Relação da satisfação no trabalho, depressão e síndrome de Burnout na cultura de segurança do paciente: estudo transversal com análise de modelagem por equações estruturais
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Data
2018-03-20
Autores
Oliveira, Alan Maicon de
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Universidade Estadual Paulista (Unesp)
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Introdução: Evidências fazem-se necessárias para fortalecer a teoria de que as condições organizacionais e os fatores psicossociais refletem na segurança dos cuidados prestados em serviços de saúde. Objetivo: Avaliar se a cultura de segurança do paciente relaciona-se com a satisfação no trabalho, com depressão e com síndrome de Burnout entre profissionais do âmbito hospitalar. Método: Trata-se de um estudo transversal, realizado entre agosto a novembro de 2016 em um hospital de ensino que é referência na assistência à saúde para 13 cidades da região noroeste do Estado de São Paulo. O critério de inclusão envolveu todos os trabalhadores com vínculo empregatício maior ou igual a três meses. Excluíram-se os indivíduos em aviso prévio, sob licença médica/afastamento ou que estavam em gozo de período de férias. A partir da relação com os 677 profissionais que trabalhavam no hospital, os participantes foram recrutados por amostragem probabilística aleatória. Conduziu-se coleta de dados por meio de instrumentos psicométricos para analisar a satisfação no trabalho (Job Satisfaction Survey – JSS), presença de depressão (Patient Health Questionnaire-9) e síndrome de Burnout (Maslach Burnout Inventory – MBI), bem como a relação desses fatores com a cultura de segurança do paciente (Safety Attitudes Questionnaire – SAQ). Análises ajustadas (multivariadas) foram executadas e calculou-se a razão de prevalência (RP) por meio de uma regressão de Poisson. O coeficiente de correlação de Pearson (r) e a modelagem de equações estruturais com mínimos quadrados parciais (PLS-SEM) foram utilizados para análise. Padronizou-se o intervalo de confiança a 95% (IC 95%) e o nível de significância em 5%. Resultados: Dos 305 profissionais selecionados, 271 compuseram a amostra final deste estudo (88,9%). Mulheres (78,6%), idades entre 36-50 anos (42,1%), equipe de enfermagem (46,1%) e 5-10 anos de atuação na área (27,3%), foram as características mais frequentes. A pontuação média do SAQ foi de 68,2 (IC 95%: 65,8-70,5), que demonstra nível de cultura de segurança abaixo do ideal. Os indivíduos com tempo de atuação profissional entre 11-20 anos expressaram percepção mais negativa da cultura de segurança em relação aqueles com menos de um ano no cargo (p=0,05). O JSS definiu neutralidade na satisfação com o trabalho, com pontuação média de 131,2 (IC 95%: 128,1-134,3). Trabalhadores do apoio técnico do hospital revelaram níveis de satisfação mais elevados do que os profissionais de saúde (p=0,02). A prevalência de depressão foi 22,1% (IC 95%: 17,2-27,1%). Os sujeitos categorizados no estrato socioeconômico D-E (renda média domiciliar mais baixa) apresentaram duas vezes mais prevalência de depressão em comparação com os da classe A (RP=2,84; IC 95%: 1,24-6,51; p=0,01). O esgotamento profissional foi apresentado em 14,8% (IC 95%: 10,5-19%) dos participantes e os homens manifestaram síndrome de Burnout aproximadamente duas vezes mais do que as mulheres (RP=1,98; IC 95%: 1,03-3,79; p=0,04). A PLS-SEM confirmou a relação da satisfação no trabalho e a ausência de síndrome de Burnout como aspectos preditivos da cultura de segurança do paciente (p <0,001). Ademais, a correlação com a variável depressão foi estatisticamente insignificante (p=0,06). Conclusão: A percepção da cultura de segurança do paciente está relacionada com a satisfação no trabalho e a síndrome de Burnout nos profissionais hospitalares. Tais achados sugerem que fatores psicossociais influenciam na qualidade e segurança dos cuidados prestados por trabalhadores da área da saúde.
