Associações entre carga de trabalho de enfermagem e ocorrência de úlcera por pressão em pacientes internados em unidade de terapia intensiva

Abstract

Pressure Ulcer (PU) is a health problem well known to health care professionals. In the context of the Intensive Care Unit (ICU). the role of the nursing crew in the prevention and treatment of this condition is paramount. Excess workload may be one of the causes of PU cases in ICU, especially when the nursing team is not adequately dimensioned to cope with the demand. This work develops an analytical observational cohort study with the objective of understanding the relationship between nursing workload and the occurrence of pressure ulcers in patients of ICUs. This research was developed in the ICU of a major hospital in Belo Horizonte, Minas Gerais, Brazil. Data concerning 66 patients was collected from August to November 2011. We used the Nursing Activities Score (NAS) to measure the number of care hours required for the patients and the Braden scale to assess the risk of PU development. The patients were observed until release, death. transfer from the ICU or PU occurrence. The data was obtained through daily analysis of patient sheets, daily visits and interviews with the nurses. We performed descriptive and inferential statistical analysis of the data using the R software package version 2.13.0. We used a Generalized Estimation Equation (GEE) with a fixed working correlation matrix. the Forward-backward algorithm and Spearmans test. Elders represented the majority of the patients (60.6%) with 66.7% developing PU with Odds Ratio (OR) = 1.04 (p=0.057). Males represented 54.5% of the patients and 77.8% of the PU occurrences. Women were less prone to developing PU with an OR = 0.19 (p=O.O17). The 14 patients who died during the period represented 44% of the PU cases with OR=3,53 (p=O.O29). Elevation of the Braden score reduced the probability of PU development (p=O.002). Using multivariate regression analysis, we show that for each 10 point increase in the Braden score. the probability of PU development increased 1.07 tirnes (p=0.009) which represents a strong evidence of the correlation of nursing workload with PU development in ICU patients.