Carga de trabalho, contexto organizacional e atuação da equipe de enfermagem na implementação de práticas voltadas para a segurança do paciente

Objective: To evaluate the workload and nursing staff performance in the patient safety practices implementation, on the pressure injury’s occurrence inpatients. Methodology: a single case study with two axes of comparative analysis: the care provided by nursing professionals with different types of contracts to clinical and surgical patients. Therefore, observational and prospective with mixed approach. To this end, we performed direct observation with the description, timing and analysis of work dynamics and interaction between the nursing staff and hospitalized patients. As an additional tool, we reviewed the medical records of hospitalized patients to screen the injury prevention measures used. Questionnaire application to members of the nursing team was concurrent with the observation period. The Workload Indicators of Staffing Needs (WISN) method was used to stipulate the number of staff needed as well as the current workload of the nursing staff. Also, the WISN method calculates the ratio between current staffing levels and the staffing levels proposed by its equations Results and Discussion: Three main points of direct observation and analysis of the speech of the people interviewed emerged: workload, organizational context and nursing care. It was observed that the use of Braden's predictive scale was not protocoled by the institution and was performed voluntarily by the nurses subject to the present research. The relocation of professionals, the distances between the sectors, the precarious physical and material structure, as well as communication problems were cited as problems for the effective provision of nursing care.. Based on WISN method, a ratio of 0.46 and nurses of 0.13 was found for nursing assistants, which characterizes that the current number of professionals was insufficient to deal with the workload found. Conclusion: Health care, alone, already incorporates several and complex elements that are difficult for professionals to interfere. In this way, it is necessary that the modifiable ones can be improved, thus it is expected that minimum physical and material structure, organizational context and investment in human resources are guaranteed by the health institution. It was possible to show that the pressure ulcer, along with management activities, significantly increases the workload of the nursing team. The nursing team must be seen beyond the numbers and to understand the complexity of the system in which it is inserted is vital, analyze the particular context of each microsystem and the interactions between the nursing team, among themselves and with the other members of the health and support team, is essential for the identification of critical points and the implementation of effective measures that enable the provision of quality care.