Como o instrumento Nursing Activities Score tem sido utilizado na prática clínica: revisão integrativa

Lachance, Joanie; Douville, Frédéric; Dallaire, Clémence; Padilha, Katia Grillo; Gallani, Maria Cecilia

doi:10.1590/S0080-623420150000700021

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Sumário

Review Article • Rev. esc. enferm. USP 49 (spe) • Dez 2015 • https://doi.org/10.1590/S0080-623420150000700021 copiar

Como o instrumento Nursing Activities Score tem sido utilizado na prática clínica: revisão integrativa

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Analisar como os estudos têm abordado os resultados obtidos com a aplicação do Nursing Acivities Score (NAS) na perspectiva de organização do cuidado em saúde, de acordo com o modelo de Donabedian.

Método

A pesquisa bibliográfica foi realizada a partir das bases de dados CINAHL e PubMed, no período compreendido entre 2003 e março de 2015. Os 36 artigos incluídos foram revisados e codificados duplamente por três avaliadores independentes e analisados à luz dos três elementos do modelo de qualidade de cuidados de saúde: Estrutura, Processo e Resultado.

Resultados

As variáveis relacionadas à Estrutura foram as mais frequentes, mas nem sempre foram testadas em relação ao NAS. Além do NAS variáveis relativas ao Processo foram menos utilizadas. No que concerne à etapa Resultado, as variáveis mortalidade e tempo de hospitalização foram as mais comuns.

Conclusão

Nenhum estudo testou a hipóteses sob a perspectiva de um modelo de cuidados de saúde, assim como de custos, uma abordagem que deve ser explorada em estudos posteriores.

Carga de Trabalho; Recursos Humanos de Enfermagem; Unidades de Terapia Intensiva; Qualidade da Assistência à Saúde; Revisão

