Fadiga por compaixão em profissionais de enfermagem: ensaio clínico de uma intervenção baseada em mindfulness para prevenção da exaustão ocupacional

Abstract

Generally, health professionals experience intense emotional exhaustion at work, when they experience "the suffering of the other" with compassion, which results in Compassion Fatigue (CF). CF is an occupational exhaustion that health professionals present coping empathically with the negative feelings resulted from their patients' suffering. Considering that nursing professionals can become physically and psychologically ill due to CF, when the intervention measure, like Mindfulness, can prevent this exhaustion and ensure their mental health, the general objective of this doctoral dissertation was to analyze the effectiveness of an intervention proposal based on Mindfulness for control and management of CF in nursing professionals who worked at the High Dependency Care Unit and at the Emergency Room of Hospital Dório Silva (HDS). Based on a mixed, descriptive and experimental design, the results of this Thesis will be presented in three studies, conducted which 37 nursing professionals (30 nursing technicians or assistants and seven nurses, with an average age of 41.8 years). The majority of them was sex female (79%) with five years of experience as nursing professional. All participants signed a Free Consent Information Term, approved by the Research Ethics Committee (CAEE N. 3,066,341), before to respond the following instruments: a) Depression, Anxiety and Stress Scale (DASS-21), to identify indicators of depression, anxiety and stress; b) Instrument for Assessing the Quality of Life at Work of Hospital Nurses (IQVTE), to identify the quality of life at work of nursing professionals, assessed in four domains (1) Valorization and institutional recognition, (2) Working conditions, safety and remuneration, (3) Identity and professional image and (4) Integration with the team; c) the Brazilian version of the Professional Quality of Life Scale 4 (ProQol-BR), to identify the occurrence of CF, as well as the levels of Burnout (BO), Secondary Traumatic Stress (STS) and Compassion Satisfaction (CS); and d) a Participant Profile Identification Protocol. The Study 1 is a descriptive study, in which indicators of mental health and quality of professional life were analyzed comparatively between professionals with and without CF, investigating the predictive factors for CF. The Study 2 is a methodological study, in which the proposal of a Mindfulness-based intervention and its results based on the perspective of nursing professionals, are presented, analyzed, and discussed. Finally, the Study 3 is a quasi-experimental study of a non-equivalent and nonrandomized control group, conducted in a clinical trial to analyze the effectiveness of the proposed Mindfulness-based intervention for the control and management of CF, the mental health and quality of life of professionals, based on five research stages: 1) pre-test (T1); 2) post-test (T3); 3) 6-week follow-up (T4); 4) 6-month follow-up (T5); and 5) 12-month follow- up (T6) after the intervention. The results showed that 32.5% (n=12) of professionals showed CF, with statistically significant differences for the Burnout (BO) (p=0.006) and Secondary Traumatic Stress (STS) (p<0.001) scores among professionals with and without FC. The predictors with the greatest impact for the CF occurrence were the STS, anxiety and the IQVTE Domain 'Integration with the Team'. The BO, anxiety, and stress levels of the professionals of experimental group (intervention) reduced significantly from the pre-test to the post-test. These results were not maintained in the follow-up stages. It was also observed that there was a decreasing in CF levels for professionals who participated at the Mindfulness-based intervention for all follow-up stages, with a statistically significant differences in CF scores between the control and experimental groups at the followed stages: T1-T4 (p=0.0348) and T1- T5 (p=0.0045). Finally, Study 4 is a compilation of the results of studies 2 and 3, following a quantitative-qualitative design, with a discussion of the findings in light of the period in which the data were collected – in the midst of the COVID-19 pandemic. According to the participants, the intervention was considered important for their self-knowledge, stress control, coping with daily stressful life situations and difficulties inherent to nursing work. It is concluded that Mindfulness-based interventions can be effective to ensure the mental health for nursing professionals with effects in the management of anxiety, stress and control of Compassion Fatigue.