Acessibilidade / Reportar erro

Factors associated with satisfaction at work in Psychosocial Care Centers1 1 Paper extracted from master's thesis "Factors associated with job satisfaction of Psychosocial Care Centers in Southern Brazil" presented to Faculdade de Enfermagem, Universidade Federal de Pelotas, Brazil. Supported by Ministério da Saúde, process # 186/2010

Abstracts

OBJECTIVES:

to analyze the prevalence of satisfaction at work and identify associated factors in Psychosocial Care Centers.

METHOD:

cross-sectional study involving 546 workers from 40 Psychosocial Care Centers in the South of Brazil. The satisfaction was identified based on the Assessment Scale of Satisfaction in the Mental Health Team and a logistic regression model was used for the adjusted data analysis.

RESULTS:

the prevalence of satisfaction at work corresponded to 66.4%. Factors directly associated with satisfaction: higher-level function (except physicians and psychologists), work time of six months or less, making a larger number of home visits, good supervision by the team, possibility to make collective choices and take courses.

CONCLUSIONS:

the satisfaction is associated with the work organization and conditions and demonstrates the need to invest in team supervisions, in process that democratize the services and in the workers' training.

Job Satisfaction; Mental Health; Community Mental Health Services; Work


OBJETIVOS:

analisar a prevalência de satisfação no trabalho e identificar fatores associados em Centros de Atenção Psicossocial.

MÉTODO:

estudo transversal com 546 trabalhadores de 40 Centros de Atenção Psicossocial, da Região Sul do Brasil. A satisfação foi identificada a partir da Escala de Avaliação da Satisfação da Equipe de Saúde Mental e a análise ajustada dos dados, realizada por modelo de regressão logística.

RESULTADOS:

prevalência de satisfação no trabalho de 66,4%. Fatores diretamente associados à satisfação: função de nível superior (excetuando médicos e psicólogos), tempo de trabalho menor ou igual a seis meses, realização de maior número de visitas domiciliares, boa supervisão pela equipe, possibilidade de fazer escolhas coletivas e cursos.

CONCLUSÕES:

a satisfação está associada à organização e às condições do trabalho e demonstra necessidade de se investir em supervisão pelas equipes, em processos que democratizem os serviços e, também, na formação de seus trabalhadores.

Satisfação no Emprego; Saúde Mental; Serviços de Saúde Mental; Trabalho


OBJETIVOS:

analizar la prevalencia de satisfacción en el trabajo e identificar factores asociados en Centros de Atención Psicosocial.

MÉTODO:

estudio trasversal con 546 trabajadores de 40 Centros de Atención Psicosocial de la región Sur de Brasil. La satisfacción fue identificada a partir de la Escala de Evaluación de la Satisfacción del Equipo de Salud Mental y el análisis ajustado de los datos efectuado mediante un modelo de regresión logística.

RESULTADOS:

prevalencia de satisfacción en el trabajo de 66,4%. Factores directamente asociados a la satisfacción: función de nivel superior (excepto médicos y psicólogos), tiempo de trabajo menor o igual a seis meses, efectuar mayor número de visitas a domicilio, boa supervisión por el equipo, posibilidad de hacer opciones colectivas y cursos.

CONCLUSIONES:

la satisfacción está asociada a la organización y a las condiciones del trabajo y demuestra la necesidad de invertir en supervisión por los equipos, en procesos que democraticen los servicios y también en la formación de sus trabajadores.

Satisfacción en el Trabajo; Salud Mental; Servicios de Salud Mental; Trabajo


Introduction

Mental Health is a global priority for public health in the 21st century. Different actions are needed to consolidate care models that rescue the citizenship of individuals in mental suffering. Therefore, the Brazilian services for care without institutionalization, within the user's territory, structured based on the Psychiatric Reform, increased numerically and reveal peculiarities in the different regions of the Brazilian territory.

