Márcia Astrês Fernandes^1*

Maria Paula Macêdo Brito²

Nanielle Silva Barbosa³

Ana Paula Cardoso Costa⁴

Álvaro Sepúlveda Carvalho Rocha⁵

Luciana Karine de Abreu Oliveira⁶

Ana Lívia Castelo Branco de Oliveira⁷

Ítalo Arão Pereira Ribeiro⁸

¹Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0001-9781-0752

²Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0002-4251-0944

³Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0001-5758-2011

⁴Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0002-1550-3685

⁵Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0002-7968-9597

⁶Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0002-9314-0234

⁷ Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0002-2634-0594

⁸Universidade Federal do Piauí. Teresina, Brasil. ORCID: https://orcid.org/0000-0003-0778-1447

*Corresponding Author

Márcia Astrês Fernandes

Departamento de Pós-Graduação em Enfermagem. Universidade Federal do Piauí. Campus Universitário Ministro Petrônio Portella. Bairro Ininga. CEP: 64049-550. Teresina, Piauí, Brasil. E-mail: m.astres@ufpi.edu.br Contato: +55 86 3215-5558

Submission: 19-02-2023

Approval: 08-03-2023

ABSTRACT

Objective: To analyze the use of psychoactive substances by the nursing staff of a high complexity hospital in the state of Piauí. Method: cross-sectional descriptive study, with a quantitative approach, carried out with 49 nursing professionals, between January and March 2019. A semi-structured questionnaire was used for data collection, presenting sociodemographic and occupational variables, related to health and the use of psychoactive substances, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Alcohol Use Disorders Identification Test (AUDIT). The research received approval opinion nº 3,588,464 from the co-participating institution. Results: Regarding the prevalence of psychoactive substance use, alcohol stood out as the most consumed substance (42.91%). Mental fatigue (14.91%), insomnia (14.91%) and stress (14.91%) were identified as factors that most motivated the use/abuse of these substances. There was a moderate risk for the use of tobacco, alcohol and sedatives among the participants. Conclusion: These risk behaviors are increasingly common in the work environment of these health professionals and require attention from institutions, promoting measures that can intervene in the work routine of these employees in order to identify and minimize the factors that motivate the problematic consumption of such substances. There is a need for further investigations that point to the use of other psychoactive substances, in addition to alcohol, with other contexts in which the nursing team operates as scenarios.

Keywords: Nursing, Team; Psychotropic Drugs; Substance Abuse, Oral; Occupational Health.

RESUMEN

Objetivo: analizar el uso de sustancias psicoactivas por parte del personal de enfermería de un hospital de alta complejidad en el estado de Piauí. Método: estudio descriptivo transversal, con abordaje cuantitativo, realizado con 49 profesionales de enfermería, entre enero y marzo de 2019. Para la recolección de datos se utilizó un cuestionario semiestructurado, presentando variables sociodemográficas y ocupacionales, relacionadas con la salud y el uso de sustancias psicoactivas, la Prueba de Detección de Consumo de Alcohol, Tabaco y Sustancias (ASSIST) y la Prueba de Identificación de Trastornos por Consumo de Alcohol (AUDIT). La investigación recibió el dictamen de aprobación nº 3.588.464 de la institución coparticipante. Resultados: En cuanto a la prevalencia de consumo de sustancias psicoactivas, el alcohol se destacó como la sustancia más consumida (42,91%). La fatiga mental (14,91%), el insomnio (14,91%) y el estrés (14,91%) fueron identificados como los factores que más motivaron el uso/abuso de estas sustancias. Hubo un riesgo moderado para el uso de tabaco, alcohol y sedantes entre los participantes. Conclusión: Estos comportamientos de riesgo son cada vez más comunes en el ambiente de trabajo de estos profesionales de la salud y requieren atención de las instituciones, promoviendo medidas que puedan intervenir en la rutina de trabajo de estos empleados con el fin de identificar y minimizar los factores que motivan el consumo problemático de tales sustancias. Existe la necesidad de más investigaciones que apunten al uso de otras sustancias psicoactivas, además del alcohol, con otros contextos en los que actúa el equipo de enfermería como escenarios.

