Introduction

According to the World Health Organization (WHO) ¹, healthcare institutions around the world employ more than 59 million workers who are exposed to a complex array of health and safety hazards every day, including but not limited to psychosocial risks, which are defined as: Interactions between the work environment, its content, organizational conditions, and capacities, needs, culture and external personal considerations of the job that the worker may present, based on their perceptions and experiences, showing influence on their health, performance and job satisfaction ². Currently, its impact on mental and physical health of the workers has now been described ³.

There are many researches focused on the measurement of occupational psychosocial risks in the health area. Nevertheless, the vast majority focus on intra-hospital environments, and tend to predominate in critical units and emergency care ^4-9, whose roles greatly differ from the daily activities carried out by Primary Health Care (PHC) workers, where professionals carry out tasks to prevent disease, promote health, follow-up, and extensive treatment to the population, especially those who have pathologies, mostly chronic, in their lives, this in the context of care implemented in the community and at people's homes, compared to brief stays in hospitals and acute illnesses that receive hospital services. Against this reality, it is possible to expect that occupational psychosocial risks differ between the different attention levels ¹⁰.

The quality of life (QoL) is a concept with various definitions. The WHO describes that it is a perception, related to the position in life of an individual considering the culture and values in which they live and with respect to their expectations, goals, concerns and rules ¹¹. This construct can vary depending the conditions faced by a human being. During the year 2019 worldwide, a new type of virus from the coronavirus family, identified as SARS-COV-2, appeared in Wuhan, China, and continued to spread during the year 2020, with figures that rose exponentially, until that on March 11, 2020, the WHO declared COVID-19 a global pandemic ¹². In Chile, to respond to the pandemic, a ministerial protocol called Testing, Traceability and Isolation (TTI) was implemented, which is developed by the PCH with the purpose of reducing the transmission of COVID-19, through interventions for the timely detection of positive cases, locate close contacts and transfer to health residences if necessary ¹³. The role performed by health team workers at this level of care during the pandemic probably led to these activities impacting the QoL of these workers and most likely with a different perception of psychosocial risks.

Nursing as a science of care must be aware of the impact of these risks on workers and their QoL, since as care managers they play a preponderant role in the health of the population, especially in the current hostile context due to the COVID-19 pandemic.

Therefore, they ask this question: what has been published regarding the psychosocial risks in PCH health workers and how do they impact their QoL previously and subsequently to COVID-19? For this reason, the proposed objective was to analyze in the latest advances available, the presence of psychosocial risks and how it impacts the quality of life of health workers in primary health care, in the previously and subsequently context of COVID-19.

Methodology

An integrative review that provides guidance on how to summarize knowledge on a specific topic, certain criteria are established in a transparent manner that ensure the quality of the results ¹⁴, based on the Crossetti methodology ¹⁵, which is comprised by five stages: 1. Problem formulation, 2. Data collection or definitions regarding literature search, 3. Data evaluation, 4. Data analysis, and finally, 5. Presentation and interpretation of results. In the first stage, a guiding question was formulated: What has been published regarding the psychosocial risks in PCH health workers and how do they impact their QoL in the previous and subsequent context of COVID-19? In the second stage, the search was organized in Spanish, English and Portuguese, a total of 6 searches were carried out in each database: (Health personnel AND PCH AND QoL AND Coronavirus infections), (Health personnel AND PCH AND QoL AND Occupational Health), (Health Personnel AND PCH AND QoL AND Occupational Risks), (Health Personnel AND PCH AND QoL AND Occupational Diseases), (Health Personnel AND PCH AND QoL AND Risk Factors), (Health personnel AND PCH AND QoL AND Psychosocial Impact). The searches were on databases of Web of Science (WOS), United States National Library of Medicine (PUBMED), Scientific Electronic Library Online (SCIELO) and Virtual Health Library (VHL). The inclusion criteria were: articles in Spanish, English and Portuguese, articles published in the period from January 2015 to December 2020, and articles related to PCH and psychosocial risks. The exclusion criteria were: Articles that did not have free access; that did not respond to the problem analyzed and duplicate articles (Table 1).

