Do frail elderly people affect the nursing workload in intensive care units?

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

doi:10.1590/1980-220X-REEUSP-2021-0599en

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

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

Do frail elderly people affect the nursing workload in intensive care units?^* * Extracted from the master’s dissertation: Idosos frágeis em unidades de terapia intensiva: prevalência, caracterização e carga de trabalho de enfermagem (Frail elderly people in intensive care units: Prevalence, characterization and nursing workload), Universidade Federal de São Paulo, 2021.

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Compare the nursing workload according to the condition of frailty in elderly people in an intensive care unit (ICU).

Method:

A cross-sectional study whose sample included patients aged ≥60 years who were hospitalized for ≥24 hours in the ICU of a university hospital in São Paulo, Brazil. The Tilburg Frailty Indicator (TFI) was used to identify frailty in elderly people and the Nursing Activities Score (NAS) was used to measure the nursing workload.

Results:

In a sample of 204 elderly people, frailty was found in 156 (76.5%). The elderly people contributed to high nursing workload (mean NAS 75.9) on the first day in the ICU, but frailty did not significantly change the NAS (p = 0.606) (frail 75.7 versus non-frail 76.5), either based on the mean value or the proportion of patients in each category.

Conclusion:

The condition of frailty in elderly people did not increase the nursing workload in the ICU.

DESCRIPTORS
Frail Elderly; Nursing; Workload; Critical Care; Intensive Care Units

	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

Acompanhe os números deste periódico no seu leitor de RSS

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