Peculiarities of Professional Burnout in Medical Personnel Employed

in the Treatment of Covid-19 in Russian Clinics

Marina Anatolyevna Kruglova

, Elena Anatolyevna Stolyarchuk

and Yana Yurievna Rubeko

Saint Petersburg State University, Saint Petersburg, Russia

Keywords: Covid 19, Professional Activity of Nurses, Mental Stress, Professional Burnout, Stress, Professional Health.

Abstract: The article considers the problem of preserving professional health due to the high level of development of

emotional burnout of nurses in Russian clinics repurposed for the treatment of Covid-19. A study of the level

of professional burnout of nurses involved in treating patients since the beginning of the pandemic was carried

out after the removal of the main quarantine restrictions. This category of personnel with a high level of

probability is prone to the development of professional burnout, since they work under conditions of high

psycho-emotional and physical stress under the influence of a significant amount of professional stress,

unfavorable social factors, as well as the threat of contracting a dangerous disease, which together provokes

the accelerated development of professional burnout. Regression analysis showed that professional burnout

lowers the general background of mood, contributes to the development of negative self-perception in nurses,

which in turn leads to a decrease in immunity and an increase in the risk of Covid-19 infection.

1 INTRODUCTION

The modern world is facing a serious test. The Covid-

19 pandemic has re-emphasized the relevance of the

problem of professional burnout, especially in the

field of helping professions. Health care workers

experience heightened levels of occupational stress

caused by the specific conditions of caring for Covid-

19 patients. The features of the professional activity

of nurses are associated with a high degree of

responsibility for the life and health of others

(Vinokur and Rybina, 2008), (Sablina and Butenko,

2010), (Caplan, 1994), (Schaufeli and Salanova,

2007), (Valero et al., 2013). They need to make quick

decisions, have a high level of self-discipline, and be

able to maintain high performance in extreme

conditions. Wherein, work with high emotional

return, experiencing constant psychological and

intellectual stress and, at the same time, maintaining

involvement in patients' problems.

This can deplete the physical and psychological

resources of a medical worker and, accordingly, lead

to his emotional (professional) burnout

https://orcid.org/0000-0001-7959-7097

https://orcid.org/0000-0002-9889-9645

https://orcid.org/0000-0002-9158-8828

(Vodopyanova and Starchenkova, 2008), (Ermakova,

2010), (Koroleva, 2007), (Afari et al., 2000), (Afari

and Buchwald, 2014).

The professional activity of nurses is

characterized by the need for constant close

interaction with both colleagues and patients. This

activity generates permanent stress, which can

contribute to the development of deviations in the

mental and somatic state of medical workers

(Vinokur, Rybina, 2008), (Sablina, 2010).

Psychosomatic manifestations of burnout include

dizziness, insomnia, shortness of breath, nausea,

excessive sweating, tremors, general malaise,

changes in blood pressure, and discomfort in the heart

(Adam et al., 2014), (Sykes, 2002). Wherein,

immunity is sharply reduced, and exacerbations of

chronic diseases occur. When the reactions move

from the level of emotions to the level of

psychosomatic disorders, this serves as an indicator

that the emotional defense cannot cope with high

loads and, accordingly, physiological disorders arise.

Professional (emotional) burnout is a complex

multicomponent phenomenon. Until now, an

unambiguous understanding of its essence has not

Kruglova, M., Stolyarchuk, E. and Rubeko, Y.

Peculiarities of Professional Burnout in Medical Personnel Employed in the Treatment of Covid-19 in Russian Clinics.

DOI: 10.5220/0011112200003439

In Proceedings of the 2nd International Scientiﬁc and Practical Conference "COVID-19: Implementation of the Sustainable Development Goals" (RTCOV 2021), pages 149-155

ISBN: 978-989-758-617-0

149

been achieved. It is known that the syndrome of

professional (emotional) burnout is characterized by

a combination of symptoms of disorders in all spheres

of life: mental, somatic and social (Hatcher and

House, 2003; Huibers et al., 2003; Vendeloo et al.,

2014).

To understand its essence, to carry out adequate

diagnostics and correction, it is necessary to

comprehensively study individual aspects of burnout

within the framework of psychology, social work and

medicine.

This is especially true in a pandemic (Sangrà et

al., 2021; Sato et al., 2020; Chen et al., 2020), since

nursing professionals work in direct contact with the

patient, and the quality of medical care largely

depends on them. Nursing in a pandemic is

particularly demanding and challenging. This activity

is associated with high psycho-emotional and

physical stress, with the impact of a significant

number of unfavorable social, household and

professional factors, as well as with a high probability

of contracting a dangerous viral infection.