The expansion is verified particularly in the network of Psychosocial Care Centers (CAPS), which in 2004 consisted of 689 services and at the end of 2010 reached the sum of 1,620 services implemented in Brazil( 11. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. DAPES. Coordenação Geral de Saúde Mental, Álcool e Outras Drogas . Saúde Mental no SUS: as novas fronteiras da Reforma Psiquiátrica. Relatório de Gestão 2007-2010. Ministério da Saúde: Brasília; 2011. 106 p. ). Among the Brazilian regions, the South presents the best CAPS coverage, with an indicator of 0.87 CAPS/100,000 inhabitants, higher than the Brazilian average of 0.66 CAPS/100,000 inhabitants( 11. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. DAPES. Coordenação Geral de Saúde Mental, Álcool e Outras Drogas . Saúde Mental no SUS: as novas fronteiras da Reforma Psiquiátrica. Relatório de Gestão 2007-2010. Ministério da Saúde: Brasília; 2011. 106 p. ).

The consolidation of the substitutive service network presupposes the problematization and organization of its work processes to consider the exchange of knowledge and practices among the professionals, as well as the valuation of creative potentials and individual competences( 22. Pereira MA. Psychosocial rehabilitation in mental health care: strategies under construction. Rev. Latino-Am. Enfermagem. jul.-ago. 2007;15(4):153-9. ). Deinstitutionalized care comes with challenges that stimulate workers, and can also cause suffering, burden and lack of satisfaction at work.

The repercussions of work derive from the work conditions (physical, mechanical, chemical and biological pressures of the work station) as well as the organization of work (prescribed operation mode, distribution of responsibilities, hierarchy, command modalities and socioprofessional relations, among others)( 33. Dejours C, Abdoucheli E. Itinerário teórico em psicopatologia do trabalho. In: Dejours C. Psicodinâmica do trabalho, contribuições da Escola Dejouriana à análise da relação prazer, sofrimento e trabalho. São Paulo: Atlas; 2011. p. 120-43. ). In mental health, daily contact with people in mental suffering is added to these factors, constituting a set that affects the workers' satisfaction and, consequently, their well-being and mental health, whose influence is perceived in the quality of user care and, therefore, of the services( 44. Bandeira M, Ishara S, Zuardi AW. Satisfação e sobrecarga de profissionais de saúde mental: validade de construto das escalas SATIS-BR e IMPACTO-BR. J Bras Psiquiatria. 2007;56(4):280-6. ).

Brazilian quantitative studies adopt concepts that relate satisfaction and dissatisfaction at work as opposite phenomena and use scales to verify them. The use of validated instruments favors the assessment of satisfaction at work in practice( 55. Bandeira M, Pitta AMF, Mercier C. Escalas Brasileiras de Avaliação da Satisfação (SATIS-BR) e da sobrecarga (IMPACTO-BR) da equipe técnica em serviços de saúde mental. J Bras Psiquiatria. 2000;49(4):105-15. ). Nevertheless, the prevalence of satisfaction at work in Brazilian community mental health services has not been assessed. In the USA, it corresponded to 59% according to the Job Satisfaction Survey, in a sample of 176 technicians( 66. Gellis ZD, Kim JC. Predictors of depressive mood, occupational stress, and propensity to leave in older and younger mental health case managers. Commun Mental Health J. 2004;40(5):407-21. ), and 90% according to the Minnesota Job Satisfaction Questionnaire, in 98 professionals( 77. Martin U, Schinke SP. Organizational and individual factors influencing job satisfaction and burnout of mental health workers. Soc Work Health Care. 1998;28(2):51-62. ).

