COPI NG MECHANI SMS USED BY NON- BURNED OUT AND BURNED OUT W ORKERS I N
THE FAMI LY HEALTH STRATEGY
Let ícia de Lim a Tr indade1 Liana Laut er t2 Car m em Lú cia Colom é Beck3
Tr indade LL, Laut er t L, Beck CLC. Coping m echanism s used by non- bur ned out and bur ned out w or k er s in t he fam ily healt h st r at egy. Rev Lat ino- am Enfer m agem 2 0 0 9 set em br o- out ubr o; 1 7 ( 5 ) : 6 0 7 - 1 2 .
This st udy aim ed t o invest igat e st r ess coping m echanism s used by w or ker s of 16 Fam ily Healt h St r at egy ( FHS)
t eam s in Sant a Mar ia, RS, Br azil. Six w or k er s w it h scor es com pat ible w it h t he Bur nout Sy ndr om e, ident ified t h r ou gh t h e Maslach Bu r n ou t I n v en t or y , an d six w or k er s w it h ou t t h e sy n dr om e w er e in t er v iew ed in Jan u ar y
and Febr uar y 2007. I n t he r epor t s’ cont ent analysis, w e ident ified t hat bur ned out w or ker s pr edom inant ly used
in div idu al m ech an ism s t o cope w it h occu pat ion al pr oblem s, w h ile n on - bu r n ed ou t w or k er s sou gh t collect iv e
m echanism s. These findings indicat e t he im por t ance of int er per sonal r elat ionships am ong FHS t eam m em ber s
t o cope w it h occupat ional st r ess and t he need t o dev elop collect iv e st r at egies t o pr ev ent st r ess and m aint ain w or k er s’ h ealt h .
DESCRI PTORS: nur sing; st r ess; w or k er s’ healt h; fam ily healt h pr ogr am
MECANI SMOS UTI LI ZADOS PARA ENFRENTAR EL AGOTAMI ENTO POR TRABAJADORES
QUE ACTÚAN EN EL PROGRAMA ESTRATEGI A DE LA SALUD DE LA FAMI LI A
La inv est igación obj et iv ó inv est igar los m ecanism os par a enfr ent ar el est r és, ut ilizados por los t r abaj ador es de
los dieciséis equipos de la Est r at egia de la Salud de la Fam ilia ( ESF) de Sant a Mar ia, RS, Br asil. Fuer on ent r evist ados,
en los m eses de en er o y f ebr er o de 2 0 0 7 , seis t r abaj ador es con pu n t aj es com pat ibles con el sín dr om e de
Bur nout , ident ificados por el Maslach Bur nout I nvent or y, y seis sin el síndr om e. En el análisis de cont enido de
las d eclar acion es, se id en t if icó q u e los t r ab aj ad or es ag ot ad os u t ilizan , p r ed om in an t em en t e, m ecan ism os individuales par a enfr ent am ient o de los pr oblem as labor ales, en cuant o los no agot ados r ecur r en a m ecanism os
colect iv os. Lo encont r ado apunt a par a la im por t ancia de las r elaciones int er per sonales ent r e los m iem br os del
equipo de la ESF par a el enfr ent am ient o del est r és labor al y par a la necesidad de const r uir est r at egias colect ivas, con el obj et iv o de pr ev enir el est r és y m ant ener la salud del t r abaj ador .
DESCRI PTORES: enfer m er ía; est r és; salud labor al; pr ogr am a de salud fam iliar
MECANI SMOS DE ENFRENTAMENTO UTI LI ZADOS POR TRABALHADORES ESGOTADOS E
NÃO ESGOTADOS DA ESTRATÉGI A DE SAÚDE DA FAMÍ LI A
A pesqu isa obj et iv ou in v est igar os m ecan ism os de en fr en t am en t o do est r esse u t ilizados pelos t r abalh ador es
das dezesseis equipes da Est r at égia de Saúde da Fam ília ( ESF) de Sant a Mar ia, RS, Br asil. For am ent r evist ados, n os m eses de j an eir o e f ev er eir o de 2 0 0 7 , seis t r abalh ador es com escor es com pat ív eis com a sín dr om e de
Bu r n ou t , iden t if icados pelo Maslach Bu r n ou t I n v en t or y , e seis sem a sín dr om e. Na an álise de con t eú do das
f alas, id en t if icou - se q u e os t r ab alh ad or es esg ot ad os u t ilizam , p r ed om in an t em en t e, m ecan ism os in d iv id u ais par a enfr ent am ent o dos pr oblem as labor ais, enquant o os não esgot ados r ecor r em a m ecanism os colet iv os. Os
achados apont am par a a im por t ância do r elacionam ent o int er pessoal ent r e os m em br os da equipe da ESF par a
o en f r en t am en t o d o est r esse lab or al e p ar a a n ecessid ad e d e con st r u ção d e est r at ég ias colet iv as, com o
obj et iv o de pr ev enir o est r esse e m ant er a saúde do t r abalhador .
