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SMAD. Revista eletrônica saúde mental álcool e drogas

versión On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.15 no.3 Ribeirão Preto jul./set. 2019

http://dx.doi.org/10.11606/issn.1806-6976.smad.2019.151483 

REVIEW ARTICLE

 

Mental changes in intensive therapy unit workers

 

 

Andressa Fernanda SilvaI; Maria Lúcia do Carmo Cruz RobazziII

IUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
IIUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil

Corresponding Author

 

 


ABSTRACT

OBJECTIVE: to investigate the scientific evidences about mental changes in Intensive Care Units (ICU) workers.
METHOD: integrative review who research took place in the EMBASE, MEDLINE and SCOPUS data bases and in the virtual libraries / collections BVS and SCIENCE DIRECT. Of 141 identified primary articles, 33 (23.4%) met the inclusion criteria and were published in 29 journals from various are knowledge.
RESULTS: the mental changes identified were: stress, suffering and tensional work, depression, asthenia, fatigue, mental overload and Burnout. At work, there are alsoconflicts, violenceand abuse, and ICU workers are predisposed to use psychotropic drugs.
CONCLUSION: the them is relevant and the list of mental changes of the ICU workers can lead them to absenteeism.

Descriptors: Occupational Health; Mental Health; Health Personnel; Intensive Care Units.


 

 

Introduction

Work is a source of fulfillment, satisfaction and pleasure for human, but it can be harmful to health, since some diseases result from the process of body wear and are strengthened by the aging process and by the type of work organization(1). Pathologies arising from work can affect both the professional and daily life activities(2).

Studies aimed at the worker's health has been gaining momentum(3), and actions for promotion, protection and rehabilitation of health and for prevention of diseases must be taken in the workplace(4), including in those in which health professionals perform their functions and are exposed to several occupational risk factors(5).

Intensive care units (ICU) are complex environments, with critical patients(6), whose care is offered by intensivists, workers from multidisciplinary health teams who work there. A doctor, a nurse, a physical therapist, from the medical, nursing and physical therapy teams, respectively, and other health professionals must form this team(7). These people must exchange knowledge to improve their patients' health status(8). However, due to the characteristics of the ICUs, they experience episodes of suffering and death, which can cause mental changes(9).

Having mental health means to be able to recover from the routine stress, deal with daily life demands, recognize your own limits, overcome difficulties, handle conflicts, traumas or major transitions of the vital cycles(10), thus reducing the possibilities of mental changes.

Considering that and given the complexity of the workplace in which they work, the motivation for carrying out such study was to be able to identify the main mental changes affecting employees who work in the ICU.

This study aimed to investigate the scientific evidence about mental changes in workers of intensive care units.

 

Method

Integrative literature review study with data collected from secondary sources(11). The integrative review is a bibliographical research that has its own methodology, which is exhausted when the reviewers finished.

For this study, the following guiding question was formulated: what are the mental changes the ICU workers show?

To do this review, we used the PICO strategy (acronym for Patient/Problem, Intervention, Comparison/Control and Outcomes/Outcome)(11), considering P (ICU workers), I (knowledge of the mental changes in these people), C (absence of these changes) and O (presence ofmental changes).

The study was conducted in April and May 2016, using the databases Medical Literature Analysis and Retrieval System Online - MEDLINE, through the seeker PUBMED, Excerpta Medica (EMBASE) and Sci Verse Scopus (SCOPUS) as well as in libraries/collections:Virtual Health Library (Biblioteca Virtual de Saúde-BVS) and Science Direct Elsevier (SCIENCE DIRECT). For the search, the descriptors from Health Sciences Descriptors (DeCS) and from Medical Subject Headings (MESH) were used, being: Intensive Care Unit/Intensive Care Units; Saúde do Trabalhador/ Occupational Health; Saúde mental/Mental Health connected by the Boolean operator (delimiter) and.

In MEDLINE, EMBASE, DIRECT SCIENCE and SCOPUS, the combinations of words were: Intensive Care Units and Occupational Health and Mental Health; in the BVS were: Unidade de Terapia Intensiva and Saúde do Trabalhador and Saúde Mental.

The inclusion criteria were: primary studies (originals)(12), which had investigated mental changes of health workers who work in the ICU, with texts available in full, published between 2006-2016, in the form of scientific articles, in English, Portuguese, Spanish, French and/or Italian, which met the objectives of this study.

One hundred and forty-one studies were identified, being 36 in EMBASE, 12 in MEDLINE, 64 in the BVS, 7 in DIRECT SCIENCE and 22 in SCOPUS. After the reading of titles and abstracts, 72 were excluded; out of the other 69, 4 studies duplicated were not considered; for reading and analysis, 65 were considered, excluding those that did not addressed the study question directly and, at the end, only 33 remained. For characterization of these studies, a tool, previously validated, for creation of study question and search for evidences was used, indicating the data that should be subtracted from the articles selected(10), to become the review consistent.

 

Results

The analysis of the 33 studies(13-45) allowed dividing them into titles of the articles and journals, authors, country, year of publication and main conclusions. The studies were diverse(13-45), and those developed by nursing prevailed; much of them were productions from authors linked to universities (76%).

Twenty-nine different journals were identified; the authorship was the same in more than one publication; Brazilian (12), Iranian (5), North American and French (four publications in each country) studies were prevalent, in 2016, 2015 and 2012 (18.33% of publications in each year).

Regarding the type of methodological design, about 20 studies were quantitative, 6 were qualitative, 1 had quantitative and qualitative approach, 6 were clinical trials and 1 used the focus group method. For a better understanding of the mental changes, the analysis of the articles was based on the Diagnostic and Statistical Manual of Mental Disorders(46).

