Carga de trabajo de enfermería y gravedad de los pacientes con COVID-19 en la Unidad de Cuidados Intensivos

Santos, Wesley Cajaiba; Lopes, Maria Carolina Barbosa Teixeira; Vancini-Campanharo, Cassia Regina; Boschetti, Daniela; Dias, Sirlei Oliveira da Silva; Castro, Meire Cristina Novelli e; Piacezzi, Luis Humberto Vieri; Batista, Ruth Ester Assayag

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Revista da Escola de Enfermagem da USP

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2024-0107en copiar

Carga de trabajo de enfermería y gravedad de los pacientes con COVID-19 en la Unidad de Cuidados Intensivos

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Evaluar la carga de trabajo y la gravedad de los pacientes de la Unidad de Cuidados Intensivos (UCI) con COVID-19.

Método:

Estudio transversal y analítico realizado en la UCI de un hospital privado. Se incluyeron todos los pacientes mayores de 18 años con diagnóstico de COVID-19 ingresados entre septiembre de 2020 y junio de 2021. Carga de trabajo evaluada mediante la Nursing Activities Score (NAS), y gravedad mediante la valoración secuencial de fallo orgánico. Se realizaron análisis descriptivos e inferenciales.

Resultados:

Se incluyeron 217 pacientes, en su mayoría hombres, edad media 62,41 años, raza blanca, obesos, no fumadores y sedentarios. El NAS medio era de 84,79. Los niveles de personal se ajustaban a la legislación y al NAS. El NAS no se asoció con la gravedad. La gravedad se asoció a mayor edad, sexo, comorbilidades, sedentarismo, tiempo de ventilación mecánica, hospitalización y muerte.

Conclusión:

La carga de trabajo fue elevada y no se asoció a la gravedad ni a los resultados. La gravedad se asoció a las condiciones demográficas y clínicas. Este estudio muestra la importancia del dimensionamiento del personal, con vistas a promover la seguridad y la calidad de los cuidados.

PALABRAS CLAVE
Enfermeros y enfermeras; Carga de trabajo; Gravedad del paciente; Unidad de Cuidados Intensivos; COVID-19

Sociodemographic variables	n(%)	Clinical variables	n(%)
Age		*Time in ICU^ Intensive Care Unit. (total/day)*
Mean (SD)	62.41 (±17.18)	Mean (SD)	16.25 (±15.86)
Median	63	Median	11
Minimum-Maximum	23–97	Minimum-Maximum	1–89
Sex		Sedentarism
Men	124 (57.1)	Yes	180 (82.9)
Women	93 (42.9)	No	37 (17.1)
Race		Time MV^ Mechanical Ventilation. (total/day)
White	171 (78.8)	Mean (SD)	8.99 (±14.14)
Brown	37 (17.1)	Median	1
Others	9 (4.1)	Minimum-Maximum	0–89
Marital Status		BMI classification^* *Body Mass Index.
Married	140 (64.5)	Slimness	1 (0.5)
Widowed	19 (8.8)	Normal	46 (21.2)
Single	21 (9.7)	Overweight	77 (35.5)
Separated	13 (6)	Obesity/Serious obesity	93 (42.8)
Others	24 (11.1)	Smoker
Occupation		Yes	8 (3.7%)
Employee	70 (32.3)	No	209 (96.3%)
Retired/pensioner	82 (37.8)	Outcome
Household	39 (18)	Discharge	139 (64.1)
		Deceased	78 (35.9)

