Effectiveness of Resiliency and Recovery Program on Compassion Fatigue among Nursing Officers working in selected Hospitals in India / Efectividad del Programa de Resiliencia y Recuperación sobre la Fatiga por Compasión entre los profesionales de Enfermería que trabajan en Hospitales seleccionados de la India / Eficácia do Programa de Resiliência e Recuperação na Fadiga por Compaixão entre Profissionais de Enfermagem que Trabalham em Hospitais Selecionados na Índia

Objective. The study objective was to evaluate the effectiveness of Resiliency and Recovery Program on Compassion Fatigue level of Nursing Officer from selected hospitals of Pune City (India). Methods. The study used a quasi-experimental approach involving single group pre-test and post-test design. 100 nursing officers, working in selected hospitals of Pune city, who were willing to participate were selected using non probability convenience sampling. The data was collected using The Professional Quality of Life Scale: Compassion Satisfaction and Fatigue (ProQoL) Version 5 of Stamm. The study included pre-test, resiliency and recovery program and post-test. Resiliency and Recovery Program is an intervention aiming to develop five resiliency skills or antibodies including (a) self-regulation, (b) perceptual maturation, (c) intentionality, (d) self-care and (e) connection and support. Results. Statistically significant difference was revealed between the pre-test and post-test score means: Compassion Satisfaction (pre-test = 28.50 to post-test = 31.0; t-18.6671, p<0.001), Burn-out (pre-test = 35.2 to post-test = 31.7; t-15.00, p<0.001), and Secondary Traumatic Stress (pre-test = 37.4 to post-test = 33.07; t-14.8996, p<0.001). Conclusion. Resiliency and Recovery Program had a significant impact on Compassion Fatigue, leading to an increase in Compassion Satisfaction, and a reduction in Burnout and Secondary Traumatic Stress. Inculcating Resiliency skills in nursing officers can help them in reducing compassion fatigue and thus aids in health promotion.

Objetivo. El objetivo del estudio era evaluar la eficacia del Programa de Resiliencia y Recuperación en el nivel de Fatiga por Compasión de los profesionales de enfermería de los hospitales seleccionados de la ciudad de Pune (India). Métodos. El estudio cuasi-experimental con evaluación pre y post-intervención en un solo grupo. Se seleccionaron 100 profesionales de enfermería que trabajaban en hospitales seleccionados de la ciudad de Pune mediante un muestreo no probabilístico por conveniencia. Los datos se recogieron utilizando la Escala de calidad de vida profesional: Compassion Satisfaction and Fatigue ((ProQOL) Version 5 de Stamm. El estudio incluyó una prueba previa, un programa de resiliencia y recuperación y una prueba posterior. El Programa de Resiliencia y Recuperación es una intervención cuyo objetivo es desarrollar cinco habilidades o anticuerpos de resiliencia que incluyen (a) autorregulación, (b) maduración perceptiva, (c) intencionalidad, (d) autocuidado y (e) conexión y apoyo. Resultados. Se observaron diferencias estadísticamente significativas entre las puntuaciones promedio obtenidas antes y después de la intervención en la satisfacción con la compasión (antes = 28.5 a después = 31; t-18.6671, p<0.0001), el agotamiento (antes = 35.2 a después = a 31.7; t-15,00, p<0.001) y el estrés traumático secundario (antes = 37.4 a después 33.1; t-14.8996, p<0.001). Conclusiones. El Programa de Resiliencia y Recuperación tuvo un impacto significativo en la Fatiga por Compasión, lo que condujo a un aumento de la Satisfacción por Compasión y a una reducción del Burnout y del Estrés Traumático Secundario. Inculcar habilidades de resiliencia a los profesionales de enfermería puede ayudarles a reducir la fatiga por compasión y, por tanto, a promover la salud.

Objetivo. O objetivo do estudo foi avaliar a eficácia do Programa de Resiliência e Recuperação no nível de Fadiga por Compaixão em profissionais de enfermagem em hospitais selecionados na cidade de Pune (Índia). Métodos. Foi realizado um estudo quase experimental com avaliação pré e pós-intervenção em grupo único. Foram selecionados 100 profissionais de enfermagem que trabalham em hospitais da cidade de Pune por meio de amostragem não probabilística de conveniência. Os dados foram coletados por meio da versão 5 da Escala de Qualidade de Vida Profissional: Compaixão, Satisfação e Fadiga (ProQoL) de Stamm. O estudo incluiu um pré-teste, um programa de resiliência e recuperação e um pós-teste. O Programa de Resiliência e Recuperação consistiu em uma intervenção cujo objetivo é desenvolver cinco habilidades de resiliência ou anticorpos que incluem (a) autorregulação, (b) maturação perceptual, (c) intencionalidade, (d) autocuidado e (e) conexão e suporte. Resultados. Foram observadas diferenças estatisticamente significativas entre as pontuações médias obtidas antes e depois da intervenção em satisfação por compaixão (antes = 28.5 a depois = 31; t-18.6671, p<0.0001), burnout (antes = 35.2 a depois = a 31.7; t-15.00), p<0.001) e estresse traumático secundário (antes = 37,4 a depois 33.1; t-14.8996, p<0.001). Conclusões. O Programa de Resiliência e Recuperação teve um impacto significativo na Fadiga por Compaixão, levando a um aumento na Satisfação por Compaixão e a uma redução no Burnout e no Estresse Traumático Secundário. Incutir competências de resiliência nos enfermeiros pode ajudá-los a reduzir a fadiga da compaixão e, portanto, promover a saúde.

