RELATI ON BETW EEN STRESSORS AND SOCI ODEMOGRAPHI C AND CLI NI CAL
CHARACTERI STI CS OF PATI ENTS HOSPI TALI ZED AT A CORONARY UNI T
1Car in a Apar ecida Mar ost i2 Rosana Apar ecida Spadot i Dant as3
Mar ost i CA, Dan t as RAS. Relat ion b et w een st r essor s an d sociod em og r ap h ic an d clin ical ch ar act er ist ics of pat ient s hospit alized at a cor onar y unit . Rev Lat ino- am Enfer m agem 2006 set em br o- out ubr o; 14( 5) : 713- 9.
This descr ipt ive st udy aim ed t o cor r elat e t he st ressor s of pat ient s hospit alized at a cor onar y car e unit and t heir sociodem ogr aphic and clinical char act er ist ics. We int er view ed 43 pat ient s w ho w er e hospit alized at a large hospit al. The st ressors were evaluat ed by m eans of a 4- point Likert scale, which m easured st ress int ensit y f o r 4 2 p o ssi b l e st r e sso r s, r a n g i n g f r o m 1 ( n o t st r e ssf u l ) t o 4 ( v e r y st r e ssf u l ) . W e co l l e ct e d d a t a o n sociodem ogr aph ic an d clin ical ch ar act er ist ics an d abou t t h e cor on ar y u n it . Dat a w er e an aly zed t h r ou gh n on param et rical st at ist ics, using Mann- Whit ney, Kruskal- Wallis and Spearm an’s correlat ion t est . A 0.05 significance l e v e l w a s a d o p t e d . Gr e a t e r s t r e s s w a s f o u n d a m o n g y o u n g e r f e m a l e p a t i e n t s w h o d i d n o t r e c e i v e psy ch ot h er apeu t ic m edicat ion , in clu din g t h e pr esen ce of m or e t h an t w o pieces of equ ipm en t an d n o ear lier hospit alizat ion at t his kind of int ensive t her apy unit .
DESCRI PTORS: st r ess; int ensiv e car e unit s; car diov ascular diseases
RELACI ÓN ENTRE ESTRESORES Y CARACTERÍ STI CAS SOCI ODEMOGRÁFI CAS Y
CLÍ NI CAS DE PACI ENTES I NTERNADOS EN UNA UNI DAD CORONARI A
La finalidad de est e est udio descript ivo fue est ablecer correlación ent re los est resores de los pacient es in t er n ados en u n a u n idad cor on ar ia y su s car act er íst icas sociodem ogr áf icas y clín icas. En t r ev ist am os a 4 3 individuos int er nados en un hospit al de gr an por t e. Par a la evaluación de los est r esor es ut ilizam os una escala Likert de 4 punt os que evaluó la int ensidad del est rés para 42 posibles est resores, variando de 1 ( no est resant e) a 4 ( m u y est r esan t e) . Recopilam os dat os par a la car act er ización sociodem ogr áfica y clín ica y r espect o a la unidad coronaria. Para el análisis de los dat os ut ilizam os la est adíst ica no param ét rica, con los t est s de Mann-Whit ney y de Kr usk al Wallis y el t est de cor r elación de Spear m an. El niv el de significancia adopt ado fue de 0 , 0 5 . Con st at am os m ay or est r és en t r e los p acien t es m ás j óv en es, d el sex o f em en in o, n o m ed icad os con psicot erápicos, con presencia de m ás de dos equipam ient os y sin int ernación ant erior en est e t ipo de unidad de t er apia in t en siv a.
DESCRI PTORES: est r és; u n idades de t er apia in t en siv a; en fer m edades car diov ascu lar es
RELAÇÃO ENTRE ESTRESSORES E CARACTERÍ STI CAS SÓCI O- DEMOGRÁFI CAS E
CLÍ NI CAS DE PACI ENTES I NTERNADOS EM UMA UNI DADE CORONARI ANA
Est udo descr it ivo, r ealizado com obj et ivo de cor r elacionar os est r essor es dos pacient es int er nados em um a unidade coronariana com suas caract eríst icas sociodem ográficas e clínicas. Foram ent revist ados 43 indivíduos int ernados em um hospit al de grande port e. Para a avaliação dos est ressores, foi ut ilizada escala t ipo Likert de 4 pont os que avaliou a int ensidade do est resse para 42 possíveis est ressores, variando de 1 ( não est ressant e) a 4 ( m uit o est r essant e) . For am colet ados dados par a a car act er ização sociodem ogr áfica, clínica e r elat iv os à unidade cor onar iana. Par a análise dos dados foi ut ilizada est at íst ica não- par am ét r ica com os t est es de Mann-Whit ney e de Kr uskal Wallis e t est e de cor r elação de Spear m an. O nív el de significância adot ado foi de 0,05. Co n st a t o u - se m a i o r e st r e sse e n t r e o s p a ci e n t e s m a i s j o v e n s, d o se x o f e m i n i n o , n ã o m e d i ca d o s co m psicot er ápicos, com pr esença de m ais de dois equipam ent os e sem int er nação ant er ior nesse t ipo de unidade de t r at am ent o int ensiv o.
