Burnout at the hospital: Healthcare workers coping with COVID-19 stress

Freitas, Maria Fernanda Marciano Barros de; Enumo, Sônia Regina Fiorim; Machado, Wagner de Lara; Messias, João Carlos Caselli; Mendes, Elisa Donalísio Teixeira

doi:10.1590/1982-0275202340e220097

Maria Fernanda Marciano Barros de Freitas

conception and design

analysis, interpretation of data

discussion of results

review

approval of the final version of the article

Pontifícia Universidade Católica de Campinas (PUC-Campinas), Escola de Ciências da Vida, Programa de Pós-Graduação em Ciências da Saúde. Campinas, SP, Brasil.

https://orcid.org/0000-0002-1578-2709

Sônia Regina Fiorim Enumo

conception and design

analysis, interpretation of data

discussion of results

review

approval of the final version of the article

Pontifícia Universidade Católica de Campinas (PUC-Campinas), Escola de Ciências da Vida, Programa de Pós-Graduação em Psicologia. Campinas, SP, Brasil.

https://orcid.org/0000-0001-9038-6151

Wagner de Lara Machado

conception and design

analysis, interpretation of data

discussion of results

review

approval of the final version of the article

Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Vida e da Saúde, Programa dePós-Graduação em Psicologia. Porto Alegre, RS, Brasil.

https://orcid.org/0000-0001-5555-5116

João Carlos Caselli Messias

analysis, interpretation of data

discussion of results

review

approval of the final version of the article

Pontifícia Universidade Católica de Campinas (PUC-Campinas), Escola de Ciências da Vida, Programa de Pós-Graduação em Psicologia. Campinas, SP, Brasil.

https://orcid.org/0000-0002-6487-4407

Elisa Donalísio Teixeira Mendes Correspondence to: E. D. T. MENDES.E-mail: elisa.mendes@puc-campinas.edu.br.

conception and design

analysis, interpretation of data

discussion of results

review

approval of the final version of the article

Pontifícia Universidade Católica de Campinas (PUC-Campinas), Escola de Ciências da Vida, Programa de Pós-Graduação em Ciências da Saúde. Campinas, SP, Brasil.

https://orcid.org/0000-0003-4251-8185

Correspondence to: E. D. T. MENDES.E-mail: elisa.mendes@puc-campinas.edu.br.

Editor

Raquel Souza Lobo Guzzo

Conflict of interest

The author declare they have no conflicts of interest.

BAT-23 Dimensions^(a) (a) BAT-23 Dimensions (Schaufeli et al., 2019): Exhaustion: severe loss of energy that results in feelings of both physical (tiredness, feeling weak) and mental (feeling drained and worn-out) exhaustion; e.g.: lack of energy to start new work, feeling completely used-up after a whole day of working, feeling tired quickly even after spending minimal effort at work, and inability to relax after work; Mental distance: strong reluctance or aversion to work; one withdraws mentally – and sometimes even physically – from work and avoids contact with others as customers, clients, and colleagues. Indifferent and cynical attitude; little or no enthusiasm and interest for the work; one functions largely on autopilot; Emotional impairment: intense emotional reactions and feeling overwhelmed by one’s emotions; e.g.: feeling frustrated and angry at work, irritability, overreacting, feeling upset or sad without knowing why, and feeling unable to control one’s emotions at work; Cognitive impairment: memory problems, attention and concentration deficits and poor cognitive performance; e.g.: difficulties to think clearly and learn new things at work, being forgetful and absent-minded, indecision, poor memory, attention and concentration deficits, and trouble staying focused at work;		N (%)	National mean^(b) (b) Percentile calculated in relation to the mean of the studied sample; P95 = very high, P75 = high, P25 = medium, P25 = lower (Sinval et al., 2022);	M (SD)	Min	P₂₅	Mdn	P₇₅	Max
Exhaustion		181	2.87 (0.8)	2.53 (0.8)	1.0	1.88	2.5	3.0	5.0
Mental distance		181	1.93 (0.8)	1.60 (0.6)	1.0	1.0	1.4	2.0	4.0
Emotional Impairment		181	1.97 (0.8)	1.76 (0.6)	1.0	1.2	1.8	2.0	3.6
Cognitive Impairment		181	2.19 (0.8)	1.69 (0.61)	1.0	1.2	1.6	2.0	5.0
Overall score		–	2.32 (0.7)	1.9 (0.55)	1.0	1.5	1.8	2.25	3.8
Classification^(c) (c) BAT-23 Classification - No distress: < 2.59 points; Risk of burnout: ≥ 2.59 and < 3.02; Probable Burnout: ≥ 3.02.
	No distress	161 (89.0)
	Risk of Burnout	12 (6.6)
	Probable Burnout	8 (4.4)
Total		181 (100)