DESCRI TORES: en fer m agem ; est r esse; saú de do t r abalh ador ; pr ogr am a saú de da fam ília
1
RN, M. Sc. in Nu r sin g , Facu lt y, Un iver sid ad e Par an aen se, Br azil, Facu lt y, Cen t r o Un iv er sit ár io Cat ólico d o Su d oest e d o Par an á, Br azil, e- m ail: let r indade@hot m ail.com ; 2RN, Ph.D. in Psychology, Associat e Pr ofessor, Escola de Enfer m agem , Univer sidade Federal do Rio Grande do Sul, Brazil, e- m ail: lila@enf.ufr gs.br ; 3RN, Ph.D. in Nur sing Philosophy, Associat e Pr ofessor, Univer sidade Federal de Sant a Mar ia, Br azil, e- m ail: car m em beck@sm ail.ufsm .br.
I NTRODUCTI ON
T
he Fam ily Healt h Pr ogram ( FHP) , cur r ent ly labeled Fam ily Healt h St rat egy ( FHS) , was cr eat ed in1994 and proposed t o change t he prim ary care m odel
a c c o r d i n g t o t h e h e a l t h s u r v e i l l a n c e r a t i o n a l e ,
incorporat ing t he basic principles of t he Unique Healt h
Sy st em ( SUS) . The FHP w as cr eat ed w it h a v iew t o
m eet ing t he growing need t o decent ralize and est ablish
h ea l t h ser v i ces a t a ci t y l ev el , b a sed o n i n t eg r a l
healt hcar e deliv er y and pr oblem - solv ing capacit y( 1).
The FHP aim s, am ong ot her t hings, t o dim inish
t he dist ance bet w een healt h t eam s and t he populat ion,
cr eat ed by t er r it or ial, econom ic, polit ical and cult ur al
issues of t he healt h m odel current at t he t im e( 2) of it s
creat ion. I t s principles include com m unit y part icipat ion
in t he ident ificat ion of healt h problem s, follow - up and
e v a l u a t i o n o f h e a l t h t e a m w o r k a n d d e f i n i t i o n o f
pr ior it ies( 1 ).
FHS car e is focu sed on t h e fam ily, w h ich is
per ceiv ed in it s social and phy sical env ir onm ent , and
a c k n o w l e d g e s h e a l t h c a r e a s a c i t i z e n ’ s r i g h t ,
ex p r essed t h r ou g h i m p r ov ed l i f e con d i t i on s,
case-r esolv in g an d h u m an ized secase-r v ices( 1 , 3 ). Th e FHS also
r ecom m en d s in t er d iscip lin ar y w or k in w h ich h ealt h
t eam m em ber s, com posed of w or k er s fr om differ ent
ar eas, w or k t oget h er an d com plem en t each ot h er ’s
w or k , aim in g f or a h olist ic ap p r oach of in d iv id u als,
v a l u i n g t h e m i n t h e i r so ci o e co n o m i c a n d cu l t u r a l
cont ex t w it h r espect , com m it m ent and et hics( 1).
Th is car e m od el en v ision s t h e in clu sion of
w o r k e r s i n t h e co m m u n i t y, so t h a t t h e y b e co m e
r efer ences in healt h car e for t he populat ion liv ing in
t h eir scop e ar ea. I n t h is w ay, FHS m em b er s w or k
d i r e ct l y w i t h p e o p l e w h o l i v e d i f f e r e n t r e a l i t i e s,
o f t e n t i m e s p e r m e a t e d b y m i se r y, v i o l e n ce , p o o r
h y gien e an d liv in g con dit ion s an d sev er al h ar dsh ips
a n d i m p o ssi b i l i t i es, w h i ch m a y a r o u se f eel i n g s o f
p ow er l essn ess d u e t o l i m i t at i on s t h at m an y t i m es
com pr om ise t h e h ealt h car e w or k er s aim f or( 3 ). Th is
com plex scenar io r equir es adapt at ion, know ledge and
com pet ence t o put car e in pr act ice( 2).
Mem ber s of t he fam ily healt h t eam s need t o
h a v e t h e r i g h t p r o f i l e f o r c a r e d e l i v e r y t o t h e
populat ion and face t he dynam ics of pr oblem s, so as
t o r ed u ce t h e r isk of su f f er in g an d st r ess( 5 ). Th u s,
w or k er s n eed t o u se copin g m ech an ism s, t h at is, a
set of cogn it iv e ef f or t s an d beh av ior s in per m an en t
ch an g e, d ev elop ed b y in d iv id u als t o m eet ex t er n al
a n d i n t e r n a l d e m a n d s , w h i c h a r e c o n s i d e r e d t o
depen d on on e’s ow n r esou r ces. Th ese m ech an ism s
ar e used t o facilit at e, elim inat e or alt er t he sit uat ion
or ev en t cau sin g t h e d ist u r b an ce ( p r ob lem - solv in g
st r a t e g i e s) a n d t o r e g u l a t e e m o t i o n a l r e sp o n se s
c a u s e d b y a s t r e s s f u l e v e n t ( e m o t i o n - f o c u s e d
st r at egies)( 6 ).