Prevención del estrés y burn-out del equipo de salud: el nexo con la calidad de la atención sanitaria y la seguridad del paciente / Preventing stress and burn-out of healthcare staff: linkage with quality of healthcare systems and patient safety

Se destaca la importancia de la prevención del estrés y burn-out en los trabajadores que integran el equipo de salud. Se señala su directa relación con el error médico, la seguridad del paciente y la calidad de la atención sanitaria. (AU)

The purpose of this work is to point out the importance of preventing stress and burn-out of the healthcare staff and its relationship with medical errors, patient safety and quality of the healthcare systems. (AU)

Fighting from the COVID-19 Frontline: A Junior Doctor’s Perspective on Fear, Duty and Calling

@#As the COVID-19 pandemic ravages the whole world, the frontline clinicians are tirelessly fighting to contain and manage the disastrous effects of the virus from their communities. Stress, despair, fear, physical and psychological burn out, decreased work out put and lowered morale are some side effects this endless battle has had on the frontline healthcare worker. Although there have been many accounts of surgeons working in the frontline, there have only been few reflections on this ongoing battle from the junior clinician’s point of view. In this article, we feature the perspectives of young residents from the orthopaedic unit at the epicenter of the COVID-19 fight in Singapore. We highlight the thoughts, fears, emotions, morale, motivating factors and reflections of junior clinicians while they work at frontlines. Fear in a dangerous new environment and amidst uncertainty is natural. However, a doctor’s call of duty goes far above fear.

Prevención de estrés y Burn-Out en el equipo de salud / Stress prevention and Burn-Out in health team

El objetivo de este trabajo es difundir la Ley Nº 2578 de la Ciudad Autónoma de Buenos Aires (CABA) del 06/12/07, promulgada por decreto N° 09/008 del 07/01/08, publicada en BOCBA N° 2.850 del 15/01/08, relativa a la creación del "Programa de Prevención, Detección Precoz y Rehabilitación del Estrés Laboral Crónico de los Trabajadores de la Salud". También hacer algunas consideraciones sobre esta enfermedad y destacar al síndrome de Burn-Out como resultado de un estrés laboral crónico que se desarrolla en los ambientes laborales del equipo de la salud

The purpose of this work is to spread Law C.A.B.A. N° 2.578 regarding the creation of the Program for the Prevention, Early Detection and Rehabilitation of Chronic Labor Stress of Health Care Workers of Autonomous City of Buenos Aires. Also make some considerations about this disease and highlight Burn Out syndrome as result of chronic work stress that develops in the work environment of the health team.

Comparative study of prevalence of burn out among medical students from two medical colleges in Eastern India

Background: Emotional exhaustion, and reduced perception of personal accomplishment is commonly defined as burn out syndrome. This may develop when there is significant stress without adequate support and resources in the face of work overload, as commonly happens with physicians and undergraduate medical students.Methods: This work attempted to study the level of burn out among all the second professional medical students in two different medical colleges and compare the trends of an urban medical college with a college in the outskirts of the city. 278 students from two medical colleges participated in the study wherein they were given standard questionnaires for assessment of stress, support, satisfaction and control parameters.Results: Overall 169 students of the 278 (60.79%) interviewed had scores correlating with burn out. Both college students showed burnout in the various parameters individually like stress, lack of support, dissatisfaction, lack of control and perception of success. There was a significantly greater prevalence of burn out scores among students in the city college (123 students or 60.84%) compared to those studying in the rural medical college (46 students or 41.07%) (p ?0.05)Conclusions: Burn out syndrome was more prevalent among city students compared to rural students. Individual as well as organizational interventions need to be targeted to prevent burnout among medical students.

Factors related to Professional Quality of Life among Community Health Practitioners in Korea / 산업간호학회지

PURPOSE: The aims of this study were to examine the work, client, and personal environments of community health practitioners, including the level of their professional quality of life (ProQOL), and identify the factors affecting their ProQOL. METHODS: Data were collected using a web-survey questionnaire, which was completed by a sample of 308 community health practitioners currently working in Korea. The questionnaire included items on ProQOL; three dimensions labeled compassion satisfaction, burn out, and secondary traumatic stress; job stress; job satisfaction; sense of community; and general characteristics. RESULTS: The mean scores for the three dimensions were 39.2±6.44 (compassion satisfaction), 31.9±3.59 (burn out), and 26.4±5.05 (secondary traumatic stress). A multiple linear regression revealed that compassion satisfaction varied significantly according to the satisfaction with job choice, sense of community, job stress, and job satisfaction. The factors affecting burn out were sense of community and work load, while the factors affecting secondary traumatic stress were education, job stress, and job satisfaction. CONCLUSION: The findings of this study suggest that comprehensive intervention focusing on improving the sense of community and job satisfaction and reducing job stress is essential to promote community health practitioners' ProQOL.

