Dotações de enfermagem

: impacto na segurança dos cuidados de saúde

Abstract

Introduction – We know that a complex and dynamic system, such as the hospital context, favors the risk of adverse events. Questioning the safety of the care provided, we approach one of the core values and a central domain of nursing sciences, the safety, in order to contribute to raising awareness among managers and policy makers of issues related to inadequate staffing of nursing teams and its reflection on the occurrence of patients adverse events. Objectives – To determine if there is an association, and the strength of this association, between exposure to a nursing care deficit hours and the occurrence of an adverse event, increase in the mean delay in hospitalization and hospital mortality. Methodology – The study been based on the quantitative, exploratory paradigm of a sample with 70,241 cases collected in tthe databases of the System for Classification of Patients in Illness and Homogeneous Diagnostic Groups, between January 1, 2011 and December 31, 2013. The data been treated using a univariate and bivariate analysis and it was performed using risk measures, with a confidence interval of 95% logistic regression models. Results – The sample consisted mostly of women (52.8%), with a mean age of 66 years, hospitalized in the surgical (40.2%), medical (41.3%) and orthopedic units (18.5%). Most of them in Lisboa e Vale do Tejo Health Region hospitals (33.8%), and 63.4% was admitted to level II hospitals, and 71.9% of patients received urgent admission. About half (50.8%) have a Charlson Comorbidity Index greater than 2. The distribution matrix of the nursing staff was performed in an average proportion of 50% in the morning shift, 30% in the afternoon shift, and 20% % on night shift, regardless of the number of Nursing hours per Patient and day identified. There is a daily deficit greater than two hours of care per patient per day of hospitalization, reaching an average of more than fifty negative hours. The existence of a statistically significant association between the hours of care deficit and the occurrence of adverse events was showed to be significantly higher when patients was exposed to a greater deficit of hours of care Conclusions - We conclude that the risk of occurrence of adverse events is 2 times more when patients was exposed to inadequate staffing, being 2.4 times higher in the occurrence of respiratory complications, 3.5 times higher in the occurrence of Urinary tract and 3.7 times higher in the occurrence of pressure ulcers and in the increase in mean delay. The results obtained show a statistically significant association between hours of care and mortality, and patients exposed to inadequate staffing present a mortality risk 2.2 times higher than patients exposed to adequate staffing. We conclude that it is essential to redefine strategies that allow the improvement of the organization and the adequacy of nursing human resources to the needs identified in the patients.

Date of Award	16 Jul 2018
Original language	Portuguese
Supervisor	Élvio Jesus (Supervisor) & Margarida Maria Vieira (Supervisor)