DESCRI TORES: est r esse; unidades de t er apia int ensiv a; doenças car diov ascular es
1
Paper ext ract ed from course m onograph; 2 RN, Ribeirão Pret o Clinical Hospit al., e- m ail: m arost i@zipm ail.com .br; 3 Ph.D., RN. Assist ant Professor, e- m ail: rsdant [email protected]. Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent
714
Relat ion bet ween st ressors...Marost i CA, Dant as RAS.
Rev Lat ino- am Enferm agem 2006 set em bro- out ubro; 14( 5) : 713- 9 w w w .eer p.usp.br / r lae
I NTRODUCTI ON
T
h e Co r o n a r y Ca r e Un i t ( CCU) i s a ca r e ar ea f or car d iac p at ien t s w it h a p ar t icu lar p h y sicaldesign and a lar ge v ar iet y of equipm ent , in or der t o
guarant ee care in crit ical healt h condit ions. The st im uli
present in t his unit ’s physical and social environm ent
can b e sou r ces of st r ess t o p at ien t s, su ch as, f or
ex am p le: sid e- b y - sid e p lacem en t of b ed s, so t h at
p at i en t p ar t i ci p at e i n w h at i s h ap p en i n g w i t h t h e
n e i g h b o r i n g p a t i e n t ; c o n s t a n t e x p e c t a t i o n o f
em er g en ci es; i n t er r u p t i o n o f r o u t i n e act i v i t i es b y
“ m edical ur gencies” ; pr esence of equipm ent close t o
b ed s; ar t if icial an d p er m an en t lu m in osit y ; ab sen ce
of windows, at m ost unit s, t hat allow pat ient s t o follow
t he t im e of day; exist ence of sound and light alarm s
fr om apparat us( 1). Mor eover, pat ient s lose pr ivacy, as
m en and wom en are placed in t he sam e environm ent .
Ot h e r d i sco m f o r t s a r e ca u se d b y t h e co n t i n u o u s
m on i t or i n g of v i t al si g n s an d car d i ac act i v i t y, t h e
absen ce of an y t y pe of r ecr eat ion for pat ien t s, an d
subsequent int er vent ions by t he m edical and nur sing
t eam s( 1 ).
St ressors are defined as st im uli t hat precede
or pr ecipit at e ch an ge, and ar e classified as int er nal
or ex t er n al. Resp on ses t o st r ess ar e in f lu en ced b y
t he int ensit y, durat ion and environm ent of t he st ress,
as w ell as by t he num ber of st r essor s pr esent at a
specific m om ent( 2). I t has been suspect ed for a long
t i m e t h at acu t e an d ch r o n i c m en t al st r ess st at es
co n st i t u t e r i sk f a ct o r s f o r h i g h e r m o r b i d i t y a n d
m or t alit y lev els due t o car diov ascular diseases( 3 ).
Care delivery t o cardiac pat ient s hospit alized
a t co r o n a r y u n i t s i s a i m e d a t d e t e ct i n g p o ssi b l e
co m p l i cat i o n s d er i v i n g f r o m t h e cl i n i cal si t u at i o n ,
r e e s t a b l i s h i n g h e m o d y n a m i c s a n d f a v o r i n g t h e
pat ien t s’ r ecov er y. Un der st an din g h ow pat ien t s f eel
can help nurses and t heir t eam t o define st ressors at
t he unit , t hus st im ulat ing t he const ruct ion of prot ocols
t o t ur n t he sect or m or e adequat e and pleasant( 4).
Du e t o t h eir com plex it y, cor on ar y u n it s ar e
consider ed int ensiv e t herapy cent er s. Var ious st udies
hav e inv est igat ed st r ess am ong pat ient s hospit alized
at t hese unit s( 4- 5). The im port ance of assessing st ress
dur ing hospit alizat ion, w it h a focus on pat ient s w it h
h ear t diseases, is based on all of t h e ph y siological
a l t er a t i o n s, m a i n l y i n t h e ca r d i o v a scu l a r sy st em ,
caused by st r ess. Thus, elim inat ing sour ces of st r ess
m ean s g u ar an t eein g a b et t er r ecov er y f or car d iac
pat ient s hospit alized at cor onar y unit s.
