Incidência de lesão por pressão e tempo de assistência de enfermagem em terapia intensiva / Incidence of pressure injury and nursing care time in intensive care

Objectives: To correlate the incidence of pressure injury (PI) with the average time of nursing care in an intensive care unit (ICU). Method: Epidemiological, observational, retrospective study, carried out in the ICU of a university hospital. Data were collected by consulting the PI incidence and the average nursing care time from ICU databases between 2010 and 2014. Measures of central tendency and variability, and Pearson's correlation coefficient were used for data analysis. Results: The average incidence of PI between 2010 and 2014 was 10.83% (SD = 2.87) and the average time spent in nursing care for patients admitted to the ICU was 15 hours (SD = 0.94). There was no statistically significant correlation between the incidence of PI and the nursing care time (r = -0.17; p = 0.199), however, the results suggested an overload on the nursing team. Conclusion: This study confirms the importance of implementing and reassessing the effectiveness of preventive care protocols for PI, in addition to warning about the work overload of nursing in assisting critically ill patients.

Type of admission and nursing workload of critical patients: a cross-sectional study.

BACKGROUND: According to the perception of nurses in the intensive care unit (ICU), surgical patients need more nursing care, thus requiring higher nursing workloads for these patients than those admitted as clinical patients. However, some study results on the relationship between the type of admission and the nursing workload are considered contradictory. AIMS AND OBJECTIVES: To identify if the type of admission (clinical, emergency surgery or elective surgery) is a predictive factor of the nursing workload required by patients on the first day or throughout their stay in the ICU. DESIGN: This was a quantitative cross-sectional study comprised of a retrospective analysis of clinical records of critical patients. METHODS: Data were collected from 1 May 2015 to 30 September 2015 in a hospital located in São Paulo, Brazil. Nursing workload was measured using the Nursing Activities Score. The type of admission and the demographic and clinical variables of the patients were investigated. Multiple linear regression was used to identify nursing workload predictive factors, with 5% significance level. RESULTS: In the analysed sample (n = 211; mean age of 60·3 ± 18·7 years), there was a prevalence of male gender (56·9%). A statistically significant difference (p = 0·025) was found between the type of admission and the nursing workload required for patients on the first ICU day. The Simplified Acute Physiologic Score (p = 0·009) was a predictor of nursing workload on the first day in the ICU, and the Logistic Organ Dysfunction System (p = 0·026) and mortality (p < 0·001) were predictors throughout the ICU stay. CONCLUSIONS: The type of admission was not a predictive factor of the nursing workload required by critical patients. RELEVANCE TO CLINICAL PRACTICE: Identifying the predictive factors of nursing workload favours the appropriate staffing of the critical unit by nurses. However, nurses should not consider the type of admission in predicting the nursing workload required by patients in the ICU.

Care time and quality indicators in Intensive Care Units.

OBJECTIVE: To verify the correlation between nursing care time and care quality indicators. METHOD: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. RESULTS: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. CONCLUSION: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.

Care time and quality indicators in Intensive Care Units / Tiempo de atención e indicadores de calidad en Unidades de Terapia Intensiva / Tempo de assistência e indicadores de qualidade em Unidades de Terapia Intensiva

ABSTRACT Objective: To verify the correlation between nursing care time and care quality indicators. Method: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. Results: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. Conclusion: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.

RESUMEN Objetivo: Verificar la correlación entre tiempo de atención de enfermería e indicadores de calidad asistencial. Método: Estudio observacional, correlacional, desarrollado en 11 Unidades de Terapia Intensiva. La población comprendió registros del cuantitativo de los profesionales de enfermería, del número de portadores de, al menos, uno de los dispositivos terapéuticos Sonda Oro/Nasogastroenteral (SONGE), Cánula Endotraqueal (COT) y Cateter Venoso Central (CVC) y de las ocurrencias relativas a las pérdidas de estos artefactos. Resultados: El tiempo correspondió a 18,86 horas (Hospital A), 21 horas (Hospital B) y 19,50 horas (Hospital C); el indicador Incidencia de Salida No Planeada de SONGE presentó una media de 2,19/100 pacientes/día; Incidencia de Extubación no planificada de COT, 0,42/100 pacientes/día; e Incidencia de Pérdida CVC, 0,22/100 pacientes/día. No hubo correlación estadísticamente significativa entre el tiempo y los indicadores analizados. Conclusión: Esta investigación puede apoyar decisiones metodológicas para investigaciones futuras que buscan el impacto de los recursos humanos en la calidad asistencial y seguridad de los pacientes.

