International Journal of Advanced Engineering Research and

Science (IJAERS)
Peer-Reviewed Journal
ISSN: 2349-6495(P) | 2456-1908(O)
Vol-8, Issue-6; Jun, 2021
Journal Home Page Available: https://ijaers.com/
Article DOI: https://dx.doi.org/10.22161/ijaers.86.52

Burnout Syndrome- Stress in Health Care Professionals

Working to Fight Covid-19 in Public Hospitals
Carlos Alberto Paraguassú-Chaves1, Carla Dolezel Trindade2, Simão Aznar Filho3,
Fabrício Moraes de Almeida4, Simão Dolezel Aznar5, Carlos Alberto Dolezel Trindade6,
Levi Pereira Granja de Souza7, Ricardo Guanabara8, and Lenita Rodrigues Moreira
Dantas9

1PhD in Health Sciences - University of Brasília - UnB, Brazil; PhD in Science - University of Havana (Cuba); Post-Doctor in Health
Sciences - UnB and Degli Studi D'Aquila University - IT. Full Professor at the University Institute of Rio de Janeiro - IURJ, Brazil. E-
mail: [email protected]
2PhD in Law - Universidad Nacional de Lomas de Zamora (Argentina). Post-doctorate - Universita deli Studi di Messina (Italy). Full

Professor at the University Institute of Rio de Janeiro - IURJ, Brazil

3PdD in Law - Universidad Nacional de Lomas de Zamora (Argentina). Post-doctorate - Universita deli Studi di Messina (Italy). Full

Professor at the University Institute of Rio de Janeiro - IURJ, Brazil

4PhD in Physics (UFC), with post-doctorate in Scientific Regional Development (DCR/CNPq). Researcher of the Doctoral and Master

Program in Regional Development and Environment (PGDRA/UNIR). Leader of line 2 - Technological and Systemic Development, and
Researcher of GEITEC ― Federal University of Rondonia, Brazil. E-mail: [email protected]
5Graduated in Law. Master of Law Student, Specialist in Law. Professor at the University Institute of Rio de Janeiro, Brazil
6Graduated in Law and Psychology. Specialist in Higher Education Teaching. Professor at the University Institute of Rio de Janeiro, Brazil
7Master's Degree in Administration from Estácio de Sá University, Brazil. Professor at the University Institute of Rio de Janeiro, Brazil.

Professor at the University Institute of Rio de Janeiro, Brazil

8PhD in Political Science from IUPERJ, Brazil. Professor at the University Institute of Rio de Janeiro, Brazil.
9Bacharel and Specialist in Geography. graduated in law. Researcher at the Higher Institute of Health Sciences and Environment of the

Amazon - AICSA. E-mail: [email protected]

Received: 15 May 2021; Abstract — Objective: The research had as general objective to analyze
Received in revised form: the incidence of Burnout Syndrome in health professionals of two public
hospitals that provide care to patients with Covid-19 in two realities in the
10 Jun 2021;
Legal Amazon. Materials and Methods:Exploratory, descriptive study, with
Accepted: 20 Jun 2021; a cross-sectional design and a quantitative approach. The data collection
Available online: 30 Jun 2021 instruments used in this study were: a) Maslach Burnout Inventory (MBI)
Questionnaire and Questionnaire of sociodemographic, professional and
©2021 The Author(s). Published by AI
psychosocial factors profile. The MBI is composed of three factors that are
Publication. This is an open access article
called Emotional Exhaustion EE, Depersonalization DE and Professional
under the CC BY license
Achievement RP. The research subjects were 140 health professionals from
(https://creativecommons.org/licenses/by/4.0/).
two public hospitals. The research project complies with Resolution 466/12
Keywords— Burnout Syndrome, Stress. of the National Health Council of Brazil, taking into account the ethical
Health professionals, Covid-19, Public aspects of research in Brazil. Main results: Health professionals working
hospitals. to combat the Covid-19 pandemic in two public hospitals have high rates of
Emotional Exhaustion (EE), Depersonalization (DE) and Low Professional
Fulfillment (PR), indicative of high rates of burnout. Individual or
associated psychosocial factors are conditioning factors and can directly
determine the occurrence of Burnout Syndrome in health professionals,
especially at this time of combating the Covid-19 pandemic. Conclusion:

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Carlos Alberto Paraguassú-Chaves et al. International Journal of Advanced Engineering Research and Science, 8(6)-2021

Show the urgency of interventions aimed at these professionals, which aim

to reduce levels of occupational stress, increase self-esteem, encourage
self-care and build a healthy work environment.

