Nursing Activities Score: nursing work load in a burns Intensive Care Unit1 1 Paper extracted from master's thesis "The nursing workload in Intensive Care Unit of Burn Care Center according to Nursing Activities Score", presented to Universidade Estadual de Londrina, Londrina, PR, Brazil

Marcia Bernadete Camuci Júlia Trevisan Martins Alexandrina Aparecida Maciel Cardeli Maria Lúcia do Carmo Cruz Robazzi About the authors

Abstracts

OBJECTIVE:

to evaluate the nursing work load in a Burns Intensive Care Unit according to the Nursing Activities Score.

METHOD:

an exploratory, descriptive cross-sectional study with a quantitative approach. The Nursing Activities Score was used for data collection between October 2011 and May 2012, totalling 1,221 measurements, obtained from 50 patients' hospital records. Data for qualitative variables was described in tables; for the quantitative variables, calculations using statistical measurements were used.

RESULTS:

the mean score for the Nursing Activities Score was 70.4% and the median was 70.3%, corresponding to the percentage of the time spent on direct care to the patient in 24 hours.

CONCLUSION:

the Nursing Activities Score provided information which involves the process of caring for patients hospitalized in a Burns Intensive Care Unit, and indicated that there is a high work load for the nursing team of the sector studied.

Workload; Nursing; Intensive Care Units; Burn Units


OBJETIVO:

avaliar a carga de trabalho de enfermagem em uma Unidade de Terapia Intensiva de Queimados, de acordo com o Nursing Activities Score.

MÉTODO:

estudo exploratório, descritivo, transversal, com abordagem quantitativa. Utilizou-se o Nursing Activities Score para a coleta de dados entre outubro/2011 e maio/2012, totalizando 1.221 medidas, obtidas de prontuários de 50 pacientes. Dados de variáveis qualitativas foram descritas em tabelas; para as variáveis quantitativas foram utilizados cálculos das medidas estatísticas.

RESULTADOS:

a média da pontuação do Nursing Activities Scorefoi de 70,4% e mediana de 70,3%, correspondendo à porcentagem de tempo gasto na assistência direta ao paciente em 24 horas.

CONCLUSÃO:

o Nursing Activities Score forneceu informações que envolvem o processo do cuidar de pacientes internados em Unidade de Terapia Intensiva de Queimados e apontou que há elevada carga de trabalho para a equipe de enfermagem do setor estudado.

Carga de Trabalho; Enfermagem; Unidades de Terapia Intensiva; Unidades de Queimados


OBJETIVO:

evaluar la carga de trabajo de enfermería en una Unidad de Terapia Intensiva de Quemados de acuerdo con el Nursing Activities Score.

MÉTODO:

estudio exploratorio, descriptivo y transversal con abordaje cuantitativo. Se utilizó el Nursing Activities Score para la recolección de datos entre octubre/2011 y mayo/2012, totalizando 1.221 medidas, obtenidas de fichas médicas de 50 pacientes. Los datos de las variables cualitativas fueron descritos en tablas; para las variables cuantitativas fueron utilizados cálculos de las medidas estadísticas.

RESULTADOS:

el promedio de la puntuación del Nursing Activities Scorefue de 70,4% y la mediana de 70,3%, correspondiendo al porcentaje de tiempo utilizado en la asistencia directa al paciente en 24 horas.

CONCLUSIÓN:

el Nursing Activities Score provee informaciones que participan del proceso de cuidar de pacientes internados en una Unidad de Terapia Intensiva de Quemados y apuntó que existe una elevada carga de trabajo para el equipo de enfermería del sector estudiado.

Carga de Trabajo; Enfermería; Unidad de Cuidados Intensivos; Unidades de Quemados


Introduction

In order to care for and treat people who have suffered burns from a wide variety of causes, with lesions differing in location, extent and depth, one needs a multiprofessional team and an appropriate place, such as a Center for Burns Treatment, which also includes the Burns Intensive Care Unit (ICU)( 11. Jong AEE, Leeman J, Middelkoop E. Development of nursing work load measurement instrument in burn care. Burns, Guildford. 2009;35(7): 942-8. ).

