Nursing Workload and care required by older adults in intensive care

Ribeiro, Joathan Borges; Lopes, Francine Jomara; Barbosa, Ana Carolina de Lima; Gallasch, Cristiane Helena; Santos, Eduesley Santana; Ferretti-Rebustini, Renata Eloah de Lucena

doi:10.1590/1981-22562023026.230134.en

Joathan Borges Ribeiro

conceptio

an

design

dat

analysis an

interpretation

writing of article or its critical review

approval of final draft for publication

overseeing all aspects of the study

vouching for any issues related to the accuracy or integrity of any part of the study.

Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-graduação de Enfermagem na Saúde do Adulto. São Paulo, SP, Brasil.

http://orcid.org/0000-0003-4151-5601

Francine Jomara Lopes

conception and design

data analysis and interpretation

writing of article or its critical review.

Instituto de ensino e Pesquisa Sírio Libanês, Programa de Residência Multiprofissional no Cuidado ao Paciente Crítico. São Paulo, SP, Brasil.

http://orcid.org/0000-0001-8756-093X

Ana Carolina de Lima Barbosa

data analysis and interpretation

writing of article or its critical review.

Centro Universitário São Camilo, Departamento de Enfermagem. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-1104-7651

Cristiane Helena Gallasch

critical review

approval of final draft for publication.

Universidade do Estado do Rio de Janeiro, Faculdade de Enfermagem, Departamento de Enfermagem Médico-cirúrgico. Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-0823-0818

Eduesley Santana Santos

critical review

approval of final draft for publication.

Universidade Federal de Sergipe, Departamento de Enfermagem e Nutrição do Centro de Ciências Biológicas e da Saúde. São Cristóvão, SE, Brasil.

http://orcid.org/0000-0001-8545-5677

Renata Eloah de Lucena Ferretti-Rebustini

critical review

approval of final draft for publication.

Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. São Paulo, SP, Brasil.

http://orcid.org/0000-0002-6159-5787

Correspondence Joathan Borges Ribeiro enfjoathan@gmail.com

The authors declare no conflict in the conception of this study.

Edited by: Marquiony Marques dos Santos

	Total	Young Adult	Older Adults	p-value*
	(mean±SD))	(mean±SD)	(mean±SD)
Length of ICU stay	5.6±7.1	5.0±6.2	6.0±7.7	0.117
SAPS3	44.3±14.7	36.5±13.4	48.3±13.7	<0.001
NAS	69.8±11.0	68.3±11.6	71.0±10.4	0.007

NAS Item at Admission	Total	Older Adults	Young Adults	p-value*
NAS Item at Admission	n (%)	n (%)	n (%)	p-value*
1a. Hourly vital signs, registration, and calculation of fluid balance.	203 (100.0)	135 (66.5)	68 (33.5)	<0.001
1b. Present at bedside and continuous observation or active for 2 hrs or more in any shift.	292 (100.0)	145 (49.7)	147 (50.3)	<0.001
1c. Present at bedside and active for 4 hrs or more in any shift.	-	-	-	-
2. Laboratory, biochemical and microbiological investigations.	459 (100.0)	261 (56.9)	198 (43.1)	0.860
3. Medication, vasoactive drugs excluded.	490 (100.0)	275 (56.1)	215 (43.9)	1.000
4a. Performing hygiene procedures.	481 (100.0)	271 (56.3)	210 (43.7)	0.409
4b. Performance of hygiene procedures took >2 hrs in any shift.	11 (100.0)	6 (54.5)	5 (45.5)	1.000
4c. Performance of hygiene procedures took >4 hrs in any shift.	-	-	-	-
5. Care of drains, all (except gastric tube).	84 (100.0)	46 (54.8)	38 (45.2)	0.717
6a. Performing mobilization and positioning procedure(s) up to three times per 24 hrs.	69 (100.0)	29 (42.0)	40 (58.0)	0.009
6b. Performing mobilization and positioning procedure(s) more frequently than 3 times per 24 hrs, or with two nurses, any frequency.	417 (100.0)	247 (59.2)	170 (40.8)	0.009
6c. Performing mobilization and positioning procedure(s) with three or more nurses, any frequency.	4 (100.0)	1 (25.0)	3 (75.9)	0.321
7a. Support and care of either relatives or patient requiring full dedication for about 1 hr in any shift.	233 (100.0)	156 (67.0)	77 (33.0)	<0.001
7b. Support and care of either relatives or patient requiring full dedication for 3 hrs or more in any shift.	3 (100.0)	1 (33.3)	2 (66.7)	0.581
8a. Performing routine administrative and managerial tasks.	76 (100.0)	38 (50.0)	38 (50.0)	0.210
8b. Performing administrative and managerial tasks requiring full dedication for about 2 hrs in any shift.	419 (100.0)	242 (57.8)	177 (42.2)	0.258
8c. Performing administrative and managerial tasks requiring full dedication for about 4 hrs or more of the time in any shift.	4 (100.0)	2 (50.0)	2 (50.0)	1.000
9. Respiratory support: any form of mechanical ventilation/assisted ventilation; spontaneous breathing; supplementary oxygen by any method.	295 (100.0)	168 (56.9)	127 (43.1)	0.926
10. Care of artificial airways: endotracheal tube or tracheostomy cannula.	140 (100.0)	67 (47.9)	73 (52.1)	0.016
11. Treatment for improving lung function: thorax physiotherapy, incentive spirometry, inhalation therapy, intratracheal suctioning.	256 (100.0)	161 (62.9)	95 (37.1)	0.005
12. Vasoactive medication, disregard type and dose.	185 (100.0)	109 (58.9)	76 (41.1)	0.454
13. Intravenous replacement of large fluid losses. Fluid administration >3 L/m²2 UTIs brasileiras: Registro Nacional de Terapia Intensiva [internet]. Características das UTIs participantes; [acesso em 20 de maio 2023]. Disponível em: http://www.utisbrasileiras.com.br/uti-adulto/caracteristicas-demograficas/#!/distribuicao-das-internacoes-por-faixa-etaria. 2023. http://www.utisbrasileiras.com.br/uti-ad... ,/day, irrespective of type of fluid administered.	3 (100.0)	1 (33.3)	2 (66.7)	0.582
14. Left atrium monitoring: pulmonary artery catheter with or without cardiac output measurement.	-	-	-	-
15.Cardiopulmonary resuscitation after arrest, in the past period of 24 hrs (single precordial thump not included).	1 (100.0)	0 (0.0)	1 (100.0)	0.433
16. Hemofiltration techniques, dialysis techniques.	36 (100.0)	13 (36.1)	23 (63.9)	0.014
17. Quantitative urine output measurement (e.g., by indwelling urinary catheter).	473 (100.0)	274 (57.9)	199 (42.1)	0.012
18. Measurement of intracranial pressure	6 (100.0)	3 (50.0)	3 (50.0)	1.000
19. Treatment of complicated metabolic acidosis/alkalosis.	6 (100.0)	2 (33.3)	4 (66.7)	0.410
20. Intravenous hyperalimentation.	8 (100.0)	6 (75.0)	2 (25.0)	0.476
21. Enteral feeding through gastric tube or other gastrointestinal route (e.g., jejunostomy).	45 (100.0)	26 (57.8)	19 (42.2)	1.000
22. Specific intervention(s) in the intensive care unit.	155 (100.0)	158 (62.0)	97 (38.0)	0.018
23. Specific interventions outside the intensive care unit: surgery or diagnostic procedures.	85 (100.0)	44 (51.8)	41 (48.2)	0.337

