Method of Patient Classification System in obstetric staff scheduling. I. Criteria and categories of care.

The lack of verified Patient Classification System methods for obstetric care provided incentives for the development of own proposal, which would be adjusted to the conditions in Polish delivery rooms and the mothers' demand for these services. Four main criteria of obstetric care were adopted which corresponded to the subsequent stages of labour. These main criteria were ascribed more than a dozen detailed criteria concerning the specific character of obstetric care, as well as general nursing care. The chart containing the criteria of care facilitated the classification of women in labour into individual categories of obstetric care. Three categories of care were distinguished: Category I of minimum obstetric care, Category II of moderate obstetric care, and Category III of intensified obstetric care.

Method of Patient Classification System in obstetric staff scheduling. II. Demand for direct nursing in the delivery room among mothers who deliver by natural birth.

After the development of categories and criteria of nursing mothers who give birth in the delivery room, the direct nursing time provided for women at childbirth by the midwives in individual categories of care was determined. The model time which should be provided for mothers according to their actual needs was also determined. The results of the study showed that among women who delivered naturally, statistically significant differences were observed between two variables: the nursing time provided and the model time. Hence, for women who deliver naturally it would be advisable that the nursing time standard for midwives resulted from the model times.

Method of Patient Classification System in obstetric staff scheduling. III. Demand for direct nursing in the delivery room among mothers who deliver by Caesarean section.

In own studies concerning the determination of the demand for the direct nursing time in the delivery room, the mothers examined were divided into two groups: those who delivered naturally and those who delivered by Caesarean section. The results of the study showed that no statistically significant differences were observed between the nursing time received from midwives by the women who delivered by Caesarean section and the model time. Therefore, the standards concerning the number of nursing staff for this group of women may be determined based on either provided or model times.

Special characteristics of nursing staff scheduling in intensive care units.

The method of determination of working time standards for nursing staff scheduling based on self-observation, which is applied in hospital practice, evokes doubts concerning its methodological correctness. Considering the lack of nursing care standards and not always optimum quality of care, this method may contribute to the preservation of standards which would not guarantee patients' safety. Therefore, studies have been undertaken to find out if there are any differences between the nursing time provided in intensive care units, and the time which patients should be provided with according to their actual demand for care. The study covered 63 patients in the ICU, for whom the time of performing 2,821 various therapeutic and nursing activities was measured. In order to determine working time standards a more reliable method was applied--an active observation with time-scheduling technique and model times. Patients who differed with respect to the diagnosis, state of health, and period of hospitalization were ascribed three categories of care according to their state of health and the adopted criteria of care. Statistically significant differences were noted between the nursing time devoted to patients and the time they should be provided with according to their demand for care.