Fatores associados à carga de trabalho de enfermagem em três Unidades de Terapia Intensiva

Rivera, Diana Isabel Cáceres; Torres, Claudia Consuelo; Romero, Luis Alberto López

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Revista da Escola de Enfermagem da USP

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2020-0272 copiar

Fatores associados à carga de trabalho de enfermagem em três Unidades de Terapia Intensiva

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Determinar a carga de trabalho de enfermagem em Unidade de Terapia Intensiva e os fatores associados ao escore NAS.

Métodos:

Estudo analítico transversal realizado em três UTIs de Bucaramanga, Colômbia, entre fevereiro de 2018 e fevereiro de 2020. A sobrecarga de enfermagem foi estimada com o Nursing Activities Score (NAS). Foi realizada análise descritiva e bivariada estratificada por UTI por meio de modelo de regressão linear múltipla robusto e estimados os fatores associados à sobrecarga de enfermagem (p <0,05).

Resultados:

Foram incluídos 362 registros. O NAS mediano foi de 68,1 pontos (Q1: 47,2–Q3: 116,7) APACHE II (β = 3,13, IC 95%: 2,28; 3,98), dias de permanência na UTI ≥ 3 (β = 16,78, IC 95%: 6,15; 27,41), serviço de origem da cirurgia (β = 22,31, IC 95%: 9,76; 34,86), categoria de diagnóstico de trauma e emergências (β = 33,72, IC 95%: 9,90; 57,53) estiveram associados a maior pontuação NAS.

Conclusões:

a equipe de enfermagem da UTI despende aproximadamente 70% do tempo com um único paciente e as tarefas administrativas ocupam a maior parte do tempo. A permanência hospitalar superior a três dias, maior pontuação do APACHE II, proveniente do serviço de cirurgia, com diagnóstico de trauma e urgências estiveram associados à elevada carga de trabalho.

DESCRITORES
Carga de Trabalho; Enfermagem de Cuidados Críticos; Unidades de Terapia Intensiva

