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

Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score

Highlights: La NAS es una herramienta que toma relevancia al momento de evaluar la carga de trabajo de los profesionales de enfermería. Se evidencia que el personal de enfermería está expuesto a altas cargas de trabajo que, en la mayoría de casos, supera lo sugerido por Consejos y Asociaciones de enfermería. Algunos factores que pueden afectar la carga de trabajo son el tipo de turnos de trabajo, sexo del profesional, tipo de UCI, el número de pacientes a cargo, entre otros. Es necesario evaluar la implementación de la NAS en distintos tipos de servicios para entender la situación y trabajo actual de los profesionales de enfermería. Introducción: Nursing Activities Score ha sido utilizada como un instrumento principalmente en la Unidad de Cuidados Intensivos para medir las actividades de enfermería, siendo esta la unidad que maneja pacientes de mayor complejidad para el cuidado. Objetivo: establecer la carga de trabajo, evaluada por Nursing Activities Score, y factores relacionados a la misma en Unidades de Cuidado Intensivo. Metodología: Revisión cualitativa tipo scoping Review, utilizando el método PRISMA. Búsqueda en las bases de datos CINAHL, LILACS, SCOPUS, SCIENCE DIRECT, SCIELO y PUBMED. Resultados: La muestra final se compone de 87 textos, que van desde el año 2007 hasta 2021. Se clasificaron en cinco categorías: Carga de trabajo en UCI, comparación entre unidades, carga de trabajo relacionada al personal de enfermería, carga de trabajo relacionada a las características de los pacientes y consecuencias de la carga de trabajo. Discusión: La revisión revela una carga de trabajo mayor al 50% en la mayoría de los estudios, esto debido a diferentes factores: principalmente las características particulares de los pacientes, no se observó una diferencia significativa entre unidades generales y especializadas, las cargas de trabajo elevadas suponen un factor de riesgo para la ocurrencia de eventos adversos. Conclusiones: Los resultados de esta revisión permiten evidenciar que el personal de enfermería está expuesto constantemente a altas cargas de trabajo. Esta carga de trabajo puede verse influenciada o influenciar diversos factores, como lo son las características de los pacientes a quienes se brinda atención o puede afectar positiva o negativamente la calidad de la atención de enfermería. Como citar este artículo: Cruz López Laura Nathalie, Quintero Osorio Jenny Fernanda, Melo Roa Juan David, Henao Castaño Ángela María. Carga laboral de profesionales de enfermería en Unidad de Cuidado Intensivo según Nursing Activities Score. Revista Cuidarte. 2023;14(1):e2680. http://dx.doi.org/10.15649/cuidarte.2680

Nursing workload in intensive care units and the influence of patient and nurse characteristics

BACKGROUND

Understanding factors that can potentially influence patient care and nursing workload in intensive care units is important. Previous studies have shown contradictory outcomes about the relationships between nursing workload and patient and nurse characteristics.

AIMS AND OBJECTIVES

This study aimed to investigate nursing workload in intensive care units and examine the association between this in relation to patient and nurse characteristics.

DESIGN

A cross-sectional design was conducted.

METHODS

All nurses who were working in the intensive care units of five hospitals and met the study criteria were enrolled in the study. Two demographic questionnaires collected nurse and patient demographic information. The Nursing Activities Score was applied to determine nursing workload in three shifts (morning, evening, night) for each nurse. Data were analysed using the independent sample t-test, one-way analysis of variance, and multivariable linear regression analysis.

RESULTS

The Nursing Activities Score was calculated for 509 patients who were under the care of 105 intensive care unit nurses. The mean (SD) Nursing Activities Score was 72.84% (22.07%). Morning shifts, male patients, medical treatments, and referred patients from the emergency ward and other intensive care units imposed a higher workload for nurses. Specifically, female nurses, increased number of patients receiving care, and increased patient length of intensive care unit stay were directly associated with increased Nursing Activities Scores. Work in surgical and burn intensive care units were inversely associated with the Nursing Activities Score.

CONCLUSION

This study suggests that the workload of nurses in intensive care units can be affected by both nurse and patient characteristics.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to ensure appropriate staffing of intensive care units by nurses. However, nurse and patient characteristics should not be considered the only factors that influence nursing workload in intensive care units.

Type of admission and nursing workload of critical patients: a cross-sectional study

BACKGROUND

According to the perception of nurses in the intensive care unit (ICU), surgical patients need more nursing care, thus requiring higher nursing workloads for these patients than those admitted as clinical patients. However, some study results on the relationship between the type of admission and the nursing workload are considered contradictory.

AIMS AND OBJECTIVES

To identify if the type of admission (clinical, emergency surgery or elective surgery) is a predictive factor of the nursing workload required by patients on the first day or throughout their stay in the ICU.

