Daily work variability in falls prevention of hospitalized patients: nursing team's perception.

BACKGROUND: The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined. METHOD: A mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020. RESULTS: From July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague's expertise, as well as suggesting improvements in the physical environment. CONCLUSION: This study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.

Burnout and network centrality as proxies for assessing the human cost of resilient performance.

The extra effort of healthcare professionals to provide care is a manifestation of resilient performance (RP), usually going unnoticed due to successful outcomes. However, it is not clear how the human cost of RP can be assessed. This study addresses this gap by investigating the relationships between proxies of RP and its human cost. The proposed approach was tested in a 29-bed intensive care unit (ICU). The centrality of each professional in the advice-seeking social network was considered as the proxy of their contribution to system resilience. A resilience score was calculated for each professional as the product of three network centrality metrics (in-degree, closeness, and betweenness) and two non-network attributes, namely their availability and reliability. Professionals' burnout was the proxy of the human cost of RP, assessed through the Maslach Burnout Inventory, composed of 22 items divided into a triad of emotional exhaustion, depersonalization, and personal accomplishment. Both questionnaires, for social network analysis and burnout, included socio-demographic questions and were answered by 99.0% of the professionals. Results indicated a weak correlation between emotional exhaustion and the resilience score (p = 0.008). This score was also weakly correlated with working overtime (p = 0.005). Overall, findings provided initial evidence that RP as measured in our study matters to burnout, and that the two proxies are exemplars of applying a more general reasoning that might be valid for other proxies.

Beyond patient classification: the "hidden" face of nursing workload.

This is a theoretical-reflective essay, which aimed to reflect on the centralization of Patient Classification Systems in workload and hospital nursing staff sizing. The reflexive interpretations were guided by two axes: Patient Classification Systems : constitution and utilities; and "Hidden" nursing activities in workload measurement. The first evidences the importance and the role of these instruments in workload identification and in hospital nursing staff sizing, exemplifying several possibilities to be used by nurses. On the other hand, with the second axis, it is clear that there are many nursing activities that are not sensitive to the application (even if systematic) of these means of patient assessment. Therefore, nursing workload measurement may be underestimated. It was inferred that the complexity of practice environments requires a macro and micro institutional look at the nursing workload measurement, especially when considered for workforce planning/sizing purposes.

Beyond patient classification: the "hidden" face of nursing workload / Más allá de la clasificación de pacientes: la cara "oculta" de la carga de trabajo de enfermería / Além da classificação do paciente: a face "oculta" da carga de trabalho da enfermagem

ABSTRACT This is a theoretical-reflective essay, which aimed to reflect on the centralization of Patient Classification Systems in workload and hospital nursing staff sizing. The reflexive interpretations were guided by two axes: Patient Classification Systems : constitution and utilities; and "Hidden" nursing activities in workload measurement. The first evidences the importance and the role of these instruments in workload identification and in hospital nursing staff sizing, exemplifying several possibilities to be used by nurses. On the other hand, with the second axis, it is clear that there are many nursing activities that are not sensitive to the application (even if systematic) of these means of patient assessment. Therefore, nursing workload measurement may be underestimated. It was inferred that the complexity of practice environments requires a macro and micro institutional look at the nursing workload measurement, especially when considered for workforce planning/sizing purposes.

RESUMEN Ensayo teórico-reflexivo, que tuvo como objetivo reflexionar sobre la centralización de los Sistemas de Clasificación de Pacientes en la evaluación de la carga de trabajo y dimensionamiento del personal de enfermería hospitalario. Las interpretaciones reflexivas fueron guiadas por dos ejes: Sistemas de Clasificación de Pacientes: constitución y utilidades; y Actividades de enfermería "ocultas" en la medición de la carga de trabajo. El primero evidencia la importancia y el papel de estos instrumentos en la identificación de la carga de trabajo y en el dimensionamiento del personal de enfermería hospitalario, ejemplificando varias posibilidades para ser utilizados por los enfermeros. Por otro lado, con el segundo eje, es claro que hay muchas actividades de enfermería que no son sensibles a la aplicación (aunque sistemática) de estos medios de evaluación del paciente. Por lo tanto, la medición de la carga de trabajo de enfermería puede estar subestimada. Se infirió que la complejidad de los ambientes de práctica exige una mirada macro y micro institucional en la medición de la carga de trabajo de enfermería, especialmente cuando se considera para fines de planificación/dimensionamiento de la fuerza de trabajo.

