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o desequilíbrio esforço-recompensa e o
Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
O DESEQUILÍBRIO ESFORÇO-RECOMPENSA E O COMPROMETIMENTO
EXCESSIVO COM O TRABALHO EM DOCENTES DE MEDICINA E
ENFERMAGEM DE UMA INSTITUIÇÃO PÚBLICA.
EFFORT-REWARD IMBALANCE AND OVERCOMMITMENT AT WORK IN
MEDICINE AND NURSING FACULTY IN A PUBLIC INSTITUTION.
EL DESEQUILIBRIO ESFUERZO-RECOMPENSA Y EL COMPROMISO
EXCESIVO CON EL TRABAJO EN DOCENTES DE MEDICINA Y
ENFERMERÍA DE UNA INSTITUCIÓN PÚBLICA.
Fernando de Camargo Aranha1, Valeria Caputo2, Selma
Tsuji3, Sebastião Carvalho4, Luiz Antônio NogueiraMartins5
2009.
questionário
Estudos de estresse ocupacional com o
desequilíbrio
esforço-
recompensa no trabalho em docentes de
medicina e enfermagem não foram
descritos pela literatura. Objetivos: 1)
Estimar as prevalências de desequilíbrio
esforço-recompensa
e
do
comprometimento excessivo com o
trabalho em docentes de medicina e
enfermagem. 2) Verificar a existência
de associação dessas variáveis de
acordo com os grupos de docentes.
Método:
foi
realizado
um
estudo
transversal com232 docentes de uma
instituição pública do Estado de São
Paulono período de abril a novembro de
Professor Assistente da Disciplina de Psiquiatria da
Faculdade
de
Medicina
de
Marília.
E-mail:
[email protected]
2
Professora Doutora e Chefe da Disciplina de Psiquiatria da
Faculdade
de
Medicina
de
Marília.
E-mail:
[email protected]
3
Professora Doutora da Disciplina de Psiquiatria da
Faculdade
de
Medicna
de
Marília.
E-mail:
[email protected]
4
Professor Doutor da Disciplina de Estatística Aplicada UNESP -campus Marília. E-mail: [email protected]
5
Livre Docente. Professor Associado aposentado do
Departamento de Psiquiatria da Escola Paulista de Medicina
– UNIFESP. E-mail: [email protected]
e
o
questionário
e
de
desequilíbrio esforço-recompensa no
trabalho (Effort-Reward Imbalance ERI). Foi utilizado o teste do qui
quadrado para verificar a associação das
variáveis entre os grupos de docentes.
Resultados:as
prevalências
desequilíbrio
esforço-recompensa
encontradas
foram
de
de
31,3%
nos
docentes de enfermagem, 14,1% nos
docentes de medicina e 17,7% na
amostra
geral,
significativa
(p=0,006).
com
entre
As
diferença
os
docentes
prevalências
de
comprometimento excessivo com o
trabalho foram similares nos docentes
de enfermagem, medicina e na amostra
geral
1
aplicados:
sociodemográfico
ocupacional
RESUMO
modelo
Instrumentos
(45,8%;
39,7%
e
40,9%
respectivamente), com diferença não
significativa
entre
os
docentes
(p=0,738). Conclusões:A proporção de
docentes
deenfermagem
com
desequilíbrio esforço-recompensa foi
2,2 vezes maior em relação aos de
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
2198
Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
medicina. Ambos os grupos de docentes
effort-reward
apresentaram elevadas prevalências de
questionnaire (Effort-Reward Imbalance
comprometimento excessivo com o
– ERI). The chi-square test was used to
trabalho,
verify the association of variables
o
categorias
que
evidencia,
profissionais,
características
nestas
marcantes
pessoais
faculty
at
groups.
work
Results:
maior
Prevalence of effort-reward imbalance
necessidade de controle e dificuldade
was 31.3% in nursing faculty, 14.1% in
para
medical faculty and 17.7% in overall
se
de
between
imbalance
desligarem
compromissosadvindos
do
dos
trabalho.
sample,
with
significant
difference
Novos estudos poderão contribuir para
between faculty (p = 0.006). Prevalence
medidas preventivas e interventivas
of overcommitment at work was similar
relacionadas ao estresse ocupacional em
in nursing and medical faculty as well
docentes de medicina e enfermagem.
as in overall sample (45.8%, 39.7% and
Palavras-chave:
Esgotamento
40.9%
profissional.
ocupacional.
significant difference between faculty (p
Epidemiologia. Docentes de Medicina.