RESUMO Objetivo: Verificar a correlação entre tempo de assistência de enfermagem e indicadores de qualidade assistencial. Método: Estudo observacional, correlacional, desenvolvido em 11 Unidades de Terapia Intensiva. A população compreendeu registros do quantitativo dos profissionais de enfermagem, do número dos portadores de, ao menos, um dos dispositivos terapêuticos Sonda Oro/Nasogastroenteral (SONGE), Cânula Endotraqueal (COT) e Cateter Venoso Central (CVC) e das ocorrências relativas às perdas desses artefatos. Resultados: O tempo correspondeu a 18,86 horas (Hospital A), 21 horas (Hospital B) e 19,50 horas (Hospital C); o indicador Incidência de Saída Não Planejada de SONGE apresentou média de 2,19/100 pacientes/dia; Incidência de Extubação não Planejada de COT, 0,42/100 pacientes/dia; e Incidência de Perda CVC, 0,22/100 pacientes/dia. Não houve correlação estatisticamente significante entre o tempo e os indicadores analisados. Conclusão: Esta pesquisa pode apoiar decisões metodológicas para investigações futuras que buscam o impacto dos recursos humanos na qualidade assistencial e segurança dos pacientes.

The influence of delayed admission to intensive care unit on mortality and nursing workload: a cohort study.

BACKGROUND: The results of studies regarding the relationship between length of stay of patients in emergency departments (EDs) and mortality in intensive care units (ICUs) are contradictory, and nothing is known about the impact of delayed admission of patients to ICUs on nursing workload. AIMS AND OBJECTIVES: To assess the influence of the time lapse between ED and ICU admissions on mortality and nursing workload in relation to intensive care patients. DESIGN: This was a retrospective cohort study that examined the medical records of patients who were 15 years of age or older and admitted directly to the ICU from the ED. METHODS: The data were collected between 2014 and 2016 in a hospital located in São Paulo, Brazil. Nursing workload was measured by the Nursing Activities Score. Multiple linear and logistic regressions were applied, with a significance level of 5%. RESULTS: Of the 534 patients analysed, the majority were men (57·49%); the mean age was 55·37 ± 19·64 years. Length of stay in the ED was not associated with nursing workload at the time of admission of patients to the ICU or during their stay in the unit. For mortality, this variable was a risk factor along with cause of admission, length of stay in the ICU and the Simplified Acute Physiology Score 3 score. For every additional hour that patients remained in the ED, their chance of dying in the ICU increased by 1%. CONCLUSION: Length of stay of patients in the ED was a risk factor for mortality in the ICU; however, this variable did not have any influence on nursing workload. RELEVANCE TO CLINICAL PRACTICE: Strategies need to be implemented to optimize the availability of ICU beds and reduce the length of stay of critical patients in the ED as delays in admitting such patients to the ICU have an impact on mortality.

Critérios de admissão do paciente oncológico em Unidades de Terapia Intensiva de hospitais gerais / Oncology patient admission criteria in Intensive Care Units of general care hospitals

