¿Impactan los ancianos frágiles en la carga laboral de enfermería en unidades de terapia intensiva?

Tanabe, Fabiola Mika; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0599en copiar

¿Impactan los ancianos frágiles en la carga laboral de enfermería en unidades de terapia intensiva?

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Comparar la carga de trabajo de enfermería de ancianos según su condición de fragilidad en unidad cuidado intensivo (UCI).

Método:

Estudio transversal con muestra incluyendo pacientes con edad ≥60 años e internación ≥24 hs en UCI de hospital universitario de São Paulo, Brasil. Se aplicó el Tilburg Frailty Indicator (TFI) para identificar fragilidad en los ancianos y el Nursing Activities Score (NAS) para medir carga de trabajo de enfermería.

Resultados:

En la muestra de 204 ancianos, la condición de fragilidad fue constatada en 156 (76,5%). Los ancianos demandaron alta carga de trabajo de enfermería (NAS promedio: 75,9) en el primer día en UCI, pero la fragilidad no cambió significativamente (p = 0,606) el NAS (frágil 75,7 vs. no frágil 76,5), tanto considerando la media o la proporción de pacientes en cada categoría.

Conclusión:

La condición de fragilidad en ancianos no repercutió en el aumento de carga de trabajo de enfermería en UCI.

DESCRIPTORES
Anciano Frágil; Enfermería; Carga de Trabajo; Cuidados Críticos; Unidades de Cuidados Intensivos

	Condition
	Frailty		Non-frailty
	Mean	Standard deviation	Mean	Standard deviation	p value
NAS – day 1	75.7	8.2	76.5	8.5	0.606
NAS – day 2	56.9	11.0	56.9	9.0	0.694
NAS – day 3	55.0	7.7	57.0	7.7	0.235
NAS – day 4	56.8	10.4	58.2	15.6	0.874
NAS – day 5	57.0	10.2	58.4	12.1	0.698
NAS – day 6	57.4	9.8	54.2	7.4	0.318
NAS – day 7	56.9	9.6	56.5	10.7	0.698
Overall mean NAS	59.5	7.3	58.8	7.6	0.179

NAS categories/items (score)	Condition				p value
NAS categories/items (score)	Frail n	%	Non-frail n	%	p value
Monitoring and titration
1a. Hourly vital signs, regular registration and calculation of fluid balance. (4.5)	–	–	–	–
1b. Presence at bedside and continuous observation or active for 2 hours or more in any shift, for reasons of safety, severity or therapy, such as: non-invasive mechanical ventilation, weaning procedures, restlessness, mental disorientation, prone position, donation procedures, preparation and administration of fluids and/or medication, assisting specific procedures. (12.1)	156	100	48	100	1
1c. Present at bedside and active for 4 hours or more in any shift for reasons of safety, severity or therapy, such as those examples above. (19.6)
Laboratory tests
Absent. (0.0)	–	–	–	–
Present. (4.3)	156	100	48	100	1
Medication, vasoactive drugs excluded
Absent. (0.0)	–	–	–	–
Present. (5.6)	156	100	48	100	1
Hygiene procedures
4a. Performing hygiene procedures such as: dressing of wounds and intravascular catheters, changing linen, washing patient body in special situations (incontinence, vomiting, burns, leaking wounds, complex surgical dressing with irrigation), special procedures (e.g. barrier nursing, etc. (4.1)	156	100.0	47	97.9	1
4b. The performance of hygiene procedures took more than 2 hours in any shift. (16.5)	–	–	1	2.1
4c. The performance of hygiene procedures took more than 4 hours in any shift. (20.0)	–	–	–	–
Care of drains – All (except gastric tube)
Absence. (0.0)	97	62.2	25	52,1
All, except gastric tube. (1.8)	59	37.8	23	47.9	0.212
Mobilization and positioning, including procedures such as: turning the patient; mobilization of the patient; moving from bed to chair; team lifting (e.g. immobile patient, traction, prone position).
6a. Performing procedure(s) up to 3 times per 24 hours. (5.5)	17	10.9	1	2.1
6b. Performing procedures(s) more frequently than 3 times per 24 hours, or with 2 nurses – any frequency. (12.4)	139	89.1	47	97.9	0.079*
6c. Performing procedure with 3 or more nurses – any frequency. (17.0)	–	–	–	–

