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Nursing Team Workload and the Apache Index of Gravity of Patients Post Liver Transplantation: A Cohort Study
Andresa Thomé Silveira1, Raquel Hohenreuther1, Natália Perin Schmidt2
1Hepatology Postgraduation Program of Federal University of Health Sciences of Porto Alegre (UFCSPA), RS, Brazil.
Background:
Liver transplantation is a complex treatment that demands a high workload from the nursing team. This study evaluated the nursing workload and its relationship with the severity of patients after liver transplantation.
Material And Methods:
A retrospective cohort study, with a review of 286 medical records of liver transplant patients from January 2014 to June 2018 in a hospital in southern Brazil was performed. Demographic and clinical characteristics were analyzed, as well as the outcome and the scores Model for End-Stage Liver Disease (MELD), Nursing Activity Score (NAS), and Acute Physiology and Chronic Health Evaluation IV (APACHE IV).
Results:
Men represented 68.9% of the sample, the mean age was 57.6 years (±10), and the MELD and APACHE IV scores respectively showed means of 24.3 (±5.6) and 58.9 (±23.7). The length of stay in the intensive care unit was 5 days (range, 3-7) and mortality was 9.1%. There was a gradual reduction in the mean NAS in 24 hours (94.9 ± 18.5), 48 hours (87.2 ± 17.0), 72 hours (83.3 ± 19.6) and at discharge (82.3 ± 18.0). Associations of NAS with MELD (P ˂ .05), APACHE IV (P ˂ .001), length of stay in the intensive care unit (P ˂ .001), and death outcome (P ˂ .001) were observed. The greatest workload was in checking vital signs, water balance, and administrative tasks (P ˂ .001).
Conclusions:
The nursing workload in the postoperative period of liver transplantation exceeds what is recommended and is related to the severity of the patients.
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