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A relação entre o Burnout, a fadiga por compaixão e as estratégias de prevenção e de coping nos cuidados paliativos em Portugal
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Abstract(s)
A realização deste relatório, no âmbito do 11º Mestrado em Cuidados Paliativos, tem como objetivo
uma análise crítico-reflexiva dos conhecimentos e competências alcançadas, para reforço da excelência
da prática clínica em cuidados paliativos (CP).
Objetivo: Encontrar uma relação entre os níveis de burnout, fadiga por compaixão, presença de
estratégias de coping e mecanismos de autocuidado entre si, assim como dos mesmos em relação à
presença ou não de planos formais de prevenção de burnout contratualizados como indicador de
qualidade de cuidados em equipas de CP.
Metodologia: Realização de estágio de 300 horas num Serviço de Cuidados Paliativos (SCP);
formação no SCP onde a aluna desempenhava a sua atividade laboral, intitulada “A relação entre o
burnout, a fadiga por compaixão e as estratégias de prevenção e de coping nos Cuidados Paliativos em
Portugal”; estudo primário quantitativo, descritivo-correlacional e transversal, com uma amostra de
profissionais de saúde em funções em equipas cadastradas no Diretório Nacional de CP 2023 do
Observatório Português de CP, que responderam a um questionário divulgado, a partir de plataforma
online Google Forms.
Resultados: Quanto ao estudo primário: a amostra constituída por 89 profissionais,
maioritariamente mulheres (86,5%), com média de idade de 42,39±8,66 anos. Prevaleceram os
residentes no norte do país, com mestrado, enfermeiros e com 8 anos de serviço. Maioritariamente,
possuem formação na área, sobretudo em CP gerais. Destacaram-se as equipas comunitárias de suporte
em CP, com a maioria a trabalhar exclusivamente na área, com tempo de funções em CP <5 anos, a
praticar horário fixo, com 35 horas de carga horária semanal e <8 horas diárias. Prevalência de nível
baixo de burnout. Média de 68,33 no Coping na morte com outros e 67,20 no Coping na morte com o
próprio. O desenvolvimento de atividades de prevenção do burnout foram sobretudo as reuniões de
equipa e almoços/jantares, semanalmente. Valor médio de 42,28 na Satisfação por compaixão, 30,53 no
Burnout e 23,62 no stresse traumático secundário; média mais elevada nos Comportamentos de
autocuidado individual. O coping influenciou o nível de burnout (p<0,05), sugerindo que o aumento do
coping resulta na diminuição do burnout. A satisfação profissional/fadiga por compaixão influenciou o
nível de burnout, com diferenças estatisticamente significativas, bem como a existência de correlações
negativas nas interações da satisfação por compaixão com as dimensões do burnout (p<0,05);
correlações positivas entre o burnout e o stresse traumático secundário e o burnout pessoal, burnout
relacionado com o trabalho e o burnout relacionado com o cliente. A equipa/unidade não possuir
contratualização de indicador “prevenção de burnout” resultou em scores mais elevados de burnout, com
destaque para o burnout pessoal. Existência de relevância estatisticamente significativa entre a
existência de um plano formal de prevenção de burnout na equipa/unidade versus burnout relacionado
com o trabalho (p=0,036).
