Ricardo Luis Barbosa

Nursing Activities Score: an updated guideline for its application in the Intensive Care Unit

Objective To describe nursing workload in Intensive Care Units (ICU) in different countries according to the scores obtained with Nursing Activities Score (NAS) and to verify the agreement among countries on the NAS guideline interpretation. Method This cross-sectional study considered 1-day measure of NAS (November 2012) obtained from 758 patients in 19 ICUs of seven countries (Norway, the Netherlands, Spain, Poland, Egypt, Greece and Brazil). The Delphi technique was used in expertise meetings and consensus. Results The NAS score was 72.8% in average, ranging from 44.5% (Spain) to 101.8% (Norway). The mean NAS score from Poland, Greece and Egypt was 83.0%, 64.6% and 57.1%, respectively. The NAS score was similar in Brazil (54.0%) and in the Netherlands (51.0%). There were doubts in the understanding of five out 23 items of the NAS (21.7%) which were discussed until researchers consensus. Conclusion NAS score were different in the seven countries. Future studies must verify if the fine standardization of the guideline can have a impact on differences in the NAS results.Objetivo Describir la carga de trabajo de enfermeria en Unidades de Cuidados Intensivos (UCI) de diferentes paises segun el Nursing Activities Score (NAS) y establecer una guia estandarizada para su utilizacion en UCI. Metodo estudio observacional en 19 UCIs de siete paises (Noruega, Paises Bajos, Espana, Polonia, Egipto, Grecia y Brasil) incluyendo 758 pacientes adultos en Noviembre de 2012. Resultados La puntuacion media total en la escala NAS fue de 72.81% com valores entre 44.46% (Espana) y 101.8% (Noruega). Las medias NAS en Polonia, Grecia y Egipto fue de 83.0%, 64.59% y 57.11% respectivamente. El NAS medio fue similar en Brasil (53.98%) y los Paises Bajos (50.96%). De los 23 items de la escala hubo problemas en la interpretacion de 5 de ellos (21.74%). Este problema se resolvio mediante el consenso entre los investigadores. Conclusion El presente estudio demuestra variacion en la carga de trabajo en UCI de diferentes paises. La guia estandarizada de puntuacion del NAS puede servir como una herramienta para resolver dudas en futuras aplicaciones.

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.OBJECTIVEnTo describe our experience in the many processes involved in the development of a Project on Research into Intensive Care Unit Patient Safety.nnnMETHODnMixed 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.

Ambiente das práticas de enfermagem e satisfação profissional em unidades críticas

Objective: to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU). Method: a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively. Results: a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. Environment of practices, length of work in the ICU and willingness to work were associated with work satisfaction. Conclusion: to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.Objective:nto analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU).nnnMethod:na cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively.nnnResults:na total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. Environment of practices, length of work in the ICU and willingness to work were associated with work satisfaction.nnnConclusion:nto invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.

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.OBJECTIVEnTo describe our experience in the many processes involved in the development of a Project on Research into Intensive Care Unit Patient Safety.nnnMETHODnMixed 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.

COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS

Objective: to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units. Method: comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event. Results: the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045). Conclusion: in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences. DESCRIPTORS: Aged. Intensive care units. Patient safety. Nursing care. Workload. Mortality. COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS

COMPARISON BETWEEN PATIENT SEVERITY AND NURSING WORKLOAD BEFORE AND AFTER THE OCCURRENCE OF ADVERSE EVENTS IN ELDERLY IN CRITICAL CARE

Objective: to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units. Method: comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event. Results: the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045). Conclusion: in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences. DESCRIPTORS: Aged. Intensive care units. Patient safety. Nursing care. Workload. Mortality. COMPARAÇÃO ENTRE GRAVIDADE DO PACIENTE E CARGA DE TRABALHO DE ENFERMAGEM ANTES E APÓS A OCORRÊNCIA DE EVENTOS ADVERSOS EM IDOSOS EM CUIDADOS CRÍTICOS

