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Objetivo: Descrever o dimensionamento do quadro de pessoal de Enfermagem na atenção básica em um município do Amazonas. Metodologia: Método qualitativo de caráter descritivo, com investigação do objeto fundamentada no Estudo de Casos Múltiplos, segundo Yin (2015). A pesquisa foi realizada em duas Unidades Básicas de Saúde UBS, localizadas no distrito do Cacau Pirêra, município de Iranduba, no estado do Amazonas. Aprovada pelo Comitê de Ética em Pesquisa da Universidade Paulista CEP/UNIP, sob o Parecer de nº 5.968.666 e CAAE 67017022.1.0000.5512. Resultados: Conforme Resolução COFEN n° 543 de 2017, as unidades em estudo obtiveram quantidade insuficiente de profissionais de determinadas categorias que resulta em pressão da carga de trabalho, porém também obtiveram números de profissionais de outras categorias em equilíbrio conforme suas respectivas demandas. Considerações Finais: Percebe-se o quão importante é essa ferramenta de gestão, que permite ampliar a visão para as condições de trabalho da equipe no momento atual, uma vez que projeta o quantitativo adequado de profissionais para favorecer assistência qualificada. Espera-se, portanto, que essa pesquisa estimule futuras investigações que levem em consideração o dimensionamento para além do ambiente intra-hospitalar e subsidie políticas que efetivem esse olhar mais ampliado sobre o tema.
Objective: To describe the dimensioning of nursing staff in primary care in a municipality of Amazonas. Methodology: Qualitative method of descriptive character, with investigation of the object based on the Multiple Case Study, according to Yin (2015). The research was carried out in two Basic Health Units - UBS, located in the district of Cacau Pirêra, Iranduba municipality, in the state of Amazonas. Approved by the Research Ethics Committee of Universidade Paulista - CEP/UNIP, under the Opinion No. 5.968.666 and CAAE 67017022.1.0000.5512. Results: According to COFEN Resolution n° 543 of 2017, the units under study obtained an insufficient number of professionals of certain categories that results in workload pressure, but also obtained numbers of professionals of other categories in balance according to their respective demands. Final Considerations: We realize how important this management tool is, which allows us to broaden the vision for the working conditions of the team at the current moment, since it designs the appropriate number of professionals to favor qualified assistance. It is hoped, therefore, that this research will stimulate future investigations that take into consideration the dimensioning beyond the intra-hospital environment and will provide input for policies that will make this broader view of the theme effective.
Propósito: Describir el tamaño del personal de enfermería en la atención básica de un municipio de Amazonas. Metodología: Método cualitativo de carácter descriptivo, con investigación de objetos basada en el estudio de casos múltiples según Yin (2015). La investigación se llevó a cabo en dos Unidades Básicas de Salud UBS, ubicadas en el distrito de Cacau Pirêra, en el municipio de Iranduba, en el estado de Amazonas. Aprobado por el Comité de Ética de la Investigación de la Universidad Paulista (CEP/UNIP), con arreglo a los dictámenes no 5.968.666 y CAAE 67017022.1.000.5512. Resultados: De acuerdo con la Resolución 543 de la COFEN de 2017, las unidades estudiadas obtuvieron un número insuficiente de profesionales de ciertas categorías que resultan en presión de la carga de trabajo, pero también obtuvieron un número de profesionales de otras categorías en equilibrio de acuerdo con sus respectivas demandas. Consideraciones finales: Se puede ver lo importante que es esta herramienta de gestión, que permite ampliar la visión de las condiciones de trabajo del equipo en este momento, ya que proyecta la cantidad apropiada de profesionales para favorecer la asistencia calificada. Por lo tanto, se espera que esta investigación estimule futuras investigaciones que tengan en cuenta la dimensión más allá del entorno intrahospitalario y subvencionen políticas que lleven a cabo este enfoque más amplio sobre el tema.
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Objective@#To evaluate the nursing workload in surgical departments by decision tree method.@*Methods@#The indexes of nursing workload of 23 surgical departments were analyzed with decision tree method from February 20 to March 26 in 2017.@*Results@#According to decision tree analysis, the number of admitted patients was high-priority variable (F=39.128, P=0.000), and the nursing workload was divided into four grades by number of admitted patients ≤ 1, 1<number of admitted patients ≤ 4, 4 < number of admitted patients ≤ 7, number of admitted patients >7, respectively. The suboptimal variables were number of operations (F=7.578, P=0.046) and number of electrocardiogram monitors used (F=28.306, P=0.000), the nursing workload was further divided into six grades by number of operations ≤ 5, number of operations>5 and number of electrocardiogram monitors use ≤ 5, number of electrocardiogram monitors use > 5, respectively.@*Conclusions@#The number of admitted patients, electrocardiogram monitors used and operative patients were significant indexes of nursing workload in surgical departments, which helps the nurse managers evaluate the nurse performance and optimize human resource allocation based on decision tree analysis and clinical practice.
