(RE)COGNIZING HEALTH CENTER WORKERS' ROUTINE: A PATH FOR BURNOUT PREVENTION AND HEALTH PROMOTION

ABSTRACT

Objetive:

to understand the routine of workers in a healthcare center in Florianopolis.

Method:

a qualitative study using descriptive exploratory research. Eighteen workers participated in the study. Data collection was done through semi-structured interviews in the period April-May 2014, using a pre-structured script containing the leading questions: "How is your daily life?" and "How is your daily life at work?" Data was analyzed based on the (theoretical) assumptions of sensible reason by Michel Mafessoli (Maffesoli's sensitivity).

Results:

six different categories that describe workers routines were found, namely: lack of time: busy, stressful, tiring; excellent, good, calm; adaptable; it varies depending on the day; reasonable, not bad; and organized.

Conclusion:

Understanding of workers routines showed that much of the tension and stress in their routine comes from the workplace.

DESCRIPTORS:
Daily activities; Worker´s health; Burnout syndrome; Health promotion

RESUMO

Objetivo:

compreender o quotidiano dos trabalhadores de um centro de saúde de Florianópolis

Método:

Estudo de abordagem qualitativa, na forma de uma pesquisa exploratório-descritiva. Participaram da pesquisa 18 trabalhadores. A coleta de dados foi realizada no período de abril a maio de 2014, através de entrevistas semiestruturadas, por meio de um roteiro, contendo as questões norteadoras: "como está o seu dia a dia?" e "como está o seu dia a dia no trabalho?". Os dados foram analisados à luz das noções e dos pressupostos teóricos e da sensibilidade de Michel Maffesoli.

Resultados:

foram encontradas seis categorias que descrevem o quotidiano dos trabalhadores: falta de tempo: corrido, estressante, cansativo; ótimo, bom, tranquilo; em adaptação; varia de acordo com o dia; razoável, mais ou menos; e organizado.

Conclusão:

a compreensão do quotidiano dos trabalhadores apontou que a maior parte da tensão e do estresse no dia a dia está concentrada no ambiente laboral.

DESCRITORES:
Atividades cotidianas; Saúde do trabalhador; Síndrome de burnout; Promoção da saúde

RESUMEN

Objetivo:

comprender lo cotidiano de los trabajadores de un Centro de Salud de Florianópolis

Método:

estudio de abordaje cualitativo en forma de investigación exploratoria- descriptiva. Participaron 18 trabajadores. La obtención de datos se realizó a través de entrevistas semiestructuradas por medio de una guía conteniendo las preguntas orientadoras: "Cómo es su día a día?" y "Como está su día a día en el trabajo?". Los datos fueron analizados a la luz de las nociones, presupuestos teóricos y sensibilidad de Michel Maffesoli.

Resultados:

se encontraron seis categorías que describen lo cotidiano de los trabajadores - falta de tiempo: desgastante, estresante, cansador; óptimo, bueno, tranquilo; la adaptación varía de acuerdo con el día: razonable, más o menos y organizado.

Conclusión:

la comprensión de lo cotidiano de los trabajadores señaló que la mayor parte de la tensión y del estrés, en el día a día, está concentrado en el ambiente laboral.

DESCRIPTORES:
Actividades cotidianas; Salud del trabajador; Síndrome de burnout; Promoción de la salud

INTRODUCTION

Work is a fundamental element of human existence as it is indispensable for one's survival and for their insertion into the social context, allowing the individual to expand their capability for creation and production.¹ However, due to capitalism and its necessity for profit, work began to demand more and more from the worker, making their work routine cruel, exhausting and stressful.² This labor logic has led to the emergence of diseases never seen before, such as Burnout Syndrome.

Burnout Syndrome is caused by chronic and daily stress in the work environment, manifested through physical and mental fatigue, cognitive problems, and emotional exhaustion.³ This syndrome commonly occurs with professionals who work in direct contact with other people.⁴

Professionals who work in the healthcare field are inserted in a workplace that is often stressful, which can lead these workers to burnout.⁵

Healthcare center workers have several tasks with a high degree of exigency and responsibility, which when associated with pressure from management for the fulfillment of goals and pressure from users who sometimes blame the professionals for service deficiencies, can lead to biological and psychological imbalance.⁶

In addition to work overload, healthcare center workers are exposed daily to several factors that can cause damage to their health such as: postural problems, spine, lower and upper limbs pain, excessive readings and annotations on medical records, conflicts with users and peers, responsibility for dealing with human life, risk of contamination and injuries, a lack of staff, inadequate working conditions, communication problems and lack of professional recognition from colleagues, the head of the unit and from the Department of Health.⁷

Linked to the several demands and risks arising from the work environment, we cannot fail to mention the fast pace of life, characterizing an instant and simultaneous living⁸ typical of postmodernity and present in people's everyday routine. The worker's health is a challenge stemming from this current lifestyle of excessive hours, varied occupational activities and increasingly frequent demands.