A função da Unidade de Terapia Intensiva é de suporte terapêutico ao paciente. O paciente com câncer muitas vezes necessita de suporte intensivo. Nesse contexto, a gravidade das disfunções orgânicas, o comprometimento da capacidade funcional, o estadiamento do câncer e a aplicação de índices prognósticos são considerados na discussão para admissão na Unidade de Terapia Intensiva. Este artigo tem como objetivo identificar os critérios para admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais, através de uma revisão integrativa, com estudos de 2007 a 2017 disponíveis em versão completa e gratuita nas bases de dados digitais: Biblioteca Virtual em Saúde, Scientific Electronic Library Online e no portal PubMed. Foram encontradas 58 publicações potenciais. Após análise preliminar dos títulos e resumos e aplicação dos critérios de inclusão e exclusão, 23 artigos seguiram para leitura na íntegra, sendo que 10 compuseram a amostra final. Sete estudos (70%) citaram o escore prognóstico APACHE II, quatro (40%) utilizaram Simplified Acute Physiology Score, dois (20%) o Sequential Organ Failure Assessment e seis (60%) utilizaram mais de um instrumento. O câncer é uma doença grave, entretanto a decisão de indicação para tratamento intensivo não deve ser baseada em apenas uma morbidade. Pacientes oncológicos podem ter benefícios ao receberem suporte intensivo. Estudos que determinam critérios objetivos para admissão e avaliam o benefício da admissão do paciente oncológico nas Unidade de Terapia Intensiva de hospitais gerais devem ser incentivados a fim de melhor definir a utilização adequada dos recursos.

The role of the Intensive Care Unit is to provide therapeutic support for the patient. The cancer patient often needs intensive support. In this context, the severity of organ dysfunctions, the impairment of functional capacity, the stage of cancer and the application of prognostic indexes are factors considered in the discussion for the patient's admission into the Intensive Care Unit. The aim of this study is to identify the criteria for admission of cancer patients into the Intensive Care Unit of general care hospitals, through an integrative review, with studies performed between 2007 and 2017, which are fully available and free for downloading in the following digital databases: Virtual Library on Health, Scientific Electronic Library Online and PubMed. Fifty-eight potential studies were found. After a preliminary analysis of the titles and abstracts and application of the inclusion and exclusion criteria, 23 articles were analyzed, of which 10 composed the final sample. Seven studies (70%) cited the APACHE II prognostic score, four (40%) used the Simplified Acute Physiology Score, two (20%) the Sequential Organ Failure Assessment and six (60%) used more than one instrument. Cancer is a serious disease, but the indication for intensive care should not be based on just one morbidity. Oncology patients may benefit from receiving intensive treatment. Studies that establish objective criteria for admission and evaluate the benefit of admission of cancer patients into Intensive Care Unit of general care hospitals should be encouraged in order to better define the appropriate use of resources.

Central line bundle maintenance among adults in a university hospital intensive care unit in São Paulo, Brazil: a best practice implementation project.

OBJECTIVES: This implementation project aimed to identify the current practice in regards to central venous catheters (CVCs) maintenance to improve knowledge amongst nursing staff and to assess increased compliance with evidence-based best practice. INTRODUCTION: Central venous catheters are considered an important therapeutic resource for the administration of fluids, drugs, blood, collection of blood samples and hemodynamic monitoring. Despite the benefits, catheter use is associated with complications such as primary infection of the catheter-related bloodstream. METHODS: This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Nine of 10 criteria were audited through direct observation of nursing professionals or patient records in relation to CVC maintenance, and one criterion involved direct questioning of nursing staff. Baseline and follow-up audits were conducted in a 12-bed adult intensive care unit in a university hospital. RESULTS: The baseline audit revealed deficits between current practice and best practice in some criteria. Barriers to implementation of CVC maintenance best practice criteria were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice guidelines in all of the audit criteria, except in one criterion: the use of sterile gloves or surgical tweezers during the execution of the dressing. CONCLUSIONS: Best practice in CVC care was achieved in the hospital, strengthening and guiding nursing care, as well as highlighting the importance of nursing records throughout the care process. However, this project highlighted the need to improve compliance through follow-up audits and periodic training to support best practice.

Tempo de assistência de enfermagem e indicadores de qualidade em Unidade de Terapia Intensiva pediátrica e neonatal / Nursing care time and quality indicators at a pediatric and neonatal Intensive Care Unit