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Objective@#To develop a reasonable performance evaluation index system for ICU nursing workload based on the hospital information system and the "structure-process-result" model.@*Methods@#The preliminary indicators of ICU nurses' performance appraisal system were constructed by the research group. Delphi method was used for expert consultation to evaluate the importance of the indicators of the performance appraisal system. After summarizing, sorting out and modifying the expert opinions, the performance appraisal index system of ICU nurses was obtained. SPSS 19.0 software is used to describe the importance of experts' evaluation of indicators at all levels, such as mean, standard deviation, coordination coefficient of experts' opinions and degree of coordination.@*Results@#The effective recovery rate of expert consultation papers was 100%. In the first round of inquiry, the average of importance assignment was 2.05-5.00, the average of rationality assignment was 2.13-5.00, and the average of importance assignment in the second round was 4.57-5.00. The average of rationality assignment was 4.71-5.00. The coefficient of variation of all levels of indicators in the first round was 0.02-0.18, the coefficient of variation in the second round was 0.02-0.12, which was less than 0.2, the positive coefficient of experts was 100%, and the authoritative coefficient of experts in the second round was 0.86 and 0.88. After two rounds of Delphi expert consultation, the ICU nurses' performance appraisal index system was finally formed, including three first-level indicators and 37 second-level indicators.@*Conclusion@#This study is based on the information system, according to the "structure-process-result" model, using the expert consultation method to construct the ICU nursing workload performance assessment index system, and establish the weight of each index, the research results are helpful to further improve the performance appraisal system of ICU nursing staff and improve the scientific management level of ICU.
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Objective To evaluate the nursing workload in surgical departments by decision tree method. Methods The indexes of nursing workload of 23 surgical departments were analyzed with decision tree method from February 20 to March 26 in 2017. Results According to decision tree analysis,the number of admitted patients was high-priority variable (F=39.128, P=0.000), and the nursing workload was divided into four grades by number of admitted patients ≤ 1, 1<number of admitted patients ≤ 4, 4 < number of admitted patients ≤ 7, number of admitted patients >7, respectively. The suboptimal variables were number of operations (F=7.578, P=0.046) and number of electrocardiogram monitors used (F=28.306, P=0.000), the nursing workload was further divided into six grades by number of operations ≤ 5,number of operations>5 and number of electrocardiogram monitors use ≤ 5,number of electrocardiogram monitors use > 5, respectively. Conclusions The number of admitted patients, electrocardiogram monitors used and operative patients were significant indexes of nursing workload in surgical departments, which helps the nurse managers evaluate the nurse performance and optimize human resource allocation based on decision tree analysis and clinical practice.
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Objective To develop a reasonable performance evaluation index system for ICU nursing workload based on the hospital information system and the "structure-process-result" model. Methods The preliminary indicators of ICU nurses' performance appraisal system were constructed by the research group. Delphi method was used for expert consultation to evaluate the importance of the indicators of the performance appraisal system. After summarizing, sorting out and modifying the expert opinions, the performance appraisal index system of ICU nurses was obtained. SPSS 19.0 software is used to describe the importance of experts' evaluation of indicators at all levels, such as mean, standard deviation, coordination coefficient of experts'opinions and degree of coordination. Results The effective recovery rate of expert consultation papers was 100% . In the first round of inquiry, the average of importance assignment was 2.05-5.00, the average of rationality assignment was 2.13-5.00, and the average of importance assignment in the second round was 4.57-5.00. The average of rationality assignment was 4.71-5.00. The coefficient of variation of all levels of indicators in the first round was 0.02-0.18, the coefficient of variation in the second round was 0.02-0.12, which was less than 0.2, the positive coefficient of experts was 100%, and the authoritative coefficient of experts in the second round was 0.86 and 0.88. After two rounds of Delphi expert consultation, the ICU nurses'performance appraisal index system was finally formed, including three first-level indicators and 37 second-level indicators. Conclusion This study is based on the information system, according to the "structure-process-result"model, using the expert consultation method to construct the ICU nursing workload performance assessment index system, and establish the weight of each index, the research results are helpful to further improve the performance appraisal system of ICU nursing staff and improve the scientific management level of ICU.
