Nursing workload related to the body mass index of critical patients

Goulart, Luana Loppi; Carrara, Fernanda Souza Angotti; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi

doi:10.1590/1982-0194201700006

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Acta Paulista de Enfermagem

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Original Article • Acta Paul Enferm. 30 (1) • Jan 2017 • https://doi.org/10.1590/1982-0194201700006 copy

Nursing workload related to the body mass index of critical patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To measure and compare the nursing workload and the frequency of the items scored in the Nursing Activities Score (NAS) considering the different groups of BMI of patients hospitalized in Intensive Care Units (ICU).

Methods

Longitudinal study conducted in the ICU of a university hospital in São Paulo in which the BMI of patients was calculated by dividing the weight by the square of the height and the nursing workload was measured through the NAS.

Results

Analysis of 529 patients showed that the NAS did not differ between the groups according to the BMI. Obese patients demanded more time for hygiene procedures and more people to support the mobilization/positioning process. Underweight patients received treatment for improving lung function with a higher frequency.

Conclusion

The results showed no difference in the nursing workload when the BMI of the patient was considered.

Intensive care units; Workload; Body mass index; Obesity; Nursing care

Variables	Body Mass Index			Total	p-value
Variables	Underweight (<18.5)	Normal/pre-obese (≥18.5 and <30)	Obese (≥30)	Total	p-value
Age
Mean (SD ^* )	57.2(22.3)	60.2(18.3)	57.8(16.9)	59.5(18.3)	0.366 ^†
Median	57.5	61	59	60
Minimum-Maximum	21-96	19-98	22-91	19-98
Gender - n(%)
Female	18(52.9)	181(46.4)	62(59.0)	261(49.3)	0.065 ^‡
Male	16(47.1)	209(53.6)	43(41.0)	268(50.7)
Discharge - n(%)
Discharged alive	26(76.5)	342(87.7)	95(90.5)	463(87.5)	0.098 ^‡
Death	8(23.5)	48(12.3)	10(9.5)	66(12.5)
Length of ICU stay
Mean (SD ^* )	7.0(7.7)	7.5(9.5)	6.8(8.2)	7.3(9.2)	0.736 ^†
Median	5	4	4	4
Minimum-Maximum	1-39	1-114	1-47	1-114
Admission category - n(%)
Elective surgery	15(44.1)	190(48.7)	52(49.5)	257(48.6)	0.882 ^‡
Emergency surgery	7(20.6)	63(16.2)	14(13.3)	84(15.9)
Medical	12(35.3)	137(35.1)	39(37.2)	188(35.5)
SAPS 3 ^§
Mean (SD ^* )	48.4(16.5)	44.2(15.0)	42.5(16.5)	44.2(15.4)	0.147 ^†
Median	50	43	40	43
Minimum-Maximum	19-90	16-93	16-84	16-93
SOFA ^\|\| admission
Mean (SD ^* )	3.7(3.1)	3.5(3.1)	3.5(3.4)	3.5(3.1)	0.912 ^†
Median	3	3	2	3
Minimum-Maximum	0-11	0-18	0-13	0-18
SOFA ^\|\| discharge
Mean (SD ^* )	2.5(3.9)	2.3(3.8)	2.0(3.7)	2.2(3.8)	0.709 ^†
Median	1	1	1	1
Minimum-Maximum	0-15	0-20	0-19	0-20
NAS
Mean (SD ^* )	64.4(8.4)	64.2(7.9)	65.3(9.1)	64.5(8.2)	0.467 ^†
Median	65.3	63.4	64.0	63.6
Minimum-Maximum	47.7-77.5	45.4-93.9	47.0-103.2	45.4-103.2

Variables	Body Mass Index			Total	p- value‡
Variables	Underweight (<18.5)	Normal/ pre-obese (≥18.5 and <30)	Obese (≥30)	Total	p- value‡
NAS ^* admission					0.802
Mean (SD ^† )	79.7(5.6)	78.9(6.4)	79.1(7.6)	78.0(6.6)
Median	77.8	77.8	77.1	77.8
Minimum-Maximum	65.8-89.6	65.8-100.5	67.2-111.9	65.8-111.9
NAS ^* discharge					0.954
Mean (SD ^† )	68.7(8.7)	68.9(8.0)	68.9(8.2)	68.9(8.8)
Median	68.3	67.2	68.2	67.9
Minimum-Maximum	58.2-88.3	46.1-103.3	58.2-97.0	46.1-103.3

