Associação entre Síndrome de burnout, uso prejudicial de álcool e tabagismo na Enfermagem nas UTIs de um hospital universitário / Association between burnout syndrome, harmful use of alcohol and smoking in nursing in the ICU of a university hospital

Resumo O artigo tem por objetivos verificar a presença da Síndrome de burnout entre profissionais da área de Enfermagem, nas Unidades de Terapia Intensiva de um Hospital Universitário, e a existência de associação entre consumo de álcool e tabaco. Participaram da pesquisa 160 profissionais de Enfermagem de 04 Unidades de Terapia Intensiva, no período de Março de 2013 a Fevereiro de 2014. Utilizou-se um questionário estruturado, acrescido da história tabágica, Maslach Burnout Inventory, Alcohol Use Disorders Identification Test, Questionário de Dependência de Fagerström, e a mensuração do monóxido de carbono. Utilizou-se o teste qui-quadrado ou exato de Fisher. A Síndrome foi encontrada em 34 profissionais, sendo a maioria do sexo feminino, casados e adultos jovens. Dezoito profissionais se declararam fumantes. Um percentual de 6,4% dos Auxiliares de Enfermagem, 50% dos Técnicos de Enfermagem e 71,4% dos Enfermeiros bebiam moderado; 5,4% dos Auxiliares de Enfermagem e 14,3% dos Enfermeiros apresentaram padrão de beber de risco e somente 01 Técnico de Enfermagem possuía possível dependência de álcool. Houve associação positiva da Síndrome com tabagismo em 01 UTI. Os serviços de Terapia Intensiva do hospital necessitam de intervenções dos gestores dos serviços, com a finalidade de cuidar da saúde dos seus cuidadores.

Abstract The article aims to determine the presence of burnout syndrome among professionals in the field of Nursing in the Intensive Care Unit in a university hospital and a possible association with consumption of alcohol and tobacco. Participants were 160 nursing professionals from 04 intensive care unit of a university hospital in the period from March 2013 to February 2014. We used a structured questionnaire, plus the smoking history, Maslach Burnout Inventory, Alcohol Use Disorders Identification Test, Fagerström Dependence Questionnaire and the measurement of carbon monoxide. We used Fisher's chi-square or Fisher exact test. Syndrome was found in 34 professionals, most of them female, married and young adults. 18 professionals reported being smokers. 6,4% of Nursing Assistants, 50% Practical Nurses and Nurses 71,4% drank moderate; 5,4% Nursing Assistant and 14,3% Nurses scored default risk drinking and only 01 Practical Nurses had possible alcohol dependence. There was a positive association of the syndrome with smoking in 01 ICU. Final considerations: Hospital Intensive Care services need assistance from the managers of services for the purpose of caring for the health of their caregivers.

Senior Nursing Students' Perceived Competence of Intensive and Critical Care Nursing / 한국간호교육학회지

PURPOSE: The purpose of this study was to examine the degree of intensive and critical care nursing competence in senior nursing students. METHODS: The research method for this study comprised a descriptive survey study with a convenience sample of 113 senior nursing students from one university. The instrument entitled ICCN-CS-1, which measures intensive and critical care nursing competence, was translated by the authors following WHO guidelines for translation process. The data were collected using ICCN-CS-1. RESULTS: The mean score of intensive and critical care nursing was above the intermediate level. The competence indices of knowledge, skill and attitude/value were also above the intermediate level, which suggests that their competence is good. For two intensive and critical care nursing domains, the nursing students' mean score of clinical competence is higher than that of professional competence. The competence of intensive and critical care is also influenced by nursing students' satisfaction in their major and clinical practice as well as their confidence in clinical practice. CONCLUSION: The senior nursing students' competence of intensive and critical care nursing is above the intermediate level. A consideration of the influencing factors of satisfaction of nursing major/ICU practice and confidence of ICU practice is needed in intensive and critical care nursing education.

Competencias profesionales en enfermeras que desempeñan su labor en una unidad de cuidados intensivos / Professional competences in nurses working in an intensive care unit

Resumen:

Objetivo: crear un perfil basado en competencias profesionales para enfermeras que desempeñan su labor en una unidad de cuidados intensivos (UCI). Método: estudio cualitativo, descriptivo, fenomenológico, con información que se obtiene por medio de entrevistas a enfermeras que trabajan en una unidad de cuidados intensivos. Análisis realizado con base en una triangulación de datos. Se obtienen significaciones elaboradas por las enfermeras, las cuales se agruparon en: competencias transversales, competencias genéricas y competencias críticas o claves. Se realiza un diccionario de competencias, asignándole una puntuación por niveles (1 a 4). Ya obtenidas las definiciones de cada competencia, se crea un diccionario de comportamientos, que establece conductas específicas que permiten medir la competencia.

Resultados: se identifican 31 conceptos, divididos en competencias transversales, genéricas y críticas, 11 conceptos corresponden a las competencias críticas o claves. El resultado final muestra un perfil de ingreso basado en la evaluación por competencias. Conclusión: la evaluación por competencias en enfermeras permite objetividad, replicabilidad y la continua mejora en la calidad de los cuidados.