Palabras clave: Grupo de Enfermería; Psicotrópicos; Sustancias de Abuso por Vía Oral; Salud Laboral.

RESUMO

Objetivo: analisar o uso de substâncias psicoativas pela equipe de enfermagem de um hospital de alta complexidade do estado do Piauí. Método: estudo descritivo transversal, com abordagem quantitativa, realizado com 49 profissionais de enfermagem, entre janeiro a março de 2019. Para a coleta dos dados foi utilizado questionário semiestruturado apresentando variáveis sóciodemográficas, ocupacionais, relacionadas à saúde e ao uso de substâncias psicoativas, o Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) e o Alcohol Use Disorders Identification Test (AUDIT). A pesquisa recebeu parecer de aprovação nº 3.588.464 da instituição coparticipante. Resultados: Em relação à prevalência de uso das substâncias psicoativas, o álcool se destacou como a substância mais consumida (42,91%). O cansaço mental (14,91%), insônia (14,91%) e estresse (14,91%) foram apontados como fatores que mais motivaram o uso/abuso dessas substâncias. Evidenciou-se o risco moderado para uso de tabaco, álcool e sedativos entre os participantes. Conclusão: Esses comportamentos de risco estão cada vez mais comuns no ambiente de trabalho desses profissionais de saúde e requer atenção por parte das instituições, promovendo medidas que possam intervir na rotina de trabalho desses colaboradores com o intuito de identificar e minimizar os fatores que motivem o consumo problemático de tais substâncias. Há a necessidade de maiores investigações que apontem o uso das demais substâncias psicoativas, além do álcool, tendo como cenários outros contextos de atuação da equipe de enfermagem.

Palavras-chave: Equipe de Enfermagem; Psicotrópicos; Abuso Oral de Substâncias; Saúde do Trabalhador.

INTRODUCTION

The use of psychoactive substances (PAS), such as tobacco, alcohol and other drugs, can cause damage to health and in the social sphere, currently establishing itself as a serious public health problem. To contain the advance of this reality, intervention policies and therapeutic techniques have been implemented as part of the care available for the approach and treatment of users of alcohol and other drugs. Contrary to the usual profile of consumption of psychoactives, there is a significant increase in this practice motivated by work-related factors^(1,2).

The health professional is characterized as a vulnerable group to get involved in situations considered to trigger stress due to work demands, irregular lifestyle, excessive working hours, sleep disorders, among other problems that facilitate exposure to physical and mental exhaustion. One way to overcome these difficulties would be the use of psychoactive substances by these workers^(3,4).

The worker, when developing the habit of consuming some SPA, may suffer from the significant complications of such an attitude in his work environment, such as, for example, reduced productivity, greater propensity for accidents at work, dissatisfaction with his work environment, development of mental disorders, absenteeism and, consequently, withdrawal from occupational activities⁽⁵⁾.

Among health workers, nursing is one of the classes most susceptible to the consumption of psychoactive substances. These professionals are inserted in all levels of health care and their work environments are usually characterized as unhealthy, with precarious structural conditions, low wages, conflicting interpersonal relationships and consequent dissatisfaction with work activities. These factors favor the worker's mental illness and, often, in the search for alternatives to relieve tension, resort to the consumption of PAS⁽⁶⁾.

In this perspective, this consumption by nurses and nursing technicians is directly proportional to the level of physical and mental exhaustion related to their work environments, especially from the organizational support, the autonomy they can perform and the quality of the relationship with other team members of health. Conflicting relationships in the work environment are related to interference in the quality of care, disharmony between the team and greater exposure to adverse events, thus leading to professional exhaustion and occupational stress that leads to the consumption of PAS, whether in a harmful form or abusive^(7,8).

The environment and circumstances related to work, especially those characterized by high levels of stress, are some of the factors that make employees vulnerable to the use of SPAs. It is attributed, therefore, to the functioning dynamics of hospital institutions, which include greater exposure to occupational risks, inadequate remuneration, accumulation of employment relationships and excessive workloads, which reflect in long working hours, the high rates of alcohol use and /or other substances, and it is necessary to evaluate this relationship in greater depth⁽⁹⁾.