Variables		Body Mass Index			p-value
		Underweight (<18.5)	Normal/pre-obese (≥18.5 and <30)	Obese (≥30)
		n(%)	n(%)	n(%)
1-Monitoring and controls	1a	-	3(0.8)	-	0.399 ^*
	1b	34(100.0)	382(97.9)	104(99.0)	0.396 ^*
	1c	-	5(1.3)	1 (1.0)	0.644 ^*
2-Laboratory investigations	Yes	34(100.0)	390(100.0)	105(100.0)	-
2-Laboratory investigations	No	-	-	-
3-Medication	Yes	34(100.0)	390(100.0)	105(100.0)	-
3-Medication	No	-	-	-
4-Hygiene procedures	4a	34(100.0)	387(99.2)	101(96.2)	0.071 ^*
	4b	-	2(0.5)	4(3.8)	0.037 ^*
	4c	-	1(0.3)	-	0.737 ^*
5-Care of drain	Yes	29(85.3)	328(84.1)	91(86.7)	0.807 ^†
5-Care of drain	No	5(14.7)	62(15.9)	14(13.3)	0.807 ^†
6-Mobilization and positioning	6a	4(11.8)	65(16.6)	15(14.3)	0.666 ^*
	6b	30(88.2)	322(82.6)	84(80.0)	0.542 ^*
	6c	- (-)	3(0.8)	6(5.7)	0.007 ^*
7-Support and care for patients and their families	7a	34(100.0)	390(100.0)	105(100.0)	-
7-Support and care for patients and their families	7b	-	-	-
8-Management and administrative tasks	8a	-	-	-	-
	8b	34(100.0)	390(100.0)	105(100.0)
	8c	-	-	-
9-Respiratory support	Yes	29(85.3)	337(86.4)	88(83.8)	0.791 ^†
9-Respiratory support	No	5(14.7)	53(13.6)	17(16.2)	0.791 ^†
10- Care of artificial airway	Yes	12(35.3)	138(35.4)	31(29.5)	0.527 ^†
10- Care of artificial airway	No	22(64.7)	252(64.6)	74(70.5)
11-Treatment for improving lung function	Yes	17(50.0)	170(43.6)	33(31.4)	0.047 ^†
11-Treatment for improving lung function	No	17(50.0)	220(56.4)	72(68.6)
12-Vasoactive medication	Yes	16(47.1)	140(35.9)	43(41.0)	0.319 ^†
12-Vasoactive medication	No	18(52.9)	250(64.1)	62(59.0)	0.319 ^†
13-Intravenous replacement of large fluid losses	Yes	4(11.8)	43(11.0)	9(8.6)	0.748 ^†
13-Intravenous replacement of large fluid losses	No	30(88.2)	347(89.0)	96(91.4)	0.748 ^†
14- Left atrium monitoring	Yes	1(2.9)	10(2.6)	2(1.9)	0.907 ^*
14- Left atrium monitoring	No	33(97.1)	380(97.4)	103(98.1)	0.907 ^*
15-Cardiopulmonary resuscitation	Yes	-	1(0.3)	1 (1.0)	0.584 ^*
15-Cardiopulmonary resuscitation	No	34 (100.0)	389 (99.7)	104 (99.0)	0.584 ^*
16-Hemofiltration techniques	Yes	-	1(0.3)	-	0.737 ^*
16-Hemofiltration techniques	No	34(100.0)	389(99.7)	105(100.0)	0.737 ^*
17-Quantitative urine output measurement	Yes	34(100.0)	390(100.0)	105(100.0)	-
17-Quantitative urine output measurement	No	-	-	-	-
18-Measurement of intracranial pressure	Yes	2(5.9)	23(5.9)	5(4.8)	0.904 ^†
18-Measurement of intracranial pressure	No	32(94.1)	367(94.1)	100(95.2)	0.904 ^†
19-Complicated metabolic acidosis/alkalosis treatment	Yes	1(2.9)	6(1.5)	4(3.8)	0.374 ^†
19-Complicated metabolic acidosis/alkalosis treatment	No	33(97.1)	384(98.5)	101(96.2)	0.374 ^†
20-Intravenous hyperalimentation	Yes	1 (2.9)	- (-)	- (-)	0.063 ^*
20-Intravenous hyperalimentation	No	33(97.1)	390(100.0)	105(100.0)	0.063 ^*
21-Enteral feeding	Yes	5(14.7)	60(15.4)	12(11.4)	0.594 ^†
21-Enteral feeding	No	29(85.3)	330(84.6)	93(88.6)	0.594 ^†
22-Specific interventions in the unit	Yes	7(20.6)	51(13.1)	14(13.3)	0.470 ^†
22-Specific interventions in the unit	No	27(79.4)	339(86.9)	91(86.7)	0.470 ^†
23-Specific interventions outside the unit	Yes	8(23.5)	89(22.8)	25(23.8)	0.975 ^†
23-Specific interventions outside the unit	No	26(76.5)	301(77.2)	80(76.2)	0.975 ^†

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Iveth Yamaguchi Whitaker. Napoleão de Barros street, 754, 04024-002, São Paulo, SP, Brazil. iveth.whitaker@unifesp.br