Elaine Machado de Oliveira

Nursing workload in neurological intensive care units: Cross-sectional study

BACKGROUND Nursing workload has been associated with quality of patient care. Thus, it is important to measure nursing workload in neurological intensive care units (neuro-ICUs). OBJECTIVE The aims of the study were to assess nursing workload in neuro-ICUs and identify independent factors associated with nursing workload. METHOD This descriptive, cross-sectional study was conducted in two neuro-ICUs with 11 beds each (for a total of 22 beds) of a private general hospital in the city of São Paulo, Brazil. Data from the first 24 hours of admission to the neuro-ICUs from 100 consecutive patients were collected from the hospital database. The Nursing Activities Score (NAS) was used to assess nursing workload in the neuro-ICUs. Data were analysed using descriptive and inferential statistics and multiple linear regression analysis. Statistical significance was set at α=0.05. RESULTS Patients were mostly men (52.00%), had a mean age of 55.10 years, median length of ICU stay of 2 days, and survival rate of 94.00%. Fifty-nine percent of patients were transferred from the surgical ward. Mean NAS was 65.18% (standard deviation=6.63%) and the risk of mortality according to the Simplified Acute Physiology Score (SAPS II) and the Logistic Organ Dysfunction System (LODS) was 17.79% and 16.30%, respectively. CONCLUSION The present results are important for the effective planning and use of nursing resources according to the care needs of patients in neuro-ICUs.

Alocação da equipe de enfermagem e ocorrência de eventos adversos/incidentes em unidade de terapia intensiva

A seguranca do paciente representa um desafio para a excelencia da qualidade no setor saude. Este estudo objetivou: verificar a adequacao entre a alocacao da equipe de enfermagem e as horas de cuidado requeridas pelos pacientes, bem como identificar a relacao entre essa alocacao com eventos adversos/incidentes (EA/I). Trata-se de pesquisa observacional, descritiva e prospectiva, desenvolvida nas Unidades de Terapia Intensiva Clinicas do 4o andar e 6o andar de um Hospital Universitario, do municipio de Sao Paulo, Brasil, no periodo de 01/11/07 a 10/12/07, com 46 pacientes. Nas UTIs 4o andar e 6o andar, respectivamente, 43,3% e 10,3% das alocacoes foram inadequadas (p = 0,000). Houve diferenca na frequencia de EA/I nas alocacoes adequadas e inadequadas da equipe de enfermagem da UTI 4o andar e UTI 6o andar, p = 0,0004 e p = 0,000, respectivamente. Concluiu-se que, quanto maior a diferenca entre as horas disponiveis e requeridas de cuidado nas alocacoes de enfermagem, menor a frequencia de EA/I.Patient safety is a challenge for the quality in health care system. This study aimed to analyze the appropriateness of the allocation of nursing staff according to the hours of care required by patients and to identify the relationship between this allocation and adverse events/incidents (EA/I). This research was observational, descriptive and prospective, developed in Clinics ICU located in the 4th floor and 6th floor at a university hospital, in São Paulo, Brazil, from 01/11/07 to 10/12/07, with 46 patients. In the 4th floor and 6th floor ICU, respectively, 43,3% and 10.3% of allocations were inadequate (p=0.000). There was a difference in the frequency of EA/I between the adequate and inadequate allocation of nursing staff in the 4th floor and 6th floor ICU, p=0.0004 and p=0.000, respectively. It was concluded that the greater the difference between available and required hours of care in nursing allocations, the lower the frequency of EA/I.

Nursing allocation and adverse events/incidents in intensive care units

A seguranca do paciente representa um desafio para a excelencia da qualidade no setor saude. Este estudo objetivou: verificar a adequacao entre a alocacao da equipe de enfermagem e as horas de cuidado requeridas pelos pacientes, bem como identificar a relacao entre essa alocacao com eventos adversos/incidentes (EA/I). Trata-se de pesquisa observacional, descritiva e prospectiva, desenvolvida nas Unidades de Terapia Intensiva Clinicas do 4o andar e 6o andar de um Hospital Universitario, do municipio de Sao Paulo, Brasil, no periodo de 01/11/07 a 10/12/07, com 46 pacientes. Nas UTIs 4o andar e 6o andar, respectivamente, 43,3% e 10,3% das alocacoes foram inadequadas (p = 0,000). Houve diferenca na frequencia de EA/I nas alocacoes adequadas e inadequadas da equipe de enfermagem da UTI 4o andar e UTI 6o andar, p = 0,0004 e p = 0,000, respectivamente. Concluiu-se que, quanto maior a diferenca entre as horas disponiveis e requeridas de cuidado nas alocacoes de enfermagem, menor a frequencia de EA/I.Patient safety is a challenge for the quality in health care system. This study aimed to analyze the appropriateness of the allocation of nursing staff according to the hours of care required by patients and to identify the relationship between this allocation and adverse events/incidents (EA/I). This research was observational, descriptive and prospective, developed in Clinics ICU located in the 4th floor and 6th floor at a university hospital, in São Paulo, Brazil, from 01/11/07 to 10/12/07, with 46 patients. In the 4th floor and 6th floor ICU, respectively, 43,3% and 10.3% of allocations were inadequate (p=0.000). There was a difference in the frequency of EA/I between the adequate and inadequate allocation of nursing staff in the 4th floor and 6th floor ICU, p=0.0004 and p=0.000, respectively. It was concluded that the greater the difference between available and required hours of care in nursing allocations, the lower the frequency of EA/I.

