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O ambiente da prática de enfermagem e a omissão dos cuidados num hospital central
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O conceito de Cuidados de Enfermagem Omissos (CEO) refere-se à omissão ou falha nas atividades do cuidado de enfermagem necessárias para o bem-estar do utente. Ocorre quando as intervenções de enfermagem planeadas ou necessárias não são realizadas, ou concluídas, dentro do prazo adequado. O ambiente de prática de enfermagem (APE) envolve características organizacionais que podem facilitar ou limitar a prática profissional do enfermeiro, e surge com influência na qualidade, na segurança e nos cuidados omissos. Examinar a relação entre o APE e os CEO em serviços de internamento de adultos de um hospital central, foi o objetivo deste estudo. Realizou-se um estudo quantitativo, descritivo, transversal e correlacional, envolvendo enfermeiros na prestação direta dos cuidados. Foi empregue um questionário com duas escalas validadas para Portugal, a Nursing Work Index-Revised-versão portuguesa (avalia o APE), e a MISSCARE (avalia os CEO). A análise dos resultados fez-se por estatística descritiva e inferencial, com recurso ao SPSS 29.
A maioria da amostra era composta por enfermeiras licenciadas com idade média de 32 anos, 8,7 anos de experiência profissional e trabalhavam em serviços de medicina interna. Classificaram o APE como favorável (x̄ = 3,17), mas os itens Remuneração satisfatória e Participação nas decisões organizacionais foram considerados desfavoráveis. Os cuidados mais omitidos incluíram a Participação em reuniões interdisciplinares e a Deambulação 3xdia. A dimensão Cuidados para a capacitação e autonomia (x̄=3,17) obteve a media mais baixa. As principais razões para a omissão foram o Inadequado número de elementos na equipa, Aumento inesperado do número ou gravidade dos doentes e Situações de doentes urgentes. A dimensão com a menor media global foi Dotação de Profissionais (x̄=2,05).
A análise dos resultados revelou que o APE não influenciou significativamente dimensões da MISSCARE como Cuidados Instrumentais e Avaliação do doente e documentação. No entanto, o APE apresentou um efeito preditor sobre as dimensões Gravidade e Fluxo de Doentes (p=0,008), Comunicação na equipa (p=0,010), e Dotação de Profissionais (p<0,001). A melhoria destes aspetos do APE permitirá menos CEO.
The concept of Missed Nursing Care (MNC) refers to the omission or failure of nursing care activities necessary for the user's well-being. It occurs when planned or necessary nursing interventions are not carried out, or completed, within the appropriate time frame. The nursing practice environment (NPE) involves organizational characteristics that can facilitate or limit the professional practice of nurses, and appears to influence quality, safety and missed care. Examining the relationship between NPE and MNCs in adult inpatient services at a central hospital was the objective of this study. A quantitative, descriptive, cross-sectional and correlational study was carried out, involving nurses in the direct provision of care. A questionnaire was used with two scales validated for Portugal, the Nursing Work Index-Revised-portuguese version (evaluates the NPE), and the MISSCARE (evaluates the MNC). The results were analyzed using descriptive and inferential statistics, using SPSS 29. The majority of the sample were licensed nurses with a mean age of 32 years, 8.7 years of professional experience, and worked in internal medicine services. They classified the NPE as favorable (x̄ = 3.17), but the items Satisfactory remuneration and Participation in organizational decisions were considered unfavorable. The most missed care included Participation in interdisciplinary meetings and 3x daily walking. The dimension Care for empowerment and autonomy (x̄=3.17) obtained the lowest average. The main reasons for omission were the Inadequate number of members on the team, Unexpected increase in the number or severity of patients and Urgent patient situations. The dimension with the lowest global average was Staffing (x̄ =2.05). The results analysis revealed that the NPE did not significantly influence MISSCARE dimensions such as Instrumental Care and Patient Assessment and Documentation. However, the NPE had a predictive effect on the dimensions of Severity and Patient Flow (p=0.008), Team Communication (p=0.010), and Professional Staffing (p<0.001). Improving these aspects of NPE will allow for less missed care.
The concept of Missed Nursing Care (MNC) refers to the omission or failure of nursing care activities necessary for the user's well-being. It occurs when planned or necessary nursing interventions are not carried out, or completed, within the appropriate time frame. The nursing practice environment (NPE) involves organizational characteristics that can facilitate or limit the professional practice of nurses, and appears to influence quality, safety and missed care. Examining the relationship between NPE and MNCs in adult inpatient services at a central hospital was the objective of this study. A quantitative, descriptive, cross-sectional and correlational study was carried out, involving nurses in the direct provision of care. A questionnaire was used with two scales validated for Portugal, the Nursing Work Index-Revised-portuguese version (evaluates the NPE), and the MISSCARE (evaluates the MNC). The results were analyzed using descriptive and inferential statistics, using SPSS 29. The majority of the sample were licensed nurses with a mean age of 32 years, 8.7 years of professional experience, and worked in internal medicine services. They classified the NPE as favorable (x̄ = 3.17), but the items Satisfactory remuneration and Participation in organizational decisions were considered unfavorable. The most missed care included Participation in interdisciplinary meetings and 3x daily walking. The dimension Care for empowerment and autonomy (x̄=3.17) obtained the lowest average. The main reasons for omission were the Inadequate number of members on the team, Unexpected increase in the number or severity of patients and Urgent patient situations. The dimension with the lowest global average was Staffing (x̄ =2.05). The results analysis revealed that the NPE did not significantly influence MISSCARE dimensions such as Instrumental Care and Patient Assessment and Documentation. However, the NPE had a predictive effect on the dimensions of Severity and Patient Flow (p=0.008), Team Communication (p=0.010), and Professional Staffing (p<0.001). Improving these aspects of NPE will allow for less missed care.
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Administração em enfermagem Ambiente de trabalho Qualidade dos cuidados de saúde Segurança do paciente Cuidados de enfermagem