Mental health linked to the quality of life of health professionals, from the perspective of SARS-Cov2

Summary Purpose of the study: To analyze the state of the art on the mental health and quality of life of health professionals who worked on the SARS-CoV-2 frontline. Method: This is an integrative literature review study. Results : Regarding the content of the works selected to compose the corpus of this study, it was possible to extract that the main reasons that affect well-being are correlated with levels of stress and anxiety. In addition, the articles linked depression and anguish as one of the determining factors tangent to the quality of life axis, despite the fact that, as explored, aspects such as physical activity were a determining factor for improving the quality of life. Conclusion: The work environment directly influences the worker's mental health, and thus reveals the high overload in which to carry out their work activities without resources and without support, consequently affecting the quality of life.


Introduction
In Brazil, nursing as a profession is admittedly new, if we consider the Exercise Law 7498/86, which has 04 decades of recognition. This fact organizes the profession in terms of rights and duties, vis-à-vis the population and the State, leading nursing and its professional dichotomies to precarious working and salary conditions (1) The transmission of SARS-CoV-2 occurs predominantly through contaminated droplets of oropharyngeal secretions from an infected person to a person free of the infection, although the role of transmission by aerosols, contact with surfaces and surfaces is still unknown. contaminated objects, where the virus can remain viable for up to 72 hours (6) , or through the fecal-oral route (7) . According to Kraemer (8) the transmission of SARS-CoV-2 is aggravated by the high average incubation time, of approximately 5-6 days (ranging from 0 to 24 days), due to people without symptoms, pre-symptomatic or with mild symptoms. able to transmit the disease (9) .
However, health professionals directly and indirectly involved in fighting the pandemic were and are exposed on a daily basis to the risk of falling ill from the corona virus. Problems such as physical tiredness and psychological stress, insufficiency and/or negligence regarding the protection measures and health care of these professionals, do not affect the different categories in the same way, and it is necessary to pay attention to the specificities of each one, in order to avoid the reduction of work capacity and the quality of care provided to patients (10).
In this scenario, health professionals are the main actors in coping activities. With the high demand, it brings consequences for changes in physical/mental health (stress/anxiety), in addition to the demand for increased workload, directly reflecting on physical performance, which consequently directly interferes with the quality of life of these individuals (11) .
In this context, it is necessary to approach information regarding quality of life (QoL). The word quality of life does not have just one meaning, it is used in a more generalized and comprehensive way, requiring a better understanding, reflection and determination (12) . It is often compared or confused with the word health, in which they are usually expressed with the same meaning (13) .
Faced with this reality, health is not simply the lack of illness, but a state of physical and mental well-being as a whole., which can only be determined by the subject himself, covering several aspects, such as physical,

Mental health linked to the quality of life of health professionals, from the perspective of SARS-Cov2
International Journal for Innovation Education and Research Vol. 11 No. 5 (2023), pg. 77 mental, emotional, social, spiritual and economic (12). Being evaluated and diversified from person to person and from circumstance to circumstance, it may involve culture, values and lived experiences (14) .
With the advent of COVID-19, a decrease in the quality of working life (QWL) of these professionals is observed, due to work overload and long hours. This scenario has contributed to an increase in the physical and mental strain of nurses and their dichotomies who continue to work, even in the absence of sick colleagues.
Other factors that aggravate health and QWL are related to structural insufficiency, absence and/or quality of personal protective equipment (PPE), in addition to exhaustion in health systems, caused by the increase in bed occupations due to hospital admissions (15) .
The study is based on the object of study: Mental health and quality of life of health professionals in the context of the SARS-Cov2 pandemic.
The study in question is based on the justification that the health professional is responsible for providing recovery, the promotion/maintenance of health and well-being to clients/patients, due to the fact that they are directly linked to care, the probability of contamination by the SARS-Cov2 virus, becomes greater in sync with physical and mental exhaustion. Therefore, since the study provides a bias for new studies/research, it will be developed with the aim of providing content for the protection and promotion of the physical and mental health of this working class. This fact is in line with the social return, because with the decrease of these professionals, everyone, society/State will become fragile in the maintenance of health/life, resulting in a problem. The relevance of the study on screen is transfigured, considering that the scientific productions related to the theme are still shy in terms of quantity. Considering that these sick actors cannot be left unmotivated and left to their own devices, studies will have to take place to bring a new look to everyone who works with health.
Through the problem, In view of the concomitant working conditions, there is all the inconvenience that the pandemic brought to the working class of health professionals, in addition to the excessive information disseminated by the media, often even erroneous, the research question was generated: What has the literature revealed about the perspective of mental health and quality of life of health professionals who worked on the SARS-CoV-2 frontline? Therefore, the objective of the study: To analyze the state of the art on the mental health and quality of life of health professionals, who worked on the SARS-CoV-2 front line.