Crisis del modelo medico actual / Crisis of the current medical model

La medicina es una de las profesiones que más cambios ha experimentado en las últimas décadas. El presente artículo describe esos cambios y señala como han modificado la práctica de la profesión y la relación médicopaciente. Al mismo tiempo describe la relación que posiblemente ellos tienen con la aparición transversal en las diferentes especialidades médicas del término de "burn out" o agotamiento que ha generado muchos artículos en los últimos años. Se sugieren posibles soluciones en la educación médica para evitar estos efectos en los nuevos profesionales.

Medicine is one of the professions that have undergone the most changes in recent decades. The article describes these changes and points out how they have modified the practice of the profession and the doctor-patient relationship. At the same time it describes the relationship that they possibly have with the transverse appearance in the different medical specialties of the term of "burn out" or exhaustion that has generated many articles in the last years. Possible solutions are suggested in medical education to avoid these effects in the new professionals

Understanding and Approaching Low Motivation in Young Adults with Diabetes Mellitus / 임상당뇨병

Young Adults with diabetes mellitus suffer from low blood sugar levels due to the influences of their personal and social environments. In addition, they experience a constantly declining motivation, causing them to experience burn-out and eventually lose their quality of life. Considering this, diabetic education should be able to understand and take into account the characteristics of young adult patients while implementing various different approaches.

Prevalencia del síndrome de burn out en los profesionales sanitarios del centro de salud Luis Alonso Suazo, de junio a septiembre del 2015, Tegucigalpa, Honduras

El propósito de la presente investigación fue establecer la prevalencia delsíndrome de Burn out en el personal profesional sanitario del centro de salud LuisAlonso Suazo en Tegucigalpa, Honduras en el período de junio a septiembre del2015.La población estudiada fue de 42 profesionales sanitarios cuyos datos fueronobtenidos a través de dos cuestionarios anónimos y de auto llenado, uno sobre lascaracterísticas sociodemográficas y el cuestionario Internacional Maslach Burnout Inventory (MBI), instrumento internacionalmente utilizado y validado para elestudio de esta patología.Se concluyó que la prevalencia del síndrome de Burn out fue de 21 profesionalessanitarios afectados representando el 50% en otras palabras la mitad de lamuestra estudiada del personal profesional sanitario del centro de salud LuisAlonso Suazo se correlaciona con la reportada en la literatura revisada, afectandomayormente a las mujeres casadas entre 40 a 44 años, se determinó que la otramitad de la muestra estudiada no reportó presencia del síndrome reportando 50%.La esfera más afectada fue el cansancio emocional con 62% seguido de ladespersonalización con 38% finalmente la realización personal presentó el 14% dela muestra estudiada.En relación con los niveles del síndrome de Burn out se presentó en primer lugarel nivel moderado representando el 36% seguido del nivel alto en un 9% en últimolugar el nivel bajo con el 5% de los afectados por el síndrome.

Síndrome de Burn Out: Identificación y Prevalencia en personal de enfermería de dos hospitales de la Ciudad de Corrientes Capital. Burn Out: Detección en enfermería en Corrientes Capital / Burn Out Syndrome: Identification and Prevalence in nursing personnel from two hospitals in the City of Corrientes Capital. Burn Out: Detection in nursing in Corrientes Capital

El Síndrome de "Burn Out" es un trastorno crónico asociado al inadecuado afrontamiento de las demandas psicológicas del trabajo. OBJETIVOS: Determinar los factores asociados al Síndrome de Burn Out en enfermería tales como carga horaria, servicio, francos semanales, turno, edad y sexo. Reconocer a los individuos en riesgo de padecer el Síndrome de BurnOut. Identificar la prevalencia del Síndrome de Burn Out en el personal de enfermería. Diferenciar el grado de afectación entre los hospitales estudiados analizando así los factores institucionales. MATERIALES Y MÉTODOS: Estudio transversal, descriptivo y analítico. Población: personal de enfermería de dos hospitales de la ciudad de Corrientes. Criterios de Inclusión: Personal de enfermería de cualquier edad, sexo, estado civil, cargo, área, horario o turno que trabajen en el hospital. Criterios de exclusión: Personal de otra labor. RESULTADOS: Se encuestaron un total de 66 enfermeros/as de los diferentes turnos, horarios y áreas. Los únicos factores relacionados estadísticamente entre sí fueron el Turno y la Realización personal. En el Hospital Vidal se encontró una prevalencia de 14,64% del síndrome de Burn Out. En el Hospital Escuela, se obtuvo una prevalencia del 12%. Se identificaron para el Hospital Vidal 5 personas en riesgo de padecer el síndrome y en el Hospital Escuela no se encontraron personas en riesgo. En Hospital Escuela un 40% marcó que nunca los problemas emocionales eran tratados de forma adecuada. En el Hospital Vidal solamente un 22% marcó de la misma manera. CONCLUSIÓN: Se propone seguir con la investigación, tomar acciones y medidas preventivas para evitar el desarrollo del síndrome