As n o specif ic st u dies h av e been pu blish ed
t o assess st ress at coronary unit s, we based ourselves
on exist ing lit erat ure about st ress at int ensive t herapy
cent ers. We found t hat t he hum anizat ion of t hese unit s
is closely linked wit h healt h professionals’ act ion upon
s t r e s s o r s( 6 ). N u r s i n g c a r e i s t h e k e y p o i n t i n
h o sp i t a l i za t i o n a t t h e se u n i t s, a s i t p e r m i t s t h e
est ablishm ent of relat ions t hat cont ribut e t o t he relief
of st r essor s for pat ient s and t heir r elat iv es( 7).
One im por t ant point som e r esear cher s hav e
highlight ed is t he ex ist ing differ ence in how pat ient s
an d n u r si n g p r o f essi o n al s p er cei v e st r esso r s( 5 , 8 - 9 ).
Nurses t end t o classify st ressors as m ore int ense and
consider t he follow ing as t he m ain sources of st ress:
feeling pain, having t ubes in t he nose and/ or m out h,
b ein g t ied u p b y t u b es, n ot r eceiv in g ex p lan at ion s
a b o u t t r ea t m en t a n d n o t m a n a g i n g t o sl eep( 6 , 1 0 ).
Pat ient s, on t he ot her hand, indicat e t he following as
t he m ost st ressful fact ors: feeling pain, not m anaging
t o sleep, having t ubes in t he nose and/ or m out h and
not hav ing cont r ol ov er oneself( 6).
Ther efor e, t his st udy aim ed t o obser v e how
s t r e s s e x p e r i e n c e d b y p e o p l e h o s p i t a l i z e d a t a
cor on ar y u n it an d t h ese pat ien t s’ sociodem ogr aph ic
an d cl i n i cal v ar i ab l es, as w el l as asp ect s o f t h ei r
hospit alizat ion at t he CCU.
OBJECTI VES
- Correlat e st ress referred by pat ient s hospit alized at
t h e CCU w i t h t h ei r so ci o d em o g r ap h i c an d cl i n i cal
ch ar act er ist ics;
- Cor r elat e st r ess r efer r ed by pat ient s w it h v ar iables
relat ed t o t he environm ent of t he Coronary Care Unit .
METHODOLOGY
Th i s d e scr i p t i v e , co r r e l a t i o n a l a n d cr o
ss-se ct i o n a l st u d y w a s ca r r i e d o u t a t t h e CCU o f a
t eaching hospit al locat ed in t he int er ior of São Paulo
St at e, Br azil. Dur ing t he st udy per iod, bet w een May
and Sept em ber 2004, 171 pat ient s w er e hospit alized
at t his unit . On ly 9 9 of t h ese com plied w it h on e of
t he inclusion cr it er ia, i. e. hospit alizat ion at t he CCU
for at least 48 hour s. This cr it er ion w as st ipulat ed t o
gu ar an t ee t h at pat ien t s cou ld spen d su f f icien t t im e
t h e s t r e s s a s s e s s m e n t i n s t r u m e n t . Of t h e s e 9 9
pat ient s, t hr ee passed aw ay, r esult ing in 96 pot ent ial
p a r t i ci p a n t s. Th en , w e co n st i t u t ed a co n v en i en ce
sam ple w it h 43 pat ient s w ho com plied w it h t he ot her
inclusion cr it er ia: age ov er 21; clinical ( phy sical and
p sy ch olog ical) con d it ion s t o b e in t er v iew ed b y t h e
r e se a r ch e r s a n d a g r e e m e n t t o p a r t i ci p a t e i n t h e
st u d y.
Th e pr oj ect w as appr ov ed by t h e Resear ch
Et h ics Com m it t ee at t h e st u d y h osp it al. Th e st u d y
p a r t i c i p a n t s w e r e p r o p e r l y i n f o r m e d a b o u t t h e
research, bot h orally and in writ ing. Bot h pat ient s and
r esear cher s signed t he infor m ed consent t er m .
D a t a w e r e c o l l e c t e d t h r o u g h i n d i v i d u a l
int erviews wit h pat ient s during t heir hospit alizat ion at
t h e CCU. A l t h o u g h t h e r e s e a r c h e r s o f f e r e d t h e
possibilit y for pat ient s t o fill out t he dat a collect ion
in st r u m en t t h em selv es, on ly f ou r of t h em ( 1 0 . 7 % )
act ually did t his. Most of t hem did not m anage t o fill
out t he inst rum ent due t o physical ( deficient sight ) or
cognit ive difficult ies ( not knowing how t o read and/ or
w r i t e ) , a n d w e r e i n t e r v i e w e d b y o n e o f t h e
r esear ch er s.