The factors related to greater satisfaction at work in community mental health services include: greater autonomy( 88. Evans S, Huxley P, Gately C, Webber M, Mears A, Pajak S, et al. Mental health, burnout and job satisfaction among mental health social workers in England and Wales. Br J Psychiatry. 2006;188:75-80. - 99. Nelson T, Johnson S, Bebbington P. Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. A multicentre cross sectional survey. Soc Psychiatry Psychiat Epidemiol. 2009;44(7):541-9. ), observation of rapid changes at the service, benefits of teamwork, keeping the clients outside the hospital( 99. Nelson T, Johnson S, Bebbington P. Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. A multicentre cross sectional survey. Soc Psychiatry Psychiat Epidemiol. 2009;44(7):541-9. ) and organizational support( 1010. Gellis ZD, Kim J, Hwang SC. New York State case manager survey: urban and rural differences in job activities, job stress, and job satisfaction. J Behav Health Serv Res. 2004;31(4):430-40. ). And lesser satisfaction has been associated with administrative tasks and a large number of cases( 1111. Isett KR, Ellis AR, Topping S, Morrissey JP. Managed care and provider satisfaction in mental health settings. Commun Mental Health J. 2009;45(3):209-21. ), inappropriate physical structure, lack of human and material resources( 1212. Acker GM. The challenges in providing services to clients with mental illness: managed care, burnout and somatic symptoms among social workers. Commun Mental Health J. 2010;46(6):591-600. - 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. ), devaluation in the workplace( 88. Evans S, Huxley P, Gately C, Webber M, Mears A, Pajak S, et al. Mental health, burnout and job satisfaction among mental health social workers in England and Wales. Br J Psychiatry. 2006;188:75-80. ) and greater burden at work( 88. Evans S, Huxley P, Gately C, Webber M, Mears A, Pajak S, et al. Mental health, burnout and job satisfaction among mental health social workers in England and Wales. Br J Psychiatry. 2006;188:75-80. , 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. - 1414. Rebouças D, Abelha L, Legay LF, Lovisi GM. O trabalho em saúde mental: um estudo de satisfação e impacto Brasil. Cad Saúde Pública. 2008;24(3):624-32. ).

To get to know the repercussions of work in community mental health services, the objectives in this study were to analyze the prevalence of satisfaction and identify the associated factors in workers from Psychosocial Care Centers in the three states that constitute the South of Brazil.

Method

Cross-sectional study and excerpt of the research CAPSUL II*, undertaken in 2011 to assess the mental health care offered at the CAPS in the South of Brazil, funded by the Ministry of Health. The data studied here were collected through a questionnaire that was self-applied to the workers of the 40 services drafted for the study, among the 308 existing CAPS, and obtained between August and December 2011. The CAPS sample was structured according to the service supply in the three states within the region, the population concentration per geographic macro-region and the guaranteed presence of the capitals, besides the different CAPS models (I, II, III and excluding CAPSchildren and CAPSalcohol and drugs).

At the 40 CAPS included in the study, all 658 active workers were invited to participate and 546 answered the questionnaire, which permitted estimated a 66% prevalence of satisfaction, with a 4.0 error margin and 95% Confidence Interval. To calculate associations, an alpha coefficient of 5% was used, with 80% statistical power to detect a minimal relative risk of 1.5 in the exposures and a 2:1 index between not-exposed/exposed.

The satisfaction outcome was defined based on the application of the Assessment Scale of Team Satisfaction in Mental Health Services (SATIS-BR), which is self-administered and contains 32 quantitative items. Each question shows answers arranged on a five-point Likert scale, in which 1 = very dissatisfied, 2 = dissatisfied, 3 = indifferent, 4 = satisfied and 5 = very satisfied. The SATIS-BR was developed by the World Health Organization (WHO) in a multicenter project and validated in Brazil( 55. Bandeira M, Pitta AMF, Mercier C. Escalas Brasileiras de Avaliação da Satisfação (SATIS-BR) e da sobrecarga (IMPACTO-BR) da equipe técnica em serviços de saúde mental. J Bras Psiquiatria. 2000;49(4):105-15. ) based on a Canadian study, with a high internal consistency coefficient (α=0.89).

The prevalence of satisfaction was calculated based on the mean global satisfaction scores, stratified in five segments: 1 = 1.0 - 1.5 (very dissatisfied); 2 = 1.51 - 2.5 (dissatisfied); 3 = 2.51 - 3.5 (indifferent); 4 = 3.51 - 4.5 (satisfied); 5 = 4.51 - 5.0 (very satisfied), their proportions were verified( 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. , 1515. Camilo CA, Bandeira M, Leal RMAC, Scalon JD. Avaliação da satisfação e sobrecarga em um serviço de saúde mental. Cad Saúde Coletiva. 2012;20(1):82-92. ) and groups 4 and 5 were identified as the presence of satisfaction.