The Burns ICU is considered a complex unit which brings together human resources and expensive specialized technological apparatus. It is necessary to have professionals available for this sector both qualitatively and quantitatively, due to the care required for the hospitalized patients. Because these are nursing professionals who care for the patients uninterruptedly over 24 hours, it is fundamental to assess their work load.

This evaluation is a way of making available a fair and efficient dimensioning of the human resources, affording the institutions planning which aims for benefits for all those involved, in particular the patients( 22. Panunto MR, Guirarello EB. Carga de trabalho de enfermagem em Unidade de Terapia Intensiva de um hospital de ensino. Acta Paul Enferm. 2012; 25(1):96-101. ).

The expression 'work load' is used as a method for calculating the workforce, that is, it is used regarding the demands of the labor and the analysis of the content of the different work activities( 33. Trindade LL, Coelho A, Pires de Pires S, ED. Revisão da produção teórica latino-americana sobre cargas de trabalho. Enferm Global. 2013;29:373-82. ).

The provision of nursing staff appropriate to the standard of attendance aimed for contributes to quality care for the patients, and, as a consequence, reduction of the burden which can be present in the work, making it less stressful and safer for professionals, institutions, and patients.

Indicators of the care demands are essential as requirements to ensure quality of care and support the quantification of the personnel in the different hospital units, principally in ICU, due to there being a heavier workload because of the characteristics inherent to the patients found there( 44. Queijo AF, Padilha KG. Nursing Activities Score (NAS): adaptação transcultural e validação para a língua portuguesa. Rev Esc Enferm USP. 2009; 43(Esp):1018-25. ).

Instruments have been created with the aim of quantifying the nursing work load and, consequently, contributing to the appropriate dimensioning of staff for assisting the patients. Among these, the Nursing Activities Score (NAS) stands out( 55. Miranda DR, Nap R, de Rijk A, Schaufeli W, Iapichino G. Nursing activities score. Crit Care Med. 2003; 31(2):374-82. ).

The NAS is a valuable tool for measuring work load, and can contribute to the appropriate dimensioning of nursing workers in ICU. Its use as a tool in ICU, however, has not been publicized in the literature( 22. Panunto MR, Guirarello EB. Carga de trabalho de enfermagem em Unidade de Terapia Intensiva de um hospital de ensino. Acta Paul Enferm. 2012; 25(1):96-101. ). In addition to this, the literature has indicated that the risks related to the insufficient number of nursing professionals, due to the different practice locations and groups of workers who undertake the care, these being the central elements which must be investigated in each specific situation( 66. Harless DW, Mark BA. Nurse staffing and quality of care with direct measurement of inpatient staffing. Med Care. 2010 Jul;48(7):659-63. ).

As a result, the implementation of a system for measuring and evaluating work load has been indicated as important for planning the number of nursing professionals( 77. Canadian Nurses Association. Measuring nurses' workload. Nursing Now: Issues and trends in Canadian Nurs. [Internet]. 2003; [acesso 13 jun 2013];15(1). Disponível em: http://www2.cna-aiic.ca/CNA/documents/pdf/publications/NN_NursesWorkloadmarch2003_e.pdf
Disponível em: http://www2.cna-aiic.ca/C...
). Thus, investigating the indicators of nursing work load allows managers to apply methods for dimensioning the professionals, with the aim of ensuring quality and the safety of the care, the workers, and the health institutions( 88. Rossetti AC, Gaidzinski RR, Fugulin FMT. Nursing workload in the emergency department: a methodological proposal. Rev. Latino-Am. Enfermagem. 2013;21(spe):225-32. ).

In the light of the above, it was proposed to apply the NAS in the Burns ICU of a public teaching hospital, with the objective of evaluating this unit's nursing work load. This study could contribute to managers' being able to plan human resources in appropriate numbers, as well as the quality of care given in the Burns ICU.

Method

This is an exploratory, descriptive and cross-sectional study, with a quantitative approach, undertaken in a six-bed Burns ICU in a teaching hospital in the north of the Brazilian state of Paraná (PR). The researchers consulted the hospital records of 50 patients admitted consecutively to the Burns ICU in the period between October 4th 2011 and 30th May 2012, aged 18 years old or over, and who remained hospitalized there for a minimum period of 24 hours. Re-admissions were excluded.

