THESIS (D.N.P. (Doctor of Nursing Practice))--School of Nursing, University of San Francisco, 2009. / Bibliography: leaves 22-26.

Objetivo: Analisar a associação entre variáveis biossociais e clínicas dos pacientes, variáveis biossociais e do trabalho da equipe de enfermagem, ambiente das práticas profissionais de enfermagem e satisfação profissional e eventos adversos (EA) moderado/grave nas Unidades de Terapia Intensiva (UTI). Método: Investigação observacional com delineamento misto: coorte histórica para a coleta de dados dos EA e Incidentes (I) e dos pacientes e transversal para a coleta de dados da equipe de enfermagem, Nursing Work Index- Revised (NWI-R) e Índice de Satisfação Profissional (ISP). O estudo foi realizado em 8 UTI do Instituto Central do Hospital das Clínicas, entre 03 de setembro e 01 de dezembro de 2012. As fontes de informações para a extração dos dados foram: prontuários dos pacientes, sistema informatizado institucional, instrumentos impressos e passagens de plantão. No tratamento estatístico utilizaram-se os testes t Student e Mann Whitney, além da correlação Pearson/Spearman. Utilizou-se a regressão logística para a associação entre as variáveis biossociais e clínicas dos pacientes e EA moderado/grave, regressão linear para a associação entre as variáveis biossociais e do trabalho da equipe de enfermagem e ISP. O modelo de regressão logística multinível analisou a associação entre as variáveis contempladas nos modelos com EA moderado/grave. Resultados: Participaram do estudo 806 pacientes, com total de 890 internações e 54 reinternações, distribuídos em UTI cirúrgicas, UTI clínicas e UTI especializadas. A maioria dos pacientes era do gênero masculino (58,09%), idade média de 54,11 anos, média SAPSII 32,29, probabilidade de morte SAPSII 19,10%, que sobreviveram à internação na UTI (78,76%). Os 806 pacientes sofreram 6.029 ocorrências, classificadas, em maior proporção, como procedimento/processo clínico (45,12%), falhas com documentação (34,12%), administração de medicamentos/fluídos endovenosos (8,39%) e acidentes com paciente (4,54%). Do total de ocorrências, 23,04% foram EA e destes, 8,19% EA moderado/grave, que foram associados às variáveis biossociais e clínicas dos pacientes: gênero masculino (p=0,04), condição de saída óbito (p=0,00) e tempo de permanência (p=0,00). Referente à equipe de enfermagem, participaram do estudo 287 profissionais, sendo 34,85% enfermeiros e 65,15% técnicos/auxiliares de enfermagem. A amostra foi caracterizada pelo gênero feminino (83,97%), com companheiro (50,53%) e filhos (63,06%), avaliou favoravelmente o ambiente das práticas para os domínios relações entre médicos e enfermeiros (2,29 pontos) e autonomia (2,31 pontos) e não favoravelmente aos domínios suporte organizacional (2,37 pontos) e controle do ambiente (2,52 pontos) e apresentou baixa satisfação profissional (ISP=10,96 pontos). A correlação entre os domínios do NWI-R com o escore ISP mostrou que o ambiente favorável às práticas de enfermagem aumentou a satisfação profissional. As variáveis NWI-R (p=0,00), tempo de trabalho em UTI (p=0,04) e sente-se disposto para o trabalho (p=0,00) foram associadas ao ISP. Os únicos fatores associados ao EA moderado/grave foram tempo de permanência na UTI (p=0,00) e condição de saída óbito (p=0,01). Conclusões: Apesar de a hipótese deste estudo ter sido refutada, constatou-se que o ambiente favorável às práticas de enfermagem aumentou a satisfação profissional. Os resultados indicaram a necessidade de ampliar as investigações sobre os fatores associados a ocorrência do EA em UTI por serem fenômenos multidimensionais e complexos. / Objective: To analyze the association between biosocial and clinical patient variables, biosocial and work variables of nursing staff, environment of nursing practices, job satisfaction and the occurrence of moderate/severe Adverse Events (AE) in Intensive Care Units (ICU). Method: Observational research with a mixed design: historical cohort study to collect datas of the AE/Incidents (I) and patients and cross-sectional for the sample of nursing staff, Nursing Work Index- Revised (NWI-R) and Index of Work Satisfaction (IWS). The study was conducted in 8 ICU of the Central Institute from the University Hospital, between 2012 September 3th and December 1st. The sources of information for the datas extraction were: patients\' medical records, computerized system, printed instruments and shift change. In the statistical analysis we used the Student T and Mann-Whitney tests, and Pearson/Spearman