Síndrome de burnout en distintas Unidades de Cuidados Intensivos

doi:10.1016/S1130-2399(09)73221-3

Enfermería Intensiva

Volume 20, Issue 4, October–December 2009, Pages 131-140

https://doi.org/10.1016/S1130-2399(09)73221-3 Get rights and content

Resumen

Objetivos

Determinar la prevalencia del síndrome de desgaste profesional (burnout) en el personal sanitario de distintas Unidades de Cuidados Intensivos (UCI).Conocer la asociación entre el burnout, sus dimensiones y variables sociodemográficas-laborales. Comparar dimensiones del burnout, características del personal y de los pacientes de distintas UCI.

Material y métodos

Estudio analítico comparativo transversal, realizado en UCI de un hospital terciario, en noviembre de 2006. La muestra fue 289 profesionales. Se entregó el cuestionario Maslach Burnout Inventory y variables sociodemográficas-laborales. Se valoró en UCI: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortalidad, estancia, aislamientos y desplazamientos terciarios. Se empleó la prueba de la χ², Fischer, Kruskall-Wallis y análisis multivariable de regresión logística.

Resultados

Contestaron el 73% de los trabajadores, edad 37 ± 9 y un 81% eran mujeres. Prevalencia de burnout 14%, afectados el 16% de enfermeros, 14% de residentes, 13% de médicos y 10% de auxiliares. El burnout se asoció a satisfacción profesional baja, relación con compañeros regular, reconocimiento laboral bajo, y tiempo trabajado y experiencia en UCI a un cansancio emocional elevado, con una p < 0,05. En la UCI Polivalente se obtuvieron valores más elevados de: TISS 42 ± 11, NEMS 35 ± 10, mortalidad 18%, estancia 5 ± 9, aislamientos 21%, síndrome burnout 17%, cansancio emocional elevado 49%, despersonalización elevada 63% y realización profesional baja 44%.

Conclusiones

La prevalencia del síndrome de burnout en nuestra muestra fue del 14%, siendo los profesionales de enfermería los más afectados. Detectamos niveles elevados de despersonalización y niveles medios de cansancio emocional y de realización profesional. Las variables relacionadas con el síndrome de desgaste profesional fueron satisfacción profesional baja, relación con compañeros regular, reconocimiento laboral bajo y un cansancio emocional elevado en el personal más experto. La UCI con mayor prevalencia de burnout, durante el mes estudiado, atendió a pacientes con mayor: TISS, NEMS, mortalidad, estancia y aislamientos.

Abstract

Objectives

To determine the prevalence of the professional burnout syndrome in health care personnel of different Intensive Care Units (ICUs). To know the association between burnout, its dimensions and sociodemographic-laboral variables. To compare the dimensions of burnout, characteristics of the personnel and of the patients of the different ICUs.

Material and methods

Analytic, comparative, cross-sectional study performed in the ICU of a tertiary hospital in November 2006 performed in a sample of 289 professionals. The Maslach Burnout Inventory questionnaire and sociodemographic-laboral variables were provided. The following were evaluated in the ICUs: Therapeutic Intervention Scoring System (TISS), Nine Equivalents of Nursing Manpower Use Score (NEMS), mortality, stay, isolations and travel of third parties. The χ² test, Fischer test, Kruskall-Wallis test and multivariate logistic regression analysis were used.

Results

A total of 73% of the workers answered. Ages ranged from 37 ± 9 and 81% were women. The prevalence of burnout was 14%, this affecting 16% of the nurses, 14% of residents, 13% physicians and 10% auxiliary workers. Burnout was associated to low professional satisfactions, relationship with regular colleagues, low work recognition and time worked and experience in the ICU to high emotional tiredness, with a p < 0.05. In a polyvalent ICU, higher values of the following were obtained: TISS 42 ± 11, NEMS 35 ± 10, mortality 18%, stay 5 ± 9, isolation 21%, burnout syndrome 17%, elevated emotional tiredness 49%, elevated depersonalization 63% and low professional performance 44%.