The period extending from seven o'clock in the morning of one day to seven o'clock in the morning of the next day was considered as 24 hours. In the event of hospitalization, data was collected from the time of admission until seven o'clock in the morning, regardless of whether 24 hours was completed. On the day of discharge or death, data was collected from seven o'clock in the morning until when the patient left the sector, irrespective of whether 24 hours was completed.

A two-part instrument was used for data collection. The first part collected data such as: age, sex, outcome (discharge from ICU or death) and the length of hospitalization in days; in the second, the NAS instrument was applied for 241 consecutive days in the six beds of the Burns ICU, totalling 1,221 measurements obtained from the hospital records of 50 patients hospitalized in this sector.

The NAS was translated to Portuguese and validated in that language in 2002, and provides data on activities undertaken by the nursing team by shift( 44. Queijo AF, Padilha KG. Nursing Activities Score (NAS): adaptação transcultural e validação para a língua portuguesa. Rev Esc Enferm USP. 2009; 43(Esp):1018-25. ) and is considered able to accurately assess the nursing work load in Adult ICU( 55. Miranda DR, Nap R, de Rijk A, Schaufeli W, Iapichino G. Nursing activities score. Crit Care Med. 2003; 31(2):374-82. ). This instrument is made up of seven major categories of care: basic activities; ventilatory, cardiovascular, renal, neurological and metabolic support; and specific interventions. It also came to cover monitoring and control, hygiene procedures, mobilization and positioning of the patient, support and care for patients and their family members, and administrative and managerial tasks. It is made up of 23 items with 32 nursing activities( 99. Ducci AJ, Padilha KG. Nursing activities score: estudo comparativo da aplicação retrospectiva e prospectiva em unidade de terapia intensiva. Acta Paul Enferm. [Internet]. 2008 [acesso 10 jan 2013];21(4):581-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002008000400008&lng=en. http://dx.doi.org/10.1590/S0103-21002008000400008
Disponível em: http://www.scielo.br/scie...
). Each activity has a score which corresponds to the percentage of the time spent on direct care undertaken in the 24-hour period. The total score can reach, at the most, 176.8% per patient. The total score results from the sum of the score of each item and allows one to calculate the amount of time spent with the nursing activities in the care for the patient( 55. Miranda DR, Nap R, de Rijk A, Schaufeli W, Iapichino G. Nursing activities score. Crit Care Med. 2003; 31(2):374-82. ).

The statistical procedures were carried out using descriptive analysis, that is, for the qualitative variables the data was described in tables; while for the quantitative data, calculation of the statistical measurements was used. The data was organized and stored in Excel 2007 electronic spreadsheets. The Statistical Package for the Social Sciences (SPSS)(r) program, version 19.0, was used for analyzing the data.

The study was approved by the Research Ethics Committee of the State University of Londrina (UEL), under decision n. 214/2011 and the Certificate of Presentation for Ethical Consideration (CAAE) 0187.0.268.000-11 was issued.

It is emphasized that for undertaking this study, the "Terms of Confidentiality" were filled out and signed, in which the researchers accepted the commitment to maintain confidentiality regarding all the information, technical and otherwise, related to the research project, including respecting confidentiality and identity.

Results

There was a predominance of male patients (74%); age varied between 18 and 76 years old (mean of 41 years old). Regarding the depth of the burn, it was identified that 70% of the patients had third-degree burns; the length of hospitalization varied from 2 to 97 days (mean of 24 days); and the patients' discharges (74%) outweigh the deaths (26%).

In relation to the nursing work load, resulting from the application of the NAS, the mean found was 70.4%, with a minimum value of 52.5%, maximum of 97%, and median of 70.3%. Knowing that each point on the NAS corresponds to 14.4 minutes, it was ascertained that the patients in the aforesaid study needed a mean of 16.9 hours of nursing care in the 24 hour period (minimum=12.6 hours and maximum=23.2 hours). This data allows one to suggest that there is a high work load for the nursing team of the Burns ICU.

The frequency with which the activities described in the NAS instrument were recorded is demonstrated in Table 1. It was identified that 100% of the patients were scored for in the following items: Item 2 - laboratory investigations; and Item 3 - medication, apart from vasoactive drugs.