correlation. We used logistic regression to the association between biosocial and clinical variables of patients and moderate/severe AE, linear regression for the association between the biosocial and work variables of the nursing staff and IWS. The multilevel logistic regression model analyzed the association between the variables included in the models and moderate/severe AE. Results: The study included 806 patients with a total of 890 admissions and 54 readmissions, distributed in surgical, clinical and specialized ICU. Most patients were male (58.09%), mean age 54.11 years, average 32.29 SAPSII, risk of death SAPSII 19.10%, which survived in the ICU (78.76%) . The 806 patients suffered 6,029 occurrences, classified in greater proportion, as procedure/clinical process (45.12%), documentation (34.12%), medication/intravenous fluids (8.39%) and patient accidents (4.54%). AE were 23.04% and 8.19% moderate/severe AE, which were associated with biosocial and clinical variables of patients: male gender (p = 0.04), death output condition (p = 0.00) and length of stay (p = 0.00). On the nursing team, 287 professionals participated in the study, 34.85% were nurses and 65.15% were technical nursing assistants. The sample was characterized by females (83.97%), with a partner (50.53%) and children (63.06%), who evaluate favorably environmental practices for the relations between doctors and nurses (2.29 points ) and autonomy (2.31 points) and not favorably to organizational support areas (2.37 points) and environmental control (2.52 points) and had low job satisfaction (ISP = 10.96 points). The correlation between the domains of the NWI-R with the IWS score showed that the favorable environment for nursing practices increased job satisfaction. The NWI-R (p = 0.00), working time in ICU (p = 0.04) and feel willing to work (p = 0.00) were associated with the IWS. The only factors associated with moderate/severe AE were length of stay in the ICU (p = 0.00) and death output condition (p = 0.01). Conclusions: Although the hypothesis of this study have been refuted, it was found that the favorable environment for nursing practices increased job satisfaction. The results indicated the need to increase research into the factors associated with the occurrence of AE in ICU because they are multidimensional and complex phenomena.

Objetivo: Analisar a associação entre variáveis biossociais e clínicas dos pacientes, variáveis biossociais e do trabalho da equipe de enfermagem, ambiente das práticas profissionais de enfermagem e satisfação profissional e eventos adversos (EA) moderado/grave nas Unidades de Terapia Intensiva (UTI). Método: Investigação observacional com delineamento misto: coorte histórica para a coleta de dados dos EA e Incidentes (I) e dos pacientes e transversal para a coleta de dados da equipe de enfermagem, Nursing Work Index- Revised (NWI-R) e Índice de Satisfação Profissional (ISP). O estudo foi realizado em 8 UTI do Instituto Central do Hospital das Clínicas, entre 03 de setembro e 01 de dezembro de 2012. As fontes de informações para a extração dos dados foram: prontuários dos pacientes, sistema informatizado institucional, instrumentos impressos e passagens de plantão. No tratamento estatístico utilizaram-se os testes t Student e Mann Whitney, além da correlação Pearson/Spearman. Utilizou-se a regressão logística para a associação entre as variáveis biossociais e clínicas dos pacientes e EA moderado/grave, regressão linear para a associação entre as variáveis biossociais e do trabalho da equipe de enfermagem e ISP. O modelo de regressão logística multinível analisou a associação entre as variáveis contempladas nos modelos com EA moderado/grave. Resultados: Participaram do estudo 806 pacientes, com total de 890 internações e 54 reinternações, distribuídos em UTI cirúrgicas, UTI clínicas e UTI especializadas. A maioria dos pacientes era do gênero masculino (58,09%), idade média de 54,11 anos, média SAPSII 32,29, probabilidade de morte SAPSII 19,10%, que sobreviveram à internação na UTI (78,76%). Os 806 pacientes sofreram 6.029 ocorrências, classificadas, em maior proporção, como procedimento/processo clínico (45,12%), falhas com documentação (34,12%), administração de medicamentos/fluídos endovenosos (8,39%) e acidentes com paciente (4,54%). Do total de ocorrências, 23,04% foram EA e destes, 8,19% EA moderado/grave, que foram associados às variáveis biossociais e clínicas dos pacientes: gênero masculino (p=0,04), condição de saída óbito (p=0,00) e tempo de permanência (p=0,00). Referente