Adriana Janzantte Ducci

Carga de trabalho de enfermagem para quantificar proporção profissional de enfermagem/paciente em UTI cardiológica

This is a descriptive study, aiming at comparing the nursing workload in a post-operatory heart surgery unit (UPOCC) using NAS, TISS-28 and NEMS, and verifying both the observed and recommended nursing staff-to-patient ratio according to the workload indexes used. Data collection happened in a University Hospital, from October to November, 2004. The sample included 55 patients, resulting in 283 nursing workload measurements. The nursing workload measured by NAS (73.7%) were statistically higher than TISS-28 (66.2%) and NEMS (59.7%). The average of nursing staff-to-patient ratio estimated by NAS (1:1), TISS-28 (0.8:1) and NEMS (0.8:1) were lower than the observed ratio in the unit (1.2:1). We concluded that NAS measured a higher nursing workload and showed a nursing staff-to-patient ratio similar to the results found in the unit studied.This is a descriptive study, aiming at comparing the nursing workload in a post-operatory heart surgery unit (UPOCC) using NAS, TISS-28 and NEMS, and verifying both the observed and recommended nursing staff-to-patient ratio according to the workload indexes used. Data collection happened in a University Hospital, from October to November, 2004. The sample included 55 patients, resulting in 283 nursing workload measurements. The nursing workload measured by NAS (73.7%) were statistically higher than TISS-28 (66.2%) and NEMS (59.7%). The average of nursing staff-to-patient ratio estimated by NAS (1:1), TISS-28 (0.8:1) and NEMS (0.8:1) were lower than the observed ratio in the unit (1.2:1). We concluded that NAS measured a higher nursing workload and showed a nursing staff-to-patient ratio similar to the results found in the unit studied.

Nursing activities score: estudo comparativo da aplicação retrospectiva e prospectiva em unidade de terapia intensiva

Objectives: To analyze the performance of the Nursing Activities Score (NAS) to measure the prospective nursing workload in Intensive Care Units (ICU) and to compare the NAS values obtained in prospective and retrospective applications of the instrument, in addition to verifying the degree of concordance in the items that comprise it applied prospectively and retrospectively. Methods: NAS was applied prospectively and retrospectively. Student’s t, Pearson’s coefficient and Intra-class correlation (ICC) were used to verify correlation and homogeneity. For agreement between each item, the Kappa coefficient was used. Results: There were differences (p < 0.001) between the prospective and retrospective NAS averages (Pearson 0.65 and ICC 0.623). Kappa was not applied to 11 items due to the high percentage of agreement in a single response category. Ten items (47.6%) had agreements equal or higher than moderate. Items with very strong and strong agreement refer to objective data that usually do not present disagreements. Items with sub-items had lower agreements. Conclusions: Prospective NAS performed well in measuring nursing workload at the ICU.Objective: To analyze the performance of the Nursing Activities Score (NAS) to measure the prospective nursing workload in Intensive Care Units (ICU) and to compare the NAS values obtained in prospective and retrospective applications of the instrument, in addition to verifying the degree of concordance in the items that comprise it applied prospectively and retrospectively. Methods: NAS was applied prospectively and retrospectively. Student’s t, Pearson’s coefficient and Intra-class correlation (ICC) were used to verify correlation and homogeneity. For agreement between each item, the Kappa coefficient was used. Results: There were differences (p < 0.001) between the prospective and retrospective NAS averages (Pearson 0.65 and ICC 0.623). Kappa was not applied to 11 items due to the high percentage of agreement in a single response category. Ten items (47.6%) had agreements equal or higher than moderate. Items with very strong and strong agreement refer to objective data that usually do not present disagreements. Items with sub-items had lower agreements. Conclusions: Prospective NAS performed well in measuring nursing workload at the ICU.

[Nursing workload to verify nurse/patient ratio in a cardiology ICU].