Cogn it iv e act ion s an d r eev alu at ion s focu sed
on coping w it h pr oblem s ar e called cont r ol st r at egies
and cognit ive act ions and r eevaluat ions of escape ar e
a v o i d a n c e - c o p i n g s t r a t e g i e s . To e f f e c t i v e l y f a c e
occupat ional pr oblem s and conflict s, cognit iv e act ions
and r eev aluat ions need t o occur concom it ant ly( 7).
We highlight t hat t he set of w or ker s’ beliefs
about t he w or ld, v alues, m ot iv at ion and com m it m ent
( in relat ion t o occupat ion for inst ance) , as w ell as t heir
l i f e s t y l e ( i . e . i m p a t i e n t , c o m p e t i t i v e ) , a r e
psychological aspect s t hat do not depend on ext er nal
phenom ena as pot ent ial st r essor s( 6 ).
I n d i v i d u a l s d e v e l o p v a r i e d c o p i n g
m e ch a n i sm s o v e r l i f e i n t h e f a ce o f a co n f l i ct i v e
sit uat ion, due t o t he int eract ion am ong m ult iple fact ors.
Th a t i s w h y s e v e r a l s t u d i e s( 2 , 4 , 6 ), a d d r e s s i n g
o c c u p a t i o n a l s t r e s s , s e e k t o u n d e r s t a n d t h e
m echanism s w or ker s use t o deal w it h conflict s in t he
w or k place, so as t o under st and t he occupat ional and
r e l a t i o n a l d y n a m i c s a s w e l l a s t h e w a y s t h e s e
in div idu als ex pr ess t h em selv es.
Coping st em s fr om t he need t o adapt t o t he
cont ext one w or ks and lives in. How ever, som e gr oups
o f w o r k e r s o f t e n f a c e s i t u a t i o n s t h a t d e m a n d
c o n s i d e r a b l e c o p i n g , l i k e i n t h e c a s e o f h e a l t h
w or k er s. Th e w or k of t h ese p r of ession als in clu d es
d i r ect an d i n t en se co n t act w i t h p eo p l e( 8 ) w h o ar e
ex per iencing, m ost of t he t im es, suffer ing caused by
p ain , illn ess or p r ox im it y t o d eat h , an d som et im es
have several needs ( i.e. econom ic, psychic and social,
am on g ot h er s) .
Healt h w or ker s m ediat e st r ess t hat or iginat es
in t he w or kplace t hr ough t he use of per sonal or gr oup
r esou r ces, w h ile cogn it iv e ev alu at ion an d t h e v alu e
at t r ibut ed t o it det er m ine w hich coping st r at egy w ill
be used and, consequent ly, t he em ot ional and som at ic
r eact ions t r igger ed by t his pr ocess( 6).
Com m it m en t an d ex p ect at ion associat ed t o
t he or ganizat ional cont ex t and int er per sonal r elat ions
a t w o r k a r e f a c t o r s t h a t c o n t r i b u t e t o p e r s o n a l
ach iev em en t , b u t also lead t o occu p at ion al st r ess.
When t he frequency and durat ion of st ressful sit uat ions
and event s incr ease, coping r esour ces t end t o deplet e
Ch r o n i c o c c u p a t i o n a l s t r e s s o r b u r n o u t
sy n d r o m e i s ch a r a ct e r i ze d b y w o r k e r s’ e m o t i o n a l
exhaust ion, depersonalizat ion and lack of professional
achiev em ent due t o ineffect iv e st r at egies for coping
w it h st r essf u l sit u at ion s( 6 , 8 ). I n spit e of t h e bu r n ou t
s y n d r o m e b e i n g i n c l u d e d i n t h e I n t e r n a t i o n a l
Classificat ion of Diseases and Relat ed Healt h Problem s
( I CD Z 7 3 . 0 ) , m an y w or k er s ar e n ot f am iliar w it h it
and it is not com m on t o associat e occupat ional st ress
t o healt h disorders or occupat ional diseases. How ever,
it is con sid er ed a sev er e h ealt h p r ob lem t h at h as
affect ed an incr easing num ber of w or ker s in t he w or ld,
h a r m i n g t h e p h y s i c a l a n d m e n t a l w e l l b e i n g o f
i n d i v i d u a l s a n d g r o u p s t h e y a r e i n s e r t e d i n( 9 ).
Con sider in g t h at FHS w or k er s pr esen t st r ess( 4 ) t h at
affect s t heir bodies and t hat m ost research in t he field
i s r e st r i ct e d t o sy m p t o m a t o l o g y( 1 0 ), w e a i m e d t o
invest igat e st r ess coping m echanism s used by w or ker s
in t he Fam ily Healt h St rat egy.
METHOD
Th i s d e scr i p t i v e st u d y u se d a q u a l i t a t i v e
appr oach t o select bu r n ed ou t w or k er s ( w it h scor es
co m p a t i b l e w i t h b u r n o u t , e v a l u a t e d t h r o u g h t h e
Maslach Bu r n ou t I n v en t or y ( MBI ) , an d n on - b u r n ed
out w or ker s. Then, w e used a qualit at ive appr oach t o
k now t he coping m echanism s t hese w or k er s used t o
deal w it h pr oblem s an d con flict s in t h eir daily w or k
r ou t in e.
