Work and Confrontation with the Real for Health Professionals During COVID-19Abstract:
Healthcare professionals faced significant challenges as they worked on the front lines during the COVID-19 pandemic. This study aimed to analyze the work activity of health professionals and the implications for their mental health and subjectivity considering their conditions, organization and work routines, which were modified in view of their urgency of action in combating COVID-19. This is a qualitative exploratory study, in which 51 semi-structured interviews were conducted with health professionals from the Brazilian Unified Health System during the months of May to September 2021. The results were analyzed using the Iramuteq textual analysis software and interpreted with the Psychodynamics of Work theory. The analyzes showed the precariousness of work characterized by unpredictability and contradictions, generating fear and a sense of exposure to risks that negatively impacted the physical and mental health of workers.
Keywords:
work; health professionals; COVID-19; mental health
Resumo:
Durante a pandemia da COVID-19, os profissionais de saúde enfrentaram desafios significativos ao atuar na linha de frente. Este estudo teve por objetivo analisar a atividade de trabalho de profissionais da saúde e as implicações para a saúde mental e subjetividade, considerando suas condições, organização e rotinas de trabalho, as quais foram modificadas diante da urgência de atuação no combate à COVID-19. Trata-se de uma pesquisa qualitativa de caráter exploratório, na qual foram realizadas 51 entrevistas semiestruturadas com profissionais da saúde do Sistema Único de Saúde brasileiro durante os meses de maio a setembro de 2021. Os resultados foram analisados com o auxílio do software de análise textual Iramuteq e interpretados à luz da Psicodinâmica do Trabalho. As análises evidenciaram a precarização do trabalho caracterizado por imprevisibilidade e contradições, gerando medo e sensação de exposição a riscos que impactaram negativamente a saúde física e a saúde mental dos trabalhadores.
Palavras-chave:
trabalho; profissionais da saúde; COVID-19; saúde mental
Resumen:
Durante la pandemia de COVID-19, los profesionales de la salud enfrentaron desafíos significativos al actuar en primera línea. Este estudio tuvo por objetivo analizar la actividad de trabajo de profesionales de la salud y las implicaciones para la salud mental y subjetividad, considerando sus condiciones, organización y rutinas de trabajo, las cuales fueron modificadas ante la urgencia en el combate a la COVID-19. Se trata de una investigación cualitativa exploratoria, en la que se realizaron 51 entrevistas semiestructuradas con profesionales de la salud del Sistema Único de Salud brasileño entre mayo y septiembre de 2021. Los resultados fueron analizados con el software Iramuteq e interpretados con la Psicodinámica del Trabajo. Los análisis evidenciaron la precarización del trabajo, caracterizado por la imprevisibilidad y las contradicciones, lo que generó miedo y una sensación de exposición a riesgos que afectaron negativamente la salud física y mental de los trabajadores.
Palabras clave:
trabajo; profesionales de la salud; COVID-19; salud mental
Healthcare workers found themselves in a state of urgency at the beginning of the COVID-19 pandemic to take a leading role at the front lines for treating a still little-known infectious disease that would later have devastating effects in terms of progression and deaths in Brazil and around the world. This scenario also brought with it intense social transformations that had repercussions on work processes, especially with regard to healthcare work, which would later be recognized by the media and society as heroic work.
Historically, the work reality of these workers, specifically in the Unified Health System ( Sistema Único de Saúde - SUS ), has been marked by structural problems which worsened with the beginning of the pandemic, such as: different and unstable employment relationships, low wages, flexibilization of worker rights, high workload, long working hours and a high level of responsibilities. In this sense, the work context in public health, which was already precarious, became even more so, intensifying the repercussions at the social, economic, physical and psychological levels (Morosini et al., 2020 ).
A study conducted on the working conditions of health professionals who worked during the pandemic in Brazil identified complaints about inadequate working conditions, lack of and precarious access to personal protective equipment (PPE), long working hours, illnesses and deaths of professionals, difficulties in taking time off to treat comorbidities, and the need for rapid updates on healthcare in the new reality (Vedovato et al., 2021 ).
In addition, the advent of the pandemic brought several unprecedented challenges to healthcare workers, especially with regard to how to act or behave in facing a new virus which was little known until then, especially at the beginning of the health crisis. Constant improvement of knowledge was necessary to maintain the health and safety of workers, given that even before the pandemic there was exposure to several occupational risks caused by ergonomic, physical, chemical, biological and psychological agents (Morosini et al., 2020 ).
