NURSING WORKLOAD: CARE PROFILE IN NEONATHOLOGY CARGA DE TRABALHO DE ENFERMAGEM: PERFIL DA ASSISTÊNCIA EM NEONATOLOGIA CARGA DE TRABAJO DE ENFERMERÍA: PERFIL DE LA ATENCIÓN EN NEONATOLOGÍA

Objective: to identify the care profile, based on the workload shown by the Nursing Activities Score (NAS), in a Neonatal Intensive Care Unit (NICU). Method: this is a descriptive and crosssectional study, with a quantitative approach, performed in the Neonatal ICU of a teaching hospital. Results: the care profile was identified through the frequency of the NAS items whose global mean value found was 56.1%. The most scored NAS items show the predominance of vital signs recording activities, schedules, calculation and regular notes of water balance; administration of nonvasoactive medications regardless of the route, hygiene procedures and support for patients and their relatives who require exclusive dedication, for about an hour, on a shift. Differences were found in the workload among the days of the week, the lowest score being 55.7 on Sunday and the highest 57.8 on Friday. Conclusion: the NAS identified the care profile in the neonatal ICU and can help nurses to adjust the sizing of staff, in addition to identifying the greatest demands in the care of their unit. Descriptors: Nursing; Workload; Neonatal Intensive Care Units; Nursing Care; Nursing Staff; Neonatology. RESUMO Objetivo: identificar o perfil assistencial, com base na carga de trabalho evidenciada pelo Nursing Activities Score (NAS), Unidade de Terapia Intensiva Neonatal (UTIN). Método: trata-se de um estudo descritivo, transversal, de abordagem quantitativa, realizado na UTI Neonatal de um hospital escola. Resultados: identificou-se o perfil assistencial por meio da frequência dos itens do NAS cujo valor médio global encontrado foi de 56,1%. Os itens do NAS mais pontuados mostram o predomínio de atividades de registro de sinais vitais, horários, cálculo e registro regular do balanço hídrico; administração de medicações não vasoativas independentemente da via, procedimentos de higiene e suporte aos pacientes e familiares que requerem dedicação exclusiva, por cerca de uma hora, em algum plantão. Encontraram-se diferenças na carga de trabalho entre os dias da semana, o menor escore pontuado foi de 55,7 no domingo e o maior de 57,8 na sexta-feira. Conclusão: o NAS identificou o perfil assistencial em UTI neonatal e pode auxiliar o enfermeiro na adequação do quantitativo de pessoal, além de identificar as maiores demandas no cuidado da sua unidade. Descritores: Enfermería; Carga de trabajo; Unidades de Cuidado Intensivo Neonatal; Atención de Enfermería; Personal de Enfermería; Neonatología. RESUMEN Objetivo: identificar el perfil de atención, a partir de la carga de trabajo evidenciada por el Nursing Activities Score (NAS), en una Unidad de Cuidados Intensivos Neonatales (UCIN). Método: se trata de un estudio descriptivo y transversal, con enfoque cuantitativo, realizado en la UCI Neonatal de un hospital escuela. Resultados: el perfil de atención se identificó mediante la frecuencia de los ítems del NAS cuyo valor promedio global encontrado fue del 56,1%. Los ítems del NAS más puntuados muestran el predominio de actividades de registro de signos vitales, horarios, cálculo y re anotación regular del balance hídrico; administración de medicamentos no vasoactivos independientemente de la vía, procedimientos de higiene y apoyo a pacientes y parientes que requieran dedicación exclusiva, durante aproximadamente una hora, en un turno. Se encontraron diferencias en la carga de trabajo entre los días de la semana, donde la puntuación más baja obtenida fue de 55,7 el domingo y la más alta de 57,8 el viernes. Conclusión: el NAS identificó el perfil de atención en la UCI neonatal y puede ayudar a los enfermeros a ajustar el número de personal, además de identificar las mayores demandas en la atención de su unidad. Descriptores: Nursing; Workload; Neonatal Intensive Care Units; Nursing Care; Nursing Staff; Neonatology. 1-6 São Paulo State University “Julio de Mesquita Filho” / UNESP. Botucatu (SP), Brazil. 1 https://orcid.org/0000-0003-47351134 2 https://orcid.org/0000-0002-3736-1665 3 https://orcid.org/0000-0002-0590-4127 4 https://orcid.org/0000-0002-7763-0524 5 https://orcid.org/0000-0003-0838-6633 6 https://orcid.org/0000-0001-9945-2928 2 Galileu College. Botucatu (SP), Brazil. 