STRESS AND COPING AMONG NURSES OF HEMATO-ONCOLOGIC UNITS* ESTRESSE E COPING ENTRE ENFERMEIROS DE UNIDADE HEMATO-ONCOLÓGICA ESTRÉS Y ESTRATEGIAS DE ENFRENTAMIENTO ENTRE ENFERMEROS DE UNIDADES HEMATONCOLÓGICAS

We analyzed stress and Coping strategies used by Hemato-Oncology Unit nurses of a Rio Grande do Sul University Hospital. This is a descriptive, cross-sectional and quantitative study, conducted between March and April 2010. We applied a Form to sociodemographic characterization, Nurses Stress Inventory and Occupational Coping Scale in 18 nurses. We identified 55.55% of nurses in low stress. "Intrinsic Factors for Job" and "Feel emotional distress with work" represented higher stress for nurses. Control was the factor more used to deal with stressors and, in this factor, "I try to do what i think is expected of me" the action more used to manage them. Nurses use problem-centered Coping strategies, considered more effective to deal with stressors. Therefore, they can have evaluated work in hematooncology unit as low-stress. Descriptors: Oncologic Nursing; Stress, Psychological; Occupational Health.

The chronic-degenerative diseases, among them cancer, are responsible for growing rates of morbidity and mortality in the world context, they have been the target of studies and have aroused especial interest for reaching important population contingences, besides representing high social and economical costs (1) . In Brazil, the estimates for the year 2013 show approximately 518,510 occurrences of new cases of cancer, strengthen the magnitude of the question of cancer in the country (2) .
On this pathology, despite the recent advance in its diagnosis and treatment with a possitibility of remission and possible cure, it is still a pathology with stigmas and related to hopelessness, pain, fear and death (3) . Furthermore, in many cases, it is an irreversible process and full of meanings for the patient and the health team. For the patients, such meanings are established from socio-cultural experiences, myths and uncertainties formed since the diagnosis, persisting during the treatment and the possible confrontation of the terminality (1) . Regarding the health team, especially the nursing team, one must consider that the demand for care to the patients with cancer is not limited to physiopathological or prognostic aspects, once it also covers the human nature in its dimensions, expressions and evolutionary phases.
In this context, under the assistance of the nursing professionals in hemato-oncologic units, the nurse must be prepared to provide assistance to the emotional, psychological and social commitments, and also to help in the adaptations to the limitation resulting from the evolution and/or treatment of the disease, preconizing an integral assistance to the patient. The care to terminal patients as well as the need of procedures and interventions of high complexity like the situations that are frequently faced by these professionals in the assistance for these patients. These professionals, many times, experience submission, control and authoritarianism of some health organizations (4) .
Under this perspective, the work of the nurse in the hemato-oncologic assistance units is characterized by uncertainties, instabilities and immediateness and by the need of confronting the situations of emergency and instability, due to the requirements, as well the specificity of the tasks and diversity of the functions performed (5) . These questions are strengthened when organizational aspects are revealed, such as work, overload, lack of control, insufficient reward and conflict of values. This can influence in the performance of hospital working activities and consequently in the quality of the assistance provided (6)(7)(8) . Besides that, the technological innovations, frequent in the assistance in hemato-oncologic units, are perceived as conditions which, when altering the labor dynamics, can affect the health of the worker to an extent in which they surpass the capacity of adaptations of these health professionals.
So, the conditions related to the assistance to patients with cancer can be evaluated as stressors and lead the nurse to occupational stress, resulting from the interaction of working conditions with the characteristics of the worker in which the demand of the work exceeds the abilities of the confrontation of the worker (9) . In this sense, the working environment is approached as a determinant context for the evaluation of the specific stressors related to occupational demands (10)(11)(12) .
Furthermore, the stress is a complex phenomenon which through the stimulus and the interaction of the subject with the internal and external environment can cause physiological, psychological, emotional and behavioral changes. So, the confrontation to the occupational demands is necessary. For such, the subject must use the strategies of Coping, considered as any individual attempt of adaptation to adverse circumstances considered stressing, whether or not it is successful in the result (7) .   Factor, with nine items (12,13,14,15,16,17,18,19,20) related to the actions and reevaluations which suggest Alpha above are considered satisfactory to attest reliability of the data for the nurses of the hematooncologic units (14) and they are close to those verified in the studies which validated these instruments in the Brazilian reality (5,13) .

INTRODUCTION
Regarding the sociodemographic characteristic of the nurses, it was noticed that there were health professionals of the female sex (88.9%), married (77.8%), with children (55.6%) and in the age range of 41 to 50 (50%). The descriptive measures for the ISN and its domains are presented in Table 1.  As to Occupational Coping Scale, its descriptive measures are presented in Table 2.  lead them to stress is evident, that is, they exceed the adaptive resources of this health professionals (16) . The definitions of these situations as stressors depend on the cognitive evaluation, according to which the subject finds the event in a series of evaluative categories and, from that, defines it as a threat, a challenge or as being irrelevant (16)(17) .

Umann
In this regard, it was noticed that 44.45% of these subjects presented High stress. In an investigation (18) among nurses of intensive therapy unit, in a unit specialized such as the hemato-oncology unit, there was a predominance of moderate stress. These results deserve attention due to the outcome of the stress to the health of the workers, among which the depression and the Burnout, whose occurrence has already been observed in different surveys involving health professionals (19)(20) . Consequently, there is reduction of the productivity, impact to the quality of life of the worker and to the care rendered by these health professionals to the patients assisted in the health services. Still, many times, the workers keep away or abandon the work, which interferes in the organizational and financial dimensions of the services of health (17,(20)(21) .
On the other hand, it was observed that 55.55% of the nurses presented Low stress. In a survey among hospital nurses (17) , it was noticed that 55.25% of those professionals presented low stress. In an investigation among nurses of a unit of a surgical clinic, 55.56% presented low stress (21) . In this sense, once the subject can use strategies for the Coping of the stressors (16) , the predominance of low stress among the nurses in that investigation can be related to the use of strategies of effective Coping for the experienced situations. The choice of these strategies is made based on the nature of the stressor, on the circumstances in which it can reproduce itself on the previous experiences of the subject, that is, how he coped with the previous situations (16) .
In this context, it was observed that the most used  (21) . In an investigation with nurses of hemodialysis in the United States, using the Ways of Coping Questionnaire, the factor Resolution of Problems presented the highest average (22) .
In the studies above and in this investigation, the factors (strategies of Coping) and the items of scales (actions to administrate the stressors) refer to the strategies of Coping centered on the problem. These are considered more effective for the confrontation of the stressors once the main worry is in the direct resolution of the stressor and the subject can direct them internally (redefinition of the element stressor) or externally (negotiate to solve the interpersonal conflict or to ask for practical help to third parties) 16,21) . About this matter, in a survey of nurses of a child oncology unit, it was observed that, instead of annulling or keeping the stressor away from their daily activities, the nurses chose to try to solve their problems and to modify their attitudes, thus being able to deal with the pressures of the people in the environment surrounding them (23) .