Estresse, coping e burnout da Equipe de Enfermagem de Unidades de Terapia Intensiva: fatores associados

Objective To investigate emotional stress, coping and burnout among nursing staff and their association with biosocial factors and characteristics of work in Intensive Care Units (ICU). Method This was a cross-sectional study, conducted in eight ICUs at a teaching hospital in the city of Sao Paulo, Brazil, in October 2012. Biosocial data and information about the professionals’ work was gathered, and they were given the Scale of Occupational Stress, Scale of Occupational Coping, List of Signs and Symptoms of Stress and the Maslach Burnout Inventory. Results The study sample consisted of 287 subjects, predominately women, with partners and children. Most professionals presented moderate stress levels and control as a coping strategy (74.47% and 79.93%, respectively), and burnout was present among 12.54%. Factors associated with stress were related to working conditions. The most prevalent protective factors were having a partner, working in the clinical ICU and liking work, while adequate amount of sleep was a protective factor for burnout. Conclusion Control of the working environment and adequate sleep are decisive and protective factors in dealing with situations of occupational stress.

Carga de trabalho de enfermagem: preditor de infecção relacionada à assistência à saúde na terapia intensiva?

Objective To analyze the influence of nursing workload on the occurrence of healthcare associated infection (HAI) in patients in the intensive care unit (ICU), according to type of treatment. Method Retrospective cohort study developed in nine ICUs in São Paulo, Brazil, from September to December 2012. Nursing workload was measured by the Nursing Activities Score (NAS). The Students t and Fishers exact tests and logistic regressions were used in the analyses. Results The sample was composed of 835 patients (54.3±17.3 years; 57.5% male), of which 12.5% acquired HAI in the ICU. The NAS of the patients admitted for clinical treatment was 71.3±10.9, and for surgery 71.6±9.2. Length of stay in ICU and severity were predictive factors for occurrence of HAI in patients admitted to the unit for clinical or surgical treatment, and male sex only for surgical patients. When considering the admissions independent of type of treatment, in addition to the variables mentioned above, index of comorbidities also remained in the regression model. The NAS was not a predictive factor of HAI. Conclusion Nursing workload did not influence occurrence of HAI in the patients included in this study.Objetivo Analizar la influencia de la carga de trabajo de enfermeria en caso de infeccion hospitalaria (IH) en pacientes en la Unidad de Cuidados Intensivos (UCI) segundo tipo de tratamiento. Metodo Estudio retrospectivo de cohorte realizado en nueve unidades de cuidados intensivos, en Sao Paulo, Brasil, de septiembre a diciembre de 2012. La carga de trabajo de enfermeria se midio por lo Nursing Activities Score (NAS). Las pruebas t de Student, test exacto de Fisher y regresiones logisticas fueron utilizados. Resultados La muestra fue de 835 pacientes (54,3±17,3 anos; 57,5% hombres), entre los cuales el 12,5% adquirio IH. El NAS de pacientes admitidos a tratamiento clinico fue de 71,3±10,9 y quirurgico, 71,6±9,2. La duracion de la estancia en la unidad y la gravedad fueron factores predictivos de la ocurrencia de IH en pacientes ingresados en la UCI para el tratamiento medico o quirurgico y los hombres solo para los pacientes quirurgicos. Al considerar las admisiones independientes del tipo de tratamiento, indice de comorbilidad tambien se mantuvo en el modelo de regresion. El NAS no fue predictivo de IH. Conclusion La carga de trabajo de enfermeria ejerce ninguna influencia sobre la ocurrencia de IH en los pacientes analizados.Objetivo Analisar a influencia da carga de trabalho de enfermagem na ocorrencia de infeccao relacionada a assistencia a saude (IRAS) em pacientes na Unidade de Terapia Intensiva (UTI), segundo o tipo de tratamento. Metodo Estudo de coorte retrospectivo desenvolvido em nove UTI em Sao Paulo, Brasil, de setembro a dezembro de 2012. A carga de trabalho de enfermagem foi mensurada pelo Nursing Activities Score (NAS). Os testes T-Student, Exato de Fisher e regressoes logisticas foram utilizados nas analises. Resultados A casuistica foi composta por 835 pacientes (54,3±17,3 anos; 57,5% do sexo masculino), dentre os quais 12,5% adquiriram IRAS na UTI. O NAS dos pacientes admitidos para tratamento clinico foi de 71,3±10,9 e para cirurgico, 71,6±9,2. O tempo de permanencia na unidade e a gravidade foram fatores preditivos para ocorrencia de IRAS em pacientes admitidos nas UTI para tratamento clinico ou cirurgico e o sexo masculino apenas para pacientes cirurgicos. Ao considerar as admissoes independentes do tipo de tratamento, alem das variaveis citadas, o indice de comorbidades tambem permaneceu no modelo de regressao. O NAS nao foi fator preditivo de IRAS. Conclusao A carga de trabalho de enfermagem nao exerceu influencia na ocorrencia de IRAS nos pacientes deste estudo.

