ABSTRACT
Hospital institutions, with their private work organization, are made of very peculiar environments characterized by tension, pain and suffering. This way the hospital sets rules, specific routines and determines the actions of the health team about the care service provided for the patients. In this context, it is possible to identify aspects in the professional actions that can set in stress symptoms, mainly due to the contact with emotionally intense situations, such as life, illness and death. Stress has been related to sensations of tension, anxiety, fear and discomfort, and there has been an increase in the number of people who define themselves as stressed. Therefore, stress is made up of psycho-physiological alterations that occur when an individual is forced to face situations beyond his/her coping abilities. Personal characteristics and the environment where the person is inserted are important factors in the occurrence and severity of the reactions to the stress process. Its development depends not only on the personality of the individual but also on his/her health state (mental and organic equilibrium) and because of it not everybody shows the same type of reaction to stressful events. Life style, past experiences, attitudes, beliefs, values, illness and genetic predisposition are important factors in the stress process development. From this relation (individual-environment) the individual uses coping resources to modify his/her relation with the environment, controlling or altering the stress-causing event. The coping, which is a response to the stress, corresponds to the cognitive and behavioral efforts oriented to deal with the internal or external demands, which are exceeding or overwhelming the individual resources. This way, the aim of the coping strategies is the reduction, elimination or stress handling according to the evaluation that the individual does of a certain event of his/her life. From the presupposition that the hospital and the provided care to the patient can be developers of stress symptoms, it is believed that studies which provide the evaluation of this event as well as the identification of stressing causes will be able to contribute to minimize and prevent the appearance of stress symptoms in health professionals working in the hospital environment. Objective The purpose of this study was to indentify the presence of stress symptoms in health-care professionals working in the hospital environment and know the main stressing causes at the working environment and the coping resources used by the professionals to deal with stressful situations. Material and methods It is a descriptive transversal study done with professionals who work at the University Hospital of the West of Parana (HUOP) and that provide direct assistance to the in-hospital patients. This hospital, which has 1 73 rooms, is a reference in high complexity in urgency and emergency assistance for the West and Southwest of Parana region and it provides assistance in various clinical specialties. The data was collected from October to December of 2007 together with professionals at the three working shifts. During the collection of the data period, the HUOP had 272 professionals who suited to the criteria to be included in this study, which was to provide direct assistance to the patient. In the definition of the sample size, it was adopted a 5% pattern error and prevalence of stress symptoms of 20%. Besides this, it was predicted a margin of 20% to the size of the sample to cover likely loss of subjects and/or information. Therefore, the calculated size sample was of 155 professionals. To define the professionals who would be included in this study, a stratification proportional to the total number of workers from each professional category was carried out. Moreover, when the number of workers of a certain category was very small (two or three at most), it was decided to include all of them. The research subjects were selected at random, and the two first workers to arrive in the sector at their working shift were invited to participate in this study. Sixteen professional, all technicians and auxiliary nurses, missed to fill the biggest part of the test as well the prepared questions and because of it they were excluded of the study, something which made the effective sample be made up of 139 professionals: 93 technicians and/or auxiliary nurses, 32 nurses, 6 doctors, 2 nutritionists, 2 physiotherapists, 1 sychologist, 1 phonoaudiologist, and 2 social assistance workers. The data was collected through a self-applicable questionnaire, to be filled individually and handed back the same day. The participants took an average of 20 minutes to answer the questionnaires. Two instruments were used; the first one was constituted of two parts, one approaching social-demographic and work related matters and the second with two discursive questions about stressful events in the working environment and the coping strategies used for dealing with them. The second instrument is the Inventory of Stress Symptoms for Adults -ISSL-, which allows us to identify, from the symptomatology shown by the subject, the presence or not of stress; the present type (somatic or psychological) and in which phase of stress the individual is. The data was kept in an Excel data bank, and we used the computer package Statistic 7.2 for the analysis of the variable, and for the calculus of the Fischer Exact Test we used the program SAS 9.1 (Statistical Analysis System). A significance level of 5% was established. For the analysis of the qualitative data, the answers to the discursive questions were grouped in four categories: intrinsic factors/ situations to work; working conditions; interpersonal relations and factors related to assistance. Results One hundred and thirty nine health professionals who provide direct assistance to the patient in hospital environment participated in this study, such as doctors, nurses, nurses technicians, physiotherapists, psychologist, phonoaudiologist, social assistants and nutritionist. The applied Inventory of Stress Symptoms revealed that from the 139 evaluated subjects 60.4% presented stress. From those, 5.7% were in the alert phase; 44.6% in the resistance phase; 7.2% at the close-to-exhaustion phase; and 2.9% in the exhaustion phase. From those who presented stress symptoms, there was a higher incidence of physical symptoms (36.7%), being followed by the physical/ psychological (16.5%) and psychological (7.2%) ones. It was observed a significant association between the presence of stress and the working sector (p = 0.0002) and the working period of time at the same institution (p = 0.0133). In relation to the stressful events, it was observed that the working conditions were pointed with more frequency as stress generators (31.1 %), followed by intrinsic working factors (26.6%), interpersonal relations (26.3%) and assistance related factors (16%). Many forms of coping were identified, and a great majority of the professionals (43.0%) uses as a strategy to deal with stress, alternatives out of the working environment, which means that they deal with the emotional response developed by the stressor event; a considerable part of the professionals (30.7%) uses as a strategy to relieve stress the focus in solving the problem - something that tries to modify the relation of the individual with the environment, promoting changes directly in the situation that causes stress; and, 26.3% did not show coping responses. Conclusions It was pointed an indicative of stress in professionals of various areas, with the prevalence of physical symptoms, in the resistance phase. The events considered as stressors by the professionals, in fact, led to the appearance of stress symptoms, being related to the working environment. Being aware of the stressors and understanding how the caretaker deal with these events support the more effective actions in order to reduce stress and improve the working conditions to these professionals. As it is extremely important that those professionals be in physical and psychological conditions which are favorable so that they can provide a better assistance as well as a proper one to the needs of the patient.