Dat a collect ion w as car r ied out in Januar y and
Febr uar y 2007, aft er t he Resear ch Et hics Com m it t ee
at Rio Gr ande do Sul St at e Univ er sit y had appr ov ed
t he r esear ch pr oj ect ( pr ot ocol No. 2006643) .
The st udy’s quant it at ive st age w as per for m ed
w it h 86 w orker s at FHS unit s in Sant a Mar ia, RS, Br azil:
12 physicians, 13 nurses, 19 nur sing t echnicians, five
d e n t i st s a n d e i g h t d e n t a l a ssi st a n t s, t o t a l i n g 5 7
professionals, as w ell as 29 com m unit y healt h agent s.
Par t icipant s signed t he fr ee and infor m ed consent t er m
a n d a n s w e r e d t h e M a s l a c h B u r n o u t I n v e n t o r y.
Af t er w ar ds, w or k er s w h o pr esen t ed scor es equ al t o
or h igh er t h an t h e 7 5t h per cen t ile on t h e su bscales
deper son alizat ion an d em ot ion al ex h au st ion an d u p
t o t h e 2 5t h p er cen t ile on p r of ession al ach iev em en t
( i n v e r s e s c o r e ) o n t h e M B I , w e r e s e l e c t e d f o r
int er v iew ing and com posed t he gr oup w it h Bur nout .
Wor ker s w ho obt ained scor es up t o t he 25t h percent ile
o n t h e s u b s c a l e s e m o t i o n a l e x h a u s t i o n a n d
deper sonalizat ion and equal t o or higher t hat t he 75t h
on pr ofessional achiev em ent w er e also select ed and
com posed t he gr oup of w or k er s w it hout Bur nout .
s e l a c s b u
S Groupn=86
d e n r u B 6 = n t u o d e n r u b -n o N 6 = n t u o e g a r e v
A SD Average Average
n o i t a z il a n o s r e p e
D 9 3 12 6
n o i t s u a h x e l a n o i t o m
E 23.9 7.2 31.1 16.7
t n e m e v e i h c a l a n o s r e
P 13.8 4.8 9 18.6
Table 1 – Dist ribut ion of t he av erage scores of Fam ily
He a l t h St r a t e g y w o r k e r s o n t h e Ma sl a ch Bu r n o u t
I nv ent or y. Sant a Mar ia, RS, Brazil 2007
Am o n g t h e p a r t i ci p a n t s, t h r ee co m m u n i t y
h e a l t h a g e n t s, t w o n u r si n g t e ch n i ci a n s a n d o n e
physician, all fem ale, 21, 27, 28, 29, 30 and 40 year s
of ag e, w er e con sid er ed b u r n ed ou t . Am on g t h ose
i d e n t i f i e d a s n o n - b u r n e d o u t , t h e r e w e r e : o n e
com m unit y healt h agent , t hr ee physicians, one nur sing
t echnician and one nur se, 31, 34, 44, 48, 61 and 68
y ear s, t hr ee of w hom w er e w om en.
I n t e r v i e w s w e r e f u l l y t r a n s c r i b e d a n d
su b m it t ed t o con t en t an aly sis, aim in g t o k n ow t h e
m e a n i n g a n d s t r u c t u r e o f t h e c o n t e n t o f t h e
par t icipan t s’ r epor t s.
Ch i - s q u a r e w a s u s e d f o r t h e q u a l i t a t i v e
v a r i a b l e s a n d S t u d e n t ’ s t - t e s t f o r c o n t i n u o u s
quant it at iv e analy sis, t o t est for associat ion bet w een
d e m o g r a p h i c c h a r a c t e r i s t i c s – g e n d e r, a g e ,
pr ofessional cat egor y ( w it h higher educat ion or not ) ,
m ar it al st at us ( w it h a par t ner or not ) and t im e of w or k
– and t he m ean inst r um ent scor es. The only significant
d if f er en ce f ou n d w as b et w een t h e av er ag e ag es of
bur ned out and non- bur ned out w or k er s ( p= 0 . 0 3 4 ) .
The indiv iduals w it h Bur nout w er e y ounger ( av er age
age of 29. 2 and 47. 6 y ear s, r espect iv ely ) .
RESULTS
Opposit e t o t he r esult s of anot her st udy( 4) and
expect at ions at t he beginning of t his st udy, t he social
r ealit y of t h e f am ilies an d t h e com m u n it y is n ot a
f act o r t h at cau ses ex h au st i o n i n w o r k er s. On t h e
con t r ar y, it g en er at es sat isf act ion b ecau se it g iv es
m ean in g t o t h e w or k t h ey r ealize, bot h for w or k er s
w it h bur nout and t hose w it hout it . Accor ding t o t hem :
[ …] sat isfact ion at w or k is seeing t hat hur t people end up happy
t hey are well t aken care of, are welcom ed, t hey leave well [ …] t hey
leave pr aising your w or k ( Wor k er w it h Bur nout ) . [ …] doing a
great j ob, having a feedback and creat e t ies wit h fam ilies ( Worker
w it hout Bur nout ) .
