Iveth Yamaguchi Whitaker

Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk

Aims and objective.  To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background.  Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design.  Prospective descriptive study. Methods.  Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results.  The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion.  Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice.  Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining appropriate strategies to prevent pressure ulcers, to improve quality of care for patient safety and to reduce length of ICU and hospital stay and costs.

Qualidade de vida dos trabalhadores de enfermagem de unidades de terapia intensiva

OBJECTIVES: To assess the quality of life of nursing assistants and licensed practical nurses from nine Intensive Care Units and to determine whether their demographic characteristics influence their quality of life. METHODS: This cross-sectional study was conducted in a teaching hospital in Sao Paulo city, Brazil. The sample consisted of 126 nursing assistants or licensed practical nurses. Data were collected from October to November, 2005. Quality of life was measured with the WHOQOL-BREF tool. RESULTS: The average score on each domain of the WHOQOL-BREF were: Social relations (66.3), psychological (60.8), physical (53.1), and environment (49.4). Among the demographics, age was positively correlated with the physical domain of quality of life, and number of jobs was inversely correlated with the physical, psychological, and social relations domains. There was also a weak correlation between age and number of jobs. CONCLUSION: The scores on the domains of quality of life among the sample of this study were low.

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.

Gravidade do trauma avaliada na fase pré-hospitalar

The trauma severity assessment and basic life support maneuvers in prehospital setting can represent to the trauma victim the opportunity of survival until his/her can get assistance in the hospital. PURPOSE: To study external cause victims assessed in the prehospital phase by the physiologic index named Trauma Score modificado (TSm). METHODS: Retrospective analyses were made of 1414 victims attended by Sistema de Atendimento Movel as Urgencias (SAMU-RESGATE-SP) in the Municipality of Sao Paulo during 1991. Data were gathered from prehospital data recording sheets and necropsy records. RESULTS: Prehospital attendance was carried out in 81.31% until 40 minutes. Non-fatal victims (83.96%) had 12 and 11 TSm scores while 53.96% of the fatal victims had 0, 1 and 2 scores. External surface (30.25%) and head/neck (20.98%) were most injured areas and 63.63% fatal victims with Injury Severity Score (ISS) ³16 died within first 24 hours. Comparing the fatal victims TSm and ISS scores verified that 81.20% victims with TSm score between 0 and 11 had major trauma (ISS ³16). CONCLUSION: Strong trends were also found out in that fatal victims with low TSm scores showed relations to the high ISS scores.

Úlcera por pressão: risco e gravidade do paciente e carga de trabalho de enfermagem

OBJECTIVES: to examine the association between pressure ulcer (PU) in critical care patients and their Braden scale score and the association between patient acuity and nursing workload, and to identify the risk factors for pressure ulcer among patients in critical care units (CCUs). METHODS: This was a cross-sectional study with 74 patients in three CCUs at a major hospital. Data were collected prospectively using the simplified acute physiology score (SAPS II), the nursing activities score (NAS), and the Braden scale. RESULTS: Approximately a third of patients (31%) had a PU. Factors associated with PUs were age, days of hospital stay, the score on the Braden scale, and the score on the SAPS II. The score on the NAS was not associated with PUs. Scores on the SAPS II and NAS were moderately correlated with the score on the Braden scale. CONCLUSION: The development of PUs was associated with advanced age, longer hospital stay, and patient acuity. Patient acuity and nursing workload were predictors of UPs.Objectives: to examine the association between pressure ulcer (PU) in critical care patients and their Braden scale score and the association between patient acuity and nursing workload, and to identify the risk factors for pressure ulcer among patients in critical care units (CCUs). Methods: This was a cross-sectional study with 74 patients in three CCUs at a major hospital. Data were collected prospectively using the simplified acute physiology score (SAPS II), the nursing activities score (NAS), and the Braden scale. Results: Approximately a third of patients (31%) had a PU. Factors associated with PUs were age, days of hospital stay, the score on the Braden scale, and the score on the SAPS II. The score on the NAS was not associated with PUs. Scores on the SAPS II and NAS were moderately correlated with the score on the Braden scale. Conclusion: The development of PUs was associated with advanced age, longer hospital stay, and patient acuity.

[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.

Carga de trabalho de enfermagem e sua relação com a gravidade dos pacientes cirúrgicos em UTI

OBJETIVOS: verificar la relacion entre la carga de trabajo de enfermeria (TISS-28) y las variables: gravedad de la enfermedad (APACHE II), supervivencia y, el tiempo de permanencia en la UCI de los pacientes quirurgicos. METODOS: La recoleccion de datos realizada de setiembre del 2002 a febrero del 2003, incluyo 143 pacientes de tres UCIs de un Hospital Docente del municipio de Sao Paulo. RESULTADOS: los pacientes no sobrevivientes obtuvieron medias de los escores APACHE II y TISS-28, estadisticamente, mas elevadas cuando comparadas a las medias de los sobrevivientes (p=0,001). Aquellos que permanecieron por mas tiempo en las UCIs obtuvieron escores TISS-28 mas elevados, mostrando mayor numero de horas de cuidados de enfermeria (CE) (p=0,005). Los pacientes con escores APACHE II mas elevados presentaron medias de horas de CE estadisticamente superiores (p=0,05). CONCLUSIONES: la carga de trabajo de enfermeria se relaciono con la gravedad de la enfermedad, la supervivencia y el tiempo de permanencia de los pacientes quirurgicos en la UCI.Objectives: The aim of this study was to analyze the relationships among nursing workload, illness severity, and the survival and the length of stay of surgical patients in ICUs. Methods: Data from 143 inpatients from three ICUs of a teaching hospital in São Paulo city were collected from September 2002 to February 2003. Results: The results showed that patients who did not survive during the length of stay in the ICUs had higher scores on illness severity (APACHE II) and nursing workload (TISS-28) than those individuals who survived (p = 0.001). Patients who had longer length of stay in ICUs also had higher scores on nursing workload (TISS-28), which in turn required more hours of nursing care (p = 0.005). And, patients who had a higher score on illness severity (APACHE II) also required more hours of nursing care (p = 0.05). Conclusion: nursing workload was related to illness severity and to the survival and length of stay in ICUs.

