Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
J Clin Nurs ; 28(11-12): 2245-2252, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30790377

RESUMO

AIMS AND OBJECTIVES: To investigate the associations between nurse staffing and the incidence and severity of hypoxaemia, arterial hypotension and bradycardia of postoperative patients during their postanaesthesia care unit stay. BACKGROUND: Nurse understaffing has been associated with adverse patient outcomes in a variety of hospital settings. In the postanaesthesia care unit, nursing shortage is common and can be related to compromised prevention, detection and treatment of adverse events. DESIGN: Observational, single-centre, prospective study that adhered to Strengthening the Reporting of Observational studies in Epidemiology checklist (see Supporting information Appendix S1); 2,207 patients admitted to the postanaesthesia care unit of a tertiary care hospital over a 5-month period were enrolled. METHODS: Incidence of hypoxaemia (arterial oxygen saturation <95%), arterial hypotension (systolic blood pressure <90 mmHg) and bradycardia (heart rate <50 beats per minute), along with episode severity, was recorded. Patients were classified into three groups as follows: sufficient staffing, low and high understaffing. Risk for hypoxaemia, arterial hypotension and bradycardia was adjusted according to patient, anaesthesia and operation characteristics. RESULTS: The incidence of hypoxaemia was significantly higher in the high understaffing group patients, while the incidence of arterial hypotension was significantly higher in both low and high understaffing group patients, compared to sufficient staffing group ones. In the high understaffing group patients, hypoxaemia and arterial hypotension episodes were of significantly higher severity. CONCLUSIONS: These associations between hypoxaemia and arterial hypotension and postanaesthesia care unit understaffing indicate that care quality and patient safety can be compromised in case patient acuity is not matched with sufficient nursing resources. RELEVANCE TO CLINICAL PRACTICE: Higher incidence of hypoxaemia and arterial hypotension advocates for the prevention of imbalances between patient number and care demands and the number of available nurses.


Assuntos
Período de Recuperação da Anestesia , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Bradicardia/epidemiologia , Feminino , Humanos , Hipotensão/epidemiologia , Hipóxia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade da Assistência à Saúde
2.
Am J Crit Care ; 17(6): 522-31, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18978237

RESUMO

BACKGROUND: Fever in a patient in the intensive care unit necessitates several nursing tasks. Moreover, factors associated with increased patient care needs may be associated with fever. OBJECTIVE: To identify relationships between fever and characteristics of fever and nursing workload at the patient level. METHODS: A prospective study was conducted in a medical-surgical intensive care unit. The sample consisted of 361 patients consecutively admitted from October 2005 to August 2006. Each patient's body temperature was measured by using a tympanic membrane or an axillary thermometer. The Therapeutic Intervention Scoring System-28 was used to measure nursing workload. RESULTS: A total of 188 patients (52.1%) had fever. Mean daily scores on the Therapeutic Intervention Scoring System and on 5 of its 7 categories were significantly higher for febrile patients than for nonfebrile patients. Fever was an independent predictor of the mean daily scores for all patients (P < .001). Peak body temperature but not duration of fever also was an independent predictor of mean daily scores for febrile patients (P < .001). CONCLUSION: In a general intensive care unit, fever in patients should be taken into consideration for the proper allocation of nursing personnel.


Assuntos
Febre , Unidades de Terapia Intensiva/organização & administração , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Carga de Trabalho , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Administração de Enfermagem , Admissão e Escalonamento de Pessoal , Estudos Prospectivos , Termômetros
3.
J Nurs Scholarsh ; 40(4): 385-90, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19094155

RESUMO

PURPOSE: To investigate differences in mortality of intensive care unit (ICU) patients according to the ratio between total patient care demands and nurse staffing. DESIGN: Observational, prospective study. Patients consecutively admitted in the medical-surgical ICU of a Greek hospital over a 1-year period were enrolled. METHODS: The Therapeutic Intervention Scoring System (TISS)-28 was used for measuring patient care demands. Daily sum of TISS-28 of patients and daily number of nurses were considered for estimating median and peak patient exposure to nursing workload. According to the values of median and peak patient exposure to nursing workload, patients were divided into three groups (low, medium, and high). Logistic regression was used for evaluating the associations between mortality during ICU length of stay and median or peak patient exposure to nursing workload, after adjusting for patient clinical severity. FINDINGS: 396 patients were included and 102 died. Differences in ICU mortality between high and low groups of median and peak patient exposure to nursing workload, although not statistically significant, were clinically remarkable, both when all patients were studied and when medical and surgical patients were separately studied. CONCLUSIONS: Consideration of individual differences in patient acuity might add sensitivity to the detection of associations between nurse understaffing and ICU mortality. CLINICAL RELEVANCE: The findings indicate that not only differences among nurse characteristics, but also differences in patient care demands, are important when investigating the effect of nurse understaffing on mortality of ICU patients. Proper nurse staffing levels should be based on the estimation of total patient acuity, rather than on the absolute number of patients.