I. INTRODUCTION emotional well-being of health professionals has been the

The Covid-19 pandemic has generated concern about the object of scientific research in recent years, as it is an
mental health of the entire society and, especially, of important health problem [9]. For Vitorino et al [6],
health professionals who are on the front lines in the fight Burnout Syndrome is characterized by emotional
against the pandemic [1]. According to Schmidt et al [2], exhaustion, depersonalization and decreased personal
in times of pandemic, physical health and combating the fulfillment, in response to chronic sources of stress.It is
causative agent of the disease are the focus of attention of identified as a common phenomenon among many
managers and health workers, however, the mental health professionals, with a higher incidence in workers who
of these professionals tends to be neglected. The Covid-19 have direct contact with people.
pandemic brought an additional problem for the well- According to McCray et al [10] currently, Burnout is
being of physicians, nurses, technicians and nursing defined by a combination of three factors: emotional
assistants and all healthcare professionals. In times of exhaustion (depletion of emotional energy due to
greater pressure, such as the fight against the new excessive work demand), depersonalization (sense of
coronavirus, these workers forget about their own health emotional distance from patients or work) and low
[1]. According to Rodrigues; Silva [3] the physical and achievement personal (feeling of low self-esteem and low
mental well-being of these professionals is affected, efficiency at work).Briefly Bernhardt et al [11] defines it
leading to the emergence of disorders related to stress and as the prolonged response to chronic stress at work.
anxiety such as Burnout Syndrome. According to Burnout Syndrome is a psychosocial phenomenon that
Rodriguez et al [4], occupational stress appears in the field arises as a response to chronic interpersonal stressors
of health as a real problem among professionals due to the present at work [12]. The most used definition of what is
exhaustive characteristics of work. For Faro et al [5], the Burnout Syndrome is Maslach's; Jackson and Leite [13]
Burnout Syndrome intensifies in this context, as the and Maslach; Jackson [14] referring to it as a
excessive workload caused by the new coronavirus grows multidimensional syndrome consisting of exhaustion.For
disorganized. Thus, work overload can cause these authors, Burnout Syndrome has been recognized as a
psychological and social disturbances, and interfere in the condition experienced by professionals who carry out
quality of life of health professionals [6]. activities in which a high degree of contact with other
It is undeniable that, given the Covid-19 pandemic, a new people is involved, including health professionals, whose
scenario of doubts and uncertainties emerged, where it task involves intense and prolonged attention to people in
appears that health professionals are more likely to situations of need or dependence [13].
develop Burnout Syndrome, as they deal with intense For Moss et al [15], Burnout Syndrome affects the
emotions such as suffering, fear and death , making it physical and emotional health of professionals, bringing
more vulnerable to a high degree of stress, in addition to worrying consequences at individual and organizational
increasing physical and psychological strain. According to levels.. For Carlotto and Câmara [16], at the beginning of
França and Rodrigues [7], occupational stress arises from any evidence, there is a need to prevent its
the worker's perception that the work environment is symptoms.According to Melo and Carlotto [17] and Moss
threatening to their physical and/or mental health, because et al [15], prevention strategies for Burnout Syndrome
they believe that this environment has excessive demands include carrying out individual and organizational
or because they do not have sufficient resources for their interventions or, ideally, a combination of both. According
coping. The Ministry of Health of Brazil and the Pan to Silveira et al [18] motivation at work is the result of a
American Health Organization in Brazil [8] recognize that series of interactions between individual effort, income
one of the possible effects of chronic exposure to obtained, organization and personal goals, while stress is
occupational stress is the triggering of Burnout Syndrome an individual's physiological and behavioral response.
or professional exhaustion, a phenomenon that affects For Gómez-Gascón et al [19], the health professional,
professionals who have intense contact with the users of when faced with potentially stressful situations, events,
its services, such as health and education professionals, people or goals, induces this reaction, which is essential
police officers, social workers, among others. The for survival.West et al [20] confirm that depression,
potential effects of occupational stress on the physical and suicidal tendencies, poor quality of life, dissatisfaction

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Carlos Alberto Paraguassú-Chaves et al. International Journal of Advanced Engineering Research and Science, 8(6)-2021