Capacitação de enfermeiros em atendimento pré-hospitalar

The performance of nurses in prehospital care (PHC) assumes acquiring specific competences. The objectives of the present study were to verify nurses’ opinion on theoretical knowledge and nursing skills necessary for the practice in pre-hospital setting and to analyze them according to their clinical practice. In this descriptive study, the opinion of nurses, from public pre-hospital care services of the City of Sao Paulo, was collected through a questionnaire and the data of the clinical practice using forms. Cardiopulmonary resuscitation was mentioned more often as basic knowledge (84%), and the most frequent procedure was oxygen therapy (15.5%). The analysis of nurses’ opinion indicated that the basic topics were related to situations that demanded making decisions, readiness and skill under stress or caring for a specific population, making training important in this area.A atuacao do enfermeiro na area de atendimento pre-hospitalar (APH) pressupoe a aquisicao de competencias especificas. Os objetivos deste estudo foram verificar a opiniao dos enfermeiros sobre conhecimentos teoricos e habilidades de enfermagem necessarios para o exercicio em APH e analisa-la de acordo com a pratica clinica. Neste estudo descritivo, a opiniao dos enfermeiros dos servicos publicos de APH do Municipio de Sao Paulo foi coletada por meio de questionario, e os dados da pratica clinica em formulario. A ressuscitacao cardiopulmonar foi mais citada como conhecimento basico (84%) e o procedimento mais frequente foi a oxigenoterapia (15,5%). A analise das opinioes dos enfermeiros revelou que os temas considerados basicos relacionaram-se as situacoes que exigem tomada de decisao, prontidao e destreza sob estresse, ou atendimento de uma populacao especifica, o que reforca a importância da capacitacao nessa area.

Estilos de liderança e perfil profissional de enfermeiros em Unidade de Terapia Intensiva

OBJETIVO: Verificar la asociacion entre estilos de liderazgo y perfil personal y profesional del enfermero frente a un miembro de su equipo en la realizacion de cuidados a pacientes de la UCI. METODOS: La muestra estuvo constituida por siete enfermeros y siete tecnicos de enfermeria que formaron parejas. Durante tres meses los enfermeros fueron cuestionados respecto al estilo de liderazgo que adoptaria cuando el tecnico de enfermeria, bajo su evaluacion, prestase cuidados a los pacientes admitidos en la UCI. RESULTADOS: Hubo predominio de los estilos persuadir, seguido de determinar y compartir de los lideres para con los liderados. CONCLUSION: En esta UCI, los enfermeros se destacan por el estilo de persuacion de liderazgo situacional en el cual explican sus decisiones y dan oportunidad de aclaraciones al equipo de liderados. No hubo relacion entre los estilos de liderazgo de los enfermeros y su perfil personal y profesional.Objective: To verify the relation between leadership styles and personal and professional profile of a nurse facing another team member when performing ICU patient care. Methods: Samples were collected on seven nurses and seven practical nurses working as partners. Throughout three months, the nurses were inquired about the leadership style applied when the practical nurse, under their assessment, performed ICU patient care. Results: Persuasion style prevailed among other styles, followed by determining and sharing between leaders and their subordinated team member. Conclusion: In this ICU, nurses stand out due to their persuading situational leadership style where they explain their decisions and provide the opportunity for clarification to the subordinated team. No relation between the nurses’ leadership style and their professional and personal profile was shown.

Nurses' training in prehospital care

The performance of nurses in prehospital care (PHC) assumes acquiring specific competences. The objectives of the present study were to verify nurses’ opinion on theoretical knowledge and nursing skills necessary for the practice in pre-hospital setting and to analyze them according to their clinical practice. In this descriptive study, the opinion of nurses, from public pre-hospital care services of the City of Sao Paulo, was collected through a questionnaire and the data of the clinical practice using forms. Cardiopulmonary resuscitation was mentioned more often as basic knowledge (84%), and the most frequent procedure was oxygen therapy (15.5%). The analysis of nurses’ opinion indicated that the basic topics were related to situations that demanded making decisions, readiness and skill under stress or caring for a specific population, making training important in this area.A atuacao do enfermeiro na area de atendimento pre-hospitalar (APH) pressupoe a aquisicao de competencias especificas. Os objetivos deste estudo foram verificar a opiniao dos enfermeiros sobre conhecimentos teoricos e habilidades de enfermagem necessarios para o exercicio em APH e analisa-la de acordo com a pratica clinica. Neste estudo descritivo, a opiniao dos enfermeiros dos servicos publicos de APH do Municipio de Sao Paulo foi coletada por meio de questionario, e os dados da pratica clinica em formulario. A ressuscitacao cardiopulmonar foi mais citada como conhecimento basico (84%) e o procedimento mais frequente foi a oxigenoterapia (15,5%). A analise das opinioes dos enfermeiros revelou que os temas considerados basicos relacionaram-se as situacoes que exigem tomada de decisao, prontidao e destreza sob estresse, ou atendimento de uma populacao especifica, o que reforca a importância da capacitacao nessa area.