Pattern of nursing interventions performed on trauma victims according to the Nursing Activities Score

Nogueira, Lilia de Souza; Padilha, Katia Grillo; Silva, Daniela Vieira; Lança, Ellen de Fátima Caetano; Oliveira, Elaine Machado de; Sousa, Regina Marcia Cardoso de

doi:10.1590/S0080-623420150000700005

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Original Article • Rev. esc. enferm. USP 49 (spe) • Dec 2015 • https://doi.org/10.1590/S0080-623420150000700005 copy

Pattern of nursing interventions performed on trauma victims according to the Nursing Activities Score

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To identify the pattern of nursing interventions performed on trauma victims in the Intensive Care Unit (ICU).

Method

Prospective study performed in the ICU of a hospital in São Paulo, Brazil. Nursing interventions were identified using the Nursing Activities Score (NAS).

Results

The sample consisted of 200 patients, most of them male, with a mean age of 40.7, victims of transport accidents. The NAS mean was 71.3%. The pattern of nursing interventions identified included monitoring and titration, laboratory investigations, medication (with the exception of vasoactive drugs), hygiene procedures, caring for drains, mobilization and positioning, support and care of relatives and patient, administrative and managerial tasks, respiratory support, care of artificial airways, treatment for improving lung function, and quantitative urine output measurement. The monitoring and mobilization interventions required care beyond what is normally required by ICU patients.

Conclusion

The results of this study provide important contributions to plan training activities and to size ICU nursing team.

Workload; Nursing, Team; Nursing Care; Intensive Care Units

Variable	Categories	#	%
Gender	Male	164	82.0
Gender	Female	36	18.0
External cause	Pedestrian or cyclist injured in a transport accident (V01-V19)	40	20.0
	Motorcyclist injured in a transport accident (V20-V29)	55	27.5
	Car, pickup truck or heavy transportation vehicle occupant injured in a transport accident (V40-V69).	20	10.0
	Falls (W00-W19)	62	31.0
	Other*	23	11.5
Nature of trauma	Blunt	189	94.5
	Penetrating	9	4.5
	Blunt and penetrating	2	1.0
Condition of discharge	Survivor	162	81.0
Condition of discharge	Non-survivor	38	19.0

Variable	Mean (dp)	Median	Min	Max
Age (years)	40.7 (18.6)	36	18	86
ISS (score)	19.3 (9.1)	17	9	50
Risk of death according to SAPS II (%)	22.9 (22.6)	15.3	0.1	92.5
Length of stay in ICU (days)	13.6 (14.6)	8	1	92

Nursing Activities Score	Categories	n	%
Basic activities
1. Monitoring and titration
Hourly vital signs, calculation and registration of fluid balance	1a	28	20.6
Present at bedside and continuous observation or active for 2 hours or more	1b	91	66.9
Present at bedside and continuous observation or active for 4 hours or more	1c	17	12.5
2. Laboratory, biochemical and microbiological investigations	Yes	136	100.0
3. Medication, except vasoactive drugs	Yes	136	100.0
4. Hygiene procedures
Performing hygiene procedures	4a	87	64.0
Performing hygiene procedures lasting more than 2 hours in any shift	4b	48	35.3
Performing hygiene procedures lasting more than 4 hours in any shift	4c	1	0.7
5. Caring for drains - all (except gastric tube), including urinary catheter	Yes	135	99.3
6. Mobilization and positioning
Performing procedures up to 3 times in 24 hours	6a	-	-
Performing procedures more than 3 times in 24 hours or with 3 nurses at any frequency	6b	99	72.8
Performing procedures with 3 or more nurses, any frequency	6c	37	27.2
7. Support and care of relatives and patient
Support and care of either relatives and patient requiring dedicated attention for about an hour in any shift	7a	132	97.1
Support and care of either relatives and patient requiring dedicated attention for 3 hours or more in any shift	7b	4	2.9
8. Administrative and managerial tasks
Performance of routine tasks	8a	136	100.0
Performance of administrative and managerial tasks requiring full dedication for about 2 hours in any shift	8b	-	-
Performance of administrative and managerial tasks requiring full dedication for about 4 hours in any shift	8c	-	-
Ventilatory support
9. Respiratory support	Yes	133	97.8
10. Care of artificial airways	Yes	122	89.7
11. Treatment for improving lung function	Yes	128	94.1
Cardiovascular support
12. Vasoactive medication, disregard type or dose	Yes	88	64.7
13. Intravenous replacement of large fluid losses	Yes	22	16.2
14. Left atrium monitoring	Yes	-	-
15. Cardiopulmonary resuscitation after arrest, in the past 24 hours	Yes	1	0.7
Renal support
16. Hemofiltration techniques. Dialytic techniques	Yes	1	0.7
17. Quantitative urine output measurement	Yes	136	100.0
Neurological support
18. Measurement of intracranial pressure	Yes	17	12.5
Metabolic support
19. Treatment of complicated metabolic acidosis/alkalosis	Yes	16	11.8
20. Intravenous hyperalimentation	Yes	-	-
21. Enteral feeding	Yes	18	13.2
Specific interventions
22. Specific interventions in the Intensive Care Unit	Yes	26	19.1
23. Specific interventions outside the Intensive Care Unit	Yes	40	29.4

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] Correspondence Addressed to: Lilia de Souza Nogueira Av. Dr. Enéas de Carvalho Aguiar, 419 - Cerqueira Cesar CEP 05403-000 – São Paulo, SP, Brazil lilianogueira@usp.br