Scientifically based knowledge on ways to prevent contagion while performing tasks has become essential. The discussion on the use of PPE and its management has become popular and has introduced other issues with it, such as the costs of these materials, their effective distribution in Brazil, and their appropriate use (Harvey, 2020 ). The use of PPE in Brazil is regulated by Regulatory Standard (NR) 32 of the Ministry of Labor and Social Security (Ordinance No. 485, 2005 ), which clarifies its functions and benefits for the exercise of work, as well as explains individualized use and the need for training for its use. However, the guidelines of regulatory bodies are not sufficient to guarantee good conditions of use, since, as seen in recent research, health professionals highlight the lack of training and/or guidance regarding its use (Martin-Delgado et al., 2020 ). Furthermore, the labor division between care levels increases complexity, revealing different particularities of health work that affect the mental health of workers (Lancman et al., 2021 ).
This study is based on the Psychodynamics of Work (PDW) (Dejours, 1992 ) as a theoretical-methodological approach which problematizes the suffering generated in the interaction between human beings and their work (Albarello & Freitas, 2022 ). PDW, which stands out in efforts to investigate subjective aspects and psychological and interpersonal elements that influence the individual at work, has been used by Psychology authors to study the experiences of pleasure, suffering and work organization for health workers (Aciole & Pedro, 2019 ; Lancman et al., 2019 ).
Dejours ( 2016 ) considers mental health as a broad concept that encompasses pleasure, in addition to suffering and psychological decompensations. In other words, it is through work that the subject builds mental health based on their own experiences of pleasure and suffering. In this sense, work can produce both health and psychological elements which ensure its preservation, as well as be a means of illness. An important contribution of PDW was precisely to highlight the great influence that work has on mental health. After all, “work is never neutral from the point of view of health” (Dejours, 2016 , p. 319).
From the PDW perspective, while the physical health of workers is related to working conditions (working hours, work pace, material resources available to perform the task, etc.), mental health is directly related to work organization (Dejours, 2016 ). Regarding the concept of work organization, Dejours ( 1992 ) clarifies that it is a division of labor which involves prescribed agreements (prescribed work) and latent agreements (real work), and encompasses the entire complexity of intersubjective relationships, which in turn involve hierarchies, control and the division of responsibilities.
The author understands prescribed work as the way in which work is organized and conceived, the tasks to be performed, in what time, the rules to be followed, and the necessary procedures, for example. It is therefore idealized work. However, work situations are impacted by unexpected events, and there is always a gap between what is prescribed (task) and the concrete reality of work (activity), also called real work. In short, real work is what the worker actually does at work. These aspects highlight the need for the worker to add something of themselves to the prescriptions, to fulfill the objectives for which they were assigned and to deal with this complex and unpredictable reality, which resists and presents itself to the worker in an affective way (Dejours, 2004 , 2012 ). Thus, the analysis of work activity and organization forms is fundamental to understanding the phenomena underlying work activity, as well as in understanding the health, suffering and illness processes of workers.
In view of the above, this study aimed to analyze the work activity of health professionals and the implications for mental health and subjectivity considering their working conditions, organization and routines which were modified due to the urgency of action in combating COVID-19.
Method
Participants
A total of 51 healthcare workers from different professions working in public health in the Northeast region of Brazil participated in this study. The interviewees were chosen through a non-randomized convenience sample. The inclusion criteria for participation in the study were: (1) being a professional working in the SUS in the Brazilian Northeast; (2) working at the front lines in the fight against COVID-19 at the time of the study; (3) consenting to participate and having their voice recorded; and (4) agreeing to conduct the interview remotely using an online videoconferencing tool. It was decided to interview healthcare professionals in general for this study, including different care levels and professional categories, in addition to those directly providing care, in an attempt to more broadly understand the context of healthcare work with COVID-19 and to give voice to invisible categories, such as receptionists and general service assistants. It is understood that the activity is always situated and that it involves dilemmas and complexities inherent to each context in which it is inserted. However, in addition to looking at the reality from the workers’ experiences, we sought to look at aspects shared by health professionals, who also experienced this reality collectively as a category.
Instrument
A semi-structured interview script in a non-directive format was used to conduct this study. The interview script was developed by the researchers themselves, with the theoretical direction for theming the questions being the Psychodynamics of Work. The instrument contained questions which covered: work history during the pandemic, work routine, experiences of pleasure and suffering, relationships and working conditions, access to and use of PPE, access to training during the period, recognition at work, experiences of prejudice, occupational health in healthcare, and the meaning of working throughout the COVID-19 pandemic. Finally, the instrument was submitted to an analysis by judges specialized in occupational health, and test interviews were conducted to predict the time, train interviewers, and assess the adequacy of the questions.