Abstract:

Purpose: To develop a profile bases on professional competences for nurses working in an intensive care unit. Methods: A qualitative, descriptive, phenomenological study providing data through interviews with nurses working in an intensive care unit. An analysis based on data triangulation was performed. Concepts, as developed by nurses, were obtained and grouped into the following classes: cross-sectional competences, generic competences and critical or key competences. A thesaurus of competences was developed, with a level score (1 to 4) being assigned to each one. Once the definitions for each competence have been established, a dictionary of behaviors is developed allowing the competence to be measured. Results: Overall, 31 concepts are identified and classified into cross-sectional, generic and critical competences, with 11 concepts corresponding to critical or key competences. Final results show an entry profile based on competences evaluation. Conclusion: Nurses evaluation based on competences allows objectivity, replicability, and continuous improvement in nursing care quality to be achieved.

Objetivo: criar um perfil baseado em competências profissionais para enfermeiras que se desempenham numa unidade de cuidados intensivos. Método: estudo qualitativo, descritivo, fenomenológico, com informação que é obtido por meio de entrevistas ás enfermeiras que se desempenham numa unidade de cuidados intensivos. Análise realizada com base na triangulação de dados. Obtêm-se significações emanadas pelas enfermeiras, as quais se agruparam em: competências transversais, genéricas, e críticas ou chaves. Elaborou-se um dicionário das competências, designando uma pontuação por níveis (1 a 4). Uma vez obtida às definições de cada competência, se realiza dicionário de comportamentos, que estabelece condutas específicas que permitem medir a competência. Resultados: se identificaram trinta e um conceitos, divididos em competências transversais, genéricas e críticas; onze conceitos correspondem as competências críticas ou chaves. Com um resultado final que mostra um perfil de ingresso baseado na avaliação por competências. Conclusão: a avaliação por competências em enfermeiras permite objetividade, réplica e a contínua melhora na qualidade dos cuidados.

The allocation and requirements of ICU nurses in the internal medicine department of National Medical Emergency Rescue Team / 中国实用护理杂志

Objective To study the allocation and requirements of ICU nurses in the intemal medicine department of National Medical Emergency Rescue Team,and explore more reasonable ICU nurses allocation method.Methods 40 patients were randomly divided into the observation group and the control group with 20 cases in each group.The control group adopted even allocation method,while the observation group allocated nurses according to ICU nursing evaluation system.The nursing effect was compared between two groups.Results ICU nursing score between two groups showed no significant difference,but the ICU indwelling time of the observation group was shorter than that of the control group.Conclusions ICU nurses need higher comprehensive quality.ICU nursing evaluation system can facilitate the allocation of nurses.Better allocation and higher overall qualities of internal medicine ICU nurses can improve ICU treatment efficiency.

Comparative study for the effect of ICNSS and APACHE Ⅱ scoring in nursing resource allocation of intensive care unit / 中国实用护理杂志

Objective To study the value of intensive care nursing scoring system(ICNSS) on care resource allocation in intensive care unit(ICU). Methods 108 ICU patients were divided into the observation group (55 cases) and the control group (53 cases) randomly. In the observation group,the ICNSS scale was applied to evaluate nursing workload, and care resource was allocated according to intensive care nursing scoring. In the control group, care resource was allocated according to dynamic monitoring of acute physiology and chronic health evaluation (APACHE Ⅱ ) scoring. The ICU monitoring time,medical cost,incidence of complications during the hospitalization,satisfaction of the nurses and the patients or their relatives were compared between two groups. Results The ICU monitoring time,medical cost and incidenceof complications during the hospitalization in the observation group were significantly less than those in the control group, while the satisfaction of the nurses and the patients or their relatives in the observation group was markedly better than that in the control group. Conclusions Care resource allocation according to ICNSS is worthy of promotion and application in ICU because it can more significantly improve nursing quality,satisfaction of nurses and patients or their relatives than care resource allocation according to APACHE Ⅱ scoring.

Avaliação dos NAS - Nursing Activities Acore - como instrumento de medida de carga de trabalho de enfermagem em UTI geral adulto / Evaluation of NAS - Nursing Activies Score - as a nursing workload measurement tool in Adult Intensive Care Unit

Esta pesquisa objetivou avaliar o NAS - Nursing Activities Score - como instrumento de medida de carga de trabalho, quanto a sua aplicabilidade em frações funcionais do dia (turnos) e possível relação com a ocupação da unidade e com o número de profissionais de enfermagem disponível. Efetivou-se como pesquisa de campo, prospectiva, de abordagem quantitativa do tipo descritivo-exploratória em uma UTI geral - adulto de 10 leitos de um hospital privado do Município de São Paulo. O instrumento foi aplicado durante dois períodos não consecutivos de 7 dias, num total de 33 pacientes que apresentaram média de idade de 70,4 anos (+/-16,5), predomínio do sexo masculino, 66,7%. O tempo médio de permanência na UTI foi de 17 dias (+/- 20,4); o SAPSII foi de 41,7 (+/-17,9); risco de morte (RM) de 33,5% (+/- 26,8); predominaram internações clínicas, 60,6%; 27,3% do Pronto Atendimento outros 27,3% procederam do Centro Cirúrgico; 63,6% tiveram alta para Unidades de Cuidados Semi-intensivos e 18,2% evoluíram a óbito. O NAS, foi aplicado 396 vezes, no final dos turnos (134-manhã; 132-tarde; 130-noturno), perfazendo 147 medidas de NAS de 24h. O NAS médio de 24h foi 69,6 (+/- 18,2). O NAS médio dos turnos foi 55,4 (+/-12,3). Análise estatística não constatou influência significativa do número de profissionais na assistência ou da ocupação da unidade sobre o NAS e o instrumento mostrou-se mais adequado à aplicação de 24 horas, conforme preconizado, que por turnos.

