Relationships between the level of Social Competence and Work-related Behaviors in a group of Physicians , Nurses , and Paramedics

The functioning of medical professionals in their work environment is determined by many factors, among them social competence. The aim of this study was to analyze how social competence is related to behaviors and experiences in the context of burnout syndrome, experienced by physicians, nurses, and paramedics in Poland with regard to sociodemographic factors. Methods. The study was conducted in 2015-2016. It involved 432 medical workers, including 29.7% physicians, 36.96% nurses, and 33.3% paramedics. The median age was 38.00. Over half (38.9%) of those surveyed were employed in hospitals, 6.9% in primary care centers, 18.3% in emergency ambulance service. The Social Competence Questionnaire (SCQ), the Work-Related Behaviour and Experience Patterns AVEM questionnaire, and a self-developed questionnaire were applied. Results. Symptoms of burnout syndrome (Type B and A) were observed in one-fourth of medical workers. 31.8% of all participants presented Type G (p < 0.0001). Behavior types prevailing in particular groups were as follows: paramedics ― Type G and Type S; physicians ― Type A and Type B, and nurses ― Type B and Type G. The general competence level correlated with Type G (p = 0.05), and I competence correlated negatively with Type B (p = 0.02). Conclusions: The problem of burnout syndrome, diagnosed on the basis of work-related behaviors and experiences, is weighty and requires implementation of holistic therapeutic and prophylactic solutions addressed to healthcare professionals. Competence in intimate and social exposure situations, as well as competence in situations requiring assertiveness significantly protect medical workers against burnout syndrome. DOI : 10.14302/issn.2574-612X.ijpr-17-1634 Corresponding author: Weronika WoliÅ„ska, Email: weronika.wolinska@pum.edu.pl Running title: Social competence and burnout


Introduction
The functioning of people in the work environment, as well as their satisfaction with professional achievements are highly determined by their social competence, attitudes towards work, strategies adopted to cope with problems, and an emotional stance on the professional roles [1,2,3].
One indicator of competence is the effectiveness of people's functioning in real professional and social situations, which means efficiency in achieving goals, the ability to build interpersonal bonds, a lack of excessive psychological and psychophysiological costs associated with work and social relations, and agreement between behavior and job requirements as well as social standards [4,5,6].A high social competence of physicians and nurses seems to be a factor that protects them against burnout syndrome.It is negatively correlated with burnout in the dimensions of emotional exhaustion, emotional detachment, and dehumanization, and positively correlated with a sense of a personal accomplishment [3,7,8].Other authors imply that aspects which should be taken into account when diagnosing burnout syndrome include the interaction between employees and their work environment, their attitudes to job requirements, and their experiences with various situations at work [9,10].
Discrepancies between job-related situational restraints and one's communicative and interpersonal skills in social situations, as well as assertive competence in intimate and social exposure situations, explain the essence of the burnout problem [1,9,10].Other authors maintain that job burnout positively correlates with the levels of emotional and social intelligence [11,12,13].
Originally burnout syndrome was described as a loss of motivation and physical power to work, perceived as workers' withdrawal syndrome, resulting from overloading with tasks posed by social and physical work environment [14], and as a consequence of exposure to prolonged work-related stress [15].This syndrome is mainly observed in jobs which involve contact with other people, the necessity of making quick and responsible decisions, and personal involvement.This problem affects especially representatives of emotionally demanding professions, such as physicians, nurses, and paramedics [16,17,18].
Characterized by high dynamism, burnout syndrome is regarded as a challenge for public health due to its increasing incidence and negative -both personal and institutional -consequences for the healthcare system [17].Researchers agree that burnout does not give symptoms immediately, but develops gradually in response to long-term exposure to stress [19,20].Negative work consequences have direct effects on employees' health, and an indirect impact on the quality of healthcare, as well as legal and economic issues [3,18,21,22,23,24].In individual cases, burnout syndrome is manifested by psychosomatic (weakness, sleeplessness) and emotional (anger and depression) problems, as well as hostility, aggression, apathy, the lack of confidence in other workers, and isolation [18].
Burnout syndrome can also be perceived as a risk factor for heart diseases, pain, and spinal diseases [13].
Unlike other diseases counted among occupational disorders, it does not entail dysfunction of a specific organ or system.It is rather a psychosocial state, which should be distinguished from physical fatigue and depression [16].