= 0.738) . Conclusions: The effort-
Docentes de Enfermagem.
reward imbalance in nursing faculty
Estresse
respectively),
without
any
was 2.2 times higher compared to
ABSTRACT
medical faculty. Both faculty groups
Occupational stress studies with effort-
presented
reward imbalance at work in medical
overcommitment
and nursing faculty have not been
denotes
described in literature. Objectives: 1) To
characteristics
estimate the effort-reward imbalance
needs and difficulty in relaxing after
and the overcommitment at work in
work in those professions. Further
medical and nursing faculty. 2) To
studies may contribute to preventive
verify if there is an association of those
and interventional measures related to
variables according to faculty groups.
occupational stress in medical and
Method: A cross-sectional study was
nursing faculty.
achieved with 232 professors of a public
Keywords:
institution in São Paulo State from April
stress. Epidemiology. Medical Faculty.
to
Nursing Faculty.
November
in
2009.
Applied
a
high
at
prevalence
work,
remarkable
of
better
Burnout.
of
which
personal
controlling
Occupational
instruments: a sociodemographic and
occupational
questionnaire
and
an
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
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Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
RESUMEN
40,9% respectivamente), con diferencia
Estudios de estrés laboral con el modelo
no significativa entre los docentes (p =
de desequilibrio esfuerzo-recompensa
0,738) . Conclusiones: La proporción de
en el trabajo en docentes de medicina y
docentes
enfermería no han sido descritos en la
desequilibrio esfuerzo-recompensa fue
literatura. Objetivos: 1) Estimar la
2,2 veces mayor en comparación con
prevalencia de desequilibrio esfuerzo-
los docentes médicos. Ambos grupos de
recompensa y el compromiso excesivo
docentes
con el trabajo en docentes de medicina
prevalencia de compromiso excesivo
y enfermería. 2) Verificar la asociación
con el trabajo, lo que demuestra, en
de estas variables según grupos de
estas
docentes.
personales
Método:
Un
estudio
de
enfermería
presentaron
profesiones,
con
una
el
gran
características
distintivas
de
mayor
transversal de 232 docentes de una
necesidad de control y dificultad para
institución pública del Estado de São
romper con los compromisos laborales.
Paulo fue realizado de abril a noviembre
Nuevos estudios podrán contribuir para
de
medidas
2009.
cuestionario
Instrumentos
aplicados:
sociodemográfico
de
prevención
y
de
y
intervención relacionadas con el estrés
ocupacional, y el de desequilibrio
laboral en docentes de medicina y
esfuerzo-recompensa
enfermería.
en
el
trabajo
(Desequilibrio Esfuerzo-Recompensa –
Palabras
ERI). Fue utilizado el test chi-cuadrado
laboral. Epidemiología. Docentes de
para evaluar la asociación de las
Medicina. Docentes de Enfermería.
clave:
Burnout.
Estrés
variables entre los grupos de docentes.
Resultados:
desequilibrio
Las
prevalencias
de
esfuerzo-recompensa
INTRODUCTION
encontradas fueron 31,3% en docentes
The scientific community has
de enfermería, 14,1% en docentes de
been interested in occupational stress,
medicina y 17,7% en la muestra
and some theoretical models have been
general, con diferencias significativas
developed with important contributions
entre los docentes (p = 0,006). Las
to epidemiological researches. Among
prevalencias de compromiso excesivo
them, the psychosocial model of effort-
con el trabajo fueron similares en
reward imbalance at work (Effort-
docentes de enfermería, medicina y en
Reward Imbalance – ERI) stands out as
la muestra general (45,8%, 39,7% y
an important predictor of stress in the
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
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Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
work environment, defined by the
sample of 232 professors, consisting of
absence of reciprocity between the
184 medical and 48 nursing staff.
