Omission of nursing care, professional practice environment and workload in intensive care units.

AIM: The present study aimed to characterize the omission of nursing care according to the nurses' perception, the professional practice environment and the nursing workload of intensive care units (ICU) in Brazil. Additionally, the influence of the practice environment and nursing workload on such omission was assessed, as well as the type of care omitted regarding priority classification. BACKGROUND: In order to ensure patient safety and quality of care, it is necessary to invest in improvements in nursing care practices. METHOD: The present cross-sectional study was performed in three large ICU in Brazil. The omission of nursing care was identified using the MISSCARE-BRASIL instrument, and the environment and duration of professional nursing practice were analysed using the Practice Environment Scale (PES) and Nursing Activities Score (NAS), respectively. RESULTS: "Ambulation three times a day or as prescribed" was the form of care reported as the most omitted in the three studied units. The reasons for not performing care included the following: inadequate number of staff, inadequate physical blueprint of the unit/sector and the professional having more than one employment relationship. Upon characterizing the work environment in the ICU according to the PES, ICU 1 and 3 were considered "mixed" environments, whereas ICU 2 was considered a "favourable" environment. CONCLUSION: The professional practice environment, as well as the workload, may constitute predictive factors for the omission of care. IMPLICATIONS FOR NURSING MANAGEMENT: The nursing workload and practice environment influence the omission of care. Moreover, the establishment of criteria for the prioritization of care when faced with adverse work conditions is necessary.

APACHE II Death Risk and Length of Stay in the ICU Are Associated With Pressure Injury in Critically Ill Patients.

BACKGROUND: The aim of this study was to identify factors associated with pressure injury (PI) occurrence in critically ill patients. This was a retrospective cohort study conducted at a mixed intensive care unit (ICU). METHODS: Univariate analysis and logistic regression were used to identify which variables are associated with PI. RESULTS: Twenty-one (15%) of 142 patients developed PI. The median and the range of the variables in the groups without and with PI were as follows: Braden scale risk score, 13 (8 - 20) and 10 (8 - 14) points, respectively; Acute Physiology and Chronic Health Evaluation II (APACHE II) death risk, 39% (2 - 97%) and 75% (26 - 96%), respectively; and length of stay in the ICU, 4 (2 - 36) and 16 (5 - 29) days, respectively. The socio-demographic variables included in the logistic regression were age (P = 0.09), Braden scale risk score (P = 0.0003), APACHE II death risk (P < 0.0001), length of stay in the ICU (P < 0.0001) and reason for ICU admission (P = 0.09). Only APACHE II death risk and length of stay in the ICU presented significant differences; the odds ratios were 1.05 and 1.25, respectively, and the 95% confidence intervals were 1.01 - 1.09 and 1.12 - 1.39, respectively. CONCLUSION: APACHE II death risk and length of stay in the ICU are probably associated with PI occurrence in the study population.