with work-life balance, and especially Burnout, have been The research had as general objective to analyze the
reported in all medical specialties and in all health-related incidence of Burnout Syndrome in health professionals of
professions. What is also more serious, according to two public hospitals that provide care to patients with
Cedfeldt et al [21], is that due to the high frequency of Covid-19 in two realities in the Legal Amazon.
such occurrences, Burnout Syndrome causes a negative
impact on the conduct of patients, as well as on their health
II. MATERIALS AND METHODS
safety.
2.1 Study Type
According to Guido et al [22], studying the stress of health
professionals in the hospital environment allows a better Exploratory, descriptive study, with a cross-sectional
understanding of its causes, which helps to elucidate design and a quantitative approach. It was developed in
everyday issues related to mental health and frequently two public hospitals for the care of patients with Covid-19
faced by these professionals.In the study "Burnout located in the Brazilian Amazon. The criteria for choosing
Syndrome in health professionals: updating on definitions, these hospitals was based on the peculiar characteristic of
risk factors and prevention strategies", Perniciotti et al [9] exclusive care for patients with Covid-19. Data collection
confirm that the propensity of health professionals to was carried out over a 3-month period in 2021.
Burnout Syndrome is well documented, especially those 2.2 Data Collection Instruments
who work in complex and intense environments such as
Questionnaires with closed questions and multiple choices
hospitals.The research by Perniciotti et al [9] makes
were used as data collection instruments for this research, in
reference to several studies.Corroborating their findings,
addition to the MBI inventory. The data collection
the studies by Bartholomew et al [23]; Rotenstein et al
instruments used in this study were: a) Maslach Burnout
[24], who identified Burnout Syndrome in physicians from
Inventory (MBI) Questionnaire; b) Questionnaire on the
different specialties (25 to 67%), Erschens et al [25];
profile of sociodemographic, professional and psychosocial
IsHak et al [26]; Low et al [27]; Rodrigues et al [28];
factors.
Shanafelt; Bradley; Wipf and Back [29] who identified in
resident physicians (7 to 76%) and Bridgeman; Bridgeman The Maslach Burnout Questionnaire (MBI) is an inventory
and Barone [30]; Woo; Ho; Tang; Tam [31]; Chemali et.al consisting of 22 items, where the individual responds to a
[32]; Koinis et al [33]; Moss; Good; Gozal; Kleinpell and seven-point Likert scale.After the initial orientation
Sessler [15], who identified Burnout Syndrome in nurses described by the inventory, alternatives are presented,
(10 to 70%). ranging from the condition "never" (0), to the intensity
"every day" (6), with which the individual will respond by
To Zanata; Lucca [12] the clinical picture is varied and can
marking an X in the intensity that best represents what is
include psychosomatic, psychological and behavioral
described in each item. The MBI is composed of three
symptoms among professionals, and produce negative
factors that are called Emotional Exhaustion EE (as
consequences at the individual, professional, family and
measured by questions 1, 2, 3, 6, 8, 13, 14, 16 and 20) DE
social levels. In the study by França et al [34] within the
Depersonalization (questions 5, 10, 11, 15 and 22) and
scope of health institutions, high rates of absenteeism due
Professional Achievement RP (questions 4, 7, 9, 12, 17, 18,
to illness stand out, and for Hyeda; Handar [35] attributes
19 and 21). Among all the instruments presented, the MBI
presenteeism with consequent commitment to the quality
is the most used to assess the Burnout Syndrome, regardless
of service provided in institutions. According to Lautert
of the occupational characteristics of the sample and its
[36]; Lorenz; Benatti; Sabino [37]; Carlotto [38]; Ferreira;
origin.
Lucca [39] in general, studies on Burnout Syndrome in health
institutions assess only one professional category, for The authors McCray et al [10]; Sanfuents [43]; Aldrees et
example, nursing workers. Nogueira-Martins [40]; Ax [41]; al [44]; Shirom [45]; Ishak et al [46] confirm that the
Tucunduva et al [42] refer to studies with medical Maslach Burnout Inventory (MBI) is the most used
professionals or analyze health professionals without instrument in the investigation of the disease, as well as in
distinction of profession. In Zanatta's Literature Review its quantification. About 90% of Burnout investigations
study; Lucca [12] on the subject showed that in Brazil were carried out through the MBI [44]. According to
there is a lack of studies on the set of health professionals Aldrees et al [44]; Arrogant [47]; Ishak et al [46] this
from the same institution, in order to obtain a questionnaire consists of 22 items, distributed as follows:
characterization of mental illness in the context of work as nine items related to emotional exhaustion, five to
a whole. depersonalization, and eight to low personal
fulfillment.Each marked item is rated on a Likert scale
from zero to six (where zero means "never"; one is "a few

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Carlos Alberto Paraguassú-Chaves et al. International Journal of Advanced Engineering Research and Science, 8(6)-2021

times a year"; two is "once a month"; three is "once a exhaustion, both physical and mental, the feeling of no
month"; a few times a month"; four points to "once a longer having energy for absolutely nothing, of having
week"; five represents "a few times a week"; and finally arrived to the limit of possibilities, lack or lack of energy
six refers to "every day"). and feeling of exhaustion of resources. b)
According to Ishak et al [46] Burnout is detected Depersonalization (DE) – The professional has not lost his
according to a cutoff score for each of the three categories: personality, but it has undergone or is undergoing changes,
emotional exhaustion ≥27, depersonalization ≥10 and low leading him to a cold and impersonal contact with the
personal fulfillment ≥33. According to Cialzeta [48] users of his services (patients, clients, etc.), starting to
(2013); Aldrees et al [44]; Shirom [45]; walls; Sanabria- have attitudes of cynicism and irony in relation to people,
Ferrand [49]; Diaz Araya [50] among the three factors showing itself indifferent to what may happen to others;
present in Burnout, emotional exhaustion was identified as the professional starts to treat patients and clients,
the most prevalent (reaching 54%, according to Aldrees et colleagues and the organization as objects. c) Professional
al [44]), since it is the symptom that most represents the Achievement (PR) – feeling of dissatisfaction with the
consequences that stress at work can cause for health work activities they have been performing and with their
professionals. And, according to Cialzeta [48]; Aldrees et emotional development, feeling of insufficiency, low self-
al [44]; walls; Sanabria-Ferrand [49]; the second most esteem, professional failure and lack of motivation. The
prevalent item is depersonalization, followed by low professional reveals low efficiency at work, sometimes
personal fulfillment. These factors consist of three related feels the desire to leave the job, characterizing a negative
dimensions, but independent of each other, which are: a) self-assessment.
Emotional Exhaustion (EE) - it is the feeling of
MASLACH BURNOUT INVENTORY QUESTIONNAIRE (MBI)
0 – Never; 1- Once a year or less; 3 – A few times a month; 4 – Once a week; 5 – A few times a week; 6 – Every day.
ONCE A YEAR OR

ONCE A MONTH

ONCE A WEEK
SOMETIMES A

SOMETIMES A
PLEASE READ THE FOLLOWING

EVERY DAY
OR LESS
AFFIRMATIONS CAREFULLY, SCORING

MONTH
NEVER

WEEK
LESS

Nº AS SINCERELY AS POSSIBLE
ACCORDING TO THE INTENSITY
DESCRIBED:

1 I feel emotionally drained from my job.

2 I feel tired at the end of the workday.
3 When I get up in the morning and go to another
workday I feel tired.
4 I can easily understand how people feel.
5 I think I treat some people as if they were
impersonal objects.
6 Working with people all day takes a lot of effort.
7 I deal effectively with people's problems.
8 My work leaves me exhausted.
9 I feel that through my work I positively influence
the lives of others.
10 I have become more insensitive to people since I
have been doing this job.
11 I am concerned that this job is hardening me
emotionally.
12 I feel very vital.