The dat a collect ion inst r um ent addr essed t he
f o l l o w i n g s o c i o d e m o g r a p h i c v a r i a b l e s : g e n d e r
( fem ale or m ale) ; civ il st at us ( m ar r ied or liv ing w it h
so m e b o d y, si n g l e , w i d o w e d , d i su n i t e d / d i v o r ce d ) ;
e d u c a t i o n ( y e a r s a t e d u c a t i o n i n s t i t u t i o n s ) ;
p r of ession al sit u at ion ( act iv e, r et ir ed , r et ir ed w it h
p a i d a ct i v i t i es, a t h o m e, u n em p l o y ed / t em p o r a r i l y
suspended fr om w or k ) . Age w as calculat ed by m eans
of t h e pat ien t ’s bir t h dat e an d in t er v iew dat e. Th e
follow ing clinical dat a w er e collect ed fr om t he pat ient ’s
m edical file: m edical diagnosis( es) w hen hospit alized
at t h e CCU an d m ed i cat i o n p r escr i b ed d u r i n g t h e
last 24 hour s.
Ot her relevant dat a included in dat a collect ion
were: exist ence of previous hospit alizat ion experience
at an int ensive t herapy unit ( yes or no) and num ber
of previous hospit alizat ions, bed occupied at t he CCU
a n d p r e s e n c e o f e q u i p m e n t / d e v i c e s d u r i n g
h o sp i t a l i za t i o n ( o r a l / n a so g a st r i c ca t h et er, u r i n a r y
cat h et er, v en ipu n ct u r e, ar t er ial pu n ct u r e, r espirat or,
or al/ n asot r ach eal t u b e, h ear t m on it or, in t r a - aor t ic
b alloon ) .
T h e I n t e n s i v e Ca r e S t r e s s o r s S c a l e
( I CSS)( 8,11) w as applied for st r ess assessm ent , using
t he v er sion t r anslat ed and v alidat ed for Por t uguese( 5).
The I CSS consist s of 42 quest ions and it s aim is t o
ident ify fact or s causing st r ess in pat ient s hospit alized
in int ensiv e t her apy unit s. This is a four - point Lik er t
scal e, i n w h i ch ( 1 ) m ean s n o t st r essf u l , ( 2 ) l i t t l e
st r essful, ( 3) st r essful and ( 4) v er y st r essful. Result s
ar e assessed b y ad d in g u p t h e scor es f or each of
t he 42 it em s, r anging fr om 42 t o 168. The higher t he
t ot al scor e, t he gr eat er t he st r ess per ceiv ed by t he
p at ien t .
Dat a w er e pr ocessed an d an aly zed t h r ou gh
St at ist ical Package for Social Science ( SPSS) soft ware,
v er sion 1 3 . 0 . To v isu alize t h e r elat ion bet w een t h e
v a r i a b l e o f i n t e r e s t ( s t r e s s o r s a t t h e CCU) a n d
c a t e g o r i c a l v a r i a b l e s ( e . g . : g e n d e r, u s e o f
psy chot her apeut ic m edicat ion, fir st hospit alizat ion at
t h e CCU, p r esen ce of eq u ip m en t an d b ed n u m b er
occupied at t he CCU) , boxplot graphs were developed
f o r t h e v i su al i n sp ect i o n o f v ar i ab l es ( g r ap h s n o t
included in t he m anuscr ipt ) .
To t est for possible differ ences bet w een t w o
g r ou p s i n r el at i on t o t h e v ar i ab l e of i n t er est , i . e.
st ressors at t he CCU, Mann- Whit ney’s non- param et ric
t est s were used. For exam ple: gender ( m ale/ fem ale) ;
u se of psy ch ot h er apeu t ic m edicat ion ( y es/ n o) ; f ir st
h o sp i t a l i z a t i o n a t t h e CCU ( y e s/ n o ) ; n u m b e r o f
equipm ent used ( unt il t w o, m or e t han t w o) . Kr usk al
Wallis was used t o t est for differences bet ween t hree
or m or e gr oups, lik e for t he v ar iable bed num ber at
t h e CCU ( beds 1 , 2 , 3 , 4 an d 5 ) . Spear m an ’s n on
-param et ric correlat ion t est was applied t o analyze t he
r elat ion b et w een st r ess scor e an d p at ien t s’ ag e. A
0. 05 significance lev el w as adopt ed.
RESULTS
Ta b l e 1 p r e s e n t s t h e 4 3 p a r t i c i p a n t s ’
sociodem ogr aphic char act er ist ics. Pat ient s’ m ean age
was 56 years ( SD= 11.9) , ranging from 21 t o 78 years.
