Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score.

BACKGROUND: Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non-existent. AIM: To assess the nursing workload in a Portuguese ICU using the NAS. STUDY DESIGN: Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six-bed Portuguese ICU between 1 June-31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines. RESULTS: The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team. CONCLUSIONS: The nursing workload reported follows the trend of the international studies and the results reinforce the importance of adjusting the nursing staffing to the complexity of nursing care in this ICU. This study highlighted periods of nursing workload that could compromise patient safety. RELEVANCE TO CLINICAL PRACTICE: This was one of the first studies carried out with the NAS after its cross-cultural adaptation and validation for the Portuguese population. The nursing workload at the patient level was higher in the first 24 h of ICU stays. Because of the 'administrative and management activities' related to the 'patient discharge procedures', the last 24 h of ICU stays also presented high levels of nursing workload. The implementation of a nurse-to-patient ratio of 1:1 may contribute to safer nurse staffing and to improve patient safety in this Tertiary (level 3) ICU.

Fall risk assessment: retrospective analysis of Morse Fall Scale scores in Portuguese hospitalized adult patients.

PURPOSE: The Morse Fall Scale is used in several care settings for fall risk assessment and supports the implementation of preventive nursing interventions. Our work aims to analyze the Morse Fall Scale scores of Portuguese hospitalized adult patients in association with their characteristics, diagnoses and length of stay. METHODS: Retrospective cohort analysis of Morse Fall Scale scores of 8356 patients hospitalized during 2012. Data were associated to age, gender, type of admission, specialty units, length of stay, patient discharge, and ICD-9 diagnosis. RESULTS: Elderly patients, female, with emergency service admission, at medical units and/or with longer length of stays were more frequently included in the risk group for falls. ICD-9 diagnosis may also be an important risk factor. CONCLUSIONS: More than a half of hospitalized patients had "medium" to "high" risk of falling during the length of stay, which determines the implementation and maintenance of protocoled preventive nursing interventions throughout hospitalization. There are several fall risk factors not assessed by Morse Fall Scale. There were no statistical differences in Morse Fall Scale score between the first and the last assessment.

Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospital.

AIM: To gain more insight into the magnitude of the problem of pressure ulcer incidence in general wards of a Portuguese hospital. MATERIAL AND METHODS: Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical wards of Aveiro Hospital during 2012. The development of (at least) one pressure ulcer during the length of stay was associated with age, gender, type of admission, specialty units, first Braden Scale score, length of stay, patient discharge outcome and ICD-9 diagnosis. RESULTS: An incidence of 3.4% participants with pressure ulcer category I-IV in inpatient setting during 2012. During the length of stay, 320 new pressure ulcers were developed, most of them category/stage II. The sacrum/coccyx and the trochanters were the most problematic areas. CONCLUSIONS: The major risk factor for the development of a new pressure ulcer during the length of stay was the presence of (at least) one pressure ulcer at the first skin assessment. The length of stay itself, age and lower Braden Scale scores of our participants also played an important role in the odds of developing a pressure ulcer. Infectious diseases, traumatism and fractures and respiratory diseases were the ICD-9 diagnoses with higher frequency of participants that developed (at least) one pressure ulcer during the length of stay. It's important to standardize procedures and documentation in all care settings. The documentation of nursing interventions is vital to evaluate the impact of evidence-based nursing.

Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital.

AIM: To analyze the first pressure ulcer risk and skin assessment records of hospitalized adult patients in medical and surgical areas of Aveiro Hospital during 2012 in association with their demographic and clinical characteristics. MATERIAL AND METHODS: Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical areas in a Portuguese hospital during 2012. The presence of (at least) one pressure ulcer at the first skin assessment in inpatient setting was associated with age, gender, type of admission, specialty units, length of stay, patient discharge and ICD-9 diagnosis. RESULTS: Point prevalence of participants with pressure ulcer category/stage I-IV of 7.9% at the first skin assessment in inpatient setting. A total of 1455 pressure ulcers were documented, most of them category/stage I. The heels and the sacrum/coccyx were the most problematic areas. Participants with pressure ulcer commonly had two or more pressure ulcers. CONCLUSIONS: The point prevalence of participants with pressure ulcer of our study was similar international literature. The presence of a pressure ulcer at the first skin assessment could be an important measure of frailty and the participants with pressure ulcer commonly had more than one documented pressure ulcer. Advanced age or lower Braden Scale scores or Emergency Service admission were relevant variables for the presence of (at least) one pressure ulcer at the first skin assessment in inpatient setting as well as respiratory, infectious or genitourinary system diseases.