Procedures
Data collection. A strategy was first implemented to publicize the study on social media and later the snowball method was also applied, which consisted of a participant directly indicating one or more other participants. Based on the health worker’s interest and willingness to voluntarily participate, the research team scheduled a time with them for the interview. The interviews took place between May and September of 2021, and were conducted via videoconferencing platform. The study was then presented and the participant read and signed an informed consent form (ICF). The interviews lasted an average of 1 hour and 15 minutes. Adopting remote interviews was necessary because the data collection period took place at a still critical moment of the COVID-19 pandemic between the first and second half of 2021, which made it impossible to use other techniques and tools to conduct the research; this was not only due to social isolation, but also to the difficulty of accessing health institutions (which were still very closed to researchers and other intervention actions), as well as the overload of workers.
Still on the subject of data collection, it is important to point out that the clinical method was not used in the way that is generally used by researchers who utilize PDW as a theoretical and methodological guide, based on debates and collective constructions about work (Merlo et al., 2021 ). In other words, the PDW was not used at the method level, but rather at the theoretical level, due to the reasons described in the previous paragraph. In any case, it was possible to approach and understand the problems raised by the workers with the contribution of PDW, considering that the research enabled creating spaces for speech and for voicing the demands of these professionals.
Data analysis . The interviews were transcribed and formed the corpus that was analyzed with the help of the IRaMuTeQ statistical textual analysis software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). The analysis was conducted using the Descending Hierarchical Classification (DHC), the Reinert method and the associations that were made with the Psychodynamics of Work theory.
The selection criteria for analyzing the text segments were those indicated by the tool, respectively: p < 0.005; ꭓ² ≥ 3.84 and frequency > 11 (cut-off point based on the average occurrence by word form). Words that appeared 100% of the time in the same class were incorporated into the analysis, even if they did not meet the previous criteria, because it was important to know which words and text segments were exclusive in some classes. Therefore, it was up to the researchers to name the classes, identify the meanings of the narratives in the contexts indicated by the tool, select those from the excerpts indicated by the program that best illustrated each class considering the characteristics of the “who says” in a procedural and qualitative way, as well as the approximations and distances between the text segments classified in the textual analysis.
Ethical Considerations
The study was submitted to and approved by the Ethics Committee of the Center for Sciences and Health of the Universidade Federal da Paraíba (CAAE No. 31141120.3.0000.5188), with the Informed Consent Form (ICF) duly signed by the participants, in addition to consent for recording the interview, clarifying that the images and audio recordings, as well as their identity were protected under the responsibility of the interviewers, the institutions and the research.
Results
Characterization of the interviewees’ profile
Of the 51 health workers interviewed, 12 were male and 39 were female. All were employed in services at the three levels of healthcare. The following professional categories stood out: nurses (9 - 18%), nursing technicians and assistants (8 - 16%), and psychologists (8 - 16%), who composed half of the interviewees. In addition, the study included workers from other professions, such as: community health agents (5), social workers (3), physiotherapists (3), doctors (3), nutritionists (3), pharmacists (2), endemic agents (2), receptionist (1), biomedical technician (1), occupational therapist (1), radiology technician (1), and dental assistant (1).
Descending Hierarchical Classification (DHC) of the analysis corpus
The corpus of analysis, entitled “Conditions, routine and training at work with COVID-19”, consisted of 51 texts, totaling 123 pages of transcribed interviews, with approximately 1,546 text segments (TSs), 54,379 occurrences, 4,842 word forms and 2,390 unique words. The corpus was divided three times in the DHC, and stabilized in 4 classes of text segments with 80.98% utilization, which corresponded to 1,252 TSs out of 1,546 TSs of the entire corpus, as can be seen in Figure 1 below:
The word classes generated in the DHC are grouped according to their lexical proximity. In this sense, the connection between the classes, shown in Figure 1 , represented the degree of similarity or distance with a given word. Thus, it was possible to observe that class 4 was the only one in comparison with the other classes that had a certain degree of lexical distance because it was not directly linked to the other three classes; this indicated that the words belonging to class 4 addressed slightly different content, although all classes shared the same theme, which was the health of healthcare workers.
The first class represented in Figure 1 in order of appearance was number 4, in which the most representative words were: masks, mask_pff2, use, buy, cape, alcohol, face shield, and scrub. This corresponded to the set of narratives of workers who expressed concern about PPE, as some topics such as a lack, rationing and poor quality of PPE provided by management were central points of discussion.
Class 1 compiled 34.1% of the TSs used in the analysis (80.98%) of the corpus and had the following most significant words: relationship, good, work, management, problem. The class generally addressed the different types of relationships that developed at work: between professionals, patients, patients’ families and with management.