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Objective To investigate whether the nursing staff scheduling pattern of different shifts in Emergency Intensive Care Unit (EICU) of a third-grade first-class hospital in Guizhou Province could be rationally arranged by using the therapeutic intervention scoring system-28 (TISS-28). Methods The nursing workload of 129 patients in EICU was evaluated by TISS-28 from March to June 2017 in the Affiliated Hospital of Guizhou Medical University to look for the best nursing staff scheduling pattern. Results The TISS-28 was used to predict the workload of nurses on night shift and day shift. The TISS-28 scores of day shift and night shift were similar, and they were respectively 38.75±5.01 and 38.66±5.04 scores. There was no statistical significant difference in predicting the nurse-patient ratio between day shift and night shift by using TISS-28 (1 :0.83±0.22 vs. 1 :0.83±0.24, P > 0.05). The number of nursing staff was adjusted from originally 9 nurses during day shift and 5 nurses during night shift to 7 nurses during day shift and 7 nurses during night shift. Conclusions According to TISS-28 score to arrange the numbers of nurses on night shift and day shift is reasonable, the nurse workload of night shift can be reduced and their working enthusiasm improved, thus the degrees of satisfaction of nurses and patients are getting higher.
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RESUMO Objetivos: Calcular e comparar o dimensionamento de pessoal no que diz respeito à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica. Métodos: Estudo prospectivo, do qual participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos (primeira e segunda internação) quanto à carga de trabalho de enfermagem, por meio do Nursing Activities Score. A primeira internação correspondeu à promoção do autocuidado. O dimensionamento de pessoal foi calculado segundo as horas do Nursing Activities Score e a resolução do Conselho Federal de Enfermagem (COFEN) 527/16, nas duas internações, e estes dados foram posteriormente comparados. Resultados: A carga de trabalho de enfermagem na primeira internação (14,6 horas) foi maior em comparação à segunda (9,9 horas) (p < 0,001). O dimensionamento de pessoal segundo as horas, de acordo com o Nursing Activities Score, foi de 26 e 18 profissionais, e de 15 profissionais, conforme a resolução do COFEN 527/16. Conclusão: O quantitativo de profissionais referente à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica, segundo as horas do Nursing Activities Score, foi superior ao recomendado pela legislação existente, demonstrando a necessidade de se reconsiderar o dimensionamento de pessoal neste perfil assistencial.
ABSTRACT Objectives: To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit. Methods: This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared. Results: The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16. Conclusion: The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.
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Humans , Male , Female , Infant, Newborn , Infant , Adult , Young Adult , Self Care/methods , Intensive Care Units, Pediatric/organization & administration , Critical Care/organization & administration , Nursing Staff, Hospital/organization & administration , Time Factors , Prospective Studies , Workload , Caregivers , Workforce , Critical Care Nursing/organization & administration , Length of StayABSTRACT
PURPOSE: This study aimed to estimate the appropriate nurse staffing ratio in intensive care units (ICUs) by measuring nursing workload based on patient's severity and needs, using the Korean Patient Classification System for critical care nurses.METHODS: The data were collected from January 18 to February 29, 2016 using a standardized checklist by observation or self-report. During the study period, 723 patients were included to be categorized from I to IV using the patient classification system. Measurement of total nursing workload on a shift was calculated in terms of hours based on the time and motion method by using tools for surveying nursing activities. The nursing activities were categorized as direct nursing care, indirect nursing care, and personal time. Total of 127 cases were included in measuring direct nursing time and 18 nurses participated in measuring indirect and personal time. Data were analyzed using descriptive statistics.RESULTS: Two patients were classified into Class I (11.1%), 5 into Class II (27.8%), 9 into Class III (50%), and two into Class IV (11.1%). The amount of direct nursing care required for Class IV (513.7 min) was significantly more than that required for Class I (135.4 min). Direct and indirect nursing care was provided more often during the day shift as compared to the evening or night shifts. These findings provided the rationale for determining the appropriate ratio for nursing staff per shift based on the nursing workload in each shift.CONCLUSIONS: An appropriate ratio of nurse staffing should be ensured in ICUs to re-arrange the workload of nurses to help them provide essential direct care for patients.
