Condiciones psicosociales de las enfermeras en el desempeño de sus funciones dentro del territorio español

Zusammenfassung

Introduction Occupational hazards have accompanied workers throughout history. In certain professions, such as nursing, professionals are exposed to a multitude of adverse risks and working conditions in the exercise of their duties, such as staff shortages, excessive workloads, night shifts, long work shifts, a high number of hours worked per week, a high frequency of rotation between services, and high psychological burden due to the management of critical situations, among others. All these working conditions make the work carried out by nurses particularly stressful and diverse, in which risks of various kinds coexist where psychosocial risk factors are the most frequent and, if appropriate measures are not taken or adequate work resources do not exist, can thus lead to manifestations of exhaustion, loss of work engagement, and a negative impact on the worker's own health, especially in services where work overload is higher, as in the case of emergency services. Objectives The objective of this study was to describe the work engagement, psychosocial risks, and psychological well-being of a sample of Spanish nurses belonging to different areas of care, analysing the relationships between these variables and their effects on the mental health of nurses. Hypothesis Nurses who suffer excessive work overload show high levels of burnout and moderate work engagement, so those who have a mediocre or poor perception of health are at increased risk of developing subjective symptoms of psychological distress. Likewise, high labour demands increase the likelihood of job burnout, while the existence of work resources increases the engagement of nurses, especially in situations with a high work overload such as the situation caused by SARS-CoV-2. Methodology An observational, descriptive, cross-sectional, and quantitative approximation study was carried out. To achieve this, it was divided into 2 phases: • Phase 1. Description and identification of the evidence available through a bibliographic analysis.• Phase 2. Field study. For the first phase, a bibliographic analysis of the available evidence was performed through 3 reviews (one narrative and two systematic). For the second phase, an observational, descriptive, cross-sectional, and quantitative approximation study was carried out on a sample of 1704 Spanish nurses between January 2019 and January 2020, using a self-administered questionnaire containing sociodemographic variables, the Spanish version of the Copenhagen Psychosocial Questionnaire (CoPsoQ-istas21) for the assessment of psychosocial risks, the Utrecht Work Engagement Scale (UWES-9) to analyse work engagement, and the General Health Questionnaire (GHQ-12) to screen potential psychiatric, not psychotic, problems of the target population. Results More than 50% of nurses perceived a high level of risk in the exercise of their duties, except in the Compensations dimension, in which they showed an intermediate-high level. In addition, a higher prevalence was observed in the Emergency Services for the five dimensions, especially in the Psychological requirements and Social support for companies dimensions, with 80’5% and 79’2%, respectively. As opposed, Primary Care nurses had a lower perception of risk as compared to those from other services, with the prevalence being less than 50% in the dimensions: Active work and skills development (39'3%), Compensation (33'1%), and Double Presence (48’7%), where it could be said that the risk is intermediate-high. On the other hand, more than 75% of Primary Care nurses achieved a mean percentage of 5 or 6 in all subscales and in the total score for the UWES-9 scale. For Emergency nurses, the percentages associated with means of 5 or 6 were 57’72% in the Vigour dimension, 71’14% in Dedication, and 62’42% in Absorption. However, for the rest of the areas, the percentages were 58’46%, 69’61%, and 69’81%, respectively, and in both services this percentage of the total was slightly higher than 62%. Specifically, in all areas under study, more than 30% reported experiencing these feelings daily. With regard to the assessment of psychological well-being, 41’14% of nurses scored values above 3 in the GHQ-12 test, being these figures lower for Primary Care nurses (30’52%), slightly higher for Emergency nurses (47’65%), and very similar in the rest of areas (42’98%). In all three models, Primary Care nurses, Emergency nurses, and other areas, the perceived and subscale health variables of the UWES test were predictive. Age was significant in the Primary Care and Other areas nurses groups, while sex and the dedication subscale of the UWES test were only significant in the last group. The absorption subscale and the total scale of the UWES test were not significant in any of the three models.Discussion This study found, in a sample of 1704 Spanish nurses, how psychological risks, the level of engagement, or psychological well-being showed significant differences between the different types of services: Emergency Services, Primary Care, and other areas. With regard to the assessment of psychosocial risks, in four of the five dimensions (CoPsoQ-istas21: Psychological requirements, Active work and skills development, Social support for companies, and Double presence), a prevalence of high level predominates in the three groups under study. Work engagementlevels were high for a considerable number of health workers under study, exceeding mean scores above 4 out of 6 in all three dimensions, with more than 30% of nurses claiming to have experienced feelings of work engagement daily. According to the data presented by our study, it is observed that four out of ten healthcare professionals may have impaired mental health (GHQ>3). The variability found between services could be explained by certain variables that can increase the perception of risk such as being a young woman, having a mediocre or poor perception of health, low work engagement, and being working in services with a high level of stress as in the case of Emergency services. Conclusions A nurse's likelihood of developing job burnout and the levels of work engagement shown will depend on a multitude of factors. These include certain working conditions such as work overload, shift type, type of service, among others, and the presence or not of certain personal, situational and organisational resources such as the psychological skills of the individual, the perception of social support, or certain personal values, that can be particularly influential factors. Likewise, a situation such as that caused by COVID-19 affects the mental health of nurses in the exercise of their functions, especially of those who are working on the front line against the virus, due to working hours, the fear of being able to spread the virus and infect loved ones and/or patients, concern about controlling the epidemic, among others. As for services, half of Primary Care nurses experienced feelings of daily work engagement, presenting higher levels of work engagement and lower perception of psychosocial risks than Emergency nurses and those from other areas. In addition, 4 out of 10 nurses showed above-cut-off scores to develop mental health problems, being higher among Emergency nurses and lower in Primary Care nurses. The implementation of a figure such as the Advanced Practice Nurse (APN) could offer very important advantages for improving the public health system, both in terms of cost-efficiency and in terms of improving the accessibility and quality of the services provided to citizens, especially in services such as Emergency ones.