A comprehensive analysis of the problem of

professional (emotional) burnout will make it

possible to create a program for early diagnosis and

comprehensive prevention of this syndrome in

medical workers. Implementation of this program

will allow preserving and strengthening the physical

and mental health of nurses and, accordingly,

improving the quality of medical care they provide to

patients.

Purpose of the work: to identify and analyze the

features of professional burnout in nurses in the

context of the Covid-19 pandemic.

2 STUDY ARRANGEMENT AND

METHODS

The study was carried out after removal of the main

quarantine restrictions (July - August of 2020). The

study involved 135 people - nurses. All respondents

are women, with an average age of 37 years. Of these,

70 people work in clinics that have retained their

focus, not related to Covid-19; 65 people work in

clinics repurposed to fight Covid-19. The sample was

divided into two subgroups in accordance with the

specifics of the work. Group 1 - nursing staff who are

not directly involved in therapeutic actions with

Covid-19, and who work in clinics that have retained

their focus (70 people). Of these, none of the

respondents had cases of the disease, either explicitly

or latently. Group 2 - nursing staff who have taken

and are directly involved in therapeutic actions for the

treatment of Covid-19, and working in clinics

repurposed to fight Covid-19 (65 people). Of these,

27 people had been ill with Covid-19 in a mild form

(without hospitalization using mechanical

ventilation) and continue to work in hospital

environment with Covid-19 patients. In 38 people,

antibodies to Covid-19 were detected, while they did

not have this disease either explicitly or latently (no

manifestations of the symptoms of the disease were

recorded). These respondents also continue to work

in a hospital environment with Covid-19 patients.

Presence of professional burnout was determined

using the methodology "Diagnostics of Professional

Burnout" (K. Maslach, S. Jackson, adapted by N.E.

Vodopyanova) (Vodopyanova, 2002). Features of the

manifestation of professional burnout were identified

using the methodology "Diagnostics of the Level of

Emotional Burnout" (V.V. Boyko) (Boyko, 2002).

The definition of well-being as an indicator of

professional "burnout" was carried out by the

Diagnostic Technique for the Rapid Assessment of

Well-Being, Activity and Mood (SAN) (Doskin et al.,

1973). The specifics of the manifestation of

professional burnout syndrome were clarified using

the Color Choice Method - a modification of the

eight-color Luscher test (Sobchik, 2012).

Mathematical processing methods:ϕ -Fisher's

criterion (angular transformation); regression

analysis. The statistical data were processed using the

SPSS-20.0 program.

3 RESULTS AND DISCUSSION

3.1 Study of Presence of Professional

Burnout and the Characteristics of

Its Manifestation in Medical

Professionals

The results obtained according to the Technique for

the diagnosis of professional burnout (K. Maslach, S.

Jackson, adapted by N.E. Vodopyanova) are

presented in Table 1.

It was found that in nursing staff in clinics not

associated with direct care for patients with Covid-19

(group 1), psychoemotional exhaustion,

depersonalization and reduction of personal

achievements are predominantly at an average level.

Mental burnout was revealed in a small part of the

respondents (22.7%). In contrast, the nursing staff of

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Table 1: Results of studying the presence of professional burnout in medical professionals (in % of the number of respondents

in the group).

Questionnaire scales

Test subjects

1st

group

2nd

group

"Psychoemotional exhaustion"

Low level

Avera

e score -6.5

oints

20 11

Average level

Avera

e score -16.5

oints

67 33

h level Avera

e score - 24.8

oints 13 56

"Depersonalization" (personal distance)

Low level

Average score -3.7

oints

43 8

Average level

Average score - 8.2

oints

36 61

High level Average score - 18.4

oints 21 31

"Reduction of personal achievements" (professional

motivation)

Low level

Average score -19.6

oints

32 12

Average level

Avera

e score - 27.2

oints

26 64

h level Avera

e score - 34.6

oints 42 24

Burnout

avera

e score - 98.4

oints

22.7 42.4

Validit

of differences

<0.01

Table 2: The results of studying the characteristics of professional burnout in medical professionals (in average scores).

