Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

RESUMEN Objetivo: Describir el modelo de gestión del cuidado de enfermería en servicios hospitalarios. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa, utilizando tipologías documental-bibliográficas que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y, con ello, descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

ABSTRACT Objective: To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

Describir el modelo de gestión del cuidado de enfermería en servicios hospitalario. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa utilizando tipologías documental-bibliográficos que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y con ello descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension / Adaptación y validación de instrumento de clasificación de paciente adulto con énfasis en la dimensión familiar / Adaptação e validação de instrumento de classificação de paciente adulto com ênfase na dimensão familiar

ABSTRACT Objectives: to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care. Methods: methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients. Results: in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7. Conclusions: the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.

RESUMEN Objetivos: adaptar y validar un instrumento para clasificación de pacientes adultos que enfatiza la red de apoyo familiar en la demanda de cuidados de enfermería. Métodos: estudio metodológico, realizado en tres fases: adaptación de un instrumento considerando la realidad de pacientes adultos; validez de contenido con siete especialistas y evaluación de las propiedades de medida (validez de constructo y consistencia interna) con 781 pacientes internados. Resultados: en la validez de contenido, los indicadores alcanzaron los valores establecidos para el Índice de Validez de Contenido (0,85-1,00). En el análisis factorial confirmatorio, los 11 indicadores fueron distribuidos en tres dominios y presentaron desviación mediana extraída y carga factorial superiores a 0,5. La confiabilidad compuesta fue superior a 0,7. Conclusiones: el presente estudio adaptó y proveyó, con evidencias de validez y confiabilidad, un instrumento para clasificación de pacientes adultos que considera la red de apoyo familiar en la demanda de cuidados de enfermería.

RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension / Adaptación y validación de instrumento de clasificación de paciente adulto con énfasis en la dimensión familiar / Adaptação e validação de instrumento de classificação de paciente adulto com ênfase na dimensão familiar

ABSTRACT Objectives: to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care. Methods: methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients. Results: in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7. Conclusions: the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.

RESUMEN Objetivos: adaptar y validar un instrumento para clasificación de pacientes adultos que enfatiza la red de apoyo familiar en la demanda de cuidados de enfermería. Métodos: estudio metodológico, realizado en tres fases: adaptación de un instrumento considerando la realidad de pacientes adultos; validez de contenido con siete especialistas y evaluación de las propiedades de medida (validez de constructo y consistencia interna) con 781 pacientes internados. Resultados: en la validez de contenido, los indicadores alcanzaron los valores establecidos para el Índice de Validez de Contenido (0,85-1,00). En el análisis factorial confirmatorio, los 11 indicadores fueron distribuidos en tres dominios y presentaron desviación mediana extraída y carga factorial superiores a 0,5. La confiabilidad compuesta fue superior a 0,7. Conclusiones: el presente estudio adaptó y proveyó, con evidencias de validez y confiabilidad, un instrumento para clasificación de pacientes adultos que considera la red de apoyo familiar en la demanda de cuidados de enfermería.

RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.

A pilot study on the possibility of human-centred participative redesign of work organization at psychiatric wards.

WHAT IS KNOWN ON THE SUBJECT?: Rationalization and an increasing shortage of nurses in psychiatric care require the improvement of working conditions. Work organization of hospital wards determines nurses' well-being on the job. In somatic care, observation-based assessments and participative improvements of work organization in the wards by involved nurses can reduce workload. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In psychiatric nursing, observation-based assessment as well as nurses' self-reports may identify characteristics of ward organization that determine nurses' well-being. This study suggests a system of characteristics of work organization at psychiatric wards that may guide participative analyses and improvement measures. This may contribute to the research on prevention of conflicts and aggressive behaviour in psychiatric wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participative analysis and, if necessary, participative redesign of work organization at psychiatric wards may reduce nurses' perceived work load. An approach to address the above is suggested for psychiatric nursing, which, in another version, is proven effective in somatic care. ABSTRACT: Introduction The study was based on an approach for participative improvement of work organization at somatic hospital wards related to characteristics that determine nurses' health. It differed from research seeking to adjust the environment to prevent aggressive behaviour at psychiatric wards. The focus was on the ergonomic principles of the whole work system and its impact on the nurses' health. Aim/Question We analysed the prerequisites for a transfer of this approach to psychiatric nursing. Method This study employed a cross-sectional design examining 11 wards of a hospital for psychiatry and neurology; 109 nurses participated. We used a multi-method design with observation-based assessments and nurses' self-reports of ward organization. Results Two clusters with wards of different work organization were identified. One cluster consisted of better-organized wards. The other included wards with a worse organization. We found substantial convergence between the observation-based assessments and nurses' self-reports. Discussion This study results indicated that observation-based assessments were an acceptable alternative to nurses' self-reports, enabling the evaluation of ward organization in a feasible and reliable way. Implications for practice This study showed an approach with a specific view on the structural quality of psychiatric wards; this may support work improvement processes in a more systematic way.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in / Validación de Instrumento para fundamentar dimensionamiento de Profesionales de Enfermería em Alojamiento Conjunto / Validação de Instrumento para fundamentar dimensionamento de Profissionais de Enfermagem em Alojamento Conjunto