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13 I feel frustrated in my work.

14 I think I'm working too hard
15 I don't really care what happens to the people I
serve.
16 Working directly with people causes me stress.
17 I can easily create a relaxed atmosphere for
people.
18 I feel stimulated after work in contact with people.
19 I have achieved many accomplishments in my
profession.
20 I feel at the limit of my possibilities.
21 I feel that I know how to properly handle
emotional problems in my work.
22 I feel people blame me in some way for their
problems.

b) Questionnaire of sociodemographic, professional and 2) Professional data: 1) Position: a ( ) graduation; b ( )

psychosocial factors profile. It is characterized by a specialization / residency; c ( ) title of master; d ( )
questionnaire with multiple choice questions, divided into doctorate; and ( ) postdoctoral. 2) Work shift: a ( )
questions of sociodemographic data (age, gender, marital morning; good night; c ( ) late; d( ) all; and ( ) in service.
status and number of children) and 08 questions of 3) Length of professional experience: a ( ) less than one
professional data (degree, area of expertise, work shift, year; b ( ) 1 to 5 years; c () 6 to 10 years; d ( ) 11 to 15
length of experience professional).Psychosocial factors years; and ( ) 16 years or older. 4) Length of experience
have 11 questions about bad behavior of patients, with Covid-19 treatment: a ( ) less than 6 months; b ( )
overload of activities, high number of patients per work from 6 months to less than one year; c( ) one year; d ()
shift, need for professional updating, execution of more than a year. 5) Number of patients and/or care
bureaucratic activities, multiplicity of roles to play, provided daily: a ( ) less than 10; b ( ) less than 20; c ( ) 20
expectations of family members, lack of resources for to 30; d ( ) 30 to 40; f ( ) more than 40. 6. Work
materials for work, high number of daily activities, lack exclusively at the hospital: a ( ) yes; b () no.
of support from coordination and colleagues, little 3) Psychosocial Factors:Analyze and mark with an X, the
participation in institutional decisions, to be answered occurrence of the described phenomena, according to the
according to the intensity that occur, being 1 (always), 2 scale proposed below: Always (1); Often (2); sometimes
(often), 3 (sometimes) , 4 (rarely) and 5 (never). (3); Rarely (4); Never (5).
Sociodemographic, Professional and Psychosocial The psychosocial factors adopted in the research are: bad
Factors Profile Questionnaire behavior of patients or family members; activity overload;
Mark with an X the answer corresponding to the high number of patients per shift; need for professional
indicative number applicable to you. updating; execution of bureaucratic activities; multiplicity
1) Sociodemographic Data: 1) Age: a ( ) up to 25 years of roles to play; family members' expectations; lack of
old; b ( ) from 26 to 30 years old; c ( ) from 31 to 35 years material resources for work; high number of daily
old; d ( ) from 36 to 45 years old; and ( ) from 46 to 55 activities; lack of support from coordination and
years old; f ( ) over 55 years old. 2) Gender: a ( ) Male b ( colleagues, and little participation in institutional
) Female. 3) Marital Status: a ( ) Single; b ( ) Married or decisions.
cohabiting; c ( ) Separated, separated, divorced or 2.3 Sampling Number
widowed. 4/ Number of children: a ( ) None; b ( ) 1 child; The research subjects were one hundred and forty (140)
c ( ) 2 children; d ( ) 3 children; and ( ) 4 children; f ( ) 5 health professionals from two public hospitals, randomly
or more children. selected, as no area of education, title, gender, length of
experience in the profession, among other variables, was

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Carlos Alberto Paraguassú-Chaves et al. International Journal of Advanced Engineering Research and Science, 8(6)-2021