This is a descriptive study, aiming at comparing the nursing workload in a post-operatory heart surgery unit (UPOCC) using NAS, TISS-28 and NEMS, and verifying both the observed and recommended nursing staff-to-patient ratio according to the workload indexes used. Data collection happened in a University Hospital, from October to November, 2004. The sample included 55 patients, resulting in 283 nursing workload measurements. The nursing workload measured by NAS (73.7%) were statistically higher than TISS-28 (66.2%) and NEMS (59.7%). The average of nursing staff-to-patient ratio estimated by NAS (1:1), TISS-28 (0.8:1) and NEMS (0.8:1) were lower than the observed ratio in the unit (1.2:1). We concluded that NAS measured a higher nursing workload and showed a nursing staff-to-patient ratio similar to the results found in the unit studied.This is a descriptive study, aiming at comparing the nursing workload in a post-operatory heart surgery unit (UPOCC) using NAS, TISS-28 and NEMS, and verifying both the observed and recommended nursing staff-to-patient ratio according to the workload indexes used. Data collection happened in a University Hospital, from October to November, 2004. The sample included 55 patients, resulting in 283 nursing workload measurements. The nursing workload measured by NAS (73.7%) were statistically higher than TISS-28 (66.2%) and NEMS (59.7%). The average of nursing staff-to-patient ratio estimated by NAS (1:1), TISS-28 (0.8:1) and NEMS (0.8:1) were lower than the observed ratio in the unit (1.2:1). We concluded that NAS measured a higher nursing workload and showed a nursing staff-to-patient ratio similar to the results found in the unit studied.

Nursing activities score: a comparative study about retrospective and prospective applications in intensive care units

Objectives: To analyze the performance of the Nursing Activities Score (NAS) to measure the prospective nursing workload in Intensive Care Units (ICU) and to compare the NAS values obtained in prospective and retrospective applications of the instrument, in addition to verifying the degree of concordance in the items that comprise it applied prospectively and retrospectively. Methods: NAS was applied prospectively and retrospectively. Student’s t, Pearson’s coefficient and Intra-class correlation (ICC) were used to verify correlation and homogeneity. For agreement between each item, the Kappa coefficient was used. Results: There were differences (p < 0.001) between the prospective and retrospective NAS averages (Pearson 0.65 and ICC 0.623). Kappa was not applied to 11 items due to the high percentage of agreement in a single response category. Ten items (47.6%) had agreements equal or higher than moderate. Items with very strong and strong agreement refer to objective data that usually do not present disagreements. Items with sub-items had lower agreements. Conclusions: Prospective NAS performed well in measuring nursing workload at the ICU.Objective: To analyze the performance of the Nursing Activities Score (NAS) to measure the prospective nursing workload in Intensive Care Units (ICU) and to compare the NAS values obtained in prospective and retrospective applications of the instrument, in addition to verifying the degree of concordance in the items that comprise it applied prospectively and retrospectively. Methods: NAS was applied prospectively and retrospectively. Student’s t, Pearson’s coefficient and Intra-class correlation (ICC) were used to verify correlation and homogeneity. For agreement between each item, the Kappa coefficient was used. Results: There were differences (p < 0.001) between the prospective and retrospective NAS averages (Pearson 0.65 and ICC 0.623). Kappa was not applied to 11 items due to the high percentage of agreement in a single response category. Ten items (47.6%) had agreements equal or higher than moderate. Items with very strong and strong agreement refer to objective data that usually do not present disagreements. Items with sub-items had lower agreements. Conclusions: Prospective NAS performed well in measuring nursing workload at the ICU.

Intervenções terapêuticas em Unidade de Terapia Intensiva: análise segundo o Therapeutic Intervention Scoring System-28 (TISS-28)

