Autopercepção vocal de profissionais do setor hospitalar em tempos de pandemia: fatores associados

Abstract

Introduction: health professionals have a high demand for voice and oral communication and, frequently, aspects inherent to the work can hinder the use of the voice, arising vocal symptoms. The presence of vocal symptoms is prevalent in voice professionals and among them are health professionals. It is known that the face mask for individual protection is essential to the work of these professionals, however it hinders communication and interferes with speech intelligibility and phono-respiratory coordination of the speaker. Another condition that also harms the voice is stress, which is prevalent among health professionals, and can be another aggravating factor, or trigger vocal problems. However, the way an individual copes with stressful situations and can adapt to them, can promote the development of a good state of health. The Sense of Coherence (SOC) assesses how individuals manage life, despite the adverse conditions of everyday life. Objective: to determine the presence of vocal symptoms in hospital health professionals and to analyze its relationship with sociodemographic and occupational data, self-perception of the work environment, oral communication with the use of face mask, and the Sense of Coherence. Method: a cross-sectional observational analytical study, approved by the University's Research Ethics Committee - CAAE No. 50717621.9.0000.5149, opinion No. 4.964.714. It was conducted with a convenience sample of 66 health professionals from a hospital. An online questionnaire was applied, with sociodemographic questions; self-perception of the work environment and self-perception of oral communication while wearing a face mask; the Vocal Symptoms Scale (VSS); the Sense of Coherence scale (SOC-13) and the Dysphonia Screening Instrument (Br- DST). After descriptive analysis, the Vocal Symptoms Scale was analyzed quantitatively, obtaining the mean values and their respective standard deviations. For the analysis of socio-demographic, occupational, work and vocal self-perception data with the VSS scores and its domains, the Mann-Whitney and Kruskal-Wallis non- parametric tests were used, since the VSS variables did not show normal distribution. In addition, the correlation between the ESV (total and domains) and SOC (total and domains) was verified using Pearson's Correlation Coefficient. In this study, SOC was used as a continuous quantitative variable in correlation testing. For all analyses, a significance level of 5% (p≤0.05) was adopted. Results: most of the sample was composed of nurses (22.7%). Most participants were female (87.9%), in the age range of 22 to 39 years (69.7%). Most of them were married (50.0%). Most had been in the profession for more than five years (60.6%), worked 20 to 40 hours per week (51.2%). The self-perception of vocal symptoms was 62%. Most spoke intensively in the work environment (54.5%), used N95 or PFFII mask (59.1%), with comfortable mask adaptation (57.6%) at work. An association was observed between the use of speech in the work environment and the limitation domain (p=0.037) and the emotional domain (p=0.039) of the VSS. Regarding the work environment, most considered as unsatisfactory the temperature (66.7%) and noise (63.6%), and perceived as satisfactory the ventilation (53.0%), and air quality (56.1%). An association was observed between noise and the total score of the VSS (p=0.005), the limitation domain (p=0.013) and the physical domain of the VSS scale (p=0.104). Most do not perceive their voices as hoarse (93.9%), and do not use force to speak (78.8%). The presence of possible dysphonia was not observed (95.5%). It was observed that most perceive effort to speak with a face mask (84.8%), difficulty understanding other people's speech using a face mask (93.9%), and self-perceived incoordination between breathing, speech, and articulation during mask use (75.8%). The majority believe that people have difficulty hearing the healthcare professional wearing the face mask (83.3%). There was an association between the total score of the VSS with the self-perception of incoordination between breathing, speech and articulation during mask use (p=0.041) and also with the self-perception of difficulty to be heard with the mask (p=0.033). There was an association between the domain limitation of the VSS with the self-perception of effort to speak with a mask (p=0.035), and also with the self-perception that other people have difficulty hearing the professional with a face mask (p=0.050). A negative correlation was observed between SOC and VSS (p < 0.05), and the same was observed between its domains (p < 0.05). Conclusion: most health professionals working in a Brazilian reference public hospital have self- perceived vocal symptoms. The presence of vocal symptoms is related to speaking in a noisy work environment, with difficulties when speaking using the face mask, and the self-perception that people have difficulty hearing the professional using the face mask. It is observed that the lower the ability to deal with stressful situations, the presence of vocal complaints among health professionals is more frequent.