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.

Stress, coping and burnout among Intensive Care Unit nursing staff: associated factors

Objective To investigate emotional stress, coping and burnout among nursing staff and their association with biosocial factors and characteristics of work in Intensive Care Units (ICU). Method This was a cross-sectional study, conducted in eight ICUs at a teaching hospital in the city of Sao Paulo, Brazil, in October 2012. Biosocial data and information about the professionals’ work was gathered, and they were given the Scale of Occupational Stress, Scale of Occupational Coping, List of Signs and Symptoms of Stress and the Maslach Burnout Inventory. Results The study sample consisted of 287 subjects, predominately women, with partners and children. Most professionals presented moderate stress levels and control as a coping strategy (74.47% and 79.93%, respectively), and burnout was present among 12.54%. Factors associated with stress were related to working conditions. The most prevalent protective factors were having a partner, working in the clinical ICU and liking work, while adequate amount of sleep was a protective factor for burnout. Conclusion Control of the working environment and adequate sleep are decisive and protective factors in dealing with situations of occupational stress.

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.

Padrão de intervenções de enfermagem realizadas em vítimas de trauma segundo o Nursing Activities Score

Objetivo Identificar el patron de las intervenciones de enfermeria en victimas de trauma en las primeras 24 horas en la Unidad de Cuidados Intensivos (UCI). Metodo Estudio prospectivo, realizado en la UCI de un hospital de Sao Paulo, Brasil. Se utilizo el Nursing Activities Score (NAS) para identificar las intervenciones de enfermeria. Resultados La muestra fue de 200 pacientes, en su mayoria hombres, edad media 40,7 anos, victimas de accidentes de trafico. El promedio NAS fue de 71,3% y el patron de las intervenciones de enfermeria incluye las actividades de monitoreo y valoracion; investigaciones de laboratorio; medicacion, excepto farmacos vasoactivos; procedimientos de higiene; cuidar de los drenajes; movilizacion y posicionamiento; apoyo y cuidado de familiares y pacientes; tareas administrativas y de gestion; apoyo respiratorio; cuidado de las vias aereas artificiales; y tratamiento para mejorar la funcion pulmonar. Las intervenciones de monitoreo y movilizacion hubo la necesidad de atencion mas alla de la que normalmente exigen los pacientes de la UCI. Conclusion Los resultados de este estudio aportan importantes contribuciones a la planificacion de las acciones encaminadas a la creacion de capacidades y el diseno del equipo de enfermeria en la unidad de criticos.Objective To identify the pattern of nursing interventions performed on trauma victims in the Intensive Care Unit (ICU). Method Prospective study performed in the ICU of a hospital in São Paulo, Brazil. Nursing interventions were identified using the Nursing Activities Score (NAS). Results The sample consisted of 200 patients, most of them male, with a mean age of 40.7, victims of transport accidents. The NAS mean was 71.3%. The pattern of nursing interventions identified included monitoring and titration, laboratory investigations, medication (with the exception of vasoactive drugs), hygiene procedures, caring for drains, mobilization and positioning, support and care of relatives and patient, administrative and managerial tasks, respiratory support, care of artificial airways, treatment for improving lung function, and quantitative urine output measurement. The monitoring and mobilization interventions required care beyond what is normally required by ICU patients. Conclusion The results of this study provide important contributions to plan training activities and to size ICU nursing team.