The present study aimed to identify the therapeutic interventions categories carried out in Intensive Care Units (ICU), finding out their prevalence and identifying their components according to TISS-28. The sample was composed of 89 adult patients who were consecutively admitted to the ICU of a university hospital in São Paulo city. Basic and Supportive Activities, Ventilatory, Cardiovascular and Renal were the TISS-28 that prevailed with a frequency of 73.0% and 100%. The frequency of the items considered Basic Activities were prevalent, that is, higher than 90.0%. The quantitative average of urinary debt was 98.2% concerning Renal Support. The results may mean quality of assistance provided to the clients, as they contribute to the human resources estimative and materials in the ICU as well.El presente estudio tuvo como objectivos, identificar las categorias de intervenciones terapeuticas realizadas en la Unidad de Cuidados Intensivos (UCI) y describir la prevalencia diaria de las mismas e identificar los items que la conforman, segun el TISS-28. La muestra estuvo constituida por 89 pacientes adultos admitidos consecutivamente en la UCI de un hospital universitario de la municipalidad de Sao Paulo. Se verifico que las categorias TISS-28 que prevalecieron fueron Actividades Basicas y Soportes Ventilatorio, Cardiovascular y Renal con frecuencias entre 73,0% y 100%. La frecuencia de los items componentes de la categoria Actividades Basicas fue prevaliente, ou sea, mayor que el 90,0%. La medida cuantitativa del debito urinario fue puntuado en 98,2% en la categoria Soporte Renal. Los resultados obtenidos pueden imprimir calidad a la asistencia prestada a los clientes, en la medida en que contribuyen a la prevision de recursos humanos y materiales en la UCI.

Therapeutic interventions in Intensive Care Units: analysis according to Therapeutic Intervention Scoring System-28 (TISS-28)

The present study aimed to identify the therapeutic interventions categories carried out in Intensive Care Units (ICU), finding out their prevalence and identifying their components according to TISS-28. The sample was composed of 89 adult patients who were consecutively admitted to the ICU of a university hospital in São Paulo city. Basic and Supportive Activities, Ventilatory, Cardiovascular and Renal were the TISS-28 that prevailed with a frequency of 73.0% and 100%. The frequency of the items considered Basic Activities were prevalent, that is, higher than 90.0%. The quantitative average of urinary debt was 98.2% concerning Renal Support. The results may mean quality of assistance provided to the clients, as they contribute to the human resources estimative and materials in the ICU as well.El presente estudio tuvo como objectivos, identificar las categorias de intervenciones terapeuticas realizadas en la Unidad de Cuidados Intensivos (UCI) y describir la prevalencia diaria de las mismas e identificar los items que la conforman, segun el TISS-28. La muestra estuvo constituida por 89 pacientes adultos admitidos consecutivamente en la UCI de un hospital universitario de la municipalidad de Sao Paulo. Se verifico que las categorias TISS-28 que prevalecieron fueron Actividades Basicas y Soportes Ventilatorio, Cardiovascular y Renal con frecuencias entre 73,0% y 100%. La frecuencia de los items componentes de la categoria Actividades Basicas fue prevaliente, ou sea, mayor que el 90,0%. La medida cuantitativa del debito urinario fue puntuado en 98,2% en la categoria Soporte Renal. Los resultados obtenidos pueden imprimir calidad a la asistencia prestada a los clientes, en la medida en que contribuyen a la prevision de recursos humanos y materiales en la UCI.

Produção científica brasileira de enfermagem em terapia intensiva de 1995 a 2004

OBJECTIVE: To investigate nursing research in critical care in Brazil from 1995 to 2004. METHODS: Selected articles from ten Brazilian scientific journals were analyzed regarding frequency of publication, authorship, research methodology, topic, and study population. RESULTS: Among 3464 published articles, only 97 (2.8%) were related to critical care. A great part of these studies (38.1%) was conducted by Masters or Doctoral graduate students. Almost a half of the studies (49.5%) used qualitative design. Main topics studied consisted of the professional performance of worker involved on care (23.7%) and emotional aspects of nursing care (21.6%). Iatrogenic occurrences also emerge as an important topic. Nursing team was a common sample (50.0%) of the studies. CONCLUSION: Nursing research in critical care in Brazil although incipient remains stable in the last two decades.OBJECTIVE: To investigate nursing research in critical care in Brazil from 1995 to 2004. METHODS: Selected articles from ten Brazilian scientific journals were analyzed regarding frequency of publication, authorship, research methodology, topic, and study population. RESULTS: Among 3464 published articles, only 97 (2.8%) were related to critical care. A great part of these studies (38.1%) was conducted by Masters or Doctoral graduate students. Almost a half of the studies (49.5%) used qualitative design. Main topics studied consisted of the professional performance of worker involved on care (23.7%) and emotional aspects of nursing care (21.6%). Iatrogenic occurrences also emerge as an important topic. Nursing team was a common sample (50.0%) of the studies. CONCLUSION: Nursing research in critical care in Brazil although incipient remains stable in the last two decades.