Table 1
Distribution of the therapeutic nursing interventions according to the Nursing Activities Score. Londrina, PR, Brazil, 2011-2012

The scores with percentages above 50% corresponded to nursing interventions related to Item 17 - quantitative measurement of the urinary output (99.6%); Item 11 - treatment for improvement of pulmonary function (97.2%); Sub-item 8.a - routine tasks (91.8%); Item 21 - enteral feeding (87.7%); Item 9 - respiratory support (83.6%); Item 5 - care for drains (74.6%); Sub-item 7.a - Support and care for the family and patient for one hour (71%); Sub-item 6.b - undertaking of mobilization and positioning more than three times in 24 hours or with two nurses in any frequency (69%); Item 10 - care with artificial airways, orotracheal tubes (OTT) or tracheostomy (68.7%); Sub-item 1.b - presence at the bedside for two hours or more (68.3%); Sub-item 4.a - hygiene procedures (51.4%).

Discussion

The predominance of male burns patients was noted, which was also ascertained in a study which analyzed the epidemiological profile of patients hospitalized in a BTU (Burns Treatment Unit) in the city of Belo Horizonte, which found that 62.5% of the patients were male( 1010. Leão CEG, Andrade ES, Fabrini DS, Oliveira RA, Machado GLB, Gontijo LC. Epidemiologia das queimaduras no estado de Minas Gerais. Rev Bras Cir Plást. 2011;26(4):573-7. ).

Data similar to that of the present investigation was found in a study undertaken in the BTU of the Federal University of São Paulo (UNIFESP), in which the mean age was 33.7 years old( 1111. Lacerda LA, Carneiro AC, Oliveira AF, Gragnani A, Ferreira LM. Estudo epidemiológico da Unidade de Tratamento de Queimaduras da Universidade Federal de São Paulo. Rev Bras Queimaduras. 2010;9(3):82-8. ).

A study carried out in a BTU in Brasília, in which the mean length of hospitalization was 27 days( 1212. Lima LS, Araújo MAR, Cavendish TA, Assis EM, Aguiar G. Perfil epidemiológico e antropométrico de pacientes internados em uma unidade de tratamento de queimados em Brasília, Distrito Federal. Com Ciênc Saúde. 2010;21(4):301-8. ), was similar to the data found in the present investigation. It is inferred that the length of hospitalization may be related to the seriousness of the burn, as well as the body surface burnt.

Discharge from the Burns ICU was greater than deaths, and may be directly related to the seriousness of the patients' condition, as well as to the care given; however, the number of deaths which occurred is considered high. A rate considered high was also found in a study of a German BTU in which the death rate was 15%( 1313. Theodorou P, Xu W, Weinand C, Perbix W, Maegele M, Lefering R, et al. Incidence and treatment of burns: A twenty-year experience from a single center in Germany. Burns. 2013;39:49-54. ).

It is also suggested that the high rate of mortality found in this study may be related to the fact that a large number of the patients admitted to the Burns ICU unit of the HUL (Londrina University Hospital) originated from towns in the rural interior of the state of Paraná and had suffered the burn some days previously, thus contributing to the delay in initiating the specific therapy, which can have serious consequences and complications for the success of the treatment.

It is emphasized that appropriate volemic resuscitation initiated straight after the accident, represents an important gain in the survival of patients with large burns( 1414. Cunha NT. Complicações das queimaduras In: Maciel E, Serra MC. Tratado de queimaduras. São Paulo: Atheneu; 2006. p. 81-90. ). Age, and the extent and depth of the body surface burnt, are variables which can influence, to varying degrees, the occurrence of death( 1515. Rosa DMC. Epidemiologia, lesão inalatória e biomarcadores: relação com prognóstico de adultos queimados internados em uma unidade de referência. [tese de doutorado]. Botucatu (SP): Faculdade de Medicina de Botucatu da Universidade Estadual Júlio de Mesquita Filho; 2009. 153 p. ). It is therefore probable that these variables may have contributed to the high rate of mortality observed in the present study.