The use of SPAs among health professionals has been the subject of different studies in recent decades. However, there is still a need for investigations aimed at studying the impacts of these substances on the work of nursing professionals. Thus, the aim of this study was to analyze the use of psychoactive substances by the nursing staff of a highly complex hospital in the state of Piauí.

METHODS

Cross-sectional study, carried out in a Hospital of High Complexity, located in the city of Teresina, Piauí. The institution, research scenario, is a teaching, research and extension hospital, state reference in high complexity care. It has 349 beds, 15 clinics and four Intensive Care Units and has outpatient services, clinical admissions, diagnosis and imaging treatment, clinical analysis laboratory and pathological anatomy.

This research is a part of a macroproject. The nursing professionals working in that institution were investigated. The Intensive Care Units (ICU) were the object of study in another part of the macroproject. Therefore, the population corresponding to the nursing team working in this sector was not considered for sample calculation purposes.

To participate in this research, the eligible population was the nursing team professionals working in the clinics, consisting of 150 professionals. For the definition of the sample, the calculation for the finite population of Barbetta⁽¹⁰⁾ was used, corresponding to 109 workers. Permanent workers who were present at the institution were included, and professionals who were away from their work duties due to vacation or any type of leave during the period of data collection were excluded.

It is important to consider that there was a significant number of losses and refusals during data collection, which limited the reach of the minimum sample. Instruments completed incompletely by participants and professionals who were absent from the workplace after two consecutive attempts, making contact impossible, were considered losses. As for the refusals, in these cases, the professionals claimed to have no interest in participating or unavailability of time.

A semi-structured questionnaire, prepared by the researchers, was used, containing sociodemographic and occupational variables related to health and the use of PAS, as well as instruments for screening drug use or dependence, namely the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)⁽¹¹⁾ and the Alcohol Use Disorders Identification Test (AUDIT)⁽¹²⁾, both validated in Brazil and widely used to detect patterns of consumption of psychoactive substances.

Data were obtained between January and March 2019. The professionals who agreed to participate in the research signed the Free and Informed Consent Form (TCLE). In a reserved place, in the work sector, they answered the self-administered questionnaire and returned it to the researcher in charge. It is noteworthy that the answered instruments were stored in individual and sealed envelopes.

The collected data were tabulated, in a double typing process, in Microsoft Excel spreadsheets and later analyzed using the Statistical Package for Social Science (SPSS) software, version 23.0, where they were submitted to descriptive statistics, through the calculation of measures of central tendency and dispersion measures. To verify the association between qualitative variables, the Chi-square test (x²) was used. The strength of the associations between the variables was measured by the Likelihood ratio (OR) and confidence intervals (95%CI), for the comparison of means between categorized groups, the ANOVA one-way test was used. For associations between quantitative variables, Pearson's correlation coefficient was used. All analyzes adopted a significance level of 0.05%.

The study was authorized by the Teresina Municipal Health Foundation (FMS) and approved by the Research Ethics Committee (CEP) of the co-participating institution, Hospital Getúlio Vargas, with opinion No.) 79650117.2.3001.5613.

RESULTS

The research sample consisted of 49 professionals who answered the questionnaire provided. Participants were mostly female (95.97%), with a mean age of 42.5 years, married marital status (44.82%), Catholic religion (76.6%) and held the position of technician (a) nursing (76.68%). Regarding length of service at the institution, professionals who worked from 0 to 5 years (32.71%) and those with more than 21 years (32.71%) stood out. The Gynecology sector had the highest number of interviewed professionals (17.11%).
The average workload of professionals at the institution is 31.4 hours, performed mainly during the daytime (57.14%). Information related to the sociodemographic and occupational profile is described in Table 1 below.

Table 1 – Characterization of the sociodemographic and occupational profile of nursing workers. Teresina, PI, Brazil, 2019.