Class 2 was the second largest, with approximately 30.67% of the 1,252 TSs. Its most representative words were arrive, enter, turn, stay, day, COVID-19, compiling the aspects related to exposure to risk in the work of facing COVID-19. This class showed that healthcare workers reported changes in care flows as a result of the pandemic. Work organization was marked by the unpredictability of the arrival and lack of PPE and medicines, protocols, information, training and continuing education.
Finally, class 3 had the following most representative words: course, activity, learn, qualification, training, and safety. The words in this class reinforced the existence and/or need for the training process to act in the COVID-19 pandemic, which represented approximately 18.69% of the TSs used to compose the classes.
The content analysis was performed after the authors organized the word classes generated in the DHC with the help of the Iramuteq software. The analysis was conducted based on the statements contained in each class and is presented below.
Content analysis of DHC classes
Not for everyone: protective equipment
The content in this class revolved around the use, access and management of PPE by healthcare professionals during the COVID-19 pandemic. Workers reported that access to appropriate masks for protection against the coronavirus would differ depending on the type of activity and the location in which it occurred. Interviewees reported that not all workers had access to the necessary PPE for safe work during the pandemic. They stated that they had access to the basics (a small number of masks, for example), but it was not enough to deal with the demands of real work and the sanitary care that the pandemic imposed on a daily basis.
In addition, there was an attitude of rationalizing PPE with the objective of prioritizing professionals who were in a specific sector of COVID-19 care, something which came from the group of workers themselves, since there was a need to set aside a specific area just to receive and care for suspected or confirmed cases of COVID-19. Thus, the fact that professionals assigned to this role needed greater protection was recognized by the group of workers.
However, workers also reported stress and the effects of the limited availability of PPE and the need to use it for a long time, sometimes longer than recommended. Examples include sweat, odors, heat, and injuries, constituting aspects which can be observed in the following statement:
Regarding masks, we received a surgical mask. Now we had twice received the one that is similar to the N95 mask, the PFF2 mask, if I am not mistaken. But it is not comfortable. On the contrary, it hurts our nose, that rod. (Man, endemic agent, primary care).
As already mentioned, access to PPE was a constant topic in the interviewees’ speeches. However, another important aspect reported was handling this equipment, since putting on and taking off PPE was a new reality for several categories of health professionals who were not used to these procedures. According to the workers, there was no prior training on correctly using the PPE, and in view of this one strategy to overcome this difficulty was the individual initiative to seek improvement through videos made available on the internet or general instructions from health agencies, since there was no further guidance from their workplaces.
Work relations as protective factors for health and as generators of suffering
The reports for this class indicated that work relationships were positively evaluated by the workers. The professionals demonstrated a sense of community among those who participated on the same team. It was possible to observe in the reports that collective work was of fundamental importance for maintaining health and performing the work. Regarding the relationship with patients, the professionals reported always seeking to alleviate the suffering of patients and establish bonds of trust through welcoming care. However, patient care was also considered a factor of suffering, mainly when related to conflicts and the inability to help given the complex health situation and states in which some patients found themselves.
While collaboration between workers was important for working, other types of interpersonal relationships in the workplace presented difficulties. For example, the relationship between workers and management was considered highly hierarchical and complex, mainly because the workers believed that there was little recognition for their work. Furthermore, staff turnover (through dismissal, for example) was seen as a problem, with unstable employment relationships making it difficult to develop strong professional relationships:
I mean, the flow of people coming and going is quite high. People don’t last long, the turnover is high, so there’s no disagreement to speak of in general, but there’s also not the level of friendship that we’re talking about. So it’s a professional relationship. (Man, nursing technician, medium complexity).
Work conditions and safety in combating COVID-19
The reports from health professionals indicated that access to work tools, such as PPE, was different for each professional category, depending on the profession and care level. According to the statements, there was a certain hierarchy of professions, in which primary care professionals (for example) suffered from the vulnerability of difficult access, as can be seen in the statement of a community agent for endemic diseases:
This agent is going from house to house, so aren’t we on the front line? ‘Oh, but it’s because contamination only occurs through aerosols and they stay there in the hospital environment’ (...) There are a lot of things they say to prevent themselves from giving us the masks. I mean, really? So, something had to be done, that’s when this measure was stipulated that we wouldn’t enter all homes, only have the conversation outside. But even so, they didn’t provide it (the N95 mask) and we feel wronged (...). In fact, I have a colleague who is on leave now and has already contracted COVID-19, it’s the third time! (Woman, community agent for endemic diseases, primary care).
In another narrative, it was possible to observe that working in the context of a pandemic involved the need for constant adaptations of procedures, techniques and tasks by professionals. In the absence of clear prescriptions and protocols, workers needed to develop collective strategies and rules of the trade based on everyday experience. The development of these “prescriptions” and their improvement occurred over time through an understanding of what works and what does not.