RESUMO Ensaio teórico-reflexivo, que objetivou refletir acerca da centralização dos Sistemas de Classificação de Pacientes na aferição da carga de trabalho e dimensionamento de pessoal de enfermagem hospitalar. As interpretações reflexivas foram norteadas por dois eixos: Sistemas de Classificação de Pacientes: constituição e utilidades; e Atividades de enfermagem "ocultas" na aferição da carga de trabalho. O primeiro evidencia a importância e o protagonismo desses instrumentos na identificação da carga de trabalho e no dimensionamento de pessoal de enfermagem hospitalar, exemplificando-se diversas possibilidades a serem utilizadas pelos enfermeiros. Em contrapartida, com o segundo eixo, percebe-se que existem muitas atividades de enfermagem que não são sensíveis à aplicação (mesmo que sistemática) destes meios de avaliação do paciente. Logo, a mensuração da carga de trabalho da enfermagem pode ser subestimada. Inferiu-se que a complexidade dos ambientes de prática requer um olhar macro e micro institucional à aferição da carga de trabalho da enfermagem, especialmente quando considerada para fins de planejamento/dimensionamento da força de trabalho.

Nursing practice environment in intensive care unit and professional burnout.

OBJECTIVE: To evaluate and compare the nursing practice environments in Intensive Care Units of a public and private hospital and the prevalence of burnout among nursing professionals. METHOD: Cross-sectional, descriptive study with a quantitative approach to the data. The data collection took place between October 2018 and March 2019, and it was carried out through a questionnaire with socio-occupational variables and with metrics of intensity. The practice environment was assessed through the Nursing Work Index Revised (NWI-R); and the burnout was assessed by the Maslach Burnout Inventory (IBM). We included professionals with, at least, six months of employment, and those who were on leave or on a fixed-term employment contract were excluded. RESULTS: The sample consisted of 296 professionals. We found Favorable environments in both institutions, however, low results in the subscales autonomy, control and organizational support in the private hospital. The prevalence of burnout among nurses was 2.5% in the public hospital and 9.1% in the private hospital, and among nursing technicians, it was 9.5% and 8.5%, respectively. CONCLUSION: The control of the environment, autonomy and support were considered critical points, referring to the importance of assessing institutions factors, that can improve the working conditions for the nursing team.

Occupational stress, burnout and patient safety culture among workers from critical care and non critical care units in a hospital in Brazil.

OBJECTIVES: To evaluate the relationship among occupational stress, burnout and the perception of patient safety culture in health workers in critical care compared to non critical care units. RESEARCH METHODOLOGY: A cross-sectional study with health workers in the critical care and non critical care units of a university public hospital in Brazil. Data were collected using the Demographic and Labour Profile Questionnaire, Safety Attitudes Questionnaire, Job Stress Scale and the Maslach Burnout Inventory. An analysis of descriptive and inferential statistics was performed in PASW Statistics® software. RESULTS: A total of 393 health workers participated in the study, with 58.3% from critical care units and 41.7% from non critical care units. There was a prevalence of workers in high demand in non critical care units and 13.4% were experiencing burnout; there was a predominance of active work in the reviews and 8.3% were experiencing burnout. The patient safety culture perception was negative in both. The multivariate analysis pointed out that the variables such as high demand and burnout increased the prevalence of negatively assessing the safety culture. CONCLUSION: Workers from non critical care units were more affected by occupational stress and burnout and seemed to evaluate the safety culture more negatively, which can interfere in the quality of care provided.