Fatores relacionados à ocorrência de eventos adversos em pacientes idosos críticos

Objective: to identify the factors associated with the occurrence of adverse events in critical elderly patients admitted to intensive care unit according to demographic and clinical characteristics. Method: a retrospective cohort study was conducted in nine units of a teaching hospital. Data were collected from medical records and from monitoring of nursing shift change. We used the t-test/Mann-Whitney, chi-square and logistic regression to test associations. Significance level of 5% was used. Results: out of the 315 elderly, 94 experienced events. Those who experienced events were men (60.6%) with mean age of 70.7 years, length of hospital stay of 10.6 days and survivors (61.7%). Most of the 183 events were clinical processes and procedures (37.1%). There was an association between adverse event and length of hospital stay in the unit (p=0.000; OR=1.10, 95% CI [1.06, 1.14]). Conclusion: the identification of associated events and factors in the elderly subsidize the prevention of these occurrences before the vulnerability of this age group.Objetivo: identificar los factores relacionados con el acaecimiento de eventos adversos en pacientes criticos de edad avanzada segun caracteristicas demograficas y clinicas, internados en Unidades de Terapia Intensiva. Metodo: estudio de corte retrospectivo realizado en nueve unidades de un hospital universitario. Se recolectaron datos de los prontuarios y del acompanamiento de la guardia de enfermeria. Las asociaciones se comprobaron mediante la Prueba de Mann-Whitney, la distribucion de Pearson (ji cuadrado) y la Regresion Logistica. El nivel de significacion fue del 5%. Resultados: sufrieron eventos 94 personas mayores del total de 315, siendo del sexo masculino el 60,6%, con edad promedio de 70,7 anos, permanencia de 10,6 dias y sobrevivencia del 61,7%. De los 183 eventos, predomino el proceso clinico y el procedimiento (37,1%). Se observo que el evento adverso y el tiempo de permanencia en la unidad estaban relacionados (p=0,000; OR=1,10; IC95%=[1,06;1,14]). Conclusion: la identificacion de los eventos y de los factores asociados a la vejez auxilia en la prevencion de dichos sucesos frente a la vulnerabilidad de ese grupo de edad.Objetivo: identificar los factores relacionados con el acaecimiento de eventos adversos en pacientes criticos de edad avanzada segun caracteristicas demograficas y clinicas, internados en Unidades de Terapia Intensiva. Metodo: estudio de corte retrospectivo realizado en nueve unidades de un hospital universitario. Se recolectaron datos de los prontuarios y del acompanamiento de la guardia de enfermeria. Las asociaciones se comprobaron mediante la Prueba de Mann-Whitney, la distribucion de Pearson (ji cuadrado) y la Regresion Logistica. El nivel de significacion fue del 5%. Resultados: sufrieron eventos 94 personas mayores del total de 315, siendo del sexo masculino el 60,6%, con edad promedio de 70,7 anos, permanencia de 10,6 dias y sobrevivencia del 61,7%. De los 183 eventos, predomino el proceso clinico y el procedimiento (37,1%). Se observo que el evento adverso y el tiempo de permanencia en la unidad estaban relacionados (p=0,000; OR=1,10; IC95%=[1,06;1,14]). Conclusion: la identificacion de los eventos y de los factores asociados a la vejez auxilia en la prevencion de dichos sucesos frente a la vulnerabilidad de ese grupo de edad.

Segurança do paciente em Unidades de Terapia Intensiva: desenvolvimento de um projeto de pesquisa