The remaining variables were organized according to six hierarchical levels, according to the theoretical determination model( 1616. Lima S, Carvalho ML, Vasconcelos AGG. Proposta de modelo hierarquizado aplicado à investigação de fatores de risco de óbito infantil neonatal. Cad Saúde Pública. 2008;24(8):1910-6. ); in which the level furthest from the outcome consisted of demographic variables (sex, age, marital situation and education) and the type of service (CAPS I, CAPS II, CAPS III) and the second level of work insertion variables (salary, workload at the CAPS, workload at another service, function in CAPS, employment relationship and length of work in CAPS).

The third level included behavioral (smoking and alcohol consumption) and work organization variables (home visit, group care and team meetings).

At the fourth level, the workers' assessment of the supervision were explored, subdivided in: by the secretary of health, by the team and by the community, on a scale from 0 to 10; after collecting these variables, they were categorized as bad (0/3), intermediary (4/6) and good (7/10). This same level includes the characteristics of CAPS work, represented by: lack of tools for work, possibility to make collective choices, possibility to take courses.

The fifth level consisted of variables related to cases of absence in a six-month period and to the health conditions, which were: self-referred health problems and suspicions of minor psychiatric disorders, using the Self Report Questionnaire 20 (SRQ 20). The SRQ 20 consists of 20 questions with a yes-or-no answer, translated and validated to Portuguese( 1717. Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of São Paulo. Br J Psychiatry. 1986;148:23-6. ); to define the prevalence of suspected minor psychiatric disorders, the cut-off point was set as eight or more positive answers for women and six or more positive answers for men.

The level that was closest to the outcome satisfaction at work, the sixth, consisted of the assessment of the work burden, measured using the Assessment Scale of the Impact of Work in Mental Health Services (IMPACTO-BR), developed by WHO and validated in Brazil( 55. Bandeira M, Pitta AMF, Mercier C. Escalas Brasileiras de Avaliação da Satisfação (SATIS-BR) e da sobrecarga (IMPACTO-BR) da equipe técnica em serviços de saúde mental. J Bras Psiquiatria. 2000;49(4):105-15. ); it presents good item homogeneity and high internal consistency with α = 0.87. IMPACTO-BR contains 18 items, each with answers arranged on a five-point Likert scale, where 1 = not at all, 2 = not much, 3 = more or less, 4 = a lot, 5 = extremely, based on which the global average was calculated and stratified according to the original five-point scale( 1212. Acker GM. The challenges in providing services to clients with mental illness: managed care, burnout and somatic symptoms among social workers. Commun Mental Health J. 2010;46(6):591-600. ).

The data were analyzed in the statistical program STATA 9.0. The bivariate analysis examined the prevalence of satisfaction in each variable studied. The associations were tested using the chi-square test, and differences with p ≤ 0.05 were considered significant. The logistic regression model was applied, the gross and adjusted odds ratios were calculated with a 95% confidence interval (95% CI) and backward selection. Variables with p ≤ 0.10 were maintained in the model.

Approval for the study protocol was obtained from the Ethics Committee at the School of Nursing of Universidade Federal de Pelotas (No 176/2011) and the ethical principles were guaranteed according to the Standards and Regulatory Guidelines of Research Involving Human Beings - Resolution CNS 196/96, use of free and informed consent form, guarantee of right to non-participation at any time in the research and anonymity of the interviewee.

Results

The study participants were 546 workers (83% of the 658 workers at the 40 services), mostly women (79.7%), with a mean age of 37.5±10.8 years, who held a higher education degree (54%) and a mean length of experience at the services of 39.6±45 months. The prevalence level of satisfaction found in the study sample corresponded to 66.4% and the mean global satisfaction was 3.6 (range from 1 to 5).

The following variables showed to be statistically associated with satisfaction at work in the gross analysis: age; education, with a downward trend as education increases; function in CAPS; employment relationship; length of experience in CAPS; supervision by the health secretary, by the team and by the community; lack of tools for work; possibility to make collective choices and take courses; absence from work in previous six months; self-referred health problem; minor psychiatric disorders and presence of work burden (Tables 1 and 2).