The BurnOut syndrome is an adaptive disorder associated to an inadequate coping of psychological demands of work. OBJECTIVES: Determine the factors associated to the BurnOut syndrome in nursery staff such as workload, service, turn, age and gender. Recognize individuals at risk of suffer the BurnOut syndrome. Identify the prevalence of the Burn Out syndrome among the nursery staff. Differentiate the level of affectation between the hospitals in study analyzing the institutional factors. METHODS: Transversal, descriptive and analytic study. The population of study is integrated by the nursery staff of two hospitals of the city of Corrientes, Argentina.Inclusion criteria: nursery staff of any age, gender, civil status, position, area, schedule or turn that work actively on the hospital. Exclusion criteria: other work personnel. RESULTS: We gathered a total of 66 questionnaires from different turns, area and schedules from the hospitals. The only statistically related factors were turn and personal realization. In the J. R. Vidal hospital were found 14.64% of prevalence of BurnOut syndrome. In the Escuela José F. de San Martín hospital was found 12% of prevalence. For the Vidal hospital was identified 5 cases of risk for Burn Out disease and in the Escuela Hospital no risk personnel were found. In the Escuela Hospial 40% of the people feels that the emotional problems never were treated in the right way, on the Vidal Hospital only a 22% feels the same. CONCLUTION: We propose study more the disease, take actions and preventive measures to avoid the syndrome development

Burn Out Among Medical Students - A Study Across Three Medical Colleges in Eastern India.

Burnout is described as a syndrome of emotional exhaustion, and reduced personal accomplishment that may develop when there is significant stress without adequate support and resources in the face of work overload, as commonly happens with physicians and undergraduate medical students. Materials and Methods : This work attempted to study the level of burn out among all the third and fifth semester medical students in three different medical colleges. 596 students from three medical colleges participated in the study wherein they were given standard questionnaires for assessment of stress, support, satisfaction and control parameters. Results : Overall 310 students of the 596 (52.01%) interviewed had scores correlating with burn out. All the colleges across semesters showed burnout in the various parameters individually like stress, lack of support, dissatisfaction, lack of control and perception of success. Conclusions : Individual as well as organizational interventions need to be targeted to prevent burnout among medical students.

Effect of Psychosocial Work Environment and Self-efficacy on Mental Health of Office Workers / 한국직업건강간호학회지

PURPOSE: This study aims to assess the effects of psychosocial work environment and self-efficacy on stress, depression, and burn-out among office workers. METHODS: Survey data were collected from 331 office workers who worked in one workplace from April 10 to 30, 2012. The impact of psychosocial work environment and self-efficacy on stress, depression, and burn-out was analyzed with hierarchical multiple regression using SAS version 9.3. RESULTS: Work-family conflicts and emotional demands were identified as main factors influencing mental health. Other work environment factors influencing mental health were role clarity for stress, possibilities for development, meaning-of work, social support-from supervisors and job insecurity for depression, and social community at work for burn-out. Self-efficacy was correlated with most psychosocial work environment and factor with independent influence on stress and depression. The final models including general characteristics, psychosocial work environment, and self-efficacy accounted for 34%, 44%, and 36% for stress, depression, and burn-out respectively. CONCLUSION: To promote mental health in office workers, there is a need to decrease work-family conflicts and emotional demands and to improve work organization and job contents, social support, and self-efficacy.

La integridad mental del personal clínico de un hospital psiquiátrico, asociada a una alta exigencia emocional y a la organización nociva del trabajo / Mental health integrity of clinical staff at a psychiatric hospital, associated to burn-out toxic management