Characteristics	All		ICU 1		ICU 2		ICU 3		p-value¥
Characteristics	n	% or Median (Q1–Q3)	n	% or Median (Q1–Q3)	n	% or Median (Q1–Q3)	n	% or Median (Q1–Q3)	p-value¥
Age, years	362	64.50(53.00–73.00)	234	64.00(53.00–73.00)	81	68.00(57.00–77.00)	47	59.00(45.00–72.00)	0.029
Gender
Female	136	37.99	85	36.48	34	43.59	17	36.17	0.514
Male	222	62.01	148	63.52	44	56.42	30	63.83
Marital status
Single	89	24.93	63	27.04	7	9.09	19	40.43
Married	149	41.74	92	39.48	39	50.65	18	38.30
Cohabiting	48	13.45	42	18.03	3	3.90	3	6.38	<0.001
Divorced	24	6.72	10	4.49	13	16.88	1	2.13
Widowed	47	13.17	26	11.16	15	19.48	6	12.77
Socioeconomic level
Low	191	53.06	146	62.39	34	42.50	11	23.91
Medium	165	45.83	88	37.61	46	57.50	31	67.39	<0.001
High	4	1.11	0	0.00	0	0.00	4	8.70
Occupation
None	139	39.04	74	31.90	42	54.55	23	48.94
Student	6	1.69	5	2.16	1	1.30	0	0.00
Employee	106	29.78	87	37.50	11	14.29	8	17.02
Self-employed	67	18.82	46	19.83	11	14.29	10	21.28	<0.001
Unemployed	7	1.97	4	1.72	0	0.00	3	6.38
Pensioner/Retiree	31	8.71	16	6.90	12	15.58	3	6.38
Service of origin
Emergencies	145	40.17	95	40.77	40	49.38	10	21.28
Surgery	83	22.99	73	31.33	8	9.88	2	4.26
Hospitalization	45	12.47	30	12.88	5	6.17	10	21.28	<0.001
Remission	56	15.51	16	6.87	22	27.16	18	38.83
Others	32	8.86	19	8.15	6	7.41	7	14.89
Patient discharge destination
Morgue	71	20.47	45	20.83	10	12.50	16	34.78
Home	35	10.53	15	6.94	19	23.75	1	2.17
Hospitalization	224	65.50	149	68.98	49	61.25	26	56.52	<0.001
Transfer	12	3.51	7	3.24	2	2.50	3	6.52
Disease category
Circulatory	152	41.99	98	41.88	47	58.02	7	14.89
Respiratory	62	17.23	49	20.94	3	3.70	10	21.28
Central Nervous System	45	12.43	32	13.68	6	7.41	7	14.89
Infectious	42	11.60	19	8.12	13	16.05	10	21.28	<0.001
Gastrointestinal	18	4.97	11	4.70	4	4.94	3	6.38
Metabolic	18	4.97	8	3.42	7	8.64	3	6.38
Renal	8	2.21	8	3.42	0	0.00	0	0.00
Connective tissue	7	1.93	6	2.56	0	0.00	1	2.13
Trauma	5	1.38	0	0.00	0	0.00	5	10.64
Psychiatric	2	0.55	1	0.43	1	1.23	0	0.00
Obstetrics	2	0.55	2	0.85	0	0.00	0	0.00
Intoxication	1	0.28	0	0.00	0	0.00	1	2.13
Days of stay in ICU	357	3.00(2.00–7.00)	234	2.00(2.00–4.00)	77	5.00(3.00–9.00)	46	11.50(7.00–17.00)	<0.001
Mortality, YES	66	21.93	46	21.30	4	10.53	16	34.04	0.031
APACHE II SOFA	307	16.00 (10.00–22.00)	234	16.00 (16.00–20.00)	73	17 (12.00–24.00)	0		0.017
Total patients	361	10.00 (8.00–11.00)	234	9.00 (8.00–11.00)	80	11.00 (10.00–15.50)	47	14.00 (13.00–14.00)	<0.001
Nurses at the time of assessment	361	4.00 (3.00–5.00)	234	4.00 (3.00–5.00)	80	3.00 (2.00–4.00)	47	4.00 (4.00–4.00)	<0.001
Percentage of occupancy	319	0.90 (0.75–1.00)	234	0.91 (0.73–1.00)	38	0.90 (0.82–1.00)	47	1.00 (0.85–1.00)	0.208

Characteristic	All	ICU 1	ICU 2	ICU 3	p-valueⱡ
Characteristic	Median (Q1–Q3)	Median (Q1–Q3)	Median (Q1–Q3)	Median (Q1–Q3)	p-valueⱡ
General NAS	68.1 (47.2–116.7)	64.2 (46–115.3)	102.0 (60.90–152.7)	60.85 (51.8–68.25)	0.001
Administrative and organizational tasks	27.40 (4.20–27.4.0)	27.40 (27.40–27.40)	4.20 (4.20–27.40)	4.20 (4.20–4.20)	0.001
Monitoring and control	16.60 (0–16.6)	4.50 (0.00–16.60)	16.60 (16.60–36.20)	16.60 (16.60–20.15)	0.001
Mobilization and postural changes	12.40 (0.00–17.90)	5.50 (0.00–17.90)	17.90 (5.50–34.90)	12.40 (5.50–12.40)	0.001
Renal support	7.00 (0.00–7.00)	0.00 (0.00–7.00)	7.00 (0.00–7.00)	7.00 (7.00–7.30)	0.001
Medication administration	5.6.0 (5.60–5.60)	5.60 (5.60–5.60)	5.60 (5.60–5.60)	5.60 (5.60–5.60)	0.001
Laboratory procedure	4.30 (4.30–4.30)	4.30 (4.30–4.30)	4.30 (4.30–4.30)	2.15 (2.10–4.30)	0.001
Hygiene interventions	4.10 (0.00–20.60)	4.10 (0.00–20.60)	20.60 (4.10–20.60)	4.10 (2.05–4.10)	0.001
Support and care of family members or patients	4.00 (0.00–4.00)	4.00 (0.00–4.00)	4.00 (4.00–4.00)	0.00 (0.00–2.00)	0.001
Specific interventions	1.90 (0.00–2.80)	1.90 (0.00–2.80)	1.90 (0.00–2.80)	0.00 (0.00–0.90)	0.001
Ventilatory support	1.40 (0.00–7.60)	1.40 (0.00–5.80)	4.40 (0.00–7.60)	2.30 (1.40–5.40)	0.002
Cardiovascular support	1.20 (0.00–3.70)	1.20 (0.00–2.50)	2.50 (0.00–3.70)	1.20 (0.60–2.45)	0.003
Drainage care	0.00 (0.00–0.00)	0.00 (0.00–1.80)	0.00 (0.00–0.00)	0.00 (0.00–0.90)	0.429
Neurological support	0.00 (0.00–0.00)	0.00 (0.00–000)	0.00 (0.00–0.00)	0.00 (0.00–0.00)	0.265
Metabolic support	0.00 (0.00–1.30)	0.00 (0.0–1.3)	0.00 (0.0–1.30)	1.30 (1.30–2.80)	0.001