Resumo Objetivo: Analisar a correlação entre tempo médio de assistência de enfermagem e indicadores de qualidade assistencial em Unidades de Terapia Intensiva Pediátrica e Neonatal (UTIPN). Métodos: Pesquisa quantitativa, documental, correlacional com coleta retrospectiva de dados, realizado na UTIPN do Hospital Universitário da Universidade de São Paulo. A relação entre o tempo médio de assistência dispensado e os indicadores assistenciais do período de janeiro de 2008 a julho de 2013 foi verificada pelos testes de Correlação de Spearman e de Pearson. Resultados: O tempo médio de assistência de enfermagem dispensado aos pacientes correspondeu ao preconizado pelo Cofen (17,9 horas), porém com percentual de enfermeiros menor que o indicado. A correlação entre tempo de assistência de enfermagem e indicador saída não planejada de sonda oro/nasogastroenteral indica que a disponibilidade de tempo influencia as notificações ou subnotificações desses eventos. Conclusão: Os resultados não evidenciaram alteração nos índices dos indicadores de qualidade em função do tempo médio de cuidado, mas sugerem poder estar relacionados à experiência profissional, capacitação da equipe de enfermagem e ações educativas para melhoria contínua dos processos assistenciais.

Abstract Objective: To analyze the correlation between the mean time of nursing care and care quality indicators in Pediatric and Neonatal Intensive Care Units (PNICU). Methods: Quantitative, documentary, correlational research with retrospective data collection, developed at the UTIPN of the University Hospital at the Universidade de São Paulo. The relation between the mean care time spent and the care indicators for the period from January 2008 till July 2013 was verified by means of Spearman's and Pearson's Correlation tests. Results: The mean time of nursing care spent on the patients corresponded to the recommendation by Cofen (17.9 hours), but with a lower percentage of nurses than indicated. The correlation between the time of nursing care and the indicator unplanned removal of oral/nasogastric/enteral tube indicates that the availability of time influences the reporting or underreporting of these events. Conclusion: The results evidenced no change in the quality indicators in function of the mean care time, but suggest possible relations with professional experience, nursing team training and educational actions for the ongoing improvement of care processes.

Nursing workload and occurrence of adverse events in intensive care: a systematic review.

OBJECTIVE: To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). METHOD: A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors. RESULTS: Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU. CONCLUSION: The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care. OBJETIVO: Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI). MÉTODO: Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos. RESULTADOS: Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP. CONCLUSÃO: A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.

Nursing workload and occurrence of adverse events in intensive care: a systematic review / Carga laboral de enfermería y ocurrencia de eventos adversos en los cuidados intensivos: revisión sistemática / Carga de trabalho de enfermagem e ocorrência de eventos adversos na terapiaintensiva: revisão sistemática

Abstract OBJECTIVE To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). METHOD A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors. RESULTS Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU. CONCLUSION The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care.

Resumen OBJETIVO Identificar evidencias acerca de la influencia de la carga laboral de enfermería en la ocurrencia de eventos adversos (EA) en pacientes adultos ingresados en Unidad de Cuidados Intensivos (UCI). MÉTODO Revisión sistemática de la literatura llevada a cabo en las bases de datos MEDLINE, CINAHL, LILACS, SciELO, BDENF y Cochrane de estudios en inglés, portugués o español, publicados hasta 2015. Los EA analizados fueron infección, úlcera por presión (UPP), caídas y errores asociados con fármacos. RESULTADOS De las 594 investigaciones potenciales identificadas, ocho compusieron la muestra final de la revisión. El NursingActivities Score - NAS (37,5%) y el TherapeuticInterventionScoringSystem - TISS (37,5%) fueron los instrumentos más utilizados para evaluación de la carga laboral de enfermería. Seis investigaciones (75,0%) identificaron influencia de la sobrecarga laboral en la ocurrencia de infección, UPP y uso de fármacos. Una investigación identificó que el NAS fue factor de protección para UPP. CONCLUSIÓN La carga laboral de enfermería requerida por pacientes en la UCI influenció la ocurrencia de EA, y los enfermeros deben monitorear a diario dicha variable a fin de asegurar el correcto dimensionamiento del equipo y la seguridad de la asistencia prestada.

Resumo OBJETIVO Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI). MÉTODO Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos. RESULTADOS Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP. CONCLUSÃO A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.

Nursing care time and quality indicators for adult intensive care: correlation analysis.

The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.

Nursing care time and quality indicators for adult intensive care: correlation analysis / Tempo de assistência de enfermagem em unidade de terapia intensiva adulto e indicadores de qualidade assistencial: análise correlacional / Tiempo de atención de enfermería en la unidad de cuidados intensivos de adultos y los indicadores de atención de calidad: análisis de correlación

The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.

