Nursing workload and patient safety - a mixed method study with an ecological restorative approach

Abstract

Objective: The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital.Method: a mixed method strategy (sequential explanatory design). Results: the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism. During the subsequent qualitative stage of the research, the nursing team stressed medication administration, bed baths, and patient transport as the aspects of care that have the greatest impact on workload and pose the greatest hazards to patient, provider, and environment safety. Conclusions: The findings demonstrated significant associations between nursing workload and patient safety. We observed that nursing staff with fewer patients presented best results of care-related and management-related patient safety indicators. In addition, the tenets of ecological and restorative thinking contributed to the understanding of some of the aspects in this intricate relationship from the standpoint of nursing providers. They also promoted a participatory approach in this study. Carga de trabajo de enfermería y seguridad de pacientes -estudio con método mixto y aproximación ecológica restaurativaEl estudio tuvo por objetivo analizar la carga de trabajo de enfermería y su potencial relación con la seguridad del paciente en unidades de internación de las áreas clínica y quirúrgica de un hospital universitario. Se adoptó un método mixto de investigación con diseño secuencial explicativo. Los resultados de la etapa cuantitativa indican que el aumento del número de pacientes atribuidos al equipo de enfermería implica en elevación de las tasas de caída de cama, infección relacionada a catéter vascular central, turnover y absentismo. En la etapa cualitativa, el equipo de enfermería destacó los cuidados relacionados con la administración de medicación, baño de cama y transporte de pacientes como aquellos que más repercuten en la carga de trabajo y representan riesgos para la seguridad de los pacientes, de los profesionales y del ambiente. Los resultados mostraron asociaciones significativas entre la carga de trabajo y la seguridad del paciente. La mejor dotación de personal mostró mejores resultados para el manejo y para el cuidado del paciente. Los principios del pensamiento ecológico y restaurativo contribuyeron a la comprensión de algunos de los aspectos involucrados en esta intricada relación, a partir de las miradas de los profesionales, con un enfoque participativo.

Nasoenteral tube: factors associated with delay between indication and use in emergency services

“…In research (19) performed in the admission units of the same hospital headquarters as the present study, adopting the same statistics, it was identified that the increase in the number of patients per nursing professional is associated with an increase in the rates of falls from bed, venous catheter-related bloodstream infections, and absenteeism. Although postulated that a worse rate of patients per nursing professional or other professionals (radiology technicians, nutrition attendants) would be associated with delays in the process of indication of tube use, this hypothesis was not confirmed in any of the stages.…”

“…Although postulated that a worse rate of patients per nursing professional or other professionals (radiology technicians, nutrition attendants) would be associated with delays in the process of indication of tube use, this hypothesis was not confirmed in any of the stages. In fact, the care units included in the previously cited study (19) have a fixed number of patients, which does not happen in the emergency department, where overcrowding is a constant. Also, the types of outcomes evaluated, which were not about delays in unit of time (minutes), can explain the difference among these findings.…”

Evaluating the intervening factors in patient safety: focusing on hospital nursing staff

“…It is known that both factors are associated with patient safety, being considered as issues widely discussed in the health area, with resources being mobilized by the WHO (1) . According to some authors, the scarce labor force in the area of Nursing in some countries, the lack of training, and the excessive workload are problems that directly compromise patient safety (7)(8)(9)(10) .…”

“…The researchers used the triangulation of methods for the analysis of safety culture on the perception of nurses and of records on hospital documents, such as records of Nursing occurrences book. The instruments used were (1) Sociodemographic and occupational questionnaire, (2) Hospital Survey on Patient Safety Culture (HSOPSC), (3) Semi-structured interview script, and (4) Checklist for analysis of events related to patient safety in nursing records.…”

“…The media constantly reports the poor working conditions, limited resources, overcrowding, and long waiting times in the public hospitals, which expose the patient to shortcomings in the care, and which have become increasingly frequent. Such reports can feed the lay population's perception of health professionals as being inefficient (1) .…”