ABSTRACT Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

RESUMEN Objetivos: elaborar y validar un instrumento para clasificación de binomios puerperio neonatal que subsidie el dimensionamiento de personal en unidades de alojamiento conjunto. Métodos: estudio metodológico. La construcción ha sido basada en referencias teóricas y legales. La validez de contenido ha sido realizada por expertos por medio de medición del índice de validez de contenido. Luego, el instrumento ha sido aplicado en una muestra de 122 binomios, y ha sido realizado análisis factorial exploratoria por el método de componentes principales. Resultados: el instrumento ha quedó constituido por siete indicadores de cuidado: Vía de parto; Morbilidad materna; Morbilidad neonatal; Amamantamiento; Agravantes sociales; Orientación de cuidados; e Interacción y vínculo. Todos con índice de validez de contenido iguales a 1. El constructo ha sido compuesto por 3 dominios, con Alfa de Cronbach de 0,62, 0,85 y 0,89. Conclusiones: el instrumento para la clasificación de binomios puerperio neonatal permite la clasificación de binomios puerperio neonatal y podrá basarse el dimensionamiento de personal en alojamiento conjunto.

RESUMO Objetivos: construir e validar um instrumento para classificação de binômios puérpera-neonato que subsidie o dimensionamento de pessoal em unidades de alojamento conjunto. Métodos: estudo metodológico. A construção foi embasada em referenciais teóricos e legais. A validade de conteúdo foi realizada por expertos por meio de mensuração do índice de validade de conteúdo. Em seguida, o instrumento foi aplicado em uma amostra de 122 binômios, e foi realizada análise fatorial exploratória pelo método de componentes principais. Resultados: o instrumento ficou constituído por sete indicadores de cuidado: Via de parto; Morbidade materna; Morbidade neonatal; Aleitamento; Agravantes sociais; Orientação de cuidados; e Interação e vínculo. Todos com índice de validade de conteúdo iguais a 1. O constructo foi composto por 3 domínios, com Alfa de Cronbach de 0,62, 0,85 e 0,89. Conclusões: o instrumento para a classificação de binômios puérpera-neonato permite a classificação de binômios puérpera-neonato e poderá embasar o dimensionamento de pessoal em alojamento conjunto.

Cirurgia abdominal de alta complexidade: classificação e escolha dos equipamentos pela equipe multiprofissional / High-complexity abdominal surgery: classification and choice of equipment by the multi-professional team / Cirugía abdominal de alta complejidad: clasificación y elección del equipo quirúrgico por el equipo multiprofesional

Introdução: Os procedimentos de alta complexidade são caracterizados pelo uso da alta tecnologia. A classificação e a escolha dos equipamentos são um desafio para os profissionais envolvidos. Objetivo: Comparar a classificação das cirurgias abdominais de alta complexidade e a escolha dos equipamentos pela equipe multiprofissional entre duas instituições hospitalares. Método: Pesquisa descritiva, quantitativa, transversal e comparativa, com questionários estruturados sobre a opinião dos cirurgiões, anestesiologistas e enfermeiros. Resultado: A classificação dos procedimentos é semelhante quando levados em conta equipamentos (P<1,0) e estrutura física (P=0,172) diferenciados. Discussão: A classificação dos procedimentos mais complexos tem concordância entre os profissionais comparado à legislação, mesmo não englobando o porte anestésico, tipo de procedimento e condições clínicas na sua classificação; a escolha dos equipamentos é do profissional que os utiliza, incluindo amplas salas de operações, sendo a cirurgia robótica dispensável aos cirurgiões. Conclusão: Há diferenças entre instituições de saúde em relação à escolha, à disponibilidade de equipamentos e aos tipos de cirurgias abdominais.

