Practical Dermatology
Burnout Syndrome and Demotivation Among Health Care Personnel. Managing Stressful Situations: The Importance of Teamwork
Desmotivación del personal sanitario y síndrome de burnout. Control de las situaciones de tensión. La importancia del trabajo en equipo
J. García-Campayoa,b,c, M. Puebla-Guedeab,c, P. Herrera-Mercadala,b,c, E. Daudénd,
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a Servicio de Psiquiatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Unidad de Psicología Clínica, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
c Unidad de Psicología Clínica, «Red de Investigación en Actividades Preventivas y Promoción de la Salud» (REDIAPP), Barcelona, Spain
d Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
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Control de las situaciones de tensión. La importancia del trabajo en equipo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">People spend almost a third of their lives at work. The workplace is where many of our interpersonal relationships are developed and where our vital interests are channeled. Work is therefore one of the key activities of human beings, and stressful situations at work and work-related stress are among the most important consequences for people's physical and mental health.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Work-Related Stress</span><p id="par0010" class="elsevierStylePara elsevierViewall">Stress is defined as a relationship or transaction in terms of adaptation and interaction between a person and the setting or environment that can place a burden on individual well-being and lead to psychological disorders, unhealthy conducts, and, ultimately, disease.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a> Stress can be a consequence of multiple factors and circumstances. However, due to its importance in people's lives, the world of work is one of the main generators of stress.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> Therefore, stress must be understood as an interactive problem involving both the worker and the organization.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Work-related stress has important consequences both for people (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and for organizations. Many studies have demonstrated the relationships between stress and health.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3–5</span></a> In dermatology, for example, psychosocially induced stress can trigger or exacerbate numerous skin diseases, including rosacea, lichen planus, various types of eczema including seborrheic dermatitis, psoriasis, and many others.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6,7</span></a> Stress is one of the main risk factors for heart disease, stroke, chronic pain, etc. It plays a role in the appearance of burnout syndrome<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> and is linked to workplace harassment (or “mobbing”)<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a> and adaptive disorders.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a> It also affects quality of life in general.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Burnout Syndrome</span><p id="par0020" class="elsevierStylePara elsevierViewall">Burnout syndrome develops as a result of situations of chronic work-related stress. According to Maslach and Jackson,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> burnout syndrome affects workers’ emotional responses and includes symptoms such as emotional exhaustion, depersonalization, and low personal accomplishment. Emotional exhaustion, which refers to the progressive loss of the capacity to dedicate oneself to work, represents an individual dimension of burnout. Depersonalization pertains to the worker's interpersonal context and entails distancing oneself emotionally from the users of one's services by adopting impersonal, insensitive, or hardened behaviors. Low personal accomplishment occurs in professionally disgruntled, unmotivated, and unsatisfied workers as a result of a negative assessment of one's achievements and dissatisfaction with one's job.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This definition of burnout syndrome, initially developed to cover care and service professions, was reconceptualized to improve its validity and to make it applicable to all types of occupations. Burnout syndrome is now defined as “a prolonged response to chronic emotional and interpersonal stressors on the job, and is determined by the three dimensions of exhaustion, cynicism, and inefficacy.”<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> Exhaustion is defined as the feeling of not being able to give any more of oneself emotionally as a consequence of prolonged exposure to work-related demands. Cynicism refers to a lack of interest and a loss of meaning, as well as indifference and the distancing of oneself from one's job. Inefficacy is a perception of not performing tasks adequately and a feeling of incompetence in one's assigned post.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A new and more extensive definition of burnout proposes a classification of the syndrome in 3 clinical subtypes. The “frenetic” subtype is seen in highly involved, ambitious, overloaded people who work increasingly harder until they reach the point of exhaustion. The “under-challenged” subtype is seen in workers who face insufficient challenges and are indifferent, unsatisfied, bored, lack personal development in their jobs, and have to cope with unstimulating work conditions. The “worn-out” subtype—characterized by a feeling of not being able to control results, lack of recognition for one's efforts, and neglect of responsibilities—is seen in people who immediately give up when faced with stress or the absence of gratification.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The consensus view is that the following factors favor the development of burnout syndrome: personal characteristics (age, sex, personality), social characteristics (marital status, number of children), and job characteristics (work overload, relationships with team members, seniority, shift, type of activity).<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The development of burnout syndrome in a worker is a gradual process. The syndrome develops continuously, with fluctuations over time, such that milder and more acute phases may appear. Depending on the preventive measures or interventions carried out, the symptoms can either become more acute or stabilize and even subside.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> indicates, burnout syndrome has very negative consequences. Burnout can affect people's physical and/or mental health, giving rise to psychosomatic disorders such as cutaneous and mucosal alterations, cardiorespiratory abnormalities, headaches, etc., and psychopathological disorders such as anxiety, obsessive-compulsive behaviors, depression, and addictions. In organizations, burnout can cause a severe reduction in professional performance, a decline in the quality of care or services, high turnover, absenteeism, and even job abandonment. Professionals in the education and health fields are exposed to especially high risk of burnout syndrome. Dermatologists, like other specialists, are no exception. Renzi et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> studied burnout and job satisfaction in dermatologists and nurses working with dermatology patients as compared to physicians and nurses in other specialties at a hospital in Rome. The authors distributed a questionnaire to the respective groups. The results showed <span class="elsevierStyleItalic">a</span>) that burnout was similar in dermatologists and other specialists, and <span class="elsevierStyleItalic">b</span>) that nurses at the general hospital were more likely than their counterparts at the dermatology hospital to experience burnout and were less satisfied with the management of their units and with their professional development opportunities. In another study, Olkinuora et al.