Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of ...HAI, using Nursing Activities Score (NAS).
This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not.
195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient's clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI.
Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.
Objective To describe nursing workload in Intensive Care Units (ICU) in different countries according to the scores obtained with Nursing Activities Score (NAS) and to verify the agreement among ...countries on the NAS guideline interpretation. Method This cross-sectional study considered 1-day measure of NAS (November 2012) obtained from 758 patients in 19 ICUs of seven countries (Norway, the Netherlands, Spain, Poland, Egypt, Greece and Brazil). The Delphi technique was used in expertise meetings and consensus. Results The NAS score was 72.8% in average, ranging from 44.5% (Spain) to 101.8% (Norway). The mean NAS score from Poland, Greece and Egypt was 83.0%, 64.6% and 57.1%, respectively. The NAS score was similar in Brazil (54.0%) and in the Netherlands (51.0%). There were doubts in the understanding of five out 23 items of the NAS (21.7%) which were discussed until researchers' consensus. Conclusion NAS score were different in the seven countries. Future studies must verify if the fine standardization of the guideline can have a impact on differences in the NAS results.
To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective ...predictive capacity according to the age group.
A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve.
Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups.
Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults.
Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian's model of healthcare organization and delivery. ...Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian's health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.
To understand the education/training of nurses working in an intensive care unit.
Case study with qualitative approach, with an intentional sample. Data collection and analysis used different ...research techniques, mainly document analysis, interview and field observation.
The data highlights feelings of well-being, satisfaction and motivation as important for education and training in a work context. Some organizational practices seem to promote interpersonal relationships and, consequently, increase the willingness of these professionals to adopt a reward perspective regarding continuing education and training, establishing a close relationship between the formal, the non-formal and the informal.
The attractiveness of this organization is related to the valorization and recognition that it can offer to the professionals. There is a reciprocity between a hospital that endorses up-to-date care and professionals who seek scientific evidence.
Patient Safety Incidents and Nursing Workload Carlesi, Katya Cuadros; Padilha, Kátia Grillo; Toffoletto, Maria Cecília ...
Revista latino-americana de enfermagem,
01/2017, Letnik:
25
Journal Article
Recenzirano
Odprti dostop
to identify the relationship between the workload of the nursing team and the occurrence of patient safety incidents linked to nursing care in a public hospital in Chile.
quantitative, analytical, ...cross-sectional research through review of medical records. The estimation of workload in Intensive Care Units (ICUs) was performed using the Therapeutic Interventions Scoring System (TISS-28) and for the other services, we used the nurse/patient and nursing assistant/patient ratios. Descriptive univariate and multivariate analysis were performed. For the multivariate analysis we used principal component analysis and Pearson correlation.
879 post-discharge clinical records and the workload of 85 nurses and 157 nursing assistants were analyzed. The overall incident rate was 71.1%. It was found a high positive correlation between variables workload (r = 0.9611 to r = 0.9919) and rate of falls (r = 0.8770). The medication error rates, mechanical containment incidents and self-removal of invasive devices were not correlated with the workload.
the workload was high in all units except the intermediate care unit. Only the rate of falls was associated with the workload.
To estimate the cost of nursing care required and available through the use of the Nursing Activities Score.
Quantitative study, direct costing of nursing care required and available in the Intensive ...Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category.
The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians.
The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.
Nursing Activities Score and Acute Kidney Injury Coelho, Filipe Utuari de Andrade; Watanabe, Mirian; Fonseca, Cassiane Dezoti da ...
Revista Brasileira de Enfermagem,
05/2017, Letnik:
70, Številka:
3
Journal Article
Recenzirano
Odprti dostop
to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI).
A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing ...Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively.
A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001).
The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.
avaliar a carga de trabalho de enfermagem em pacientes de terapia intensiva com lesão renal aguda (LRA).
estudo quantitativo, em Unidade de Terapia Intensiva, no período de abril a agosto de 2015. O Nursing Activities Score (NAS) e o Kidney Disease Improving Global Outcomes (KDIGO) foram utilizados para medir a carga de trabalho de enfermagem e classificar o estágio da LRA, respectivamente.
foram incluídos 190 pacientes. Os pacientes que desenvolveram LRA (44,2%) possuíam NAS superiores quando comparados aos sem LRA (43,7% vs 40,7%), p<0,001. Os pacientes com LRA nos estágios 1, 2 e 3 de LRA demonstraram NAS superiores aos sem LRA, houve relação entre os estágios 2 e 3 com os sem LRA, p=0,002 e p<0,001.
o NAS apresentou associação com a existência de LRA, visto que seu valor aumenta com a progressão dos estágios, tendo associação com os estágios 2 e 3 de LRA.
High costs of intensive care as well as quality of care and patient safety demand measurement of nursing workload in order to determine nursing staff requirements. It is also important to be aware of ...the factors related to high patient care demands in order to help forecast staff requirements in intensive care units (ICUs).
To describe nursing workload using the Nursing Activities Score (NAS); to explore the association between NAS and patients variables, i.e. gender, age, length of stay (LOS), ICU discharge, treatment in the ICU, Simplified Acute Physiology Score II (SAPS II) and Therapeutic Interventions Scoring System-28 (TISS-28).
NAS, demographic data, SAPS II and TISS-28 were analysed among 200 patients from four different ICUs in a private hospital in São Paulo, Brazil.
NAS median were 66.4%. High NAS scores (>66.4%) were associated with death (
p-value 0.006) and LOS (
p-value 0.015). Logistic regression analysis demonstrated that TISS-28 scores above 23 and SAPS II scores above 46.5 points, classified as high, increased 5.45 and 2.78 times, respectively, the possibility of a high workload as compared to lower values of the same indexes.
This study shows that the highest NAS scores were associated with increased mortality, LOS, severity of the patient illness (SAPS II), and particularly to TISS-28 in the ICU.
to analyze the formation of nursing doctorates in Brazil, from theses production, disciplines and other strategies focusing on research offered by courses.
a descriptive and analytical study of the ...performance of 18 doctoral courses in nursing, running from 1982 to 2010, and defended their theses between 2010-2012.
502 theses were defended in this period, most linked to the online research process of health and nursing care. There are gaps in the knowledge of theoretical and philosophical foundations of care, nursing history and ethics. There are also weaknesses in the methodological design of the theses, with a predominance of descriptive and/or exploratory studies. This was consistent with international standards set with regards to the proposition of research of disciplines and complementary strategies in forming the doctorate.
despite the efforts and advances in research formation, it is essential to expand to more robust research designs with a greater impact on production knowledge that is incorporated into practice.
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