Trata-se de studo de abordagem quantitativa, correlacional e descritivo, elaborado com o objetivo de analisar o tempo utilizado pela equipe de Enfermagem para assistir aos pacientes internados em unidade de terapia intensiva adulto, bem como verificar sua correlação com os indicadores de qualidade assistencial. A identificação do tempo médio de assistência despendido e dos indicadores de qualidade assistencial foi efetivada por meio de consulta aos instrumentos de gestão, utilizados pela chefia de Enfermagem da unidade. O tempo médio de assistência despendido com os pacientes manteve-se equilibrado, porém, inferior aos indicados pelos órgãos oficiais brasileiros. A correlacão entre o tempo de assistência de Enfermagem despendido por enfermeiros e o indicador incidência de extubação acidental indicou que a incidência de extubação acidental diminui, à medida que aumenta o tempo de assistência de Enfermagem despendido por enfermeiros. Os resultados desta investigação demonstram a influência do tempo de assistência de Enfermagem, provido por enfermeiros, no resultado do cuidado ministrado.

Un estudio de enfoque cuantitativo, de correlación y descriptiva, elaborado con objetivo de analizar el tiempo empleado por equipo de enfermería para asistir pacientes hospitalizados en Unidad de Cuidados Intensivos de Adultos y verificar su correlación con indicadores de calidad de la atención. La identificación del promedio de tiempo de cuidados y de indicadores de calidad asistencial fue realizada por medio de consulta a las herramientas de gestión utilizadas por el jefe de enfermería de la Unidad. El promedio de tiempo de cuidado ministrado a los pacientes se mantuvo equilibrado, pero inferior a los indicados por organismos oficiales en Brasil. La correlación entre tiempo de cuidados de enfermería e indicador de incidencia extubación accidental indicó que esta disminuye con aumento de tiempo de atención de enfermería utilizado por enfermeras. Los resultados de esta investigación demuestran la influencia del tiempo de atención de enfermería por las enfermeras, en los resultados de la atención prestada.

Tempo de assistência de enfermagem em UTI e indicadores de qualidade assistencial: análise correlacional / Nursing care time and quality indicators for ICU: correlation analysis

Estudo exploratório, retrospectivo, de natureza quantitativa, desenvolvido com o objetivo de analisar o tempo utilizado pela equipe de enfermagem para assistir aos pacientes internados na Unidade de Terapia Intensiva Adulto (UTIA) do Hospital Universitário da Universidade de São Paulo (HU-USP), bem como verificar sua correlação com os indicadores de qualidade assistencial. O período de análise foi 01 de janeiro de 2008 a 31 de dezembro de 2009. Os dados foram coletados dos instrumentos de gestão utilizados pela chefia de enfermagem da Unidade. A análise do tempo médio de assistência dispensado em relação ao tempo médio de assistência requerido pelos pacientes foi efetuada por meio do teste estatístico t pareado. Para verificar a correlação do tempo médio de cuidado dispensado aos pacientes da UTIA com o indicador de qualidade incidência de perda de cateter venoso central foi utilizado o coeficiente de correlação de Sperman, enquanto que para os demais indicadores foi utilizado o coeficiente de correlação de Pearson. O tempo médio de assistência de enfermagem dispensado aos pacientes, no período analisado, correspondeu a 14 horas, das quais 31% foram ministradas por enfermeiros e 69% por técnicos/auxiliares de enfermagem. Os pacientes internados requereram cerca de 16 horas de cuidados. A aplicação do teste estatístico demonstrou que as diferenças encontradas, entre as horas de assistência dispensadas pela equipe de enfermagem e aquelas requeridas pelos pacientes, foisignificativa (p< 0,001), sugerindo sobrecarga de trabalho aos profissionais de enfermagem da UTIA. A análise correlacional entre o tempo de assistência de enfermagem dispensado por enfermeiros e o indicador de qualidade incidência de extubação acidental, evidenciou coeficiente de correlação de Pearson de (r = - 0,454), com p valor de 0,026, indicando linearidade negativa entre as variáveis, o que permitiu inferir que a incidência de extubação acidental diminui à medida que aumenta o tempo de assistência de enfermagem dispensado por enfermeiros. Os resultados encontrados permitiram verificar que as horas médias de assistência de enfermagem dispensadas aos pacientes da UTIA foram inferiores às preconizadas pelos órgãos oficiais brasileiros. O tempo médio de assistência requerido pelos pacientes internados, nessa Unidade, foi superior ao preconizado pela ANVISA e inferior ao estabelecido pela Resolução COFEN n°293/04. Esse dado indica que a avaliação do quantitativo de pessoal de enfermagem nas UTIs requer o conhecimento prévio das demandas assistenciais dos usuários e não apenas a utilização dos parâmetros indicados pelos órgãos oficiais, uma vez que esse procedimento pode ocasionar um super ou sub-dimensionamento de profissionais de enfermagem. Os resultados desta investigação demonstram a influência do tempo de assistência de enfermagem, provido por enfermeiros, no resultado do cuidado ministrado aos pacientes assistidos na UTIA. As limitações da presente investigação, ouseja, o fato de ter sido realizada em apenas uma Unidade de uma única Instituição, trazem restrições para a sua generalização. Assim, considera-se necessário o desenvolvimento de novas pesquisas que contribuam para a validação desse achado, no contexto nacional. O acúmulo de evidências pode contribuir para comprovar o impacto das horas de assistência de enfermagem nos resultados assistenciais e na segurança dos pacientes.