Th e in t er p er son al r elat ion sh ip am on g t eam
m e m b e r s, h o w e v e r, w a s f o u n d t o b e a so u r ce o f
dissat isfact ion and suffer ing for bur ned out w or k er s,
w ho consequent ly do not ask colleagues t o help and
solve pr oblem s, as obser ved in t his r epor t : [ …] w e don’t
trust anybody here, there’s no way to m ake friends in the workplace,
t hey’re colleagues [ …] since we have no one t o share wit h, you get
over w helm ed ( Wor k er w it h Bur nout ) .
Ob ser v in g t h e cop in g m ech an ism s w or k er s
used t o deal w it h pr oblem or conflict iv e sit uat ions at
w or k , w e f ou n d t h at bu r n ed ou t w or k er s f r equ en t ly
use indiv idual m echanism s in t hese ev ent s.
Ph y s i c a l e x h a u s t i o n a n d a v o i d a n c e
st r at eg i es( 8 ) ap p ear i n t h e r ep o r t o f w o r k er s w i t h
bur nout : [ …] I ’m depr essed, I ’m v er y t ir ed because of t he
eight - hour daily w or kload ( …) I ’m t r ying t o for get , t o delet e t he
pr oblem s I have at w or k, I st ar t ed t o t ake nat ur al m edicine and
st ar t ed t o delet e t hings, I had t oo m uch headache, neck pain
( Wor k er w it h Bur nout ) .
Th e w or k er s w it h Bu r n ou t r ep or t ed , m an y
t im es dur ing t he st udy, t hat lack of social suppor t and
d if f icu lt in t er p er son al r elat ion sh ip s w it h in t h e w or k
t eam , w h i ch f r eq u en t l y m ad e t h em u se i n d i v i d u al
coping m echanism s, am ong w hich t hey highlight t hose
focused on em ot ion( 6), such as cr y ing, w hich m ay be
a for m of em ot ional r elease or ex haust ion.
On t he ot her hand, non- bur ned out w or k er s
p o i n t e d o u t se v e r a l co l l e ct i v e st r a t e g i e s t o so l v e
p r o b l e m s a n d f e w i n d i v i d u a l s t r a t e g i e s a n d , a s
op p osed t o b u r n ed ou t w or k er s. Th ey seek h elp in
t he w or k t eam or fr om ot her colleagues and in ot her
healt h unit s or services: w e do like, call anot her unit [ …] w e
go t o t he unit and t alk t o t he t eam , w it h t he physician, w it h t he
nur sing t echnician [ …] som et im es w e call a polit ician [ …] go t o
t he r adio [ …] t alk t o t he neighbor s ( Wor k er w it hout Bur nout ) .
Th e t i m e o f e x p e r i e n ce i n t h e p r o f e ssi o n
w a s m e n t i o n e d b y t h e n o n - b u r n e d o u t a s a
d e t e r m i n a n t f a c t o r t o c o p e w i t h o c c u p a t i o n a l
p r o b l e m s . Th e y r e p o r t e d t h a t t h e i r e x p e r i e n c e
en ab l ed t h em t o st ay cal m an d r at i o n al i ze i n t h e
f a ce o f st r e ssf u l si t u a t i o n s w h i ch , co n se q u e n t l y,
p er m it t ed p r ob lem solv in g . Th ese r ep or t s con v er g e
w i t h st at i st i cal an al y si s r esu l t s o f t h e i n st r u m en t ,
w h i c h r e v e a l t h a t e a r l y a g e i s s i g n i f i c a n t l y
c o r r e l a t e d ( p = 0 , 0 3 4 ) w i t h B u r n o u t s y n d r o m e
sco r e s. Ol d e r w o r k e r s ( a v e r a g e o f 4 7 . 6 y e a r s o f
a g e ) p r e se n t e d l o w e r v a l u e s o n t h e su b sca l e s o f
e m o t i o n a l e x h a u st i o n a n d d e p e r so n a l i za t i o n a n d
h i g h v a l u es o n p r o f essi o n a l a ch i ev em en t .
An ot h er ch ar act er ist ic obser v ed in t h e n on
bu r n ed ou t w or k er s gr ou p w as t h e u se of pr oblem
-solv ing coping st r at egies, w hile t he ot her gr oup used
avoidance and em ot ion- focused coping st r at egies. The
u se of p r ob lem - solv in g cop in g st r at eg ies f acilit at ed
problem solving, alleviat ed or elim inat ed t hem , w hich
in t ur n fav or s indiv iduals’ w or k and healt h.
DI SCUSSI ON
Th e i n t e r v i e w s r e v e a l e d t h a t b u r n e d o u t
w or k er s t en d t o f ocu s on t h em selv es, so t h at t h ey
ar e able t o live w it h or bear t he sit uat ion consider ed
st r essful. They use per sonal r esour ces and avoidance
co p i n g st r a t e g i e s, w h i ch g e n e r a t e s su f f e r i n g a n d
fr ust r at ion at w or k , at t he sam e t im e as it does not
solv e t h e pr oblem .
