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Print version ISSN 0034-7094
Rev. Bras. Anestesiol. vol.61 no.4 Campinas July/Aug. 2011
Austeclínio Newton Marinho AndradeI; Marco Antônio Costa de Albuquerque, TSAII; Aley Newton Marinho AndradeIII
IMedical Student of UFS
IIMasters in Health Sciences; Anesthesiologist of Hospital Universitário da UFS; Coordinator of Anestesiologia do Hospital Universitário da UFS
IIIAnesthesiologist of Cooperativa de Anestesiologia de Sergipe
BACKGROUND AND OBJECTIVE: To assess the impact caused by stress on occupational health of anesthesiologists in Sergipe and to propose solutions to improve work conditions, quality of the service provided, and quality of life.
METHODS: WHOQOL-BREF questionnaire was applied; the sample size was determined by the Barbetta method; and Student t test and Analysis of Variance were used for intergroup comparisons, considering significant a p < 5%.
RESULTS: This study demonstrated that the mean weekly working hours is 61.33 hours. In the subjective analysis of quality of life, 53.1% of the respondents had a negative or non-established evaluation. On the item "leisure activities", 61.2% answered they have very few opportunities or none at all, demonstrating agreement with personal satisfaction and working assessment. The age group of 41 to 52 years old had the best scores. A significant difference regarding gender and number of working days/week was not observed. The general domain had lower scores than the others in all variables analyzed.
CONCLUSIONS: Excessive working load contributed to a negative self-evaluation on quality of life, besides hindering access to leisure activities. The implementation of a quality policy in work institutions, as well as a personal reevaluation in search of innovation, professional recycling, leisure alternatives, and motivation are factors that can contribute to improve the quality of life and work of these professionals.
Keywords: Anesthesiology; Quality of Life; Stress, Psychology; Occupational Health.
Due to personal and collective needs, occupational health is constantly being discussed. In view of the repercussions caused by stress not only in the professional life of an individual but also in personal and social life, society has been recognizing its importance1,2.
With anesthesiologists the situation is the same, since stress is unavoidable, and it becomes harmful when one cannot control it resulting in physical and psychosocial problems3.
In the eyes of the population, health care professionals are protected from these problems by the institution they work at, by their colleagues, and by the financial return4.
However, direct and indirect evidence that this conception is unrealistic do exist, since Anesthesiology is an area identified as being extremely stressful5, which has been demonstrated in several studies5.
We evaluated the level of stress of anesthesiologists of the Sergipe Anesthesiologists Cooperative, relating quality of life and the degree of satisfaction with ones' health, the number of weekly workdays and shifts, gender, and age group.
This study assessed the impact of stress on their personal and professional life, proposing solutions to improve working conditions, quality of service provided, and quality of life.
An exploratory, descriptive, transversal study was undertaken without identifying the volunteers, using a standardized questionnaire.
Respondents are anesthesiologists of the State of Sergipe Anesthesiologists Cooperative, and the study was carried out in their work environment as follows: the investigator visited the operating room of the following hospitals - Hospital de Urgência de Sergipe, Maternidade Santa Isabel, Maternidade Nossa Senhora de Lourdes, Fundação Beneficente Hospital de Cirurgia, Hospital Universitário, Hospital São Lucas, and Hospital Primavera - and the focus of the investigation was presented. Those interested in participating answered the questionnaire that was divided into two parts: the first one, with general personal data such as age, gender, working shift, and number of weekly working days; and the second that contained the quality of life evaluation through a questionnaire developed by the Quality of Life Group of the World Health Organization, the abbreviated version of the World Health Organization Quality of Life (WHOQOLBREF) whit 26 questions and scores graded from 1 to 5 points6.
This questionnaire contains two general questions on quality of life and the degree of satisfaction with one's health, while the remaining 24 involve physical and psychological aspects, social relationships, and environment. With this questionnaire it is possible to subjectively assess the degree of satisfaction of the respondent with his/her working capacity, physical appearance, access to information, leisure, sex life, financial status, working and health services conditions, general social relationships, work safety, and housing6.
The guidelines of the Quality of Life Group of the World Health Organization regarding the questionnaire scores were followed. The Barbetta method was used to define the sample size.
The study population was composed of 104 anesthesiologists, and the tolerable error considered was 5%. We obtained a study sample of 49 anesthesiologists.
The Student t test and Analysis of Variance (ANOVA) were used in the intergroup comparisons, considering a level of significance of 5%. The objective of the Student t test is to compare means between two groups or samples, independently or paired, assuming the homogeneity of variances, while ANOVA has the same objective, but in case of more than two groups.
The SPSS 17.0 (Statistical Package for the Social Science) was used in the analysis, and data were expressed as percentage, and mean and standard deviation.
Physicians who refused to participate, professionals that could not be found, and the authors were excluded from the study.
Before answering the questionnaire, all participants signed an informed consent.
Forty-nine anesthesiologists from the Sergipe Anesthesiologists Cooperative, representing 45.79% of the total, participated in the study. The mean time of employment was 15.04 years, ranging from 3 to 38 years, and mean weekly hours worked was 61.33, ranging from 35 to 90 hours (Table I).
Thirty-one were males (63.3%) and 18 females (36.7%) (Table II). A predominance of the age range between 29 and 40 years, representing 46.9% of the sample, followed by 41 and 52 years (36.7%), and over 52 years (16.3%), was observed (Table II). Participants' age ranged from 29 to 65 years with a mean of 42.2 years (Table III).
The morning shift predominated (75.5%), followed by the evening shift (18.4%) and nocturnal (6.1%) (Table II).