Introduction: High-complexity procedures are characterized by the use of high-technology. The classification and choice of equipment are challenging for the professionals involved. Objective: To compare the classification of high-complexity abdominal surgeries and the choice of equipment by the multi-professional team between two hospital institutions. Method: Descriptive, quantitative, transversal and comparative research, with structured questionnaires on the opinion of surgeons, anesthesiologists and nurses. Results: The classification of procedures is similar when considering differentiated equipment (P<1.0) and physical structure (P=0.172). Discussion: The classification of more complex procedures is in agreement between professionals when compared to the legislation, even if not encompassing anesthetic dimensions, type of procedure or clinical conditions in their classification; the equipment is chosen by the professional who uses them, including operating rooms, with robotic surgeries being expendable to surgeons. Conclusion: There are differences between the choices made by health institutions, the availability of equipment and the types of abdominal surgeries.

Introducción: procedimientos de alta complejidad se caracterizan por el uso de alta tecnología. La clasificación y elección de los equipos son un desafío para los profesionales. Objetivo: comparar la clasificación de cirugías abdominales de alta complejidad y la elección del equipo por parte del equipo multiprofesional entre dos instituciones hospitalarias. Método: investigación descriptiva, cuantitativa, transversal y comparativa, con cuestionarios estructurados sobre la opinión de cirujanos, anestesiólogos y enfermeras. Resultados: la clasificación de los procedimientos es similar cuando se consideran equipos diferenciados (P<1,0) y estructura física (P=0,172). Discusión: la clasificación de procedimientos más complejos está de acuerdo entre los profesionales en comparación con la legislación, incluso si no abarca dimensiones anestésicas, tipo de procedimiento o condiciones clínicas en su clasificación; el equipo es elegido por el profesional que los utiliza, incluidos los quirófanos, y las cirugías robóticas son dispensables para los cirujanos. Conclusión: hay diferencias entre las elecciones realizadas por las instituciones de salud, la disponibilidad de equipos y los tipos de cirugías abdominales.

Comparison through a prospective and randomized study of two replenishment methods at polyvalent hospitalization units with two-bin storage systems / Comparación mediante un estudio prospectivo y aleatorizado de dos métodos de reposición en unidades de enfermería en hospitalización polivalente de agudos con almacenamiento mediante doble cajetín.

OBJECTIVE: Two-bin storage systems increase nursing staff satisfaction and decrease inventories, but the implications that logistic staff would determine the needs of replenishment are unknown. This study aimed to evaluate whether entrust to logistics staff this responsibility at the polyvalent hospitalization units with two-bin storage is associated with higher risk of outstanding orders. METHODS: This was a prospective randomized experiment whit masking. Outstanding orders were considered variable response, those corresponding to assessments of the logistics staff were included in the control group and those corresponding to the nursing staff in the control group. Concordance between observers was analyzed using the Bland-Altman method; the difference between groups, with the U of Mann-Whitney and the cumulative incidence of outstanding orders and their relative risk was calculated. RESULTS: The mean amount requested by the logistic and nursing staff was 29.9 (SD:167.4) and 36 (SD:190) units respectively, the mean difference between observers was 6.11 (SD:128.95) units and no significant differences were found between groups (p = 0.430). The incidence of outstanding orders was 0.64% in the intervention group and 0.15% in the control group; the relative risk, 2.31 (0.83 - 6.48) and the number of cases required for an outstanding order, 516. CONCLUSIONS: Outstanding order relative risk is not associated with the category of the staff that identifies the replenishment needs at the polyvalent hospitalization units.