Figure 1 shows the articles in alphabetical (E) and numerical form (from 1 to 33), and has some of these data.

 

Discussion

After the analysis of the articles included in the review, the results indicated that the mental changes were caused by work demands, patients' complexity, relationships between colleagues, organizational characteristics(47), among others. Such changes encumber health systems through work leaves/replacements of those absent and may diminish the quality of the care provided to the patient(48).

The main alterations identified were:

- Stress(13,16,18-19,22-23,27,30,32): it may cause tension, biopsychosocial imbalance, overloads and uncomfortable situations; reduce the physical and mental capabilities(49) and lead to illness, in addition to negatively influencing the care provided(50-51) by workers of the ICU to critical patients. Stress, asthenia, and physical and emotional exhaustions may compromise the work, and the cycle of family and friendships, reducing the quality of life(52). The reactions of individuals faced with adversity must be improved, because they tend to influence the work dynamic(53).

- Suffering and tension in the workplace(14,17,23-24,32-33,36): they may be experienced and influence the intensivists' illness process(54). Suffering manifests itself through experience of unfavorable circumstances, mostly(55); it provides physical/mental disharmony between the individuals and the work, influencing their health(56). Lack of autonomy, integration and support for professional development,difficulties in relationships and disrespect in the workplace can change the experiences of suffering and pleasure(54). Denial, retraction, resistance, conflict and organizational problems can cause it(56); however, work can be pleasurable when there is professional achievement, freedom of expression, trust, feelings of solidarity and recognition(54). Environments with work overload, excess shifts, low pay, and few resources to provide critical patients with an effective care can generate suffering(57). Places causing tension favor cardiac changes in workers.

- Depression, asthenia, fatigue and mental overload(16,19-21,23,29,34,45): overload results in tension, irritability, stress, depression, fatigue and disagreements in the health team, which can lead to decrease in interest, income and productivity(58). It also favors the fatigue, Burnout and absenteeism(45). Intensivists can present anguish and suffering(59). Complaints of exhaustion and extreme tiredness means fatigue; depressed people tend to have it, as well as asthenia and sensation of heavy body, in addition to decreased interest and pleasure in activities, changes in sleep patterns, feelings of worthlessness and thoughts of death(60) Caring for critical patients requires scientific and technical expertise and appropriate psychological conditions(58).

- Burnout:(23,38,45) process in which the state of professional exhaustion and high levels of stress are reached, and reports of disappointment, lack of interest(61) and absenteeism(45). States of stress, suffering at work, Burnout and depression in ICU workers require the attention of scholars and of the managers of the services(62).

Conflicts, violence and mistreatment were also identified in the studies(22,40-41,43), factors that can trigger mental changes among the intensivists, faced with excessive emotions; disagreements on which type of care management will be applied are included(41). Divergencies between therapeutics, techniques and ways to develop the procedures can cause problems such as anxiety, fatigue, Burnout and conflicts.Understanding the mistreatment in the workplace and its impact on the intensivists is crucial to managers of hospitals(43). Although all team members should have the same objective, the way of doing and understanding may be different(47), causing divergencies. Mutual respect must ensure that spaces and work activities are considered(63); conflicts make workers vulnerable to stress, sleep disorders, depression and Burnout(62).

The predisposition of the intensivists to use psychotropics(25) can occur because stress, fatigue, mental and physical exhaustion, depression, anxiety and Burnout favor its use(64). The use of antidepressants, anti-anxiety drugs and benzodiazepines have increased; they help in controlling mental disorders, but can cause dependency(65).

Regarding financial costs(37), the mental changes can lead to absenteeism and increase the demand for health services, encumbering them, mainly in situations of precarious works.

Also, changes in the ICU workers' quality of life (QOL) occur(15,26,28), since this perception that the individual has of their life changes according to their values and concerns(52,67), showing it tends to be more pronounced in active individuals(68). Musculoskeletal pain are related to reports of the worst QOL indices in workers(69), including the intensivists, because they affect the performance of their activities.

The training using emotional intelligence improves the mental and general health of ICU nurses(27), reducing the anxiety of doctors and nurses who work in these environments(32).

One verified that the scientific literature about mental changes in intensivists of the ICU is a theme that has become robust, denoting concerns regarding the health of these people, who work in a complex sector, favoring mental wear. The search for solutions to minimize these problems is a challenge to be overcome.

Stress, Burnout and depressive disorders are considered mental changes; suffering is a symptom of severe emotional disturbance; conflicts and violence are able to trigger such changes; in its turn, the predisposition to use medicines helps in controlling some of them(48). Faced with this scenario, the demand for health services can increase, with increase in financial costs and decrease in the QOL of the intensivists.

The limitations of this study refer to the use of three databases and the aspect of time, which was restricted to ten years of search. However, it was confirmed that mental changes that can lead to harmful situations may occur in these workers.

 

Conclusion

The mental changes in ICU workers were: stress, suffering and tension at work, depression, asthenia, fatigue, mental overload and Burnout. At work, these people, who are also subjected to conflicts, violence and mistreatment, showed a predisposition to the use of psychotropic substances and fall in the indices of quality of life, which can lead to absenteeism and financially encumber the health system. The contributions of this study to the development of knowledge in the health field was to highlight the need for monitoring the mental health of these workers, faced with the results found, to reduce the possible damage caused by labor activities.

 

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Corresponding Author:
Maria Lúcia do Carmo Cruz Robazzi
E-mail: avrmlccr@eerp.usp.br

Received: March 31th 2017
Accepted: Dec 3rd 2018

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