Author, year/country Journal	Aim	Sample (application of NAS)	Context (type of ICU)	Strategy used for applying the tool	Evaluating the Quality of Care (Donabedian, 1978)
Author, year/country Journal	Aim	Sample (application of NAS)	Context (type of ICU)	Strategy used for applying the tool	Structure	Process	Outcome
Adell et al.⁽¹⁴⁾, 2005/Spain Enferm Intensiva.	To evaluate NAS results throughout the hospitalization.	N_patient=250 N_NAS=1,880	General adult ICU	3 times/day (per shift) and then average NAS/day	-Age -Gender -Special clinical conditions -Origin*	-NAS	-Mortality* -LOS
Altafin et al.⁽¹⁵⁾, 2014/Brazil Rev Bras Ter Intensiva.	To evaluate nursing workload.	N_Patient=437 N_NAS=NS	Adult ICU	Every 24h at 7a.m.	-Age* -Gender* -Reason for admission* -Origin* -Severity index (APACHE II) * -Organ Failure (SOFA)*	-NAS -TISS-28*	-LOS* -Mortality*
Argibay-Lago et al.⁽¹⁶⁾, 2014/Spain Enferm Clin.	To assess nursing workload among nurses providing special treatment to patients.	N_patient=46 N_NAS=NS	>1 ICU patients after suffering sudden cardiac arrest, with or without therapeutic hypothermia	Every 24 h	-Age -Gender -Clinical data	-NAS -TISS 28 -NEMS	-Mortality* -Neurological evolution*
Camuci et al.⁽¹⁷⁾, 2014/Brazil Rev Latino Am Enfermagem.	To evaluate nursing workload in a burns intensive care unit.	N_patient=50 N_NAS=1,221	Burns ICU	Every 24h	-Age -Gender -Burn data	-NAS
Carmona-Monge et al.⁽¹⁸⁾, 2013/Spain Rev Esc Enferm USP.	To compare the NAS in two ICUs.	N_patient=103 N_NAS=941	Two Clinical adult ICUs	Every 24h	-Age -Gender -Reason for admission -2 types of ICU	-NAS	-LOS -Mortality
Carmona-Monge et al.⁽¹⁹⁾, 2013/Spain Rev Esc Enferm USP.	To assess nursing workload from admission to discharge among 3 groups of ICU patients.	N_patient=563 N_NAS=5,704	Medical ICU	Every 24h	-Age -Gender -Reason for admission* -Ratio 1: 2, 1: 3,	-NAS -Invasive procedure	-LOS -Mortality
Ciampone et al.⁽²⁰⁾, 2006/Brazil Acta Paul Enferm.	To compare nursing care needs of elderly and non-elderly patients.	N_patient=50 N_NAS=NS	Adult ICU	Every 24h	-Age* -Gender -Comorbidities	-NAS -Type of treatment	-LOS -Destination -Mortality
Coelho et al.⁽²¹⁾, 2011/Brazil Texto Contexto Enferm.	To identify nursing workload and its association with demographic and clinical patient’s data.	N_patient=100 N_NAS=100	Cardiac Intensive Care Unit	Once, 24 h after admission	- Age* -Gender* Origin* -Reason for admission* -Organic dysfunction (LODS)* -Severity index (SAPS II)* -Mortality risk*	-NAS	-LOS* -Mortality*
Cremasco et al^.(22), 2013/Brazil J Clin Nurs.	To verify the association between nursing workload and pressure ulcer risk and illness severity.	N_patient=160 N_NAS=NS	University ICU	Every 24h	-Age -Gender -Severity index (SAPS II)* -Pressure ulcer risk (Braden Scale)* -Reason for readmission	-NAS	-PU Development* -LOS*
Cyrino et al.⁽²³⁾, 2012/Brazil Esc Anna Nery.	To analyze the impact of the Patient Classification System on the care process and nosocomial infection.	N_patient=214 N_NAS=NS	Adult Medical-Surgical ICU	Every 24 h	-Age* -Gender -Reason for readmission -Patient classification System* -Bed occupancy rate	-NAS	-Nosocomial infection* -Mortality* -LOS*
Silva et al.⁽²⁴⁾, 2010/Brazil Rev Latino Am Enfermagem.	To identify factors related to discharge of ICU patients in hospitals with intermediate care units.	N_patient=600 N_NAS=NS	4 General ICUs	Twice Every 24h After admission to discharge	-Age -Gender -Comorbidities -Severity index (SAPS II) -Beds ratio ICU : IU -Risk of death (SAPS II) -Organ dysfunction	-NAS	-Mortality * -LOS
Silva et al.⁽²⁵⁾, 2011/Brazil Rev Latino Am Enfermagem.	To identify factors associated with death and readmission.	N_patient=600 N_NAS=1,200	2 General public and 2 private ICUs	Twice 24h Admission/discharge	-Age -Gender -Origin -Mortality risk (SPAS II) -Organ dysfunction (LODS)	-NAS	-Mortality * Readmission* -LOS
