Meaningful Life Orientations in the Prevention of Mental Health of Medical Workers, in Connection with the Covid-19 Pandemic.

Papko Elena Vladimirovna ORCID: 0000-0003-3069-2805 Postgraduate student of the Academy of Psychology and Pedagogy, Southern Federal University Southern Federal University 105/42, Bolshaya Sadovaya st., Rostov-on-Don, 344006, Russian Federation papko@sfedu.ru

Introduction

The spread of a new coronavirus infection, as well as infectious diseases of a new etiology, draws increased attention of society, the occurrence of a risk of disease among the population, with high mortality and a clear decrease in the quality of life, subsequently transferred disease is an urgent health problem. The emergence of the COVID-19 pandemic has put a high strain on human resources, namely medical workers who are in direct contact with patients, providing care to patients with a poorly studied and highly contagious disease in the absence of treatment.

A study of the mental health of Russian medical workers during the spread of SARS-CoV-2 was conducted by M.Y. Sorokin, E.D. Kasyanov and others. During the study on the PSM – 25 scale, 81.2+31.0 doctors experience the greatest stress, compared with the average (70.7+30.0) and junior medical staff (62.8+26.1). A higher level of stress was recorded among medical personnel in direct contact with patients: 97.5+31.0 among medical workers confident of having contact with COVID-19 patients and 67.9+29.0 not in contact ^[17]. It should be noted that the most unfavorable prognosis for responding to stress was revealed in a group of young professionals with less medical experience, mainly doctors, as well as those who do not have social support in family relationships. Medical workers in the conditions of a pandemic demonstrate psychological problems common to health workers, manifestations of distress that have specific dynamics. With a decrease in psychological stress as a compensatory mechanism, an indicator of depreciation of patients with respiratory diseases arises ^[3,9].

According to a study by M.B. Karpukhina, T.V. Iconikova and others, adaptation disorder in medical personnel is expressed to varying degrees in most employees of the polyclinic level. Maladaptation syndrome includes psychological, anxiety-depressive and vegetative manifestations, while about 40% of medical workers experience subclinical manifestations of anxiety, depression – 10% ^[8]. O.V. Konovalova and V.A. Militsina separately highlight the features of coping strategies inherent in medical workers, for example, 30% of medical workers use coping, focused on avoidance and social distraction^[10].

In the work of E.L. Nikolaev, the psychological context of professional stress of medical workers is considered, namely, the prevalence of emotional burnout. Medical workers tend to note symptoms of the exhaustion phase, among doctors – 74+20.28, among nurses – 41.80+18.01 according to a questionnaire to identify the degree of "Emotional burnout" ^[14]. I.Y. Khudova and G.E. Ulumbekova in their work on burnout, the features associated with COVID-19 include: uncertainty in their own competence, concern for family and children, physical stress from working in a PPE ^[20]. In the work of E.I. Sukhanova, it is noted that professional burnout is also associated with the fear of being in the role of a patient, which causes neglect of one's own health ^[18]. V.V. Grebneva and A.V. Grebnev in their work consider the influence of physicality in the formation and prevention of professional maladaptation of doctors, namely, they make connections with the ratio of verbal designation of feelings and formation symptoms of professional maladaptation, so it is typical for medical workers to use verbal metaphors of physicality when labeling emotional problems ^[6].

T.I. Rastorgueva, O.B. Karpova and T.N. Proklova in the psychological support of the activities of medical workers note that the main organizational and psychological technologies are concentrated in conducting psychological diagnostics, organizing a "healthy working environment", reducing the outflow of personnel ^[16].   Satisfaction with work among medical workers is associated with individual psychological attitudes, namely, attitude to life, as well as the manifestation of positive thinking ^[19].

It seems important to us to consider the value-semantic orientations of medical workers as determining the direction of the goals and meanings of interaction, conducting daily activities, as well as determining personal properties. With the psychological support of medical personnel, there is a need for managerial decisions and the formation of working groups of doctors. The work of medical personnel in the brigade formation takes into account the interaction of nursing staff and doctors as the main groups of contact with patients. 

Organization and methods of research

At this stage, 84 respondents (n=84), male and female employees of medical organizations with more than 3 years of work experience aged 22 to 52 years of the Southern Federal District of Rostov-on-Don participated in the empirical study. According to the type of professional activity, the examined employees were divided into subgroups: doctors – n = 36 (43%); average medical staff (paramedic, nurse) n = 48 (57%). All study participants are directly involved in providing medical care to patients with coronavirus infection.  

As a study of the value-semantic orientations of medical personnel, the test "Life-meaning orientations" developed by D.A. Leontiev was used, which allows us to evaluate the overall indicator of the meaningfulness of life, as well as life-meaning orientations and the locus of control ^[12]. The research procedure involved filling out questionnaires in the assembly hall in the presence of a psychologist. When processing empirical data, methods of descriptive statistics (mean values, standard deviation) were used to generalize and systematize the results. In statistical processing of quantitative data with a normal distribution, the parametric Student t-test was used. Statistical processing of the results of the study was carried out using the program "Statistica 6.1".

Based on the study of factors affecting the psychological state of medical workers, a model of psychological prevention of the occurrence of stressful conditions that violate adaptation was developed. This model includes individual conversations and group training seminars.  The leading factor of the model is the actualization of life orientations as a component of the support of personality.

Psychological education allows medical personnel to get acquainted with the methods of self-regulation in practice, to gain knowledge about psychological health and methods of its support. Actualization of psychological knowledge makes it possible to realize the information already received and integrate it into everyday life, within the framework of psychoprophylactic measures, there was also a task to integrate psychohygiene techniques into the daily working environment of medical personnel. This task was solved by organizing a break for conscious work with one's condition, the presence of memos and templates for use at the moment of routine activities, for example, when washing hands and disinfection.