Variables	Average		N	%
Gender		Male	02	4,13
		Female	47	95,97
Age	42,5
Marital Status		Married	22	44,82
		Single	16	32,71
		Divorced	05	10,21
		Stable Union	04	8,23
		Widow(er)	02	4,13
Religion		Catholic	36	76,68
		Espiritism	03	6,40
		Christian	07	14,91
		Others	01	2,10
Professional Categories		Nurse	11	24,52
		Nurse Technician	33	73,38
		Nurse Auxiliary	01	2,20
Time working in the Instituition		0 - 5 years	16	32,71
Time working in the Instituition		6 - 10 years	13	28,18
		11 -15 years	03	6,40
		> 21 years	16	32,71
Work Sector		Cardiovascular	07	14,91
		Bariatric	02	4,13
		Medical clinic	03	6,40
		Gynecology	08	17,11
		Pneumology	05	10,21
		Nephrology	02	4,13
		CCIH	01	2,10
		Surgical II	02	4,13
		Surgical III	02	4,13
		CME	02	4,13
		Ophthalmology	03	6,40
		Hemodynamics	04	8,69
		Orthopedics	05	10,21
		Dermatology	02	4,13
		Hospitalization	01	2,10
Weekly working hours	31,4
Work Shifts		Day	28	57,14
		Night	04	8,69
		Day/Night	17	34,16
		Total	49	100

Source: Elaborated by authors.

Table 2 – Characterization of self-reported health conditions by nursing workers. Teresina, PI, Brazil, 2019.

Variables		n	%
Chronic disease	HAS*	06	12,24
	DM**	02	4,13
	Depression	03	6,40
	Others	06	12,24
	None	32	64,99
Current health status	Very good	05	10,21
	Good	30	61,22
	Regular	14	28,56
Pre-work health status	Very good	17	34,16
	Good	26	53,02
	Regular	04	8,69
	Bad	02	4,13
Worker health problems increase	Mental fatigue	14	28,56
	Irritation	07	14,91
	physical fatigue	27	55,12
	Insomnia	03	6,40
	Depression	04	8,69
	Anxiety	06	12,24
	osteoarticular	07	14,91
	Stress	16	32,72
	Somnolence	04	8,69
	Others	01	2,10
Total		49	100

Caption: *Systemic Arterial Hypertension; **Diabetes mellitus.

Source: Elaborated by the authors.

Table 3 – Association of the risk of addiction related to tobacco use and work aspects among nursing workers. Teresina, PI, Brazil, 2019.

Variables	Low Risk	Moderate Risk	p-valueor
Professional Categories Nurse Nurse Technician Nurse Auxiliary	Xxxxx 11(100%) 30(90,9%) 01(100%)	- 03(9,1%) -	0,380*
Time working at the institution* 0-5 years 6-10 years 11-15 years >21 years	16(100%) 12(92,3%) 03(100%) 14(87%)	- 01(7,7%) - 02(12,5%)	0,343*
Weekly workload	31,4±8,3	36,0±31,7	0,468**
Total weekly workload	41,9±17,2	40±27,7	0,856**
Work shifts Day Night Day/Night	28(100%) 02(66,7%) 15(88,2%)	- 01(33,3%) 02(11,8%)	0,043*

Caption: * Likelihood ratio; ** Anova One-way.

Sourde: Elaborated by authors.

Table 4 – Association of the risk of dependence related to alcohol use and work aspects among nursing workers. Teresina, PI, Brazil, 2019.

Variables	Low Risk	Moderate Risk	p-value
Professional Categories Nurse Nurse Technician Nurse Auxiliary	Xxxxx 10(90,0%) 30(90,9%) 01(100%)	01(9,1%) 03(9,1%) -	0,910*
Time working at the institution* 0-5 years 6-10 years 11-15 years >21 years	14(87,5%) 12(92,3%) 03(100%) 15(93,8%)	02(2,5%) 01(7,7%) - 01(6,2%)	0,814*
Weekly workload	30,3±8,2	46,5±20,4	0,002**
Total weekly workload	41,3±17,5	46,5±20,4	0,584**
Work shifts Day Night Day/Night	27(96,4%) 03(100%) 14(82,4%)	01(3,6%) - 03(17,6%)	0,216*

Caption: * Likelihood ratio; ** Anova One-way.

Sourde: Elaborated by authors.