Nursing practice environment in intensive care unit and professional burnout / Entorno de la práctica enfermera en cuidados intensivos y el síndrome de desgaste ocupacional o burnout profesional / Ambiente de prática de enfermagem em terapia intensiva e burnout profissional

ABSTRACT Objective: To evaluate and compare the nursing practice environments in Intensive Care Units of a public and private hospital and the prevalence of burnout among nursing professionals. Method: Cross-sectional, descriptive study with a quantitative approach to the data. The data collection took place between October 2018 and March 2019, and it was carried out through a questionnaire with socio-occupational variables and with metrics of intensity. The practice environment was assessed through the Nursing Work Index Revised (NWI-R); and the burnout was assessed by the Maslach Burnout Inventory (IBM). We included professionals with, at least, six months of employment, and those who were on leave or on a fixed-term employment contract were excluded. Results: The sample consisted of 296 professionals. We found Favorable environments in both institutions, however, low results in the subscales autonomy, control and organizational support in the private hospital. The prevalence of burnout among nurses was 2.5% in the public hospital and 9.1% in the private hospital, and among nursing technicians, it was 9.5% and 8.5%, respectively. Conclusion: The control of the environment, autonomy and support were considered critical points, referring to the importance of assessing institutions factors, that can improve the working conditions for the nursing team.

RESUMEN Objetivo: Evaluar y comparar los entornos de la práctica enfermera en Unidades de Cuidados Intensivos de un hospital público y de uno privado y la prevalencia del burnout entre los profesionales de enfermería. Método: Se trata de un estudio transversal, descriptivo, con enfoque cuantitativo de los datos, cuya recopilación se llevó a cabo entre octubre de 2018 y marzo de 2019, mediante un cuestionario elaborado con variables sociolaborales y métricas de intensidad. El ambiente de la práctica se evaluó a través del Nursing Work Index Revised (NWI-R) y el burnout, por el Inventario de Burnout de Maslach (IBM). Participaron aquellos profesionales que poseían como mínimo seis meses de vínculo laboral y fueron excluidos los que estaban alejados o con contrato de trabajo por un período determinado. Resultados: La muestra estaba compuesta por 296 profesionales. Se comprobaron entornos favorables en ambas instituciones, aunque con resultados frágiles en las subescalas autonomía, control y apoyo organizacional en el hospital privado. La prevalencia de burnout entre los enfermeros era del 2,5% en el hospital público y del 9,1% en el privado, y entre los técnicos de enfermería, del 9,5% y del 8,5%, respectivamente. Conclusión: El control del entorno, la autonomía y el apoyo son puntos críticos, lo que demuestra la importancia de evaluar determinados factores de las instituciones que mejoren las condiciones laborales para el personal de enfermería.

RESUMO Objetivo: Avaliar e comparar os ambientes de prática de enfermagem em Unidades de Terapia Intensiva de um hospital público e outro privado e a prevalência de burnout entre os profissionais de enfermagem. Método: Estudo transversal, descritivo, com abordagem quantitativa dos dados. A coleta de dados ocorreu entre outubro de 2018 e março de 2019 e deu-se por meio de um questionário com variáveis sociolaborais e métricas de intensidade. O ambiente de prática foi avaliado através do Nursing Work Index Revised (NWI-R) e o burnout pelo Inventário de Burnout de Maslach (IBM). Foram incluídos profissionais com no mínimo seis meses de vínculo empregatício e excluídos os que estivessem afastados ou em contrato de trabalho por período determinado. Resultados: A amostra foi de 296 profissionais. Verificaram-se ambientes favoráveis em ambas as instituições, porém, com resultados frágeis nas subescalas autonomia, controle e suporte organizacional no hospital privado. A prevalência de burnout entre enfermeiros foi de 2,5% no hospital público e 9,1% no privado, e entre técnicos de enfermagem foi de 9,5% e 8,5%, respectivamente. Conclusão: O controle do ambiente, a autonomia e o suporte foram considerados pontos críticos, remetendo à importância de avaliar fatores das instituições que possam melhorar as condições laborais para a equipe de enfermagem.

