Burnout in the staff of a chronic care hospital / Burnout en el personal de un hospital de crónicos

ABSTRACT OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013-2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences.

RESUMEN OBJETIVO Estimar la prevalencia de Burnout en un hospital de media-larga estancia, monitorizar su evolución y evidenciar la importancia de los puntos de corte utilizados para evitar sesgos en la interpretación de los resultados. MÉTODOS Se realizaron dos estudios transversales (2013-2016), aplicando la versión española del cuestionario Maslach Burnout Inventory al personal de un hospital de crónicos (n = 323). Fueron variables resultado: prevalencia de Burnout y alto grado de afectación de las subescalas y variables predictoras: características sociodemográficas y factores desencadenantes y moduladores del síndrome. La asociación entre variables se cuantificó mediante odds ratio. RESULTADOS El índice de participación pasó del 31,5% al 39,3%. Los profesionales presentaron un nivel medio de Burnout en ambos momentos, observándose menor grado de afectación de las subescalas de despersonalización y realización personal en el corte realizado en 2016. La puntuación media de las subescalas en 2016 fue 21,5 para el cansancio emocional, 4,7 para la despersonalización y 41,7 para la realización personal, frente a los valores de cansancio emocional = 21,6, despersonalización = 6,9 y realización personal = 36,3 obtenidos en 2013. La puntuación de la escala de cansancio emocional fue ligeramente superior al valor promedio de los estudios nacionales (19,9), mientras que el resto de valores fueron similares a los valores promedio de los estudios considerados. La prevalencia de Burnout y la interpretación de los resultados variaron significativamente en función de los puntos de corte considerados. En ambos estudios, las variables sociodemográficas mostraron escasa significación, mientras que el apoyo social y las relaciones interpersonales se asociaron al grado de Burnout de los profesionales. CONCLUSIONES Nuestra prevalencia de Burnout fue similar a la de otros estudios consultados, aunque el componente emocional es más marcado en nuestro medio. La interpretación de los resultados varió significativamente en función de los puntos de corte aplicados, debido a las diferencias transculturales.

Carga de trabalho de enfermagem em unidades de terapia intensiva publicas e privadas / Nursing workload in public and private intensive care units

OBJETIVO: Comparar pacientes de unidades de terapia intensiva públicas e privadas segundo carga de trabalho e intervenções de enfermagem. MÉTODOS: Estudo comparativo, tipo coorte retrospectivo, com 600 pacientes internados em 4 unidades de terapia intensiva localizadas em São Paulo. A carga de trabalho e as intervenções de enfermagem foram identificadas pelo Nursing Activities Score nas primeiras e últimas 24 horas de permanência do paciente na unidade de terapia intensiva. Os testes do qui-quadrado de Pearson, exato de Fisher, t de Student e Mann-Whitney foram utilizados na comparação dos grupos. RESULTADOS: A média do Nursing Activities Score calculado na admissão da unidades de terapia intensiva foi 61,9 e, na saída, de 52,8. Diferenças significativas foram encontradas entre os pacientes admitidos nas unidades de terapia intensiva públicas e privadas em relação ao Nursing Activities Score médio na admissão e em 12 das 23 intervenções de enfermagem realizadas nas primeiras 24 horas de internação na unidade crítica. Os pacientes internados nas unidades de terapia intensiva públicas apresentaram maior valor médio do escore e, em geral, tiveram maior frequência de intervenções, exceto àquelas relacionadas a "cuidados com drenos", "mobilização e posicionamento", e "hiperalimentação intravenosa". Os grupos também diferiram em relação à evolução do Nursing Activities Score entre admissão e saída da unidade de terapia intensiva na casuística total e entre os sobreviventes. CONCLUSÃO: Pacientes internados em unidades de terapia intensiva públicas e privadas apresentam particularidades em relação à demanda de cuidados requerida e tal achado pode subsidiar os gestores na busca de um adequado ...

OBJECTIVE: This study sought to compare patients at public and private intensive care units according to the nursing workload and interventions provided. METHODS: This retrospective, comparative cohort study included 600 patients admitted to 4 intensive care units in São Paulo. The nursing workload and interventions were assessed using the Nursing Activities Score during the first and last 24 hours of the patient's stay at the intensive care unit. Pearson's chi-square test, Fisher's exact test, the Mann-Whitney test, and Student's t test were used to compare the patient groups. RESULTS: The average Nursing Activities Score upon admission to the intensive care unit was 61.9, with a score of 52.8 upon discharge. Significant differences were found among the patients at public and private intensive care units relative to the average Nursing Activities Score upon admission, as well as for 12 out of 23 nursing interventions performed during the first 24 hours of stay at the intensive care units. The patients at the public intensive care units exhibited a higher average score and overall more frequent nursing interventions, with the exception of those involved in the "care of drains", "mobilization and positioning", and "intravenous hyperalimentation". The groups also differed with regard to the evolution of the Nursing Activities Score among the total case series as well as the groups of survivors from the time of admission to discharge from the intensive care unit. CONCLUSION: Patients admitted to public and private intensive care units exhibit differences in their nursing care demands, which may help managers with nursing manpower planning. .