There was a moderate risk of sedative abuse by nurses (6.2%) who stayed at the institution for more than 21 years and who worked day/night shifts.

DISCUSSION

The study was carried out in a high-complexity general hospital that serves several specialties, assisting referred patients of medium and high complexity. From the analyzes carried out, it can be observed that the participants are predominantly female professionals, married, who work as a nursing technician and who have Catholicism as their religion, results similar to another study carried out in a Brazilian hospital⁽³⁾. The predominance of females in the nursing team is common and reflects the culture of this profession, which, since its inception, has been mostly performed by women⁽¹³⁾.

Most professionals considered their health status to be “good”, however a significant number of the sample reported having a chronic disease, including DM and SAH. These conditions must be considered, as they reflect on the perception of the health-disease process by these workers. A set of factors related to the activities carried out by nursing professionals contribute to the development and aggravation of Chronic Noncommunicable Diseases (NCDs) in this population. Throughout life, they produce serious complications and have a strong impact on the quality of life of these people ⁽¹⁴⁾.

Through the report of these diagnoses, the need to consider the self-care of the nursing professional as a necessary resource for health promotion emerges. This is to identify in more detail the critical nodes in this field and positively corroborate with the implementation of changes aimed at the physical and mental well-being of these workers, aiming at quality of life, in addition to healthy work relationships⁽¹⁵⁾.

Other health problems were cited by the participants, with emphasis on physical fatigue and stress. Nursing work favors exposure to workloads, whether physical or mental, which cause, as consequences, damage to the worker's health. It is possible to state that the symptoms of stress can be considered risk factors for the consumption of alcohol and other licit and illicit drugs⁽¹⁶⁾.

As for the workload, researchers on the subject state that changes in the sleep cycle and an exhaustive workload are contributing factors to the use of psychotropic drugs. In addition, professionals are susceptible to the development of psychological problems resulting from work. The nursing team is routinely exposed to internal and external workloads, which, in turn, can cause wear and damage to the worker's health. It is important to establish an adequate workload that provides productive work, which is a predisposing factor for the use of substances as a resource and support for the required demands^(3,17).

In the context of the work environment, a study carried out with nursing professionals who worked in primary care and in hospital institutions, observed the use of psychoactive substances between the two publics and revealed that the strong desire for the consumption of alcohol and sedatives was greater among professionals working in a hospital institution. It is noteworthy that this class experiences workloads with specific characteristics of each occupational environment⁽¹⁸⁾.

The findings of this study are in line with what is described by other researchers about the consumption of psychoactives by the nursing team being represented, especially by alcohol, followed by tobacco and sedatives^(6,17,19). Alcohol carries the cultural aspect of acceptability and its consumption starts earlier when compared to other substances, often still in adolescence.

However, users in general are aware of the possibilities of short- and long-term damage⁽¹⁶⁾.

Alcohol consumption may be related to the stressful environment in which nursing professionals are inserted, since it is a substance that depresses the central nervous system and causes disinhibition, decreased tension and relaxation, facilitating the attraction to consumption among workers ⁽⁵⁾.

Accordingly, there are the findings of an Australian study, carried out between 2014 and 2015 with 5,041 participants (nursing professionals and the general population of the country), in which 16.2% of the participants reported risky habits related to the consumption of alcoholic beverages^{( 20)}.

The workplace can be a contributing factor to substance use by providing inadequate conditions for carrying out work activity, resulting in the use of these substances to relieve, for example, stress. Allied to this, the work environment imposes obstacles to the adoption of healthy lifestyle habits, such as work routines and physical structure⁽⁷⁾.

In the past, it is necessary to investigate external and individual conditions that can influence the use of psychoactive substances by nursing professionals, such as: family relationships, demands and other health behaviors⁽¹⁶⁾. It is worth mentioning that in addition to the chronic use of alcohol, the misuse of medications prescribed to patients and the abuse of opiates and anxiolytics have been common harmful practices adopted by health professionals in the world and a target of global concern⁽²¹⁾.

There is an increase in the use of over-the-counter drugs, including a variety of opiates and other illicit drugs, thus, it is observed that the exacerbated consumption of these drugs is related to other aspects of life that can be determinant for consumption among healthcare professionals. health⁽²²⁾.

