Anesthesiologists-Resuscitators’ Mental States In Extreme Activity Conditions

Research results

According to the survey results, 79.6 % of anesthesiologists-resuscitators considered their work to be stressful factors full that they have to face almost daily, 28.6% – faced a threat to life in the performing professional duties course, 40.8 % – with threats, insults and intimidation, 14.3 % – received bruises and minor injuries, 20.4 % - often experienced a anxiety state in the activities course, and 26.5 % – a decrease in performance. 53.3 % of the subjects had a high organizational stress level according to the McLin’s scale, i. e. they had a low tolerance to the stress factors action of stress dotors arising at work and a high predisposition to professional stress.

The average integrative PBS index according to the Vinokur's method in anesthesiologists-resuscitators corresponded to high values (49.4 ± 9.4). In 67.3 %, formed PBS was detected, characterized by severe physical, mental and emotional exhaustion, a decrease in self-esteem of the work quality and its significance, and the health problems appearance.

In 46.9 %, using the MPQ-A method, a reduced adaptive abilities level was detected, while only 4.1 % – had good adaptive abilities. 14.2 % of the subjects were characterized by asthenic reactions and adaptive abilities high situational anxiety states, hypochondriacal fixation, increased fatigue and weakness. In 24.4 %, reactions and conditions indicating the impulsive reactions presence, aggressiveness and, in general, expressed neuro-psychic tension were detected.

According to the Hanin-Spielberger’s (1983) method, 30.0 % of anesthesiologists-resuscitators had a high situational anxiety level, characterized by increased nervousness and anxiety.

The dominance of trophotropic tendencies according to the Lusher’s method was revealed in 55.9 % of the subjects.

The total deviation from the autogenic norm was 15.6 ± 6.2, which indicates good performance reserves, but with a tendency to accumulate fatigue, which is not so easy to get rid of and can only be overcome by significant willpower. In 14.7 % of anesthesiologists-resuscitators, the general emotional background was characterized by increased excitability, anxiety, uncertainty, and a high nervous breakdown probability. Increased fatigue, sharp mood swings, and powerlessness feelings were observed in 5.9 %.

According to the Kulikov’s (2003) method of determining the dominant state, 35.3 % of doctors were characterized by fatigue, concentration lack, lethargy, inertia, low efficiency, 29.4 % – a passive and pessimistic attitude to life, 17.6 % – a reduced mood, a gloom sense and frustration, 11.6 % – reduced emotional stability.

For a more detailed analysis, all subjects were divided into two groups, depending on the maladaptive states signs presence:

Group 1 (18 people, 36.7 %) – anesthesiologists-resuscitators who have maladaptive conditions signs (formed PBS level, asthenic presence and psychotic conditions, maladaptation signs).

Group 2 (31 people, 63.3 %) – anesthesiologists-resuscitators who have no maladaptation conditions signs.

According to the survey results, 11.1 % of the subjects in Group 1 and 32.2 % in Group 2 believed that they were more likely to be in a good mood. A greater Group 1 number (44.4 %) compared to Group 2 (16.1 %) (p ≤ 0.05) noted a decrease in their performance. Also, Group 1 anesthesiologists-resuscitators were more likely to have health complaints (63.2 %) compared to group 2 (29.0 %) (p ≤ 0.01).

Results analysis using the MPQ-A method showed that Group 1anesthesiologists-resuscitators had lower adaptive potential personal indicators (68.6 ± 13.1), compared with Group 2 (38.4 ± 13.8) (p ≤ 0.001), that is, Group 1 doctors are more difficult to cope with difficult situations and they are more likely to have neuropsychiatric breakdowns.

Compared to Group 2, the Group 1 subjects had lower behavioral regulation indicators (p ≤ 0.001), communication potential (p ≤ 0.001), and moral normativity (p ≤ 0.01) (Figure 1 ), indicating difficulties in self-regulation, difficulties in building contacts with colleagues and patients, increased conflict and reduced behavior normativity.

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Note : here and further in Figure 2 , the differences between Groups 1 and 2 are significant when: * – p ≤0 .05, ** – p ≤ 0.01, *** – p ≤ 0.001.