Materials and Methods
The aim of this study was to analyze relationships between the job-related behavior types and the levels of social competence presented by physicians, nurses, and paramedics employed in various healthcare centers in Poland, with regard to sociodemographic factors.The following hypotheses were formulated: There are differences in the severity of burnout syndrome between physicians, nurses, and paramedics, depending on age, sex, education, years in the profession, and years in the previous job.

Medical workers with high social competence
show a low level of burnout syndrome.
There is a relationship between the social competence of medical workers and the types of jobrelated behaviors, suggesting burnout syndrome.

Participants
The

Methods
Three research instruments were employed in the study, namely the Social Competence Questionnaire (SCQ) [25], a standardized questionnaire, the Workrelated Behavior and Experience Patterns -AVEM [1,9,10], and a self-developed questionnaire for sociodemographic data.
The level of social competence was measured using the SCQ developed by Anna Matczak (2012) [25].This is a self-report instrument consisting of 90 items, including 60 diagnostic items (concerning social competence) and 30 nondiagnostic items (concerning other abilities).The total score for the diagnostic items is a general indicator of social competence.Surveyed individuals assess their effectiveness in performing tasks (How well would you manage if …?) using a four-point scale: definitely well, quite well, rather poorly, definitely badly.The sum of the scores for the diagnostic items is the total score.The diagnostic items have been developed on the basis of the classification of difficult social situations proposed by Argyle.Four types of situations were distinguished: 1) intimate situations (I), which refer to close interpersonal contact; 2) social exposure situations (SE), which refer to competence, which determines the effectiveness of behaviors in the situations of social exposure; 3) formal situations, which require accommodating oneself to strictly defined rules or regulations; and 4) situations demanding assertiveness (A), which are associated with competence that determines the effectiveness of behaviors in situations that require assertiveness [26].
Based on the results of factor analysis, three out of the four social scales were included in the final version of the questionnaire: The (I) scale, which refers to competence determining the effectiveness of behaviors in situations of close interpersonal contact with patients, listening to  Type G -"healthy-ambitious" Type S -"unambitious" Risk Type A -"excessively ambitious" Type B -"burnout" The respondents' responses for the AVEM questionnaire were organized and entered to the UPS computer system (license no.PRV/010612/EDU), which is an integral part of the questionnaire and serves for computing data.Responses to specific questions were introduced according to the key, and the respondents were assigned to one of four types of behavior.

Statistical Analysis
The

Statistically Significant Correlations
Analysis of sten scores for social competence (SCQ) and stanine scores for behavior types (AVEM) demonstrated a statistically significant correlation between the general social competence level and Type G (healthy-ambitious) behavior (r = 0.17, p = 0.05), and a negative correlation between the level of competence in the I scale and Type B (burnout) behavior (r = -0.23,p = 0.02).

Correlations between social competence (SCQ)
and the AVEM dimensions.The levels of general competence and competence in the I , A, and SE scales correlated positively with two dimensions, namely resistance to stress and emotional or subjective wellbeing.Negative correlations were only observed between tendency to resignation and the levels of general competence and competence in the I, A, and SE scales.The lower the social competence, the higher the tendency to resign in the case of failure (Table 5).
There were significant differences in workrelated behaviors and experiences between the professional groups analyzed in this study.The greatest differences were noted in resistance to stress (6)(7)(8), and commitment to work (1-5) -Table 6.