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Humans , Checklist , Classification , Critical Care , Intensive Care Units , Methods , Nursing Care , Nursing Staff , NursingABSTRACT
Objective To investigate the predictive value of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) for nursing workload in emergency intensive care unit (EICU).Methods A retrospective cohort study was conducted. Critical patients except for trauma admitted to EICU of West China Hospital of Sichuan University from June 2012 to July 2016 were enrolled. APACHE Ⅱ score and therapeutic intervention scoring system (TISS-28) score were calculated in each case. The relationship between APACHE Ⅱ score and TISS-28 score was analyzed by correlation analysis and curve estimation.Results A total of 1148 patients were enrolled, including 689 male (60.0%), and age of (56±19) years old, APACHE Ⅱ score was 19 (13, 25), and TISS score was 19 (13, 25). The Spearman correlation coefficient between APACHE Ⅱ score and TISS-28 score was 0.849 (P < 0.001), and that among the linear model quadratic model, composite model, growth model, logarithm model, cubic model and exponential modelR2 were 0.669, 0.710, 0.792, 0.764, 0.765, 0.765, respectively (allP < 0.01), and the most suitable description for relationship between APACHE Ⅱ score and TISS-28 score curve was cubic model. The nursing workload was significantly increased when APACHE Ⅱ score ≥30, and it was decreased when APACHE Ⅱ score < 30.Conclusion APACHE Ⅱ was a useful score for predicting the nursing workload in EICU.
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Comparar a sobrecarga de trabalho entre profissionais de enfermagem em saúde mental que atuam em serviço público e aqueles do serviço privado. Métodos: pesquisa quantitativa, realizada com 70 profissionais de enfermagem em dois serviços. Para coleta de dados, aplicou-se a escala de avaliação do impacto do trabalho em serviços de saúde mental. Resultados: na análise global, não se observou diferença estatística significativa na média de pontos para sobrecarga de trabalho entre os profissionais das duas instituições. Entretanto, todas as médias das subescalas apresentaram diferenças estatísticas, sendo que a subescala repercussões emocionais no trabalho apresentou maior significância. Conclusão: a equipe de enfermagem do serviço privado apresentou maiores médias de sobrecarga.
Objective: to compare the workload in nursing mental health professionals who work in the public service and the private service. Methods: this is a quantitative research conducted with 70 nursing professionals in two services. For data collection, the evaluation scale of the work impact on mental health services was applied. Results: in the overall analysis, there was no statistically significant difference in the average score for workload among professionals of both institutions. However, all subscale averages had statistical differences, and the subscale emotional repercussions at work showed the highest significance. Conclusion: the nursing staff from the private service had higher workload average.
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Humans , Working Conditions , Nursing , Mental HealthABSTRACT
Objective To construct the gall-stone patients' nursing workload measurement project by Delphi method,so as to measure single disease workload scientifically and reasonably.Methods The gall-stone patients' nursing workload measurement project were designed on the basis of consulting literature and experts discussion,then two rounds of consultations were made with experts by using the Delphi method.Results The valid recovery rate of questionnaires of two rounds consultations were all 100％ (22/22).The expert authority coefficient was 0.886 1.Nursing workload measurement project,directly related to the gall bladder calculi 54 nursing projects,including technical 46,unskilled 7;indirectly related to the gall bladder calculi 36 nursing projects,including technical 17,unskilled 19.Conclusions The measurement project of gall-stone patient determined by Delphi method has high reliability,which is significant to the scientific measuring of nursing single disease workload.
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Objective To investigate the human resources of neurosurgery intensive care unit(NICU)using modified nursing activity score(NAS).Methods NAS was used to investigate the nursing work load of all shifts and compute the needed personnel for every shift,followed by adaption of nursing staff based on the results.Results Based on the scores by NAS,day shift was the heaviest in work load,followed by early night shift and then by late night shift.The differences between day shit and early night shift or late night one were both statistically different(P<0.05 for both).Conclusions The adjustment based on the results by NAS will reduce nursing risk and improve quality of nursing.
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Objetivos: Avaliar a adequação do quadro de pessoal de enfermagem e compreender como esses profissionais percebem essa questão. Métodos: Estudo avaliativo, exploratório, descritivo com abordagens quantitativa e qualitativa, desenvolvido nas UTIs Pediátrica Mista e Obstétrica do Hospital Dom Malan/IMIP em Petrolina-PE. Calculou-se o dimensionamento de enfermagem e foram realizadas 13 entrevistas semiestruturadas, analisadas segundo Bardin. Resultados: A UTI Pediátrica Mista possui correto quantitativo de pessoal e na Obstétrica há redução do quadro. As unidades possuem déficit de enfermeiros e uma incorreta distribuição por categoria/leito. Observou-se que a equipe de enfermagem da UTI Pediátrica Mista considera sua carga de trabalho elevada, enquanto que na UTI Obstétrica esta foi considerada leve. Conclusão: O dimensionamento de enfermagem sem conformidade com a legislação vigente pode comprometer a qualidade dos cuidados oferecidos, sobretudo em unidades de cuidados críticos.