à equipe de enfermagem, participaram do estudo 287 profissionais, sendo 34,85% enfermeiros e 65,15% técnicos/auxiliares de enfermagem. A amostra foi caracterizada pelo gênero feminino (83,97%), com companheiro (50,53%) e filhos (63,06%), avaliou favoravelmente o ambiente das práticas para os domínios relações entre médicos e enfermeiros (2,29 pontos) e autonomia (2,31 pontos) e não favoravelmente aos domínios suporte organizacional (2,37 pontos) e controle do ambiente (2,52 pontos) e apresentou baixa satisfação profissional (ISP=10,96 pontos). A correlação entre os domínios do NWI-R com o escore ISP mostrou que o ambiente favorável às práticas de enfermagem aumentou a satisfação profissional. As variáveis NWI-R (p=0,00), tempo de trabalho em UTI (p=0,04) e sente-se disposto para o trabalho (p=0,00) foram associadas ao ISP. Os únicos fatores associados ao EA moderado/grave foram tempo de permanência na UTI (p=0,00) e condição de saída óbito (p=0,01). Conclusões: Apesar de a hipótese deste estudo ter sido refutada, constatou-se que o ambiente favorável às práticas de enfermagem aumentou a satisfação profissional. Os resultados indicaram a necessidade de ampliar as investigações sobre os fatores associados a ocorrência do EA em UTI por serem fenômenos multidimensionais e complexos. / Objective: To analyze the association between biosocial and clinical patient variables, biosocial and work variables of nursing staff, environment of nursing practices, job satisfaction and the occurrence of moderate/severe Adverse Events (AE) in Intensive Care Units (ICU). Method: Observational research with a mixed design: historical cohort study to collect datas of the AE/Incidents (I) and patients and cross-sectional for the sample of nursing staff, Nursing Work Index- Revised (NWI-R) and Index of Work Satisfaction (IWS). The study was conducted in 8 ICU of the Central Institute from the University Hospital, between 2012 September 3th and December 1st. The sources of information for the datas extraction were: patients\' medical records, computerized system, printed instruments and shift change. In the statistical analysis we used the Student T and Mann-Whitney tests, and Pearson/Spearman correlation. We used logistic regression to the association between biosocial and clinical variables of patients and moderate/severe AE, linear regression for the association between the biosocial and work variables of the nursing staff and IWS. The multilevel logistic regression model analyzed the association between the variables included in the models and moderate/severe AE. Results: The study included 806 patients with a total of 890 admissions and 54 readmissions, distributed in surgical, clinical and specialized ICU. Most patients were male (58.09%), mean age 54.11 years, average 32.29 SAPSII, risk of death SAPSII 19.10%, which survived in the ICU (78.76%) . The 806 patients suffered 6,029 occurrences, classified in greater proportion, as procedure/clinical process (45.12%), documentation (34.12%), medication/intravenous fluids (8.39%) and patient accidents (4.54%). AE were 23.04% and 8.19% moderate/severe AE, which were associated with biosocial and clinical variables of patients: male gender (p = 0.04), death output condition (p = 0.00) and length of stay (p = 0.00). On the nursing team, 287 professionals participated in the study, 34.85% were nurses and 65.15% were technical nursing assistants. The sample was characterized by females (83.97%), with a partner (50.53%) and children (63.06%), who evaluate favorably environmental practices for the relations between doctors and nurses (2.29 points ) and autonomy (2.31 points) and not favorably to organizational support areas (2.37 points) and environmental control (2.52 points) and had low job satisfaction (ISP = 10.96 points). The correlation between the domains of the NWI-R with the IWS score showed that the favorable environment for nursing practices increased job satisfaction. The NWI-R (p = 0.00), working time in ICU (p = 0.04) and feel willing to work (p = 0.00) were associated with the IWS. The only factors associated with moderate/severe AE were length of stay in the ICU (p = 0.00) and death output condition (p = 0.01). Conclusions: Although the hypothesis of this study have been refuted, it was found that the favorable environment for nursing practices increased job satisfaction. The results indicated the need to increase research into the factors associated with the occurrence of AE in ICU because they are multidimensional and complex phenomena.