Initially, 201 articles were identified after applying descriptors, search strategies and filters. Upon application of phase 2 criteria, only 19 articles met said criteria. After applying phase 3 exclusion criteria a sample of 8 selected articles remained. These articles had to meet the quality criteria: Consistency between objectives and methodology used, justification of quantity and type of the sample, consistency between results or conclusions with stated objectives. Having the final sample defined, the evaluation and analysis stage is fulfilled, corresponding to stage 3 and 4 of the review, (Figure 1). Finally, in stage 5, the most relevant results were presented, taking into account the name of the article, authors, country, year, objective and main results.

Source: Own development

Figure 1 State of the art review flowchart, 2021. 

Results

Of the articles selected ^16-23, 38% were from Brazil ^19,20,22, 25% from Spain ^17,18 and 13% from China ²¹, USA ²³ and Oman ¹⁶⁾ respectively. Regarding the temporality of the studies, 50% corresponded to year 2020 ^16-19, 25% to the year 2019 ^20,19, 13% to year 2018 ²² and 2016 ²³ respectively, showing a large majority of articles after the pandemic period. Nevertheless, only one study ¹⁶ analyzed the variables in the context of COVID-19 pandemic.

The main risk described was work stress, followed by anxiety and compassion fatigue. Regarding the most affected health personnel, the nursing group was identified in 88% of the selected articles ^16-21,23, followed by the medical team and related professions (nursing technicians, pharmaceutical chemists, dentists, nutritionists, among others). Regarding QoL, a negative relationship was found in the presence of psychosocial risks in general, as well as intimately related factors such as burnout syndrome and repetitive contact with situations of suffering. The main results of the selected studies are presented below (Table 3).

Discussion

Based on the objective of analyzing latest advances available, the presence of psychosocial risks and how it impacts the QoL of health workers in PHC, before and after COVID-19. It has been shown that the main risk identified was work stress, which had a negative relationship with QoL. However, a small number of articles that accounted for the problem studied became evident, concurring with what was exposed in a recent scoping review ²⁴, carried out in the PubMed and Google Scholar databases. Most of the literature found was from Latin America, represented only by Brazil ^19,20,22, which illustrates the need to study the psychosocial risks in PHC by other countries in the region, even more due to the current hostile context established by the COVID-19 pandemic, where its impact on mental health included depression, anxiety, anguish, agitation, tiredness and insomnia symptoms in health care workers ^25-27.

It is proper to mention that in half of the selected studies ^17,20,22,23, they stated the presence of burnout syndrome, which, although it is not a psychosocial risk, has nevertheless been described by the scientific community that arises as a result of chronic exposure to psychosocial risk factors during work activity ²⁸. A preponderant element of this review is the identification of a high incidence of work stress in PHC, consistent with other studies, where a more adverse psychosocial environment has even been described than at hospital level ²⁹.

Regarding QoL, a negative relationship with psychosocial risks was identified in health workers, especially in those work environments that turned out to be demanding and very tense, consistent with what was exposed by Barbosa-Teles, et al ³⁰, where he described a significant association between effort-reward imbalance and poor QoL, both for general QoL and for the physical, social, and environmental domains of the WHO whoqol-bref questionnaire.

In the face of a complex and hostile scenario, where the negative impact of psychosocial risks on the QoL of workers has become evident, the need for its approach has arisen; a “psychosocial risk intervention model” has recently been published ³¹, whose core axis is comprised by social support in the company and quality of the leadership, because "interpersonal relationships with colleagues and customers or users has become especially relevant today for our identity as people and our physical and mental balance" ³², in this context, as a nursing group, is urgent to cultivate healthy work environments, favoring labor relationships and correct leadership as care managers.

Conclusions

Once the articles were analyzed, the expected objective was achieved. Thus, concluding that psychosocial risks have a negative impact on the QoL of PCH workers. However, there are few studies that demonstrate the problem that was raised in this review, situation that is emphasized in the local reality since in Chile no studies that deal with the subject studied were found, an unfortunate scenario; however, a window of opportunity for nursing as a discipline, profession and science of care, where a great possibility of study opens up in a poorly addressed problem, even more considering that the context of interest (COVID-19 pandemic) is of recent manifestation.

Conflicts of interests

The authors stated that they do not have any type of conflicts of interests.

Financing

No funding of any kind was used for the preparation of this document.