Most p at ien t s w er e m en ( 3 1 p at ien t s; 7 2 . 1 % ) , 2 4
p at ien t s ( 5 5 . 8 % ) w er e m ar r ied an d eig h t w id ow ed
( 18.6% ) . Only 14 ( 32.6% ) pat ient s were professionally
act ive at t he t im e of hospit alizat ion; t he ot hers w ere
r et i r ed ( 1 8 ; 4 1 . 9 % ) , w o r k ed at h o m e ( 2 ; 4 . 7 % ) ,
ret ired wit h paid work ( 7.0% ) , t em porarily suspended
due t o healt h problem ( 9.3% ) or unem ployed ( 4.7% ) .
On ly sev en ( 1 6 . 3 % ) pat ien t s possessed m or e t h an
eight years of form al educat ion, which can j ust ify t he
sm all num ber of pat ient s who filled out t he inst rum ent s
716
Ta b l e 1 - So c i o d e m o g r a p h i c c h a r a c t e r i z a t i o n o f
par t icipant s. Ribeir ão Pr et o, 2005.
f iv e ex ist in g beds an d t h e dist r ibu t ion of t h e st u dy
par t icipan t s acr oss t h e beds t h ey w er e h ospit alized
in . Most in t er v iew ees occu pied bed 3 ( 1 2 pat ien t s;
27.9% ) dur ing hospit alizat ion, follow ed by bed 1 ( 9;
20.9% ) , bed 5 ( 8; 18.6% ) , bed 2 ( 7; 16.3% ) and bed
4 ( 7; 16.3% ) . ) 3 4 = N ( e l b a i r a
V Interval Median Mean ) D S
( N(%)
) s r a e y ( e g
A 21-78 58,2 56,73
) 9 , 1 1 ( ) s r a e y ( n o i t a c u d
E 0-18 4,0 5,0(4,1) s r a e y 4 li t n
U 27(62,8)
s r a e y 8 d n a 5 n e e w t e
B 9(20,9)
s r a e y 1 1 d n a 9 n e e w t e
B 4(9,3)
s r a e y 2 1 n a h t e r o
M 3(7,0)
r e d n e G e l a m e
F 12(27,9)
e l a
M 31(72,1)
s u t a t S l i v i C d e i r r a
M 24(55,8)
e l g n i
S 6(14,0)
d e w o d i
W 8(18,6)
d e c r o v i d / d e t i n u s i
D 5(11,6)
n o i t a u t i S l a n o i s s e f o r P e v it c
A 14(32,6)
d e r it e
R 18(41,9)
s e it i v it c a d i a p h t i w d e r it e
R 3(7,0)
d e i r a l a S e m o h t
A 2(4,7)
d e y o l p m e n
U 2(4,7)
o t e u d d e d n e p s u s y li r a r o p m e T m e l b o r p h tl a e
h 4(9,3)
Part icipant s’ clinical charact erist ics are shown
in Table 2. The m ost frequent diagnosis at t he m om ent
of hospit alizat ion was Acut e Myocardial I nfarct ion ( 23;
53.5% ) , followed by angina ( 11; 25.6% ) . We included
t h e u se of p sy ch ot r op ic m ed icat ion on t h e m ed ical
p r e scr i p t i o n , o n t h e d a y t h e i n t e r v i e w w a s h e l d ,
b e ca u se t h e u se o f t h e se d r u g s co u l d a f f e ct t h e
p a t i e n t ’ s p e r ce p t i o n a b o u t t h e st r e ss ca u se d b y
hospit alizat ion. Thir t y - one pat ient s ( 72. 1% ) had not
r eceiv ed any psy chot r opic dr ug dur ing t he 24 hour s
befor e t he int er v iew .
Tab l e 2 - Cl i n i cal ch ar act er i zat i o n o f p ar t i ci p an t s.
Ribeir ão Pr et o, 2005.
) 3 4 = N ( e l b a i r a
V N(%)
d e z i l a t i p s o h n e h w s i s o n g a i D n o it c r a f n I l a i d r a c o y M e t u c
A 23(53,5)
s i r o t c e p a n i g n
A 11(25,6)
a m e d E g n u L e t u c
A 2(4,7)
e r u li a F t r a e H d e t a s n e p m o c e
D 3(7,0)
s r e h t
O 4(9,3)
n o i t a c i d e m c i p o r t o h c y s p f o e s U s e
Y 12(27,9)
o
N 31(72,1)
The locat ion of beds at t he CCU under st udy
was consider ed a possible st r essor, because it places
pat ien t s in m or e u n f av or able sit u at ion s in t er m s of
v isualizing ot her pat ient s and t he bed’s pr ox im it y t o
t he door, so t hat pat ient s have t o t olerat e m ore noise
and lum inosit y. Figur e 1 show s t he placem ent of t he
Figure 1 - Disposit ion of beds at CCU
Th e f o l l o w i n g a sp ect s r el a t ed t o t h e CCU
e n v i r o n m e n t c a m e u p a s p o s s i b l e s t r e s s o r s f o r
pat ient s: bed at CCU, hospit alizat ion t im e, pr ev ious
hospit alizat ions at t he unit and equipm ent use. Table
3 r epr esent s t he r esult s of t hese char act er ist ics.