Th e per cept ion of lack of su ppor t f r om t h e
w or k t eam and lack of t r ust in colleagues appear in
t h e r ep or t s of w or k er s f r om t h e b u r n ed ou t g r ou p
and com pels t hem t o use t heir ow n r esour ces t o cope
w i t h p r o b l e m s , w h i c h a g g r a v a t e s s t r e s s a n d
consequent ly leads t o suffer ing. These w or k er s r efer
t o so ci a l su p p o r t f r o m a f u n ct i o n a l p e r sp e ct i v e ,
char act er ized as a set of r eal or per ceiv ed st r uct ur al
e l e m e n t s , p r o v i d e d b y o t h e r s t o s o l v e p r a c t i c a l
pr oblem s and/ or facilit at e daily t asks( 12). I t represent s
t he com m it m ent of indiv iduals w it h pr oact iv e cont r ol
st r at egies in t he face of st r essful sit uat ions( 7).
Em ot ion- focused st r ess coping st r at egies ar e
f r eq u en t ly u sed in sit u at ion s con sid er ed last in g or
unm odifiable. They ar e an alt er nat iv e for indiv iduals
t o d iv er t t h eir t h ou g h t s, r ed u ce t h e lev el of st r ess
and ev aluat e t he sit uat ion bet t er( 6). Cr y ing is one of
t h e s e s t r a t e g i e s a n d h e l p s t o a l l e v i a t e a n x i e t y.
How ev er, w h en an in div idu al h as last in g f eelin gs of
pow er lessness, s/ he can develop depr ession or abuse
of alcohol, dr ugs, sm oking and m edicat ion( 8) t o avoid
st r ess. On t h e ot h er h an d , ef f or t s t o k eep u p t h e
a p p e a r a n c e o f p e r m a n e n t d i s p o s i t i o n f o r w o r k ,
en t h u si a sm a n d sa t i sf a ct i o n ca n a l so l ea d o n e t o
subst ance use, such as st im ulant s( 8,12- 13).
Consider ing t hat t he m ode of w or k pr oposed
b y t h e FH S i s t e a m w o r k( 1 ), i t d e m a n d s g o o d
r elat ion sh ips am on g it s m em ber s an d in t er per son al
We believe t hat t he FHS dem ands individuals
t o be w illing t o w or k in gr oup, since all act ions and
int ervent ions in t his care m odel are based on collect ive
act ivit ies and decisions. Thus, w e consider t hat , w hen
b u r n e d o u t w o r k e r s u se a v o i d a n ce a n d e m o t i o n
-f ocu sed cop in g m ech an ism s, t h ey d o n ot allev iat e,
elim inat e or alt er st ressor s but , inst ead, t hey becom e
v u ln er able t o illn esses.
A c c o r d i n g t o t h e f r e q u e n c y, i n t e n s i t y,
ch ar act er ist ics an d t im e on e is ex posed t o st r essf u l
sit uat ions, one’s cognit ive abilit y t o evaluat e sit uat ions
det er ior at es, adapt at ion m ech an ism s ar e ex h au st ed
and a pr ocess of physical and em ot ional exhaust ion( 6,8)
b eg in s, w h ich lead s t o t h e Bu r n ou t sy n d r om e t h at
affect s t he gr oup of bur ned out w or k er s.
The sy ndr om e is pr oduced by an im balance
b e t w e e n w o r k e r s’ e x p e ct a t i o n s a n d w o r k r e a l i t y,
gener at ing psy chological and phy sical m anifest at ions,
w it h repercussions for t he personal, fam ily, social and
o c c u p a t i o n a l l i f e o f i n d i v i d u a l s( 1 4 ). Th e B u r n o u t
sy ndr om e is char act er ized by phy sical sy m pt om s lik e
t i r e d n e s s , i r r i t a b i l i t y, i l l n e s s e s , e s p e c i a l l y
p sy ch o so m a t i c d i sea ses a n d d ef en si v e b eh a v i o r s,
su ch as a t en den cy t o becom e isolat ed, f eelin gs of
om n ipot en ce, lack of in t er est in w or k , absen t eeism ,
desir e t o abandon t he j ob, ir ony and cy nicism( 15).
I n a d d i t i o n , t h e p r e s e n c e o f s t r e s s e d
indiv iduals w it hin t he t eam m ay lead t o inefficiency,
p o o r c o m m u n i c a t i o n , w o r k d i s o r g a n i z a t i o n ,
dissat isfact ion an d dim in ish ed pr odu ct iv it y, w h ich in
t ur n affect t he or ganizat ional cont ex t and t he qualit y
of car e deliv er ed t o fam ilies( 4).
I n t e r m s o f n o n - b u r n e d o u t w o r k e r s ,
collect iv e w or k in m u lt id iscip lin ar y t eam s ap p ear ed
as a different ial in relat ion t o burned out w orkers. For
t h ese w or k er s, t h e t eam st an ds ou t as a sou r ce of
suppor t for pr oblem solving and gener at es sat isfact ion
a t w o r k . Th e se f i n d i n g s co r r o b o r a t e st u d i e s t h a t
appoin t social su ppor t as an im por t an t elem en t f or
coping w it h st r ess( 6,7,12).