DISCUSSION
The functioning of healthcare workers in a therapeutic team is determined by many factors, of which social and professional competence, stress-coping styles, and attitudes towards work all play especially important parts [27,28,29]. This 12.99 0.002  Their counterparts showing no burnout symptoms were more likely to actively cope with problems and search for social support (p =0.003) [36].

Conclusion and Implications
Burnout syndrome (Type B) occurs in physicians, nurses and paramedics regardless of their place of work, it is related to low level of social competence, particularly in intimate situations.Selected variables differentiate the occurrence of types of professional burnout between groups of professionals.
Our findings show clearly that the problem of job burnout in the studied professional groups is study was conducted in Poland in 2015-2016 with the consent of the Bioethical Commission of the Pomeranian Medical University in Szczecin, Poland (KB-0012/92/12/2014). Purposive random sampling was used to select study participants.Those invited to the study were physicians and nurses from internal diseases, surgical, and pediatric wards, and other healthcare institutions in Szczecin, paramedics providing emergency service in Szczecin, and primary care physicians from Szczecin and Wrocław.All people employed in selected healthcare centers had equal chances to take part in the study.Our research on social competence, as well as behaviors and experiences associated with work, involved 432 medical workers from two medical centers (Szczecin and Wrocław), composed of 144 (33.49%) physicians, 160 (37.73%) nurses, and 122 (28.77%) paramedics.185 (42.82%) respondents had master's degree education.The average age of the medical workers was 33.6 ± 11.7 years and the median was 28 years (range: 21-66 years).Detailed sociodemographic data are presented in

1 .
patients, showing understanding and empathy for their fears, and tolerance for their impatience and dissatisfaction with therapeutic effects.This scale contains 15 items; the minimum score is 15 points, and the maximum is 60 points.The (SE) scale, which refers to being an object of attention and potential appraisal from many people; it includes 18 items and has a minimum score of 18 points and a maximum of 72 points.The (A) scale, which refers to attaining one's own goals and satisfying needs through persuasion, and the ability to influence other and resist the influence of others; it includes 17 items, and has a minimum score of 17 points and a maximum score of 68 points.The point scores were converted into sten scores: 1-3 sten was considered a low score, 4-7 sten was considered an average score, and 8-10 was considered a high score [25].The AVEM questionnaire measures people's individual resources in the context of dealing with job requirements, types of behavior, a risk of developing mental health problems, possible threats, and trends in the field of psychological interventions [1,10].The AVEM questionnaire consists of 66 statements divided into 11 scales (each including 6 statements) and rated on a five-point Likert scale (from fully agree to fully disagree).The questionnaire scales measure three dimensions of work-related behavior and experiences that determine one's effectiveness at work [1,9,10]: Commitment to work expressed in terms of perceived significance of work, career ambition, tendency to exert, striving for perfection, emotional distancing.A positive behavior type in relation to job requirements is manifested by high perceived significance of work, as well as conscious regulation of energy expenditures.These factors determine one's ability to maintain detachment from difficult situations at work. 2. Resistance to stress are regarded in terms of one's tendency to resign in the case of failure, active coping with problems, as well as balance and emotional stability.The arrangement of these features reflects different levels of work satisfaction, individual stresscoping strategies, and general attitudes towards life.3. Emotional or subjective well-being is described in terms of work satisfaction, life satisfaction, and perceived social support.This is a specific psychological factor that protects workers' mental health, and determines individual ways of dealing with job requirements.The scores for 11 scales can be calculated using a spreadsheet.Raw results are converted into standard results by means of tables with normalized data.The spreadsheet shows centile scores, and those obtained through converting them into stanine scores.Based on the interplay of these 11 scales, four types of behavior and experiences can be derived by means of cluster analysis [10,17]:

Table 4 .
Types of work-related behavior vs. selected variables M -mean; Q 1 -Q 3 -first quartile -third quartile and dimensions (I) scale (SE) scale (A) scale total SCQ important and requires holistic therapeutic and preventive solutions.It is important that a diagnosis of work-related behavior types and social competence measurement should be supplemented with analysis of external learning and working conditions.Prevention of burnout syndrome should start as early as during the process of educating future medical workers, through improving their social competence.It can be achieved by using appropriate methods, such as training of assertiveness, interpersonal skills, communication methods, and coping with stress in social exposure situations.Ours is one of relatively few studies searching for the connection between burnout syndrome and social competence of physicians, nurses, and paramedics.Competence, which visibly protects medical workers against job burnout (diagnosed on the basis of workrelated behaviors and experiences), involves assertive competence, competence in intimate situations, and competence in social exposure situations.Several practical implications can be derived from the results presented in this study.It seems that the most important conclusion is that social competence of physicians, nurses, and paramedics can act as a buffer against negative consequences of gainful employment, often involving negative emotions.This observation gains special importance in the context of the possibility of training social competence at work[37], as it contributes to the prevention of burnout syndrome.In future study projects dealing with the relationship between competences of medical professionals with the risk of burnout syndrome and sociodemographic variables, the use of analysis methods developed by Fei Hao et al, 2015, Shuai LI, 2016 and Kar et al, 2016, ought to be considered.Correspondence analysis of a number of variables will help determine which of these variables have the strongest influence on

Table 3 .
Distribution of work-related behavior types in the groups of physicians, nurses and paramedics type of distribution was determined for all variables.The Shapiro-Wilk test was employed to verify the normality of these distributions.Arithmetic means, standard deviations, medians, and ranges of variability (extremes) were calculated for the measurable (quantitative) variables, while frequencies (percentages) Freely Available Online www.openaccesspub.org| IJPR CC-license DOI : 10.14302/issn.2574-612X.ijpr-17-1634Vol-1 Issue 1 Pg.no.-20 were determined for qualitative variables.Logistic regression was used to determine the influence of explanatory variables on the odds ratio (OR) of having higher social competence with a 95% confi-11.09,p < 0.0001.Competence in situations demanding assertiveness (A) -meaning exerting influence on and resisting influence of other people -differentiates nurses from physicians, and physicians from paramedics (F = 11.09,p < 0.0001).Competence in social exposure situations (SE) -which refers to being an object of attention and potential appraisal -differs paramedics from nurses (F = 2.87, p = 0.06).Symptoms of burnout syndrome (Type B) were observed in 25% (106), behavior is a relatively high level of internal balance and emotional stability, satisfaction with life, high perceived social support, and relative satisfaction with life beyond work.This type was observed in 22% of paramedics, every fifth nurse (21.3%), and only every seventh

Table 3 .
Types of behavior and experiences observed in the studied professional groups depended on age, years in the profession, and years in the previous job -

Table 5 .
Correlations between social competence (SCQ) and dimensions of work-related behavior and experiences (AVEM) (raw results) r -Pearson's linear correlation coefficient; p -level of significance for r; scales: competence determining effectiveness of behaviors in I -intimate situations; SE -social exposure situations; A -situations requiring assertiveness

Table 6 .
Relationships between actual profession and the scales of work-related behavior and experiences F -ANOVA with Tukey's post hoc test; p -level of significance for F; competence level.Pereira-Lima and Loureiro (2015) investigated 400 medical residents in Brazil to learn how social competence was related to burnout syndrome and the incidence of job burnout among nurses.Taking into account the mean age of the nurses in the study and all nurses in Poland (49 years in 2016), we can say that this group of medical workers is at the highest risk of burnout syndrome (especially nurses employed in Freely Available Online www.openaccesspub.org| IJPR CC-license DOI : 10.14302/issn.2574-612X.ijpr-17-1634Vol-1 Issue 1 Pg.no.-27 primary care centers, as well as palliative and long-term care) [32,33].Maslach, C., et al. (2001) noticed that burnout syndrome affects more women than men.If