Objective. Investigate the burnout syndrome among undergraduate students in nursing. Methods. Explanatory sequential mixed method study conducted at a public university in Brazil. Of the 119 nursing students, 114 consented to participate and answered a questionnaire composed of sociodemographic, academic variables, and the Maslach Burnout Inventory - Student Survey, which were analyzed by multiple linear regression. The participants of the quantitative phase with the indicative / risk of burnout were interviewed individually (n=21) to provide an in-depth understanding of the students' experiences regarding the dimensions of the syndrome, whose statements were analyzed by the Collective Subject Discourse. Results. The prevalence of burnout syndrome was 10.5% among the surveyed. The more advanced the school year, the higher were the exhaustion (p=0.003), depersonalization (p<0.001) and low academic effectiveness (p=0.012) scores. Students with a higher workload of assignments also had higher scores of exhaustion (p=0.001), depersonalization (p<0.001) and academic (in)effectiveness (p=0.042). Dissatisfaction with the course was related to higher exhaustion (p=0.049) and depersonalization (p=0.001). The collective speeches showed the daily demands of the course, considered as intense, producing overload and exhaustion, which produced symptoms of physical and mental illness. Thus, there was the student's distancing from the course activities, as a defensive attitude, which culminated in feelings of incompetence and frustration. Conclusion. The occurrence of burnout syndrome dimensions among nursing students was related to the activities of academic daily life. It is urgent to invest in health promotion and prevention actions of these individuals in the university context.How to cite this article: Galdino MJQ, Almeida LPBM, Silva LFR, Cremer E, Scholze AR, Martins JT, et al. Burnout among nursing students: a mixed method study. Invest. Educ. Enferm. 2020; 38(1):e07.

RESUMO: Objetivou-se avaliar o estresse ocupacional e fatores associados entre enfermeiros de hospitais públicos. Estudo transversal com amostra de 185 enfermeiros de três hospitais públicos do Paraná. Os dados foram coletados entre novembro de 2015 e abril de 2016, mediante questionário de caracterização dos participantes e a Job Stress Scale. Realizaram-se análises descritivas e regressão logística. Entre os participantes, predominou o trabalho passivo e o de alta exigência. A percepção negativa dos serviços de apoio à assistência (p=0,003), programas de educação continuada (p=0,007), tempo e oportunidades para solucionar os problemas da assistência (p<0,001) e participação em decisões administrativas (p=0,014) aumentaram as chances de os enfermeiros perceberem o trabalho como estressante. Em contrapartida, maior tempo de trabalho na instituição (p<0,001) e apoio social (p<0,001) associaram-se a menores percepções de trabalho desgastante. Conclui-se que o estresse do enfermeiro esteve associado a fatores do ambiente laboral, sobretudo aqueles que dificultam prestar assistência de qualidade. DESCRITORES: Saúde do trabalhador; Estresse psicológico; Enfermeiras e enfermeiros; Hospitais públicos. ESTRESSE OCUPACIONAL E FATORES ASSOCIADOS ENTRE ENFERMEIROS DE HOSPITAIS PÚBLICOS* OCCUPATIONAL STRESS AND ASSOCIATED FACTORS AMONG NURSES AT PUBLIC HOSPITALSABSTRACT: We aimed to assess the occupational stress and associated factors among nurses from public hospitals. Cross-sectional study with a sample of 185 nurses from three public hospitals in Paraná. The data were collected between November 2015 and April 2016, using a questionnaire to characterize the participants and the Job Stress Scale. Descriptive analyses and logistic regression were applied. Among the participants, passive and high-demand work was predominant. The negative perception of the care support services (p=0.003), continuing education programs (p=0.007), time and opportunities to solve the care problems (p<0.001) and participation in administrative (p=0.014) increased the chances that the nurses would perceive the work as stressful. On the opposite, longer experience at the institution (p<0.001) and social support (p<0.001) were associated with lesser perceptions of exhausting work. In conclusion, the nurse's stress was associated with factors from the work environment, mainly factors that hamper highquality care delivery. DESCRIPTORS: Occupational health; Stress, psychological; Nurses; Hospitals, public. ESTRÉS OCUPACIONAL Y FACTORES ASOCIADOS ENTRE ENFERMEROS DE HOSPITALES PÚBLICOSRESUMEN: = La finalidad fue evaluar el estrés ocupacional y factores asociados entre enfermeros de hospitales públicos. Estudio trasversal con muestra de 185 enfermeros de tres hospitales públicos de Paraná. Los datos fueron recolectados entre noviembre del 2015 y abril del 2016, mediante cuestionario de caracterización de los participantes y la Job Stress Scale. Fueron ejecutadas análisis descriptivas y regresión logística. Entre los participantes, predominó el trabajo...

This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants’ discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.