Ta b l e 3 - Ch a r a c t e r i z a t i o n o f p a r t i c i p a n t s ’
hospit alizat ion. Ribeir ão Pr et o, 2005.
e l b a i r a
V Interval Median Mean(SD) N(%) n o i t a z i l a t i p s o h t s r i F s e
Y 33(76,7)
o
N 10(23,3)
t a e m i t n o i t a z i l a t i p s o H n o i t c e l l o c a t a
d 2-11 3,0 2,3(1,9)
s y a d 2 0 li t n
U 19(44,2)
s y a d 5 0 o t 3 0 m o r
F 18(41,9)
s y a d 6 0 n a h t e r o
M 6(14,0)
t n e m p i u q e f o r e b m u
N 2-5 2,0 2,3(0,7)
U C C t a d e B 1 d e
B 9(20,9)
2 d e
B 7(16,3)
3 d e
B 12(27,9)
4 d e
B 7(16,3)
5 d e
B 8(18,6)
At dat a collect ion , 1 9 par t icipan t s ( 4 4 . 2 % )
had been hospit alized for t w o day s, 18 for bet w een
t hr ee and fiv e day s ( 41. 9% ) and t he ot her pat ient s
for m ore t han six days ( 14.0% ) . Thirt y- t hree ( 76.7% )
m ent ioned t his was t he first t im e t hey were hospit alized
at t he CCU or at anot her int ensiv e t her apy unit . I n
our sam ple, an average of 2.3 equipm ent s and devices
h ad been in st alled in pat ien t s ( SD = 0 . 7 ) , r an gin g Relat ion bet ween st ressors...
Marost i CA, Dant as RAS.
Rev Lat ino- am Enferm agem 2006 set em bro- out ubro; 14( 5) : 713- 9 w w w .eer p.usp.br / r lae
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$'& $'& $'& $'&
f r o m 2 t o 5 . Th e m o st f r e q u e n t e q u i p m e n t s a n d
dev ices w er e: v enipunct ur e w it h ser um t her apy and
h ear t m on it or in g , in all p at ien t s. Ot h er eq u ip m en t
included: ar t er ial punct ur e for m onit or ing or w it h an
in t r od u ct or y sh eat h f or p er cu t an eou s t r an slu m in al
cor onar y angioplast y in 7 ( 16. 3% ) pat ient s, Ur inar y
cat h et er ( 5 ; 1 1 . 6 % ) an d p r esen ce o f i n t r a- ao r t i c
balloon ( 2; 4.7% ) .
The var iable of int er est , i.e. st r essor s at t he
CCU, w as m easur ed by m eans of t he I nt ensiv e Car e
S t r e s s o r s S c a l e ( I CS S )( 8 , 1 1 ), u s i n g t h e v e r s i o n
t r anslat ed and v alidat ed for Por t uguese. Cr onbach’s
Alpha cor r esponded t o 0. 93, t hat is, t he inst r um ent
w as r eliable for use in t he st udy sam ple. I n anot her
st udy involving nurses at t he sam e t eaching hospit al,
t h e au t h or s u sed t h is scale t o assess pr ofession als’
p er cep t ion of st r ess in p at ien t s h osp it alized in an
i n t e n s i v e t h e r a p y u n i t , a n d a l s o f o u n d a h i g h
Cr onbach’s Alpha coefficient ( 0. 90)( 10).
Th e av er ag e scor e on t h e SSI T w as 7 2 . 1 1
( SD = 2 1 . 7 ) , w it h an in t er v al fr om 4 3 t o 1 3 4 . Th e
p ossib le in t er v al f or t h e scale r an g ed f r om 4 2 ( 4 2
quest ions x 1) t o 168 ( 42 x 4) . The higher t he t ot al
scor e, t he gr eat er t he st r ess per ceiv ed at t he CCU.
I n gener al, w e could also assess t he r esult s of t his
scale by analyzing t he m ean score of answers t o t he
it em s, i.e. scor e for all it em s div ided by t he num ber
of it em s, equiv alent t o 1.7 in our st udy ( SD = 0.5) ,
w it h m ean scor es r an gin g f r om 1 t o 3 . 2 . As st r ess
scor es on t h e scale ar e: ( 1 ) n ot st r essfu l, ( 2 ) lit t le
st r e ssf u l , ( 3 ) st r e ssf u l a n d ( 4 ) v e r y st r e ssf u l , i n
g e n e r a l , t h e s t u d y p a r t i c i p a n t s c o n s i d e r e d
hospit alizat ion at t he CCU as a not st ressing and lit t le
st r essin g ex per ien ce.
