ORIGINAL RESEARCH

Satisfaction in, and impact of work on, the multidisciplinary team in a psychiatric hospital

Giselle Cristina Dias^I; Antonia Regina Ferreira Furegato^II

^I Nurse. Graduate Student by the School of Nursing of Ribeirão Preto, University of São Paulo. Ribeirão Preto, São Paulo, Brazil. E-mail: gicrisenfe@hotmail.com
^II Nurse. Professor, School of Nursing of Ribeirão Preto, University of São Paulo. Ribeirão Preto, SP, Brazil. E-mail: furegato@eerp.usp.br

DOI: http://dx.doi.org/10.12957/reuerj.2016.8164

ABSTRACT

Objective: to identify job satisfaction and impact of work among members of a multidisciplinary team at a psychiatric hospital. Method: an exploratory, quantitative, cross-sectional descriptive study was conducted in 2013, with the multidisciplinary team of a psychiatric hospital in São Paulo city. The population comprised 138 members of the multidisciplinary team, of whom 116 formed the sample. Data were collected by: interview script, a Mental Health Service Team Satisfaction Assessment Scale and a Mental Health Service Work Impact Assessment Scale. Results: average satisfaction score was 3.4, indicating indifference, i.e., low levels of satisfaction. Also, the overwork index was 1.9, indicating a medium degree of overwork. Conclusion: it was concluded that low levels of satisfaction show the need to review institutional projects.

Keywords: Psychiatric nursing; job satisfaction; mental health; occupacional health.

INTRODUCTION

Health is the result of the proper management of physical, emotional, social, professional, intellectual and spiritual areas, and quality of life is associated with the maintenance of inner balance before daily situations ^1-5. Evidently, people work with the purpose of obtaining financial return, but each individual's performance is better if he/she is motivated and committed with the job.

Professional achievement can be directly associated with job satisfaction. This has implications with supervision, benefits, salary, opportunities, organization policies and the control that the workers have on their life and work conditions. Is also points out that being satisfied is an important professional achievement factor and may be understood as a mental health protection factor for the worker^6-8.

The hospital environment itself can be considered a stressing factor, because it has unhealthy and hazardous conditions, if compared to other types of services⁹.

In light of the foregoing, this study has the purpose to identify the job satisfaction and impact on professionals of the cross-sectional team of a psychiatric hospital.

LITERATURE REVIEW

It is known that healthcare professions are in third position as stress generators. Nursing is in the fourth position as the most stressing¹⁰.

Because the nursing team work is divided in shifts, the workers suffer harm as regards the participation in social events, which reflects in their mental health^10,11.

Healthcare professionals live with anxiety, pain, suffering and negative feelings from the patients. The distress experienced by the team is great, which generates psychic tension. Because of this, it is necessary to give due attention to the team's psychological aspect, to allow the coping with stressing factors and experiences in the work location^6-12.

METHODOLOGY

This is a descriptive cross-sectional study, conducted in a psychiatric care facility in a city in the inland part of the State of São Paulo, in 2013. Of the 138 professionals in the cross-sectional team of the study facility, 116 professionals participated in the research. However, four of them were not interviewed because they were on vacation, two refused to participate, five were away and 11 were excluded because they had been in the institution for less than six months, totaling 22 subjects excluded from the study.

116 professionals from the facility participated in this study, 11 physicians, eight nurses, four psychologists, one physiotherapist, three occupational therapists, three social assistants, one dentist, one nutritionist, two physical educators, one pharmacist, 69 nursing technicians and 12 health aides. The selection criteria was acting in the facility for at least 6 months as a member of the higher level education professionals team or as nursing aid and technician and not having been away on vacation or leave.

The following investigation instruments were used: script for interview with mental health professionals (REPSM), built by the researchers, based on the literature on the research topic. Composed of 14 items, with questions on subject identification, level of education, practice in mental health service and other sociodemographic data; the Assessment Scale for Mental Health Services Team Satisfaction (SATIS-BR, abbreviated in Portuguese); and Assessment Scale for Mental Health Services Work Impact (IMPACTO-BR), and the last two are part of a set of scales for assessment of mental health services, developed by the Mental Health Division of the World Health Organization (WHO), which were validated for Brazil ¹².

The SATIS-BR Scale contains 32 quantitative questions that assess the satisfaction degree of the team as regards the services provided and the work conditions in the facility in which they work, and three descriptive questions that complement this information and are related to the opinion of the team on the services. The answers are placed in ordinal scale (Likert type), with five points, ranging from Very unsatisfactory (1) to Very satisfied (5). Four factors were identified. Factor 1 – Team's satisfaction degree related to the quality of the services provided; Factor 2 – Team's satisfaction degree related to the work conditions; Factor 3 - Team's satisfaction degree related to the work conditions; Factor 4 - Team's satisfaction degree related to their relationship with co-workers and with their hierarchical superiors ¹².