Objetivo Relatar a experiencia sobre os diferentes processos envolvidos no desenvolvimento de um Projeto de Pesquisa em Seguranca do Paciente em Unidades de Terapia Intensiva. Metodo Estudo com delineamento misto: coorte historica para a coleta dos dados dos pacientes e eventos adversos/incidentes e transversal para a coleta dos dados da equipe de enfermagem. A coleta de dados ocorreu durante 90 dias, em 2012, no Instituto Central do Hospital das Clinicas da Universidade de Sao Paulo e o Hospital Universitario da Universidade de Sao Paulo. Processos desenvolvidos A pesquisa envolveu diversas etapas para sua efetivacao: implantacao doNursing Activities Score (NAS) no Instituto Central do Hospital das Clinicas da Universidade de Sao Paulo, desenvolvimento de sistema de banco de dados, digitalizacao de prontuarios, treinamento de monitores, extracao e carga de dados dos pacientes e coleta de dados durante a passagem de plantao, prontuarios. Consideracoes finais Treinamentos, comprometimento dos pesquisadores e parceria com profissionais da tecnologia da informacao foram fundamentais para a qualidade dos resultados obtidos e da producao cientifica alcancada. Espera-se que esse relato de experiencia possa orientar e encorajar os pesquisadores a realizar pesquisas complexas que contribuam para a construcao do conhecimento na enfermagem e saude.OBJECTIVE To describe our experience in the many processes involved in the development of a Project on Research into Intensive Care Unit Patient Safety. METHOD Mixed design study: historic cohort study of the collection of data on patients and on adverse events/incidents and transversal design on the collection of data on a nursing team. The data were collected over a period of 90 days in 2012 at the Instituto Central do Hospital das Clínicas da Faculdade de Medicina of the Universidade de São Paulo (ICHC-FMUSP)and the University Hospital of the Universidade de São Paulo HU-USP).Procedures carried out: This study involved a number of stages: application of the Nursing Activities Score (NAS) at the ICHC-FMUSP, creation of a database system, hospital record inputs, monitor training, patient data extraction and load, collection of data during duty shift changes, and records. Final considerations : Training, researcher commitment, and collaboration with IT (Information Technology) professionals were crucial to the quality of the results obtained and of scientific production achieved. We hope that our report will serve to guide and encourage researchers to carry out complex surveys contributing to improve nursing and health knowledge.

Patient safety in Intensive Care Units: development of a research project

Objetivo Relatar a experiencia sobre os diferentes processos envolvidos no desenvolvimento de um Projeto de Pesquisa em Seguranca do Paciente em Unidades de Terapia Intensiva. Metodo Estudo com delineamento misto: coorte historica para a coleta dos dados dos pacientes e eventos adversos/incidentes e transversal para a coleta dos dados da equipe de enfermagem. A coleta de dados ocorreu durante 90 dias, em 2012, no Instituto Central do Hospital das Clinicas da Universidade de Sao Paulo e o Hospital Universitario da Universidade de Sao Paulo. Processos desenvolvidos A pesquisa envolveu diversas etapas para sua efetivacao: implantacao doNursing Activities Score (NAS) no Instituto Central do Hospital das Clinicas da Universidade de Sao Paulo, desenvolvimento de sistema de banco de dados, digitalizacao de prontuarios, treinamento de monitores, extracao e carga de dados dos pacientes e coleta de dados durante a passagem de plantao, prontuarios. Consideracoes finais Treinamentos, comprometimento dos pesquisadores e parceria com profissionais da tecnologia da informacao foram fundamentais para a qualidade dos resultados obtidos e da producao cientifica alcancada. Espera-se que esse relato de experiencia possa orientar e encorajar os pesquisadores a realizar pesquisas complexas que contribuam para a construcao do conhecimento na enfermagem e saude.OBJECTIVE To describe our experience in the many processes involved in the development of a Project on Research into Intensive Care Unit Patient Safety. METHOD Mixed design study: historic cohort study of the collection of data on patients and on adverse events/incidents and transversal design on the collection of data on a nursing team. The data were collected over a period of 90 days in 2012 at the Instituto Central do Hospital das Clínicas da Faculdade de Medicina of the Universidade de São Paulo (ICHC-FMUSP)and the University Hospital of the Universidade de São Paulo HU-USP).Procedures carried out: This study involved a number of stages: application of the Nursing Activities Score (NAS) at the ICHC-FMUSP, creation of a database system, hospital record inputs, monitor training, patient data extraction and load, collection of data during duty shift changes, and records. Final considerations : Training, researcher commitment, and collaboration with IT (Information Technology) professionals were crucial to the quality of the results obtained and of scientific production achieved. We hope that our report will serve to guide and encourage researchers to carry out complex surveys contributing to improve nursing and health knowledge.