DESIGN

This was a quantitative cross-sectional study comprised of a retrospective analysis of clinical records of critical patients.

METHODS

Data were collected from 1 May 2015 to 30 September 2015 in a hospital located in São Paulo, Brazil. Nursing workload was measured using the Nursing Activities Score. The type of admission and the demographic and clinical variables of the patients were investigated. Multiple linear regression was used to identify nursing workload predictive factors, with 5% significance level.

RESULTS

In the analysed sample (n = 211; mean age of 60·3 ± 18·7 years), there was a prevalence of male gender (56·9%). A statistically significant difference (p = 0·025) was found between the type of admission and the nursing workload required for patients on the first ICU day. The Simplified Acute Physiologic Score (p = 0·009) was a predictor of nursing workload on the first day in the ICU, and the Logistic Organ Dysfunction System (p = 0·026) and mortality (p < 0·001) were predictors throughout the ICU stay.

CONCLUSIONS

The type of admission was not a predictive factor of the nursing workload required by critical patients.

RELEVANCE TO CLINICAL PRACTICE

Identifying the predictive factors of nursing workload favours the appropriate staffing of the critical unit by nurses. However, nurses should not consider the type of admission in predicting the nursing workload required by patients in the ICU.

Nursing Activities Score: qual periodicidade ideal para avaliação da carga de trabalho?

Resumo Objetivo: Comparar a carga de trabalho obtida a partir do Nursing Activities Score (NAS) pontuado três vezes ao dia, no final de cada turno de trabalho, e pontuado uma vez ao dia considerando as 24 horas. Métodos: Estudo longitudinal prospectivo, realizado com adultos internados em um Centro de Terapia Intensiva de um hospital público de alta complexidade do sul do Brasil. A coleta de dados foi realizada através do sistema Epimed Monitor®. No primeiro período do estudo (Período 1) a pontuação média do NAS foi obtida a partir de três avaliações diárias e no segundo período (Período 2) o NAS foi pontuado uma vez ao dia. A comparação das variáveis foi verificada por meio dos testes t-Studente Mann Whitney U. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição de origem. Resultados: Durante o estudo foram realizadas 1738 avaliações de NAS em 338 pacientes. A média de pontuação do NAS foi de 74±20,9% para o total de pacientes. Não houve diferença entre a média do Período 1 (74,1±20,8%) e a média do Período 2 (73,9±21%) (p= 0,806). O Período 2 teve mais avaliações na categoria de NAS <50% e menos avaliações na categoria de NAS 50,1-100% em relação ao Período 1 (p<0,001 e p= 0,029, respectivamente). Conclusão: A pontuação média do NAS é semelhante quando comparada a aferição realizada três vezes ao dia com a realizada uma vez ao dia considerando as 24 horas anteriores para avaliação de carga de trabalho de enfermagem.

Trabalho e educação na saúde: análise da produção científica brasileira entre 2011 e 2014

RESUMO O estudo aqui relatado teve como objetivo atualizar a análise da produção científica sobre trabalho e educação na saúde no Brasil para o período 2011 a 2014. Trata-se de um estudo de síntese com um total de 757 artigos analisados. A categoria 'Formação-Capacitação' manteve a liderança do número de publicações (51,9%), seguida de 'Profissionais de Saúde' (42,4%). Houve redução do percentual de publicações sobre mercado de trabalho, política de recursos humanos e administração de recursos humanos. Os últimos investimentos na formação e capacitação dos trabalhadores podem contribuir para a produção de novos trabalhos baseados no cotidiano dos serviços, sendo necessário avançar no detalhamento da produção científica.

Nursing workload for cancer patients under palliative care

OBJECTIVE

To verify the nursing workload required by cancer patients undergoing palliative care and possible associations between the demographic and clinical characteristics of the patients and the nursing workload.

METHOD

This is a quantitative, cross-sectional, prospective study developed in the Connective Bone Tissue (TOC) clinics of Unit II of the Brazilian National Cancer Institute José Alencar Gomes da Silva with patients undergoing palliative care.

RESULTS

Analysis of 197 measures of the Nursing Activities Score (NAS) revealed a mean score of 43.09% and an association between the performance status of patients undergoing palliative care and the mean NAS scores. The results of the study point to the need to resize the team of the unit.

CONCLUSION

The NAS has proven to be a useful tool in oncologic clinical units for patients undergoing palliative care.

OBJETIVO

Verificar a carga de trabalho de enfermagem requerida por pacientes com câncer sob cuidados paliativos e possíveis associações entre as características demográficas e clínicas dos pacientes e a carga de trabalho de enfermagem.

MÉTODO

Trata-se de um estudo de abordagem quantitativa, transversal, prospectivo, desenvolvido na clínica de Tecido Ósseo Conectivo (TOC) da Unidade II do Instituto Nacional de Câncer José Alencar Gomes da Silva, com pacientes em cuidados paliativos.