prioritized. The freedom of professionals to respond to the The Emotional Exhaustion (EE) dimension showed high
survey voluntarily and those who are exclusively dedicated rates, which may be causing symptoms of exhaustion and
to the treatment of Covid-19 were prioritized. Considering frustration. The Depersonalization (DE) dimension also
the chronicity and intensity of stress for the manifestation presented a high index that can manifest itself through
of Burnout Syndrome, the study population consisted of negative attitudes such as derogatory treatment, cold and
physicians, nurses, technicians and nursing assistants, distant attitudes and disconnection from the problems of
physiotherapists, biomedical, speech therapists, patients and clients and co-workers. The professional's
pedagogical therapists, ambulance drivers and all other performance is directly influenced by the high rates of
active professionals in combating Covid-10 in times of Depersonalization found in the research, which express the
pandemic. interpersonal context where the subject's work is
2.4 Inclusion and exclusion criteria and ethical developed, and the decrease in personal achievements,
aspects represents the self-assessment that the individual performs
of his/her occupational and personal performance.
All health professionals working in the fight against
Regarding the Professional Achievement (PR) dimension,
Covid-19 and who signed the free and informed
it can be observed that the health professionals of the two
consent form and returned the completed
Hospitals had slightly higher PR rates compared to those
questionnaires were included.The exclusion criterion
found in the international and national literature, by the
was not returning the informed consent form and not
GEPEB group, by the Manual España and Manual
filling out the questionnaires. The research project
Americano.
complies with Resolution 466/12 of the National
Health Council of Brazil, taking into account the For Maslach, Schaufeli and Leiter [51] emotional
ethical aspects of research in Brazil. exhaustion is characterized by feelings of being
overwhelmed and exhausted of their physical and
emotional resources, leading to depletion of energy to
III. RESULTS AND DISCUSSION invest in situations that arise at work. This dimension
The results found in the applied MBI questionnaire were according to Maslach and Leiter [52]; Carlotto and Câmara
calculated using the Likert scale, ranging from 0 to 6. [16] is considered a central quality and the most obvious
After the sum of the items, a total value for Emotional manifestation of the syndrome, being associated with
Exhaustion (EE), Depersonalization (DE) and Professional feelings of frustration in view of the professionals'
Fulfillment (PR) was obtained, with each value obtained perception that they are unable to understand the energy to
being divided by the total number of health professionals, care for patients as they did before [52]; [16]. Maslach,
obtaining the average of each factor. Schaufeli and Leiter [51] explain that as emotional
exhaustion worsens, depersonalization or cynicism can
It is observed in Table 1 that the two Hospitals had high
occur, which are characterized by a distant or indifferent
rates of Emotional Exhaustion (EE), Depersonalization
attitude of the individual towards work, colleagues and
(DE) and low Professional Fulfillment (PR). They are
patients. These authors argue that depersonalization is
indicative of high rates of Burnout incidence. All indices
considered a response to emotional exhaustion,
above the averages recommended by international and
constituting an individual's coping strategy in the face of
national literature: Emotional Exhaustion (EE) ≥27,
chronic stress.
Depersonalization (DE) ≥10 and low Professional
Achievement (PR) ≥33. Carlotto and Câmara [16] explain that the gradual loss of
empathy and indifference towards work culminates in
The means found are higher than those found and
affective insensitivity and excessive distance from the
recommended by the GEPEB - Study and Research Group
public that should receive their services, compromising the
on Stress and Burnout Syndrome. Group formed by
ability of health professionals to provide quality care to
Brazilian and Spanish researchers, who over the years
their patients. According to Moss et al [15], this dimension
have been developing studies, courses and investigations
can also be expressed by unprofessional comments
on processes of stress, burnout, quality of life, resilience
directed at co-workers, by blaming patients for their
and engagement in various professional groups (teachers,
problems or by the inability to express empathy/regret
psychologists, doctors, nurses, etc.) in order to understand
when a patient dies. While the dimension of reduction in
and develop health at work.The findings in the current
personal fulfillment refers to the subject's tendency to
research are also superior to those found and
negatively assess himself/herself in relation to their skills
recommended by Manual Spain and the American Manual.
and productivity at work, which can lead to reduced self-
esteem [30]; [15];[51]. In this dimension, the individual