It was also identified that in addition to work with greater workload and intensity, there was precariousness of work, since employment relationships were fragile, based on hours worked; and even formal, Consolidation of Labor Laws ( Consolidação das Leis do Trabalho – CLT ) and contractual relationships demanded extra effort from workers. Work overload is evidenced in some statements in which workers reported feeling the accumulation of activities, pressure and intensity of work, in addition to the difficulties in dealing with losses caused by the pandemic, which were compounded by the lack of mental health actions. The reduced number of professionals in some categories, such as Community Health Agents ( Agente Comunitário de Saúde – ACS ), also contributed to the increase in workers’ working hours.
Training to act in combating COVID-19
The interviewees described that the search for training was generally initiated by the workers themselves, since there was little or no incentive to seek training by the health institutions in which they worked. The courses and training were mostly online and free, offered by unions, professional councils and the Ministry of Health, albeit in an incipient way, but also because it was a new virus and knowledge about it was still scarce. Therefore, learning the new tasks that emerged with the pandemic happened through online courses, through reading information and news, live broadcasts, video classes and cooperation with the team, along with exchanging experiences and adapting procedures that were commonly known. Although this search was facilitated by access to the internet, health professionals stated that there was some difficulty in accessing training and continuing education. This was perceived by them as a risk for themselves and for patients.
It was also possible to identify a feeling of helplessness among workers related to training for working with COVID-19, which was present during the initial moments of the pandemic and at its peak. COVID-19 was treated as a relatively new disease in the beginning, and there were no protocols and/or rigorous scientific knowledge for treatment, but rather recent possibilities that were possible alternatives. Despite these alternatives being recommended at that time, they did not guarantee complete success in saving lives, constituting a factor which limited the prospects for care and had repercussions on the work of health professionals. The workers learned to work with COVID-19 from daily life, and being in contact with the real work.
Workers assessed that health and safety policies at work were important, however they were also considered to be flawed and with little or no concern for the mental health of the category. In addition, they reported a lack of protocols, which led them to realize the need to create protocols themselves to deal with the responsibilities that real work imposed. This demand for protocols involved the emergence of new needs, such as dealing with death, as narrated below:
The hardest part for me was dealing with the absence of these protocols which make us go through the meaning of death. It’s like having a family member who has disappeared and not being able to bury the body. Many people couldn’t even say goodbye and had no preparation or training for it. (Man, psychologist, high complexity).
Discussion
The results presented showed that the COVID-19 pandemic had different implications for work processes in the health sector and for the health of workers. For example, resources became increasingly scarce during the global health crisis. As a result, health and safety protocols were created and adapted to meet the urgent needs of services, without scientific support or support from international bodies, such as the recommendation to reuse masks for a longer period or number of times than that indicated by the manufacturer in 2020. These factors put the lives of workers, patients they treated, staff and their families at risk (Miranda et al., 2020 ).
The feeling of biological insecurity caused in workers contributed to mobilize negative feelings and affections, which reverberated psychologically, since the lack of adequate working conditions created a scenario with high potential for suffering and mental illness. For Dejours and Abdoucheli ( 1994 ), suffering at work is omnipresent, and workers will always be in contact with some type of suffering. However, workers also perceive the need to develop individual and collective defensive strategies, even if unconsciously, to manage situations that generate suffering, resulting from the unpredictability of the environment.
For example, it was possible to find actions in the reports of professionals to optimize and manage distribution of protective equipment performed by the work collective itself, meaning an example of a collective defensive strategy, possibly motivated by the poor management of health institutions regarding provision of this equipment. A series of complex initiatives which contribute to forming rules of the trade are necessary for coordination and cooperation among workers to occur, as long as they are efficient and are drawn up by the workers themselves, resulting from stabilized agreements between the members of the work collective (Dejours, 2012 ). In this sense, engaged participation of these professionals in the decision-making processes, as those who truly experienced the challenging daily routine in the services, can be considered as a positive example of management based on appreciation of the reality of the work.
On the other hand, the worker may be led to exhaust their resources in terms of individual and/or collective defensive strategies when faced with aspects of the work organization which do not favor freedom of management, transformation and improvement in the work, as occurred in some work contexts during the COVID-19 pandemic. This leads the worker to feel frustrated, afraid and powerless in relation to their work, which can culminate in a state of pathogenic suffering and in cases of mental illness, when there is no longer any possibility of negotiation between the worker and the work organization. For the PDW, “pathogenic” suffering is different from “creative” suffering. Creative suffering occurs when the worker is able to transform work situations which generate suffering through creativity (Dejours & Abdoucheli, 1994 ).