The Joint Committee on Health at Work make up by: ILO/WHO (International Labour Organization and the World Health Organization) in 1992, recognized that inappropriate management, affects people's health through physiological and psychological mechanisms known as stress. The aim of this study was to evaluate the risks associated to toxic management, and to certain psychological demands; as contributors to mental distress, lack of stress and job dissatisfaction of psychiatrists, vitality psychologists and medical residents of a Child Psychiatric Hospital (CHPH). Material and methods The study design was a cross-sectional survey, descriptive and observational. Instrument: The Copenhagen Psychosocial Questionnaire (The Copenhagen Psychosocial Questionnaire COPSOQ). Originally developed in Denmark, was adapted and validated in Spain. The internal consistency of the scales was Cronbach's a (0.66 to 0.92) and Kappa indices (0.69 to 0.77). Statistical analysis. Descriptive analysis was expressed by means, percentages and standard deviations. Bivariate analysis was calculated between psychosocial factors and dimensions of health. The comparisons between categorical variables were analized through chi square tests, and Fisher's exact test was used when the number of observations in the cells of the contingency table was less than 5. The results were expressed by prevalence ratios and their respective confidence intervals were calculated. Statistical analysis was performed using JMP statistical package version 7 and SPSS version 17. Results A total of 111 clinicians were surveyed: 30 psychiatrists, 46 psychologists and 35 medical residents. The response rate was 97%. The age range of the clinical staff was, from 26 to 65 years, with M=40, SD=6.5 years. Association between psychosocial demands and dimensions of health. Major problems presented by clinical staff, were explained from 3 axes. First axis, about psychological demands. We evaluated five types of psychological demands, but those that emerged as predictors of mental distress, loss of energy and cognitive behavioral stress symptoms, were the emotional demands. Emotional demands had statistically significant associations with mental distress (OR 3.67, 95% CI 1.28-10.01), behavioral symptoms (OR 3.59, 95% CI 1.28-10.06) and cognitive stress (RP 2.15, 95% CI 1.00-5.12) as well as lack of vitality (OR 1.78, 95% CI 1.01-3.13) (table4). Second axis: about quality of leadership, this concept showed statistically significant association with: mental distress (OR 2.83, 95% CI 1.19-6.76), with cognitive symptoms (OR 2.33, 95% CI 1.00-5.60) and behavioral stress (RP 2.24, 95% CI 1.06-4.75) and lack of vitality (OR 1.65, 95% CI 1.06-4.75). Other high-risk concept was: Managers' low social support, that showed statistically significant association with job dissatisfaction (OR 3.08, 95% CI 1.41-6.73), lack of vitality (OR 1.41, 95% CI 1.12-1.78) and mental distress (OR 1.39, 95% CI 1.07-1.81). Within the same second axis of analysis, lack of predictability was significantly associated with: mental distress (OR 2.33, 95% CI 1.40-3.88), behavioral symptoms (OR 2.11, 95% CI 1.31-3.41) cognitive stress symptoms (OR 2.07, 95% CI 1.19-3.61), and lack of vitality (OR 1.63, 95% CI 1.17-2.29). Third axis: the effort-reward imbalance; had a statistically significant association between job insecurity and all dimensions of health such as behavioral symptoms of stress (RP 1.97, 95% CI 1.14-3.41), lack of vitality (RP 1.94, 95% CI 1.23 -3.07), mental distress (RP 1.73, 95% CI 1.04-2.88), and cognitive symptoms of stress (RP 1.39, 95% CI 1.12-1.72). But stronger association was found between insecurity and job dissatisfaction (OR 7.65, 95% CI 1.09-53.75). Hence, the lack of esteem was significantly related to mental distress (OR 2.11, 95% CI 1.12-3.95), with behavioral symptoms of stress (OR 1.82, 95% CI 1.03-3.23), and lack of vitality (OR 1.42, 95% CI 1.00-2.11). Discussion According to Karasek-Theorell's theoretical model, high demands, low control and low social support (the combination of these factors brought together the work of psychiatrists, psychologists and residents) this condition represents the greatest risk to health. Clinical professionals are treated disrespectfully, have no appreciation; causing an effort/reward imbalance in their work. Our results are consistent with research conducted with the same instrument in Sweden, Denmark, Serbia, Germany and Spain. These articles found that psychiatrists and psychologists are exposed to high emotional demands. In contrast a high quality management shows clear relationship to mental well-being, with high vitality and acceptable levels of stress. Our findings show that low social support from managers, increase psychosocial risks and stress findings which are consistent with a Chilean study. Although most participants (except residents) have an acceptable job safety almost eight of every ten respondents claimed to be quite concerned about possible changes or delays in salary, or requiring a second job. Security at work is a fundamental aspect of the model of effort-reward-balance. Lack of this characteristic has a negative impact on human health. The human rights organization in Latin America (HR), found that 33% of latino workers expressed "anxiety" because of job insecurity, furthermore recognized the relationship between job insecurity and an increase in cancer and depression. Latino workers seem to be the most affected by new global order, where employment is based on the informal economy. A poll by the Washington Post, Kaiser Family Foundation and Harvard University affirmed that 33% of latinos expressed "anxiety" by job insecurity, compared with 22% of Afro-American and 20% of white people. Complications in health and life prognosis for these workers and their productivity, affects directly the quality care of the patients, beyond production costs. The Chilean analysis concluded that is necessary to give special attention to health sector working population due to the importance of their work. In conclusion, our results suggest that high emotional demands coupled with a poor quality of leadership, characterized by a highly hierarchical power structure, with low esteem, lack of support and unfair treatment was associated with mental distress, and behavioral symptoms of stress and lack of vitality. The total of these deficiencies and their interaction could potentially cause an effort / reward imbalance in clinician work. From the standpoint of prevention, it is about working there; where the exposures have been identified. The risk factors such as stress need to be controlled from its source: toxic management. It seems relevant to include our proposals, in order to improve organization culture and create healthier environments for the staff, so we recommend: 1) A strategic program to protect health of the hospital staff. 2) To assess and reward the efforts, accomplishments, contributions, results and not permanence. 3) Assign a fair wage according to their preparation and the functions performed. 4) It is necessary that managers and middle managers solve conflict well, plan their job correctly and be able to establish proper communication channels with their subordinates. 5) Promote labor stability. 6) Flexible hours, according to the needs of people and not just production. 7) Working conditions should provide development opportunities and the tasks must be varied and meaningful. 8) Promote teamwork, encourage social support and avoid competition. 9) Strengthen the esteem and recognition, including a promotion plan in terms of expectations of each employee. 10) Eliminate highly hierarchical power structures.