Table 1
Prevalence of satisfaction according to demographic variables, type of service, insertion in work, behavioral variables and the respective Odds Ratio (OR), 95% confidence intervals (95% CI) and p-values, in CAPS workers from the South of Brazil, 2011. (N=546)

Table 2
Prevalence of satisfaction according to the variables work organization, assessment of supervision, work organization, health conditions, burden and respective Odds Ratios (OR), 95% confidence intervals (95% CI) and p-values, in CAPS workers from the South of Brazil, 2011. (N=546)

After adjustments, the chances that the CAPS workers were satisfied with their work were 86% higher for higher-level workers (nurse, social worker, pedagogue, occupational therapist, physical educator, plastic artist, music technician, nutritionist, pharmacist, physiotherapist, speech therapist) than for physicians and psychologists; and 84% higher for workers with between six and 40 home visits per month when compared to those with up to five home visits per month. In addition, assessing the supervision by the team as good increased the chances of satisfaction by 2.9 in relation to those workers who assessed it as bad; and the possibility of making collective choices and taking courses increased the chances of being satisfied by 6.4 and 1.3 times, respectively (Table 3).

Table 3
Adjusted analysis of effect of independent variables on satisfaction at work at Psychosocial Care Centers in the South of Brazil, 2011. (N=546)

The variables that showed to be inversely associated with satisfaction after adjustments were: working at CAPS between seven and 24 months, which reduced the chances of being satisfied by 70% when compared to workers with six months or less of experience at the services; lack of tools for work, which dropped the chances of satisfaction by 62%; and work burden, which reduced the chances of being satisfied at work in Psychosocial Care Centers by 52% (Table 3).

The variables training, employment contract and minor psychiatric disorders were maintained in the model, although they did not demonstrate significance, as they are potentially confounding.

Discussion

In line with the literature, this study identified a strong association between satisfaction and work conditions and with the organization of work in the CAPS. The workers' individual characteristics were less significant among the factors associated with satisfaction.

The mean global satisfaction coefficient identified, corresponding to 3.6, is close to other Brazilian studies. These assessed satisfaction in workers active in services that were implemented after the changes resulting from the Brazilian Psychiatric Reform and identified global satisfaction scores of 3.43 and 3.59 using SATIS-BR( 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. - 1414. Rebouças D, Abelha L, Legay LF, Lovisi GM. O trabalho em saúde mental: um estudo de satisfação e impacto Brasil. Cad Saúde Pública. 2008;24(3):624-32. ), classified as bordering on indifference, on a scale from 1 to 5 points. Other studies identified higher mean satisfaction rates (4.05 and 4.02), but their samples characterize a single service( 1515. Camilo CA, Bandeira M, Leal RMAC, Scalon JD. Avaliação da satisfação e sobrecarga em um serviço de saúde mental. Cad Saúde Coletiva. 2012;20(1):82-92. , 1818. Pelisolli C, Moreira AK, Kristensen CH. Avaliação da satisfação e do impacto da sobrecarga de trabalho em profissionais de saúde mental. Rev Saúde Mental Subjetividade UNIPAC [Internet]. [acesso 6 mar 2014] 2007; 9: 63-78. Disponível em: http://pepsic.bvsalud.org/pdf/mental/v5n9/v5n9a05.pdf
http://pepsic.bvsalud.org/pdf/mental/v5n...
). Intermediary satisfaction scores were identified in studies in Italy, which used a non-validated questionnaire( 1919. Gigantesco A, Picardi A, Chiaia E, Balbi A, Morosini P. Job satisfaction among mental health professionals in Rome, Italy. Commun Mental Health J. 2003;39(4):349-55. ) and the Minnesota Satisfaction Questionnaire( 2020. Galeazzi GM, Delmonte S, Fakhoury W, Priebe S. Morale of mental health professionals in Community Mental. Health Services of a Northern Italian Province. Epidemiol Psichiatr Soc. 2004;13(3):191-7. ).

Nevertheless, the Brazilian studies did not assess the prevalence of satisfaction at work in community mental health services, in this study identified as 66.4%. In the USA, the prevalence rate corresponded to 59% when using the Job Satisfaction Survey, in a sample of 176 technicians( 66. Gellis ZD, Kim JC. Predictors of depressive mood, occupational stress, and propensity to leave in older and younger mental health case managers. Commun Mental Health J. 2004;40(5):407-21. ), and to 90% when using the Minnesota Job Satisfaction Questionnaire, in 98 professionals( 77. Martin U, Schinke SP. Organizational and individual factors influencing job satisfaction and burnout of mental health workers. Soc Work Health Care. 1998;28(2):51-62. ).