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> analyzed stress symptoms, burnout, and suicidal ideation in 2671 Finnish medical workers. In male specialists, the highest burnout indices were observed in general practice, psychiatry, internal medicine, oncology, pulmonary diseases, and—surprisingly—dermatology. In female specialists, the highest indices were seen in general practice, radiology, internal medicine, neurology, pulmonary diseases, and—again—dermatology. Non-specialists had a higher risk of burnout than specialists of both sexes. Additionally, higher burnout rates were observed in physicians working at municipal health centers than in those who worked at private centers, universities, or research institutes. The authors distinguished between higher-burnout specialties such as oncology, pulmonary diseases, and psychiatry and lower-burnout specialties such as obstetrics, gynecology, otorhinolaryngology, and ophthalmology. A third study, carried out in Croatia, studied the prevalence of burnout in doctors in 3 specialty groups: <span class="elsevierStyleItalic">a</span>) internal medicine and pediatrics, <span class="elsevierStyleItalic">b</span>) surgery and obstetrics/gynecology, and <span class="elsevierStyleItalic">c</span>) dermatology, otorhinolaryngology, and ophthalmology. Fortunately, 81.86% of the specialists analyzed had no symptoms of burnout. Among those who did have burnout, there were no differences by sex, number of work hours, or specialty group.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Prevalence</span><p id="par0050" class="elsevierStylePara elsevierViewall">According to surveys on the conditions of quality of life at work in the European Union, stress is the second most common reason for sick leave in the region.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a> The surveys also found that 28% of workers suffered from stress<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a>; in 2005, following the incorporation of new European Union member states, this figure rose to 30%.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a> The prevalence of burnout syndrome is directly related to work-related stress and ranges from 4%<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> to 30.5%.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> In general, it is considered that around 12% of European workers could currently have burnout syndrome. In the health sector specifically, the prevalence of burnout syndrome has been estimated at around 14.9% in various European countries, including Spain.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a> Stress is considered to be one of the risk factors that contributes the most to morbidity and mortality in any working population, and it is therefore among the factors that contribute the most to health problems in the general population.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Managing Stressful Situations</span><p id="par0055" class="elsevierStylePara elsevierViewall">Work-related stress and burnout syndrome constitute a psychological, physical, and biological reaction that can affect both professionals and patients. Stress must therefore be taken into account in medical facilities, especially in dermatology clinics, where stress is one of the situations most closely related to the onset, exacerbation, and perpetuation of skin diseases. Skin diseases of this type often cause severe physical and psychological suffering and have a greater impact on patients’ quality of life. Consequently, providing care for these patients in dermatology clinics can be very difficult. The diseases they present can be very difficult to treat because of their characteristics and consequences.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> In dermatology, the assessment of emotional balance is an important element in the diagnosis, treatment, and prevention of numerous diseases. Stress must therefore be taken into account because it can be related to morbidity associated with skin conditions in a working population.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to controlling situations of strain and stress, as in other diseases, there are 3 types of prevention<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Primary intervention: This type of intervention focuses on reducing or eliminating the causes of stress through activities aimed at promoting mental health in the workplace and adapting the work environment. The aim of these interventions is to create a healthier work environment.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Secondary intervention: The aim of this type of intervention is to reduce the health-related consequences of stress through actions that lead to greater awareness and the adoption of effective coping strategies, thereby strengthening workers’ skills and capacities.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Tertiary intervention: These interventions focus on treating people in whom the consequences of work-related stress have been or are currently present. The aim of this type of intervention is to reduce the negative consequences of stress in order to rehabilitate and readjust the person and to facilitate his or her return to work.</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">In addition, a series of individual and organizational strategies can be implemented by workers as well as organizations—either large (hospitals) or small (dermatologists’ offices)—in order to prevent and reduce stressful situations that generate work-related stress, which in the long term leads to the development of burnout syndrome<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Work Climate and Teamwork</span><p id="par0085" class="elsevierStylePara elsevierViewall">The work climate is the set of all people, groups, organizations, and physical or social elements with which the organization shares information, results, products, etc.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> In order to improve the achievement of goals and objectives and reduce stressful situations, organizations should foster a climate in which workers feel comfortable, involved, and integrated, with good relationships both horizontally (with coworkers) and vertically (with superiors). A good work climate has positive consequences such as accomplishment, affiliation, power, productivity, low turnover, satisfaction, involvement, adaptation, innovation, etc. In contrast, an inappropriate work climate causes high turnover, absenteeism, low levels of innovation, low productivity, etc.