El objetivo de esta investigación fue evaluar los riesgos asociados a las formas nocivas de la organización del trabajo, que unidas a ciertas exigencias psicosociales coadyuvan en la génesis del malestar mental, la falta de vitalidad, el estrés y la insatisfacción laboral de los psiquiatras, psicólogos y residentes del Hospital Psiquiátrico Infantil (HPI). Material y métodos El diseño del estudio fue observacional, transversal y descriptivo. Instrumento. El Cuestionario Psicosocial de Copenhague (The Copenhagen Psychosocial Questionnaire CoPsoQ). El instrumento original de origen danés fue adaptado y validado en España, mostrando tener validez y fiabilidad contrastada, con a de Cronbach (0.66 a 0.92) e índices de Kappa (0.69 a 0.77). Resultados Participaron 111 profesionistas, de los cuales 30 son psiquiatras, 46 psicólogos y 35 médicos residentes. Se obtuvo una respuesta del 97%. La edad mínima del personal clínico se ubicó entre 26 a 35 y la máxima de 56 a 65 años, con una M= 40, DE=6.5 años. Asociación entre las exigencias psicosociales y las dimensiones de salud. Los problemas más apremiantes que presentó el personal clínico se explican a partir de tres ejes. Primer eje, de las exigencias psicológicas: las de tipo emocional tuvieron asociaciones estadísticamente significativas con el malestar mental (RP 3.67, IC95% 1.2810.01), con los síntomas conductuales (RP 3.59, IC95% 1.28-10.06) y cognitivos del estrés (RP 2.15, IC95% 1.00-5.12) así como con la falta de vitalidad (RP 1.78, IC95% 1.01-3.13). El segundo eje, de la calidad de liderazgo: mostró asociación estadísticamente significativa con: el malestar mental (RP 2.83, IC95% 1.19-6.76), con los síntomas cognitivos (RP 2.33, IC95% 1.00-5.60) y los conductuales del estrés (RP 2.24, IC95% 1.06-4.75) y con la falta de vitalidad (RP 1.65, IC95% 1.06-4.75). El escaso apoyo social por parte de los jefes, mostró asociación estadísticamente significativa con la insatisfacción laboral (RP 3.08, IC95% 1.41-6.73), la falta de vitalidad (RP 1.41, IC95% 1.12-1.78) y el malestar mental (RP 1.39, IC95% 1.071.81). Dentro del segundo eje de análisis, la falta de previsibilidad mostró asociación estadísticamente significativa con: el malestar mental (RP 2.33, IC95% 1.40-3.88), con los síntomas conductuales (RP 2.11, IC95% 1.31-3.41) y con los síntomas cognitivos del estrés (RP 2.07, IC95% 1.19-3.61), así como con la falta de vitalidad (RP 1.63, IC95% 1.17-2.29). Tercer eje, del equilibrio esfuerzo-recompensa: se observó asociación estadísticamente significativa entre la inseguridad laboral y todas las dimensiones de salud (síntomas conductuales del estrés (RP 1.97, IC95% 1.14-3.41); falta de vitalidad (RP 1.94, IC95% 1.23-3.07); malestar mental (RP 1.73, IC95% 1.04-2.88) y síntomas cognitivos del estrés (RP 1.39, IC 95% 1.12-1.72). Sin embargo, la asociación de mayor fuerza se observó entre la inseguridad y la insatisfacción laboral (RP 7.65, IC95% 1.09-53.75). Por lo que se refiere a la falta de estima, ésta se asoció en forma significativa con el malestar mental (RP 2.11, IC 95% 1.12-3.95), con los síntomas conductuales del estrés (RP 1.82, IC95% 1.03-3.23) y con la falta de vitalidad (RP 1.42, IC95% 1.00-2.11). Discusión La existencia de la organización nociva en el hospital se explica por medio del modelo demanda-control-apoyo social, en donde los clínicos se exponen a una alta demanda emocional, falta de control y autonomía en el trabajo, aunado a un bajo apoyo social. Esta condición representa la situación de mayor riesgo para su salud. La carencia de respeto, la falta de reconocimiento y el trato injusto podrían ser el origen de un desequilibrio en el esfuerzo-recompensa del trabajo clínico. La pobre calidad de liderazgo, caracterizada por una estructura organizacional y de poder altamente jerarquizada, sumada a la falta de apoyo social, a la inseguridad laboral y a la falta de previsibilidad están afectando de forma muy importante la salud mental de los clínicos del HPI al crear un clima organizacional negativo que contribuye al ausentismo, a la baja productividad y muy probablemente perturba la calidad de la atención a los pacientes. Es necesario, por esto, proteger la integridad mental del personal del hospital.