Assuntos
Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem Hospitalar , Carga de Trabalho , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Qualidade da Assistência à Saúde
4.
Nurs Crit Care ; 12(1): 34-41, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17883662

RESUMO

The importance of measuring nursing workload in the intensive care unit (ICU) has been supported by both an increasing demand for nursing personnel and the relationship of nursing workload with patient safety. According to previous studies, the correlation between clinical severity of ICU patients and nursing workload measured by Therapeutic Intervention Scoring System has been estimated to be particularly high. The aim of this study was to investigate whether clinical severity of ICU patients can be used for the prediction of nursing workload on a daily basis. All patients admitted in the ICU of the General University Hospital of Patras for a 5-month period were enrolled in the study. Projet de Recherche en Nursing (PRN) Réa and Acute Physiology and Chronic Health Evaluation (APACHE) II scores of patients were calculated, the first on a daily basis and the second on the day of admission. Simple linear regression was used for statistical analysis of data. One hundred thirty-eight patients were studied. A progressive increase in mean daily PRN Réa of patients all along the amplitude of APACHE II values was shown. APACHE II could predict 25.6% (p < 0.01) of the daily variability of PRN Réa of patients. Regarding categories of PRN Réa, respiration, communication, diagnostic methods and treatments were significantly predicted by APACHE II. APACHE II explained higher proportions of PRN Réa in medical male patients aged >60 years. Clinical severity of the ICU patients measured by APACHE II is an important early indicator of daily nursing workload, especially of care demands associated with respiration, diagnostic methods and treatments.


Assuntos
APACHE , Estado Terminal/enfermagem , Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/normas , Feminino , Grécia , Pesquisas sobre Atenção à Saúde , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Probabilidade , Proibitinas , Índice de Gravidade de Doença , Recursos Humanos
5.
Intensive Crit Care Nurs ; 26(3): 169-74, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20435477

RESUMO

OBJECTIVE: To investigate the association between fever and agitation in elderly, critically ill patients. SETTING: Medical-surgical Intensive Care Unit (ICU) of a Greek, tertiary care hospital. RESEARCH METHODOLOGY: Descriptive, quantitative study conducted from October 2005 to September 2006. Patient temperature was measured by a tympanic membrane or an axillary thermometer. Agitation-Sedation scale was used for evaluating agitation. Variables found to contribute to agitation in previous studies were also collected. RESULTS: One hundred sixty-one patients > or =65 years, who were consecutively admitted to the ICU, were enrolled. Fever was found to be an independent predictor of agitation (OR, 1.86; 95% CI, 1.02-3.49). High fever (>39.3 degrees C), was associated with a higher possibility for patients to manifest severe agitation (p=0.046). CONCLUSION: Considering the significant adverse consequences of agitation, antipyretic therapy may be recommended for the elderly ICU population, especially when fever is combined with other factors predisposing to agitation or when fever becomes high.


Assuntos
Ansiedade/epidemiologia , Estado Terminal/psicologia , Febre/epidemiologia , Agitação Psicomotora/epidemiologia , Idoso , Feminino , Febre/psicologia , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino
6.
Heart Lung ; 39(3): 208-16, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20457341

RESUMO

OBJECTIVES: We investigated whether mortality in intensive care unit (ICU) patients without cerebral damage is associated with fever manifestation and characteristics. METHODS: Patients admitted to a medical-surgical ICU between October 2005 and July 2006 were prospectively studied. Exclusion criteria were acute brain injury, intracerebral/subarachnoid hemorrhage, ischemic stroke, and brain surgery. An ear-based or axillary thermometer was used to measure body temperature. The association between fever (ear-based temperature, >38.3 degrees C), fever characteristics, and ICU mortality was evaluated using univariate and multivariate analysis. RESULTS: Two hundred and thirty-nine patients were enrolled. Fever was not associated with ICU mortality after adjustment for confounding patient factors. A significant dose-response increase of ICU mortality according to 1 degree C increments of peak body temperature was demonstrated, whereas peak body temperature was an independent predictor of ICU mortality. CONCLUSION: These findings imply that, although fever is not generally associated with mortality in patients without cerebral damage, it can be harmful and should be suppressed when it becomes very high. Rigorous clinical trials are needed to help establish antipyretic therapy guidelines.


Assuntos
Estado Terminal/mortalidade , Febre , Unidades de Terapia Intensiva , Mortalidade/tendências , APACHE , Idoso , Temperatura Corporal , Encefalopatias , Intervalos de Confiança , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA