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Muñoz-Torres TJ, Casique-Casique L. Estrés laboral y su efecto biopsicosocial en el cuidado de enfermería. Rev Enferm Inst Mex Seguro Soc. 2016;24(2):141-4.

Job stress and its biopsychosocial effect on nursing care

Teresita de Jesús Muñoz-Torres,¹ Leticia Casique-Casique²

¹Programa de Licenciatura en Enfermería, Unidad Académica Multidisciplinaria Zona Media, Universidad Autónoma de San Luis Potosí, Rioverde, San Luis Potosí; ²Facultad de Enfermería y Obstetricia, Campus Celaya-Salvatierra, Universidad de Guanajuato, Celaya, Guanajuato. México

Correspondence: Teresita de Jesús Muñoz-Torres

Email: teresita._.torres@hotmail.com

Received: April 10^th 2015

Judged: November 25^th 2015

Accepted: January 20^th 2016

Abstract

The occupational stress is a phenomenon of global nature by high prevalence rates; situation which, today, is considered as the disease of the 21st century. At the present, Mexico ranks the first worldwide surpassing China and United States. The biopsychosocial effect is caused by the physiological reactions that activate the pituitary-adrenal axis and the Vegetative Nervous System, whereby a hormone release occurs what the excited, regulates or inhibits the activity of the organs. Therefore, nurses should consider the implementation of non-pharmacological interventions focused on the physiological, cognitive and behavioral responses as well as organizational and individual level, as these interventions not only reflect the economic, human and political feasibility but have demonstrated a decreased of occupational stress a month after the intervention. To accomplish this, nursing should consider as part of their job training the management and control of instructional techniques and alternative treatment to potentiate the actions of care, but above all, the results in health.

Keywords: Professional burnout; Nursing; Nursing care

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Introduction

Occupational stress is a global phenomenon based on its high prevalence, which makes it a public health problem for the impact it has on economic, social, political, and health aspects. Because of this situation, occupational stress is today considered the disease of the 21^st century.

However, its origins, according to Montero Granthon’s contributions in 2010, date back to 1930, when Dr. Hans Selye observed that patients exhibited common symptoms regardless of the condition: tiredness, loss of appetite, fatigue, low weight, among others, a phenomenon Selye called the "syndrome of being sick".¹ From then until now, the well-accepted definition is that described by the National Institute of Occupational Safety and Health, which explains occupational stress as the set of harmful and emotional responses produced by the imbalance between occupational demands and the capabilities, resources, or needs of the worker, which can lead to poor health or an injury.²

Reflecting on current health issues allows nursing to recognize the importance of their participation and their impact on individual, family, social, and professional orders, while showing the particularities of their actions.

Epidemiology

In 2007 Marulanda Ruiz said that the World Health Organization (WHO), from the records made by European countries, established about 300 to 500 cases of occupational stress per 100,000 workers. It estimated that 40% of workers presented a chronic illness, 10% disability, and about 1% died. In turn, he mentioned that the International Labour Organization (ILO) indicated a prevalence of 8,000 cases per 100,000 workers.³

In Latin America, the percentages of occupational stress also grow each year. Argentina is one of the countries most affected, because a study of 100 employees determined that 65% of workers in the federal capital were suffering from stress and that this condition was manifested by 18% within the country.⁴

Arreola said that in Mexico, as in Argentina, high levels of stress are presented as data reported by the Asociación Mexicana de Estrés, Trauma y Desastres for 2008 showed that 54% of the population suffered from stress, i.e. 52 million people, so the organization has found that occupational stress is a public health problem for which it is necessary to find solutions.⁵

Lopez Moreno in 2012 revealed, in turn, that a study of 6,000 Mexican companies in 2011 by Grant Thornton International Business Report established that Mexico ranked seventh in the table of occupational stress.⁶ However, by 2013, Mexico went on to take first place in the world, surpassing China and the United States;⁷ this means that seven out of every 10 Mexicans suffer from this modern disease.⁸

Bio-psychosocial effects

In 2012 Lopez Moreno, in the same study mentioned, said that stress was not considered part of occupational diseases in the Ley Federal del Trabajo, so the increase of this disease and its consideration as an occupational disease in 2010 caused the International Labour Organization (ILO) and Mexico to determine that this health problem should be addressed by public health institutions through family medical units.⁶  

This situation arose because occupational stress, being conceptualized as an imbalance between the demands and capacities to cope, generates a reaction that manifests itself through a lower level of autonomy, work overload, and greater emotional demands; therefore, occupational stress is considered a disease that adversely affects the physical, psychological, and social health of workers.^9,10