NAS categories/items (score)	Condition				p value
NAS categories/items (score)	Frail n	%	Non-frail n	%	p value
Support and care of relatives and patient, including procedures such as telephone calls, interviews, counseling. Often, the support and care of either relatives or patients allow staff to continue with other nursing activities (e.g.: communication with patients during hygiene procedures, communication with relatives while present at bedside and observing the patient).
7a. Support and care of either relatives or patients requiring full dedication for about one hour in any shift such as to explain clinical condition, dealing with pain and distress, difficult family circumstances. (4.0)	153	98.1	47	97.9	1*
7b. Support and care of either relatives or patients requiring full dedication for 3 hours or more in any shift such as to inform about death, demanding circumstances (e.g.: large number of relatives, language problems, hostile relatives). (32.0)	3	1.9	1	2.1
Administrative and managerial tasks
8a. Performing routine tasks such as processing of clinical data, ordering examinations, professional exchange of information (e.g.: ward rounds, clinical visits). (4.2)	–	–	–	–
8b. Performing administrative and managerial tasks requiring full dedication for about 2 hours in any shift such as research activities, protocols in use, admission and discharge procedures. (23.2).	155	99.4	48	100.0	1
8c. Performing administrative and managerial tasks requiring full dedication for about 4 hours or more of the time in any shift such as death and organ donation procedures, coordination with other disciplines. (30.0)	1	0.6	–	–

NAS categories/items (score)	Condition				p value
NAS categories/items (score)	Frail n	%	Non-frail n	%	p value
Ventilatory support
9. Respiratory support: Any form of mechanical/assisted ventilation with or without positive end-expiratory pressure, with or without muscle relaxants; spontaneous breathing with positive end-expiratory pressure (e.g. CPAP or BiPAP), with or without endotracheal tube; supplementary oxygen by any method. (1.4)
10. Care of artificial airways: Endotracheal tube or tracheostomy cannula. (1.8)
11. Treatment for improving lung function: Thorax physiotherapy, incentive spirometry, inhalation therapy, intratracheal suctioning. (4.4)
Absence (0.0)	73	46.8	21	43.8
9 and 10	4	2.6	–	–
9 and 11	5	3.2	1	2.1
9, 10, and 11	37	23.7	13	27.1	0.635
9	36	23.1	13	27.1	0.569
11	1	0.6	–	–
Cardiovascular support
12. Vasoactive medication, disregard type and dose. (1.2)
13. Intravenous replacement of large fluid losses. Fluid administration >3 l/m²/day, irrespective of type of fluid administered. (2.5)
14. Left atrium monitoring: Pulmonary artery catheter with or without cardiac output measurement. (1.7)
15. Cardiopulmonary resuscitation after arrest, in the past period of 24 hours (single precordial thump not included). (7.1)
Absence (0.0)	107	68.6	31	64.6
12 and 14 (1.2 and 1.7)	3	1.9	1	2.1
12 (1.2)	46	29.5	16	33.3	0.612
Renal support
16. Hemofiltration techniques, dialysis techniques. (7.7)
17. Quantitative urine output measurement (e.g.: by indwelling urinary catheter). (7.0)
Absence (0.0)	29	18.6	9	18.8
16 (7.7)	1	0.6	–	–
17 (7.0)	123	78.8	39	81.2	0.718
16 and 17 (7.7 and 7.0)	3	1.9	–	–
Neurological support
Absence (0.0)	146	93.6	46	95.8	0.736*
18. Measurement of intracranial pressure. (1.6)	9	5.8	2	4.2
Metabolic support
Absence (0.0)	140	89.7	43	89.6
19. Treatment of complicated metabolic acidosis/alkalosis. (1.3)	15	9.6	5	10.4	1
20. Intravenous hyperalimentation. (2.8)	1	0.6	–	–	1
21. Enteral feeding through gastric tube or other gastrointestinal route (e.g., jejunostomy).	–	–	–	–
Specific interventions
Absence (0.0)	125	80.1	40	83.3
22. Specific interventions in the intensive care unit: Endotracheal intubation, insertion of pacemaker, cardioversion, endoscopy, emergency surgery in the previous 24 hours, gastric lavage. Routine interventions without direct consequences to the clinical condition of the patient, such as: radiographs, echography, electrocardiogram, dressings, or insertion of venous or arterial catheters are not included. (2.8)	21	13.5	3	6.2	0.175
23. Specific interventions outside the intensive care unit: Surgery or diagnostic procedures. (1.9)	7	4.5	5	10.4	0.158*
22 and 23 (1.9 and 2.8)	3	1.9	–	–

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] Corresponding author: Fabiola Mika Tanabe Alameda Santos, 2415, Cerqueira Cesar 01419-101 - São Paulo, SP, Brazil fabiola.tanabe@gmail.com