expended
effort
and
the
obtained
The authors have fulfilled the
rewards.1 Stress is characterized by the
ethical
individual's
commitment under job
Declaration. The project was approved
demands in order to get different
by the Research Ethics Committees of
rewards: promotion, financial gain,
Marilia
recognition or esteem in labor relations
575/06) and Federal University of São
or job security. The full model also
Paulo
includes the overcommitment (OC) at
following applied instruments: 1) a
work
correlated
characteristics
of
to
principles
Medical
(protocol
of
Helsinki
School
391/09)
the
personal
sociodemographic
greater
control,
questionnaire,
and
(protocol
with
the
occupational
prepared
by
the
recognition and difficulty in relieving
researcher, and 2) an effort-reward-
the commitments.2 Some prevalence of
imbalance-at-work
variables obtained by this model at
(ERI).3
physicians and nurses working have
questionnaire
The ERI questionnaire consists
been described, although there are not
of
23
questions
studies with similar results in the
dichotomous
investigated job categories. Therefore,
disagree), scored from 1 to 5 according
this research was conducted to 1)
to stress level, in which 6 questions are
estimate the prevalence of effort-reward
related to effort and 11 to distinct
imbalance and overcommitment at work
rewards. The remaining 6 questions
in medical and nursing faculty; and 2)
approach overcommitment (OC) and are
verify if there is an association of those
scored from 1 to 4 with Likert scale
variables according to faculty groups.
responses (strongly disagree to strongly
agree).3
responses
The
validated
METHOD
being
Brazil
with
(agree
instrument
in
17
has
with
or
been
health
A cross-sectional study was
professionals of a public university. The
achieved with medical and nursing
reproducibility (intraclass correlation
faculty (n=263) of a public institution in
coefficient)
São
regarding
Paulo
State
from
April
to
of
the
the
effort,
questionnaire
reward
and
November in 2009. The questionnaires
overcommitment was 0.76, 0.86 and
were collected soon after being applied,
0.78
with a response rate of 88.21% for a
consistency (Cronbach’s alpha) for
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
respectively.
The
internal
2201
Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
similar dimensions was 0.68, 0.78 and
36 to 45, 19.4% aged 25 to 35, 15.5%
0.78 respectively.4 The questionnaire
aged 56 to 65, and 2.2% aged over 65
has a good performance in researches
years. As for marital status, 76.3% had
employing the full model as it considers
stable relationship and 53.4% had one
the overcommitment at work.5
or two dependents.
The overcommitment at work is
As
for
workplaces,
39.2%
shown at low, medium and high
worked in only one institution, 41.8%
intervals established from the cutoff
had more than one job, 13.8% had more
points of scores in tertiles, with the
than two jobs and 5.2% worked at least
highest tertile as reference. The effort-
in three places beyond the institution.
reward imbalance (ERI) was obtained
Paid duties were performed by 38.8% of
by the sum of effort score (e), divided
the professionals.
by the sum of reward score (r),
multiplied
by
a
correction
factor
Prevalence of quantitative variables
(c=0.5454) by employing the formula: e
/ (r x c). The results were dichotomized
As
for
the
effort-reward
to obtain an indicator of presence
imbalance (ERI > 1), prevalence of
(values greater than 1) or absence
14.1% in medical faculty and 31.3% in
(lesser or equal 1) of imbalance.3 It was
nursing faculty has been identified with
used the chi-square test to verify the
significant difference between groups.
association of variables between faculty
Because of scarcity of researches in
groups, and the program SPSS 18.0
those categories, some other similar
(SPSS Inc., Chicago, United States) to
studies are presented with the following
analyze data.
effort-reward
imbalance:
22.8%
in
German nurses6, 24.1% in Canadian
RESULTS AND DISCUSSION
nurses7, 19.07% in Chinese physicians8,
18.5% in Swiss physicians9 and 25.1%
in
characteristics
research with Swiss physicians and
of
faculty
general
sample
German
physicians10.
Sociodemographic and occupational
Recent
nurses has identified prevalence of
21.6% and 18.7% respectively11.
As for the sociodemographic
In relation to overcommitment at
characteristics, 53.4% were men, of
work (high tertile), medical faculty has
which 34.5% aged 46 to 55, 28.4% aged
presented 39.7%, and nursing 45.8%,
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
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Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
without
any
significant
O desequilíbrio esforço-recompensa...
difference
between them.
similar values were found in Japanese
medical residents and French nurses,
This variable focuses on the
with overcommitment of 44.4% and
personal style of adaptation comprising
40.8% respectively12,13. A Brazilian
attitudes
by
study has identified overcommitment at
exaggerated effort to obtain recognition,
work in 26% and 10% of neonatal ICU
and difficulties in relieving the work.
physicians and nurses respectively, with
Lower
significant difference between them14.
and
emotions
prevalence
caused
(15.7%)
was
identified in German physicians10, and
Table 1 – Association of effort-reward imbalance (ERI) according to faculty group in a
Higher Education Institute, Marília–SP, Brazil, 2009.