Administração de medicamentos ­ carga de trabalho da equipe de enfermagem em unidade de internação clínica / Medication administration ­ nursing workload in clinical inpatient units / Administración de medicamentos ­ carga de trabajo del equipo de enfermería en unidad de internación clínica

Objetivos: verificar a quantidade e tipo de medicamentos prescritos e administrados por técnicos de enfermagem em unidade de internação e discutir suas implicações na carga de trabalho da enfermagem e na segurança dos pacientes. Método: estudo transversal exploratório realizado em três unidades de internação clínica de um hospital universitário do sul do país, entre dezembro de 2014 e março de 2015. A amostra foi de 162 escalas de trabalho de pacientes atribuídos aos profissionais de enfermagem. Os dados foram coletados com instrumento específico e analisados por meio de estatística descritiva. Resultados: o número médio de doses prescritas por turno/técnico foi de 60,45 (dp = 20,26) e administradas foi de 34,50 (dp = 15,64). Identificou- se 16 diferentes tipos de vias para administração dos fármacos. Conclusão: o número e tipo de medicamentos prescritos e administrados geram implicações na carga de trabalho da equipe e contribuem para risco de erros (AU).

Objectives: To verify the number and types of drugs prescribed and administered by nursing technicians in inpatient units and discuss its implications for nursing workload and patient safety. Method: exploratory cross-sectional study carried out in three inpatient units of a university hospital in southern Brazil from December 2014 to March 2015. The sample consisted of 162 work schedules of nurses that provided direct care to patients in the referred units. Data was collected with a tool designed for this purpose and analyzed with descriptive statistics. Results: the average number of doses prescribed per shift/technician was 60.45 (sd = 20.26) and administered was 34.50 (sd = 15.64). Sixteen different types of routes for administering the drugs were identified. Conclusion: The number and types of drugs prescribed and administered impact nursing workload and increase the risk of errors (AU).

Objetivos: verificar la cantidad y tipo de medicamentos prescriptos y administrados por auxiliares de enfermería en unidad de internación, y discutir sus implicaciones en la carga de trabajo de enfermería y en la seguridad de los pacientes. Método: Estudio transversal exploratorio, realizado en tres unidades de internación clínica de hospital universitario del sur de Brasil, entre diciembre de 2014 y marzo de 2015. Muestra de 162 escalas de trabajo de pacientes atribuidas a profesionales de enfermería. Datos recolectados con instrumento específico, analizados por estadística descriptiva. Resultados: El número promedio de dosis prescriptas por turno/auxiliar fue de 60,41 (SD=20,26), y el de administradas, 34,50 (SD=15,64). Fueron identificadas 16 tipos de vías de administración para los fármacos. Conclusión: El número y tipo de medicamentos prescriptos y administrados genera implicancias en la carga de trabajo del equipo e incrementan el riesgo de errores (AU).

[Educational strategies to improve adherence to patient identification]. / Estratégias educativas para melhorar a adesão à identificação do paciente.

OBJECTIVE: The aim of this study was to analyze the impact of educational actions on the results of an adherence indicator while checking patient identification wristbands before high-risk care. METHODS: This is a descriptive and exploratory study that was conducted in a large university hospital between January 2013 and December 2014, where 6,201 patients were interviewed. Data were analyzed by descriptive statistics. RESULTS: The analysis and monitoring of the adherence indicator in patient identification wristbands showed a tendency to increased percentage along the study period, from 42.9% to 57.8% between January and April 2013,and from 81.38% to 94.37% between September and December 2014. CONCLUSIONS: Teaching strategies based on staff awareness improved the professionals' adherence to checking patient ID wristbands. In addition, this result can contribute to strengthening the safety culture within the institution.

Motivations, contradictions and ambiguities in the leadership of nurses in management positions in a university hospital.

