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.

Pressure ulcer (risk) assessment: recommendations to improve nursing practice

Pressure ulcer (risk) assessment is complex and multifactorial. National and inter-national guidelines give orientations about pressure ulcer (PU) management and provide important recommendations. However, it's necessary to know our reality in order to improve Evidence-Based Nursing. The main aim of this study was to pro-vide some recommendations to improve clinical practice, clinical research, clinical management and continuous education on PU domain. The study was designed as a retrospective cohort analysis of electronic health record database from adult patients admitted to general wards in a Portuguese hospital during one year. The study had a sample of 8147 participants where 34.4% had "high risk" of PU deve-lopment at the first PU risk assessment, 7.9% had (at least) one PU at the first skin and tissue assessment and 3.4% developed (at least) one PU during the length of inpatient stay. (Im)"mobility" was the major risk factor assessed through Braden Scale for PU development. The systematic PU risk assessment: is sensitive to patient clinical changes; should be performed since the hospital admission; and should be used in combination with nursing clinical judgement. The systematic skin and tissue assessment: identifies early changes in skin and tissue condition; should be performed since the hospital admission; and should identify wounds of different aetiologies. The PU assessment could be improved with the implementation of a validated tool in order to standardised data record, to monitor PU/wounds charac-teristics and their evolution

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Pressure ulcer incidence and Braden subscales: Retrospective cohort analysis in general wards of a Portuguese hospital.

AIM: To study the influence of Braden subscales scores (at the first pressure ulcer risk assessment) on pressure ulcer incidence using a univariate and a multivariate time to event analysis. MATERIALS AND METHODS: Retrospective cohort analysis of electronic health record database from adult patients admitted without pressure ulcer(s) to medical and surgical wards of a Portuguese hospital during 2012. The hazard ratio of developing a pressure ulcer during the length of inpatient stay was calculated by univariate Cox regression for each variable of interest and by multivariate Cox regression for the Braden subscales that were statistically significant. RESULTS: This study included a sample of 6552 participants. During the length of stay, 153 participants developed (at least) one pressure ulcer, giving a pressure ulcer incidence of 2.3%. The univariate time to event analysis showed that all Braden subscales, except "nutrition", were associated with the development of pressure ulcer. By multivariate analysis the scores for "mobility" and "activity" were independently predictive of the development of pressure ulcer(s) for all participants. CONCLUSION: (Im)"mobility" (the lack of ability to change and control body position) and (in)"activity" (the limited degree of physical activity) were the major risk factors assessed by Braden Scale for pressure ulcer development during the length of inpatient stay. Thus, the greatest efforts in managing pressure ulcer risk should be on "mobility" and "activity", independently of the total Braden Scale score.

Memórias de enfermagem e aids no hospital nereu ramos (1986-1996) / Memories of nursing and aids at nereu ramos hospital (1986-1996) / Memorias de enfermería e sida em el hospital nereu ramos (1986-1996)

Trata-se de pesquisa qualitativa com abordagem histórica com o objetivo de objetivo de historicizar as memórias dos profissionais de enfermagem acerca do surgimento da Aids e sua evolução no Hospital Nereu Ramos (HNR), em Florianópolis(SC), de 1986 a 1996. Foram realizadas entrevistas com 7 profissionais de enfermagem que atuavam na instituição no período descrito, utilizando-se o método de história oral e como referencial teórico memória.A pesquisa respeitou as diretrizes e normas regulamentadoras envolvendo seres humanos recomendadas pela resolução n° 196/96 e foi aprovada pelo Comitê de Ética em Pesquisa da Universidade Federal de Santa Catarina(UFSC). A partir da análise temática de conteúdo foram encontradas diversas categorias e subcategorias das quais destacamos: a) a memoria do enfrentamento face à Aids e b) a memoria do enfrentamento face as pessoas com HIV/Aids no HNR Embora essa doença tenha causado sérios transtornos a equipe de saúde,provocou mudanças positivas em relação as condições físicas, estruturais, materiais e organizacionais do HNR e principalmente no reconhecimento do papel social da lnstituição pela sociedade catarinense.