The risk of moderate dependence on tobacco and alcohol is associated with the characteristics of these products as being licit substances, easily accessible and frequently consumed by the population. In addition, the use of cigarettes is associated with stress and pressure for use in moments of recreation. Authors also claim that a higher level of education contributes as a protective factor for tobacco consumption^(2,23,24).

The study showed moderate risk for alcohol consumption presented by professionals working in the institution from zero to five years. There is concern about the possibility of early stress in the work environment, favored by contexts of illness. However, other barriers make it difficult for professionals to recognize the problem (overconsumption), including fear, shame and concerns about losing their nursing license^(7,25,26).

It was possible to observe that the professionals of the nursing team who worked in the institution between zero and five years present a moderate risk for the consumption of sedatives. As with alcohol, sedatives are used as interventions to relieve tensions caused by the profession related to nursing. Authors report that, among women, there is a greater use of sedatives and amphetamines, agreeing with the study population in which females were predominant⁽²⁷⁾.

The study presented as limitations the low adherence of nursing professionals to the research, characterized by losses and refusals. A marked resistance to answering the collection instrument can be observed, mainly coming from higher education professionals (nurses), who, despite the strategies carried out, did not show interest in participating. The cross-sectional approach can also limit the results, since the study was restricted to a specific hospital institution.

The research stands out for investigating the relationship between the use of psychoactive substances by nursing professionals in a hospital institution, highlighting the factors that contribute to drug consumption among nursing team workers at this level of care, in order to favor the development of actions capable of promoting an improvement in the occupational health of these professionals.

CONCLUSION

The psychoactive substance most consumed by nursing professionals was alcohol. Tobacco, inhalants, sedatives, opiates and other substances were also mentioned as being used by the participants. A moderate risk was indicated for the use of tobacco, alcohol and sedatives.

The use of these substances was related to mental fatigue, insomnia and stress, being consumed as an alternative to relieve these symptoms. These risk behaviors are increasingly common in the work environment of these health professionals and require attention from institutions, promoting measures that can intervene in the work routine of these employees in order to identify and minimize the factors that motivate problematic consumption. of such substances.

There is a need for further investigations to deepen knowledge about the use of other psychoactive substances, in addition to tobacco and alcohol, with other contexts in which the nursing team operates as scenarios. The findings may provide subsidies to managers and workers themselves in carrying out preventive actions, harm reduction and treatment according to the different needs identified.

REFERENCES

1. Bardach AE, Alcaras AO, Ciapponi A, Garay OU, Riviere AP, Palacios A, et al. Alcohol consumption's attributable disease burden and cost-effectiveness of targeted public health interventions: A systematic review of mathematical models. BMC Public Health [Internet]. 2019 [cited 2023 Mar 05]. Available from: https://doi.org/10.1186/s12889-019-7771-4.

2. Andrade GSP, Pinto, KDS, Barreto CA. Uso de substâncias psicoativas por profissionais da saúde– enfermeiros. Revista Saúde em foco [Internet]. 2019 [citado 2023 Mar 05]; 11:588-598. Disponível em: https://portal.unisepe.com.br/unifia/wp-content/uploads/sites/10001/2019/05/053_USO-DE-SUBST%C3%82NCIAS-PSICOATIVAS-POR-PROFISSIONAIS-DA-SA%C3%9ADE-ENFERMEIROS.pdf.

3. Junqueira MAB, Santos MA, Araújo LB, Ferreira MCM, Giuliani CD, Pillon SC. Depressive symptoms and drug use among nursing staff professionals. Esc Anna Nery [Internet]. 2018 [citado 2023 mar 05]; 22(4). Available from: https://doi.org/10.1590/2177-9465-ean-2018-0129.

4. Gir E, Baptista CJ, Reis RK, Menegueti MG, Pillon SC, Silva ACDO. Increased use of psychoactive substances among Brazilian health care professionals during the COVID-19 pandemic. Arch Psychiatr Nursing [Internet]. 2022 [cited 2023 Mar 05]; 41:359-367. Available from: https://doi.org/10.1016/j.apnu.2022.09.004.