Wor k t eam s d o n ot al w ay s w or k t og et h er,
since t he collect iv e const r uct ion of decision sy st em s
is d if f er en t in each social g r ou p an d r elat es t o t h e
nat ur e of each w or k or ganizat ion( 6,14). How ever, in t he
c a s e o f t h e FH S , t h i s c a r e m o d e l r e c o m m e n d s
m u lt idisciplin ar y w or k , w h ich is a ch ar act er ist ic t h at
f av or s g r ou p p er f or m an ce.
Non- bur ned out individuals also r epor t ed t hat
t im e in t he profession is a fact or t hat favors
decision-m aking at w or k. Appar ent ly, past exper iences pr ovide
su p p o r t t o d eal w i t h p r o b l em si t u at i o n s, al l ev i at e
a n g u i sh a sso ci a t ed t o o ccu p a t i o n a l p r o b l em s a n d
pr ev en t t h e Bu r n ou t sy n dr om e.
St r ess cop in g m ech an ism s m od if y ov er t h e
y e a r s a n d t h e r e i s a t e n d e n c y f o r i m m a t u r e
m echanism s t o be r eplaced by ot her m or e developed
on es, an d f or in d iv id u als t o b ecom e m or e r ealist ic
and w illing over t im e( 6). When experiences gained w it h
t im e in t h e pr ofession ar e associat ed t o in div idu als’
m at u r it y, t h ey en ab le p eop le t o ev alu at e sit u at ion s
t hat can be changed and t hose t hat cannot , as w ell as
t o seek t he best m echanism s t o deal w it h pr oblem s.
I t is im p or t an t t o k eep in m in d t h at som e
people hav e a chr onic t endency t o st r ess, w hich can
be of genet ic origin or due t o life st yle, life hist ory, or
yet , an int er act ion bet w een t hese fact or s. Thus, st r ess
can b e g en er at ed b y ex t er n al sou r ces in on e’s lif e
a n d a l so b y o n e’ s i n n er w o r l d , w h o se ef f ect s a r e
m ed i at ed b y l ear n ed cop i n g st r at eg i es, esp eci al l y,
d u r in g ch ild h ood , b u t w h ich can b e d ev elop ed an d
incor por at ed acr oss one’s lifet im e( 1 6 ).
FI NAL CONSI DERATI ONS
Con f lict iv e sit u at ion s in t h e FHS w or k p lace
ar e evaluat ed and t r eat ed differ ent ly bet w een bur ned
o u t a n d n o n - b u r n e d o u t w o r k e r s. Th e f i r st se e k
individual m echanism s t o cope w it h pr oblem s and t he
lat t er seek collect iv e m ech an ism s.
Wor k er s dev elop indiv idual and/ or collect iv e
d e f e n s e s t o c o p e w i t h s u f f e r i n g . Th e r e f o r e , w e
underst and t hat individuals are not passive in relat ion
t o w or k or g an izat ion , b u t t h at t h ey ar e cap ab le of
pr ot ect ing t hem selves, developing defenses t hat hide,
a v o i d o r o v e r c o m e s u f f e r i n g d u e t o t h e w o r k
r out ine( 6,8,15).
I n an aly zin g t h e r epor t s of n on - bu r n ed ou t
and bur ned out w or k er s, w e per ceiv e t hat collect iv e
m ech an ism s t o cop e w it h st r essf u l sit u at ion s f av or
t h e f o r m er, w h o f o cu s t h ei r st r a t eg i es o n so l v i n g
pr oblem s, w hile t he bur ned out use individual em ot
ion-focused st r at egies, t r y ing t o r egulat e t heir em ot ional
r e sp o n se t o co n f l i ct i v e si t u a t i o n s, w h i ch l e a d t o
illn esses.
I nt erpersonal relat ionships were det erm inant s
for non- burned out workers t o cope wit h occupat ional
st ress, develop m ot ivat ion at work and int ervene wit h
problem s. For t he burned out workers, t hen, t hese were
Th is st u d y ’s r esu lt s ar e in ag r eem en t w it h
r esear ch( 4 , 9 , 1 7 ) car r ied ou t by h ealt h pr ofession als in
ot her scenarios, in w hich suffering at w ork is frequent ly
r elat ed t o w or ker s’ fr agile social suppor t , am ong ot her
aspect s. Ther efor e, w e believe t hat , despit e t he st udy’s
l i m i t at i o n s, i . e. t h at each p ar t i ci p an t at t r i b u t ed a
sin g u lar v alu e t o w or k an d h as a d if f er en t lev el of
com m it m en t an d ex pect at ion s in r elat ion t o h is/ h er
occu p at ion , t h is st u d y h ig h lig h t s t h e or g an izat ion al
con t ex t an d in t er per son al r elat ion sh ips as essen t ial
elem ent s for t he dev elopm ent of occupat ional st r ess
cop in g m ech an ism s.
REFERENCES
1 . Min ist ér io d a Saú d e ( BR) . Cad er n o d e At en ção Básica: Pr ogr am a de Saú de da Fam ília. Br asília ( DF) : Min ist ér io da Sa ú d e ; 2 0 0 1 .