For the French sociologist Michel Maffesoli, postmodernity can be defined as "the synergy of archaic phenomena with technological development".^9:22 In other words, postmodernity brings a recovery of some values from days of antiquity, such as creativity, playfulness, festivity, the oneiric and imaginary, in line with the new technologies and discoveries of the scientific world.

On the other hand daily life/routine¹⁰ is considered the way of life of each person and the community, where it is the relearning that is present in this which makes evolution in the process of living possible.¹¹ This routine can be defined as: "The way of living of human beings in the present, expressed in everyday life through interactions, values, beliefs, symbols and images that outline the process of living, a movement of being healthy and sick, punctuating its life cycle".^12:24

During curricular and extension activities carried out at the nursing undergraduate level, some workers of a Health Center in the municipality of Florianópolis (in the State of Santa Catarina in southern Brazil) have reported fatigue they have felt during their day-to-day work, which is aggravated by the fast pace of life, being characteristic of contemporary daily life, and involving other aspects outside of the work environment such as traffic and violence, among others.

Keeping in mind the notions about daily life/ routine and postmodernity presented herein, along with the occupational demands and risks (physical and psychological) which healthcare professionals experience on a daily basis, we aimed at understanding the routine of Healthcare Center workers, seeking to contribute to the prevention of burnout and health promotion.

It is worth mentioning that it was the Ottawa Charter in 1986 where health promotion began to be understood in a broader way, involving economic, political, social, cultural, biological and behavioral dimensions interconnected with each other, so that reaching quality of life would be possible.¹³

METHODO

The present study has a qualitative approach in the form of an exploratory-descriptive research.

This study was carried out with workers from a healthcare center in the city of Florianópolis, southern Brazil. Eighteen (18) workers who accepted to be part of the research were interviewed, holding varied occupations: nurse, doctor, pharmacist, dentist, nursing technician, cleaning staff, oral health assistant, community health agent and administrative assistant.

Data collection was conducted through semistructured interviews in the period April-May 2014, through a script containing information on participants (fictitious name, gender, age, occupation, weekly workload, experience in profession, marital status and if they have children), as well as guiding questions: "How is your daily life?" and "How is your daily life at work?"

Data obtained from the interviews were ordered, organized and categorized through the use of ATLAS.ti software version 6.1, where each topic was separated and stored. Keywords and categories were identified, synthesizing the classification by the most relevant themes and highlighting common and repetitive aspects, as well as those that were different and brought forth important information about their reality. The data analysis was carried out in light of the notions and theoretical assumptions of Maffesoli's sensitivity.

In order to preserve the anonymity of the participants, they were given a list containing names of superheroes and superheroines from comic books, so that they could choose a fictitious codename to be used in this study. Workers were so-named since similar to superheroes and superheroines, these professionals devote a great deal of their time to preserving people's health and life, with each using skills ("superpowers") and specific knowledge.

This research was approved by the Florianópolis Municipal Government and the Ethics Committee of the Federal University of Santa Catarina, under protocol number 28293314.9.0000.0121 and opinion of number 551,189. The participants of this study signed the Clear and Informed Consent Form (TCLE) recommended by Resolution 466/ CNS of 2012.

RESULTS AND DISCUSSION

Of the 18 participants in this study, 16 were women and two were men with ages between 22 and 53 years, with working experience ranging from two to 32 years, and a weekly workload of between 30 and 88 hours.

Regarding marital status, 11 of the subjects are married, four are single and three have stable unions, 11 have children and seven do not.

Based on participants' answers to the guiding questions "How is your daily life?" and "How is your daily life at work?", six categories emerged that describe the workers' daily lives: lack of time: busy, stressful, tiring; excellent good, calm; adaptable; it varies depending on the day; reasonable, not bad; and organized. Each category is discussed in more detail below.

Lack of time: busy, stressful, tiring

Among the 18 workers interviewed, 13 reported a lack of time being associated with stress, fatigue and the rush of daily life, especially due to work, as can be seen in the following speech:

It is busy, tiring. [...] it is more because of the work itself. In the personal aspect things are calm, it is really more the work that even ends up influencing the personal side. [...] I feel more stressed. [...] I do not have time to do other things that I would like to do (Batgirl).