Nursing Activities Score (NAS)	Simple models: Raw effects			Final model (R2: 42.48) (n:297) ¥¥
Nursing Activities Score (NAS)	β	CI 95%	p¥ Value	β	CI 95%	p Value*
Age, years	0.01	(–0.32; 0.34)	0.995	–0.31	(–0.64; 0.025)	0.070
β0: 86.42	R2 = 50.19ⱡ	(65.32; 107.52)	0.000
Gender	Reference: Female
Gender (male)	0.65	(–10.38; 11.68)	0.908	6.98	(–3.06; 17.04)	0.172
β0: 86.44	R2 = 50.30	(77.44; 95.44)	0.000
Service of provenance	Reference: Emergency Department
Surgery	13.59	(–0.08; 27.26)	0.051	22.31	(9.76; 34.86)	0.001
Hospitalization	8.24	(–8.65; 25.15)	0.338	11.65	(–8.37;31.68)	0.253
Remission	3.27	(–11.71; 18.27)	0.667	–4.10	(–18.41; 10.19)	0.572
Others	4.66	(–15.85; 25.18)	0.655	19.79	(–2.19; 41.78)	0.007
β0: 81.70	R2 = 49.93	(73.94; 89.46)	0.000
Diagnostic category	Reference: Metabolic–Infectious
Metabolic sphere	–11.70	(–32.25; 8.86)	0.264	–3.10	(–23.83; 17.63)	0.769
Cardiovascular	–19.41	(–34.22; –4.61)	0.010	–9.93	(–26:53; 6.60)	0.240
Gastrointestinal	12.60	(–17.51; 42.72)	0.411	15.02	(–12.12; 42.17)	0.277
Traumatology and emergencies	2.27	(–26.82; 31.38)	0.878	33.72	(9.90; 57.53)	0.006
β0: 99.71	R2 = 49.37	(86.22; 113.20)	0.000
APACHE II	3.17	(2.44; 3.89)	0.000	3.13	(2.28; 3.98)	0.000
β0: 37.72	R2 = 45.72	(25.69; 49.76)	0.000
Days of stay in ICU	Reference: Days of stay in ICU
≥3 Days of stay in ICU	17.99	(7.30; 28.70)	0.001	16.78	(6.15; 27.41)	0.002
β0: 75.99	R2 = 49.43	(67.39; 84.59)	0.000
Location IPS	Reference ICU 1
UCI 2	24.04	(10.38; 37:70)	0.001	19.27	(3.88; 34.66)	0.014
UCI 3	–23.72	(–30.99; –16.45)	0.000	–	–	–
β0: 84.70	R2 = 48.18	(78:26; 91.14)	0.000

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Diana Isabel Cáceres Rivera, Calle 30 A 33–51, dianai.caceres@ucc.edu.co