OBJETIVO: Los sistemas de almacenamiento mediante doble cajetín aumentan la satisfacción del personal de enfermería y disminuyen los inventarios, pero no se conocen las implicaciones de que sea el personal de logística quién determine la necesidad de reposición. El objetivo de este estudio fue evaluar si encomendar dicha responsabilidad a este personal en unidades de hospitalización polivalente de agudos entraña un mayor riesgo de pedidos extraordinarios. METODOS: Se realizó un estudio experimental, prospectivo aleatorizado con enmascaramiento. Los pedidos extraordinarios se consideraron variable de respuesta; los correspondientes a valoraciones del personal de logística se incluyeron en el grupo de intervención y los del personal de enfermería, en el de control. La concordancia entre observadores se analizó con el método de Bland-Altman; la diferencia entre grupos, con la U de Mann-Whitney y se calculó la incidencia acumulada de pedidos extraordinarios y su riesgo relativo. RESULTADOS: La cantidad media solicitada por el personal de logística y el de enfermería fue 29,9 (DE:167,4) y 36 (DE:190) unidades respectivamente, la diferencia media entre observadores fue 6,11 (DE:128,95) unidades y no se encontraron diferencias significativas entre los grupos (p =0,430). La incidencia de pedidos extraordinarios fue 0,64% en el grupo de intervención y 0,15% en el de control; el riesgo relativo, 2,31 (0,83 ­ 6,48) y el número de casos necesarios para un pedido extraordinario, 516. CONCLUSIONES: El riesgo de pedidos extraordinarios en unidades de hospitalización con almacenamiento mediante doble cajetín no está asociado con la categoría profesional del personal que identifica las necesidades de reposición.

Work organization in hospital wards and nurses' emotional exhaustion: A multi-method study of observation-based assessment and nurses' self-reports.

BACKGROUND: Ward organization is a major determinant for nurses' well-being on the job. The majority of previous research on this relationship is based on single source methods, which have been criticized as skewed estimations mainly due to subjectivity of the ratings and due to common source bias. OBJECTIVES: To investigate the association of ward organization characteristics and nurses' exhaustion by combining observation-based assessments with nurses' self-reports. DESIGN AND PARTICIPANTS: Cross-sectional study on 25 wards of four hospitals and 245 nurses. SETTING: Our multi-method approach to evaluate hospital ward organization consisted of on-site observations with a standardized assessment tool and of questionnaires to evaluate nurses' self-reports and exhaustion. METHODS: After establishing the reliability of our measures, we applied multi-level regression analyses to determine associations between determinant and outcome variables. RESULTS: We found substantial convergence in ward organization between the observation-based assessments and nurses' self-reports, which supports the validity of our external assessments. Furthermore, two observation-based characteristics, namely participation and patient-focused care, were significantly associated with lower emotional exhaustion among the nurses. CONCLUSIONS: Our results suggest that observation-based assessments are a valid and feasible way to assess ward organization in hospitals. Nurses' self-reported as well as observation-based ratings on ward organization were associated with nurses' emotional exhaustion. This is of interest mainly for identifying alternative measures in evaluating nurses' work environments, to inform health promotion activities and to evaluate job redesign intervention.

Exploring differences in inpatient drug purchasing cost between two pediatric hospitals.

OBJECTIVES: In this study, the hospital cost of purchasing drugs at two children's hospitals is explored with respect to high-cost drugs and drug classes and discussed with regard to differences in hospital setting, drug price, or number of treatments. METHODS: The purchasing costs of drugs at the two hospitals were retrieved and analyzed. All information was connected to the Anatomic Therapeutic Chemical code and compared in a Microsoft Access database. RESULTS: The 6-month drug purchasing costs at Astrid Lindgren Children's Hospital (ALCH), Stockholm, Sweden, and Lucile Packard Children's Hospital at Stanford (LPCH), Palo Alto, California, are similar and result in a cost per patient day of US $149 and US $136, respectively. The hospital setting and choice of drug products are factors that influence the drug cost in product-specific ways. CONCLUSIONS: Several problems are highlighted when only drug costs are compared between hospitals. For example, the comparison does not take into account the amount of waste, risk of adverse drug events, local dosing strategies, disease prevalence, and national drug-pricing models. The difference in cost per inpatient day at ALCH may indicate that cost could be redistributed in Sweden to support pediatric pharmacy services. Also, when introducing new therapies seen at the comparison hospital, it may be possible to extrapolate the estimated increase in cost.