Introduction: Evidence is needed to support the theory that organizational conditions and psychosocial factors reflect on the safety of care provided in health services. Objective: To evaluate if patient safety culture is related to job satisfaction, depression and burnout syndrome among professionals in the hospital setting. Method: This is a cross-sectional study conducted between August and November 2016 in a reference teaching hospital for 13 cities in the Northwest region of the State of São Paulo. Inclusion criteria were all workers with an employment bonding time greater than or equal to three months. Individuals on notice, under medical leave or on vacation were excluded. From the list of 677 professionals who worked at the hospital, participants were recruited by random probabilistic sampling. Data were collected through psychometric instruments to analyze job satisfaction (Job Satisfaction Survey – JSS), the presence of depression (Patient Health Questionnaire-9), and burnout syndrome (Maslach Burnout Inventory – MBI), as well as the relationship between these factors with patient safety culture (Safety Attitudes Questionnaire – SAQ). Adjusted (multivariate) analyzes were performed and the prevalence ratio (PR) was calculated using a Poisson regression. Pearson correlation coefficient (r) and the partial least squares structural equation modeling (PLS-SEM) were used for analysis. The confidence interval was set at 95% (95% CI) and the significance level at 5%. Results: Of the 305 professionals selected, 271 were in the final sample of this study (88.9%). Individuals were more frequently female (78.6%), with ages between 36-50 years (42.1%), from the nursing staff (46.1%) and with 5-10 years of work in the area (27.3%). The mean SAQ score was 68.2 (95% CI: 65.8-70.5), which demonstrates a below-optimal level of safety culture. Subjects with a professional activity time between 11-20 years showed a more negative perception of the safety culture when compared to those with less than one year in the job (p=0.05). The JSS showed neutrality in job satisfaction, with an average score of 131.2 (95% CI: 128.1-134.3), and technical support workers of the hospital revealed higher levels of satisfaction than health professionals (p=0.02). The prevalence of depression was 22.1% (95% CI: 17.2-27.1%). Subjects classified in D-E socioeconomic level (lower average domestic income) showed twice the prevalence of depression compared to those in class A (PR=2.84, 95% CI: 1.24-6.51, p=0.01). Of the participants, 14.8% (95% CI: 10.5-19%) reported professional exhaustion and men showed burnout approximately twice as much as in women (PR=1.98, 95% CI: 1.03-3.79, p=0.04). PLS-SEM confirmed the relationship of job satisfaction and the absence of burnout syndrome as predictive aspects of the patient safety culture (p<0.001). In addition, the correlation with the depression variable was not statistically significant (p=0.06). Conclusion: The perception of patient safety culture is related to job satisfaction and burnout syndrome in hospital professionals. These findings suggest that psychosocial factors influence the quality and safety of care provided by health workers.
Introduction: Evidence is needed to support the theory that organizational conditions and psychosocial factors reflect on the safety of care provided in health services. Objective: To evaluate if patient safety culture is related to job satisfaction, depression and burnout syndrome among professionals in the hospital setting. Method: This is a cross-sectional study conducted between August and November 2016 in a reference teaching hospital for 13 cities in the Northwest region of the State of São Paulo. Inclusion criteria were all workers with an employment bonding time greater than or equal to three months. Individuals on notice, under medical leave or on vacation were excluded. From the list of 677 professionals who worked at the hospital, participants were recruited by random probabilistic sampling. Data were collected through psychometric instruments to analyze job satisfaction (Job Satisfaction Survey – JSS), the presence of depression (Patient Health Questionnaire-9), and burnout syndrome (Maslach Burnout Inventory – MBI), as well as the relationship between these factors with patient safety culture (Safety Attitudes Questionnaire – SAQ). Adjusted (multivariate) analyzes were performed and the prevalence ratio (PR) was calculated using a Poisson regression. Pearson correlation coefficient (r) and the partial least squares structural equation modeling (PLS-SEM) were used for analysis. The confidence interval was set at 95% (95% CI) and the significance level at 5%. Results: Of the 305 professionals selected, 271 were in the final sample of this study (88.9%). Individuals were more frequently female (78.6%), with ages between 36-50 years (42.1%), from the nursing staff (46.1%) and with 5-10 years of work in the area (27.3%). The mean SAQ score was 68.2 (95% CI: 65.8-70.5), which demonstrates a below-optimal level of safety culture. Subjects with a professional activity time between 11-20 years showed a more negative perception of the safety culture when compared to those with less than one year in the job (p=0.05). The JSS showed neutrality in job satisfaction, with an average score of 131.2 (95% CI: 128.1-134.3), and technical support workers of the hospital revealed higher levels of satisfaction than health professionals (p=0.02). The prevalence of depression was 22.1% (95% CI: 17.2-27.1%). Subjects classified in D-E socioeconomic level (lower average domestic income) showed twice the prevalence of depression compared to those in class A (PR=2.84, 95% CI: 1.24-6.51, p=0.01). Of the participants, 14.8% (95% CI: 10.5-19%) reported professional exhaustion and men showed burnout approximately twice as much as in women (PR=1.98, 95% CI: 1.03-3.79, p=0.04). PLS-SEM confirmed the relationship of job satisfaction and the absence of burnout syndrome as predictive aspects of the patient safety culture (p<0.001). In addition, the correlation with the depression variable was not statistically significant (p=0.06). Conclusion: The perception of patient safety culture is related to job satisfaction and burnout syndrome in hospital professionals. These findings suggest that psychosocial factors influence the quality and safety of care provided by health workers.
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Administração de Serviços de Saúde, Ambiente de Instituições de Saúde, Gestão da Segurança, Qualidade da Assistência à Saúde, Saúde do Trabalhador, Análise Fatorial, Health Services Administration, Health Facility Environment, Safety Management, Quality of Health Care, Occupational Health, Factor Analysis, Administración de los Servicios de Salud, Ambiente de Instituciones de Salud, Gestión de la Seguridad, Calidad de la Atención de Salud, Salud Laboral, Análisis Factorial