The activities evaluated by the NAS instrument in this study showed a high mean work load in the Burns ICU, which may suggest burden for this sector's nursing team, that is, an insufficient number of professionals. This data indicates a high demand for nursing care, demonstrating that to provide care within what is considered the ideal, it would be necessary to have one nursing professional to attend, comprehensively, only one patient per work period.

Thus, the importance is shown of the dimensioning of the nursing team, as the human resources, in quantity and quality, are essential for caring comprehensively for the patient and his or her family members, as well as for promoting appropriate conditions for the work of the nursing team, improving their quality of life and affording safety to the institution( 1616. Panunto MR, Guirarello EB. Carga de trabalho de enfermagem em Unidade de Terapia Intensiva de um hospital de ensino. Acta Paul Enferm. 2012; 25(1):96-101. ).

This high mean was shown to be higher than that of the study undertaken in a general ICU in a medium-size* University Hospital in São Paulo, in which the mean of the NAS was 66.5% and remained above 50% throughout the period of hospitalization in that unit( 1717. Gonçalves LA, Garcia PC, Toffoleto MC, Telles SCR, Padilha KG. Necessidades de cuidados de enfermagem em Terapia Intensiva: evolução diária dos pacientes segundo o Nursing Activities Score (NAS). Rev Bras Enferm. 2006;59(1):56-60. ).

In another investigation carried out in a general adult ICU in a private hospital, also in the city of São Paulo, the data was similar to the present study's findings, in observing that the mean of the 24-hour NAS was 69.6%( 1818. Conishi RMY, Gaidzinski RR. Nursing Activities Score (NAS) como instrumento para medir carga de trabalho de enfermagem em UTI adulto. Rev Esc Enferm USP. 2007;41(3):346-54. ). Also in the city of São Paulo, another study showed a mean NAS equal to 69.9%, in five ICUs in two private hospitals, a result which is similar to that found in the present investigation( 1919. Gonçalves LA, Padilha KG. Fatores associados à carga de trabalho de enfermagem em Unidade de Terapia Intensiva. Rev Esc Enferm USP. 2007;41(4):645-52. ). In a post-operative cardiac surgery ICU in another Sao Paulo hospital, a mean of 73.7% for the NAS was found( 2020. Ducci AJ, Zanei SSV, Whitaker IY. Carga de trabalho de enfermagem para quantificar proporção profissional de enfermagem/paciente em UTI cardiológica. Rev Esc Enferm USP. 2008;42(4):673-80. ).

However, a study which analyzed adult patients hospitalized in ICUs in two public hospitals and two private hospitals in the city of São Paulo identified mean nursing work load on admission equal to 61.9% and 52.8% on the last day of hospitalization - data which is below the present investigation's results( 2121. Silva MCM, Souza RMC, Padilha KG. Factors associated with death and readmission into the Intensive Care Unit. Rev. Latino-Am. Enfermagem. 2011; 19(4):911-9. ). Another study on nursing work load in an Adult ICU in the interior of the state of São Paulo identified a mean NAS equal to 62.2%, that is, below what was identified in the present investigation( 1616. Panunto MR, Guirarello EB. Carga de trabalho de enfermagem em Unidade de Terapia Intensiva de um hospital de ensino. Acta Paul Enferm. 2012; 25(1):96-101. ).

A study undertaken in Spain in a cardiology ICU identified a mean NAS of 41%, this data being lower than that of the present study, as well as lower than the values found in studies undertaken in Brazil in this type of unit( 2222. Adell AB, Campos RA, Cubedo RM, Quintana BJ, Sanahuja RE, Sanchís MJ, et al. Nursing Activities Score (NAS). Our experience with a nursing load calculation system based on times. Enferm Intens. 2005; 16(4):164-73. ). Yet another investigation, this one carried out in a cardiology and neurology ICU in a tertiary São Paulo hospital, found a mean NAS equal to 65.18%( 2323. Queijo AF, Martins RS, Andolhe R, Oliveira EM, Barbosa RL, Padilha KG. Nursing workload in neurological intensive care units: cross-sectional study. Intensive Crit Care Nurs. 2013;29(2):112-6. ).