RESULTADOS

A análise de 197 medidas do Nursing Activities Score (NAS) revelou um escore médio de 43,09% e uma associação entre a performance status de pacientes em cuidados paliativos com os valores médios do NAS. Os resultados do estudo apontam para a necessidade de redimensionamento da equipe da Unidade.

CONCLUSÃO

O NAS mostrou-se um instrumento passível de utilização em unidades clínicas oncológicas, com pacientes em cuidados paliativos.

Nursing Activities Score and Acute Kidney Injury

ABSTRACT Objective: to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI). Method: A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively. Results: A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001). Conclusion: The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.

Nursing workload and occurrence of adverse events in intensive care: a systematic review

OBJECTIVE

To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU).

METHOD

A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors.

RESULTS

Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU.

CONCLUSION

The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care.

OBJETIVO

Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI).

MÉTODO

Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos.

RESULTADOS

Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP.

CONCLUSÃO

A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.

Carga de trabalho de enfermagem relacionada ao índice de massa corporal de pacientes críticos

Resumo Objetivo Mensurar e comparar a carga de trabalho de enfermagem e a frequência dos itens pontuados no Nursing Activities Score (NAS), considerando os diferentes grupos de IMC de pacientes internados em Unidade de Terapia Intensiva (UTI). Métodos Estudo longitudinal realizado na UTI de hospital universitário em São Paulo, na qual o IMC do paciente foi calculado dividindo-se o peso pelo quadrado da altura e a carga de trabalho de enfermagem foi mensurada pelo NAS. Resultados A análise de 529 pacientes mostrou que o NAS não diferiu entre os grupos conforme o IMC. Os pacientes obesos demandaram mais tempo para o procedimento de higienização e maior número de pessoas para mobilização/posicionamento. Pacientes de baixo peso receberam mais frequentemente tratamento para melhora da função pulmonar. Conclusão Os resultados não apontaram diferença na carga de trabalho de enfermagem quando se considerou o IMC do paciente.

Financial impact of nursing professionals staff required in an Intensive Care Unit

Objective

to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals.

Method

a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing.

Results

the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44.

Conclusion

the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution.

[Nursing workload in specialized Semi-intensive Therapy unit: workforce size criteria]

OBJECTIVE

To assess the nursing workload (NW) in Semi-intensive Therapy Unit, specialized in the care of children with Craniofacial anomalies and associated syndromes; to compare the amount of workforce required according to the Nursing Activities Score (NAS) and the COFEN Resolution 293/04.

METHOD

Cross-sectional study, whose sample was composed of 72 patients. Nursing workload was assessed through retrospective application of the NAS.

RESULTS

the NAS mean was 49.5%. Nursing workload for the last day of hospitalization was lower in patients being discharged to home (p<0.001) and higher on the first compared to last day of hospitalization (p< 0.001). The number of professionals required according to NAS was superior to the COFEN Resolution 293/04, being 17 and 14, respectively.

CONCLUSION

the nursing workload corresponded to approximately 50% of the working time of nursing professional and was influenced by day and outcome of hospitalization. The amount of professionals was greater than that determined by the existing legislation.

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

RESUMO Objetivo Identificar os fatores associados à carga de trabalho de enfermagem no cuidado a pacientes no pós-operatório de cirurgia cardíaca. Método Estudo de coorte prospectivo, conduzido com 187 pacientes da Unidade de Terapia Intensiva Cirúrgica (UTI) do Instituto do Coração. Os dados foram coletados nas primeiras 24 e 72 horas do paciente na UTI. A variável dependente foi a carga de trabalho calculada por meio do Nursing Activities Score (NAS) e as independentes foram de natureza demográfico-clínicas e escores de morbimortalidade. Para análise dos dados utilizou-se os testes de Wilcoxon-Mann-Whitney e de correlação de Spearman, e a regressão linear com modelo de efeitos mistos. Resultados A maioria dos pacientes era do sexo masculino (59,4%), com média de idade de 61 anos (±12,7) e 43,9% desenvolveram algum tipo de complicação no pós-operatório. Nas 24 horas, a carga de trabalho foi de 82,4% (±3,4) e foi de 58,1% (±3,4) nas 72 horas. Os fatores associados ao aumento do NAS foram: tempo de internação do paciente na UTI (p=0,036) e a presença de complicações (p<0,001). Conclusão A gravidade do paciente nas 24 horas, em oposição a inúmeros estudos, não influenciou no aumento da carga de trabalho, a qual se mostrou associada ao tempo de internação e às complicações.

The use of the Nursing Activities Score in clinical settings: an integrative review

Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian's model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian's health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.

Nursing workload in a coronary unit according to the Nursing Activities Score

Objective: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument.Method: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012.Results: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts.Conclusion: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.