5. Carlos MA, Herval ÁM, Gontijo, LPT. Consumo de álcool entre os trabalhadores da saúde da família. RFO UPF [Internet]. 2018 [citado 2023 Mar 05]; 23(2). Disponível em: https://doi.org/10.5335/rfo.v23i2.8394.

6. Scholze AR, Silva AD, Martins JT, Dálcol C, Cremer E, Melo EC. Uso de substâncias psicoativas entre profissionais da enfermagem da atenção básica e instituição hospitalar. RECOM [Internet]. 2020 [citado 2023 Mar 05]; 10:e3737. Disponível em: https://doi.org/10.19175/recom.v10i0.3737.

7. Scholze AR, Trevisan MJ, Grandi ALD, Galdino MJQ, Robazzi MLDCC. Uso de substâncias psicoativas entre trabalhadores da enfermagem. Rev Port Enferm Saúde Ment [Internet]. 2017[citado 2023 Mar 05]; 18(18):23–30. Disponível em: https://doi.org/10.19131/rpesm.0188.

8. Lin CF, Huang CI, Yang CM, Lu MS. The relationship between work environment satisfaction and retention intention among nursing administrators in Taiwan. J Nurs Res [Internet]. 2019 [cited 2023 Mar 05];27(5):e43. Available from: https://doi.org/10.1097/jnr.0000000000000312.

9. Nadaleti NP, Ribeiro JF, Ferreira PM, Santos SVMD, Terra FDS. Autoestima e o consumo de álcool, de tabaco e de outras substâncias em trabalhadores terceirizados. Rev Latino-Am Enfermagem [Internet]. 2019 [citado 2023 Mar 05]; 27:e3199. Disponível em: https://doi.org/10.1590/1518-8345.3401.3199.

10. Barbetta PA. Estatística aplicada às ciências sociais. 6 ed. Florianópolis: UFSC; 2006.

11. Henrique IFS, De Micheli D, Lacerda RB, Lacerda LA, Formigoni MLOS. Validação da versão brasileira do teste de triagem do envolvimento com álcool, cigarro e outras substâncias (ASSIST). Rev Assoc Med Bras [Internet]. 2004 [citado 2023 Mar 05]; 50(2):199-206. Disponível em: https://doi.org/10.1590/S0104-4230200400020003.

12. Lima CT, Freire ACC, Silva APB, Teixeira RM, Farrel M, Prince M. Concurrent and construct validity of the AUDIT in an urban Brazilian sample. Alcohol Alcohol [Internet]. 2005 [cited 2023 Mar 05]; 40:584-9. Available from: https://doi.org/10.1093/alcalc/agh202.

13. Silva JDF. O enfermeiro no exercício de uma profissão predominantemente feminina: uma revisão integrativa [Internet]. Universidade Federal do Maranhão; 2017. [cited 2023 Fev 14]. Disponível em: https://monografias.ufma.br/jspui/bitstream/123456789/2067/1/JacksonSilva.pdf.

14. Domingues JG, Silva BBCD, Bierhals IO, Barros FC. Doenças crônicas não transmissíveis em profissionais de enfermagem de um hospital filantrópico no Sul do Brasil. Epidemiol Serv Saúde [Internet]. 2019 [citado 2023 Mar 05]; 28: e2018298. Disponível em: https://doi.org/10.5123/S1679-49742019000200011.

15. Fernandes FP. Educação em saúde para promoção do autocuidado. Universidade Federal de Minas Gerais; 2019. [citado 2023 Mar 05]. Disponível em: https://www.nescon.medicina.ufmg.br/biblioteca/imagem/FERNANDA-PEREIRA-FERNANDES.pdf.

16. Carmo DRPD, Siqueira DFD, Mello ADL, Freitas EDO, Terra MG, Cattani NA, et al. Relações entre o uso de substâncias, ansiedade, depressão e estresse por trabalhadores de universidade pública. Rev Bras Enferm [Internet]. 2020 [citado 2023 Mar 05]; 73. Disponível em: https://doi.org/10.1590/0034-7167-2019-0839.