The objective of this exploratory, retrospective, quantitative study was to analyze the time spent by the nursing staff to assist patients in Adult Intensive Care Unit (AICU) of the University Hospital, University of São Paulo (UH-USP) and verify its correlation with quality care indicators. This research started on January 1st, 2008 until December 31st, 2009. Data were collected from the administration tools used by the head nursing staff of the unit. Analysis of the average length of time in relation to the average length of time required by patients was performed using the Paired t-test. The Spearman\'s correlation coefficient was used to verify the correlation of the average length of care time given to patients of the AICU with the quality indicator incidence of loss during central venous catheter insertion while for the other indicators the Pearson correlation coefficient was applied. The average length of time regarding assistance to patients, in the analyzed period, accounted for 14 hours, of which 31% were performed by nurses and 69% for technicians / nursing assistants. The hospitalized patients required approximately 16 hours of care. The application of statistical test showed that the differences found between the hours of assistance given by the nursing staff and those required by patients was significant (p < 0.001), suggestive of the heavy workload for the nurses in the AICU. The correlational analysis between length of time of nursing care given by nursesand the quality indicator incidence of accidental extubation evidence the Pearsons correlation coefficient (r = - 0.454), with p value of 0.026, indicating negative linearity between variables, which allowed us to infer that the incidence of accidental extubation decreases with increasing nursing care time given by nurses. The results revealed that the average hours of nursing care to patients of AICU were lower than those recommended by the official Brazilian Agencies. The average time of care required by patients hospitalized in this unit was higher than that recommended by ANVISA and lower than that established by COFEN Resolution Nr. 293/04. It indicates that the quantitative assessment of nursing staff in ICUs requires prior knowledge of the user´s health care demands and not only the use of parameters indicated by official agencies, since this procedure may cause an over-or under-dimensioning of nursing professionals. The results of this study showed the influence of nursing care time provided by nurses in the outcome of care given to patients assisted in the AICU. The limitations that needs to be addressed regarding the present study is the fact that it was performed in just one Unit of a unique Institution, which brought restrictions for its generalization. Thus, further studies are needed to contribute to the validation of this finding in a national context. The addition of more evidence may help to demonstrate the impact of nursing care time in health care resultsand patient safety.

Nursing workload and staff allocation in an intensive care unit: a pilot study according to Nursing Activities Score (NAS).