A lack of time in the daily lives of people has become something chronic. We rarely meet anyone who does not complain about their lack of time or daily rush, because "people definitely do not have the time. They are always late, rushing and running behind the machine".^14:121

The sense of time was modified along the human trajectory from the insertion of technologies that allowed a reorganization of work.⁸ In pre-industrial societies, the human being followed nature's clock and their own body clock to organize their daily life activities. In industrial societies, with the introduction of the mechanical clock in people's daily lives, time became linear, rigorously controlled and organized by work.

Nowadays, we live in the simultaneous and instantaneous time of computers, where despite having more freedom and flexibility, we are also immersed into logic of racing and exacerbated competition, in addition to long working hours, something that reduces free time for pleasurable activities and causes damage to health.¹⁵

"The linear time of the clock, lived today as a natural and almost homogeneous time, took nearly 300 years to be incorporated into Western society. We question if we will experience the same process with the computer that has led to the incorporation of clock time".^8:213

In postmodern society,¹⁶ there is also a predominance of creativity when we talk about work, and not only in the sense of the value of work. This creativity demanded by the labor market, coupled with the simultaneity and the instantaneousness of time, can contribute to an increase of stress and an overload of tasks in daily life, since it requires greater preparation and adaptation of the people to the labor market demands, leading to the emergence of diseases.

Excellent, good, calm

If daily routine has a stressful dimension, paradoxically, it can also be calm, good and even great.

Among the participants, 11 mentioned that their daily life is excellent, good, quiet, most of which referred to their context outside of work, as shown by the following worker's speech:

[...] at the moment it's okay, now it's a good phase for me because as a mother I'm better, because we don't stress ourselves as much outside the house when we aren't home so we can rest a little more to be able to work (Rogue).

Other participants also portrayed their daily lives in the same way, although including their work environment:

[...] it's okay. [...] it's not as difficult of a service, because we do not do everything in one day. So we go with it, one day we do a little bit, another day another bit, rest a little, work another bit, we have our breaks, so it's not a job that we start at eight in the morning until ten at night, never stopping for anything. It is a job that we do according to what the body allows [...] (Invisible Woman).

Here we can observe the paradoxes and contradictions characteristic of postmodernity associated with labor, because when asked about everyday life in the general context, the majority of respondents answered good, great and calm. But when asked this same question associated to the work environment, stressful and busy seem to predominate.

This brings us to the intensification of labor, a reflection of the capitalist production mode where the focus becomes production rather than labor, transforming the professional into a mere productive instrument, without their needs being considered.¹⁴

When the worker is seen as an instrument and not as a human being, work loses its positive character, which would be the construction of individuality and the socio-environmental aspects of the person.² Work is only seen as something negative, that "drains" the individual's vital energy, not as something that strengthens or energizes, thereby requiring time away from work so that the person recovers from the wear and tear suffered in the work environment.

Another aspect that we highlight here is also the question of relativistic sensitivity, one of the theoretical assumptions of Michel Maffesoli's sensitivity.⁹ This notion speaks about the relativity of reality, because each person has their way of observing the world around them. Thus, for some participants, the daily work life is hectic and for others not, because each person sees reality in a different way. We could also question whether for some the day-to-day running would no longer be naturalized, since we live in an instantaneous and simultaneous society expressed by an ethic of the moment,¹⁷ also seen as a society of haste,¹⁸ denoting a fast life.

In adaptation

The daily life of the Healthcare Center workers also presents itself in adaptation. Five study participants reported that their day-to-day lives are adaptable, as demonstrated in the following speech:

[...] here we are always trying to review the work process, trying to adjust it to better care for people, regarding our well-being at work [...] (Supergirl).

The adaptation process is part of our daily life. We are constantly adapting to new technologies, environmental changes, moments and rhythms of life.

As already mentioned, time in postmodernity is simultaneous and instantaneous,⁸ influencing people's rhythm of life and their organization and adaptation to everyday life demands; and it is necessary to be constantly rethinking the dimensions that involve the routine, seeking to have a better quality of life both in the work environment as well as in the personal and family context.

On the other hand, we seek a balance between the different dimensions of our living and living among others (in society), which demands our attention and our time; for the individual, and for others who can be our family or our work, which brings us to the idea of a constant search for balance. "Human beings experience, therefore, a constant need for equilibrium, in this existential seesaw between the impositions of the environment and their own subjectivity."^19:322

It is more systematized [...].[...] I really enjoy working, work satisfies me a lot, but I have another priority in my life that is my son, so I'm in the process of readapting my time. Some time for me, time for my family, time for my son and time for work (Spiderman).

