Rev Esc Enferm USP2014; 48(3):537-51 www.ee.usp.br/reeusp/ RESUMEN Objetivo: Identificar los factores de riesgo para la ocurrencia de caídas en pacientes adultos hospitalizados. Método: Revisión integradora de la literatura de artículos publicados entre los años 1989 al 2012 en las bases de datos LILACS, SciElO, MEDLINE y Web of Science. Resultados: La muestra final estuvo compuesta por setenta y un artículos. Entre los factores de riesgo de caídas indicados en esta revisión están los relacionados con el paciente (intrínsecos), con el ambiente hospitalario y con el proceso de trabajo de los profesionales de la salud, especialmente enfermería (extrínse-cos). Conclusión: La detección sistemática de factores de riesgo asociados a caídas fue identificada como un factor que contribuye a la reducción de este daño, favoreciendo de esta manera su no ocurrencia, la que a pesar de ser prevenible puede acarrear consecuencias graves, incluyendo la muerte. DESCRIPTORESAccidentes por caídas Pacientes interno Hospitalización Seguridad del paciente Atención de enfermeira Revisión RESUMOObjetivo: Identificar os fatores de risco para a ocorrência de quedas em pacientes adultos hospitalizados. Método: Revisão integrativa realizada nas bases de dados LILACS, SciELO, MEDLINE e Web of Science, abrangendo artigos publicados entre 1989 e 2012. Resultados: Setenta e um artigos compuseram a amostra final do estudo. Os fatores de risco para quedas apresentados nesta revisão foram relacionados ao paciente (intrínsecos), ao ambiente hospitalar e ao processo de trabalho dos profissionais da saúde, em especial à enfermagem (extrínsecos). Conclusão: A triagem sistemática de fatores de risco para queda foi identificada como fator contribuinte para a redução desse agravo, auxiliando a não ocorrência deste evento que, apesar de ser prevenível, pode determinar consequên-cias graves incluindo o óbito. DESCRITORES Acidentes por quedas Pacientes internados Hospitalização Segurança do paciente Cuidados de enfermagem Revisão ABSTRACTObjective: Identifying risk factors for the occurrence of falls in hospitalized adult patients. Method: Integrative review carried out in the databases of LILACS, SciELO, ME-DLINE and Web of Science, including articles published between 1989 and 2012. Results: Seventy-one articles were included in the final sample. Risk factors for falls presented in this review were related to patients (intrinsic), the hospital setting and the working process of health professionals, especially in nursing (extrinsic). Conclusion: The systematic screening of risk factors for falls was identified as a contributing factor to the reduction of this injury, helping the nonoccurrence of this event that, despite being preventable, can have serious consequences including death. DESCRIPTORS

ObjectiveTo estimate the prevalence of burnout in intensivist doctors working in adult, pediatric and neonatal intensive care units in five Brazilian capitals.MethodsDescriptive epidemiological study with a random sample stratified by conglomerate with 180 intensivist doctors from five capitals representing the Brazilian geographic regions: Porto Alegre (RS), Sao Paulo (SP), Salvador (BA), Goiania (GO) and Belem (PA). A self-administered questionnaire examining sociodemographic data and the level of burnout was evaluated through the Maslach Burnout Inventory.ResultsA total of 180 doctors were evaluated, of which 54.4% were female. The average age was 39 ± 8.1 years, 63.4% had specialization as the highest degree, 55.7% had up to 10 years of work experience in an intensive care unit, and 46.1% had the title intensive care specialist. Most (50.3%) had weekly workloads between 49 and 72 hours, and the most frequent employee type was salaried. High levels of emotional exhaustion, depersonalization and inefficacy were found (50.6%, 26.1% and 15.0%, respectively). The prevalence of burnout was 61.7% when considering a high level in at least one dimension and 5% with a high level in three dimensions simultaneously.ConclusionA high prevalence of burnout syndrome among intensivist doctors was observed. Strategies for the promotion and protection of health in these workers must be discussed and implemented in hospitals.

Objective:to identify risk factors for falls in hospitalized adult patients. Methods:a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0. Results:risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01]. Conclusion:risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and positively influences patient safety.

Objective: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument.Method: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012.Results: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts.Conclusion: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.

Aim:To develop and validate a predictive model for falls in hospitalized adult clinical and surgical patients, assessing intrinsic (i.e. patient-related) and extrinsic factors (i.e. care process-related). Background:To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand patient and environmental factors, along with care delivery processes. Design:A matched case-control study. Methods:This study was conducted in the medical and surgical wards of a Brazilian teaching hospital. The sample included 536 patients, with data collected in 2013- Data analysis included descriptive statistics and conditional logistic regression.Cases of patients aged 18 years or older who fell while hospitalized were included.One patient who did not fall during hospitalization, matched by sex, ward and admission date, was selected as a control for each included case. Results: The SAK Fall Scale (Severo-Almeida-Kuchenbecker) was developed and validated. The scale includes seven variables: disorientation/confusion, frequent urination, walking limitations, lack of caregiver, postoperative status, previous falls and number of medications administered within 72 hr prior to the fall. This scale showed acceptable predictive accuracy. Conclusions: The newly developed SAK Fall Scale includes five intrinsic and two extrinsic variables and differs from other predictive scales for falls. The findings of this study are broad and the scale, which is easy to apply, can be used worldwide by nurses in health services. In advanced practice, the testing of a new model for fall risk contributes to preventive interventions and thus has an impact on patient safety. K E Y W O R D S adult, advanced practice, falls, nurses, patient safety, risk management *Member of the Study Group on Adult and Elderly Care -GEPECADI -CNPq.• The study gives data for a new prediction model that should be used to predict fall risk.• The findings should be used to support the care and safety of hospitalized clinical and surgical patients. 564 | SEVERO ET AL.