The short insertion period in deinstitutionalized services for people in mental services permits less exposure to the daily reality at the CAPS. Consequently, the workers may not have experienced a range of situations to permit an assessment, like workers with longer experience at CAPS. These evidences support the findings that associated five to ten years of work experience in Mental Health with lower satisfaction levels( 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. ); and differ from a study in the United Kingdom that associated five or more years of work with higher satisfaction levels( 1111. Isett KR, Ellis AR, Topping S, Morrissey JP. Managed care and provider satisfaction in mental health settings. Commun Mental Health J. 2009;45(3):209-21. ).

When the CAPS team uses the home visit strategy, it mainly intends to enable the family to use its own resources, include it in the treatment process and increase the possibilities of bonding with the professionals( 2121. Pietroluongo APC, Resende TIM. Visita domiciliar em Saúde Mental - o papel do psicólogo em questão. Psicol. Ciênc Profissão. 2007;27(1):22-31. ). The workers identified with the enhanced view of the madness phenomenon and with deinstitutionalized and territorial care aim to reintegrate the users with their family and community and, thus, do home visits, is one of the frequent work strategies.

Many professionals get unique interdisciplinary work experience in the CAPS. Higher-education professions in mental health, with different work processes, can articulate them and organize them in a specific manner( 22. Pereira MA. Psychosocial rehabilitation in mental health care: strategies under construction. Rev. Latino-Am. Enfermagem. jul.-ago. 2007;15(4):153-9. ). The results support the identification of the association between satisfaction and autonomy in community health service work in the United Kingdom and the USA( 88. Evans S, Huxley P, Gately C, Webber M, Mears A, Pajak S, et al. Mental health, burnout and job satisfaction among mental health social workers in England and Wales. Br J Psychiatry. 2006;188:75-80. - 99. Nelson T, Johnson S, Bebbington P. Satisfaction and burnout among staff of crisis resolution, assertive outreach and community mental health teams. A multicentre cross sectional survey. Soc Psychiatry Psychiat Epidemiol. 2009;44(7):541-9. , 1111. Isett KR, Ellis AR, Topping S, Morrissey JP. Managed care and provider satisfaction in mental health settings. Commun Mental Health J. 2009;45(3):209-21. ) but, nevertheless, did not identify an association with profession/function( 1111. Isett KR, Ellis AR, Topping S, Morrissey JP. Managed care and provider satisfaction in mental health settings. Commun Mental Health J. 2009;45(3):209-21. ) and a difference in satisfaction between physicians and nurses( 1919. Gigantesco A, Picardi A, Chiaia E, Balbi A, Morosini P. Job satisfaction among mental health professionals in Rome, Italy. Commun Mental Health J. 2003;39(4):349-55. ).

The results indicate that greater importance is attributed to the relations established in the work team, through supervision and collective choices, as observed in a study of 209 workers at CAPS and Home-Based Therapeutic Services, in which team difficulties or problems were identified as the most prevalent situation that bothered the workers among the situations mentioned( 2222. Kirschbaum DIR. Nursing agents' perceptions on their work in mental health with psychotic patients in a psychosocial community center. Rev. Latino-Am. Enfermagem. mai.-jun. 2009;17(3):368-73. ).

Besides the situations defined in the teams' internal arrangements, factors associated with satisfaction can be established based on service management, such as the possibility to make collective choices, the possibility to take courses, lack of tools for work. These results are in accordance with findings in the literature that associated satisfaction with organizational support( 1010. Gellis ZD, Kim J, Hwang SC. New York State case manager survey: urban and rural differences in job activities, job stress, and job satisfaction. J Behav Health Serv Res. 2004;31(4):430-40. ), rapid changes in the services(9) and physical structure, human and material resources( 1212. Acker GM. The challenges in providing services to clients with mental illness: managed care, burnout and somatic symptoms among social workers. Commun Mental Health J. 2010;46(6):591-600. - 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. ).

