Nursing workload in hematopoietic stem cell transplantation: a cohort study

Silva, Juliana Bastoni da; Póvoa, Valéria Cristina Oliveira; Lima, Maria Helena de Melo; Oliveira, Henrique Ceretta; Padilha, Kátia Grillo; Secoli, Sílvia Regina

doi:10.1590/S0080-623420150000700014

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Sumário

Original Article • Rev. esc. enferm. USP 49 (spe) • Dec 2015 • https://doi.org/10.1590/S0080-623420150000700014 copy

Nursing workload in hematopoietic stem cell transplantation: a cohort study^* * Extracted from the thesis “Eventos adversos e carga de trabalho de enfermagem em pacientes submetidos ao transplante de células-tronco hematopoiéticas: estudo de coorte”, Escola de Enfermagem, Universidade de São Paulo, 2015.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Measure nursing workload required by patients submitted to autologous and allogeneic hematopoietic stem cell transplantation (HSCT) and analyze the Nursing Activities Score (NAS) of the nursing team during the hospitalization period for HSCT.

Method

A prospective cohort study conducted from January 2013 to April 2014 with 62 patients hospitalized in the HSCT unit of a university hospital in Campinas, São Paulo, Brazil. The workload was measured through NAS and data analysis was through chi-square test or Fisher’s exact test, Mann-Whitney test and Spearman’s correlation coefficient; with 5% significance level.

Results

Mean nursing workload was 67.3% (SD of 8.2) in autologous HSCT patients and 72.4% (SD of 13.0) in allogeneic HSCT patients (p=0.1380).Monitoring and titration showed, in more than 50% of the time, patients demanded intensified care, requiring two hours or more in a nursing shift for reasons of safety, severity or therapy.

Conclusion

The nursing workload and the NAS items with the highest scores reflect the magnitude, complexity and specificity of care required by patients submitted to HSCT.

Hematopoietic Stem Cells Transplantation; Nursing, Team; Workload; Nursing Care; Intensive Care Units

Demographical and medical variables	Type of HSCT

	Autologous		Allogeneic		p-value

	n	%	n	%
Gender					0.0919*
Male	16	66.7	17	44.7
Female	8	33.3	21	55.3
HSCT diagnosis					<0.0001**
Leukemia	1	4.2	18	47.4
Lymphoma	10	41.7	10	26.3
Multiple myeloma	11	45.8	6	15.8
Other	2	8.3	4	10.5
Diagnosis-HSCT interval					0.7173*
≤12 months	6	25.0	8	21.1
>12 months	18	75.0	30	78.9
Disease stage					0.0002**
Early	2	8.3	10	26.3
Intermediate	16	66.7	6	15.8
Late	6	25.0	22	57.9
SAH					0.0471*
No	11	45.8	27	71.1
Yes	13	54.2	11	28.9
Comorbidities*					0.0443*
No	7	29.2	21	55.3
Yes	17	70.8	17	44.7
Bloodstream infection					0.2575*
No	11	45.8	23	60.5
Yes	13	54.2	15	39.5
Exit condition					0.1930**
Survivor	21	87.5	28	73.7
Death	3	12.5	10	26.3

Phases of HSCT	NAS score (%)

	Autologous		Allogeneic		p-value*

	Mean (SD)	Median (Min.-Max.)	Mean (SD)	Median (Min.-Max.)
Conditioning (n=24; n=38)	63.4 (7.4)	63.5 (50.4-79.8)	68.9 (12.6)	65.7 (50.2-105.4)	0.1535
Infusion (n=24; n=38)	74.4 (19.8)	73.3 (39.2-120.6)	84.6 (20.0)	85.1 (39.2-142.4)	0.0645
Post-HSCT (n=24; n=35)	68.1 (9.4)	67.2 (53.8-92.2)	71.6 (13.0)	70.9 (45.6-109.3)	0.2220

Observations in the period for HSCT (total f=2193)
Nursing activities	*Subitens*	f	%
Basic Activities
1. Monitoring and titration	1a	1035	(47.2)
	1b	969	(44.2)
	1c	189	(8.6)
2. Laboratory		2193	(100)
3. Medication		2193	(100)
4. Hygiene procedures	4a	1031	(47.0)
	4b	967	(44.1)
	4c	195	(8.9)
5. Care of drains		102	(4.6)
6. Mobilization and positioning	6a	1838	(83.8)
	6b	329	(15.0)
	6c	26	(1.2)
7. Support and care of relatives and patient	7a	2126	(96.9)
	7b	67	(3.1)
8. Administrative and managerial tasks	8a	458	(20.9)
	8b	1691	(77.1)
	8c	44	(2.0)

Ventilatory Support

9. Respiratory support		274	(12.5)
10. Care with artificial airways		100	(4.5)
11. Treatment for improving lung function		150	(6.8)

Cardiovascular Support

12. Vasoactive medication		122	(5.6)
13. Intravenous replacement of large fluid losses		39	(1.8)
14. Left atrium monitoring		–	–
15. Cardiopulmonary resuscitation		01	(0.05)

Renal Support

16. Hemofiltration techniques		47	(2.1)
17. Quantitative urine output measurement		2193	(100)

Neurological Support

18. Measurement of intracranial pressure		–	–

Metabolic Support

19. Treatment of complicated acidosis or metabolic alkalosis		30	(1.4)
20. Intravenous hyperalimentation		344	(15.7)
21. Enteral feeding		70	(3.2)

Specific Interventions

22. Specific interventions in the intensive care unit		151	(6.9)
23. Specific interventions outside the intensive care unit		126	(5.7)

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: Juliana Bastoni da Silva. Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz. CEP 13083-887 - Campinas, SP, Brazil. jbastoni@unicamp.br