OBJECTIVES: The objectives of the study were to identify the daily nursing workload in an intensive care unit (ICU) and to analyse the adequacy of nursing staff in a six hour shift according to the Nursing Activities Score (NAS). METHOD: The sample consisted of 68 patients from a general 25-bed adult ICU in a private hospital with 250 beds in São Paulo, Brazil. The nursing workload of all patients admitted in the ICU over a one month period in 2004 were measured daily according to the NAS. For the analysis of nursing staff it was considered the number of nurses available in a six hour shift. Data were submitted to descriptive analyses. RESULTS: Most patients were elderly and remained on average 12 (+/-16.4) days in the ICU. The mean NAS was 63.7 (+/-2.4%) and remained above 58.5% throughout the month. Apart from the 16th day of data collection there was an excess of nursing professionals in a six hour shift during the study period (range from 0.8 to 4.8 professionals). CONCLUSIONS: The study results show the importance of nursing staff adequacy to workload fluctuations for reducing ICU costs.

[The need for nursing care in intensive care units: daily patient assessment according to the nursing activities score (NAS)]. / Necessidades de cuidados de enfermagem em terapia intensiva: evolução diária dos pacientes segundo o Nursing Activities Score (NAS).

This study aimed to characterize patients admitted to ICU according to their bio-social factors and admissions and verify the daily needs for nursing care according to NAS. The sample was composed by 50 adult patients who were consecutively admitted to the ICU of a University Hospital in São Paulo city. It was concluded that most patients were older than 60 with an average of 3.5-day stay in the ICU; they came from the Emergency Room and were referred to the Semi-Intensive Care Unit. NAS average was 66.5% (+/- 9.1) with a score higher than 50.0% during their stay in the ICU.

Necessidades de cuidados de enfermagem em Terapia Intensiva: evolução diária dos pacientes segundo o Nursing Activities Score (NAS) / Necesidades de cuidados de enfermería en la Unidad de Cuidados Intensivos: evaluación diaria de los pacientes según el Nursing Activities Score (NAS) / The need for nursing care in Intensive Care Units: daily patient assessment according to the Nursing Activities Score (NAS)

O estudo teve como objetivos caracterizar os pacientes internados na UTI quanto aos dados bio-sociais e de internação, e verificar as necessidades diárias de cuidados de enfermagem, segundo o NAS. A amostra foi constituída por 50 pacientes adultos admitidos consecutivamente na UTI de um Hospital Universitário do município de São Paulo. Concluiu-se que a maioria dos pacientes tinha idade acima de 60 anos, permaneceu, em média, 3,5 dias na UTI, foi procedente do Pronto Socorro e recebeu alta para a Unidade Semi-Intensiva. A média do NAS foi de 66,5 por cento (± 9,1), constatando-se que permaneceu acima de 50,0 por cento no decorrer de toda internação na UTI.

This study aimed to characterize patients admitted to ICU according to their bio-social factors and admissions and verify the daily needs for nursing care according to NAS. The sample was composed by 50 adult patients who were consecutively admitted to the ICU of a University Hospital in São Paulo city. It was concluded that most patients were older than 60 with an average of 3.5-day stay in the ICU; they came from the Emergency Room and were referred to the Semi-Intensive Care Unit. NAS average was 66,5 percent (± 9,1) with a score higher than 50.0 percent during their stay in the ICU.

El trabajo tuvo como objetivos caracterizar a los pacientes internados en la UCI en función de los datos bio-sociales y de internación; verificar las necesidades diarias de cuidados de enfermería según el NAS. La muestra estuvo constituida por 50 pacientes adultos admitidos consecutivamente en la UCI de un Hospital Universitario de la municipalidad de Sao Paulo. Se concluyó que la mayoría de los pacientes tenía edad superior a los 60 años; permaneció, en promedio 3,5 días en la UCI, procedía de Emergencia y fue dado de alta para la Unidad Semi-Intensiva. El promedio del NAS fue de 66,5 por ciento (± 9,1), constatándose que permaneció por encima del 50,0 por ciento en el transcurso de toda la internación en la UCI.

[Therapeutic interventions in intensive care units: analysis according to therapeutic intervention scoring system-28 (TISS-28)]. / Intervenções terapêuticas em unidade de terapia intensiva: análise segundo o therapeutic intervention scoring system-28 (TISS-28).