Of the studies found on the NAS in ICU undertaken in Brazil, only two identified means higher than those of the present investigation; one undertaken in the north-west of the state of Paraná (mean for the NAS of 104%)( 2424. Inoue KC, Kuroda CM, Matsuda LM. Nursing activities score (NAS): Carga de trabalho de enfermagem em UTI e fatores associados. Ciênc Cuidado Saúde. 2011;10(1):134-40. ) and the other carried out in a surgical cardiology ICU in a public teaching hospital in the city of Sao Paulo (daily mean of 74.6%)( 2525. Dias MCCB. Aplicação do Nursing Activities Score - N.A.S.: como instrumento de medida de carga de trabalho de enfermagem em UTI Cirúrgica Cardiológica. [dissertação de mestrado]. São Paulo: Escola de Enfermagem da Universidade de São Paulo; 2006. 115 p. ).

Conclusion

With the results found, it can be asserted that the NAS instrument was able to provide information concerning the process of caring for patients hospitalized in a Burns ICU, and by applying it, it was identified that there is a high work load, that is, burden for the nursing team of the unit studied.

Although this investigation's results contribute to the advance of knowledge and have achieved the objective proposed, it is important to consider - as limitations of the study - that it was undertaken in only one Burns ICU (not permitting the generalization of the findings), the inexistence of Brazilian studies using the NAS in burns patients hospitalized in ICU, the small sample, and the non-correlation of work load with the variables of age and the patient's clinical conditions, among others.

Thus, it is suggested that further studies in this line be undertaken, with the same characteristics of the population studied, or in multi-centric studies, with the aim of showing the institutions that through the systematized application of the NAS, it is possible to use it as an indicator for work load and, consequently, for assisting in the appropriate dimensioning of the nursing team for the assistance for the patient.

