Rafaela Andolhe

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.

Carga de trabalho de enfermagem em unidade de terapia intensiva de cardiologia e fatores clínicos associados

O estudo objetivou identificar a carga de trabalho de enfermagem em unidade de Terapia Intensiva de Cardiologia e verificar a associacao dessa variavel com caracteristicas demograficas e clinicas dos pacientes. A amostra foi de 100 pacientes internados no periodo de agosto a setembro de 2006, na Unidade de Terapia Intensiva Cardiologica de um hospital privado, do Municipio de Sao Paulo. O Nursing Activities Score, o Symplified Acute Physiologic ScoreII e o Logistic Organ Disfunction System foram utilizados para medir a carga de trabalho de enfermagem, a gravidade e a disfuncao orgânica, respectivamente. A carga de trabalho de enfermagem foi de 66,60%, equivalente a 5,30 horas de trabalho, em um turno de oito horas. A excecao do tempo de permanencia na Unidade de Terapia Intensiva, que apresentou moderada correlacao com a carga de trabalho, nao houve associacao com as demais variaveis analisadas. Recomenda-se a ampliacao da amostra para conclusoes generalizaveis.The objective of this study was to identify the nursing workload in the Cardiac Intensive Care Unit and to verify the association of this variable according to demographic and clinical patient’s characteristics. The sample consisted of 100 patients hospitalized between August and September of 2006 in a Cardiac Intensive Care Unit of a private hospital in Sao Paulo, Brazil. The Nursing Activities Score, Simplified Acute Physiologic Score II, and the Logistic Organ Dysfunction System were used to measure the nursing workload, severity, and organic dysfunction, respectively. The nursing workload was 66.60% which is equivalent to 5.30 work hours during an eight hour shift. Except for the length of stay in the Intensive Care Unit, which showed a moderate correlation with the workload, there was no association with the other analyzed variables. An expansion of the sample to provide generalized conclusions is highly recommended. DESCRIPTORS: Workload. Intensive care units. Cardiology. Nursing. LAS CARGAS DE TRABAJO DE ENFERMERIA EN LA UNIDAD DE CUIDADOS INTENSIVOS DE CARDIOLOGIA Y LOS FACTORES CLINICOS ASOCIADOS RESUMEN: El estudio tuvo como objetivo identificar la carga de trabajo de enfermeria en la Unidad de Cuidados Intensivos de Cardiologia y verificar la asociacion de esta variable con caracteristicas demograficas y clinicas de los pacientes. La muestra consistio en cien pacientes hospitalizados entre agosto y septiembre de 2006, en la Unidad de Cuidados Intensivos de Cardiologia de un hospital privado de Sao Paulo. El Nursing Activities Score, Symplified Acute Physiologic ScoreII y Logistic Organ Disfunction System se utilizaron para medir la carga de trabajo de enfermeria, la gravedad y disfuncion organica, respectivamente. La carga de trabajo de enfermeria fue del 66,60%, equivalente a 5,30 horas de trabajo en un turno de ocho horas. Excepto por el tiempo pasado en la Unidad de Cuidados Intensivos que mostro una correlacion moderada con la carga de trabajo, no hubo asociacion con las otras variables. Se recomienda ampliar la muestra para conclusiones generalizadas. DESCRIPTORES: Carga de trabajo. Unidades de terapia intensiva. Cardiologia. Enfermeria. 735

Clinical evolution of adult, elderly and very elderly patients admitted in Intensive Care Units

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥ 18 and <60 years), 216 elderly (≥ 60 and <80 years) and 105 very elderly (≥ 80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.El estudio comparo la evolucion clinica de adultos, ancianos y muy ancianos internados en Unidades de Terapia Intensiva localizadas en Sao Paulo, Brasil. El estudio fue retrospectivo longitudinal, del tipo comparativo. Participaron 279 adultos (≥18 y <60 anos), 216 ancianos (≥60 y <80 anos) y 105 muy ancianos (≥80 anos). Los adultos difirieron de los otros grupos en relacion a la unidad de destino y evolucion de la gravedad, segun Simplified Acute Physiology Score II. Fue mas frecuente el encaminamiento de los adultos para unidades de internacion, sin embargo los ancianos y muy ancianos sobrevivientes de la internacion en la unidad critica presentaron mejoria mas acentuada antes del alta. Entre adultos y ancianos ocurrio diferencia en relacion a la mortalidad, con mayor tasa en el grupo mas viejo; entretanto, la mortalidad de los muy ancianos y adultos fue similar. En general, los resultados indicaron que la edad mas avanzada no fue factor asociado a los resultados indeseables de la asistencia intensiva.