We u sed n on - par am et r ic st at ist ical t est s t o
v e r i f y p o ssi b l e r e l a t i o n s b e t w e e n t h e v a r i a b l e o f
in t er est ( st r essor s at t h e CCU) an d ot h er v ar iables
( gender, bed at t he CCU, fir st hospit alizat ion at t he
u n i t o r n o t , p r e s e n c e o f e q u i p m e n t a n d u s e o f
p s y c h o t r o p i c m e d i c a t i o n ) . W i t h r e s p e c t t o
so ci o d e m o g r a p h i c v a r i a b l e s, w o m e n p r e se n t e d a
higher m ean value of st ressors t han m en in t he st udy
sam p le. How ev er, Man n - Wh it n ey sh ow ed t h at t h is
difference w as not st at ist ically significant ( p > 0.05) .
As t o t he relat ion bet w een age and perceived st ress,
w e f ou n d t h at , t h e y ou n ger t h e pat ien t , t h e h igh er
st r e ss l e v e l s d u r i n g h o sp i t a l i z a t i o n a t t h e CCU.
Spearm an’s correlat ion t est confirm ed a negat ive and
st at ist ically significant relat ion bet ween t hese variables
( r= - 0.324; p < 0.05) .
We also look ed at t h e r elat ion w it h clin ical
variables and hospit alizat ion at t he CCU. Pat ient s who
did not receive psychot ropic drugs during t he 24 hours
befor e t he int er v iew per ceiv ed st r ess m or e int ensely
t han pat ient s who did. However, t his result was found
st at ist ically in sig n if ican t ( p > 0 . 0 5 ) w h en ap p ly in g
M a n n - W h i t n e y ’ s n o n - p a r a m e t r i c t e s t . Pa t i e n t s
hospit alized in bed 1 obt ained a higher m ean scor e
on t he st ressor scale t han pat ient s in ot her beds, but
we found t he result was st at ist ically insignificant ( p >
0.05) when applying Kruskal- Wallis. Pat ient s who were
hospit alized for t he fir st t im e and pat ient s w ho used
m o r e t h a n t w o eq u i p m en t s d u r i n g h o sp i t a l i za t i o n
r ep or t ed m or e in t en se st r ess. Ag ain , t h ese r esu lt s
w ere not st at ist ically significant ( p > 0.05) .
DI SCUSSI ON
W h e n w e r e l a t e d p e r c e i v e d s t r e s s w i t h
p ar t i ci p an t s’ so ci o d em o g r ap h i c ch ar act er i st i cs, w e
f ou n d t h at st r ess w as in v er sely r elat ed t o age, i. e.
t he older t he pat ient s, t he low er t heir st r ess scor es.
The cor r elat ion bet w een t hese t w o v ar iables can be
consider ed bet w een w eak and m oder at e ( r = - 0.324)
and st at ist ically significant ( p< 0.05) . I n anot her st udy,
t h e au t h o r s f o u n d a h i g h er st r ess t o l er an ce l ev el
am ong aged per sons( 12), w hich confir m s our r esult s.
El d er l y p er son s ar e p r ob ab l y m or e con d i t i on ed t o
accept som e discom for t s and inconv eniences dur ing
h o s p i t a l i z a t i o n a n d b e c o m e c o m p l i a n t w i t h
t reat m ent( 12). Ot her aut hors indicat ed age as an aspect
t h a t i n f l u e n c e s p a t i e n t s ’ c o p i n g r e s p o n s e w i t h
h o sp i t al i zat i o n at an i n t en si v e car e u n i t( 1 3 ). Wh at
g e n d e r i s c o n c e r n e d , a l t h o u g h w o m e n r e p o r t e d
g r ea t er st r ess t h a n m en , t h i s d i f f er en ce w a s n o t
s t a t i s t i c a l l y s i g n i f i c a n t . St u d i e s a b o u t s t r e s s i n
int ensive t herapy pat ient s have not revealed a relat ion
bet w een st r ess an d pat ien t s’ gen der. Ot h er aspect s
in clu de t h e disease an d it s ev olu t ion , t h e pat ien t ’s
p e r so n a l i t y a n d e m o t i o n a l co n d i t i o n a n d a sp e ct s
in h er en t t o t h e en v ir on m en t at t h is u n it , su ch as
isolat ion and lack of sleep, am ong ot her s( 13).
The use of psychot herapeut ic m edicat ion was
con sid er ed an em ot ion al st at e m od if ier, m ak in g it
easier for pat ient s t o be hospit alized at t he CCU. I n
our st udy, pat ient s receiving drugs, such as anxiolyt ic
agen t s, in dicat ed low er st r ess lev els. On e essen t ial
goal in cr it ical pat ient t r eat m ent is pain cont r ol and
718
com b in at ion of an alg esics an d sed at iv es im p r ov es
crit ical pat ient s’ st ress response, which is in line wit h
our st udy.