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experiences a decline in the feeling of competence and Burnout Syndrome" exceeds the value of 200 million
success, as well as in their ability to interact with others dollars due to spending on early retirement and reduced
[16]. hours worked for the medical category. According to
Table 1 shows the values obtained for each public hospital Hamidi et al [59] a study carried out in the United States
and the general average obtained for all two hospitals shows that 28% of the physicians evaluated with Burnout
(item ALL). Syndrome showed an intention to leave their work and
after two years 13% actually did so, resulting in costs
Table 1: Presentation and Comparison of the mean
ranging between 15 and 55 million dollars .
values of EE, DE and PR by Hospital Unit
About which professionals are more affected by Burnout
VARIABLES H1* H2** ALL Syndrome, Borges et al [1] in their study “Risck Factors
N=50 N= 90 N= 140 For Burnout Sydrome In Health Professionals During The
EE 34,0 39,0 36,5 Covid-19 Pandemic, show that nurses, nursing assistants
and technicians are more likely to develop occupational
DE 16,0 12,0 14,0 stress. In the current scenario, this problem is more likely
RP 36,0 34,0 35,0 to be acquired by professionals, since the demand for
H1* Hospital 1 H1** Hospital 2 health services has grown exorbitantly and the global
health infrastructure was not prepared for such demand, in
addition to the fear of the collapse of the health system.
According to Perniciotti et al [9] the consequences of For Borges et al [1], overwork, lack of resources and
Burnout Syndrome in health professionals are serious, as professionals in many places, the high number of deaths
moderate and high levels of Burnout Syndrome are and cases of infected people and the fear of becoming
associated with: 1) individual disorders, such as post- infected are realities in hospital environments today. Also
traumatic stress disorder. traumatic (PTSD), alcohol abuse, according to Borges et al [1] in their research, work
psychosomatic complaints, drug use, depression and overload, stress, physical exhaustion, depression and
suicidal ideation; 2) behavioral changes related to job compromised social interaction are the main risk factors
dissatisfaction, lack of organizational commitment and for the development of Burnout Syndrome in health
intention to leave work; 3) problems at work, such as professionals, as well as suffering psychological, caused
absenteeism, worse results in patient safety measures and by insomnia, anxiety, depression, sadness, isolation from
errors in professional practice. These statements about the family and friends during the pandemic. Fear of
consequences of Burnout Syndrome in health professionals contracting the disease and family members' infection are
are corroborated by important authors such as Moss et al also major causes of psychological stress. It is noteworthy
[15]; Dyrbye et al [53]; Lacovides, Fountoulakis, Kaprinis that, in the specific analysis of sociodemographic data,
and Kaprinis [54]; Lazarescu et al [55]; Maslach and they indicate that women suffered a greater psychological
Leiter [56]; and Moss et al [15]. impact from the outbreak in the pandemic. The hospital
According to Carlotto and Câmara [16]; Lacovides et al environment generates more psychological problems for
[54]; Moss et al [15]) the consequences of Burnout health professionals. The causes are related to the demand
Syndrome culminate in a decrease in the quality of life of for work in an emergency situation caused by the Covid-
health professionals and in the efficiency at work, 19 pandemic. Thus, more attention should be directed to
negatively impacting patient care. For Waterman et al [57], health professionals who are on the front line against the
the occurrence of errors in professional practice also disease, as the importance of these professionals is
causes harm to the professional, as it is related to loss of unquestionable for the social good [1].
confidence, sleep difficulties, reduced job satisfaction, Borges et al [1] in their review study found the main
increased levels of occupational stress and damage to the stress factors for health professionals in combating
professional image. For Moss et al [15], the abandonment Covid-19. Among these factors, the following stand out:
of professional practice increases the turnover of Exhaustive workload; Increased number of confirmed and
professionals in hospitals, resulting in high organizational suspected cases; Close contact with infected patients;
costs for the replacement of employees. Distance from family and friends; Lack of personal
Perniciotti et al [9] state that no national studies were protective equipment; Risk of contracting the virus and
identified that point out the organizational expenses concern about contagion from their family members; Risk
attributed to the Burnout Syndrome in health professionals. of being infected, getting sick or dying, in addition to the
According to Dewa, Jacobs, Thanh and Loong [58] a study possibility and fear of infecting other people; Exposure to
carried out in Canada estimates that the "total cost of large-scale deaths and frustration over the loss of their

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Carlos Alberto Paraguassú-Chaves et al. International Journal of Advanced Engineering Research and Science, 8(6)-2021

patients' lives; The stress and pressure of dealing with feeling of impotence in the face of occupational life
your job, plus the risk of getting sick; Aggression itself situations, feeling of confusion and uselessness,
by people who seek care and cannot be accepted due to irritability, little attention to detail, increased
limited resources; Limited knowledge of virus prevention absenteeism, feeling of exaggerated responsibility or out
and control; Inappropriate feelings of support; Lack of of context, negative attitude, rigidity and low level of
specific medications, and media coverage. enthusiasm.
The most prevalent emotional symptoms presented by In the sociodemographic questionnaire, the main factors,
health professionals in combating Covid-19 are also as shown in Table 2, were the predominance of females
corroborated by the review research by Borges et al [1]. (85%), age from 31 to 45 years (45%), marital status,
Among them, depression, fear, lack of energy, insomnia, married (49%) and single (41 %) and professionals with
stress associated with difficulty falling asleep and waking children (75%), with a predominance of one to two
up in the morning stand out, anxiety, compromised social children (50%). Comparing these findings with studies in
relationships, anguish, insecurity, irritability, sadness and Brazil, we found very similar results regarding the
apprehension. predominance of females in the health area, the age range
For Barbosa and Beresin [60]; Benevides-Pereira [61] being lower than in other studies, which can be justified by
The symptomatic process of Burnout Syndrome can be the emergency entry of newly graduated professionals in
grouped into four areas: psychosomatic, behavioral, the pandemic combat service.
emotional and defensive: Psychosomatic refers to the Table 2: Sociodemographic Data: gender, age, marital
onset of headaches, muscle tension, gastrointestinal status and number of children (N = 140)
disorders, weight loss, insomnia, asthma and high blood VARIABLES Fr%
pressure; Behavioral factors are identified as absenteeism
from work, violent behavior, impotence regarding Gender
interactivity, drug use and dependence, as well as Male 15%
problems in family relationships; Emotional ones are Feminine 85%
marked by affective isolation, impatience, irritability,
concentration and memorization difficulties; And, finally, age range
in relation to defensives, there is the denial of one's Up to 25 years old 10%
emotions, detachment from people and selective
from 26 to 30 years old 15%
attention, with the sole purpose of warding off a negative
experience. For Benevides-Pereira [61] the person who From 31 to 35 years old 25%
presents the Burnout Syndrome does not necessarily have From 36 to 45 years old 20%
all these symptoms. The degree, type and number of
From 46 to 55 years old 20%
manifestations experienced will depend on the
configuration of individual factors (such as genetic over 55 years old 10%
predisposition, socio-educational experiences), Marital status
environmental factors (workplaces or cities with a higher
Not married 41%
incidence of pollution, for example) and the stage at
which the person is in the process of developing the Married 49%
syndrome. Separated/Separated/Divorced/Widowed 10%
McCornnell apud Guimarães and Cardoso [62], Number of children
elaborates a scheme about the signs and symptoms in the
None 25%
individual with Burnout Syndrome, as follows: a)
Physical signs and symptoms: similar to those of 1 son 25%
occupational stress, such as fatigue, feeling of intense 2 children 25%
exhaustion, indifference or coldness, feeling of low
3 sons 15%
performance, headaches, gastrointestinal disturbances,
sleep disorders and breathing difficulties; b) Behavior 4 sons 5%
symptoms: serious changes in behavior generally 5 or more children 5%
affecting colleagues, patients, patients' relatives and even
Fr% = Relative frequency
their own relatives; c) Psychological symptoms:
appearance of changes, such as working more intensely,

