Medición y comparativa de carga de trabajo enfermero teórica y real, en unidades de hospitalización médica y quirúrgica en hospital de tercer nivel, con taxonomía NIC (Nursing Interventions Classification)

Laburpena

Several tools can be used to plan nursing allocation but none include all variables that influence care. The Nursing Interventions Classification (NIC) used in the nursing care process sheds light on the work and care of nurses in work processes and various scenarios and can be used as a tool to measure their work by quantifying each intervention in terms of time. The main goal of this study is to estimate the theoretical nursing allocation necessary in inpatient nursing units (INU), using NICs as a tool for measuring nursing, depending on the reason for patient admission, and comparing this to actual nursing allocation. Methodology: Six-phase cross-sectional observational study were carried out during 2018-2021 at a third level 3 hospital in Madrid. Phase 1. NICs planned/executed in INUs were validated, with a group of 10 care nurses and after 2 consultation rounds. Phase 2. Units to be studied were chosen by considering the number of beds assigned to the service and the existence of an exclusive INU for the speciality. Phase 3. Theoretical NICs were described for each unit studied, analysing the reasons for admission in each unit for over two months, creating affinity care groups and updating care plans. The work of each unit was reviewed by two or three of its nurses, while the total work of the phase was supervised by three nurses. Phase 4. Phase 1 and 3 NICs were analysed, grouping them according to the concepts, execution times and whether or not they were included in the calculation of the healthcare reality time, explaining how they are measured if calculated or the reason for exclusion, as applicable. Phase 5. NICs for each INUs were measured over one week. Variables analysed: unit activity, patient number and characteristics, number of nurses and NIC. The sum of NIC times was used to calculate the workload and theoretical nursing allocation. Phase 6. Theoretical and actual nursing allocation and nursing work were analysed by unit and between medical and surgical unit blocks. Microsoft Office 365 Access and Excel were used for statistical data analysis. Binary variables were expressed in absolute and relative frequencies, while quantitative variables were expressed by mean, standard deviation and quartiles. Results: Phase 1. 263 NIC in INUs were validated. Phase 2. 4 surgical INUs were chosen (general and digestive surgery, traumatology, vascular surgery, gynaecology) and 4 medical INUs (internal medicine, gastroenterology, geriatrics and hematology). Phase 3. 1578 reasons for admission were analysed, creating affinity care groups ranging from 4 in haematology to 10 in vascular surgery. The number of NICs in the care plans for each unit ranges from 35 in traumatology to 48 in haematology. Phase 4. 81 NICs were considered to calculate healthcare reality times, of which 40 were common to all units. Phase 5. 299 patients were studied in the 163 inpatient beds available in the eight units. The number of NICs calculated per unit ranged from 54 in gynaecology to 71 in vascular surgery. Average theoretical daily workload varied from 94,21 hours in gynaecology to 269,56h in internal medicine, while theoretical allocation ranged from 3,92 to 11,22 nurses in these same units. Phase 6. Average theoretical and actual workload observed in 24 hours varied from 94,21h theoretical - 99,43h actual in gynaecology to 269,25h theoretical - 216h actual in internal medicine. Theoretical and actual nurse allocation in 24h ranged from 3,92 theoretical - 4,14 actual nurses in gynaecology and 11,22 theoretical - 9 actual nurses in internal medicine. Theoretical work in surgical units was 175,76h while in medical units it was 200,28h. The actual workload accounted for 154,29h and 156,73h respectively. Theoretical allocation in surgical units was 7,32 nurses compared to 8,34 in medical units. The actual allocation was 6,43 in the former and 6,45 in the latter. Conclusions: Work overload is detected in all units studied, except in gynaecology, more prominent in general and digestive surgery units, internal medicine, gastroenterology and geriatrics, which on average would require two more nurses per day.