Objective: To compare occupational stress levels of nurse staff working in the surgical unit before and after the intervention "wellness room". Method: Quasi-experimental study with a sample of 60 nurse staff working in a surgical unit of a teaching hospital in the Southern Region of Brazil. The intervention was conducted in a room in the workplace for six months and consisted of sections of aesthetic care, relaxation, lectures and workshops to reduce occupational stress. Data were collected through the Demand-ControlSupport Questionnaire before and after the intervention, and the comparative analysis was performed by the Wilcoxon test. Results: After the intervention, there was a decrease in demand and an increase in control and in the social support received at work in all professional categories, but the differences were not statistically signifi cant. Conclusion: The intervention "wellness room" reduced occupational stress levels in the sample studied; however, it was not a signifi cant decrease. Descriptors: Occupational Health; Nursing; Stress, Psychological; Working Environment; Clinical Trial. RESUMOObjetivo: Comparar os níveis de estresse ocupacional entre trabalhadores de enfermagem do bloco cirúrgico antes e após a intervenção "sala de bem-estar". Método: Estudo quase-experimental com amostra de 60 trabalhadores de enfermagem do bloco cirúrgico de um hospital escola da Região Sul do Brasil. A intervenção foi realizada por seis meses e consistiu em seções de cuidados estéticos, de relaxamento, palestras e ofi cinas para redução do estresse ocupacional em uma sala no local de trabalho. Os dados foram coletados pelo Demand-Control-Support Questionnaire antes e após a intervenção, sendo a análise comparativa realizada pelo teste de Wilcoxon. Resultados: Após a intervenção, houve diminuição da demanda, aumento do controle e do apoio social recebido no trabalho em todas as classes ocupacionais da enfermagem, mas as diferenças não apresentaram signifi cância estatística. Conclusão: A intervenção "sala de bem-estar" reduziu os níveis de estresse ocupacional na amostra pesquisada, apesar de não se tratar de diminuição signifi cativa. Descritores: Saúde do Trabalhador; Enfermagem; Estresse Psicológico; Ambiente de Trabalho; Ensaio Clínico. RESUMENObjetivo: Comparar los niveles de estrés ocupacional entre trabajadores de enfermería de la sección quirúrgica antes y después de la intervención "sala de bienestar". Método: Estudio cuasi-experimental con una muestra de 60 trabajadores de enfermería del bloque quirúrgico de un hospital escuela de la región sur del Brasil. La intervención se realizó durante seis meses y consistió en sesiones de cuidados estéticos, de relajación, con charlas y talleres para la reducción del estrés ocupacional en una sala del lugar de trabajo. Se recolectaron los datos con el Cuestionario Demanda-Control (Demand-Control-Support Questionnaire) antes y después de la intervención, y el análisis comparativo se realizó con la prueba de Wilcoxon. Resultados: Tras la intervención, dism...

Objetivo: refletir sobre os limites e as potencialidades demindfulness para a assistência de enfermagem, explorando as evidências científicas disponíveis, o uso na assistência à saúde e na assistência de enfermagem. Método: a reflexão pautou-se nos tópicos: Mindfulness e evidências científicas, Mindfulness na assistência à saúde, e Mindfulness na assistência de enfermagem. Resultados: o potencial das práticas de mindfulness foi evidenciado para tratar e prevenir problemas relacionados com o estresse e promover estratégias de enfrentamento consideradas mais assertivas, tanto para os clientes como para os próprios profissionais de enfermagem. As limitações envolveram a insipiência da temática no âmbito da enfermagem brasileira e no delineamento dos estudos, pois as intervenções baseadas em mindfulness requerem protocolos mais longos que exigem capacitação e engajamento na prática. Considerações finais: evidências apontam diversas potencialidades de intervenções baseadas em mindfulness para o autocuidado e atenção aos usuários e familiares, promovendo assistência integral e prescrevendo uma perspectiva inovadora para o cuidado.

This study aimed to analyse the geographical distribution of COVID-19 and to identify highrisk areas in space and time for the occurrence of cases and deaths in the indigenous population of Brazil. This is an ecological study carried out between 24 March and 26 October 2020 whose units of analysis were the Special Indigenous Sanitary Districts. The Getis-Ord General G and Getis-Ord Gi* techniques were used to verify the spatial association of the phenomena and a retrospective space−time scan was performed. There were 32041 confirmed cases of COVID-19 and 471 deaths. The non-randomness of cases (z score = 5.40; p <0.001) and deaths (z score = 3.83; p <0.001) were confirmed. Hotspots were identified for cases and deaths in the north and midwest regions of Brazil. Sixteen high-risk space−time clusters were identified for the occurrence of cases with a higher RR=21.23 (p <0.001) and four risk clusters for deaths with a higher RR=80.33 (p <0.001). These clusters were identified from 22 May and were active until 10 October 2020. The results indicate critical areas in the indigenous territories of Brazil and contribute to better directing the actions of control of COVID-19 in this population.