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In order to improve the work climate, organizations should implement strategies to reduce stressful situations and increase workers’ commitment to and involvement in the company—or the hospital, in our case—thereby creating in the workers a sense of belonging and aligning the organization's objective with the workers’ personal objectives, increasing workers’ motivation and satisfaction, and fostering mutual cooperation, support, and assistance, both horizontally (among coworkers) and vertically (from managers to employees).</p><p id="par0095" class="elsevierStylePara elsevierViewall">Teams arise from previously formed groups. We understand a “group” to be a set of interdependent individuals who share a common destiny, in the sense that something that affects one group member will also affect the others.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> Due to this shared objective, the relationship between these individuals must be based on cooperation, as they are interdependent and responsible for everything that happens. A group becomes a team when, in addition to a shared sense of commitment, it also pursues important group-based performance outcomes or results.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a> In other words, teams have a purpose that is oriented towards achieving particular objectives.</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the characteristics that are common to all team-based organizations. When an organization such as a clinic or a hospital has adequate teams, it results in lower costs (both direct and indirect), better mechanisms for coordinating and integrating members, and greater creativity. In addition, teams also produce emotional and psychological benefits for their members because they satisfy various individual needs as well as the need for affiliation and integration in a group.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a> This enables workers—administrative staff, hospital porters, surgeons, traumatologists, dermatologists, nurses, etc.—to have greater autonomy and responsibility and therefore achieve more ambitious targets and objectives.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In hospitals and clinics, is very common for work to be done by multidisciplinary teams consisting of professionals from different fields and schools of thought. As a result, these teams are more vulnerable to conflict. The ability to manage conflicts is essential to the proper functioning of a team. The aim is not to avoid conflicts, but rather to resolve them effectively and prevent negative effects. A conflict is a discrepancy and contradiction that arises as a result of differences between people. Well-resolved conflicts bring about healthy and favorable consequences for both the organization and the people who form part of it. It is important to avoid incorrect conflict management, which can lead to a situation of passivity and stagnation in the group. In contrast, a well-managed conflict gives rise to change, growth, and creativity. Group conflict has been associated with greater innovation and more effective interpersonal relationships,<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a> but when not managed properly it can also lead to diminished efficacy and well-being as well as higher turnover.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">33</span></a> There are 2 possible types of conflicts<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a>: <span class="elsevierStyleItalic">a</span>) conflicts related to information or tasks, and <span class="elsevierStyleItalic">b</span>) conflicts of interest or emotional and interpersonal conflicts. Conflicts of the first type are valuable because they can prompt members of the team and of the organization to reevaluate the situation and adapt it to their objectives. Conflicts of the second type are always negative for a team.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The following is an appropriate way to manage a conflict. Before getting involved, be aware of what the conflict is and what its possible consequences are. Observe, listen, and interpret before acting. It is important to detect and accept the existence of a conflict; ignoring the conflict neither solves it nor eliminates it. Once you have accepted that a conflict exists, identify the people involved and assess the importance of the conflict by observing and listening to the various parties. Then, reach consensus-based decisions about how to solve the conflict with the participation of the involved parties. It is fundamental to observe and show interest in the existing problems in order to address their causes. <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows a series of basic recommendations to reduce the likelihood of conflict.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In order for teams to function properly, there need to be basic rules based on respect, balance of power, values, and equality, in addition to adequate communication and assertive attitudes.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Communication within a team is very important because it is a requirement for the team's success. However, not all types of communication are effective. There are positive types of communication that bring about change and progress, while other types of communication generate negative consequences and a hostile work environment.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Assertiveness—the most appropriate and reinforcing type of behavior—entails having respect for others and asking for respect in return, reaching a compromise between the involved parties, and allowing individuals to express themselves freely and to achieve their objectives. Whereas nonassertive people express their opinions inadequately—either because they avoid expressing opinions in order to please others or because they disrespectfully impose their opinions on others—assertive people express respect for themselves and for others. This, in turn, increases trust and causes people to feel more satisfied with themselves and with their relationships with other people.</p><p id="par0130" class="elsevierStylePara elsevierViewall">By using assertive communication, teams can develop more fluid, frank, and direct communication among their members. In addition, the level of respect for other people will be greater and the work environment will be ideal for achieving shared objectives.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Finally, in large organizations (hospitals and clinics) as well as small facilities (doctor's offices), it is important to detect workers who are unmotivated or stressed in order to allow early prevention and intervention in stressful situations and to improve the functioning of teams.