Questionnaire

scales

voltage resistance emaciation

Validity of

differences

Test

subjects

1 2 3 4 5 6 7 8 9 10 11 12

Group 1 10.2 11.3 8.7 9.8 13.2 13.8 15.4 7.6 6.9 7.3 8.2 5.2 p<0.01

Group 2 16.2 21.6 27.5 24.6 15.3 15.1 28.5 24.7 17.5 29.7 27.9 27.8 p<0.01

clinics where patients with Covid-19 are treated

(group 2) showed a tendency for high values to appear

on all scales. Mental burnout was diagnosed in a very

significant part of the respondents (42.4%). It should

be noted that the respondents of group 2 are in a

stressful situation, they are already on the verge of

depleting all their resources: emotional, physical,

energy. They are characterized by chronic emotional

and physical fatigue. This, namely, may be associated

with a weakening of the immune system and the

susceptibility of some doctors to the Covid-19

disease. In addition, health professionals in group 2,

compared with health professionals in group 1,

demonstrate greater emotional restraint in relation to

others, while they show signs of depression and

irritability. Wherein, the respondents of both groups

are not inclined to level the value of their activities;

they consider themselves to be quite competent and

wealthy professionals. Perhaps they tend to feel guilty

about their own negative manifestations or feelings,

but this does not lead to a dramatic decrease in

professional and personal self-esteem. Despite the

general fatigue of the respondents, especially of

group 2, they retained a positive professional

productivity, interest in work and optimism.

The results obtained by the methodology

"Diagnostics of the level of emotional burnout" (V.V.

Boyko) are presented in Table 2. The analysis was

carried out for all indicators, highlighting the leading

symptoms of "burnout" (highlighted in bold in the

table). Based on the qualitative analysis, a conclusion

was made about the degree of formation of each

phase.

It was found that among middle-level medical

professionals, the leading symptoms of professional

burnout are: 1) the experience of traumatic

circumstances; 2) dissatisfaction with oneself; 3)

"being caged"; 4) anxiety and depression; 5)

inadequate selective emotional response; 6)

emotional and moral disorientation; 7) expansion of

the sphere of economy of emotions; 8) reduction of

professional duties; 9) emotional deficit; 10)

emotional detachment; 11) personal detachment

(depersonalization); 12) psychosomatic and

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psychovegetative disorders. It was found that nursing

personnel have practically all the symptoms of

professional burnout corresponding to all three

phases. There is a rather pronounced difference

between the selected groups. So, in group 1, the level

of professional burnout is more consistent with an

uncommon or emerging symptom, while in group 2,

indicators of an emerging and existing symptom

prevail. It was revealed that in group 1 the developing

symptoms are: the experience of traumatic

circumstances; dissatisfaction with yourself;

inadequate selective emotional response and

emotional and moral disorientation. Probably, these

respondents strive to realize themselves

professionally, to “make a career”. However, the

situation of the pandemic, together with various

unmet personal needs, does not give them the

opportunity to "fully realize themselves" by

satisfying their professional ambitions. Therefore,

many working situations by this group of respondents

can be perceived as traumatic, aggravating the

growing dissatisfaction with themselves and giving

rise to inadequate selective emotional response and

emotional and moral disorientation, which, in turn,

lead to a tendency to expand the sphere of saving

emotions. This is a very negative trend, since it

manifests itself in the behavior of people employed in

the "person-to-person" sphere, moreover, in the

sphere of a helping profession, which presupposes the

presence of empathy in relations with other people.

Therefore, the emerging symptoms can prevent these

respondents from performing their professional

duties efficiently.

The data in Table 2 show that for the respondents

of group 2, the most characteristic is the experience

of dissatisfaction with oneself; at the same time, they

feel “driven into a cage” and, against this background,

experience anxiety and depression. In addition, since

these respondents are not completely satisfied with

themselves, they tend not to show this and,

accordingly, seek to expand the sphere of saving

emotions, but this tendency in behavior inevitably

leads to a reduction in professional duties. Feeling

guilty about the fact that they cannot fully realize their

communicative potential and give the necessary level

of attention to patients, this group of respondents

quite naturally begins to experience emotional and

personal detachment, and, in order to reduce their

state of cognitive dissonance, begins to formulate

various "excuses" of their behavior. However,

"excuses" work only on a rational level, without

affecting the level of the unconscious, therefore, this

group has a manifestation of psychosomatic and

psychovegetative disorders, in particular, a decrease

in immunity and susceptibility to infectious diseases.

