Interruptions and their effects on the dynamics of the nursing work

A survey was conducted with 133 nurses in a school hospital in the state of São Paulo from October 2015 to March 2016, through the use of a self-administered questionnaire. For data analysis, Chi-square and Fischer tests have been used.

Results

Most of the nurses have reported frequent and recurring interruptions during their work activities. The interruptive processes are more frequent during the documentation process (n=118; 91.5%) and guidance to the patient/family (n=58; 45%). They are caused by the ringing of the phone (n=114; 87%), and by problem solving in the unit (n=107; 81.7%).

Conclusions

According to the nurses’ opinion, the interruptive processes have repercussions on the working dynamics, on the caring process and on the patient’s safety.

Workflow; Time management; Nursing staff; Nursing process

Interruptions	N	%
Frequency*
1-3	6	4.6
4-6	19	14.5
7-10	33	25.2
11-13	18	13.7
More than 13	55	42.0
When it occurs**
Documentation	118	91.5
Body care	10	7.8
Skin and mucous membrane care	11	8.5
Monitoring and controls	41	31.8
Medication administration	14	10.9
Patient/family guidance	58	45.0
Emotional support to patient/family	31	24.0
Nutrition and Hydration	8	6.2

Interruptions	N	%
Causes*
Unforeseen and emergency needs	91	69.5
Patients with complications	59	45.0
Supply of materials/equipment	56	42.7
Companions asking for information	85	64.9
Parallel conversations	32	24.4
Problem solving at the unit	107	81.7
Telephone ringtone	114	87.0
Alarms	43	32.8
Calls for cooperation with co-workers	78	59.5
Calls for cooperation other professionals	87	66.4
Time to return to the initial activity (min)*
1-2	20	15.3
3-4	30	22.9
5-6	34	26.0
7-8	10	7.6
9-10	13	9.9
More than 10	24	18.3
Does it happen again?*
No	11	8.3
Yes, after (min)*	121	91.7
1-3	8	6.7
4-7	28	23.5
8-11	24	20.2
12-15	19	16.0
More than 15	40	33.6
Impairment in professional performance***
M (Sd)	6.3 (2.3)

Interruptions	Shifts*

	M	A	E	FT
Frequency*
1-3	1 (3.7)	1 (3.2)	1 (4.5)	1 (3.1)
4-6	4 (14.8)	5 (16.1)	1 (4.5)	6 (18.8)
7-10	8 (29.6)	8 (25.8)	3 (13.6)	11 (34.4)
11-13	6 (22.2)	4 (12.9)	4 (18.2)	4 (12.5)
More than 13	8 (29.6)	12 (38.7)	12 (54.5)	10 (31.3)
When it occurs*
Documentation	25 (92.6)	28 (90.3)	20 (90.9)	28 (87.5)
Body care	5 (18.5)	1 (3.2)	2 (9.1)	1 (3.1)
Skin and mucous membrane care	5 (18.5)	0 (0.0)	3 (13.6)	2 (6.3)
Monitoring and controls	8 (29.6)	11 (35.5)	12 (54.5)	3 (9.4)
Medication administration	7 (25.9)	2 (6.5)	3 (13.6)	0 (0.0)
Patient/family guidance	15 (55.6)	13 (419)	9 (40.9)	9 (28.1)
Emotional support to patient/family	6 (22.2)	6 (19.4)	6 (27.3)	5 (15.6)
Nutrition and Hydration	3 (11.1)	1 (3.2)	0 (0.0)	3 (9.4)
Causes*
Unforeseen and emergency needs	18 (66.7)	24 (77.4)	16 (72.7)	17 (53.1)
Patients with complications	14 (51.9)	16 (51.6)	15 (68.2)	3 (9.4)
Supply of materials/equipment	12 (44.4)	16 (51.6)	11 (500)	7 (21.9)
Companions asking for information	19 (70.4)	23 (74.2)	15 (68.2)	11 (34.4)
Parallel conversations	6 (22.2)	8 (25.8)	5 (22.7)	6 (18.8)
Problem solving at the unit	24 (88.9)	22 (71.0)	21 (95.5)	23 (71.9)
Telephone ringtone	22 (81.5)	28 (90.3)	18 (81.8)	28 (87.5)
Alarms	12 (44.4)	11 (35.5)	10 (45.5)	2 (6.3)
Calls for cooperation with co-workers	18 (66.7)	20 (64.5)	18 (81.8)	9 (28.1)
Calls for cooperation other professionals	19 (70.4)	18 (58.1)	12 (54.5)	21 (65.6)

