Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit.

The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.

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.

Nursing workload assessment in an intensive care unit: A 5-year retrospective analysis.

AIMS: To study the correlation between the workload of intensive care nursing teams and the sociodemographic, anthropometric and clinical characteristics of patients in critical condition in a Portuguese Intensive Care Unit (ICU) during a 5-year period. BACKGROUND: Currently, indices of nursing workload quantification are one of the resources used for planning and evaluating ICUs. Evidence shows that there are several factors related to critical patients and their hospitalisation which potentially influence the nursing workload. DESIGN: Retrospective cohort analysis of a health record database from adult patients admitted to a Portuguese ICU between 1 January 2015-31 December 2019. METHODS: Simplified Therapeutic Intervention Scoring System (TISS-28) scores of 730 adult patients. Three TISS-28 assessments were considered: first assessment, last assessment and average. The STROBE guidelines were used in reporting this study. RESULTS: The TISS-28 has an average of 34.2 ± 6.9 points at admission, which is considered a high nursing workload. A somewhat lower result was found for the discharge and average assessments. It shows that basic activities accounted for the highest percentage of time spent (38.0%), followed by the cardiovascular support category (26.5%). The TISS-28 shows consistent results throughout the study period, despite a small trend reduction in the last 2 years. CONCLUSIONS: Lower workloads were found for age ≤44 years and with a shorter length of stay. Higher workload was more probable in patients classified in Cullen Class IV (OR = 2.5) and with a normal to higher weight percentile (OR = 1.9 and 1.5, respectively). RELEVANCE TO CLINICAL PRACTICE: Knowledge of the factors influencing the nursing workload facilitates the implementation of rules to improve performance in nursing interventions, based on the redefinition of care priorities, increased productivity, human resources management and reduction of additional costs to the organisation, related to possible adverse events, among others.

Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese hospital.

AIM: To analyze the first pressure ulcer risk and skin assessment records of hospitalized adult patients in medical and surgical areas of Aveiro Hospital during 2012 in association with their demographic and clinical characteristics. MATERIAL AND METHODS: Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical areas in a Portuguese hospital during 2012. The presence of (at least) one pressure ulcer at the first skin assessment in inpatient setting was associated with age, gender, type of admission, specialty units, length of stay, patient discharge and ICD-9 diagnosis. RESULTS: Point prevalence of participants with pressure ulcer category/stage I-IV of 7.9% at the first skin assessment in inpatient setting. A total of 1455 pressure ulcers were documented, most of them category/stage I. The heels and the sacrum/coccyx were the most problematic areas. Participants with pressure ulcer commonly had two or more pressure ulcers. CONCLUSIONS: The point prevalence of participants with pressure ulcer of our study was similar international literature. The presence of a pressure ulcer at the first skin assessment could be an important measure of frailty and the participants with pressure ulcer commonly had more than one documented pressure ulcer. Advanced age or lower Braden Scale scores or Emergency Service admission were relevant variables for the presence of (at least) one pressure ulcer at the first skin assessment in inpatient setting as well as respiratory, infectious or genitourinary system diseases.

Vivências em serviço de urgências: o papel dos acompanhantes dos doentes / Emergency room: the role of the accompanying person

As pessoas que acompanham um utente no serviço de urgência (SU), familiares ou não, são parte integrante da unidade de cuidados. Em Portugal, a prática comum no acompanhamento a adultos é a permanência numa sala de espera exterior. Este estudo exploratório realizado em Portugal procura compreender melhor as vivências em SU dos diversos envolvidos, procurando clarificar o papel dos acompanhantes no serviço de urgência, para reflectir sobre formas de promover a sua participação em todo o processo. Adoptou-se a técnica dos incidentes críticos que foi aplicada por entrevista a 71 indivíduos que representam as diversas partes envolvidas: 2 administrativos (2,8 por cento); 7 médicos (9,9 por cento); 9 auxiliares de acção médica (12,7 por cento); 9 bombeiros (12,7 por cento); 9 utentes (12,7 por cento); 20 enfermeiros (28,2 por cento); 15 acompanhantes (21,1 por cento). Os principais resultados indicam que: i) os participantes relatam mais incidentes negativos que positivos (72,9 por cento), associados a comportamentos e atitudes emocionais (tais como, agressividade dos acompanhantes, distância e agressividade dos profissionais e acompanhantes que dificultam a prestação de cuidados); ii) os participantes raramente referem insatisfação ou ineficácia dos cuidados e tratamentos (constituem 4,3 por cento dos incidentes); ii) os incidentes positivos (17,1 por cento) referem-se a profissionais humanos e sensíveis (50 por cento) e eficazes (25 por cento). O serviço de urgência constitui uma zona de tempestade emocional e é necessário repensar a forma como o acompanhante dos doentes decorre.

Those who accompany a patient in the emergency service, either members of the family or others, are an integral part of the care unit. In Portugal, the usual practice in adults' accompaniment is the permanence in an exterior waiting room. This exploratory study aims at better understanding the emergency service experiences of all those involved, trying to clarify the role of the accompanying person, and reflecting on ways of promoting their participation in the entire process. The Critical Incidents Technique was adopted and administered by interview to 71 participants that represent the several involved parts: 2 administrative workers (2.8%); 7 doctors (9.9%); 9 medical assistants (12.7%); 9 fire-fighters (12.7%); 9 users (12.7%); 20 nurses (28.2%); 15 accompanying persons (21.1%). The main results suggest that: i) participants report more negative incidents (72.9%), related to emotional behaviours and attitudes (such as accompanying person's aggressiveness, professionals' distance and aggressiveness); ii) participants' reference to dissatisfaction or inefficacy of care is rare (4.3% of the incidents); iii) positive incidents are centred on sensitive professionals (50%) and efficacy (25%). The emergency service is an area of emotional storm and it is necessary to rethink the way users are being accompanied by their dear ones.