Trabajar mejor para trabajar mejor: ¿Se discute la problemática profesional en el Congreso Argentino de Cardiología? ¿Se ocupa el médico de esta problemática? / Better Work, Working Better: Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem? / Better Work, Working Better: Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem?

Introducción Los grandes cambios producidos en las dos últimas décadas en las reglas laborales en salud, los estilos de trabajo, la organización sanitaria, el uso y la importancia de la tecnología y en la consideración social acerca del profesional médico tienen causas complejas y multifactoriales; las mismas presentan elementos comunes como el empeoramiento de la remuneración que perciben los médicos, la disminución absoluta y relativa de los honorarios profesionales y la percepción del médico respecto de su propia profesión y marcan una realidad que exige reconsiderar el lugar del médico en sus nuevos escenarios de trabajo. Objetivos Definimos como "problemática médica" a toda vivencia o situación problemática que experimenta el médico durante el ejercicio de su actividad. Sobre el tema existen abundantes datos y opiniones en los últimos años referidos a la insalubre situación laboral del médico y a la propia percepción negativa sobre su tarea. El objetivo de presente trabajo fue explorar si la problemática médica era tratada en el Congreso Argentino de Cardiología. Material y métodos Estudio observacional, descriptivo, sobre la existencia de temas libres y mesas sobre problemática médica en los últimos tres Congresos Argentinos de Cardiología y su ubicación temática. Algunas de las palabras clave fueron: realidad laboral, trabajo médico, burn out, bioética, ética, condiciones de trabajo y otras. Resultados Hubo en total 2254 temas libres en los tres años, de los cuales 8 (0,35%) trataron sobre elementos de problemática médica. Los temas libres se ubicaron en las categorías "miscelánea", psicosociales, educación médica o salud pública. Hubo 13 mesas, organizadas por el Comité de Bioética, el Área de Investigación de la Sociedad Argentina de Cardiología, CONAREC y la Fundación Cardiológica Argentina. Conclusiones En el período estudiado hubo una proporción muy escasa de mesas y temas libres dirigidos a la problemática médica, estos últimos sin un marco conceptual preestablecido adecuado. Así, la problemática médica no es considerada un objeto de estudio relevante. Es conveniente la discusión e investigación para la búsqueda de planteos y soluciones a múltiples niveles, o no podrá hacerse un diagnóstico y tratamiento del tema, con las eventuales y enormes implicaciones futuras potenciales.

Background The big changes produced during the last two decades have produced a reality that requires physicians to reconsider the role they play in their new working scenario. These changes include regulations in health care working, work styles, health organization, use and importance of technology and how the physician is socially considered. The causes are complex and multifactorial, yet they share common elements as worse payment to physicians, an absolute and relative reduction in professional fees and physicians' perception about their own profession. Objectives A "medical problem" is defined as any problematic experience or situation felt by a physician during his/her practice. In the last years, there are plenty of information and several opinions about this matter, in reference to the working conditions of physicians and to their negative self-perception about medical practice. The goal of the present study was to explore if the Argentine Congress of Cardiology dealt with the medical problem. Material and Methods Observational and descriptive study about open-topic sessions and roundtable sessions dealing with the medical problem -and under which field the medical problem was considered- during the past/latest three Argentine Congresses of Cardiology. The following key words were used: working reality, medical practice, burnout, bioethics, ethics and working conditions, among others. Results Of 2254 open topics presented in the three years, 8 (0.35%) dealt with the medical problem. The open topics were considered under "miscellany", psychosocial, medical education or public health fields. Thirteen roundtable sessions were identified and organized by the Committee on Bioethics, the Research Area of the Argentine Society of Cardiology, the CONAREC and the Argentine Cardiology Foundation. Conclusions We found very few roundtable sessions and opened-topic sessions -and without an adequate preestablished conceptual framework- focused on the medical problem. Thus, the medical problem is not considered an important topic of study. Discussion and investigation are convenient to search for arguments and solutions at multiple levels, otherwise it will not be possible to make a diagnosis and treatment of the topic, with the eventual and important future implications.

A study of the significance of death conferences in the palliative care unit : through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore

When patients hospitalized in a palliative care unit die, particularly when their deaths were not peaceful ones, we, as health professionals, feel distressed, senses of helplessness and defeat, and even regret. However, busy daily clinical practice usually does not allow us to express these feelings. After going through such an experience repeatedly, your self-efficacy may be reduced and you could feel burned out. In this study, through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore, a death conference was organized for us, health professionals who had been directly concerned with the patient, to discuss questions, conflicts, and dilemmas that arose when we provided care and express feelings that had been repressed. And other participants in the conference, who had not been directly concerned with the patient, gave their affirmative views. The conferences served to: (1) promote mutual understanding, trustful relationships, and teamwork among us, (2) increase our awareness of palliative care, and (3) allow us to cope with stress and prevent us from feeling burned out. These effects are considered to help implement improved health care. In the former part of the conference remarks were divided into three categories, (1) regret, (2) questions, conflicts, and dilemmas, and (3) senses of helplessness and defeat, and in the latter part affirmative views were mainly stated.