Interruptions	Units and Services*

	IU	SU	DTSS	ADM

	N(%)	N(%)	N(%)	N(%)
Frequency*
1-3	1 (3.2)	3 (4.1)	2 (22.2)	0 (0.0)
4-6	3 (9.7)	7 (9.5)	4 (44.4)	5 (26.3)
7-10	3 (9.7)	21 (28.4)	1 (11.1)	8 (42.1)
11-13	7 (22.6)	8 (10.8)	1 (11.1)	2 (10.5)
More than 13	16 (51.6)	34 (45.9)	1 (11.1)	4 (21.1)
When it occurs
Documentation	29 (93.5)	69 (93.2)	4 (44.4)	16 (84.2)
Body care	1 (3.2)	8 (10.8)	1 (11.1)	0 (0.0)
Skin and mucous membrane care	5 (16.1)	6 (8.1)	0 (0.0)	0 (0.0)
Monitoring and controls	10 (32.3)	28 (37.8)	3 (33.3)	0 (0.0)
Medication administration	4 (12.9)	10 (13.5)	0 (0.0)	0 (0.0)
Patient/family guidance	20 (64.5)	30 (40.5)	7 (77.8)	1 (5.3)
Emotional support to patient/family	11 (35.5)	16 (21.6)	4 (44.4)	0 (0.0)
Nutrition and Hydration	1 (3.2)	5 (6.8)	2 (22.2)	0 (0.0)
Causes
Unforeseen and emergency needs	22 (71.0)	56 (75.7)	3 (33.3)	9 (47.4)
Patients with complications	21 (67.7)	37 (50.0)	1 (11.1)	0 (0.0)
Supply of materials/equipment	14 (45.2)	40 (54.1)	1 (11.1)	1 (5.3)
Companions asking for information	27 (87.1)	51 (68.9)	5 (55.6)	2 (10.5)
Parallel conversations	7 (22.6)	21 (28.4)	1 (11.1)	3 (15.8)
Problem solving at the unit	28 (90.3)	63 (85.1)	6 (66.7)	10 (52.6)
Telephone ringtone	28 (90.3)	65 (87.8)	6 (66.7)	15 (78.9)
Alarms	11 (35.5)	31 (41.9)	0 (0.0)	1 (5.3)
Calls for cooperation with co-workers	24 (77.4)	49 (66.2)	3 (33.3)	2 (10.5)
Calls for cooperation other professionals	17 (54.8)	52 (70.3)	6 (66.7)	12 (63.2)

Statements	Md	Q1-Q3
They affect very little patient /family care.	3	2-4
They are more detrimental to patient’s safety when caused by:
◾ Members of the nursing team	3	2-4
◾ Other health professionals	3	2-4
◾Companion/family	3	2-4
◾ Alarms and phone calls	3	2-4
During drug administration, they often lead to errors.	4	4-4
They always make me forget what I was doing.	3	2-4
They have a direct influence on patient’s safety.	4	4-5
They greatly affect patient/family care.	4	3-4
They interfere in the excellence of care.	4	4-4
During drug administration, they rarely lead to errors.	2	2-4
They do not make me forget what I was doing previously	4	2-4
They contribute to stress at work.	4	4-5

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author: Renata Longhi Sassaki. E-mail: renatasassaki@hotmail.com

Brasil

Brasil

Interruptions and their effects on the dynamics of the nursing work* * Study contemplated with the Scientific Initiation Grant of the Faculdade de Medicina de São José do Rio Preto (FAMERP), 2015-2016.

ABSTRACT

Objectives

Methods

Results

Conclusions

Interruptions and their effects on the dynamics of the nursing work^* * Study contemplated with the Scientific Initiation Grant of the Faculdade de Medicina de São José do Rio Preto (FAMERP), 2015-2016.