Burnout syndrome in health personnel at the Caseros Model Sanatorium

INTRODUCTION

“Burnout syndrome” also known as professional exhaustion syndrome, was first defined by psychoanalyst Herbert J. Freudenberger in 1974 as “a set of nonspecific medical, biological, and psychosocial symptoms that develop in the workplace as a result of excessive energy demands.” This professional observed that many of the workers at the institution where he practiced exhibited significant emotional exhaustion, as well as a loss of motivation and commitment to their work. To describe this particular state of “psychological exhaustion” he adopted the term “burnout,” which is commonly used in the field of clinical pharmacology, to refer to the effects of chronic drug use. Researchers Christine Maslach and Susan Jackson subsequently adopted the concept suggested by Freudenberger and set out to define the syndrome in a more technically rigorous manner and to design instruments for measuring it among healthcare workers. In fact, the characteristics currently accepted as defining burnout syndrome emerged from the work of these authors, who proposed three essential “dimensions”

1) the feeling of emotional exhaustion;

2) Depersonalization; and

3) The perception of a lack of professional fulfillment.

According to Maslach’s explanatory model and according to Jackson, emotional exhaustion is a key factor in the development of the syndrome and consists of a growing sense of exhaustion at work that a person experiences following failed attempts to adapt to a stressful environment. To protect themselves from this negative feeling, the individual would try to isolate themselves from others through a defense mechanism known as depersonalization, characterized by distant behavior and the dehumanization of relationships with patients and other members of the healthcare team. Over time, a sense of professional unfulfillment emerges: a complex feeling of personal inadequacy for the job, arising from the realization that the demands placed on them exceed their ability to meet them adequately, despite their attempts to adapt. Burnout itself constitutes the final phase of the process and is the response to an intolerable work situation.

Owing to the effects that the syndrome can have on the health of healthcare institutions and, consequently, on the quality of their professional performance and the care provided to patients, strategies must be implemented to enable both preventions, as well as early detection and appropriate treatment of those affected.

The objectives of this study are to determine the prevalence of burnout syndrome among medical and nursing staff at the Sanatorio Modelo de Caseros in the Province of Buenos Aires (Argentina) and to identify likely predisposing factors and propose solutions for addressing them in that work environment.

METHODS

An observational, descriptive, and cross-sectional study was conducted on 11 physicians and 4 nurses at the “Sanatorio Modelo de Caseros” in the town of Caseros, Province of Buenos Aires, Argentina, from June–July 2024. The study population was divided into two groups on the basis of their profession. The in y instrument used for data collection was the Brief Burnout Questionnaire (BBQ) by Bernardo Moreno Jiménez and colleagues, which was developed from modifications made by that group to Maslach’s Burnout Inventory (MBI) and validated by Rivera Delgado.

For the systematic review, brief questionnaires with variations and the clinical consequences reported by the various studies will be used to identify differential patterns. Statistical comparison techniques will be applied to this condition based on data obtained through exhaustive search and consultation with healthcare personnel.

Permission and informed consent will be requested from healthcare personnel to participate in the research.

A questionnaire will be administered to determine the occupational demographic factors associated with burnout syndrome.

The CBB and the Maslach scale will be administered to assess burnout syndrome among healthcare professionals at the Sanatorio Modelo de Caseros.

Data processing will be computerized, and the latest statistical software will be used.

The CBB questionnaire consists of 21 items, includes introductory questions with general information, and explores three fundamental variables:

1) Burnout syndrome (BS),

2) The causes of burnout (CBO)

3) Consequences of burnout (CON)

The BSS variable, in turn, consists of three subvariables that align with the model by Maslach and Jackson, each containing three items: emotional exhaustion (CE); depersonalization (DP); and (RP). The CBO variable, for its part, is analyzed in terms of its components: tedium (TE), task characteristics (TC), and organizational

(OR), each with three items. The CON variable is not divided into components and contains three items in total.

EVALUATION CRITERIA

Burnout Factors

Burnout Syndrome

Consequences of Burnout

The CBB is not designed to specifically assess the subscales comprising the antecedents, burnout, and its consequences but rather the global scales.

For the purposes of diagnosing Burnout Syndrome, the cutoff point is 25 points. In other words, a score of 25 or higher indicates that a person is clearly affected by Burnout Syndrome.

For assessing the consequences of burnout, a population or individual can be considered critically affected by these consequences when a score higher than 8 is reached.