Conclusions

The prevalence of the burnout syndrome in our sample was 14%, those being affected most being the nursing professionals. We detected elevated levels of depersonalization and middle levels of emotional tiredness and professional performance. The variables related with professional burnout syndrome were low professional satisfaction, relationship with regular colleagues, low work recognition, and elevated emotional tiredness in the more expert personnel. The ICU with the greatest prevalence of burnout during the month studied attended patients with greater TISS, NEMS, mortality, stay and isolations.

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Proponer un modelo de predictores del estrés traumático secundario.
Se trata de un diseño transversal descriptivo.
El estudio se llevó a cabo en las unidades de cuidados intensivos de un hospital terciario de Madrid.
La muestra estuvo formada por 103 profesionales sanitarios.
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Se evaluaron variables sociodemográficas tales como género, años de experiencia y puesto, el estrés traumático secundario, la pasión por el trabajo, los estresores laborales, el esfuerzo emocional, la empatía, la autocompasión.
Se establece: a) para la fatiga por compasión, los años de experiencia como factor de riesgo (β = 0,224 y p = 0,029) y la pasión armoniosa como protector (β = −0,363 y p = 0,001); b) para la sacudida de creencias, el esfuerzo emocional y la empatía como factores de riesgo (β = 0,304 y p = 0,004; β = 0,394 y p = 0,000, respectivamente) y c) para la sintomatología, los estresores laborales y la empatía como factores de riesgo (β = 0,189 y p = 0,039; β = 0,395 y p = 0,000, respectivamente) y los años de experiencia como protector (β = −0,266 y p = 0,002).
Este modelo predictivo del estrés traumático secundario asienta factores protectores que podrían aumentarse, como la pasión armoniosa, y factores de riesgo que sería conveniente reducir, como la empatía y el esfuerzo emocional, con el fin de mejorar la calidad asistencial y de vida de los profesionales.
To propose a predictive model of secondary traumatic stress.
A descriptive cross-sectional study was carried out.
The study was conducted in the Intensive Care Units of a hospital in Madrid (Spain).
The sample comprised 103 health professionals.
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Sociodemographic variables such as gender, years of experience and position, secondary traumatic stress, passion for work, work stressors, emotional effort, empathy and self-compassion were evaluated.
The result identified the following: a) years of experience as a risk factor for compassion fatigue (β = 0.224 and P = 0.029), and harmonious passion as a protector (β = −0.363 and P = 0.001); b) emotional effort and empathy as risk factors for shattered assumptions (β = 0.304 and P = 0.004; β = 0.394 and P = 0.000, respectively); and c), work stressors and empathy as risk factors for symptomatology (β = 0.189 and P = 0.039; β = 0.395 and P = 0.000, respectively), and years of experience as a protector (β = −0.266 and P = 0.002).
This predictive model of secondary traumatic stress identifies protective factors which could be reinforced, such as harmonious passion, and risk factors which should be reduced, such as empathy and emotional effort, with a view to promoting quality of care and quality of life among these professionals.
Measuring the nursing workload in intensive care with the Nursing Activities Score (NAS): A prospective study in 16 hospitals in Belgium
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Citation Excerpt :
In fact, insufficient nurse staffing is detrimental to the outcomes of intensive care patients [5,6]. Studies have demonstrated an association between inadequate nurse-to-patient ratio (N/P) and high mortality [6-11]; an increase in complications and adverse events [6,10,12-14]; an increase in nosocomial infections [12,15-18]; poor satisfaction of relatives and families of the patient [12,19,20]; an increase in pressure ulcers [12,21,22]; missing care [23]; poor pain management [24]; increased length of stay due to surgical complications [25]; and more musculoskeletal injuries and burnout injuries in nurses [26]. In addition, these factors increase hospital costs.
The evaluation of nursing workload is a common practice in intensive care units (ICUs). It allows the calculation of an optimal nurse/patient ratio (N/P) which is a major challenge to ensuring the quality of care while controlling the costs of health care. The objectives of this study were, therefore, to evaluate the N/P ratio and to study nursing activities in intensive care in French-speaking Belgium.
The Nursing Activities Score (NAS) was prospectively recorded by shift for two periods of one month each in 16 French-speaking Belgian hospitals for a total of 316 ICU beds in 24 ICUs.
We included 3377 patients in the study, of which 64% were medical (versus surgical). The results for 24-hour NAS (68.6%) were significantly different from the NAS per shift (Morning: 61.3%, Afternoon: 58.4%, Night: 55.0%). Outliers were significantly more prevalent among men and patients who died and outliers had longer stays in the ICU. Finally, mobilization-positioning and clinical-administrative tasks took, on average, more time for nurses in the ICU.
