Carga de trabalho da enfermagem e cultura de segurança em Unidade de Terapia Intensiva

Abstract

Assessing the safety culture is critical for problems in health organizations to be identified. In this sense, interventions aimed at improving patient safety must, necessarily, consider the working conditions and, in particular, the nursing workload arising from the demands of patient care. The study aims to analyze the workload and safety culture for the ICU nursing team. It consists of a mixed study, with concomitant triangulation, performed at the Intensive-Adult Therapy Unit (UTI'A) of the Hospital Universitário de Santa Maria (HUSM). The study population consisted of patients and nursing workers. Patients participated in the survey to obtain the measurement of the workload of nursing workers, and nursing workers to evaluate their perception of the culture of safety in the ICU. The research had three sources of data: 1º) Documentary research: carried out in patients' records through four instruments: Questionnaire on sociodemographic and clinical data of patients; Nursing activities scores; Control sheet of items 1, 4, 6, 7 and 8 of the NAS; Gravity Parameters; 2º) Questionnaire: applied to nursing workers through two instruments: Questionnaire of sociodemographers and professionals of nursing workers and the Questionnaire on Safety Attitudes (SAQ); 3) Semi-structured interview with nursing workers, aiming to know their perception about the workload and the security climate in the ICU. The quantitative data were organized by means of the double independent typing in a spreadsheet in the form of a database, using the program Epi-info®, version 6.4. After checking for errors and inconsistencies, the data analysis was performed in the PASW Statistics program. The qualitative analysis was based on the framework proposed by Bardin (2009). In order to carry out the research, the ethical principles of Resolution No. 466/2012 of the National Health Council (CNS) were observed. The findings of this study allowed an organization of the results in two chapters. The first chapter focused on the workload of the nursing team. Through the NAS it was possible to verify that nursing workers occupy an average of 70% of the time of a worker. This result was corroborated by qualitative data, based on the following categories: "Demand for care of patients attended at the ICU of a university hospital" and "Work organization: repercussions on nursing workload and patient safety", Which evidenced a perception of high workload and problems in work organization that interfere with patient safety. The second chapter was based on the safety culture, in which, through SAQ, there was a negative safety culture for the safety climate, working conditions and perception of unit and hospital management and a positive safety culture for Teamwork climate, perception of stress and satisfaction at work. There was also convergence with the qualitative data, from the category: Safety Culture in ICU: perception of nursing workers, which showed that work overload is linked to a negative perception of safety culture. The integration of the quantitative and qualitative results showed, mainly, convergence between the data collected through the different methodological approaches. From the results it is concluded that work overload interferes with the perception about safety culture. Descriptors: Patient safety; Organizational