Evolução clínica de adultos, idosos e muito idosos internados em Unidade de Terapia Intensiva

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥ 18 and <60 years), 216 elderly (≥ 60 and <80 years) and 105 very elderly (≥ 80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.El estudio comparo la evolucion clinica de adultos, ancianos y muy ancianos internados en Unidades de Terapia Intensiva localizadas en Sao Paulo, Brasil. El estudio fue retrospectivo longitudinal, del tipo comparativo. Participaron 279 adultos (≥18 y <60 anos), 216 ancianos (≥60 y <80 anos) y 105 muy ancianos (≥80 anos). Los adultos difirieron de los otros grupos en relacion a la unidad de destino y evolucion de la gravedad, segun Simplified Acute Physiology Score II. Fue mas frecuente el encaminamiento de los adultos para unidades de internacion, sin embargo los ancianos y muy ancianos sobrevivientes de la internacion en la unidad critica presentaron mejoria mas acentuada antes del alta. Entre adultos y ancianos ocurrio diferencia en relacion a la mortalidad, con mayor tasa en el grupo mas viejo; entretanto, la mortalidad de los muy ancianos y adultos fue similar. En general, los resultados indicaron que la edad mas avanzada no fue factor asociado a los resultados indeseables de la asistencia intensiva.

Nursing workload in a cardiac intensive care unit and associated clinical factors

O estudo objetivou identificar a carga de trabalho de enfermagem em unidade de Terapia Intensiva de Cardiologia e verificar a associacao dessa variavel com caracteristicas demograficas e clinicas dos pacientes. A amostra foi de 100 pacientes internados no periodo de agosto a setembro de 2006, na Unidade de Terapia Intensiva Cardiologica de um hospital privado, do Municipio de Sao Paulo. O Nursing Activities Score, o Symplified Acute Physiologic ScoreII e o Logistic Organ Disfunction System foram utilizados para medir a carga de trabalho de enfermagem, a gravidade e a disfuncao orgânica, respectivamente. A carga de trabalho de enfermagem foi de 66,60%, equivalente a 5,30 horas de trabalho, em um turno de oito horas. A excecao do tempo de permanencia na Unidade de Terapia Intensiva, que apresentou moderada correlacao com a carga de trabalho, nao houve associacao com as demais variaveis analisadas. Recomenda-se a ampliacao da amostra para conclusoes generalizaveis.The objective of this study was to identify the nursing workload in the Cardiac Intensive Care Unit and to verify the association of this variable according to demographic and clinical patient’s characteristics. The sample consisted of 100 patients hospitalized between August and September of 2006 in a Cardiac Intensive Care Unit of a private hospital in Sao Paulo, Brazil. The Nursing Activities Score, Simplified Acute Physiologic Score II, and the Logistic Organ Dysfunction System were used to measure the nursing workload, severity, and organic dysfunction, respectively. The nursing workload was 66.60% which is equivalent to 5.30 work hours during an eight hour shift. Except for the length of stay in the Intensive Care Unit, which showed a moderate correlation with the workload, there was no association with the other analyzed variables. An expansion of the sample to provide generalized conclusions is highly recommended. DESCRIPTORS: Workload. Intensive care units. Cardiology. Nursing. LAS CARGAS DE TRABAJO DE ENFERMERIA EN LA UNIDAD DE CUIDADOS INTENSIVOS DE CARDIOLOGIA Y LOS FACTORES CLINICOS ASOCIADOS RESUMEN: El estudio tuvo como objetivo identificar la carga de trabajo de enfermeria en la Unidad de Cuidados Intensivos de Cardiologia y verificar la asociacion de esta variable con caracteristicas demograficas y clinicas de los pacientes. La muestra consistio en cien pacientes hospitalizados entre agosto y septiembre de 2006, en la Unidad de Cuidados Intensivos de Cardiologia de un hospital privado de Sao Paulo. El Nursing Activities Score, Symplified Acute Physiologic ScoreII y Logistic Organ Disfunction System se utilizaron para medir la carga de trabajo de enfermeria, la gravedad y disfuncion organica, respectivamente. La carga de trabajo de enfermeria fue del 66,60%, equivalente a 5,30 horas de trabajo en un turno de ocho horas. Excepto por el tiempo pasado en la Unidad de Cuidados Intensivos que mostro una correlacion moderada con la carga de trabajo, no hubo asociacion con las otras variables. Se recomienda ampliar la muestra para conclusiones generalizadas. DESCRIPTORES: Carga de trabajo. Unidades de terapia intensiva. Cardiologia. Enfermeria. 735

Distribución de la equipo de enfermería y ocurrencia de eventos adversos/incidentes en unidad de cuidados intensivos

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.