OBJECTIVE: To analyze the contradictions and ambiguities which permeate nurses' motivation for exercising leadership in management positions, in a university hospital. METHOD: This study has a qualitative approach and is exploratory and descriptive, and used a total of 33 semi-structured interviews which were submitted to thematic analysis. RESULTS: The information converged on five categories: Motivation to take on a management position; The view of nursing managers on the exercising of leadership; The emblematic aspect of working with people; Leadership in nursing--mediatory and conciliatory; Time: a dilemma between managing and caring. CONCLUSION: Leading people can be both a great encouragement, and an impeding aspect, bearing in mind the nuances of teamwork and the complexity of the context in which this process is constructed. In addition to this, conciliatory and mediatory attitudes are shown to be fundamental for a healthy and productive organizational atmosphere; however, the lack of time was indicated as a dilemma between managing and caring.

Nursing workload and patient safety--a mixed method study with an ecological restorative approach.

OBJECTIVE: The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital. METHOD: a mixed method strategy (sequential explanatory design). RESULTS: the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism. During the subsequent qualitative stage of the research, the nursing team stressed medication administration, bed baths, and patient transport as the aspects of care that have the greatest impact on workload and pose the greatest hazards to patient, provider, and environment safety. CONCLUSIONS: The findings demonstrated significant associations between nursing workload and patient safety. We observed that nursing staff with fewer patients presented best results of care-related and management-related patient safety indicators. In addition, the tenets of ecological and restorative thinking contributed to the understanding of some of the aspects in this intricate relationship from the standpoint of nursing providers. They also promoted a participatory approach in this study.

[The social representations of the process of choosing leaders in the perspective of the nursing team]. / Representações sociais do processo de escolha de chefias na perspectiva da equipe de enfermagem.

This exploratory-descriptive, qualitative study was performed with the objective to analyze the social representation of the process of choosing leaders among nursing workers of a university hospital. The information was obtained through free word association and open interviews. For the purposes of this study, thematic content analysis was performed, guided by the Social Representations Theory. Through this focus the following category emerged: division of the nursing team - the input and output of the process of choosing leaders. The category consists of a crystallization of the social representation of the subject, anchored in elements related to leadership, impartiality, change, knowledge, trust and humanization. The idea of leadership is highlighted as inducing a movement in the division of the team as it is associated with the process of choosing leaders for an environment of communication, suitable for integrating the team and recognizing potential leaders.

[The notion of task in focus groups]. / A noção de tarefa nos grupos focais.

The aim of this paper is to revisit the concept of task in light of Pichon-Riviére's referential and to discuss its application in research with focus groups. Focus groups are understood as a research technique which proposes to investigate a topic in depth, allowing the construction of new ideas and answers on the subject in focus. The presuppositions of operative groups were used to support the research practice with focus groups. In these, the notion of task has a key strategic position from which it seeks to intervene in society through dialogue and collective construction, unlike simple data collecting

Leadership in nursing: analysis of the process of choosing the heads.

The process of choosing heads can be strategic to achieve desired results in nursing care. This study presents an exploratory and descriptive research that aims to analyze the process of choosing heads for the ward, in the nursing area of a teaching hospital in Porto Alegre. Data was collected from registered nurses, technicians and nursing auxiliaries through a semi-structured interview technique and free choice of words. Three theme categories emerged from content analysis: process of choosing heads, managerial competences of the head-to-be and team articulation. Leadership was the word most frequently associated with the process of choosing heads. The consultation process for the choice of the leader also contributes to the success of the manager, as it makes the team members feel co-responsible for the results achieved and legitimizes the head-to-be in their group.

[Construction and implementation of two quality indicators in nursing services]. / Construção e implantação de dois indicadores de qualidade assistencial de enfermagem.

