. Rev Esc Enferm USP 2011; 45(3): 722-9.
[http://dx.doi.org/10.1590/S0080-62342011000300025] [PMID: 21710081]
]. Moreover, the excessive hourly work load hinders having a social life and enjoying recreational activities, thereby contributing to the physical and mental burden of nursing staff members and exerting a negative impact on both life quality and work performance [33Santos TM, Frazão IS, Ferreira DM. Occupational stress in nurses of a university hospital. Cogitare Enf 2011; 16(1): 76-81.].

Psychological suffering among nursing staff members has been related to the characteristics of the labor organization, work process and patient’s specificity. Factors associated with psychological suffering include little autonomy in the decision-making process, little recognition of the importance of their work, inadequate continued training program as well as a lack of material and human resources [2Martins VF, Ferreira VM, Guilhem D. Psychophysiological consequences arising from the stress of everyday life and work activities. Salud Ment 2013; 36(2): 141-7.
[http://dx.doi.org/10.17711/SM.0185-3325.2013.017]
]. Moreover, exposure to physical and verbal aggression, a lack of job security and low pay contribute to problems such as stress, cardiovascular alterations and sleep disorders [35Silva OM, Ascari RA, Schiavinato D, Ribeiro MC. Disease risks faced by the SAMU nursing staff: an integrative review. Rev Saúde Públ Santa Cat 2014; 7(1): 107-21.]. Thus, nurses experience different violence forms of a physical and psychological nature that negatively affect their work performance and health [36Siqueira VR, Giacomitti CN, Eloy F, Kuster TC. The violence in the nursing work process in emergency care: an integrative literature review. Voos Rev Polid Elet da Fac Guai 2014; 4(2): 21-33.].

The demands of the work process of the nursing staff require specialization, technical-scientific knowledge, leadership skills, discernment, responsibility and clinical practice, which places considerable pressure on these healthcare professionals [37Hercos TM, Vieira FS, Oliveira MS, Buetto LS, Shimura CM, Sonobe HM. The work of nursing professionals in intensive care units in oncology patient care. Rev Bras Cancerol 2014; 60(1): 51-8.]. Moreover, bureaucratic activities, the constant contact with death and human suffering, difficult family relations, the lack of recognition on the part of supervisors and administrators, the lack of encouragement for continued education and the lack of institutional strategies to minimize the physiological and psychological consequences to nurses, patients and family are risk factors for mental illness among of the nursing staff members [37Hercos TM, Vieira FS, Oliveira MS, Buetto LS, Shimura CM, Sonobe HM. The work of nursing professionals in intensive care units in oncology patient care. Rev Bras Cancerol 2014; 60(1): 51-8.].

Mental illness stemming from stress in the workplace depends on individual aspects and one’s relationship with this environment [38Medeiros AJ, Nóbrega MM. The stress among nurses in emergency care and emergency units: A literature review. Rev Bras de Ed e Saúde 2014; 3(3): 53-7., 39Vitorino LM, Monteiro FP, Silva JV, Dias EM, Santos AE. Quality of nursing staff of life in urgency and emergency units. Rev Ciênc Méd 2014; 23(2): 83-9.]. The physical symptoms involved in mental illness and a reduction in productivity include musculoskeletal disorders, which are generally associated with chronic pain and disability [40Lima AC, Magnago TS, Prochnow A, Ceron MD, Schardong AC, Scalcon CB. Factors associated with musculoskeletal pain in hospital nursing workers. Rev Enferm UERJ 2014; 22(4): 526-32.], tachycardia, insomnia, insecurity, anxiety, weariness [41Kurebayashi LF, Gnatta JR, Borges TP, Silva MJ. Traditional Chinese medicine diagnostic evaluation of stress symptoms treated by auriculotherapy: a clinical trial. Rev Eletr Enf 2014; 16(1): 68-79.], headache, sensation of fatigue and pain in the lower limbs [34Farias SM, Teixeira OL, Moreira W, Oliveira MA, Pereira MO. Characterization of the physical symptoms of stress in the emergency health care team. Rev Esc Enferm USP 2011; 45(3): 722-9.
[http://dx.doi.org/10.1590/S0080-62342011000300025] [PMID: 21710081]
]. Exposure to continuous stress leads the organism to exhaustion and contributes to the emergence of opportunistic diseases; thus, physical stress leads to psychological stress and vice versa [34Farias SM, Teixeira OL, Moreira W, Oliveira MA, Pereira MO. Characterization of the physical symptoms of stress in the emergency health care team. Rev Esc Enferm USP 2011; 45(3): 722-9.
[http://dx.doi.org/10.1590/S0080-62342011000300025] [PMID: 21710081]
]. Factors associated with the nursing staff’s work include physical and emotional aspects, and pain, with repercussions regarding work performance and life quality [3Almeida AN, Gurgel ER, Silva SR. Quality of life related to health of nurses in the operating room of clinical hospital Dr. Alberto Lima. Rev de Ciên da Amaz 2013; 2(1): 8.]. Thus, knowledge on work-related factors that affect the mental health of nursing staff members is indispensable, as the quality of health care depends on healthy, motivated staff members.

Moreover, care quality and staff members productivity of staff members under stress or with occupational diseases are compromised, leading to high rates of absenteeism and being on leave from work due to health reasons [42Forte EC, Trombetta AP, Pires DE, Gelbcke FL, Lino MM. Theoretical approaches on the health of nursing workers: an integrative review. Cogitare Enferm 2014; 19(3): 604-11.].