This is a qualitative research with a historical approach that aimed to historicize nurse's memories about the appearance and development of AIDS at Nereu Ramos Hospital (HNR) in Florian6polis, Santa Catarina state, between 1986 and 1996. Several interviews were conducted with seven nurses that worked at the institution during the period of the study, using verbal history as method and memory as referential. The research followed the ethical principles recommended by resolution 196/96 and it was approved by the Research Ethics Board of the Universidade Federal de Santa Catarina (UFSC). Using thematic content analysis, several categories and subcategories emerged, from which we highlight: a) The memory of coping with AIDS and b) The memory of copingwith people presented with HIV at HNR. Although AIDS caused serious problems to the health team, there were significant positive changes in the physical, structural, material, and organizational conditions of HNR, especiallyin the recognition of its social role to Santa Catarina's society.

Este trabajo es una lnvestigación cualitativa can enfoque histórico, cuyo objetivo fue historicizar las memorias de los profesionales de enfermería acerca de la aparición y el desarrollo del SIDA en el Hospital Nereu Ramos(HNR), de Florianópolis - SC, en el período comprendido entre 1986 y 1996. Fueron realizadas entrevistas cansrete profesionales de enfermería que actuaban en la institución en el período de estudio, y para ello se utilizaronel método de la historia oral y, como referencial teórico, la memoria. La investigación respetó las Directrices y Normas de Regulación de Investigación en Seres Humanos de la Resolución n." 196/96 y fue aprobada por el Comité de Ética en lnvestigación de la UFSC. A partir del análisis temático se encontraron varias categorías y subcategorías, de las cuales destacamos: a) la memoria de los enfrentamientos ante el SIDA; b) la memoria delos enfrentamientos ante las personas que viven con SIDA en el HNR. A pesar de que el SIDA en el HNR haya causado serios trastornos al equipo de salud, provocó mudanzas positivas en las condiciones físicas, estructurales, materiales y organizacionales y, sobre todo, en el reconocimiento del papel social de la institución por la sociedad del estado de Santa Catarina.

O Enfrentamento de Profissionais de Enfermagem no cuidado de pessoas com Aids / Coping of Nursing Professionals who take care of people with Aids – an Educative-Reflective Practice

Trata-se do relato de experiência de um processo educativo-reflexivo, embasado na Pedagogia Problematizadora, desenvolvido com profissionais de enfermagem de uma instituição de referência no controlo da aids, sobre os problemas que vivenciam e enfrentam ao cuidar de pessoas com aids. A operacionalização da proposta ocorreu no final do segundo semestre do ano de 2006, com 10 técnicos de enfermagem, sob a forma de oficinas, norteadas pelo Método do Arco de Charles Maguerez. No decorrer das oficinas, os problemas identificados foram agrupados em cinco pontos-chave: as Características Particulares das Pessoas com aids; os limitados Recursos Humanos e Físicos; as difíceis Questões Administrativas/Organizacionais da instituição, a Discriminação e Preconceito; Vida Profissional influenciando negativamente na Vida Pessoal. As discussões realizadas mostram que os profissionais tentam lidar com os problemas que surgem no seu cotidiano, procurando novas formas que permitem transformar a sua realidade. Concluímos ainda que alguns desses problemas estão em consonância com estudos realizados anteriormente na instituição, pelo que os profissionais e a administração da Instituição necessitam desenvolver, em conjunto, estratégias de enfrentamento mais eficazes para solucionar os problemas do dia-a-dia. A realização deste trabalho também abriu caminho para a realização de um novo estudo, de cunho histórico, na instituição.