Methodology
The study is based on a review of the integrative type of narrative literature, which enables the synthesis and analysis of the scientific knowledge already produced on the investigated topic (16) . In order to search for the knowledge produced on the subject, the research question was formulated: What has the literature revealed

Mental health linked to the quality of life of health professionals, from the perspective of SARS-Cov2
International Journal for Innovation Education and Research Vol. 11 No. 5 (2023), pg. 79 In the fourth stage, the selection began based on previously defined criteria. Documents exported and organized in an Excel spreadsheet, comprising the data: Year of publication; Author training; Methodology; Place of publication; Level of Evidence and Summary of Results. Nine studies were selected to compose the corpus of this study.
As you can see, with the application of the FREE filter, a total of 306 studies were eliminated, out of the 386 found. Next, 77 studies were eliminated, for having questions in the title such as; quality of life and/or mental health of children, adolescents, students, patients/clients. This was followed by the reading of the abstracts, in order to understand the theme if it went against the object of study, delimited here.
Of these, all that were directed to health professionals, who brought quality of life linked to psychic illness, were separated. This selection resulted in 09, who were eligible for the study on screen. For an illustrative question and quick and visual understanding below, see Table 01, with the selection stages of the studies that were elected.  The fifth stage corresponded to the critical analysis of the selected works, comparing theoretical knowledge, identifying conclusions and implications resulting from the integrative review.
Sixth stage, after analyzing and interpreting the data, the synthesis of the knowledge obtained in the publications was carried out, which produced 09 results in narrative form, describing common findings and divergences, represented in table 02. The level of evidence represents the quality of the available scientific evidence and defines the confidence in the information used, which makes it possible to define a certain recommendation, following figure No. 02, was brought to support the classification of the selected studies, in relation to evidence.

Results
Regarding the content of the works selected to compose the corpus of this study, it was possible to extract that the main reasons that affect well-being are correlated with levels of stress and anxiety. Concerning the professions of the authors, it is necessary to point out that the number of authors is greater than the productions, considering that some studies have more than one author/departments in their constitution, being subdivided into 5 (five) medical authors, 3 (three) authors nurses, 1(one) pharmacist, 1(one) biomedical, 1(one) social worker and 1(one) unspecified profession being identified as an entity.

Mental health linked to the quality of life of health professionals, from the perspective of SARS-Cov2
International To support the analysis, we sought to base the content analysis method, which is described as: … set of communication analysis techniques aimed at obtaining, through systematic procedures and objective description of the content of messages, indicators (quantitative or not) that allow the inference of knowledge regarding the conditions of production/reception (inferred variables) of these messages (20 ) To support the analysis, we sought to base the content analysis method, which is a technique for analyzing communications and data, with the aim of promoting indicators based on systematic procedures. Thus, content analysis can be of two types: analysis of "meanings" (thematic analysis) and analysis of "signifiers" (procedural analysis) (21) With regard to this research, the chosen analysis technique was the thematic categorical analysis. This technique allowed us to condense the data, categorizing and standardizing them in order to make their interpretations more accessible.
Category 01-Nursing presents greater psychic suffering.

Category 02-Nursing professional resilience, as a contributory factor
Category 03-the stress of the medical professional becomes greater

Discussion
Category 01-Nursing presents greater psychic suffering.
Constructed by 04 studies, arising from approaches of studies that converged to the presentation of mental health disorders of nursing professionals.
Studies point out the wear and tear, the service overload of these professionals at the height of the Covid-19 pandemic. This fact changed the routine of life, at home and in the work unit, which, added to the financial crisis that plagues nations in general, increasingly flattening the income of families, was a summation, as the vast majority began to accumulate more shifts to maintain financial life. Bearing in mind that nursing is a profession mostly composed of females, who often assume the role of family/household provider Corroborating with the PAHO discussion (22) , it strongly points out that the pandemic has greatly altered the lives of health professionals, with emphasis on nursing, which is increasingly etherizing the illness, the need for continuous treatment of professionals to maintain the balance between linear mental health, bringing the need for the State to care for those who care.
Studies launched based on PAHO (22) point out that the COVID-19 pandemic caused an increase of approximately 25% in the prevalence of anxiety and depression worldwide, mitigating human mental illness, this in 2020.

