2009, Number 5
Síndrome de burnout en médicos y personal paramédico
Pereda-Torales L, Márquez CFG, Hoyos VMT, Yánez ZMI
Full text
Language: Spanish
References: 26
Page: 399-406
PDF size: 108.70 Kb.
ABSTRACT
Introduction: Burnout syndrome is one of the most studied manifestations of job stress. The burnout concept was used by the first time in the area of psychology by Freudenberger in 1974. This psychologist defined it as a condition of fatigue or frustration that is produced by the commitment to a reason, lifestyle or relationship that does not produce the expected effort. Afterwards, Maslach and Jackson proposed three interrelated dimensions: emotional weariness (EW) which estimates the experience of emotional fatigue for the demands of work; the depersonalization (DP) which measures the answers of impersonal type and negative attitudes towards the patients; and the personal accomplishment (PA) which reflects the personal satisfaction and the competition in the practice of the daily work. These dimensions are joined in the Maslach Burnout Inventory (MBI) that is used to measure the afore mentioned syndrome.Several studies have demonstrated the presence of burnout syndrome among medical and paramedic personnel. The close contact with the patients and the work overload are the main reasons of this syndrome. In a multicentre study carried out among 248 doctors of the United States, 40% presented the syndrome with emotional detriment, which coincides with another study carried out with nurses attending patients with palliative care and marrow transplants.
Also, in a study carried out among residents of internal medicine of the University of Washington, there was a prevalence of 76% of professional wear, with an autoperception of a lower quality in the professional care of the patients, after comparing them with nonaffected residents. In Mexico, a study that investigated burnout level in a group of 450 medical practitioners, nurses and paramedics of 12 institutions revealed the following information: 10.9% presented emotional weariness, 19.6%, depersonalization, and 74.9, low personal accomplishment. Palmer et al. determined a general prevalence of 44% of the syndrome in anesthesiologists. The work overload and the conflict of values were variables that influenced the presence of this syndrome. At the Instituto Mexicano del Seguro Social, Aranda et al. carried out a study among family physicians, where the prevalence of burnout syndrome was 42.3%. Likewise, Cabrera et al. found that, out of 236 studied nurses, 92 (39%) had information compatible with burnout syndrome, with statistically significant differences for the age and the antiquity in the place after comparing them with nurses without burnout syndrome.
The burnout syndrome was considered by the World Health Organization as work risk. Its trascendence is rooted in the impact it has in the labor relation between medical and/or paramedic personnel and the health institutions. For this reason, we considered it important to investigate the presence of this syndrome among the medical and paramedic personnel working at hospital of the Mexican social security.
Materail and Methods: Design: Transversal comparative survey.
Population: Of a total population of 240 workers of the health area assigned to a general hospital a sample of 160 was obtained that included doctors, nurses and medical assistants based on an average prevalence of the syndrome in 30%, with an alpha level of 0.05 and a power of 90%.
Instrument of evaluation: The survey was based on the following sociodemographic and labor variables: age, marital status, academic level, labor antiquity, antiquity of adscription to the hospital, category, service and labor shift.
To evaluate the burnout syndrome, the MBI questionnaire was used in its previously validated Spanish version. The afore mentioned instrument is an objective way of measuring and determining the burnout level that a person experiences, in its three subscales: EW, DP and PA. The survey consists of 22 items with a Likert type punctuation scale (0-6), of which 9 valued EW, 5, DP, and 8, PA. With regard to the EW, which values the sensation of being emotionally exhausted by the daily contact with people to whom it is necessary to attend as object of work, a punctuation of 27 or higher indicated a high level; between 19 and 26, moderated; and lower than 19, low. In the subscale DP, which measures the degree in which the response towards the patients is cold, distant and impersonal, punctuations above 10 indicated a high level; from 6 to 9, moderated; lower than 6, low. In the subscale PA, which values the feelings of competition and efficiency for the accomplishment of the work and the relation with the people who are being attended, values above 40 indicated personal high accomplishment; from 34 to 39, intermediate; and under 33, low. In the case of obtaining a low emotional depletion, a low depersonalization and a high personal accomplishment, it was considered that no burnout was present. In the rest of the cases, the presence of burnout syndrome was established.
Compilation of the information: From August to December, 2005, the survey was applied to each of the workers, indicating them that they should answer and return it in a term not longer than five days. They were all informed previously about the general objectives of the study and its confidential and anonymous character. The head investigator integrated later on the database.
Statistical tests: Descriptive and inferential statistics were carried out. The odds ratio and confidence intervals of 95% were calculated to measure the association between the sociodemographic and labor factors with the professional wear.
Results: Of 160 workers to whom the survey MBI was applied, only 146 returned it in a complete form. Regarding the frequency and the percentages of the three categories studied with the qualifications of low, average and high for every subscale that composes the burnout syndrome, it was observed that the highest evaluations fit the medical assistants.
There was a 19.6% prevalence of burnout syndrome among the groups of doctors with at least one of three disturb subscales. Likewise, it was observed that all medical assistants had an alteration of a minimum of two subscales. The nursing personnel did not present information that constitutes a risk for the development of burnout syndrome. Only four sociodemographic and labor variables were found as risk factors for the presence of burnout syndrome, as well as their relation with each of the subscales composing it.
When the variables compared age, labor antiquity and time of adscription in the service with each of the subscales of the burnout, we observed that depersonalization appeared in older workers and longer antiquity in the position and the lack of personal accomplishment in workers with longer time in the service. There were no statistically significant differences in the subscale of emotional weariness.
Discussion: In the last years, burnout syndrome has acquired special relevance, mainly because of the series of repercussions that it has in the labor and personal area. Numerous studies exist on the prevalence of this syndrome in different health professionals, but in present work incorporated medical assistants, since they are those who have the first contact with the patients in our institution.
The prevalence figures for burnout syndrome reported by other studies realized in Mexico among medical personnel go from 42.3% to 50%. In this research the prevalence was lower and the dimension of emotional weariness is more affected. It is necessary to emphasize that all the medical assistants presented, at least, two disturb subscales of burnout syndrome, wich were much higher than the prevalence of 64% reported by Anaya et al. In the nursing category, it is worth mentioning that there is no information revealing the presence of the syndrome of emotional wear, which differs from the reports in other studies in Mexico and Spain.
In our study, among the variables considered as risks factors marital status is included. Married workers had a higher risk to present alterations in each of the scales that burnout values, which does not happen with workers that do not have a couple. Other studies offer contradictory information in the matter and they indicate that bachelors have a higher possibility of having the afore mentioned emotional wear.
Likewise, in conformity with previous works, to be employed at the evening shift and to offer service in the external consultation were also related to a higher predisposition to burnout syndrome.
As other studies, in this research it was found a higher level of burnout in older professionals. Some authors point out that age constitutes a risk factor, while others think that it is a protector.
Regarding the DP and RP, these appeared in workers whose labor antiquity was longer. Probably this is due to the fact that professional wear is accentuated with the years of work because there is a major loss of energy and a lack of expectations of professional improvement.
In conclusion, the prevalence of burnout syndrome among the medical assistants is very high. Because of this, it is necessary to adopt measures to avoid the development of this pathology.
One of these strategies can be individual and group interventions directed to the prevention of the syndrome, as well as the promotion of an integral treatment in all dimensions in order for the personnel of the health area to carry out their work in ideal conditions of quality, efficiency and personal satisfaction.
REFERENCES