Research results and their discussion

Let's start considering the results with an analysis of group differences and a description of the selected groups among the respondents surveyed. Using the analysis, the array of medical workers was divided into 2 groups:

1st – doctors n = 36;

2nd - average medical staff (paramedic, nurse) n = 48.

Table 1

Indicators of demographic and psychological methods (M±SD) score

Generalized data on the method of "Meaning-life orientations" show lower results on the scale of "Life process". At the same time, the importance of achieving life goals and attention to the process of life have similar meanings, which indicates the commitment of medical personnel to focus on the future, building plans and projects, perceiving the process of life as interesting and rich. Doctors pay significantly more attention to the development and construction of a picture of the future compared to the average medical staff, thus they are more purposeful for the future, development and achievements that will occur over time.  The medical workers of the 1st group had statistically more pronounced results, allowing them to note the orientation towards goals in life, while the workers of the 2nd group are distinguished by the orientation towards the result of life, a sense of how productive and meaningful the part of it was lived.

Considering psychological methods of stress prevention in modern conditions, N.Y. Galkina notes that as a result of experiencing stress, a person has certain problems with cognitive and physiological processes, difficulties in communication and professional activity. Natural methods of preventing various types of stress can be actions that a modern person has been engaged in since childhood – listening to his favorite music, reading fiction, walking with pets ^[4].

Determination of the targets of psychological correction of the state of maladaptation of medical workers providing inpatient care to patients with coronavirus infection, in the study of A.A. Rayevsky, S.P. Ivashev, A.P. Mironova, were allocated to "Astheno-neurotic complex", "Conversion manifestations", "Emotional and moral disorientation". Medical workers who are prone to the manifestation of these maladaptation complexes may be recommended methods of prolonged psychological assistance aimed at developing an individual response style, working with non-constructive coping strategies ^[15]. In the results of testing the program of prevention and correction of professional burnout of doctors, A.N. Blinkov and N.S. Shevchenko note that the resource approach using elements of neuro-linguistic programming technologies shows a statistically significant relationship in reducing the level of professional burnout ^[2].

In the work of L.S. Kulzhabayeva, R.O. Shaikhova, psychological means of stress prevention in professional activity are focused on eliminating potential sources of stress – not only in the external, but also in the inner world of a person. Of particular importance here is the training of mental self-regulation skills, which, when applied comprehensively, can increase the level of efficiency and restore the resources expended ^[11].

In the article by A.D. Golmenko, V.A. Khaptanova, E.L. Vygovsky, prevention of violations of the socio-psychological adaptation of medical workers is considered as work aimed at symptoms that occur at various stages of emotional burnout. With satisfactory and stable adaptation, methods of psychoeducational and psychocorrective work can be applied, and with maladaptation, medical measures can be used to a greater extent. Medical personnel who are in a satisfactory and stable adaptation need counseling based on the results of psychodiagnostics, individual psychological counseling on personal request, group psychocorrection work. Medical personnel at the stage of maladaptation require an analysis of morbidity based on the results of medical examination, additional preventive examinations ^[5].

Prevention of emotional burnout syndrome in medical workers, according to E.V. Elfimova, M.A. Elfimov and A.S. Berezkin, consists in meeting needs, creating motivation for work, compliance with recommendations for work and rest ^[7]. The experience of organizing psychological training of medical personnel to work with patients with COVID-19, according to the results of the study by I.N. Abrosimov et al., includes a set of measures aimed at improving the level of communicative competencies, developing skills of emotional self-regulation in stressful situations, preventing emotional burnout, increasing stress tolerance in working conditions in the red zone^[1].

In the study of A.O. Nadirbekova, V.A. Krementsov and others, the prevention of professional burnout in medical workers includes a model from the testing procedure, the study of creative products of activity, individual conversations and group seminars.  This method allowed medical workers to master the established standards of work, the development of adaptive individual psychological properties and personality qualities, which contributed to overcoming and correcting stress ^[13].

The model of psychological prevention is based on the actualization of life-meaning orientations that allow you to maintain balance and search for personal resources. Personal resources are presented as a system of human abilities to eliminate contradictions with the living environment, to overcome life difficulties based on the transformation of the value-semantic dimension of personality. Life-meaning orientations can be considered in two aspects. Firstly, these are the areas of life in which this particular person is most likely to find the meaning of his life. Secondly, it is the connection of the meaning of life with the future, present and past of a person. Life-meaning orientations reflect the extent to which there is a significant goal in a person's life, to what extent he considers the process of his life rich and interesting, and to what extent he is satisfied with the results he has already achieved. The focus of the medical worker's attention on life-meaning orientations allows for psychoprophylactic work. The prevention program included methods of interactive teaching the basics of self-regulation, a lecture (on basic psychological concepts and human properties), methods of self-regulation, a method of introspection, elements of group psychotherapy.

Conclusions

Today, medical professionals face situations that generate more stress than daily situations. The results of the study of the features of stress resistance of medical workers, the detail of which is associated with a risk to life during the period of restrictive measures associated with the spread of SARS-CoV-2, necessitate the development of an algorithm for psychoprophylactic measures, including psychological support, aimed at actualizing life orientations. In order to prevent the formation of states of mental traumatization and professional maladaptation in medical workers. The importance of achieving life goals and attention to the life process is important for medical personnel, which indicates a commitment to future orientation, building plans and projects, and perceiving the life process as interesting and eventful. Doctors pay significantly more attention to the development and construction of a picture of the future in comparison with the average medical staff, thus they are more purposeful for the future, development and achievements that will occur over time.  The doctors had statistically more pronounced results, allowing them to note the orientation towards goals in life, while the average medical staff is distinguished by the orientation towards the result of life, a sense of how productive and meaningful the part of it was lived.