Indicators monitor the quality of services and improve the attention offered to the patients. Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil, has been developing strategies to assess its services according to its institutional management policy of quality The present study aims to report the experience at this university hospital with the construction and implementation of quality indicators in its nursing services. In 2006, four indicators were established: incidence of pressure ulcer, with a goal of < or = 10:1000 patients per day/month and incidence of falls from bed whose goal was established as < or = 2:1000 patients per day/month. Our challenge was to build and implement these indicators as management tools to assess the quality of nursing services, for this is a large hospital.

[Punitive written warnings issued by nursing services managers]. / Análise das advertências geradas pelas chefias de enfermagem.

This survey aims at analyzing the reasons that generated punitive written warnings from a university hospital of Nursing Services in the period 2001 to 2006 involving different managers. This is an exploratory and descriptive study with quantitative approach. The data were categorized into 4 distinct groups, those being: errors of medicines, disciplinary problems, ethical and technical failures. Among the problems identified 236 disciplinary incidents were the most (46%), the medication errors accounted for 28%, ethical issues and 11% technical failure 11%. There were not statistically significant changes or trends identified over the years or between different departments of nursing. It is suggested it should be studied the interference through the use of appropriate tools to manage the performance of managers.

[Shift reporting: a strategic resource for the continuity of nursing care]. / Passagem de plantão: um recurso estratégico para a continuidade do cuidado em enfermagem.

Shift reporting is an important tool for organizing and planning nursing care. The purpose of this study was to describe how shift reporting is conducted in some wards of a teaching hospital in Porto Alegre, Rio Grande do Sul, Brazil, and to identify the nurses' knowledge on how to systematize this activity. Two data collection methods were used in this qualitative study: observation of shift report; and a questionnaire answered by nurses. Data were submitted to thematic content analysis. In all wards, shift report happened during a nurses' meeting, when information was exchanged, although nurse knew other form of shift reporting. Several positive and negative factors affect shift reporting, and the nursing staff should try to make this activity as easy, systematic, and effective as possible.

[Performance analysis of venous puncture, and nasogastric and nasointestinal tube placement in a pediatric ward]. / Análise da punção venosa e sondagens nasogástrica e nasoenteral em unidade de internação pediátrica.

This article is an observational study that analyzes the performance of venous punctures and nasogastric and nasointestinal tube placement in pediatric patients, performed by nurses in a pediatric ward. This exploratory descriptive study was carried out at a teaching hospital in Porto Alegre, Rio Grande do Sul, Brazil, and its purpose is to identify frequency and time spent in the performance of these procedures, as well as to provide data for the management of nursing human resources. Two nurses were selected intentionally and an observation structured record was used to collect the data. The average time spent in the performance of venous punctures was 17.62 minutes, and tube placement, 10.8 minutes. The outcomes provided an understanding of the processes complexity, whose elements are related to the nurse's work process, as well as to the other professionals involved, the family and the child who underwent the procedures.

[Nursing personnel planning in a surgical unit]. / Dimensionamento de pessoal de enfermagem em centro cirúrgico.

This case study discusses the application of a model to determine the number of nurses in the surgical unit in a general hospital of Porto Alegre, Rio Grande do Sul, Brazil. The obtained results were compared with literature findings. Results of calculations identifying the annual capacity of the unit and the annual capacity of nursing hours are presented. The results obtained by applying this model can allow higher precision when planning the number of nurses needed in this unit for nursing care during pre- and post-surgery, thereby contributing to improve productivity.

[Nursing diagnosis for allogeneic bone marrow transplantation patient: case study]. / Diagnósticos de enfermagem de paciente submetido à transplante de medula óssea alogênico: estudo de caso.

This case study aims at presenting the follow-up of a patient who underwent allogeneic bone marrow transplantation and the experience of the nursing team of the Centro de Transplante de Medula Ossea (Bone Marrow Transplantation Center) at the Hospital de Clínicas de Porto Alegre, Brazil, during the development of the systematization of the nurse practice emphasizing the period of elaboration of the nursing diagnosis. Twenty-six diagnosis established in this case are discussed and put together in the format of a table to allow the reader to have a view of their initial and ending periods, during the in-patient treatment time.