Beyond patient classification: the “hidden” face of nursing workload

Abstract

This is a theoretical-reflective essay, which aimed to reflect on the centralization of Patient Classification Systems in workload and hospital nursing staff sizing. The reflexive interpretations were guided by two axes: Patient Classification Systems : constitution and utilities; and “Hidden” nursing activities in workload measurement. The first evidences the importance and the role of these instruments in workload identification and in hospital nursing staff sizing, exemplifying several possibilities to be used by nurses. On the other hand, with the second axis, it is clear that there are many nursing activities that are not sensitive to the application (even if systematic) of these means of patient assessment. Therefore, nursing workload measurement may be underestimated. It was inferred that the complexity of practice environments requires a macro and micro institutional look at the nursing workload measurement, especially when considered for workforce planning/sizing purposes.

Validation of a Nursing Workload Measurement Scale, Based on the Classification of Nursing Interventions, for Adult Hospitalization Units

“…In line with other studies consulted, even with different naming of the items to be measured, they also obtained more workloads in those included within the physiological domain [ 16 ]. We have to highlight that one of the limitations that we found when measuring the items of the scale is the fact that many interventions are carried out at the same time, giving rise to the phenomenon of “multitasking”, which we also found in other similar studies [ 22 , 44 ], which shows that sometimes, the time collected from all the interventions carried out by the nurse to their patients in a work shift is greater than the hours of that shift. In addition, by contemplating all the possible interventions in the four nursing functions and not only those included in the care function, as occurs in other workload measurement studies [ 40 ], records related to management, documentation, care and support for the family, etc., which are less studied or valued bibliographically until now, as a nursing activity are included.…”

Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension

“…It is important to highlight that the time of direct care should not be considered superior to the patient’s dependence in relation to care complexity, severity and dependence related to activities of daily living, given that the PCS generically and indirectly capture these load components nursing work ( 4 ) .…”

“…The indicators “Support and family support network” and “Participation of the companion” are the main differentials of the APCI in relation to the other instruments available for the classification of adult patients ( 4 ) ; in addition, it has similarities to instruments validated for neonatal and for binomials in obstetric rooming ( 40 - 41 ) .…”

“…Today, the presence of family members and companions is common for adult patients, many of whom were previously healthy and underwent surgical treatment with early discharge ( 14 ) ; in this sense, the patient classification instruments must progress with the care scenario to safely and reliably support the nursing management practice ( 4 - 5 , 7 , 12 ) . Considering this context, the question that guided the present study was: Does the adaptation of the Pediatric Patient Classification Instrument for the classification of adult patients have evidence of validity and reliability to be used in managerial nursing practice?…”

Sistematização dos processos de trabalho na gestão pública de práticas integrativas em saúde: relato de caso

“…Na área da saúde é muito frequente a discussão sobre PT das equipes assistenciais (Gleriano et al, 2021;Nunes et al, 2018;Vieira-Meyer et al, 2020;Vizzoni et al, 2021), bem como é tradicional o cálculo para dimensionamento de equipes assistenciais, em especial da enfermagem (Carvalho & Nascimento, 2020;de Oliveira et al, 2022;Moraes et al, 2021;Nishiyama et al, 2020), olhando para o que se entende como gestão em saúde.…”