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of Interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres822690" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec819495" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres822689" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec819496" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Work-Related Stress" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Burnout Syndrome" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Prevalence" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Managing Stressful Situations" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Work Climate and Teamwork" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-24" "fechaAceptado" => "2015-09-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec819495" "palabras" => array:6 [ 0 => "Stress" 1 => "Burnout" 2 => "Professional burnout syndrome" 3 => "Teamwork" 4 => "Psychodermatology" 5 => "Dermatology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec819496" "palabras" => array:6 [ 0 => "Estrés" 1 => "<span class="elsevierStyleItalic">Burnout</span>" 2 => "Síndrome del profesional quemado" 3 => "Trabajo en equipo" 4 => "Psicodermatología" 5 => "Dermatología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Almost one-third of our lives is spent in the workplace, where much of our interaction with others takes place and where we are exposed to stressful situations. Work-related stress has consequences for the individual's physical and mental health. Stress and professional burnout syndrome are the main consequences of work situations characterized by a constant state of tension. Stress is the second leading cause of absenteeism in the European Union, and around 12% of European workers are currently affected by burnout syndrome. It is therefore vital to identify demotivated and stressed staff in both large organizations (hospitals and clinics) and smaller centers (private practices) so as to facilitate preventive measures and ensure early intervention in situations of stress, with a view to improving the performance of work teams.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las personas invertimos casi un tercio de nuestra vida en el lugar de trabajo, donde se desarrollan gran parte de las relaciones interpersonales y las situaciones de tensión. El estrés laboral asociado a estas conlleva consecuencias para la salud física y mental de las personas. El estrés laboral y el síndrome del profesional quemado <span class="elsevierStyleItalic">(burnout)</span> son las principales consecuencias derivadas de las situaciones de tensión constantes en el trabajo. El estrés es la segunda causa de baja laboral en la Unión Europea, y alrededor de un 12% de los trabajadores europeos podría padecer actualmente el síndrome del profesional quemado. Por todo esto, es fundamental la detección en las organizaciones, grandes (hospitales y clínicas) y pequeñas (consultas), del personal desmotivado y estresado, ya que permitirá una prevención e intervención precoz en las situaciones de tensión generadas y una mejora en el funcionamiento de los equipos de trabajo.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Campayo J, Puebla-Guedea M, Herrera-Mercadal P, Daudén E. Desmotivación del personal sanitario y síndrome de <span class="elsevierStyleItalic">burnout</span>. Control de las situaciones de tensión. La importancia del trabajo en equipo. Actas Dermosifiliogr. 2016;107:400–406.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Physical \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Behavioral \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Psychological \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muscle tension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lack of involvement in work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hostility \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ulcers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduced performance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anxiety \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Headaches \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase in smoking and use of other addictive substances \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Depression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Changes in appetite \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Apathy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insomnia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abandonment of healthy habits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emotional exhaustion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cynicism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tachycardia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dissatisfaction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Irritability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Frustration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cerebrovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Adaptive problems \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Skin diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interpersonal conflicts \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1383281.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Health Impact of Stressful Situations at Work.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Physical</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Emotional</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Headaches \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emotional distancing \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Insomnia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cynical attitude and apathy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Osteomuscular pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Helplessness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Impatience and irritability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Disorientation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic fatigue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Depression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Psychological</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Work-related</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Feelings of emptiness, exhaustion, failure and powerlessness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Decrease in work capacity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low self-esteem and professional fulfillment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Over- or under-involvement and motivation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nervousness and restlessness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Boredom and presenteeism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Loss of values and expectations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Decrease in quality of work \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Modification of self-concept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hostility \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Difficulty concentrating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Interpersonal conflicts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low tolerance of frustration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Communication problems \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aggressiveness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Behavioral</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Addictive and avoidance behaviors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inability to lead a relaxed life \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High-risk behaviors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Increasing irritability and low personal performance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Disorganization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1383283.