Faculty
Medicine
Nursing
Total
n(%)
n(%)
n(%)
≤1
158(85.9)
33(68.8)
191(82.3)
> 1*
26(14.1)
15(31.3)
41(17.7)
Total
184(100.0)
48(100.0)
232(100.0)
ERI
*Chi-square test
p = 0.006
Table 2 – Association of overcommitment at work (OC) according to faculty group in a
Higher Education Institute, Marília–SP, Brazil, 2009.
Faculty
OC
-
Medicine
Nursing
Total
n(%)
n(%)
tertile
n(%)
Low
61(33.2)
14(29.2)
75(32.3)
Medium
50(27.2)
12(25.0)
62(26.7)
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
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Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
High*
73(39.7)
22(45.8)
95(40.9)
Total
184(100.0)
48(100.0)
232(100.0)
*Chi-square test
p = 0.738
As far as it has been observed in
In regard to those findings, new
this master’s dissertation by Graduate
researches on those outcomes may
Program in Psychiatry and Medical
contribute
Psychology at UNIFESP, this research
interventional
is the first one to describe the variables
occupational stress in medical and
of effort-reward imbalance in medical
nursing faculty.
and nursing faculty.
to
measures,
However
In this study it was possible to
preventive
some
and
related
to
limitations
should be highlighted. A paucity of
identify higher prevalence of effort-
research
reward imbalance in nursing faculty
professional categories has limited the
compared to medical faculty, enabling
extension of the debate, and the
to assert that the ratio of effort-reward
accuracy of the conclusions on the
imbalance in nursing faculty was 2.2
prevalence results. The restriction of the
times higher than in medical faculty.
study to only one education institution
The results have shown that nursing
precludes the generalization of findings.
faculty devotes high efforts while
Concerning
obtaining low rewards at work, which
results of a dichotomized effort-reward
implicates
imbalance (ERI) equation may limit the
more
imbalance
when
compared to medical faculty.
on
those
statistical
models
analysis,
and
the
categorization of presence or absence
As for the overcommitment at
while assuming an established cutoff
work (high tertile), similar proportions
point of 1. As a continuous measure, the
were identified in both groups. The high
ratio ERI may bring more specific
rates in those two categories suggest
results on scores variation, and produce
equal exposure to occupational stress,
stronger statistical evidence15. While a
with more controlling needs at work and
self-assessment tool, ERI questionnaire
difficulty in relieving the commitments.
favors logistic and economic aspects for
data collection, and the feasibility of
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
2204
Revista Eletrônica Gestão & Saúde ISSN: 1982-4785
Aranha FC; Caputo V; Tsuji S; et al.
O desequilíbrio esforço-recompensa...
epidemiological researches with distinct
methodological design. Nevertheless,
there
may
be
limitation
on
the
individual integral approaching, and on
the
complexity
behavior,
of
when
his
/theorie_measurement_evidence.
pdf
particular
standardized
quantitative measure of self-assessment
4. Chor D, Werneck GL, Faerstein
E, Alves MG, Rotenberg L. The
Brazilian version of the effortreward imbalance questionnaire
to assess job stress. Cad Saude
Publica 2008;24(1):219-24.
is used.
ACKNOWLEDGEMENTS
To physicians Bruno da Cunha Tomaz,
Cíntia Lopes Dias e Saulo Nardy Nader
5. Griep RH, Rotenberg L,
Landsbergis P, VasconcellosSilva, PR. Uso combinado de
modelos de estresse no trabalho
e a saúde auto-referida na
enfermagem. Rev Saude Publica
2011;45(1):145-52.
for their assistance in data collection.
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Sources of funding: No
Conflict of interest: No
Date of first submission: 2015-02-08
Last received: 2015-02-09
Accepted 2015-02-09
Publishing: 2015-06-30
Revista Eletrônica Gestão & Saúde. Vol. 6 (Supl. 3). Junho, 2015 p.2198-06
2206
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