In any case, the CBB is not a clinical questionnaire; therefore, the consequences of burnout must be assessed using a specific instrument.

The Maslach Burnout Inventory (MBI) consists of 22 items in the form of statements concerning professionals’ feelings and attitudes in their role and is designed to measure professional burnout. This test aims to measure the frequency and intensity with which burnout is experienced.

Write the number you believe is appropriate for how often you feel the statements:

0 = never

1 = a few times a year or less

2 = once a month or less.

3= a few times a month.

4 = once a week.

5 = a few times a week.

6 = every day.

The primary objective of the study was to estimate the prevalence of burnout syndrome among healthcare workers. The secondary objectives were to determine the factors associated with and severity levels of burnout syndrome by occupation. The presence of burnout syndrome was defined if each participant’s score was greater than 21 on the CE scale, greater than 6 on the DP scale, and less than 36 on the RP scale. Based on the scores obtained on each MBI subscale, participants were classified into low, moderate, and high levels. The categories were defined according to the following cutoff points:

CE: low (< 12 points), moderate (12–21 points), high (> 21 points)

Low DP (< 3 points), moderate (3–6 points), and high (> 6 points)

Low RP (40 points), moderate RP (40–36 points), and high RP (< 36 points).

RESULTS

To identify factors associated with Burnout Syndrome, the analysis was designed to simultaneously adjust for two independent variables (a sense of life and career plan). Given this, at least two cases of burnout had to be included for each variable. With an expected frequency of 10% (definition of burnout as 3 out of 3 positive subscales), 20 healthcare professionals were required to detect at least 2 cases of burnout.

The survey was sent to 25 healthcare staff members, yielding 15 complete responses, for a 60% response rate. Among the 15 participants who responded, 11 were physicians (74%), and 4 were nurses (26%). Sixty percent were women, and the median age was 34 years, with a range of 29–39 years. The characteristics of the population according to the presence and absence of burnout syndrome are summarized in the following tables.

REFERENCE: CE-emotional exhaustion; DP-dépersonalization; RP-lack of personal fulfillment.

DISCUSSION

The level of distress detected among healthcare workers at the “Sanatorio Modelo de Caseros” in the town of Caseros, Buenos Aires, Argentina, was striking. The diagnostic symptom with the highest mean score among healthcare workers was depersonalization.

The situations identified as the primary causes of workplace stress varied significantly depending on the profession. The following were cited: “working with terminally ill patients” by nursing staff and “feeling of social vulnerability” and “risk of malpractice” among physicians.

The differences between the perceptions of nursing staff and those of medical staff regarding the main sources of workplace stress could be related to the specific characteristics inherent in the roles and activities performed in each of these professions, even when they are carried out in the same healthcare facility. It is likely that, nursing staff are the ones who have more frequent contact and develop closer bonds with terminally ill patients, a fact that could cause feelings of helplessness or frustration if they lack the necessary training to care for this type of patient.

The prevalence of this syndrome among healthcare workers due to the COVID-19 pandemic was also considered.

In a prepandemic study in Argentina, Muñoz A. et al. reported a 29% prevalence of burnout syndrome among resident physicians using the same definition. The higher prevalence among physicians could be related to the postpandemic effects of COVID-19. This is because pandemics and epidemics have negative effects on the health of healthcare workers, leading to acute stress, depression, anxiety, exhaustion, and burnout syndrome.

In turn, studies have shown that those with burnout syndrome are younger and have less work experience. Although not conclusive, most related research suggests that, as the years increase, individuals gain experience and confidence in their work tasks and are less vulnerable to work-related stress. Medical residents are a vulnerable group; during this period, key processes of adaptation and adjustment to new tasks occur, placing young people under constant stress. Although this is a point of controversy, some authors argue that young people are the ones who most frequently experience work-related stress and burnout, as they lack sufficient coping mechanisms to address excessive demands.

Given the high prevalence of burnout syndrome among healthcare workers, there is a clear need to implement short-term coping and prevention strategies at the healthcare center that is the subject of this study. In designing these strategies, the proposals provided by the respondents on how to resolve common problems in their work environment should be considered. Furthermore, given that a large proportion of doctors and nurses reported having days off during the week and engaging in some form of physical activity, these strategies could include measures aimed at encouraging the continuation of these healthy habits and the development of recreational activities during available free time.

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