Cómo el instrumento Nursing Activities Score se ha utilizado en la práctica clínica: revisión integradora

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) • Dic 2015 • https://doi.org/10.1590/S0080-623420150000700021 copiar

Cómo el instrumento Nursing Activities Score se ha utilizado en la práctica clínica: revisión integradora

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

Analizar cómo los estudios se han ocupado de los resultados obtenidos con la aplicación del Nursing Acivities Score (NAS) en la perspectiva de organización de cuidados en salud, de acuerdo con el modelo de Donabedian.

Método

Una búsqueda bibliográfica se realizó a partir de las bases de datos CINAHL y PubMed para el período entre 2003 y marzo de 2015.

Resultados

El 36 artículos retenidos fueron revisados y codificados en dos ocasiones por tres evaluadores independientes y analizados a la luz de los tres elementos del modelo de calidad cuidado de la salud de Donabedian: Estructura, Proceso y Resultado.

Conclusión

Las variables relacionadas con la Estructura fueron el más común, pero no siempre se probaron para el NAS. Adémas del NAS, las variables relacionadas con el Proceso fueron menos recurrentes. En cuanto a la etapa de Resultado, las variables mortalidad y duración de la estancia hospitalaria fueron los más comunes. Sin embargo, ningún estudio probó hipótesis desde la perspectiva de un modelo de organisation de la atención de salud, así como de costos, un enfoque que debe ser explorado en estudios futuros.

Carga de Trabajo; Personal de Enfermería; Unidades de Cuidados Intensivos; Calidad de la Atención de Salud; Revisión

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