There is a significant difference in N/P ratio between the Belgian regulation (1/3) and the one calculated by the NAS (1/1.5). A systematic objective assessment of shift workload should be done to avoid N/P ratio differences in intensive care.
Burnout and posttraumatic stress in paediatric critical care personnel: Prediction from resilience and coping styles
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Finally, some environmental variables such as the number of night shifts the week before, time since last vacations, and conflicts with colleagues are associated with higher burnout. No associations have been found with patient-related variables, such as their severity or mortality.10,12,30 Given the high rates of burnout and PTSD in PICU staff found in previous studies, combined with the lack of information regarding which variables are related to distress in that sample, this study attempts:
Our aims were (1) to explore the prevalence of burnout syndrome (BOS) and posttraumatic stress disorder (PTSD) in a sample of Spanish staff working in the paediatric intensive care unit (PICU) and compare these rates with a sample of general paediatric staff and (2) to explore how resilience, coping strategies, and professional and demographic variables influence BOS and PTSD.
This is a multicentre, cross-sectional study. Data were collected in the PICU and in other paediatric wards of nine hospitals. Participants consisted of 298 PICU staff members (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in non-critical paediatric units (53 physicians, 104 nurses, and 32 nursing assistants). They completed the Brief Resilience Scale, the Coping Strategies Questionnaire for healthcare providers, the Maslach Burnout Inventory, and the Trauma Screening Questionnaire.
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El agotamiento profesional (burnout) es estudiado en forma descriptiva; se han propuesto factores psicosociales sin concretarlos en estudios analíticos. El objetivo de este trabajo es analizar la presencia de burnout y su posible asociación con características de la Unidad de Cuidado Intensivo (UCI) y la práctica del médico intensivista.
Estudio caso-control, con encuesta digital/impresa en recurso humano de salud (RHS) colombiano (octubre de 2014-octubre de 2015) basada en el instrumento Maslach Burnout Inventory-Human Services Survey (MBI-HSS), complementado por los componentes sociodemográfico, laboral y del entorno. Los casos fueron médicos intensivistas con nivel medio o alto en cualquier dimensión del burnout mediando exposición en el último año a factores de especialidad, equipo, edificio o entorno; los controles fueron otros profesionales o técnicos de salud. Los datos fueron recogidos en la plataforma Google o tabulados, integrados con Microsoft Excel® 2013 y analizados con estadística descriptiva/inferencial con Epi-Info® 7.2 y SPSS® 23.
Se captaron 154 registros; 77 hombres (50%), con edad mediana de 35 años (RIQ 30-42); intensivistas: 62 (40%); casos: 56 (36%). Prevalencia de burnout: 3,2% (2/62). Factores de riesgo identificados: sexo masculino (OR 9,28; p < 0,001), profesor de UCI (OR 4,16; p < 0,001), razón de salarios ideal/real <65% (OR 2,42; p = 0,015), turnos nocturnos (OR 2,37; p = 0,02), ruido (OR 2,38; p = 0,011), ubicación en la región andina (OR 2,86; p = 0,005), maltrato por compañeros (OR 3,44; p = 0,026) y transporte en carro (OR 3,55; p = 0,003).
Hubo menor prevalencia, pero mayor riesgo de burnout, en los intensivistas. Los factores de riesgo y las diferencias encontradas señalan la UCI como un sistema social también propenso a albergar condiciones de desigualdad e inequidad. Es preciso investigar más el burnout e interrogar las políticas nacionales de RHS y de desarrollo hospitalario.
There have been descriptive studies on burnout with some psychosocial factors being proposed, but analytical studies are scarce or absent. The aim of this article was to analyse presence of burnout and its possible association with the characteristics of ICU and physician practice.
Case-control study; Colombian healthcare human resource (HHR) answered a digital and printed questionnaire (October 2014–October 2015) based upon Maslach Burnout Inventory-Human Services Survey (MBI-HSS), supplemented by sections on sociodemographic, occupational, and environmental factors. Cases were defined as ICU physicians with middle-high risk in any burnout dimension while exposed to factors of the specialty, equipment, building, and environment. Controls were other health personnel. Data were collected using a Google platform or tabulated, integrated into Microsoft Excel ® 2013, and analysed using Epi-Info ®7.2 and SPSS® 23, using both descriptive and inferential statistics.
Data from 154 questionnaires were collected, and included; 77 (50%) men, median age 35-yr (IQR 30-42); ICU physicians: 62 (40%); cases: 56 (36%). Burnout prevalence: 3.2% (2/62). Identified risk factors were: being male (OR 9.28; P<.001), ICU teacher (OR 4.16; P<.001), salary ratio ideal/real <65% (OR 2.42; P=.015), night shifts (OR 2.37; P=0.02), noise (OR 2.38; P=0.011), location in Andean Region (OR 2.86; P=0.005); abuse by peers (OR 3.44; P=0.026), and transportation by car (OR 3.55; P=0.003).