The analysis of the obtained results in general

showed that in group 1 there are no clearly

pronounced dominant symptoms in each phase or in

the entire syndrome of "emotional burnout". On the

contrary, in group 2 in each phase there are dominant

symptoms, which, in fact, determine the

manifestation of the syndrome of professional

"burnout" in general. So for the phase of "stress" the

dominant symptoms are "caged in", anxiety and

depression, dissatisfaction with oneself. Moreover,

from our point of view, it is precisely the feeling of

“driven down” that determines the manifestation of

anxiety and depression against the background of

general dissatisfaction with oneself. In our opinion,

this is quite predictable, since the doctors of this

group are forced to be in isolated hazardous areas,

they have limited contacts with loved ones, they are

tired of the constant stress. Fatigue is likely to be

viewed as their own weakness, therefore, they

experience dissatisfaction with themselves and a state

of depression. For the "resistance" phase, the

dominant symptom is the expansion of the sphere of

saving emotions, which "triggers" emotional and

moral disorientation and the reduction of professional

duties. That is, we can say that the respondents feel a

complete hopelessness and are in such a state when

they “give up” by themselves and there can be no

question of any high-quality performance of

professional duties. Therefore, it is quite natural that

for the phase of "exhaustion" the dominant symptom

is emotional detachment, which stimulates the

development of personal detachment against the

background of psychosomatic and psychovegetative

disorders.

3.2 Study of the Characteristics of

Well-being of Nursing Personnel

It was found that the respondents of group 1

demonstrate a more positive mood, greater activity

and better mood in comparison with the respondents

of group 2.

We believe that in the conditions of work with

patients with Covid-19, coupled with the constant

need to comply with increased safety measures, being

in a confined space, fatigue accumulates, and the total

number of various problems that lie both in the

professional, personal and interpersonal spheres

increases. Therefore, the results obtained did not

surprise us; rather, we were upset by the fact that

nurses from group 2, in the process of their extremely

demanded work in a pandemic, unfortunately, feel

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uncomfortable, do not have a very high level of

activity, which may explain the decreased mood

background.

Table 3: The results of the assessment of well-being by the

nursing personnel (in average points).

Test

sub

ects

1st group 2nd group

Validity of

differences

Scales M σ M σ

Wellbein

6.7 0.45 3.8 0,.57

<0.01

Activit

6.8 0.56 4.2 0.54

<0.01

Moo

5.9 0.54 3.6 0.59

<0.01

3.3 Clarification of the Features of

Manifestation of the Syndrome of

Professional "Burnout"

The results obtained by M. Luscher's Color Test were

analyzed for each group separately. In doing so, we

were specifically interested in two aspects: 1) desired

goals or behavior dictated by desired goals, and 2)

denied or suppressed properties that carry anxiety.

The results are shown in Table 4.

It was found that the respondents of group 1

demonstrate a set of more constructive attitudes of

behavior in comparison with the respondents of group

2. So only 22 % of respondents from group 2 at the

time of the study were inclined to use adequate

methods of response in stressful situations, while in

group 1 - 67 % of respondents chose response options

inherent in adequate constructive behavior. Let us

stop in more detail on the choices that were made for

the analyzed positions.

In group No. 1, 7 % of respondents are

characterized by a positive state, a desire for

recognition, for activities that ensure success. 11 %

actively strive for success, for independent decisions,

overcoming obstacles in their activities. 19 % of the

respondents in this group have a businesslike, slightly

increased excitement, enthusiasm, optimism, a desire

for contacts, for expanding the scope of their

activities. 14 % of respondents experience a sense of

satisfaction, calmness, a desire for a calm

environment, while they express a reluctance to

participate in conflicts and experience stress. 10 % of

the respondents in this group are characterized by

business excitement, active striving for a goal, to

overcome all difficulties. They would like to receive

high marks for their performance. Wherein, in this

group, 12 % of respondents experience a feeling of

anxiety, fear of loneliness, the desire to get away from

conflicts and avoid stress. For 2 %, a feeling of

resentment, even anger, against the background of a

desire for cruelty and authority in relationships is

characteristic. 8 % experience a state close to stress,

feel difficulty in relationships, experience a feeling of

limited opportunities. For 17 % of the subjects, a state

of frustration was characteristic due to the limitation

of ambitious requirements against the background of

insufficient purposefulness.

Therefore, we can say that this group of

respondents demonstrates a generally favorable

picture of the manifestation of behavioral attitudes.

Only 33 % of respondents experience obvious

difficulties in adapting to the environment, which, in

our opinion, may be due to the process of professional

burnout. The generally positive picture for this group,

from our point of view, can be explained by the fact

that 1) these respondents in a pandemic were not

associated with the processes of providing care to

patients with Covid-19 and, accordingly, did not

experience the negative impact of severe restrictive

measures; 2) they were not at increased risk of

infection; 3) these respondents practically did not

change the characteristics of their lives, with the

exception of those restrictions that were introduced in

conditions of self-isolation.