The work burden was inversely associated with satisfaction, as identified in other studies( 88. Evans S, Huxley P, Gately C, Webber M, Mears A, Pajak S, et al. Mental health, burnout and job satisfaction among mental health social workers in England and Wales. Br J Psychiatry. 2006;188:75-80. , 1111. Isett KR, Ellis AR, Topping S, Morrissey JP. Managed care and provider satisfaction in mental health settings. Commun Mental Health J. 2009;45(3):209-21. , 1313. De Marco PF, Citero VA, Moraes E, Nogueira-Martins LA. O impacto do trabalho em saúde mental: transtornos psiquiátricos menores, qualidade de vida e satisfação profissional. J Bras Psiquiatria. 2008;57(3):78-183. - 1414. Rebouças D, Abelha L, Legay LF, Lovisi GM. O trabalho em saúde mental: um estudo de satisfação e impacto Brasil. Cad Saúde Pública. 2008;24(3):624-32. , 2020. Galeazzi GM, Delmonte S, Fakhoury W, Priebe S. Morale of mental health professionals in Community Mental. Health Services of a Northern Italian Province. Epidemiol Psichiatr Soc. 2004;13(3):191-7. ). The burden may be related to service management, in the form of an insufficient number of workers to provide user care within the territory, as well as to work organization difficulties. Daily work in CAPS presupposes commitment to psychosocial care and creativity in the search to reinsert the user but, besides a conquest, these premises may represent an obligation and even a burden for the service workers( 2323. Lapischies SRL, Lima ZG, Jardim VMR, Coimbra VCC, Kantorski LP. O trabalho em serviços da rede de atenção psicossocial: dificuldades enfrentadas pelos trabalhadores. Cogitare Enferm. 2012;17(3):697-702. ).

Satisfaction may be overestimated due to the possible dissatisfaction among the workers who chose not to manifest their opinion and the workers absent from their workplace; also, the use of logistic regression may have expanded the confidence intervals of the associations, increasing the variance of the estimates. In addition, the limitations inherent in a cross-sectional study are considered, which does not identify the changes over time in the variables involved. Possible interferences include the different lengths of the services' existence, as some had a recent history and may not have established routines and defined their functioning yet.

Final Considerations

The results show a strong association between satisfaction and factors related to the organization and work conditions in the CAPS, based on which reflections are possible and collective actions can be proposed to enhance the workers' satisfaction. Adapting the services' material conditions (physical area, equipment, drugs, material) to comprehensive care and to the range of activities needed for deinstitutionalized care delivery is highlighted.

It is also important to expand and qualify the supervision by the team, including opportunities for discussion and planning in daily service work, as well as decentralized and democratic management processes. Another aspect that should be considered is the workers' training, articulated with the conceptual frameworks and training areas in the CAPS, stimulated and promoted by the managers.

The transition between models is ongoing. The deinstitutionalized care model is not hegemonic and coexists with the asylum model. Workers who believe in the Psychiatric Reform and value the organization forms of their work are the main occupants of the work places in mental health. Enhancing their satisfaction, keeping in mind that one third of the interviewees are dissatisfied at their work, may contribute to the consolidation of the model.

References

  • 1
    Ministério da Saúde (BR). Secretaria de Atenção à Saúde. DAPES. Coordenação Geral de Saúde Mental, Álcool e Outras Drogas . Saúde Mental no SUS: as novas fronteiras da Reforma Psiquiátrica. Relatório de Gestão 2007-2010. Ministério da Saúde: Brasília; 2011. 106 p.
  • 2
    Pereira MA. Psychosocial rehabilitation in mental health care: strategies under construction. Rev. Latino-Am. Enfermagem. jul.-ago. 2007;15(4):153-9.
  • 3
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  • 1
    Paper extracted from master's thesis "Factors associated with job satisfaction of Psychosocial Care Centers in Southern Brazil" presented to Faculdade de Enfermagem, Universidade Federal de Pelotas, Brazil. Supported by Ministério da Saúde, process # 186/2010

Publication Dates

  • Publication in this collection
    16 Dec 2014
  • Date of issue
    Nov-Dec 2014

History

  • Received
    03 Sept 2013
  • Accepted
    29 Aug 2014
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