It varies depending on the day

The routine reported by the workers of this study shows itself to be dynamic and varying by daily interactions. Two participants mentioned that their daily lives vary according to work demand or the moment of life in which they are in. It is possible to understand this dynamic in the report below:

Some days are quiet, some days are stressful, it depends... (Raven).

These statements show us the strength in the daily life of the imaginary world,²⁰ this world of images, imaginations, the imaginary, beliefs and values that involve and define our existence and living (cause and effect of all social life).

It also depends on my attitude when I get to work, it influences a lot. [...] generally on my way, I leave college and I come to have lunch here and I think: today everything is going to go well again, I'm going to have a good day's work, I'll be able to meet people and I'll finish the work day well. That's what I think every time I come, because if I come with the mindset 'oh my God, not again', that will not help, it will make things worse (Black Widow).

Some adverse situations that hinder people's daily lives may arise in both the day-to-day work environment and in the personal and family context of life, causing stress, irritation, discomfort, sadness, and finally negative feelings, consequently influencing their present moment of life. However, these negative feelings can bring about learning and reflection both for the person, as well as in their family context.

Reasonable, not bad

The workers routine is 'reasonable' and also 'not bad', as reported by two participants. One of them refers to the working environment and the other to the general context of life, as follows:

My routine? Yeah, it's reasonable, I can't that it's so bad, because we are responsible for making our own day. So I try to keep my mind focused on work and do the best with patients. [...] reasonable because some very annoying things have happened and then, until everything is resolved you get a little weirder, but nothing that will last forever, it fades. So it's reasonable because I keep my focus on work (Dazzler).

This participant referred to his/her daily life as reasonable in the context of their work, and reported that this is due to some conflicts that occurred with the work team.

Conflicts both in the work environment and in the family context are common since people have different ways of being, acting and thinking, being related to: "[...] worries that are part of the nature of man, among them defending their purposes, for which mechanisms are used in order to achieve them that allow for controlling the physical environment and the relationships that surround it, even assuming that this may result in the unexpected".^21:2

Conflicts, whether between individuals or groups, can cause harm to the work process. However, this has a positive character when there is reflection and a confrontation, aiming at personal, group and organizational improvements and changes.²²

One participant described his or her routine outside the work environment as 'not bad' due to the lack of time it takes to perform other pleasurable activities on a day-to-day basis. Here, we return to the question of the fast pace and the demands present in the daily lives of people which often make it impossible for them to perform other actions aimed at leisure and well-being.

Organized

One of the participants referred to their daily life as organized, otherwise they would not have time to perform all their daily tasks, as presented below:

[...] everything is well-organized. It's a routine day, it's a routine like that, it's not really tight, but I do everything at a specific time so I can meet the demands of my day-to-day (Miss Marvel).

Organization has always been present throughout human history; when leaving the forest, they came to meet the working world in cities which required skills of relationship, coexistence and organization in order to face the new reality.²³

Referring again to the question of the simultaneity and instantaneousness of time⁸ associated with the innumerable demands of daily life, organization and planning of the activities of daily life as well as in the work environment are extremely necessary for us to carry out all or most of these activities.

It also highlights the role of daily life/routine in the process of human living. If on one hand some feel suffocated by it, on the other hand routine brings forth some certainty for life, outlining a rhythm and making us question: at what pace do we build our contemporary routines?

CONCLUSION

With this research it was possible to understand the daily lives of Healthcare Center workers located in the city of Florianópolis.

The lack of time and the fast pace coupled with the demands of everyday life, especially in the work environment, was present in most of the interviewees' responses. In contrast, more than half of the participants also described their daily lives as "good", "great" and "calm" when it came to the overall context of life outside the workplace, suggesting that most of the tension and stress in the daily lives of these professionals is concentrated in the work environment, pointing to the need to be attentive to the prevention of burnout. These contradictions between the general context of life and the work routine reveal a fragmented being, since it is not possible to have exactly the same health state in and out of work.

Conducting further studies that understand the reality of Healthcare Center workers is necessary in order to facilitate care preparation in preventing physical and psychological risks, especially burnout, which are present in the daily lives of these professionals. This is necessary for promoting their health and for contributing to improve not only their work process, but also their process of living and living together.

We notice that creating favorable environments, developing individual skills, as well as strengthening popular participation is very pertinent here, moving towards reorganization of health services, and being able to contribute to constructing healthier public policies.

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Publication Dates

• Publication in this collection
  2018

History

• Received
  07 Sept 2015
• Accepted
  24 May 2016