Table 4: The results of studying the characteristics of the leading attitude of the behavior of nurses depending on age.

Test subjects

1st group 2nd group

Validity of

differences

Options of parameters Behavioural set

Choice

options

Amount in

Choice

options

Amount in

Desired goals or behavior dictated by

desired goals

+1+2 14% +1+0 8% p<0.01

+1+6 12% +1+2 10%

<0.05

+2+1 7% +1+7 17%

<0.01

+2+3 11% +2+0 18%

<0.01

+3+2 10% +4+2 11%

<0.05

+3+4 19% +4+6 12%

<0.01

+3+6 17% +4+7 8%

<0.01

Denied or suppressed alarming

properties

-1-5 8% -1-7 12% p<0.01

-2-7 2% -2-6 4%

<0.05

Peculiarities of Professional Burnout in Medical Personnel Employed in the Treatment of Covid-19 in Russian Clinics

153

Figure 1: Regression model of the influence of mental burnout on well-being and features of the leading attitude of the

behavior of nursing staff.

In group No. 2, 10 % of the subjects were

characterized by a feeling of satisfaction and

calmness. For 11 %, a generally positive mood is

characteristic; they seek to find ways of solving

emerging problems and strive for self-affirmation.

Wherein, 8 % experience a negative state and feel the

need to get rid of stress by finding peace and

relaxation. 17 % are characterized by the fact that they

experience a feeling of dissatisfaction with the

attitude of other people towards themselves; they tend

to negatively relate to the situation, strive for peace

and rest; in general, the condition is defined as

negative. 18 % of respondents in this group

experience a sense of dissatisfaction due to the desire

for recognition and the desire to impress. In 12 %, a

negative mood prevails due to various griefs and, as a

consequence, they feel the need for emotional release.

8 % of respondents demonstrate a very negative mood

and a desire to get away from any problems, as well

as a tendency to inadequate solutions. For 12 % of the

subjects of this group, a state close to stress is

characteristic against the background of emotional

dissatisfaction and, accordingly, the desire to leave

the psychogenic situation. 4 % of respondents are also

characterized by a state close to stress; they

demonstrate inadequately increased self-control and

an unreasonable desire for recognition

Therefores, 79 % of respondents in this group are

characterized by very negative trends in behavior and

self-perception, which is probably due to the

peculiarities of their professional activities in the

context of the Covid-19 pandemic.

Regression analysis, in which the scale "Mental

burnout" was used as an independent variable, found

the effect of this variable on "Well-being" (β = -0.32);

"Activity" (β = -0.24); “Mood” (β = -0.26) of the

respondents, as well as their “Desired goals or

behavior dictated by the desired goals” (β = -0.31)

and “Denied or suppressed properties that carry

anxiety” (β = -0.29).

This model explains 56.4 % of the variance in

mental burnout. Therefore, a high level of mental

burnout leads to a decrease in the general background

of mood, contributes to the development of negative

self-awareness among nurses both at the physical and

psychological levels.

4 CONCLUSIONS

Nursing personnel who have been involved in the

care of Covid-19 patients since the start of the

pandemic are highly susceptible to occupational

burnout.

The most significant symptoms, the presence of

which may serve as an indicator of the onset of the

development of the syndrome of professional

burnout, are inadequate selective emotional response;

expanding the sphere of saving emotions; reduction

of professional duties related to the field of

"resistance", as well as emotional; personal

detachment and psychosomatic and psychovegetative

disorders related to the sphere of "exhaustion".

Presence of at least one of these symptoms in a

dominant position can serve as a diagnostic indicator

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of the development of professional (emotional)

burnout syndrome.

Professional (emotional) burnout leads to a

decrease in the general background of mood,

contributes to the development of negative self-

awareness in nurses, as a result, it can contribute to

weakening the immune system and increase the risk

of contracting the Covid-19 viral infection.

Based on the results of the study, a training

program was developed, which is currently being

implemented in a remote format. This program is

aimed at overcoming the syndrome of professional

(emotional) burnout in nursing staff working in

clinics repurposed to combat Covid-19, through

improving overall well-being, awareness of the

current psychological defense and correction of

unwanted behaviors by working on emotional

responses and the development of empathic and

reflective abilities.

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