Фрагмент исследования качества жизни и профессионального выгорания врачей детских поликлиник г. Волгограда

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Doing your duty is a strong deontological prin- Materials and methods: The results of questionciple of professional pediatric practice. After the naire SF-36 and «Assessment of professional burnout» healthcare reform [4], the medical workload increased (APB) (Adaptation of «Maslach Burnout Inventory" and there was a threat that these principles would be questionnaire» (MBI) by Vodopyanova N.E., Starchenimplemented due to high physical and psycho- kova E.S.) [2] were compiled on the information base of em°ti°nal stress and risk of developing professional the research. The sample consisted of 126 female pedia- ^rnDtwml) tareut The prot>lem of emotioml tium^ ^ians from clinics of Volgograd. Three groups were is directly related to the QL of medical workers and formed: 36-49 years old, pre-retirement (50-55 years has a great impact on the quality of all medical care. old) and retirement age (56 years and more). For doctors and rnras this is manifested by irritation SF-36 is a non-specific quality-of-life (QL) when communicating with patients, demonstrating questionnaire. The 36 questions are grouped into eight their own worth, loss of self-esteem and worries about scales: Physical Functioning, Role-Physical functioning, to professional and personal failure. Numerous Bodily Pain, General Health, Vitality, Social Function-studies have proven that healthcare workers are at ing, Role-Emotional and Mental Health. Each scale vargreatest risk [3]. Especially high risk among primary . , ... , ... ^ ^ • . j ies between 0 and 100 where 100 represents complete care pediatricians because in tense conditions associated with responsibility for the patient's life, the factor of h A11 scales *?т two mainuindicators by which communication with parents additionally acts. the components of population health are assessed: After the adoption in 2018 of Federal Law Mental Health and Physical Health. No. 350, the New Pension Reform changed the rules The questionnaire «Assessment of professi°nal for calculating the retirement age, towards its increase, burnout» (APB)c°ntams 22 statements about feelings and consolidated the concept of “pre-retirement age”. and experiences associated withperformance of work We assessed the QL and professional burnout of pedi- activities. ft consists of tkree scored categories: «emoatricians with more than 10 years of work experience tional exhaustion», «depersonalization» and «reduction including pre-retirement and retirement ages. of professional achievement». This method is needed 53 ФЕДЕРАЛЬНЫЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ 2 (26)2020 to individually identify signs of burnout and depending on gender and age. Results: the SF-36 questionnaire showed that majority of the respondents had a level of QL assessment in a gradation above the average (Table 1) if compared with the standardized indicators of a population study of the quality of life [1]. There are higher assessments of QL level on at least 6 scales in all age groups, except for the 35-49 age group, in whom this was observed only in 44.4 %. In general, the most favorable situation is among people of retirement age (84.6 % have excess on 6 scales, 46.1 % on 8 scales). Perhaps this is due to formation of this group of persons with a high level of adaptation and motivation to professional activity which are characterized by professional longevity. Table 1 Indicatorsof scales SF-36 № Scale Value (score) / age 36-49 50-55 56 and more 1 Physical Functioning (PF) 77,96 ± 3,34 78,00 ± 6,09 79,23 ± 6,30 2 Role-Physical functioning (RP) 62,96 ± 6,98 71,67 ± 9,41 84,62 ± 6,66 3 Bodily Pain (BP) 70,26 ± 5,10 71,87 ± 7,25 77,62 ± 6,12 4 General Health (GH) 60,56 ± 3,94 56,33 ± 4,82 71,23 ± 6,29 Physical Health 47,30 ± 1,89 46,04 ± 2,30 48,61 ± 2,85 5 Vitality (VT) 54,81 ± 3,89 63,67 ± 5,38 71,15 ± 4,57 6 Social Functioning (SF) 62,30 ± 3,61 77,27 ± 5,09 84,38 ± 4,33 7 Role-Emotional (RE) 66,59 ± 7,35 82,07 ± 7,20 84,46 ± 7,23 8 Mental Health (MH) 56,30 ± 3,81 64,80 ± 5,15 77,54 ± 3,96 Mental Health 41,74 ± 2,12 48,51 ± 2,10 53,01 ± 1,65 Comparison of QL in the age groups of 36-49 year old doctors and the group of pre-retirement ages revealed the features: a higher level of social functioning in persons of pre-retirement age (p < 0.05). If we compare the groups