Clima de segurança, carga de trabalho e dimensionamento de pessoal de enfermagem em Unidade de Terapia Intensiva

Abstract

Current descriptive study, with a quantitative approach, analyzes the potential relationship between the patient's safety atmosphere, work load and the size of the nursing staff in an adult Intensive Care Unit (AICU). Analysis was developed in a hospital school in the northwestern region of the state of Parana, Brazil. The subjects were nursing professionals and the clinical charts of the patients involved. Data were collected between June and October 2014 by two methods: a) Questionnaire on Safety Attitudes (QSA): the team's perspective on this type of care, which verified the safety atmosphere among the nursing professionals (13 nurses and 15 nursing-technicians); b) Nursing Activities Score (NAS) which measured the workload by analyzing 81 clinical charts of patients. In the case of QSA, score average among the dominions was taken into consideration, or rather, results were adequate with a score above 75, and inadequate below this score. In the case of NAS, the median of total score of 32 nursing items/activities per patient/day was employed to classify the work shift of the professionals into high/low work load. The sum of NAS applied to the mathematical operation proposed by Brazilian legislation and the literature was the basis for the analysis of the AICU staff. The association of average results from QSA among professionals with high and low workloads, according to their respective shifts was tested. Among the results, the following total averages by QSA domain were given: Team Work Atmosphere (77.38 points); Safety Atmosphere (69.90 points); Job Satisfaction (88.04 points); Stress Perception (67.19 points); Management´s perception (60.71 points); Working Conditions (74.11 points). NAS average amounted to 571, which classified work shifts as low work load (below than or equal to 571 points) and high work load (over 571). The size of the nursing staff revealed that the team has a 5-member deficit and the nurse category worked with only half the team necessary for the sector's demand. The analysis between QSA and NAS resulted in a positive statistical association among 3 QSA dominions: team work atmosphere (p-rate 0.010); safety atmosphere (p-rate 0.009) and job satisfaction (p-rate 0.020). Although there was no statistical association between the other 3 dominions (stress perception, management´s perception and working conditions) and the work load, the decrease in dominion averages among professionals with high work loads was reported when compared to professionals with low work loads. Results show that the safety atmosphere at the ICU under analysis was inadequate. Four out of the six dominions evaluated scores below standard. Staff size failed to comply with legislation and high work load and the patient's safety atmosphere were associated.