2 https://orcid.org/0000-0002-3736-1665 * Article extracted from the End-of-Course Paper << Nursing workload in a Neonatal ICU – the care profile >>. São Paulo State University “Julio de Mesquita Filho”/(UNESP), 2019. How to cite this article Midori DF, Serafim CTR, Castro MCN, Russo NC, Spiri WC, Lima SAM. Nursing workload: Care profile in neonathology. Rev enferm UFPE on line. 2021;15(2):e246921 DOI: 10.5205/1981-8963.2021.246921 The Neonatal Intensive Care Unit (NICU) is intended to serve newborns in serious or lifethreatening conditions, needing complex care and requiring high-tech equipment and devices, as well as a specialized multiprofessional team. Given the specificity required for the care of newborns, the work of the nursing team that continuously assists patients by providing direct and indirect intensive care should be highlighted, which can often generate work overload for these professionals due to the association between the clinical severity of the newborns and the constant technological evolution. Care demand indicators are increasingly necessary as requirements to ensure the quality of care. In this sense, the use of the Nursing Activities Score (NAS), an instrument to assess the workload of the nursing team, allows the assessment of the care profile of the population to which it is applied, since it encompasses 81% of the activities held by the nursing team, which are divided into seven main categories: basic activities, ventilatory support, cardiovascular support, renal support, neurological support, metabolic support and specific interventions, which are explained in 23 subitems. The NAS measures the workload of the nursing team according to the care provided during a period of 24 hours. Each activity is equivalent to a determined score, where the needs of the patients met by the team can be converted into working hours, considering that each NAS point corresponds to 14.4 minutes of care. The use of NAS is widely promoted in adult ICUs. Although its use has been expanded to other care sites, there are still few studies on its use in NICUs that show the association between nursing team’s dedication time and care complexity. In order to make the systematic calculation of employees, i.e., the nursing staff sizing, it is advantageous to work with an instrument that allows the visualization of the type and frequency of interventions performed on the patient, thus providing precision in the calculation of the nursing workload. In addition, the nurse is responsible for qualitatively and quantitatively equating his/her team, as well as providing access to instruments such as NAS, which allows correlating the care profile to the profile of the available team. The correct sizing implies the safety and quality of care provided to patients and in the health and the quality of life of nursing professionals. Accordingly, NAS can be considered as a valuable instrument for patient classification and workload assessment, thus being able to be used by the nursing staff in the NICU setting. The creation of a computer application to use the NAS showed that its application allows diagnosing the care needs of adult ICU clientele, characterizing them by analyzing the frequency of INTRODUCTION care provided described in each item of the instrument. The knowledge about the workload contributes to the nursing team in the managerial, care and research scope. In addition, it optimizes the nurse’s time when recording data collection, ensuring more time for direct patient care. For nurses in critical units, it is important to know the care profile through a nursing workload score to assess the main characteristics of care in this unit, in order to characterize patients individually and/or collectively. Accordingly, this study seeks to answer questions about the care profile of newborns admitted to a NICU, based on the Nursing Activities Score instrument. To identify the care profile, based on the workload shown by the NAS, in a NICU. This is a descriptive and cross-sectional study, with a quantitative approach, developed in a reference NICU of a Teaching Hospital in the countryside of the state of São Paulo, comprising 17 beds. All newborns admitted in the period from October 2018 to March 2019, who remained hospitalized for at least 24 hours, were included. Data collection was performed in July 2019 and was based on managerial reports generated by the institution’s computerized system. The data identified to characterize the sample were: gender, age in weeks of gestation, birth weight and days of life at admission. NAS is routinely used in the unit, at night, by a nurse on duty, duly trained in the use of the computerized system, which uses the version of NAS for the NICU setting, adapted for the institution's computerized system. NAS is a nursing workload assessment instrument, divided into 23 items, subdivided into seven categories: basic activities, ventilatory support, cardiovascular support, renal support, neurological support, metabolic support and specific interventions. Items 1, 4, 6, 7 and 8 are mutually exclusionary, and the others may or may not be scored. With different scores, according to the therapeutic interventions held, the total NAS score can reach 176.8 points, which corresponds to the percentage of time spent per the nursing team professional with the patient, where each point corresponds to 14.4 minutes. Thus, a patient with a score of 100 needs 100% of the working time of a nursing professional in 24 hours, i.e., a professional must serve a maximum of two patients with a NAS score less than or equal to 50%. Data were transferred to an Excel® database, Windows 2010 version, and the results were submitted to descriptive statistics of relative, absolute and mean frequenc