The present study aimed to identify the therapeutic interventions categories carried out in Intensive Care Units (ICU), finding out their prevalence and identifying their components according to TISS-28. The sample was composed of 89 adult patients who were consecutively admitted to the ICU of a university hospital in São Paulo city. Basic and Supportive Activities, Ventilatory, Cardiovascular and Renal were the TISS-28 that prevailed with a frequency of 73.0% and 100%. The frequency of the items considered Basic Activities were prevalent, that is, higher than 90.0%. The quantitative average of urinary debt was 98.2% concerning Renal Support. The results may mean quality of assistance provided to the clients, as they contribute to the human resources estimative and materials in the ICU as well.

Intervenções terapêuticas em unidade de terapia intensiva: análise segundo o Therapeutic Intervention Scoring System-28 (TISS-28) / Therapeutic interventions in intensive care units: analysis according to Therapeutic Intervention Scoring System-28 (TISS-28)

O presente estudo teve como objetivos descrever a prevalência diária das categorias de intervenções terapêuticas e identificar a prevalência dos itens componentes de cada categoria de intervenções terapêuticas, segundo o TISS-28. A amostra incluiu 89 admissões consecutivas na UTI geral de um Hospital Universitário do município de São Paulo. Das 7 categorias do TISS-28, houve prevalência na pontuação das categorias Atividades Básicas e Suportes Ventilatório, Cardiovascular e Renal, com freqüência entre 73,0 por cento e 100,0 por cento. A freqüência dos itens componentes da categoria Atividades Básicas foi maior do que 90,0 por cento. O sub-item medida quantitativa do débito urinário foi pontuado em 98,2 por cento na categoria Suporte Renal. Os resultados obtidos podem imprimir qualidade a assistência prestada aos clientes, na medida em que contribuem para a previsão de recursos humanos e materiais na UTI.

Necessidades e expectativas de familiares de pacientes em Unidade Intensiva de Ortopedia / Necesidades y expectativas de familiares de pacientes en UTI de ortopedia / Needs and expectations of family with hospitalized patient in orthopaedic Intensive Care Unit (ICU)

Trata-se de um estudo exploratório e descritivo, que teve como objetivo geral conhecer as necessidades da família de pacientes internados em Unidade de Terapia Intensiva - UTI de ortopedia. O processo de hospitalização requer rearranjos na família, a qual muitas vezes busca auxílio junto a profissionais de saúde afim de minimizar a ansiedade gerada neste momento. Os familiares de pacientes internados nesta UTI foram entrevistados pelos pesquisadores e os resultados obtidos revelaram a necessidade de medidas urgentes no sentido de melhores perspectivas assistenciais no âmbito da enfermagem. As necessidades verbalizadas pelos familiares foram agrupadas em assistência à família, assistência administrativa e assistência ao paciente. Face aos resultados expressos neste estudo, sugerimos que os profissionais de UTI revejam a sua dinâmica de trabalho o que implica em incluir a família do paciente na assistência

This is an exploratory descriptive study that had as general purpose to know the needs of family with hospitalized patient in orthopedic intensive care unit. The admission process require readjustment in the family that often search assistance next to health professionals aiming to minimize the anxiety generated in this moment. The members of the family of patients hospitalized on ICU were interviewed by researchers and the obtained results revealed the needs of urgent measures in the sense of better care perspectives in the Nurse ambit. The needs verbalized by members of the family were grouped in assistance to the family, administrative assistance and assistance to the patient. In face of results expressed in this study, we suggest that the ICU professionals to see again their work dynamics that implicate to include the family of patient in the assistance

Se trata de un studio explorátorio y descriptivo, que tiene como objetivo general conocer las necessidades de la família de pacientes internados en un Unidad de Terapia Intensiva (UTI) de ortopedia. El proceso de hospitalización requiere rearreglos en la família, la cual muchas vezes busca auxilio junto a los profesionales de salud para sanar o al menos minimizar su ansiedad en este momento. Los familiares de pacientes internados en esta UTI fuerón entrevistados por los investigadores y los resultados obtenidos revelarón la necessidad de medidas urgente en el sentido de tener mejores perspectivas asistenciales en el ámbito de enfermería. Las necessidades verbalizadas por los familiares fuerón agrupadas en assistencia a la familia, assistencia administrativa y assistencia al paciente. Frente a los resultados expresados en este studio sugerimos que los profesionales de UTI revean su dinámica de trabajo lo que implica en incluir a la família del paciente en la asistencia