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)
- Autores: María Antonia Ramos Mateos
- Directores de la Tesis: Alfonso Muriel García (dir. tes.), Patricia Fernández Bustos (codir. tes.)
- Lectura: En la Universidad de Alcalá ( España ) en 2022
- Idioma: español
- Tribunal Calificador de la Tesis: Diego José Feria Lorenzo (presid.), Juana Cristina Francisco del Rey (secret.), Isabel María Morales Gil (voc.)
- Programa de doctorado: Programa de Doctorado en Ciencias de la Salud por la Universidad de Alcalá
- Materias:
- Enlaces
- Tesis en acceso abierto en: TESEO
- Resumen
- español
Para planificar las dotaciones de enfermeras existen diversos instrumentos, pero ninguno incluye todas las variables que influyen en el cuidado. La Clasificación de Intervenciones de Enfermería (NIC) permiten conocer el trabajo y cuidados realizado por las enfermeras, pudiéndose convertir en un instrumento, al cuantificar en tiempos cada intervención. El objetivo principal es estimar la dotación teórica necesaria de enfermeras, en unidades de enfermería de hospitalización (UEH), utilizando las NIC como instrumento de medida y compararla con la dotación de enfermeras reales.
Metodología. Estudio observacional transversal realizado en 6 fases, durante 2018-2021 en un hospital de tercer nivel de Madrid. Fase 1: Se validaron las NIC planificadas en UEH con 10 enfermeros. Fase 2: Se eligieron de las unidades con criterios de inclusión/exclusión. Fase 3: Se describieron de las NIC teóricas de cada UEH, analizando los motivos de ingreso de dos meses, y sus planes de cuidados. Fase 4: Se agruparon las NIC por similitud de conceptos y tiempos, y se describieron las computadas en la realidad asistencial explicando el modo de hacerlo. Fase 5: Se midieron las NIC de cada unidad una semana. Variables: actividad de la unidad, número y características de pacientes, número de enfermeras y NIC. Fase 6: Se comparó el trabajo y la dotación teórica con real, por unidad. Los datos se analizaron con Access y Excel de Microsoft Office 365 y se expresaron mediante frecuencias absolutas y relativas, medias, desviación típica y cuartiles.
Resultados. Fase 1: Se validaron 263 NIC. Fase 2: Se estudiaron 8 UEH (cirugía general y digestiva, traumatología, cirugía vascular, ginecología, medicina interna, gastroenterología, geriatría y hematología). Fase 3: Se analizaron 1578 motivos de ingreso. El número de NIC surgidas de los planes de cuidados en cada unidad, oscila entre 35 en traumatología y 48 en hematología. Fase 4: Las NIC tenidas en cuenta para computar en la realidad asistencial fueron 81 NIC, de ellas 40 comunes en todas las unidades. Fase 5: Se estudiaron a 299 pacientes, en las 163 camas disponibles en las 8 unidades. Las NIC computadas por unidad varió entre 54 en ginecología y 71 en cirugía vascular. Fase 6: El trabajo teórico y real en 24 horas, varió entre las 94.21h teóricas/99.43h reales de ginecología, y las 269.25h teóricas/216h reales de medicina interna. La dotación teórica y real de enfermeras en 24h, osciló entre las 3.92 enfermeras teóricas/4.14 reales de ginecología, y las 11.22 enfermeras teóricas/9 reales de medicina interna.
Conclusiones. En todas las unidades estudiadas, excepto en ginecología, se detecta una sobrecarga laboral, siendo más acentuada en las unidades de cirugía general y digestiva, medicina interna, gastroenterología y geriatría, que de media precisarían 2 enfermeros más diariamente.
- English
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.
- español