of 35-49 years old and pensioners, it was revealed that the indicators of 4 scales are significantly higher among pensioners: Role-Physical functioning (p < 0.05), Vitality (p < 0.01), Social Functioning(p < 0.01), and Mental Health (p < 0.01). This may be due to the fact that pensioners who have remained to perform their professional functions have a high level of motivation and professional priorities. We identified the dynamics of changes in the physical and psychological components of health, which showed the expected inversion of the dominant parameter in assessing the quality of life. Over the years, physical health is inferior to psychological health (Fig. 1). The analysis of professional (emotional) burnout was conducted from an age perspective and according to the prevalence in the study groups and the integral indicator of burnout (Table 2). Table 2 Distribution of professional burnout scales by age group, % Age Level of burnout Distribution (person/level) Integral indicator of burnout Emotional exhaustion Depersonalization Reductionofprofession al achievement 36-49 Low 33,3 0 37 Medium 11,1 25,9 48,1 High 44,4 18,5 11,1 Very high 11,1 55,5 3,7 50-55 Low 26,4 0 52,8 Medium 19,8 13,2 33 High 39,6 39,6 13,2 Very high 13,2 46,2 0 56 and Low 69,3 7,6 61,6 more Medium 23,1 30,8 30,8 715 ± 053 High 7,6 30,8 0 Very high 0 30,8 7,6 54 2 (26) 2020 ФЕДЕРАЛЬНЫЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ Fig. 1. Indicators of QL of doctors Fig. 2. Levels of emotional burnout in different age groups Fig. 3. Levels of depersonalization in different age groups 55 ФЕДЕРАЛЬНЫЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ 2 (26)2020 Fig. 4. Levels of reduction ofprofessional achievement in different age groups 56 Retired pediatricians have a significantly lower level of emotional exhaustion in comparison with the group of 35-49 years old (p < 0.05) and persons of pre-retirement age (p < 0.01). When analyzing the data in general, there are high and very high levels of depersonalization. A high level of depersonalization is a defensive reaction for a rational assessment of the situation without emotions. At the same time, depersonalization is characterized by the presence of an emotional buffer between the patient and the doctor. People of retirement age have the lowest level of depersonalization, which indicates less detachment (Fig. 3). The index of reduction of professional achievements is low in all age groups with a tendency to strengthen with age (Fig. 4). The integral indicator of burnout in all age groups was at a high level with a peak in the preretirement age group (9.13) and a significant decrease in the group of pensioners (p < 0.05). Correlation analysis of the burnout and QL scales revealed an average inverse between emotional exhaustion and the values of Physical Functioningscale (r = -0.59), Role-Physical functioning (r = -0,57), Bodily Pain (r = -0,67), General Health (r = -0,55), Social Functioning (r = -0,62), Mental Health (r = -0,63) and Vitality (r = -0,76). Conclusion. The results of the study show that the QL of pediatricians of retirement and pre-retirement age is above the average level. However, all groups have a high level of professional burnout. The most unfavorable indicators of professional burnout are observed in the pre-retirement age group. Groups of retirement and pre-retirement age consist mainly of highly qualified specialists. In the modern life of society, they are able to extend the period of their professional longevity if the supervisory authority begins to introduce preventive measures to protect mental health and optimize working conditions.

Об авторах

Л. П Сливина

Волгоградский государственный медицинский университет

Email: slivins@yandex.ru
доктор медицинских наук, заведующий кафедрой профильных гигиенических дисциплин

М. Е Морозов

Волгоградский государственный медицинский университет

Email: mmor@inbox.ru
Преподаватель колледжа

А. А Хайдукова

Волгоградский государственный медицинский университет

студент 6-го курса лечебного факультета

Е. И Калинченко

Волгоградский государственный медицинский университет

Email: kalin.l@mail.ru
кандидат медицинских наук, доцент кафедры профильных гигиенических дисциплин

И. В Федотова

Волгоградская государственная академия физической культуры

Email: calin.fedotova@mail.ru
кандидат медицинских наук, доцент кафедры спортивной медицины

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