Therefore, it is understandable that occupational stress causes physiological reactions that activate the pituitary-adrenal axis and autonomic nervous system, which causes a hormone release that excites, regulates, or inhibits organ activity. In connection with the above, the pituitary-adrenal axis is responsible for activating the physical and psychological reactions by secretion of adrenocorticotropin hormone (ACTH), which stimulates the adrenal glands to produce corticosteroids (glucocorticoids and androgens) that produce organ excitement in the bloodstream that prepares the body for coping by increasing heart rate, contracting the spleen to release erythrocytes, peripheral vasoconstriction, cerebral, muscular and cardiac vasodilation, pupil dilation, and increased blood coagulation and lymphocyte. For its part, the autonomic nervous system secretes catecholamines (adrenaline and noradrenaline) that are responsible for putting the body in a state of alert and preparing for fight or flight; however, these responses in the body depend on the perception that the individual may have about the demands of work.¹¹

The person suffering from occupational stress presents both physiological and psychological demonstrations, as well as social and organizational. In the physiological field it causes muscle pain, dry mouth, hyperventilation, tachypnea, vomiting, diarrhea, colitis, polyuria, fatigue, dermatitis, and hypertension. In the psychological realm it causes states of anxiety, loss of sense of humor, nightmares, insomnia, and difficulty in concentration, learning, and memory.11 The consequences that occupational stress generates at the social level are associated with a behavior change that tends to aggression, irritability, suspicion, and isolation, which deteriorate interpersonal relationships that are relevant when establishing support networks. Meanwhile, at the organizational level the main effects include absenteeism and loss of labor.¹²

Nursing care

Statistical data and the biopsychosocial impact seen show an unstable outlook on the health of countries where greater occupational stress occurs, as it causes changes that affect the physiological, psychological, and social functioning of the person who has it; when not handled with scientific knowledge, occupational stress can become a chronic degenerative disease.

In this situation, it is essential that nursing professionals perform interventions that promote a healthy life in people with occupational stress and prevent it in vulnerable people, to generate an impact in controlling this phenomenon called stress.

Although research in recent years has been aimed at identifying factors and frequency, the few articles focusing on the management and control of occupational stress mention that the implementation of nonpharmacological or alternative techniques is of great importance in the care of people susceptible to developing stress in the work environment; for example, Novaes et al. determined from the 46 articles, three dissertations, and three books found and analyzed, that there are three levels of intervention: in the first place, organizational strategies; secondly, those in the work environment, and finally, individual strategies, represented by those that regulate human response and emotions to cope with stressful situations. Therefore, the authors conclude that it is a problem in which individual-process and work-organization interact.¹³

Meanwhile, Albert Marine et al. describe that interventions for the prevention of occupational stress can be grouped, on the one hand, into interventions targeted at the person using cognitive-behavioral, relaxation, music therapy, therapeutic and multicomponent massage; on the other hand, there are also interventions targeting the job, such as changing attitudes, peer support, and participation in problem solving and decision-making.¹⁴

Consequently, part of the non-pharmacological treatment that nurses can implement for the prevention, management, and control of occupational stress includes techniques grouped into three types of response:

• Cognitive: based on problem-solving, thought detection, mental relaxation, and cognitive restructuring by Ellis and Beck’s method.
• Physiological: includes Jacobson’s progressive relaxation training or under the guidelines of the technique adapted by Wolpe.
• Behavioral or motor: refers to techniques of emotional self-control through breathing.^15-20

In recent years, training in stress inoculation has taken on great importance because it combines didactic teaching, cognitive restructuring, problem solving, relaxation, and behavioral and reinforcement techniques to establish and develop skills that enable the person to cope not only short-term but with future difficulties.²¹

These non-pharmacological alternatives mentioned above reflect not only economic, human, and political feasibility, but have shown a decrease in occupational stress one month after intervention.^14,22

It is important to note that work represents not only a human right but also the intellectual, emotional, and physical development that contributes in fulfilling the social and personal side of the individual; however, it has conditions that must be evaluated and monitored to reduce the negative manifestations at the physical, emotional, and social level, thereby achieving the empowerment of positive events, such as creativity, initiative, and teamwork.

Conclusion

With new epidemiological changes, which are a direct effect of the globalized world, it becomes a priority for nursing as a care discipline, which is responsible for prevention and health promotion, to face new challenges to effectively and opportunely meet the needs of the population, which are related to a higher level of self-care. Therefore, nursing should consider the management and mastery of educational techniques and alternative treatment as part of their vocational training to enhance actions, but above all, results in health.

References

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