Burnout entre médicos intensivistas ou Sociedade do burnout

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Abstract

Resumo Os médicos que atuam em unidades críticas são propensos a exaustão emocional, manifestações de despersonalização e insatisfação profissional. Essas três manifestações compõem o que foi identificado como burnout e são motivo de crescente preocupação. Neste artigo, os autores revisam a literatura disponível sobre o burnout entre os médicos intensivistas, mas discutem-no sob uma ótica que inclui o problema em uma manifestação mais ampla, relacionada ao culto do desempenho e à subsunção da vida ao capital, entendendo esse fenômeno como relacionado com a sociedade do burnout. Também se discutem iniciativas para combater esse quadro na perspectiva de uma visão ampliada do conceito de biopolítica, especialmente a psicopolítica.

Translated abstract

Abstract Physicians who work in critical care units are prone to emotional exhaustion, manifestations of depersonalization, and professional dissatisfaction. These three manifestations make up what has been identified as burnout, and are a cause for growing concern. In this article, the authors review the available literature on burnout among intensive care physicians, but discuss it from a perspective that includes burnout as a broader manifestation, related to the exaltation of performance and the subsumption of life to capital, understanding this phenomenon as related to the society of burnout. The authors also discuss initiatives to combat burnout from the perspective of an expanded view of the concept of biopolitics, especially psychopolitics.

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Most cited references 31

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Job burnout.

C Maslach, W. Schaufeli, M. P. Leiter (2001)

Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy. The past 25 years of research has established the complexity of the construct, and places the individual stress experience within a larger organizational context of people's relation to their work. Recently, the work on burnout has expanded internationally and has led to new conceptual models. The focus on engagement, the positive antithesis of burnout, promises to yield new perspectives on interventions to alleviate burnout. The social focus of burnout, the solid research basis concerning the syndrome, and its specific ties to the work domain make a distinct and valuable contribution to people's health and well-being.

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Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians.

Michael Krasner, Ronald M Epstein, Howard Beckman … (2009)

Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce. To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients. Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Delta], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Delta = -6.8; 95% CI, -4.8 to -8.8; depersonalization, 8.4 to 5.9; Delta = -2.5; 95% CI, -1.4 to -3.6; and personal accomplishment, 40.2 to 42.6; Delta = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Delta = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Delta = -4.1; 95% CI, -1.8 to -6.4); total mood disturbance (33.2 to 16.1; Delta = -17.1; 95% CI, -11 to -23.2), and personality (conscientiousness, 6.5 to 6.8; Delta = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Delta = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = -0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = -0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001). Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.

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Job satisfaction among nurses: a literature review.

Hong Lu, Alison E While, K Louise Barriball (2005)

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any health-care delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction. This paper analyses the growing literature relating to job satisfaction among nurses and concludes that more research is required to understand the relative importance of the many identified factors to job satisfaction. It is argued that the absence of a robust causal model incorporating organizational, professional and personal variables is undermining the development of interventions to improve nurse retention.

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Author and article information

Contributors

Edison Moraes Rodrigues Filho: Role: ND

José Roque Junges: Role: ND

Journal

Journal ID (publisher-id): sausoc

Title: Saúde e Sociedade

Abbreviated Title: Saude soc.

Publisher: Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. (, SP, Brazil )

ISSN (Print): 0104-1290

ISSN (Electronic): 1984-0470

Publication date (Print and electronic): September 2018

Volume: 27

Issue: 3

Pages: 809-819

Affiliations

[1] São Leopoldo Rio Grande do Sul orgnameUniversidade do Vale do Rio dos Sinos orgdiv1Programa de Pós-Graduação em Saúde Coletiva Brazil efilho@ 123456hcpa.edu.br

[2] São Leopoldo Rio Grande do Sul orgnameUniversidade do Vale do Rio dos Sinos orgdiv1Programa de Pós-Graduação em Saúde Coletiva Brazil roquejunges@ 123456hotmail.com