NURSING WORKLOAD, STRESS/BURNOUT, SATISFACTION AND INCIDENTS IN A TRAUMA INTENSIVE CARE UNITS

Objective: to analyze the influence of workload, stress, Burnout, work satisfaction, the nursing team’s perception of the care environment, and the presence of adverse events in a Trauma Intensive Care Units. Method: an observational study conducted at the Intensive Trauma Therapy Unit 195 patients were prospectively followed for the collection of incidents, and instruments were used to measure Nursing workload, stress, Burnout, job satisfaction and work environment assessment by the nursing team. Data were analyzed using appropriate statistics for the study. Results: we observed 1,586 incidents, predominantly no harm incidents (78.44%). Among the nursing staff, 77.40% had average levels of stress; 17.00% presented Burnout; 56.6% were dissatisfied and considered the environmental characteristics to be inadequate. Nursing workload was high (73.24%). An association between incident and length of stay was found. No harm incidents were associated with nursing workload. Conclusion: identifying associated factors can prevent the occurrence of incidents. DESCRIPTOR: Patient safety. Intensive care units. Workload. Burnout, professional. Nursing. CARGA DE TRABALHO DE ENFERMAGEM, ESTRESSE/BURNOUT, SATISFAÇÃO E INCIDENTES EM UNIDADE DE TRATAMENTO INTENSIVO DE TRAUMAObjetivo: analisar a influencia da carga trabalho, estresse, Burnout, satisfacao e percepcao do ambiente de cuidado, pela equipe de enfermagem com a presenca de eventos adversos em Unidade de Terapia Intensiva de Trauma. Metodo: estudo observacional realizado em Unidade de Terapia Intensiva de Trauma. Para a coleta de incidentes foram acompanhados 195 pacientes, prospectivamente, sendo utilizados instrumentos para medir a carga de trabalho de enfermagem, estresse, Burnout, satisfacao no trabalho e trabalho de avaliacao do ambiente laboral pela equipe de enfermagem. Os dados foram analisados por meio de analise estatistica. Resultados: ocorreram 1.586 incidentes, predominantemente incidentes sem dano (78,44%). Entre a equipe de enfermagem, 77,40% tinham niveis medios de estresse; 17,00% apresentaram Burnout; 56,6% estavam insatisfeitos e consideraram as caracteristicas ambientais inadequadas. A carga de trabalho de enfermagem foi alta (73,24%). Houve associacao entre incidentes e tempo de permanencia. Os incidentes sem dano tiveram associacao com a carga de trabalho de enfermagem. Conclusao: a identificacao de fatores associados pode prevenir a ocorrencia de incidentes.

El ambiente de la práctica de enfermería y la satisfacción profesional en unidades críticas

Objective: to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU). Method: a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively. Results: a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. Environment of practices, length of work in the ICU and willingness to work were associated with work satisfaction. Conclusion: to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.Objective:nto analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU).nnnMethod:na cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively.nnnResults:na total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. Environment of practices, length of work in the ICU and willingness to work were associated with work satisfaction.nnnConclusion:nto invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.

Nursing practice environment and work satisfaction in critical units

Objective: to analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU). Method: a cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively. Results: a total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. Environment of practices, length of work in the ICU and willingness to work were associated with work satisfaction. Conclusion: to invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.Objective:nto analyze the association between the environment of nursing practices and work satisfaction in Intensive Care Units (ICU).nnnMethod:na cross-sectional study was performed in eight adult ICUs of a public university hospital between 2012 and 2015. The Nursing Work Index-Revised (NWI-R), in their short forms, and the Index of Work Satisfaction (IWS) were applied to investigate the environment of nursing practices and work satisfaction, respectively.nnnResults:na total of 100 (34.84%) nurses and 187 (65.15%) nursing assistants/technicians participated in this study. The environment was favorable for autonomy and relationships and it showed vulnerability for control of practices and organizational support. The IWS score indicated low work satisfaction. Environment of practices, length of work in the ICU and willingness to work were associated with work satisfaction.nnnConclusion:nto invest in the environment of practices, in factors that promote willingness to work and length of experience in the ICU increases nursing work satisfaction.

Seguridad del paciente en las Unidad de Cuidados Intensivos: desarrollo de un proyecto de investigación

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.OBJECTIVEnTo describe our experience in the many processes involved in the development of a Project on Research into Intensive Care Unit Patient Safety.nnnMETHODnMixed 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.