Objective: To analyze the relation between the work environment and psychoactive substance consumption among hospital nurses. Methods: Cross-sectional and descriptive study, involving nurses from three public hospitals in a city in the South of Brazil, being two medium-complexity and one high-complexity institution. The study population consisted of 221 nurses. Based on this figure, the stratified sample size was calculated, considering a 50% proportion, 95% confidence level and 5% maximum error, resulting in a minimum number of 175 participants. Through proportional stratification per institution, a minimum of 103 high-complexity nurses was defined, as well as 36 nurses from each medium-complexity institution. The following inclusion criteria were adopted: having worked at the institution for at least one year and not being on leave. The data were collected between October 2015 and April 2016. In the data collection, sociodemographic and occupational information, the Nursing Work Index -Revised and the Alcohol, Smoking and Substance Involvement Screening Test. The data were analyzed in the software Statistical Package for Social Sciences, version 20.0. Initially, the normality was verified by means of the Kolmogorov-Smirnov test. Descriptive analyses were developed by absolute and relative frequencies for the categorical variables; and medians and dispersion measures for the numerical variables. Results: Alcohol, tobacco and sedatives were the most consumed substances. The monthly income was positively correlated with alcohol consumption among nurses at the medium-complexity hospitals (p=0.01). At the high-complexity hospital, alcohol consumption was negatively correlated with the physician-nurse index (p=0.03). Autonomy, physician-nurse index and organizational support were negatively correlated with the use of sedatives (p<0.01; p<0.01; p=0.02, respectively). Conclusion: The more negative the nurse's work environment, mainly in the relation with physicians, organizational support and autonomy, the greater the consumption of psychoactive substances. ResumoObjetivo: Analisar a relação entre o ambiente de trabalho e o consumo de substâncias psicoativas entre enfermeiros hospitalares. Métodos: Estudo transversal e descritivo, realizado com enfermeiros de três instituições hospitalares públicas localizados em um município da Região Sul do Brasil, sendo duas de média complexidade e uma de alta complexidade. A população deste estudo foi composta por 221 enfermeiros. Com base nesse número, calculou-se o tamanho amostral por estratos, considerando-se a proporção de 50%, nível de confiança de 95% e erro máximo de 5%, o que resultou no número mínimo de 175 participantes. Mediante a estratificação proporcional por instituição definiu-se o mínimo de 103 enfermeiros da alta complexidade e 36 de cada instituição de média complexidade. Adotou-se como critérios de inclusão: trabalhar na instituição há pelo menos um ano e não estar afastado por licença. A coleta de dados foi realizada entre outubro de 2015 e abril de 2...

RESUMOCONTEXTO: O ambiente laboral da enfermagem pode predispor os trabalhadores ao uso de substâncias psicoativas, interferindo em sua saúde e na qualidade da assistência prestada. OBJETIVO: Identificar o uso de substâncias psicoativas entre trabalhadores da enfermagem. MÉTODOS: Estudo transversal realizado com 49 trabalhadores de enfermagem das áreas hospitalar e atenção primária de um município da Região Sul do Brasil. Os dados de caracterização dos profissionais e do Alcohol, Smoking and Substance Involvement Screening Test foram analisados por estatística descritiva, odds ratio e teste de qui-quadrado de Pearson. RESULTADOS: O álcool foi a substância lícita mais consumida, e entre as ilícitas destacou-se a Cannabis. Não houve relação significativa entre o uso de álcool e as variáveis analisadas. Relacionaram-se ao tabagismo fatores ocupacionais e ligados à dependência da substância. Às substâncias psicoativas ilícitas vincularam-se apenas os fatores ligados ao seu consumo. CONCLUSÃO: Os gestores precisam ser sensibilizados quanto ao uso de substâncias psicoativas pelos trabalhadores, rompendo com a concepção de punição e preconceito, bem como elaborar estratégias individuais e coletivas que ajudem os trabalhadores a interromper com uso nocivo e, assim, possam melhorar sua saúde e qualidade de vida. BACKGROUND:The nursing work environment may predispose workers to the use of psychoactive substances, interfering with their health and the quality of care provided. AIM: To identify the use of psychoactive substances among nursing workers. METHODS: A cross-sectional study was carried out with 49 nursing workers from the hospital and primary care areas of a municipality in the Southern Region of Brazil. Data from the characterization of professionals and the Alcohol, Smoking and Substance Involvement Screening Test were analyzed by descriptive statistics, odds ratio and Pearson's chi-square test. RESULTS: Alcohol was the most widely used licit substance, and among the illicit drugs marijuana was highlighted. There was no significant relationship between alcohol use and the analyzed variables. Occupational factors related to substance dependence were related to smoking. Illicit psychoactive substances were linked only to the factors related to their consumption. CONCLUSION: Managers need to be sensitized to the use of psychoactive substances by workers, breaking with the conception of punishment and prejudice, and workers need to seek strategies that help them stop using harmful drugs and thus improve their health and quality of life.