Correlación de Calidad de vida-satisfacción y niveles de burn out en cajeros de supermercados de Asunción / Correlation of quality of life-satisfaction and levels of burn-out in supermarket cashiers Asunción

La presente investigación de tipo no experimental-correlacional, busca conocer la relación existente entre Calidad de Vida - Satisfacción y niveles de Síndrome de Burn Out en cajeros de supermercados de la ciudad de Asunción. La muestra está compuesta por cajeros de supermercado de la ciudad de Asunción, seleccionados a través de una técnica no probabilística de muestreo intencional y de participación voluntaria. Los instrumentos aplicados son el Cuestionario de Calidad de vida y Satisfacción de Endicott y el Inventario Maslach de Burn Out. El análisis y procesamiento de los datos aplicó técnicas de estadística descriptiva e inferencial. Los objetivos propuestos se alcanzaron y se sugiere el estudio de otras muestras de trabajadores tanto de ámbitos públicos como privados, sus condiciones de trabajo o variables psicológicas relacionadas a los mismos y aportar resultados importantes para desarrollar políticas de salud laboral.

This non-experimental research and correlational study, seeks to understand the relationship between quality of life - satisfaction and levels of Burn Out Syndrome in supermarket cashiers in the city of Asuncion. The sample consists of supermarket cashiers in Asuncion, selected through a probability, not intentional sampling technique, and considering voluntary participation. The applied instruments were the Quality of Life Questionnaire and Satisfaction of Endicott and the Inventory Maslach Burn Out. The analysis and data processing techniques used descriptive and inferential statistics.

Agentes de prevención de comportamientos autodestructivos en la escuela: acerca del malestar docente / Prevention agents of self-destructive behaviorschool

El escrito presenta una reflexión basada en la contribución de algunos autores sobre el tema del malestar docente y su potencial relación con la prevención de comportamientos autodestructivos en el ámbito escolar. Se registran algunos comentarios de docentes hechos en talleres durante el año lectivo 2008, a partir de los cuales se plantea el desafío del docente de educar en la posmodernidad convirtiéndose él mismo en preventor de comportamientos autodestructivos, tanto para sí mismo como para sus estudiantes. Se explora asimismo el concepto de Burn Out como una forma de expresión del malestar docente y se concluye con algunas sugerencias para evitar el desgaste en docentes, con lo que de forma indirecta, se estaría previniendo comportamientos autodestructivos en las escuelas.

The writing presents an analysis based on the contribution of several authors on the topic of teacher discomfort and its relation to the prevention of self-destructive behaviors in schools. Some comments of teachers registered during school year 2008 were relevated and analyzed. This conduces to the challenge of teaching in the postmodern era, becoming (the teacher) a preventive actor, for himself and for his students. There is also some thought dedicated to the concept of Burn Out, as one of the possible expressions of discomfort. The article concludes with some suggestions to avoid the Burn Out Syndrome in teachers. This will indirectly help to prevent self-destructive behaviors in schools.

A Study of Emergency Room Nurses' Burn-out, Nursing Performance, and Professional Identity / 산업간호학회지

This study was done to examine ER nurses' burn-out, as an understanding in the relationship of nursing performance and professional identity. The subjects of the study were nurses working in the emergency room of the general hospital with over 300 beds, located in D metropolitan city and C city. The self-report questionnaires were administered and 120 were collected. For the data analysis, SPSS WIN 12.0 was used. ER nurses' burn-out was 2.99, the mean of nursing performance was 3.69, and professional identity was 3.51. The extent of ER nurses' burn-out showed significantly negative correlation with the extent of nursing performance(r=-.257), along with professional identity(r=-.192). While ER nurses' nursing performance showed significantly positive correlation with professional identity(r=.696). In conclusion, the higher professional identity, the fewer ER nurses experienced burn-out, and the higher extent of nursing performance was obtained. It is necessary to create activities and programs to reduce and prevent burn-out.

A Case Complicated with Collagen Disease Related with SLE during Hemodialysis / 日本農村医学会雑誌

A 60-year-old man who developed a nephrotic syndrome underwent a renal biopsy, and the case was diagnosed as membranoproliferative glomerulonephritis (MPGN). Despite chemotherapy using steroid, immunosuppresive and anticoagulant drugs, the patient exhibited persistently high urinary protein levels (above 8 g/day), and the renal function deteriorated gradually.<BR>One and half years later, hemodialysis was started, but soon he had a high fever (above 38-40°C). Laboratory data revealed high levels of both antinuclear antibody titer and immune complex (IC) titer, and a low level of CH50.<BR>Considering an active collagen disease like SLE, steroid pulse therapy and plasma exchange were instituted. The therapy was very effective this time.<BR>It is well known that many patients with SLE and a long term history of hemodialysis develop a condition of so called “burn out” in which the activity of SLE declined to allow the withdrawal of steroid therapy. Also well known is the developement of hypocomplementemia in many patients with MPGN.<BR>In our case, it was difficult to clarify what caused the high fever and other clinical symptoms. We must carefully observe the clinical symptoms of SLE.