Group 1 doctors were characterized by greater social passivity, slower adaptation to changes in professional activity, a tendency to a reduced mood background, self-doubt, anxiety, volitional control weakening, impulsivity and conflict, in comparison with Group 2 (Figure 2 ). Group 2 anesthesiologists-resuscitators were more active, sociable, optimistic, resistant to physical and mental stress, able to make decisions independently without unnecessary doubts about its correctness. Group 1 doctors were characterized by greater social passivity, slower adaptation to changes in professional activity, a tendency to a reduced mood background, self-doubt, anxiety, weakening of volitional control, impulsivity and conflict, in comparison with Group 2 (Figure 2 ). Group 2 anesthesiologists-resuscitators were more active, sociable, optimistic, resistant to physical and mental stress, able to make decisions independently without unnecessary doubts about its correctness.

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The total deviation from the autogenic norm was significantly higher in Group 1 (19.4 ± 6.6) compared to Group 2 (12.9 ± 4.3) (p ≤ 0.01), which indicates that the Group 2 anesthesiologists-resuscitators had more additional performance reserves and resistance to stress.

The Group 1 subjects had higher situational indicators (49.7 ± 4.9) and personal anxiety (55.0 ± 6.0) compared to Group 2 (33.4 ± 9.3, 41.9 ± 8.2, respectively) (p ≤ 0.05), that is, Group 1 anesthesiologists-resuscitators were more prone to anxiety, tension and excessive experiences.

According to the Kulikov’s (2003) method (Table 1 ) the Group 1 doctors had a more pronounced passive attitude to the life situation, a low overall mood background, low activity, greater self-doubt, emotional tone instability.

Results discussion

According to their own opinion, the anesthesiologists-resuscitators activity was many stressful factors full. 1/3 faced extreme factors at work, related to the risk to life and health. More than half of the anesthesiologists-resuscitators had a low tolerance to organizational stress, a reduced adaptive abilities level, characterized by difficulties in adaptation, low neuropsychological stability and a high functional disorders probability. Almost 2 / 3 were found to have formed PBS. Our results indicate a higher PBS incidence among anesthesiologists-resuscitators than according to other researchers (Parfenov, 2012; Sanfilippo et al., 2018).

The need for rest, the desire to spend less energy was identified in more than half of the anesthesiologists-resuscitators; 1 / 3 were characterized by low performance, passive and pessimistic attitude to life. Increased fatigue, sharp mood swings, and a powerlessness sense were observed in 5.9 %. 36.7 % showed maladaptive states signs, the formed PBS level, the asthenic presence and psychotic states, and maladaptation signs. Anesthesiologists-resuscitators who have maladaptive conditions signs, more often noted a decrease in performance and complaints about their health status compared to those who did not have these signs.

Anesthesiologists-resuscitators with maladaptive states signs were characterized by difficulties in self-regulation, building contacts with colleagues and patients, increased conflict and reduced behavior normativity. They were characterized by greater social passivity, slower adaptation to changes in professional activity, a tendency to a reduced mood background, self-doubt, anxiety, and a volitional control weakening.

Doctors who had no maladaptive states signs had a satisfactory adaptive abilities level neuropsychiatric stability, adequate self-esteem, well-developed communication abilities, a high socialization level, and additional performance reserves and resistance to stress. They are more active, sociable, optimistic, resistant to physical and mental stress, more confident, able to make decisions independently, without unnecessary doubts about its correctness.

The results obtained should be taken into account when organizing preventive measures to reduce the developing maladaptive conditions likelihood in anesthesiologists-resuscitators. Preventive measures should be carried out in several directions at once: professional & organizational, social, individual psychological. Professional & organizational direction should be focused on reducing organizational stress, rationalizing the work and rest regime, providing, if necessary, additional paid vacations, necessary, modern and ergonomic workplace equipment, a room presence for psychological unloading. The social direction, first of all, includes measures aimed at diagnosing the social climate in the team, developing communication skills and the ability to resolve difficult situations without conflict. Individual psychological direction of prevention: individual and personal diagnostics; measures aimed at developing self-confidence and forming an adequate self-esteem; skills development to recognize and manage their emotions; training in self-regulation skills.