Bakgrund: Skiftarbete är en vanlig arbetsmodell för sjuksköterskor runt om i världen. Skiftarbete är dock förknippat med negativa konsekvenser så som dygnsrytmsstörning och ohälsa. Det är därför viktigt att tydligare belysa hur skiftarbete påverkar sjuksköterskor och den vård som ges. Syfte: Att beskriva skiftarbetes konsekvenser på sjuksköterskor och deras arbete. Metod: En litteraturöversikt baserad på 14 kvantitativa studier hämtade från PubMed. Använda sökord var: shift work, nurse, patient safety och fatigue. Översikten har gjorts enligt Friberg (2012a), där likheter och teman skapats utifrån studiernas resultat. Resultat: Långa och snabbroterande skift kan bidra till utbrändhet, sömnsvårigheter, fatigue och ökad misstagsfrekvens. Långa skift är trots detta uppskattat av många sjuksköterskor då det innebär kortare arbetsvecka. Det är dock av stor vikt att man får möjlighet att återhämta sig ordentligt. Diskussion: Resultatet knyts an till Kims (1987) teori om omvårdnadens domäner och skiftarbetets konsekvenser på sjuksköterskan, interaktionen och miljön diskuteras. Utformandet av hälsosamma arbetsmiljöer där sjuksköterskans och patientens säkerhet prioriteras är av stor vikt för att förebygga skiftarbetets konsekvenser. / Background: Shift work is common among nurses all over the world. It has been related to negative consequences like circadian rhythm disorders and health issues. Hence it is important to illustrate how shift work is affecting nurses and the care they are giving. Aim: To describe the consequences shift work has on nurses and their work. Method: A literature review based on 14 quantitative studies, collected from PubMed. The search terms were: shift work, nurse, patient safety and fatigue. The studies have been investigated and analyzed with influence by Friberg (2012a), where similarities and themes were identified. Results: Extended and quickly rotating shifts contributes to burnout, sleep disturbances, fatigue and elevated frequency of errors. Despite this, many nurses are satisfied with working extended shifts since it shortens their workweek. A central aspect is the opportunity to recover between shifts. Discussions: The authors discuss the results based on Kim’s (1987) theory on nursing domains, and the consequences of shift work on nurses, client-nurse interaction and environmental factors. Forming healthful work environments where the safety of both nurses and patients are prioritized are crucial to prevent negative consequences of shift work.

The profession of a general nurse is a specific job with high demands. At present, recruiting and retaining general nurses is an urgent and fundamental problem not only in the Czech Republic but also worldwide. The extent of the shortage of general nurses is not clear. The Czech Nursing Association (ČAS) reports figures ranging from 2000 to 3300 for the years 2017 and 2018. The lack of trained and qualified general nurses results in a series of negative effects, impacting not only the quality but also availability of the care provided. Some foreign studies even indicate that the shortage of nurses increases the likelihood of complications and patient deaths (Aiken et al., 2014). By recognizing the motivational and demotivational factors impacting the satisfaction of nurses we can help to retain general nurses in their jobs and increase their work performance. The research survey implemented at one specific intensive care unit of the highest level was conducted using the qualitative research method. The data collection took place in the form of semi-structured interviews and was completed by achieving data saturation. The qualitative data were audio recorded to maintain authenticity. The interviews were subsequently transcribed. An open coding technique was used to analyze the data of ten survey...