Agotamiento profesional, clima ético y organización del trabajo en unidades de cuidados intensivos de covid-19: estudio de método mixto

Dorneles, Ademir Jones Antunes; Dalmolin, Graziele de Lima; Barlem, Edison Luiz Devos; Silveira, Rosemary Silva da; Andolhe, Rafaela; Camponogara, Silviamar; Magnago, Tânia Solange Bosi de Souza; Costa, Valdecir Zavarese da

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Brasil

Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (Suppl 3) • 2023 • https://doi.org/10.1590/0034-7167-2022-0684 copiar

Agotamiento profesional, clima ético y organización del trabajo en unidades de cuidados intensivos de covid-19: estudio de método mixto

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

analizar la asociación entre el agotamiento profesional y la percepción del clima ético en profesionales de enfermería de la Unidad de Cuidados Intensivos covid-19 y la relación con la organización del trabajo desde la perspectiva de los directivos de estas unidades.

Métodos:

estudio de método mixto realizado en tres hospitales universitarios del sur de Brasil entre diciembre de 2021 y marzo de 2022. Se desarrolló un estudio transversal con 110 profesionales de enfermería, seguido de un estudio exploratorio-descriptivo mediante entrevistas semiestructuradas con seis gestores. Se utilizó estadística descriptiva, analítica y análisis textual discursivo.

Resultados:

hubo un 10% de prevalencia de agotamiento profesional y un 24,5% de percepción de clima ético negativo. La asociación entre el agotamiento profesional y el clima ético reveló sobrecarga y fatiga durante la jornada laboral, relacionadas con la tensión, el miedo y el estrés que surgieron de las consecuencias de la organización y las relaciones laborales en la Unidad de Cuidados Intensivos covid-19.

Conclusiones:

hubo asociación entre agotamiento profesional y clima ético y elementos de la organización del trabajo.

Descriptores:
Agotamiento Profesional; COVID-19; Unidades de Cuidados Intensivos; Enfermería; Salud Laboral

	n	Peers			Patients			Managers			Hospital			Physicians			Overall EC
	n	Md	IQR	U	Md	IQR	U	Md	IQR	U	Md	IQR	U	Md	IQR	U	Md	IQR	U
EE	Low (77)	3.75	0.63	811.50^* * p < 0.05; U - Mann-Whitney test.	3.75	0.75	741.50^* * p < 0.05; U - Mann-Whitney test.	3.83	0.75	894.50^* * p < 0.05; U - Mann-Whitney test.	3.67	0.67	856.00^* * p < 0.05; U - Mann-Whitney test.	3.67	0.67	902.50^* * p < 0.05; U - Mann-Whitney test.	3.73	0.64	806.50^* * p < 0.05; U - Mann-Whitney test.
EE	High (33)	4.25	0.88	811.50^* * p < 0.05; U - Mann-Whitney test.	4.25	0.88	741.50^* * p < 0.05; U - Mann-Whitney test.	4.15	0.83	894.50^* * p < 0.05; U - Mann-Whitney test.	4.00	0.58	856.00^* * p < 0.05; U - Mann-Whitney test.	4.00	1.25	902.50^* * p < 0.05; U - Mann-Whitney test.	4.08	0.80	806.50^* * p < 0.05; U - Mann-Whitney test.
DP	Low (70)	4.00	0.50	916.50^* * p < 0.05; U - Mann-Whitney test.	4.00	0.75	898.00^* * p < 0.05; U - Mann-Whitney test.	4.00	0.83	842.50^* * p < 0.05; U - Mann-Whitney test.	3.83	0.67	930.00^* * p < 0.05; U - Mann-Whitney test.	3.92	0.71	885.50^* * p < 0.05; U - Mann-Whitney test.	3.96	0.67	849.50^* * p < 0.05; U - Mann-Whitney test.
DP	High (40)	3.75	0.75	916.50^* * p < 0.05; U - Mann-Whitney test.	3.50	0.69	898.00^* * p < 0.05; U - Mann-Whitney test.	3.67	0.67	842.50^* * p < 0.05; U - Mann-Whitney test.	3.67	0.67	930.00^* * p < 0.05; U - Mann-Whitney test.	3.50	0.67	885.50^* * p < 0.05; U - Mann-Whitney test.	3.62	0.62	849.50^* * p < 0.05; U - Mann-Whitney test.
PA	Low (27)	3.75	0.50	822.50^* * p < 0.05; U - Mann-Whitney test.	3.50	0.50	799.00^* * p < 0.05; U - Mann-Whitney test.	3.67	0.67	800.50^* * p < 0.05; U - Mann-Whitney test.	3.50	0.67	736.50^* * p < 0.05; U - Mann-Whitney test.	3.50	0.83	827.50^* * p < 0.05; U - Mann-Whitney test.	3.62	0.43	741.50^* * p < 0.05; U - Mann-Whitney test.
PA	High (83)	4.00	0.75	822.50^* * p < 0.05; U - Mann-Whitney test.	4.00	0.75	799.00^* * p < 0.05; U - Mann-Whitney test.	4.00	0.67	800.50^* * p < 0.05; U - Mann-Whitney test.	3.83	0.67	736.50^* * p < 0.05; U - Mann-Whitney test.	3.83	0.83	827.50^* * p < 0.05; U - Mann-Whitney test.	3.93	0.67	741.50^* * p < 0.05; U - Mann-Whitney test.
SB	Absent (99)	4.00	0.75	322.50^* * p < 0.05; U - Mann-Whitney test.	3.75	0.75	311.00^* * p < 0.05; U - Mann-Whitney test.	4.00	0.67	331.50^* * p < 0.05; U - Mann-Whitney test.	3.83	0.67	284.50^* * p < 0.05; U - Mann-Whitney test.	3.83	0.67	219.00^* * p < 0.05; U - Mann-Whitney test.	3.85	0.65	263.00^* * p < 0.05; U - Mann-Whitney test.
SB	Present (11)	3.50	0.50	322.50^* * p < 0.05; U - Mann-Whitney test.	3.50	0.75	311.00^* * p < 0.05; U - Mann-Whitney test.	3.50	0.67	331.50^* * p < 0.05; U - Mann-Whitney test.	3.50	1.33	284.50^* * p < 0.05; U - Mann-Whitney test.	3.17	0.67	219.00^* * p < 0.05; U - Mann-Whitney test.	3.52	0.83	263.00^* * p < 0.05; U - Mann-Whitney test.