Cardiovascular risk factors among patients with acute unilateral inner ear hypofunction: A case-control study.

Objectives: To assess the prevalence of cardiovascular risk factors (CVRFs) and their impact on acute unilateral inner ear hypofunction (AUIEH), including acute unilateral peripheral vestibulopathy (AUPVP), sudden sensorineural hearing loss (SSNHL) and acute unilateral audiovestibular hypofunction (AUAVH). Methods: One hundred and twenty-five patients consecutively diagnosed with AUPVP, SSNHL or AUAVH and 250 sex- and age-matched controls were included. Cases presented a mean age of 58.6 ± 14.7 years and included 59 women and 66 men. The correlation between CVRFs (high blood pressure [HBP], diabetes mellitus [DM], dyslipidemia [DLP], cardiocerebrovascular disease [CCVD]) and AUIEH was assessed by multivariate conditional logistic regression analysis. Results: A higher prevalence of CVRFs was identified in patients than in controls (30 individuals with DM, 53 with HBP, 45 with DLP and 14 with a previous history of CCVD, p < .05). A significantly elevated risk of AUIEH was found in patients with two or more CVRFs (adjusted odds ratio [OR] 5.11; 95% CI 2.23-11.70). Previous CCVD individually predicted AUIEH (OR 8.41; 95% CI 2.36-29.88). Subgroup analysis showed the same tendency for AUPVP and SSNHL. Conclusion: Acute unilateral inner ear hypofunction patients presented significantly more CVRFs than controls, and the presence of two or more CVRFs was associated with AUIEH. Future studies evaluating vascular risk in AUIEH may include AUPVP and SSNHL patients from the same source population to better characterize risk profiles that can indicate a vascular origin. Level of Evidence: 3b.

Cardiovascular Risk and Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis.

OBJECTIVES/HYPOTHESIS: It was previously suggested that patients with idiopathic sudden sensorineural hearing loss (ISSNHL) have a higher risk of cardiovascular disease. The aim of this study is to determine if ISSNHL patients have an increased cardiovascular risk by means of a systematic review and meta-analysis. METHODS: A systematic literature review was performed using PubMed, Embase, Cochrane Libraries and Web of Science. Studies with a clear definition of ISSNHL, investigating an association between traditional vascular risk factors and ISSNHL were included. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two reviewers extracted the data, assessed the risk of bias and performed the analysis of the collected evidence. RESULTS: Nineteen case-control studies and two cohort studies were included (102,292 patients). Individual studies argued for higher prevalence of hypercholesterolemia, diabetes mellitus (DM) and higher blood pressure (HBP) in ISSNHL patients with a range of odds ratios (ORs) from 1.03 to 19. Pooled analysis of adjusted ORs revealed a significantly increased risk of ISSNHL for patients with hypertriglyceridemia (OR 1.54; 95% confidence interval [CI] 1.18-2.02) and high levels of total cholesterol (TC) (OR 2.09; 95% CI 1.52-2.87 after sensitivity analysis), but not for HBP, DM, or high levels of low- and high-density lipoproteins. CONCLUSION: An association between higher vascular risk profile and ISSNHL seems apparent in high levels of triglycerides (TG) and TC, but more studies are needed to confirm this hypothesis due to the high levels of data heterogeneity in the literature. LEVEL OF EVIDENCE: NA Laryngoscope, 133:15-24, 2023.

The role of tonsillectomy in psoriasis treatment.

Psoriasis is a chronic and immune-mediated skin disease with a considerable negative impact on quality of life. The link between psoriasis, especially guttate psoriasis, and streptococcal infections, namely tonsillitis, has been studied for several years. Some authors have also suggested an association with other types of psoriasis, such as plaque psoriasis, which is the most common. The role of tonsillectomy in the treatment of plaque psoriasis is not consensual. This case report aims to discuss this topic. The authors intend to highlight the growing evidence of a relationship between plaque psoriasis and an infectious pathology of the otolaryngology area. A clinical case of severe chronic plaque psoriasis with exacerbations linked to acute tonsillitis is described. The case was recalcitrant to dermatological treatment and tonsillectomy was included in the treatment options. After surgery, the skin disease was evidently controlled and significant improvement on the patient's quality of life was also evident.