17. Carvalho DPD, Rocha LP, Pinho ECD, Tomaschewski-Barlem JG, Barlem ELD, Goulart LS. Cargas de trabalho e os desgastes à saúde dos trabalhadores da enfermagem. Rev Bras Enferm [Internet]. 2020 [citado 2023 Mar 05];72:1435-1441. Disponível em: https://doi.org/10.1590/0034-7167-2017-0659.

18. Silva AD, Melo EC, Martins JT, Dálcol C, Cremer E, Scholze AR. Uso de substâncias psicoativas entre profissionais da enfermagem da atenção básica e instituição hospitalar. RECOM [Internet]. 2020 [citado 2023 Mar 05]; 10:e3737. Disponível em: https://doi.org/10.19175/recom.v10i0.3737.

19. Junqueira MAB, Ferreira MCM, Soares GT, Brito IE, Pires PLS, Santos MA, et al. Uso de álcool e comportamento de saúde entre profissionais da enfermagem. Rev Esc Enferm da USP [Internet]. 2017 [citado 2023 Mar 05]; e03265. Disponível em: https://doi.org/10.1590/S1980-220X2016046103265.

20. Perry L, Xu X, Gallagher R, Nicholls R, Sibbritt D, Duffield C. Lifestyle health behaviors of nurses and midwives: The ‘fit for the future’study. Int J Environ Res Public Health [Internet]. 2018 [cited 2023 Mar 05]; 15(5):945. Available from: https://doi.org/10.3390/ijerph15050945.

21. Maciel MPGS, Santana FL, Martins CMA, Costa WT, Fernandes LS, Lima JS. Uso de medicamentos psicoativos entre profissionais de saúde. Rev enferm UFPE on-line [Internet]. 2017 [citado 2023 Mar 05]; 11(7). Disponível em: https://doi.org/10.5205/1981-8963-v11i7a23468p2881-2887-2017.

22. Caixeta AC, Silva RDC, Abreu CRDC. Uso abusivo de psicotrópicos por profissionais da saúde. Revista JRG de Estudos Acadêmicos [Internet]. 2021 [citado 2023 Mar 05]; 4(8): 188–200. Disponível em: https://doi.org/10.5281/zenodo.4627867.

23. Toney-Butler TJ, Siela D. Recognizing Alcohol and Drug Impairment in the Workplace in Florida. StatPearl [Internet]. 2018[cited 2023 Mar 05]; 1-31. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507774/.

24. Ayoub AC, Sousa MG. Prevalência do tabagismo em profissionais de enfermagem de um hospital cardiovascular. Rev Bras Enferm [Internet]. 2019 [citado 2023 Mar 05]; 72(1):181-9. Disponível em: https://doi.org/10.1590/0034-7167-2018-0145.

25. Ribeiro IAP, Marques LL, Assis LRDS, Silveira HND, Lacerda JN, Mendes MRRDS. Substâncias Psicoativas no Contexto do Trabalhador da Saúde. Rev. Enferm. Atual in Derme [Internet]. 2019 [citado 2023 Mar 05]; 90(28). Disponível em:https://doi.org/10.31011/reaid-2019-v.90-n.28-art.530.

26. Ribeiro IAP, Fernandes MA, Rocha DDM, Silva JS, Ribeiro HKP, Soares NSA. Consumo de substâncias psicoativas por trabalhadores de enfermagem: revisão integrativa. Texto Contexto-Enferm [Internet]. 2020 [citado 2023 Mar 05]; 29:e20180488. Disponível em: https://doi.org/10.1590/1980-265X-TCE-2018-0488.

27. Scholze AR, Martins JT, Galdino MJQ, Ribeiro RP. Ambiente ocupacional e o consumo de substâncias psicoativas entre enfermeiros. Acta Paul Enferm [Internet]. 2017 [citado 2023 Mar 05]; 30(4):404–11. Disponível em: https://doi.org/10.1590/1982-0194201700060.

Promotion and thanks:

Universidade Federal do Piauí (UFPI). Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519

Rev Enferm Atual In Derme 2023;97(1): e023039