Thus, analysis of the activity should not only take into account physical and organizational factors, but also emotional ones. Professionals were more likely to develop depression, physical exhaustion due to the intense work schedule and rhythms, anxiety, difficulty sleeping, as well as feelings of anguish and fear during the pandemic period (Bezerra et al., 2020 ). Added to the participants’ reports of suffering at work, these aspects revealed the need that existed and exists to develop actions which are/were consistent with the needs of workers, mainly related to mental health demands. Therefore, the psychological consequences of COVID-19 for health workers, such as psychological suffering and the fear of infecting colleagues, friends and family, must be (and were, in this study) considered in the interpretation and transformation of the work situation (Gondim et al., 2018 ).
Coexistence and positive relationships between professionals can contribute to develop positive feelings about work. For example, a study conducted by Dias et al. ( 2020 ) identified that positive affective constructions strengthen interpersonal relationships at work, constituting a way to encourage humanization in the workplace, in which managerial actions play a key role in developing such relationships. According to Dejours ( 2012 ), one’s identity in the social field mediated by work activity involves the dynamics of recognition, implying judgment from peers, which is only possible if there is a collective. This dynamic suggests that cooperation is inseparable from identity and mental health at work; when this is not the case, suffering cannot be transformed into pleasure (it becomes pathogenic).
From this perspective, work teams were considered cohesive and involved in the work activity, which is important for creating strategies to deal with suffering and for recognition at work, with the latter being a factor of pleasure. Cooperation involves respect and reciprocity, and requires workers to be able to manage conflicts, dialogue and act towards common goals. There must be mutual understanding and strengthening of trust among workers to achieve this collective status (Dejours, 2012 ). This means that work is also considered a social relationship, not just an individual activity, involving a complex set of relationships established between people, those with whom and for whom they work, which aims to coordinate the singular intelligences that presuppose the invention and appropriation of collective know-how (Gernet & Dejours, 2021 ).
However, the health sector has suffered from the work precariousness and flexibilization processes, which highlights the need to ask what are the costs to the health of workers given the knowledge that weakening employment relationships directly impacts professional well-being (Gondim et al., 2018 ). In addition, unstable relationships also harm developing work collectives, as they hinder development of lasting work relationships.
This shows why debates on work collectives have always occupied a prominent space in publications on the Psychodynamics of Work (Dejours, 2004 , 2013 ), since working implies a relationship with others, it implies working for someone, be it a client/patient, a boss or a colleague (Dejours, 2013 ). For example, it is known that the work activity of health professionals is addressed to the patients they serve and the managers they report to; however, it is observed in the present study that the activity is also addressed to work collectives.
Suffering is considered a starting point for the Psychodynamics of Work, which can mobilize the subjectivity of the worker in order to protect it (Dejours, 2012 ). In this context, the work collective is seen as a support and management network of the activity, providing support to the individual activity. It also reinvents procedures that are more aligned with the real work. In fact, the interviewees’ reports highlighted the need to think about ways of managing the work by creating protocols and instruments in an attempt to optimize the service and minimize the risks for themselves and for other people.
The central axis of a work collective is cooperation. Cooperation implies collectively and consensually readjusting work organization as it is proposed, creating practical rules that must be accepted and respected by all (Dejours, 2013 ). The pandemic scenario, the need for reassessment in the face of unforeseen events, and the speed with which knowledge about COVID-19 was gained by healthcare professionals were responsible for the great importance they gave to the work collective. The collectives took on the role of providing their members with updates on know-how, on the virus and the disease, on the proper use of PPE, and ultimately on the maintenance of the activity itself considering the unprecedented nature of the pandemic for all workers interviewed. But not only that, they took on the role of a support network in the face of failures, errors and demands from management.
Therefore, the results of the study indicated that the high workload combined with new configurations of health work during the pandemic had an impact on the health of workers, with psychological emergencies and imminent exposure to the virus, aggravated by the limited availability of PPE, training and continuing education for the work. Therefore, the precariousness of working conditions before and during the pandemic period was one of the most recurrent themes in the workers’ reports, with emphasis also on the reported lack of professional recognition and appreciation, work overload without significant salary changes or additional payment for the risks and unhealthiness faced. This contributed to a scenario of helplessness and unnecessary exposure to risks.
It is important to emphasize that the results discussed represent only a part of the reality of health professionals in the Northeast region of Brazil during the height of the pandemic, which imposes limitations on generalizing the data. Therefore, there is a need for more comprehensive investigations involving other regions of Brazil from a multi-methodological perspective.