The IMPACTO-BR scale contains 18 quantitative questions, that assess the degree of overload experienced by the mental health professionals that work on a daily basis with individuals with psychic distress and three complementary descriptive questions. The answers are placed in a five-point ordinal scale (Likert type). The scale showed, based on the analysis of its metric qualities, the existence of three factors: Factor 1 – Overload regarding the effects experienced by the team on their physical and mental health; Factor 2 – Overload regarding the work impact on the team's function; Factor 3 – Overload regarding the emotional impact of the work ¹².

The project was approved by the Ethics Committee of the Nursing School inRibeirão Preto of University of São Paulo ( 212/2012). Consent and authorization were obtained from the facility's administrative coordination. The participants were informed on the nature, objectives and procedures during the research . All those who agreed to participate signed the Informed Consent.

The Package for Social Sciences (SPSS) software, version 10.0, was used for statistical analyses. Descriptive analysis and inferential analysis were used. The Fisher test was used to calculate the associations¹³. The general satisfaction and overload average scores and the values related to sub-scales were calculated. For comparison among the results obtained between the satisfaction and overload factors, we used the Spearman Correlation; the Bonferroni correction was used for multiple comparison¹³. The comparison of the work satisfaction and overload factors was performed by the Kruskal-Wallis¹³ Test. For all statistical tests, p<0,05 values were defined as significance levels.

RESULTS

Sample characterization

Of the 116 study subjects, 74 (63,8%) are females, 40 (54%) are single and there is a prevalence of male subjects that are married 25 (59,5%). Most of the sample - 60 (5,7%) – has no children and the male sex represented 21 (50%) of those who have children. The larger proportion of the subjects has high school education - 62 (53,4%) and 54 (46,6%) have higher education. The age of the subjects ranged between 20 and 74 years. Around 1/3 of the participants worked at the facility for up to 2 years, another third 3-10 years and another third more than 11 years, ranging between 1 and 38 years of work.

Job satisfaction

The data obtained through the SATIS-BR Assessment Scale allowed to calculate the satisfaction scores per subject and the average satisfaction score for the sample set. The general satisfaction score ranged from 2,2 to 4,8 and the score average was 3,4, value situated in Indifferent, indicating low satisfaction levels.

The highest satisfaction factor was Relationships, showing average score of 3,7, followed by the factors Service quality and Work conditions with 3,4 average scores. The lowest satisfaction factor was Participation in service, as shown in Table 1.

TABLE 1: Average and standard deviation of general satisfaction scores and by factors, according to the responses from professionals in a psychiatric hospital. Franca, São Paulo, 2013. (N=116)

Considering the three questions with the highest satisfaction levels, we observed a good team relationship (4,1), service reliability and team self-confidence, expressed in the valuation of the relationship with the co-workers, in the recommendation of the service to friends and family (3,9) and the team's level of responsibility in the service (3,8).

The job benefits (2,3) were a negative point among the satisfaction scores. Among other aspects of lower satisfaction, we point out salary (2,4) and the participation in the assessment process of the service's programs and activities (3).

The specific satisfaction scores were compared for the different professionals in the nursing team. The lowest average satisfaction score for nurses was (2,8), for nursing technicians (3,1) and nursing aides (3,3), regarding Participation in the service. In the comparison among the nursing team members, the Kruskal-Wallis test was performed and no statistically significant differences were observed among the satisfaction scores (p=0,81).

As regards the satisfaction qualitative questions, we observed that approximately 80% of the subjects interviewed like being around the patients, caring for them and observing their improvement, followed by the good relationship with the co-workers.

What generates the most dissatisfaction in the team (approximately 64%) are the aspects related to the institutional standards and rules and the devaluation of the professionals by the hospital management.

The great majority of the professionals (95%) believes that the service can be improved with more training and continued education and that hiring more employees for the sector would also deliver improvements.

Overload at work

Through data obtained in the IMPACTO-BR Assessment Scale, it was verified that the average overload score for the professionals was 1,9, ranging between 1,0 and 4,3. The average overload level was between Not at all and Not really, indicating relatively low levels of overload. The overload values obtained, discriminating the global impact and the scale factors, are in Table 2.

TABLE 2: Average and standard deviation of general overload and divided by factors, according to the responses from professionals in a psychiatric hospital. Franca, São Paulo, 2013. (N=116)

The factor with the greatest impact wasWork effect on the team's relationship, followed by Emotional effects on the work. The factor with the lowest overload was associated to the effects on the subjects' physical and mental health.