Este estudo merece ser replicado com amostra mais dilatada para obtenção de um conhecimento
mais efetivo do fenómeno estudado. É crucial ter-se uma equipa multidisciplinar motivada, com recursos
pessoais e institucionais que permitam prosseguir com excelência os princípios fundamentais dos CP
Abstract: The main objective of this report, within the scope of the 11th Master's Degree in Palliative Care, is a critical-reflective analysis of the knowledge and skills achieved, in order to reinforce excellence in palliative care. Objective: To find a relationship between the levels of burnout, compassion fatigue, presence of coping strategies and self-care mechanisms, with each other, as well as between them in relation to the presence or absence of formal burnout prevention plans contracted as an indicator of quality in Palliative Care Services. Methodology: Completion of a 300-hour internship in a Palliative Care Service; training at a Palliative Care Service, where the student carried out her work activity, entitled “The relationship between burnout, compassion fatigue and prevention and coping strategies in Palliative Care in Portugal"; primary quantitative, descriptive-correlational and cross-sectional study, with a sample of health professionals working in teams registered in the National Directory of Palliative Care 2023 of the Portuguese Palliative Care Observatory, who responded to a questionnaire disseminated, from an online Google Forms platform. Results: As for the primary study: the sample consisted of 89 professionals, mostly women (86.5%), with an average age of 42.39±8.66 years. The majority were residents in the north of the country, with a Master's degree, nurses and with 8 years' service. The majority had training in the area, especially in general PC. Community support teams stood out, with the majority working exclusively in the area, with <5 years of CP service, working fixed hours, with a 35-hour week and <8 hours a day. Prevalence of a low level of burnout. Average of 68.33 in Coping with death with others and 67.20 in Coping with death with self. The activities used to prevent burnout were mainly team meetings and weekly lunches/dinners. Average value of 42.28 in Compassion satisfaction, 30.53 in Burnout and 23.62 in Secondary traumatic stress; highest average in Individual self-care behaviors. Coping influenced the level of burnout (p<0.05), suggesting that an increase in coping results in a decrease in burnout. Professional satisfaction/compassion fatigue influenced the level of burnout, with statistically significant differences, as well as the existence of negative correlations in the interactions between compassion satisfaction and the dimensions of burnout (p<0.05); positive correlations between burnout and secondary traumatic stress and personal burnout, work-related burnout and client-related burnout. The team/unit not having a Burnout Prevention Indicator contract resulted in higher burnout scores, especially personal burnout. There was a statistically significant difference between the existence of a formal burnout prevention plan in the team/unit and work-related burnout (p=0.036). This study deserves to be replicated with a larger sample in order to gain a more effective understanding of the phenomenon studied. It is crucial to have a motivated multidisciplinary team with personal and institutional resources that allow them to pursue the fundamental principles of palliative care with excellence.
Abstract: The main objective of this report, within the scope of the 11th Master's Degree in Palliative Care, is a critical-reflective analysis of the knowledge and skills achieved, in order to reinforce excellence in palliative care. Objective: To find a relationship between the levels of burnout, compassion fatigue, presence of coping strategies and self-care mechanisms, with each other, as well as between them in relation to the presence or absence of formal burnout prevention plans contracted as an indicator of quality in Palliative Care Services. Methodology: Completion of a 300-hour internship in a Palliative Care Service; training at a Palliative Care Service, where the student carried out her work activity, entitled “The relationship between burnout, compassion fatigue and prevention and coping strategies in Palliative Care in Portugal"; primary quantitative, descriptive-correlational and cross-sectional study, with a sample of health professionals working in teams registered in the National Directory of Palliative Care 2023 of the Portuguese Palliative Care Observatory, who responded to a questionnaire disseminated, from an online Google Forms platform. Results: As for the primary study: the sample consisted of 89 professionals, mostly women (86.5%), with an average age of 42.39±8.66 years. The majority were residents in the north of the country, with a Master's degree, nurses and with 8 years' service. The majority had training in the area, especially in general PC. Community support teams stood out, with the majority working exclusively in the area, with <5 years of CP service, working fixed hours, with a 35-hour week and <8 hours a day. Prevalence of a low level of burnout. Average of 68.33 in Coping with death with others and 67.20 in Coping with death with self. The activities used to prevent burnout were mainly team meetings and weekly lunches/dinners. Average value of 42.28 in Compassion satisfaction, 30.53 in Burnout and 23.62 in Secondary traumatic stress; highest average in Individual self-care behaviors. Coping influenced the level of burnout (p<0.05), suggesting that an increase in coping results in a decrease in burnout. Professional satisfaction/compassion fatigue influenced the level of burnout, with statistically significant differences, as well as the existence of negative correlations in the interactions between compassion satisfaction and the dimensions of burnout (p<0.05); positive correlations between burnout and secondary traumatic stress and personal burnout, work-related burnout and client-related burnout. The team/unit not having a Burnout Prevention Indicator contract resulted in higher burnout scores, especially personal burnout. There was a statistically significant difference between the existence of a formal burnout prevention plan in the team/unit and work-related burnout (p=0.036). This study deserves to be replicated with a larger sample in order to gain a more effective understanding of the phenomenon studied. It is crucial to have a motivated multidisciplinary team with personal and institutional resources that allow them to pursue the fundamental principles of palliative care with excellence.
Description
Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos.
Keywords
Cuidados Paliativos Burnout Fadiga por compaixão Coping Autocuidado Palliative care Compassion Fatigue Self-cares