Note:
^(a)
BAT-23 Dimensions (Schaufeli et al., 2019Schaufeli, W. B., De Witte, H., & Desart, S. (2019). Burnout Assessment Tool (BAT) – Test Manual [Unpublished report]. Belgium.): Exhaustion: severe loss of energy that results in feelings of both physical (tiredness, feeling weak) and mental (feeling drained and worn-out) exhaustion; e.g.: lack of energy to start new work, feeling completely used-up after a whole day of working, feeling tired quickly even after spending minimal effort at work, and inability to relax after work; Mental distance: strong reluctance or aversion to work; one withdraws mentally – and sometimes even physically – from work and avoids contact with others as customers, clients, and colleagues. Indifferent and cynical attitude; little or no enthusiasm and interest for the work; one functions largely on autopilot; Emotional impairment: intense emotional reactions and feeling overwhelmed by one’s emotions; e.g.: feeling frustrated and angry at work, irritability, overreacting, feeling upset or sad without knowing why, and feeling unable to control one’s emotions at work; Cognitive impairment: memory problems, attention and concentration deficits and poor cognitive performance; e.g.: difficulties to think clearly and learn new things at work, being forgetful and absent-minded, indecision, poor memory, attention and concentration deficits, and trouble staying focused at work;
^(b)
Percentile calculated in relation to the mean of the studied sample; P⁹⁵ = very high, P75 = high, P²⁵ = medium, P²⁵ = lower (Sinval et al., 2022Sinval, J., Vazquez, A., Hutz, C., Schaufeli, W., & Silva, S. (2022). Burnout Assessment Tool (BAT): validity evidence from Brazil and Portugal. International Journal of Environmental Research and Public Health, 19(3), 1344. https://doi.org/10.3390/ijerph19031344
https://doi.org/10.3390/ijerph19031344... );
^(c)
BAT-23 Classification - No distress: < 2.59 points; Risk of burnout: ≥ 2.59 and < 3.02; Probable Burnout: ≥ 3.02.
All means are below the national mean, but within the SD (Sinval et al., 2022Sinval, J., Vazquez, A., Hutz, C., Schaufeli, W., & Silva, S. (2022). Burnout Assessment Tool (BAT): validity evidence from Brazil and Portugal. International Journal of Environmental Research and Public Health, 19(3), 1344. https://doi.org/10.3390/ijerph19031344
https://doi.org/10.3390/ijerph19031344... ).

Stressors from the COVID-19 Coping Scale		N	1 - Not stressful	2 - Somewhat stressful	3 - Stressful	4 - Very stressful	M (SD)
Stressors from the COVID-19 Coping Scale		N	n (%)	n (%)	n (%)	n (%)	M (SD)
Disease
	a. Risk of getting sick	179	11 (6.1)	55 (30.7)	74 (41.3)	39 (21.8)	2.79 (0.85)
	b. Risk of hospitalization	179	15 (8.4)	37 (20.7)	51 (28.5)	76 (42.5)	3.05 (0.98)
	c. Risk of transmitting COVID-19 to friends and family due to my exposure at work	179	6 (3.4)	20 (11.2)	45 (25.1)	108 (60.3)	3.42 (0.82)
	d. Conflicting news and information about the disease, its treatment, and isolation	130	8 (6.2)	47 (36.2)	46 (35.4)	29 (22.3)	2.74 (0.88)
Mean - disease (mean % of 4 items = 24.4)		–	10 (6.0)	39.7 (22.2)	54 (32.6)	63 (36.7)	–
Family
	e. Risk of worsening my financial situation during this pandemic period	180	20 (11.1)	62 (34.4)	50 (27.8)	48 (26.7)	2.7 (0.9)
	f. Not being able to maintain my routine	179	20 (11.2)	53 (29.6)	59 (33.0)	47 (26.3)	2.7 (0.9)
	g. Risk of being separated from the people I love due to quarantines	177	7 (4.0)	36 (20.3)	46 (26.0)	88 (49.7)	3.2 (0.9)
Mean - family (mean % of 3 items = 24.9)		–	7.6 (8.7)	26.1 (28.1)	28.2 (28.9)	38.1 (34.2)	–
Work
	h. Lack of structure and adequate safety equipment	180	38 (21.1)	56 (31.1)	40 (22.2)	46 (25.6)	2.52 (1.09)
	i. Increased workload	179	30 (16.8)	54 (30.2)	57 (31.8)	38 (21.2)	2.58 (1.00)
	j. Risk of making a mistake while performing a procedure	179	20 (11.2)	52 (29.1)	60 (33.5)	47 (26.3)	2.75 (0.97)
	k. Lack of adequate and accessible emotional support	180	45 (25.0)	66 (36.7)	43 (23.9)	26 (14.4)	2.28 (1.00)
	l. Lack of understanding and discrimination from the public about my work	178	37 (20.8)	58 (32.6)	43 (24.2)	40 (22.5)	2.48 (1.06)
Mean - work (mean % of 5 items = 24.9)		–	34.0 (18.9)	57.2 (31.9)	48.6 (27.1)	39.4 (22.0)	–
Total = 2,023 (%)		–	257 (12.7)	596 (29.4)	538 (26.6)	632 (31.2)	2.77 (0.66)
Perceived Control of the Situation		166	None	A Little Bit	Some	A lot	2.98 (0.82)
Perceived Control of the Situation		166	8 (4.8)	33 (19.9)	79 (47.6)	46 (27.7)	2.98 (0.82)