Objectives: To assess the adequacy of nursing staff and understand how these professionals perceive this issue. Methods: evaluative, exploratory, descriptive, quantitative and qualitative study, developed in Obstetric and Mixed Pediatric ICUs for the Hospital Don Malan / IMIP in Petrolina-PE. Was calculated the scaling nursing and 13 semistructured interviews were conducted, analyzed according to Bardin. Results: Mixed Pediatric ICU has correct number of staff and Obstetric decreasing the frame. The units have shortage of nurses and an incorrect distribution by category/ bed. It was observed that the nursing staff of the Pediatric ICUs Mixed considers its high workload, while in the ICU Obstetric this was considered mild. Conclusion: The scaling of nursing without compliance with the current legislation may compromise the quality of care offered, especially in units of critical care.
Objetivos: Evaluar el cuantitativo de personal de enfermería y comprender cómo estos perciben este problema. Métodos: Estudio evaluativo, exploratorio, descriptivo con abordaje cuantitativo y cualitativo, desarrollado en las UCIs Pediátrica Mixta y Obstétrica del Hospital de Don Malan/IMIP en Petrolina-Pernambuco. Se calculó el dimensionamiento de enfermería y 13 entrevistas semi-estructuradas fueran realizadas, analizadas según Bardin. Resultados: UCI Pediátrica Mixta tiene el número adecuado de personal y en la Obstétrica una disminución del cuadro. Las unidades tienen escasez de enfermeras y una incorrecta distribución por categoría-cama. Se observó que el personal de enfermería de la UCI Pediátrica Mixta considera que su carga de trabajo elevada, mientras que en la Unidad de Cuidados Intensivos Obstétrica se consideró leve. Conclusión: La escala de enfermería, sin el cumplimiento de la legislación vigente, puede comprometer la calidad de la atención ofrecida, sobretodo en unidades de atención crítica.
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Humans , Male , Female , Adult , Workload , Nursing, Team/organization & administration , Intensive Care Units, Neonatal , Intensive Care Units, Pediatric , BrazilABSTRACT
Objective To measure the nursing workload in ICU,and provide the basis for the scientific distribution of human resources and reasonable scheduling in ICU.Methods ICU patients of the First and Third People's Hospital of Zigong from July to September,2011 were selected.The TISS-28 and NAS were applied to measure the nursing workload in the ICU.The number of staff nurses on each day and on each shift was recorded.Results The total nursing workload and the per capita nursing workload for each day in a week showed no significant difference,and the per capita nursing workload of different shifts and the needs of nurse-patient ratio of different patients in ICU were significantly different.Conclusions The allocation of nursing staff should be balance for each day in a week and different shifts for each day.The configuration of the nursing human resources should be based on actual nursing workload,no only considering the species of the diseases,the disease condition,self-care ability and cooperation of the patients,but also the proficiency of nurse skills.
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Objective To screen nursing workload items in the perioperative period of lumbar disc herniation by using Delphi method for providing scientific basis in order to undertake nursing care cost calculation of single disease. Methods The measuring content of nursing workload was firstly designed on the basis of consulting literature and experts discussion,then two rounds of consultations were made with experts by using the Delphi method. Results Valid questionnaires collected back were 35 and 37,respectively, accounting for 89% and 94% in the two rounds of consultations with the experts,by which fully reflected the support of experts to the study. The average number of authoritative coefficients in the two rounds of consultations with the experts was respectively 0.79, 0.88,which indicated high reliability of the consulting. The overall coordination index for nursing care items in the preoperative/intraoperative/postoperative period of consulting experts respectively was 0.265/0.305/0.359 and 0.435/0.316/0.425, which had statistical significance and indicated the good coordination among the experts advice in determining the nursing care items and the desirability of the results. Conclusions Measurement items of nursing workload in perioperative period of lumbar disc herniation had been screened scientifically and reliably,which could accurately measure the nursing workload of the disease and lay the foundation for further accounting of nursing care cost.
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Objective To explore the collocation ratio of direct nursing time to indirect nursing time of clinic nursing personnel in our hospital and the difference between different departments, so as to offer academ-ic evidence to collocate the nursing personnel resources reasonably. Methods Observation method was adopted to choose six typical clinics such as respiration internal medicine and so on as observed objects, and then tested the working hours of 22 nursing proceedings which were defined by the topic group, so as to get the work load and average working hours of nurses. Results Time needed for direct and indirect nursing pro-ceedings in different departments was obtained, as well as the ratio of 5 proceedings accounted for the total 22, also deficiency of nursing personnel in 6 departments were tested. Conclusions Evaluation of clinic nursing personnel's work load as an important index to measure the labor intensity of chnic nursing personnel can offer important evidence to optimize allocation of clinic nursing human resources.