References

  • 1
    Jong AEE, Leeman J, Middelkoop E. Development of nursing work load measurement instrument in burn care. Burns, Guildford. 2009;35(7): 942-8.
  • 2
    Panunto MR, Guirarello EB. Carga de trabalho de enfermagem em Unidade de Terapia Intensiva de um hospital de ensino. Acta Paul Enferm. 2012; 25(1):96-101.
  • 3
    Trindade LL, Coelho A, Pires de Pires S, ED. Revisão da produção teórica latino-americana sobre cargas de trabalho. Enferm Global. 2013;29:373-82.
  • 4
    Queijo AF, Padilha KG. Nursing Activities Score (NAS): adaptação transcultural e validação para a língua portuguesa. Rev Esc Enferm USP. 2009; 43(Esp):1018-25.
  • 5
    Miranda DR, Nap R, de Rijk A, Schaufeli W, Iapichino G. Nursing activities score. Crit Care Med. 2003; 31(2):374-82.
  • 6
    Harless DW, Mark BA. Nurse staffing and quality of care with direct measurement of inpatient staffing. Med Care. 2010 Jul;48(7):659-63.
  • 7
    Canadian Nurses Association. Measuring nurses' workload. Nursing Now: Issues and trends in Canadian Nurs. [Internet]. 2003; [acesso 13 jun 2013];15(1). Disponível em: http://www2.cna-aiic.ca/CNA/documents/pdf/publications/NN_NursesWorkloadmarch2003_e.pdf
    » Disponível em: http://www2.cna-aiic.ca/CNA/documents/pdf/publications/NN_NursesWorkloadmarch2003_e.pdf
  • 8
    Rossetti AC, Gaidzinski RR, Fugulin FMT. Nursing workload in the emergency department: a methodological proposal. Rev. Latino-Am. Enfermagem. 2013;21(spe):225-32.
  • 9
    Ducci AJ, Padilha KG. Nursing activities score: estudo comparativo da aplicação retrospectiva e prospectiva em unidade de terapia intensiva. Acta Paul Enferm. [Internet]. 2008 [acesso 10 jan 2013];21(4):581-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002008000400008&lng=en. http://dx.doi.org/10.1590/S0103-21002008000400008
    » Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002008000400008&lng=en. http://dx.doi.org/10.1590/S0103-21002008000400008
  • 10
    Leão CEG, Andrade ES, Fabrini DS, Oliveira RA, Machado GLB, Gontijo LC. Epidemiologia das queimaduras no estado de Minas Gerais. Rev Bras Cir Plást. 2011;26(4):573-7.
  • 11
    Lacerda LA, Carneiro AC, Oliveira AF, Gragnani A, Ferreira LM. Estudo epidemiológico da Unidade de Tratamento de Queimaduras da Universidade Federal de São Paulo. Rev Bras Queimaduras. 2010;9(3):82-8.
  • 12
    Lima LS, Araújo MAR, Cavendish TA, Assis EM, Aguiar G. Perfil epidemiológico e antropométrico de pacientes internados em uma unidade de tratamento de queimados em Brasília, Distrito Federal. Com Ciênc Saúde. 2010;21(4):301-8.
  • 13
    Theodorou P, Xu W, Weinand C, Perbix W, Maegele M, Lefering R, et al. Incidence and treatment of burns: A twenty-year experience from a single center in Germany. Burns. 2013;39:49-54.
  • 14
    Cunha NT. Complicações das queimaduras In: Maciel E, Serra MC. Tratado de queimaduras. São Paulo: Atheneu; 2006. p. 81-90.
  • 15
    Rosa DMC. Epidemiologia, lesão inalatória e biomarcadores: relação com prognóstico de adultos queimados internados em uma unidade de referência. [tese de doutorado]. Botucatu (SP): Faculdade de Medicina de Botucatu da Universidade Estadual Júlio de Mesquita Filho; 2009. 153 p.
  • 16
    Panunto MR, Guirarello EB. Carga de trabalho de enfermagem em Unidade de Terapia Intensiva de um hospital de ensino. Acta Paul Enferm. 2012; 25(1):96-101.
  • 17
    Gonçalves LA, Garcia PC, Toffoleto MC, Telles SCR, Padilha KG. Necessidades de cuidados de enfermagem em Terapia Intensiva: evolução diária dos pacientes segundo o Nursing Activities Score (NAS). Rev Bras Enferm. 2006;59(1):56-60.
  • 18
    Conishi RMY, Gaidzinski RR. Nursing Activities Score (NAS) como instrumento para medir carga de trabalho de enfermagem em UTI adulto. Rev Esc Enferm USP. 2007;41(3):346-54.
  • 19
    Gonçalves LA, Padilha KG. Fatores associados à carga de trabalho de enfermagem em Unidade de Terapia Intensiva. Rev Esc Enferm USP. 2007;41(4):645-52.
  • 20
    Ducci AJ, Zanei SSV, Whitaker IY. Carga de trabalho de enfermagem para quantificar proporção profissional de enfermagem/paciente em UTI cardiológica. Rev Esc Enferm USP. 2008;42(4):673-80.
  • 21
    Silva MCM, Souza RMC, Padilha KG. Factors associated with death and readmission into the Intensive Care Unit. Rev. Latino-Am. Enfermagem. 2011; 19(4):911-9.
  • 22
    Adell AB, Campos RA, Cubedo RM, Quintana BJ, Sanahuja RE, Sanchís MJ, et al. Nursing Activities Score (NAS). Our experience with a nursing load calculation system based on times. Enferm Intens. 2005; 16(4):164-73.
  • 23
    Queijo AF, Martins RS, Andolhe R, Oliveira EM, Barbosa RL, Padilha KG. Nursing workload in neurological intensive care units: cross-sectional study. Intensive Crit Care Nurs. 2013;29(2):112-6.
  • 24
    Inoue KC, Kuroda CM, Matsuda LM. Nursing activities score (NAS): Carga de trabalho de enfermagem em UTI e fatores associados. Ciênc Cuidado Saúde. 2011;10(1):134-40.
  • 25
    Dias MCCB. Aplicação do Nursing Activities Score - N.A.S.: como instrumento de medida de carga de trabalho de enfermagem em UTI Cirúrgica Cardiológica. [dissertação de mestrado]. São Paulo: Escola de Enfermagem da Universidade de São Paulo; 2006. 115 p.

  • 1
    Paper extracted from master's thesis "The nursing workload in Intensive Care Unit of Burn Care Center according to Nursing Activities Score", presented to Universidade Estadual de Londrina, Londrina, PR, Brazil

Publication Dates

  • Publication in this collection
    Mar-Apr 2014

History

  • Received
    23 Mar 2013
  • Accepted
    30 Sept 2013
Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br