However, the three variables with the greatest impact were physical exhaustion after work (2,9), the fear of the possibility of being physically assaulted by a patient (2,7) and the thought of changing the work area (2,2).

The need to search for a mental health professional, due to emotional problems caused by the job (1,2), was the variable with the lowest overload impact, among the three lower variables, followed by the depressive feeling for working with individuals with mental disorders (1,3). The fact of being in contact with individuals with mental disorder and of this affecting the workers' social lives was the third lowest overload variable (1,3).

In the Spearman Correlation coefficient analysis, we observed a significant negative correlation at 5% of the satisfaction and overload scores (r= - 0,4987).

The Bonferroni Correction was also performed for multiple comparisons, which makes it possible to state that the whole set of results is significant at 5%.

Thus, the satisfaction scores were associated to the overload scores, in each domain, with a few significant results, as shown in Table 3.

TABLE 3: Spearman Correlation Coefficient (*) for the general satisfaction and impact on work scores, in psychiatric hospital. Franca, São Paulo, 2013 (N=116)

(*) Significant correlations at 5% level, with correction for multiple comparisons

The impact factors were compared among the three nursing team categories. The average score with the greatest impact in the nurses, 2,1, wasEmotional effects of the job; for nursing technicians, 2,2, it wasTeam relationship; for nursing aides, 2,0, Team relationship and Emotional effects of the job. In the Kruskal-Wallis test, no statistically significant differences were observed among the impact scores for the nursing team (p=0,92).

As regards the qualitative questions on overload, the subjects were questioned about the work aspects that result in greatest overload. Approximately 80% declare that they face problems for not having enough employees in the sectors, because the facility does not hire enough employees and also because of the absences and leaves of col-workers.

The increase in number of employees was considered a condition of lower overload in the service by approximately (75%) of the subjects and, then, the teamwork.

As regards the work aspects that they would like to change to reduce the overload, they said that they would hire more employees and increase pay (67%).

DISCUSSION

Job satisfaction

The data obtained reveal that the study professionals have intermediate levels of satisfaction, situated at indifference. These results show the need to review the organizational projects, with the purpose to improve the service.

It is understood that the study professional are more satisfied with their interpersonal relationships in the work environment and dissatisfied with their participation in their work site decisions.

In other healthcare services, we also verified that interpersonal relationships appear as a relevant factor in the work environment, teamwork is experienced as a support and relief point¹⁴.

Among the lowest satisfaction scores, the participants feel dissatisfied with the benefits and the salary provided by the facility, similarly to other studies^15,16 and with their participation in the service's programs and activities, suggesting that the organizational aspects are among the most unsatisfactory in the service¹⁷.

Teamwork is a great manner to obtain good results within organizations. The managers and administrators need to trust and respect the actions of the team members. In order for their companies to obtain good results from the service provided and stay in the market, they need to encourage the work in an integrated manner, with collective responsibility, to obtain good results¹⁸.

According to the subjects in this study, there are few expectations of promotion in the service. Professional capacitation and improvement in mental health are not considered, thus discouraging the search for better education and studies in mental healthcare.

From the results presented, we observe the need for the facility to review a few points in its management, with the purpose to provide better working conditions for the team and a more effective participation of these professionals in the service, which would motivate the employees.

It was also perceived that the satisfaction associated with the factor Work Conditions is lower for the nursing team, when compared to the other professionals in the cross-sectional team.

Among the aspects that may have influenced the lower satisfaction with work conditions among the nursing team members, is the low pay for the class, often insufficient to maintain their personal and family lives, with leads them to search for other ways to support themselves, with double or even triple shifts.

A few factors were identified that lead to dissatisfaction at work ¹⁹. Satisfaction is experienced from autonomy, good salary and good work conditions, capacitation and training, professional achievement and expectation for promotion; on the other hand, dissatisfaction is experienced from lack of support by the hierarchical superiors, lack of professionalism and group-oriented relationship, improper work area, lack of materials and equipment, low salary, insufficient number of employees overloading the team, stress in the work environment, lack of interaction within the team, lack of recognition, not being valued, lack of confidence on job stability, among others.

The excessive hour load, low pay and lack of leisure hours negatively affect the workers' physical and mental health, and thus it is necessary to rethink the reasons that led the nursing professionals to feel more dissatisfied with the work conditions, when compared to the other members of the cross-sectional team¹⁵.