Daud-Gallotti et al. ⁽²⁶⁾, 2012/Brazil PLOS ONE.	To evaluate the association between nursing workload and HAI.	N_patient=195 N_NAS=NS	3 Medical ICUs and 1 step-down beds unit	Every 24h Every shift (3 times)	-Age -Gender -Origin -Severity index (APACHE II) and SAPS II) -Organ dysfunction (SOFA) -Comorbidities -Nurse-patient ratio -Absenteeism	-NAS -compliance with the nurses’ care plan -Procedures -Communication failure	-HAI* -LOS -Adverse events
Sousa et al.⁽²⁷⁾, 2008/Brazil Rev Latino Am Enfermagem.	To compare illness severity and nursing workload and to identify predictors of nursing workload for the treatment of elderly patients.	N_patient=71 N_NAS=71	General	Every 24h at 8 a.m.	-Age* -Gender -Severity index (SAPS II)	-NAS	-Mortality
Feitosa et al.⁽²⁸⁾, 2012/Brazil Esc Anna Nery.	To evaluate the demand for nursing care.	N_patient=45 N_NAS=328	Two General Adult Clinical-Surgical ICUs	Every 24 h	-Age -Gender	-NAS -Type of treatment (related to diagnosis)	-LOS -Mortality
Giakoumidakis et al.⁽²⁹⁾, 2011/Greece Nurs Crit Care.	To identify the factors affecting the length of stay in hospital.	N_patient=313 N_NAS=313	Cardiac surgery ICU	Every 24h Once	-Age -Gender -Comorbidities -Perioperative and mortality risk (EuroSCORE)	-NAS -Type of surgery -Procedure	-LOS*
Gerasimou-Angelidi et al.⁽³⁰⁾, 2014/Greece J Nurs Manag.	To study the association between family satisfaction and nursing workload.	N_patient=106 N_NAS=NS	Adult ICU	Three times/day (per shift)	-Age, -Severity index (SAPS II) (covariables)	-NAS	-Family Satisfaction ICU 24 (FS ICU-24)* -LOS*
Giakoumidakis et al.⁽³¹⁾, 2012/Greece Eur J Cardiovasc Nurs.	To identify the risk factors for increased in-hospital mortality.	N_Patient=313 N_NAS=313	Cardiac surgery	Every 24h Once at admission	-Age -Gender -Comorbidities -BMI -Surgery and Mortality risk (EuroScore)	-NAS -Type of surgery	-Mortality* -LOS
Gonçalves et al.⁽³²⁾, 2006/Brazil Rev Bras Enferm.	To determine the daily nursing care needs.	N_patient=50 N_NAS=NS	Adult ICU	Every 24h	-Age* -Gender -Reason for admission -Origin*	-NAS -Type of treatment	-Mortality* -LOS*
Gonçalves et al.⁽³³⁾, 2007/Brazil Rev Esc Enferm USP.	To analyze nursing workload on the first day of admission and associated factors.	N_patient=214 N_NAS= 214	5 Adult private ICUs -3 general and 2 neurological	Once, 24 h after admission	-Age -Gender -Diagnosis	-NAS -Type of treatment	-Mortality* -LOS*
Inoue et al.⁽³⁴⁾, 2010/Brazil Acta Paul Enferm.	To analyze nurse-patient ratios based on NAS.	N_patient=107 N_NAS=NS		Every 24 h	-Age -Gender -Reason for admission -Nurse-patient ratio*	-NAS -Type of treatment	-Destination -LOS
Kakushi et al.⁽³⁵⁾, 2014/Brazil Rev Latino Am Enfermagem.	To identify direct and indirect nursing-care time.	N_patient=NS N_NAS=24,886	Children and adult private ICU	Every 24 h,	-Age -Reason for admission -Categories of nursing team -Bed occupancy rate	-NAS (direct care) -Indirect care*	-LOS
Lago et al.⁽³⁶⁾, 2011/Brazil Int J Palliat Nurs.	To evaluate the provision of medical and nursing care to children in the last 24 hours of life	N_patient=34 N_NAS=34	Pediatric ICU	Every 24 h Once in the last 24h of life before death	-Age, -Gender -Ratio 1: 1-2	-NAS -Decision making -Procedure -Type of treatment* (RCR or not RCR)	-LOS
Lucchini et al.⁽³⁷⁾, 2011 /Italy Assist Inferm Ric.	To assess the association between adverse events, nurse staffing levels and workload.	N_patient=240 N_NAS=NS	Adult Clinical and Surgical ICU	Every 24 h	-Age -Ratio nurse-patient* -Bed occupancy rate*	NAS	-Adverse events*
