Title : Study of workload, professional qualification in nursing and occurrence of health incidents
Abstract:
Studies have confirmed that work conditions are important factors for the quality of nursing care, patient safety and the satisfaction of the professional. Among the nursing action fields is the intensive treatment in pediatrics and neonatology, population that, because of its vulnerable condition, is more exposed to incidents and adverse events. This research investigated whether there is an association between the work conditions of intensivist nursing and the occurrence of adverse events in patients hospitalized in a neopediatric Intensive Care Unit. This is an evaluative, descriptive and documentary research, with a cross-sectional, analytical design, carried out in the Neonatal and Pediatric Intensive Care Units of the State Health Department of Paraná hospitals. The participants were organized in Group I, composed of nurses and nursing technicians (n = 143) and Group II, divided into two subgroups. Subgroup I, patients hospitalized for more than 24 hours, in the week of data collection (80); and Subgroup II: medical records of patients who were discharged, transferred or died during the month of the collection (n = 79). For the evaluation of predictive variables, related to the qualification, workload, personnel size and working environment, the following instruments were applied: sociodemographic questionnaire, Nursing Activities Score and Brazilian Nursing Work Index-Revised. For the identification of the adverse events, considered as outcome variable, patients' medical records were consulted, and the Global Trigger Tool methodology was applied, using the tools provided by the National Health Service. The data were collected between April 2017 and January 2018 on seven consecutive days in each unit. The confirmation of adverse events was performed by a pediatrician with experience in incident analysis. For the analysis, the results of quantitative variables were described by mean, maximum, minimum and standard deviation. The Student's t-test was considered in the analysis workload and sizing. The analysis of the association among the variables was performed by calculating the Chances Ratio, by logistic regression. The results showed that the team seeks qualification, since 21% of nursing technicians have graduation degree, 61% of them in nursing, and 76.4% of nurses have post-graduation degree, with 80.1%, specialists in intensive care. 53.1% of the participants consider the professional qualification for intensive care unit action as the most important factor to avoid incidents and adverse events. The workload measured in the units varied between 55.7% and 93.9%, converted into hours resulted between 13.38 and 22.53, respectively. The sizing showed oscillations when compared to the parameters of the current legislation, but with the exception of the neonatal unit of hospital A, where all work scales exceeded the quantitative stipulated by the Nursing Activities Score application. The environment was considered favorable by four of the six units surveyed. From the 79 medical records analyzed, 32 (40.5%) presented a total of 85 triggers. Thirty adverse events were confirmed in 22 patients (27.5%), with an average of 1.36 AE / patient and a prevalence of 38%. Infection was the most prevalent AE, totalizing 12 cases (40%), followed by skin lesion; 28 (93.3%) adverse events were categorized as temporary damage. The analysis found no association between workload, sizing, environment and qualification with adverse events. However, the daytime work period, female professionals and the existence of Continuing Education Service in the institution were considered protective factors. It was concluded that there was no association between the working conditions and the occurrence of adverse events. The hospitals with exclusive care by the Unified Health System, show efforts to keep staff in appropriate numbers and encourage training and professional qualification.