Mental health linked to the quality of life of health professionals, from the perspective of SARS-Cov2
International Journal for Innovation Education and Research Vol. 11 No. 5 (2023), pg. 84 Faced with this reality, it is clear that nursing, who spends more time with clients seeking health care, becomes much more vulnerable to all possibilities of infection, viral/bacterial/fungal. In addition to direct exposure to contamination by the virus, they also suffer the psychosocial impacts resulting from this context.
The studies showed the occurrence of symptoms suggestive of mental disorders (anxiety and depression) related to female nursing professionals, color or brown race, with a monthly income of less than 05 minimum wages who worked in the private sector, having symptoms of Down Syndrome Burnout and living with parents.
In this formed scenario, we can infer the idea of deficiency or even lack of emotional and financial support, on the part of the State/health companies, added to the fear of infecting family members, a mental zone of conflicts and emotions was formed between the need of job maintenance and drastic changes in job management functions.
On the other hand, there was a "certain" confidence that the government and health companies would be able to overcome the pandemic through research/vaccines, in addition to joining forces with co-workers, in addition to considering religious support, which supplied these actors inserted and a confusing and complex scenario, without knowing what they were facing and what weapons to use in this installed war.
Luz, et al. (23) , describe that the work of the nursing team has technical complexity, which demands greater scientific knowledge and control in making immediate decisions, thus maximizing professional exhaustion during the workday. In addition to the scientific side, nursing has another unique role in patient care: humanization. Within the hospital staff, nurses become the closest bridge to patient recovery, evaluating and mediating care services.
This scenario presents the growth of the population that becomes ill, the actors on the scene experience tensions and anguish to a greater degree, which added to the increase in the incidence of psychic disorders, although it should be noted that not all health professionals experienced this tense form of life/feeling (24) .

Category 02-Resilience of nursing professionals in the face of pandemic chaos
To start the discussion of this category, in which he used 03 studies, which were approached by the theme addressed. Resilience is currently considered a profile that leaders/professionals need to present during certain situations that may occur in their work routines.
Considering that the job market is increasingly competitive, it is essential that professionals who deal directly/indirectly with people and situations, have more and more understanding and preparation to work with; people, tools, strategies and processes, so that they can extract the best from their teams, according to the companies' objectives, in the contemporary world.

Mental health linked to the quality of life of health professionals, from the perspective of SARS-Cov2
International Journal for Innovation Education and Research Vol. 11 No. 5 (2023), pg. 85 In strengthening the fact described here, Souza (25) describes that resilience is an important factor of the universal human capacity to live with the crisis, go through it, transform adversity into learning and, even so, emerge stronger.
Faced with this reality, nursing faces crisis situations during most of its work, but the pandemic, at its peak, was unknown with a high degree of lethality. This fact, marked and changed the life of the professional category, which was invisible to the social eyes, starting to gain visibility by society and rulers, with a single factor to be considered, it needs that State/society, rethink the way of dealing with these professionals, because most of them urge for looks and actions that contemplate the modification of their state of mental health.
Based on the reality presented, it is possible to perceive the importance of promoting and preventing mental illness among nursing professionals and everyone who makes up the health workforce, in order to make them more resilient, promoting a better quality of life in a general context. Thus, promoting the character of confrontation and positive construction in the face of adversity, and thus, being resilient.

Category 03-The stress of the medical professional
In this category, 02 studies were grouped, which also follow the same line as the previous ones, "grouped by approximation". These studies addressed the condition of the medical professional, in the face of the pandemic that had a direct impact, increasing suffering, reflecting on physical and mental health. Even though it is a problem, there are still few researchers/scholars who are willing to carry out a survey to try strategies to mitigate the problem.
In this line of care, we can understand that the fact, which contributed the most, was undoubtedly at the height of Covid-19, causing an overcrowding of patients with the virus, with fewer and fewer professionals with preparation and expertise to help, in the relay covering days off, hours of rest during shifts, in addition to the lack of knowledge about the disease and the great possibility of contamination, generating uncertainty, fear of death, separation from the family.
Collaborating with the discussion, the study by Almeida, et al (26)  In this perspective, the reality experienced in which there were no choices, the need for this professional and many other health categories justifies the illness, unfortunately both the health units of the unified health system (SUS) and so little the health companies that provide "private" health services, do not have a plan to meet needs that are invisible to the eye, but with great power to devastate the subject's life, regardless of their profession, especially when this professional is caring for a population in conditions of an already established disease.

Conclusion
In the face of all setbacks, it is possible to conclude that no one is prepared for the pandemic that is plaguing us, and, with that, it showed us the high overload of health professionals in which they carried out their work activities without resources and without support. In addition, linked to these factors, there is the psychological suffering resulting from the lack of equipment, the long hours of work and the lack of a suitable place to rest, which consequently directly affected their quality of life.
Through the research used in the corpus of this study, the predominance of methodological processes with a cross section proved to be more prevalent, linked to a field research and another quali-quanti. However, it is necessary to promote and provide research regarding the thematic axis, since it becomes essential since producing science aimed at professionals who are on the front line only SARS-CoV-2 in their work practice, since science raises an improvement in professional practice, however, it generates protection for them, covering all occupational health in which it ensures support for both physical and mental health, and, with that, an improvement in health care in society. Considering that the productions available in the database both in the Brazilian social fabric and in the world scenario are scarce.
Therefore, taking into account that the work environment directly influences the mental health of the worker.
Factors such as management style, stress, dangerousness, noise, environmental condition, among others, affect not only physically, but mentally the individual. Thus, it is up to the reflection of the population, our rulers and professionals of the class, alluding to the necessary improvements for a good quality in the resolution of health care.