Burnout prevalence was lower, but risk of burnout higher in ICU physicians. Risk factors and differences found also suggest ICU as a social system prone to harbouring inequality and inequity. It is necessary to study burnout more, and to question national policies on HHR and hospital development.
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2016, Acta Colombiana de Cuidado Intensivo
La unidad de cuidados intensivos (UCI) es uno de los servicios hospitalarios de mayor complejidad y costo. Conlleva para el médico intensivista a un tiempo satisfacciones, presiones, frustraciones y conflictos en un entorno cada vez más estresante, en el cual tiende a desarrollar enfermedades laborales. Una de esas es el agotamiento profesional (burnout), que comprende agotamiento emocional, desapego frente al paciente y falta de realización profesional. Ha faltado interrogar a los intensivistas sobre su percepción respecto a la especialidad, su quehacer, la unidad donde trabajan o el entorno donde viven, aspectos que no son fácilmente cuantificables. Se propone usar la teoría fundamentada (grounded theory) para explorar cuáles estructuras o procesos al interior de la UCI colombiana pueden fomentar el burnout en estos especialistas.
Estudio con enfoque cualitativo basado en teoría fundamentada de Strauss y Corbin, bajo la sospecha de la génesis del burnout mediada por la interrelación entre características de a) especialidad, b) equipo, c) edificio hospitalario y d) entorno. Muestreo teórico por conveniencia y entrevista estructurada con formulario por bloques a médicos intensivistas en Bogotá ⿿fuesen profesores, especialistas o residentes. Transcripción de audio a Microsoft Word^® 2013; información codificada y clasificada con NVivo 10; contraste y saturación de información contra previos análisis de situación de la UCI entre 1995 y 2015.
Se entrevistaron 14 especialistas. Para ellos, la evolución de la UCI y el Sistema de Seguridad Social en Salud en Colombia moldean su presente: a) especialidad fuertemente masculina, reactiva frente a problemas de salud pública (enfermedad coronaria, trauma, sepsis), principalmente de anestesiólogos e internistas; b) gran dependencia de tecnologías en salud (monitores, ventiladores); c) carencia de recursos e improvisación estructural en el hospital; d) preocupación por riesgos biológicos empeorada por otra de riesgos laborales y administrativos-precarización laboral, falta de cohesión gremial y fragilidad estatal. La conciencia sobre burnout está mediada por la literatura extranjera, siendo sentido como asunto ajeno.
La UCI y la práctica del intensivismo en Colombia pueden reflejar condiciones de desigualdad e inequidad predisponentes de enfermedad laboral. Se precisa un enfoque epidemiológico-social para superar el desconocimiento sobre el burnout y otras enfermedades laborales asociables al trabajo en la UCI.
The intensive care unit (ICU) is one of the most complex and costly services in the modern hospital. ICU implies pressures, frustrations, conflicts for the intensive care physician in an ever more stressful environment, with a tendency to develop occupational illnesses. One of these is burnout, comprised of emotional exhaustion, depersonalisation, and lack of personal accomplishment. There is a need to question ICU physicians on their perceptions about the specialty, the job, the very ICU where they work, or their outside environment, topics not so easily quantifiable. Grounded theory is proposed here to explore which structures or processes may promote burnout in them.
A qualitative study was conducted based on grounded theory, as proposed by Strauss and Corbin, under the suspicion of the genesis of burnout mediated by some inter-related features of a) specialty; b) equipment; c) hospital facility; d) environment. Theoretical sampling by convenience and structured interview with questions by blocks to intensive care physicians of Bogota⿿whether they be professors, physicians, residents. Audio transcription to Microsoft Word^® 2013; information coded, classified with NVivo 10; contrast and saturation of information against previous ICU situation analyses published between 1995 and 2015.
Fourteen physicians were interviewed. According to them, ICU evolution and the Colombian General System of Social Security in Health define its present situation: a) strongly male specialty, reactive to Public Health problems (coronary disease, trauma, sepsis), mainly composed of anaesthesiologists and internists; b) huge dependence on health technologies, namely monitors and ventilators; c) lack of resources and structural improvisation in the hospital; d) concern about biological risks, worsened by occupational, administration risks⿿precarious work, lack of union, and fragile State, cohesion. Awareness of burnout is only seen through foreign literature, thus the physicians consider it as an unrelated issue.
ICU and intensive care practice in Colombia may reflect conditions of inequality towards the genesis of occupational illnesses. A social epidemiology focus is required to overcome ignorance on burnout, and other possibly conditions related to ICU.

