Nursing care assessment on the perspective of patient safety in intensive care UNITS: perception of nurses, family members and patients

Technological advances combined with healthcare assistance bring increased risks related to patient safety, causing health institutions to be environments susceptible to losses in the provided care. Sectors of high complexity, such as Intensive Care Units have such characteristics highlighted due to being spaces designed for the care of patients in serious medical condition, when the use of advanced technological devices becomes a necessity. Thus, the aim of this study was to assess nursing care from the perspective of patient safety in intensive care units. This is an evaluative research, which combines various forms of data collection and analysis in order to conduct a deepened investigation. Data collection occurred in loco, from April to July 2014 in hospitals equipped with adult intensive care unit services. For this, a checklist instrument and semi-structured interviews conducted with patients, families, professionals were used in order to evaluate the structure-process-outcome triad. The instrument for nursing care assessment regarding Patient Safety included 97 questions related to structure and processes. Interviews provided data for outcome analysis. The selection of interviewees/participants was based on the willingness of potential participants. The following methods were used to collect data resulting from the instrument: statistical analysis of inter-rater reliability measure known as kappa (K); observations from judges resulting from the observation process; and added information obtained from the literature on the thematic. Data analysis from the interviews was carried out with IRAMUTEQ software, which used Descending Hierarchical Classification and Similarity analysis to aid in data interpretation. Research steps followed the ethical principles presented by Resolution No. 466 of December 12, 2012, and the results were presented in three manuscripts: 1) Evaluation of patient safety in Intensive Care Units: a focus on structure; 2) Health evaluation processes: a nursing care perspective on patient safety; 3) Patient safety in intensive care units: perception of nurses, family members and patients. The first article, related to the structure, refers to the use of 24 items of the employed instrument, showing that most of the findings were not aligned with the adequacy standards, which indicates poor conditions in structures offered in health services. The second article provides an analysis of the pillar of Processes, with the use of 73 items of the instrument, showing that 50 items did not meet the required standards for safe handling due to the absence of adequate scientific guidance and effective communication in nursing care process. For the third article, results indicate that intensive care units were safe places, yet urges for changes, especially in the physical structure and availability of materials and communication among professionals, patients and families. Therefore, our findings suggest that the nursing care being provided in the evaluated intensive care units contains troubling shortcomings with regards to patient safety, thereby evidencing an insecure setting for the assistance offered, in addition to a need for urgent measures to remedy the identified inadequacies with appropriate structures and implement protocols and care guidelines in order to consolidate an environment more favorable to patient safety.A evolução tecnológica combinada à assistência em saúde proporciona o aumento nos riscos relacionados à segurança do paciente, que torna as instituições de saúde ambientes passíveis e prováveis de prejuízos no cuidado ofertado. Os setores de alta complexidade, como as Unidades de Terapia Intensiva, possuem tais características destacadas, pois esses espaços têm por objetivo cuidar de pacientes em condições clínicas graves quando o uso de aparatos tecnológicos avançados torna-se uma necessidade. Diante disso, o objetivo desse estudo foi avaliar o cuidado de enfermagem na perspectiva da segurança do paciente em Unidades de Terapia Intensiva. Trata-se de uma pesquisa avaliativa, quanti-qualitativa, que combina formas diferentes de coleta de dados, a saber: observação, aplicação de instrumento de avaliação e entrevista semiestruturada com pacientes, familiares e profissionais, avaliando, assim, a tríade estrutura-processo-resultado do cuidado em enfermagem nas Unidades de Terapia Intensiva. A coleta de dados ocorreu entre abril e julho de 2014, em Unidades de Terapia Intensiva. Para a parte quantitativa (estrutura e processos) foi utilizado a análise estatística da medida de concordância interobservador denominada Kappa (K), e para a parte qualitativa (entrevistas) a técnica de interpretação dos dados deu-se com auxílio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires (IRAMUTEQ). Os resultados da análise da “estrutura” e “processos” demonstrou que a maioria dos achados se encontrava fora dos padrões de adequação, o que aponta condições precárias nas estruturas e, processos incipientes nos serviços de saúde. Os “resultados” indicam que as Unidades de Terapia Intensiva são locais seguros, contudo urgem por mudanças, principalmente na estrutura física e na disponibilidade de materiais. Portanto, aponta-se que o cuidado de Enfermagem desenvolvido nas unidades de terapia intensiva avaliadas contém falhas preocupantes com relação à segurança do paciente, o que evidencia um quadro de insegurança na assistência ofertada e a necessidade de intervenções urgentes no sentido de corrigir as não adequações apontadas, proporcionando estruturas apropriadas e implantação de protocolos e diretrizes de cuidado, para que se consolide um ambiente propicio a segurança do paciente