NAS Category	Activity		OR	95%CI	p-value
Basic Activity	1a	Hourly vital signs, registration, and calculation of fluid balance	1.970	1.360-2.850	<0.001
	1b	Present at bedside and continuous observation or active for 2 hrs or more in any shift.	0.497	0.343-0.720	0.720
	1c	Present at bedside and active for 4 hrs or more in any shift.	-	-	-
	2	Laboratory, biochemical and microbiological investigations.	1.104	0.554-2.202	0.778
	3	Medication, vasoactive drugs excluded.	1.043	0.277 – 3.930	0.951
	4a	Performing hygiene procedures.	0.571	0.173-1.879	0.356
	4b	Performance of hygiene procedures took >2 hrs in any shift.	0.923	0.278-3.066	0.896
	4c	Performance of hygiene procedures took >4 hrs in any shift.	-	-	-
	5	Care of drains, all (except gastric tube).	0.882	0.552-1.411	0.600
	6a	Performing mobilization and positioning procedure(s) up to three times per 24 hrs.	0.505	0.302-0.846	0.009
	6b	Performing procedure(s) more frequently than 3 times per 24 hrs, or with two nurses, any frequency.	1.926	1.178-3.149	0.009
	6c	Performing procedure(s) with three or more nurses, any frequency	0.253	0.026-2.452	0.236
Basic Activity	7a	Support and care of either relatives or patient requiring full dedication for about 1 hr in any shift.	2.210	1.535-3.182	<0.001
	7b	Support and care of either relatives or patient requiring full dedication for 3 hrs or more in any shift.	0.382	0.340-4.238	0.433
	8a	Performing routine administrative and managerial tasks.	0.731	0.448-1.193	0.211
	8b	Performing administrative and managerial tasks requiring full dedication for about 2 hrs in any shift.	1.324	0.809-2.166	0.264
	8c	Performing administrative and managerial tasks requiring full dedication for about 4 hrs or more of the time in any shift.	0.766	0.107-5.484	0.791
Ventilatory Support	9	Respiratory support: any form of mechanical ventilation/assisted ventilation; spontaneous breathing; supplementary oxygen by any method.	1.039	0.724-1.493	0.834
	10	Care of artificial airways: endotracheal tube or tracheostomy cannula.	0.615	0.415-0.912	0.015
	11	Treatment for improving lung function: thorax physiotherapy, incentive spirometry, inhalation therapy, intratracheal suctioning.	1.709	1.194-2.446	0.003
Cardiovascular Support	12	Vasoactive medication, disregard type and dose.	1.166	0.806-1.685	0.415
	13	Intravenous replacement of large fluid losses. Fluid administration >3 L/m2/day, irrespective of type of fluid administered.	0.383	0.035-4.253	0.435
	14	Left atrium monitoring: pulmonary artery catheter with or without cardiac output measurement.	-	-	-
	15	Cardiopulmonary resuscitation in past period of 24 hrs (single precordial thump not included).	0.000	0.000	0.995
Renal Support	16	Hemofiltration techniques, dialysis techniques.	0.406	0.201-0.823	0.012
Renal Support	17	Quantitative urine output measurement (e.g., by indwelling urinary catheter).	3.425	1.306-8.982	0.012
Neurologic Support	18	Measurement of intracranial pressure.	0.765	0.153-3.830	0.745
Metabolic Support	19	Treatment of complicated metabolic acidosis/alkalosis.	0.379	0.069-2.091	0.266
	20	Intravenous hyperalimentation.	2.332	0.466-11.670	0.303
	21	Enteral feeding through gastric tube or other gastrointestinal route (e.g., jejunostomy).	1.056	0.568-1.963	0.863
Specific Interventions	22	Specific intervention(s) in the intensive care unit.	1.546	1.081-2.211	0.017
Specific Interventions	23	Specific interventions outside the intensive care unit: surgery or diagnostic procedures.	0.791	0.495-1.264	0.327

[1] Correspondence Joathan Borges Ribeiro enfjoathan@gmail.com

Brasil

Brasil

Nursing Workload and care required by older adults in intensive care

Abstract

Objective

Method

Results

Conclusion

Brasil

Brasil

Nursing Workload and care required by older adults in intensive care

Abstract

﻿Objective

Method

Results

Conclusion

Objective