Individual psychological predictors of occupational stress of the surgeons on the example of orthopedic surgeons

Kekteeva Yuliya Igorevna Assistant, the department of Psychotherapy, the faculty of Clinical Psychology and Social Work, Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation 117997, г. Москва, ул. Островитянова, д. 1 psihoteraphy@mail.ru Gardanova Zhanna Robertovna Doctor of Medicine Professor, Head of the Department of Psychotherapy, the faculty of Clinical Psychology and Social Work, Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation 117997, г. Москва, ул. Островитянова, д. 1 psihoteraphy@mail.ru

Chistiakova Natalia Viktorovna PhD in Psychology Docent, the department of Pedagogy and Pedagogical Psychology, the faculty of Clinical Psychology and Social Work, Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation 117997, г. Москва, ул. Островитянова, д. 1 dik_dog@list.ru

introduction

Surgeons are exposed to a high level of stress in their daily work and are at risk of social maladaptation against the background of changes and the occurrence of functional disorders. By the nature of their professional activity, they experience diverse emotions, and, unfortunately, of a negative nature, which are associated with an intensive work schedule, performing a large amount of work, experiencing situations of failure and disappointment in the case of the progression of patients' illness and deterioration of the prognosis of treatment. At the same time, in the conditions of an aggravated epidemiological situation, they are afraid of getting sick themselves, suffer from uncertainty in the development of their career and lack of sufficient clinical practice in their specialty ^[8]. In general, emotional reactions can have a negative impact on the nature of interaction with the patient when providing medical care ^[4]. Strengthening and deepening of asthenic emotions against the background of experiencing distress reduces the subjective level of stress resistance in the workplace in solving professional tasks ^{[1; 6]}.

Orthopedic traumatologists have to work in increasingly tightly regulated conditions, taking into account the time deadline ^[9]. New protocols of surgical treatment, the inability to adjust the work schedule, floating meals and rest time, bureaucratic requirements leave an imprint on the emotional state of specialists. Continuous operation contributes to changing the speed of manipulations when performing high-tech operations. Modern medical knowledge is being actively developed and updated, and surgeons of all profiles must constantly support them and develop themselves. These changes often occur so quickly that by the time specialists acclimatize to one innovation, objective reality imposes other requirements. Unfortunately, orthopedic traumatologists are increasingly disappointed in their profession, which leads to professional mistakes and unethical behavior in the doctor?patient communication system.

In addition, orthopedic traumatologists are morally unprepared to work in modern conditions, when new skills are acquired and familiar, but not relevant, methods of work are not used. At the same time, new functional roles are being formed that are not directly related to surgical treatment in inpatient settings. High-tech medical care in surgery has reoriented orthopedic traumatologists to a population-based model of medical care. 

Orthopedic traumatologists are subject to stress in situations that arise outside the field of interaction with the patient. They must perform administrative duties, in addition to their main activities. Performing unusual tasks provokes a stress reaction, and the constantly changing working environment predisposes to a high degree of strain on the body's resources. Often specialists try to cope with the loads on their own, resorting to maladaptive coping strategies through emotional detachment, self-isolation and denial. Ineffective coping behavior has a negative impact on the mental state and provokes pathological reactions to the chronic effects of professional stress factors.

Orthopedic traumatologists demonstrate lower psychoemotional well-being compared to other professional groups ^{[10; 11]}. They tend to have an increased level of anxiety due to intense workload, high competitiveness, chronic lack of sleep, administrative pressure ^[3]. The problem of studying professional stress factors related to the psycho-emotional well-being of orthopedic traumatologists is important for the preservation of mental health and the effectiveness of medical care.

 OBJECTS AND METHODS OF RESEARCH

The theoretical and methodological basis of the study is the personality-oriented approach of B.D. Karvasarsky, as well as the conceptual model of psychological support for the professional development of the doctor B.A. Yasko ^{[2; 6]}. The study involved 75 male patients, employees of the Department of Traumatology and Orthopedics on the basis of the FSBI CCB of the Russian Academy of Sciences and GUZ GKB No. 1 named after N.I. Pirogov of the Moscow Health Committee. The assessment of the functional state, the level of anxiety and the features of coping behavior of the subjects were carried out using the approved psychodiagnostic tools and the statistical data analysis package SPPS 28.0.1.0. Comparative analysis of individual differences in the functional state and features of the emotional sphere of the personality of the subjects was carried out using the anxiety scale of C.D. Spielberger in the adaptation of Y.L. Khanin, the coping test of R. Lazarus in the adaptation of L.I. Wasserman, as well as the questionnaire "Well–being – activity - mood" by V.A. Doskin et al. ^[5]. In order to assess the level of emotional exhaustion associated with the professional activities of orthopedic traumatologists, the "burnout" test was used by K. Maslach and S. Jackson in the adaptation of N.E. Vodopyanova.