The purpose of this study was to evaluate the NAS - Nursing Activities Score - as a workload measurement tool. Specifically, the study examined the NAS for its applicability for parts of the day (shifts) and its correlation with occupation rate and number of nursing professionals available. As an exploratory, descriptive, prospective field study, with a quantitative approach, data was collected in a ten-bed adult Intensive Care Unit (ICU) of a private hospital in São Paulo city. The NAS tool was utilized during two non-consecutive periods of 7 days, classifying a sample of 33 patients with mean age of 70 years (+/-16.5). Most of the patients were men (66.7%). Length of stay in the ICU was 17 days (+/- 20.4); mean Simplified Acute Physiologic Score II - SAPSII -was 41.7 (+/-17.9) with mean probability of death of 33.5% (+/- 26.8); the major reason for admission was medical, 60.6%. 27.3% of the patients were admitted from the emergency room, while the other 27.3% came from Surgical Center. 63.6% were transferred to Intermediate Care Units from ICU and 18.2% died during hospital stay. The NAS was applied 396 times, at the end of each shift (134-morning; 132-evening; 130-night), totaling 147 twenty-four hour measures. The mean 24h NAS was 69.6 (+/- 18.2). The mean shift NAS was 55.4 (+/-12.3). Statistical analysis showed no significant association between the NAS value and the number of nursing professionals available. Additionally, no significance was found.

Avaliação do processo ensino-aprendizagem da técnica de ressuscitação cardiopulmonar pela equipe de enfermagem / Evaluation of the cardiopulmonary resuscitation teaching-learning by the nursing team

O estudo teve como objetivo avaliar o processo ensino-aprendizagem da técnica de ressuscitação cardiopulmonar pela equipe de Enfermagem, no pós-operatório de cirurgia cardíaca. A amostra foi composta de 37 enfermeiros, 10 técnicos, e 53 auxiliares de Enfermagem de uma Unidade de Terapia Intensiva Cirúrgica, de um Hopsital de Ensino, da rede pública do Município de São Paulo. No método do estudo foi elaborado um modelo padrão ("check-list"), para enfermeiros; e outro, para os técnicos e auxiliares de Enfermagem; que foram apreciados por um "corpo de juízes", e utilizados na avaliação da habilidade (execução) e do conhecimento (descrição) dos enfermeiros, técnicos e auxiliares, em duas etapas de coleta de dados. Os resultados foram analisados, permitindo constatar que: 1) As médias dos escores dos enfermeiros, técnicos e auxiliares de Enfermagem, na habilidade (execução) e no conhecimento (descrição), não alcançaram os escores totais estipulados pelos juízes para cada cenário, na 1ª etapa do estudo. 2) As médias dos escores dos enfermeiros, técnicos e auxiliares de Enfermagem, na habilidade (execução) e no conhecimento (descrição), não alcançaram os escores totais estipulados pelos juízes para cada cenário, na 2ª etapa do estudo. 3) Houve melhora estatisticamente significativa tanto na habilidade (execução) quanto no conhecimento (descrição) dos enfermeiros, técnicos e auxiliares de Enfemagem, nos cenários do modelo padrão, quando comparadas as duas etapas do estudo.

This study had as goal to evaluate the cardiopulmonary resuscitation teaching-learning process by the nursing team in cardiac surgery posoperative. The sample consisted of 37 nurses, 10 technicians and 53 Nursing aides of an Intensive Care Unit of a university hospital, in the public health care chain of the city São Paulo. In the study method , we established two standard models (check-list) one for nurses and another one for the technicians and Nurisng aides and they were appreciated by a judge corps and used in the evaluation of the skill (execuation) and the knowledge (description) shown by nurses, technicians and Nursing aides in two steps in the operationalization of the data collecting. The results, were analised and showed that: 1) The score level among nurses, technicians and Nursing aides on skill (execution) and on knowledge (description) didn't achieve the score stipulated by the judges for each scenery in the first step of the study. 2) The score level among nurses, technicians and Nursing aides on skill (execution) and on knowledge (description) didn't achieve the score stipulated by the judges for each scenery in the second step of the study. 3) There was a statistically significant improvement both on skill (execution) and on knowledge (description) among nurses, technicians and Nursing aides in the standard model sceneries, whem compared to the previous steps of the study.