Comunicação verbal com pacientes inconscientes / Verbal communication with unconscious patients

OBJETIVO: A comunicação com pacientes críticos nas unidades de cuidados intensivos gera desafios para a equipe de enfermagem e demanda habilidades específicas. MÉTODOS: Trata-se de um estudo desenvolvido em duas etapas, por meio de métodos qualitativos, para caracterização e padronização da comunicaçao verbal utilizada com pacientes inconscientes. A primeira etapa consistiu de revisão sistemática e de análise de conteúdo da literatura disponível sobre comunicação e estimulação verbal em pacientes inconscientes. RESULTADOS: Os resultados da análise de conteúdo foram utilizados na segunda etapa do estudo e forneceram a base para a construção de uma mensagem padronizada de estímulo. Quatro áreas problemáticas foram identificadas: dificuldades básicas na comunicação com pacientes que não são capazes de responder, pressões do ambiente de trabalho, conhecimento limitado sobre as necessidades de pacientes insconscientes, e conhecimento detalhado limitado do porquê e de como se comunicar com pacientes insconscientes. CONCLUSÃO: A mensagem estímulo desenvolvida pode facilitar a comunicação com pacientes inconscientes.

OBJECTIVE: Communication with critically ill patients in intensive care settings generates specific challenges for nursing staff, and demands well-developed skills. METHODS: A study was conducted in two phases using qualitative methods to characterise and standardise verbal communication used with patients. The first phase consisted of a systematic search and content analysis of the literature concerning communication and verbal stimulation of unconscious patients. RESULTS: The results of the content analysis were then used in phase two and informed the development of a standardised stimulus message.There appear to be four main problem areas: basic difficulty in communicating with a patient who cannot respond; pressures of the working environment; limited knowledge about unconscious patients' needs; limited detailed knowledge of why or how to communicate with unconscious patients. CONCLUSION: The stimulus developed, has been shown to facilitate the communication with the unconscious patients.

Finalidade das estratégias de supervisão utilizadas em ensino clínico de enfermagem / Purpose of supervision strategies used in nursing clinical practice

O presente artigo resulta de trabalhos de grupo realizados por enfermeiros durante uma formação sobre o processo de supervisão, leccionada pelos autores enquanto membros do Centro de Estágios da Escola Superior de Saúde da Universidade de Aveiro - Portugal. Tem como objectivos aprofundar conhecimentos acerca desta temática, identificar a finalidade das estratégias que são utilizadas e a quais dão mais ênfase. A recolha de dados foi realizada através da narração de episódios significativos, por 20 enfermeiros cooperantes na supervisão, no período de janeiro a fevereiro de 2005. Desenvolveu-se um estudo exploratório-qualitativo tendo-se procedido à análise de conteúdo das referidas narrações. Com o presente estudo verificámos que os enfermeiros, utilizam as estratégias de supervisão com a finalidade de prestar atenção, clarificar, encorajar, servir de espelho, dar opinião, ajudar a encontrar soluções para os problemas, negociar, orientar, estabelecer critérios e condicionar. Da análise dos resultados concluímos que os supervisores deste estudo se aproximam de um perfil não-directivo.

The present paper results from group works carried by nurses during their formal education in the process of supervision, taught by the authors as members of the Center of Clinical Practice of the Higher Education in Health at the University of Aveiro, Portugal. Its objectives are to deepen knowledge concerning this theme, to identify the purpose of the strategies that are used, and to which to give more emphasis. The data collection was carried out through the narration of significant episodes by 20 cooperative supervising nurses in the period of January to February of 2005. An exploratory study of a qualitative nature was developed. The study verified that the nurses, while supervisors in clinical practice, use supervising strategies with the purpose of paying attention, clarifying, encouraging, serving as a mirror, giving opinions, helping to find solutions for problems, negotiating, guiding, establishing criteria, and to condition. Through the analysis of the results, we conclude that the supervisors' strategies approach a non-directive profile.

El presente artículo resulta de trabajos de grupo realizados por enfermeros durante una formación sobre el proceso de supervisión, el cual fue enseñado por los autores como miembros del Centro de Práctica Clínica de la Escuela Superior de Salud de la Universidad de Aveiro - Portugal. Su objetivo es profundizar el conocimiento referente a esta temática, para identificar el propósito de las estrategias que se utilizan y saber a cuáles dan más énfasis. La recolección de los datos fue realizada por 20 enfermeros cooperativos en la supervisión, a través de la narración de episodios significativos, en el período de enero a febrero de 2005. Se desarrolló un estudio exploratorio de naturaleza cualitativa, analizado el contenido de las referidas narraciones. Con el presente estudio pudimos concluir que los enfermeros utilizan las estrategias de supervisión con el propósito de dar atención, aclarar, animar, servir de espejo, dar la opinión, ayudar a encontrar las soluciones para los problemas, a negociar, a orientar, a establecer criterios y a condicionar. Del análisis de los resultados concluimos que los supervisores de este estudio se acercan a un perfil no directivo.