The reading of the answers to the qualitative questions of the SATIS-BR scale showed that, among the factors most frequently mentioned as source of satisfaction for the professionals in the study facility, the contact and the care provided to the patients, followed by the harmonious relationship with the co-workers. The organizational aspects, such as standards and rules, followed by the dissatisfaction with the professional valorization.

The study participants believe in the possibility of improvement of the service after training, as well as hiring more employees, which would result in less overload.

Job overload

Considering that the psychiatric hospital has characteristics that favor the workers' overload, due to the fact that it had direct contact with patients in psychotic episode and serious clinical condition, we expected to find high overload scores. However, this was not the finding in this facility.

By studying nursing workers at a university hospital in Rio Grande do Sul, we observed that minor psychic disorders occur in 18.7% of the professionals and that they are more frequent among workers that suffer strong work demand²⁰.

In this study, before the relatively low results, associated to overload, we consider that the professionals found coping ways or strategies to reduce it. These strategies were identified in another study, which, by investigating coping strategies against stress among the nursing team in an emergency room, found avoidance, in which the professionals tried to forget the stressors, delayed confrontation or blocked their emotions; they spoke about the problem and negotiated alternatives; participated in religious, sports and leisure activities, and these were used to relieve the stress level at work²¹.

In this study, we observed a significant satisfaction of the professionals about the factor Relationships at work, supposing that the help from co-workers contributes with the reduction of emotional overload, influencing the low overload score result found.

Therefore, it is observed that, from these results, the study team workers suffer more overload through the effects of the job on the quality of the worker's health and less overload through the effects of the job on the workers' physical and mental health.

By researching mental healthcare workers, it was evidenced that the social support strategies, which means, the search for support and help through the relationship with other people, like family members, friends or co-workers, help to reduce the overload arising from the daily contact with users in mental distress²².

It is necessary that the healthcare managers contribute with the reduction of overload on these professionals, providing, as a consequence, a better care and more safety to the patient²³.

It is known that, when there are means to ensure the well-being of the professionals in their work place, they become more motivated and provide more quality of work²⁴.

It is believed that, the better the perception of the facilities and the nursing team in relation to the need for maintenance and mental health prevention are, the better the work conditions and quality of life of this professional are, once they feel more satisfaction, happiness and achievement, personally and professionally.

The organizations must encourage, stimulate and motivate their workers, create a satisfactory and healthy environment for the workers²⁵.

As regards the lower impact scores, these are the need to search for help from a mental health professional, feel depressed for working with individuals with mental disorders, and, finally, the contact with the users affecting the participants' social life, thus showing that the emotional status of these workers suffers less impact in the study facility.

By assessing the SATIS-BR and IMPACTO-BR scales scores, we verified that the whole set of results is significant, suggesting that the higher the overload level is, the lower the satisfaction level is.

The fact of dealing with organic, emotional or social suffering requires the development of interpersonal skills²⁶ by the professionals involved, suggesting that a psychological follow-up of the professionals would be ideal, with the purpose to develop adapting and handling strategies to act with the users.

In this study, we verified that the nursing professionals suffer more impact than the other team members and that Team relationship is the factor that overloads them the most.

Prophylactic measures to promote and protect the worker's health need to be started in the technical schools and higher education courses, so that, from this moment, the future professionals may be aware of the important of maintaining their health.

By Reading the answers regarding the qualitative questions in the IMPACTO-BR scale, we noticed that the cross-sectional team feels overloaded and dissatisfied with the number of employees in the facility, suggesting the hiring of employees, teamwork and salary increase as aspects that provide less overload.

There are still questions that deserve future attention: where is the concern of these employees with the quality of the care provided? Could it be a bias of the instrument applied?

Considering the overload experienced by the study team in relation to the organizational aspects, it becomes relevant to reflect and search for alternatives with the purpose to provide improvements in the institutional environment, such as work conditions, salary, benefits, promotions and incentives to professional growth and continuous improvement in the mental healthcare area, more training, implementation of programs to prevent and promote the workers' health.

CONCLUSIONS

The results showed that the cross-sectional team professionals have low satisfaction levels, feel more satisfied when in contact with the users and in the relationship with the team members.

Low overload rates were identified, although the hiring of more professionals, increase of salary, professional valorization and team work are shown as aspects necessary to improve the service.

The nursing team shows less satisfaction related to work conditions and suffers more impact on work, compared with the other professionals in the cross-sectional team.

However, the results alert to the work conditions, the participation in the service and the organizational aspects, which are among those that generate the most dissatisfaction in the job.

Considering these results, we notice the need to review the institutional projects, searching for better benefits, incentives and professional valorization. Programs to promote and protect the workers' health also need to be implemented in this facility. The investment in capacitation in the mental healthcare area of the team and the hiring of more employees may also be considered.

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