Among women, 15 work more often in the morning (83.3%) and 3 in the evening (16.7%). Of the women interviewed, none of them work in the nocturnal shift, and among males 3 had a larger working load at night (9.7%), but the morning shift also predominated with 71%, followed by the evening with 19.4% (Table II).
When quality of life was subjectively evaluated (general domain), 6.1% answered very good, 40.8% good, 32.7% neither good nor bad, 18.4% bad and very bad 2% (Tale II). Regarding how much they enjoy life (psychological domain), 19 answered very much (38.8%); 19 more or less (38.8%); and 11 very little (22.4%) (Table II).
When they were assessed regarding the degree of satisfaction with their personal relationships (social domain), 51% stated they were satisfied; 5 (10.2%) were dissatisfied; and one (2%) was very dissatisfied (Table II). Regarding whether they have enough energy for their daily life (physical domain), 61.2% answered moderately, and only 2% said very little (Table II).
Regarding leisure activities (environmental domain), 28.6% answered they have very little leisure opportunities.
When the scores per gender were compared with Student t test, a statistically significant difference was not observed in any of the gender-related domains, with a p higher than 5%. Although the absolute value of the psychological and physical domains was higher among males; among females it was higher in the social, environmental, and general domains (Table IV).
When comparing the scores per domain among the different age groups, we noticed that the age group between 41-52 years had higher scores when compared to other age groups in all domains (Table V).
Analyzing mean scores according to the length of employment in relation to weekly hours worked, it was observed that professionals with 15 to 26 years of occupation had lower scores (56.32) when compared to those with more than 26 years (69) and those with less than 15 years (63.13) (Table VI).
Among the interviewees, a relative variation was observed regarding the number of days worked per week, with a minimum of four and a maximum of seven days per week. When the scores of the questionnaire were analyzed it was observed that the differences were not statistically significant (Table VII).
This study was carried out with 45.79% of the anesthesiologists of the Sergipe Anesthesiologists Cooperative, a significant percentage when compared to similar studies5.
The mean weekly workload of the anesthesiologists in Sergipe is 61.33 hours, considered elevated when compared to other professions, but lower than that observed in other places in the same field. In a study published in 2004 titled "The night shift in Anesthesiology reduces sleep latency", it was observed that the mean workload was 72 hours7. It is also interesting that over the years the mean number of working hours did not decrease, which deserves a deeper analysis explaining the motivating factors for remaining at work with elevated working hours.
On the subjective analysis of quality of life, 53.1% of interviewees had a negative or undefined assessment, a higher percentage than a similar study undertaken in Recife, where 44.6% had the same perception5, and than a study performed amongst Uruguayan physicians8, which indicates the need of a more detailed study to attest such degree of dissatisfaction.
Regarding how much they enjoy life, 61.2% answered a moderate amount or very little, also considered a high score that reflects psychological dissatisfaction, corroborating the previous data.
We observed that among respondents, 63.2% considered that they have moderate or very little energy for everyday life.
On the item leisure activities, 61.2% of anesthesiologists answered a moderate amount, or very little or no opportunity at all, revealing that they have a high level of demand and that overwork limits performance of other activities considered essential for physical and mental health. They are also dissatisfied with their personal relationships (friends and relatives), and 40.8% answered dissatisfied, very dissatisfied, or indifferent.
After data analysis, we observed that being an Anesthesiologist in the State of Sergipe is very stressful, disrupting several aspects of life, causing not only physical and psychological changes, but also in personal and environmental relationships. We propose a reevaluation of all professionals in this field to review working conditions and wages, which are the causative factors of professional dissatisfaction resulting in consequences in physical and psychoemotional health.
Other studies reported similar problems regarding anesthesiologists. Studies on their personalities observed that they are more reserved, serious, intelligent, assertive, self-sufficient, and uptight when compared to physicians in other specialties9.
Their specialty gives them the impression that theydo not need the cooperation of other physicians. Because they work alone, they feel they have stability and independence, therefore, they have difficulties in trusting their colleagues fearing the patient will develop severe sequelae, which leads them to trust only their own performance generating psychological and emotional overload, being responsible for the high rate of drug addiction and suicide among these professionals3.
The creation of a commission to evaluate working conditions in the hospitals in the State of Sergipe is of capital importance. This commission should be independent and have the support of public and private sectors to put into practice in all hospitals and clinics where anesthesia is performed the Resolution # 1,802/06 of the Federal Medical Board, to improve working conditions. In parallel, the Society of Anesthesiologists of the State of Sergipe can elaborate a proposal to improve the working health of these professionals, searching for subsidies to perform, along with the Anesthesiologists Cooperative, periodical evaluations of these professionals, directly interfering on the insertion of anesthesiologists in the labor force. Additionally, they also should try to improve network services and guidance on working conditions, as well as evaluate the workload and other factors that interfere with the practice of anesthesiology.
We conclude that the results of this study reflect the difficult time of insertion of physicians into the labor market, associated with cultural factors that impose an increased workload to maintain the status quo and financial gains. This result is similar to that of other studies, indicating the need to take individual and collective attitudes to attenuate and/or improve the health and satisfaction of these professionals. The recognition and diagnosis of the problem makes us reflect that something must be done so we can continue to practice medicine with dignity, taking care of our patients the best way possible, while remaining healthy for professional practice with quality in our daily life.
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Correspondence to: Submitted on August 11, 2010. Received from Universidade Federal de Sergipe (UFS), Brazil.
Dr. Austeclínio Newton Marinho Andrade
Rua João Vieira de Aquino, 122 Conjunto Leite Neto Jardins
49027150 - Aracaju, SE, Brazil
Approved on December 13, 2010.
Submitted on August 11, 2010.
Received from Universidade Federal de Sergipe (UFS), Brazil.