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OriginalSíndrome de burnout en distintas Unidades de Cuidados IntensivosBurnout syndrome in different Intensive Care Units

Resumen

Objetivos

Material y métodos

Resultados

Conclusiones

Abstract

Objectives

Material and methods

Results

Conclusions

Rev Calid Asist

Enferm Clin

Gaceta Sanitaria

Soc Sci Med

Estudio sobre la prevalencia del burnout en los médicos del área sanitaria de Talavera de la Reina

Aten Primaria

Síndrome de burnout en el personal de enfermería de un hospital de Madrid

Rev Esp Salud Pública

Síndrome de burnout en profesionales de enfermería de cuidados críticos

Enferm Intensiva

Burnout en enfermería y atención hospitalaria

Enferm Clin

Síndrome de burnout en los equipos de enfermería de cuidados intensivos de Cataluña

Metas de Enfermería

Staff Burnout

J Soc Issues

Staff Burnout Syndrome in alternative Institutions Psycotherapy theory

Research and Practice

Síndrome de desgaste profesional

Tiempos Médicos

Maslach Burnout inventory manual

MBI. Inventario Burnout de Maslach. Síndrome del quemado por estrés laboral asistencial

Adaptación española del MBI, Síndrome del quemado por estrés laboral asistencial

The measurement of esperiencet burnout

Journal of Occupational Behavir

¿Está quemada la enfermería?: síndrome de burn-out

Enferm Intensiva

Estrés laboral y burnout en enfermería

Metas de Enfermería

El síndrome de burnout

Rev Rol Enferm

Relaciones entre el síndrome de burnout en profesinales de enfermería. Factores sociodemográficos y reactividad al estrés

Enferm Clin

Personality hardiness, ways of coping, social support and burnout in critical care nurses

J Adv Nurs

Personality hardiness, occupational stress and critical care nurses

Res Nurs Health

Inmunidad de enfermería a los efectos del Burnout

Metas de Enfermería

Original
Síndrome de burnout en distintas Unidades de Cuidados IntensivosBurnout syndrome in different Intensive Care Units