La institución hospitalaria con su organización particular constituye ambientes peculiares caracterizados por tensión, dolor y sufrimiento. En ese contexto es posible identificar en las acciones de los profesionales aspectos que pueden desencadenar síntomas de estrés, principalmente debido al contacto con situaciones emocionalmente intensas, tales como la vida, la enfermedad y la muerte. El estrés ha sido relacionado a sensaciones de tensión, ansiedad y miedo. Está compuesto de alteraciones psicofisiológicas que ocurren cuando el individuo es forzado a enfrentar situaciones que están más allá de sus habilidades de enfrentamiento. Características personales y el medio en que el sujeto está inserto son factores importantes en la ocurrencia y en la gravedad de las reacciones al proceso de estrés. Su desencadenamiento depende tanto de la personalidad del individuo como del estado de salud en que éste se encuentra (equilibrio orgánico y mental) y, por eso, no todas las personas demuestran el mismo tipo de reacción a eventos estresantes. A partir de esa relación el individuo echa mano de los recursos de enfrentamiento utilizados para modificar su relación con el ambiente, controlando o alterando el evento causante de estrés. Objetivos Identificar la presencia de síntomas de estrés en profesionales-cuidadores en el contexto hospitalario, y conocer los principales estresores del ambiente de trabajo y los recursos de enfrentamiento utilizados por los profesionales para lidiar con las situaciones de estrés. Material y métodos Estudio transversal descriptivo realizado con profesionales que actúan en el Hospital Universitario del Oeste de Paraná (HUOP), Brasil, y que prestan asistencia directa al paciente ingresado. Los datos fueron recolectados en el período de octubre a diciembre de 2007 junto a profesionales de los tres turnos de trabajo, seleccionados aleatoriamente, por medio de preguntas autoaplicables, contestadas individualmente y devueltas en el mismo día. Los participantes tomaron alrededor de 20 minutos para responder a las preguntas. Fueron utilizados dos instrumentos, el primero estuvo constituido por dos partes, una abordó preguntas sociodemográficas y relacionadas con el trabajo, y la segunda conteniendo dos preguntas subjetivas sobre eventos estresantes en el ambiente de trabajo y las estrategias de enfrentamiento utilizadas para lidiar con ellos. El segundo instrumento es el Inventario de Síntomas de Estrés para Adultos (ISSL), el cual permite identificar, a partir de la sintomatología presentada por el sujeto, la presencia o no de estrés, el modelo presente (somático o psicológico) y en cuál fase del estrés se encuentra el individuo. Resultados La aplicación del Inventario de Síntomas de Estrés reveló que de los 139 sujetos evaluados, 60.4% presentaban estrés. De esos, 5.7% estaban en la fase de alerta; 44.6%, en la fase de resistencia; 7.2%, en la fase de casi-agotamiento y 2.9% en la fase de agotamiento. Se observó asociación significativa entre la presencia de estrés y el sector de trabajo (p = 0.0002) y tiempo de trabajo en la referida institución (p = 0.0133). Con relación a los eventos estresantes se observó que las condiciones de trabajo fueron apuntadas con mayor frecuencia como generadoras de estrés (31.1%), seguida de factores intrínsecos del trabajo (26.6%), relaciones interpersonales (26.3%) y factores relacionados a la asistencia (16%). Se identificaron varias formas de enfrentamiento, siendo que la mayor parte de los profesionales (43.0%) utiliza como estrategia para lidiar con el estrés alternativas fuera del ambiente de trabajo, o sea, lidian con la respuesta emocional desencadenada por el evento estresor; una parte considerable de los profesionales (30.7%) utiliza como estrategia para alivio del estrés el enfoque en la resolución del problema - que busca modificar la relación de la persona con el ambiente, promoviendo cambios directamente en la situación generadora de estrés; y, por último, 26.3% no presentaron respuestas de enfrentamiento. Conclusiones Se constató indicativo de estrés en los profesionales de las diversas áreas, prevaleciendo síntomas físicos, de la fase de resistencia. Los eventos considerados como estresores por los profesionales han llevado, de hecho, al surgimiento de síntomas de estrés, estando éstos relacionados al ambiente de trabajo. Conocer los estresores y entender cómo el cuidador lidia con estos eventos favorece el emprendimiento más efectivo de acciones con el objetivo de reducir el estrés y mejorar las condiciones de trabajo de esos profesionales. Es primordial que éstos se encuentren en condiciones físicas y psicológicas favorables para que puedan prestar una asistencia mejor y adecuada a las necesidades del paciente.