In this sense, it is important to emphasize the importance of the data discussed acquiring scientific and social projection. The COVID-19 pandemic has left deep social scars and highlighted the urgency of thinking about ways to value SUS workers, promoting mental health actions and strengthening collectives, which (as discussed) were aspects of the work that proved to be important elements for supporting and creating ethical principles of action. In addition, it is expected that the results of this study will have practical implications for developing public policies for managing workers’ health and safety, as well as for health policies, training and knowledge construction for action in public health emergency situations.
References
-
Aciole, G. G., & Pedro, M. J. (2019). Sobre a saúde de quem trabalha em saúde: Revendo afinidades entre a psicodinâmica do trabalho e a saúde coletiva [On the health of those who work in health: Reviewing affinities between work psychodynamics and collective health]. Saúde Debate, 43(120), 194-206. http://dx.doi.org/10.1590/0103-1104201912015
» https://doi.org/10.1590/0103-1104201912015 -
Albarello, B. A., & Freitas, L. G. (2022). A clínica psicodinâmica do trabalho e adaptações realizadas por pesquisadores no Brasil [The psychodynamic clinic of work and adaptations made by researchers in Brazil]. Revista Psicologia: Organizações e Trabalho, 22(2), 2039-2046. https://doi.org/10.5935/rpot/2022.2.22498
» https://doi.org/10.5935/rpot/2022.2.22498 -
Bezerra, G. D., Sena, A. S. R., Braga, S. T., Santos, M. E. N., Correia, L. F. R., Clementino, K. M. F., Carneiro, Y. V. A., & Pinheiro, W. R. (2020). O impacto da pandemia por COVID-19 na saúde mental dos profissionais da saúde: Revisão integrativa [The covid-19 pandemic’s impact on the mental health of health personnels: Integrative review]. Revista Enfermagem Atual, 93(spe). https://doi.org/10.31011/reaid-2020-v.93-n.0-art.758
» https://doi.org/10.31011/reaid-2020-v.93-n.0-art.758 - Dejours, C. (1992). A loucura do trabalho: Estudo de psicopatologia do trabalho [The madness of work: A study in the psychopathology of work]. Cortez-Oboré.
-
Dejours, C. (2004). Subjetividade, trabalho e ação [Subjectivity, work and action]. Revista Produção, 14(3), 27-34. https://doi.org/10.1590/S0103-65132004000300004
» https://doi.org/10.1590/S0103-65132004000300004 - Dejours, C. (2012). Trabalho vivo: Trabalho e emancipação [Living work: Work and emancipation]. Blucher.
- Dejours, C. (2013). A sublimação, entre sofrimento e prazer no trabalho [Sublimation, between suffering and pleasure at work]. Revista Portuguesa de Psicanálise, 33(2), 9-28.
- Dejours, C. (2016). Organização do trabalho e saúde mental: Quais são as responsabilidades do manager? [Work organization and mental health: What are the manager’s responsibilities?]. In K. B. Macêdo, J. G. Lima, A. R. D. Fleury, & C. M. S. Carneiro (Orgs.), Organização do trabalho e adoecimento: Uma visão interdisciplinar [Work organization and illness: An interdisciplinary view] (pp. 317-331), PUC Goiás.
- Dejours, C., & Abdoucheli, E. (1994). Itinerário teórico em psicopatologia do trabalho [Theoretical itinerary in work psychopathology]. In C. Dejours, E. Abdoucheli, & C. Jayet, Psicodinâmica do trabalho: Contribuições da Escola Dejouriana à análise da relação prazer, sofrimento e trabalho [Psychodynamics of work: Contributions of the Dejourian School to the analysis of the relationship between pleasure, suffering and work] (pp. 119-145). Atlas.
-
Dias, J. S., Rocha, L. P., Carvalho, D. P., Tomaschewski-Barlem, J. G., Barlem, E. L. D., & Gutierres, E. D. (2020). Saúde, comportamento e gestão: Impacto nas relações interpessoais [Health, behavior, and management: Impact on interpersonal relations]. Texto & Contexto Enfermagem, 29, 1-12. https://doi.org/10.1590/1980-265X-TCE-2019-0057
» https://doi.org/10.1590/1980-265X-TCE-2019-0057 - Gernet, I., & Dejours, C. (2021). Avaliação do trabalho e reconhecimento [Work evaluation and recognition]. In P. F. Bendassolli, & L. A. P. Soboll (Orgs.), Clínicas do Trabalho [Work clinics] (pp. 70-79). Artesã.
