Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

ABSTRACT:Studies with nursing continuing education are common in the literature with a predominance of qualitative approaches. Quantitative assessments are punctual and focused on a single quality indicator, and few studies relate these indicators to the profile of nursing staff. The objective of the study was to describe the Training Cycles of the Clinical Hospital of Uberlândia as a strategy of a Nursing Continuing Education Program and evaluate the attendance indicators and their association with the nursing staff profile. The Training Cycles of the Clinical Hospital of Uberlândia are cyclic courses that are offered continually, in a mandatory participation regime, during work hours, outside of the hospital, focused on Nursing staff. The study was conducted in 2013/2014 and has a documentary character. It was held in a public high complexity university hospital in Brazil. The Relative Frequency Attendance was calculated in relation to the nursing professional category and shift. Attendance indicators were affected by professional category. Participation increased over time for the technical level (assistants and nursing technicians) and decreased for nurses. We found an attendance rate of 54.49% in nursing hospital staff. The attendance indicators were also different for the period/shift of the course (gradual decrease of attendance from morning to afternoon to night). We also observed a decrease in attendance indicators over time. Attendance indicators were effective in describing the results of the Continuing Education Program and allowed the service administrators to associate the indicator results to the nursing profile. These results served as a basis for adjustments in the continuing education program of the institution.

Background: Cardiovascular diseases are the main cause of death and loss of quality of life in the long term. In the USA, cardiac surgeries represent the most performed surgery category, with an average cost of USD 40,000. Because it is a complex procedure and leads the patient to a critical post-operative state, there is a necessity of intensive care.Objective: Compare the health indicators of patients submitted to postoperative myocardial revascularization surgery when they are in a general Intensive Care Unit (GICU) or in a cardiac Intensive Care Unit (CICU) in a Brazilian institution.Methods: This is a quantitative, retrospective, descriptive study of patients submitted to a coronary artery bypass grafting surgery in a hospital of high complexity. Data were collected from the medical records and grouped into two phases. Phase 1 is the pre-implantation of the CICU, with a total of 50 patients, in a period in which the postoperative of myocardial revascularization surgeries were performed in the GICU. The second phase corresponds to the postoperative period performed in the CICU, with a total of 60 patients.Results: Males were predominant in the study, with the mean age being over 60 years. The most frequent comorbidities in the two groups were systemic arterial hypertension, dyslipidemias and type 2 diabetes mellitus. The main postoperative complications were surgical site infections, cardiac arrhythmias and pleural effusion. After the implementation of the specialized ICU, there was a reduction in the total hospitalization time and a reduction in cost by day and total cost of hospitalization.Conclusions: The specialized ICU promoted a reduction in the total hospitalization time of patients submitted to coronary artery bypass grafting surgeries and a reduction in hospital costs for the Brazilian public health service, facts that demonstrate the importance of these specialized services in high complexity hospitals.

ABSTRACT:Although satisfaction is a key point in the evaluation of continuing education, few studies have conducted its assessment, particularly in relation to long-term programmes. The objective of this study was to evaluate the evolution of satisfaction indicators applied to a continuing education program in a university hospital of high complexity. For this, a satisfaction form was filled out after each of the 11 Cycles of Training, and the findings were related to the rates of attendance. It was observed that the nursing professionals gave a positive evaluation of the cycles when each course was evaluated individually, with a tendency to change over time. However, dissatisfaction was observed in relation to the organization criteria for the event, which tended to get worse over time. In addition, different nursing professional categories apparently presented different satisfaction levels, although this association cannot be proven. The results proved that the evaluation of satisfaction with the course or program over time can offer quality indicators for the better management of continuing education programs, and future works should take into account the profile of professionals involved with the program.

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The assessment of nursing workload offers both support for patient care planning and service management. In an Intensive Care Unit (ICU) this workload is measured by the Nursing Activities Scores (NAS), although in specialized areas such as Cardiology, its use is still diminished. Objective: To describe NAS and the prevalence of its sub-items in a Brazilian Cardiac ICU. We also aimed to evaluate NAS oscillation since the opening of the unit, and according to the day of the week. Methods: Daily NAS records collected from November 2014 to October 2018 were assessed, totaling 8600 assessments distributed over 49 months. The data were analyzed according to time, day of the week, number of records per day, and dichotomizing if NAS was higher or lower than 50 points. Results: NAS presented mean value of 52.91 points and a median of 53.40 points. The mean NAS values per month ranged from 45.00 to 59.10 points. The percentage of NAS assessments above 50 points ranged from 20.59 to 92.34% per month and proved to be a better indicator for assessing the variability of the monthly workload. When combined two by two, 66.01% of NAS combinations scored more than 100 points, suggesting the need for more than one nursing professional per day. When the data were stratified by year, 2018 had the lowest means compared to the others. When compared to the mean values in function of the day of the week, it was observed that Monday to Friday (with the highest mean on Wednesday, the predominant day for cardiac surgeries) showed higher values than weekends. Conclusions: Overall, NAS showed low values compared to other general or cardiac ICUs, it also presented temporal variability and our results showed risk of workload overload which can compromise patient care and safety. Such results reinforce the importance of the administrative and assistant aspects of the routine use of NAS in ICUs specially in specialized environments as Cardiac ICU.