Interrupções no trabalho do enfermeiro e sus interferências na segurança do paciente

Abstract

Objective: This is a cross-sectional, observational quantitative study, whose objective was to analyze the interruptions in the primary activities of nurses at an Emergency Care Unit at a university hospital in Minas Gerais. Method: There were 40 nurses participating in the study, from both day and night shifts, who worked in the unit. Data collection was performed from June 8th to July 23rd, 2018, through the direct non-participant observation of interruptions in nurses primary activities, after approval of the Research Ethics Committee and the hospital. The descriptive analysis was done using Microsoft Excel. In addition to that, it was performed absolute and relative frequency distribution. Results: During the 113.2 hours of data collection, 736 primary activities were observed, being: 277 (37.6%) of indirect care to the patient; 211 (28.7%) of direct care; 144 (19.6%) of administrative activities; 99 (13.5%) of personal activities; and 5 (0.7%) of teaching and research activities. Regarding the time of interruptions, it was found that nurses spent more time during indirect care (34.9%). Of the 736 activities, 426 (57.9%) were interrupted, with an average of 1.8 interruptions per primary activity, at a total of 1,334 occurrences (11.8 interruptions per hour). The indirect care was the most interrupted (53.5%), followed by direct care (29.8%), administrative activity (13.2%) and personal activity (3.5%). The activity with the highest number of interruptions was the nursing record (28.1%), followed by patient evaluation (13.7%), and procedures or patient care (10.6%). The interruptions corresponded to 41% of nurses' work time during the observation period. The median duration of interrupted primary activities was eight minutes and the non-interrupted was 2.5 minutes. The number of interruptions was higher in the morning shift (36%), but the duration of interruptions was higher at the night shift (34.1%). The main sources of interruptions were the nursing team (40.6%) and self-interruption (13.3%), being the sources that most demanded the nurses' time, 41.2% and 12.3%, respectively. Regarding the reasons for the interruptions, the most frequent were those related to the patient (31%), administrative (24%), personal (18%), help (17%), environment (8%) and teaching and research (2%). The main reasons were providing and receive information related to the patient (18.1%), parallel conversation (12.5%) and alarms (6.1%). The reason that most consumed the nurse's time was the parallel conversation (32.3%). After the occurrence of interruptions, the nurses did not return to primary activity in 1.8% of the cases, being necessary to attend from one to 30 interruptions before returning to the initial activity. When comparing the frequency of interruptions of the Emergency Care Subunits and the Intensive Care Unit of the Emergency Care Unit, it was observed that the second corresponded to 54% of the interruptions, besides representing 61.5% of the total time of the interruptions. Conclusion: The knowledge of the interruptions in the work of the nurse can contribute to list interruptions that promote patient safety and those that generate problems for concentration and interfere in the quality of care and in the patient safety. The professional should stick to the activity in execution and evaluate the pertinence of the intervention according to the situation.