NAS items (score)	Total (%)
1. Monitorization and controls
1 a. Vital signs, calculation and recording of water balance (4.5 points)	122 (3.4)
1 b. Presence at the bedside and continuous or active observation for 2 hours or more on any shift for reasons of safety, severity or therapy, such as: NIMV, weaning, agitation, mental confusion, prone position, preparation and administration of fluids or medicines and assistance with specific procedures. (12.1 Points).	2876 (81.1)
1 c. Presence at the bedside and continuous or active observation for 4 hours or more on any shift due to safety, severity or therapy. (19.6 Points)	549 (15.5)
2. Lab tests: Biochemistry and microbiology. (0 and 4.3 Points)
Present	3530 (99.5)
Absent	17 (0.5)
3. Medication, excepted vasoactive drugs (0 and 5.6 Points)
Present	3534 (99.6)
Absent	13 (0.4)
4. Hygiene procedures
4 a. Normal (4.1 Points)	1680 (47.4)
4 b. Carrying out hygiene procedures lasting more than 2 hours in any shift (16.5 Points)	1728 (48.7)
4 c. Carrying out hygiene procedures lasting more than 4 hours in any one shift. (20 Points)	139 (3.9)
5. Care of drains. All except gastric tube (0 and 1.8 points)
Present	402 (11.3)
Absent	3145 (88.7)
6. Mobilization and positioning
6 a. Performing the procedure(s) up to three times in 24 hours. (5.5 Points)	362 (10.2)
6 b. Performing the procedure(s) more than three times in 24 hours or with 2 nurses at any frequency. (12.4 Points)	2877 (81.1)
6 c. Performing the procedure(s) with 3 or more nurses at any frequency. (17.0 Points)	308 (8.7)
7. Support and care for relatives and patients
7 a. Support and care for family members and patients who require exclusive dedication for around 1 hour on any shift, such as: explaining medical conditions, dealing with difficult family circumstances. (4.0 Points)	3458 (97.5)
7 b. Support and care for family members and patients who require exclusive dedication for 3 hours or more on any shift, such as: death, special circumstances (e.g. large numbers of family members, language problems and hostile families). (32.0 Points).	89 (2.5)
8. Administrative and managerial tasks
8 a. Carrying out routine tasks such as: clinical data procedures, requesting examinations and exchanging professional information (e.g. on call and clinical visits). (4.2 Points)	2742 (77.3)
8 b. Carrying out administrative and managerial tasks that require full dedication for around 2 hours on any given shift, such as: research activities, application of protocols, admission and discharge procedures. (23.2 Points)	799 (22.5)
8 c. Carrying out administrative and managerial tasks that require full dedication for around 4 hours or more on any given shift, such as: death and organ donation procedures, coordinated with other disciplines. (30.0 Points)	6 (0.2)
9. Respiratory support (0 and 1.4 points)
Present	3213 (90.6)
Absent	334 (9.4)
10. Care of artificial airways (0 and 1.8 points)
Present	2083 (58.7)
Absent	1464 (41.3)
11. Treatment to improve pulmonary function (0 and 4.4 points)
Present	3291 (92.8)
Absent	256 (7.2)
12. Vasoactive drugs (0 and 1.2 points)
Present	1491 (42)
Absent	2056 (58)
13. Intravenous replacement of major fluid losses (0 and 2.5 points)
Present	1242 (35)
Absent	2305 (65)
14. Left atrium monitoring. Pulmonary artery catheter with or without cardiac output measurements. (0 and 1.7 Points)
Present	18 (0.5)
Absent	3529 (99.5)
15. Cardiopulmonary resuscitation in the last 24 hours. Excludes precordial thump. (0 and 1.7 Points)
Present	11 (0.3)
Absent	3536 (99.7)
16. Hemofiltration techniques. Dialysis techniques (0 and 7.7 points)
Present	726 (20.5)
Absent	2821 (79.5)
17. Quantitative measurement of urine output (0 and 7.0 points)
Present	3194 (90)
Absent	353 (10)
18. Intracranial pressure measurements (0 and 1.6 points)
Present	18 (0.5)
Absent	3529 (99.5)
19. Treatment of metabolic acidosis/alkalosis. (0 and 1.3 Points)
Present	988 (27.9)
Absent	2559 (72.1)
20. Total Parenteral Nutrition (0 and 2.8 points)
Present	89 (2.5)
Absent	3458 (97.5)
21. Enteral feeding by gastric tube or other gastrointestinal route (0 and 1.3 points)
Present	2145 (60.5)
Absent	1402 (39.5)
22. Specific intervention(s) in the Intensive Care Unit.
Present	3213 (90.6)
Absent	334 (9.4)
23. Specific interventions outside the Intensive Care Unit (0 and 1.9 points)
Present	514 (14.5)
Absent	3033 (85.5)

		SOFA	Age	Mechanical ventilation time	Time in ICU^ Intensive Care Unit.
NAS	p-value	0.6415	0.4524	0.7067	0.9784^* *Spearman’s Correlation Coefficient.
SOFA	p-value	-	0.0007	0.0001	0.0001

Variables	Sequential organ failure Assessment				p-value
Variables	N	Mean (SD)	Median	Minimum-maximum	p-value
Sex
Men	124	3.15 (2.37)	3	0–17	0.0141^* *Mann-Whitney test.
Women	93	2.46 (1.99)	2	0–11
Body Mass Index
Slimness/Normal	47	3.3 (3.3)	3	0–17	0.9562^ Kruskal-Wallis test.
Overweight	77	2.74 (1.86)	3	0–9
Obesity/Serious Obesity	93	2.72 (1.81)	3	0–10
Race
White	171	2.96 (2.29)	3	0–17	0.1384^* *Mann-Whitney test.
Non-white	46	2.43 (2)	2	0–9
Smoker
Yes	8	3.13 (1.55)	3.5	0–5	0.3324^* *Mann-Whitney test.
No	209	2.84 (2.26)	3	0–17
Sedentarism
Yes	180	3.02 (2.05)	3	0–13	0.0002^* *Mann-Whitney test.
No	37	2.03 (2.86)	2	0–17
Comorbidities
None	41	3.02 (2.91)	2	0–17	0.0529^ Kruskal-Wallis test.
1–2	101	2.45 (1.69)	2	0–9
3–4	54	3.22 (2.15)	3	0–11
5 or more	21	3.52 (2.94)	4	0–13
Outcome
Discharge	139	2.32 (2.03)	2	0–17	<0.0001^* *Mann-Whitney test.
Decease	78	3.81 (2.27)	3	0–13

	Outcomes		p-value
	Discharge n (%)	Decease n (%)	p-value
Age
Mean (±SD)	58.27 (±17.17)	69.77 (±14.61)	<0.0001^* *Mann-Whitney test.
Median	60	73.5
Minimum-Maximum	23–92	24–97
Body Mass Index
Slimness/Normal	32 (68.1)	15 (31.9)	0.7246^ Chi-square test.
Overweight	47 (61)	30 (39)
Obesity/Serious Obesity	60 (64.5)	33 (35.5)
Smoker
Yes	4 (50)	4 (50)	0.4622^* *Fisher’s exact test.
No	135 (64.6)	74 (35.4)
Comorbidities
None	32 (78)	9 (22)	0.0421^ Chi-square test.
1–2	66 (65.3)	35 (34.7)
3–4	32 (59.3)	22 (40.7)
5 or more	9 (42.9)	12 (57.1)

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: Ruth Ester Assayag Batista, Rua Napoleão de Barros, 754, Vila Clementino, 04024-002 – São Paulo, SP, Brazil, ruth.ester@unifesp.br