-
Gondim, A. A., Pinheiro, J. A. M, Mendes, C. F., & Neves, L. (2018). O impacto do processo de precarização laboral em serviços de saúde [The impact of precarious labor in health care services]. Revista da SBPH, 21(1), 56–73. http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1516-08582018000100004&lng=pt&tlng=pt
» http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1516-08582018000100004&lng=pt&tlng=pt -
Harvey, J. (2020). COVID-19 and PPE in context: An interview with China. Journal of Public Health, 42(3), 480-482. https://doi.org/10.1093/pubmed/fdaa077
» https://doi.org/10.1093/pubmed/fdaa077 -
Lancman, S., Sato, A. T., Hein, D. T., & Barros, J. O. (2019). Precarização do trabalho e sofrimento psíquico: Ação em psicodinâmica do trabalho em um serviço de farmácia hospitalar universitário [Precariousness of work and psychic suffering: Psychodynamics of work action in a university hospital pharmacy service]. Revista Brasileira de Saúde Ocupacional, 44, e33. http://dx.doi.org/10.1590/2317-6369000006118
» https://doi.org/10.1590/2317-6369000006118 -
Lancman, S., van Wijk, L. B., Rocha, T. O., Souza, N. B. M., & Silva, T. N. R. (2021). Os trabalhadores do contexto hospitalar em tempos de pandemia: Singularidades, travessias e potencialidades [Hospital workers in times of pandemic: Singularities, journeys and potential]. Interface, 25, 1-15. https://doi.org/10.1590/interface.210119
» https://doi.org/10.1590/interface.210119 -
Martin-Delgado, J., Viteri, E., Mula, A., Serpa, P., Pacheco, G., Prada, D., Lourenção, D. C. A., Baptista, P. C. P., Ramirez, G., & Mira, J. J. (2020). Availability of personal protective equipment and diagnostic and treatment facilities for healthcare workers involved in COVID-19 care: A cross-sectional study in Brazil, Colombia, and Ecuador. PLoS One, 15(11), e024218 . https://doi.org/10.1371/journal.pone.0242185
» https://doi.org/10.1371/journal.pone.0242185 - Merlo, A. R. C., Mendes, A. M. B., Duarte, F. S., & Araújo, L. K. R. (2021). Psicodinâmica do trabalho no Brasil: práticas clínicas [Psychodynamics of work in Brazil: clinical practices]. In P. F. Bendassolli & L. A. P. Soboll (Orgs.), Clínicas do trabalho [Work clinics] (pp. 188-203). Belo Horizonte: Artesã.
-
Miranda, F. M. D., Santana, L. L., Pizzolato, A. C., & Saquis, L. M. M. (2020). Condições de trabalho e o impacto na saúde dos profissionais de enfermagem frente a covid-19 [Working conditions and the impact on the health of the nursing professionals in the context of covid-19]. Cogitare Enfermagen, 25, e72702. https://doi.org/10.5380/ce.v25i0.72702
» https://doi.org/10.5380/ce.v25i0.72702 - Morosini, M. V. G., Chinelli, F., & Carneiro, C. C. G. (2020). Coronavírus e crise sociossanitária: A radicalização da precarização do trabalho no SUS [Coronavirus and socio-sanitary crisis: The radicalization of precarious work in SUS]. In L. B. Silva, & A. V. Dantas (Orgs.), Crise e pandemia: Quando a exceção é regra geral [Crisis and pandemic: When the exception is general rule] (pp. 93-111). EPSJV.
- Portaria No. 485. (2005, 11 de novembro). Aprova a Norma Regulamentadora No. 32 (Segurança e saúde no trabalho em estabelecimentos de saúde) [Approves Regulatory Standard No. 32 (Safety and health at work in health facilities)]. Ministério do Trabalho e Emprego.
-
Vedovato, T. G., Andrade, C. B., Santos, D. L., Bitencourt, S. M., Almeida, L. P., & Sampaio, J. F. S. (2021). Trabalhadores (as) da saúde e a COVID-19: Condições de trabalho à deriva? [Health workers and covid-19: flailing working conditions?]. Revista Brasileira de Saúde Ocupacional, 46, e1. https://doi.org/10.1590/2317-6369000028520
» https://doi.org/10.1590/2317-6369000028520
-
Support:
This research was conducted with support from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Call MCTIC/CNPq/FNDCT/MS/SCTIE/Decit no. 07/2020 and process no. 402104/2020-0.
-
How to cite this article:
Máximo, T. A. C. O., Torres, T. L., Moura, E. I., Silva, W. J. P., Vasconcelos, L. E. M., & Cruz, R. E. P. (2024). Work and confrontation with the real for health professionals during COVID-19. Paidéia (Ribeirão Preto), 34, e3427.doi: https://doi.org/10.1590/1982-4327e3427
Edited by
-
Associate editor:
Marina Flório Ferreira Bertagnoli