Lucchini et al^.38), 2012 /Italy Assist Inferm Ric.	To detect the impact of ventilation mode on nursing workload.	N_patient=200 N_NAS=NS	General adult ICU	Every 24 h		-Ventilation mode* -NAS
Lucchini et al.⁽³⁹⁾ 2014/Italy Intensive Crit Care Nurs.	To analyze the application of the Nursing Activities Score in an intensive care department.	N_patient=5,856 N_NAS=28,390	General, Neurologic and Cardiothoracic Surgery ICU (adult and pediatric)	Every 24 h in the morning (retrospectively)	-Age* -Severity index (SAPS II and SAPS III)* -Pressure ulcer risk* (Braden scale)	-NAS -Level of sedation (RASS)*	-LOS*
Nogueira et al.⁽⁴⁰⁾, 2007/Brazil Rev Bras Ter Intensiva.	To explore the correlations between NAS, severity index and mortality.	N_patient=148 N_NAS=NS	Adult ICU	Every 24h	-Age -Gender -Reason for admission -Severity index (APACHE II)*	-NAS	-Mortality* -LOS
Nogueira et al.⁽⁴¹⁾, 2013 \ Brazil Rev Bras Ter intensiva.	To compare nursing workloads in public and private ICUs	N_Patient=600 N_NAS=1,200	2 Public and 2 Private ICUs	Every 24 h Twice Admission and discharge	-Age -Gender -Organ dysfunction (LODS) -Severity index (SAPS II) -Type of ICU*	-NAS	-LOS -Mortality*
Nogueira et al.⁽⁴²⁾, 2014/Brazil PLOS ONE.	To identify the factors related to the high nursing workload demanded in the treatment of trauma victims.	N_patient=200 N_NAS=200	Trauma ICU	After the first 24h	-Age* -Gender* -AIS* -Organ dysfunction(LODS)* -ISS* -Origin* -Reason for admission* -Comorbidities* -Mortality risk * (SAPS II, APACHE II)	-NAS -Interval between ER and ICU*
Novaretti et al.⁽⁴³⁾, 2014/Brazil Rev Bras Enferm.	To identify the influence of nursing workload on the occurrence of noninjurious incidents and adverse events.	N_patient=399 N_NAS=NS	2 Clinical-Surgical ICU. Patients ³15 years old	Three times/day (per shift) and then, average NAS/day	-Severity index (APACHE II)	-NAS	-Mortality -LOS -Incidents without injury* -Adverse events*
Nunes et al.⁽⁴⁴⁾, 2013/Brazil Rev Latino Am Enfermagem.	To analyze nursing workload related to the ideal and current nurse-patient ratio.	N_patient=144 N_NAS=406	Neonatal ICU	Every 24 h	-Age -Weight -Type of unit*	-NAS
Padilha et al.⁽⁴⁵⁾, 2008/Brazil Intensive Crit Care Nurs.	To describe nursing workload and its association with patient variables.	N_patient=200 N_NAS=200	2 General and 2 Neurological ICUs	Every 24h First 24h after admission	-Age -Gender -Severity index (SAPS II)*	-NAS -Therapeutic interventions (TISS-28)*	-LOS* -Mortality*
Padilha et al.⁽⁴⁶⁾, 2010/Brazil Int Crit Care Nurs.	To identify and analyze daily nursing workload and the adequacy of nursing staff.	N_patient=68 N_NAS=690	Adult ICU Private hospital	Every 6h shift, Daily	-Age -Gender -Origin -Occupancy Rate -Nurse-patient ratio*	-NAS	-LOS
Panunto et al.⁽⁴⁷⁾ 2012/Brazil Acta Paul Enferm.	To evaluate nursing workload	N_patient=107 N_NAS=574	Adult ICU	Every 24h	-Age -Gender -Reason for admission -Origin	-NAS -Type of treatment	-LOS
Peng et al.⁽⁴⁸⁾, 2014/China Nurs Health Sci.	To explore the correlation between patient illness severity and nursing workload.	N_patient=229 N_NAS=NS	Rescue room of the Emergency Department (trauma)	Every 24 h	-Gender -Severity index (APACHE- II)* -Nurse-patient ratio -Reason for admission	-NAS
Queijo et al.⁽⁴⁹⁾, 2013/Brazil Int Crit Care Nurs.	To assess nursing workload in neuro ICUs and identify independent factors associated with nursing workload	N_patient=100 N_NAS=NS	General, Cardiovascular and neurological ICU	The first 24 h after admission	-Age* -Gender* -Clinical history -Reason for admission* -Severity index (SAPS II) -Organ Dysfunction (LODS) -Origin*	-NAS	-LOS -Mortality*

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[1] Correspondence Addressed to: Maria Cecilia Gallani. 1050, Avenue de la Médecine. Quebec, Canada. maria-cecilia.gallani@fsi.ulaval.ca