BPN/ Coping with COVID-19 stress		N	1 - Never	2 - Sometimes	3 - Most of the times	4 - Almost always	5 - Always	M (SD)
BPN/ Coping with COVID-19 stress		N	n (%)	n (%)	n (%)	n (%)	n (%)	M (SD)
Perception of Challenge
Relatedness
	1. Do you think you can handle this stressful situation by yourself, by regulating your behavior and emotions? (Self-comforting)	176	1 (0.6)	35 (19.9)	53 (30.1)	50 (28.4)	37 (21.0)	3.49 (1.05)
	2. Do you seek any kind of instrumental or emotional support to deal with this situation? (Support-seeking)	176	70 (39.8)	65 (36.9)	16 (9.1)	12 (6.8)	13 (7.4)	2.05 (1.2)
Competency
	5. Do you strive to solve the problems that arise during the pandemic, make plans, get organized? (Problem-solving)	176	3 (1.7)	16 (9.1)	47 (26.7)	42 (23.9)	68 (38.6)	3.89 (1.08)
	6. Have you been seeking information, reading, asking questions about the disease, about treatment, about self-care during the COVID-19 pandemic? (Information-seeking)	174	4 (2.3)	19 (10.9)	31 (17.8)	27 (15.5)	93 (53.4)	4.07 (1.17)
Autonomy
	9. Do you handle this situation well, try to distract yourself or interpret what happens differently? (Accommodation)	175	11 (6.3)	55 (31.4)	48 (27.4)	35 (20)	26 (14.9)	3.06 (1.17)
	10. Do you try to negotiate your ideas with colleagues and management when dealing with problems? (Negotiation)	174	15 (8.6)	43 (24.7)	42 (24.1)	34 (19.5)	40 (23.0)	3.24 (1.29)
Total adaptive WC = 1,051 (%)		-	104 (9.9)	233 (22.1)	237 (22.5)	200 (19.0)	277 (26.3)	3.62 (0.72)
Perception of threat
Relatedness
	3. To deal with the stress of the COVID-19 pandemic, would you rather let others decide or do something for you? (Delegation)	176	124 (70.5)	47 (26.7)	3 (1.7)	1 (0.6)	1 (0.6)	1.34 (0.6)
	4. Have you been emotionally distancing yourself from other people, avoiding them or becoming insensitive or paralyzed in those moments? (Social Isolation)	177	81 (45.8)	75 (42.4)	5 (2.8)	9 (5.1)	7 (4.0)	1.79 (1,0)
Competency
	7. Do you believe there’s nothing you can do, feel confused and exhausted, lacking the energy to deal with the COVID-19 pandemic? (Helplessness)	176	67 (38.1)	80 (45.5)	14 (8.0)	11 (6.2)	4 (2.3)	1.89 (0.95)
	8. Are there times when you feel like physically or mentally escaping from this situation, or even denying that it is so serious, thinking that soon everything will be solved? (Escape)	174	52 (29.9)	78 (44.8)	19 (10.9)	17 (9.8)	8 (4.6)	2.14 (1.09)
Autonomy
	11. During this period, do you constantly think about and remember the bad aspects of the situation? (Submission)	174	27 (15.5)	92 (52.9)	26 (14.9)	14 (8)	15 (8.6)	2.41 (1.11)
	12. Do you feel angry about the situation? (Opposition)	128	30 (23.4)	55 (43.0)	16 (12.5)	13 (10.2)	14 (10.9)	2.42 (1.26)
Total maladaptive WC = 977 (%)		–	381 (39.0)	427 (43.7)	83 (8.5)	37 (3.8)	49 (5.0)	2.0 (0.64)

Predictors		Coefficient	Standard error	p-value
Predictors kept after stepwise selection for Burnout
	Intercept	-0.67	10.33	.0.05
	Has a religious belief	-0.22	0.11	.0.05
	Has more than one job	-0.15	10.08	.0.06
	Nurse/Technician	-0.30	0.12	.0.02
	Physiotherapist	-0.31	0.17	0.07
	Physician	- 0.62	0.14	.0.00
	In psychiatric care	- 0.54	10.22	0.01
	COVID-19 Stress Score	-0.17	10.06	.0.00
	Adaptive Coping	-0.10	10.05	0.07
	Maladaptive Coping	-0.29	10.06	.0.00
Predictors kept after stepwise selection for COVID-19 stress
	Intercept	- .1.53	0.19	.0.00
	Male	-0.24	10.09	0.01
	Education: Undergraduate/ Graduate	-0.16	10.09	0.07
	Number of risk contexts	- 0.06	10.03	0.04
	Burnout Score	-0.32	10.09	.0.00
	Maladaptive Coping	- 0.30	10.07	.0.00

[1] Correspondence to: E. D. T. MENDES.E-mail: elisa.mendes@puc-campinas.edu.br.

Brasil

Brasil

Burnout at the hospital: Healthcare workers coping with COVID-19 stress

Burnout no hospital: enfrentamento do estresse da COVID-19 por trabalhadores da saúde

Abstract

Objective

Method

Results

Conclusion