Th e ex p er ien ce of b ein g h osp it alized at an
I CU, w h e t h e r a sso ci a t e d o r n o t w i t h t h e d i se a se
p r o cess o r t h e sp eci al i zed en v i r o n m en t ex er t s an
i m p o r t a n t i m p a c t o n p a t i e n t s ’ r e c o v e r y a n d
rehabilit at ion( 15). As we agree wit h t his st at em ent and
believe t hat t he fr equency at w hich pat ient s live t his
ex p er ien ce cou ld af f ect t h eir st r ess p er cep t ion , w e
cor r elat ed t he ex ist ence of ear lier hospit alizat ions in
int ensive t herapy unit s wit h t he st ress referred during
t h e p r esen t h o sp i t al i zat i o n . I n t h e st u d y sam p l e,
p a t i en t s w h o w er e h o sp i t a l i zed f o r t h e f i r st t i m e
r ep or t ed m or e in t en se st r ess t h an ot h er p at ien t s,
a l t h o u g h w e d i d n o t f i n d a n y s t u d y a b o u t t h i s
cor r elat ion in lit er at ur e.
As t o hospit alizat ion at t he CCU in it self, ot her
r e s e a r c h e r s( 1 6 - 1 8 ) d e s c r i b e t h a t m o s t p a t i e n t s
h ospit alized at in t en siv e t h er apy u n it s ar e con f in ed
t o a b ed , m an y of w h om h av e r eceiv ed a t u b e or
t racheot om y and need m echanical vent ilat ion. Besides
assist ed v en t ilat ion , w h ich w as n ot p r esen t in ou r
pat ient s, t his st udy highlight s t he presence of art erial
punct ur es, cent ral v enous lines, ur inar y cat het er, as
w e l l a s b r e a t h i n g a n d ci r cu l a t i o n m o n i t o r i n g b y
elect r od es. Th ese f act or s can cau se t h e f eelin g of
bein g t ied u p, w h ich of t en cau ses f ear. Ou r r esu lt s
d em on st r at ed t h at , in t h e st u d y sam p le, t h e m or e
equipm ent pat ient s use, t he higher t he st r ess lev els
t hey feel.
We found t hat pat ient s hospit alized in bed ( 1)
at t he CCU ( Figur e 1) indicat ed higher st r ess scor es
t han pat ient who were hospit alized in m ore favorable
b ed s in t er m s of p r iv acy, m or e d ist an t f r om ot h er
pat ient s’ noise and less illum inat ed. How ev er, t hese
r esult s w er e not st at ist ically significant eit her.
CO N CLU SI O N S A N D FI N A L
CONSI DERATI ONS
Alt h ou g h t h e r esu lt s g o ag ain st ou r in it ial
per cept ion abou t t h e st r essin g ex per ien ce of bein g
hospit alized at an int ensiv e t her apy unit , w e believ e
t h is r esu lt can be j u st if ied by t h e sm all n u m ber of
par t icipan t s.
Hospit alizat ion at t he CCU was m ore st ressful
f or y ou n g er f em ale p at ien t s w h o h ad n ot r eceiv ed
p sy ch ot h er ap eu t i c d r u g s d u r i n g t h e l ast 2 4 h ou r s
bef or e t h e in t er v iew an d w h o w er e h ospit alized f or
t he first t im e at an int ensive t herapy unit .
A l t h o u g h w e d i d n o t f i n d a s t a t i s t i c a l l y
si g n i f i ca n t co r r e l a t i o n b e t w e e n st r e ss, p a t i e n t s’
sociodem ogr aphic and clinical v ar iables and t he CCU
environm ent , we have observed t hat t hese differences
do exist and can becom e st at ist ically significant when
a l a r g e r s a m p l e i s u s e d . H o w e v e r, d u e t o t h e
im por t an ce of m in im izin g st r ess in car diac pat ien t s
h o s p i t a l i z e d i n c o r o n a r y u n i t s , w i t h a v i e w t o
prevent ing com plicat ions and aggravat ing t heir clinical
sit uat ion, w e believ e fur t her r esear ch is needed.
Nur ses act iv e at a CCU can adv ise pat ient s
who are hospit alized for t he first t im e in an int ensive
t h e r a p y e n v i r o n m e n t , w i t h a v i e w t o d e cr e a si n g
per ceiv ed st r ess. An ot h er aspect of n u r sin g act ion s
could be t o m odify t he environm ent , m inim izing noise
and lum inosit y at t he beds.
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