The working conditions and health of the nursing staff underscore the need for changes in the organization and work process, as well as the responsibility of occupational nurses to develop strategies aimed at factors associated with the work process of this team that affects their mental health [43Rodrigues EP, Rodrigues US, Oliveira LdeM, Laudano RC, Sobrinho CL. Prevalence of common mental disorders in nursing workers at a hospital of Bahia. Rev Bras Enferm 2014; 67(2): 296-301.
[http://dx.doi.org/10.5935/0034-7167.20140040] [PMID: 24861075]
]. Thus, there is an important relationship between occupational risks and the complexity level of symptoms and diseases stemming from the work process of the nursing staff as the kind of the work environment and the way these healthcare professionals react to the interaction of all these factors [44Oliveira EB, Silva AV, Junior EF, Costa HF, Nascimento LP, Souza LA. Psychosocial risk factors in neonatal intensive care unit: impact to the nurse’s health. Rev Enf UERJ 2013; 21(4): 490-5.]. Furthermore, consumption of psychoactive substances causes ill adaptation to the stressor with dysfunction in social and work activities [45Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment Disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemol Ment Health 2009; 5: 15.
[http://dx.doi.org/10.1186/1745-0179-5-15] [PMID: 19558652]
].

The theories’ choice to guide nursing practices provides scientific support to the care focus and the evaluation of interventions [46Noel DL. Occupational health nursing practice through the Human Caring lens. AAOHN J 2010; 58(1): 17-24.
[http://dx.doi.org/10.3928/08910162-20091216-02] [PMID: 20027992]
]. Interpersonal approaches include psychoeducation about the patient's role, formulation of the problems from an interpersonal perspective, exploration of options for changing dysfunctional behavior pattern [45Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment Disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemol Ment Health 2009; 5: 15.
[http://dx.doi.org/10.1186/1745-0179-5-15] [PMID: 19558652]
]. Considering the findings of the present study, we suppose that high level of perceived job satisfaction could be related to the “community centered model” in mental health care services. Similar studies should be conducted by including different types of mental health organizations, such as psychiatric hospitals, to explore the differences [47Sancassiani F, Campagna M, Tuligi F, Machado S, Cantone E, Carta MG. Organizational wellbeing among workers in mental health services: A pilot study. Clin Pract Epidemol Ment Health 2015; 11: 4-11.
[http://dx.doi.org/10.2174/1745017901511010004] [PMID: 25767557]
].

The planning of interventions directed at health problems stemming from the work process of the nursing staff requires a diagnostic assessment. According to the organic law of Health n. 8080/90 of 19 September 1990 [48Organic health law no. 8080/90 of 19 September 1990 Official Gazette. In: Brasília, DF: Legislature 1990. Available from: http://www. planalto.gov.br/ocivil_03/leis/18080.htm], an action that aimed the mental’s health prevention and the promotion of occupational health should be part of any healthcare program directed at the nursing staff.

Thus, strategies for protecting the nursing staff’s health should address three health care levels: basic (prevention of occupational risks and mental health promotion), moderate complexity (direct care of the problem) and high complexity (follow up and assistance to return to the workforce).

CONCLUSION

The scientific evidences on the mental health and work process of the nursing staff were identified: mental health risk factors, the relationship between mental illness and both physical symptoms and productivity related to work activities as well as feeling and perceptions of the nursing staff members regarding the work process and their mental health. The risk factors identified were work-related accidents, violence in the workplace, the physical and mental demands of the job, excessive work activities, work pressure, poor relationships with the nursing team and administrators and individual psychological characteristics.

The findings demonstrate that mental illness causes physical symptoms and lowers productivity, with repercussions to the nurses’ lives of nurses and their family/social relations. Thus, mental health, occupational health and the work process are interrelated and can influence one another in a positive or negative fashion. The strategies identified to preserve the nursing’s staff mental health include the training of communication skills, emotional intelligence and participative management.

This study provides a better understanding of the nursing staff’s mental health complexity, demonstrating that the work process of these healthcare professionals involves peculiarities that expose nurses to the risk of physical and mental disorders. This study also highlights the importance of occupational nurses and their work regarding the health care of their work teams.

The nurse’s work need to understand the problems’ complexities of mental health and substance use among nursing workers to recognize, identify and take care of workers at risk, providing adequate mental health care. Although this theme has gained increasing interest from researchers, proving that all these factors contribute to the risk to mental health of nursing professionals, the protective measures and care are being neglected by managers in both the private network, the public network. The health of nursing workers is another challenge for this profession that needs to be taken care of and should be careful.

AUTHORS' CONTRIBUTIONS

SLS, EBS, MDCL, participated in the manuscript revision, assessing the overall structure of the study since first time. SCV, ECOR, JJCN participated in the bibliographic research, articles selection, and manuscript editing, figures and tables creation, manuscript editing. LBSV e MBF participated in the assessment of the overall structure of the final form of study. All research time participated in the discussions about the manuscript revisions, and all approved the manuscript final version to submit to journal.

CONFLICT OF INTEREST

The authors confirm that this article content has no conflict of interest.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

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[http://dx.doi.org/10.17711/SM.0185-3325.2013.017]
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[4] Neves HCC, Souza ACS, Medeiros M, Munari DB, Ribeiro LCM, Tipple AFV. Security of nursing staff and determining factors for adherence to personal protective equipment. Rev Lat Am de Enf 2011; 19(2): 8.
[5] Lee JS, Akhtar S. Effects of the workplace social context and job content on nurse burnout. Hum Resour Manage 2011; 50(2): 227-45.
[http://dx.doi.org/10.1002/hrm.20421]
[6] Gärtner FR, Nieuwenhuijsen K, Ketelaar SM, van Dijk FJ, Sluiter JK. The mental vitality @ work study: effectiveness of a mental module for workers health surveillance for nurses and allied health care professionals on their help-seeking behavior. J Occup Environ Med 2013; 55(10): 1219-29.
[http://dx.doi.org/10.1097/JOM.0b013e31829f310a] [PMID: 24064780]
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