RESEARCH RESULTS

The average age of the subjects is 39.4+5.2 years. The majority of orthopedic traumatologists demonstrated low indicators of well-being ? 32 people (42.6%), activity ? 25 people (33.4%), mood – 18 people (24%), which is more than half of the sample. Less than half of the respondents have average indicators of mental state: the scale of well–being – 46 people (36.8%), the scale of activity - 53 people (42.4%), the scale of mood – 49 people (39.2%). Using visually presented analog histograms, the following values were obtained for low?level indicators of the diagnosed scales: well?being ? 2.14 ± 0.58 points (60.2%), activity - 2.02 ± 0.6 points (52.8%), mood - 1.6 ± 0.58 points (48.4%).

Individual-level values of subjective anxiety of traumatologists-orthopedists are in the zone of potential risk. High reactive anxiety prevails in 34 specialists (45.7%), and the average is observed in 21 doctors (28%). The optimal level of stress tolerance was recorded only in 20 subjects in the sample, which was 26.6% of the total sample.

The analysis of the results of the test of R. Lazarus' coping strategies showed that the studied group has a significant superiority of the average level indicators on the main scales. In the "Confrontation" scale ? 32 subjects with an average level (42.6%), in "Self–control" ? 15 people (20%), in "Distancing" - 28 people (37.3%). The average range of indicators of most coping strategies indicates a borderline state in the self-assessment of the own stress response of orthopedic traumatologists. This may be due to a pronounced focus on finding an adaptive solution in the event of an emergency problem situation, with limited resource potential.

A high degree of emotional exhaustion was detected in 15% of the subjects. The average subscale values were: 21.8+10.2 points in the assessment of affective lability, 11.6+7.3 points in terms of the severity of negativism, 31.2+11 points regarding the reduction of professional skills, respectively. The obtained results indicate the predisposition of the subjects to insomnia, irritability and sharpness in communication when interacting with colleagues and patients. In addition, the experience of dissatisfaction with professional activity, responsibility for the life and health of patients, low motivation and general fatigue provoke negative reactions at the psychosomatic level of the subject's organization.

Correlation analysis revealed the presence of significant links between reactive anxiety and well-being (r _emf=-0.64 at p?0.01), between activity and self-control (r _emf=0.59 at p?0.01), as well as between the level of personal anxiety and professional reduction (r _emf=0.49 at p?0.01). High reactive anxiety can be considered as an indicator of predisposition to emotional exhaustion when choosing maladaptive coping strategies. In general, there was a direct interaction of the main subscale values of mental health of traumatologists-orthopedists with a pronounced tendency to asthenia, emotional instability, rigidity, low activity and reduced mood with the risk of developing chronic fatigue syndrome. Based on the factor analysis using the Varimax-rotation method, two main factors were identified in assessing the mental health of orthopedic surgeons, which explain 54% and 33% of the total variance. The first factor "Risk of neuroticism" included such indicators as low well-being and activity (-0.637 and -0.642, respectively), high subjective anxiety (0.736) and emotional exhaustion (0.723). The second factor "Occupational stress" includes a tendency to use confrontation (0.536), flight (0.519) and distancing in behavior (0.503) with pronounced professional reduction (0.628). The neuropsychic load of professional activity triggers a characteristic individual-typological symptom complex of personality neuroticism with a high sensitivity to external influences, which can negatively affect the effectiveness of medical care.

conclusion

The present study reveals the features of the subjective perception of professional stress factors of orthopedic traumatologists in modern conditions. The results obtained confirm that the level of occupational stress has increased dramatically recently. The state of emotional exhaustion among orthopedic traumatologists is most clearly manifested in situations of neuropsychiatric stress directly related to the threat to the life and health of the patient. The considered aspects of psychological well-being demonstrate the existence of a connection between the state of mental health and the choice of adaptive strategies of coping behavior in solving professional tasks in surgical treatment. In conditions of multitasking professional activity, orthopedic traumatologists are potentially prone to mental health deterioration. The level of stress resistance is sharply reduced in people with low functional status due to high workloads, while they are distinguished by pronounced reactive anxiety, negativism and low empathy against the background of reduction of professional achievements. The results obtained indicate that orthopedic traumatologists are at risk of emotional exhaustion and need specialized corrective measures.