Las cargas de trabajo de enfermería en la unidad de cuidados intensivos de cardiología y los factores clínicos asociados

O estudo objetivou identificar a carga de trabalho de enfermagem em unidade de Terapia Intensiva de Cardiologia e verificar a associacao dessa variavel com caracteristicas demograficas e clinicas dos pacientes. A amostra foi de 100 pacientes internados no periodo de agosto a setembro de 2006, na Unidade de Terapia Intensiva Cardiologica de um hospital privado, do Municipio de Sao Paulo. O Nursing Activities Score, o Symplified Acute Physiologic ScoreII e o Logistic Organ Disfunction System foram utilizados para medir a carga de trabalho de enfermagem, a gravidade e a disfuncao orgânica, respectivamente. A carga de trabalho de enfermagem foi de 66,60%, equivalente a 5,30 horas de trabalho, em um turno de oito horas. A excecao do tempo de permanencia na Unidade de Terapia Intensiva, que apresentou moderada correlacao com a carga de trabalho, nao houve associacao com as demais variaveis analisadas. Recomenda-se a ampliacao da amostra para conclusoes generalizaveis.The objective of this study was to identify the nursing workload in the Cardiac Intensive Care Unit and to verify the association of this variable according to demographic and clinical patient’s characteristics. The sample consisted of 100 patients hospitalized between August and September of 2006 in a Cardiac Intensive Care Unit of a private hospital in Sao Paulo, Brazil. The Nursing Activities Score, Simplified Acute Physiologic Score II, and the Logistic Organ Dysfunction System were used to measure the nursing workload, severity, and organic dysfunction, respectively. The nursing workload was 66.60% which is equivalent to 5.30 work hours during an eight hour shift. Except for the length of stay in the Intensive Care Unit, which showed a moderate correlation with the workload, there was no association with the other analyzed variables. An expansion of the sample to provide generalized conclusions is highly recommended. DESCRIPTORS: Workload. Intensive care units. Cardiology. Nursing. LAS CARGAS DE TRABAJO DE ENFERMERIA EN LA UNIDAD DE CUIDADOS INTENSIVOS DE CARDIOLOGIA Y LOS FACTORES CLINICOS ASOCIADOS RESUMEN: El estudio tuvo como objetivo identificar la carga de trabajo de enfermeria en la Unidad de Cuidados Intensivos de Cardiologia y verificar la asociacion de esta variable con caracteristicas demograficas y clinicas de los pacientes. La muestra consistio en cien pacientes hospitalizados entre agosto y septiembre de 2006, en la Unidad de Cuidados Intensivos de Cardiologia de un hospital privado de Sao Paulo. El Nursing Activities Score, Symplified Acute Physiologic ScoreII y Logistic Organ Disfunction System se utilizaron para medir la carga de trabajo de enfermeria, la gravedad y disfuncion organica, respectivamente. La carga de trabajo de enfermeria fue del 66,60%, equivalente a 5,30 horas de trabajo en un turno de ocho horas. Excepto por el tiempo pasado en la Unidad de Cuidados Intensivos que mostro una correlacion moderada con la carga de trabajo, no hubo asociacion con las otras variables. Se recomienda ampliar la muestra para conclusiones generalizadas. DESCRIPTORES: Carga de trabajo. Unidades de terapia intensiva. Cardiologia. Enfermeria. 735

Evolución clínica de adultos, ancianos y muy ancianos internados en Unidades de Terapia Intensiva

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥ 18 and <60 years), 216 elderly (≥ 60 and <80 years) and 105 very elderly (≥ 80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.El estudio comparo la evolucion clinica de adultos, ancianos y muy ancianos internados en Unidades de Terapia Intensiva localizadas en Sao Paulo, Brasil. El estudio fue retrospectivo longitudinal, del tipo comparativo. Participaron 279 adultos (≥18 y <60 anos), 216 ancianos (≥60 y <80 anos) y 105 muy ancianos (≥80 anos). Los adultos difirieron de los otros grupos en relacion a la unidad de destino y evolucion de la gravedad, segun Simplified Acute Physiology Score II. Fue mas frecuente el encaminamiento de los adultos para unidades de internacion, sin embargo los ancianos y muy ancianos sobrevivientes de la internacion en la unidad critica presentaron mejoria mas acentuada antes del alta. Entre adultos y ancianos ocurrio diferencia en relacion a la mortalidad, con mayor tasa en el grupo mas viejo; entretanto, la mortalidad de los muy ancianos y adultos fue similar. En general, los resultados indicaron que la edad mas avanzada no fue factor asociado a los resultados indeseables de la asistencia intensiva.