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Symptoms Associated With Burnout Syndrome.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Individual strategies</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Learn relaxation techniques \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Develop effective new coping strategies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Improve management of emotions and conflicts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Seek appropriate professional training; focus on doing good work rather than on output \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Distance oneself from problems; be flexible and adaptable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maintain and care for one's social network of friends and family \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Improve interpersonal relations with coworkers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adopt hobbies and pastimes to unwind outside of work \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exercise, eat healthy food, and get enough rest \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Organizational strategies</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Avoid authoritarianism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Increase workers’ autonomy and control over their own work \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Promote flexible working time arrangements \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Establish clear communication channels and clarify decision-making processes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Promote professional advancement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Set clear, well-defined objectives \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clarify roles within the organization \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Avoid overloading or underloading workers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Increase recognition, rewards, and positive reinforcement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Develop anticipatory socialization programs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Offer in-service training to help workers keep their knowledge and skills up to date \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Encourage team bonding and a good work climate \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1383284.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Individual and Organizational Strategies to Prevent and Reduce Stressful Situations That Cause Work-Related Stress.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teams are the basic work units \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teams are only used when appropriate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teams are directed by other teams \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">There may be various types of teams \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The introduction of teams is not seen as an end point but rather an ongoing process \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teams are designed with flexibility in order to facilitate adaptation to the new situation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teams stay aligned with one another \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teams are designed to be compatible with the organizational philosophy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The organization must make an intentional effort to introduce structures of this sort \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1383280.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Characteristics of a Team-Based Organization.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Listen to other people first \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recognize and accept differences of opinion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do not be unpleasant at work \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do not accept unpleasantness from anyone else \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ask for clarification when you have doubts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clarify responsibilities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Provide updates to people who need them \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Be sensitive to other people's traits and characteristics \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Establish basic rules \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Assertiveness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance of power \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1383282.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Basic Recommendations to Reduce the Likelihood of Conflict.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress, appraisal and coping" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.S. 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| año/Mes | Html | Total | |
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| 2023 Noviembre | 94 | 54 | 148 |
| 2023 Octubre | 85 | 46 | 131 |
| 2023 Septiembre | 68 | 44 | 112 |
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| 2023 Mayo | 88 | 35 | 123 |
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| 2023 Marzo | 65 | 34 | 99 |
| 2023 Febrero | 61 | 33 | 94 |
| 2023 Enero | 46 | 35 | 81 |
| 2022 Diciembre | 96 | 35 | 131 |
| 2022 Noviembre | 47 | 30 | 77 |
| 2022 Octubre | 49 | 25 | 74 |
| 2022 Septiembre | 47 | 51 | 98 |
| 2022 Agosto | 85 | 38 | 123 |
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| 2022 Mayo | 84 | 64 | 148 |
| 2022 Abril | 153 | 38 | 191 |
| 2022 Marzo | 133 | 46 | 179 |
| 2022 Febrero | 178 | 38 | 216 |
| 2022 Enero | 155 | 46 | 201 |
| 2021 Diciembre | 87 | 42 | 129 |
| 2021 Noviembre | 112 | 69 | 181 |
| 2021 Octubre | 64 | 68 | 132 |
| 2021 Septiembre | 56 | 41 | 97 |
| 2021 Agosto | 100 | 36 | 136 |
| 2021 Julio | 81 | 26 | 107 |
| 2021 Junio | 60 | 33 | 93 |
| 2021 Mayo | 68 | 45 | 113 |
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| 2021 Marzo | 113 | 35 | 148 |
| 2021 Febrero | 88 | 37 | 125 |
| 2021 Enero | 92 | 31 | 123 |
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| 2020 Noviembre | 47 | 27 | 74 |
| 2020 Octubre | 64 | 29 | 93 |
| 2020 Septiembre | 36 | 17 | 53 |
| 2020 Agosto | 46 | 26 | 72 |
| 2020 Julio | 30 | 21 | 51 |
| 2020 Junio | 38 | 38 | 76 |
| 2020 Mayo | 44 | 32 | 76 |
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| 2020 Marzo | 42 | 23 | 65 |
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| 2019 Agosto | 4 | 0 | 4 |
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| 2019 Enero | 2 | 0 | 2 |
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| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Febrero | 96 | 4 | 100 |
| 2018 Enero | 50 | 10 | 60 |
| 2017 Diciembre | 159 | 14 | 173 |
| 2017 Noviembre | 61 | 9 | 70 |
| 2017 Octubre | 37 | 10 | 47 |
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| 2017 Agosto | 33 | 9 | 42 |
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