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According to studies by Benevides-Pereira [61]; Martinez than 6 months of experience (mainly newly graduated
[63]; Russell and Velzen [64], there is no single agreement doctors), the professionals with little experience in Covid-
on the possibility of a higher incidence of Burnout with 19 treatment (50% with less than 6 months of experience)
regard to sex. Women have had higher scores in Emotional and with a predominance of patient care or more than 40
Exhaustion and men in Depersonalization. This fact can be calls for daily care (75%), and 90% do not work with
analyzed by the social and cultural characteristics of men, exclusivity in the Hospital Unit, that is, these professionals
who are not encouraged to show their emotions and after have a second or third job.
high levels of stress tend to react inappropriately, through Table 3: Professional Data (N = 140)
Depersonalization. Predominates health professionals
between 36 and 45 years old who, due to their age, should VARIABLES Fr%
already have a greater professional identity. There are Education
scientific reports that professionals under the age of 40 are Elementary or Middle Level 35%
at higher risk of incidence, as young professionals need to
learn to deal with work issues. According to Benevides- Professional Medium Level 25%
Pereira [61], it is important to note that Burnout appears at University graduate 15%
the beginning of a professional's career, being externalized Specialization 16%
later with work changes. Sarriera [65] says that Burnout is
a state of chronic stress and to reach the state of a Master's degree 5%
syndrome, the body issues several alerts and seeks to Doctorate degree 2%
combat or compensate, when it is defeated, stress becomes Work shift
chronic, as a syndrome, which can lead to physical,
psychosomatic, psychic or social illnesses. According to Morning 10%
Benevides-Pereira [61] and Martínez [63], a stable Evening 10%
relationship would be among the lowest incidence of
Night 20%
Burnout, as single people or people with unstable
relationships have greater emotional exhaustion, low morning/evening 40%
professional achievement and greater depersonalization. on-call regime 20%
There is no consensus on the health professional's marital
Professional Experience Time
status in relation to Burnout Syndrome, that is, the
predominance of married marital status does not confirm Less than 1 year 20%
in other studies, which indicate single and young people as 1 to 5 years 15%
a predisposing factor to the syndrome. The number of
6 to 10 years 25%
children also brings controversial results, as this can be a
factor that balances the professional, enabling better 11 to 15 years old 25%
combat strategies. However, according to Martínez [63], 16 years or more 15%
the existence of children makes people who have a stable
Time of Experience with Covid-19
relationship may be more resistant to Burnout Syndrome,
Treatment
as the general tendency found in parents is to be more
mature, stable and a good relationship with the family and Less than 6 months 50%
children brings greater capacity to face personal problems From 6 months to 1 year 30%
and emotional conflicts, and to be more secure with family
More than 1 year 20%
support.
Number of Patients or Calls for Daily
As for the professional variables evaluated in this study,
Service
the main factors described in Table 3 were obtained, with a
predominance of professionals with primary and secondary Less than 10 0%
education with 35% (nursing assistants), professional Less than 20 5%
secondary level with 25% (nursing technician) and
from 20 to 30 20%
graduates with 15% (nurses and doctors without
specialization) and professionals with specialization more than 40 75%
(15%). Professionals working in two shifts predominate Do you work exclusively at the Hospital?
(40%), with professional experience from 6 years to 15
Yea 10%
years with (50%), with emphasis on professionals with less

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No 90% interference factor in the interpersonal relationships of the