2 . Tr in d ad e LL. O est r esse lab or al d a eq u ip e d e saú d e d e f a m íl i a : i m p l i c a ç õ e s p a r a a S a ú d e d o Tr a b a l h a d o r. [ d isser t ação] . Por t o Aleg r e ( RS) : Escola d e En f er m ag em / UFRGS; 2 0 0 7 .
3. Lev cov it z E, Gar r ido NG. Saúde da Fam ília: a pr ocur a de um m odelo anunciado. Cad Saúde da Fam ília 1996 j aneir o-j unho; ( 1) : 3- 8.
4 . Cam elo SHH, An g er am i ELS. Sin t om as d e est r esse n os t r abalhador es at uant es em cinco núcleos de saúde da fam ília. Rev Lat in o- am En f er m agem 2 0 0 4 j an eir o; 1 2 ( 1 ) : 1 4 - 2 1 . 5 . Tak em ot o MLS, Silva EM. Acolh im en t o e t r an sf or m ações no pr ocesso de t r abalho de enfer m agem em unidades básicas d e s a ú d e d e Ca m p i n a s . Ca d S a ú d e Pú b l i c a 2 0 0 7 f e v ; 2 3 ( 2 ) : 3 3 1 - 4 0 .
6 . La za r u s A, Fo l k m a n S. Est r é s y p r o ce so s co g n i t i v o s. Bar celon a: Mar t in ez Roca; 1 9 8 6 .
7. Pinheir o FA, Tr óccoli BT, Tam ayo MR. Mensuração de coping no am bient e ocupacional. Psicologia: t eor ia e pesquisa 2003 ab r il; ( 2 ) : 1 5 3 – 8 .
8. Lautert L. O Processo de enfrentam ento do estresse no trabalho hospitalar: um estudo com enferm eiras. I n: Haag GS, Lopes MJM, Sch u ck JS, o r g an i zad o r as. A En f er m ag em e a saú d e d o s t rabalhadores. Goiânia ( GO) : AB; 2001. p. 114- 40.
9. Mur ofuse NT, Abranches SS, Napoleão AA. Reflexões sobr e
e st r e sse e Bu r n o u t co m a e n f e r m a g e m . Re v La t i n o - a m En f er m ag em 2 0 0 5 m ar ço; 1 3 ( 2 ) : 2 5 5 - 6 1 .
1 0 . Nor on h a APP, Fer n an d es DC. Est r esse lab or al: an álise da pr odução cient ífica br asileir a no SciELO e BVS- Psi. Fr act al 2 0 0 8 , j u lh o- d ezem b r o; 2 0 ( 2 ) : 4 9 1 - 5 0 2 .
1 1 . Mi n ay o MCS. O Desaf i o d o Con h eci m en t o. 7 ed . São Pau lo ( SP) - Rio de Jan eir o ( RJ) : Hu cit ec- Abr asco; 1 9 9 6 . 12. Alonso Fachado A, Mont es Mar t inez A, Menendez Villalv a C, Gr aça Per eir a M. Adapt ação cult ur al e validação da ver são por t u gu esa do qu est ion ár io Medical Ou t com es St u dy Social Su p p o r t Su r v ey ( MOSS- SSS) . Act a Med Po r t u g u esa 2 0 0 7 m ai o ; 2 0 : 5 2 5 - 3 3 .
13. Lipp M. As im plicações do est r esse ex cessiv o nos casos d e f a r m a c o d e p e n d ê n c i a . Es t u d o s d e Ps i c o l o g i a 1 9 8 7 ; ( 1 ) : 1 7 0 - 5 .
14. Belt r an CA, Mor eno MP, Lopez TT. Fact or es psicosociales y sín dr om e de bu r n ou t en m édicos de fam ilia. An Fac Med [ on lin e] 2 0 0 5 sep [ cit ado 2 0 0 8 m ar 5 ] ; ( 3 ) : [ 1 2 scr een s] . D i s p o n i b l e e n l a W e b : h t t p : / / w w w . s c i e l o . o r g . p e / s c i e l o . p h p ? s c r i p t = s c i _ a r t t e x t & p i d = S 1 0 2 5 - 5 5 8 3 2 0 0 5 0 0 0 3 0 0 0 0 6 & l n g = e s& n r m = i so .
1 5 . Be n e v i d e s- Pe r e i r a AMT. Bu r n o u t : q u a n d o o t r a b a l h o am eaça o bem - est ar do t r abalhador. São Paulo ( SP) : Casa do Psi c ó l o g o ; 2 0 0 2 .
1 6 . Li p p M . Es t r e s s e e m o c i o n a l : a c o n t r i b u i ç ã o d e e st r e sso r e s i n t e r n o s e e x t e r n o s. Re v Psi q u i a t r i a Cl ín i ca 2 0 0 1 ; ( 6 ) : 3 4 7 - 4 9 .
17. Mar t ins JT, Robazzi MLCC. Nur ses’ w or k in int ensiv e car e unit s: feelings of suffer ing. Rev Lat ino- am Enfer m agem 2009; 1 7 ( 1 ) : 5 2 - 8 .