1. MAIN TOPIC: Burnout and perception of the ethical climate in covid-19 ICU nursing professionals and the relationship with the organization of work from the perspective of managers of these units.
2. INTEGRATION: QUAN+qual
Burnout prevalence: high emotional exhaustion, n=33 (30%), high depersonalization, n=40 (36.4%), low professional achievement, n=27 (24.5%). Burnout: n=11(10%). Nurses: n= 5 (17,2 %) and Nursing technicians: n=6 (7,4%).
Factor Concept (Olson, 1998)	EC Mean (SD)	Examples of participants’ speeches	Meta-inferences
Peers: It covers how supportive and transparent the relationships between colleagues are, reflecting on the quality of care.	3.88 (0.57)	1- The covid unit came, so we increased the number of employees to manage this new unit, many new employees started. (X2) 2- A nursing team very engaged in care, they didn’t go to the bathroom, didn’t have a snack, worked long shifts with no breaks, we left there exhausted, with emotional and physical fatigue, serving and managing the new routines; impotence generated great anguish... because the number of deaths was very high. (X3)	Convergences The Peers factor associated with the dimensions of burnout, especially in emotional exhaustion, reveals work relationships marked by differences in professional experience, a great number of new hires in the institutions and teamwork permeated by a difficult nursing care routine in a pandemic scenario with a high level of stress among people and exhaustion of professionals. The uncertainties caused by changes in the work organization process (new protocols) in covid-19 ICU influenced the emergence of professional exhaustion and the perception of the EC in this scenario.
Patients: Reflects how much information is shared between health professionals and patients	3.82 (0.57)	1- Arriving at the shift with a crowded unit and seeing there were few technicians, a colleague was crying. The atmosphere was always one of apprehension, patients walked in and left in black bags. We could only show a picture of the death, it wasn’t pleasant, but it was the alternative to show that their relative was in that bag. (X4)	The organization of work and the relationship with patients was marked by the instability surrounding covid-19, which caused tension, fear, stress and exhaustion (overload) of professionals.
Managers: They refer to the immediate leadership and general leadership of the organization, addressing aspects related to the respect and support from managers to nurses.	3.92 (0.59)	1- Some nursing technicians and nurses with morbidities; fear led to excessive care, causing conflicts in the team. (X1) 2- Although we had a very valid structure, there were things the unit needed, but nobody entered, it was shielded. (X5) 3- Working in an environment of death was the downside of covid-19. (X3) 4- The impotence was that of needing to do more, but not having the opportunity, those were endless weeks. (X6)	The Managers factor was related to the coordination and relationship with nursing professionals, revealing management in a scenario of uncertainties with new technical and administrative needs, lack of nursing workers given the sick notes or the greater demand for care, generating overload in the role of manager of the nursing team. The commitment of managers in this scenario was demonstrated with a positive EC mean, although with favorable elements to the occurrence of burnout.
Hospital: Presents the relationship between health professionals and hospital management, about the institution’s mission.	3.72 (0.53)	1- If the pandemic lasted longer, I don’t know if we would have financial, physical and mental conditions. (X4) 2- We needed someone from the care team to go to the meetings and inform about our covid-19 ICU needs. (X5)	The Hospital factor highlighted the need for a closer relationship between frontline professionals and institutional managers in order to assess and understand the work situation that constituted an environment of high emotional tension, mainly because of the work overload arising from the growing technical and material needs.
Physicians: Work climate between physicians and nurses. Shared relationship of knowledge and how ethical are the decisions made together.	3.76 (0.58)	1- Physicians without experience anchored in physicians with experience; sometimes there was mistrust, difficulties in making decisions, some cases of difficulty also in terms of professional respect between teams, causing stress; I guess because there were several teams working, so these conflicts always end up getting near me, I go there and talk to those responsible, together we improve work. (X1)	The Physicians factor showed elements of professional exhaustion in relation to trust and respect between physicians and nurses in decision-making, demonstrating the still distant relationship with physicians.

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[1] Corresponding author: Graziele de Lima Dalmolin, E-mail: grazi.dalmolin@gmail.com