health professional.
Fr% = Relative frequency
Table 4: Predominant Classification and Relative
Frequency of Psychosocial Factors.
According to studies by Benevides-Pereira [61], people
with higher education are more predisposed to burnout, Psychosocial Factors Classification Fr%
with a greater professional perspective or a higher level of
Misbehavior of patients or family Sometimes 45,0%
responsibility, but professional achievement may be
members
related to the status and recognition of the high level of the
profession. Excessive work entails several inconveniences Activity overload Often 40,0%
and leaving them susceptible to Burnout. The longer the High number of patients per shift Always 55,0%
working time and the greater the workload dedicated to the
Need for professional updating Always 70,0%
institution, the more prone to Burnout Syndrome. The
length of professional experience is not in agreement with Execution of bureaucratic activities Rarely 30,0%
other studies, and some studies describe Burnout as a Multiplicity of roles to play Often 40,0%
process of wear that increases over time, while others have
family members' expectations Always 80,0%
a higher incidence in those who enter the labor market, due
to little experience and not have even developed adequate Lack of material resources for work Sometimes 35,0%
strategies to face professional problems. As for the length High number of daily activities Always 35,0%
of experience, Burnout starts to reveal itself from the first
Lack of support from coordination and Rarely 30,0%
year of work in excessive and overwhelming conditions.
colleagues
Although the professional experience of those surveyed is
not a factor that triggers the Burnout syndrome, when Little participation in institutional Sometimes 30,0%
observed together with the short time working at the decisions
institution, it may indicate possible predispositions to the Caption: Always (1); Often (2); sometimes
onset of Burnout. According to Benevides-Pereira [61], (3); Rarely (4); Never (5).
work overload has been one of the most cited variables as
predisposing to Burnout, as it is related both to the
quantity and the excessive quality of demands, which The factor bad behavior of patients or family members was
exceed the performance capacity. The closer the worker's referred to as sometimes (45.0%), being a factor that in
relationship with the person he or she must professionally this classification may represent a trigger of Burnout. The
assist, the greater the probability of triggering the Burnout activity overload factor was referred to as Frequently
process. Among the professionals surveyed, those who do (40.0%), reinforcing what many studies say that this is a
not work exclusively in a single institution (90%) stand triggering topic for Burnout Syndrome. In several
out, a factor that can generate a constant adaptive need to explanatory models, it is the emotional exhaustion factor
adapt to each new work environment. According to Silva that is triggered primarily in the Burnout Syndrome
and Fogaça [66], the professional having other jobs process, thus, the physical and mental fatigue resulting
implies more efforts, more planning and more preparation from professional activity, the energy depletion resulting
for different activities, increasing the feeling of mental from the overload of activities, can be considered as
burden and decreasing the possibility of obtaining contributing factors for emotional exhaustion and
pleasure. consequently Burnout [67].
According to the data obtained in the research on The high number of patients per shift was classified as
psychosocial factors, Table 4 can be seen, where the Always (55.0%), a factor that is associated with the high
predominant classification and relative frequency of these number of daily activities and the high number of patients
factors are specified. Psychosocial factors affect assisted by the professional and the high number of calls
professionals from different areas and this reality has for assistance can trigger Burnout. The factor needing
generated great interest and concern not only from the professional updating was represented as Always 70.0%.
international scientific community, but also from According to studies by Benevides-Pereira [61], people
government groups, given the seriousness of the with high professional motivation are more prone to
consequences, both individual and organizational, burnout. The factor execution of bureaucratic activities
presented by Burnout Syndrome, especially as an presented the classification Rarely (30.0%). The
multiplicity of roles to play factor was rated Frequently

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(40.0%). This factor can contribute to the presence of In the study, there was a predominance of females (85%),
Burnout Syndrome. The factor expectation of family aged from 31 to 45 years (45%), married (49%) and single
members was rated Always (80.0%), representing that (41%) and professionals who have children (75%),
family support can influence the Burnout indices. predominantly number of one to two children (50%).
The factor lack of material resources for the work, Comparing these findings with studies in Brazil, we found
presented classification Sometimes (35.0%), and the factor very similar results regarding the predominance of females
little participation in institutional decisions, Sometimes in the health area, the age range being lower than in other
(30.0%) did not present indices that can directly studies, which can be justified by the emergency entry of
collaborate in the occurrence of the Syndrome of Burnout. newly graduated professionals in the pandemic combat
In the research carried out, the factor lack of support from service. There was a predominance of professionals with
the coordination and colleagues presented a classification primary and secondary education with 35% (nursing
Rarely (30.0%), which does not seem to contribute to the assistants), professional secondary level with 25% (nursing
occurrence of Burnout. technician) and graduates with 15% (nurses and physicians
without specialization), professionals working in two shifts
According to Tamayo and Tróccoli [67], the perception of
(40% ), with professional experience from 6 years to 15
organizational support depends on the same attribution
years with (50%) and mainly newly graduated physicians,
process that people use to define the commitment of others
professionals with little experience in the treatment of
in social relationships. This perception is influenced by the
Covid-19 (50% with less than 6 months of experience and
frequency, intensity and sincerity of expressions of praise
predominantly of patient care or more than 40 calls for
and approval and by aspects related to payment, job
daily care (75%), 90% with another job. Individual or
category, job enrichment and influence on the
associated psychosocial factors are conditioning factors
organization's policies. In the understanding of Vasques-
and can directly determine the occurrence of Burnot's
Menezes and Soratto [68], social support refers to the
Syndrome in health professionals, especially at this time of
social network naturally established between co-workers,
combating the Covid-19 pandemic.
neighbors and acquaintances, and can be understood as the
help to solve problems, which can be in the sense of allow The scenario found requires a strategic planning policy for
the discharge of an affective charge. According to Russell health promotion and prevention for these professionals,
and Venzel [64] social support has been identified as the both by hospitals and by the State Health Department. We
resource that enables the individual to be able to withstand hope that this article will contribute to update the available
stress. According to current hypotheses, individuals who literature on Burnout Syndrome and facilitate the
are related to social support are able to trust others to help understanding of the nuances that involve its triggering in
them in stressful situations. health professionals, highlighting the importance of
evaluating preventive interventions. The urgent need for
interventions aimed at these professionals is evident,
IV. CONCLUSION aimed at reducing levels of occupational stress, increasing
The present study concludes that health professionals self-esteem, encouraging self-care and building a healthy
working to combat the Covid-19 pandemic in two public work environment.
hospitals have high rates of Emotional Exhaustion (EE),
Depersonalization (DE) and low Professional Fulfillment
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