A Enfermagem nos Cuidados Paliativos / Nursing in Hospice Care: reflection

A morte representa a última etapa do processo de viver humano. É uma realidade da qual não podemos fugir. Tendo em consideração as atividades que os enfermeiros realizam com o doente terminal, este artigo tem como objetivo refletir sobre o cuidado de enfermagem e a importância dos cuidados paliativos. Tendo como ponto de partida as definições de cuidado e cuidados paliativos, pretendemos destacar o papel dos enfermeiros no cuidado ao doente terminal e sua família, quando já não é possível curar, mas apenas cuidar. Embora seja necessária uma constante atualização de conhecimentos, o cuidar em cuidados paliativos é uma arte, onde as relações humanas assumem um papel de destaque e permitem a preservação da qualidade de vida da pessoa mesmo numa situação complexa, proporcionam uma morte tranqüila e promovem um processo de luto saudável.

Uma história de sucesso: 30 anos da Pós-Graduação em Enfermagem da UFSC / A success story: 30 years of the Nursing Graduate Program at UFSC

Pesquisa qualitativa com abordagem sócio-histórica, que objetivou historicizar a trajetória do Programa de Pós-Graduação em Enfermagem da Universidade Federal de Santa Catarina partindo da percepção das coordenadoras. Foram realizadas entrevistas com seis coordenadoras do Programa. Os dados encontrados expressam três categorias de análise: 1) a criação do curso e o desafio das pioneiras; 2) a retomada do Curso de Mestrado e os avanços; 3) o Doutorado e a consagração do Programa e sua expressão no cenário nacional e internacional. O estudo possibilitou conhecer como se deram a criação do programa, os avanços, os desafios, a participação dos órgãos financiadores, a produção científica dos docentes e discentes e a contribuição do Curso no contexto nacional e internacional. Concluímos que, o programa contribui expressivamente para o desenvolvimento do saber em enfermagem e saúde, na qualificação de docentes e pesquisadores e estimulando a melhoria da prática de enfermagem no país, e no exterior.

This is a qualitative study, using a socio-historical approach. Its objective is to place into a historical perspective the trajectory of the Nursing Graduate Program at the Federal University of Santa Catarina, Brazil, from the historical perspective of its coordinators. In order to so, structured interviews were carried out with six of the coordinators who served in the Program. The data found express three categories of analysis: 1) the creation of the course and the challenge of the pioneers; 2) the return of the Master's Course and advances; 3) the Doctorate and the consagration of the Program, its contribution to the national and international scene. This study made it possible to get to know more about the creation of the Program, the advances made, the challenges faced, the participation of the financial organs, the scientific production of the faculty and the students, as well as the contributions of the Course in the national and international arenas. We conclude that the program has expressly contributed towards the development of knowledge in nursing and health care, in the qualification and professional preparation of faculty and researchers, as well as contributed to the improvement of the nursing practice in Brazil and abroad.

Es una investigación cualitativa con abordaje socio-histórico, cuyo objetivo fue historiar, a partir de la percepción de sus coordinadoras, la trayectoria del Programa de Postgrado en Enfermería de la Universidad Federal de Santa Catarina. Para llevar a cabo tal objetivo, se realizaron una serie de entrevistas parcialmente elaboradas con seis coordinadoras que trabajaron en el Programa. Los datos obtenidos expresan tres categorías de análisis: 1) la creación del Curso y el desafío de las pioneras; 2) la retomada del Curso de Maestría y sus avances; 3) el Doctorado y la consagración del Programa así como su manifestación en el escenario nacional e internacional. El estudio nos permitió conocer cómo se realizó la creación del Programa, los avances, los desafíos, la participación de las entidades de subvención, la producción científica de los profesores y alumnos, la contribución del Curso en el contexto nacional e internacional. Podemos concluir que el Programa de Postgrado ha contribuido de forma relevante para el desarrollo del conocimiento y del saber en enfermería y salud, así como en la capacitación de profesores e investigadores, también para la mejora de la práctica de la Enfermería en el país y en el exterior.